Objectives

Vision & Mission

Graduate Medical Education is the key word in a developing economy like ours. We need doctors, doctors who know the people, doctors who know what the people mean and what the people need. In quintessence, graduate medical education, has to lead a raw unlearned school kid to become a mature young person with the right attitude towards the patient, their disease and its management. The graduate has to necessarily be not only a physician, but also be a sociologist, psychologist, anthropologist, economist. This entails a long process of learning many subjects from basic medical subjects to medical and surgical specialties. We at Tirunelveli Medical College have developed a new method of enthusing students to learn the facts and understand the patient. We have taken inputs from the internet resources of various international organizations and medical schools. We acknowledge these leaders for the start up knowledge. The new program is named “Mentored Clinical Training Program” under the Innovates TVMC initiative

Vision:
We envision through the program a clan of young medical graduates who understand the disease and treatment through the eyes of the patient, learn to treat the human being with compassion and know that the patient is endowed with their own rights.
Mission:
The Program will endure to train the graduate medical student to

  • Understand the basics of clinical interviewing and reasoning and its sound relationships to disease processes, diagnosis, treatment and its responses and basis of clinical research
  • Understand the foundation of a ethical and trust based doctor patient relationship
  • Communicate effectively with patients, patient relatives, professional colleagues, paramedical staff and community stakeholders.
  • Understand the Indian and Tamilnadu health systems and to inform the stakeholders - the local health authority, and patients.
  • Understand medical and health legislations of the country and state, global health regulations and requirements, medical ethics & clinical jurisprudence.
  • Understand the strengths and limitations of other Indian Systems of Medicine.

FAQ


Mentored Clinical Training Program

We start with asking ourselves the following questions
1. Does the student have the needed knowledge and skills to apply in any clinical situation?
The present curriculum, takes the student through three sessions - basic medical science courses in anatomy, physiology and biochemistry, paraclinical courses in pathology, microbiology and pharmacology and clinic-based teaching in various subjects like general medicine, general surgery, pediatrics, obstetrics & gynecology, orthopedics, and others. But the whole system is compartmental and hence a disconnect of knowledge and application. The student learns to interview patients but lacks the simple thought connectivity on how to apply this interview to what they learned earlier. This results in a quaint situation - the student “learns everything, sees everything, but knows nothing”

2. How can the student integrate the knowledge and skills?
We need to develop a system of study that bridges this gap. The system should be simple and usable, without any additional effort for the faculty leading to a higher-level thinking skills that allows the student autonomy to integrate all information and situtations for pragmatic scientific decision making. To this effect is the Mentored Clinical Training Program (MCTP).

3. What are the Specific Learning Objective of the MCTP?
After completing the lesson, the graduate medical student will be able to:

  • listen to the patient with rapt attention, calm and empathy for the purpose of finding clues to his disease and treatment responses.
  • Record patient interview, record pertinent investigations and treatment, record clinical progress; use the clinical vocabulary that is global in practice to describe diseases, its origin, effects, diagnosis, treatment and outcome; explain the meaning of the words or terms used in regular clinical practice; discuss the differences and similarities between two or more clinical diagnosis and discuss the methods of confirming the diagnosis.
  • Understand and make inferences from the text books on the causation, clinical presentation, effects, diagnosis, management and outcome of each treatment and long term prognosis of the disease; demonstrate understanding by writing critically to interpret and evaluate clinical problems and represent textual information by table and diagrams
  • Vocally state an opinion about a clinical problem and discuss using examples from the text to support the opinion, list the different diagnosis with similar features, outline the diagnosis, management and outcome.
  • Discuss and analyze the clinical environment of a hospital, derive implied knowledge from the social responses of the patients and patient care-givers, faculty, nurses and paramedical staff. Enlist elements of ethic and nonethic in such observed and analyzed facts. Identify and trace the development of medical ethics and clinical etiquette.
  • Produce an effective persuasive essay on the work you have done inside the hospital, labs of the hospital and wards; and use the work as an inspiration, draw parallels between practice and text, explore the nature and implications of a disease, as a societal concern. Use specific examples to illustrate an aspect of human behavior you have seen in the wards.
  • Demonstrate mastery in the study of medicine through cooperative learning and research.

4. How does the Program Work?
The MCTP will be implemented at TVMC from March 2012. It will be a program will be

ONE Year, ONE Subject,
ONE Mentor, ONE Student
ONE Patient.

The student spends as much time as possible with the patient in hospital and follow up the patient. The student, in consultation with his or her mentor, will define, describe, discuss, analyze all the components of the patient's medical problem that includes

