Author: ahpeindia

Humanities

Using paintings in the health humanities: Dr P Ravi Shankar

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Health humanities use subjects traditionally known as the humanities for specific purposes in health professions education. Various subjects like literature, philosophy, drama, music, and fine arts are used to explore various topics in the health humanities. Different teaching-learning activities like book readings, role-plays, critical analysis, musical performances, painting, and photography are used. Paintings have been used in several countries.

Using paintings in health professions education (HPE)

In many western nations, students visit museums accompanied by their teachers and art curators from the museums. They work in groups and critically analyze the paintings. Paintings have several advantages in the education of healthcare professionals. They can introduce students to unfamiliar and problematic life situations, help them understand the patient perspective, empathize with sickness and suffering and help them express their emotions. Students with artistic skills have also been encouraged to paint and selected paintings have been displayed in exhibitions in institutions and online collections.  

Paintings have the advantage of not having a language barrier, a problem in many developing countries. Due to various reasons, the language of instruction for the health sciences in many nations is European colonial languages. Paintings do not have this limitation though the identification with the scenes and characters depicted in the paintings may be more difficult if they are from a western setting and a historical time period. However, paintings can also be used to introduce students to important moments in the history of medicine. Important figures and events in traditional systems of medicine can also be highlighted. Students also gain knowledge of important art works and artists who have explored the human condition.  

Robert Pope was a Canadian artist who died young from Hodgkin’s lymphoma and his work is showcased at the Robert Pope archive. The artworks of Robert Pope dealing mainly with the patient perspective on cancer have been used by several educators during health humanities sessions. Student submissions to art competitions held at the International Medical University, Malaysia from 2012 are showcased at the Inspire gallery   

Online art collections

Access to online art collections is available through the following links: The Met Collection, National Gallery of Art, Open Culture website, Google Arts and Culture Collections, the NYU Literature Arts and Medicine Database, A museum of many artists (MoMA) and https://artsandculture.google.com/ among other collections. Access to art from India is more limited though Kamat’s Potpourri offers access to a good collection of paintings.

Visual thinking strategies (VTS)

Visual thinking strategies (VTS) have been widely used. Astute observation is fundamental to the practice of medicine. Visual arts depend on attention to detail and have been shown to improve the observation skills of physicians. VTS developed by Abigail Housen and Philip Yenawine encourages thoughtful discussion of and engagement with art. The method uses three questions to focus on observations. What do you see? Why do you say that? What else do you see? The method also improves the tolerance of ambiguity and promotes teamwork and interprofessional collaboration. The patient-practitioner relationship is strengthened, and patient-centered care can be provided. Students work in groups and learn to communicate with each other and listen and work together to analyze the painting.   

The skills developed while analyzing paintings can be transferred to clinical settings. Students practice and reflect on clinical observation and develop habits to help in the effective observation of patients. VTS is grounded in the educational theories of Lev Vygotsky and knowledge is built through the process of interaction between the learner and others through the process of scaffolding. Social constructivism and creating knowledge with others are the basis of his educational philosophy. Like other learning activities creating a safe environment is important. Paintings have several important benefits in educating health professionals and can be incorporated without major problems into health humanities modules.   

(Dr P Ravi Shankar is a faculty member at the International Medical University Centre for Education (ICE), in Kuala Lumpur, Malaysia. He is a PSG-FAIMER Fellow and has an enviable list of publications in several areas in medical education, specially in the health humanities)

AHPE Official

Message from President AHPE 2022: Dr Anshu

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It is a privilege and an honour to be given the responsibility of leading the Academy of Health Professions Educators as its President for 2022. I have been lucky to be associated with this organization since it was a fledgling idea, and have seen it grow from a concept to a functional body. In the process, I have had the opportunity to be mentored by several giants in medical education.

We are at crossroads. Since competency-based medical education has been introduced in a nation-wide process, teachers and institutions have had to adapt quickly and on many fronts. The process includes concepts which the faculty themselves have not experienced as students. So, understandably the journey is expected to be a bumpy ride. Since 2019, a lot of med-ed jargon such as, early clinical exposure, self-directed learning, clerkship, integration, flipped classrooms, simulation-based learning, workplace-based assessment, etc. have been making the rounds. As an Academy we have had the expertise and the opportunity to provide the scaffolding and make these concepts easy to implement. This has been done through regular webinars through the AHPE forum. These webinars are freely accessible through our website. Furthermore, our members have been conducting faculty development programmes both offline and online.

