162 resultados para Community-based medical education


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Graduate attributes are now a ubiquitous feature of higher education in Australia and internationally, and have been part of engineering education for more than a decade. The idea of graduate attributes is an apparently simple concept, focusing on educational outcomes, rather than inputs and process. While there is evidence of some benefits in engineering education arising from the introduction of outcomes-based accreditation, there is also evidence of many short-comings of the graduate attributes approach. There would be significant value in Engineers Australia providing additional discipline-specific guidance on attribute development. There would be significant value in Engineers Australia simplifying and consolidating the current multi-document accreditation system. A genuinely outcomes-based accreditation system would be based (only) on the demonstrated individual student attainment of appropriate graduate attributes, which might be delivered/gained by a range of means, including distance education. To fully meet the letter and spirit of the law for accreditation, programs will need to adopt some method of certification of individual student attainment of graduate attributes - one such method would be the use of student portfolios.

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Community involvement in monitoring Victoria’s Marine Protected Areas (MPAs) engages coastal volunteers in looking after their marine ‘front yards”. The Management Strategy for Victoria’s System of Marine National Parks and Marine Sanctuaries dedicates an entire theme to community engagement with core key performance areas. This includes community participation. The Sea Search community based monitoring program was developed in 2003 to engage volunteers in meaningful ecological data collection for future sustainability of Victoria’s MPAs. Deakin University, an academic institute, and Parks Victoria, the management agency for Victoria’s MPAs, through a research partner program, trialled three different habitat monitoring methodologies. The trails assessed volunteer ability to collect scientific data, and social science aspects for their involvement in a community-based monitoring program. Information collected by volunteers, feeds directly into their local MPA management strategies to address issues such as climate change, introduced pests and human impacts and natural ecological variation.

The Sea Search program addresses the two action programmes, Agenda 21 and the Rio Declaration on Environment and Development, created at the United Nations Earth Summit, held in 1992. Both documents highlight the need for community engagement and capacity building for sustainability, health and integrity of the earth. Involvement in the Sea Search program builds the volunteer’s capacity by learning scientific skills, interacting with other like minded community members, and creating relationships with all organisations involved in the delivery of the program. In this regard, Sea Search is a citizen science program involving all sectors in society by promoting public-interest and research for decision making and planning of Victoria’s system of Marine National Parks and Marine Sanctuaries.

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Involving community in natural resource management has occurred under a wide variety of approaches, ideologies and titles over the last 30 odd years, with equally wide variety of outcomes for both the community and natural resource management!. Community Based Natural Resource Management (CBNRM) is now a commonly used and promoted, if not always well defined, approach. Claims about the benefits of CBNRM cover wildlife management and biodiversity, sustainable utilisation and management of natural resources, poverty reduction, increased livelihoods outcomes, improved food security, as well as less material benefits of livelihood diversification, empowerment, increased gender equality, and better institutional relations. There are also some fairly convincing criticisms of CBNRM reflecting on assumptions of the nature of communities, institutional arrangements and both institutional and community expectations. This paper reflects on the changing nature of community engagement in natural resource management, the emergence of CBNRM as an approach and the lessons learned from promoting CBNRM across case studies in the developing world.

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User participation has been embraced worldwide as a means to provide better consumer outcomes in health and community care. However, methodologies to achieve effective consumer engagement at the programme design level have remained under-explored. The purpose of this study was to evaluate the impact of a Participatory Action Research (PAR)-inspired methodology used to develop a consumer-directed community care/individualised funding service model for people with disabilities. A retrospective analysis of case notes and internal reports for the first 6 years of an ongoing project were examined. The findings suggest that PAR methodologies need to take into account community development, group support, and capacity building as well as succession planning and risk management issues in order to facilitate the often lengthy policy and project development process. Drawing on these findings, this article discusses five lessons and their methodological implications for PAR in a health or social policy/programme design context.

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Objective: Although low back pain is characterized by both pain and disability, there is a paucity of studies that have concurrently examined risk factors for these features in community-dwelling women. We aimed to investigate the prevalence and identify factors associated with both back pain and disability.

Design: A questionnaire was mailed to 542 women from a community-based research database. Detailed demographic data were collected, including participants' menopause, relationship, and employment status. Point and period prevalence estimates for back pain were derived. Participants were classified based on pain intensity and disability scores calculated from the Chronic Pain Grade Questionnaire, and factors associated with high levels of pain and disability were examined.

