Family Adoption Programme finds its place in new MBBS Curriculum

NMC mentions in the circular, "Family adoption program is recommended as a part of curriculum of Community Medicine and should begin from 1st professional year and remain throughout the curriculum. The orientation towards the same may be a part of foundation course under the theme of 'Field visit to community health centre' (8 hrs) which is already allocated to foundation course in GMER 2019. The family adoption shall include villages not covered under PHC adopted by medical college, and if travel time from college to site is more than 2 hours on week-ends, in such situation, bastis / Jhuggis/ towns or on outskirts of cities may be adopted."

Medical Dialogues had earlier reported that NMC's consideration of introducing a new Family Adoption Programme as a part of the MBBS curriculum. Such a step was taken by the top medical regulator with an aim of making healthcare services accessible in the rural areas in an equitable manner.

Earlier the possibility of including this programme under the supervision of the Community Medicine Department of every College had 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.

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 had mentioned the possibility of introducing "Family Adoption Programme" in the MBBS curriculum.

Finally making the possibility into reality, the NMC has introduced the long speculated program in its new CBME curriculum for MBBS course. The details of the program, as mentioned in the NMC circular dated March 31, 2022 are as follows:

NMC has discussed in detail regarding the features of the newly introduced Family Adoption Program. The top medical body has mentioned in the circular about the need of the program, the aim and objectives, targets that students need to achieve and other details. Besides, the circular also includes a proto-type log book that students need to maintain for Family Adoption.

• Need of the Program:

In India, around 65.5 % of population resides in rural settings (as per 2020 statistics) whereas availability of health care facilities and services are skewed towards urban set ups. Though adequate healthcare supplies exist in the community, it is the access to healthcare to a rural citizen that is a major concern. Issues like health illiteracy, ignorance about communicable and non communicable diseases, means to reach health care facility, services, take time off from their daily wages work and workforce shortages are some of the barriers that limits timely and quality health related awareness and care leading to a scenario of 'Scarcity in abundance'. Hence there is a need to take measures to make healthcare more accessible to the rural and needy population and impart community based and community oriented training to budding healthcare professionals.

• Aim:
  

Family adoption program aims to provide an experiential learning opportunity to Indian Medical graduates towards community based health care and thereby enhance equity in health.

• Objectives of the Program:

During the Medical UG training program, the learner should be able to :

1. Orient the learner towards primary health care

2. Create health related awareness within the community

3. Function as a first point of contact for any health issues within the community

4. Act as a conduit between the population and relevant health care facility

5. Generate and analyse related data for improving health outcomes and Evidence based clinical practices.

• Specifics of the Program:

Family adoption program is recommended as a part of curriculum of Community Medicine and should begin from 1st professional year with competencies being spread in ascending manner for entire MBBS training program. The orientation towards the same may be a part of Foundation course under the theme of 'Field visit to community health centre' (8 hrs) which is already allocated to foundation course as per GMER 2019.

The family adoption shall preferably include villages not covered under PHCs adopted by medical college. If transit time from college to site in more then 2 hours, then bastis / jhuggis/ towns on outskirts of cities may be considered for family adoption. Medical students may be divided into teams and cach tear may be allocated visita, with 5 families per student. These fumilice may be introduced during their first visit; however, the model may be flexible depending upon the number of students and svailable famities for sdoption. The entire team should work under a mentor teacher for entire pert of the training program.

• Other considerations:
  

Every college may arrange one diagnostic medical camp in the village wherein identification of: anemia, malnutrition in children, hypertension, diabetes mellitus, ischemic heart diseases, kidney diseases, any other local problems may be addressed.

If required, patients shall be admitted in the hospital for acute illness under care of student, charges may be waived off or provide concession or govt. schemes.

For chronic illness, students shall be involved.

Subsidized treatment charges may be provided under govt. schemes or welfare schemes.

Camps may be arranged by Dean and Community Medicine P.S.M. department with active involvement of Associate/ Asst. Professors, social worker and supporting staff, Local population may be involved with village Ieaders.

Visit by students be made to the visit as mentioned in table below. Annual follow up diagnostic camp can be continued by the PSM department. As a step towards environment consciousness, students may be encouraged for tree plantation/medicinal plants around beginning of monsoons, in the environs of the families adopted. This could be also included in the environs of the hostels/ residence of students wherever possible.

At the end of the programme, students may be envisioned to become leaders for the community.

• TARGETS TO BE ACHIEVED BY STUDENTS:

First Professional Year:

-Learning communication skills and inspire confidence amongst families

-Understand the dynamics of rural set-up of that region

- Screening programs and education about ongoing government sponsored health related programs

- Learn to analyse the data collected from their families

-Identify diseases/ ill-health/ malnutrition of allotted families and try to improve the standards

2nd Professional Year

- inspire active participation of community through families allotted

- Continue active involvement to become the first doctor /reference point of the family by continued active interaction

- Start compiling the outcome targets achieved

3rd Professional Year

- Analysis of their involvement and impact on existing socio-politico-economic dynamics in addition to improvement in health conditions

- Final visit in the last months in advance to examination schedule, to have last round of active interaction with families

- prepare a report to be submitted to department addressing:

1) Improvement in General Health

2) Immunization

3) Sanitation

4) De-addiction

5) Improvement in anemia, tuberculosis control

6) Sanitation process

7) Any other issues

8) Role of the student in supporting family during illness/ medical emergency

9) Social responsibility in the form of environment protection programme in form of plantation drive (medical plants/ tree), cleanliness and sanitation drives with the initiative of the medical student.

NMC has also mentioned in a table regarding the year-wise progress that the students are expected to make, competency that the students will achieve, suggested teaching and learning methods, suggestive assessment methods, and the required hours of teaching. Further the circular also includes the prototype log book of the Family Adoption Programme that the students need to maintain.The log book will maintain all the necessary records including name of the student, village name, Tehsil District, State/Union Terrirory, Name and status of the mentor, name and address of the ASHA worker, name and address of the families, etc.