Authors from Brazil, Colombia, India, Japan, and the United States contribute to this issue’s collection of papers.  The themes are equally diverse: interprofessional education and collaborative care, family medicine curriculum. longitudinal integrated curriculum, education of dietitians, mental health, health equity, leadership education, conference success factors, and blended learning in dental education.  Themes and nationalities converge as researchers explore new ways to teach and assess learners and to investigate those methods to look for evidence of effectiveness.

Unfortunately, many of the submissions we receive provide limited evidence of impact. We encourage authors to look beyond learner’s reaction to innovations (Kirkpatrick Level 1) and assess change in knowledge or skill (Kirkpatrick Level 2) or change in behavior (Level 3).  These are significantly harder to evaluate but provide more meaningful information about the effect of an innovation.

We encourage our readers to respond to papers with their own critical insights in the form of letters to the editor and follow up studies.  When extending research in a domain previously presented, authors should emphasize what makes their context or profession unique so that their work is not simply a replication.  Sometimes this is a matter of feasibility – educators in country X are resistant to try an innovation used in other parts of the world because they perceive that added costs do not exceed benefits.  Providing evidence for costs and benefits of a known innovation in that context can be very useful.  However, a clear argument needs to be presented for why the context merits a new study of that innovation.  Notably, most resistance to change comes from an argument made solely based on cost with benefit an afterthought.

Finally, a word about word counts.  The American writer Mark Twain wrote, “I apologize for such a long letter.  I didn’t have time to write a short one.”  TLDR is the retort of busy people – too long, didn’t read.  We have word limits for reasons of cost (our variable costs are copyediting and HTML conversion) and also because the most effective papers make their points concisely.  Enough said.

Our mental health series culminates in this issue with a report from the TUFH Community of Practice for IDD Population and Complex Care.  The group identified gaps in the literature on approaches to autism and in the education of the workforce that cares for individuals with autism.  Their paper should be seen as the start of a global conversation on this challenging topic.  This TUFH Community of Practice will hold online seminars and discussions throughout the year.  More information about joining this group and other TUFH Communities of Practice is available at Communities of Practice - The Network: TUFH.

A longitudinal integrated clerkship in obstetrics and gynecology is discussed in a paper from Duke University in the United States. The LIC model offers students an opportunity to participate in comprehensive care of patients over an extended period.  Evaluation of this and other innovative models for clinical education is needed for continuous improvement in the field and we encourage researchers to take up the challenge.  Led by a student, the authorship team on this paper includes a post-graduate trainee (resident), educational coordinators, and faculty from two disciplines.

The range of other topics in this issue is wide: a comparative review of AI use in China and Indonesia, gender bias, teledentistry, a process for surgical innovation, a tool for assessing diversity in lecture presentations, public health leadership, education reform in Chile, and student contributions on curriculum evaluation and mental health in Brazil.

Success of the journal has led to more submissions, which means difficult selection decisions and a queue for publication after acceptance.  We are grateful to our consortium secretariat members for their support - with their support we can make the journal freely available and avoid authorship fees.  Increasing the number of issues per year would require additional resources.  In the meantime, we look forward to selecting the highest quality submissions and ask for your patience on publication of accepted papers.

Our TUFH Annual Meeting is upon us, and it is worth re-committing to the core mission of TUFH – one that is very much connected to this journal.  The conference focuses on the north star of TUFH’s mission: educating the health workforce and having a positive impact on societal wellness.

TUFH aims to achieve this mission in several ways: Influencing education institutions’ policies through the 9 domains in the social accountability self-assessment tool (ISAT), educating students and faculty in courses that focus on social accountability, conducting Fellowships in social accountability, and strengthening regional centers of excellence for greater local impact.

Our greatest strength, and the way we can have the greatest impact, is in discovering new knowledge, evaluating the current state of education, and measuring the effect of innovations.  Research can uncover uncomfortable truths and hold policy makers accountable, and publication of that research can be a powerful antidote to policies that are not working.  Powerful forces often want to suppress data and analysis that run counter to their wishes, so we need to gather the data in the most robust manner possible and present inferences that are strongly grounded in solid analytics.

This issue includes papers with evidence for policy makers to consider.  Economic status, indebtedness, relationship status, and sexual orientation are correlated with capacity for resilience among Black osteopathic students and attention to these factors may improve support for these students.  Performance anxiety and burnout in emergency medicine residents can, and perhaps should, be measured using an innovative scale used in sports psychology.  Service learning can engender better interpersonal skills in students pursuing rehabilitation careers.  Burnout among caregivers can be ameliorated through training.  And we cannot assume that all students are facile with computer applications relevant to their education.  These are some examples of inferences generated by papers in this issue that can be presented to decision makers for action.

