Abstract:

Improvement of the education at the Faculty of Medicine is a cornerstone for the country development programs because it deals with capacity building of the health workforce. The Public Health Department (PHD) at the Faculty of Medicine of Cairo University is responsible for the Community Medicine Training Program (CMTP) provided to fourth year medical students. As part of the medical education reform, PHD redesigned the CMTP and implemented a reformed program. Re-designing the training program was based on the engagement of different stakeholders from PHD, other faculty departments and Ministry of Health (MOH) staff in the urban and rural primary health care (PHC) facilities. Before implementing the CMTP in the coming academic years, it was necessary to subject it to extensive evaluation by all parties engaged in this training and to exchange experience with those having similar programs to further improve the quality of the program.

Aim of the study:
To evaluate the practical component of the reformed CMTP provided to fourth year medical students at Cairo University by:
1) reviewing the students' performance,
2) exploring the perspectives of the PHD staff at Cairo University and Ain-Shams University (one of the major universities in Egypt) towards the program
3) exploring the views of the managers of the MOH PHC centers where medical students receive their PHC training towards the program.

Methodology:
Quantitative data were obtained by reviewing the performance scores of 1492 students enrolled in the reformed CMTP. Qualitative data were obtained by conducting 7 focus group discussions with PHD staff and MOH PHC managers. The study was reviewed by the Institutional Review Board at Faculty of medicine in Cairo University.

Results:
The reformed CMTP included three major modules. First module included generic skills: leadership, team work, student-staff interaction and creativeness. Second module included service-learning and hands-on problem solving in a rural community through seminars and visits to rural families. Third module included understanding the PHC within the MOH system through seminars and visits to the PHC centers.
It was found that the total students' mean score ± standard deviation was 94.2% ± 9.9%. About 91% of students scored >85% of the total marks. The rural health module showed the highest mean performance scores (94% ± 14.6%), followed by the generic skills module (92.5% ± 15.8%) and the PHC module (89.2 %± 17.4%). The performance score for the generic skills was highest for the student-staff interaction (93.8% ± 17.5%).
Analysis of the focus group discussions showed that there was a general consensus that the reformed program was greatly successful. Participants expressed appreciation to the introduction of generic skills in the CMTP. They referred the success in management of CMTP to small-group teaching, the enthusiasm of the critical mass of the junior faculty members who worked closely with the students, and the community-oriented and service-learning approaches.

Conclusion:
The reformed CMTP was found to be successful and it is recommended to continue using the reformed program for the coming years.

Keywords:

Training in Community Medicine, stakeholder in medical education, public health, primary health care, Egypt.