RESEARCH ARTICLE


https://doi.org/10.5005/jp-journals-11003-0132
Journal of Medical Academics
Volume 6 | Issue 2 | Year 2023

First-year Medical Undergraduate Students’ Perceptions and Experiences Regarding Family Adoption Program: Challenges and Lessons


Priya Arora1, Vishal Sharma2, Nidhi Budh3, Samar R Hossain4

1–3Department of Community Medicine, Army College of Medical Sciences, Delhi, India

4Department of Community Medicine, Maulana Azad Medical College, Delhi, India

Corresponding Author: Priya Arora, Department of Community Medicine, Army College of Medical Sciences, Delhi, India, Phone: +91 8588806900, e-mail: drpriarora@rediffmail.com

Received: 29 May 2023; Accepted: 19 October 202; Published on: 30 December 2023

ABSTRACT

Introduction: In 2021, National Medical Commission (NMC) introduced a family adoption program (FAP) as part of the Community Medicine Curriculum to sensitize the upcoming medical professionals to the health needs of the community, learn communication skills, health education, basic health services, and function as a link between the health system and the families, enabling them to become physicians of first contact.

Objectives: To know the perceptions of first-year medical students toward the FAP.

To assess the challenges encountered by the students during family adoption visits.

Materials and methods: Cross-sectional study among phase 1 undergraduate medical students using a self-administered questionnaire and analysis of feedback for FAP given by the students.

Results: Students reported a positive impact of FAP visits on their communication skills for interacting with families. They, however, feel that it should be included a little later in the curriculum so they have more clinical skills when they go for FAP visits.

Conclusion: Family adoption is instrumental in improvement in self-perceived communication skills and ability to help community with their health problems.

How to cite this article: Arora P, Sharma V, Budh N, et al. First-year Medical Undergraduate Students’ Perceptions and Experiences Regarding Family Adoption Program: Challenges and Lessons. J Med Acad 2023;6(2):49–52.

Source of support: Nil

Conflict of interest: None

Keywords: Family adoption challenges, Family adoption program, Medical students

Worldwide, the focus is shifting from only hospital-based teaching of medical professionals to “Community Oriented Medical Education (COME)”. Just as the concept of primary healthcare is an approach to the health system, COME is an approach to medical education. It is an education which is “focused on population groups and individual persons taking into account the health needs of the community concerned.” Its aim is to produce community-oriented doctors who are able and willing to serve their communities and deal effectively with health problems at primary, secondary, and tertiary level.1 In India, it was implemented as the Rural Oriented Medical Education (ROME) scheme, which led to the policy decision of compulsorily attaching rural and urban health centers to the Preventive and Social Medicine Department of every medical college.

Community-based education for health professionals is effective in fostering health personnel who are responsive to community needs.2 It is also effective in reducing hospital referrals and improving communication and clinical management skills.3-5

The graduate medical curriculum is oriented toward training students to undertake the responsibilities of a physician of first contact who is capable of looking after the preventive, promotive, curative, and rehabilitative aspect of medicine. The importance of the community aspects of healthcare and of rural healthcare services is to be recognized. The importance of social factors in relation to the problem of health and diseases should receive proper emphasis throughout the course, and to achieve this purpose, the educational process should also be community-based rather than only hospital-based.6 The National Medical Commission (NMC) was established “to provide for medical education system that improves access to quality and affordable medical education, ensures availability of adequate and high-quality medical professionals in all parts of the country; that promotes equitable and universal healthcare that encourages community health perspective and makes services of medical professionals accessible to all citizens; that promotes national health goals.”7

In 2021, NMC introduced a family adoption program (FAP) as part of the Community Medicine Curriculum to sensitize the upcoming medical professionals to the health needs of the community. FAP begins in the first year, wherein families are allotted in an area not covered by the Rural Health Training Center (RHTC) of the department. In the beginning of phase 1, the students need to regularly follow up these families till completion of phase 3 of Bachelor of Medicine, Bachelor of Surgery (MBBS) training. The competencies and targets for the three phases have been explicitly described. The program requires the students to learn communication skills, health education, basic health services, and function as a link between the health system and the families, enabling them to become physicians of first contact as envisaged in the Graduate Medical Education (GME), 1997.6-9 The FAP is expected to hone communication skills which are the backbone of the profession; learning to be humane and empathize with the rural population by understanding their customs and limitations as also many positive aspects of community unity.10,11

Family adoption program (FAP) was implemented in the institute as per the NMC guidelines. A brief session on the needs and competencies of FAP was conducted, followed by the allotment of 100 students into four groups. The families were allotted to an underserved resettlement colony in Delhi. Three-hour visits were arranged for the students every alternate week till the hours mandated by NMC were completed. The supervisors briefed the students prior to every visit regarding the objectives of the visit. The students collected demographic and health-related information for the allotted families, participated in health checkups and facilitated the use of health services by the community by working in liaison with community-level workers like Accredited Social Health Activist (ASHA), Anganwadi Workers (AWWs), and Auxiliary Nurse Midwives (ANMs).

Since it is a novel scheme that has brought a major change in the involvement and approach of students in community care, the current study is being planned to assess the perceptions, experiences, and challenges faced by the students during their visits for the FAP. This study will help to identify facilitating factors and challenges associated with the program so that it may be better implemented for the newer batches.

Objectives

Materials and Methods

Type of Study

Cross-sectional.

Study Subjects

Phase 1 undergraduate medical students of the 2021 batch in Army College of Medical Sciences (ACMS) who have attended 75% of the family adoption visits during part of their Community Medicine Curriculum.

