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Introduction

It is generally recognized that reproductive health plays a significant role in the health and well-being of a population. However, in spite of their potential to bring “more benefits to people at less cost than any other single technology available to the human race,”1 high quality reproductive health services are still unavailable to a large portion of the world’s population. According to the United Nations Population Fund (UNFPA), “over 350 million couples worldwide lack access to the full range of modern family planning methods…120 -150 million married women worldwide wish either to have no more children or to delay their next birth at least two years…but lack access to the contraception that would make this possible”.2 Furthermore, within the purview of reproductive health, improved emergency obstetric care can prevent a significant number of maternal deaths and related neonatal deaths.3 High quality reproductive health care is also considered to be an essential element for a nation’s stability and has “been known to speed a nation’s development.”4

Investing in preservice medical education institutions to improve the quality and quantity of reproductive health training in developing countries (DCs) is a critical part of increasing access to reproductive health services and improving overall health. Supporting the development of reproductive health content in preservice medical education is particularly important in progressing toward goals set at the 1994 International Conference on Population and Development (ICPD) and reinforced at the 1999 ICPD+5. The Programme of Action produced at the 1994 conference specifically states that “[r]eproductive health eludes many of the world's people because of such factors as: …inappropriate or poor-quality reproductive health information and services”. As such, national policy should emphasize the need to strengthen these areas in addition to focusing on the role of developing human resources to improve these conditions.5

Preservice medical education is a vital component in improving the quality of care because of its significant potential impact and sustainability. However, few resources are currently available to assist with preservice curricula development or reform; instead the majority of training programs, materials, and donor support has traditionally been directed at improving inservice education. The lack of reproductive health resources available for use in preservice education results in a greater likelihood that primary care physicians and other non-obstetrician/gynecologists in DCs will be educated through inservice training rather than through preservice training on reproductive health topics. Thus, there is a need for research, resources, and support in the area of preservice medical education in reproductive health.

Preservice medical education represents a more efficient use of resources because it provides the educational foundation for future providers, reaches a greater number of providers, and takes place over a longer time period, resulting in more substantial educational outcomes than inservice training.6 In comparison, inservice training is more appropriate for reinforcing preservice medical education, and provides critical opportunities to update skills and introduce new information and technologies that were unavailable during a physician’s preservice education. Clarifying the roles of preservice and inservice training and coordinating with the extended system of health provider education and deployment are critical elements to maximizing the effectiveness of both types of training.7

In conjunction with efforts such as faculty training, strengthening clinical skill instruction and providing increased opportunities for practice, preservice medical education should be updated regularly to incorporate the most current content. If mechanisms are put in place to ensure that preservice medical education is strengthened so that students graduate with the necessary skills, the need for more costly inservice training could be reduced.

Goals of the Resource Guide

This Resource Guide was developed in an effort to expand access among faculty, students, and medical institutions to inservice resources that can be used in preservice medical education, and to raise awareness of the need for increased support and materials for reproductive health in preservice medical education. The Resource Guide is intended to be a tool for medical faculty and students in DCs interested in strengthening their reproductive health curricula in preservice medical education.

The Resource Guide catalogs reproductive health training materials that can be adapted by students and faculty to strengthen reproductive health medical education within their medical schools. These resources cover a range of topics in reproductive health and may be used to supplement existing courses or to develop new courses specific to reproductive health. In addition to their use for reproductive health course development, the resources on curriculum development that are presented here could be used to strengthen other areas of the medical curriculum. The resources cataloged here will assist faculty with the process of developing curricula, adapting these resources, and enhancing their training skills. Contact information for key organizations that have produced the international reproductive health research and training materials featured in the Resource Guide is presented in the Organizations section.

Another goal of the Resource Guide is to report on the state of reproductive health in preservice medical education in DCs in order to summarize activities, create a community of researchers and experts, and identify areas of need for future development. Research and reports described in the State of the Field affirm that preservice medical education is an important area of intervention, yet consistently identify significant barriers to researching and implementing curricular change in reproductive health and other content areas in medical schools. Barriers can include lengthy curricular change processes, difficulty in measuring outcomes, competing curricular priorities, and a lack of trained faculty. As the current body of work is considered, awareness of current research, resources, and needs in the field of preservice medical education will develop and a dialogue will ideally emerge to produce new ideas for innovative research and solutions.

