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Community Medicine Clinical Attachment 2017
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Contact Information
Address : Department of Community and Family Medicine,
…… Faculty of Medicine, University of Jaffna,
Adiyapatham Road, Kokuvil,Sri Lanka.
Telephone : +9421 221 8178 (direct)
+9421 221 2073 - Ext 245
Fax : +9421 221 2073 (direct)
Email : [email protected]
Staff
Name Designation Email address
Dr. R. Surenthirakumaran Head of the Department [email protected]
Dr. S. Kumaran Lecturer [email protected]
Dr. P. A. D. Coonghe Lecturer [email protected]
Dr. N. Sivarajah Visiting Lecturer [email protected]
Dr. R. Kumar Lecturer [email protected]
Mr. S. Sivakanthan Senior Lecturer [email protected]
Mrs. V. Sureskumar Technical Officer [email protected]
Mr. K. Mathusuthan Technical Officer [email protected]
Miss. R. Tharmaranee Public Health Nursing
Sister
Mr. V. Premakumar Public Health Inspector [email protected]
Mrs. S. Mayooran Clerk [email protected]
Mr. K. Balachandran Labourer
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Table of Contents 1. Introduction ......................................................................................................................................................4
1.1 Organization of Clinical Attachment ................................................................................................4
1.2 Programme timing and duration .......................................................................................................4
1.3 Organization ..............................................................................................................................................4
1.4 Tutors ...........................................................................................................................................................4
1.5 Learning methods ...................................................................................................................................5
1.6 The role of the student .........................................................................................................................5
1.7 Student attendance policy ...................................................................................................................6
1.8 Assessment ...............................................................................................................................................6
1.9 List of activities: ......................................................................................................................................7
2. MOH Appointment .........................................................................................................................................9
2.1 Introduction to MOH Office and services .......................................................................................9
2.2 Poly clinic (ANC and CWC) ............................................................................................................... 10
2.3 Family planning clinic ......................................................................................................................... 12
2.4 Well women clinic ............................................................................................................................... 13
2.5 Postnatal care ........................................................................................................................................ 14
2.6 Field visit with Public Health Midwife: Growth monitoring and nutrition ....................... 15
2.7 School Health Programme………………………………………………………………………………………….17
2.8 Supervision of staff ............................................................................................................................. 18
2.9 MOH Conference ................................................................................................................................... 18
2.10 NCD Community Screening Programme ................................................................................. 19
2.11 Community-based communicable disease control activity: Dengue ............................. 20
2.12 Food sanitation ................................................................................................................................... 21
2.13 Slaughter house ................................................................................................................................. 22
2.14 Market sanitation ............................................................................................................................... 23
2.15 Refuse disposal ................................................................................................................................... 23
2.16 Introduction to gender-based violence and child abuse: Nallur DS Office ................. 24
2.17 Occupational health .......................................................................................................................... 25
2.18 Expanded Programme on Immunization (EPI) and Adverse Events Following
Immunization (AEFI) surveillance .......................................................................................... 26
2.19 Outbreak investigation .................................................................................................................... 27
2.20 Community empowerment: Mothers’ Clubs ............................................................................ 28
3. Health system, public healthcare institutions and surveillance ............................................... 29
3.1 Office of RDHS Jaffna ......................................................................................................................... 29
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3.2 Hospital administration ...................................................................................................................... 30
3.3 Managing drugs and equipment ..................................................................................................... 31
3.4 Health information system .............................................................................................................. 32
3.5 Infection control and waste management .................................................................................. 33
3.6 Surveillance system ............................................................................................................................ 34
3.7 Malaria control activity ....................................................................................................................... 35
3.8 Tuberculosis control activity ............................................................................................................ 36
3.9 Water sanitation ................................................................................................................................... 37
3.10 Public health review meeting ........................................................................................................ 37
4. Care of persons with special needs ..................................................................................................... 39
4.1 Home for Elders’ Kaithady ................................................................................................................ 39
4.2 Community-based elderly care ....................................................................................................... 40
4.3 Nuffield School for the Deaf & Blind ............................................................................................. 41
4.4 Sivapoomi School for Children with Special Needs................................................................. 42
4.5 Association for Rehabilitation of the Disabled (AROD) .......................................................... 43
4.6 Jaffna Jaipur Centre for Disability Rehabilitation (JJCDR) ................................................... 44
4.7 Cancer Aid for North/East (CANE) ................................................................................................. 45
4.8 Mental Health Services in the Community – Shanthiham……………………………………………… 46
5. Skills Lab ......................................................................................................................................................... 47
6. Clerkship Review ........................................................................................................................................ 48
7. Student assessment and evaluation .................................................................................................... 48
8. Guidance on reflection ............................................................................................................................... 53
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1. Introduction
The Community Medicine Clinical Attachment is held on a rotational basis in the third and
fourth year of the medical undergraduate programme. The curriculum has been developed
in accordance with Sri Lanka Medical Council guidelines. The general objectives of the
attachment are:
To gain familiarity with the structure and delivery of preventive health services
in Jaffna and the Northern Province;
To identify and critically analyze health problems, health programmes and
health-related organizations and activities in the community;
To gain skills in communication, health planning and management; and
To develop a positive attitude towards public health and health promotion.
