The first imperative should be a guarantee for adequate curricular time in community work from the highest academic authorities in each health profession. Beyond this sanction, specific activities, responsibilities and assignments should be programmed collectively by the representatives of the professions participating in the Project. Through the joint curricular activities, the multidisciplinary interaction will be enhanced and shaped for optimal performance in the community work.
Planning should permit sufficient flexibility to allow some degree of student choice in working with various professional and population groups. This encourages students to take the initiatives they consider adequate and creative for each situation. On the other hand, when student performance is restricted by inflexible schedules and locations, they perceive themselves to be in a curriculum "straitjacket", which serves to hinder performance and creativity.
Equally important is the selection of qualified and motivated teachers that can function as models for the students. Experience has shown that community oriented programs frequently fail under the leadership of poorly qualified and/or unmotivated personnel. Thus, it is essential for institutions to develop a qualified academic staff for community health work just as rigorously as they do for teaching basic and clinical sciences. The development of such staff should start with a careful selection based on background and aptitude for community work, followed by additional training in epidemiology, health education, communications, social work, project management and selected topics of health science and technology. Further professional development opportunities for personnel with outstanding dedication should include visits to other institutions with experiences in community work, and fellowships for pursuing advanced studies in areas relevant to their work.
Suitable educational materials such as books, reprints, videos, etc. are also indispensable in allowing universities to compare and critique their community work projects. These types of materials usually stimulate students through reflexive reading and group discussions, which provide means for self-evaluation in the students' understanding of their respective work experiences. One desirable outcome is an enhanced level of communications and feedback between students and teachers, which naturally strengthens the educational process.
Similarly, the process can be reinforced by inviting teachers from other institutions with similar work and research activities to share their experiences and opinions. Selected community members should be included as special guests to present public viewpoints and hear the opinions of students and teachers. Representatives of health and education services, officials of local government, and members of selected non-governmental organizations would serve as additional information sources and provide unique perspectives for an enriched student experience.
Previous Latin-American experiences in community work suggest that, without adequate university and health services support, students placed in community learning situations tend to lose direction, become frustrated, and eventually develop negative attitudes toward community work. This scenario does not prove the failure of community experiences but, rather, attests to the significance of proper leadership.
One additional comment is necessary in the case of the dental component of the UNI Projects. When dental schools engage in community work, activities are often directed toward primary schoolchildren. The reason is obvious: they comprise a stable population of 6 - 13 years-old, which are well-suited for dental work. Despite the logic of this approach and potential benefits for children, teachers, and even parents, one must remember that communities are much larger. The presence of dentistry in health care centers in Latin America is generally minimal to nonexistent, which necessitates serious efforts to overcome this limitation. This is particularly important in multi-professional experiences, such as the UNI Projects, which include medicine and nursing - disciplines that are often found in health care centers. The need to learn how to work with multi-professional health staffs in different settings suggests that dental schools should seek to diversify their community work locations.
Finally, a critical aspect of developing experiences in and with communities is the selection of the learning methodology. Judging from previous experiences, communities usually expect solutions for their very real problems. So when student activities are planned around objectives that fail to consider the needs and expectations of the local population, such activities are perceived as artificial and inappropriate for that community. To avoid failure, the most reasonable approach is a problem-solving methodology in which communities' expectations are coordinated with students' training needs. However, it is instructive to discuss findings in the international literature concerning Health Sciences Education. Problem Based Learning Methodology (PBL) has been widely used in recent years, especially by medical schools, some of which employ curricula entirely planned around and based on problems. Usually selected a priori by the faculty, each problem represents an axis around which students organize their study, searching for information and interactions such as community visits that answer their questions. In other words, by facing "the problem", students direct their own learning. However, it is important to note that these institutions usually adopt PBL models as opposed to the traditional methodology of learning through traditional coursework. In the whole process, the focus of attention is centered on what the student has to learn, and not on the solutions for the problem itself.
On the other hand, Latin-American universities have pioneered new orientations in community and health services for several decades in order to promote the use of Problem-Solving Based Learning. Specifically, the aim has been to stimulate self-directed learning in articulating solutions for community problems. This does not imply the use of communities strictly for teaching purposes. Instead, it represents the process of developing alternative methodologies for training health professionals. By combining learning and services, the educational process is transformed from purely formative to formative/productive one. This distinction constitutes a basic difference between the approach of most institutions employing PBL especially in industrialized countries and that of the Latin-American institutions. It is in this context that the proposals of the UNI Program were developed. The goal is to promote and systematize the sharing of experiences among universities, communities and heath services mutually engaged in articulating solutions to community health problems. With regard to the training of health professionals, this mission represents the most important challenge of the current era in Latin-American higher education.