public health education programs thiland

8/3/2019 Public Health education Programs Thiland

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Public Health Foundation of India178

International Conference onNew Directions for Public Health Education in Low and Middle Income CountriesProcesses, Proceedings and Proposed Next Steps

Country background

The population of Thailand was 64 million in 2007. The official language is Thai, although Chinese andMalay are also spoken. Buddhism is the nationalreligion, with 95% of the population practising it;

Islam, christianity and hinduism are also practisedfreely.1

Thailand is a middle-income country with agross national income (per capita) of PPP inter-national $ 9140 in 2006,2 and despite being largelyagrarian has been seen to rapidly urbanize in re-cent decades. In the past 40 years Thailand haschanged from an agrarian into an export-oriented,industrialized economy. This transformation hashad considerable impact on its society and the wayin which its peoples and the State have responded

to the rapidly changing political and health needs.

Health situation and trends

Thailands public health system is also in the pro-

cess of transition. A significant improvement hasoccurred in the health of the nation over the past 4decades. From 1964- to 2006, life expectancy at birthincreased from 55.9 to 69.9 years in men, and from62.0 to 77.6 years in women. Infant mortality ratedeclined from 84.3 to 11.3 per 1000 live births, andthe maternal mortality ratio also declined from317.3 to 9.8 per 100,000 live births during the sameperiod.3

This epidemiological transition began in theearly 1970s and corresponded with a decrease indiseases associated with poverty, those that werepreventable with vaccination and those that werenon-communicable. In the 2006 Burden of DiseaseStudy using DALY (disability-adjusted life year) asthe indicator, it was found that the top three causes

of DALY loss for men were HIV/AIDS, road traf-fic injuries and alcohol abuse-related diseases.4 In women, these causes were cerebrovascular diseases,HIV/AIDS and diabetes.4

Public Health Education in Thailand

Pattapong Kessomboon, PhDNusaraporn Kessomboon, PhD


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Public Health Foundation of India 179

International Conference onNew Directions for Public Health Education in Low and Middle Income Countries

Processes, Proceedings and Proposed Next Steps

Public health and healthcare ser-

vices in Thailand

The Thai health service systems are dominated by

the public sector. They have evolved from a sys-

tem of self-reliance, based on local wisdom, to one

of up-to-the-minute professional services. The num-

ber of people using the health services increased

from 38.5% in 1970 to 77.5% in 2004, whereas those

on self-medication decreased from 51.4% to 20.9%

during the same period.3 Several health sector re-forms have been implemented to increase accessi-bility, improve quality control, contain costs and

increase efficiency.5,6

The Ministry of Public Health (MOPH) is themain national health agency. It owns the majorityof health resources, particularly in the rural areas.Its major role is in providing comprehensive healthservices, ranging from individual care for out-pa-tients and in-patients, to public health outreachactivities. Doctors, dentists, pharmacists and nurses,

Source: Thailand Health Profile, 2005073

Fig. 1. Mortality rates due to major causes of death in Thailand, 19672006


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as well as paramedical personnel (e.g. graduatesfrom Public Health Colleges), are expected to beable to take public health roles for promoting health

and preventing disease.

Provincial and district health offices overseepublic health planning and implementation at thelocal level. Regional offices of the MOPH super-vise the provincial and district offices. In recent

years local governments are taking an increasinglyactive role in public health as a result of the Decen-tralization Act.

