Paradigm Shifts in Medical -Health Education[1]

Paradigm+Shifts+in+Medical+%2fHealth+Education%3a+Implications+for+Medical%2fhealth+Librarians+in+Sub-Saharan+Africa%0d%0aBy+Dr.+Margaret+Adeogun%2c+Librarian%2c+University+of+Eastern+Africa%2c+Baraton%0d%0a%0d%0a%0cAims+of+the+Paper%0d%0a%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0aTo+create+an+awareness+of+PBL+as+a+modern+highly+effective+medical+education+System.+To+sensitize+librarians+to+the+challenges+of+modern+information+services+to+support+medical+education+in+the+21st+century.+To+promote+greater+access+to+medical+literature.+To+promote+the+acquisition+of+information+literacy+skills+among+medical+and+health+students.%0d%0a%0d%0a%0cFocus+of+the+Paper%0d%0a%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0aFeatures+of+Problem-based+Learning+(PBL).+Their+usefulness+in+Medical%2fHealth+Education+Emerging+roles+of+the+medical%2fhealth+librarian+in+a+PBL+curriculum+Librarians+are+challenged+to+expand+beyond+traditional+roles+to+designing+and+building+quality+knowledge+management+infrastructure%0d%0a%0d%0a%0c%ef%81%ae%0d%0a%0d%0athat+will+provide+access+to+quality-filtered%2c+evidence-based%2c+and+critically+analysed+information+designed+for+use+by+health+care+trainers%2c+student+and+consumers.%0d%0a%0d%0a%0cGeneral+Introduction%0d%0a%ef%81%ae%0d%0a%0d%0a%e2%80%a2+%e2%80%a2%0d%0a%0d%0a%e2%80%a2%0d%0a%0d%0aPost-modern+world+preference+is+for+employees+with+the+following+skills%3a+Versality+and+innovation%3b+Use+information+for+knowledge+building%3b+and+Acquire+lifelong+learning+skills.%0d%0a%0d%0a%0cChallenge+to+Educational+System%0d%0a%ef%81%ae+%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0aClosure%2c+didactic+system+no+longer+effective+Favoured+pedagogy+is+a+studentcentred%2c+%2c+resource-based+and+problem-solving+approach+popularly+known+as+PBL+PBL+enables+students+to+apply+ideas+from+information+resources+to+build+meaning.+Favoured+in+medical+education%0d%0a%0d%0a%0cWhy+PBL%3f%0d%0a%ef%81%ae%0d%0a%0d%0aThe+growth+in+biomedical+research+and+the+need+to+adopt+the+rapidly+advancing+research+to+medical+practice+has+placed+a+new+demand+on+health+care+givers+to+acquire+skills+for+selfdirected+and+independent+learning+which+will+enable+them+to+continue+to+learn+throughout+their+professional+life%0d%0a%0d%0a%0c%ef%81%ae%0d%0a%0d%0aThe+public+and+health+educators+are+beginning+to+question+the+relevance+of+the+traditional%2c+didactic+and+faculty-centred+medical%2fhealth+education+which+relies+heavily+on+lectures%2c+assigned+reading+in+textbooks%2c+and+term+papers+as+methods+of+impacting+knowledge.+This+method+has+been+found+wanting+and+incapable+of+impacting+self-directed+lifelong+learning+skills+to+HCPs.%0d%0a%0d%0a%0c%ef%81%ae%0d%0a%0d%0aHCPs+need+skills+to+construct+and+develop+clinical+useful+knowledge+and+clinical+reasoning+strategies+to+address+health+problems.+To+achieve+this%2c+their+education+must+actively+engage+them+in+opportunities+for+knowledge+seeking%2c+and+interaction+with+real+world+information+resources+for+knowledge+building+and+learning+to+continue+to+learn.%0d%0a%0d%0a%0c%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0aMedical+and+library+literature+suggests+that+students+who+study+through+PBL+are+more+effective+health+care+providers+that+those+who+study+through+the+conventional+system.+They+develop+information+literacy+skills+which+they+pass+on+to+their+clients.+They+are+better-prepared+for+professional+services+than+those+in+the+traditional+counterparts+in+the+following+areas%3a%0d%0a%0d%0a%0c%ef%81%ae+%ef%81%ae+%ef%81%ae+%ef%81%ae+%ef%81%ae+%ef%81%ae+%ef%81%ae%0d%0a%0d%0aIndependent+learning+Problem-solving+Self-Evaluation+techniques+Data-collection+Knowledge+of+behavioral+sciences+Medical+record+keeping+Knowledge+of+social+and+emotional+issues+of+their+patients.