Indira Gandhi National Open University (IGNOU) offers post Graduate Diploma in various medical specialties. The theory material is developed in a self instructional style and the practical training is provided through contact sessions conducted in tertiary and secondary health institutions through a three-tier hands-on-training model which not only provides flexibility in pace and place of learning but also ensures that after completion of the training process, a student can actually practice the skills with confidence in his own work environment. In addition, this three-tier system has integrated the pedagogy of skill learning and has ensured that the benefit of both, group learning and one to one learning is given to the students.
The model describes the implementation of practical component in three steps at three levels. The tertiary level infrastructure (Medical College) where the academicians could be involved as counselors conveys the second step of learning process. Second, the involvement of secondary level health infrastructure (District Hospital) where the subject specialists could help the students in repeatedly performing the skills and thus guide them practicing the skill that are taught in tertiary level. Third, the student performs his job at the primary level health setup. This could also be a clinic/health set up run by the student himself where the student tries to practice the learned skills without any supervision. In IGNOU parlance, these three levels are called as prorgramme study centre (PSC), Skill Development Centre (SDC) and Work Place (WP) respectively. For administrative purpose, the programme study centers are linked up with the Regional Centres (RCs) which are a part of the IGNOU establishments. The PSC becomes the nucleus of programme implementation process. The Programme In-charge (PIC) is stationed at the PSC. He/she is normally a permanent faculty of the medical colleges with additional responsibilities of being the PIC. He will primarily be monitoring the learning process of all students enrolled in his institution with the help of other counselors. The students will be required to come here to attend the contact sessions in theory and practical. The end assessment examination would also be held here. Every student has an opinion to select his nearest SDC. The number of SDCs is not fixed. There could be as many SDCs as the number of students. SDC is selected as per the guidelines where students are allowed to practice the skills under supervision. At work place, the students will practice the skills without supervision so that enough number of patients are examined by them before appearing in the termend examination for certification.
Implementation Process of Practical Component
Every course has a practical component. The skills that the students need to learn under each course are listed in their programme guide. The skill training is divided into three parts i.e. training at PSC, training at SDC and training at Work place. The students have to maintain record for each case as mentioned in their practical manual. For all the three places, the time division against each skill is also mentioned in the practical manual. At the PSC, students are demonstrated each skill. To ensure that they have understood the steps involved in each of the skills demonstrated, they should also practice the skills on at least one of the sample cases. If they get opportunity, they are allowed to practice the same skill on more number of patients at PSC. However, if they do not get more chances, they practice the same procedure at their allotted SDC.At the SDC, the students practice all the skills taught to them at the PSC. To guide them, there are counsellors at SDC. Depending upon the programme students has to perform the activities himself under the supervision of the counselor. Guidelines are given to ensure that the minimum of patients/activities are practiced at SDC.
The regional health sciences advisory committee (RHSAC) streamlines the implementation of practical component at all levels to promote the health programmes in states by ensuring proper hands on training at peripheral level
Similarly, a student has so do un-supervised activities at the work place. These activities are recorded in the logbook.
Log Book Maintenance
The students are supplied with logbooks. This helps to ensure that the skill training is implemented in a standardized manner throughout the country. The logbooks are countersigned by the counselors of medical college/SDC so that the learning defects of the students are identified in time and reinforcement of training could be provided. The programmes where logbooks are not supplied, major headings/formats for recording the activities/case records are provided in the practical manuals. Students are required to write down the details of procedures. They have to maintain record for all the cases they perform at SDC and the work Place.
In some programmes, logbooks carry a weightage of 10% marks in the final evaluation. This further enhances the regularity of maintenance of logbooks by students.
In the teleconferencing sessions, subject experts are invited to deal on various subject areas as marked for that session. While dealing with the theory component, principles/concepts dealt in different units are highlighted and the questions arose by the students are replied with the help of examples so that they could link them to practical activities. In the practical component, important clinical examination procedures are dealt with and attempts are made to deal with rare patients and where possible, show them live or get video clips. Discussions are also generated with the help of models or with the video clips of five to ten minutes on certain procedures. Attempts are also be made to make model case presentation, case discussion and simulate clinical rounds/ seminars. Most of the presentations follow the format of panel discussion or lecture demonstrations. Attempts are made to link the practical spells with the teleconference dates wherever feasible. This increases the participation of students. Some of the teleconference sessions are also recorded so that students missing important sessions could go through these cassettes.
Evaluation of Students
Students undergo evaluation both in theory and practical component. In theory, the internal assessment is done through tutor marked assignments having weightage of 25 to 30%. In term-end examination, the weightage is 70%. In practical examination, the internal assessment varies from 30 to 50%. It is essential to pass in the internal component so as to become eligible for term-end examination. The term-end examination includes long case, short case, spots and viva-voce. 50% of the examiners are external examiners. This helps to maintain standard of the examination process. The framing of the examination questions, checking of the answer sheets are done by a panel of examiners of respective specialties. Thus, at all levels of evaluation of a student professional quality is given prime importance.
To ensure proper implementation of the programme monitoring is done at three levels. Feedback from the peripheral setups (Skill development centres) is collected by the regional consultant who in turn sends bimonthly reports to programme coordinator. Feedback at state level is taken in the Regioanl Health Sciences Advisory Committee (RHSAC) meeting held one to twice a year. At the school level, feedback is collected directly from the students and counselors through performa that are incorporated in the programme guide. Time to time feedback is also collected in structured performa from the Programme In-charge, Regional consultant, Regional centres. In addition, feedback is also collected in every 4-5 years while revising and updating the programmes. The regional health sciences advisory committee (RHSAC) is formed in every state which has the members from state health departments, Medical College having the PSC, Regional centre of IGNOU and the School of Health Sciences. As all the persons involved in the programme implementation meet together, the hurdles in implementation process are identified and the remedial measures are taken. This committee thus helps to streamline the implementation of practical component at all levels. The Regional Consultant is usually a retired medical person having a personal rapport at state level. This helps to promote the health programmes in states and win the confidence of professional colleagues as well as the state Governments. Health being a state subjects the regional consultant’s personal efforts makes significant impact on popularising the programmes. The regional consultant by physical supervision to SDCs in the state ensures proper hands on training at peripheral level.