Results: A total of 506 (93.4%) women completed the questionnaire. More than 90% of participants had experienced low back pain, with 75.1% and 22.5% reporting pain in the past 12 months and currently, respectively. Seven percent of women reported a high level of disability and 16% reported high-intensity pain. Women with higher levels of disability were more likely to have a higher body mass index and to have pain currently, whereas those with greater pain intensity were more likely to be younger, have a higher body mass index, not be employed outside the home, drink alcohol, and have current pain.

Conclusions: Low back pain is a common problem for community-based women. A high body mass index and current pain were factors independently associated with both high pain intensity and disability. Longitudinal investigation is required to determine the predictive nature of these factors and their potential role in preventing pain and disability.

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Multi-strategy interventions have been demonstrated to prevent falls among older people, but studies have not explored their sustainability. This paper investigates program sustainability of Stay on Your Feet (SOYF), an Australian multi-strategy falls prevention program (1992–1996) that achieved a significant reduction in falls-related hospital admissions. A series of surveys assessed recall, involvement and current falls prevention activities, 5 years post-SOYF, in multiple original SOYF stakeholder groups within the study area [general practitioners (GPs), pharmacists, community health (CH) staff, shire councils (SCs) and access committees (ACs)]. Focus groups explored possible behavioural changes in the target group. Surveys were mailed, except to CH staff and ACs, who participated in guided group sessions and were contacted via the telephone, respectively. Response rates were: GPs, 67% (139/209); pharmacists, 79% (53/67); CH staff, 63% (129/204); SCs, 90% (9/10); ACs, 80% (8/10). There were 73 older people in eight focus groups. Of 117 GPs who were practising during SOYF, 80% recalled SOYF and 74% of these reported an influence on their practice. Of 46 pharmacists operating a business during SOYF, 45% had heard of SOYF and 79% of these reported being ‘somewhat’ influenced. Of 76 community health staff (59%) in the area at that time, 99% had heard of SOYF and 82% reported involvement. Four SCs retained a SOYF resource, but none thought current activities were related. Seven ACs reported involvement, but no activities were sustained. Thirty-five focus group participants (48%) remembered SOYF and reported a variety of SOYF-initiated behaviour changes. Program sustainability was clearly demonstrated among health practitioners. Further research is required to assess long-term effect sustainability.

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Objectives: To undertake a cost–benefit analysis of ‘Stay on Your Feet’, a community-based falls prevention program targeting older people at all levels of risk in New South Wales, Australia. Hospital separations were monitored in the intervention region, a control region and for the state of New South Wales as a whole. Changing admission patterns over the intervention period were used to assess the impact of the program.

Methods: Cost–benefit analysis compared the costs of the program with two estimates of savings from avoided hospital admissions. The first compared the cost of hospital admissions in the intervention region to a control region of similar demographics, while the second compared hospital utilization in the intervention region with the state of New South Wales as a whole using falls-related hospital diagnosis related group (DRG) codes.

Results
: The total direct costs of the program were estimated at A$781 829. Both methods identified clear overall net benefits ranging from A$5.4 million for avoided hospitalizations alone to A$16.9 million for all avoided direct and indirect costs. The confidence intervals around these estimates were small. The average overall benefit to cost ratio for the intervention as a whole was 20.6:1.

Conclusions
: These findings suggest that well-designed community-based interventions targeting falls prevention among older people are highly cost effective and a wise investment for all levels of government. The models used are conservative and are likely to underestimate the real benefit of the intervention, which may have lasted for some time beyond the life of the program.