1.1 Organization of Clinical Attachment 1.2 Programme timing and duration
Timing: Third or fourth year
Duration: Eight weeks
1.3 Organization
A group of 25-30 students will be attached to the Department of Community &
Family Medicine (DCFM) for 8 weeks during the third /fourth year.
This group will be divided into 2 groups of 13-15 students; group leaders will be
selected and rotated during the appointment.
Each student will receive a student guide; an orientation will be held at DCFM on
the first day of the attachment.
Transport facilities will be provided for some visits.
Each student is expected to maintain log sheets for each activity and submit
them to DCFM on a weekly basis.
Each student is expected to compile a portfolio and submit it to DCFM at the end
of the appointment for assessment.
1.4 Tutors
Teaching and assessment is shared among members of staff of DCFM, Medical
Officer of Health (MOH) Nallur, and other community tutors.
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Tutors are drawn from a wide variety of backgrounds; most would have
experience and expertise in the health and/or social sector or with voluntary
organizations. Ideally, they will reflect existing partnerships and collaborations
between government and non-government health sectors.
Much of the teaching and course activities take place in the University Field
Project Area, which is the Nallur MOH Area. In some instances, community
tutors meet students at their places of work; on other they accompany students
on visits to community-based organizations.
1.5 Learning methods
The objectives for each day are clearly set out in the student guide with
suggestions for achieving them. Students will enjoy a variety of teaching methods,
which may include:
Small group discussions;
Shadowing clinicians, other health professionals and non-clinical members of the
health team;
Contact with community members/patients;
Observation of provider-patient encounters;
Role play;
Reflection; and
Self-directed learning and research.
1.6 The role of the student
Students are expected to be present at the specified learning site with their
tutors from 8.00 am to12.00 noon.
They are expected to be proactive and obtain the support of their tutors to
assess and achieve their learning objectives. If the student feels that he/she has
not met the learning objectives for the day, he/she should seek further guidance.
Students should always approach clients/community members/patients in pairs
(male and female) and respectfully inform them of the purpose of their
visit/activity.
Students should maintain learning logs related to activities of each day and
submit them at the end of each week. After completing each activity, students
should reflect, collate and write up relevant material to be included in their
portfolios, which should be submitted to the Department at the end of the
clerkship.
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Each student should obtain advice on selecting a topic for his/her health
education activity.
1.7 Student attendance policy
Attendance is mandatory for all clerkship attachment-related activities; 100%
attendance is required. Absence from a scheduled learning activity will be excused
only on the grounds of sickness, which should be supported by a medical certificate
from a government medical institution. The student should inform the Head of the
Department about his/her absence before the commencement of the scheduled
activity.
1.8 Assessment
Assessment will take place throughout and at the end of the appointment. You will
be graded out 100 on the following components:
Attendance, attitude and application 7.5 marks
Professionalism 7.5 marks
Learning logs 20 marks
Health education activity 15 marks
OSCE 30 marks
Portfolio assessment 20 marks
The total allocated toward the Second Examination for Medical Degrees from the
Community Medicine Clinical Attachment is 10 per cent of the final grade for
Community Medicine.
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1.9 List of Activities:
Introduction to Community Medicine Clinical Attachment (1 day)
Appointment with MOH (20 days)
1 Introduction to MOH Office and services
2 Poly clinic (ANC and CWC)
3 Poly clinic (Family Planning Clinic)
4 Well women clinic
5 Postnatal care
6 Field visit with PHM: Growth monitoring and nutrition
7 School Health Programme
8 Supervision of staff
9 MOH Conference
10 NCD Community Screening Programme
11 Community-based communicable disease control activity
12 Food sanitation
13 Slaughter house
14 Market sanitation
15 Refuse disposal
16 Introduction to gender-based violence and child abuse:
Nallur DS Office
17 Occupational health
18 Expanded Programme on Immunization (EPI) and Adverse
Events Following Immunization (AEFI) surveillance
19 Outbreak investigation
20 Community empowerment (Mother’s Clubs)
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Health system, public health care institutions and surveillance (10 days)
Care of persons with special needs (8 days)
Skills Lab (1 day)
Clerkship review (7 days)
1 Office of Regional Director of Health Services (RDHS ) Jaffna
2 Hospital administration
3 Managing drugs and equipment
4 Health information system
5 Infection control and waste management
6 Surveillance system
7 Malaria control activities
8 Tuberculosis control activities
9 Water sanitation
10 Public health review meeting
1 Elders’ Home Kaithady
2 Community-based elderly care: Cooperative Hospital Moolai
and Sivapoomi Elders’ Home
3 Nuffield School for Deaf and Blind
4 Sivapoomi School for Children with Special Needs
5 Association for Rehabilitation of the Disabled (AROD)
6 Jaffna Jaipur Center for Disability Rehabilitation
7 Cancer Aid for North/East (CANE)
8 Mental health services in the community: Shanthiham
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2. MOH Appointment
2.1 Introduction to MOH Office and services
Students will be posted with
the Medical Officer of Health
(MOH) Nallur. The tutor will
first discuss the
responsibilities of the
Medical Officer of Health.
Then students will be
divided into groups, and will visit various sections of the MOH Office and observe the
activities. Students should maintain learning logs to list and reflect on the activities.