Private hospitals have grown rapidly, with anincrease from approximately 10% of total beds in1985 to 21% in 2002. The services they offer aremainly profit-based. After the economic crisis in1997, many private hospitals were closed down or


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reduced in size. Recently, some have re-orientedtheir services to attract more foreign patients. Theyhave been so successful that in 2001 it was estimated

that there were 1 million foreign patients.7

Thailands annual health expenditure rosefrom 4.47% of GDP in 1983 to 6.12% in 2002. Pub-lic spending increased during the same period, from31.5% to 34.09%. The MOPH shares more thantwo-thirds of public spending on health.8

Before October 2001, 75% of Thai people wereinsured under major health insurance schemes, suchas the Civil Servant Medical Benefit Scheme, theSocial Security Scheme, and the scheme for the

poor, the children, the elderly and the disabled. InOctober 2001, the government started to imple-ment the universal coverage of healthcare (the 30Baht scheme), which covers previously uninsuredpersons. The health insurance coverage was raisedby up to 95% in 2006.3

Situation and trend of human resource for

health in Thailand

Multiple cadres of human resource for health(HRH) are produced in Thailand. They are classi-

fied into two main groups, viz., health service pro-viders and public health managers. A new categoryof health personnel has emerged, viz. the healthcare

purchasers, since the introduction of the 2001 Na-tional Health Security Act. The distribution ofmain cadres of HRH is shown in Table 3. It shouldbe noted that information on the numbers and dis-tribution of public health managers at central, re-gional, provincial and district levels is lacking. Thisreflects a gap in human resource planning.

The high economic growth together with in-creased opportunities in higher education, greaterurbanization, an increase in the population of theelderly, a higher prevalence of chronic diseases,greater coverage of and access to essential healthcareservices, and a greater usage of these services byforeign patients have all resulted in the increasingdemand for and, hence, a shortage of HRH, par-ticularly in the rural public health facilities.

Situation of public health and medical educa-

tion institutions in Thailand

There are many types of public health educationprogrammes in Thailand, ranging from a certifi-


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cate course to a PhD programme. The programmesare mostly organized by the public sector. MOPHand the Ministry of Education are playing a major

role in devising these programmes.

Roles of the MOPH

The MOPH, the major healthcare provider inThailand, is also playing a significant role in pro-ducing health personnel for its healthcare facilities.It has nursing colleges and public health collegesnationwide. The main cadres are professional nurses(4-year course), technical nurses (2-year course),health workers for health centres (2-year course),

dental hygienists (2-year course), assistant pharma-cists (2-year course) and mid-wives (2-year course).Recently, the increasing numbers of traffic injurycases have forced the MOPH to produce a newcadre of emergency medical assistants who willprovide medical services prior to hospitalizationand assist medical staff in emergency rooms.

The MOPH produces most of the paramedicstaff (2-year study) for its health centres at sub-dis-trict level. It is also important to note that ruralrecruitments, training in rural health facilities and

hometown placements after graduation were fac-tors that led to the balanced distribution of nursesand other paramedics in Thailand.

An important strategy to improve the healthservices in rural areas, particularly in the healthcentres, was to produce lower-level professionals whose capacity is being continuously enhanced.Patients with minor problems are adequately caredfor by the health centre staff. The extensive invest-ment since the early 1980s for developing ruralparamedical personnel has greatly reduced the num-ber of outpatient visits to hospitals and the demandfor doctors services.3

The continuing education programmes forlower-level professionals are organized in various ways and by different educational institutions. Afew of the paramedical personnel usually take aBachelors degree in Public Health in an open university or in the special programmes run by uni-versity-based colleges of public health. Some stu-dents choose further study on the MPHprogramme of the university-based College of Pub-lic Health or Department of Community Medi-cine (in three universities in Thailand there is no

separation between the College of Public Health


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and the Department of Community Medicine). Theobjective here is to become a district health officeror a public health manager at provincial or regional

public health offices.

The MOPH public colleges also provide con-tinuing education for their alumni by training themfor health promotion activities. The first-, middle-and high-level public health administrators are giventraining that corresponds to their ranking. Thisfacility for continuing education for promotionmotivates staff to undergo further education.

