|Year : 2019 | Volume
| Issue : 2 | Page : 83-85
Community physicians: Words, actions and outcomes: TRP5
Vikas Bhatia, Susmita Dora
Department of Community Medicine and Family Medicine, AIIMS, Bhubaneswar, Odisha, India
|Date of Submission||26-Nov-2019|
|Date of Acceptance||27-Nov-2019|
|Date of Web Publication||19-Dec-2019|
Department of Community Medicine and Family Medicine, 3rd Floor, Academic Block, All India Institute of Medical Sciences, AT/PO: Sijua, Bhubaneswar - 751 019, Odisha
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Bhatia V, Dora S. Community physicians: Words, actions and outcomes: TRP5. Indian J Community Fam Med 2019;5:83-5
Community Medicine is a science and art of promoting health, preventing diseases, and prolonging life by range of interventions (promotive, preventive, curative, rehabilitative, and palliative) in close partnership or association with healthcare delivery system and with active community participation and intersectoral coordination, as described in the IAPSM textbook. Many terms such as Preventive Medicine, Social Medicine, Community Health, and Public Health are used synonymously for the specialty “Community Medicine.” Many specialties undergo changes in the nomenclature which evolves over the years and decades. We observe such requests coming from many other clinical specialties and super-specialties as medicine undoubtedly is dynamic and rapidly changing science. Regulatory bodies such as Medical Council of India had recommended the nomenclature as Community Medicine for the academic purposes to impart MBBS and MD degrees. Recently, Community Medicine has been described as a clinical specialty along with other clinical subjects in the MBBS curriculum released by the National Medical Commission as per the Gazette of India Notification, Regd. No. D. L.-33004/99, Extraordinary No. 390 dated November 6, 2019.
The Royal College of Physicians defines community medicine specialty as one which deals with populations and comprises those doctors who try to measure the needs of the population (both sick and well), those who plan and administer services to meet those needs, and those who are engaged in research and training in the field. The EURO Symposium in 1966 defined community health as one which includes all the personal health and environmental services in any human community, irrespective of whether such services were public or private ones. Even though these definitions reasonably describe the specialty, it is high time for the Community Physicians to focus on certain aspects in the changing world.
We were taught TRP as Temperature, Respiratory Rate, and Pulse for a patient in our early school days of medicine. We also hear TRP as television rating point regularly which tells of a show determining its effectiveness and gives an idea about the reach and frequency of advertising messages toward a target population. TRP5 of a community physician is highly relevant to understand, follow to sharpen our competencies to enhance professional excellence and better outcomes:<
T – Teaching and training
R – Research
P1 – Policy-engagement
P2 – Project/programs participation and management
P3 – Public health practice
P4 – Patient care
P5 – People and partnership.
As far as teaching is concerned, all community physicians in a medical college or academic institute are intensely involved with undergraduate students, postgraduate residents, and training of interns. This can be further strengthened by updating not only with new scientific knowledge but also with the technology and medical education techniques and tools. Many of us are actively engaged in training programs of the medical officers, paramedical, health staff, frontlines workers, and others providing health care. Developing the training material and methodologies as per the need should be an important assignment for us.
Community physicians should prepare, implement, and manage research projects to develop new treatments, pioneering cost-effective diagnostics, innovations, and ideas to deal with existing and emerging challenges in health of the community. Bringing out health models, introduction of new vaccines, innovations in disease epidemiology and management of patients, and documenting success stories and good experiences are many of the pioneering competencies. However, some make enormous efforts in research and get it funded as extramural projects and also publish the work as it is required for professional growth in the institutions and disseminating the outcomes with the fellow professionals.
