DR. J E PARK MEMORIAL ORATION
Year : 2013 | Volume
: 57 | Issue : 3 | Page : 144--146
Innovations in teaching/learning methods for medical students: Research with mentoring
Sr. Advisor Community Medicine and Epidemiologist, Director Armed Forces Medical Services (Medical Research), Professor and Head, Department of Community Medicine, ACMS, Delhi Cantt, Formerly Professor, Department of Community Medicine, Armed Forces Medical College, Pune, Maharashtra, India
Sr. Advisor Community Medicine and Epidemiologist Director Armed Forces Medical Services (Medical Research), Professor and Head, Department of Community Medicine, ACMS, Delhi Cantt
In this era of evidence-based medicine, innovative teaching learning methods coupled with appropriate mentoring are required to make the undergraduate medical students interested in the speciality of Community Medicine. Teaching research methodology to medical students by a hands-on approach along with mentoring by involving them in small, feasible, sustainable, and replicable studies on a topic of interest clearly showed renewed interest among students toward the subject.
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Kotwal A. Innovations in teaching/learning methods for medical students: Research with mentoring.Indian J Public Health 2013;57:144-146
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Kotwal A. Innovations in teaching/learning methods for medical students: Research with mentoring. Indian J Public Health [serial online] 2013 [cited 2021 Oct 21 ];57:144-146
Available from: https://www.ijph.in/text.asp?2013/57/3/144/119822
It always has been and is now even more exciting time to pursue a career in Community Medicine (CM)/Preventive and Social Medicine (PSM). The burden of old, emerging and reemerging diseases is increasing world over. Epidemiological transitions in the developed world are taking place along with epidemiological combinations in the developing countries. The efforts to combat the challenges in improving the health of the community require appropriate strategies and actions. However, this is the considered view of most of the public health specialists; the perceptions of the medical undergraduates, due to various reasons are quite different.
CM/Public Health/PSM is currently undergoing an "identity crisis" of high public expectations versus relative invisibility in day-to-day life. The Medical students at undergraduate level perceive the speciality to be of a lower status than other specialities, as low paying with lack of prominent role models and also lacking clearly defined career paths as specialists in CM. The students in today's era of evidence-based medicine favor "hard" clinical knowledge over "soft" health promotion/disease prevention, knowledge, and skills. This has also been commented upon and discussed in the international forum like World Health Organization South East Asia Regional Organization (WHO SEARO) Health ministers' meeting in September 2005. It was mentioned during that meeting that "medical graduates who enter the specialty of Public Health face major handicaps compared with those selecting other specialties…Public Health is generally regarded as a drop-out specialty in SE Asia…Inadequately trained professionals who do nothing to elevate the status of the specialty, with some exceptions…This was radically different from the situation in most developed countries".
At the same time, medical colleges have the responsibility to direct their education, research, and service activities toward addressing the priority health concerns of the community/region/nation. The Indian Public Health Association has to play a major role in addressing the challenges being faced by the CM. It has to inform public of what Public Health is and how it contributes to lives of population by explaining the role of clinician vis a vis CM specialist. IPHA has to take concrete steps for drawing new professionals into CM. We as faculty in the medical colleges have to play our role by increasing the specialty's visibility, accentuating importance, and infusing public health concepts early in students' experiences. Making CM interesting at the undergraduate (UG) level for shaping career choices and ensuring that basic CM training is available to those who pursue other specialties is a must for all faculty members.
There are various teaching/learning methods with inherent as well as practical strengths and limitations of each. These include but are not limited to: lectures; small group learning, which can be problem based, case based, tutorial, case study, case scenario with discussions and debate; e learning, web based, computer assisted; self-instruction modules/exercises; site visits, community placement; personal reflection; self-directed learning, etc. A combination of these techniques is generally required in every medical college. However, to fulfill our obligation to make CM interesting and acceptable, we need to innovate. Innovation is also required as students have varied learning styles and need diverse opportunities for learning. Moreover, students may hate anything that they do not see as clinically relevant.
There is a recent trend away from problem-based learning to case-based learning. This is possible in our speciality by teaching medical students practical aspects in the community and healthcare facilities. Importance of CM to clinical medicine and providing an opportunity to UGs to practice CM vis a vis only textbook definitions and theoretical knowledge. Practical "hands-on" experiences have been shown as essential component of learning. The innovations also need to include more effective role modeling in CM. However, innovations should never be at the cost of quality and content, which needs to be delivered and examined with the same rigor as other medical specialties.