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Pedagogical discourse in Papua New Guinea (PNG) community schooling is mediated by a western styles education. The daily administration and organisation of school activity, graded teaching and learning, subject selection, content boundaries, teaching and assessment methods are all patterned after western schooling. This educational settlement is part of a legacy of German, British and Australian government and non-government colonialism that officially came to an end in 1975. Given the colonial heritage of schooling in PNG, this study is interested in exploring particular aspects of the degree of mutuality between local discourses and the discourses of a western styled pedagogy in post-colonial times, for the purpose of better informing community school teacher education practices. This research takes place at and in the vicinity of Madang Teachers College, a pre-service community school teachers college on the north coast of Papua New Guinea. The research was carried out in the context of the researcher’s employment as a contract lecturer in the English language Department between 1991-1993. As an in-situ study it was influenced by the roles of different participants and the circumstances in which data was gathered and constituted, data which was compatible with participants commitments to community school teacher education and community school teaching and learning. In the exploration of specific pedagogic practices different qualitative research approaches and perspectives were brought to bear in ways best suited to the circumstances of the practice. In this way analytical foci were more dictated by circumstances rather by design. The analytical approach is both a hermeneutic one where participants’ activities are ‘read like texts’, where what is said or written is interpreted against the background of other informing contexts and texts, to better understand how understandings and meanings are produced and circulated; and also a phenomenological one where participants’ perspectives are sought to better understand how pedagogical discursive formations are assimilated with the ‘self’. The effect of shifting between these approaches throughout the study is to build up a sense of co-authorship between researcher and participants in relation to particular aspects of the research. The research explores particular sites where pedagogic discourse is produced, re-produced, distributed, articulated, consumed and contested, and in doing so seeks to better understand what counts as pedagogical discourse. These are sites that are largely unexplored in these terms, in the academic literature on teacher education and community schooling in PNG. As such, they represent gaps in what is documented and understood about the nature of post-colonial pedagogy and teacher training. The first site is a grade two community school class involved in the teaching and early learning of English as the ‘official’ language of instruction. Here local discourses of solidarity and agreement are seen to be mobilised to make meaningful, what are for the teacher and children moments in their construction as post-colonial subjects. What in instructional terms may be seen as an English language lesson becomes, in the light of the research perspectives used, an exercise in the structuring of new social identities, relations and knowings, problematising autonomous views of teaching and learning. The second site explores this issue of autonomous (decontextualised) teaching and learning through an investigation of student teachers’ epistemological contextualisations of knowledge, teaching and learning. What is examined is the way such orientations are constructed in terms of ‘traditional’ and ‘modern’ epistemological and pedagogical alignments, and, in terms of differently conceived notions of community, in a problematisation of the notion of community schooling. The third and fourth sites examine reflective accounts of student teachers’ pedagogic practices, understandings and subjectivities as they confront the moral and political economies and cultural politics of schooling in School Experiences and Practicum contexts, and show how dominant behaviourist and ‘rational/autonomous’ conceptions of what counts as teaching and learning are problematised in the way some students teachers draw upon wider social discourses to construct a dialogue with learners. The final site is a return to the community school where the discourse of school reports through which teachers, children and parents are constructed as particular subjects of schooling, are explored. Here teachers report children’s progress over a four year period and parents write back in conforming, confronting and contesting ways, in the midst of the ongoing enculturation of their children. In this milieu, schooling is shown to be a provider of differentiated social qualifications rather than a socially just and relevant education. Each of the above-mentioned studies form part of a research and pedagogic interest in understanding the ‘disciplining’ effects of schooling upon teacher education, the particular consequences of those effects, what is embraces, resisted and hidden. Each of the above sites is informed by various ‘intertexts’. The use of intertexts is designed to provide a multiplicity of views, actions and voices while enhancing the process of cross-cultural reading through contextualising the studies in ways that reveal knowledges and practices which are often excluded in more conventional accounts of teaching and learning. This research represents a journey, but not an aimless one. It is one which reads the ideological messages of coherence, impartiality and moral soundness of western pedagogical discourse against the school experiences of student-teachers, teachers, children and parents, in post-colonial Papua New Guinea, and finds them lacking.

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Background : There is only limited evidence available on how best to prevent childhood obesity and community-based interventions hold promise, as several successful interventions have now been published. The Victorian Government has recently funded six disadvantaged communities across Victoria, Australia for three years to promote healthy eating and physical activity for children, families, and adults in a community-based participatory manner. Five of these intervention communities are situated in Primary Care Partnerships and are the subject of this paper. The interventions will comprise a mixture of capacity-building, environmental, and whole-of-community approaches with targeted and population-level interventions. The specific intervention activities will be determined locally within each community through stakeholder and community consultation. Implementation of the interventions will occur through funded positions in primary care and local government. This paper describes the design of the evaluation of the five primary care partnership-based initiatives in the 'Go for your life' Health Promoting Communities: Being Active Eating Well (HPC:BAEW) initiative.

Methods/Design : A mixed method and multi-level evaluation of the HPC:BAEW initiative will capture process, impact and outcome data and involve both local and state-wide evaluators. There will be a combined analysis across the five community intervention projects with outcomes compared to a comparison group using a cross-sectional, quasi-experimental design. The evaluation will capture process, weight status, socio-demographic, obesity-related behavioral and environmental data in intervention and comparison areas. This will be achieved using document analysis, paper-based questionnaires, interviews and direct measures of weight, height and waist circumference from participants (children, adolescents and adults).

Discussion :
This study will add significant evidence on how to prevent obesity at a population level in disadvantaged and ethnically diverse communities. The outcomes will have direct influence on policy and practice and guide the development and implementation of future obesity prevention efforts in Australia and internationally.