The MOPH health facilities provide practicalexperience for the trainees as well as improves the

service provision of healthcare If there is a persis-tent shortage of medical doctors or amaldistribution of doctors in an area, the MOPHsteps in to provide medical doctors. Ten regionalhospitals have been given more money and staff tobetter fulfil this new objective in collaboration withuniversity-based medical schools. Medical studentsspend 3 years in a medical school for their basicmedical studies and another 3 years in a regionalhospital for their clinical rotations. The successesand failures of this practice need further evaluation.

Various MOPH departments and units orga-nize continuing education and training courses onspecific topics for their staff. Some of these courses,such as the International Field Epidemiological Training Programme organized by the Bureau ofEpidemiology, Department of Disease Control, andMOPH,9 and the Epidemiology of Injury and In-jury Care Management organized by the TraumaCentre at Khon Kaen Regional Hospital (one ofthe WHO collaborating centres) enjoy mixed par-ticipation by both Thais and international partici-

pants.10

The health training and Health Institute of theMOPH are having a significant impact on the atti-tudes of Thai healthcare providers and medical edu-cators through their training courses and learningaids. The training provides participants with newperspectives on health, disease, death, primary care,providerpatient relationships, cultural aspects of

illnesses and so on. The slogan of these courses ishumanized healthcare as opposed to modernizedhealthcare. The theories and thinking from the

discipline of medical anthropology have made asignificant impact in developing the Thai commu-nity healthcare models.11

Roles of university medical schools

Medical schools in Thailand produce mainly spe-cialists. Although the general consensus is that moregeneral practitioners are needed to meet the increas-ing needs of primary care services, most medicalschools are reluctant or unable to realise this goal.

As a result there is an imbalance in the numbers ofmedical specialists versus general practitioners. Aprogramme has been in instituted since 1972 toincrease the numbers of doctors in rural areas byensuring that all new graduates work in publichospitals, particularly in rural district hospitals, forthe first 3 years. If they breach the contract, theyhave to pay a fine of approximately US $10,000.However, the higher salaries paid in the privatesector and increasing inflation rates have made theprogramme less effective.12

Community Medicine Departments of medi-cal schools are responsible for the primary care andpublic health education components of the medi-cal curriculum. Medical students tend to find spe-cialties other than these subjects more appealing,although a small proportion of medical graduatesdo choose a career in these disciplines. To addressthis problem, the Khon Kaen University (KKU)has developed initiatives to make primary care andpublic health more attractive to medical students(see Appendix 1). The fact that doctors are gener-

ally looked upon as the team leaders in the publichealth services, in spite of having inadequate atti-tudes, skills and knowledge of the subject, makesthis initiative all the more important. Ultimately,doctors who are hospital directors or public healthmangers at provincial health offices will eventuallychoose to study public health because of its rel-evance to their work.


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These doctors can choose to do an in-servicetraining programme in preventive medicine andthen take a final examination organized by the Thai

Medical Council Royal College of Preventive Medi-cine. If they pass the exam they will be given acertificate in Thai Medical Council Board of Pre- ventive Medicine.

A small number of medical doctors choose tostudy a Masters in public health or a PhD in thesubject in a university-based college of public health.Some prefer taking government scholarships tostudy the subject abroad. Others may even preferto opt for a course in business management, suchas an MBA.

The KKU is planning initiatives for medicalgraduates to study public health, such as a Mastersdegree and a PhD in health systems development.The key stakeholders, such as the National HealthSecurity Office, the Society of Rural Medical Doc-tors, the MOPH and faculties from other universi-ties, are presently discussing the design of theprogramme. A module-based curriculum is prefer-able to suit the needs of the often busy medicaldoctors. This programme is expected to strengthen

ties between the public health education depart-ment and doctors who work in rural areas.

An MSc in community medicine at KKU hasalso been developed as an international programmeto provide greater opportunities for the exchangeof experiences between students from differentcultural backgrounds (see Appendix 2).

A 4-week intensive course on communityhealthcare and research is organized annually toprovide learners with a comprehensive understand-ing of community health development in Thailand.

The students are expected to write a health sys-tems research proposal by the end of the course(see Appendix 3).

