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Indian Journal of Community Medicine

Letter to Editor: "Family Health Study: Core of Public Health Practice"

Author(s): Dr. Anju Bala, Dr. Arun Kumar Aggarwal

Vol. 30, No. 3 (2005-07 - 2005-09)

"The place of medicine is into the stream of life and not on its bank", Rene Sand

To put this concept into practice, community-based teaching through family visits is the core of medical graduates training. "Community" is equivalent of "Ward" and "family" for community teaching is equivalent to the allotment of "patient beds".

Family visits should give the students sufficient exposure to make them understand the association of various environmental factors, socio-economic factors and the psychological or emotional factors with the health and disease of the family. They should learn family interactions and life cycle approach.

However, it has been observed that due to some operational reasons students do not benefit much from these family visits. There is big gap of time (almost 1 year) between family study practical and final examination. Medical students do family study practical in 2nd prof and appear for exam in new final year. When they are allocated families they don't have any exposure to communication skills.They don't have any clinical experience nor they have any exposure to social science techniques, nutritional assessments etc. Students are allotted only one family which give them little exposure. Thus we make following suggestions to improve the family study:

1. In first year, in addition to basic subjects-students should be given one week crash course on better communication techniques that will be helpful through-out their carreer. They should also be taught about common killer diseases especially for children and mothers. They should have clinical knowledge and skills at least of the level of health workers by the end of first year. They should be able to manage patients as per national health program guidelines at the level of health workers.

2. Each student should be allotted at least four families-two families each in rural and urban areas and in each area one family should be from low socioeconomic status and the second from good socioeconomic status. This will give opportunity to learn varied factors influencing health and will expose the students to the challenges of behaviour change communication.

3. There should be fixed time slots for family presentation. Family workup should be linked with family presentation and discussion. Student should be encouraged to initiate actions following the discussions. Students should be helped to draw research hypothesis from discussions and should be helped to initiate small operational projects, feasible within the available time and resources.

4. Students should visit their families every six months at least.They should re-visit the families at least three months before the exams to update the status and submit their reports. Before the final examination, previous work done by the student should be graded and examiners must review these files and ask questions from the files.

Dr. Anju Bala,
Social Medical Officer, GMC Patiala

Dr. Arun Kumar Aggarwal,
Asstt. Prof. Community Medicine, PGIMER, Chandigarh.

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