Healthy population study - opportunities to develop global citizens and health care professionals

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I. Horbachevsky Ternopil National Medical University

Healthy population study - opportunities to develop global citizens and health care professionals

L. Fedoniuk

E. Burgess-Pinto

S. Yastremska

C. Shumka

Public Health is defined as “the art and science of preventing disease, prolonging life and promoting health through the organized efforts of society” (Acheson, 1988; WHO). Activities to strengthen public health capacities and service aim to provide conditions under which people can maintain health, improve their health and wellbeing, or prevent the deterioration of their health [2, 7]. Public health focuses on the entire spectrum of health and wellbeing, not only the eradication of particular diseases [1, 4]. Many activities are targeted at populations such as health campaigns.

Public Health studies play a major role in aiding and prolonging life [8]. A fundamental quality of Public Health is its preventative nature. Prevention is far more effective and far less expensive than cure. Through the prevention of health issues, individuals can spend more of their years in good health [5, 9]. Public Health helps to detect health issues as early as possible and responds appropriately to avoid the development of adversed conditions and disease [3, 10]. A Public Health perspective is diverse and takes into account the health of the whole population, rather than focusing on health at an individual level.

The work of public health professionals is important because public health initiatives affect people every day in every part of the world. Public Health addresses broad issues that can affect the health and well-being of individuals, families, communities, populations, and societies - both now, and for generations to come [1, 5, 6, 8].

The aim of the study - through interactive learning in an international setting, to develop understanding among students of how people relate to each other and to their environments, to compare Canadian and Ukrainian approaches to the Sustainable Development Goals, and create space for understanding different ways of knowing and how these enhance health and wellbeing.

Materials and methods

Health Studies (HLST) 400 is a professional course with a strong emphasis on cultural and linguistic immersion in Ukrainian contexts. One objective of this initiative is to enhance the I. Hor- bachevsky Ternopil National Medical University (TNMU) nursing curriculum using this innovative course as a model for the national BScN program in Ukraine. It is an opportunity for TNMU faculty to harmonize their national nursing curriculum with contemporary best practices. MacEwan Nursing faculty work collaboratively with the TNMU faculty to create and deliver the course. Students are provided with an opportunity to experience true immersion into Ukrainian, culture, language and professional contexts. The language program is one-week long, is conducted at Ukrainian Catholic University in Lviv, and includes lessons in medical terminology. HLST 400 is a three-credit senior elective that provides students with critical perspectives in an international setting to recognize their collective responsibility in addressing current and future planetary health issues and opportunities to develop as global citizens and health care professionals. HLST 400 program at TNMU incorporates visits to local health care facilities, as well as practical and personal interaction with Ukrainian and international medical and nursing students, health professionals, and clients. It is an opportunity for MacEwan students to understand their Canadian professional identity in a global context and come to appreciate Ukraine as a country that is joining the community of democratic nations.

According to the HLST 400 Course, 23 students spent two weeks at TNMU, focusing on global/ planetary health issues. The educational course was created in collaboration with Faculty of Nursing (MacEwan University, Canada). Participants include faculty members and Ukrainian students as well as International students from several countries (including Ghana, Nigeria). Instruction focused on interactive learning and included flipped classroom format, seminars, team-based learning and field clinics coordinated by MacEwan faculty members in partnership with the TNMU faculty members. Visits to a variety of health care facilities also took place including pediatric clinics, mental health hospital, HIV clinic, perinatal centre, orphanages, and rehabilitation centres.

The course was organized to align with three essential components of planetary health: relationality, sustainability, and ways of knowing. Through interactive learning in an international setting, students developed a shared understanding of how people relate to each other and to their environments, compared Canadian and Ukrainian approaches to the Sustainable Development Goals, and created space for understanding different ways of knowing and how these enhance health and wellbeing.

Improvements/changes to the program had been made based on (1) the Consortium of Universities for Global Health Education Competences (CUGH); the latest iteration of international/global health, namely planetary health, which is broader and more inclusive (for example, it encompasses indigenous ways of knowing), and (2) feedback from students and faculty (MacEwan and TTMU) who participated in the program in May 2018.

There are four major changes to the program. To develop community engagement skills, a learning activity was integrated into the city tours. In Ternopil, the students partnered with TNMU students to engage in a “walk along” survey of the community. Students commented on how this activity made them more aware of their surroundings. To enhance the community engagement learning experience in Ternopil square - this is a collaboration between students and faculty from the two institutions that started in Year 1. This year, students compared standards and guidelines for hypertension and were involved in conducting a public survey. Standards and guidelines were reviewed as well as elements of survey research. Students reflected on challenges they encounter in ensuring integrity, regarded and respected for others are prioritized. This activity was approved by the Rector and Board of Ternopil National Medical University. To further explore complementary and alternative medicine and consider implications for care. Students who participated in the program in 2018 were intrigued with alternative therapies such as salt rooms for asthma and bee therapy for the treatment of depression.

HLST 400 is designed for team-based learning. Students from TNMU and MacEwan were randomly assigned to teams of 5 to 7 students who were working interdependently throughout the course to work together to research a project and create a presentation. The teams were interprofessional, comprised of medical, pharmacy, nursing, and public health students. The MacEwan and TNMU faculty members acted as facilitators in the process.

During the realization of the HLST 400 program all participants evaluated evidence-informed knowledge specific to global health interventions that aim to improve health outcomes such as the Sustainable Development Goals and the Global Burden of Disease Project. They analyzed the key issues and emerging challenges that influence global health priorities, policy, research, and practice agendas. Students had the opportunity to describe how beliefs, norms, behaviours, and practices influence perceptions of health and wellbeing. All of them enhanced critical thinking skills in relation to international global health and strengthen their analytical foundations as global citizens. Participants developed abilities for collaborative team work, worked together to research issues, conducted evaluations, analyzed situations, and proposed potential solutions, demonstrated awareness of ethical considerations in global health partnerships.

Evaluation includes four components: assessment of Contribution/Professionalism - 20 %, Walk Along Community Survey - 10 %, Field Narrative Assignment - 30 %, Team project - 40 %.

The Department of Nursing Strategic Plan (20162020) highlights nursing education and practice competencies specific to global health priorities and the Sustainable Development Goals. MacEwan's internationalization plan intends to create environments in which students and faculty can succeed in diverse contexts, that they should “actively engage in diversity” in “an integrated, long term approach”. The TNMU-MacEwan partnership offers opportunities for collaboration on research and publications between faculty and students which addresses Goal #2 of the strategic plan: Commitment Research and Scholarly Excellence. An indicator for this goal includes faculty/student dissemination at international levels. HLST 400 in Ukraine correlates well with these strategic directions and provides students with experiences of “life-changing personal meaning and professional preparation”. Inclusion of the Sustainable Development Goals along with the concept of global citizenship and collaborating with TNMU faculty, relates directly to the strategic direction “to expand the scholarly network within which every faculty and school works internationally with colleagues in universities in other countries” and to “inspire students to be engaged as global citizens”.

The face-to-face format of the trip was invaluable in enhancing emotional and informal learning as well as developing capacity as global citizens. HLST-400 strengthens the analytical and practical knowledge of students by introducing global/planetary perspectives on health and by providing an international experience.

The course provides an excellent foundation for students who wish to pursue graduate studies in global health either in Nursing or in Public Health. At a practice level, it provides students with insight into structural barriers to healthcare experienced by a lower middle income country (Ukraine) as compared to Canada (high income) and a better understanding of patients/clients and professionals from diverse backgrounds.

Prospects for Research. Prospects for further research related to studying the quality of the training of specialists from the global health.

Literature

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