Students are expected to engage in reflective writing at the end of each day. All
learning activities are to be included in the portfolio.
Outcomes:
At the completion of the visit, the student should be able to
List the duties of MOH
Describe the role of MOH in the following activities
o Control of communicable & non – communicable diseases
o Maternal and child health
o Environmental sanitation
o Primary health care and volunteer training
o Health education
o Community empowerment and mobilization
Describe the survey report of MOH and its usefulness
Identify and describe
o Infectious Diseases Register
o Notification Card
o Field investigation forms
o Weekly Return of Communicable Disease
o Weekly Epidemiological Return
Describe the returns originating and received by the MOH Office and their
usefulness
List the maps and charts maintained in the MOH Office and discuss their
usefulness
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Learning resources:
Ministry of Health (2016). Annual Health Bulletin 2014.
Ministry of Health (2011). Surveillance Case Definitions for Notifiable
Diseases in Sri Lanka (p.1-2).
2.2. Poly clinic
Antenatal Clinics (ANC), Child Welfare Clinics (CWC) and Family Planning Clinics are
conducted at Policy Clinics held at Nallur MOH. Students are expected to gain hands-on
skills in ANC and CWC during Poly Clinic visits.
Antenatal clinic (ANC)
Each student will be allocated a pregnant mother
(with her prior permission). The student is expected
to follow-up the mother from the time of registration
at the clinic to her exit from the clinic. The student
should participate in all clinic procedures relevant to
this mother during her clinic visit. The student should
observe the activities of the PHM, PHNS and the MOH
in the clinic.
Students
should
critically reflect on the activities in the clinic,
complete the learning logs, and prepare a report to
be included in the portfolio. The report should
contain a list of activities the student contributed to
at the ANC.
Outcomes:
At the completion of the visit, the student should be able to
Describe the purpose of the ANC
Describe the pregnancy record (H512 A and B) and its importance
Describe the activities conducted to monitor pregnancy
Describe the activities carried out to improve the health of pregnant mothers
Describe health and social risk assessment and referral procedures
Describe immunization procedures
Assess the usefulness of the ANC
Prepare a critical report of the activities observed atthe ANC
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Learning resources:
De Silva, Chitramalee (n.d.). The Impact of Family Health Programme on Family
Wellbeing.
Family Health Bureau (2014). Prevention and Control of Micronutrient
Deficiencies in SriLanka. MCH Quarterly 3(4).
Family Health Bureau (2011). Maternal Care Package: A Guide to Field
Healthcare Workers.
H512A.
Ministry of Health (2016). Guideline on Model MCH & Family Planning Clinic.
Ministry of Health (2016). Annual Health Bulletin 2014.
Ministry of Health (2015). Micronutrient Supplementation for Lactating Women.
Ministry of Health (2014). Antenatal Care Circular (General Circular no. 02-
85/2014).
World Health Organization and Ministry of Health (n.d.). Public Health Success in
Sri Lanka.
Child welfare clinic (CWC)
Each student will be allocated a mother with a child at
the CWC. The student should follow up the child (and
mother) from the time of registration at the clinic to the
time of exit from the clinic. The student is expected to
take part in all clinic procedures relevant to this child
during the clinic visit. The student should observe the
activities of the PHM, PHNS and the MOH in the clinic.
Students should critically reflect on the activities in the
clinic, complete the learning logs, and prepare a report
to be included in the portfolio. The report should contain a list of activities the student
contributed to at the CWC.
Outcomes:
At the completion of the visit, the student should be able to
Describe the activities usually carried out at the CWC in the order in which they
are performed
Describe the importance of the Child Health Development Record (CHDR)
Acquire skills to complete a CHDR and interpret the data on a CHDR
Use the CHDR as a tool to educate the mother
Describe the methods of successful breast feeding
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Describe complementary feeding and its importance
Describe the developmental stages of a child
Describe the expanded immunization programme and age-appropriate
immunization
Learning resources:
De Silva, Chitramalee (n.d.). The Impact of Family Health Programme on Family
Wellbeing.
Epidemiology Unit (2016). National Immunization Schedule for EPI Vaccines.
Epidemiology Unit (2015). Cold Chain.
Family Health Bureau (2017). Child Health Development Record (CHDR).
(Available at DCFM and MOH Nallur)
Family Health Bureau (2014). Guideline on Establishing Nutrition Clinics in
Medical Officer of Health Areas.
Family Health Bureau (2014). Prevention and Control of Micronutrient
Deficiencies in Sri Lanka. MCH Quarterly 3(4).
Family Health Bureau (2011). Maternal Care Package: A Guide to Field
Healthcare Workers.
Family Health Bureau and UNICEF (2013). Early Child Development Standards.
Ministry of Health (2016). Iron Supplementation for Infants and Young Children.
Ministry of Health (2016). Guideline on Model MCH & Family Planning Clinic.
Ministry of Health (2016). Annual Health Bulletin 2014.
Ministry of Health (2015). Micronutrient Supplementation for Lactating Women.
2.3 Family planning clinic
Students are expected to acquire contraceptive
counseling skills at this visit. They will first be
briefed on how to advise a woman/couple to select
a contraceptive method available through the
national programme. Then students will be divided
into groups and will follow the clients who attend
the clinic with their permission. Students should
critically reflect on the activities in the clinic,
complete the learning logs, and prepare a report to
be included in the portfolio.
