See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/319493614

A Handbook for Postgraduate students of Community Medicine

Book · August 2017

CITATIONS READS

0 2,608

1 author:

Pavan Pandey
Jhpiego
18 PUBLICATIONS   15 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Evaluation of MDA program in U.P View project

Childhood stunting prevention View project

All content following this page was uploaded by Pavan Pandey on 05 September 2017.

The user has requested enhancement of the downloaded file.

BI

C
OS

I
 H
L
TA

R
T
U
TI

L
P
A

e
ST

s
IC

e
S

ra
A Handbook

c
h
for
Sa
m
pl
in
g
Postgraduate
students of
Community
Ep
ide
mio
log
y

Medicine Grants 
DR PAVAN PANDEY
VERSION 1.0  SC
I
W EN
R I T
ICS
T I I F
ETH
N IC
G
Be the
Change
that you wish t see in the world:
M K Gandhi
2 Handbook for Postgraduate Students of Community Medicine

Contents

I. Welcome note

II. Goal and objectives of post-graduation in community

medicine

III. Epidemiology

IV. Medical-Biostatics

V. Computer proficiency

VI. Proposal/protocol writing

VII. Research methodology

VIII. Ethics

IX. Academic English writing

X. Scientific writing

XI. Thesis

XII. Posting at RHTC

XIII. Clinical Skills

XIV. Nonpharmacological health intervention

XV. Critical appraisal

XVI. Peer review

XVII. Plagiarism

XVIII. Suggestive activities

XIX. Useful resources

XX. Suggestive list of readings

Dr Pavan Pandey; mail suggestions to [email protected] Page 2

3 Handbook for Postgraduate Students of Community Medicine

Introduction: Why I wrote this handbook

It has been only been two years since I completed my post-

graduation but I believe that during these two years I got much better

exposure about the working of the Indian health system than during three

years of post-graduation. Although I got several opportunities to work in

different research projects during my post-graduation, though systematic

exposure to the working of Indian health system, however, was insufficient.

During the past five years, I (along with many more students and teachers)

noted that teaching of community medicine is not uniform across India. In

addition, it is my firm belief that the teaching of community medicine in

current form is not as per the needs of Indian health system. Although a

curriculum and guidelines exist for post-graduation in community

medicine; they are not followed uniformly everywhere and in my view, the

present curriculum is outdated and in no way prepare a community

medicine PG to the overcome the challenges faced by Indian health system.

Currently, at most places, stress is given on acquiring

theoretical knowledge, seminar/journal club presentation, publication of

papers, and undergraduate teaching. All these are an essential part of post-

graduation but not the end in itself. More crucial is the application of

Dr Pavan Pandey; mail suggestions to [email protected] Page 3

4 Handbook for Postgraduate Students of Community Medicine

theoretical knowledge in the field to solve the real world health problem(s)

and learning from such experiences. It would be wrong to blame teachers

alone for the present scenario because I believe there is a lack of interest

and knowledge about community medicine from student side as well. All

this and more gave me the inspiration to write this handbook so that

coming generations of community physician are better prepared to serve

Indian health system. I do not claim that this handbook is complete or

perfect but this will certainly guide you to utilise your time as a post-

graduate student in a better way. I expect some of you reading this

handbook to contact me to share your experience, views, and suggestions to

make this handbook better and more useful to students. This is the first

draft of the handbook and some topics are yet to be finalised while some are

incomplete; which of course can wait but your time is precious thus I

decided to share with you the topics which I believe are as of now complete.

With Best Wishes

Dr Pavan Pandey
Polite Request: If you want to contribute towards improving this

handbook then please email your thought and suggestions to

[email protected]

Dr Pavan Pandey; mail suggestions to [email protected] Page 4

5 Handbook for Postgraduate Students of Community Medicine

1. Welcome! सु स्वागतम!

Congratulations on opting community medicine as your post-

graduate speciality. All the members of Indian Association of Preventive

and Social Medicine (IAPSM) fraternity are pleased to have you with us. I

hope that each and every member of community medicine fraternity will try

their best to make your post-graduation a memorable experience and will

facilitate your transformation into a proficient community physician. There

can be all but only two reasons for choosing community medicine: first and

more common is that you did not get the branch of your choice and so you

decided to settle for community medicine. Second and a less common

reason is that you are actually interested or I may say in love with (just like

me) community medicine and you have decided to dedicate your life to it.

In either case, embrace that you are here and try to make the most of your

time while you are here. I hope that this post-graduation will be a stepping

stone for your bright career and will inspire you to make individuals,

families, communities, and our country a bit healthier than they already

are.

In the world there are three types of doctors – the first type

are those “who diagnose & treat, the second type are those ‘who diagnose

Dr Pavan Pandey; mail suggestions to [email protected] Page 5

6 Handbook for Postgraduate Students of Community Medicine

& treat & counsel for prevention’ and there is a rare third type ‘Who

diagnose & treat & counsel for prevention & advocate for policy

changes at local community level, district, state & national level

for promotion of health’. A proficient community physician

would be categorised as the third type (from personal

communication with Dr Rajesh, PGI Chandigarh). So as a community

physician you are expected to treat illness, educate the patients on

preventing complications/recurrence and simultaneously work on a

research project(s) to generate scientific evidence so as to advocate for

policy change(s) in order to minimise the impact of diseases at the

population level. This handbook intends to orient you about the world of

community medicine and how you should prepare yourself for the journey

in the world of community medicine.

Technically speaking, everything which affects human health

directly or indirectly comes under the pursuits of community medicine

whether it is the food we eat, place we defecate, air we breathe, place where

we live, work or receive treatment. This makes community medicine an

extremely broad field; community medicine borrows concepts and

principles from various scientific disciplines way beyond medical sciences

such as statistics, social science, communication, management etc. to

Dr Pavan Pandey; mail suggestions to [email protected] Page 6
7 Handbook for Postgraduate Students of Community Medicine

improve the health of the population. This is because community medicine

is not limited to the hospitals rather it involves working with the people in

the community where they live and interact with their surroundings. Like

any other post-graduation course, an MD in community medicine is an

intensive course. It is because other than treating illness you have to devise

a strategy for their prevention and it is will be your responsibility to see that

how these strategies are performing in the real world. But before anyone

can help you to become a proficient community physician you have to help

yourself, I advise that you should commit yourself to self-study, be

proactive, always be open to new ideas and never hesitate to questions what

you don’t understand. During the coming three years, you should grab all

the opportunities which present itself, whether it’s a conference, a lecture, a

health camp, an ASHA meetings, Polio vaccination session, a focal outbreak

or a village health and nutrition day meeting. Try to spend your evening

hours in the wards (specifically medicine, paediatrics, obstetrics, &

gynaecology) of the hospital attached to your medical colleges as this will

help you improve clinical skills and will also provide you with the unique

opportunity to practice clinical epidemiology. In the coming three years,

you are expected to expand your knowledge base, acquire transferable skills

Dr Pavan Pandey; mail suggestions to [email protected] Page 7

8 Handbook for Postgraduate Students of Community Medicine

and develop insight into the working of Indian health system by working on

academic activities, research projects, and your dissertation.

As a community medicine student, your job is not to

memorise every single data out there, but your job is to generate and

utilise data to improve the health of masses. So it will be my advice to you

that do not bother yourself with numbers and data because it is in their

nature to change. Instead, keep a notebook and write in it all the latest

number you come across with their source and whenever anyone bothers

you with data open your notebook and politely tell them the data they are

interested in. In your day to day life actively observe the health-related

behaviour of both healthy and sick individuals and use your knowledge to

educate them to improve their health-related behaviour.