In the last decade, the National Conferences in Health Professions Education (NCHPE) have become a common meeting ground where faculty of all specialities have had the opportunity to air their concerns and get solutions. Each year they are based on a relevant theme, and it is heartening to see the quality of educational research presentations improve. Building this community of practice is an important achievement, for it is through informal interactions that ideas and networks proliferate.

At the AHPE, our endeavour will be to empower our faculty to grow together. There have been attempts to give representation to faculty of all health professions, from different parts of India, and to learn from each other. Newer ideas will always be welcome and we will always look out for enthusiastic faculty to take this journey forward. We intend to work with the regulatory bodies, and represent diverse points of view, because the answers are never in black and white. Academic debates and discussions are a sign of a healthy, growing and aware society.  

There are several areas which need our attention. And the quality of medical schools is foremost on our minds. As the numbers of colleges increase, we need to keep tabs on the quality of teaching-learning and assessment. Quality cannot be achieved with minimum faculty, neither can there be shortcuts in this journey. The quest for excellence demands adequate manpower, transparency, delegation of work, accountability, supervision, monitoring and integrity.

I am lucky to have stood on the shoulders of my distinguished predecessors and seen their vision for this Academy. With their guidance and with the support of my accomplished team members, I wish to take small steps towards this dream. We might not be able to achieve it all immediately, but every step in this journey will make a small difference. And therefore each little contribution from the AHPE members matters. Please feel free to reach out to us with fresh ideas and suggestions.  

With warm regards,

Anshu

President, AHPE, 2022

Obituary

In Memoriam: Dr Rita Sood

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The members of the Academy of Health Professions Education (AHPE) are extremely distressed to learn about the demise of Dr Rita Sood on 8 April 2021. Dr Sood was the Founder-President of AHPE. One of India’s foremost medical educationists, she paved the way for the future of the country’s health professions education activities along with her colleagues, and mentored a whole generation of medical teachers.

Dr Rita Sood was Professor of Medicine and Professor In-charge of the Centre for Medical Education and Technology (CMET) at the All India Institute of Medical Sciences. She was trained in medical education at Dundee, UK in 1990 and involved in the faculty development activities of the Centre for Medical Education and Technology (CMET) at AIIMS since its inception in 1990. She was actively involved in the various educational projects including the WHO sponsored consortium project ‘Inquiry driven strategies for innovations in medical education. Dr Sood was the chief editor of two books on medical education: Assessment in Medical Education – Trends and Tools (1995) and Postgraduate Training in Medicine- Key Issues (2002, for the Indian College of Physicians). She has also published extensively in peer reviewed journal and written chapters on medical education. She served as short-term consultant to UNICEF and temporary advisor to WHO for issues related to medical education. She was a Fellow of the FAIMER institute, Philadelphia, USA and course faculty for all the three regional FAIMER institutes in India. She represented India and was President of the South-East Asian Regional Association for Medical Education (SEARAME).

For us at AHPE, Dr Rita leaves behind a legacy of erudite work, and fond memories. She was the pioneer who had organized the first National Conference on Medical Education in 2007, and now the national conferences have been held for more than a decade, expanding each year. She was the epitome of grace, and in her own soft spoken style, she had supported and mentored many a Fellow who was venturing into medical education. She will be missed immensely for her leadership, wisdom, humility, counsel, grace and elegance.


On behalf of AHPE, we offer our deepest condolences to her bereaved family and wish them strength to bear this loss.

AHPE Official

Message from President AHPE 2021: Dr Vivek Saoji

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I am happy to take over as President of Academy of Health Professions Educators (AHPE) India, an organization of enthusiastic, energetic and erudite educators across all the disciplines of Health Science in India.  At the outset I thank the AHPE for giving me this honour and opportunity to serve the academy, which I shall do to the best of my abilities.

Currently, we are going through both unprecedented as well as exciting times. Unprecedented because COVID-19 has ravaged our lives like never before, it has disrupted our lives in health, economy, and education, social, cultural and all other aspects.  Education, particularly Health Professions Education (HPE) has been the biggest casualty of this pandemic, nevertheless it has opened up new opportunities and a new normal is evolving.

