Strengthening Pre-service

Medical education on IYCF

Prof S AnejaDr Praveen Kumar

Lady Hardinge Medical College & associated Hospitals , New Delhi

The Global Strategy for Strategy for

IYCFIYCF Developed by WHO and UNICEF to

focus world attention on the impact of optimal infant and young child feeding practices

Malnutrition has been responsible , directly or indirectly , for more than 50% of the deaths occurring among children <5 years

U-5 Child Deaths (%) Saved with Preventive InterventionsU-5 Child Deaths (%) Saved with Preventive Interventions

13

6

5

4

4

3

3

2

2

2

2

1

1

- 2 4 6 8 10 12 14 16

Percentages

*Br eastf eeding

Complementar y f eeding

Zinc

Hib vac

Clean del iver y

Water , sani tation, hygiene

Ante ster oids

Vit A

T T

NB temp contr ol

Nevir apine + no BF

Measles vac

Antibio f or P ROM

Breastfeeding is defined as exclusive breastfeeding for first 6 months and continued breastfeeding during 6-11 months

Source: Jones et al. LANCET 2003; 632:65-7134

NFHS- 3: Nutrition status of Children

Children under 3 years who are underweight (%)- 45.9

Children age 6-36 months who are anemic (%)- 79.2

NFHS- 3:Child Feeding Practices

Children under 3 years BF within 1hr (%)-23.4

Children 0-5 months Exclusively BF (%)-46.3

Children age 6-9 months receiving solids or semisolid food and breast milk - 55.8

What is answer ?

Promotion & support Optimal Infant & Young Child feeding Practices

Status of KAP among workers in Infant

Feeding

•33% doctors /nurses did not discuss Infant feeding with mothers

•Majority of family physicians recommend Supplementary fluids to BF babies

Lawrence 1982 ,Lazzaro et al 1995

Why do we need to

strengthen

Pre service Education ?

Change in practices is easier if we train our undergraduate well

Unlearning and then relearning is more difficult

If pre-service skill development is good , in-service training can focus on CMEs,Updates, and refresher courses

Current IYCF training under

Medical Education

Current training in IYCF is inadequate

Very little attention on skill development

Training is imparted differently in various departments

Workshop on Strengthening

Infant and Young Child

Feeding in Pre service

Medical education

Gurgaon 5th-6th Nov 2005

Supported by -BPNI

Where We started from

39 faculty members from Deptt of Pediatrics/ Community Medicine

12 Zonal colleges/ leaders Core Group Model plan of action

National workshop-conclusions

Most of our UG teaching is in form of didactic lecture which gives knowledge part

Current teaching is unable to impart competency in the skills necessary to support appropriate IYCF practices

Those providing knowledge and skills ( Faculty & Residents) at present level need to be adequately trained in these skills

National Workshop-

suggestions

Involve 3rd key department ( Obstetrics) which has important role in early initiation and giving support to mothers

Strengthening Pre-service

Curriculum

Strengthening /revisiting existing teaching curriculum

Focusing on most relevant learning objectives

Tailoring the teaching ( contents and methods)to achieve the learning objectives

Ensuring students are adequately trained in IYCF guidelines( knowledge &skills)

Review and Revise contents and teaching methods as an ongoing exercise

Stepwise plan of Action

1. Identify gaps2. Identify remedial actions3. Develop teaching material4. Feedback from experts5. Sensitize faculty in Zonal

Workshop6. Introduce teaching material7. Evaluate8. Feedback

Training -MCI

guideline

•

Didactic lectures should not exceed >1/3rd of the time schedule;

2/3rd of the time should be spent on the practical, clinical and group discussion

Learning process to include living experiences,problem oriented approach, case studies and community health services

Identify gaps & remedial

measures

Several meeting of Core group members ( March- Sep 2006)

Identify gaps & remedial

measures Topics for didactic lecture &

practical decided Divided among core group members

to review and develop suitable teaching materials

Developed materials presented before all core group members for critical review

Core group Members

Pediatrics Prof. S Aneja ( LHMC) Prof MMA Faridi( UCMS) Prof AP Dubey ( MAMC) Prof Piyush Gupta ( UCMS) Prof Tejinder Singh( CMC Ludhiana)

Dr Praveen Kumar ( LHMC) Dr Dheeraj Shah ( UCMS)

Core group Members

Community Medicine Prof. AT Kanan ( UCMS) Prof DK Taneja ( MAMC) Dr Pragati Chhabra ( UCMS) Dr Anita Gupta ( UCMS)

Obstetrics Prof. Manju Puri ( LHMC)) Prof Kiran Aggrawal ( UCMS) Dr Sonal ( Vadodra)

Identify gaps & remedial

measures

A 2 day meeting of all members ( Dec 2006) and teaching material finalized

Decided to incorporate evaluation of family practices and socio-cultural factors in CM practical

Teaching Materials

Standard Lectures related to IYCF --- Power point presentations,

lecture notes -- Video clips on Assessment of BF,

cup feeding,expression of breast milk

-Photographs Guidelines for Integrated session

Teaching Materials

Paed:6 practical session( 18 hrs) plan with guidelines how to conduct

- Assessment of BF - Positioning , Breast & nipple problem - Feeding of LBW, Expression of BM -Not enough milk - Complementary feeding CM: 4 practical session( 12 hrs) plan with

guidelines how to conduct - Good Coomunication skills -Ass of family & socio cultural factors affecting BF- Ass of family & socio cultural factors affecting Complementary feeding

Teaching Materials -

Evaluation-Guidelines for formative & summative

assessment -Model questions with answers and

how to mark these-Sample OSCEs-Sample MCQs

Teaching Materials

Lectures(10hrs)oPediatrics- 5oCM- 2oObstetrics- 1

Practical(30hrs)oPediatrics- 5-6oCM- 4oObstetrics- ( components to be

incorporated with ANC & Postpartum cases)

Training Schedule

Assist the partner medical colleges on developing a locally appropriate and feasible teaching schedule which is suitable for faculty of all three departments

Sensitization to

Zonal Coordinators

New Delhi- 4th Feb 2007 Model teaching materials presented

for feedback Decided to field test prepared

teaching materials in Zonal workshop Introduce teaching materials in

participating Medical colleges

Field test- 2 Zonal workshops

Vadodra ( Gujrat) : Prof Dulari Gandhi 10 Medical colleges 44 Faculty members 4 groups –to suggest teaching plans

CMC Ludhiana: Prof Tejinder Singh

11 Medical colleges 51 Faculty members 4 groups –to suggest teaching plans

What's next?

To hold 10 remaining Zonal WorkshopsIntroduction of teaching materials in

participating medical collegesFeedback from participating facultyEvaluation –impact ?

Teach IYCF with specific learning objectives and better teaching methods

Monitor & evaluate

Review and Revise

Acknowledgements

• Breast Feeding Promotion Network of India

• Marcia BTF• UNICEF