Everyone values their personal development, but I

recommend all students of a particular college to work and study as a team

to learn from each other’s insight, experience, knowledge and working

style. Community medicine requires an array of skills, ranging from

biostatistics to epidemiology to sociology to anthropology. Not everyone

can excel in all these areas, but through collective efforts, everyone can help

Dr Pavan Pandey; mail suggestions to [email protected] Page 8

9 Handbook for Postgraduate Students of Community Medicine

each other in overcoming their weaknesses. I wish each and every one of

you the very best for your all future endeavours!!!

Dr Pavan Pandey

And welcome again!!!

------------------*****---------------------

Dr Pavan Pandey; mail suggestions to [email protected] Page 9

10 Handbook for Postgraduate Students of Community Medicine

2. Goals and Objectives of post-graduation in

community medicine

Goal: The overall goal of post-graduation in community medicine is to

acquire knowledge, skills and competencies to assess the health needs of

the population; devise strategy, policies and program to fulfil these needs.

Specific expected objectives:

1. Provide leadership and serve as a resource person to communities for

identification, assessment, and addressing current and emerging public

health problem(s). Demonstrate competency to formulate specific

strategies and program based on sound scientific evidence for promoting

health and controlling health problems identified through such

assessment.

2. Comprehend and demonstrate the ability to synthesise valid scientific

evidence(s) to advance existing knowledge related to the issues affecting

the health of masses and individual patients.

3. Comprehend and demonstrate the understanding of principles involved

in health need assessment.

Dr Pavan Pandey; mail suggestions to [email protected] Page 10

11 Handbook for Postgraduate Students of Community Medicine

4. To acquire knowledge and understanding of the fundamental concepts

and methods of epidemiology and their application in improving the

health of masses.

5. To acquire the ability to formulate an epidemiological intervention on

the basis of evidence (when available), to appropriately respond to a

public health problem.

6. To acquire a basic understanding of biostatistical concepts and methods

so as to undertake an independent research project/study.

7. Comprehend and demonstrate the clinical skills to treat common illness

under the pursuits of primary health care.

8. To acquire sound understanding about working of Indian health system.

9. To acquire competency in designing and organising an effective health

education campaign directed at public health problems.

10. Comprehend and demonstrate a good understanding of the socio-

cultural, political and ethical issues surrounding any public health

problem.

Dr Pavan Pandey; mail suggestions to [email protected] Page 11

12 Handbook for Postgraduate Students of Community Medicine

11. Comprehend and demonstrate a sound understanding of the principle,

theories, methods, and interventions used in health promotion.

------------------*****---------------------

Dr Pavan Pandey; mail suggestions to [email protected] Page 12

13 Handbook for Postgraduate Students of Community Medicine

3. Epidemiology

The distinct entity of community medicine is

‘epidemiology’. There are several definitions of epidemiology but most

widely used is “Epidemiology is the study of the distribution and

determinants of health-related events in specified populations, and the

application of this knowledge to improve the health of the masses. Rather

than looking at an individual patient Epidemiology concern itself with the

whole or part of the population. A much broader definition of

epidemiology is: “It is the study (scientific, systematic, data-driven)

of the distribution (frequency, pattern) and determinants (causes,

risk factors) of health-related states and events (not just diseases) in

specified populations and the application of (since Epidemiology is a

sub-discipline within community medicine) this study to the control of

health problems” . There are six core functions of epidemiology: public

health surveillance, field investigation of health events,

conducting epidemiological studies, health care evaluation,

intersectoral linkage and health policy development.

In order to become a competent community physician, you

have to first become a proficient epidemiologist. Epidemiology teaches us

Dr Pavan Pandey; mail suggestions to [email protected] Page 13

14 Handbook for Postgraduate Students of Community Medicine

how to use valid scientific methods (epidemiological study) for addressing

and analysing health-related problems in a community. Following are the

minimum expectations from a community physician in terms of

Epidemiology:

I. Ability to use the knowledge and tools of epidemiology to assess and

solve health-related problems of a given population.

II. Evaluate epidemiological studies conducted earlier, including critical

appraisal of the research question, study design, methods, statistical

analyses, results and their interpretation.

III. Ability to formulate a research question with appropriate research

objective based upon literature review; thereafter design and conducts

an epidemiological study to answer the research questions.

IV. To select appropriate study designs, sampling strategies, measurement

methods, questionnaire development and strategy for data collection &

analysis for specific research aims.

V. Competency to teach the basic principle of epidemiology to

undergraduate and non-medical personnel.

VI. Theoretical competency to plan and conduct a health intervention trial.

Dr Pavan Pandey; mail suggestions to [email protected] Page 14

15 Handbook for Postgraduate Students of Community Medicine

VII. Competency to report and appraise the epidemiological studies within

the frameworks of recommended reporting guidelines (STROBE,

CONSORT, STARD, PRISMA etc).

It is recommended that student makes themselves familiar

with the basics of epidemiological study design before the end of the first

year so that they can decide what kind of study design they want to

adopt for their thesis. Along with skills for field epidemiology, you must

make yourself familiar with the concepts of clinical epidemiology. This

will increase your competency in identifying public health problems

existing in the hospitals as well as in the community; thus broadening

your scope for conceiving critical research questions. Along with

learning the theoretical concepts of epidemiology I strongly advise you

to practice epidemiology at every chance you get. The hospital attached

to your medical college generates a tremendous amount of data (related

to morbidity and mortality) for a large number of diseases. As a group

exercise, you can use the hospital data to calculate different types of

epidemiological measure of disease burden (rates, ratio, proportion,

incidence and prevalence) for your institute. This will give you practical

exposure in using secondary data for statistical analysis. You can even

design a dashboard of indicators for monthly reporting by various

Dr Pavan Pandey; mail suggestions to [email protected] Page 15

16 Handbook for Postgraduate Students of Community Medicine

departments for discussion. In addition, you can practice on the HMIS

monthly progress report generated for different blocks and for the whole

districts. This can help you in identifying seasonal trends in the

incidence and prevalence of different health related events. There are

several other organisations/personnel which generates a tremendous

amount of health-related data on monthly basis e.g. ICDS, ANM, ASHA,

and other health worker cadre which is of public health importance, you

can innovate to use their data to improve your understanding of

epidemiology.

Suggestive reading list for epidemiology:

I. Principle of epidemiology in public health practices; CDC, USA

(freely available online).

II. Rothman KJ. Epidemiology: an introduction.

III. Rothman KJ, Greenland S. Modern Epidemiology. Lippincott,

Williams & Wilkins

IV. Ashchengrau and Seage. Essentials of Epidemiology and Public

Health –– Jones and Bartlett

V. MacMahon B, Trichopolous D. Epidemiology, principles and

methods. (2nd Edition) Little Brown and Co. 1996

Dr Pavan Pandey; mail suggestions to [email protected] Page 16

17 Handbook for Postgraduate Students of Community Medicine

VI. Porta M, Last JM. A Dictionary of Epidemiology. Oxford

University Press.

VII. Rose G. The Strategy of Preventive Medicine. Oxford University

Press

VIII. Sackett DL, Haynes RB, Guyatt G. Clinical Epidemiology: a

basic science for clinical medicine. Lippincott, Williams & Wilkins.

IX. Szklo M, Nieto FJ. Epidemiology: Beyond the Basics. Jones &

Bartlett.

X. Michael Gregg. Field Epidemiology

------------------*****---------------------

Dr Pavan Pandey; mail suggestions to [email protected] Page 17

18 Handbook for Postgraduate Students of Community Medicine

4. Medical-Biostatistics

If epidemiology is the “engine” of community medicine

then biostatistics is the “fuel” on which the community medicine runs.

Application of statistical principle in the field of medical science comes

under the domain of biostatistics. Many of your colleagues from other

departments will definitely approach you for calculation of sample size for

their thesis or they will consult you about which statistical test is most

appropriate for their data set. Make sure that you do not disappoint them

and yourself. Following are the minimum competencies expected from you

regarding biostatistics:

I. Ability to apply principles of biostatistics in epidemiological research

design.

