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Indian Journal of Community Medicine

Vol. 30, No. 2 (2005-04 - 2005-06)


Development of Community Medicine Sub-specialities

Community Medicine is a speciality of Medicine that is concerned with disease prevention and health promotion among individuals, families and communities. Scope of this speciality is quite wide. It ranges from planning and provision of Public Health Services, to the delivery of Primary Medical Care throughout the life cycle of human beings, i.e., from childhood to the old age. It demands not only study of general medicine covering all the organ systems of human body but also the awareness of the civic, social, legal, and economic organization of the society.Therefore, a Community Medicine specialist has to acquire a vast body of knowledge and a range of skills. He/she must have basic understanding and skills not only to deliver general primary medical care to individuals and families, but should also possess in-depth knowledge of epidemiology of communicable and non-noncommunicable diseases, should be familiar with principles of social and behavioral sciences, and ought to have necessary management skills for organizing health services to prevent diseases and promote health among individuals, families and communities through organized community actions.

It may not be possible for every Community Medicine specialist to have in-depth understanding of all the aspects of Community Medicine speciality. A multi-disciplinary team having sound knowledge base on each aspect of the speciality is an essential pre-requisite for those institutions that have responsibilities of teaching and conducting research in Community Medicine. Therefore, it is prudent that every Community Medicine specialist particularly those in academic positions should consider concentration on some of the aspects (sub-specialties) / themes (programs) of Community Medicine as per the following framework so that they can keep themselves abreast of the latest developments taking place in their chosen sub-speciality/ program and can contribute to the development of the sub-specialties while maintaining acquaintance with general principles and practice of community medicine.

One can choose any of the four core sub specialties of Community Medicine for teaching, research and practice, i.e., Family Medicine, Health Management, Health Promotion, and Epidemiology. Similarly for application of the chosen sub speciality one can choose a theme (program), i.e., Reproductive & Child Health, Communicable Diseases, Non- Communicable Diseases, Environmental Health. Within these themes, one can focus on sub-themes for example within the theme of Reproductive and Child Health one can focus on perinatal/neonatal/pre-school child/school health/adolescent health/ infertility/menstruation and menopause/reproductive tract diseases/ maternal health/contraception etc. One can choose malaria (vector born diseases)/ TB (airborne infections)/ HIV (Sexually transmitted infection)/ diarrheal diseases (water born infections) from the theme of Communicable Diseases; and nutrition (obesity/under nutrition), lifestyle (tobacco, physical activity)/ accidents/ mental health from the non-communicable disease programs. Environmental Health sub themes could be air pollution, sanitation, occupational health etc. This framework allows one to prioritize the focus of ones work by choosing a sub speciality and a theme/program. Thus each Community Medicine specialist can decide for himself/herself where he/ she should devote most or least time so that in a given time span of say 5 to 10 years, he/she can make significant advance in the selected sub speciality and thematic area of work.

The use of proposed framework is illustrated below. One can find out where lie ones interests by answering following questions. In which sub speciality of Community Medicine you are interested? You can choose the subspeciality by ranking your interest in the sub-specialties given in the first column below according to the time and energy you want to devote to it (Rank I-most, II-more, III-some, IV-Least). Similarly you can choose the program theme or sub theme of your interest by ranking the second and third column given below.

Sub Speciality Theme Sub-theme (Programs)
Health promition Non Communicable Diseases Tobaccao, Nutrition etc.
Epidemiology Communicable Disease HIV, TB, Malaria, etc.
Health Management Reproductive & Child Health Family Planning, ARI etc.
Family Medicine Environmental Health Air Pollution, Sanitation etc.

In a large Community Medicine department/institution, having about 12 faculty members, most sub-specialties, themes and sub themes can be covered. Usually there are only 5-6 faculty members in most of the departments of Community Medicine. In such a situation each faculty member can focus on a sub speciality plus a theme/sub theme and rest can be taken care of by faculty members in other sister institution that can be networked together for teaching and research purposes.

This framework provides a structure for organizing academic departments and service organizations. One should keep in mind that essential knowledge of all sub specialties is required for working on a theme or sub theme (program). And for working in a sub speciality one requires to choose a theme or sub theme (program). For example if one wishes to focus on epidemiology, not only he/she must understand various epidemiological study designs, but should have focus on any one or two NCDs / CDs also.

As the scope of Community Medicine is vast, it may not be possible for every specialist to have in-depth expertise of the all the sub specialties and themes of Community Medicine. To track the recent advances and to contribute to its development every specialist particularly those engaged in teaching and research should choose a sub speciality (Family Medicine/ Epidemiology/ Health Management/ Health Promotion) and a Program (Non Communicable Disease/ Communicable Disease/Reproductive and Child Health/ Environmental Health etc.) for teaching, research and practice so as to advance the body of knowledge and skills which will also enrich the general principles and practice of Community Medicine.

Dr. Rajesh Kumar

Prof. and Head
Community Medicine Department
Post Graduate Institute of Medical Education and Research

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