It is also exciting time because a lot is happening, particularly in HPE. COVID has compelled us to use technology in our teaching-learning process. We were talking about blended learning and flipped classroom, simulation-based learning and use of technology in teaching-learning but sparsely use it.  COVID has fast forwarded all this, the lessons learned during this time will certainly be useful for enhancing the learner experiences and overall enhancing the teaching-learning process. 

Secondly, the roll out of new Competency-Based Medical Education (CBME) curriculum by the MCI/NMC.  This paradigm shift has changed the focus from discipline-based, traditional curriculum to competency-based, integrated curriculum, here the emphasis of all the teaching-learning activities is on “ability to do and/or perform”, rather than ability to know.  The challenge and the responsibility on all of us is to successfully navigate through these changes, adapt to new normal as early as possible as well as to successfully implement the much needed CBME curriculum.

We at the AHPE have the onus and responsibility to be leaders in bringing about this change, empower and encourage our faculty, help to fulfil the aspirations of our faculty and students and finally be the change we want it to happen. 

It will be my endeavour to carry on the good work of my predecessors, and create innovative opportunities for capacity building in HPE. I want to take all the specialities in Health Sciences together, foster interdisciplinary and interprofessional collaborations, promote the concepts of educational scholarship and bring HPE with global standards. Finally our ultimate goal is to carve out Competent, Confident, Compassionate and Creative physicians out of novices.  I am sure you will join with me in this journey.

Best wishes

Sincerely,

Dr Vivek A Saoji

AHPE Official

Message from AHPE President 2020: Dr Arun Jamkar

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Let me first profusely thank the Academy of Health Professions Educators (AHPE) for nominating me as President of this prestigious organisation that is tirelessly working for improving quality medical education across the country.

From the time of my tenure as Vice Chancellor of the Maharashtra University of Health Sciences (MUHS), I have been passionately pursuing the implementation of competency-based medical education (CBME). We took several steps to start this reform in the MUHS and we had taken efforts to have faculty development in CBME under the guidance of Dr NG Patil. The MUHS was first to take curricular initiatives in competency-based medical education.

We need to congratulate the Board of Governors (BoG), Medical Council of India (MCI) for starting the long-awaited CBME programme in the MBBS course which was envisioned in the Vision 2015 document, and introducing reforms accordingly. The CBME committee of MCI under the chairmanship of Dr Avinash Supe has done an enormous job by creating the whole curriculum with all its microdetails. The MCI was able to start this programme in year 2019 in a phased manner. Because of the efforts of the committee, faculty development required for CBME is being done systematically through MCI-recognized nodal and regional centres all across the country.

I am happy that this dream and passion of all medical educationists across the country is being fulfilled. Now, it is the turn of us AHPE members, as the biggest pool of medical educationists in the country, to rededicate ourselves for effective implementation of CBME across the country.

We need to communicate to the BoG and the forthcoming National Medical commission to assure our assistance and co-operation for the implementation, especially once phase 2 and phase 3 (para-clinical and clinical subjects) will be introduced.

Recently, the BoG has declared the EXIT examination. The next important step will be to study and research assessment of medical graduates to thoroughly prepare for EXIT exam after 5 years. Research need to be done develop a model for the exam process, and convince legal experts and other concerned authorities for having multiple question paper-based exams at different centres across the country. We, as medical educationists, need to work on getting away from the recall system, and implement question papers which have questions which are creative and promote analytical skills.

Technology for implementing CBME as well as evaluation needs to introduced. India being a software nation, does not have a dearth of talent in this regard. Therefore, this challenge must be undertaken.

Students are our important stakeholders. We should start a Student Wing to get a 360° feedback from students for reforms in medical education and make our education system more student-centered.

Since we are an Academy of Health Professions Educators, we need to work towards developing interdisciplinary collaborations and dialogue, particularly with respect to technology, for dental, nursing, physiotherapy and AYUSH education.  

All this will continue to develop through AHPE webinars, newsletters, academic linkages, creating distance learning modules and strengthening the role and participation of Health Science Universities by involving their Vice Chancellors.

