Patan Academy of Health Sciences started preparedness for COVID-19 in response to increasing number of patient in neighboring country. Outbreak preparedness in resource limited setup is challenging. Despite this, preparedness was done in reference to WHO interim guidance utilizing best available resources. During this preparedness, one patient was isolated as suspected COVID-19. This paper presents level of preparedness achieved with the limited resources and the lesson learned while isolating the patient.Keywords: COVID-19; Disaster; hospital preparedness
Introduction: Nepal with a poor health infrastructure and resources when hit by the COVID-19 pandemic in 2020, the health system and the health workers were not well prepared to handle the crisis. Method: We conducted a survey during the initial phase of the pandemic (July-October, 2020) to understand the perspective of PAHS medical graduates on the management of COVID-19. A survey questionnaire was prepared in Google form and circulated through official group emails. Result: Total 80 graduates participated in the survey of which 55(68.8%) were working in the country (36/55 working within the government health system) during the pandemic and 7(8.8%) were enrolled into residency program in the country. Of the participats 66% reported that their health facility was only partially prepared to take care of COVID-19 patients. The local government and the community of their workplace were reported as supportive for the efforts of the pandemic management by 30(37.7%) and 33(41.5%) respondents respectively. The graduates working during the pandemic were involved in various activities like swab collection (8), screening (30), critical care (37), patient education/counseling (41), managing non-COVID-19 patients (47) and administrative work (17). Conclusion: Inadequate planning of service delivery, finance, risk communication and resources were identified as major lacking nationally while shortage of human resources, logistic and PPE were reported as the major lacking locally by the participating graduates. The fresh PAHS graduates were found to be contributing at their respective workplaces fitting into both the clinical and non-clinical roles during the initial phase of pandemic in Nepal.
Background: Residents need to show their proficiency in clinical and teaching skills. A good amount of their time during residency is spent teaching their juniors. Moreover, once they graduate, their roles will be clinician and teacher. Therefore, the "Resident as a teacher" module was included in the curriculum of the general practice residency program at Patan Academy of Health Sciences. This study was designed to evaluate the change in the teaching skills of residents after going through the module. Methods: This was a qualitative study where three groups were interviewed. The first group was residents who underwent 'Resident as Teacher Training' and were involved in teaching their juniors. The second group was junior residents who were involved as learners and the third group was faculties. The questionnaire was used for interviewing and the thematic analysis was done and the findings of these three groups were analyzed.Results: There was a total of 25 general practice residents who were interviewed. The residents who were involved in teaching (N=11) stated that the training program increased their confidence 8(72.7%) and communication skills 8(72.7%). The residents who were learners (N=9) stated that they are more comfortable with the seniors in teaching and learning sessions. Faculties (N=5) stated that residents interacted well. Barriers to effective teaching were, difficult to manage time for preparation and supervision by faculty. Conclusions: General practice residents who went through the Resident as Teacher module stated that they were confident and had improvement in their teaching skills.Keywords: General practice resident; Nepal; postgraduate program; resident as a teacher; student as a teacher.
Competency-based medical education has evolved as an alternative approach in the residency training program. It shows potential to align educational programs with health system priorities through defining the competencies of graduating doctors. Designing and implementing Competency Based Post Graduate (CBPG) training in a resource-limited setting, where most of the trainings are still run in a conventional approach, is a big challenge. Patan Academy of Health Sciences, School of Medicine has taken the competency-based approach in the postgraduate residency training. Defining core competencies and connecting those to teaching methodology and assessment system are important initial steps in implementing the competency-based approach. The institution has implemented Entrustable Professional Activity (EPA), which is a unit of professional practice and helps to measure the trainees' achievements in the form of milestones. This paper describes the process of piloting and implementing the CBPG program at this school.The school launched the CBPG training in 2018 and so far, three batches of residents have been enrolled in nine different subjects/disciplines. The first batch of trainee, having the PAHS Core competencies and the pre-defined discipline-specific EPAs certified, will be completing their training soon. The program is time and resource consuming. Continuous faculty development, commitment, supportive leadership and faculty readiness to adapt to newer approaches are the key to the program's successful implementation.Keywords: Competency based medical education; Nepal; patan academy of health sciences; post graduate training; residency program
Nepal is a small, lower-middle-income country; with a population of around 30 million. As per WHO, Nepal has a low doctor-patient ratio (0.7/1000) and even lower specialists (e.g., surgical) workforce (0.003/1000); additionally, data from Nepal Medical Council show the number of postgraduate specialists is 1/3rd of the total registered doctors. The mismatch in the doctor-patient ratio is further aggravated by the overwhelming number of doctors in urban areas; when 80% of the population are in rural Nepal. This inequitable discrepancy in the healthcare system requires: proper training of competent medical graduates, a fair distribution across the country, and effective changes in the healthcare system. Competency-based medical education plays an important role in: standardizing education, training competent doctors, and deploying them where they are needed the most. The Government of Nepal has recently established Medical Education Commission-which plans to oversee the entrance exams; and expand the postgraduate training to be conducted by private hospitals, previously not affiliated with any medical colleges or universities. Historically, Civil Medical School started training compounders and dressers in Nepal in 1934. A big milestone was achieved with the establishment of the Institute of Medicine under Tribhuvan University in 1972, which has continued to train all categories of health manpower needed in the country. In 2006 Nepal Medical Council developed "Regulations for Post-graduate Medical education". Thereafter, several institutions started providing postgraduate training, for example: the BP Koirala Institute of Health Sciences, Kathmandu University, National Academy of Medical Sciences, and Patan Academy of Health Sciences (PAHS). The PAHS conducts PG programs and post-PG fellowships in line with competency-based medical education. In addition to formative assessments, research thesis, and a publishable article; PAHS requires its trainees to be certified in a pre-set of entrustable professional activities (EPAs) and to master eight Core Competencies domains in: Professionalism, Patient-centered care, Procedural skills, Clinical Reasoning, Communication, Scholarship, Leadership, Community orientation. The number of medical colleges in Nepal has since expanded to 24 (medical 21 and dental colleges 3). Private medical colleges make up about 3/4th of the total medical colleges in Nepal. This makes the inclusion and regulation of more components of the competency-based curriculum in postgraduate training programs, and its monitoring, somewhat of a challenge
Background: Patan Academy of Health Sciences intended to implement problem based learning in proficiency certificate level nursing program who have just completed grade 10. Presently in Nepal, the available literature on use of problem based learning as teaching learning methods is limited to undergraduate medicine who have passed 10+2 or equivalent. It was conducted to measure the perception of students and faculty on problem based learning in nursing program.Methods: Nursing faculty who have been involved in teaching learning of nursing curriculum were trained to conduct problem based learning and write problem based learning case. Prior to run problem based learning case, students were also oriented for the problem based learning process. A 44 students and seven faculty returned the filled data collection tool. Results: Both the students and tutors perceived that the problem based learning is an effective teaching learning method. They also found that the attributes of problem based learning such as self-directed learning, collaborative learning, team work and fun learning. Students were eager to have more problem based learning session in their curriculum. Faculty also perceived that problem based learning can be a better teaching learning methods and it can be implemented in proficiency certificate level nursing.Conclusions: This study shows the acceptance of problem based learning as a teaching learning methods in proficiency certificate level nursing program by both the students and faculty.Keywords: Nursing curriculum; PBL; perception.