II. Ability to calculate sample size for different types of epidemiological

study designs.

III. Ability to analyse the data at hand and use appropriate statistical

test(s) to obtain results.

IV. Ability to interpret, summarise, and communicate results of any

epidemiological studies to the common man, colleagues, professional

Dr Pavan Pandey; mail suggestions to [email protected] Page 18

19 Handbook for Postgraduate Students of Community Medicine

audiences and policy makers, in the context of public health

principles.

V. Ability to operate at least one statistical software packages for data

entry, management and analysis.

VI. Ability to utilise the secondary data for conducting statistical

analyses, obtaining results and drawing a conclusion.

Some student might hate mathematics, but I would like to

make it clear that medical biostatics is not all about mathematics; rather it

is about obtaining and utilising data to draw a valid conclusion for

improving the health of the population. Medical biostatics is all about data;

what is the best method to obtain data (survey methodology), what is the

best method to analyse data, how to obtain valid results from available

data, how to interpret results and determine implications of results at hand.

In my view, without understanding the basics of biostatics it would be

difficult (if not impossible) for you to become a fine community physician.

Like in any other fields of arts and science, the popular

belief that ‘practice makes you perfect’ holds true for biostatistics; the more

you practice the more quickly you will learn. Whenever you come across

any bio-statistical jargon like multivariate, regression, ANOVA, t-test,

sample size and most commonly p-value etc. then don’t just skip these

Dr Pavan Pandey; mail suggestions to [email protected] Page 19

20 Handbook for Postgraduate Students of Community Medicine

terms for a later occasion, instead try to learn about these terms one at a

time. A practical way to learn biostatistics and its role in the research is to

follow the sequence of step in any scientific research from its inception

(review of literature) to its completion (results & discussion) and

understand what competency is required in terms of biostatistics that might

is expected at each stage. All these books are good and you need not

buy/read each one of them. Just pick any books from those mentioned

below.

1. Rosner, Bernard. Fundamentals of Biostatistics

2. WW Daniel. Biostatistics: Basic Concepts and Methodology for the

Health Sciences.

3. Abhay Indrayan. Medical Biostatistics: Chapman & Hall/CRC

Biostatistics Series

4. Betty R. Kirkwood, Jonathan A.C. Sterne. Essential of Medical

Statistics

5. Blastland M, Dilnot A. The tiger that isn’t-Seeing through a world

of numbers.

6. Statistics Toolkit by Rafael Perera, Carl Heneghan and Douglas

Badenoch ------------------*****---------------------

Dr Pavan Pandey; mail suggestions to [email protected] Page 20

21 Handbook for Postgraduate Students of Community Medicine

5. Computer proficiency
I strongly advocate that a community medicine PG should be

competent in operating a computer, specifically Microsoft Office

package i.e., Microsoft Word, PowerPoint, and Excel. It would be better

if you can join a local computer teaching class or all PGs of a

department hire a professional to teach Microsoft Office package in the

computer lab of your department itself. It is essential to learn how to

operate a computer efficiently because there are numerous

features/applications in the Microsoft Office which are vital in today’s

world, which of course you will eventually learn but you will waste

precious time in the process. It is also advocated that you should buy a

personal laptop if you already do not have one, as it will give you more

time to practice Microsoft Office and various statistical packages, in

addition, it will provide a portable place to store your data, books,

videos, and presentations. All of this is recommended because you

cannot survive in the world of community medicine if you are not able

to operate computer efficiently.

In addition to Microsoft Office, a PG of community

medicine should able to operate the statistical software. Statistical

software is an application by the means of which you can analyse your

Dr Pavan Pandey; mail suggestions to [email protected] Page 21

22 Handbook for Postgraduate Students of Community Medicine

statistical data for obtaining meaningful results. In order to become

proficient community physicians, you should able to operate at least

one of many statistical packages available. SPSS is the most commonly

used software but it is not available for free, some other packages such

as Epi-info and R- statistical package can be downloaded from the

internet free of charge. The Internet is filled will videos, instruction

manuals, online courses and mock data sets for learning these

packages. I recommended that none of you should be dependent on

others to learn these statistical packages; you should take care of your

own learning and be your own master. After making yourself familiar

with the basics of these packages you must learn the advanced features

of these software. Many institutes (CMC, Vellore in particular) provide

onsite training in these statistical packages, surf the internet to get

more information. I will recommend that you should learn to operate

one such software before the start of your thesis. I will also recommend

that in addition to analysing your own data, you should also analyse the

data from the thesis of your colleagues from other departments as this

will give you more hands-on practices in operating statistical packages.

------------------*****---------------------

Dr Pavan Pandey; mail suggestions to [email protected] Page 22

23 Handbook for Postgraduate Students of Community Medicine

6. Research Methodology

In the world of science, fact/hypothesis are proved or discarded on the

basis of results obtained through valid scientific experiments and

conduction of such scientific research comes under the domain of

research methodology. It is defined as the science of studying how

research is done scientifically in order to generate evidence that is valid

and reproducible using approved methods. Before you are able to

undertake your thesis or write even a research protocol you should

know how to properly conduct research and what the different

steps/components of scientific research are. Acquiring the knowledge

about steps involved in conducting a research is thus the very first step

towards becoming a competent researcher and a community physician.

Thus I advise you that research methodology should be one of the first

things which you should learn during the first year of PG. You can learn

more about research methodology through workshops conducted by

many institutes. In addition, many courses are available online. Once

you acquire basic knowledge and skills related to research methodology

you should support PGs of other departments in writing their research

protocol, this will give you hands-on experience in designing and

writing research protocol.

Dr Pavan Pandey; mail suggestions to [email protected] Page 23

24 Handbook for Postgraduate Students of Community Medicine

Suggestive reading:

1. Ranjit Kumar 4th edition. Research Methodology; A step by step

guide for beginners.
2. C R Kothari; Research Methodology
3. Bowling A. (2009) Research methods in health: investigating
health and health services. Maidenhead: Open University Press.
4. Bowling A, Ebrahim S, eds. (2005) Handbook of health
research methods: investigation, measurement and analysis.
Maidenhead: Open University Press.
5. Hulley SB, Cummings SR, Browner WS, Grady DG,
Newman TB. Designing Clinical Research: An Epidemiologic
Approach
6. J. H. Abramson, Z. H. Abramson. Research Methods in
Community Medicine: Surveys, Epidemiological Research,
Programme Evaluation, Clinical Trials, Sixth Edition
7. Richard H. Morrow and Peter G. Smith: Field Trials of Health
Interventions: A Toolbox
8. Colin Robson, Kieran McCartan; Real World Research, 4th
Edition
9. Abhaya Indrayan; Basic Methods of Medical Research

------------------*****---------------------

Dr Pavan Pandey; mail suggestions to [email protected] Page 24

25 Handbook for Postgraduate Students of Community Medicine

7. Proposal/protocol writing

After conceiving the idea what you want to research you need to draw

a plan of action for conducting your research. A research

proposal/protocol is a blueprint of the research to be conducted

detailing the manner/methodology in which the research would be

undertaken. For every research project, you will ever undertake in your

life you will have to write and submit a research proposal/protocol

first. This proposal will be scrutinised by ethical committee members

and grant bodies before granting you the permission/fund to undertake

the research. Thus you must master the skills needed to write research

proposal before the end of the first year of post-graduation or if

possible earlier. Many universities have a pre-designed format for

submitting a research proposal, find out about any such format

recommended by your institute/university. Many researchers publish

their research protocol in the journal as scientific articles. Do go

through the websites of the prestigious journal for retrieving protocols

in order to review such published protocol. Medical education unit of

Delhi University has drafted a template for writing research protocol

search on the internet to download a sample.