%0d%0a%0d%0a%0cWhat+is+PBL%3f%0d%0a%ef%81%ae%0d%0a%0d%0aPBL+is+an+educational+terminology+that+describes+a+learning+process+that+is+centred+on+the+investigation+and+resolution+of+real+life+problems.+Students+working+in+small+self-directed+teams+learn+through+structured+exploration+of+an+identified+medical%2fhealth+problem.+They+employ+a+variety+of+resources+to+identify+the+problems+and+the+conditions+necessary+for+a+good+resolution.%0d%0a%0d%0a%0cPBL+supports+knowledge+construction+and+provides+students+with+insights+into+the+research+process.+%ef%81%ae+The+PBL+environment+promotes+deeper+exploration+of+content%2c+active+and+independent+learning.+%ef%81%ae+It+nurtures+lifelong+learning+habits+and+promotes+responsible%2c+wellknowledgeable+health+care+providers.%0d%0a%ef%81%ae%0d%0a%0d%0a%0cAims+of+PBL%0d%0a%ef%81%ae+%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0aTo+teach+problem-solving+skills+which+are+essential+to+good+clinical+judgment.+To+integrate+basic+sciences+with+clinical+sciences+throughout+the+curriculum.+To+develop+lifelong+learning+through+the+promotion+of+active+independent+learning-+a+commitment+required+of+today%e2%80%99s+health+care+practitioners.+To+enable+students+develop+their+problemsolving+abilities%2c+thereby+making+them+effective+self-directed+learners.%0d%0a%0d%0a%0cFeatures+of+PBL%0d%0a%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0aIt+is+a+case-based%2c+small+group+tutorial+learning.+A+tutorial+teacher+guides+the+students+in+each+tutorial+group.+The+students+identify+some+clinical+problems.+Formulates+the+hypotheses+for+the+investigation%3b%0d%0a%0d%0a%0c%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0aThe+group+defines+both+the+human+and+information+resources+needed+to+explore+the+problem.+They+begin+to+collect+needed+information+from+a+variety+of+resources.+The+information+is+analysed%2c+synthesised+and+the+findings+are+discussed.+It+is+a+learning+rather+than+a+teaching+process%0d%0a%0d%0a%0cLiterature+on+PBL%0d%0a%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0aPBL+students+are+more+effective+health+care+providers+(McMaster+Univ.+Study%2c+Univ.+of+Transkei+Study).+PBL+students+acquire+lifelong+learning+skills+earlier+(Rankin+1992).+They+use+the+library+more+and+more+frequently+(Marshall%2c+1993).+They+are+more+competent+problemsolvers+(Univ.+of+Kwazulu-Natal)%0d%0a%0d%0a%0cWhy+PBL+for+Africa%3f%0d%0a%ef%81%ae%0d%0a%0d%0aThe+African+health+crises+xterised+by+high+mortality+rates%2c+plummeting+life+expectancy%2c+epidemics%2c+e.+t.+c.+suggest+that+HCPs+need+modern+skills+to+enable+them+to+deliver+efficient+health+care+services+that+will+address+and+provide+solutions+to+the+crises.%0d%0a%0d%0a%0c%ef%81%ae%0d%0a%0d%0aApproaching+medical%2fhealth+education+from+a+knowledge+and+problem-based+perspective+will+equip+health+care+professionals+with+competency+in+information+gathering%2c+management+and+communication.+These+skills+will+enable+them+to+effectively+select%2c+absorb+and+adapt+the+vast+array+of+biomedical+resources+into+solving+the+continuously+emerging+clinical+and+epidemiological+problems+in+Sub-Saharan+Africa.%0d%0a%0d%0a%0c%ef%81%ae%0d%0a%0d%0aThe+need+to+achieve+PHC+for+all+means+that+the+educational+setting+of+health+care+providers+of+today+need+to+move+to+the+community+where+they+can+practically+and+physically+identify+clinical+and+epidemiological+issues+and+design+solutions+to+them%3b+work+in+groups+of+health+care+providers+to+identify+healthrelated+problems%3b+educate+the+community+as+well+as+their+co-workers%2c+and+continue+learning+for+life+so+as+to+keep+professional+skills+up-to-date+and+improve+competence+as+much+as+possible%0d%0a%0d%0a%0c%ef%81%ae%0d%0a%0d%0aHCPs+are+the+components+of+the+national+health+system+in+the+nations+of+SubSaharan+Africa%2c+and+are+therefore+the+right+people+to+educate+the+community+about+proper+health+care.