I am proud to have a dedicated Executive Committee and wish to thank them for the time they contribute to AHPE. With their support and an active AHPE membership, we need well-planned and coordinated efforts to convert this dream into a reality.

Dr Arun Jamkar

CBME

Early Clinical Exposure: Concerns and Challenges: Dr Munira A Hirkani

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Early Clinical Exposure (ECE) is a teaching-learning methodology, which fosters exposure of medical students to patients as early as in the first year of medical college. The goals of ECE are to provide social relevance and a context for application of the basic science teaching. The outcomes are: gain in medical knowledge, achieving few basic clinical skills, and internalizing a wide range of attitudes.

The learning experiences offered in the preclinical phase play an important role in laying a strong foundation for learning clinical subjects. The objectives of the preclinical phase are not only to cater to the framed subject-wise outcomes, but also to keep the students motivated and make learning relevant to patient care. Patient interaction in supervised settings will facilitate students to learn from patients in a holistic manner. Students will get an opportunity to understand disease as perceived by patients and its financial, social, physical and psychological impact on them. Early involvement in the healthcare environment also validates students’ decision to opt for medicine as a career.

There have been a few concerns expressed by faculty regarding the concept, implementation and assessment of ECE. We are addressing a few of these concerns in a pointwise fashion here:

  • Students are already burdened with the curriculum of subjects of Phase 1. Now with the additional load of clinical teaching, less time and importance will be devoted to the basic science subjects. “If a student is forced to learn clinical topics as part of core competencies he will forget the basic mechanisms that are actually core of the subject”.

Early clinical exposure is a teaching-learning strategy that involves introduction of clinical content to enhance the relevance and understanding of the basic science subjects. It is not meant for learning of the diagnosis and disease management, but rather understanding how the altered anatomy, physiology and biochemistry lead to the various manifestations of the disease. Students motivated as a result of these experiences would be more likely to learn with a deeper approach and adopt self- directed learning strategies to achieve their learning targets.

EXAMPLE: Observation of a patient of chronic obstructive pulmonary disease (COPD) during ECE should be followed up with discussion on understanding the reason of slow deep breaths, so that the concept of airway resistance, lung compliance and work of breathing are reinforced. So, to conclude, ECE involves teaching the basic science concepts planned around the clinical content/ case and not teaching the clinical content. If a student understands the basic mechanism and regulations and its importance, he will appreciate the importance of the subjects learnt in preclinical phase.

  • When planning the ECE sessions which domain of learning should be addressed?

ECE supplements and enriches the regular teaching and learning of various concepts and clinical skills. ECE should be used, but not limited to achieving the higher learning objectives in the cognitive domain. It will be an excellent tool to develop the attitude of professionalism and effective communication skills. During the first-year clinical exposure should be ideally limited to observation of the doctor-patient interaction and demonstration of some important clinical signs.

EXAMPLE: The objectives of exposing the students to a patient of anemia should be to explain the derangement of functions due to decreased haemoglobin count and the altered hematological investigations expected, along with demonstration of pallor. The objectives however should be extended to include the realization of the social and financial impact of the disease and its treatment.

  • Which phase faculty will be responsible to conduct ECE sessions?

ECE is an activity which will require teamwork. The preclinical faculty will be able to decide best, the topics for ECE, frame its objectives and schedule it in their programme. Keeping in mind the purpose of ECE as envisaged by the Medical Council of India (MCI), the preclinical faculty would be the best to conduct these sessions and facilitate the discussion. However, participation of the clinical faculty, although not a must would not be amiss depending on the type of sessions planned.

EXAMPLE: Visit planned to the Blood bank or dialysis unit can be conducted by the faculty involved with the working of these units on a day-to-day basis. ECE sessions for anemia, jaundice, hypertension or diabetes mellitus in OPDs or wards, can be conducted by preclinical faculty themselves.

It always helps to collaborate and discuss with faculty of other phases during planning, and partner with them for the smooth implementation of the sessions. ECE sessions planned in community settings, e.g. for malnutrition, will require greater support of Community Medicine specialists for its planning, implementation and conduct.

  • It will be so difficult to organise the ECE sessions for the 100 or more students to the Hospitals. The same patient may not be available the next time an ECE session is planned. The number of faculty are also insufficient. How can we manage?

