Community-based Advocacy Communication Social Mobilization (ACSM) intervention by empowering key community leaders: Evaluation using the RE-AIM framework.

Background: Based on the theme of World Tuberculosis (TB) Day 2018-"Wanted Leaders for TB free world," various studies and country-level project have witnessed how training leaders on TB has helped enhance TB awareness in the community. This study was conducted to evaluate the effectiveness of Advocacy Communication and Social Mobilization (ACSM) intervention strategy through key community leaders, using Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Materials and Methods: This study was undertaken by the Department of Community Medicine, Sri Manakula Vinayagar Medical College and Hospital (SMVMCH), Puducherry, in the field practice area of Primary Health Centre (PHC), Thirubuvanai. The STOP TB, ENGAGE-TB, and National TB Elimination Program (NTEP) guidelines were used for interventions. Key community leaders (KCL) list (N = 117) was obtained from Mannadipet commune panchayat and PHC. The study was conducted in four phases: phase 1 (baseline): quantitative data: proportion of presumptive TB cases from notification register; phase 2 (intervention): training program for staff nurses, auxiliary nurse midwife (ANM), Accredited Social Health Activist (ASHA), and Anganwadi workers (group activity), participatory rural appraisal (PRA) activity for self-help group (SHG) leaders, and health education session for religious leaders and ex-panchayat leaders; phase 3: strengthening of ongoing activity: health education session and active case finding for TB; and phase 4: end line: outcome of the intervention, evaluated using the RE-AIM framework. Results: As an outcome of the intervention, there was a marginal increase (21 cases) in the proportion of presumptive TB cases when comparing before (2018) and after (2019) intervention. The proportion of presumptive TB cases identified and referred by KCL was 312. A total of 77 presumptive TB cases were identified through community-based active case finding (ACF). Two sputum samples (on the spot early morning) were collected and sent for Cartridge-based nucleic acid amplification testing (CBNAAT), of which three cases were positive. Conclusion: This study was community led and involved leaders from diverse backgrounds, optimizing the chance of success. For sustainability, we have initiated TB support group.

'Student centered approach' in implementing community based active case finding for tuberculosis in rural, Puducherry - A qualitative evaluation.

BACKGROUND: As a part of Competency Based Medical Education (CBME) the competencies related to Communication skills, survey technique, can be improvised by exposing the students in community based Active Case Finding for Tuberculosis which helps in sustaining the activity. METHODS: Community based house-to-house survey using "Student centered approach" was carried out to identify Presumptive TB cases as per the program definition among fourteen villages covered by Thirubhuvanai, Primary Health Centre. The team comprised of trained MBBS student, medical interns supervised by Post graduates, Medical social workers posted at the Department of Community Medicine, of a medical college, Puducherry. After training Mobile based application (Epicollect5) was used for survey. Feedback from students were obtained to explore their experience from ACF. Free listing and pile sorting was done among interns to explore their experience on Epicollect using Visual Anthropic software. RESULTS: The major learning of the medical students from ACF activities were communication skills, rapport building with the community people, Screening for TB and their problem. Free listing identified 14 salient variables depending on the cut-off value of 0.083 (Smith's Salience Score) and subjected to pile sorting. Cognitive map identified their experiences into three categories namely knowledge on TB screening, uses of Epicollect and paper-based questionnaire. Totally 19,134 households were screened, among them 77 presumptive TB cases were identified, three positive pulmonary TB cases were detected and linked to TB care pathway. CONCLUSION: "Student centered approach" proved to be effective strategy in ACF for TB from student's reflection. This rigorous ACF outreach activity shares dual benefits individual and community level benefit and also programme level benefits. Implementing this approach of involving MBBS students in ACF activity was successful and it is feasible to continue every year propounded by National TB Elimination Program (NTEP) guidelines.

Implementation and Evaluation of Competency-based Medical Education in Phase I of Undergraduate Medical Curriculum.

Introduction: Adaptation to the "Competency-based Medical Education" (CBME) is a major challenge faced by medical colleges all over India. Hence, the present study aimed to evaluate the mechanisms adopted in the process of implementation of CBME in Phase I at our institution. Methods: In this qualitative study, 12 faculty members including professors, associate professors, assistant professors, and tutors from preclinical departments of the first professional year participated as the study participants. Focus Group Discussion were conducted with the participants regarding the strategies adopted and the challenges faced in implementation of CBME. Gap analysis was done based on the guidelines from CBME modules. In depth interview was conducted with the heads of the pre-clinical departments to propose appropriate action plans. The interviews were audio-recorded and thematic analysis of the transcripts was done. Results: The crucial areas identified were the implementation of early clinical exposure, AETCOM, integrated, and skill modules during the COVID pandemic. The faculty expressed lack of clarity in designing the sessions for "Self-Directed Learning". Tapering the content relevant to basic sciences was a major challenge faced in the integrated sessions. The faculty members requested sensitization to different student centric instructional methods for small group teaching and guidelines for valid assessment strategies. Conclusions: Acquisition of competencies is enhanced by appropriate instructional methods and effective assessment strategies. Frequent and constant hands-on training on the CBME modules through "Faculty Development Programs" plays a crucial role in the successful implementation of CBME.

'Learning from home': role of e-learning methodologies and tools during novel coronavirus pandemic outbreak.

BACKGROUND: During the crucial time of coronavirus pandemic, education is being remodelled: opening the doors of electronic learning (e-learning). The review emphasises on the various e-learning methods that can be used in the current scenario. METHODS: The review was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines on databases, namely, PubMed, Google Scholar and Cochrane. Out of 1524 identified articles, after the process of screening and based on the eligibility criteria, 45 full-text articles were reviewed. RESULTS: Though there are many caveats on the path of successful implementation this is the right time that we step towards e-learning. The article discusses the methods and tools in e-learning that can modify the traditional ways of content delivery, record maintenance, assessment and feedback. CONCLUSION: During the period of 'planet arrest', when the whole world is locked down with the motive of social distancing, let us stay connected with e-learning.