Roles of the University College (or Faculty)

of Public Health

Old universities with a separate college (or faculty)

of public health usually provide a Bachelors,Masters and PhD degree in the subject. The oldestFaculty of Public Health in Thailand is Mahidol

University in Bangkok where workshops and shortcourses on specific public health topics are offeredfrequently.

In view of expanding industrialization and thelimited number of jobs in the MOPH, there is anincreasing trend for the university colleges of Pub-lic Health to focus their Bachelor programmes onindustrial hygiene and occupational health andsafety.

The Masters in public health and PhD

programmes of many colleges of public health aresimilar. They offer core courses and electives. Adissertation or thesis is required to graduate. Theonly differences stem from the differences in thequality of teaching, the practical elements, educa-tional support, and the learning environment (seeAppendices 4 and 5).

There is a tendency to organize a PhDprogramme with dual tracts. Students will spend 2years in Thailand and another year abroad to studyat the collaborating universities. The PhD

programmes with reputable professors are likelyto be supported financially by the Golden JubileePhD programme of the Thai Research Fund andgrants from donating agencies.

Roles of the university Faculty of Pharmacy

One of the major health expenditures is on drugs.Pharmacists are one of the key players in publichealth. They also have a responsibility to protect

consumers from substandard medicines. The col-laborative module-based Master of PharmaceuticalScience in Pharmacy Management run by a con-sortium of four faculties of Pharmacy in Thailand,with close collaboration with the MOPH, has shedsome light on how to efficiently organize a Mastersprogramme nationwide (see Appendix 6).


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Roles of the University College Faculty of

Nursing

Nurses constitute the majority of health personnelin Thailand. They are known for their managementskills and a tradition of strong group work. Theyare capable of undertaking both therapeutic andpublic health work, as well as immunizations andmother and child health. Their responsibilities havenow extended to disease management and homecare of patients.

University Faculties of Nursing also provideMasters programmes in Public Health and Com-

munity Nursing. These programmes are structuredin a similar way to that of other university courses.

The 4-month Faculty of Nursing course onNurse Practitioner is very popular among practic-ing nurses. The students are taught clinical diagno-sis and treatment of patients with common condi-tions in primary care. Office-based disease preven-tion, health promotion, home healthcare andchronic disease management are among the keysubjects.

Discussion

1. Globalization and the transitions and reforms inthe healthcare system in Thailand have had majorinfluences on human resource planning, produc-tion and utilization. The public health workforceis seen as one of the key players in health planningand improvement programmes. This role has erst-while been dominated by medical practitioners. The

Faculty of Public Health in educational institutionsshould be involved in and take a more active rolein promoting the role of public health workers.

2. The need for new cadres in the publichealth workforce and their greater involvement inpublic health has been necessitated by the complex-ity of emerging health problems in Thailand. Tra-ditional public health programmes are in urgent

need of re-evaluation. There need to be less clear-cut boundaries of tasks between public health andother development activities and programmes. All

those involved in this endeavour must redefine theirroles.

3. Past experience has proven Thailands ca-pability of establishing new types of public organi-zations with a higher efficiency and accountabil-ity, such as the Health Systems Research Institute,the Health Security Office, the Thai Health Pro-motion Foundation, and so on. These organizationshave demonstrated that the most challenging oftasks can be staffed with people of the highest ca-pability. It would thus be judicious to form a simi-lar public health organization with a new cadre ofpublic health workforce at the provincial level.

4. The Thai Health Promotion Foundationhas been a key promoter of many health campaignsby civic groups in that country. They have a regu-lar source of revenue from 2% of taxes from to-bacco and alcohol sales with which they fund theirhealth promotion activities. The Foundation iskeen to support public health educationprogrammes. As such, a cooperative effort between

the government and the Foundation should bemade to plan degree and non-degree-based coursesin public health to strengthen the public health workforce. A module-based curriculum for part-time students, organized in collaboration with anumber of colleges and university departments,could offer a favourable choice for students.

