Innovative programmes of medical education: II. Commentary and lessons for India

Major areas in which innovative approaches in medical education have been tried include student selection, learning strategies, and community orientation. It is relatively easier to implement innovations in a new institution. In established medical schools, running two simultaneous curricula tracks, the traditional and the innovative has emerged as a popular strategy for introducing new systems of education. Institutional commitment to the objectives and matching implementation effort determine the success of an innovative programme. Stronger links between the medical education and health service systems not only enhance the community orientation of the graduates, but also help improve the quality of health care provided to the community. There is a need to experiment with innovative approaches to education of physicians in our country. Establishment of medical education units in medical schools will be a practical beginning in the right direction.     

Anti-tobacco education programs for children and youth at different stages of schooling

Anti-tobacco education programmes for children and youth, developed at the National Research Institute of Mother and Child, are presented. The targets and goals of elaboration and implementation of these programmes are discussed. The four programmes contribute to a continuum of anti-tobacco education from preschool to secondary school. For each programme, the elaborated educational objectives, curriculum structure and methodology are presented. Problems related to evaluation of health promotion programmes are discussed in relation to the requirements of evidence-based medicine. Results of pilot programme implementation are presented. The programmes have been accepted by teachers, pupils and parents and can be implemented in the reformed education system in Poland.     

The lessons of medical cooperation (1995-1998): the formation of young teams trained in emergency services at two Romanian pediatric hospitals]

A cooperation programme, aimed at improving the running of pediatric hospitals in Bucharest (Romania) was conducted by a team of Assistance Publique-H?pitaux de Paris from 1995 to 1998. MATERIAL AND METHODS: The introduction mentions the context of the health care system in order to help to follow the role of emergency services. The method to improve the child health services was based on an initial evaluation of emergency structures and procedures. A questionnaire was filled in after a four-year programme to test the impact of the counselling concerning the organization of the casualties and emergency division, the medical and nursing training and the use of equipment. RESULTS: The results show: a centralization of the emergencies and the implementation of an intensive care unit in one out of the two hospitals. The discussion points out the criteria of efficacy for cooperation programmes and gives examples of medical cooperation in eastern countries. CONCLUSION: The conclusion insists on the multidisciplinary approach of medical programmes, with training of young teams.     

Training program in Japan for health caretakers from developing countries.

In 1979, the International Center for Medical Research was organized in Kobe University School of Medicine and promoted the scientific cooperation through invitation of foreign scientists from developing countries as the Core University of Medical Science of Japan Society for the Promotion of Science (JSPS). Perinatal medicine is one of the main subjects in this program and we have accepted more than thirty neonatologists from Indonesia, Philippines, Thailand and other developing countries.     

Simulation in paediatrics: An educational revolution

Recent changes in the culture of medical education have highlighted deficiencies in the traditional apprenticeship model of education, and emphasized the need for more experiential modalities of learning. Simulations, which are scenarios or environments designed to closely approximate real-world situations, have recently found their way into the medical training of health care providers. High-fidelity simulators are life-like mannequins connected to computer systems that control the physiological and physical responses of the mannequin. These simulators are able to provide direct feedback to learners in safe, risk-free environments. This technology has been used to teach all aspects of medical care, including medical knowledge, technical skills, and behavioural training or communication skills. The present article provides a general overview of simulation that will hopefully help to generate interest in paediatric simulation across Canada. Several tertiary care paediatric hospitals in Canada are already using simulation to teach health care providers; continued growth and interest is expected in this exciting area of medical education.     

Final report of the FOPE II Financing of Pediatric Education Workgroup

Some of the challenges of financing pediatric medical education are shared with all medical education; others are specific to pediatrics. The general disadvantage that funding of graduate medical education (GME) is linked to reimbursement for clinical care has uniquely negative consequences for freestanding children's hospitals because they therefore receive little Medicare GME support. This represents both a competitive disadvantage for such hospitals and an aggregate federal underinvestment in children's health care that now amounts to billions of dollars. The need to subsidize medical student and subspecialty education with clinical practice revenue jeopardizes both activities in pediatric departments already burdened by inadequate reimbursement for children's health care and the extra costs of ambulatory care. The challenges of funding are complicated by rising costs as curriculum expands and clinical education moves to ambulatory settings. Controversies over prioritization of resources are inevitable. Solutions require specification of costs of education and a durable mechanism for building consensus within the pediatric community. Pediatrics 2000;106(suppl):1256-1269; medical student education, continuing medical education, medical subspecialties, children, pediatrics, health maintenance organizations, managed care, hospital finances, children's hospitals.     

