A Critical Appraisal of the New Competency-Based Medical Undergraduate Curriculum in Biochemistry.

The new competency-based medical education undergraduate curriculum (CBMC) was launched for the 2019 admission batch of MBBS students. The programme is designed to create an "Indian Medical Graduate" (IMG) possessing the requisite knowledge, skills, attitudes, values and responsiveness, so that the graduate may function appropriately and effectively as a physician of first contact with the community while being globally relevant. Given that implementation of this curriculum is still in its infancy across the country, we stand to gain from a unified approach to its implementation. Phase I of the curriculum includes anatomy, physiology, and biochemistry along with professional and personal development modules. Biochemistry enjoys an enviable position in the medical curriculum as it explains the molecular basis of diseases. We present an appraisal of the curriculum in Biochemistry by reviewing the components against Harden's six themes which are considered when planning or developing a curriculum. Further, five core components of CBME are selected on the basis of three research papers to characterize underlying assumptions of CBME to suggest ways of logical implementation for achieving the competencies expected of the Indian Medical Graduate. The insight gained shall help students to be equipped with competencies which they shall be able to use in their day- to- day work, which shall ultimately help benefit patient care and the society at large. Supplementary Information: The online version contains supplementary material available at 10.1007/s12291-022-01088-y.

Academia-industry collaboration to provide interdisciplinary experiential learning opportunities in public health professions education and improve health of female factory workers.

Background: The community medicine department of our medical school, in addition to addressing its mandate to prepare undergraduate students for primary care and graduate students for careers in public health, administers several community-based interventions. An international organization involved with improving health of female factory workers globally invited us to partner in their efforts locally. We used the Precede-Proceed model to design an intervention to deliver the desired project outcomes. Activities: : Recognizing that this partnership with industry would provide a learning opportunity to our Master's degree program students, we involved them in a needs assessment survey in order to make an educational diagnosis to identify the influencing and reinforcing factors. Our faculty and students interfaced with a multidisciplinary team including mid-level factory managers, health-care staff, and peer health educators within the textile industry. Outcomes: : Through this industry-academia collaboration, our health professions training institution was able to provide supplementary experiential learning opportunities to students in our Master's degree in Community Medicine program by involving them in all the project stages from planning based on health needs assessment, to module design, implementation, and program evaluation along with interdisciplinary teams from the textile industry. Students then reflected on their learning experience using a modified Kolbe's experiential learning cycle to improve their performance when they replicated the intervention with the next factory under the same project. Conclusion: The use of PRECEDE-PROCEED model in the industry-academia collaboration and Kolb's framework provided supplementary experiential learning opportunities for deliberate practice, receiving feedback, and reflecting on their learning to our Master's in Community Medicine degree students.

Nipah outbreak in North Kerala - What worked? Insights for future response and recovery based on examination of various existing frameworks.

Asia Pacific region has been witnessing numerous public health emergencies in recent years with the Nipah outbreak in North Kerala (2018), India, needs special mention. Threats posed and experiences gained have compelled health systems to draft frameworks nationally and internationally for preparedness, outbreak response, and recovery. Our failure to obtain comprehensive guiding frameworks for application in the Indian context for Ebola, Severe Acute Respiratory Syndrome, Influenza A (H1N1), and Nipah outbreaks led us to the search outside India for frameworks that have worked in the past. A thorough review of the WHO, Centers for Disease Control and Prevention, and Malaysian framework was done to identify explicit components and replicable objectives to the national context. In the absence of a specific framework, Nipah recovery and response experience that worked in Kerala outbreak (2018) was compared against novel H1N1 (2015) guidelines at national level. This article provides the groundwork and insights as a value addition toward an India-specific framework of action for response and recovery for Nipah outbreaks in future.

A critical review of new competency-based curriculum for community medicine using various curricular review frameworks.