5. Civic society groups and non-governmen-tal organizations (NGOs) play a key role in publichealth improvement. Various types of NGOs anda vast number of community leaders are actively

engaged in improving the health of the nation. These social activists could be a valuable asset forplanning public health educational programmes andproviding resources. Religious groups are alsoamong the majors social activists which employmodern management techniques to implementtheir religious campaigns. A Masters degree inBuddhism offered by the Chulalongkorn


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Rachawittayalai Buddhist University might be ac-cepted as an elective course for the Masters degreein a public health programme. Peace of mind of

the public health workforce should be one of therequired educational goals.

References1 Pramualratana P, Wibulpolprasert S. Health Systems in Thai-

land. 2006.

2 WHO.World Health Statist ics 2008. URL: http://

www.who.int/whosis/en/index.html.3 Wibulpolpresert S (ed). Thailand Health Profile 20052007.

Bureau of Policy and Strategy, Ministry of Public Health.Nonthaburi: Printing Press. 2008.

4 The Thai Working Group on Burden Attributable to RiskFactors MoPH. Thailands Risk Burden in 2006. 2007.

5 Towse A, Mills A, Tangcharoensathien V. Learning from

Thailand's health reforms. BMJ 2004;328:1035.6 Pannarunothai S, Patamasiriwat D, Srithamrongsawat S. Uni-

versal health coverage in Thailand: Ideas for reform and policy

struggling. Health Policy 2004/4. 2004;68:1730.7 Wibulpolprasert S, Pachanee CA, Pitayarangsarit S,

Hempisut P. International service trade and its implicationsfor human resources for health: A case study of Thailand.

Hum Resour Health 2004;2:10.

8 Tangcharoensathien V, Pitayarangsarit S, Vasavid C. Uni- versal healthcare coverage and medium term financing im-

plications. Nonthaburi: International Health Policy Program, Thailand; 2002.

9 www.moph.go.th

10 www.kkrh.go .th11 www.shi .or.th

12 Wibulpolprasert S, Pengpaibon P. Integrated strategies totackle the inequitable distribution of doctors in Thailand:

Four decades of experience. Hum Resour Health 2003;1:12.


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Introduction

Community healthcare is an essential component

of any healthcare system, without which the na-

tionwide delivery of healthcare becomes inequitableand inefficient. It is therefore crucial to train medi-

cal and health personnel in appropriate and ad-

equate attitudes, skills and knowledge to provide

appropriate quality health services at the commu-

nity level.

This paper presents an overview of the field

work components of the current Community

Medicine curriculum at the Faculty of Medicine at

Khon Kaen University (KKU), Thailand. A de-

scription of the courses is given here; the results of

the evaluation of the course will be presented later.Medical students at KKU undertake five courses

in Community Medicine over the 5-year study pe-

riod. The course consists of both theoretical and

experiential components.

The programme

Year 1:Visits to community and health service

facilities in the region of Khon Kaen

Objective: To introduce students to the societal

and health service facilities, define their roles and

activities in serving target groups, as well as their

relationship with the healthcare profession.

Learning processes

A brief introduction is given to the whole class.

Students are then divided into small groups of 10

12 and are made to plan specific objectives of their

visit to the field, as well as to think of any ques-

tions they might wish to ask the directors or staff

of the facilities.Each group spends half a day in one facility.

The facilities include community health centres,

the regional hospital, mental health hospital, uni-

versity hospital, rehabilitation centre for disabled

children, and schools for the blind, the deaf, poor

girls from rural communities, and so on.

The groups present their findings to the whole

class the following week. Discussions are encour-

aged during the presentation. Faculty staff correct

students misconceptions and give additional les-

sons, particularly on the importance of the facili-ties in serving people in the community.

Evaluation

1. Attendance

2. Participation in the group processes

3. Peer assessment

4. Staff assessment

5. Written examination

6 . Presentation.