The large number of students in many of the colleges at present does pose a challenge to the conduct of ECE. But the large number of clinical cases available at most hospitals will provide the solution and so will judicious use of technology. What can be done is that some ECE sessions can be planned in the classroom settings, to help correlate basic science subjects. Videos of real or simulated patients, report of laboratory investigations, photographs and other relevant clinical material can be used.

EXAMPLE: For endocrine disorders like gigantism, acromegaly, hyperthyroidism etc. the doctor-patient interaction can be video recorded with permission for teaching purpose. These videos will ensure that all students are exposed to similar content and will also make the sessions more manageable in terms of faculty requirement. Though it is still advisable to discuss in smaller groups to maintain interactivity.

The ECE conducted in the classroom seems to be the least resource-intensive and feasible, but bringing them into the authentic hospital environment will go a long way to inculcate attitudes and motivate students.

It may not be possible or necessary to have the same patient for all the students undergoing ECE sessions in the hospital setting. Planning these sessions on similar cases to achieve the objectives will do the trick.  

EXAMPLE: For ECE to hemiplegia or Parkinson’s disease, even if different patients are examined by different batches of students, the objectives (e.g. to discuss the impact of the locomotor disability on their life, its financial implication and providing explanation of basis of symptoms and signs) can still be achieved.

  • How to assess the objectives of Early Clinical Exposure?

Formative assessment plays an important role in the assessment of ECE. Reflections written down by the students and reviewed by the faculty will help assess the objectives of ECE planned. The attitudes, the learnings (both knowledge and skills) can be documented in the log book. A record of students’ participation in various activities and discussion during ECE should be maintained.

Summative assessment can include modified essay questions, clinical vignette-based short answer questions requiring students to demonstrate understanding of alteration in normal anatomy, physiology and biochemistry and its clinical expression.

EXAMPLE: A healthy male aged 45 years, visits an ophthalmologist complaining of double vision since last three months along with drooping of eyes. The symptoms are more pronounced in the evening. He has no other associated symptoms and is not taking any other treatment. His physical, neurological and ophthalmic examination are normal. On blood investigations, acetylcholine receptor antibodies are detected.

  • Explain the altered physiology leading to the above condition.

“Many ideas grow better when transplanted into another mind than the one where they sprang up.” So keep sharing best practices with each other.

(Dr Munira A Hirkani is an Associate Professor in the Dept. of Physiology, at Seth GS Medical College & KEM Hospital, Mumbai. She is Associate Director of the GSMC FAIMER Regional Institute, Mumbai and Co-Convener MCI Nodal Center. )

CBME

Simulation-based learning in competency-based medical education: The Indian context: Dr Dinesh Badyal

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Simulations are being used in the airline industry for training, re-training and certification. For the airline industry, safety is of paramount importance. Medical services also look at safety as a very important parameter. Risk reduction strategies are being used in these two areas. Medical education curricula have been trying to use simulation-based learning (SBL) for years. Simulations are presently being used for skill acquisition and assessment. However, the following dilemmas remain: what to use in simulations, why to use simulations and how to use simulations for learning.

In India, we have two contrasting scenarios related to availability of clinical material for learning in medical colleges. In some well-established colleges there are large number of patients, while in other colleges, there are a smaller number of patients or patients refuse examination by students. Simulations and simulation-based teaching can be useful in these scenarios. The use of skills and simulation labs have become mandatory in India for undergraduate medical education from 2019 as per the new competency-based curriculum.

Due to the above reasons, medical colleges are trying to set up simulation labs and start simulation-based teaching. However, unfortunately most colleges buy mannikins and fill their simulation labs with a variety of plastic material without realizing their need or without having any teaching-learning relevance. In a way they invest heavily in plastic mannikins but not in training their stakeholders in how to develop and implement simulation-based teaching-learning.

Simulation laboratories can be used to learn technical or non-technical skills. Non-technical skills including communication, team-based learning etc. can be very effectively taught in simulated scenarios. In technical skills, techniques like intravenous injections, lumbar puncture can be done repeatedly and improvements can be done. It is not always possible to learn these skills in real encounters. Therefore, simulation encounters using various simulations e.g. mannikins, standardised patients, or hybrid models can help a lot to improve student learning and patient safety. The confidence of learners improve and they can practice multiple times on simulations and also take remedial actions. Otherwise, a learner cannot poke a patient multiple times to learn intramuscular injections.

