Socially Accountable Undergraduate Medical Education in CMC Vellore

1. Socially Accountable Undergraduate Medical Education in CMC Vellore

2. The mission of Christian Medical College Vellore • To train health personnel who are professionally excellent, compassionate, ethically sound, able to lead health teams and cope with the changing needs of the communities around them

3. The mission of Christian Medical College Vellore • Special concern for the disabled, disadvantaged, marginalized and vulnerable. • Commitment to innovation in health care, education and research

4. Curricular Innovations • Foundation Course • Integration of disciplines : horizontal and vertical through Early clinical Exposure, Integrated Learning Programs • Clerkship • Family Medicine Posting • Community orientation programs • Secondary Hospital Programs • Leadership and Management training • E-learning

5. Foundation Courses • First year – 3 weeks • Second year (clinical years) – 3 days • Internship – 5 days

6. I MBBS Foundation Course • First 3 weeks • Clinical exposure, ethics, professionalism, communication skills, CPR • Group discussions on the health situation in India, its problems and challenges • Interactive session with inspirational senior faculty and individuals working in the rural community to understand why they are there and what they are doing • Community visit

7. Clinical and Internship Orientation Programs • Ethics, professionalism, communication skills, Basic and Advanced life support • Hospital Infection Control • Pediatric emergency care • Palliative care

8. Integration of Medical Disciplines Integration of Basic and Clinical Sciences: • Integrated Learning Programs Integration of Theory and Practice: • Clerkship and Residential • Internship

9. Horizontal and Vertical Integration of Disciplines

10. Integrated Learning Program • Lectures, clinics, self-learning, group discussions, quizzes, Problem –Based Learning, videos, exposure to social aspect of illness, practical sessions on Evidence-based medicine Evaluation • MCQs, feedback

11. Clerkship • One month each in Medicine, Surgery and Pediatrics • The sub-intern is below the level of intern, and takes partial patient care under the supervision of faculty and registrars. • Students learn to function as team members.

12. MedicineResponsibilities of a Clerk • Follow up 7 patients from admission to discharge for allotted patients under the supervision of the ward team • Write the history, physical findings, problem sheet and daily progress notes for the allotted patients in the case record book. (All case summaries countersigned by the registrar) • Communicate daily with patient • Present allotted patients during ward rounds • Undertake procedures under supervision • Maintain a case record and log book of their clinical experience

13. Innovations towards Primary and Secondary Health Care

15. Family Medicine Posting • 2 weeks in I Clinical Year Objectives: • Understand the principles of family medicine which include first contact care, continuity of care, patient-centred consultation and comprehensive care. • Learn the management of sixcommon problems in family practice. • Explain the bio-psycho-social approach to illness and the influence of the patient’s context on the disease.

16. Teaching Learning Methods • Clinics, log books, Following a patient through the hospital visit, Visits to all sections of the hospital including the pharmacy, lab; Visit to an urban slum Assessment • Logbook, feedback

17. Secondary Hospital Programs

18. Network of 220 Secondary Hospitals 20-200 bed hospitals Remote and rural areas of India Broad based Services 2 year service obligation for all graduates INDIA Vellore

19. Objectives of the Secondary Hospital Program To sensitize students to: • To the relevance and challenges of health care in secondary hospitals • Understand how a secondary hospital works • Learn about the diagnosis and management of common clinical problems seen in the hospital and community • Develop a positive attitude towards care in rural locations.

21. Secondary Hospital Program Challenging Experiences

22. Different sets of hospitals used for students of different stages based on the specific objectives of each SHP and the strengths of the hospitals • All postings include a visit to the local community

23. Phases of the SHP Identifying Secondary Hospitals Allocating student groups Identifying CMC faculty Workshop for Secondary Hospital Faculty Briefing students Student and faculty visit to Secondary Hospitals Submission of log books Feedback Student Presentations on SHP Review and Planning for the next program Phase 1 Phase 3 Phase 4 Phase 2 Phase5

24. Student Activities during the SHP I (First MBBS) • shadow doctors in the OPD and wards • follow a patient thorough the entire hospital visit and then back in the community • make a presentation on a basic science topic of interest to the hospital • make a community visit to learn about the lifestyle of the rural people

25. Student Activities during the SHP II in II MBBS • work up cases in the outpatient and in the wards • study the morbidity profile of patients presenting to the hospital • meet with as many staff as possible to learn about the importance of team work in the efficient running of a hospital • Undertake a study on the social determinants of health in one village near the hospital

26. Common illnesses: malnutrition, tuberculosis, GERD ,typhoid fever.. Student Activities during the SHP II

27. Student Activities during the SHP II Understand the differences in the diagnostic facilities available in secondary level hospitals as compared to tertiary level centres like CMC

29. Student Activities during the SHP III – (Pre-final Year) • Learn to diagnose and manage conditions commonly seen in a secondary hospital in the outpatient and emergency areas • Perform some procedures under supervision • Participate as a team member in the day to day activities of the hospital • Study one outreach program of the hospital

30. SHP III Diabetic clinic Village Health Visit UGI scopy Ascitic Tap Bissamkattuck

31. Assisting in Surgery: Learn about team effort!

32. Community visits • visit one of the community development program of the hospital and understand its relevance to health care

33. Some unique cases…. Bear Mauling Huge Ovarian Cyst “Everyday we are faced with a host of new experiences we have never dealt with and are unlikely to see again..” 33

34. “What shocked me was the hard work, perseverance and commitment of the people who worked hand-in-hand as part of the team. I realized that life and work in rural areas with the less privileged and no great facilities is ‘no less’ than the work done in a tertiary hospital” Student Quote “…The SHP throws light on people with needs, provides scope to venture out, builds challenges - in short, plays a trailer of the ‘real’ life that we are far from…” Student Quote

35. E-learning in CMC

36. E-learning • Started as a project in collaboration with TUFTS University, Boston • E-learning platform developed by TUFTS adapted for our use • Content uploaded • Innovative projects funded to create new learning material

37. Application of E-learning in Curriculum • Entire MBBS schedule uploaded. • Majority of MBBS lectures uploaded with faculty permission - students can seamlessly access teaching resources of CMC. • Student feedback conducted online • Quizzes, Assignments and Announcements

38. 20 innovation projects funded to develop electronic resources for teaching • undergraduate medical, allied health science, distance education, postgraduate and patient education

39. Examples of Innovation Projects • Anatomy – cross-sectional anatomy; histology; student videos • Physiology with Medicine – examination of the cardiovascular system : videos • Biochemistry – lectures; cases; discussion forum • Microbiology – spotters, videos, cases, news letters • Ophthalmology – Vertical integration for the Optometry course

40. Radiodiagnosis– Self learning and evaluation material for radiation safety • Radiotherapy – Understanding concepts of MRI and its clinical relevance • Medical Genetics: Fact sheets and images of inheritance patterns of genetic disorders • EBM – Module on evidence –informed health care • Surgery – Efficacy of clinical videos for teaching surgical concepts • Dermatology – PBL cases • Dental – Patient resources for dental health

44. Summary • A variety of curricular innovations to enhance integrated learning, practical training and social relevance of Medical Education • Are replicable teaching models for socially accountable Medical Education in India

45. Thank you