In addition to innovations, what is required in our country is mentoring of the students. Mentoring is an old time tested tradition and a mentor has been called a "wise and trusted counselor" whom Odysseus entrusted with the care and education of his son, Telemachus (Homer's Odyssey). In the medical colleges, studies have shown that mentors were seen as important career-enhancing factor for medical students and as influential factors in the selection of specialty. The effect of mentoring was observed on research career guidance, productivity, and success. Mentoring combined with innovative teaching/learning technique of "hands-on" training for UGs with the involvement of postgraduate (PG) students has been tried in the Department of Community Medicine, Armed Forces Medical Services (AFMC).
As critiques of CM keep on harping about our speciality being increasingly away from the healthcare facilities, the approach was tried in a Health Care Facility (HCF) setting. Similar efforts were carried out by all faculty members; however, one of the experiences in the form of a case study has been presented here.
Indian Council of Medical Research (ICMR) Short-term studentship (STS) scheme for undergraduate students was utilized to study an important aspect of healthcare while teaching the students, both UG as well as PG, the nuances of research methodology, data analysis, report writing, and finally paper writing and publication process.
It was realized that implementation of universal/standard precautions (SPs) suffers from various lacunae in the developing countries like India. Few available studies showed impressive knowledge levels among healthcare workers and administrators coupled with poor attitudes and practices regarding Universal Precautions (UPs). However, there were no injury surveillance programs, availability of personal protective equipment and engineered safety devices was low, postexposure prophylaxis was not universally available, and even routine hepatitis B vaccination was also not 100%. Thus Health Care Workers (HCWs) were seen to be at a greater risk due to sub-optimal infection control practices, lack of equipment, lack of training, and also low compliance with UPs. In developed countries like USA, proportion of HCWs experiencing one or more Needle Stick Injury (NSI) in one year fell from 24% to 8.6% in a span of 8 years due largely to UPs.
To begin with, a sixth semester volunteer UG student was involved to design a study with the objectives: to assess the frequency of exposure to Blood and Body Fluit (BBF) and NSI among HCWs of a tertiary care hospital; and to determine the specific jobs leading to increased risk of exposure to BBF and NSI among them. A cross-sectional survey among HCWs of a tertiary care hospital was planned and later done after approval by ICMR under the STS scheme.
Next year the focus was kept only on hand hygiene as adherence to proper hand hygiene was found to be below 40% in most hospitals and poor hand hygiene was responsible for 40% nosocomial infections. Again one of the UG students designed a study to describe the extent to which hand washing procedures are known and followed by healthcare workers in a large tertiary care hospital. Again a simple cross-sectional survey was conducted among HCWs. Additionally, observation checklist was also developed for observation of the HCF.
These two studies coupled with Knowledge Attitude Practice (KAP) studies from other parts of India provided enough evidence that UPs need to be implemented as compliance of universal/SPs by healthcare workers is pivotal in preventing hospital-acquired infections as well as protecting the HCWs. It was thus thought that one of the most effective ways to ensure the practice of UPs by HCWs is to teach the UG students regarding this issue. The existing curricula of MBBS do not address this subject adequately.
Thus a study was launched to explore education needs of medical students as perceived by students and faculty and to evaluate the knowledge and attitude about SPs and infection control guidelines. The study participants were UGs and faculty. In addition to the KAP, concordance and discordance between UGs and faculty and preferred methods were also assessed.
All three research projects were approved by ICMR under STS and were published as papers in medical journals. The PG students provided the continuous support in all aspects of the study in direct supervision of the faculty member.
The mentoring included teaching/learning of all components of research: review of literature; designing research; designing instruments; testing validity and reliability of Instruments; pilot testing; conduct of a study; interview techniques; sample size calculation; sampling; data collection and collation; analysis; report writing; and paper writing. It was also ensured that mentoring did not become a means to promote own agenda and due credit was given to the students as is evident from the publications.
Teaching research methodology to medical students by a hands-on approach along with mentoring was carried out in the Department of Community Medicine, AFMC. All activities by the students were under guidance and supervision in the true spirit of 'Mentoring'. Well-designed small studies were conducted by students with built in 'Quality Assurance' and using appropriate methodology. In-house/departmental resources were utilized for these projects with a small fraction of ICMR STS funds being used, that is, 'Sustainable Research'. There was a stamp of approval as all projects were approved by ICMR the premier institution of our country. The limitations of research were known and spelt out clearly by the students themselves in the report as well as papers, that is, they were taught how to draw proper 'Inferences' from research. A positive attitude was noticed among the students involved in these activities; however, it is too early to assess measurable impact. Continuation of these efforts coupled with a long-term follow up is required to assess the impact.
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