Coming Soon: NMC plans on Introducing Family Adoption Programme in MBBS Curriculum

The possibility of including this programme under the supervision of the Community Medicine Department of every College has been mentioned in a recent paper penned down by the President of UG Medical Education Board of NMC, Dr Aruna V Vanikar and Dr Vijayendra Kumar, a member of the UGMEB.

Published in the Indian Journal of Preventive & Social Medicine, the paper titled "The family adoption programme: Taking Indian medical undergraduate education to villages", has provided a brief understanding of the availability of doctors in India when compared to the rural population.

In India, rural population constitutes about 66.7% of the country's total population with 662538 villages distributed amongst 736 districts of the country. On the other hand, when the situation of rural healthcare is taken into account, the system is plagued with inequitable access to healthcare.

AT the same time, UGMEB members have identified the lacunae of the current Indian medical education as the "'production of doctors with poor practical knowledge".

So, with the aim of making medical facilities available to the rural population in India and also to improve the practical knowledge and hands-on training of the would-be doctors, the paper written down by the President of the UGMEB, Dr Vanikar has mentioned the possibility of introducing "Family Adoption Programme" in the MBBS curriculum.

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What will be this Family Adoption Programme?

Before discussing the programme in detail, the paper has referred to the inclusion of Rural Health Training Centre (RHTC) in the subject of community health medicine. This center, owned by the college or affiliated with Government-owned Health Center, and is currently the main means to train the MBBS students and interns in community-oriented PHC/rural health care system.

Opining the need to further crystallize this programme, Dr. Vanikar in the paper has introduced the Family Adoption Programme through village outreach project.This programme, which is likely to be inculcated into the MBBS curriculum after getting clearance from the NMC, is likely to be implemented in the following steps-

1. With an aim of achieving "health for all", every new MBBS batch will be assigned to a village, not covered under RHTC. Each student might get assigned to five to seven households or more, if they wish.

2. The students would be mentored by someone at the level of Assistant Professor along with of senior resident (SR) as supportive mentors. Each mentor may take care of 25 students to guide them for conducting health education to the families/ households. So, depending on the size of the batch, e four (4) to ten (10) mentors will be required.

3. Before the students receive their fresher's welcome, they will be introduced to their corresponding village house-holds by the mentors during the induction course. During this course, a suitable time will be decided with the village head/mukhiya and a special visit might be organized twice a week.

4. The social outreach, FAP programme should be introduced by addressing the Gram Sabhas by Head of the department/ senior faculty suggested by Head of the institute accompanied by a medical social worker attached to the hospital in coordination with the department, to sensitize the villagers and gain their acceptance and confidence.

5. The MBBS students will receive training for interacting with the households and gain confidence with the families. During the visits, minimum one ASHA worker for every group of 25 students will accompany them and train them for interacting with the families and connecting with the community and assisting them in learning responsibility of an ASHA.

6. During the first year of the MBBS curriculum, minimum 10 village visits must be made. This should be followed by telemedicine practice for the next 2 years accompanied with three-monthly data collection in the first year and annual data collection subsequently. Village visit must be continued at least three times a year for these next 2 years. These visits may be counted in curricula hours.

7. These programmes can also be used for implementing the annual vaccination drives.

8. The student must maintain a log book with separate sections for each house-hold to record the data during every visit.

The logbook must contain names of every member, age (preferably with birth dates if available), sex, address of the house-hold, education of each member, employment data, size of living space and surrounding.

Further, other demographics, that may be noted down include history of illness, addictions, hobbies, interesting facts about health and house-hold, height, weight, vitals, general, oral hygiene, haemoglobin, blood sugar and urine dipstick etc.

Besides, in a matter of illness or medical emergency, the student should take initiative in being the primary contact for the family. The student should contact the respective mentors for further management of the patient and the hospital attached to the college should provide treatment facilities. The students should maintain follow-up records as well and those reports need to be periodically evaluated by the mentors with the help of senior residents.

Evaluation:

The paper indicates, that the entire datasheet concerning the FAP should be submitted by the students by the end of 6^th semester for evaluation.

"Progress notes must include every demographic point and history recorded. These should include the positive effect of visit in the form of improvement in general health, sanitation, de-addiction, whether healthy lifestyles like reading good books, sports/ yoga activities have been inculcated in the house-holds. Improvement in health, including anemia, tuberculosis control and sanitation awareness and any other issues will reflect the impact," the paper mentioned.

The paper has further referred to the possibility of including environment protection programme in the form of plantation drive (medicinal plants/trees), cleanliness and sanitation drives with the initiative of the medical student in the house-hold, as a part of social responsibility.

During the annual visits to the villages, interns, auxiliary nurse midwives/ nurses and Ayush doctors may be included where possible as a part of the team, Dr. Vanikar has suggested in the paper.

"Incentives in the form of presentation of this work at international fora, conferences, publications and awards can be provided which will make the whole project attractive for students and young faculty alike. Each college has to provide logistic support for the visit by students, faculty, and other staff to these village/s," the paper has suggested.

Positive Outcomes:

The positive outcomes that are expected of this Family Adoption Programme include the emergence of MBBS students as doctors with excellent communication skills. Further, the students are expected to learn being humane and empathize with the rural population by understanding their customs and limitations as also many positive aspects of community unity.

It is expected that the students will become better doctors with practical field training from the very beginning of the MBBS curriculum.

On the other hand, the mentors or junior faculty members will emerge as role models for the students and they might emerge as the Consultants at the rural level.

Finally, the colleges will come out as the s field health care providers with sustained activity and will be improving their image in field of medical education. Private institutes as well will be able to discharge their corporate- social responsibility and also communicate with other counterparts, governments and at international fora.

For the Government, the FAP will help realizing the motto of "health for all" and take the country forward.

Speaking to Medical Dialogues regarding the matter, Dr. Aruna Vanikar said, "These days, students are not getting enough hands-on training and they lack actual interaction with the patients and their families. This programme will help the students to become more keen and receptive healthcare workers."

Responding to the question of when this programme might be implemented, Dr. Vanikar added, "We have only suggested about this programme and the members have expressed their interest in it. Once the NMC clears it, it is expected to be included in the curriculum from the next year onwards."

"This programme will be part of the curriculum and the students details of the programme including scoring and other aspects would probably be decided by the respective colleges and universities," she added.

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