Theory and Practice of Learning Through the Family Adaptation and Field Visits in Medical School: A Reflective Perspective : Journal of the Scientific Society

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Theory and Practice of Learning Through the Family Adaptation and Field Visits in Medical School

A Reflective Perspective

Konikkara, Pearl S.; Sahoo, Bimal Kumar1; Pal, Debkumar1; Taywade, Manish1,

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Journal of the Scientific Society 50(1):p 125-128, Jan–Apr 2023. | DOI: 10.4103/jss.jss_198_22
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Medical education in the curriculum of Bachelor of Medicine, Bachelor of Surgery (MBBS) aims to produce doctors who are competent enough to provide comprehensive health care.[1] The comprehensive health-care concept was first used by the Bhore Committee in 1946.[2] The provision of integrated promotive, preventive, and curative health services from womb to tomb should exist for every individual residing in a geographical area. Primary health care came into existence in 1978 following the international conference at Alma-Ata in Union of Soviet Socialist Republics (USSR).[2]

The anticipated learning experience exposes undergraduates to real-life situations to acquire skills where the community serves as a laboratory for them. The community medicine/preventive social medicine department plays a significant role in the community orientation of medical education.[3,4] The Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, developed a community medicine curriculum considering the above view. This curriculum provided enough opportunity and exposure to the students in their medical training. The community medicine and family medicine department have the teaching and research priorities to provide primary health care in the hospital at rural health training centers. The undergraduate students' training is linked to primary health care.[5]

Health – A Comprehensive Approach to All Determinants

The medical aspect of health is seen to be given more importance in comparison with social or educational or any other determinants of health. In a simple example regarding hypertension, more importance is always given to pharmacological management in comparison with nonpharmacological interventions such as aerobic exercise, dietary modification, and salt restriction.[6] Community medicine subject is the only opportunity where other determinants of health give more weightage in comparison of medical factors. It has been seen that the interest among MBBS students in choosing community medicine is not high.[7] The approach of applying intervention in all the determinants may create more interest in the subject.[8]

The primary objective of medical education revolves around developing the skills and competencies so that students would be able to provide appropriate health care on the community stage.[9,10] The field practice area/community has been considered the live laboratory to give students a real-life experience and feel. Visits made by students to respective families with due follow-up visits (longitudinal) enrich them to gauge the role and impact of different factors present around the family such as social and environmental that lead to the prevailing disease/health condition.[11] Family Health Advisory Services (FHAS) sets the ground to move beyond the textbook knowledge and is reasonable for appraising the necessary interventions required for the family.[12] Table 1 describes the identification of problems and possible interventions Table 1.

Table 1:
Identification of problems with possible interventions

Family Health Advisory Services

The aim and objective of the program are to study the family allotted to them. Each student was assigned one family, almost with five members or more. During 3 years, they visit the allotted village and their families to understand the health problems and events. The sole purpose was to comprehend the socioeconomic, environmental, and social factors contributing to health problems. They also get an opportunity to understand to health-seeking behavior of the people. Community-based interventions are planned and proposed for each family, including the community diagnosis and intervention. These exercises are structured in the journal/record, including demographic details, social, environmental, nutritional, antenatal and postnatal care, under-five, adolescent, and geriatric care.

Lessons Learned

From this visit of FHAS, the following students have learned the following lessons:

  1. Health is among the lowest priorities of these villagers due to the distance to clinics, waiting time, and consultation time
  2. Awareness regarding different diseases and the perception of health and healthcare-seeking behavior are low
  3. Active participation is of utmost importance for medical students for learning
  4. Communications skills to listen, counsel, and understand health issues with empathy are important for medical students
  5. Decision-making by the head of the family is very crucial
  6. Primary physician's role is vital in health and diseases. It is an art to play the role of primary care physician
  7. Health educator's role is pivotal to resolving the social and behavioral science concepts in health care.

The diagrammatic representation of intermingled issues and causes in the form of a web gives concluding remarks about the profundity of self-appreciated realization by the student [Figure 1].

Figure 1:
Web of causation


The FHAS posting and family visits provide a holistic approach and opportunity to practice theory in community medicine. The vital skills demonstrated as community practitioners are in-depth perception, active participation, well-versed communication skills, and decision-making by identifying the problem and suggesting situation-based appropriate intervention.

Research quality and ethics statement

The authors declare that this manuscript does not require Institutional Review Board's/Ethic's review or approval.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.



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                        Community medicine; family adaptation; medical students; village visits

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