Mental health promotion for young people: A proposal for a tripartite approach

ABSTRACT Child and adolescent mental health promotion programmes may be more effective if they include a combination of different approaches to health promotion rather than relying primarily on one approach. A group of complementary approaches that could be combined in a single programme include: (i) a community-wide media campaign to highlight the harmful effects of family discord on the mental health of young people; (ii) a school-based social skills programme to improve the social skills of young people; and (iii) a life skills programme to build the competence of young people 'at risk' for developing mental health disorders. The potential value of this particular combination of approaches is discussed with the aim of facilitating the development of innovative new child and adolescent mental health promotion programmes in Australia.     

Current practice in health promotion.

Progress in health promotion and preventive programme planning is limited by a lack of data on the development of current activities. A cross sectional survey of hospitals, community health centres, and other health agencies in New South Wales was therefore undertaken to determine the nature and extent of health promotion programmes being conducted in the period July to December 1983. A subsample of 1198 preventive programmes in child and family health was identified, making up 26% of all programmes operating in this period. Results indicate that three major types of programme are being conducted in child health. These are in the areas of (1) parent education and support, (2) school health education, including drug and alcohol education and personal development, and (3) child safety and first aid. Although the nature of these programmes generally corresponds with current thinking on what priorities in health promotion should be, results also indicate that evaluation of these programmes is limited. Most programmes assess only what participants think of the programme rather than assessing changes in knowledge, attitude, behaviour, or health status. Improvements in evaluation practice are required if preventive intervention programmes are to undertake seriously the task of altering the pattern of diseases and problems in childhood and adolescence.     

Infectious diseases in African children

Present status and problems of infectious diseases in African children are detailed. The Department of Paediatrics, Mie University School of Medicine has 10 years' experience of international medical cooperation with African countries. At present, the department is participating in two projects in Ghana and Zambia. The activities have been carried out in the field of priority infectious diseases in African children. Major infectious diseases in Africa are malaria, diarrhoeal diseases, acute respiratory infections and some specific parasitic diseases. Human immunodeficiency virus infection has also become a threat to the health and survival of children in Africa. To reduce morbidity and mortality due to these diseases, primary health care activity may be an effective and economical measure. Japan is expected to make further technological and economical contributions to the control of the infectious diseases in developing countries. Japanese paediatricians should be aware of the condition of child health in developing countries and consider what can be done to help.     

The pediatric practice of the child health associate.

Child health associates are individuals who have completed the three-year Child Health Associate Program at the University of Colorado School of Medicine and are certified by the Colorado State Board of Medical Examiners to practice pediatrics under physician supervision. To our knowledge, this study is the first to describe the practice profile of child health associates. We found them able to provide health care services without direct physician assistance to 91.4% (2,160 of 2,363) of pediatric patients in ambulatory settings. They saw the same variety of patients as primary physicians and identified a broad range of common pediatric problems. Each supervising physician spent an average time of 5.9 minutes with the child health associate in evaluating the 8.6% of patients who required consultation. The child health associate is fully able to serve as a primary health care practitioner for children.     

Le fil institutionnel en période Covid : utilisation de la plateforme Discord au CMPA

The COVID crisis led hospitals to reorganize care services and to develop innovative strategies to provide care at a distance. In our health care and education centre for adolescents, which provides both long-term psychiatric care and high school education, inpatients and outpatients were mostly confined at home. In order to ensure continuity of care as well as maintain institutional ties, different communication tools were used. Among them, we particularly relied upon Discord (social network initially designed for gamers) which allowed us to set up an entire virtual ward, maintain individual and group care programmes as well as team meetings. This innovation generated a number of preliminary questions and precautions which guided our decisions regarding the server settings. The outcome of this experiment is globally positive, both quantitatively and qualitatively, even if care at a distance showed its limits. Despite the involvement and creativity of health professionals, the confinement period disrupted and even led to the discontinuation of some care projects.     