Study Instrument

Self-administered questionnaire, which was validated by the faculty of the department. The questionnaire had four parts—part 1—basic information about the student, sociodemographic information of the allotted family, part 2—attitude of student toward family adoption curriculum, part 3—student perception of achievement of objectives of FAP, part 4—open-ended questions for students reflections regarding challenges faced during the visits.

Regarding the achievement of objectives of the FAP, students were asked to score their perception of learning on a scale of 1–10, 10 being the highest possible score, meaning they think they were able to achieve the objective. The questions that the students were asked were as per the document given by NMC and consisted of the following questions.

  • Learning communication skills to interact with family members in community-based settings.

  • Gain confidence of the family members as healthcare facilitators.

  • Understand community dynamics and healthcare delivery system of the area.

  • Learn to clinically examine and identify health problems of the family members.

  • Provide health education related to healthier lifestyles.

  • Educate families about government health programs.

  • Learn to analyze data from the families.

  • Participate in activities for environmental sustenance.

  • Communicate with community-level functionaries like ASHA/AWWs.

  • Facilitate healthcare utilization by the family.

The score for each of these questions was added, and a composite score out of 100 was obtained for each respondent.

Data Collection

The students were explained about the feedback pro forma and informed consent for participation in the study was obtained from all eligible students of phase 1 (2021 batch). Confidentiality of students’ personal identity was ensured. A total of 100 students were eligible to be a part of the study based on their attendance.

Duration of Study

December 2022.

Data Analysis

The variables from the questionnaire were coded and entered in Microsoft Excel sheet. Statistical Package for the Social Sciences (SPSS) version 26 was used to analyze quantitative variables. The responses to open-ended questions were recorded verbatim and analyzed by identifying common themes.

RESULTS AND DISCUSSION

All 100 students of 2021 admission year were eligible based on their attendance in the FAP and filled up the pro forma (Table 1).

Table 1: Gender of the students
Frequency Percent Valid percent Cumulative percent
Valid Female 57 57.0 57.0 57.0
Male 43 43.0 43.0 100.0
Total 100 100.0 100.0

About 57% of the students were females, while 43% were males.

Students’ self-perceived individual score for each of the objectives were added to get a composite score out of 100. Table 2 shows the score distribution of the students (Fig. 1).

Table 2: Self-reported score of the students
Score Standard error 95% confidence interval
Lower Upper
Median 69.00 1.56 67.00 72.50
Minimum 25
Maximum 98
Percentiles 25 56.00 2.68 51.25 62.24
50 69.00 1.56 67.00 72.50
75 81.00 2.25 77.00 84.00

Fig. 1: Total self-reported score of the students for 10 parameters of FAP

The maximum score reported was 98, while the minimum was 25. The median score was 69. The variation in the scores could be due to both individual perception of fulfilment of objectives as well as due to differences in attitudes and cooperation of families allotted to these students (Fig. 2).

Fig. 2: Self-reported score of male and female students

A difference in average scores of male vs female students was observed, with average scores being higher for males compared to females. Since it was a new community-based program that had been added as a part of the curriculum, it is likely that female students were a little hesitant in approaching communities during the visits. The difference in the median score of males and females for self-perceived achievement of objectives of the FAP was significant, as given by Mann–Whitney U test, with z-score of –4.186 and p-value < 0.0001 (Table 3).

Table 3: Difference in median score of males and females
Test parameter Total score
Mann–Whitney U 624.500
Wilcoxon W 2277.500
Z –4.186
p-value 0.000

Overall, the highest score reported for all the students combined was lowest for being able to clinically examine the family members and identification of health problems, while the highest reported total score was for learning communication skills and being able to communicate with family members in community-based settings. This is understandable as these students were taught about basic principles of health communication in sessions conducted by the faculty while they were in the nascent stages of learning medicine, so they were not very confident about their clinical skills. In a study conducted in Tamil Nadu to get reflective feedback from medical students regarding the FAP, the students reported positive changes in confidence and communication skills after visiting the families.10 In a study conducted in South Africa, final-year medical students reported increased confidence, consultation skills, application skills, and knowledge of community health problems after a session of exposure to primary care in the community.12 Over the passage of time, these students are also likely to gain more confidence and ability to apply their clinical skills.

Regarding the attitude of the first year toward FAP (Fig. 3), >80% agreed that FAP should have been included in the medical curriculum and that they have been able to improve upon their communication skills after the FAP visits to the community. However, almost 70% feel that FAP should have been included at a later stage of the curriculum and half of them feel this time could have been better utilized for first-year subjects of the curriculum. Since these students are hesitant and unsure of their clinical skills, perhaps they want to be better equipped to handle medical problems of the community. However, 50% also feel that their visits have been able to make a difference in health status/attitude of the families which is a positive sign for the implementation of FAP.

Fig. 3: Attitude of students toward FAP

Among the challenges mentioned by the students as part of their reflection were–hesitancy on the part of family members to reveal information, nonavailability of all family members for health checkups during visits, families getting disappointed about not getting any “real” benefit, family members being busy in their household chores and not wanting to spare time.

CONCLUSION

The FAP is a very ambitious scheme to improve health of families as well as improvement in community-based training for community health problems for undergraduate students. Despite the challenges faced, the students have found it to have a positive impact on their communication acumen with the community.

Ethical Clearance

Study cleared by Ethics Committee—Base Hospital and Army College of Medical Sciences, Delhi Cantt. vide letter no IEC-03/2022/41.

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