+A+PBL+educational+programme+will+equip+health+professionals+with+the+skills+needed+to+educate+the+community+about+proper+health+care.+An+improved+medical+knowledge-base+of+the+community+is+a+move+towards+attaining+health+development+in+Sub-Saharan+Africa.%0d%0a%0d%0a%0c%ef%81%ae%0d%0a%0d%0aIt+is+for+these+reasons+that+many+medical%2fhealth+schools+from+the+late+1970s+up+to+the+present+began+to+drift+away+from+the+traditional+lecture-oriented+approach+to+a+more+student%e2%80%93driven%2c+problem-based+approach+to+learning.+PBL+is+a+widely+adopted+methodology+in+the+West+and+in+South+Africa.%0d%0a%0d%0a%0cSpread+of+PBL+in+SubSaharan+Africa.%0d%0a%ef%81%ae%0d%0a%0d%0aOver+20+tertiary+institutions+in+South+Africa+have+adopted+the+PBL+pedagogy.%0d%0aIn+Francophone+Africa%2c+Cameroon+adopted+PBL+in+the+training+of+its+district+health+managers.%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0a%0c%ef%81%ae%0d%0a%0d%0aRelatively+new+in+East+Africa%2c+but+South+Africa+is+introducing+PBL+to+some+sections+of+the+region%2c+e.g.+the+University+of+Kwazulu-Natal%2c+will%2c+beginning+from+October+2006%2c+offer+M.SC.+Nursing+programme+in+five+universities+in+Kenya+and+Tanzania.+The+curriculum+includes+some+PBL+tracks.%0d%0a%0d%0a%0cInformation+User+Xteristics+of+PBL+Students%0d%0a%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0aThey+use+the+library+and+its+facilities+more+frequently+and+for+longer+hours.+They+explore+more+reference+services+and+research+tools+more+frequently+and+in+more+depth.+They+are+involved+in+serious+information+management.%0d%0a%0d%0a%0c%ef%81%ae%0d%0a%0d%0aThey+search+the+following+more%3a+End-user+Medline+searching%3b+Reserve+or+short-term+loan+materials%3b+Photocopying+Services%3b+Realia%3b+and+AV+Materials%0d%0a%0d%0a%0c%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0aThey+favour+self-selected+rather+than+faculty-recommended+resources+They+exercise+a+greater+amount+of+intellectual+curiousity+and+may+request+for+resources+off+the+topic+They+need+the+librarian+as+a+major+human+resource+in+tutoring+especially+in+providing+information+literacy+skills%2c+and+guidance+in+information+sourcing.%0d%0a%0d%0a%0cChallenges+of+the+PBL+curriculum+to+Librarians.%0d%0a%ef%81%ae%0d%0a%0d%0aThe+nature+of+library+services+in+a+student-centred%2c+self-directed+learning+scenario+is+quite+different+from+the+lecture-centred+approach.+Library+services+for+lecture-centred+methodology+are+planned%2c+specific+and+within+control+because+courses+and+reading+lists+are+spelt+out.%0d%0a%0d%0a%0c%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0aThe+self-directed%2c+explorative+nature+of+PBL+programmes+means+that+a+greater+variety+of+information+resources+are+needed.+Difficult+to+determine+with+precision+the+information+needs+of+the+programme.+In+addition%2c+the+PBL+curriculum+is+modular+and+changes+frequently%2c+consequently+the+needed+resources+as+well+as+the+objectives+of+the+modules+change+more+frequently+than+in+the+conventional+curriculum.%0d%0a%0d%0a%0c%ef%81%ae%0d%0a%0d%0aTherefore+collection+development+for+PBL+must+be+reviewed+frequently+and+access+to+quality+health+information+must+be+provided+more+often+than+usual.+The+librarian+needs+to+provide+exceptionally+broad+choices+of+information+resources.+The+long-term+objective+of+PBL+curriculum+is+to+foster+the+research+capacity+of+health+care+providers.+Access+to+quality+health+information+is+the+foundation+for+any+meaningful+research+activities.