Public Health Dentistry as a Career Choice - Attitude of Dental Undergraduate Students in Puducherry.

Background: To pursue further education in a particular specialty of dentistry, it is important for dental students to be aware of the "expectation" associated with any specific specialty in dentistry. Therefore students 'attitudes' towards 'expectations' of various specialties, to a large extent enables a meaningful understanding that facilitates appropriate planning in the dental sector for the community. Materials and Methods: A cross-sectional questionnaire based survey was conducted, which included, final year and dental interns studying in two dental institutions, in the State of Puducherry. It consisted of 27 questions that were graded using 5-point Likert scale. The responses for the attitude questions toward selecting Public Health Dentistry for post-graduation were categorized into three factors, negative attitude (includes score 0-21), neutral attitude (score 22-44), and positive attitude (score 45-64). Differences between groups were examined using t-test for proportions. The level of statistical significance was set at p < 0.05. Results: Among 221 respondents, 73 (33.0) were males and 148 (67.0) females. About (52.2%) of the respondents had positive attitude toward selecting Public Health Dentistry as their future career and (76.7%) had neutral attitude, around (5 %) had negative attitude towards the speciality for pursuing post-graduation in both the two institutions. Conclusion: Our study could highlight many factors namely gender, year of study etc which influence the attitude of students for selecting PHD as career choice. These specific factors could be kept in mind while course planning for government or private institutions so that maximum interest can be fetched among students.

Educational Research and Scholarship in India: The Way Forward.

Medical education research (MER) aims to improve the practice of medical education by applying the theory of educational research. Internationally, medical education research has grown exponentially and has established itself as a distinct field. In contrast, in India, the medical faculty is either bogged down by clinical responsibilities, or is busy with biomedical research. The recent initiatives such as implementation of competency-based medical education (CBME) for medical undergraduates, and push coming from regulatory agencies besides National Education Policy have become game changers. The emerging concept of scholarship, takes in to account all scholarly activities in a fair manner. The scholarship of teaching and learning (SoTL) is helpful in connecting teaching with better patient care outcomes through evidence based approach. It also promotes a community of practice to boost research and publication activities. Finally, there is a need to enlarge the scope of research from treating sick children to promoting total wellbeing, which requires interdisciplinary and interprofessional approach to research.

Applying systems approach for bridging education, research, and patient care in a health sciences university.

Systems approach provides a logical and scientific basis for explaining the functioning of a system in a holistic manner. The health sciences university is a system with its three major operations - education, research, and patient care, which can be conceived as inputs, process, and output, respectively. The system is aided by a feedback loop to inform and correct the system. Systems thinking enable us to identify the deficiencies existing in each of the components so that appropriate remedial action can be taken. In this article, we have identified deficiencies in the health sciences system. Further, we have suggested a five-point formula to achieve connection among education, research, and patient care. We need to Form consortia and networks to create a mass movement, Uniform regulations to remove bottlenecks, Reform curricula to make them credit linked and competency based, Inform all through a faculty development initiative, and finally, Transform the system by setting examples and demonstrating success. The initiative taken by the Medical Council of India in introducing a competency-based curriculum for MBBS, and the revised accreditation manual introduced by the National Assessment and Accreditation Council can provide a lot of opportunities to explore the potentiality educational research to answer many questions that can help us in connecting research with education and patient care.

Systems approach in medical education: The thesis, antithesis, and synthesis.

Systems approach is a time tested, method of trying to understand the reality holistically, and resolving the issues by problem-solving method. It has resulted in enormous applications in almost every field of knowledge, science, technology, industries, agriculture, and health or education. The main essence of systems thinking lies in minimizing the inputs, optimizing the process to maximize the outputs through continuous feedback, and monitoring. Medical education has been greatly benefitted as the systems approach has influenced all aspects, from delineating the competencies of doctors, designing curriculum that includes comprehensive assessment. However, of late, there has been a debate as to whether the systems approach can really contribute to resolve complex issues such as bringing curricular reforms, or promote policy changes in patient care, education, or research. This involves a paradigm shift from problem-solving approach to "pattern recognition" and adaptive action to correct the system. This review based on critical appreciation, begins with a thesis that systems approach is a great tool. It then exposes its inadequacy to address complex systems. This is antithesis. In the end, a synthesis of both the contradictory views has been proposed as a take home.