The development of low-resource intensive simulations and simulated  environments can contribute to better skills learning and improved patient safety. It is reported to improve patient outcomes too. The use of low-fidelity simulation can be also very useful if appropriate teaching learning methods are employed. The educational material in a simulation module can include learning objectives, methods, material needed, logistics  about space, time, practice time, faculty training tips and assessment strategies e.g. checklists, OSAT (Objective structured assessment of technical skills), OSCE (Objective structured clinical examination), OSPE (Objective structured practical examination). The possibility of using hybrids i.e. video/computer simulation/ real patients should be explored as in India at number of places ample number of patients are available. Hybrid models can be used for intramuscular injection by using actual subject for palpation of bony landmarks and marking site of injection followed by actual administration into simulated arm.

All stakeholders should make appropriate efforts and invest time & money in equipping faculty with skills to develop educational material for the simulation-based learning and train more and more faculty in using simulations in learning.

(Dr Dinesh Badyal is Professor, Dept of Pharmacology & Professor, Dept of Medical Education, Christian Medical College, Ludhiana. He is a FAIMER Institute Fellow, an IFME Fellow, and a CMCL-FAIMER Fellow. He is Director of the CMCL-FAIMER Regional Institute and Convener, MCI Nodal Centre for Faculty Development.)

AHPE Official

Message from AHPE President 2019: Dr Nirmala Rege

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Dear All,

It is my pleasure to write this presidential message on behalf of the Academy of Health Professions Educators (AHPE).  This organization, launched to further quality and relevance of health professions education, has completed six years this year.  I am proud that many of its founder members have contributed to the innovations in health professions education and participated in policy making decisions, that are evident in the changes observed in the curricula of various health professions in India.

This year, the Ministry of Health and Family Welfare has approved the new curriculum framed by the Medical Council of India (MCI). As you all aware, this is a competency-based undergraduate curriculum for the Indian Medical Graduate.  Many of you must have undergone training for the same in Basic and Advanced Courses held by MCI Nodal and Regional Centres. However, there is always a gap between training received in a protected environment conceptualizing activities that may happen in the future, and implementing what is learnt during in real life. All of us are approaching the situation with some anxiety, apprehension and loads of expectations from administrators, students and the society.  At the same time, various opportunities have opened up, and I witness the creativity of faculty members, as is evident through the discussions among various professional groups, conferences and workshops organised by various institutions.

The other development that has taken place is that the National Medical Commission (NMC) Bill has been passed by both the houses of Parliament. Though it aims at providing a medical education system that guarantees availability of high quality medical professionals in adequate numbers to meet the needs of the country, there are certain points, like accreditation of medical institutions, uniformity in assessment of students at national level, and regulation of course fees in private colleges, that need further deliberations.

Though both the above developments are related to medical education, other disciplines of health professions are also making changes in their curricula to keep updated and abreast with the global developments in education.

I feel that in such a scenario, the role of a professional body like AHPE is very crucial. Such organizations should serve as a link between the regulatory body and the stakeholders, so that the changes that the regulatory body aspires to infuse in medical education can be facilitated. It should constantly encourage and initiate dialogue with the stakeholders understanding their problems and challenges, provide them the necessary support when required, solve their queries using expertise in the field, and communicate the same to the regulators so that necessary modifications can be done. It should promote collaborations among and outside health professions that have both, local and global dimensions. Together, we can transform health professions education to build tomorrow’s better world.

I am happy that AHPE is taking baby steps in that direction. This year some important topics in the new curriculum like disability competencies, self- directed learning, assessment in competency based learning, early clinical exposure etc. have been discussed through webinars, wherein direct one to one exchange of sharing was possible. AHPE also accepted a collaborative venture with Sri Balaji Vidyapeeth, which has planned a National faculty development programme for curriculum reforms.  AHPE always provides a  window to the world of health professions education through its annual National Conference of the Health Professions Educators (NCHPE).

