Referral of presumptive TB among operators of community medicine outlets

BACKGROUND: Case detection is an important part of TB control programmes. In 2007, the TB programme in Ghana join the WHO´s public-private partnership with community medicine outlet operators to increase referral of persons with presumptive TB for laboratory investigation. Information on factors likely to influence referral is scarce in Ghana. We assessed these factors among pharmacists and over-the-counter (OTC) medicine sellers.METHODS: In 2019–2020, we conducted computer-assisted telephone interviews among community pharmacists and OTC medicine sellers in the Eastern Region of Ghana. We used a structured questionnaire and collected data on respondents´ sociodemographics and professional characteristics. We used logistic regression to investigate characteristics associated with self-reported referral of presumptive TB cases.RESULTS: Of all respondents who completed the interviews, 68.7% (321/467) reported having ever referred a presumptive TB case and 72.1% (336/466) had received specific training. Associated factors of presumptive TB referral were having received specific training (OR 2.7, 95% CI 1.5–4.9); performing both dispensing and managerial functions (OR 2.8, 95% CI 1.4–5.5); operating from OTC shop (OR 6.2, 95% CI 1.6–23.4) and the availability of a TB laboratory within walking distance (OR 3.3, 95% CI 1.2–9.5).CONCLUSION: Interviewees largely support TB referral. However, a significant proportion does not follow the strategy closely. We recommend more specific TB training courses.

Performance of Undergraduate Medical Students in Formative and Summative Evaluations in Community Medicine in a Medical College in India

Background: Assessment and evaluation should be a continuous activity associated with curriculum development. Continuous formative examinations are the stepping stone for good learning and better performance in summative examination. However, the correlation or predictability of formative examinations has not been quantified in the Community Medicine subject in the bachelor of surgery (MBBS) course in India. Objectives: The objective of this study was to explore the correlation of performance in continuous assessments and final summative evaluation in third-year professional MBBS students in Community Medicine and the predictability of formative scores for the final examination marks. Methods: An institution-based retrospective longitudinal study was conducted in the Medical College of Kolkata, India. A total of 237 undergraduate medical students were followed up for two years to track their results in three successive examinations. The scores obtained in formative and summative evaluations in third-year professional MBBS students in Community Medicine were analyzed to find out the correlation between them, and multiple linear regression was also performed in SPSS. Results: The strong and significant correlation (0.64) between the sixth semester and internal examination results suggests the importance of the sixth semester examination for the preparation of finals. The third semester examination, although conducted two years prior to the finals, still had significant correlation with the finals, but the correlation was weak (0.17). Conclusions: Formative examination in Community Medicine, which spans for overall three and half years, plays an essential role in the preparation of students for the finals, more so for achieving good scores. Performance in these two examinations can only explain more than one fourth of the variability of the performance in the finals.

COVID-19 Pandemic: Response by Department of Community Medicine in a Medical College of Mumbai, India

The role of community medicine in epidemiology and disease outbreaks is significant. Covid-19 pandemic was an opportunity to realize this potential.Here we present the role of Community Medicine department of a Medical College in Mumbai, which was a global hotspot for Covid -19. The responses were initiated in the first week of February, prior to the detection of the first case in the city. With the progression of the pandemic, the roles have changed and adapted accordingly. The activity of Community Medicine department is unique to this specialty and has provided a lifetime experience for its residents andfaculty.Our purpose here is to project the roles depicted in this model so that some of them can be followed by community medicine departments of other colleges and continued post-pandemic too.

Effectiveness of Educational Interventions on Internship Training in Community Medicine in a Tertiary Care Centre in Alappuzha District of Kerala, South India; A Quasi-Experimental Study

BACKGROUND India has been facing various challenges in the past decade, which include outbreaks of different communicable diseases and the rising of slow pandemics of non-communicable diseases. The current COVID 19 pandemic brings to light the need to revamp the training in public health during the internship. A standardized and outcome-based approach to internship training is the need of the hour for the Indian medical graduate (IMG). The internship program in community medicine should train the Indian medical graduate to develop patient management and administrative skills to promote health care through a health facility. The training provided is not standardized or evaluated across the medical colleges. Hence, it was aimed to study the effectiveness of educational interventions on internship training during the posting at the rural training health centre (RTHC). METHODS A quasi-experimental study was conducted among the interns posted in the rural training health centre using a validated semi-structured questionnaire as a pretest followed by a post-test after two weeks of training on the primary health care system. The perception of the students towards the training was assessed using the Likert 5 point scale. RESULTS The pre-test score was 5.30 (SD 2.105) and the post-test mean score was 9.35 (SD 2.033) [P < 0.01]. The gender-based analysis also showed significance within genders. Student perception revealed 80 % found the training useful, 90 % agreed that the guidance provided by the field staff helped them and 90 % agreed that the intervention changed their outlook towards the internship training in community medicine. CONCLUSIONS The study has brought a positive outlook towards giving adequate guidance to acquire knowledge and skills to interns by the active involvement of faculty. Rethinking and re-implementation of the existing internship training in the community is the need of the hour. KEYWORDS Internship Training, Community Medicine, Medical Education, Kerala, GMR 2019