The purpose of the present review is to examine the new competency-based undergraduate curriculum in community medicine against the established frameworks and criteria and suggest the way forward for achieving competencies expected of the Indian Medical Graduate (IMG). The new Graduate Medical Education Regulations, 2018, is based on Harden's concept of the curriculum. Hence, we reviewed the components of new curriculum against Harden's conceptualization of various components of the curriculum, and since it claims it is competency-based, we used Tyler's Goal/Objective-Based Evaluation. The new undergraduate curriculum has shown a move toward integration of course content and defined the competencies in more measurable terms. However, it appears that the earlier information-based curriculum corresponding to book chapters ("topics") has been modified to specify higher cognitive domains with no explicit link between the IMG level curriculum outcomes to subject level intended learning outcomes (ILOs). The mechanism to link ILOs to assessment is also not clear and so needs more clarity. The assessment system hinted at in the current document is mostly based on the existing conventional system of 50% as pass cutoff, etc., against criterion-referenced assessment applicable to competencies that need to be performed. Furthermore, there is no guidance on the creation of educational opportunities and environment for students and faculty - perhaps it is left to "Curriculum Implementation Support Programme (CISP) Workshops." Hence, the need for preparing a roadmap/blueprint to learning experiences and assessment methods and levels and milestones to be reached at various phases of MBBS and during internship is required.

Development, validation and use of appropriate assessment tools for certification of entrustable professional activities in community medicine to produce a competent postgraduate: A pilot study.

BACKGROUND: Adoption of competence-based medical education (CBME) is the need of the hour. OBJECTIVES: The objective of the study is to develop and validate appropriate assessment tools for the community medicine entrustable professional activities (EPAs) and to assess the usefulness of the validated tools in the assessment of postgraduate (PG) students. METHODS: An interventional study for 14 months was done in the department of community medicine. After the sensitization of faculty members and PGs, three EPAs were selected through consensus between faculty members and appropriate assessment tools mini-clinical evaluation exercise (Mini-CEX), case-based discussion (CBD), and direct observation of procedural skills (DOPS). Rubrics of milestones were formulated for the selected tools, and the designed tools were validated. These three validated tools were used for the quarterly assessment. RESULTS: The item-content validity index for all three assessment tools was one, while Scale Content Validity Index for Mini-CEX and CBD were 1, and for DOPS, it was 0.87. Three PG students were assessed using the validated tools thrice for the three selected EPAs. The PGs opined that assessment using rubrics made their task-specific, while faculties were quite satisfied with the assessment process as it removed subjectivity. CONCLUSIONS: The developed and selected tools of EPAs were found to have a substantial level of both face validity and content validity. The tools were also found to useful for periodic assessment in workplace settings and acceptable to both PG students and internal/external faculty members.

Are our rural adolescents eating healthy?: Implications for redesigning school health interventions - A cross sectional study in rural Coimbatore.

BACKGROUND: Adolescence is a period of transition where independence in thinking and behavior is established and food choices that are made are followed for several years, and this can influence their health in adulthood. Hence, understanding the eating habits are necessary to plan effective nutritional interventions in adolescents. OBJECTIVES: The main objective of the study is to find out the extent of malnutrition among rural adolescents as well as evaluate their eating habits against recommended dietary food groups and to compare eating habits across gender and age groups. METHODS: A cross-sectional study was done among 1425 adolescents from 13 rural schools from 2014 to 2015, and the variables considered in this study were age, sex, body mass index (BMI), and the eating habits of the adolescents. RESULTS: Undernutrition was seen among 23% and overweight/obesity among 8% of adolescents. The habit of taking milk and milk products, fruits, and green leafy vegetables were very poor among the adolescents. Significant association was found between eating habits and BMI. Furthermore, late adolescents had better eating habits, and significant gender difference was seen in certain eating habits. CONCLUSIONS: The study shows that it is possible to understand the gaps in eating habits of adolescents, and this can be used to plan tailor-made nutritional interventions to adolescent groups as their eating habits are different and have long-term nutritional and health implications.

Effectiveness of multi-strategic health screening cum educational intervention model in promoting health of school children in rural Coimbatore.