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Outcomes:
At the completion of the visit, the student should be able to
Name and describe the contraceptives methods available through the National
Family Planning Programme
Describe the correct route and dosages of administration of selected
contraceptives and state the advice that should be given to acceptors of
particulars methods
Recommend appropriate contraception for clients and explain the advantages
and disadvantages of each method
List and identify the equipment used for IUCD insertion
Describe the steps involved in insertion of an IUCD
List and identify equipment used for insertion of implants
Describe the steps involved in insertion of implants
Observe a visit conducted by PHM to the home of a couple who recently adopted
a family planning method.
Learning resources:
World Health Organization (2015). Fact Sheet: Family planning/contraception.
World Health Organization (2015). Medical Eligibility Criteria for Contraceptive
Use.
Family Health Bureau (2014). Annual Report on Family Health 2013.
Family Health Bureau (2011). Maternal Care Package: A Guide to Field
Healthcare Workers.
Family Health Bureau (n.d.). Guidelines for Service Providers (COC, DMPA, IUD).
Ministry of Health (2016). Annual Health Bulletin 2014.
Ministry of Health (2011). Provision of Reproductive Health Services for
Teenagers.
2.4 Well women clinic (WWC)
Students will be posted with the MOH. Initially the
tutor will discuss the objectives and the activities
carried out at the WWC. Each student will be assigned
a client and should follow her up from the time of
registration at the clinic to her exit from the clinic.
The student is expected to take part in all clinic
procedures relevant to her clinic visit. The student
should observe the activities of the PHM, PHNS and the MOH in the clinic. Students should
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critically reflect on the activities in the clinic, complete the learning logs, and prepare a
report to be included in the portfolio.
Outcomes:
At the completion of the visit, the student should be able to
• List the objectives of the WWC
• Describe the activities that are carried out in the WWC
• Carry out the clinical procedures that are performed at the WWC
• List the records maintained by PHM as relevant to the WWC
• List the non-communicable diseases targeted at the WWC and understand the
rationale behind their selection
• Describe the health promotion activities that may be done to overcome the
above non communicable diseases
• Describe the referral procedures followed in the WWC
• Discuss the importance of maintaining good medical records and a proper
referral pathway
Leaning resources:
Mallawaarachchi, DS Virginie et al. (2016). Healthy Lifestyle Centres: A Service
for Screening Non-Communicable Diseases through Primary Health-Care
Institutions in Sri Lanka. WHO South-East Asia Journal of Public Health 5(2): 89-
95.
National Cancer Control Programme (2014). Prevention and Early Detection of
Common Gynecological Cancers.
National Cancer Control Programme (2014). Early Detection and Management of
Breast Symptoms.
2.5 Postnatal care
Students will be posted with a PHM. Initially the
tutor will discuss the objectives and the
activities carried out at the postnatal clinic and
during a postnatal domiciliary visit. Then the
students will be divided into two groups and will
accompany PHMs on a home visit. Students
should discuss postnatal care among
themselves and with the PHM. Students should
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critically reflect on the activities in the clinic, complete the learning logs, and prepare a
report to be included in the portfolio.
Outcomes:
At the completion of the visit, the student should be able to
• Describe the activities taking place at the postnatal clinic
• Describe postpartum domiciliary care delivered by the PHM
• Discuss the rationale for family planning during the postpartum period
• Explain benefits of healthy pregnancy spacing
• Describe the return to fertility of postpartum women (lactating and non-
lactating)
• Describe contraceptive methods appropriate for lactating women
• Carry out health education for postpartum mothers
Leaning resources:
Ministry of Health (2014). Postpartum Care.
Family Health Bureau (2017). Child Health Development Record (CHDR).
(Available at DCFM and MOH Nallur).
Family Health Bureau (2011). Maternal Care Package: A Guide to Field
Healthcare Workers
Family Health Bureau (n.d.). Guidelines for Service Providers (COC, DMPA,
IUD).
World Health Organization (2015). Medical Eligibility Criteria for
Contraceptive Use.
2.6 Field visit with Public Health Midwife: Growth monitoring
and nutrition
Students will be posted with the PHM.
Initially the tutor will discuss the objectives
and the importance of growth monitoring
and nutrition. Then students will be divided
into two groups and will carry out a home
visit related to growth monitoring and
nutrition. The students should discuss
growth monitoring and nutrition among
themselves and with the PHM. They should
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critically reflect on the activities in the clinic, complete the learning logs, and prepare a
report to be included in the portfolio.
Outcomes:
At the completion of the visit, the student should be able to
• List the objectives of growth monitoring
• List and carry out the steps in growth monitoring
• Identify and describe the different types of growth charts used to monitor the
growth of children attending the weighing posts
• List the actions that should be taken depending on the results of the growth
trends of the child
• List the records maintained by the PHM on growth monitoring at her office and
at the weighing post
• Identify the causes of growth faltering among children and suggest ways to
overcome them
• Identify the shortcomings in the weighing
post and recommend improvements
Learning resources:
Family Health Bureau (2017). Child Health
Development Record (CHDR). (Available at
DCFM and MOH Nallur)
Family Health Bureau (2014). Guideline on Establishing Nutrition Clinics in
Medical Officer of Health Areas.
