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COMMENTARY
Year : 2016  |  Volume : 60  |  Issue : 1  |  Page : 64-67  

Community medicine: Desperate times calling for desperate measures


Assistant Professor, Department of Social and Preventive Medicine, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India

Date of Web Publication23-Feb-2016

Correspondence Address:
Shailendra Singh Chaudhary
Department of Social and Preventive Medicine, Sarojini Naidu Medical College, Agra - 282 010, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-557X.177313

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   Abstract 

This article is an attempt by authors to find the solutions for some of the common queries and problems faced by postgraduate students and young faculty members of department of Community Medicine. Topics which are discussed here include: nomenclature of the department, teaching and training of undergraduate and postgraduate students, services to the community and job opportunity after completion of degree/diploma in Community Medicine/PSM/Public Health.

Keywords: Community Medicine, Social and Preventive Medicine, Public Health etc


How to cite this article:
Chaudhary SS, Nagargoje MM. Community medicine: Desperate times calling for desperate measures. Indian J Public Health 2016;60:64-7

How to cite this URL:
Chaudhary SS, Nagargoje MM. Community medicine: Desperate times calling for desperate measures. Indian J Public Health [serial online] 2016 [cited 2020 Jun 4];60:64-7. Available from: http://www.ijph.in/text.asp?2016/60/1/64/177313

Great sanitary awakening that started in the early nineteenth century led to the recognition of hygiene and sanitation as important aspects of health of the people at the lowest ebb. This awakening led to the enactment of the Public Health Act of 1848 in England, making the state directly responsible for the health of the people. [1] Preventive medicine, on the other hand, originated with separate demonstrations by James Lind (1753) and Edward Jenner (1796) about the prevention of certain diseases (i.e., scurvy and small pox) by specific interventions (lemon and vaccination, respectively). [1] The concepts of public health and preventive medicine, along with those of social medicine as pioneered by Neumann (1847) and Virchow (1848), became complementary to modern curative medicine in the early twentieth century. With this background, the World Health Organization (WHO) organized the First World Medical Education conference in London in the year 1953. Its agenda included recognition of importance of preventive and social medicine in the training of physicians. With that understanding, the government of India organized its first medical education conference in the year 1955, which recommended that each medical college should have a preventive and social medicine department with full-time staff. [2]

Meanwhile as a professional movement, in the USA, Community Medicine department appeared when some medical schools began to establish a new department (or rename an existing Department of Preventive Medicine) and charge it with functions of defining the health problems of a community (in the vicinity of the college, or an adopted community) and to suggest solutions, maintain surveillance, and monitor progress. [3] More recently the Department of Community and Family Medicine was commissioned in all six All India Institute of Medical Sciences (AIIMS)-like institutions (ALIs) recently established under the Pradhan Mantri Swasthya Suraksha Yojana (PMSSY). [4]

Regarding the nomenclature of the department, an apex body of medical education, i.e., the Medical Council of India (MCI), has affirmed in favor of Community Medicine in place of Preventive and Social Medicine. [5] On the contrary, most of our older textbooks have not only retained the title of "Preventive and Social Medicine" but also have limited themselves in their content and approach. Newer publishers have more affection for the name "Community Medicine" but otherwise, they are also not very elaborative in aspects of Community Medicine per se. Our point of view here is very simple: Character; and not the name, is of utmost importance.

With this, we have another issue to discuss as follows: Is it a preclinical department or paraclinical department or a clinical department? Even though, the Supreme Court and the MCI says it to be a clinical department, [6],[7] the issue remains unsettled but if we start providing all the services that are prescribed by the MCI, this question will never arise. The issue of clinical vs paraclinical, or preclinical is not legal but mental.


   Undergraduate Teaching Top


We start teaching of Community Medicine from the very first year of MBBS with a university exam at the end of the III rd Professional part 1. This shows the importance of Community Medicine on one hand but by keeping it with pre-clinical subjects of foundation without an examination, it serves no purpose, but to see the apathy and neglect from first-year students, who are way too busy to cope up with the pressure of anatomy, physiology, and biochemistry. The solution is either teaching of Community Medicine from second year onwards or making it a part of university examination in the first year and second year. Apart from having a 150 marks theory and practical examination at the end of the III rd Professional part 1, we must also have a 50 marks multiple choice question (MCQ) or short answer question (SAQ) type theory examination (without practical) at the end of I st , II nd , and III rd Professional part 2 to remain as the focus point of students throughout the MBBS curriculum.

Almost three-fourth of the pages of our standard textbooks for undergraduates (UG) belong to MCH, nutrition, and communicable and noncommunicable diseases, which are also covered in the MBBS curriculum elsewhere. In our views, we should restrict ourselves regarding managing these issues in the community with specific preventive and promotive measures that are not covered elsewhere. th


   Postgraduate Teaching and Training Top


Postgraduate teaching

Most of our reference books (e.g., Maxcy, Oxford, Hunter, and Christae) belong to the foreign publications. Reference textbooks for Community Medicine and/or Public Health, being a specialization of health need and problems of our country and community, should be of Indian origin. We need our own success and failure stories, our own examples, our own explanations, and our own weakness and their solutions in a concise manner that can lead to the public health awakening in India.

