The socio‑demographic profile of family physician graduates of blended‑learning courses in India

CONTEXT: India’s lean cadre of 250,000 general practitioners and 30,000 government doctors has limited options to update themselves. Since 2006, Christian Medical College (CMC) Vellore has run blended‑learning programs in family medicine, namely, postgraduate diploma in family medicine (PGDFM) and master in medicine in family medicine (M.MED FM) training more than 3000 doctors. A graduate follow‑up study was undertaken in 2022. AIM: The aim of the study was to describe the socio‑demographic characteristics of family physicians (FPs) in India who graduated between 2008 and 2018 from the FM blended‑learning programs run by the CMC, Vellore. SETTINGS AND DESIGN: Informed by an empirical‑analytic paradigm, this descriptive study used a cross‑sectional survey design to uncover graduate FPs’ profiles, practices and experiences. METHODS AND MATERIALS: Using a purposively designed, piloted and validated electronic questionnaire, data were collected between March and July 2022, deidentified and analysed using Statistical Package for Social Sciences (SPSS) TM and Epi InfoTM. RESULTS: Among the 438 FP respondents (36%), there was an almost even split in gender (49.3% male, 50.7% female). Moreover, 25.8% were below the age of 40 years, 37.4% were in the 40–49 age group, and 33.8% were 50 years of age or older; 86% lived and worked in urban areas. The PGDFM or M.MED FM was the highest educational qualification of 64.4% of the doctors. Male FPs pursued postgraduate studies at a significantly younger age and earned significantly more than their female counterparts. CONCLUSIONS: The blended learning model creates an important pathway for doctors, especially women, to pursue higher education with flexibility. Preferential selection criteria can target rural‑based physicians. Strong policy‑level advocacy is needed to establish FM as a specialty with equitable pay scales. Socio‑demographic profiling can be used as an effective advocacy tool.http://www.jfmpc.com/Family MedicineSDG-03:Good heatlh and well-beingSDG-04:Quality Educatio

Opportunistic Research in Rural Areas through Community Health Worker Training: A Cost-effective method of Researching Medication Misuse in Rural India

Background: In India it is estimated that one third of expenditure of households is spent on health related expenses, and medication purchases make up a large proportion of these costs. Objective: To investigate a novel methodology, which was cost effective, to collect large amounts of data to further understand medication purchases and misuse in rural India. Methods: This study explores the research approach that was conducted in 2012-13 by Layleaders enrolled in the Community Lay-Leaders’ Health Certificate Program initiative by Christian Medical College (CMC), Vellore, India. Results: The methodology demonstrated a large data collection capacity, where 100 Layleaders participated and collected over 5000 surveys across 515 villages in North, Central and North East India. Conclusions: Incorporating opportunistic research methods into community health worker training can be a cost effective way to collect meaningful and useful data in rural India. This study demonstrates a successful methodology that may be transferable to other rural areas and others conducting research training as part of community health worker training should consider such opportunistic research

"The refer less resolve more" initiative: A five-year experience from CMC Vellore, India

India′s one billion plus strong population presents huge health care needs. Presently, approximately 250,000 general practitioners and 30,000 Government doctors are a part of the Indian healthcare workforce, but 80% of them are based in urban India. Problems which plague healthcare delivery and attributed to physician practice may be enumerated as - physicians (1) lack competencies, (2) lack updating, (3) prescribe irrationally (pressures from pharmaceutical companies and patients), (4) practice unethically, (5) refer excessively to specialists and other clinical professionals, and (6) investigate for diseases without justification. A multi-competent Family Physician who could provide a single-window, ethical, and holistic healthcare to patients and families is the need of the hour. Therefore, training, equipping, and empowering these 250,000 doctors to become such physicians will reduce health costs considerably. Distance medical education using all the andragogic methods can be used to train large number of individuals without displacing them from their work-places. Distance learning provides a useful interface for rapidly developing a specialized pool of doctors practicing and advocating family medicine as most-needed discipline. This motivated CMC Vellore, a premier institution for medical education in India, to start a the "refer less resolve more initiative" by offering "two year family medicine diploma course" by distance mode. This is an innovatively-written program consisting of problem-based self-learning modules, video-lectures, video-conferencing, and face-to-face contact programs. Ten secondary level hospitals, across the country, under the supervision of national and international family medicine faculty form the pillars of this program. This distance learning program offered by CMC Vellore has become the platform for change as there is special focus is on ethics, rational prescribing, consultation skills, application of family medicine principles; and practical demonstration of compassionate, cost-effective and high-quality care. The change in attitude has resulted in transformation in three major aspects of practice: professional, ethical, and patient care. So far, 942 private practitioners and 177 government doctors have been enrolled

Can credit systems help in family medicine training in developing countries? An innovative concept

There is irrefutable evidence that health systems perform best when supported by a Family Physician network. Training a critical mass of highly skilled Family Physicians can help developing countries to reach their Millennium Development Goals and deliver comprehensive patient-centered health care to their population. The challenge in developing countries is the need to rapidly train these Family Physicians in large numbers, while also ensuring the quality of the learning, and assuring the quality of training. The experience of Christian Medical College (CMC), Vellore, India and other global examples confirm the fact that training large numbers is possible through well-designed blended learning programs. The question then arises as to how these programs can be standardized. Globally, the concept of the "credit system" has become the watch-word for many training programs seeking standardization. This article explores the possibility of introducing incremental academic certifications using credit systems as a method to standardize these blended learning programs, gives a glimpse at the innovation that CMC, Vellore is piloting in this regard partnering with the University of Edinburgh and analyses the possible benefits and pitfalls of such an approach

Evaluation of the effectiveness of a community health worker training course in India

Community health workers (CHWs) have long played a key role in delivering healthcare in rural and remote populations, through primary care, prevention, and education. Numerous mechanisms of training and supporting CHWs have been implemented, and the World Health Organization (WHO) has outlined recommendations for the programmatic and financial aspects of CHW programs. This study evaluated the outcomes of a CHW training program in India whereby community development workers from faith-based organisations have been trained since 2011 to extend health promotion, education, and basic services to rural, remote, and poor communities across the country. Triangulation of quantitative and qualitative data and course information was conducted, and analysis pointed to the effectiveness of the trainees in their respective work locations. Outcomes were noted in these areas: health promotion (trainees had gained skills and confidence to implement health promotion interventions); first aid and primary care (graduates were treating common conditions in the community); beneficiary diversity (rural and poor beneficiaries were frequently cited as well as trainees and their families); and, spiritual health (the nurture of person was an important part of conducting CHW activities). The consistency of the data across these areas suggests that the training course is effective in its delivery, its contribution to the expansion of healthcare coverage, and its potential for impact across India