This year NCHPE 2019 will be organized by KLE Academy of Higher Education and Research (KAHER) University’s, Jawaharlal Nehru Medical college at Belgavi from  21- 23 November 2019. The theme is “Competency Based Medical Education: Transformative Learning:  From Theory to Practice”. The sessions of this conference, as in the past, will be interactive and will provide an opportunity for the participants to  advance their knowledge, share their viewpoints and present their research projects in the field of health professions education. I request you all to join in. I assure you that this conference will add value to your endeavours to enhance the quality of health professions education in your institution.

Finally, I want to express my gratitude to our Executive Committee members for the time they contribute to AHPE. Their services to the organization are voluntary but they are committed to the cause.  The diversity of perspectives that they bring to the activities helps AHPE meet its objectives and remain updated with emerging innovations in health professions education.

Thank you.

Nirmala Rege

CBME

Is it time to shift to flipped classrooms?: Dr Anshu

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One oft-heard complaint from teachers in medical schools in India is that students don’t attend lectures. The woes of low attendance in theory classes are a repeated refrain from administrators. And this isn’t a problem just restricted to India. Worldwide, schools are beginning to realize that even the best lecturers are not always successful in attracting students to lectures. Clearly, the traditional lecture isn’t doing too much to engage students. Teachers need to think of newer ways to capture the attention of this digital generation of learners. Is it time then to shift to flipped classrooms?

In a traditional model, teachers deliver didactic content to students in the classroom, and give them homework to hone their skills. The flipped classroom reverses the manner in which time is spent inside and outside the classroom. The flipped classroom is an educational model where students are assigned didactic study content before a class, and the classroom time is utilized for more engaging and active learning strategies. With the availability of technology, such asynchronous and distributed learning formats are possible in our settings. To give you an example, teaching videos or assigned readings are uploaded on an online platform before the scheduled class. Students are expected to study and come prepared. Once students are in the classroom, they are given a short quiz or assessment to ensure that they are ready with the basics. This helps in ensuring that unprepared students will not distract learning of other prepared students during the group exercises. Students then work in teams to apply their knowledge to assigned tasks.

The concept of the flipped classroom comes from time-tested educational theories. Teaching and learning do not occur in closed systems. Learning often happens outside the formal boundaries of time and space, and learners need meaningful enriching experiences. In the flipped classroom format, students can metacognitively manage the pace of their own learning, identify their learning gaps, and formulate their plans of moving ahead with the guidance of their teachers. The role of classroom activities is to scaffold student learning and facilitate learner-centred collaborative environments.

How can you design flipped classrooms in your setting?

The key to designing flipped classrooms is organizing how you will teach. The first step is to have a look at your learning outcomes and plan backwards. Make learning outcomes explicitly clear to learners. Think about the assessment and learning activities that your students must undertake actively to achieve those outcomes. Write down a clear schedule of what you expect learners to do and share it with them. Remember to sort the material based on difficulty level. Difficult and advanced concepts need to be taught in class, while easier instructional material that might be easy to assimilate by learners can be given as pre-reading assignments. While doing this, do not forget the cognitive load on the learners, and estimate the time they will require to study on their own. In the classroom, develop small formative assessments to determine the learning gaps. You can also use technological advances like audience response systems or online assessments to determine learning gaps. Use active learning strategies like group work and hands-on skill training.

Clearly, using the flipped classroom approach needs organizational changes such as altered arrangements of the classrooms, and availability of resources such as books, audio-visual aids, computers and the internet. This also requires much more preparation from faculty than the traditional lecture, due to the unpredictability of what learners may need. Creation of web-based content like online lectures, videos and assessment may take time to prepare, but once done, they can be re-used easily for future batches of learners. Learning material must be easy to access. Proper sequencing of tasks from easy to difficult is essential. Flipped classrooms can free up time for interactive activities and hands-on training. Collaborative strategies such as brainstorming, concept-mapping, team-based learning and problem-based learning are suitable for medical students. The role of the teacher will be to facilitate learning as subject experts by moderating discussions, resolving doubts, providing feedback and ensuring that learning objectives are met.

How do flipped classrooms help?

Flipped classrooms make students responsible for their own learning. They can use the face-to-face time to interact with teachers and peers, ask specific questions, obtain guidance, receive feedback, and apply their newly learnt knowledge to real-life scenarios. Students seem to love this kind of active learning as it allows them the freedom to think and discover things for themselves. Use of formative assessments helps students in identifying their own learning gaps. This format takes students to a deeper level of learning instead of merely cramming the subject.

