[Teaching hygiene and public health with student facilitators an attempt to enhance student participation]

In order to enhance student participation in lectures of hygiene and public health, we introduced a student facilitator (SF) system into the lectures of the fourth grade medical students. All students were assigned to one of the 28 classes as SF, thus each class had 4 to 5 SFs. A few weeks before the lecture, each teacher gave SFs various instructions to prepare for the class depending on the theme and teaching strategies. Some classes consisted of dialogues between the teacher and SFs in other classes gave presentations related to the theme of the lecture. For example, SFs in a class of epidemiology performed a small epidemiological survey using their fellow students as study subjects, thus allowing students to learn epidemiological design and calculation of odds ratios. In a class of care management, SFs played roles of caregiver, family member, social worker, physician, etc., showing how actual care management is conducted. The evaluation survey for the SF system showed that in general, students rated the SF system positively, especially at the time they served as SFs. Most of the students showed more interest in the subjects and felt more confident about what they learned as compared to ordinary classes. This finding is important because, previously, the largest problem with the lectures of hygiene and public health used to be the poor interest of students in the subject itself. On the other hand, students sometimes complained about the poor quality of the presentation by SFs. Also, a few students sometimes felt that for obtaining the large volume of knowledge required by the national board examination for medical practice, the SF system was inefficient. In summary, the SF system has some advantage in evoking interests in learning hygiene and public health with sufficient systematic preparation. However, it may not be an efficient way to simply obtain large amounts of knowledge. To improve the SF system, well designed teaching strategies in addition to a carefully prepared textbook are essential.