Family Health Bureau (2014). Prevention and Control of Micronutrient
Deficiencies in Sri Lanka. MCH Quarterly 3(4).
Family Health Bureau (2011). Maternal Care Package: A Guide to Field
Healthcare Workers.
Family Health Bureau and UNICEF (2013). Early Child Development Standards.
Ministry of Health (2016). Iron Supplementation for Infants and Young Children.
Ministry of Health (2015). Micronutrient Supplementation for Lactating Women.
Ministry of Health (2016). Annual Health Bulletin 2014.
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2.7 School Health Programme
Students will be posted with MOH and PHI. Initially
the tutor will discuss the components and the
activities carried out as part of School Health
Programme. Next students will be divided into
groups and will evaluate the sanitary level of the
school. Then the tutor will briefly discuss the
activities carried out during the School Medical
Inspectio
n (SMI). Students will carry out the SMI activity
under the supervision of the MOH. During this
activity students are expected to observe the
activities of the PHI, MOH, and the school
teachers. The students should critically reflect on
the activities of the School Health Programme,
complete the learning logs, and prepare a report
to be included in the portfolio.
Outcomes:
At the completion of the activity, the student should be able to
• Describe the School Health Programme (SHP)
• Describe the health services available for school children through SHP
• Describe a healthy school environment
• List and describe the components of a school sanitary survey
• Describe the components of SMI and their importance
• List records and other instruments used during SMI
• Discuss the role of teachers and health personnel at SMI
• Examine school children and fill the SMI form
• Identify common illnesses among school children indifferent age groups
• Describe preventive measures and treatment given to school children at SMI
• Describe referral pathways for children with problems that cannot be
managed at SMI
• List the topics, materials, and methods used in delivering health education
• describe the functions of a school health club
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Learning resources:
Ministry of Health (2016). School Health Programme.
Ministry of Health (2016). Medical Inspection of School Children and Referral to
Hospitals.
Ministry of Health (2015). Weekly Iron Folic Acid Supplementation Programme
(WIFS) for School Children.
Ministry of Health (n.d.). School Medical Inspection.
Ministry of Health (n.d.). School Health Promotion Programme 2008-2012.
PHI Manual (n.d.). Chapter 9: School Health Programme.
2.8 Supervision of staff
Students will be posted with the MOH Nallur. Initially the tutor will discuss the objectives
and importance of staff supervision. Then the tutor will explain how to carry out
supervision and use supervisory skills to improve the performance of health programmes.
Then students will observe a supervisory activity carried out by the MOH and discuss
issues related to the particular activity. The students should reflect on staff supervision,
complete the learning logs, and prepare a report to be included in the portfolio.
Outcomes:
At the completion of the activity, the student should be able to
• Describe the role of supervision in routine programme management
• Understand the difference between supervision and inspection
• Describe the steps of supervision
• Discuss the outcomes of supervision
• Describe the usefulness of supervision
• Describe the role of the MOH in supervision
Learning resources:
The University of Kansas (2016). Providing Supervision for Staff and Volunteers
2.9 MOH Conference
Students will be posted with the MOH. Initially the tutor will discuss the objectives and
importance of the MOH Conference. Students will observe the activities carried out during
the conference. Student should discuss and critically reflect on the activities they observe,
complete the learning logs, and prepare a report to be included in the portfolio
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Outcomes:
At the completion of the visit the student should be able to
• Describe the objective(s) of the MOH Conference
• Describe the concept of team work
• Describe the monitoring and evaluation of services at divisional level
• Understand the importance of routine reporting
• Explain the usefulness of effective reporting
• Describe the usefulness of routine reporting in surveillance
Learning resources:
Ministry of Health (2015). Guidelines for Conducting Monthly and Local
Conference at the Medical Officer of Health Areas.
Tzenalis, Anastasias and Chrishanthy Sotiriadou (2010). Health Promotion as
Multi-Professional and Multidisciplinary Work. International Journal of Caring
Sciences 3(2):49-55.
2.10 NCD Community Screening Programme (NCSP)
Students will be posted with the MOH.
Initially the tutor will discuss the
objectives, importance and components
of the NCSP. Then students will be
divided into groups, which will carry out
and observe the activities of the PHM,
PHNS, PHI and Medical Officers carrying
out different components of the NCSP.
Students should critically reflect on the
activities of the Programme, complete the learning logs, and prepare a report to be
included in the portfolio.
Outcomes:
At the completion of the activity, the student should be able to
• Describe the health services available for prevention of NCDs in Sri Lanka
• List the components of the NCSP
• Describe the components of the NCSP and their importance
• List the records and other instruments used in the NCSP
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• List health education topics, materials and methods used to deliver health
education in the NCSP
• Discuss the roles of community leaders and health personnel in the NCSP
• Identify the common NCDs found among people indifferent age groups
• Describe the prevention and control measures targeting each NCD
• Describe referral mechanisms available to manage NCDs
Learning resources:
Mallawaarachchi, DS Virginie et al. (2016). Healthy Lifestyle Centres: A Service
for Screening Non-Communicable Diseases through Primary Health-Care
Institutions in Sri Lanka. WHO South-East Asia Journal of Public Health 5 (2):
89-95.
