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   Table of Contents - Current issue
May-August 2020
Volume 33 | Issue 2
Page Nos. 33-84

Online since Tuesday, December 8, 2020

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EDITORIAL  

Co-editors' notes p. 33
Danette McKinley, Michael Glasser, Maaike Flinkenflogel
DOI:10.4103/1357-6283.302707  
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GUEST EDITORIAL Top

Best of projects that work p. 35
Ralf Rundgren Graves
DOI:10.4103/1357-6283.302492  PMID:33318451
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ORIGINAL RESEARCH ARTICLES Top

Train-the-trainer: Pilot trial for ebola virus disease simulation training Highly accessed article p. 37
Catherine D Tobin, Myrtede Alfred, Dulaney A Wilson, Lacey MenkinSmith, Kathy L Lehman-Huskamp, John J Schaefer, Kenneth Catchpole, Lydia Zeiler, Brian Fletcher, JG Reves
DOI:10.4103/efh.EfH_262_19  PMID:33318452
Background: Highly infectious but rare diseases require rapid dissemination of safety critical skills to health-care workers (HCWs). Simulation is an effective method of education; however, it requires competent instructors. We evaluated the efficacy of an internet-delivered train-the-trainer course to prepare HCWs to care for patients with Ebola virus disease (EVD). Methods: Twenty-four individuals without prior EVD training were recruited and divided into two groups. Group A included nine trainees taught by three experienced trainers with previous EVD training. Group B included 15 trainees taught by five novice trainers without previous EVD training who completed the train-the-trainer course. We compared the efficacy of the train-the-trainer course by examining subject performance, measured by time to complete 13 tasks and the proportion of steps per task flagged for critical errors and risky and positive actions. Trainees’ confidence in their ability to safely care for EVD patients was compared with a self-reported survey after training. Results: Overall trainees’ confidence in ability to safely care for EVD patients did not differ by group. Participants trained by the novice trainers were statistically significantly faster at waste bagging (P = 0.002), lab specimen bagging (P = 0.004), spill clean-up (P = 0.01), and the body bagging (P = 0.008) scenarios compared to those trained by experienced trainers. There were no significant differences in the completion time in the remaining nine training tasks. Participants trained by novice and experienced trainers did not differ significantly with regard to the proportion of steps in a task flagged for critical errors, risky actions, or positive actions with the exception of the task “Man Down in Gown” (12.5% of steps graded by experienced trainers compared to 0 graded by novice trainers, P = 0.007). Discussion: The online train-the-trainer EVD course is effective at teaching novices to train HCWs in protective measures and can be accomplished swiftly.
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Tiered team research: A novel concept for increasing research productivity in the academic setting Highly accessed article p. 46
Vignesh K Alamanda, Chad A Krueger, Rachel B Seymour, Daniel J Stinner, Joseph Wenke, Joseph R Hsu
DOI:10.4103/efh.EfH_80_19  PMID:33318453
Background: Research has become a key pillar of academic medicine and a cornerstone of residency training; however, there continues to be significant barriers to ensuring research productivity for residents. We implemented a novel tiered team approach which aimed to increase research productivity and promote collaboration during residency training. Methods: This was a retrospective study that evaluated the implementation of a novel tiered team research approach at a single institution between 2009 and 2013. Analytical software was used to visualize and display the research interconnections among the authors of the captured publications. In addition to using Gephi to determine the research interconnections, the growth in research capability of the tiered team and its individual members were also graphically depicted. Results: The research team produced a total of 77 publications during the study period (2009–2013). Significant and frequent collaboration and coauthorship was noted as the years progressed following implementation of tiered team research. Discussion: Tiered team research can be readily implemented at most institutions and can lead to increases in productivity of published research. It can also promote collaboration and peer mentorship among those involved.
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TUFH 40TH ANNIVERSARY SPECIAL PAPERS: PRACTICAL ADVICE PAPERS Top

