Indmedica Home | About Indmedica | Medical Jobs | Advertise On Indmedica
Search Indmedica Web
Indmedica - India's premier medical portal

Indian Journal of Community Medicine

Innovative Field Training in Epidemiology

Author(s): MB Soudarssanane, A Sahai

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

MB Soudarssanane(1), A Sahai(2)

An imaginative practical learning experience for undergraduate medical students in epidemiology has been engaging the attention of teachers of preventive medicine. In 1997, the Medical Council of India, recommended three community block postings – approximately one month each – between the third and seventh semesters of MBBS curriculum(1), to strengthen its earlier recommendation of 1977 of only one such posting, to further orient medical education on need based approach. At Jawarharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, several experiences of such innovative methods of teaching of Preventive and Social Medicine in general, and of Epidemiology in particular, have earlier been reported(2-5). Due to practical issues as of now, only two such postings in third and sixth/seventh semesters are under way. The newly constructed innovative teaching method for third semester, which took almost three years to take its full evolution, was introduced to measure a public health problem and its attributes by cross sectional study in a village. [Cross sectional survey was more practical for community based training, given the resources and timings of class -10.00 to 13.00 hrs every day for 4 weeks (23 working days) – and traveling about 30 kms (to/fro) daily from the institute to village of posting. The second objective of the study was to undertake epidemiological/qualitative investigations of cases of public health importance, identified in the village of posting.

Material and Methods

Three batches of 17, 35 and 34 students each underwent the new epidemiology based community block postings in May, July/August and Sept/Oct 2001 respectively.

I. The Posting Schedule

Day 1: Pre-test is done to enable students to make a situational analysis on their current understanding of rural life in general, their health problems/needs. Subsequently, briefing is done on the community block posting.
Day 2: Village visit, after prior intimation, and discussion by students with village leaders to identify their major health problems. A spot map is also prepared by students with the help of local self-help groups.
Day 3: Literature review at institute library to identify variables to be studied – regarding the prioritized problems – decide on feasibility and short-list the final variables.
Day 4: Formulation of schedule and translation into local language (and re- translation, for verifying), at the department - for the cross sectional survey.
Day 5: Field visit to pre-test and modify the schedule; deciding/choosing the sample.
Day 6 to 11: Data collection by students in sub-groups using spot-map. Two to three students make a sub-group and each interviews three to five families everyday.
Day 12 to 13: Case work by students on selected situations. For this, student-groups are re-allotted depending on the number of cases.
Day 14 to 15: After briefing on the method of analysis, data forms are rotated amongst the students as every student is given the responsibility of analyzing one variable.
Day 16 to 18: Clinico-Social case presentations by students with a faculty moderator.
Day 19 to 21: Community Diagnosis presentation by students with a faculty moderator. Day 22: Post-test/ Debriefing/ Students’ feedback on the community block posting.
Day 23: Revisit to village/ sharing information with villagers/ health education.

Note: The first author (MBS) visited the villages throughout the 3 postings for guidance of the students, assisted by residents.

II. Details of the topics worked upon by the three batches:

Two topics – covering one disease entity among adults and another among under-fives – on the measurement of disease and its attributes, and two to three case-situations for detailed clinico-social or qualitative case studies (in the village of posting) were chosen by each batch under guidance (Table 1).

Results

I. Knowledge and Practical skills inculcated for the students:

Information on the skills inculcated was by concurrent observation during field work – by faculty and residents, and feedback from students including informal discussions. Due cross checking of the assessment was ensured.

(a) Knowledge- and skills through the case studies:

The detailed work-up of case studies and the presentations/ discussions enabled the understanding of clinico-social aspects of disease entities – including the agent, host, and environmental/social factors in causation; and levels at which prevention had failed in those cases; and health measures (technical/administrative) required. In addition, various social aspects of health were highlighted, by utilizing other life situations studied (like events preceding a suicidal episode, health related facts due to long hours of life at sea among fishermen, and social/economic empowerment of women).