In a systematic review, Chen et al (2017) have shown that the flipped classroom is a promising approach to improve learner motivation and engagement. They were found to be at least as effective as traditional lectures. There is not enough evidence yet to suggest that this method helps in better knowledge retention or transfer of knowledge to professional practice.

As with any other major curricular change, transitions to flipped classrooms will require drastic alterations in organizational culture. It is important to create an environment of inquiry and open questioning. This transition must be facilitated by good administrative coordination and communication between faculty and students. Additionally, technological support will be critical to sustaining this model. Faculty training is essential to understand how redesigning of face-to-face classroom time can be best done. If used well, the flipped classroom model allows efficient use of time and technology. Watching student enthusiasm towards learning can be very fulfilling.

(Dr Anshu is Secretary, AHPE. She is Professor in the Department of Pathology at the Mahatma Gandhi Institute of Medical Sciences Sevagram, Maharashtra)

CBME

The different shades of social obligation and medical colleges in India: Dr Sucheta Dandekar

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The ultimate goal of medical colleges in India or anywhere else in the world is to improve the health of people, be it physical, mental or social. This is invariably attempted by juggling the three-pronged approach of educating the future health professionals; conducting relevant clinical research; and delivering comprehensive patient care. To make this possible, amalgamation of the social determinants such as behaviour, environment and social conditions and the values associated with social obligation (quality, equity, relevance and effectiveness) need to be adhered to.

Quality in health care has the community in mind and where treatment is person- and situation-specific and should be coordinated to serve the complete needs of a patient or a citizen. Equity implies that all persons from the community have equal access to the health services. Relevance is adhered to, when the most important health problem is identified and treated on priority such that the person, groups, society and community benefits. Effectiveness is achieved when all the available resources and infrastructure are put to optimal use to benefit individuals and the population. Establishing these values are the key towards social accountability.

It is nearly 22 years since WHO defined social accountability of medical schools as, “the obligation of medical schools to direct their education, research and service activities towards addressing the priority health needs of the community, region, and/or nation they have a mandate to serve. The priority health needs are to be identified jointly by stakeholders namely, governments, healthcare organizations, health administrators, health professionals and the public” (Boelen and Heck, 1995).

The terms ‘social obligation’, ‘social responsibility’, ‘social responsiveness’, and ‘social accountability’ are often used interchangeably.  At the moment, students from our medical schools are ‘being taught’ ‘social responsibility’ by sending them to the rural health centres and making them work as per the Medical Council of India (MCI) norms. When some of our students take part in blood donation camps, when they visit the community during floods, when they respond to the epidemics, they are being ‘socially responsive’. Most of the times, this is tackled on a voluntary basis. The more the students from a medical school come forward, the more it is a reflection of the effectiveness of our teaching. However, how prepared are we for all the principles to be tested remains debatable. This shall lead us to becoming ‘socially accountable’, when we are ready for an evaluation and accreditation process. Sensitizing of the stakeholders regarding issues of social accountability and accreditation is important. This, perhaps, shall be the much-needed step in making a positive impact on the society.

Medical educationists have acknowledged the challenges faced by Indian medical schools and suggested that if progress has to be made, it should be based on contextual planning of the curriculum, such that it incorporates the health needs of the community and encourages sound educational research, with the governmental agencies also seeing eye-to-eye. Researchers have suggested the identification of current and prospective social needs and challenges, adaptation of education programs to meet these needs and, evaluation to show that the society has benefitted from the interventions.

We realize that there is a need to work collaboratively by advocating changes to the health system. Faculty of our medical schools have a large responsibility of inculcating this into the system by taking into confidence the governing bodies, community, institutional administrators and students. The understanding of the importance of this symbiotic relationship cannot be denied. Some medical schools are no doubt, closer to implementing a model of social obligation as compared to others.

 

(Dr Sucheta Dandekar is a FAIMER Institute Fellow (2010) and an IFME Fellow (2014). She has completed her MHPE from the University of Keele in 2018. She is Professor and Head of the Dept. of Biochemistry & Clinical Nutrition at Seth GS Medical College & KEM Hospital, Mumbai)