The curricula for postgraduate (PG) students must include community ophthalmology, community otolaryngorhinology, preventive cardiology, preventive oncology, preventive accidentology, preventive geriatrics, preventive orthopedics, community psychiatry (mental health), community dentistry, social obstetrics, and social pediatrics. The emphasis should also be given to healthy nutrition and healthy environment for living and working. Sanitation and personal hygiene should be covered in a manner that not only can improve the knowledge of students but is also interesting at the same time. The curriculum of our specialty must also include the details of hospital administration, health administration, health economics, public health education, occupation and industrial health, medical laws and ethics in medical practice, research methodology and ethical issues in biomedical research, bioinformatics and statistical application in public health and research, and epidemiological investigation of epidemics or outbreaks, etc.

The idea is simple and straight: Teaching should be specific and definitive; it have separate curriculum and textbooks for UGs and PGs; give our PGs something to study during their postgraduation and add the details of Public Health system and functioning in the PG syllabus.

Postgraduate training

Similar to a family study or family case study for MBBS students, shouldn't we have a village study or community study at the PG level? In that study the PG student will collect information of community anatomy and physiology, will look for community pathology, will make a conclusive diagnosis, will identify the focus points for action and treat accordingly, will give health education, and will monitor the progress toward the improvement of health and health related behavior of that community. This should not only be included in their training but should also be a part of the final examinations. This community study must replace old pattern of clinicosocial case or community case for assessment of PG students.


   Services We Provide to the Community Top


Apart from UG and PG teaching and training and running of urban and rural health and training centers, no other service is adopted uniformly by our department throughout India. Though there are many other useful services, which are provided by this department in various institutes, for example, immunization clinic, antirabies clinic, infectious disease ward, geriatrics clinic, sex and marriage counseling center, AIDS education and training center, mobile health van, public health laboratory, health camps, and general outpatient department (OPD) including others.

And here comes the issue of uniformity versus uniqueness. Can we unanimously decide over the services and training in our discipline? Let us agree for our uniform training of students and services to community. Some variations are acceptable but restrict ourselves to a common agenda that we think is the need of the hour. Institutions that desire to excel beyond this should be welcomed and encouraged. [8]


   Job Placements After Postgraduation Top


When we asked various alumni, regarding their love for teaching over other lucrative jobs of public health like government health system or nongovernmental organizations (NGOs) or public health institutions (PHIs) or national health programs, the most common cited reasons were as follows: Lack of job security (contractual appointment by most of the NGOs/PHIs), hampered family life (due to hectic work schedule), occupational health hazards (originating due to the absence of rest in-between the period of extensive work schedule), or unnecessary and excessive leg-pulling or harassment by seniors, especially those with a nonmedical background. When we contacted a few public health managers, they claimed that casual attitude, lack of devotion, poor communication skills, or underperformance of medicos or changing priorities of organizations are the main reasons for that. This, along with easy and cheap availability of public health experts with a MPH or MBA or other public health degree/diploma/certificate course, has led to a sharp disinterest among Community Medicine people to work outside the secluded clutches of medical colleges. [9] For public health experts, 5 years' of teaching and training in Community Medicine during graduation, internship, and postgraduation should be considered as the 5 years' experience in the field of Public Health.

Those who join the government health system had another issues to fight. They are often given no special responsibility or opportunity in their health system. According to our view, appropriate responsibilities must be given to a public health specialist in cadre whenever available.

Another point that we want to raise is the attrition among Community Medicine experts. Not only newly passed PGs of Community Medicine but some of older faculty members are also involved in clinical practices or other activities not directly related to Community Medicine or public health. Our advice to such Community Medicine experts, who have an inclination toward clinical practice, is to adhere to the principles of Preventive and Social Medicine. They can try their luck in sex and marriage counseling, preventive cardiology, preventive oncology, or genetic counseling as a full-time or part-time specialist.

So, indeed, this seems to be the desperate times for Community Medicine and we need to act immediately before the curtains fall for us.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Park K. Park′s Textbook of Preventive and Social Medicine. 22 nd ed. Jabalpur, India: M/s Banarsidas Bhanot Publishers; 2013. p. 5-10.  Back to cited text no. 1
    
2.
Mudaliar Committee Report. Available from: http://nihfw.org/NDC/DocumentationServices/Reports/Mudaliar%20%20Vol.pdf. [Last accessed on 2014 Dec 27].  Back to cited text no. 2
    
3.
Bhalwar R, Vaidya R. Textbook of Public Health and Community Medicine. Pune, India: Department of Community Medicine, Armed Forces Medical College (AFMC) World Health Organization; 2009. p. 3-4.  Back to cited text no. 3
    
4.
Kumar R Family Medicine at AIIMS (All India Institute of Medical Sciences) like institutes. J Family Med Prim Care 2012;1:81-3.  Back to cited text no. 4
    
5.
Kumar R. Academic community medicine in 21 st century: Challenges and opportunities. Indian J Community Med 2009;34:1-2.  Back to cited text no. 5
[PUBMED]  Medknow Journal  
6.
Mahajan BK, Gupta MC. Textbook of Preventive and Social Medicine. 4 th ed. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd.; 2013. p. 3.  Back to cited text no. 6
    
7.
MCI Regulations on Graduate Medical Education, 1997, Chapter IV - Examination Regulation; p. 53. Available from: http://www.mciindia.org/GME/Regulations. [Last accessed on 2014 Dec 27].  Back to cited text no. 7
    
8.
Kumar R. Journal, association and public health in medical colleges. Indian J Community Med 2010;35:1-2.  Back to cited text no. 8
[PUBMED]  Medknow Journal  
9.
Azhar GS, Jilani AZ. Future of community medicine in India. Indian J Community Med 2009;34:266-7.  Back to cited text no. 9
[PUBMED]  Medknow Journal  




 

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