South Asian Institute of Health Promotion (SAIHP)

This unit provides training, education and research into various dimensions of health profession education and focuses on the acquisition of knowledge and skills and capacity building of health care professionals.

Integration of Tobacco Control and Cancer Prevention into Health Profession Education through Curricular Innovation.

Program Director: Dr Sanghamitra Pati
Coordinators: Dr SoumyakantaDas, Dr Jayanti Mishra, Dr Hemamalini Rath, Dr Sonali Kar

Principal Investigator: Dr Sanghamitra Pati

This project initiated cancer screening education component in Internship training. Interns were imparted a module on basics of cancer screening and early detection methods relating to common cancers and tobacco counseling with an aim for application in their forthcoming career as a general practitioner.

Oral cancer Prevention and Detection skill building program for medical students through curricular innovation

Oral cancer is a public health issue in India. Although oral cancer teaching is incorporated in the dental education curriculum, till date no studies have examined the relation between oral cancer education and the oral cancer prevention and detection skills of dental students. This study was conducted with the utilization of the PRECEDE-PROCEED framework to develop, implement, and evaluate a randomized pretest/posttest controlled study to examine the association between specific oral cancer education and oral cancer prevention and detection skills among medical students enrolled at the state Medical Colleges of Orissa, India. Results from this study demonstrated the effectiveness of faculty-facilitated standardized patient-based training on the oral cancer prevention and early detection skills of medical students.

Tobacco smoking is the leading cause of morbidity and premature mortality in India. To deal with the problem we need to have a sustainable critical mass of competent and skilled health care personnel in tobacco cessation and treatment. It is also imperative that they should acquire the basic knowledge and skills as a component of their professional education. Medical, dental, nursing, physiotherapy and paramedical students should be familiar with the negative health effects of tobacco; they should possess adequate knowledge base and inculcate specific client-centered tobacco cessation counseling skills during the formative years. There is no area of health profession education that will yield greater returns in better health, saved lives, and reduce medical costs than emphasis on tobacco control. Keeping this in view, the present work was undertaken to assess the content of different health profession curricula of India in the context of tobacco control and identify the relevant tobacco control competence of the teaching modules.

The analysis revealed that the under graduate medical curriculum of all the medical colleges have some tobacco related content particularly under the teaching of pathology and community medicine. But they are limited to the disease and clinical aspects. No specific time slot is allotted for tobacco control in particular. In comparison to the western world, it appears that Indian health education system lacks the appropriate integration of tobacco into various health profession courses. The large mass of students has remained an unexplored potential. There is a strong need for sensitization of the concerned curriculum designers in this regard. Efforts should be taken to include tobacco particularly tobacco abuse prevention and cessation. The respective apex councils of India i.e. Medical council, nursing council, dental council and national associations should take a proactive role in prioritizing tobacco information through the health profession education and promoting a culture that builds competency in tobacco prevention and treatment.

(This work has received APACT Award in Taipei, Taiwan)

Training medical students in tobacco prevention and treatment skills is critical if we are to have competent physicians, prepared to address the grave levels of morbidity and mortality associated with tobacco use. Medical students should possess adequate knowledge of health risks of tobacco use and they should acquire appropriate skills for helping their patients in smoking prevention and cessation. Both of these are complementary to each other towards preparing health professionals for leadership roles in tobacco control. However, in India, enough attention has not been given to elicit the active participation of physicians in tobacco control. Particularly, the medical students have remained an unexplored potential and the missed opportunity. As a result, most of the physicians lack the necessary skills, competence and above all the confidence to handle the problem of smoking cessation among their patients. Keeping this in view a project was taken up to develop skills and competence of medical students with the objective of improving medical student inquiry into smoking and the delivery of advice accordingly for patients in their clinical years routine consultations. We attempted to determine whether a curriculum on tobacco intervention could garner medical students’ acceptance; improve relevant knowledge, attitudes, and self-confidence; and be applied in students’ early clinical experience. The targeted learners were the 149 first-year medical students.