Table 1: Topics for cross sectional and case studies by the students

Batch (n) Cross sectional study Detailed case-work
First (17) 1. Alcohol consumption by
adult males
1. A chronic alcoholic
  2. Acute diarrhea disease
in under-fives
2. A child with diarrhea and dehydration
Second (35) 1. Smoking among adult males 1. A long-time smoker
  2. Acute respiratory infections in
under-fives
2. A child with pneumonia
    3. An episode of suicide
    4. Occupational-Health
aspects in life of fishermen
Third (34) 1. Blood pressure distribution and
hypertension among adults
1. A patient with hypertension
  2. Malnutrition in under-fives 2. A child with malnutrition
    3. Empowerment of women
through cottage industry
in village economy

(b) Knowledge and skills through the cross sectional survey methodology:

From the cross sectional studies – the main aspect of this new training methodology – students appreciated the following technical, managerial and behavioral skills.

  1. Building rapport with villagers, identifying and prioritizing their health problems; communication skills to interact with villagers.
  2. Selecting health problem(s) for the study.
  3. Appreciating the features of study: (a) resources for the posting (b) defining a case© importance of numerator and denominator in identifying determinants of disease and (d) interpretation of the information on prevalence and risk factors.
  4. Skill to review literature and identify workable variables.
  5. Schedule preparation and modification after pre-testing; importance of translation into local language (Tamil, in this instance), and re-translation to ensure uniform administration of schedule and minimizing observer error.
  6. Appreciate the sampling concepts.
  7. Work scheduling, network analysis and active involvement in data collection.
  8. Relevance of proper completion of schedule and data analysis.
  9. Interpretation of findings and inferences.
  10. Presentation skills including defending scientific ideas, acceptance of constructive criticism, discussion skills and presence of mind.
  11. Teamwork.
  12. Health education skills, importance and joy of sharing information with villagers.
  13. Developing skills of epidemiological case investigation.
  14. Appreciating limitations of a study, including bias/factors contributing to validity.

Note: Results of the studies/case works form the contents of papers elsewhere. This paper concentrates only on medical education.

II. Feedback from students

There was active participation by students of all three batches in this new community block posting, as students realized the correlation of points discussed in theory on ‘general epidemiology’ with related practical aspects in field. This practical opportunity to understand epidemiological concepts was the success of this program. Student response (n=86) was elicited using Liekerts scale during the posttest.

About 90% of students termed the whole experience of ‘survey per se’ as ‘highly useful’. More than two-thirds (70%) rated the clarity of objectives, schedule preparation, master-chart compilation and presentations/discussions as ‘highly effective’. The posting program, case studies and data analysis were valued as ‘highly useful’ by 55% of students. Students rating of their overall position (subjective) on relevant knowledge and skills was 35% before and 62% after the posting.

III. Feedback from the department

It was observed that students consulted voluntarily the residents and faculty – not only during working time but also often on ‘off duty hours’ – indicative of the enthusiasm generated by practical experience, and hence appreciation of concepts of epidemiology. Students depicted keen interest and eagerness to learn, inclusive of their active participation in the posting. A healthy competition was observed in the presentations.

Conclusions

This innovative field training of undergraduate medical students proved that practical training in epidemiology is feasible within the new recommendations of MCI, including successful practical demonstration of epidemiological concepts like disease patterns and their determinants, measures of central tendency, concepts of bias, recall, validity of data and issues in study methodology, analysis and interpretations in epidemiological studies.

References

  1. Medical Council of India. Regulations on Graduate Medical Education. 1997; p16.
  2. Srinivasa DK, Soudarssanane MB, Gautam Roy, Ramalingam G, Narayan KA, Rotti SB, Danabalou M, Ajit Sahai. Community experience for medical students. World Health Forum. 1993; 14(4): p 188-90.
  3. Soudarssanane MB, Rotti SB, Gautam Roy, Srinivasa DK. Research as a tool to teach epidemiology. World Health Forum. 1994; 15(1): 48-50.
  4. Soudarssanane MB, Gautam Roy, Srinivasa DK. Undergraduate experience of practical epidemiology in JIPMER. Indian Journal of Community Medicine. 1992; XVII (4): 134.
  5. Soudarssanane MB, Rotti SB, Santhosh Kumar V, Srinivasa DK. Supervised group discussion to teach investigation of an epidemic. Indian Journal of Community Medicine. 1994; XIX (2-4): 72-3.

(1) Deptt. of Preventive and Social Medicine.
(2) Biometrics Jawaharlal Institute of Postgraduate Medical Education and Research Pondicherry 605 006
Received: 15-4-05

Access free medical resources from Wiley-Blackwell now!

About Indmedica - Conditions of Usage - Advertise On Indmedica - Contact Us

Copyright © 2005 Indmedica