%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0a%0c%ef%81%ae%0d%0a%0d%0aConsidering+the+poor+conditions+of+the+resources+in+our+libraries%2c+and+the+fact+that+many+of+our+medical+librarians+lack+modern+information+services+skills%2c+the+PBL+librarian+has+the+responsibility+to+support+and+press+for+initiatives+that+will+enhance+access+to+health+information+resources%2c+and+also+provide+opportunity+for+continuing+training+in+health+information+and+services+to+equip+medical+librarians+with+modern+information+services+skills%0d%0a%0d%0a%0cPartnership+Programs+for+Enhanced+Access+to+Information%0d%0a%ef%81%ae%0d%0a%0d%0a%ef%81%ae+%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0athe+Partnerships+in+Health+Information+(Phi)+(http%3a%2f%2fwww.intute.ac.uk%2fhealthand+lifesciences%2fhosted%2fphi+The+AGORA+and+HINARI+initiatives+The+(PERI)+initiative+facilitated+by+INASP+The+Ptolemy+Project+(http%3a%2f%2fwww.ptolemy.ca)%0d%0a%0d%0a%0cOpen+Access+Initiatives%0d%0a%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0aDirectory+of+Open+Access+Journals+(http%3a%2f%2fwww.doaj.org+Free+Medical+Journals+(http%3a%2f%2fintlcirc.ahajournals.org+Publications+on+Malaria+(http%3a%2f%2fwww.malaria.org)+U.S.+National+Library+of+medicine+(http%3a%2f%2fpubmedcentral.nih.gov)%0d%0a%0d%0a%0c%ef%81%ae%0d%0a%0d%0a%ef%81%ae+%ef%81%ae+%ef%81%ae%0d%0a%0d%0aFlying+Publisher+(http%3a%2f%2fwww.flyingpublisher.com)+http%3a%2f%2fwww.freemedicaljournals.com+(FT+over+1450+medical+journals)+http%3a%2f%2fwww.freebooks4doctors.com+(FT+access+to+over+650+current+medical+books)%0d%0a%0d%0a%0cICT+Infrastructure%0d%0a%ef%81%ae%0d%0a%0d%0aNo+efficient+information+transfer+and+access+can+take+place+without+good+ICT.+This+is+still+lacking+in+our+institutions.+The+librarian+still+has+to+continue+to+fight+vigorously+for+efficient+and+effective+ICT.%0d%0a%0d%0a%0cPhysical+Facilities%0d%0a%ef%81%ae+%ef%81%ae%0d%0a%0d%0a%ef%81%ae+%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0aPhysical+facility+must+be+adequate%3b+Seating+arrangement+must+be+comfortable%3b+Library+needs+to+open+for+longer+hours+It+may+be+necessary+to+have+the+medical+library+close+to+the+tutorial+areas+Additional+staff+may+be+needed%0d%0a%0d%0a%0cLibrarians+as+Teachers%0d%0ain+accessing+and+managing+information+resources+%e2%80%93+Computerised+literature+searching+%e2%80%93+Problem-based+approach+to+information+resources.+%e2%80%93+How+to+organise+and+retrieve+information+%e2%80%93+Filing+lessons+and+how+to+create+databases%0d%0a%ef%81%aeTraining%0d%0a%0d%0a%0c%ef%81%ae%0d%0a%0d%0a%ef%81%ae+%ef%81%ae+%ef%81%ae+%ef%81%ae+%ef%81%ae%0d%0a%0d%0aDesign+library+instructions+to+meet+specific+instructions+and+provide+them+at+the+point-of-need.+This+needs+collaboration+between+the+librarian%2c+and+the+medical+teacher.+Guide+the+students+to+formulate+research+questions+into+MeSH+terms+Direct+students+in+identifying+and+selecting+relevant+resources+Teach+skills+in+using+health+information+sources+Teach+communication+skills+Teach+information+re-packaging+skills%0d%0a%0d%0a%0cContinuing+Professisonal+Development+for+Librarians%0d%0a%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0aLibrarians+must+pursue+initiatives+that+provide+opportunities+for+professional+development.+Phi+facilitates+continuing+training+in+health+information+and+services%0d%0a%0d%0a%0cConclusion%0d%0a%ef%81%ae%0d%0a%0d%0aAchieving+health+for+all+in+Sub-Saharan+Africa+depends+to+a+large+extent+on+how+well+HCP+are+able+to+adapt+biomedical+information+to+solving+the+health+crisis.+The+PBL+librarian+plays+a+major+role+in+equipping+medical%2f+health+students+with+modern+information+management+skills+needed+to+address+the+problems.+Their+increasing+responsibilities+mean+that+they+are+no+longer+a+complementary+resource%2c+but+educators+in+their+own+right+and.%0d%0a%0d%0a%0c