Rashmi Vyas

Attitude of medical students towards Early Clinical Exposure in learning endocrine physiology

BackgroundDifferent teaching-learning methods have been used in teaching endocrine physiology for the medical students, so as to increase their interest and enhance their learning. This paper describes the pros and cons of the various approaches used to reinforce didactic instruction in endocrine physiology and goes on to describe the value of adding an Early Clinical Exposure program (ECE) to didactic instruction in endocrine physiology, as well as student reactions to it as an alternative approach.DiscussionVarious methods have been used to reinforce didactic instruction in endocrine physiology such as case-stimulated learning, problem-based learning, patient-centred learning and multiple-format sessions. We devised a teaching-learning intervention in endocrine physiology, which comprised of traditional didactic lectures, supplemented with an ECE program consisting of case based lectures and a hospital visit to see patients. A focus group discussion was conducted with the medical students and, based on the themes that emerged from it, a questionnaire was developed and administered to further enquire into the attitude of all the students towards ECE in learning endocrine physiology.The students in their feedback commented that ECE increased their interest for the subject and motivated them to read more. They also felt that ECE enhanced their understanding of endocrine physiology, enabled them to remember the subject better, contributed to their knowledge of the subject and also helped them to integrate their knowledge. Many students said that ECE increased their sensitivity toward patient problems and needs. They expressed a desire and a need for ECE to be continued in teaching endocrine physiology for future groups of students and also be extended for teaching other systems as well. The majority of the students (96.4%) in their feedback gave an overall rating of the program as good to excellent on a 5 point Likert scale.SummaryThe ECE program was introduced as an alternative approach to reinforce didactic instruction in endocrine physiology for the first year medical students. The study demonstrated that students clearly enjoyed the experience and perceived that it was valuable. This method could potentially be used for other basic science topics as well.

Clinical training at remote sites using mobile technology: an India–USA partnership

Christian Medical College (CMC), India, and Tufts University School of Medicine, USA, have developed an ‘institutional hub and spokes’ model (campus‐based e‐learning supporting m‐learning in the field) to facilitate clinical education and training at remote secondary hospital sites across India. Iterative research, design, development, and testing merged three key elements for effective mobile learning: an underlying learning management system to organize data; mobile access to a knowledge repository using commonly owned phones; and mobile applications that match the learner, learning theory, and mode of learning based on student‐articulated needs. CMC is institutionalizing academic and technical support for e‐learning and m‐learning, ensuring future sustainability. Assessing and sharing best practices for mobile‐supported training and resources will leverage strengths and build capacity across the CMC–secondary hospital mobile/e‐learning network. This model can advance interdisciplinary health training initiatives in developing countries, improving clinical services and health for underserved populations across the world.

Normal hematological indices, blood chemistry and histology and ultrastructure of pancreatic islets in the wild Indian bonnet monkeys (Macaca radiata radiata)

Abstract:  The present study is aimed at determining some haemtological and biochemical parameters in the wild Indian bonnet monkeys as also the microscopic and ultrastructural characteristics of their pancreatic islets. Adult wild Indian bonnet monkeys (Macaca radiata radiata) of both sexes weighing between 2.5 and 4 kg were used in these experiments. Their platelet, reticulocyte and total leukocyte counts and the blood concentrations of hemoglobin and plasma proteins and the serum concentrations of aspartate amino transferase, alanine amino transferase and calcium are similar to the values reported for M. mulatta. Plasma glucose is lower when compared with reported values of M. mulatta and M. fascicularis. Insulin levels are comparable with those of M. mulatta and M. nigra. Histology of islets is similar to that of humans. Ovoid cell collections of islet cells are scattered throughout the pancreas. Ultrastructure of A, B and D cells is similar to humans. These findings suggest that this relatively underutilized macaques may be a suitable model for biomedical research.

Students awareness of learning styles and their perceptions to a mixed method approach for learning.

Background: Individualization of instructional method does not contribute significantly to learning outcomes although it is known that students have differing learning styles (LSs). Hence, in order to maximally enhance learning, one must try to use a mixed method approach. Hypothesis: Our hypothesis was that awareness of preferred LS and motivation to incorporate multiple learning strategies might enhance learning outcomes. Aim: Our aim was to determine the impact of awareness of LS among medical undergraduates and motivating students to use mixed methods of learning. Materials and Methods: Before awareness lecture, LS preferences were determined using Visual, Aural, Read/Write, and Kinesthetic (VARK) questionnaire. Awareness of LS was assessed using a validated questionnaire. Through a lecture, students were oriented to various LSs, impact of LS on their performance, and benefit of using mixed method approach for learning. Subsequently, group discussions were organized. After 3 months, VARK preferences and awareness of LSs were reassessed. Student narratives were collected. Qualitative analysis of the data was done. Results: There was a significant increase in the number of students who were aware of LS. The number of participants showing a change in VARK scores for various modalities of learning was also significant (P < 0.001). Conclusion: Thus, awareness of LSs motivated students to adapt other learning strategies and use mixed methods for learning.