BACKGROUND: Schools are the best setting for health promotion activities, and in India, for many, the schools are in fact the only nurturing and supportive place where they learn health information and have positive behavior consistently reinforced. Therefore, health promotion addressing the nutrition and personal hygiene habits among school children would improve health of school children and mold them into healthy productive citizens of tomorrow. OBJECTIVES: The objective of the study is to find the effectiveness of multi-strategic health screening cum educational intervention model in promoting the health of school children. METHODS: A school-based intervention was designed using multi-strategic approach to promote the health of 2500 school children in 13 schools in rural Coimbatore. Logic model was used to plan the intervention, and the approach included health screening, nutrition and personal hygiene assessment and educational intervention in three phases over a period of 1 year. The multi-strategic approach comprised of approach through doctors, teachers, and through peer educators. The effectiveness of the intervention was assessed with improved nutrition and personal hygiene habits, improved body mass index status, and reduction in sickness absenteeism. RESULTS: There was a significant improvement in nutrition and personal hygiene habits among school children. There was also significant reduction in the proportion of underweight category. Furthermore, a slight increase in sickness absenteeism was observed. CONCLUSION: Our study shows evidently that a multi-strategic health screening cum educational intervention model can be implemented and can be effective in bringing changes in the nutrition and personal hygiene habits thereby promoting the health of school children.

A tool for quickly identifying gaps in diet of school children for nutritional educational interventions.

Compared to adults, assessment of dietary intake of school children has always been a great challenge in public health practice. Hence, this paper aims to share our experience in overcoming the problems in dietary assessment of large number of school children aged 6-17 years and the practicality of the tool for quickly identifying the broad gaps in the diet of individual Children for providing them dietary counseling. Based on the Indian Council of Medical Research/National Institute of Nutrition recommendations for balanced diet among school children, a simplified dietary gap assessment tool was developed to identify gross gaps in their diet and also a system of scoring it so as to measure effectiveness of the nutritional educational program. The simplified tool was effective in overcoming the challenge of making the children understand the concept of portion size by replacing it with inquiry of frequency of food intake in 'yes" or "no" terms and thereby making it easy to administer and is time efficient enough to enable a large number of students to be screened.

Early clinical exposure through innovative interactive clinical anatomy lectures.

BACKGROUND: Traditional lecture-based teaching of anatomy tends to focus on the discipline per se rather than relating it to clinical conditions. As a result, students often lose interest in the basic sciences. We hypothesized that a lecture format that encourages students to relate anatomy to case presentations might help them in appreciating clinical relevance. We therefore proposed to develop, implement and evaluate innovative interactive clinical anatomy lectures (ICALs) for first year medical students of our institution as a method to implement the 'early clinical exposure' teaching strategy being promoted by the Medical Council of India. METHODS: The first year medical students (n=150) were divided into two groups by lottery: the study group (n=75) and the control group (n=75). The study group received nine ICALs along with traditional gross anatomy lectures (TGL) and dissection. The control group received only TGL along with dissection. A post-test in clinical anatomy was conducted for both groups. The responses of the study group on TGL and ICALs on their learning and understanding of the clinical conditions were collected using the nominal group technique. RESULTS AND CONCLUSION: It is feasible to introduce early clinical exposure within lectures even with 150 students. There was a statistically significant (p<0.001) difference in the mean post-test scores of the two groups, which shows that ICALs are effective in correlating anatomical and clinical information to students. The nominal group technique responses of the study group showed that they appreciated it as a better method of teaching and learning.

Effectiveness of tobacco counseling training module (TCTM) in enhancing the knowledge, attitude, ability to identify oral manifestations, self-confidence, and skills (KAASS) in tobacco counseling among undergraduate dental students - An interventional study.