  • patient's complaints in chronology and duration, clinical history of the patient including the history of the present illness, past illness, personal, family, occupational, racial, economic, social situations of the patient, food and other habits.
  • General examination of the patient, examinations of his systems
  • Analysis of the clinical scenario and making a clinical differential diagnosis, analyze further each of the diagnosis and make a list of similarities and differences of each based on the clinical presentations of the patient.
  • Make a list of diagnostic tests and analyze the question WHY? for each of the tests, and further analyze the results in correlation with the clinical presentations and arriving at a final diagnosis. In such event a discussion on the economic and social issues of the diagnostic tests is to be analyzed.
  • Analyze the diagnosis, its epidemiology, patho-biology, progression,  socioeconomic issues, cultural issues, outcome, different treatment methods, the treatment instituted in the patient, the outcome of such treatment.
  • dentify and investigate all factors that comprise the patient's life that affected the illness, diagnosis, management and outfall of the disease.
  • At the end of the tenure the student will write the Mentoring Summative Assessment Record (M.S.A.R). This will be in a thesis format with specific references from the literature pertinent to the discussion and analysis. The writing of the MSAR  is the final and most essential part of the program. This is essential because it helps the student to organizes his or her thoughts and express what he or she has learnt through the process of graduate medical course at TVMC in the routine and specifically through the MCTP.
  • The pinnacle of the program would be the MCTP open house program, where the students will give a 7 minute presentation of the work done and will face the questions of a board of assessors. The board of assessors will also evaluate the written work. The grading of the study will be done as per a prepared system (Table 1)
  • The best record will receive Academic Achievement Prize for Graduate Clinical Work.

5. From there to where?
This program envisaged from the coming academic session ie the summer of 2012 with first clinical year TVMC student. We will review the outcomes from student and faculty participants. We shall ask each participant

  • whether the participant was  comfortable with the program.
  • Whether they were able to develop a dynamic mentor-student relationship
  • Whether the mentor was able to improve their teaching skills
  • Whether the student was able to improve their learning skills
  • Whether the students were able to understand their intellectual strengths and clinical approach to optimize future patient care.

6. What More?
This program is enunciated as a special education initiative and does not affect the MCI and Affiliate University mandated assessment methodologies in vogue presently.


References

  1. Robert C. Stanton, MD, Lisa D et al; The Mentored Clinical Casebook Project at Harvard Medical School; Academic Medicine, Vol. 82, No. 5 / May 2007 516-520
  2. Birks J, Farrell E, Newson A. Flexible teaching and learning in general practice. Aust Fam Physician. 2004;33:687-689.
  3. Krebs N, Primak L. Comprehensive integration of nutrition into medical training. Am J Clin Nutr. 2006;83:945S-950S.
  4. O'Brien K, Crespo L, Wallach P, Elnicki M. Internal Medicine Clerkship Directors' opinion regarding clinical input in the preclinical years: the 2002 CDIM basic science survey results. Teach Learn Med. 2006;18:105-109.
  5. Weatherall D. Science in the undergraduate curriculum during the 20th century. Med Educ. 2006;40:195-201.
  6. Windish D, Price EG, Clever SL, Magaziner JL, Thomas PA. Teaching medical students the important conection between communication and clinical reasining. J Gen Int Med. 2005;20:1108-1113.
  7. Charon R. Narrative and medicine. N Engl J Med. 2004;350:862-864.
  8. Chur-Hansen A. Medical students' essay-writing skills: critertia-based self- and tutor-evaluation and the role of language background. Med Educ. 2000;34:194-198.
  9. DasGupta S, Charon R. Personal illness narratives: using reflective writing to teach empathy. Acad Med. 2004;79:351-356.
  10. Driessen E, van Tartwijk J, Vermunt JD, van der Vleuten CP. Use of portfolios in early undergraduate medical training. Med Teach. 2003;25:18-23.
  11. Grant A, Berlin A, Freeman G. The impact of a student learning journal: a two-stage evaluation using the nominal group technique. Med Teach. 2004;25:659-661.
  12. Pinskey L, Fryer-Edwards K. Working and performance portfolios for evaluation and reflection on learning. J Gen Int Med. 2004;19:582-587.

Assessment


MSAR ASSESSMENT SYSTEM

O
A
B
C
D
ANALYSIS OF THE EXTENT OF PERFORMAMCE
Recording of Patient Illness Accuracy and Keenness exhibited in recording the complaints in chronology and duration, clinical history of the patient including the history of the present illness, past illness, personal, family, occupational, racial, economic, social situations of the patient, food and other habits. General examination of the patient, examinations of his systems, investigations done, their results, treatment accorded, outcomes and responses.
Analysis of Patient Ilness: The depth and extent of analysis of the clinical scenario, the width of clinical differential diagnosis, depth of analysis of each diagnosis, analysis of the diagnostic test results in correlation with the clinical presentations and arriving at a final diagnosis, and discussion on the economic and social issues of the diagnostic tests.
ANALYSIS OF THE DEPTH OF PERFORMANCE
Analysis of Outcome of Patient Illness: The depth of analysis of the diagnosis, its epidemiology, patho-biology, progression,  socioeconomic issues, cultural issues, outcome, different treatment methods, the treatment instituted in the patient, the outcome of such treatment
Analysis of Outfall of Patient Illness: The depth and breadth of the discussion on the racial, socio-economic, cultural, professional and community factors that comprise the patient's life that caused the illness; that affected the  diagnosis, management and outcome of the disease;  and the outfall of these on the life of the patient.
ANALYSIS OF THE IMPACT OF PROGRAM
Analysis of Student Effort: The extent of student effort at preparing the analysis in terms of text book reading, referencing in primary reference material like text books, journals, internet sources.
Description of the feelings of the Student during the program: The choice of words and sentences, and how well has the student presented his feeling about the illness, the diagnosis, treatment, outcome, outfall and life of the patient. His insight into the life of the patient .
Organisation and Presentation of the MSAR: