Sunday, October 19, 2014

Early clinical exposure and formative assessment strategies for Indian Medical students

Students are naturally driven more toward curricular assessment preparations as they perceive these semester assessments as a key to their long term career goals and may want to spend time preparing more for what they perceive to be the dominant requirement of their assessment driven curriculum as well as future career, which is to pass their MBBS and get a PG seat of their choice. We clearly need to build in an appealing assessment strategy for the 'early clinical exposure' program matching student goals or else (as pointed out by Dr Deven) this program may fail in its early phase. We have implementable ideas for this assessment strategy that we can share with any of you who may be interested.

Most of our students are engaged in taking coaching for PG entrance right from 6th semester (anecdotally i am told they pay approximately an advance of Rs 90,000 for this foundation course). They spend whatever  little time they can spare from their coaching in meeting their formal curricular requirements by attending lecture classes and semester exams. In this current climate if we are to sustain ECE we have few options (below).

Our solution for the above problem statement is to take early clinical exposure to the lecture classes (or whatever else the students are interested or attuned to attend). In the last two months at our institute we have been taking a 'live patient' every week to the lecture class and have had the pleasure of seeing the 'joy' on students' faces when they are able to finally correlate 'real' life requirements (albeit complex) with the requirements of their curriculum. To meet curricular requirements, we introduce a few theory questions and PG MCQs around the patient's problem as soon as we finish with the patient's story and its associated clinical problem solving conversations.

This appears to have been acceptable to our 6th sem students as this week, even in the lecturer's absence the students continued the lecture class on their own and reported good outcomes in our blended learning forum. The lecturer was in Mumbai meeting medical educationists, Dr Tejinder, Dr Vinay, Dr Shobna and Dr Bipin Batra for a common project.

This last lecture in the lecturer's absence was presented by a brave 6th sem student wanting to share her experience around her close relative who was also a patient with hepatic encephalopathy due to non-alcoholic fatty liver disease (an increasingly common cause of cirrhosis in the West and now in India).

I had agreed for the student to present her close relative as i felt this brave step would enable her student colleagues to develop a 'real' life empathic connection between what they study for their exams and what can happen to any of them/us. The student not only presented the case and discussed theory in the power point slides she had herself prepared but the class also discussed, other than PG MCQs, the theory question around hepatic encephalopathy posed in this years past 'university' theory exams (shared by our intern who was present in the class and who had taken the same 'university' exam where that particular question had been posed). A PG pathology (we do not have PGs in medicine yet) was present in the lecture class to guide the UG students. All this activity was documented by the students in our online discussion forum (there is a hint here on how we can effectively shape a formative assessment strategy using these online information traces of our students).

Hope to continue this variety of 'early clinical exposure' in the coming months with our students but would also like to benefit from your inputs on if/how to be on the right track.

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