Suggestive reading:

Dr Pavan Pandey; mail suggestions to [email protected] Page 25

26 Handbook for Postgraduate Students of Community Medicine

1. Beverly A Browning; Grant writing for dummies

2. Otto O Young. Guide to effective grant writing: How to write a

successful NIH grant applications

3. E Karsh, A S Fox. The only grant writing book you’ll ever need

4. The National Science Foundation (NSF): online guidelines for

scientific research proposal writing, which can be accessed here:

http://www.nsf.gov

5. Purdue online writing lab. Introduction to grant writing

https://owl.english.purdue.edu/owl/resource/981/1/

6. https://grants.nih.gov/grants/how-to-apply-application-

guide/format-and-write/write-your-application.htm

------------------*****---------------------

Dr Pavan Pandey; mail suggestions to [email protected] Page 26

27 Handbook for Postgraduate Students of Community Medicine

8. ETHICS

Ethics or moral philosophy is a branch of philosophy that

involves systematising, defending, and recommending concepts of

right and wrong conduct (from Wikipedia.org/ethics). Every sphere

of human action/intention needs some kind of external regulation for

its proper conduct. Following this lead, research and investigation

into the cause of disease or health behaviour need some kind of

regulation which safe guards the rights of all those (humans &

animals) involved in research. This aspect falls under the domain of

‘ethics’ or more specifically ‘public health ethics’. Those who are

involved in research related to any aspect of human’s health are

responsible for the protection of participants’ rights, safety, and

welfare, and for scientific integrity. This becomes crucial in countries

like India, as a developing nation many of those who participate in

the research are not always aware of their every right as a research

participant. Each investigator is held responsible for the local laws

and ethical standards that apply to their role in a research project.

Every investigator who collects data through direct or indirect contact

with individuals is responsible in their individual capacities to protect

the rights of those participating in the research. A very simple

Dr Pavan Pandey; mail suggestions to [email protected] Page 27
28 Handbook for Postgraduate Students of Community Medicine

example is that many of you or your friends/colleague would

carelessly post a picture or other details related to patient/participant

on the social media without their permission. This is a violation of the

patient’s privacy and ethical rights. Before you share any information

related to patient/participant it is your duty to obtain informed

(written/oral) consent for reproduction of any kind of data. More so if

you are so called ‘principal investigator’ and you delegate data

collection to the so called data collectors (any other third party) it is

your responsibility as investigators for the protection of rights of a

study subject. It is your responsibility to train data collectors in the

principles and practice of research ethics. In many instances due to a

lack of awareness among research investigators and lack of standard

training guidelines rights of study participants are violated. This

violation may not have a happy ending for all those (including

investigators & data collectors) involved in a research project. During

post-graduation and probably for rest of your life, many of you will be

involved in a variety of healthcare research projects. Thus it is

advised that during any research project you must ensure that study

participant rights are upheld; it is the only way to protect your

integrity.

Dr Pavan Pandey; mail suggestions to [email protected] Page 28

29 Handbook for Postgraduate Students of Community Medicine

Following are the suggestive reading and resources:

a. Merritt MW, Labrique AB, Katz J, Rashid M, West KP Jr., et al. (2010) A

Field Training Guide for Human Subjects Research Ethics. PLoS Med

7(10): e1000349. doi:10.1371/journal.pmed.1000349

b. JHSPH Human Subjects Research Ethics Field Training Guide

c. “Research Ethics Training Curriculum, 2/e” by Family Health

International

d. Responsible Conduct of Research: A Guide for Faculty

------------------*****---------------------

Dr Pavan Pandey; mail suggestions to [email protected] Page 29

30 Handbook for Postgraduate Students of Community Medicine

9. Academic English writing

Most of us learned English as a second language either

in school or in college. Many of you might have noted some

grammatical mistake in the language used in this handbook; this is

because I am still working on my academic English. Writing academic

English is an essential skill to be acquired during your post –

graduation because all major journals in India and world over require

manuscript to be submitted in English. Also, the presentation given in

conferences and the grant proposal submitted to funding agencies need

to be in proper academic English. Acquiring the ability to write

academic articles, presentations, and research proposal in good-quality

academic English is thus essential to advance your career. Scientific

article written in poor quality English are likely to be either rejected or

sent for revision of language by journal editors. I strongly recommend

that you should acquire the skills in academic English writing.

Many students may be confident in speaking in

English in everyday situations, but you still need to make yourself

familiar with the content of academic English writing. Academic

English writing involves writing English using the proper form of

grammar, punctuation, avoiding plagiarism, appropriate referencing,

Dr Pavan Pandey; mail suggestions to [email protected] Page 30

31 Handbook for Postgraduate Students of Community Medicine

and as per journal’s recommendations if any. To make yourself familiar

with academic English you must make a habit of reading articles from

prominent journals in order to better understand the words used

frequently in scientific article and style of writing. Again a lot of

material in the form of online courses, e-books, pdfs, articles and

website are available to learn these skills.

Suggested reading:

1. Academic writing handbook: London school of hygiene and tropical

medicine available from

http://www.lshtm.ac.uk/edu/qualityassurance/academic

writinghandbook.pdf

2. Murray, R & Moore, S -The Handbook of academic writing: A fresh

approach. Open University Press-McGraw-Hill

3. Hilary Glasman-Deal; Science Research Writing for Non-Native

Speakers of English: A Guide for Non-Native Speakers of English

------------------*****---------------------

Dr Pavan Pandey; mail suggestions to [email protected] Page 31

32 Handbook for Postgraduate Students of Community Medicine

10. Scientific writing

Writing is a very important part of science; it is used

to document and communicate ideas, activities, and findings to others.

There could not be any progress in the field of science if scientists do

not communicate and share their findings with each other and with the

world. The mode of communicating in the scientific world is by the

means of scientific articles, dissertations, grant proposal, program

evaluation reports, and presentations. All these need to be written in a

well-defined and specified style known as scientific writing. Conceiving

great research questions and undertaking research is only a three-

quarters of the complete picture. If the results of your experiment no

matter how outstanding they are, if presented in a poor manner or not

presented at all then they might undermine the efforts put in

conducting the research. In many instances, words written by you are

the only means by which you can communicate to other scientists,

student, and government. Thus it is essential that language used in all

scientific publication should fulfil a minimum technical standard to

enable anyone to understand results and reproduce the experiments,

but it should be casual enough to permit other scientists who are not in

the same exact field of research to understand the impact of your

Dr Pavan Pandey; mail suggestions to [email protected] Page 32

33 Handbook for Postgraduate Students of Community Medicine

research. Thus you need to make yourself familiar with scientific

writing in order to be a competent community physician. Mastering

scientific writing along with academic English writing will help you

advance your career as a researcher in the field of community

medicine. Lots of books, presentations, and online courses are

available which teaches the basics of scientific writing. But scientific

writing in a true sense is an art, with consistent practice, everyone can

acquire the basic skills for scientific writing and like many forms of

arts, some people acquire it easily and quickly as compared to others. I

recommend that you read as many as the scientific article as possible

from prestigious journals and try to re-write or paraphrase them on

regular basis to improve your scientific writing skills. Acquiring

competencies in scientific and academic English writing can also be a

means of additional income as you can earn by assisting others in

publishing their scientific articles.