Ministry of Health (n.d.). National Multisectoral Action Plan for the Prevention
and Control of Non-Communicable Diseases 2016-2020.
Non-Communicable Disease Unit (2008). National NCD Programme:
Implementing Structure.
World Health Organization and Ministry of Health (n.d.). Public Health Success in
Sri Lanka
2.11 Community-based communicable disease control activity:
Dengue
Students will be posted with an area PHI in the Nallur MOH Area. The students will be
divided into 4 or 5 groups. Each group
will accompany the PHI or a member
of the village-level Dengue Control
Committee to a notified address. The
residence and its vicinity will be
inspected for breeding sites. Any
identified breeding sites will be
destroyed. The students will engage in
health education with the residents at
the notified address and neighbors.
Students should critically reflect on
community-based dengue control activities, complete the learning logs, and prepare a
report to be included in the portfolio.
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Outcomes:
At the completion of the activity, the student should be able to
Describe community-based dengue prevention and control activities
Describe the PHIs role in dengue prevention and control activities
Identify and eliminate dengue vector breeding sites
Understand the importance of community engagement in infection control
Learning resources:
Epidemiology Unit (2017). Dengue Surveillance.
Epidemiology Unit (2012).Fogging in Dengue Control. Part 1 and Part 2.
Epidemiology Unit (2011). Surveillance Case Definitions for Notifiable Diseases
in Sri Lanka.
Epidemiology Unit (2009). Weekly Epidemiological Report: Dengue: The
Changing Scenario of the Severity of the Disease.
PHI Manual (n.d.). Duties and Responsibilities of Public Health Inspectors.
Sirisena, PDNN and F. Noordeen (2016). Dengue Control in Sri Lanka:
Challenges and Prospects of Improving Current Strategies. Sri Lankan Journal of
Infectious Diseases 6(1): 2-16.
World Health Organization (2012). Global Strategy for Dengue Prevention and
Control.
2.12 Food Sanitation
Students will be posted with the PHI. The tutor will first discuss the objectives, importance
and components of food sanitation
and the Food Act of Sri Lanka. Then
students will be divided into groups
and will accompany the PHI to food
handling establishments, a bakery,
dairy and a factory to observe the
activities of the PHI in different
components of food sanitation.
Students should critically reflect on
food sanitation activities, complete
the learning logs, and prepare a
report to be included in the portfolio.
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Outcomes:
At the end of the field visit, the student should be able to
• Understand the Food Act No 26 of 1980
• Describe the role of the PHI in the implementation of the Food Act
• Describe health hazards associated with an eating place
• List the legal standards that apply to an eating house in relation to supplying
uncontaminated food to consumers
• Name diseases spread by contaminated food and describe the measures that
should be taken by food handling establishments to prevent the spread of
disease
• Describe the examination and investigation carried out at food handling
establishments, including the various forms/tools used during a field visit
• Describe the content of ordinances which deal with the functioning of an eating
house
Learning resources:
Government of Sri Lanka (n.d.). Food Act no. 26 of 1980.
Amendments to the Food Act and other Relevant Regulations.
PHI Manual (n.d.). Duties and Responsibilities of Public Health Inspectors.
Food and Agriculture Organization (2003). General Principles of Food Hygiene.
2.13 Slaughter house
Students will be posted with the PHI to the slaughter
house. They will observe the activities of the PHI at
the slaughter house. Students should critically reflect
on activities at the slaughter house, complete the
learning logs, and prepare a report to be included in
the portfolio.
Outcomes:
At the end of the field visit, the student should be able to
• Describe the slaughter house, its location, and purpose
• Describe the steps involved in the slaughter of cattle
• List the common diseases of cattle and describe their ante-mortem and post-
mortem features
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• Describe the hazards associated with slaughter house work:
Disposal of waste products; water supply; storage of meat; transport of meat
Learning resources:
Food and Agriculture Organization (n.d.). Slaughterhouse Cleaning and
Sanitation.
Butchers Ordinance of Sri Lanka.
PHI Manual (n.d.). Duties and Responsibilities of Public Health Inspectors.
2.14 Market sanitation
Students will be posted with the PHI. The tutor
will first discuss the objectives of market
sanitation, its importance, and the various
stakeholders involved. Then the students will
observe the activities of the PHI in a market
location. Students should critically reflect on
market sanitation, complete the learning logs,
and prepare a report to be included in the
portfolio.
Outcomes:
At the completion of the field visit, the student should be able to
• Describe the market and its location
• Describe the PHIs duties in market sanitation
• Describe the occupational hazards associated with a market
Learning resources:
PHI Manual (n.d.). Duties and Responsibilities of Public Health Inspectors.
World Health Organization (2006). A Guide to Healthy Food Markets.
2.15 Refuse disposal
Students will be posted with the PHI. The tutor will discuss
the objectives of refuse disposal, its importance, and the
various stakeholders involved. Then the students will
observe the activities of the PHI in refuse disposal. Students
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should critically reflect on refuse disposal, complete the learning logs, and prepare a
report to be included in the portfolio.
Outcomes:
At the completion of the field visit the student should be able to
• Describe the methods of refuse disposal used in the Jaffna Municipal Council
Area
• Describe collection, transport and final disposal of refuse in Jaffna
• Describe constraints in proper refuse disposal and suggest improvements
• List the health hazards of insanitary refuse collection and disposal
• Discuss the occupational hazards of workers involved in refuse disposal.
