Comparative study of community medicine practice in MBBS curriculum of health institutions of Nepal

Abstract

Background: A revolution in health care is occurring as a result of changes in the practice of medicine and in society. Medical education, if it is to keep up with the times, needs to adapt to society's changing attitudes. Presently medical education has been criticised for its orientation and insensitivity to people's need. The MBBS curriculum of medical institutions of Nepal has been focusing on community-based approaches and is still guided by the same notion. The question put forward is whether it has been appropriate to nurture the present health needs and aspiration of people. Objective: The objective of the present study is to review the existing community based medical education in health institutions of Nepal to strengthen the components of community care. Materials and methods: Qualitative study was done by reviewing the curricula and existing community medicine courses/activities in MBBS curriculum Findings and Discussion: The curriculum of all the health institutions have addressed signifi cantly on community medicine practice. As per Institute of Medicine, the community medicine practice is achieved through community based learning experiences like community diagnosis, concurrent fi eld with families of sick members and district health system management practice. In BP Koirala Institute of Health Sciences, community medicine practice is undertaken through exposure to community diagnosis program, health care delivery system, family health exercise, applied epidemiology and educational research methodology, management skills for health services and Community Oriented Compulsory Residential Rotatory Internship Program (COCRRIP). In KUSMS, community medicine module is carried out as-community diagnosis program, community health intervention project, school health project, occupational health project, health delivery system functioning, family health care activities and Compulsory Residential Rotatory Internship Program in outreach clinics. In the practice the practical aspects are largely unstructured that waste too much time in non-educational activities and rely on learning and doing. Meanwhile, expectation of the community is increasing and the challenge of nurturing their demands has come in forefront. Community has perceived that the medical schools are concentrating on fulfi lling the demand of their curriculum rather directing on their health care need. Conclusion: Health institutions need to be accountable to take the responsibility of strengthening the health status of the community of their catchments areas. The practice of community medicine need to be done in an innovative way and these schools should execute continual intervention activities and complement other institutions working in their areas.

Assessment of graduate public health education in Nepal and perceived needs of faculty and students

“…A community-based approach to medical training has always been an integral part of the Nepalese medical-school curriculum [11,12]; however, the inability of Nepali health professionals to efficiently deal with the recent cholera epidemic in western Nepal, which claimed 301 lives, is an example of the inadequacy of public health training in the country [13,14]. There has been little investment into research on epidemiology, health-information systems, or management [11] and, in contrast to medical education, public health education has received relatively little attention or investment.…”

Perceptions of Education Quality and Influence of Language Barrier: Graduation Survey of International Medical Students at Four Universities in China

“…However, IMSs' home countries are generally medically underserved, where the population need to benefit from enhancement of primary care and an increase in general practitioners [44][45]. In fact, community-oriented approaches have already been emphasized at medical schools in many Asian and African countries, including India [46], Nepal [47][48], Pakistan [49] and Ghana [27], with the aim to produce health professionals with competencies and values to serve in local communities, particularly rural areas [50]. Given the vital position of community medicine in IMSs' home countries, policy planners and educators in China should consider reorienting the medical education tailored to IMSs to some degree, putting more effort to fortify theoretical teaching of community medicine and create more practice opportunities in a community setting, to meet the medical conditions of IMSs' home countries.…”

Perceptions of Education Quality and Influence of Language Barrier: Graduation Survey of International Medical Students at Four Universities in China

“…In IMSs' countries of origin, which are generally medically underserved, the population need to bene t from the enhancement of primary care and an increase in general practitioners [45][46]. Thus, the medical schools in these countries have been emphasizing communityoriented approaches [28,[47][48][49][50], aiming at producing health professionals with competencies and values to serve in local communities, particularly rural areas [51]. Given the vital position of community medicine in IMSs' home countries, policy planners and educators in China are advised to consider reorienting the related syllabus in line with the need of IMSs, putting more primary care contents into the community medicine course and creating more practice opportunities in a community setting.…”