Year 2: Studying community health needs in

urban areas

Objective: Students learn how to use qualitative

research methods in studying the health needs of

Appendix 1

Field Practice in Community Medicine for Medical Students at Khon

Kaen University


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patients with chronic illnesses in urban communi-

ties.

Learning processes

Lectures on the basics of qualitative research meth-

ods are given. Group practicals are also given un-

der staff supervision. Rapid community survey, in-

depth interview and focus group discussion meth-

ods are taught in the class.

Baseline health data of the communities are

given by health personnel responsible for health

services in the area. Students are divided into small

groups of 1820, with a staff member as their ad-

viser. Each group is further sub-divided into 45groups. Each sub-group is assigned the name and

address of a patient with a chronic illness, such as

diabetes mellitus, hypertension, chronic obstruc-

tive pulmonary disease (COPD), heart disease,

gouty arthritis, chronic liver disease, chronic kid-

ney disease, schizophrenia, and so on.

The students research the diseases and receive

guidance from staff. They then plan specific objec-

tives of their study and prepare an outline of ques-

tions for the patients and their families in the com-

munities to be visited. They organize a focus groupdiscussion with community health volunteers and

community leaders.

Each group visits patients and their families

two to three times during the one-week study pe-

riod. The groups present their findings to the whole

class the following week. Discussions are encour-

aged during the presentation. Faculty staff correct

students misunderstandings and give additional

lessons, particularly on the importance of the ho-

listic approach to understanding the health needs

of the patients.

Evaluation

1. Attendance


3. Peer assessment

4. Staff assessment

5 . Presentation


7. Field-work report (group activities)

8. Students opinions about the activities.

Year 3: Studying community health needs in

rural areas and working together for health

Objective: Students learn how to use both quanti-

tative and qualitative research tools in studying the

health needs of people in rural areas. They also learn

how to work together with students from the other

four health science faculties of the KKU and the

local people to improve the health of the commu-nities.

Learning processes

Lectures are given on basic themes of community

health surveys, quantitative methods, advanced

qualitative methods, basic data analysis skills, and

community health development. Group practicals

are also provided with staff supervision. For the

advanced qualitative methods, the seven tools for

studying community ways of life are taught. The

tools applied are from theories of humanities andsocial science.

Early in the semester, groups of students will

go to target rural communities once or twice over

weekends to collect baseline health data of the com-

munities from the healthcare facilities in the area.

They plan their work with community leaders and

health volunteers. Secondary data is used as a basis

for planning the community survey and health ser-

vices. Students spend 2 weeks in the target com-

munities. The quantitative and qualitative meth-

ods are used during the survey.

A conference with community leaders and

health volunteers is organized. Survey results are

presented, followed by a process of co-planning for

health development; the A-I-C (appreciation, in-

fluence and control) technique is used for this. A

prioritization exercise is performed because of re-

straints in time and resources. Students and local


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people then work together on the agreed plan of

action. The groups evaluate their work, and simul-

taneously prepare their reports and presentations.

At the same time, the sub-groups of students

make three or more visits to patients with chronic

diseases from both poor and rich families. They

then make comparisons on the quality of life be-

tween the rich and poor families.

The groups present their findings to the whole

class during the following two weeks at KKU.

Community leaders are also invited to give their

opinions. Discussions are encouraged during the

presentations. Faculty staff correct students mis-

understandings and give additional lessons, particu-larly on the importance of community participa-

tion and cultural issues in health development.

Evaluation

1 . Attendance


3. Peer assessment

4. Staff assessment

5. Presentat ion


7. Field-work report (during group activities)8. Students opinions about the activities.

Year 4: Studying roles of community hospi-

tals and a new approach to health promotion

Objective: Students learn the role community hos-

pitals play in providing comprehensive health ser-

vices, management of healthcare resources at the

district level, and a new approach to health pro-

motion. They also learn how to provide holistichealthcare to patients at primary care centres.