Learning resources:
Christopher, Chrishanthi (2016). Drowning in Waste: Garbage Problems Out of
Control.
PHI Manual (n.d.). Duties and Responsibilities of Public Health Inspectors.
World Bank (2012). What a Waste: A Global Review of Solid Waste
Management.
2.16 Introduction to gender-based violence and child abuse:
Nallur DS Office
Students will be posted to the DS Office Nallur. Initially the Women Development Officer
(WDO) will provide a brief introduction to the issues related to gender-based violence
(GBV) and child abuse and
describe the roles of various
stakeholders working on this
issue in the field at MOH and
DS level. The WDO will then
discuss a few case studies
relevant to GBV and child
abuse to familiarize the
students with challenges
associated with addressing
this problem at field level. Students should critically reflect on GBV and child abuse,
complete the learning logs, and prepare a report to be included in the portfolio.
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Outcomes:
At the completion of the activity, the student should be able to
• Describe the infrastructure and services available to address GBV and child
abuse in Sri Lanka
• Discuss the role of the public health team in the prevention of GBV and child
abuse
• Discuss the role of other fieldworkers in the prevention of GBV and child abuse
• Be aware of the common risk factors of GBV and child abuse
• Describe existing referral pathways for cases of GBV and child abuse
• Describe the role of community organizations in prevention
Learning resources:
Ministry of Women and Child Affairs (2016). Policy Framework and National Plan
of Action to Address Sexual and Gender-based Violence in Sri Lanka 2016-2020.
Guruge et al. (2015). A Review of the Sri Lankan Health-Sector Response to
Intimate Partner Violence: Looking Back, Moving Forward.
Guruge et al. (2017). Intimate Partner Violence in the Post-War Context:
Women’s Experiences and Community Leaders’ Perceptions in the Eastern
Province of Sri Lanka.
Kodikara, Chulani and Thiagi Piyadasa (n.d.). Domestic violence intervention
services in Sri Lanka.
National Child Protection Authority Act, No. 50 of 1998.
Prevention of Domestic Violence Act, No. 34 of 2005.
National Committee on Women (2005). Plan of Action Supporting the Prevention
of Domestic Violence Act.
National Child Protection Authority (2017).
2.17 Occupational health
Students will be posted with a PHI. The tutor will
first discuss the objectives, importance and
components of occupational health in Sri Lanka.
Then the students will visit small scale work
places (e.g. service station, rice mill, etc.) and
observe the activities of the PHI. Students are
expected to critically reflect on occupational
health, complete the learning logs, and prepare
a report to be included in the portfolio.
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Outcomes:
At the completion of the activity, the student should be able to
• Conduct a small industry visit and assess occupational health hazards
• Describe the welfare measures that are available at such work places
• Describe the interaction between management and the workers and its effects
• Be aware of the relevant preventive measures that should be adopted
Learning resources:
International Labour Organization (n.d.). Occupational Safety and Health:
Country Profile.
Ministry of Labour Relations and Manpower (n.d.). A Safer Workplace Profits
Everyone.
National Institute of Occupational Health and Safety (2017).
Madurawala, Sunimalee (2013). Dying to Work? Why Health and Safety in the
Workplace is an Important Economic Issue in Sri Lanka.
PHI Manual (n.d.). Duties and Responsibilities of Public Health Inspectors.
2.18 Expanded Programme on Immunization (EPI) and Adverse
Events Following Immunization (AEFI) surveillance
Students will be posted to the MOH Office.
The tutor will introduce the students to the
EPI programme and AEFI surveillance. They
will be familiarized with the infrastructure and
facilities available at the MOH Office to
maintain the cold chain and deliver
immunization services at the community level.
The students will also observe the delivery of
immunization services. Students are expected
to critically reflect on EPI and AEFI, complete
the learning logs, and prepare a report to be included in the portfolio.
Outcomes:
At the completion of the activity, the student should be able to
• List the objectives of EPI and AEFI
• Describe in detail the national immunization schedule
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• Understand technical aspects related to the maintenance of the cold chain as
relevant to a field setting
• Describe the system in place for AEFI surveillance
Learning resources:
Epidemiology Unit (2012). Immunization Handbook 3rd Edition
Epidemiology Unit (2017). National Immunization Schedule – Sri Lanka.
Epidemiology Unit (2016). Cold Chain.
Sri Lanka Medical Association (2014). SLMA Guidelines and Information on
Vaccines.
Epidemiology Unit (2009). Contraindications and Precautionary Conditions for
Vaccination.
Epidemiology Unit (2016). Inactivated Polio Vaccine.
Epidemiology Unit (2017). Applicability of Dengue Vaccination.
Epidemiology Unit (2012). National Guidelines on Immunization Safety
Surveillance.
Epidemiology Unit (2015). AEFI Forms
2.19 Outbreak investigation
Students will be posted with a PHI. The tutor will first discuss the objectives, importance
and components of an outbreak investigation. Then students will be divided into groups
and visit areas in the Nallur MOH Area from which infectious cases have been reported in
that specific month. The students will observe/discuss the activity/activities carried out by
the PHI. Students are expected to critically reflect on outbreak investigation procedures,
complete the learning logs, and prepare a report to be included in the portfolio.