A comparative study of community medicine and public health curriculum at medical schools in Iran and North America

Background: Community medicine and public health are the core subjects in medical education. One of the main competencies of general physicians in the national curriculum is having knowledge and skills in health promotion and disease prevention in the health system. Any curriculum revision in community medicine departments needs to incorporate the evidence and use pioneer countries’ experiences in this issue. This study aims to compare community medicine and public health courses in medical schools between Iran and selected universities in North America. Methods: The elements of a community medicine curriculum for medical students were compared in a descriptive-comparative study using the Bereday model. These elements included objectives and competencies, educational strategies, teaching and learning methods, assessment, and educational fields in a community medicine curriculum in Iran and in selected universities in North America. A literature search was conducted in CINAHL, SCOPUS, MEDLINE, Web of Science, EBSCO, and on university websites. Results: Essential aspects of community-based strategies among community medicine and public health curriculum of general medicine in universities in Canada and the United States included a longitudinal approach, training in urban and rural primary care centers, teaching by family physicians and health center staff, a spiral curriculum, focus on social determinants of health, taking of social and cultural histories and social prescriptions, learning teamwork, and using LIC (Longitudinal Integrated Curriculum). Conclusion: The objective of community medicine and public health curriculum in selected North American universities was to prepare general practitioners who work in Level 2 and 3 hospitals and to improve their skills to provide high-quality services to the community. Some of the successful points in the selected universities that could be replicated in Iranian faculties of medicine included using integration strategy, a spiral curriculum, and an LIC approach.

The contribution of family medicine to community-orientated health services in Mali: A short report

Family medicine has not received appropriate attention in the sub-Saharan African context. In particular, family medicine is rarely recognised as a medical speciality and most African countries are silent on the role of family medicine in their health systems. There is, however, an emerging interest in developing family medicine as a key component of primary healthcare. Postgraduate training in family medicine is progressing and many countries have already established specific training programmes. In addition, there have been attempts to define the importance of family medicine, which, we expect, this short report contributes to. Interviews were conducted with physicians, partners and beneficiaries of two international development projects funded by the Canadian government. The one project supports training of health professionals and the other education of healthy women and girls in the community. The objective was to document the strengthening of primary healthcare through the creation and adaptation of a new family and community medicine postgraduate medical programme (which includes both family and community medicine) emphasising field training, immersion in local communities and interdisciplinary collaboration. This article underlines the importance of family medicine in Mali by documenting how what is now termed family and community medicine can promote community-orientated health services. To do so, we use the examples of initiatives and actions done through two international health development projects.

Effectiveness of a Mindfulness and Self-Compassion Standard Training Program versus an Abbreviated Training Program on Stress in Tutors and Resident Intern Specialists of Family and Community Medicine and Nursing in Spain

Stress is one of the most common problems among healthcare professionals, as they are exposed to potentially stressful and emotionally challenging situations in the workplace. Mindfulness-based stress reduction (MBSR) training programs have been shown to decrease stress. The objective of this study was to compare the effectiveness of an abbreviated 4-weeks MBSR training program in relation to a standard 8-weeks one on the stress levels. A controlled and randomized clinical trial was designed, in which 112 tutors and resident intern specialists in Family and Community Medicine and Nursing of six Spanish National Health System teaching units (TUs) participated. Participants included in the experimental groups (EGs) received a MBRS training program (standard or abbreviated), while control group (CG) participants did not receive any intervention. The stress levels were assessed by the Perceived Stress Questionnaire (PSQ) in three different moments during the study: before, immediately after, and 3 months after the intervention. Adjusted covariance analysis (ANCOVA), using pretest scores as the covariate, showed a significant reduction in stress (F(2,91) = 5.165; p = 0.008; η2 = 0.102) in the post-test visit, attributable to the implementation of the standard training program, but without the maintenance of its effects over time. No significant impact of the abbreviated training program on stress levels was observed in the intergroup comparison. A standard 8-weeks MBSR training program aimed at tutors and resident intern specialists in Family and Community Medicine and Nursing produces significant improvements in stress levels compared with the abbreviated intervention and no intervention. New studies about abbreviated training programs are needed to provide effective treatments which improve well-being of these professionals.