(Note: Community hospitals in Thailand have 10

120 beds, depending on the size of the population

they serve; this ranges from 30,000150,000 people.)

Learning processes

Fifteen to 18 students study on a 4-week rotation

basis. During the first 3 days, lectures are given on

the basics of the roles community hospitals play in

providing comprehensive health services, principles

of primary care and family medicine, occupationalhealth, and new approaches to health promotion

and management of healthcare resources at the dis-

trict level. Standardized cases are used for teaching

medical consultation skills at a special skills labo-

ratory.

Four to five students spend two weeks in a

community hospital to learn, from adjunct medi-

cal teachers, the themes already discussed. Students

observe the comprehensive services provided, such

as ambulatory care, disease prevention and health

promotion at the health services facilities, health

education, medical consultation and in-patient care

for non-serious conditions. An outreach

programme for occupational health services is also

provided.

Students have a chance to hold discussions with

distinguished farmers who have transformed their

lives from poverty to a better situation.

Students discuss the management of healthcare

resources with various mangers at the hospitals and

the director, who is usually a medical doctor. Dataon the issues and problems arising from the hospi-

tal records are studied.

Students are required to attend four half-days

at primary care units. They practice medical con-

sultations with close supervision of the faculty staff.

On returning to the department, students share

their experiences with peers in a series of seminars.

Discussions are encouraged. Faculty staff correct

students misunderstandings and give additional les-

sons, particularly on the roles of medical doctors

in community hospitals and primary care.

Evaluation

1. Attendance


3. Peer assessment

4. Staff assessment

5. Examination on skills


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7. Hospital practice report


Year 5: Studying and conducting health

systems research and home healthcare

Objective

Students learn how to conduct a health systems

research project, starting from developing research

questions through writing a research article. Com-

prehensive health services at primary and commu-

nity care level are also emphasized, particularly on

home healthcare.

Learning processes

Twelve to 14 students study on a 4-week rotation

basis. Tutorials on health systems research meth-

odology and advanced data analysis using statisti-

cal computer software are provided.

Students are divided into two small groups.

Each group has to conduct a research project with

close supervisions from two faculty staff. The

project is expected to serve policy-makers infor-mation needs. The students learn how to commu-

nicate with policy stakeholders at the beginning of

their project to assess their information needs.

The needs vary from information concerning

health issues (such as identifying or prioritizing

community health needs, identifying risk or pro-

tective factors, evaluating the effectiveness or re-

sponsiveness of a health programme) to informa-

tion about organizational problems.

Scientific rigor is emphasized. Literature re-

views with critical appraisal exercises are per-formed. Students are expected to write a publish-

able article. During the research presentation, stake-

holders are invited to ensure utilization of research

results through understanding of translational re-

search in learning.

All students are required to attend two half-

day practice sessions at primary care units. They

practice medical consultations with close supervi-

sions of the faculty staff. Home healthcare consul-

tations are provided at home by medical students

and staff. Discussions with peers and staff of the

primary care unit are carried out to ensure the con-

tinuity of care.

Health screening services for workers in a fac-

tory are provided in the outreach programme.

Evaluation:1 . Attendance


3. Peer assessment

4. Presentation of research results

5. Research reports (written and poster)

6. Staff assessment (oral examination)

7. Computer skills examination



SummaryEducation at the Department of Community Medi-

cine at KKU has some unique features compared

with other medical schools. A long-term evalua-

tion of the programme is being performed cur-

rently; further discussions on its effectiveness will

be described at a later date.

References1. Department of Community Medicine. Community Medi-

cine in the KKU Medical curriculum. Faculty of Medicine,Khon Kaen University. 2006.

2. Kessomboon P, Kessomboon N. Medical education reform to

produce more primary care doctors. Health Care Reform Project.

Nonthaburi: Ministry of Public Health; 2000.

public health education programs thiland

Documents