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A 10 min education programme was developed which, if effective in changing the behaviour of pregnant women, would eliminate or greatly reduce the risk of congenital toxoplasmosis. It was taught in 26 randomly selected (case) prenatal classes offered to women early in their pregnancy. The remaining 26 (control) classes received routine class material which did not mention toxoplasmosis. A questionnaire was administered to all women prior to this early class (pre-test) and again after the last prenatal class, held just prior to delivery (post-test). Changes in pet, food and personal hygiene behaviour between the pre- and post-test were determined and a score calculated by adding points for change towards those behaviours recommended in the programme and subtracting points for change in the opposite direction. Cat owners in case classes had a significantly higher score in pet hygiene behaviour than those in control classes (P less than 0.05). No significant difference was found between the food or personal hygiene scores of women in case and control classes, possibly because of low power. However, although behaviours did not differ on the pre-test, women in case classes had significantly better cooking methods for roast beef and hamburger on the post-test (P less than 0.05 and P less than 0.01 respectively). It is concluded that this programme is effective and should be offered to all women in order to reduce congenital toxoplasmosis incidence.

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Health services delivery is increasingly shifiing to community-based settings. The competencies required of future health professionals require a shiji in their educational preparation. Service learning is suggested as an educational method with the potential to reform health professions education in tandem with the changes occurring in the health services delivey. The Health Professions Schools in Service to the Nation Program (HPSISN), a US demonstration project of service learning in the health professions, examines the impact of service learning on students, faculty, communities and institutions across a wide array of universities and community settings. This paper describes the evaluation of the HPSISN program, including the evaluation model, key study questions, findings and lessons learned. The HPSISN evaluation was designed to assess the effectiveness of service learning as a pedagogy in health professions education and describe the impact of service learning activities through university-community partnerships. The evaluation model was built upon a case study approach first developed for assessment of service learning courses at Portland State University and honors the participants' commitment to mutually beneficial community partnerships. The findings illustrate the implications of service learning in the health professions and the lessons learned for education and evaluation.As health services delivery in the USA shifts to community-based settings and managed care models, new health professionals need a different set of competencies for practice. New policies, practices and settings for health services professionals are changing career paths and the knowledge base required for serving communities and populations. These shifts necessitate changes in educational preparation so that future professionals are competent and able to work in these settings. In addition, higher education institutions, in the USA, are under increasing pressure to move out of the 'ivory tower' and to become more directly engaged in applying intellectual strength to the solution of societal problems. One method for responding has been the integration of service learning into health professions education.Service learning is an educational method that may have the potential to reform health professions educational curricula in ways that reflect the changing health care and higher

Continual improvement efforts have been slower in health professions education than in health care delivery. This article identifies the lessons learned by teams working in an Interdisciplinary Professional Education Collaborative in overcoming barriers to carrying out continual improvement efforts in these educational organizations.

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