The program was carried out during the inter semester summer break period. We used motivational interviewing as a framework for promoting behavior change. A tobacco control curriculum was developed from the materials of the motivational interviewing and other standardized international tobacco control curricula of proven efficacy. The teaching comprised of detailed studying of the manual, followed by an interactive workshop and finally concluded with a modified Objective Structured Clinical Skills Examination Station. The faculty found that all students demonstrated basic competence. Students were encouraged to apply the learnt skills during their ward duty in 3rd semester in which each student spent2 half-days per month with patients under the supervision of a senior resident. Student endorsement of the curriculum and its components was assessed by a confidential evaluation questionnaire, which was administered at the conclusion of their training. Students provided ratings using 7-point Likert-type scales with anchors at the midpoints and the extremes. Gains in students’ attitudes, knowledge, and self confidence were gauzed by comparing responses to pretest and posttest versions of the Learning Outcomes Questionnaire (LOQ).The evaluation showed that first-year medical students favorably received the initial implementation of the tobacco control curriculum. Most students found the educational content important and appropriate for their level of training. Medical students in their early years can gain from training on promoting behavior change. It is highly recommended that such curricular innovation should be initiated at a priority basis.

Tobacco smoking is a significant public health issue in India. Health professionals play a crucial role in reducing the impact of tobacco. Past studies reveal that most of the physicians are not providing tobacco cessation counseling to their patients. The present work was undertaken to assess the medical curriculum and teaching India in the context of tobacco. The study was completed by the medical faculty and comprised: tobacco content and skills, curricular evaluation, faculty perceptions. RESULTS: The under-graduate medical curriculum has some tobacco-related content. Most of the medical colleges provide less than 12 hours of teaching on the adverse health effects of tobacco. There is no training on tobacco prevention during internship.

Students don’t learn tobacco cessation during their clinical years. Post-graduation students excepting three disciplines don’t receive teaching in tobacco control. It is the general belief among the faculty that tobacco abuse is not under the domain of medical education. Analyses of the extant medical curriculum in India reveal that although negative effects of tobacco is incorporated in some ways in the curricula, it is neither systematic nor vertically integrated and makes no mention of the issues of skills and competence surrounding anti tobacco counseling. In comparison to the western world, Indian medical education lacks the appropriate incorporation of tobacco into medical courses. There is a strong necessity to include tobacco particularly tobacco abuse prevention and cessation. Medical council of India and policy makers need to examine the role of faculty in prioritizing tobacco information and promoting a culture that builds competency in tobacco prevention and treatment.

Health Professionals, particularly the general practitioners are in a strategic position to provide direct services for tobacco cessation. However, to date, in India, only about 0.5% of smokers receive cessation counseling from their physicians. The present study assessed the attitude and practice of tobacco cessation among health professionals and explored the potential barriers to physicians-based tobacco cessation practice. A total of 720 general practitioners, 280 in Rural and 440 in Southern Orissa, were interviewed regarding their personal tobacco use and their general attitude, knowledge and approach with patients regarding tobacco cessation practice. 29% of GPs in the study were found to be using either smoking or smokeless form of tobacco, with a higher prevalence in the rural area. Almost all GPs considered that giving information about tobacco cessation to their patients is an important intervention to control tobacco related diseases. 67% GPs feel that cessation counseling is not part of their job, and 45% think their patients will not accept their advice. With regard to beliefs about the provision of cessation counseling to patients, 86% of GPs lack confidence in providing such counseling; and 83% would like to be trained on tobacco cessation strategies. The GPs who use tobacco were less inclined to provide cessation counseling than their nonsmoker counterparts. Thus in order to implement tobacco control in clinical practice in India, it appears essential first to reduce the number of GPs who smoke/chew tobacco and to improve GP training on tobacco cessation procedures.

This study using both quantitative and qualitative research methodology explored the attitude of medical interns towards tobacco control and tobacco cessation counseling in the general practice. Majority of interns expresses their willingness to learn the conuselling skills pertaining to tobacco cessation and they felt internship would be the optimal stage to get such training. Almost all the interns agreed that tobacco control should be a part of medical education and it should be integrated phase wise without overburdening the medical curriculum. It was further suggested by some interns that inter semester or post examination breaks could be productively utilized for the tobacco prevention skill building program.

Drug abuse is a growing public health menace in the developing world. In a hugely populated country India the problem has enormous impact on socio-economic productivity. Physicians play crucial role in the prevention and treatment of substance abuse. They should possess appropriate clinical skills and knowledge-base for identification, healing and counseling the drug abusers. Internship, the preparatory stage of primary care practice is of paramount significance in physician education. We took up an initiative with an aim to foster core competence of drug abuse among residents, the future general practitioners of the state. This six-week duration program comprising an addiction-specific training module was administered to 105 interns doing residency in the medical colleges of Orissa. It was a combination of theory and standardized patient based training. The course was interdisciplinary with faculty drawn from clinical, laboratory streams along with social workers and the drug rehabilitation personnel.

