Best Practices

BEST PRACTICE 1

1. Title of the Practice

SCALE-UP: (Self-directed, Competency driven, Academic and Leadership oriented, Experience based, Undergraduate and Postgraduate training)

2. Objectives of the Practice

The objective of this practice is to align with the mission statements of Sri Balaji Vidyapeeth,

• to create an innovative ecosystem that facilitates the development of competent and committed health care professionals, who will be able to deliver evidence-based quality care,
• to innovate modern health care delivery that is affordable and accessible to the public,
• to learn experientially the needs of the society to promote wellness for all.

The Adult learning principles, such as self-directed, experiential and evidence-based learnings are the foundations for this practice. Inculcating the human values and professionalism along with proficiency are the primary concepts embedded in this practice.

3. The Context

The Health sciences curriculum is governed by the statutory bodies to a significant extent. The focus on other graduate attributes that are required for their real-world competence is lesser compared to the knowledge and skill that is imparted. Therefore, there arises a need to enrich the curriculum and to add value to the learning of the future health care professional.

Taking advantage of the flexibility inherent in the curriculum of the statutory bodies, a plethora of initiatives in teaching, learning, evaluation and innovation have been designed and implemented , across all disciplines.

4. The Practice

Teaching-Learning-Evaluation practices:

In PG program:

Competency based learning and training (CoBaLT©) is a system implemented in the Postgraduate education of the Medical and Dental disciplines. It consists of:

• Defining outcomes of postgraduate education.
• Enumerating competencies required to be developed.
• Converting competencies to measurable Entrustable Professional Activities.
• Fixing milestones and acceptable levels of performance at various stages of learning.
• Ensuring continuous monitoring by an e portfolio.
• Providing for reflective learning.
• Constant monitoring and intervention for laggers.

All the courses have enumerated their EPAs and respective Milestones of competency attainment. The monitoring and assessment are based on the Workplace based assessment methods such as the use of standardised patients, simulators, OSCE along with an e-portfolio and Multi-source Feedback. This feedback-based assessment has enabled reflective and self-directed learning among the postgraduates. This innovative method has been copyrighted.

Principles of heutagogy is embedded in the learning of the postgraduate students, especially in the PG program of health professions education, to promote self-directed learning and learning through teaching.

In UG program

High fidelity simulation in the form of Standardized patients have been incorporated in the clinical training of the undergraduates to practice before clinical encounters. An exit OSCE exam is conducted on the competencies acquired by the undergraduates of medical discipline, as  Cobweb competency mapping which serves as a feedback and provides opportunities for improvement.

Similar competency based training  called as Systematic Competency oriented Education Programs (SCORE) is done for the dental interns, in which the skill to be acquired is listed out and a systematic training is provided for them, which is also assessed at the end using OSCE/ OSPE.

Breaking the silos-based learning, the nursing discipline has implemented the integrated teaching in under graduation, using multidisciplinary expertise.

The Allied Health Sciences faculty has incorporated a Choice-Based Credit Systems (CBCS) in all the programs. They have also implemented the unified first year syllabus in the BSc courses for better learning.

In UG and PG program

The exam assessment system is rendered transparent and objective by the implementation of a system where one question/ set of questions  is corrected by one examiner for all students.

The post validation of the answers are done for every exam to improve the quality of the exam system as well as to use the analysis for syllabus revision.

The overall goal of all aspects of the above is to improve competency of the outgoing students for a better outcome across disciplines.

Research and Innovation practices:

MIPTECH, a mission to improve intellectual property and technology transfer, has been setup to foster translational research, innovation, discoveries, patents, copyrights and start-ups in health care.  Through establishment of Innovation café / Bio-Incubator center, innovative ideas of the students are encouraged. Sensitization workshops, followed by intensive brainstorming workshops are conducted for the faculty and students, by dedicated team from MIPTECH, to generate innovative ideas. The ideas are ultimately converted into patents/ copyrights/ technology transfer/ start-ups, by providing sustained logistic and financial support. The postgraduates are guided to convert their dissertations into publications through a series of workshops and guidance towards identification of the journals.   

Experiential practices in Patient Care:

Outreach and extension activities beyond curriculum augment the clinical and community learning through schemes. HeART (Health appraisal by Rapid Techniques) is one of the unique practices, which is intended to train the students on the organization, structure, function and treatment needs of patients in a hospital care setting. Yet another unique venture to tune the graduates towards the need of the community is done during the second year. Termed as CD-FIT (Community Diagnosis Feasible Intervention Technique), this is a unique variant of community postings, based on problem-based learning. Overall objective is to arrive at a community diagnosis through a community survey using primary and secondary data sources and to carry out feasible intervention. CReAMS (Clinical Research and Audit by Medical Students)is yet another, first of its kind program for second year UG medical students. Through this program, the students learn about the perception of patients availing treatment in a hospital and to know the basic functioning of a hospital as well. They are posted across various wards, OPD and Service areas of the Hospital. They perform a cross sectional survey from the patients pertaining to the disease profile, basic demographic data, hospital service-oriented information and patient satisfaction data.

To reach the unreached by exploring the unexplored, novel concept of two-wheeler nursing care has been implemented and students are posted to deliver the patient care under supervision. Transgender Clinic that caters to the psycho-social, socio-cultural and healthcare needs of the transgender community provides a clinical learning platform.

5. Evidence of Success

• The competency-based teaching and learning for postgraduates has enhanced their graduate attributes in professionalism, ethics and self-directed learning. The exam outcome of the medical postgraduates has increased to 90% in the last 5 years.
• The exit OSCE exams for medical undergraduates and the SCORE training for dental undergraduates indicate an appreciable attainment of the program outcomes.
• All the sustained efforts of the MIPTECH committee have benefitted SBV with 37 patents and 135 copyrights and 3 technology transfers and 8 start-ups in less than a year.
• Students are instilled with the spirit of research and publications that is evident tin the 127 ICMR STS projects SBV is awarded in last 5 years.
• The benefit of experiential training is reflecting in the way the resident doctors to combat the COVID 19 threat and to protect the patients.

6. Problems Encountered and Resources Required:

Initiatives that are beyond curricular norms, indeed pose  challenge in smartly accommodating them within the stipulated time and schedule. Much effort, resource and time were spent in holding numerous workshops and training for the Faculty and students in implementing the competency-based training, e-portfolio, CBCS and OSCE/OSPE formative assessment method. All faculty had to assume multiple roles, other than teaching and administration, as resource persons in various training workshops.

Notes:

At Sri Balaji Vidyapeeth, the aim is to expose the learners to different aspects of professional development and target all the roles required for the development of a holistic and competent graduate. The best part of these initiatives is that they are being implemented throughout the duration of the course and thus play an important role in the incremental growth of the learners. As the initiative aims to accomplish the educational objectives of the course and the local contextual understanding, all the teaching institutions can explore their scope for the adoption of similar kinds of initiation.

BEST PRACTICE 2

1. Title of the Practice

Promoting Wellness through Focus on Salutogenesis: the SBV Model

2. Objectives

The Objective of this best practice are as follows:

• To create a pluralistic approach towards health care, with the holistic wisdom of traditional medicine, such as yoga therapy and music therapy as well as evidence-based modern medicine.
• To promote general wellness for patients, community, students, faculty and employees of SBV, thus promoting the well-being of a society.
• To conduct research integrating both the systems and to create robust evidence towards holistic care and wellness.

3. The Context

Salutogenesis focuses on health and well-being, rather than on disease. The “salutogenic model” is concerned with the relationship between health, stress, and coping, termed as “wellness”. Wellness is multidimensional and holistic, encompassing emotional, mental and spiritual well-being, as well as lifestyle and environment.

Modern medicine or (Allopathy) is a system that is strongly based on evidence-based health care towards management and curing of a disease, while Indian traditional medicine is a science firmly grounded on the time-tested wisdom of providing a holistic well-being. The WHO Traditional Medicine Strategy 2014–2023, World Health Assembly Resolution on Traditional Medicine (WHA62.13) and National Health Policy of India (2002 and 2017) have also envisaged integration of indigenous and modern systems of therapy. Sri Balaji Vidyapeeth (SBV) takes cognisance of the crucial role of both systems in promoting the well-being of the society and therefore has taken initiatives to integrate both the sciences in patient and community care as well as in student and employee welfare.

4. The Practice

Unique centres such as Centre for Yoga therapy, Education and Research (CYTER) andCentre for Music Therapy Education and Research (CMTER) were established in 2010.  They were entrusted with the task of facilitating transformation of focus from pathogenesis to salutogenesis through various activities in realms of patient care, education and research. Adequate infrastructure facilities were provided, and eminent faulty members were recruited to fulfill this mission. SBV therefore has a cohesive policy on Salutogenesis to ensure sustenance.

Patient care and Wellness:

Yoga and Music therapy programs are customised for the patients and are offered for various medical conditions such as diabetes, hypertension, musculoskeletal and psychiatric disorders. Lifestyle consultations are also offered as part of Master Heath Check-up in the Corporate Services Wing of the hospital. Services are provided by qualified music therapists and yoga therapists, to adult and paediatric in-patients and out-patients, ICU, catheterization labs, ICU waiting area, operation theatres and labour rooms to name a few.

