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SHORT COMMUNICATION
Year : 2021 | Volume
: 10
| Issue : 3 | Page : 231-234
Fetal medicine as a part of early clinical exposure
Lalitha Natarajan1, Darshana Srinivasan2, Dhakchenya C Sekar2, Punithavathi Krishnamoorthi2, Pananghat A Kumar3
1 Department of Obstetrics and Gynecology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
2 Department of Final Year Medical Students, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
3 Department of Clinical Simulation Laboratory, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
Correspondence Address:
Dr. Pananghat A Kumar
Clinical Simulation Laboratory, PSG Institute of Medical Sciences and Research, Coimbatore - 641 004, Tamil Nadu
India
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/ijhas.IJHAS_211_20
CONTEXT: Clinical relevance of basic sciences is not well appreciated by the preclinical students. In an effort to remedy this, Medical Council of India has introduced the program of early clinical exposure. Although broad guidelines are provided, institutions have been bestowed with the responsibility of conducting this important program depending on the available resources and local logistics.
AIMS: The aim of the study is to create an awareness of correlation of fetal medicine with the participants taught during preclinical year, particularly embryology.
SETTINGS AND DESIGN: Preclinical students were posted in the Division of Fetal Medicine in the Department of Obstetrics and Gynecology, as observers. The program enabled the students to appreciate the procedures performed in the clinics and to interact with the consultants and health-care staff during their posting. They interacted with the patients as well.
SUBJECTS AND METHODS: Preclinical students observed the clinical procedures performed in the clinics. Tests were conducted before and after the intervention, and their results were compared to evaluate the effectiveness of the program. Open-ended feedback was also taken to assess the impact of this program on the students.
STATISTICAL ANALYSIS USED: Fisher's exact test was used to evaluate the test scores.
RESULTS: Test scores revealed that this program improved the general awareness about the scope of fetal medicine and its direct relevance to the fetal developmental events; they learn in embryology. Feedback comments reiterated this fact.
CONCLUSIONS: Posting of preclinical students in fetal medicine during ECE program has observed the desired effect of them realizing the clinical significance of subjects; they are learning during their preclinical year of study. It has also impressed upon them the scope of fetal medicine as a subject.
Keywords: Affective domain, early clinical exposure, fetal medicine
Medical Council of India had mandated a program of “Early clinical exposure” (ECE) to be implemented during the preclinical training period of undergraduate training, which has now been endorsed by National Medical Council as well.[1] This program aims at bringing out clinical relevance of preclinical participants and link it to patient care. Implementation of this program was made easy in our institution, since we had initiated a unique program of “Clinical Observership” earlier on 2001 itself, the learning objectives of which matched very much with that of ECE.[2] During the 1st year of the MBBS course, students were posted in selected clinical departments, wherein they had the opportunity of being in the hospital surroundings, observing a few clinical procedures such as blood transfusion, cardiac catheterization, and dialysis. They also had the opportunity of interacting with the patients as well as the clinical consultants. At present, ECE is being held in two rotations of five clinical departments each. Clinical departments for this important program have been identified, based on their direct clinical relevance and the willingness of the faculty to be part of this program. Section of fetal medicine, within the Department of Obstetrics and Gynecology, was one such department, where students got posted as part of ECE, during the past academic year.
Significance of introducing preclinical students to live clinical scenarios in the hospital environment has been reported from quite a few European countries and also from South Africa, as well.[3],[4],[5] There seems to be a paucity of information regarding the conduct and content of ECE from our country. Students of our institution have reported their experience of exposure to ECE in the departments of cardiology, neurology, and nephrology and the clinical simulation laboratory.[6],[7],[8],[9] To our knowledge, there has been no report of fetal medicine, as a component of ECE and hence this report.
Subjects and MethodsFirst-year medical students divided into groups of ten were posted in the Fetal Medicine Unit of the Department of Obstetrics and Gynecology as observers for half a day, as part of the ECE program. This study was approved by the Institutional Human Ethics Committee at our institution (No: 17/335).
Design of the program
The program was designed such that it enabled the students to observe, assimilate all the proceedings in the clinic during their postings, and to interact with the consultants and health-care staff during their posting. Students could interact with the patients as well. A questionnaire related to the core content of the program was administered as a pretest and posttest to assess the impact of the program on the students.
The students got the opportunity to observe ultrasound examinations of antenatal cases during 11–14 weeks of pregnancy, which included nuchal translucency scan and the midtrimester (18–22 weeks) target scans. They were briefed on the normal appearance of each organ system in the first and second trimester, in correlation with the embryology that is being taught to them as part of their 1st year curriculum. In addition to observation of the ultrasound examinations, students had the opportunity to go through one of the following four basic modules, prepared for this program: central nervous system, gastrointestinal system, urogenital system, and the face and limbs. Two short videos on the development of the fetal CNS and the fetal circulation were added to integrate the knowledge of embryology into the program. The modules contained the normal appearance and a few common major anomalies of all the organ systems that are commonly encountered in current practice [Table 1].