This research should be reflected by framing of policies through advocacy and influencing the policy-makers and key stakeholders in decision-making. Community physicians should be part of various taskforces and core committees constituted by the governments and extend services as technical experts or resource person to the government or other institutions. Our deep theoretical knowledge should be transformed into action by being a team leader or member or contributor in the health and nutrition program planning, implementation, monitoring, evaluation, and documentation of the case studies, publications, experiences, and results. It will lead to achievement of the set goals in a time-bound manner and improvement in health status of the state or country as a whole. Carrying out projects on a large-scale, capacity building of the healthcare personals and improving the health status of the high priority groups in the community should realistically be followed.
Public health practice by a community physician is a strength which is possessed by virtue of the extensive training. Theoretical knowledge will gradually disappear or will exist only as words in the classrooms. Practical application by actively involving in outbreak investigation, disaster management, public lectures, awareness sessions, supervising or establishing or working in diagnostics and public health laboratories, interventions for control of occupational health hazards, various acts and laws, clinical nutrition in health facilities or applied community nutrition interventions, and behavior change communication are some of the significant examples which must be inculcated and applied.
Patient care in the holistic approach, serving as a family physician, providing quality medical care at different facilities such as hospital, health centers, and outreach areas should be strongly focused. Patient care is the biggest casualty as we begin to spent years in the specialty and move up in the profession. We must be clear in our thoughts that we are Physicians also (we are community medical physicians and professionals). Practice the clinical skills gained right through the academic career at MBBS level and MD resident and in early professional career. Patient care brings respect in the fraternity, builds trust with community, and creates opportunities to widen the network. The list of clinical skills for faculty in Community and Family Medicine has been recommended at the conclave on community and family medicine in Institutes of National Importances on December 18–19, 2015. These recommendations were approved by the MOHFW, Government of India (GOI).
The final P of the TRP5: a community physician is bound by the origin of the specialty and inbuilt in the name itself. We have to spent time with people requiring excellent communication, people-friendly approach with essence of working for the people and with the people. Establishing partnershi p with international, national, regional organizations, GOI, and State Government officials in the health, Women and Child Development, and others for strong intersectoral coordination, training institutes, media, nongovernmental organizations (NGOs), community, and civil society organizations requires additional efforts but has to be learned and applied.
Dr. Sneh Bhargava Committee report on September 21, 2012, has recommended work standards for faculty of autonomous institutions. Functions of a faculty as recommended by the committee are: teaching and training, research, service delivery and patient care, and corporate activities, which applies to community medicine faculty as well. Distribution of time for all these components of TRP5 varies with position and organization, such as medical school, research organization, practicing physician, or engagement in health system or international or national NGOs.
As we look at P5, only handful of our colleagues translate their research work in policy-making, able to influence the government policies, and manage large-scale program implementation, public health practice, patient care and foster people, and partnership. For enhancing the professional excellence, we must sharpen our skills and practice TRP5 for a competent community physician.
Thus, TRP5 for community medicine can be defined as “Community Physician is a game changer who transmits the acquired knowledge into practice through teaching and training, innovates through research, engages in health policies, manages and participates in the health programs, application of skills in public health practice, imparting quality patient care while working for and with the people by fostering strong partnerships with a mission of creating healthy communities.”
| References|| |
Joseph A, Kadri AM, Krishnan A, Garg BS, Ahmed FU, Kumar P, et al
. IAPSM Declaration 2018: Definition, role, scope of community medicine and functions of community medicine specialists. Indian J Community Med 2018;43:120-1.
] [Full text]
National Medical Commission. The Gazette of India: Extraordinary. Part III-Sec 4. National Medical Commission; 2019. p. 10-2.
Acheson RM. Medicine, the community, and the university: a century of Cambridge history. Br Med J 1978;2:1737-41.
Dash S. Textbook of Community Nutrition. Third. Kolkatta: Academic publishers; 2018. p. 6.
Dr. Sneh Bhargava Committee. Work Standards for Faculty of Autonomous Institutions of Medical Education Under the Department of Health and Family Welfare. Government of India; 2012.
Ministry of health and Family welfare.GOI. Conclave on Community and Family Medicine in Institutes of National Importance with special Emphasis on new AIIMS; 2013.