• 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