Suggested reading:

1. Mimi Zeiger. Essential of writing bio-medical research paper.

2. Publication Manual of the American Psychological Associations, 6th

edition

Dr Pavan Pandey; mail suggestions to [email protected] Page 33

34 Handbook for Postgraduate Students of Community Medicine

3. Online course ‘writing in science’. Freely available at

http://online.stanford.edu/course/writing-in-the-sciences

4. Online course how to write and publish scientific papers; freely

available at https://www.coursera.org/learn/how-to-write-a-

scientific-paper

------------------*****---------------------

Dr Pavan Pandey; mail suggestions to [email protected] Page 34

35 Handbook for Postgraduate Students of Community Medicine

11. Thesis/Dissertations

Not just PGs of community medicine but every

MD/MS candidate from all departments are required to submit a thesis

in order to qualify for examination of MD/MS degree. A thesis or

dissertation is defined as a “long essay about original research

conducted and written by candidates themselves for awarding

university degree.” For PGs of community medicine; the thesis is a

single practical learning exercise during which you will apply acquired

theoretical knowledge of epidemiology, critical appraisal, biostatistics,

survey design, questionnaire design, data collection, scientific writing,

statistical applications, and public health skills. We recommended that

in addition to conducting your thesis you must support PGs from

another department in their thesis. This will give you exposure to

different study design as well as different healthcare setting in which

research can be conducted. You need to be proactive in grabbing all the

opportunities and make yourself available in assisting other PGs in

completing their thesis and publishing their results. Your thesis topic

need not be sophisticated or advanced; a well-researched simple idea is

much useful to the country and society than a poorly researched

Dr Pavan Pandey; mail suggestions to [email protected] Page 35

36 Handbook for Postgraduate Students of Community Medicine

complicated idea. Having said that, it is my advice that you should

avoid undertaking a thesis simply to determine the prevalence rate of a

health condition/s. Instead, go for more advanced epidemiological

study designs. But you should undertake only those research projects

as your thesis which you can be completed within stipulated time and

the resources available to you. ICMR and other research institute

provide funds for conducting MD/MS thesis every year. Look for local

NGOs and ongoing project at your institute which can support your

thesis project.

Objectives of Thesis: The overall objective of undertaking a thesis is

to enable each student to develop as independent researchers, i.e. each

student acquire skills necessary to conceive a naïve research idea, plan

the research project effectively, interpret the results and provide a

recommendation based on their results. Its specific objectives are:

i. Acquisition of skills in identifying, asking and framing the critical

research questions.

ii. Critically evaluate the research conducted earlier in a chosen field in

terms of concepts, methods, and results.

iii. Acquisition of skills in developing an appropriate methodology for

finding the answer to a research question.

Dr Pavan Pandey; mail suggestions to [email protected] Page 36

37 Handbook for Postgraduate Students of Community Medicine

iv. Acquisitions of skills in collecting and analysing data.

v. Acquisitions of skills in interpreting results and sharing the findings

with his/her peer, faculty members and another researcher of the

world.

Suggested reading:

1. Swetnam, D. Writing your dissertation.

2. Murray, R. How to Write A Thesis. 2nd edition.

3. Winstanley, C. Writing a Dissertation for Dummies.

4. Writing Dissertation and Grant Proposals: Epidemiology, Preventive

Medicine and Biostatistics By: Lisa Chasan-Taber

------------------*****---------------------

Dr Pavan Pandey; mail suggestions to [email protected] Page 37

38 Handbook for Postgraduate Students of Community Medicine

12. Posting at Rural Health Training Centre

Posting at RHTC will be your window to catch a

glimpse of the manner in which Indian health system works.

Implementation of health programs has always been a great challenge for

India government. Posting at RHTC will give you the opportunity to assess

the ground realities of all national health programs. It is my advice that

either before or during your posting at RHTC read the operational

guidelines for important national health programs and then evaluate the

functioning of these programs at your RHTC. Every health program has

inbuilt indicators for monitoring a given program, use these indicators to

assess the current status of health program of your choice at your RHTC. In

addition evaluate the sub-centers, aganwadi centre, PHC, CHC as per the

established norms and find out the difference if any existing between the

established norms and the prevailing conditions. Try to assess the reason

for existing deficiencies and think of the ways how these gap(s) can be

minimised.

Posting at RHTC is the most critical period of post-graduation. Do

not devote your whole time just treating patients; instead, learn how a

primary health centre is managed. While posted at RHTC figure out what is

the annual budget allotted to the PHC, how and in what all activities the
Dr Pavan Pandey; mail suggestions to [email protected] Page 38
39 Handbook for Postgraduate Students of Community Medicine

budget is spent, how the drugs are procured, how annual health activities

are planned. In sort be an administrator of the RHTC and not just any other

physician. List of activities to be undertaken while posted at RHTC:

Attend the weekly/ monthly ANM meeting which takes place at the

PHC. Preside over these meeting to learn what kind of data they

collect and share with the PHC.

Similar to ANM meeting attend the monthly ASHA meeting which

takes place at the PHC. Preside over these meeting to learn how the

instructions flow from what kind of data they collect and share with

the PHC.

Celebrate different health days related to public health at your RHTC

such as world TB day, Malaria week, breastfeeding fortnight, etc.

Draft the annual program implementation plan for the PHC and

review the RoP for the given year. Assess how much of the proposed

activities in the RoP have been completed.

Learn about the indenting procedure for drugs and other logistics for

PHC.

------------------*****---------------------

Dr Pavan Pandey; mail suggestions to [email protected] Page 39

40 Handbook for Postgraduate Students of Community Medicine

13. Clinical skills

The duty of community medicine practitioners is not only to

diagnose and treat diseases in their health centre/clinics but their practices

also include prevention of diseases and disabilities and promotion of health

in the community served by their health centres. Thus, they are supposed to

be “doctor +”; the plus sign denotes focus on disease prevention and health

promotion in addition to the traditional role of curative care performed by

other doctors [from Dr Rajesh, PGI, Chandigarh]. Is it suggested that

community medicine specialists are supposed to provide primary health

care to the entire community through the health centre/ clinic/ dispensary;

the specturum of primary health care includes the diagnosis and treatment

of acute and chronic illnesses for children, adults and elderly, preventive

check-ups, routine maternity and new born care, immunizations, certain

minor surgeries and mental health care in consultation with other

specialists when needed. [from Dr Rajesh, PGI, Chandigarh].

Before you opted Community Medicine, you all were a

doctor and you will always be a doctor first for the rest of your life. During

PG you should master basic sets of clinical skills. These skills will

compliment your public health related skills and will help you become a

competent community physician. I believe a post-graduate student of

Dr Pavan Pandey; mail suggestions to [email protected] Page 40

41 Handbook for Postgraduate Students of Community Medicine

community medicine should possess clinical skills which are better and

sharper than an MBBS student and equal or less than the specialist of the

field. Given the chief morbidities faced by Indian population, I would

suggest that you should get exposure to Obstetrics & Gynecology, Pediatric

and General Medicine, beyond that it is up to you to master other skills.

Primary health care forms an important pillar of the Community Medicine.

The eight elements of primary health care concept will further guide you

about the array of clinical skills that you must possess as a community

medicine specialist. Some departments of community medicine such as

PGI, Chandigarh and CMC Vellore provides good clinical exposure to post-

graduate students. Try to find out their pattern and request the Head of

Department to allow you get the clinical exposure. I would suggest that you

should at least spend the evening hours in the wards of Obstetrics, Pediatric

and Medicine. Also, spend time in the TB ward of your college. If the

paediatrics department of your college has a nutritional rehabilitation

centre (NRC) then try to spend about two weeks in NRC to get the first-

hand exposure of the facility based management of severe acute

malnutrition. Furthermore, PHFI, runs some short term courses on

Diabetes, Hypertension, Thyroid and Gestational Diabetes disorders. CMC

Vellore conducts a distance learning course on Family Medicine. There is

Dr Pavan Pandey; mail suggestions to [email protected] Page 41

42 Handbook for Postgraduate Students of Community Medicine

an array of courses which government routinely conducts to improve the

skills of government employee such as IMNCI, BEmOC, CEmOC, etc. If

such courses are organised during your tenure then please make sure to be

part of it. Make a list of the diseases/health conditions which are of public

health importance and read the treatment guidelines of all these diseases.

OBJECTIVES: Following are the basic competencies related to

clinical skills which a community medicine postgraduate should

possess:

I. Effective management of common diseases within the limited resources.

II. Identification of complex health problems and their appropriate

referral.

III. Clinical skill related to supporting important national health

programmes (viz. vector control, TB, filarial, noncommunicable

diseases, family planning, reproductive & child health).

IV. Taking care of disadvantaged groups in the community such as the

elderly, mentally and physically handicapped persons.

V. Effective communication with patients, family, colleagues and other

health care workers, and community.

Dr Pavan Pandey; mail suggestions to [email protected] Page 42

43 Handbook for Postgraduate Students of Community Medicine

VI. Management of a wide range of common medical emergencies in the

context of evidence-based first aid medicine.

VII. Decision making regarding the need for, and the appropriate and cost-

effective use of, modern technological investigations and ability to

interpret the results of these investigations.

VIII. To organise and actively engage in community care by means of health

camps.

Suggestive books and resource:

1. 100 CASES in General Practice: Anne Stephenson, Martin Mueller,

John Grabinar, P John Rees

2. The Rational Clinical Examination: Evidence-Based Clinical

Diagnosis by David L Simel, Drummond Rennie.

3. National Institute for Clinical Excellence: A useful website for a range

of treatment guidelines https://www.nice.org.uk/guidance

4. Washington Manual of Outpatient Internal Medicine.

5. Primary Care Medicine: Office Evaluation and Management of the

Adult Patient by Allan H. Goroll, Albert G. Mulley

------------------*****---------------------

Dr Pavan Pandey; mail suggestions to [email protected] Page 43

44 Handbook for Postgraduate Students of Community Medicine

14. Nonpharmacological health intervention

Medicines are not the only thing that cures patients,

sometimes a simple verbal advice about the correct or desired health

behaviour can also improve the health of an individual. There are a

range of diseases/health conditions which do not always require

administration of a drug and then there are some circumstances

where nothing other than a change in health behaviour is only

effective remedy e.g. exclusive breastfeeding, complementary feeding,

washing hand, increasing physical activity in obese, prevention of

HIV/RTI etc. Nonpharmacological interventions represent a wide

range of treatments/intervention directed at patients/individual. For

the theoretical purpose, these nonpharmacological interventions

involve surgical procedures, implantable devices, ultrasound & laser

treatments and participative interventions such as rehabilitation,

education, behavioural interventions, and psychotherapy. The

number of published randomised controlled trials assessing

nonpharmacological treatments is increasing with time with each

passing year.

Lately, a lot of stress is given to intervention which

successfully changes an individual/ caretaker/ couple/ family/

Dr Pavan Pandey; mail suggestions to [email protected] Page 44

45 Handbook for Postgraduate Students of Community Medicine

community member’s behaviour towards adopting a healthy

habit/behaviour. These habits vary from disease to disease and from

one health condition to other viz. increasing fruit consumption,

reducing salt consumption, increasing physical activity, avoiding self-

medication, adoption of family planning methods and increasing the

use of various types of counselling services. Now a day, health centres

(PHC/CHC/DH) have a number of counsellors related to the different

national health programs (e.g. family planning, HIV/AIDS,

noncommunicable diseases, TB). This highlights the growing

importance of behaviour change communication in today’s complex

world. Thus I would advise that you must undertake an

interventional research project either individually or along with your

colleague. This intervention can be as simple as sending an SMS or a

phone call to pregnant women for availing antenatal care or to a

woman who have delivered a child to exclusively breastfeed her baby.

Conducting and evaluating nonpharmacological

interventions have some specific methodological issues. Nevertheless,

it is essential for you to overcome these barriers and appropriately

design and adequately evaluate nonpharmacological interventions to

improve the health status of population. In the next version of the

Dr Pavan Pandey; mail suggestions to [email protected] Page 45

46 Handbook for Postgraduate Students of Community Medicine

book, I will collect and incorporate different publications related to

such non-pharmacological intervention, by that time you are on your

own.

Suggestive reading:

1. Boutron I, Ravaud P, Moher D; Randomized Clinical Trials of

Nonpharmacological Treatments

Dr Pavan Pandey; mail suggestions to [email protected] Page 46

47 Handbook for Postgraduate Students of Community Medicine

15. Critical appraisal of research article

Where and when an article is published, or who wrote it

should not be an indication of its trustworthiness and relevance. During

your post-graduation and for the rest of your life you will read numerous

scientific articles. You may come across a variety of epidemiological design

in these scientific articles viz. ecological, cross-sectional, case-control,

cohort, clinical trials or systematic review. Also before undertaking any

research project including your thesis, you are required to undertake a

review of already published articles so as you gather evidence for

conducting research projects. And before you can think of

adopting/utilising results from a published article into your practice, you

need to make a decision for yourself whether the methodology adopted by

the article is valid, can the study claims the result it has presented and can

it be applicable under condition/population you desired. To answer these

and many more questions you need to assess the article for its quality,

validity and generalizability. This process is called critical appraisal.

“Critical appraisal is the process of systematically examining research

evidence to assess its validity, results, and relevance before using it to

inform a decision”. Critical appraisal is an essential step in the process of

putting research into practice. Asking questions about an article’s research

Dr Pavan Pandey; mail suggestions to [email protected] Page 47

48 Handbook for Postgraduate Students of Community Medicine

methodology, scrutinising its data collection and analysis methods, and

evaluating how its findings are presented will help you to determine

whether that article’s conclusions should influence practical decision-

making. I would recommend that you should learn the basics of critical

appraisal before the end of first-year life.

An oversimplified approach to critical appraisal is presented below:

1. Is the study valid?

The first step is to decide whether the study was unbiased by evaluating its

methodological quality. Different criteria for validity of articles are used for

different types of questions on treatment, diagnosis, prognosis and

economic evaluation. Depending on the validity of an article we can classify

it within a scale of levels of evidence and degrees of recommendation.

2. What are the results?

If we decide that the study is valid, we can go on to look at the results. At

this step, we consider whether the study’s results are important for us. For

example, did the experimental group show a significantly better outcome

compared with the control group? We also consider how much uncertainty

there is about the results, as expressed in the form of p values, confidence

intervals and sensitivity analysis.

Dr Pavan Pandey; mail suggestions to [email protected] Page 48

49 Handbook for Postgraduate Students of Community Medicine

3. Are the results useful?

Once you have decided that your evidence is valid and important, you need

to think about how it applies to your question. It is likely, for example, that

your patient or population may have different characteristics to those in the

study.

Critical appraisal skills provide a framework within which to consider these

issues in an explicit, transparent way.

Suggestive reading and resources:

1. Critical Appraisal Skills Programme: this website provides a list of

resources and checklists for critical appraisal of a variety of

epidemiological study design. Available at http://www.casp-uk.net/

2. How to Read a Paper: The Basics of Evidence–Based Medicine by

Trisha Greenhalgh

3. Users' Guides to the Medical Literature: A Manual for Evidence-

Based Clinical Practice: by Gordon Guyatt

4. Centre for Evidence Based Medicine: another very important website.

Available at http://www.cebm.net/

5. Online course of critical appraisal of research article:

http://eyes.cochrane.org/free-online-course-journal-peer-review

Dr Pavan Pandey; mail suggestions to [email protected] Page 49

50 Handbook for Postgraduate Students of Community Medicine

6. Online free short course on Critical appraisal of randomised control

trials in dermatology:

https://www.nottingham.ac.uk/research/groups/cebd/news-

updates/news/2016/free-online-course-critical-appraisal.aspx

7. A Compendium of Critical Appraisal Tools for Public Health Practice:

http://www.nccmt.ca/uploads/media/media/0001/01/5aad550fc93c

b202f01048e98b174b5e70233359.pdf

------------------*****---------------------

Dr Pavan Pandey; mail suggestions to [email protected] Page 50

51 Handbook for Postgraduate Students of Community Medicine

16. Peer review

Consider a scenario in which researchers researched what they liked and

authors published what they liked. Such a world did existed until some

decades ago. No matter how much efforts you have given in undertaking a

research, it will be up to the person who reviews your article to decide

whether or not your research will appropriate for publication in the journal.

Peer review – the use of experts, or peers, to help judge the value of

submitted work – is now ubiquitous. Peer review is a type of exercise

wherein your work is subjected to a constructive criticism so as to evaluate

its usefulness. Peer review normally involves one or more expert judging

the work undertaken by another expert, the first provides inputs to help

improve the original work. It is a type of critical appraisal taken from the

view of editors or granting agencies. The comments might be more or less

formal; they might correspond to set topics or areas, or might be general

and unstructured. Peer review helps us (editors, granting agencies) decide

who receives funding for research, and which research projects see the light

and which don’t. It is used to help decide which manuscripts should be

published in journals and how they should be changed before publication.

It has, therefore, become the arbiter of scientific careers and a major

Dr Pavan Pandey; mail suggestions to [email protected] Page 51

52 Handbook for Postgraduate Students of Community Medicine

influence on what gets into the public domain. In the health sciences, this

means that it probably affects what happens to patients. As science has

become more complex and competitive, so the role of peer review has

become more prominent. When difficult decisions are at stake, the phrase

“peer review” is used by many to reassure and impress. It has become a

short hand for fairness and objectivity.

Suggestive reading and resources:

1. Peer Review in Health Sciences by Fiona Godlee and Tom Jefferson

2. Scientific Peer Reviewing Practical Hints and Best Practices by Peter

Spyns and Marı´a-Esther Vidal

3. Peer Review Presentation: available from

https://owl.english.purdue.edu/owl/resource/712/01/

------------------*****---------------------

Dr Pavan Pandey; mail suggestions to [email protected] Page 52

53 Handbook for Postgraduate Students of Community Medicine

17. Plagiarism

Most of us have either copied the answer from our friends/colleagues or

have helped others copy our answers during under-graduation

examination. We all should thank god that our answer copies were checked

by a human and not by any plagiarism detecting kinky software(s) else both

the smart and not so smart students would have scored a big Zero because

(as each student would be labelled as having committed plagiarism) both

had copied their response from a published text without acknowledging or

citing the original source. Having said that ‘Plagiarism’ is the "wrongful

appropriation" and "stealing and publication" of another author's “work”

(language, thoughts, ideas, or expressions) and the representation of them

as one's own original work. We all are very eager to publish scientific

articles from our research projects especially from our thesis; in the due

process, we must be cautious of that fact we might directly or indirectly

committing plagiarism. No matter how smart you think you are? Nowadays

such powerful software is employed by publishing industry (journals&

books) which can detect plagiarism to the minuscule extent. There is no

shame whatsoever in citing or crediting someone else for their own work.

At present, every type of work related to academic writing (both

Dr Pavan Pandey; mail suggestions to [email protected] Page 53

54 Handbook for Postgraduate Students of Community Medicine

educational and corporate) is regulated by rules that writers, particularly

beginners, aren't aware of or don't know how to follow. This is especially

true for young Indian including me at the time of my post-graduation.

Many of these rules have to do with research and proper citation. Gaining

familiarity with these rules, however, is critically important, as inadvertent

mistakes can lead to charges of plagiarism, which is the uncredited use

(both intentional and unintentional) of somebody else's words or ideas.

Many research institutes do not consider ‘Plagiarism’ as a crime in itself but

they believe plagiarism as a copyright infringement, but for many others in

academia and industry, it is a serious ethical offence. In many countries,

plagiarism is not defined or punished by law, but rather by institutions

(including professional associations, educational institutions, and

commercial entities, such as publishing companies). In very simple words,

plagiarism is an act of fraud. It is considered by most academic fraternity as

stealing someone else's work and lying about it.

According to some laws all of the following acts mentioned below

are considered as an act of plagiarism:

• turning in someone else's work as your own

• copying words or ideas from someone else without giving credit

Dr Pavan Pandey; mail suggestions to [email protected] Page 54

55 Handbook for Postgraduate Students of Community Medicine

• failing to put a quotation in quotation marks

• giving incorrect information about the source of a quotation

• changing words but copying the sentence structure of a source

without giving credit

• copying so many words or ideas from a source that it makes up the

majority of your work, whether you give credit or not.

May be some of the work produced in this handbook can

be labelled as plagiarised. Thus I will advise you to learn the basics of

plagiarism and avoid it to the every extent possible. It is should be the

sole responsibility of the each and every student to learn the proper

form of citation. This is essential for your metamorphosis into an

able academician and a competent community physician. If you are

unclear about plagiarism and/or need assistance never hesitate to ask

or look on the internet about the most commonly accepted definition

of plagiarism.

Please find below some resources which you find useful:

Dr Pavan Pandey; mail suggestions to [email protected] Page 55

56 Handbook for Postgraduate Students of Community Medicine

18. Suggestive Activities to take part-in during

Post-Graduation

There are some activities which every post-graduate student of

community medicine should be part of. Unfortunately, I came to know

about most of these activities after completing my post-graduation.

Following are the list of activities which will give you the insight into the

working of Indian health system:

I. Select/adopt a village or more appropriately a health sub-center in the

catchment area of the RHTC or any other block of the district and work

closely with village ASHA, ANM and residents of the village for the

complete duration of your post- graduation. The health sub-centre is the

first contact between the health system and the citizens of this country.

They are the most peripheral health out post. Health planning of the

whole block, district, state, and in fact for the whole country starts from

tens of thousands of existing health sub-centres. This sub-center can act

as a field laboratory for your future learning and experimentation. Use

the Indian public health standards for health sub-centre.

II. Sansad Adarsh gram yojana: SAGY has a health component in its

scheme. I need not to tell you that if you can assist or support a member of

parliament in achieving health related objective of his/her adopted village

Dr Pavan Pandey; mail suggestions to [email protected] Page 56

57 Handbook for Postgraduate Students of Community Medicine

how useful this contribution can mean to your future. Log on to its

website to contribute.

III. At the beginning of your post-graduation; visit the CMO office and

try to establish a working relationship with District Program Manager,

RMNCHA consultant and other officials of district health administration.

Every year every district conducts a variety of training for different cadres

of health workers; in addition, a lot of surveys related to different health

program are conducted annually in a given district. Keep regular track of

any such training(s) and survey(s) that might interest you.

IV. Annual Pulse Polio rounds: Every year health department conducts

annual rounds of pulse polio wherein every child under five years of age is

given oral Polio vaccine. Don’t miss this opportunity: it will give you the

insight into what goes in for planning of mass immunisation campaign.

V. Annual national deworming days: Every year health department in

most states conducts two round of the annual deworming day. Make sure

you are part of the planning to undertake this annual exercise.

VI. Monthly ASHA and ANM meeting at RHTC: During the time you

are posted at RHTC and if possible during your complete post-graduation

make a habit of attending ASHA meeting at nearest PHC/CHC. This will

give you an exact idea about the ground realities of various health related

Dr Pavan Pandey; mail suggestions to [email protected] Page 57

58 Handbook for Postgraduate Students of Community Medicine

programs. Assess their knowledge on common health issues and think of a

way in which you can build their capacity. Observe how they micro-plan

health activities in a village. Try to learn from them how they plan and

organise VHND.

VII. Block and district level-Annual PIP preparation meetings: Every

year each block and district conduct a series of meetings to formulate

Program Implementation Plan (PIP) for next financial year. PIP is the

blueprint of activities to be conducted in a given year and how much all

the listed activities will cost. Becoming part of this exercise will give you

an insight about the planning machinery for different health programs at

block and district level. This is an immensely important exposure which

you should be part of to gain practical planning skills; you can learn how

to plan, how to execute a plan and how to evaluate that plan. Before taking

part in any planning activities, download and study guidelines for the

formulation of PIPs and arrange a copy of last few years PIPs. Following

submission of PIP, there will be an ROP meeting, make sure you don’t

miss that. Make a comparison between ROP v/s PIP and present in the

department as a part of the seminar.

VIII. Female and male sterilisation and eye camp at any of the

PHC/CHCs: Study the mechanism of client/patients inflow at these

Dr Pavan Pandey; mail suggestions to [email protected] Page 58

59 Handbook for Postgraduate Students of Community Medicine

camps and observe whether these camps are conducted as per guidelines.

Observe what all it takes in terms of logistics, manpower, management

and administration for successful conduction of such camp. Try to identify

gaps in the organisation of such camps against prescribed norms and try

to work out how these gaps can be filled.

IX. Annual national and state level conferences of IAPSM and

IAPH: State and National level conference are a good platform to share

your experience and research work with students and faculty of other

colleges, discuss thesis work, ongoing research project, future endeavour,

and research collaborations.

X. Monthly meeting of Anganwadi worker and their supervisors at the block

level: This is an important activity related to maternal and child health.

XI. Monthly meeting of district TB officer and TB coordinator from all blocks

in a given district, observe how they plan for logistics, provide treatment,

counsel patients and other program related activities. In addition, through

the network of ASHA, ANM and TB coordinators in your area; try to get

information about any patients currently on Cat-I or II DOTS medications

who begin to default from their regime. Try to pursue all such patients to

re-start their medications and prevent them from defaulting. This exercise

will help test and improve your health education skills.

Dr Pavan Pandey; mail suggestions to [email protected] Page 59

60 Handbook for Postgraduate Students of Community Medicine

XII. Outbreak Investigations: Be in touch with district epidemiologist; if

there is an epidemic or focal outbreak then accompany them in outbreak

investigations.

XIII. Try to attend review meeting of all important health program at district

and block level.

XIV. Although institutional deliveries have tremendously increased, women do

deliver babies at home. If you notice a home delivery in your area then try

to investigate its cause and try to analyse how could such events can be

prevented in future. Also, try to assess the home based newborn care

provided to the neonate and has he/she received zero doses of vaccines.

XV. Verbal autopsy: Standard assessment format for conducting a verbal

autopsy for maternal and child death is available on the internet. In many

districts such verbal autopsy is regularly conducted, if there is such a

trend in your district then try to be part of as many verbal autopsies as

possible and if not, then try to conduct a verbal autopsy yourself.

XVI. Every PHC/CHC has fixed days for providing Antenatal care to pregnant

women and immunisation to infants. Utilise this opportunity to provide

health education to mothers (about nutrition, childbirth, child feeding,

family planning etc.) by organising group counselling sessions. This

Dr Pavan Pandey; mail suggestions to [email protected] Page 60

61 Handbook for Postgraduate Students of Community Medicine

exercise can be conducted as a health education intervention trial [see an

example http://dx.doi.org/10.1017/S1368980009991364].

XVII. Train ANM and ASHA workers for imparting nutritional health

education to pregnant and lactating mothers at their home. WHO and

UNICEF have designed course for training health workers in providing

education about complementary feeding to women. Read it and train

health workers in your area. [available from

http://www.who.int/nutrition/publications/infantfeeding/9241546522/e

n/ ]

XVIII. NITI Ayog offers internship opportunity for post graduates students in

health sector. It is the apex think tank of the country and any experience

of working there would look better than anything else on your CV. For

more information log on to its website.

XIX. Many women will deliver children at the RHTC. Make a due list of the

dates of immunization for all these children. Chhattisgarh organizes a

program known as Sishu Suraksha Maah. Please log on to internet to

know more about the program.

------------------*****---------------------

Dr Pavan Pandey; mail suggestions to [email protected] Page 61

62 Handbook for Postgraduate Students of Community Medicine

19. Useful Resources

1. Purdue online writing lab (https://owl.english.purdue.edu/owl/)

2. Online courses website:

a. Coursera (https://www.coursera.org/ )

b. Edx.org

3. Epidemiology: http://www.epidemiolog.net/

4. Good source for a variety of public health resources:

http://www.jhsph.edu/offices-and-services/institutional-review-board/

5. http://www.authoraid.info/en/

6. Centre for Evidence Based Medicine: another very important website.

Available at http://www.cebm.net/

7. https://www.tripdatabase.com/

8. Guide for Writing and Designing the Oral Presentation This guide can be
found at

http://www.jhsph.edu/academics/degreeprograms/mph/Forms_MPH/

Designing%20and%20Writing%20a

n%20Effective%20Presentation.pdf.

9. Student 4 best evidence: A very useful website, you will find lots of
interesting blogs written by experts

http://www.students4bestevidence.net/
Dr Pavan Pandey; mail suggestions to [email protected] Page 62
63 Handbook for Postgraduate Students of Community Medicine

10. The Committee on Publication Ethics (COPE)

https://publicationethics.org/about

------------------*****---------------------

Dr Pavan Pandey; mail suggestions to [email protected] Page 63

64 Handbook for Postgraduate Students of Community Medicine

20. List of suggested readings

1. Studying skills from London School of Economics:

http://www.lse.ac.uk/socialPolicy/InformationForCurrentS

tudents/basicStudySkills.aspx

2. Testing treatments available from

http://www.testingtreatments.org/book/?nabm=0

3. Searching Skills Toolkit: Finding The Evidence by Caroline De

Brun and Nicola Pearce-Smith

4. Evidence-Based Medicine Toolkit (2nd Ed) by Carl Heneghan

and Douglas Badenoch

5. Bad science by Ben Goldacre

6. Oxford handbook of public health practice

7. Evidence-Based Medicine: How to Practice and Teach EBM

by Straus SE et al. (2010).

8. Teaching Evidence-Based Practice – CEBM

videos http://www.cebm.net/teaching-evidence-based-practice/

9. Handbook of Epidemiology; by Wolfgang Ahrens , Iris Pigeot

10. Where There is no Doctor - A Health Care Handbook by for

Voluntary Health Association of India.

Dr Pavan Pandey; mail suggestions to [email protected] Page 64

65 Handbook for Postgraduate Students of Community Medicine

11. Health policy planning for developing health system by

Andrew Green

12. Outbreak Investigations Around the World: Case Studies in

Infectious Disease by Mark S. Dworkin

13. Field epidemiology by Michael Gregg

14.Oxford advanced learner’s dictionary

15. Chronic Disease Epidemiology, Prevention, and Control:

Edited by Patrick L. Remington, MD, MPH; Ross C. Brownson, PhD

and Mark V. Wegner, MD, MPH Publisher: APHA Press

16.Control of Communicable Diseases Manual, 20th Edition;

Author: Edited by David L. Heymann, MD Publisher: APHA Press

17. Primary Health Care THEORY AND PRACTICE by Trisha

Greenhalgh

18. Health system performance comparison An agenda for

policy, information and research

19. High level expert group; report- Planning commission of

India

20. David Moher, Douglas Altman, Kenneth Schulz, Iveta

Simera, Elizabeth Wager Guidelines for Reporting Health Research:

A User's Manual

Dr Pavan Pandey; mail suggestions to [email protected] Page 65

66 Handbook for Postgraduate Students of Community Medicine

------------------*****---------------------

Dr Pavan Pandey; mail suggestions to [email protected] Page 66

View publication stats