Training healthcare workers increases IFA use and adherence: Evidence and cost‐effectiveness analysis from Bangladesh

Iron and folic acid (IFA) supplementation programmes are important for preventing and controlling anaemia among pregnant women in low‐ and middle‐income countries. However, frontline health care workers often have limited capacity and knowledge, which can compromise such programmes'' effectiveness. Between 2012 and 2014, Nutrition International and the Government of Bangladesh implemented a programme intended to increase IFA supplement consumption during pregnancy. The programme provided frontline health care workers with training on the benefits of IFA supplementation, the use of interpersonal communication and health promotion materials during antenatal care visits and health management information systems to track reported adherence to IFA supplementation. Using a quasi‐experimental design, this study investigates the programme''s effectiveness and cost‐effectiveness at increasing IFA supplement consumption and adherence among pregnant women. The difference‐in‐differences regression analysis comparing outcomes in an intervention and comparison group concluded that the programme increased IFA consumption by an average of 45.05 supplements (P value = 0.018) and increased the share of women that reported adherence to a regime of at least 90 supplements by 40.35 percentage points (P value = 0.020). Knowledge of IFA supplement dosage and benefits also increased among frontline health care workers and pregnant women. The programme cost $47.11 USD (2018) per disability‐adjusted life year averted, which is considered highly cost‐effective when evaluated against several cost‐effectiveness thresholds. This study suggests that the capacity building of frontline health care workers is an effective and cost‐effective method of preventing and controlling anaemia among pregnant women in resource‐constrained areas.     

Modernising medical careers for paediatricians

Modernising medical careers (MMC) is a major reform of postgraduate medical education that offers many opportunities to improve the training delivered. New training programmes are being developed to support the delivery of a competency-based curriculum. Success of these reforms will depend on sufficient resources being available to support this more focused training. This article summarises the changes and the challenges that this reform in postgraduate medical education brings.     

Asset-Based Community Development as a Strategy for Developing Local Global Health Curricula

Background

A significant and growing proportion of US children have immigrant parents, an issue of increasing importance to pediatricians. Training globally minded pediatric residents to address health inequities related to globalization is an important reason to expand educational strategies around local global health (LGH).

Organization of school health care during health reform implementation in Poland

School children and adolescents needs particularly good medical health care because of the specific character of this developmental period and the danger due to risky behaviours among pupils. The aim of this study was to assess the quality prophylactic health care for pupils in the early stage of initiating health care reforms. The initiation of the health reform on January 1st 1999 caused a deterioration of prophylactic medical health care in pupils. It may also produce more health problems among school children and adolescents in the future.     

Infant feeding in the time of HIV: rapid assessment of infant feeding policy and programmes in four African countries scaling up prevention of mother to child transmission programmes.

OBJECTIVE: To assess the infant feeding components of prevention of mother to child HIV transmission (PMTCT) programmes. METHODS: Assessments were performed across Botswana, Kenya, Malawi and Uganda. 29 districts offering PMTCT were selected by stratified random sampling with rural and urban strata. All health facilities in the selected PMTCT district were assessed. The facility level manager and the senior nurse in charge of maternal care were interviewed. 334 randomly selected health workers involved in the PMTCT programme completed self-administered questionnaires. 640 PMTCT counselling observations were carried out and 34 focus groups were conducted amongst men and women. RESULTS: Most health workers (234/334, 70%) were unable to correctly estimate the transmission risks of breastfeeding irrespective of exposure to PMTCT training. Infant feeding options were mentioned in 307 of 640 (48%) observations of PMTCT counselling sessions, and in only 35 (5.5%) were infant feeding issues discussed in any depth; of these 19 (54.3%) were rated as poor. Several health workers also reported receiving free samples of infant formula in contravention of the International Code on Breastmilk Substitutes. National HIV managers stated they were unsure about infant feeding policy in the context of HIV. Finally, there was an almost universal belief that an HIV positive mother who breastfeeds her child will always infect the child and intentional avoidance of breastfeeding by the mother indicates that she is HIV positive. CONCLUSION: These findings underline the need to implement and support systematic infant feeding policies and programme responses in the context of HIV programmes.     

