Table 2. Characteristics of the two programmes analysed.
| Characteristics | ELAM | MEAH |
|---|---|---|
| Graduates | 542 Ecuadorian students (average 60 per year) | 60 masters students in 2 cohorts |
| 5000 total graduates by August 2007 | ||
| Programme duration | 6 years (not including pre-medicine) | 2 years (including modular and thesis phase) |
| Pedagogy | ||
| Knowledge | Strong focus on community-based determinants of health. | Understanding and integration of different types of knowledge, including integration of different disciplines (health, social sciences, environmental and ecological sciences); community, specialized and strategic knowledge24 |
| Disease prevention strategies, community knowledge building and coping with poor resources in rural areas | Includes understanding of different dimensions of scholarship, including integration, application and engagement25 | |
| Skills and techniques | Core clinical skills (including knowledge of practising alternative and green medicine) | Qualitative and quantitative research methods |
| Community health management and public engagement for health promotion | Problem solving (problem-based learning) | |
| Collaboration and teamwork – especially through interdisciplinary group work for modules and in focus of research in defined communities of impact | ||
| Attitudes and values | Approaching medicine as a public good rather than as a commodity | Ethical research and practice: respect, reciprocity, relevance, responsibility26 |
| Student evaluation designed to emphasize knowledge, skills and attitudes, including reflective journals on learning process | ||
| Links to local level community capacity | ||
| Selection process | Focus on marginalized populations and service equity: Selecting students from underserved communities | High involvement in: universities (14/30 students), government and NGOs(14/30), communities (11/30) with 5 students who are indigenous leaders |
| Over 100 ethnic groups represented and > 50% women | Interdisciplinary scope: health disciplines (medicine, nursing, veterinary medicine), other professions (engineering, law, planning, disaster preparedness), sciences (chemistry, biology) | |
| 100s of interviews conducted per country, in country of origin by Cuban Embassy except in the United States of America (where a faith-based organization administers interviews) | 50% women | |
| 1st cohort selected from 150 applicants, 90 interviews conducted by Canadian and Ecuadorian team in university of application | ||
| 588 Ecuadorian ELAM trainees in 2005 represented 17 provinces, > 10 ethnic groups, > 50% women | ||
| Community orientation | Curriculum strongly focused on community-oriented primary care | Each teaching module includes community field experience |
| Some students complete 6th year working with Cuban medical brigades in home country | Thesis projects must define a community of impact and community involvement. These have already resulted in a range of community workshops, educational and planning activities | |
| Links with national level capacity | ||
| Partners in Ecuador | One year rural practice (año rural) funded by Ecuadorian Ministry of Health | 3 provincial universities (Bolivar, Cuenca and Machala) and 1 regional university (Universidad Andina Simon Bolivar) |
| Many alumni and support networks exist for graduates and current students | 1 national NGO (Centro Estudios y Asesoría en Salud/Health Research Advisory Centre) | |
| No formal links with Cuban Embassy after graduation | Creation and support of an Ecuadorian network of laboratories for environmental health research | |
| Consolidated experience in Ecuador informs national and international initiatives (including Canadian community of practice in ecosystem approaches to health)27 | ||
| Links with international level capacity | ||
| International funding | Cuban Ministry of Health | Canadian International Development Agency (University Partnerships in Cooperation & Development) with in-kind support from University of British Columbia and partners |
| Partner countries | Cuba | Canada, Cuba, Ecuador and Mexico |
| Countries of students | 29 countries from Africa, North America and South America | Ecuador |
ELAM, Escuela Latinoamericana de Medicina (Latin American School of Medicine) in Cuba; MEAH, Masters in Ecosystem Approaches to Health; NGO, nongovernmental organization.