Assessment of Self Perception of Competencies among a Group of Dental interns in Pondicherry, India.

CONTEXT: The general dentist must not only have a broad biomedical and clinical education but also be able to demonstrate professional and ethical behavior as well as effective communication and interpersonal skills. In addition he or she must have the ability to evaluate and utilize emerging technologies, continuing professional development opportunities, and problem-solving and critical thinking skills to effectively address current and future issues in health care. But the extent to which the core competencies are taught and the students' level of proficiency in these competencies in Indian scenario is to be explored at large. AIMS: The present study aims at assessing the self-perceived level of competencies and their importance for future practice and the extent to which the competencies are taught in the curriculum among interns of dental college in Pondicherry, India. SETTINGS AND DESIGN: The cross-sectional observational study was conducted among dental interns of Indira Gandhi Institute of Dental Sciences, Pondicherry. SUBJECTS AND METHODS: A total of 72 interns participated in the study. A short version of the Freiburg Questionnaire to Assess Competencies in Medicine" was used in this study. Questionnaire has three sections with same set of questions, which the student had to rate: (i) To what extent do you have the following competencies at your disposal? (ii) To what extent will your future job require the following competencies? and (iii) To what extent is competencies taught to you? After the results were obtained a focused group discussion with the responders was done. Focused group discussion consisted of open questions to the groups in all the four domains and the responses of the students were scribed. RESULTS: In all four domains, self-perceived level of competency was not satisfactory. However, all students stated that the competencies were highly relevant for their future practice. Despite this, most of the competencies are not taught to necessary extent in the curriculum. The results of the present survey revealed that the participating students perceived deficiencies in all domains of competencies. CONCLUSIONS: These results indicate that the core competencies are still barely integrated into dental curricula and that further research in this field is needed.

Effectiveness of problem-solving exercises in radiology education for undergraduates.

Background: The teaching of radiology to undergraduates in India is largely didactic. We incorporated innovative methods including problem-solving exercises in teaching to assess the impact on the outcome with respect to knowledge and interpretive skills in radiology. Methods: We enrolled all students of the 2014-15 MBBS batch. The topics in radiology were divided in two parts. The first part was taught by innovative methods including problemsolving exercises and integrated teaching. The second part was taught by the conventional lecture method. Validated item banks were used to assess the increase in knowledge and interpretive skills developed by these modalities to compare their effectiveness. Results: Students showed an improvement in knowledge and interpretive skills scores irrespective of whether they we were taught by the innovative or conventional teaching method. However, the gain in scores were higher and statistically significant for interpretive skills when taught by the innovative teaching method. Conclusions: Innovative teaching methods that involve integrated teaching and use of problem-solving exercises and picture-archiving communicating system are beneficial for promoting interpretive and problem-solving skills of undergraduates in learning radiology.

Extending professional education to health workers at grass root level: an experience from all India institute of medical sciences, new delhi.

BACKGROUND: In India, the opportunities for professional education of the grass root level health workers are grossly inadequate. Capacity building of all categories of health workers is needed for enhancing health outcomes. OBJECTIVES: To plan and implement a professional development training program for all categories of allied health workers and to assess its outcomes in terms of knowledge and skills. MATERIALS AND METHOD: We planned and organized a 'one week'(15 h) training program for 10 categories of allied health workers (1260) working in our hospital. The program included nine generic skills/topics: the prestige of AIIMS, sterilization & infection control, universal precaution, biomedical waste management, public health, life style & healthy nutrition, fire safety, communication skills and office procedure besides subject specific skills. Trainers were drawn from 12 departments. Training methodology included interactive lectures, narratives, demonstrations, videos, PPT slides, and informal discussions with participants. The effectiveness of the program was judged on the basis of participants' feedback, feedback from the supervisors, and our own observations post training. RESULTS: Feedback from the participants and their supervisors after training was encouraging. The participants described training as a "life time experience". The supervisors reported improvement in confidence, communication skills, and awareness of workers. CONCLUSION: The success of the program was due to the use of interactive methods, involvement of multidisciplinary team, and commitment from leadership. We recommend that professional education should be linked with career advancement. Academic institutions can play a key role in taking such initiatives.

