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Indian Journal of Community Medicine

Innovative Integrated Teaching of Epidemiology

Author(s): MB Soudarssanane, A Sahai

Vol. 32, No. 1 (2007-01 - 2007-03)

It is well known that a strong knowledge in epidemiology, a basic subject within Preventive Medicine, is very essential for students to appreciate the steps in prevention of any disease. Therefore, strengthening of the teaching of epidemiology is an interesting and challenging task. Various related newer teaching methods from the department of PSM, JIPMER, have earlier been reported – both for theory1 and practical2,3 teachings. To impress the students about the relevance of the subject, a newer teaching method was introduced. This included the presentation of actual epidemiological studies, during the class, along with discussion of the theory points thereof, and integration of the clinical teaching departments in such presentations. To inculcate further interest among students, studies from the local population were chosen for these presentations and the results thereof were carefully highlighted to strengthen the concepts/principles in epidemiology. Such presentations were edited (in prior planning) to last 10 minutes each.

Material and Methods

On an average 10 to 12 theory classes are programmed for epidemiology, in the third semester. This is also the time when students start their clinical postings. A correlation of the steps of decision making, regarding identification of risk factors and causes of disease, with the related bedside discussions would help the learning process. This idea of presenting to students, the findings of related studies conducted in local population, during every theory class on epidemiology, for the various study methodologies thereof, was introduced to a batch of 56 third semester students in July-October 2002. To avoid repetition of presentation from the coordinating department (PSM) and to integrate clinical departments into the teaching of epidemiology, they were requested to present their studies – so as to suit the requirements of the students.

During the 12 classes for III semester (one-hour duration each), a 10-minute presentation of actual studies – conducted within the institute – was made to the students to support, elaborate and strengthen every class. Departments of Medicine, Dermatology and P&SM presented respectively a case report, case series and cross sectional study (supported by participation by the Dean of the Institute), departments, of Surgery, P&SM and Anesthesiology presented respectively a case control study, a cohort study and an intervention trial. The role of chance and tests of significance in inferences on risk factors was elaborated by the second author. The first author used findings from the presented studies to discuss the role of bias and the judgment of disease causation.

Discussion on screening for disease was strengthened by discussant points from guest faculty – the then secretarygeneral of IAPSM and two professors from a sister medical college. The short presentations were built within the onehour theory discussion (occasionally two hours) of the related study method in epidemiology. In collaboration with the participating sister departments, these studies were initially screened and selected by one of the authors (MBS) who was the discussant faculty for all theory classes in epidemiology, to suit the needs of the lecture-discussion.

Results

The presentations by various departments are given in Table 1. These were used. as practical support for the theory discussions. Students appreciated the findings from actual studies. Their interest was increased as these studies were from the local population. They were impressed by the clinical relevance of the subject of epidemiology (and P&SM) and appreciated the value of applied bio-statistics.

Table 1 : List of Studies Presented in the Integrated Teaching of Epidemiology

Sr.
no.
Name
of study
Study
method
Presenting
Department
Main
concepts
highlighted
1 Unusual presentation
of brain (pituitary)
tumour
Case Study Medicine Statements of
scientific facts
2 Mucocutaneous
manifestations
in HIV/AIDS
Case Series Dermatology Inferences
from percentages
3 Distribution of
Blood Pressure &
of Hypertension
in an Urban Area
Cross-sectional
study
P&SM Interpretation of
Prevalence
measurements
4 Risk Factors in l
Duodenal Ulcer
Case Contro Surgery Interpretation of
Odds Ratio
5 Distribution of
Blood Pressure
and Incidence of
Hypertension in
an Urban Area
Cohort Study P&SM Incidence and Relative
Risk measurements
6 Effect of Fention
sulphate on heart
rate & BP
Intervention Anesthes-
iology
Blinding;
Bias minimizing
7 Discussion on
role of chance
and tests of
significance
Statistical
tests used
in above
studies
Biometrics wing
and of P&SM
Interpretation
role of chance
8 Discussion on
role of bias
Examples
of bias
in above
P&SM Interpretation
bias in
above of
role of bias
9 Judgment of
causation of
disease
Example from
book
P&SM Doll and Hill
criteria
10 Concepts of
screening for
disease
Discussant
comments
Guest P&SM
disease
faculty
Test validity,
sensitivity,
specificity
and PPV

Forty-six students gave their anonymous feedback (out of 56). All of them, except one, welcomed the new teaching method. Only one student felt that one-way theory lecture was better and that it was not that essential to involve so many departments. The major suggestion was to involve students in such studies. The comments from students were:

  • brought statistical studies from a mere theoretical concept to something very practical
  • application value of the topic was made evident
  • that the concept can be applied in every field – apartfrom P&SM
  • better form of teaching than just bookish knowledge
  • concepts are made clear using a variety of real studies
  • showed how epidemiology is useful in daily medical practice; how P&SM would be extended to other clinical subjects as well
  • there was the required variety which attracts the attention of the students

Discussion

The Medical Council of India stresses the need for active teaching/learning of epidemiology as an essential requirement for training of socially oriented doctors to support the need based health care delivery system. This philosophy is also refl ected in the Institute Objectives of JIPMER.

Various efforts are required to translate this educational concept into action. The integrated teaching of epidemiology, incorporating presentation and discussion of actual studies conducted in the local population with involvement of clinical departments is a novel attempt in the lecture discussions of the subject. That this innovative method has been very successfiil is evident from the feedback of the students.

References

  1. Soudarssanane MB et al. Learner oriented teaching of epidemiology. Bull of JIPMER: Vol 13,1994; 60-65
  2. Soudarssanane MB et al. Research as a tool to teach epidemiology. World Health Forum: 15(1),1994; 48-50
  3. Soudarssanane MB, Sahai A. Innovative Field Training in Epidemiology – Accepted for publication in Ind J Comm Med as a brief report

Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Pondicherry, India.
Received : 15.04.05

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