Finally, the Resource Guide aims to assist in defining the community of professionals working in reproductive health preservice medical education. By identifying the current work and the organizations working in the field, the Resource Guide provides a foundation on which a community of professionals can work together to develop coherent strategies and accelerate the rate of progress being made in translating the goals of the ICPD from policy to action.

Audiences and Access

The Resource Guide is primarily intended for use by medical school faculty and students in DCs to enhance their medical school curricula. Ministries of Health, Ministries of Education, policymakers, and medical school administrators will also benefit from the literature review and discussion of the importance of a strong reproductive health component in medical school curricula. The Resource Guide may also serve as a reference to define the scope of topics to include in medical school curricula, evaluate the reproductive health content in medical school curricula, and link vested parties to NGOs and other resources that can assist them in fulfilling their goals for medical education.

Although developed for use in medical education, stakeholders will find the Resource Guide useful for allied health professional curricula development as well. Allied health professional education faces the same challenges of incomplete and outdated reproductive health content and barriers to curricular change. Since allied health professionals provide the majority of basic health care in DCs, it is critical that they too receive a sound reproductive health education.

Professionals in the international reproductive health training community will find the Resource Guide helpful as a reference tool to identify current resources as well as other organizations working in the field through which they can pursue partnerships for future efforts. Physicians and allied health professionals may also find it helpful to identify inservice training materials that will help them train their colleagues and provide comprehensive reproductive health care services in their clinics and hospitals.

For some potential users, the Resource Guide will not be a useful or accessible resource until the infrastructure necessary for reliable Internet connectivity is developed.8 ,9 This is a global issue that has repercussions for all health professionals interested in the most recent research available in her/his field in order to practice evidence-based medicine and to provide high quality services to their clients. For more information about efforts to overcome this information divide, visit the International Network for the Availability of Scientific Publications (INASP) at http://www.inasp.info/health/index.html. [See Appendices for more information on INASP.]

  1. State of the World’s Children 1992, (UNICEF) in: De Castro Buffington S. A Framework for Establishing Integrated Reproductive Health Training. Baltimore: JHPIEGO Corporation. Advances in Contraception. 1995; 11:317-324.
  2. United Nations Population Fund. State of World Population 1997: The Right to Choose. New York, NY: United Nations Population Fund; 1997. Available at http://www.unfpa.org/swp/swpmain.htm Accessed October 14, 2004.
  3. Baskett TF. Essential Management of Obstetric Emergencies. 3rd ed. Bristol: Clinical Press Limited; 1999: 6-7.
  4. Stewart F, Shields W, Hwang A. Reproductive Health Care: An Essential Foundation for Prosperity and Pace. Contraception. 2003; (68):73.
  5. United Nations Population Fund. Programme of Action of the International Conference on Population and Development, ed. Reproductive Rights and Reproductive Health: 7.3. Available at http://www.unfpa.org/icpd/icpd_poa.htm#ch7. Accessed April 6, 2004.
  6. JHPIEGO. Preservice Education for Reproductive Health Professionals. Baltimore, MD: JHPIEGO; November, 2002. Available at http://www.jhpiego.org/pubs/infoshts/prsrvcrh.pdf. Accessed April, 2004.
  7. Griffin J, Sullivan R. “Balancing preservice education and inservice training,” Paper presented at Developing the Next Generation of FP/RH Service Providers: Trends and Issues in Workforce Development. December 3-5, 2003; Baltimore, USA. Available at http://www.gatesinstitute.jhsph.edu/whatsnew/lf2003.htm Accessed August 6, 2004.
  8. Bailey C, Pang T. Health information for all by 2015? Lancet. 2004; 364:223-24.
  9. Godlee F, Pakenham-Walsh N, Ncayiyana D, Cohen B, Packer A. Can we achieve health information for all by 2015? Lancet.2004; 364:295-300.

Return to Reource Guide Table of Contents | Proceed to Section: State of the Field

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