Establishing a Medical Humanities in Nepal with the help of a FAIMER Fellowship by Ravi Shankar

In this guest posting, Dr Ravi Shankar tells us how a FAIMAR Fellowship help him to develop and deliver a medical humanities curriculum in Nepal. Ravi writes…

Dr. Badyal, my good friend during my postgraduate residency e-mailed me in late January 2007 informing about a FAIMER fellowship in South Asia. At that time my knowledge and ideas about FAIMER were nebulous. I knew that it was an American organization involved in international medical education. FAIMER Regional Institutes: The Foundation for Advancement of International Medical Education and Research (FAIMER), Philadelphia in 2007 was in the process of starting regional institutes in Latin America, Africa and Asia. In Asia they were primarily focusing on India and the South Asia region and three regional institutes were started in India at Ludhiana in the north, Mumbai in the west and Coimbatore in the South. The PSGFAIMER Regional Institute at Coimbatore was inviting applications for a two year part time fellowship in medical education.

Curriculum Innovation Project: The application called for the submission of a Curriculum Innovation Project (CIP) and the quality and nature of the project would play an important role in the selection process. I was thinking about the project I would like to carry out in the institution I was working in at the time, Manipal College of Medical Sciences (MCOMS), Pokhara, Nepal. I have a keen interest in literature and the arts. I am a frequent trekker and a keen amateur nature photographer. I often write about my treks, other travels and medical issues for Nepalese newspapers and magazines. I and my colleagues had been conducting problem-stimulated, small group learning sessions in Pharmacology for over five years in 2007.1 We had gradually come to like this method of teaching-learning. The students after some initial problems also liked this method of active learning.

Selection for PSGFAIMER: It was in the third week of February that I was informed of my selection as one of the sixteen fellows for the 2007-2008 session. There were certain assignments which I had to complete and take with me when I went for the first on-site session in Coimbatore, India in April 2007. I was excited! The program seemed to be a good mixture of small group presentations, mini lectures and activity-based sessions.

First on-site session at PSGFAIMER: From Pokhara it was a long bus journey to the Nepalese border town of Sunauli. Crossing the border in the afternoon at the peak of the April heat was an unnerving experience. I then took a bus to the Indian town of Gorakhpur. From Gorakhpur it was a long train (two and half days) journey to Coimbatore. Luckily FAIMER was providing fellows with air-conditioned sleeper tickets. The food at Coimbatore was excellent and being very fond of South Indian food I was having a great time. Our faculty members introduced us to a number of tools which would be helpful for completing our projects and for conducting small group learning sessions.2 One idea I really liked was selecting a group leader, a recorder, a time keeper and a presenter for each group activity and rotating the roles from one session to another. The faculty introduced me to a number of questions which I had to answer before I could start work on my project. As I had suspected right from the beginning my project still needed a lot of work! Dr. Janet Grant from the Open University, United Kingdom (UK) was especially helpful. She had a lot of material on curriculum planning and design and was kind enough to share them with me.

Initial days of the module: I decided to have the sessions in the evening so that we did not encroach on the time of other subjects in the curriculum. However, it also meant that students had to come and participate in the sessions during their leisure time and at odd hours. My colleague, Mr. P. Subish, a clinical pharmacist was very helpful. He helped me with the logistics and kindly provided the meeting room adjacent to the Drug Information Center (DIC) in the teaching hospital for the sessions.2 He was also very interested in the subject and was one of the first faculty participants. Initially the sessions were a touch and go affair. Certain students came for one or two sessions and then stopped coming. Some others were irregular and attended when they could. The module was voluntary, would not be assessed summatively and did not carry any marks in the final examination. The only course of action open to me was to make the sessions as interesting and informative as possible to attract students and retain them in the module. Certain faculty members were also very interested in participating, learning about MH and acting as cofacilitators.

The module is established: We had interacted with many students but many of them were not convinced about devoting time and effort for something which was not in the curriculum. In the Clinical Science campus, the tide turned when a sixth semester lady student expressed interest in the module. She stated that she will come and attend a session and if she finds it interesting then she would strongly recommend the module to her friends. All six of them (she and her five friends) would then attend the sessions regularly. She and her friends added strength, interest and variety to the module. I especially remember their creative contributions and enthusiasm for role-plays, group activities and debates. The sessions were very interesting and used a variety of learning methods to explore MH. Literature and art excerpts, role-plays, debates and group activities were used.