Medical students' perception of professionalism: a qualitative study from Saudi Arabia.

BACKGROUND: Professionalism has emerged as a core competency for the medical professionals globally. However, few studies have been reported from the Gulf region to assess the situation and take steps to promote professionalism. AIM: To elicit the views of final year medical students, interns, and residents to explore what professionalism meant to them, what problems they encountered, and what can be done to promote professionalism. METHOD: We adopted qualitative approach including 10 focus group discussions. The proceedings were tape-recorded, transcribed, and analyzed independently by two researchers. RESULTS: The respondents admitted that that they were deficient in the acquisition of professional values. According to them, professionalism was not taught or assessed. They followed "hidden curriculum". They considered very few teachers as positive role models. The deficiencies could be attributed to negative role modeling by the faculty or deficiencies in the curriculum such as lack of rich clinical experiences, limited interaction with health team, and absence of feedback besides organizational issues. CONCLUSION: The students' views should be tallied with other sources of evidences. Nevertheless, they have policy implications on faculty recruitment, development, curriculum reform, and an organizational culture that supports professionalism.

Structured internship orientation programme for undergraduate students: easy transition to clinical work.

BACKGROUND: Internship is a phase of training when a new graduate is expected to acquire skills under supervision, so that he/she may become capable of functioning independently. Often, new graduates go through this period without a clear aim. We conducted an orientation programme before fresh graduates started their 1-year internship to familiarize them with their clinical tasks and their role in the community. METHODS: Interns were invited to participate in a one-and-a-half day programme conducted by faculty members and administrators that included interactive lectures, structured panel discussions, group discussions and role plays. The participants provided feedback using a structured questionnaire and during informal group discussions. They were also evaluated by a pre-test and post-test questionnaire. RESULTS: Of the 41 interns who attended the programme on day 1 and the 28 who completed it on day 2, 19 completed the post-test questionnaire. The post-test score (median 14.5; range 10-18) represented a significant improvement over the pre-test score (median 13, range 3-16). All participants felt that the workshop was successful in achieving its objectives. CONCLUSION: A brief and structured orientation programme before internship offers a practical means of making the transition of new graduates from students to practising doctors smoother.

Innovative method of needs assessment for faculty development programs in a Gulf medical school.

BACKGROUND: Faculty development lays the foundation for the quality enhancement in medical education. However, programs are not always based on the needs of the participants, and there is dearth of information on methods to derive faculty's needs. The Medical Education Unit at the University of Dammam, Saudi Arabia, carried out an innovative method to identify and prioritize faculty needs in order to plan future activities. METHODS: A questionnaire was designed, pilot-tested and administered to all faculty members (N=200). The respondents rated the perceived importance (high, moderate, low) and their performance (good, average, poor) on twelve competencies described in the literature. The ratings of perceived importance - high/moderate, and self-rated performance- average/poor, were summed up to determine priority rankings for continuing education. The respondents' rating of various continuing education activities, their willingness to participate and commit time, and their suggestions for strengthening faculty development were also analyzed. RESULTS: All the twelve competencies were perceived as 'highly important' by the subjects. They felt most confident in teaching in large and small groups, attitudes and ethical values, and decision making skills. The competencies prioritized as "gaps" were knowing how to develop learning resources, plan curriculum, evaluate courses and conduct research. The prioritized activities were specialized courses, orientation workshops for the new faculty, and training in educational research skills. This implied a multi-phased approach to faculty development. A majority (62.4%) were willing to devote 2.2 hours per week to faculty development. Respondents suggested initiatives that should be undertaken by the Medical Education Unit and the broader institution. CONCLUSION: We demonstrated a participatory approach to needs assessment by identifying the gaps between "perceived importance" and "self-rated performance", as criteria for determining priorities. Findings also demonstrated the need for adopting a comprehensive approach to faculty development in which both departmental and organizational initiatives are required. Our findings are applicable to the Gulf Region context and our methodology can be applied anywhere.

