|Year : 2016 | Volume
| Issue : 2 | Page : 238-241
MD Family Medicine - Calicut experience: History is made here
Department of Family Medicine, Government Medical College, Calicut, Kerala, India
|Date of Web Publication||18-Oct-2016|
Nandanan, P O Tharuvana, Via Mananthavady, Wayanad - 670 645, Kerala
Source of Support: None, Conflict of Interest: None
Government Medical College, Calicut, Kerala - the first medical college in India to start Doctor of Medicine (MD) in family medicine as a postgraduate course. This was in the year 2012. Till date, this is the only medical college to have MD Family Medicine program in India. The college was allowed two MD Family Medicine seats per year by the Medical Council of India, and this is a 3 year course. The first batch of MD Family Medicine students has passed out from the Government Medical College, Calicut in July 2015. In this article, the author, who has been working as an assistant professor in the Department of Family Medicine, ever since the department started in the year 2012, shares her experiences in setting up the department, its functioning and the achievement of bringing out the first batch of successful MD Family Medicine specialists. Another laurel, of which the institution is proud of, is that they were able to incorporate family medicine teaching program in the MBBS curriculum. A brief introduction about Government Medical College, Calicut, is also given.
Keywords: Department of Family Medicine, family medicine in UG curriculum, Government Medical College - Calicut, MD Family Medicine
|How to cite this article:|
Roshni M. MD Family Medicine - Calicut experience: History is made here. J Family Med Prim Care 2016;5:238-41
| Introduction|| |
It is indeed a great achievement. History has been made. The first batch of MD Family Medicine students in India has passed out from the Government Medical College, Calicut  [Figure 1], in July 2015. The concept of family medicine is a step in the right direction. It is indeed something to be proud of, that, Calicut Medical College is the first ever college in the country to offer a Doctor of Medicine (MD) program in family medicine and is taking the initiative to draw the attention of the masses and also the medical students to the relevance of such a practice in our country.
Family medicine is a recognized specialty, an independent academic discipline in India since 1983. It is a specialty of medical science which is concerned with providing comprehensive care to individuals and families by integrating biomedical, behavioral, and social sciences. A family doctor provides primary and continuing care to the person and the entire family, addresses physical, psychological, and social problems, and coordinates comprehensive health-care services with other specialists as needed. The Medical Council of India (MCI) requires 3-year residency for family medicine specialty, leading to the award of MD in family medicine or Diplomate of National Board (DNB) in family medicine. DNB family medicine training is available at several National Board of Examinations affiliated institutions throughout the country.
| Government Medical College, Calicut|| |
This prestigious institution is located in the city of Calicut (Kozhikode – new name of Calicut) in Kerala state, India. It was established in the year 1957 as the second medical college in the state. The vast and sprawling medical college complex are located about 7 km east from the heart of Calicut city. This college and allied institutions serve 40% of the population of Kerala. With bed strength of 3150, it is the largest hospital in the state. The annual intake of MBBS students in this college is 250. Now, the college provides postgraduation in 24 disciplines and has super specialty courses in 10 departments. This medical college is affiliated to the Kerala University of Health Sciences. A well-equipped MCI recognized center for Medical Education Technology is functioning in this college.
| A New Beginning|| |
It all started way back in 2012 when the newly created Family Medicine Department started functioning at Calicut Medical College. It was the vision of the former principal and some senior faculty in the college to start MD Family Medicine postgraduate course, here in this college. The administrative paperwork for this was completed, and the admissions for MD Family Medicine postgraduation started in the year 2012. The institution was allotted two MD Family Medicine seats per year. Currently, admissions are open for the fifth batch of MD Family Medicine residents. One encouraging fact is that these students are here by choice, not by chance. When a new department is formed, it is expected that there will always be a few hurdles. The department needed senior faculty members to become professors and associate professors. Hence, the department was officially formed by pooling senior faculty members from various related specialties and as a qualified family medicine specialist, I joined as an assistant professor in the department. It was fortunate to have a professor in internal medicine, who was very much interested in the family doctor concept as the head of the department. Other faculty members in the department were senior persons from pediatrics, obstetrics and gynecology, and general surgery. In almost all the departments in our college, there were some very cooperative, enthusiastic teachers who supported the family doctor concept and were willing to join us in training the residents. The first priority was to prepare a syllabus and curriculum for the course. This was done after an extensive study of various family medicine programs within and outside India. The prepared syllabus was accepted by the Kerala University of Health Sciences, to which medical college Calicut is affiliated. It is available on the university website. The syllabus and curriculum specify the learning objectives, what the resident is expected to learn and what skill he or she is supposed to be competent in during each clinical posting.
| Clinical Rotation|| |
The next step was to set up an ideal clinical rotation pattern, keeping in mind that the course should give the student the professional backbone required to deal with most of the common problems that we come across in our general practice. During their 3 years residency, 2 years training is in the medical college itself and 1 year in the periphery. The training is done under the supervision of family medicine faculty along with the help of teachers in the individual departments. The 2 years training in the college is during the first and final year. During this time, they have to undergo rotation training in various clinical specialties such as internal medicine, pediatrics, surgery, obstetrics and gynecology, pulmonology, orthopedics, community medicine, ENT, ophthalmology, dermatology, physical medicine, pain, and palliative medicine. They learn to deal with common ailments in various specialties and at the same time, they are also updated regarding newer trends in the clinical field. Before the residents go to each specialty for their clinical rotation, the teaching faculty, and the residents are made aware of the topics to be covered and the skills to be learnt and practiced during each posting. Emphasis is given on primary health care, comprehensive care, communication skills, holistic approach, patient-centered care, documentation, identification of red flag signs and symptoms, timely referral, follow-up, and coordination of care.
