Nurturing Care Interventions for Realizing the Development Potential of Every Child: From Pilot to Scale Up in Maharashtra.

The WHO-UNICEF nurturing care framework (NCF) for early childhood development provides a roadmap for action, focusing on pregnancy and the first three years of life. It emphasizes the need to invest in capacity building and empowerment of service providers, families and communities to create a conducive environment that promotes child development. We describe our experience of implementing nurturing care interventions, beginning with a pilot project in Maharashtra covering a population of 10000 to and scaling it up to a model called Aarambh (the beginning), catering to a population of 1,500,000. Opportunities available within the existing services across multiple sectors were used; Integrated Child Development Services (ICDS) scheme, the health sector, and others. It utilized multiple approaches for promoting NCF within families; home visits by frontline workers (FLWs), mothers' meetings, growth monitoring and promotion sessions, and community-based events as key opportunities. Joint training for FLWs, establishing supervisors of FLWs as their trainers, and an interactive training curriculum were critical elements identified for the success of the model. An environment of appreciation for the FLWs and their supervisors helped build their confidence and helped them own the interventions.

Practice-based Learning and Improvement (PBLI) in Postgraduate Medical Training: Milestones, Instructional and Assessment strategies.

Patient-safety and quality-improvement are high-priority issues. One of the ways by which this can be implemented is by training residents to gather and appraise scientific evidence, as well as to evaluate their own patient-care practices. This competency is called Practice-based Learning and Improvement (PBLI). Training in PBLI provides residents with skills and knowledge necessary to reflect on their own strengths and deficiencies, identify their own learning needs, and engage in learning for improvement. PBLI also involves teaching residents to access and integrate literature by using scientific evidence and practice experience to make better clinical decisions. Training in PBLI has been found to lead to better health outcomes. We recommend explicitly incorporating elements of PBLI training and assessment in the present residency training curriculum in India. Implementing PBLI training and assessment will also require capacity-building through targeted faculty development programs.

Teaching and Assessing Communication Skills in Medical Undergraduate Training.

Good communication skills are essential for an optimal doctor-patient relationship, and also contribute to improved health outcomes. Although the need for training in communication skills is stated as a requirement in the 1997 Graduate Medical Education Regulations of the Medical Council of India, formal training in these skills has been fragmentary and non-uniform in most Indian curricula. The Vision 2015 document of the Medical Council of India reaffirms the need to include training in communication skills in the MBBS curriculum. Training in communication skills needs approaches which are different from that of teaching other clinical subjects. It is also a challenge to ensure that students not only imbibe the nuances of communication and interpersonal skills, but adhere to them throughout their careers. This article addresses the possible ways of standardizing teaching and assessment of communication skills and integrating them into the existing curriculum.