• CMC hospital
• hospitals
CMC Vellore
Network of 200 rural secondary hospitals across India
1909 – First batch of nursing students
2200 bed teaching hospital
Dr. Ida S Scudder
Christian Medical College Schools of Medicine Allied Health Science & Nursing
Addressing public health problems through distance learning
Lessons from a postgraduate course in HIV clinical care
The Fellowship in HIV Medicine
HIV care scenario in India - late 1990’s
• Emerging HIV epidemic
• Lack of care services -Primary and secondary level -Rural areas
• Lack of trained personnel-Doctors involved in care unable to leave work place
• Lack of training programmes
Collaboration between Medical School & Distance Education University
Christian Medical College
National level traininginstitution in Medicine
Resource centre for HIV Medicine
• Clinical care• Laboratory testing• Counseling
Open University Centre for Education in Medicine
• Training and capacity building
• Assistance in course development
• Guidance and support in implementation
EDUCATIONAL APPROACH
SELECTION TRAINING HIV CARE SERVICES
PROJECTIMPLEMENTATION
TRAINING- SERVICE DEVELOPMENT TRAINING- SERVICE DEVELOPMENT APPROACHAPPROACH
Interested doctors
Contact &Distance courses OP, IP, HIV testing
Counseling, Staff education, ART
HIV CARE PROBLEM
2.3 million casesLack of care facilities Stigma
Focused objectives
1. Independent practice
2. Context specific learning
3. Service development
• Improve doctors knowledge and skills for - Independent care of HIV
patients- at secondary level
• Develop HIV services at students institutions
- Basic components- Quality- assured - Accessible
INTEGRATED COURSE DESIGN
Distance Course
MONTHS 0 5 12
Project phase
Contact courses CC-I CC-II CC-III
MODULES
IMPLEMENTATION
PLANNING
TRAINING SERVICE DEVELOPMENT
CC-IV
LAB TECHNICIAN & COUNSELLOR TRAININGTEAM TRAINING
NETWORKING
Course development
• Course team
• Faculty training
• Development of course materials
• Systems
• Quality assurance Faculty training workshop
Course team
Based on OU best practices
Critical factors in course design
• Selection• Contact courses
• Integrated learning texts
• Project work
• Student support• Assessments
• Student and hospital• Progressive skill
development• Case based and
contextual materials• Staged and guided
project work• Mentoring• Knowledge, skills and
project work
Project work
• Towards development of HIV care services- Out patient care- Inpatient services- Counseling- Lab testing- ART- Infection control- Staff education
Project work- critical factors1. Need based2. Administrative support3. Staged project work4. Project guide
CMC & local guide5. Seed grant6. Site visits7. Monitoring
Examples of project work
ART CLINIC COMMUNITY CARE STAFF TRAINING
HOSPITAL BASED CARE PALLIATIVE CARE SUPPORT GROUP
0
10
20
30
40
50
60
70
80
90
100
Mean score (%)
Distancecourse
Project Theory Practicals
COURSE ASSESSMENTS
PASSMARK
Development of knowledge and skills for Independent practice
1 year evaluation- Service development
0
10
20
30
40
50
60
70
80
90
100
HIV te
stin
g
Counse
ling
Out
-pat
ient c
are
In-p
atie
nt c
are
Staff
educ
atio
n
Pre-course
Post-course
• 75% of institutionshad basic componentsof HIV care
• Increase service utilisation • Improved quality of
services
% AVAILABILITY OF BASIC SERVICES
3 year External evaluation
• 70% of graduates were working in their original hospitals
• Graduates were competent in HIV careGreater responsibilities given to graduates
• Quality of HIV services had improved- Staff had been trained- Policies and guidelines were being used- Linkages to the community enhanced- Climate of HIV care had improved
DLCCMC
Christian Medical College,Vellore
MaulanaAzad
Medical College,
New Delhi
School of TropicalMedicine,Kolkotta
Distance learning centre•Coordination•Material development•Quality assurance
Regional Training centres
UP-SCALING- OU model
Critical factors in up scaling process
• Selection of centres
• 6 month faculty development programme
• Upgrading institutional infrastructure
• Setting up systems
Regional training centres
FHM class, Kolkotta Project presentation Computer session
Clinical examination OSCE examination Informal sessions
33
4615
29
4
3 1
17
16
12
4
2
1
32
14
25
1
1
12
33
Graduates -Sector
Government Hospital
48%
Voluntary
sector
47.6%
Private 4.4%
Distribution of FHM Graduates
2002-2009Total number of graduates- 237Drop out rate- 4.6%
Vellore
Delhi
Kolkotta
Conclusions• The Fellowship in HIV Medicine has succeeded in:
- Developing a sizable cadre of HIV physicians- Ensuring quality assured and comprehensive HIV services at the community level
• Such a well developed DL course can be rapidly and efficiently replicated.
• It is possible to address emerging or unmet health care needs through distance learning.
CONCLUSIONCritical factors to addressing public health problems
through DL
• Partnership with DL resource centre• Careful design and development• Motivation and expertise of faculty• Selection of motivated students• Need based project work• Basing the DL course in centres where clinical
expertise and experience is available
Further developments at CMCDistance education department
Courses• PG Diploma in Family
medicine• Course for MBBS doctors
working in rural hospitals• Fellowship in Diabetes
care• Primary health worker
training
Proposal for School of Distance Learning in MedicineCMC-OU collaboration
Proposed DL courses• Distributed undergraduate
medical training
• General practice
• Priority health areas
• Health worker training
• Specialty disciplines
AcknowledgementsHIV /STI Research Intervention, Population Councilfunded by the European Union
Resource Centre for Sexual Health and HIV/AIDS fundedby DFID
Maulana Azad Medical College, New Delhi
School of Tropical Medicine, Kolkotta
Open University Centre for Education in Medicine
Graduation Fellowship in HIV Medicine 2002