Prerequisites for age-appropriate education in type 1 diabetes: a model programme for paediatric diabetes education in Germany

Abstract:  Continuous diabetes education for children, adolescents and their parents are widely accepted as an integral part of every type 1 diabetes therapy. Especially in paediatric diabetes care age-appropriate, demand-oriented and individualized practical information and skills training are mandatory for achieving good metabolic control and psychosocial well-being. A paediatric multidisciplinary diabetes team experienced in an intensified insulin therapy with a differential substitution of prandial and basal insulin needs (MDI or CSII) and in child psychology is required to initiate and maintain lifelong diabetes self-management. In Germany an education programme for children aged 6–12 years and another programme for adolescents and young adults have previously been evaluated in multicenter studies. Programmes were considered with respect to applicability, acceptance by target groups and efficacy (knowledge, competence, quality of life and glycaemic control). Furthermore, a programme specifically designed for parents of children affected was evaluated. Contents, modular structures, developmental psychological background and didactic concepts of all above mentioned programmes are presented in detail. Apart from teaching insulin therapy according to current guidelines special emphasis is laid on translating this knowledge into everyday self-management behaviour. In addition, emotional coping with the chronic disease and its psychosocial consequences is supported. In the context of the Disease-Management–Program for Type 1 Diabetes in Germany these programmes for young people were certified and reimbursed nationwide by health insurances.     

The new emergency medical technician-paramedic and emergency medical technician-intermediate curricula: History, changes, and controversies

In recent years there has been considerable change and improvement in pediatric prehospital education. The evolution of ENIS (emergency medical services) for children has paralleled the evolution of EMS hat with a laf of several years. The most recent advance has been the release of the new paramedic and emergency medical technician intermediate (EMT-I) national standard curricula. The new curricula represent a major improvement in the training of EMTs and paramedics in the care of sick or injured children. In fact, what this new curriculum represents is the incorporation of the many continuing medical education efforts that have been developed, produced, and taught by the emergency medical services for children community over the past 15 years. This new curriculum now focuses on assessment-haled medicine that is in-line with the rest of emergency care. In addition, this new curriculum now provides an educational fornmt similar to that undertook by most pediatric continuing medical education courses in an effort to overcome common educational barriers. This curriculum provides significant hands-on training through both skill, practice , and casebased learning. This will hopefully give paramedics basic knowledge, an understanding of disease processes of the child and skills that will allow them to provide care for ill and injured children with confidence. The curriculum also provides a more directed focus on the importance of maintaining an airway and breathing in the child and that a deficiency in these are usually the root of most pediatric emergencies. In addition, it covers relevant topics in pediatric care as well as topics which are of concern to the paramedic student. Although the new curriculum incorporates changes in all we know about pediatric care, to further overcome barriers in pediatric education there trust he better teaching modalities for the EMT and the paramedic, an increase in their experience in dealing with sick and injured children from a multitude of settings, and development of better training models.     

The long-term effect of cyproterone acetate on growth in girls with idiopathic precocious puberty

To define the effect of cyproterone acetate (CPA) on statural growth, 25 girls with idiopathic precocious puberty who had been treated with CPA were studied retrospectively. The final height SDS was –1.12±1.16 (mean±SD). The daily CPA dose was negatively related to the final height SDS. We divided our subjects into two groups according to the daily CPA dose [low dose, 84.9±15.4 mg/m² (n=19) vs high dose, 135.8±17.1 mg/m² (n=6)]. In the low dose group, the difference of the final height SDS minus height SDS for bone age at the initiation of CPA treatment was 0.55±1.16 and final height SDS was –0.82±1.05. The final height was not significantly different from the target height in the low dose group subjects whose target heights were obtained. Since the increment of height age to the increment of bone age during the treatment was significantly less in the group needing and treated with high dose CPA, high doses of CPA may reduce growth velocity more than its suppressive effect on bone maturation. These results suggest that CPA has an effect on statural growth in girls whose clinical symptoms can be controlled with a low dose of CPA, although they have not been compared with final height in untreated Japanese girls.Androcur Study Group consists of the following personnel: K. Fujieda, Department of Paediatrics, Hokkaido University School of Medicine; A. Okuno, Department of Paediatrics, Asahikawa Medical College; K. Sanayama, Department of Paediatrics, Chiba University School of Medicine; K. Shimozawa, Department of Paediatrics, Tokyo Medical and Dental University School of Medicine; N. Matsuo, Department of Paediatrics, Keio Gijuku University School of Medicine; Y. Oyama, Department of Paediatrics, Kitasato University School of Medicine; Y. Igarashi, Department of Paediatrics, Hamamatsu Medical College; M. Ogawa, Department of Paediatrics, Nagoya University School of Medicine; S. Okada, Department of Paediatrics, Osaka University School of Medicine; T. Kondo, Third department of Internal Medicine, Osaka Children's Medical Centre; Y. Nishi, Department of Paediatrics, Hiroshima Red Cross Hospital