Insights

The ‘Refer less; Resolve’ more Initiative

Dr Rebekah Zechariah

The Background:

Our country’s billion-plus population presents insurmountable healthcare needs and the skewed distribution of healthcare personnel adds to this challenge. With almost 80% of health professionals choosing to practice in urban India, and 70% of the population living in rural India, primary health care is inaccessible in many states.

This huge burden was perceived by the Founder and Visionary of the Distance Education department at Christian Medical College Vellore, Dr Vinod Shah. During his years of service in many rural areas, Dr Shah saw the urgent need for good training in primary care and brought this vision back to his alma mater CMC Vellore.

It was in 2004 that the Distance Education Unit was set up with a single focus of “taking education to healthcare professionals where they are” rather than displacing them from their workplaces. The goal was to offer excellent primary care training, upskill health professionals and thereby enable the General Practitioner to be able to resolve more and refer less, and appropriately. The answer to this was in Family Medicine and thus began the Post-Graduate Diploma in Family Medicine (PGDFM) course!

The Early Days:

After some birthing issues as with any new concept, the idea of training for sound primary care was well received but the question of “how” remained paramount in the minds of the early leaders of the department. How would one propose to train the thousands of GPs in our country while they continue to remain in their respective workplaces and practice medicine? How would one monitor their learning and ensure quality? How would one remain true to CMC’s ethos of “not to be served, but to serve”?

The answers were found in adopting the Blended Learning approach. Blended learning is a hybrid learning program which involves a combination of self-directed learning combined with face-to-face interactions with students and their facilitators intermittently throughout the course.

The Blended Learner:

The first two years (2004 - 2006) were spent in understanding the concept of the blended learner and training faculty to write course material for this modality of training. Problem-based self-learning modules were created and this was supplemented with face-to-face interactions (Contact Programs). In addition to the interactive modules, the contact programs were structured to be a time where hands-on skills would be taught using various teaching-learning methods. The contact programs would also be a time to discuss values and attitudes and look at those aspects of medicine that are often neglected, yet paramount to a good patient-doctor relationship.

Contact Programs - focus on values, attitudes and hands-on skills

Partnerships - A vital part of the program:

The structured training during the contact programs is offered in partnership with CMC’s network of secondary care hospitals across the country. These centres are places where wholistic and ethical patient care is offered and provides an opportunity for the students to learn how good medicine can be practised even in low resource settings. Currently, the program is offered in partnership with 14 centres across India.

The Impact:

Since 2006, approximately 3000 doctors have graduated from the Family Medicine program and have been able to influence practice change not only in their own spheres of work but also on a national platform. Several alumni are in leadership roles and are able to advocate for Family Medicine in India. With the experience of running this program for the past 14 years and with several requests from other countries for the same training, the international version of the Family Medicine course is being launched in April 2020, with the same vision and goal with which it was started.

Alumni from the Family Medicine course have expressed the need for training in other areas of Medicine and this began the onset of other blended learning courses being offered by the department including Diabetes, Geriatrics, Mental Health, General Dentistry and currently, Rehabilitation Medicine in the pipeline.

Further details about these programs can be found at courses.cmcdistedu.org

Dr Rebekah Zechariah

MD (Internal Medicine), MD (Geriatrics), MS (Higher Education)
Head, Distance Education Department
Christian Medical College, Vellore