Editorial

Preparing health professionals for community-based practice: Some issues for consideration

Debra Jackson
Professor, Faculty of Nursing, Midwifery and Health, University of Technology, Sydney (UTS), Broadway NSW

Deborah C Saltman
Department of General Practice, University of Sydney, Sydney NSW

PP: 201 - 203

Article Text

Changes to models of health care delivery and chronic disease management have shifted the focus of care from in-patient hospital settings to the community. This provides an impetus for educationalists to facilitate adequate student clinical exposure to the range of community-based and interdisciplinary health care options and service models. However, it can be difficult to establish enough clinical places to meet the needs of the large undergraduate health student body (Smith, Corso, & Cobb, 2010). In the community, this difficulty is exacerbated because community practice settings tend to be small; they cannot be swamped by large numbers of students, and may only be able to adequately host one or two students at any one time. When considering that some universities have several hundred or even thousands of health professional students to accommodate within the confines of the academic calendar, the extent of the challenge is apparent.

However, despite the scope of the challenge, there is clearly a need to develop innovative means of ensuring that students are able to engage with community-based services and interact with patients, clients and families who are primarily cared for within community (rather than hospital) environments. Models such as service learning provide options that can enhance opportunities for student engagement in the community sector. Service learning has been framed as a form of experiential learning in which community service is combined with established strategies such as reflective learning (Cashman & Seifer, 2008; Seifer, 1998) and praxis (Parsi & List, 2008). Students are placed into community-based organisations with varying foci and are able to work with clients of these services to meet their own learning needs, and also to benefit the community organisation and its clients. Service learning has been used in a range of ways to enrich health professional undergraduate education, including providing nursing students with opportunities to undertake health assessments with homeless persons and gain experience in the research process (Schaffer, Mather, & Gustafson, 2000), and fostering student understanding of the concepts of health equity and social justice (Redman & Clark, 2002).

Working in an Australian regional environment, Goddard, Mackey, and Davidson (2010) initiated an innovative teaching and learning intervention in which undergraduate students were provided with the opportunity to work in the community with families of children with disabilities over a sustained period of time. Through this initiative students were able to see first-hand the challenges and difficulties facing families and undertake family health assessments, thus creating heightened awareness of the needs of families, including support needs around issues such as carer burden, social isolation and exhaustion. Students also gained a deeper understanding of primary health care approaches and how they are able to be applied in practice (Goddard et al., 2010).

General practice also represents a valuable site of clinical training and learning. Though some general practice settings are able to accommodate students, others are not. Various factors impact on the ability of a general practice to become a learning space for students, and this includes the availability of health professionals to supervise students. Furthermore, like many community-based settings, generally practice environments have limited capacity for student placements. By that we mean that a general practice can only effectively accommodate a limited number of students at any one time. However, increasingly, general practice is moving from a single practitioner model, to a more interdisciplinary service model and so has growing potential as a clinical learning environment for various health professional disciplines. In addition there are literally thousands of general practice settings across Australia, and their very number means that there is the potential for considerable community-based clinical exposure for students through these practice settings.

Though health care professions have tended to educate separately, within individual disciplines, (Smith & Seeley, 2010), effective interdisciplinary collaboration is crucial to community health care delivery, and this creates a need to consider models for interdisciplinary education. Despite the potential value of interdisciplinary clinical education having been long recognised, it is still relatively uncommon and has been difficult to implement in a widespread and sustained fashion (Smith & Seeley, 2010). This difficulty has been attributed to a range of factors including structural issues that act to inhibit and constrain opportunities for student and faculty interdisciplinary collaboration, inertia, resistance, disciplinary gate-keeping and territorialism (Baldwin, 2007). However, the shortage of clinical sites and the imperative to ensure students do have appropriate exposure to community care settings could provide the impetus to overcome some of the barriers.

Interdisciplinary collaboration offers opportunities to increase clinical placements (Smith & Seeley, 2010) and may be facilitated by bringing students from multiple disciplines together to learn together in cooperative community-based environments. Furthermore, students in community settings could be encouraged to form learning relationships with students from universities other than their own, as well as across-discipline dyadic learning partnerships. These types of collaborative approaches could help students to develop more holistic understandings and heightened awareness of cross-disciplinary and institutional issues, and also have the benefit of fostering closer relationships between academic institutions and the community health sector (Smith & Seeley, 2010).

In order to meet the demands of the many complex situations they will encounter, health professionals need to be able to work effectively as individuals as well as in interdisciplinary groups and teams, depending on the situation at hand (Saltman et al., 2007). Through participating in community-based and interdisciplinary clinical learning opportunities students may develop an enhanced awareness of interdisciplinary teamwork and collaboration, and gain first-hand experience of how people from different disciplinary backgrounds can work together in various team and group configurations. Opportunities to gain experience in individual, team and group work with interdisciplinary colleagues in community-based organisations will hold students in good stead for their futures as they work together to meet the needs of patients, families and communities.

View references

Navigate: Archives | Contents | Top of page

Search

Translate

Related Publications from eContent Management