Creating wellness in the community:

Numerous International/ National / Regional workshops/Seminars are conducted every year, to spread awareness among the professional and the public on the inevitable role of alternate therapies. International Day of Yoga commemorative events and Common Yoga Protocol demonstration during June are being held since 2015 onwards. Regular awareness programs are organised in pubic settings such as old-age homes, schools, colleges, hospitals, transgender community etc. “Nādam”, a go-green initiative through healthy sound and music and Audio CDs as part of “Nāda-Sowkyam” series, has been released.  “BālaNādaSangamam” is a program of mass chanting and singing by school students, to inculcate the value of wellness at a young age. Voyaging of Yoga Basics to Grass Roots – VYBGR is a unique practice to take Yoga to the Primary Health Care, through the community outreach programs. CYTER was appreciated by the Government of India for the unique initiative for Yoga at Home with the family during the COVID lockdown.

Stakeholders and their Wellness:

Generalized salutogenic sessions, through Yoga and Music are provided for the faculty, staff and students of SBV on all working days, before/ after working hours. Innovative “Yogabhyāsa” program is done for all students of SBV who receive regular yoga practice sessions to foster a sense of wellness. MEETS (Musically express your Emotions and Thoughts for Success) is a participatory Group Music therapy session, provided for the first-year graduates of SBV. In addition, awareness and practice sessions are embedded in the introductory/ induction programs for all streams of undergraduate students. Mass Yoga demonstration by all students and faculty is held on commemoration days such Yoga day and National Youth day, to internalise the practice of yoga in day-to-day life.

Wellness in the SBV Curriculum:

To reinforce the concept of holistic well-being, apart from practice sessions and awareness programs, unique Allied Health Sciences Programs and Courses have been commenced in Music and Yoga therapy such as PG certificate courses, PG diploma, MSc, MPhil and PhD programs. Yoga therapy has been incorporated in UG nursing curriculum and offered as electives in Allied Health Sciences Courses. Interdisciplinary value-added courses benefitting student and faculty are also conducted periodically.

Research and Collaboration:

Numerous interdisciplinary research projects in collaboration with Medical/ Dental/ and Nursing disciplines of SBV are being done to fortify the evidence on salutogenesis.

Memorandum of understanding was signed with IMC University of Applied Sciences, Krems (Austria), Anglia Ruskin University, (Cambridge, UK),  Kaivalyadhama Yoga Institute (Lonavla), Amity University (New Delhi) and Dev Sanskriti Vishwavidyalaya (Haridwar), Membership School of International Association of Yoga Therapists (USA), to strengthen SBV’s practice on salutogenesis as well as share it with the world.

5. Evidence of Success

More than 50,000 patients have been treated by CYTER and more 11,000 benefitted by Music therapy. Feedback and testimonials from patients indicate excellent perception of this best practice. Yoga for wellness has improved the performance of students and productivity of the faculty. General awareness of the benefit of Integrative medicine has spread among the students and doctors, which in turn is benefitting the patients. Recently it was practiced as a measure of stress relief for all staff during the COVID curfew with a great measure of success. The research outcomes are as follows:

The major finding is that such adjuvant and integrative therapy is found to halt disease progression and facilitate healing and enhance quality of life. Extensive web links and social media presence is there for both centres that gives ample and public evidence of the positive transformation facilitated by this best practice of SBV.

6. Problems Encountered and Resources Required

Any innovative change will be met with scepticism. SBV has faced its own challenges in terms of establishing the infrastructure, the faculty structure, governance system, as no statutory norms were available for these systems. In addition, it required great efforts to bring about attitudinal change among all stakeholders, especially the health professionals, to adopt the new philosophy of salutogenesis rather than pathogenesis. Challenges were also faced in designing new courses and systems for patient care. Planning and conducting research integrating these systems. Being a unique, discipline-specific expertise, faculty are scarce in both Yoga and Music therapy. Thus, there is a challenge in recruitment of more human resources, to cope up with the increased workload of these centres. However, placing the alumni back into the centres is a strategy that is being followed.

Another issue is perception of Yoga and music as ‘external’ to the conventional healthcare system and the tendency to remain rooted in a pathogenic orientation. This is being addressed by demonstrating success of these practices, networking with professionals across the board and optimizing the use of IT driven tools.

7. Notes

While implementing, the other institutions must realize that all such programs and activities focusing on salutogenesis have to be tailored to meet the requirements of different streams of students and fit in seamlessly with their regulatory programs. While the policies of the Central Government are highly supportive about the wellness concepts, it may be beneficial to organize more faculty development programs/ awareness programs for public to bring desirable changes.