As we work in a world that can seem antagonistic to science, publication and dissemination of knowledge can be our most important tool to fight for change.

Bill Burdick, MD, MSEd

Co-Editor, Education for Health

Secretary-General, TUFH

The first step for innovation in education of the health workforce is establishment of desired competencies.  Learning objectives and learner assessment follow from those competencies.  A World Health Organization consensus document published in this issue offers a competency framework for essential public health functions that can serve to guide education for this cadre of health workers.

While the WHO paper reflects a global consensus on competencies, regional considerations continue to be important.  Regional context offers a new lens on issues we thought we understood, whether it’s pregnancy and rural mental health in war-torn Sudan, education at the US-Mexican border, or dental education in India.  Techniques – educational or clinical – practiced in one region face different challenges and need to be newly tested as they are introduced in other parts of the world.  This issue of Education for Health contains several articles that demonstrate this concept.  We encourage authors to emphasize unique elements of their local context when analyzing innovations that may be common in other regions.

Many regions are starting to use artificial intelligence algorithms in medical education.  Our first paper on this subject addresses its ability to predict engagement and performance of students based on the degree of their interaction with a learning management platform.  Some of the terminology is new, for example, “confusion matrix,” and familiarity with these new terms will help educators interpret future studies on artificial intelligence.  Given the present low cost of entry, we may find an equalizer effect between high and low resource areas as AI usage becomes more prevalent.  Because of this low financial barrier, we are likely to find it applied widely. Widespread use will challenge us to be familiar with concepts such as those presented in the paper on AI algorithms to test its utility, authenticity, creativity, and efficiency.

Several education innovation papers appear in this issue – virtual training in cytology, microlearning for wound healing, and reflective practice. There is also a paper on the process of innovation itself.

Finally, the issue contains conceptual papers on social determinants of health – one on stakeholders’ impact, another on the regional profiles of students, and a third using an equity lens to advance social accountability.

Our wide regional authorship offers an opportunity to test ideas in new contexts.  We present these global and regional papers to our audience with the hope that readers will want to assess these and other innovations in their part of the world.

Two papers on mental health are featured in this issue of Education for Health, one from Myanmar and the other from the United States.  In Myanmar, the authors share their experiences supporting health workers in the conflict zones.  In the US, a first aid program for people suffering from mental health issues is discussed.  Women's health is highlighted in two papers - one focused on an innovative teaching program on IUD insertion using pre-recorded videos (Uganda), and another about teaching emergency medical technicians' knowledge and skills needed to assist with a normal vaginal delivery (India).  Other topics in this issue include professional identify formation of public health trainees (India), development of an interprofessional curriculum for age-friendly care (US), and perceptions of standard setting (Myanmar).  We also feature papers on simulation for radiology education and another for pediatric lumbar puncture, both from India.  Finally, three papers related to medical trainees - one on the pipeline of pre-medical students into medical school (US), one on the challenges facing Black students (US), and another on the development of two-year internship curriculum (Egypt).

Authors in this issue continue to come from a diverse range of countries, with a strong showing by countries often underrepresented in the literature.  We look forward to hearing from authors everywhere.  When English is not your first language, try to work with a native speaker to polish the text.  Our first-rate copyeditor will take it from there.

Looking back to maintain our forward trajectory

Declarations at the end of a TUFH annual meeting are hard to write and easy to forget. It’s easy to forget what came the year before – we are often so focused on creating anew that we don’t look back at what we declared after previous conferences.  We are trying to do better.  The declaration that emerged from the Ubuntu 2024 conference which brought TUFH and Rural WONCA together continues the theme of community wellness through attention to people, place, and policies.  Community remains a consistent throughline from previous declarations – working with, working in, and working for.  Thanks to the joint conference sponsorship with Rural WONCA, we continued the focus on rural communities that started with the Thunder Bay meeting in 2012, an emphasis that was reinforced in the Vancouver declaration that came out in 2022 and was amplified in the Sharjah declaration that emerged last year.

The goals presented in Thunder Bay 2012, Vancouver 2022, Sharjah 2023, and Ubuntu 2024 have been consistent:

1. Community engagement: Communities must be part of generating solutions to their own health care needs and enabled to be actively involved in implementing these solutions. Developing community capacity to engage with policy development through supporting locally led social innovation in health initiatives and continuous learning processes is essential.  


2. Equity in rural health: Based on the principle of equity, we need to prioritize rural issues as we restructure the health system towards realizing health for all. We should aim to produce practitioners likely to work in underserved communities by assisting students in these communities to obtain sufficient primary and secondary education to be able to enter health professional training.