Community intervention projects as a strategy to integrate essential public health functions (EPHF) with clinical knowledge into the curriculum of medicine p. 51
Marco Sosa
DOI:10.4103/efh.EfH_245_20  PMID:33318454
Background: Students in medical school often do not get the opportunity to apply public health principles to their work. This can affect the likelihood that they will apply population and public health principles in practice. Activities: From 2010 to 2015, the faculty of Medicine at Fundacion Universitaria San Martin from Sabaneta Campus – Colombia, developed an educational strategy called “Community Health Intervention Projects” (CHIP) as a new way to integrate essential public health functions with clinical knowledge into the curriculum. This approach was based on Community-Based Medical Education (COME) and Community-Oriented Primary Care. Seven CHIPS were developed by 65 undergraduate students partnering with organizations as two secondary schools, one clinic, two community-based groups, one nongovernmental organization, and two secretaries of health in four different cities. Outcomes: The breastfeeding programs increased the time of breastfeeding by the mothers and the tools to measure breastfeeding have been used in other research projects (Medellin 2015, Envigado 2017). The project about increasing Knowledge, Attitudes, and Practices in Sexual and Reproductive Health (SRH) in young scholars from two cities (Caldas and Sabaneta) served as a springboard for one of the students of medicine to receive a scholarship to attend the global forum in SRH “Women Deliver” in Kuala Lumpur in 2013. The project about Comprehensive and Integrated Delivery Health-care Program, addressed to children with asthma, were adopted by the Ambulatory Clinics Organization after the results of the pilot program (2016–2017). This project won the TUFH– FAIMER student projects for health award in 2016, showing the sustainability and generalizability of the educational program. Conclusion: Health professions educators can use CHIPS to integrate the mission-related axes in their programs: Academia, research, and extension activities in a community setting.
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Academia–industry collaboration to provide interdisciplinary experiential learning opportunities in public health professions education and improve health of female factory workers p. 55
Suvetha Kannappan, Thomas V Chacko
DOI:10.4103/efh.EfH_129_20  PMID:33318455
Background: The community medicine department of our medical school, in addition to addressing its mandate to prepare undergraduate students for primary care and graduate students for careers in public health, administers several community-based interventions. An international organization involved with improving health of female factory workers globally invited us to partner in their efforts locally. We used the Precede-Proceed model to design an intervention to deliver the desired project outcomes. Activities: Recognizing that this partnership with industry would provide a learning opportunity to our Master’s degree program students, we involved them in a needs assessment survey in order to make an educational diagnosis to identify the influencing and reinforcing factors. Our faculty and students interfaced with a multidisciplinary team including mid-level factory managers, health-care staff, and peer health educators within the textile industry. Outcomes: Through this industry–academia collaboration, our health professions training institution was able to provide supplementary experiential learning opportunities to students in our Master’s degree in Community Medicine program by involving them in all the project stages from planning based on health needs assessment, to module design, implementation, and program evaluation along with interdisciplinary teams from the textile industry. Students then reflected on their learning experience using a modified Kolbe’s experiential learning cycle to improve their performance when they replicated the intervention with the next factory under the same project. Conclusion: The use of PRECEDE–PROCEED model in the industry–academia collaboration and Kolb’s framework provided supplementary experiential learning opportunities for deliberate practice, receiving feedback, and reflecting on their learning to our Master’s in Community Medicine degree students.
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Socially responsible students and improved health for community-the benefits of service-learning in Pakistan p. 61
Ayub Rukhsana
DOI:10.4103/efh.EfH_182_20  PMID:33318456
Background: In developing countries, marginalized groups of the society suffer due to inadequate health workforce, physical inaccessibility to health-care facilities and nonavailability of appropriate services. Service-learning, which combines community service with structured preparation and reflection exercises, may be used to reach such communities. Service learning electives aimed at teaching students their required coursework as well as the importance of commitment to the community, were developed. Activities: In four different projects, college students developed and delivered an educational campaign to community members. Knowledge of participants was tested pre- and post-intervention. For two projects, on-site hemoglobin (Hb) testing was provided through point of care testing before and at 8 weeks’ post-intervention. Women and children were given immediate treatment. Focus group discussion was carried out for students and participants. Outcomes: Significant improvement was seen in the sense of social responsibility of students and knowledge of community members about iron deficiency anemia in all the four campaigns. In one of the studies, the initial point-of-care testing (POCT) screening for Hb found that 52.9% of women and 46.9% of children were anemic (Hb <120 g/L). The average Hb concentration increased post-intervention both in women and children. Conclusion: More SL campaigns utilizing the huge untapped human resource in the form of the college and high school students will provide assistance to those involved in public health. These campaigns provided an opportunity to undergraduate medical students to interact with community members leading to significant learning for both students and community participants. Hb tests were conducted in the community through POCT, which enabled immediate treatment of anemia and improvement in an important health indicator.
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Posta las lilas: A model of integral commitment to the community p. 66
Maria De La Paz Grebe, Angel Martin Centeno, Soledad Alvarez De Campos
DOI:10.4103/efh.EfH_177_19  PMID:33318457
Background: The Posta Sanitaria Las Lilas (La Posta) is a health promotion project of the medical school. Its purpose is to improve the health of individuals and the society by fostering qualitative changes in people’s attitudes and habits in relation to every aspect of their health. The project serves a population of 25,000 inhabitants that live in conditions of vulnerability and poverty. It is based on a specific approach to social commitment and accountability that integrates teaching, research, and care with the whole community. Activities: The project activities are oriented toward key dimensions for each person and the community. There are two programs: health and education that involve physicians, students, residents, teachers, volunteers, and community members. Outcomes: The project has increased the number of medical appointments, medical records, and workshop participants. It is difficult to establish objective indicators that may reflect the changes in the life of the community members. In this article, findings of an impact evaluation study are presented. We also describe unexpected results for those who participated in the project. Conclusion: La Posta is part of the University’s agenda and a place of meaningful and formative learning. All program activities are implemented with the support and resources of the institution. A network of various organizations cooperates with La Posta in order to help promote the welfare of the community. They are all committed to contributing to the development of project participants’ personal resources rather than merely addressing their unmet needs. This requires thinking about people in all dimensions (biological, psychological, social, and spiritual).
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BRIEF COMMUNICATION Top