The program output gives enough impetus for incorporating addiction-medicine into internship training. Moreover, as in-service primary care physicians are often the frontline care providers for drug abusers, they need to inculcate the basic know-how through continuous medical education.

Assessment of educational needs of primary care physicians in behavioral medicine

General physicians working in primary health centers (PHC) are the frontline health care providers in India. Studies have demonstrated that significant number of patients approach to primary care physicians with mental and psychological factors that play a role in onset, progression and severity of many common biomedical health problems. Behavioral medicine integration would be helpful in improving the clinical outcomes of such patients. However in India, there is little or no training in behavioral medicine for the physicians, unlike many training programs in other countries. A project was undertaken towards designing appropriate innovation in medical education curriculum for teaching behavioral medicine. The purpose of this qualitative study was to explore the perceptions and experiences of primary care physicians across different specialty areas working in various PHCs of Orissa (India) regarding the practice of behavioral medicine and psychosocial methods.

Semi-structured in-depth interviews were conducted with physicians. Examination of key words, phrases, and concepts used by the physicians revealed five themes that physicians related to their incorporation of psychosocial/behavioral medicine methods: (1) factors limiting the practice of behavioral medicine (inadequate training; cultural barriers); (2) demand for behavioral medicine services; (3) patient-doctor issues related to behavioral medicine); (4) physician’s role strain; and (5) intuition and experience. These findings suggest that general physicians would benefit from undergraduate and residency curricula in behavioral sciences, tailored to their unique needs. It is also strongly advocated that GPs do need continuous education in behavioral medicine.

In India, stroke is the leading cause of morbidity and mortality and a major contributor to disability. While many stroke victims do receive reasonably good medical care during the acute phase of the illness, the same is not for rehabilitation. Especially, among rural patients, the rehabilitation aspect is almost neglected, handled casually, or omitted entirely. Sustained care of stroke patients should be an integral part of health care services. The primary health care personnel need to be adequately trained in the basic principles and techniques of stroke rehabilitation. This work was conducted to foster appropriate skills and knowledge among health care personnel working in rural area through a short reorientation program. A one-week multidisciplinary module with hands-on training was imparted to the physicians, nurses, pharmacists and health workers of four primary health centers (PHC) of Orissa. The faculty comprised occupational therapists, physiotherapists, psychologists, speech pathologists, rehabilitation specialist nurses and social workers. 48 participants took part in this program, sponsored by SAIH, a state level non governmental organization. Pre and post tests were done to determine the change in knowledge of stroke rehabilitation care followed by a delayed post test after six weeks. It was observed that physicians and nurses were using partly the rehabilitation techniques. The participants had problems in applying techniques relating to speech pathology and occupational therapy. It is recommended that there should be at least one occupational or physiotherapist for every PHC to provide the specific rehabilitation care needs of the stroke patients in the rural population.

Incorporation of Environmental health component into Health Profession Education

With the widespread presence of environmental health hazards, concern about the health risks and consequences from environmental toxins and pollutants have increased globally. Accordingly, leading health institutions in the western world have recognized the need for health professionals’ environmental health education and have made necessary integration. With rapid urbanization, fast globalization and explosive population growth in the recent decades environmental health assumes paramount importance in India. Furthermore, total costs of environmentally attributable pollutant-related diseases such as lead poisoning, asthma, and cancer is enormous. A review study was done to assess the relevance and content of health profession curriculum relating to environmental health. It was found that till now environmental health is not formally taught as a discipline and is embedded in a fragmented manner throughout the medical education lacking a systematic and focused orientation. Training of Interns on the specially related to environmental health issues is almost nonexistent.

Given the biologic, psychological, and social impact of environmental health hazards, there is a need for allotting environmental health education an exclusive and distinct place in the medical education curriculum. To address this need, it is strongly recommended that efforts should be directed towards increasing education about environmental health in the medical school curricula, in residency training, and in continuing medical education.

Developing an interdisciplinary Foundation Program for Post graduate Medical students of Orissa

An Assessment of Comfort and Confidence among Physicians of Orissa towards dealing sexuality issues in clinical practice

Integrating Sexual and Reproductive Health Care in Medical Curriculum in Indian Context

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