3. Educate the health workforce in context: recruit students from underserved communities and train them in generalist practice and primary health care. Deliver health services by locally based health care teams wherever possible.


4. Create social and health policies for the public good: Accreditation should include measurement of responsiveness of institutions to the needs of their communities. Universal coverage can strengthen health systems and lead to improved access.  And community-led approaches can co-create policies and solutions that reflect the needs of marginalized communities, including women, rural populations, migrants, indigenous peoples and disabled people.

Many of the papers in this issue support these themes: impact of rural placements, models of education in the community, workplace education of pharmacy students in Nepal, community immersion of dental students, impact of covid on vulnerable populations, and a theoretical perspective on teamwork.  Several other articles are indirectly related: the use of virtual reality in education of dental students, of caregivers of patients with dementia, and as an adjunct to other simulation tools.  Also in this issue are papers on professional development of Japanese women in medicine, professional identify of underrepresented students, and academic support of students.

I suggest we revisit the Ubuntu declaration and the others that preceded it throughout the year and hold ourselves accountable for the lofty ideas they present.  As stated in the conclusion of the Ubuntu declaration, we challenge readers to work with The Network: TUFH and Rural WONCA individually and through their local organizations to align education, policy and systems innovations with these key goals.  Then analyze the evidence, draw your inferences and disseminate the knowledge through publication in this and other journals.  Let’s not forget the goals we wrote in years past so we can maintain our forward trajectory.

Bill Burdick

Co-Editor

This issue of Education for Health is aligned with our annual meeting in Cape Town, South Africa, held in collaboration with Rural WONCA; the theme is People, Place, and Policy for Community Wellness.  In many ways, this issue is emblematic of those concepts.  People are the focus of refugee eye care, and “seeing people, not patients, a strength based approach to asset mapping” which emphasizes the humanity in the individuals we care for.   Place features prominently in the piece on the ravages of war in Sudan on the lives of medical students, in the determinants of community oriented medical education, in the staircase model of community involvement, and in the medical education of US citizens in Cuba.  Policy is broadly represented by the innovative education methods presented in tele-urgent care, flipped classroom, and gamification papers.

Mental health papers are starting to appear in this issue with a piece on student mistreatment, and imposter phenomenon and depression.  In future issues, we would like to see papers about the mental health of the people we care for in our communities. 

If you are reading this at the conference in South Africa, consider the ways in which the papers in this issue contribute to your insights about people, place, and policy and their relation to community wellness.  If you are not at the conference, join the conversation through reading and responding with your own submissions, and your letters.

Bill Burdick

Co-Editor

Thailand, Iran, Sudan, and Brazil are represented in this issue with reports on rural recruitment, educational environment, a new teaching tool, and the impact of war.  Repeated studies, including one in our next issue, demonstrate the predominance of authors from high resource countries in academic publications.  We continue to encourage authors from the rest of the world to submit their work so our readers get a more balanced view of the state of health workforce education.

A commentary from Guest Co-Editors, Sailaja Musunuri and Tine Hansen-Turton from Woods Services, provides global context for our new series on mental health.  Advances in neurophysiology provide better diagnostic and treatment options but they may be thwarted by stigma and access issues that deter people in need from getting help.  Voices from all corners of the world need to be heard on these issues.

Efficient manuscript processing is the key to a vibrant journal.  The average number of days from submission to acceptance for Education for Health is 49, a dramatic improvement from a year ago, and in keeping with industry standards.  Our reviewer team is doing valiant work providing timely feedback to authors, and they could use your help to offset the workload.  We would particularly like to see more published authors from this journal volunteer to become peer reviewers.  If you are interested, contact me directly at drwburdick@gmail.com. 

Finally, Payal Bansal will remain a Co-Editor but she is taking a well deserved sabbatical after many years of service to attend to other responsibilities.  We look forward to her return.

Bill Burdick

Co-Editor, Education for Health

Several papers in this issue focus on social accountability – perceptions of education staff and students, use of storytelling to achieve deeper understanding, and implementation of new education tools.  A related paper addresses education about planetary health in low- and middle-income countries. In addition, we describe the new 2024-2027 TUFH Strategic Plan which highlights social accountability.

We go beyond social accountability with a pair of papers on influences on career pathways - one looking at high school students and the other at early medical students.   Another set of papers on education innovations addresses impact of active learning methods, reverse role simulation, and virtual shadowing.  Our practical advice paper offers lessons learned in development of mission and vision statements.

With 3 Commentaries, 6 Research papers, 1 Student Contribution, 1 Practical Advice Paper, 2 Brief Communications, and 2 Letters to the Editor, there is a lot to digest.    If you have comments on any of these papers, please send us your letters!