The Christian Medical College in Vellore, India developed a distance learning Fellowship in HIV Medicine program in collaboration with the Open University Centre for Education in Medicine to address the growing HIV epidemic and lack of trained healthcare workers in India. The 3-year program utilized distance learning materials and in-person training courses to provide doctors with the knowledge and skills to independently treat HIV patients and develop HIV care services in their own hospitals. Over 200 doctors graduated from the program between 2002-2009, establishing basic HIV testing, counseling, and treatment services at their hospitals across India to improve access to care. The success of this model demonstrated that distance learning can effectively help address emerging public health issues.
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Distance Learning for Health Workshop: Programmes of Training for Health Managers and Medical Educators - Anand zachariah
1. ⢠CMC hospital
⢠hospitals
CMC Vellore
Network of 200 rural secondary
hospitals across India
1909 â First batch of nursing students
2200 bed teaching hospital
Dr. Ida S Scudder
Christian Medical College
Schools of Medicine
Allied Health Science
& Nursing
2. Addressing public health problems
through distance learning
Lessons from a postgraduate course in
HIV clinical care
The Fellowship in HIV Medicine
3. HIV care scenario in India - late 1990âs
⢠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
4. Collaboration between
Medical School & Distance Education University
Christian Medical College
National level training
institution 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
5. EDUCATIONAL APPROACH
SELECTION TRAINING HIV CARE
SERVICES
PROJECT
IMPLEMENTATION
TRAINING- SERVICE DEVELOPMENTTRAINING- SERVICE DEVELOPMENT
APPROACHAPPROACH
Interested
doctors
Contact &
Distance courses OP, IP, HIV testing
Counseling,
Staff education, ART
HIV CARE PROBLEM
2.3 million cases
Lack of care facilities
Stigma
6. 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
7. INTEGRATED COURSE DESIGN
Distance Course
MONTHS 0 5 12
Project phase
Contact courses CC-I CC-II CC-III
MODULES
IMPLEMENTATIONPLANNING
TRAINING SERVICE
DEVELOPMENT
CC-IV
LAB TECHNICIAN & COUNSELLOR TRAININGTEAM TRAINING
NETWORKING
8. Course development
⢠Course team
⢠Faculty training
⢠Development of course
materials
⢠Systems
⢠Quality assurance
Faculty training workshop
Course team
Based on OU best practices
9. 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
10. Project work
⢠Towards development of
HIV care services
- Out patient care
- Inpatient services
- Counseling
- Lab testing
- ART
- Infection control
- Staff education
Project work- critical factors
1. Need based
2. Administrative support
3. Staged project work
4. Project guide
CMC & local guide
5. Seed grant
6. Site visits
7. Monitoring
11. Examples of project work
ART CLINIC COMMUNITY CARE STAFF TRAINING
HOSPITAL BASED CARE PALLIATIVE CARE SUPPORT GROUP
13. 1 year evaluation-
Service development
0
10
20
30
40
50
60
70
80
90
100
H
IV
testing
C
ounseling
O
ut-patientcareIn-patientcareStaffeducation
Pre-course
Post-course
⢠75% of institutions
had basic components
of HIV care
⢠Increase service utilisation
⢠Improved quality of
services
%
AVAILABILITY OF BASIC SERVICES
14. 3 year External evaluation
⢠70% of graduates were working in their original
hospitals
⢠Graduates were competent in HIV care
Greater 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
16. Critical factors in up scaling
process
⢠Selection of centres
⢠6 month faculty
development
programme
⢠Upgrading institutional
infrastructure
⢠Setting up systems
19. 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.
20. CONCLUSION
Critical 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
21. Further developments at CMC
Distance education department
Courses
⢠PG Diploma in Family
medicine
⢠Course for MBBS doctors
working in rural hospitals
⢠Fellowship in Diabetes
care
⢠Primary health worker
training
22. Proposal for School of Distance Learning in Medicine
CMC-OU collaboration
Proposed DL courses
⢠Distributed undergraduate
medical training
⢠General practice
⢠Priority health areas
⢠Health worker training
⢠Specialty disciplines
23. Acknowledgements
HIV /STI Research Intervention, Population Council
funded by the European Union
Resource Centre for Sexual Health and HIV/AIDS funded
by DFID
Maulana Azad Medical College, New Delhi
School of Tropical Medicine, Kolkotta
Open University Centre for Education in Medicine
