Feature

Making Continuous Learning Creative

While most hospitals conduct CME programmes for the benefit of medical practitioners, some hospitals have been successful in making CME more interesting using novel methods, reports K Deepalakshmi

When a man's education is finished, he is finished— goes a saying. The medical fraternity has to constantly update their knowledge as a whole lot of new procedures and technology are being developed in the healthcare industry. "What is learnt say 10 years ago is not considered as acceptable now," says Dr Thankam Varma, Medical Director, Institute of Reproductive Medicine & Women's Health, Madras Medical Mission, Chennai, and continues, "Clinicians should update themselves with the risks, benefits, advantages and disadvantages of new technologies."

For the benefit of doctors, hospitals conduct continuous medical education (CME) programmes which help them learn the latest innovations in the field of medicine, brush up their knowledge and cope with the latest medical practices.

A typical CME attended by clinicians involves lectures by eminent specialists on a designated topic. Apart from some in-house training programmes, the CMEs are generally open for all the doctors. The conception of CME being like attending college classes again is slowly changing. In some hospitals, CMEs are more than plain lectures. Efforts are made to make CMEs appealing by implementing innovative teaching methods.

Stories on Slides

One common method followed in CME is to deliver the lectures with the help of Power Point presentations. A picture can convey more than words. It is almost impossible to imagine any CME without slide presentations these days. "Once, I used to get my presentations done from outside. Now, it's taken care of by my staff," says Dr HK Chopra, Senior Consultant, Cardiology, Moolchand Medcity, New Delhi, who is also the Chairman of World Health Academy.

The presentations are not just restricted to pictures, but are made more vibrant with the help of graphics, pie charts and algorithms. Visuals are easier to recall, therefore any information given in such a form is sure to appeal better. Recreating a treatment or a procedure in a graphical form makes it easier to imagine and understand.

Animated Explanation

Another technique is to employ 2D and 3D animations to explain a procedure. A procedure explained using animation is easier to understand than words or a book. "I conduct training programmes using computer animation with appropriate background music," says Dr Chopra, who feels adding music breaks the monotony. In addition, by associating the procedure with the music, one can easily remember what was taught whenever the music is recalled.

Hands and Eyes

"The best way to learn is to assist and learn. When this isn't possible, the next best way is to see and learn," says Dr Ravi Agarwal, Paediatric Cardiac Surgeon, Frontier Lifeline, Chennai. A procedure is demonstrated to the doctors and explained. One way to do this is by recording the procedure when it is being performed and screening the video to doctors. In this method, the doctors are viewing a delayed demonstration.

Another way is to watch the live demonstration by video conference. "When it is not possible to accommodate everyone in an operation theatre, a few assist the procedure in the theatre and the rest watch it from the conference hall," says Dr Agarwal. The procedure is relayed from the operation theatre to an auditorium or wherever the CME is being conducted. The doctors are able to view the proceedings through a projector.

The viewing, however, is not confined to the hospital premises. Thanks to advancement in communication technology, it can be seen from anywhere. For example, Frontier Lifeline conducted a CME on ROSS procedure I & II in 2006. The two-day programme included lectures on the surgical procedures, followed by live demonstrations of the surgeries, which were streamed directly from Frontier Lifeline to TICEL Biopark, Taramani, about 20 km away. This enabled lively interactive discussion between the surgeons at Fronter Lifeline and the delegates at the workshop, about the surgical alternatives.

Leaping Boundaries

Communication links play a major role in making such video conferences possible. Rockland Hospital, New Delhi, in association with Reliance Communication conducted a CME through video conference, in which doctors from Lucknow, Jaipur and Ludhiana participated. "These methods reduce the need for travel and the time spent on it," says Dr MP Sharma, Medical Advisor and HOD of Gastroenterology, Rockland Hospital. "We are developing an in-house videoconference facility," he adds.

"We offer telemedicine to our patients. The same technology is used for CME whenever needed," explains Dr Umesh Gupta, Director of Medical Service & Chief Quality Officer, Apollo Hospitals, Bangalore. This way a CME programme in one city can be attended by doctors from the other associated hospitals of Apollo, eliminating the need for their physical presence.

"We used satellite telecast technology to make our doctors interact with international delegates," says Dr Ashish Tiwari, Staff Physician and spokesperson of Bombay Hospital, Mumbai. The Hospital conducted a CME on orthopaedics last year, where doctors from Singapore and Malaysia participated and interacted with the doctors sitting in Mumbai.

Apollo Hospitals Group has launched a website called ww.medvarsity.com'. Medical practitioners can register to access the content of CME available online. Currently, the site has CME programmes on more than 20 topics and is updated with new ones periodically.

Discuss & Learn

The concept of blackboard teaching is slowly being replaced by interactive sessions. Says Dr Sharma, "With the availability of internet and scope for research, learning has evolved a lot." CMEs are made livelier by creating a platform for the participants to interact with each other and with the speakers, where the topic is analysed and discussed.

"At the end of each session, the topic is thoroughly discussed and the answers for all the whys, whats and whens are found," explains Dr Varma.

The discussions are conducted more scientifically by enabling the participants to vote for the best suggestions and alternatives. "We use voting pads to select the best out of the available options discussed in the session," says Dr Agarwal. The facility is now available in many hotels. The result is known more accurately thus enabling a healthier discussion.

Training at Heart

Narayana Hrudayalaya, Bangalore conducts a special training programme for general practitioners, called 'emergency coronary care management' which usually runs for two to four weeks. This training programme is prepared keeping in mind that rural and semi urban populations are catered for by general practitioners rather than specialists. As Dr Vijay Singh, Assistant Medical Superintendent, Narayana Hrudayalaya, Bangalore, points out, "Lacking coronary specialists in these areas, many patients come to us at advanced stages. This can be avoided if an earlier diagnosis is possible." The programme enables a general practitioner to give first aid to coronary emergency cases and then refer to a specialist. The training programme is conducted on-site, where the practitioners are asked to assist, observe and acquire hands-on training.

The Hospital also conducts a session for alternative medical practitioners for diagnosing coronary problems and identifying the symptoms. "These practitioners mainly cover the rural areas and when they are given information about symptoms of coronary emergencies, they can refer the patients to specialists at the right time," he adds.

"The practitioners first listen, then see, assist, get assisted and finally carry out the procedure independently," says Dr Varma. To reach this level is not an easy task. A clinician is given the opportunity after a careful study of his performance. In Bombay Hospital, certain treatments are demonstrated on the patient after taking his consent.

Gathering Feedback

At the end of each CME session in Madras Medical Mission, the participants fill a feedback form on what they feel about the session as a whole. The speakers also give their feedback on the participants. All staff are expected to participate in CME and are awarded credits. These in turn reflect on their appraisal.

"CME has been made mandatory by the Medical Council of India. During the renewal of their license every five years, the clinicians are expected to enumerate the CMEs they have attended," says Dr Singh.

However, Dr Varma feels that both the State and Central Governments should take measures to make CMEs compulsory and available through Government medical colleges.

Continuing Education

CME is a continuous process in many hospitals. "At the end of the session, we announce the topic and the date of the next CME," says Dr Varma. Bombay Hospital has a separate department to arrange CME. Though a training programme, the CME is often arranged by doctors, unlike the soft skills training organised by the HR department.CME has evolved tremendously over the years. From an initiative by clinicians to a part of routine in hospitals, CME has definitely come a long way. This is a welcome change. With the availability of technology and the capacity to buy the technology, it is necessary to train oneself to make use of these technologies.

k.deepalakshmi@expressindia.com