Application of community-oriented medical education criteria to the United Arab Emirates (UAE) context:

Richards and Fulop¹ have developed five criteria to determine the community orientation of a medical school. Application of these criteria to the UAE context indicates the following:

1. The extent to which the school’s guiding principles are community oriented:

The Faculty of Medicine and Health Sciences (FMHS) curriculum was designed with the core mission ‘to provide medical and paramedical graduates and postgraduates of internationally recognized quality, specially attuned to the needs and aspirations of the UAE and its culture, achieved by excellence in teaching, research and service, directed to the needs of the community’. This mission is further reinforced in other guiding principles espoused by our founding curriculum designers: ‘to provide an undergraduate medical education program oriented to the needs of the UAE community’ and ‘to be actively involved in the delivery and development of health care in the Al Ain Medical District’.

2. The emphasis placed in the curriculum on concepts and knowledge of what constitutes a community and a population, how to measure and cope with health needs and how to take proper account of the cultural and social background:

From year one of our seven-year curriculum the students learn basic concepts in epidemiology, ethics, psychology, sociology and family dynamics. Knowledge of the cultural perspective of illness and of the impact of social and community influences on individuals is further developed in the second year of the curriculum in the Principles of Medical Practice Module. Research projects undertaken by students in preclinical and clinical years enhance students’ abilities to measure and cope with health care needs of the community. Some of these student-initiated projects have been published in refereed journals, referred to in the local press and commented on by leading members of the community.

3. The extent to which community based learning forms part of the curriculum

Years one and two students are introduced to community-based programs through field visits to primary health care centers, school health clinics, preventive medicine departments and alternative therapists. During years of clinical rotations, students primarily follow a hospital based curriculum. Family Medicine clerkship is based in the community and primary health centers. Similarly, during Community Medicine clerkship students conduct projects based in the community. Therefore during junior and senior clinical rotations, our students work with appropriate professionals in both inpatient and outpatient settings. In addition to serving the community, these opportunities provide excellent training experiences for students.

4. The degree of community involvement in the training program

Community involvement in the curriculum is currently limited. Perceived intrinsic problems include difficulties in precisely defining ‘community’ in this culturally diverse population. When applying Wallerstein & Shelin’s² definition of community as "a group of people with something in common: a language, geographic boundaries, age, attendance at primary care clinics, a shared cause or bond of identity, history or values…" to our context there are discernible challenges. Since oil was first exported in 1962, the UAE has grown from an undeveloped desert terrain to a highly developed wealthy, and diversified country. Traditional community systems and cohesion are not as obvious. Approximately 20 per cent of the UAE population is Emirati and the rest are expatriates who are very mobile. The main bond in the population is probably that of the Islamic religion. Cultural and religious norms of the country place considerable constraints on organization of community based-curricula since there are restrictions on women students visiting families and men students not being welcomed unless the male head of the family is present. To accommodate these constraints, various improvisations have been adopted. For example, while collecting data from the ‘community’ our students mostly work with their relatives, family friends and/or public organizations such as schools, clinics, police which also observe segregation of the sexes. The University administration expects students to follow a strict code of conduct in accordance with social and religious norms. These regulations limit movement and exposure of women students outside the medical school campus.

Baseline epidemiological date are also limited as in the past these data were not maintained by the existing hospitals due to lack of expertise and necessary equipment. The country’s security constraints on collecting and publishing baseline epidemiological data also makes community-based research difficult. However, the FMHS has taken the lead in this area by initiating a number of research projects to establish baseline data.

5. The organizational linkages between the school or program and the health services system

The FMHS collaborates with the Ministry of Health, Preventive Medicine Departments, Municipalities and Road Traffic Police at various stages in the curriculum. These links provide opportunities for members of the institution to familiarize themselves with the social, economic and political forces affecting the health of the community. Some of our faculty involve themselves in an advisory capacity to these agencies. The FMHS also organizes conferences on common health problems of the UAE, where local and international health care issues are identified and shared. The FMHS has developed collaborative teaching and research activities between faculty in population-based sciences and those in clinical departments and nursing school.

In conclusion, the above description indicates that despite external constraints the FMHS is endeavoring to put into practice the objectives of the Mission Statement. Though we are optimistic that many recent initiatives will contribute to meeting our objectives in this field, it appears that forces for change, especially those external to the academic institution are powerful and not likely to diminish in the foreseeable future.

References

1. Richards R, Fulop T. Innovative schools for health personnel: Report of ten schools belonging to the Network of Community-oriented Educational Institutions for Health Sciences. World Health Organization, Geneva, 1987.

2. Wallerstein N, Shelin B. Techniques for developing a community partnership. In: Rhyne R, Bogue R, Kukulka G, Fulmer H eds. Community-Oriented primary care: health care for the 21^st century. American Public Health Association, Washington DC, 1998.