Faculty development and medical education units in India: a survey.

BACKGROUND: Faculty development in medical education is gaining momentum in India. While planning a National Conference on Medical Education (NCME 2007), we did a survey of principals and faculty of medical colleges to understand the status of faculty development programmes and medical education units in medical colleges in India. METHODS: Questionnaires were sent to principals of medical colleges by surface mail and to faculty through a web-based programme to elicit information on various aspects of faculty development programmes and medical education units. The responses of both groups were analysed. RESULTS: The number of medical education units has increased rapidly after regulations have been revised in 1997 by the Medical Council of India. The main activities of medical education units were to conduct workshops targeted at medical teachers. The frequently covered topics were teaching-learning, media and student assessment. Lectures dominated the methodology of imparting information. Evaluation was done mainly by feedback questionnaires and pre-test/post-test questionnaires. Projects and follow up were rarely used. The responses from both groups were strikingly similar. The major strengths of medical education units were perceived as availability of trained and motivated faculty, good infrastructure and supportive leadership. The shortcomings were lack of infrastructure, funding and full-time faculty, besides time constraints and resistance to change. The respondents suggested strengthening of infrastructure, appointment of full-time faculty and staff, incentives and recognition of contributions to faculty development, making participation a mandatory requirement, extending the scope of faculty development programmes to include research and networking at the national level. Conclusion. The study reveals the need for policy decisions that support functioning of medical education units in India besides active participation of the faculty.

From reorientation of medical education to development of medical educators.

Re-orientation of medical education in India has not been fully successful because the development of medical teacher, a critical component has not been adequately addressed. Faculty development is a key factor. We have identified six shifting trends in faculty development that can contribute to the development of a medical educator in India. These include a shift from: One time training to continuing professional development; information based approach to project based approach; training to scholarship; lack of accountability to accountability and recognition; individual efforts to networking; and role of treatment providers to health promoters. We have discussed how these shifts are in tune with the global trends. We recommend that the initiatives taken in India in the recent past, viz., constitution of a Task Force by the Ministry of Health and Family Welfare, establishment of several medical education centers should be harnessed by forming a national working group. Such a group would provide policy directions for faculty development which will lead to a concrete plan for implementation and thereby addressing a critical component of the re-orientation of medical education.

Inquiry-driven strategies for innovation in medical education: experiences in India.

Four medical institutes, viz, AIIMS, New Delhi; CMC, Vellore; JIPMER, Pondicherry and IMS-BHU, Varanasi formed a consortium to introduce reforms in undergraduate medical education. A detailed inquiry was conducted by administering questionnaires to the faculty, recent graduates and patients to identify the deficiencies in the present system. Morbidity patterns prevalent in the community at primary, secondary and tertiary care levels were determined. These were matched with the actual curricula being followed and the assessment patterns. The main findings were: inadequate emphasis on practical skills (including communication), insufficient coverage of common diseases; and neglect of behavioral, social and ethical aspects in the curriculum. Based on these findings certain corrective programmes are being introduced. The content areas in the curriculum have been classified in to 'must know', 'good to know' and 'need not know'. A list of essential skills have been identified. Steps are on to ensure that these skills are acquired by the graduates. A modular approach to the teaching was suggested and modules on some of these topics are under preparation.

Need-based undergraduate medical curriculum.

There is a growing concern over the quality of medical education for undergraduates in India. This paper is an attempt to define a need-based curriculum and outline the initiatives taken by the Medical Council of India (M.C.I.) in developing a need-based curriculum. The steps include: clear delineation of goals and objectives of education; adoption of innovative teaching and learning methodology, adjustments in the course structure, updating of course content, rationalizing assessment strategy, and emphasis on structured and skill oriented internship. For effective implementation of these measures, strategies such as establishment of Medical Education Unites (MEUs), visible funding of education, more recognition to teaching and impetus to staff development activities have been suggested.