Table 1: Content of the early clinical exposure course in fetal medicineSelection of the video graphs and modules depended on the clinical case, available for the program on that particular day. Anomalies, if any, encountered in the patient were discussed with reference to the underlying fetal pathology.
ResultsProgram evaluation
The program was evaluated quantitatively based on the pre and posttest scores. The test covered questions to assess their awareness of events during normal development, particularly of cardiovascular, pulmonary, and nervous systems and the possible congenital anomalies. Qualitative assessment was performed based on their feedback comments.
Test scores
The test scores revealed that the students have improved their comprehension regarding the content of the program. Fisher's exact tests on the test scores proved that the postactivity responses have registered significant improvement regarding their awareness of fetal anatomy and physiology. The program has helped them to understand the general aspects of fetal medicine and the relevance of embryology to this clinical participant.
Feedback
Students have expressed their appreciation of the content of the modules presented to them. It was, in general, amazing experience for them to have visualized the events during embryonic development in a pregnant lady, who underwent the regular mandatory antenatal checkup. A few of their remarks have been appended to illustrate the students' response [Table 2].
DiscussionECE as an effective and interesting learning program has been brought out in earlier observations.[6],[7],[8],[9],[10],[11],[12] ECE posting in fetal medicine becomes important, since the undergraduate medical student does not have the opportunity of getting exposed to the practice of fetal medicine, as a specialty in spite of their rather long postings in the Department of Obstetrics and Gynecology. The departments, selected for ECE, are the ones where an intern/compulsory rotatory residential intern does not get posted. Feedback analysis of the present batch of students reveals that the program in fetal medicine has provided them the rich opportunity of monitoring fetal growth and intrauterine events. Even though basic details of human development are expected to be learned in their embryology course, during the 1st year of MBBS, they do not have access to witness the intrauterine events in the conventional academic schedule. Embryology remains as a standalone purely theoretical. They tend to memorize the facts, without appreciating the intricacies of amazing embryological events. Exposure of the students to the field of fetal medicine has given them the opportunity to connect the abstract science with clinical medicine and reality. Analyzing their experience in fetal medicine, the observations indicate that they had gained practical insight into the human fetal development and some of its complications. A 1st year medical student finds embryology a tough subject, mainly because the events that happen in utero are not easy to imagine and comprehend. It is true that embryological events are depicted with varying clarity in three dimensions, in video graphs and youtube presentations. Yet, very many intricacies are left to the sheer imagination of the students. In the department of fetal medicine, students got to observe the routine ultrasound scans of pregnant ladies and to interact with the clinicians. They visualize position of the fetus during different trimesters and the ultrasound images of the developing organ systems. They also got the first-hand opportunity to appreciate that embryological events happen simultaneously with events interacting with parallel developments. This program has provided them the unique opportunity of getting an overall idea of the general behavior of the fetus in utero and eventually to consider the fetus as a patient.
Students realized that fetal medicine is a specialty which calls for maternal-fetal interventions, which basically involve two patients – the mother and the fetus, demanding extremely thoughtful and careful approach. They witnessed the routinely conducted anomalies scans and appreciated the significance of identifying congenital anomalies, early during pregnancy.
Fetal medicine makes use of ultrasonography for routine screening procedures. It has been well documented that ultrasonography training equips a student for diagnostic skills. Students had the opportunity of realizing the value of this very important diagnostic modality, right during the preclinical year of their training itself.
ConclusionPosting in fetal medicine has remarkably helped them to realize the role of ultrasound examination in patient care.[13],[14] The experience has enhanced their awareness of contemporary medical practice, which happens to be one of the goals of ECE. New specialties are evolving in the practice of medicine, and this program has helped the students to realize one such specialty, during the very 1st year of their career in medicine itself. This exposure to the specialty could develop an interest in fetal medicine in the young medico's mind, early in his career. ECE provides an avenue to know recent advances and emerging specialties. It does not involve extra resources to implement an interesting and beneficial session of ECE in fetal medicine. The routine clinical material coming up in the clinic could provide the core content of such sessions. Our experience of posting the students for ECE in fetal medicine has been very encouraging and enriching, since it has contributed immensely to achieving the goals of successful ECE.
Acknowledgments
Authors wish to thank the faculty members of Obstetrics and Gynecology of our institution, who actively took part in the program to make it a success. We acknowledge the help rendered by Dr. Merlyn Veronica, for her help in the statistical analysis of the test results.
Financial support and sponsorship
Routine Institutional.
Conflicts of interest
There are no conflicts of interest.
References
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