The second visit to PSG: I resigned from MCOMS in October 2007 and joined a new medical school in the Kathmandu valley, KIST Medical College in Imadol, Lalitpur. The college management was very supportive of new ideas and we decided to start MH sessions for the faculty members and medical, dental officers. Soon it was time for my second visit to Coimbatore in April 2008. A new batch of 2008 fellows had joined and we were now ‘seniors’. The second on site session was less intensive than the first and I felt we learned less but I liked the methods FAIMER employed to increase interaction between the 2007 and 2008 fellows and their method of poster presentation. The 2007 fellows explains his poster to a group of 2008 fellows and one 2008 fellow explains the poster to a larger audience using a flip chart. The 2007 fellows were given the responsibility of guiding and helping the 2008 fellows in their learning and project work. I think our faculty wanted us to act as role models for the 2008 fellows. We were expected to demonstrate to the junior fellows that it was possible to plan and carry out a CIP.

MH module for faculty at KISTMC: I had started MH sessions at KISTMC from March 2008 and Dr. Piryani, an Internal Medicine specialist joined as cofacilitator. The topics and the learning modalities used were similar to the first module at MCOMS. The sessions were conducted for about two hours on Sunday afternoons and used literature and art excerpts, case scenarios, small group work and role plays to explore various aspects of MH.2 Feedback was obtained from the participants at the end of each session using a semi-structure form and on completion of the module.

Talk to faculty members at KISTMC: I gave a talk to faculty members at KISTMC about MH and its present situation around the world. I stressed on the need to develop MH in Nepal. Dr. Shapiro and Dr. Deborah Kirklin from the UK were kind enough to offer comments on the initial draft of the presentation. Around this time, we were planning a MH module for undergraduate medical students. I was discussing with my cofacilitator, Dr. Piryani about the modalities of the module. Considering the problems previous participants had with literature excerpts we decided not to use them in the student module.

MH module for students at KISTMC: In early February we started the module for students at KISTMC. The module is being held in the college auditorium on the top floor of the hospital. Topics like empathy, the patient, the family, the doctor, doctor-patient relationship, the healthcare team, the medical student, breaking bad news are to be discussed. Many of these topics are similar to those discussed in previous modules while some are different. The students are divided in to six groups and each group has been named after a famous personality in medicine, medical humanities. We use the LCD projector to link together various topics and organize the various tasks and activities in a logical and orderly sequence.

The sessions: The learning modalities are similar to those used previously. The session is held every Wednesday from 8 am to 9.30 am. Each topic is being covered in two parts called ‘bytes’ and six faculty members from the clinical and paraclinical sciences are acting as cofacilitators along with the two of us (I and Dr. Piryani). Dr. Huw then at the Patan Academy of Health Sciences occasionally acted as a guest facilitator and guided us with the module. Student feedback is obtained at the end of each session and groups are formatively assessed by the facilitator. Participant feedback has been positive.

Thus the FAIMER Fellowship has been a wonderful learning opportunity. I was introduced to many ideas and concepts in medical education and educational leadership. I have learned to use the power of the listserv to stay in touch with other fellows, to moderate electronic discussions, and to share ideas and information. The fellowship introduced me to many new concepts in small group learning and I was able to improve my facilitation skills considerably. It was wonderful getting introduced to MH and being able to take the first steps to develop the discipline in a small, developing country. I sincerely hope the discipline of Medical Humanities will become common in other medical schools in Nepal and South Asia and more and more South Asian medical educators take advantage of the wonderful opportunity offered by FAIMER.

References:

1) Shankar PR, Dubey AK, Mishra P, Upadhyay D, Subish P, Deshpande VY. Student feedback on problem-stimulated learning in pharmacology: a questionnaire based study. Pharmacy Education 2004; 4: 51-6.

2) Shankar PR. Medical humanities: sowing the seeds in the Himalayan country of Nepal. Literature, arts and medicine blog. Posted April 14th, 2008.

3) Shankar PR, Piryani RM, Karki BMS. A Medical Humanities module for faculty members and medical/dental officers at the KIST Medical College, Imadol, Nepal. In: Souvenir, Research Conference on Health Science, Kathmandu: Institute of Medicine 2009: pp.70.

Address for correspondence:

Dr. P. Ravi Shankar

KIST Medical College

P.O. Box 14142

Kathmandu

Nepal.

Phone: 977-1-5201680

Fax: 977-1-5201496

E-mail: ravi.dr.shankar@gmail.com

  • Deborah Kirklin

    Thanks for this interesting post Ravi. It’s great to hear that Educational Foundations are open to creative and innovative ideas like this. Obtaining funding for medical humanities projects can be a challenge and it would be good to hear from others about what works in their part of the world.

  • Punita Salwan

    It was interesting to go through your FAIMER Fellowship experience.Your vivid description has eased my nerves as I enter the FAIMER world of 2010 Fellows.Reading about your hindrances on the way and how you tackled them has boosted up my confidence which was a bit jaded till now.Carry on with more such posts.