A Networking Approach to Reduce Academic and Social Isolation for Junior Doctors Working in Rural Hospitals in India

INTRODUCTION Graduates from Christian Medical College (CMC) Vellore face many challenges while doing their service obligation in smaller hospitals, including academic and social isolation. To overcome these challenges, CMC aspired through its Fellowship in Secondary Hospital Medicine (FSHM), a 1-year blended on-site and distance-learning program, to provide academic and social support through networking for junior doctors working in rural areas. The purpose of this paper is to report the evaluation of the networking components of the FSHM program, with a focus on whether it succeeded in providing academic and social support for these junior doctors. METHODS A mixed method evaluation was done using written surveys for students and faculty and telephone interviews for students. Evidence for validity was gathered for the written survey. Criteria for validity were also applied for the qualitative data analysis. RESULTS The major strengths of networking with faculty and peers identified were that it provided social support,, academic support through discussion about patient management problems and a variety of cases seen in the hospital, guidance on projects and reminders about deadlines. Recommendations for improvement included use of videoconferencing and Yahoo Groups. CONCLUSION It is useful to incorporate networking into distance-learning educational programs for providing support to junior doctors working in rural hospitals.

Improving the effectiveness of physiology record books as a learning tool for first-year medical students in India

In compliance with the Medical Council of India, preclinical medical students maintain a record of their laboratory work in physiology. The physiology record books also contain a set of questions to be answered by the students. Faculty members and students had indicated that responding to these questions did not serve the intended purpose of being an effective learning tool. The purpose of this study was to obtain the views of the medical students and faculty members at our institution concerning the usefulness of responding to the questions and to gather suggestions for possible improvement. Data were collected through focus groups and questionnaires to first-year medical students and faculty members in physiology and were analyzed using qualitative and quantitative methods. The students and faculty members viewed the physiology record books as a potentially useful learning aid, but lack of time led the students to write the answers without understanding the topic rather than generating their own responses to the questions. Faculty members and students recommended that the students should write the responses to the questions on site during the practical classes, using relevant on-site resources and interacting with faculty members. The findings of the present study may be of value to other medical colleges in India and outside India with modifications based on their specific needs to improve the effectiveness of physiology record books as a learning tool.

An academic support programme for rural practitioners in India.

What problems were addressed? Medical graduates in India obtain the MBBS degree after 5.5 years of medical training (including 1 year of rotating internship) and can practise as general practitioners after registering with the Medical Council of India. Graduates of the Christian Medical College (CMC), Vellore, India, a tertiary care hospital, have a service obligation that requires them to work for 2 years at secondary (smaller) hospitals. Graduates of government and a few other private medical colleges also have service obligations in secondary hospitals. Secondary hospitals have between 20 and 200 beds and offer generalist practice in medicine, surgery, paediatrics, and obstetrics and gynaecology, along with limited laboratory support. They also provide local community-based programmes in areas such as antenatal care, and malaria and tuberculosis programmes. Graduates were not well equipped to practise in smaller hospitals and faced challenges that pertained especially to the differences between these hospitals and tertiary care centres, and referred to limited laboratory support, limited access to academic resources and academic isolation. The need to provide support to practitioners in smaller rural hospitals is well recognised. At CMC, we designed a year-long fellowship in secondary hospital medicine (FSHM) for CMC graduates in order to address the problems of inadequate preparation for practice in secondary hospitals and academic isolation. The programme provides access to academic resources and other strategies that will better equip graduates to practise at secondary hospitals. What was tried? The FSHM consists of a blend of 15 paper-based, distance-learning modules, three contact sessions, community project work and networking. It is designed to support medical graduates during rural service, to help them to practise effectively in smaller hospitals, and to motivate them to return to practise in these hospitals. The curriculum development process for the FSHM reflected a six step approach described by Kern that included: the identification of the problem; a needs assessment; the formulation of objectives; the selection of educational strategies and assessment methods aligned to the objectives; implementation, and evaluation. The Logic model framework of linking programme outcomes to programme processes was used to evaluate the programme. The programme was subjected to mixed-methods evaluation 3 years after its implementation, using focus group discussions with FSHM students, written surveys of students and faculty members, and telephone interviews with students and medical superintendents. Evidence for validity was gathered for the written survey. Criteria for trustworthiness were applied for the qualitative data analysis. What lessons were learned? The majority of FSHM students (94%) and faculty members (74%) rated the programme as very good or excellent in its effectiveness in helping students to practise effectively at secondary hospitals. Qualitative data analysis showed the programme had provided academic and social support, helped in improving patient care and brought about changes in hospital practice. In addition, the programme had developed confidence in FSHM students in their ability to provide good quality clinical care with limited resources, created awareness in students of challenging opportunities in rural practice and motivated them to consider practice in secondary hospitals. A recommendation for improvement was to add more content in dermatology. Distance education programmes may help to meet the health care needs of society by helping junior doctors to practise effectively in small hospitals and may motivate them to consider future practice in such hospitals.