BACKGROUND: Tobacco use has emerged as a major public health issue with increasing tobacco-related morbidity and mortality. Despite evidence that even brief tobacco counseling by health care professionals is effective in motivating a tobacco user to quit, there was a lack of customized tobacco counseling training module (TCTM) for students of dentistry in their existing curriculum. This study was undertaken to evaluate the effectiveness of a customized TCTM in improving KAASS in tobacco counseling among undergraduate dental students. METHODS: TCTM that was previously pilot tested was implemented as a value addition in Public Health Dentistry for two academic years. Changes in knowledge, attitude, ability to identify oral manifestations, self-confidence, and skills (KAASS) in tobacco counseling were assessed before and after implementation of TCTM. Mean pre and post intervention scores were compared. RESULTS: Mean scores for knowledge, attitude, ability to identify oral manifestations, and self-confidence (KAAS) at baseline were 4.4 ± 0.9, 5.1 ± 0.7, 4.5 ± 1.1, and 1.3 ± 0.4, respectively. Mean KAAS scores post intervention were 13.5 ± 1.0, 8.7 ± 0.4, 9.4 ± 0.7, and 3.5 ± 0.5, respectively. There was a significant improvement in the mean KAAS score post intervention compared to baseline. Tobacco counseling skills also significantly improved among the participants following implementation of the training module (68.8%) did well compared to the baseline (0%). CONCLUSION: TCTM was effective in enhancing knowledge, attitude, ability to identify oral manifestations, and self-confidence in tobacco counseling among undergraduate dental students.

A qualitative analysis of an interactive online discussion by health professions educators on education research.

INTRODUCTION: In view of increasing demand for reforms in medical education in India, it is important to generate evidence through education research to increase the relevance and improve the quality of medical education. Education research is still at a nascent stage in India for a number of reasons. This study elicited health professions educators' views about the dearth of education research in Southeast Asia and what is needed to improve it. METHODS: Qualitative content analysis of an interactive, online discussion on 'education research' between PSG-FAIMER Regional Institute fellows and faculty was carried out. RESULTS AND DISCUSSION: Forty-four health professionals exchanged approximately 492 email messages during the discussion. One main concern expressed within the group was that the medical curriculum was not in tune with the health care needs of the society and reforms in the curriculum should be based on research. Most fellows felt that their work in education research was not appreciated in their schools. Participants felt that education research was done for altruistic reasons and only by self-motivated faculty. Participants also said that regulatory bodies were not concerned about the quality of education and its related research. Measures that could improve education research also emerged during the discussions. Interactive online discussions elicited important issues about education research in India. Participants noted that there is no recognition or rewards to encourage faculty to conduct education research. They also said that there is need to educate faculty about changes elsewhere in medical education and to make them more aware of education research generally.

Designing flipped classroom using Kemp's instructional model to enhance deep learning and self-directed collaborative learning of basic science concepts.

BACKGROUND: The flipped classroom pedagogy allows students to introduce a topic and gather their own meanings outside of the classroom, then explore the topic and create their meanings or exclude their misconceptions during class. Our aim was to enhance the ability of self-directed learning (SDL) among medical undergraduates. Pedagogical benefits of the model are highlighted along with potential challenges to its use. MATERIAL AND METHODS: Kemp's Instructional model was used to design flipped classroom. Need analysis was done to assess the perceptions of the students on the current teaching practices and their expectations for adoption of innovative methods. Validation of content was done by Delphi method by subject experts across the institutions. Content included objectives; case scenarios and extended multiple choice questions. Students were divided into two groups. Group A and Group B, 50 in each. A topic was given 1 week prior and both groups were subjected to a pretest to identify their self-study performance. Group A was exposed to 4 sessions of flipped classroom. They were provided with PowerPoint slides with voice recordings. In the classroom, first 30 min was meant for quiz and next 30 min was meant to clarify the doubts. Group B were exposed to the 4 regular lecture sessions. Both the groups were subjected to the posttest and test after 4 weeks. Later with another topic, flipped classroom was conducted for all the 100 students and the feedback was taken from all the students and faculty using a validated questionnaire. RESULTS: Posttest scores of students who were flipped were statistically significant (p < 0.001). Most (98%) students opined that these interactive sessions evoked interest in the topic. Flipped classroom sessions were found to be effective in improving students' learning behavior toward SDL, collaborative learning skills and critically analyzing the basic concepts. CONCLUSIONS: By following a systematic process (Kemp's instructional Model, it is possible to design need-based flipped classroom sessions. They are found to be effective in improving students' learning behavior toward deep learning, self-efficacy, SDL, collaborative learning skills, critically analyzing the basic concepts. In a flipped classroom, "the learning environment transforms into a dynamic and more social space where students can participate in critiques or work through problems in teams.

