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Indian Journal of Community Medicine

Teaching Epidemiology in Community Setting for Medical Under Graduates-our Experience from Eastern Nepal

Author(s): K.C. Premarajan, S. Nagesh, N. Jha, S. Kumar, B.K. Yadav

Vol. 31, No. 4 (2006-10 - 2006-12)

K.C. Premarajan, S. Nagesh, N. Jha, S. Kumar, B.K. Yadav

Introduction

The mission of B.P. Koirala Institute of Health Sciences (BPKIHS) is to improve the health status of the people of Nepal by providing holistic health care through training of socially accountable health professionals. To translate this mission into a reality, the MBBS curriculum and the teaching programs are need based, integrated, community – oriented, student centered and partially problem solving in line with innovative medical education programs epitomized in the Edinburgh Declaration of 1998. The MBBS students have to do six weeks of Residential Field Posting in the community and are conducted in three blocks of two weeks each. This paper discusses one of the residential fields posting to teach epidemiological principles in a community setting.

When epidemiology is taught as classroom lecturediscussion only, students find the subject very difficult to understand and they are not able to imbibe its relevance. It is inthis context that the Dept. of Community Medicine at BPKIHS introduced the innovative program of field-based training in Epidemiology for VI Semester MBBS students for the first time in April 2003, with the following objectives. At the end of the posting, students will be able to 1) Understand the importance of designing a scientific study 2) Develop practical skill to plan, conduct and report a community based epidemiological study 3) Appreciate team work and self learning ability.

Material and Methods

The 52 students of VI Semester MBBS were divided in to 10 groups with 5-6 students. Every group was told to select a topic of public health importance with special reference to Eastern Region of Nepal and students were given the option to decide on the exact place of study. For better interaction and guidance, each faculty was given the charge of two groups only. On the first day of the posting, students were briefed on the purpose of the posting to make them understand the relevance and how epidemiology can be practiced in the community level. Total duration of the posting was two weeks. First three days were spent on theoretical orientation to the subject, protocol development including questionnaire preparation, logistic planning etc. Each team to chose a team leader. Faculty acted only as facilitator so as to have active involvement of students at every stage of the program, thereby facilitating active learning. The studies were conducted in the six districts of Eastern Developmental Region such as Dhankuta, Jhapa, Ilam, Morang, Sunari and Therhatum. List of topics selected for the studies is given in table-I. Faculty accompanied the students during the data collection. This was followed by data analysis and report preparation in the Department. On the final day, each group made a brief presentation of their study finding in presence of faculty from different departments and also submitted a comprehensive report. Student evaluation and feedback was taken at the end of the posting.

Result

This residential field posting in epidemiology was done during the period April 1-15 2003. Ten descriptive studies completed by students brought out very useful epidemiological data on the public health problems in Eastern region of Nepal. For example, students realized the low awareness and utilization of maternal care services. They could observe and study the various health hazards of workers in a jute mill and of women working in a tea estate. Interacting with inmates of an orphanage run by SOS Village, one group understood the positive effect of family environment and nutrition on the physical, mental and social development of orphan children. On conducting a survey on the health status of a refugee population, students came to know the health needs of a high risk group and the positive impact of primary health care service provided by an International NGO on health status of refugee population. The group that studied the fire disaster in Terhathum could observe and study the impact and rehabilitation process being carried out by the Government and non-government agencies.

During the posting, students developed the following skills such as (1) how to conduct field research (2) survey scheduling, questionnaire preparation and logistic planning (3) enlisting community support (4) team work (5) decision making in the field (6) ability to collect information from different sources and (7) data analysis

The feedback taken from the students showed that they developed the confidence and positive attitude towards community based studies. Eighty five percent felt the posting was useful in understanding the practical aspect of epidemiological studies. Seventy six percent of students rated the program from good to excellent. Sixty one percent of the students gave the opinion that this posting would help in their future research activities and in becoming community oriented doctors.

Table I: List of Topics and Place of Study.

S.No. Study Topics Place District
1. Study of morbidity among jute
mail workers
Sonapur Sunsari
2. Epidemiological study on social,
family and health problem of
women working in a tea estate
IIam IIam
3. Descriptive study on tuberculosis
patients with Nepal Anti-tuberculosis
Associatioon
Biratnagar Morang
4. Study of treatment seeking behaviour
and Health Care Services
Dhankuta Dhankuta
5. Study of health status of children in
refugee camp
Damak Jhapa
6. Study of health morbidity and social
problems of bhutanese refugee
population
Damak Jhapa
7. Socio-economic factor and treatment seeking
behaviour of leprosy patients
of Netherlands Leprosy Relief
Biratnagar Morang
8. Study of maternal care services Hansposa Sunsari
9. Study of nutritional status of children
at SOS Balgram
Itahari Sunsari
10. Study on effect of fire disaster on
Health and Rehabilitation
Myanglum Terhthum

Discussion

In this posting, we tried to practice learner centered learning in a community environment where there was ample opportunity for group and collaborative work. Here self-exploration was promoted leading to intrinsic motivation, which is a measure of success of an educational process2. In the process of conducting a study in the community, the students also developed the ability to approach the community, to work as a team and crisis management skill in the field. One group who studied the fire disaster commented “Reality differs from what is written in the books. The study in Myanglung was an eye opener to us into the real world of chaos and disaster. We were always attached to the bookish knowledge of do’s and don’ts in case of emergency, but there we got the first hand information of what people do in real life situation. We had a really educating experience which we will never forget in our life.” We need to consider our Medical students as adult learners and experience is the adult learner’s living textbook. This type of participatory learning breaks the monotony of routine classroom session and cultivates selfdirected learning.

Feedback from the students showed that they were able to relate the epidemiological information and skill to local and current health problems or situations. Experience of staying in the community represents valuable educational resources in Community Medicine. Feedback from the students showed that they enjoyed the process of learning epidemiological principles by actually applying in the fields. Another benefit of such posting is that the data from these studies can be used as learning material to teach subjects such as occupational health, disaster management, rehabilitation, Health management etc during the subsequent semesters. Similar method was tried for teaching epidemiology by making the interested students do small research project like case-control studies3. But that was mainly hospital based studies and in our case we gave opportunity for the whole batch to do field studies in the community. Similarly, medical students were encouraged to take up community-based projects during their rural internship4. Following the success of the posting we have introduced this posting as a regular program for VI semester students.

To conclude, this posting was a very good learning experience for the students and faculty. Such postings make the medical education really community based and helps in sensitizing the young medical graduates to the community health problems and solutions.

References

  1. Annual Report and Plan of Action. B.P. Koirala Institute of Health Sciences, Dharan, Nepal 2004, 1-2.
  2. Amin Z, Eng. KH; Basics in Medical Education. Singapore World Scientific Publication Co. Ltd. 2003, 31-4.
  3. Soudarssanane M B, Rotti S B, Roy G et al. Research as a tool to teach epidemiology. World Health Forum 1994; 15: 48-50.
  4. Pratinidhi AK, Joshi JK, Bawikar SP, Javedbar SJ; Community based projects in rural internship: an alternative approach, Medical Education. 1992 Sept 26; (5): 368-71.

Deptt. of P&SM, JIPMER, Pondicherry – 605006
E-mail: [email protected]
Received: 21.2.05

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