Curriculum development for a module on noncommunicable diseases for the master of public health program

Background: As the burden of noncommunicable diseases (NCDs) has been rising globally, various educational programs have introduced chronic disease epidemiology teaching, which is now a component of most of the Master of Public Health (MPH) programs. However, the process of curriculum development for these courses has not been adequately documented for use by educators planning such courses. Methods: A detailed process of curriculum development based on David Kerns six-step approach was undertaken for a 2-week course on NCDs, as part of the MPH program of a tertiary institution in South India. The processes were documented so that the method of curriculum development for such a course could be made available for educators across this field. Results: The course on NCDs was carried out over 73 learning hours (2 weeks) for a group of MPH students including medical, dental, allied health, and nursing graduates. Evaluation of the revised curriculum at the end of the 2 weeks revealed that mean scores for knowledge and confidence in skills increased by 50% (11.1–16.6, t-test, P < 0.001) and 79% (3.3–5.9, t-test, P = 0.002), respectively, from baseline scores. Discussion: The revised curriculum was effective in improving knowledge and confidence in epidemiological skills. The documented process of curricular development using standard methods if made publicly available can be of use to those involved in planning similar educational programs for students of public health.

Project‐based faculty development for e‐learning

The Christian Medical College, Vellore, in collaboration with Tufts University, Boston, conducted an advanced workshop in e‐learning for medical faculty members in India.

Demographic profiling of students: an advocacy tool for family medicine

What problems were addressed? Every year, India witnesses 56 000 maternal deaths and 1.83 million deaths in children aged under 5 years, most of which are caused by infections, and struggles with supporting 64 million people with diabetes. Large numbers of well-trained, multi-competent family physicians are needed to address this dual burden of disease in India. However, training opportunities are limited and there is no mandated system of revalidation for the 250 000 private practitioners and 30 000 government doctors who function as primary care physicians to the country’s 1.2 billionstrong population. There have been very few takers for residential courses in family medicine offered since 1990. The government struggles to release the already lean health workforce for 3 years of training. A 2-year postgraduate diploma in family medicine was started as a blended learning programme (distance learning and hands-on components) in 2006 by the Christian Medical College, Vellore, India to increase the skills of generalist doctors right in their workplaces. It was focused on doctors serving in rural settings and in the northern states, which have poor health indices. High enrolments for this course from India and abroad prompted the authors to look at the demographic profile of applicants for this course over 6 years and to use the information as an advocacy tool to inform relevant stakeholders about this approach to addressing the huge training need. What was tried? Existing data (for 2006–2012) on candidates applying for entry to the course were analysed. A dissemination booklet was printed and the information shared with all relevant stakeholders, namely: (i) institutional, national and international faculty staff; (ii) institutional, university and government authorities, and (iii) international partners. What lessons were learned? A total of 1314 doctors applied to enter the course. Of these, 45% were female, 42% were aged 31–40 years and 46% were government doctors (indicating the reach of the course in strengthening public health systems). A total of 90% of applicant doctors were in active practice, 73% had no postgraduate degree and 40% had not engaged in educational pursuits for at least 10 years. Overall, 60% were from the south Indian states, 14% were non-resident Indians from the Middle East, and 4% were of other nationalities, predominantly African. Reasons for application were described as the wish to update knowledge and improve practical skills by 64% of applicants. A total of 77% of applicants indicated that they had applied because they could undertake the course without leaving their workplaces. Disseminating this information has resulted in: (i) better understanding of the students by the teaching faculty who have tailored their teaching accordingly; (ii) policy changes on the part of the institution, for example, increased focus on selecting applicants from the northern states, establishing more northern regional centres and initiating scholarships for students from rural and northern areas; (iii) increased awareness of the need for and commitment to promote family medicine among university and government officials, and (iv) a collaboration with the University of Edinburgh to start an online Masters degree programme in family medicine in India and Africa. Thus, demographic profiling has proven to be an effective advocacy tool to influence relevant stakeholders to promote the much-needed specialty of family medicine in India.