Replicating the Kerala State's Successful COVID-19 Containment Model: Insights on What Worked.

Although Kerala was the first state in India to report COVID cases, it was well prepared drawing on its past experience in managing effectively the Nipah outbreak and Kerala floods. It knew and initiated the measures required for containment because of its prior experience with mobilizing community-based groups, involvement of local-self government in decentralized planning, and participation in the containment and relief measure as well as a system-ready health system and infrastructure. The measures taken to "flatten the curve" that is unique to Kerala and the determinants of success are described in detail as "what worked" using the framework we developed post the Nipah outbreak containment experience. These are being shared with the hope that the insights these measures undertaken by the state provide can be used elsewhere to translate and replicate components that work.

Preventing "Neurophobia": Remodeling Neurology Education for 21st-Century Medical Students through Effective Pedagogical Strategies for "Neurophilia".

Neurology has a reputation, particularly as a complex "head-to-toe" discipline for undergraduate medical students. Neurophobia syndrome, a global phenomenon, fundamentally stems from pedagogical deficiencies during the undergraduate curriculum, the lack of vertical integration between basic neurosciences and clinical bedside neurology, the lack of clinical reasoning exercises, cognitive heuristics, and clinical problem-solving, errors in diagnostic competence, and hyposkilia. This ultimately results in poor clinical competence and proficiency in clinical neurology and causes attrition in nurturing a passion for learning the neurology discipline. This article explores plausible factors that contribute to the genesis of neurophobia and multifaceted strategies to nurture interest in neurosciences and provide possible solutions to demystify neurology education, especially the need for evidence-based educational interventions. Remodeling neurology education through effective pedagogical strategies and remedial measures, and using the Miller's pyramid, would provide a framework for assessing clinical competence in clinical bedside neurology. Technology-enhanced education and digital classrooms would undoubtedly stamp out neurophobia in medical students of the 21st century. It will not frighten off another generation of nonneurologist physicians to empower them to hone expertise in order to tackle the increasing burden of neurological disorders in India. Furthermore, promoting neurophilia would facilitate the next generation of medical students in pursuing career options in neurology which would be quintessential not only in closing India's looming neurologist workforce gap but also in fostering interest in research imperatives in the next generation of medical students.

Enhancing the Clinical Reasoning Skills of Postgraduate Students in Internal Medicine Through Medical Nonfiction and Nonmedical Fiction Extracurricular Books.

OBJECTIVE: To improve the clinical reasoning skills of postgraduate students in internal medicine through 2 kinds of extracurricular books: medical nonfiction and nonmedical fiction. METHODS: Clinical reasoning is difficult to define, understand, observe, teach, and measure. This is an educational innovation under an experimental framework based on a cognitive intervention grounded in constructivist and cognitivist theories. This study was conducted from June 1, 2014, through May 31, 2015. It was a pre-post, randomized, controlled, prospective, mixed-methods, small-group study. The intervention was through medical nonfiction and nonmedical fiction books. The process was structured to ensure that the students would read the material in phases and reflect on them. Clinical reasoning (pretests and posttests) was quantitatively assessed using the Diagnostic Thinking Inventory (DTI) and clinical reasoning exercises (CREs) and their assessment using a rubric. A qualitative design was used, and face-to-face semistructured interviews were conducted. RESULTS: Posttest total scores (DTI=188.92; CREs=53.92) were higher for the study group after the intervention compared with its own pretest scores (DTI=165.25; CREs=41.17) and with the pretest (DTI=159.27; CRE=40.73) and posttest (DTI=166.91; CREs=41.18) scores of the control group. Interviews with the study group confirmed that the intervention was acceptable and useful in daily practice. CONCLUSION: We introduced, evaluated, and proved an approach to teaching-learning clinical reasoning based on the assumption that the clinical reasoning skills of postgraduate students in internal medicine can be enhanced through 2 kinds of extracurricular books and that fun as well as interest will enhance learning. This study is not only about teaching-learning clinical reasoning but also about the humanities in medical education.