Community medicine postings give exposure to the community-based approach to the various components of health-care delivery, and this can be further strengthened when clinical training is extended to primary and secondary care hospitals. The 1-year peripheral training in primary health care is during the 2nd year. This is carried out in two phases - a term of 6 months in a primary health center and the next 6 months in a secondary care hospital. At the start of the peripheral training, each resident is allotted five families. The family study has to be done with initial family health survey, regular visits to the family, and follow-up of their health care.
Other than academic activities such as seminars, case presentations, lectures, journal club, radiology club, and group discussions, other activities for the residents include health education classes to the public and health workers, conducting medical camps, and research activities including thesis work. The thesis works done by the residents are community-based studies. They have had their works presented at state, national, and international conferences. The department has research publications to its credit. A log book is maintained by the resident.
| Creating Awareness|| |
The main job, even before the students go for their clinical rotation, is to create awareness regarding family medicine among the faculty in various departments. For this lectures regarding family doctor concept was given in almost all the departments in our college and in the peripheral health centers. This ensured better understanding and cooperation from everyone. A family medicine Continuing Medical Education programme was conducted by the department in the year 2013. This was a huge success, and there were many positive feedbacks following this. Newspaper articles regarding principles of family medicine are given periodically.
| Family Medicine for Undergraduates|| |
It was a great achievement that, family medicine was included in the MBBS curriculum at Medical College, Calicut. The college has an annual intake of 250 MBBS students. Each one of them has family medicine clinical posting during their fifth semester. The posting is for 2 weeks, and they come in batches of twenty students each. By exposing them to the principles of family medicine during their formative years, we can make a great difference to their outlook. Now, they are aware of the need of comprehensive health care and the family doctor concept. Many have started showing interest in this specialty. The “Vision 2015” document put forward by the MCI states the role of the MBBS graduate as physicians of the first contact in the primary care setting for the community. Family medicine is a specialty that adds the missed ingredient in the current undergraduate medical education in India.
| Evaluation of Residents|| |
Evaluation of residents for their knowledge and acquisition of attitudes, skills, and competencies is a continuous process throughout their 3 years period of training. The day-to-day clinical work of the resident is closely observed by the teaching faculty. At the end of each clinical posting, the residents are assessed in a formal format by the faculty.
| University Examination Pattern|| |
Four papers of 100 marks and 3 h duration each.
Clinical practical and viva-voce (as applied to family medicine)
Total – 400 marks.
- One long case – (medicine) – 45 min = 100 marks
- Five short cases –15 min each – 40 × 5 = 200 marks
-One short case each from pediatrics, surgery, and OBG
-One short case from either
-One patient counseling station.
Viva-voce: Four stations - 25 marks each (4 × 25 = 100)
- Instruments, interpretation of ECG, X-rays, biochemistry
- Pharmacological agents
- Thesis work discussion
- Public health programs.
Conducting MD Family Medicine examination for the first batch of postgraduate students was a novel experience. The exam was conducted by two internal and two external examiners as per university regulations. Two of the best family medicine specialists in India were our external examiners. Theory examination was followed 2 weeks later by clinical exam. Both students cleared the examination, and they have created history by becoming the first MD Family Medicine specialists in the whole of India. All this was possible only because of the constant encouragement and support of our well-wishers. We are very thankful to our former principal, head of the department and our senior faculty members, for their valuable support, advice, and guidance.
The success of MD Family Medicine program at Calicut Medical College should be a motivation for other centers to start the same and make available more MD Family Medicine training opportunities across the country. Faculty from several colleges in India had visited Calicut medical college and inquired about the procedures to start MD Family Medicine Program in their respective colleges. This is really encouraging. Many colleges have applied for permission to start MD in family medicine and let us hope that many more will follow.
To achieve a healthy India, family practice, the backbone of the health-care delivery system in India must be strengthened. The government must put forth immense efforts to strengthen family medicine in India. The number of family medicine postgraduation seats available in India has to be increased, and this has to be done in proportion to the needs of the society. At the same time, we should strive to create awareness regarding the importance of primary health care among the medical undergraduates. One-way to do this is to incorporate family medicine in the MBBS curriculum throughout India. It is the duty of the lawmakers and the professional bodies to strengthen family medicine adequately so that it becomes the often sought-after specialty for young medical graduates.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Kerala University of Health Sciences. Available from: http://www.kuhs.ac.in
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Sankarapandian V, Christopher PR. Family medicine in undergraduate medical education in India. J Family Med Prim Care 2014;3:300-4.