Learning experience of undergraduate medical students during 'model preparation' of physiological concepts.

PURPOSE: Learning physiological concepts and their practical applications in the appropriate contexts remains a great challenge for undergraduate medical students. Hence the present study aimed to analyze the learning experience of undergraduate medical students during an active learning process of 'preparation of models' depicting physiological concepts. METHODS: A total of 13 groups, involving 55 undergraduate medical students with three to five individuals in each group, were involved in model preparation. A total of 13 models were exhibited by the students. The students shared their learning experiences as responses to an open-ended questionnaire. The students' responses were analyzed and generalized comments were generated. RESULTS: Analysis of the results showed that the act of 'model preparation' improved concept understanding, retention of knowledge, analytical skills, and referral habits. Further, the process of 'model preparation' could satisfy all types of sensory modality learners. CONCLUSION: This novel active method of learning could be highly significant in students' understanding and learning physiology concepts. This approach could be incorporated in the traditional instructor-centered undergraduate medical curriculum as a way to innovate it.

Evaluation of medical interns' learning of exposure to revised national tuberculosis control programme guidelines.

BACKGROUND: As per the Medical Council of India (MCI), the posting in the Chest and TB department is elective during internship. Hence, they lack hands on exposure to various components of RNTCP programme. This gap in treating TB patients by using RNTCP guidelines may be bridged by sensitizing the interns through early exposure of medical interns to training programmes. OBJECTIVE: The workshop was conducted and evaluated, 1) To know learners' immediate reaction and 2) To know its effects on their learning and practice. METHODS: A series of training workshop on RNTCP guidelines was organized for Interns by the Core-committee of the State Task Force (STF), RNTCP and Department of Community Medicine, Sri Manakula Vinayagar Medical College and Hospital (SMVMCH), Puducherry, during January 2012-November 2012. A Pre and Post test self-administrated questionnaire, immediate feedback and other open-ended feedback after six months was obtained from Interns to know its effect on their clinical practice. RESULTS: The pre and post test mean scores were highly significant (p<0.001). In the analysis of feedback, the consensus score for all the responses was above 75%. As per the responses of the feedback from interns taken after six months, the three broad categories of common responses from the manual content analysis emerged were: 1) Effect of training in patient care, 2) Acquaintance of RNTCP Guidelines, 3) Future Plan of application of lessons learned. CONCLUSION: This training programme has been well received by the medical interns and has now been incorporated as a regular activity for the Interns posted in the Department of Community Medicine.

Epidemiology of injury in rural Pondicherry, India.

BACKGROUND: To find out the prevalence of "all" injuries, its nature, outcome and sources of treatment among rural population of Pondicherry. METHODS: It was a triangulated study of quantitative (survey) and qualitative (Focus Group Discussion, FGD) methods. The trained second year medical undergraduate students paid house visits to all houses in five feasibly selected villages of our field practice area. The students interviewed the housewife and obtained information for all injuries for each family member in last one year and its sources of treatment. We could obtain information for 1,613 (96.7%) households. Post-survey, FGDs were undertaken to explore the various traditional treatments for the common injuries. The data was entered and analyzed using Epi_info 6.04d software package. RESULTS: Overall, the prevalence of all injury among all age groups was 30.6% in last one year. Injuries were significantly more after 18 years of age and among men (p was less than 0.001). About 99.2% injuries reported were accidental and majority (58.2%) went to government doctor for treatment. Most common causes of injuries were fall on the ground from height or due to slip (7.4%), road traffic accidents (5.6%), agriculture related injuries (5%) and bites by scorpion/insects/snakes /dogs (4.1%). FGDs explored some potentially harmful traditional remedial measures at village level such as application of mud or cow dung on the injury and burning the site of thorn prick on foot sole. CONCLUSIONS: Considering the high prevalence of all injuries related to road traffic accidents, fall from height and agriculture work related injuries across all age groups, especially among men and some potentially harmful traditional treatments, an intervention in the form of targeted injury prevention program for different age and sex group, focusing health education efforts based on local epidemiology and behavioral practices is needed.

Epidemiology of childhood injuries in rural Puducherry, South India.

OBJECTIVE: To study the epidemiology of injuries among children (<14 years) in a rural population. METHODS: The present Cross Sectional Study was undertaken in rural Pondicherry. The trained second year medical undergraduate students paid house visits to all houses in five feasibly selected villages. The students interviewed the mother of children aged < 14 years and obtained information on injuries in last 1 year and its sources of treatments. The authors could obtain information for 1,613 households (96.7%). The data was entered and analyzed using Epi_info 6.04d software package. RESULTS: Overall, prevalence of injuries among below 14 years was 23% in the last 1 year. The prevalence of injuries among infants, 1-4 years children and 5-14 years children was 32 (15.2%), 110 (24.5%) and 274 (23.7%) respectively. Prevalence of injury was significantly higher among male children (p = 0.001). All injuries were accidental and 68.2% injuries occurred in home environment followed by that in school. Source of treatment for majorities of injuries (58.4%) were government doctors. Notably, village level Anganwadi workers (AWW) or Auxiliary Nurse Midwife (ANM) were not consulted for the treatment. Falls were the leading cause of injury. Fall on ground from height, burns, bite by scorpion/insect/snake/dogs, and road traffic accidents were the four leading causes of injury among children. CONCLUSIONS: There is a need for community based health education intervention for mothers, caregivers, school teacher and capacity building of village level health workers such as ANM and AWW. Health education message should include preventive measures for the leading causes of childhood injuries.