Journey Towards Implementing “Community Based Medical Education (CBME) at Indus Medical College”

Abstract

Introduction: Till last few decades doctors were mainly trained in tertiary care hospitals. Appreciating need of competency to manage community’s sufferings and health issues; during last 30-40 years, medical education has undergone significant re-formations and re-organization in its delivery and training of medical personnel, with consequent focus on communities ‘health i.e., Community-Based Medical Education (CBME). The aim of this was to ascertain academic value and training superiority (if any), of CBME trainees if compared with in-hospital trained residents. Methods: We were advised by the national medical regulatory authority to incorporate CBME in curriculum. To meet this requirement a pilot study was formulated, to help add final CBME component in curriculum. We planned a quantitative, prospective, quasi-experimental study, that compared two groups of residents with maximum possible similarities. One group was to be trained in communities and other within the Indus Medical College Hospital (IMCH). The Curriculum Committee designed a 4-week CBME program, for 6 residents of year-one, which was held at nearby rural health facility, about 2 kms from Indus IMCH, while other group, comprising same number of residents trained within the main campus of the institute. Research instrument, the questionnaire was based on Specific Learning Objectives (LOs), formulated by Curriculum and Assessment Committee, these were based on the results (anemia) of patient’s Blood Picture, i.e., to ascertain cause of gross anemia. The learning objectives i.e., Cognition, Psychomotor and Affective included e.g., conversation with patients, history-taking, examination and interpretation of blood smears. Results: These were based on the participants’ responses to questionnaire i.e., Table of Specification (TOS) that incorporated all the three domains of learning (Knowledge, Skills, Attitude), relevant to the training objectives. The assessment of residents included tools, such as MCQs, OSCE, Mini-CEX, DOPS, Short Essay Question (SEQs) and Practical demonstrations etc. Out of 6 residents, 3 secured more than 80%, 2 had between 80 and 70% and one got less than 70% score. Average score obtained by CBME trainees was 80%, while other group had average score of 64.66%. Based on these results, it can be justifiably inferred that CBME training should be part of doctors in training. Conclusion: The score obtained by of COME trained residents was compared with residents of same year in the matched subject. Observation was, CBME residents had at least 15% score higher than in-hospital residents.