Coverage of antimicrobial resistance in the revised indian medical curriculum: Lip service only? p. 70
Vijayaprasad Gopichandran, Bharath Kumar Tirupakuzhi Vijayaraghavan
DOI:10.4103/efh.EfH_251_19  PMID:33318458
Background: The undergraduate medical curriculum has undergone a major revision. This study was designed to systematically review the revised Indian medical school curriculum to assess the extent of coverage of antimicrobial resistance (AMR) and antibiotic stewardship-related competencies. Methods: We undertook a document review of the recently revised Indian medical curriculum to identify the extent of coverage of competencies related to AMR and antibiotic stewardship. With the use of a previously described search strategy, we queried the online freely accessible version of the curriculum in duplicate and independently. We describe by volume, by subject and by the tenets of Miller’s pyramid all references to AMR and stewardship. Results: Out of 2939 competencies that medical students are expected to complete over a 5.5-year period, 17 (0.57%) relate to AMR and antibiotic stewardship policies (ASP). There are no references to AMR or ASP in Pediatrics, Surgery, Obstetrics and Gynecology, Ear, Nose and Throat, Ophthalmology and Orthopedics. Community Medicine has few links through integrated teaching but has no direct AMR or ASP content. When categorized by Miller’s domains, two of the competencies, both in Pharmacology, deal with the “Does” category, which is the practical skill gained by the student. There are five competencies which belong to the “Shows How” category and the remaining 10 belong to the knowledge categories. Discussion: There is poor coverage of AMR and stewardship in the revised Indian medical curriculum, suggesting that there is very little appreciation of the enormous threat that AMR poses to public health. This is a huge missed opportunity that needs immediate corrective action.
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STUDENT CONTRIBUTION Top

Cooking demonstrations to teach nutrition counseling and social determinants of health p. 74
Hannah Hashimi, Kristin Boggs, Caroline N Harada
DOI:10.4103/efh.EfH_234_19  PMID:33318459
Background: Future physicians should feel comfortable educating patients on disease-specific diets, and culinary medicine is an innovative approach to preparing medical students for this task. We present an engaged-learning program where medical students give community cooking demonstrations to gain experience counseling adults on nutrition and simultaneously develop understanding of the social determinants of health. Student volunteers undergo training in culinary skills, nutrition, motivational interviewing, and social determinants of health. They then lead cooking demonstrations at a local farmers’ market and later participate in a group debriefing session with faculty. Methods: Postexperience surveys were obtained. The primary outcome evaluated was feasibility of this educational intervention. Secondary outcomes were (1) student perception of the value of the program and (2) student self-rated learning of nutrition science, nutrition education, and social determinants of health. Results: A total of 117 students participated in the program over 3 years and 57% answered the postexperience survey. Students filled 91% of available volunteer slots (79 first-, 26 second-, 3 third-, and 9 fourth-year students). In a postexperience survey, 94.7% responded that the experience resulted in learning about nutrition education and 82.4% reported learning about social determinants of health. In commentary, students note that medical education was enhanced by interacting with community members. Discussion: Culinary education in a community setting is a feasible medical school service-learning activity that is well received by students. It can enhance learning of nutrition counseling skills and improve student understanding of the social determinants of health.
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LETTERS TO THE EDITOR Top

Protecting medical students against workplace research bullying: A graduate's experience and standpoint p. 79
Ahmed Abu-Zaid
DOI:10.4103/efh.EfH_95_20  PMID:33318460
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Volunteering to organize quiz events: What motivates medical students? p. 81
Chetna Dengri, Yash Aggarwal, Vishali Moond, Amir Maroof Khan
DOI:10.4103/efh.EfH_77_20  PMID:33318461
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Emotional intelligence: A long-time neglected factor for academic performance p. 83
Rinki Hans, Manoj Kumar Hans
DOI:10.4103/efh.EfH_298_18  PMID:33318462
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