Outcomes:
At the completion of the activity, the student should be able to
Describe steps of outbreak investigation
Discuss the respective roles of members of the public health team in an
outbreak investigation
Discuss the respective roles of members of the public health team in the
prevention of an outbreak
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Learning resources:
Center for Disease Control and Prevention (2016). Steps of an Outbreak
Investigation.
WHO (2008). Foodborne Disease Outbreaks.
Epidemiology Unit (2012). Diarrhoea Outbreak Report – Lindula.
PHI Manual (n.d.). Duties and Responsibilities of Public Health Inspectors.
2.20 Community empowerment: Mothers’ Clubs
Students will be posted with a PHM. The tutor
will discuss the objectives, importance and
components of community empowerment in
preventive health activities. Then the students
will be divided into groups and meet members
of a Mothers’ Club to discuss their activities
and
understand how community empowerment activities
contribute towards improving the health status at
the community level. The students will observe/
discuss the activity/activities carried out by the PHI.
Students are expected to critically reflect on
Mothers’ Clubs, complete the learning logs, and
prepare a report to be included in the portfolio.
Outcomes:
At the end of the community empowerment activity, students should be able to:
• Discuss how community empowerment activities could lead to improved health
• Understand the relationship between socio-cultural/ economic issues andhealth
or disease prevention
• Discuss the challenges associated with community mobilization for
empowerment
• Describe the strengths and weaknesses of the Mothers’ Clubs
Learning resources:
World Health Organization (1998). Health Promotion Glossary.
Ministry of Health and UNICEF (2015). Review of the Functioning and Impact of
Mother Support Groups in the Northern and Eastern Provinces of Sri Lanka.
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3. Health system, public health care institutions and surveillance
3.1 Office of RDHS Jaffna
Students will be posted with the Regional Director of
Health Services (RDHS) Jaffna. The tutor will provide
an overview of the health system, decentralization
and the 5S frame work for healthcare management.
Then students will be divided into groups and visit
the various sections of the RDHS Office and observe
the activities. Students are expected to critically
reflect on activities at the RDHS Jaffna, complete the
learning logs, and prepare a report to be included in the portfolio.
Outcomes:
At the completion of the visit, the student should be able to
• Describe the structure of the health system of Sri Lanka
• Describe the role of provincial and regional health systems
• Perform a SWOT analysis and discuss the strengths and weaknesses of a
decentralized health system
• Describe the structure and organization of the RDHS Office
• Describe the 5S organizational principles and their relevance for healthcare
management
Learning resources:
Ministry of Health (2016). Annual Health Bulletin 2014.
Rannan-Eliya, Ravi and Lankani Sikurajapathy (2009). Sri Lanka: “Good
Practice” in Expanding Healthcare Coverage.
Dalpadatu, Shanthi et al. (n.d.). Public Hospital Governance in Sri Lanka.
Indrasiri, H.R.U (2003). Provincial Councils and Devolution: A Lost Opportunity
of Decentralization.
Provincial Department of Health Services Northern Province (n.d.). Statistical
Hand Book 2015.Office of the Provincial Director of Health Services Northern
Province (available at Faculty of Medicine Library).
RDHS Jaffna (2015).Statistical Hand Book 2014 RDHS Division Jaffna.Office of
the RDHS Jaffna (available at Faculty of Medicine Library).
Redesigning Care (2013). 5S in Healthcare.
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3.2 Hospital administration
Students will be posted with
the Director of Teaching
Hospital Jaffna. The tutor will
first discuss the administrative
setup of a healthcare
institution. Students also will
be introduced to the Sri Lanka
Establishments Code and
financial regulations. Then students will be divided into groups and visit the administrative
and financial units of the hospital. Students are expected to critically reflect on hospital
administration, complete the learning logs, and prepare a report to be included in the
portfolio.
Outcomes:
At the completion of the visit, the student should be able to
• Describe the administrative setup of a Teaching Hospital
• List the duties and responsibilities of the Director
• Describe links with other healthcare institutions regarding patient care
• List the duties and responsibilities of the Administrative Officer
• List the registers & inventories maintained at the Administrative Unit and
discuss their usefulness
• Describe the procedures involved in ordering and issuing equipment,
consumables etc.
• List the duties and responsibilities of the Accounting Officer
• List the registers & inventories maintained at the Financial Unit and their
usefulness
• Discuss the financial regulations in place at healthcare institutions
Learning resources:
Ministry of Health (2016). Annual Health Bulletin 2014.
Dalpadatu, Shanthi et al. (n.d.). Public Hospital Governance in Sri Lanka
World Health Organization (2017). Management for Health Services Delivery:
Readings for a New Hospital Manager.
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3.3 Managing drugs and equipment
Students will be posted with the Chief Pharmacist and a Ward In-Charge Nursing Officer at
Teaching Hospital Jaffna. Initially, the Chief
Pharmacist will discuss needs assessment, ordering
and receiving drugs and equipment from the
Medical Supplies Division, storage and distribution
of drugs within the institution, and drug regulation.
Then the students will visit the drug stores and
observe the facility. Next, the students will go to an
in-patient unit where the Ward In-Charge Nursing
Officer will explain how the drugs are ordered and maintained at the ward level. Students
are expected to critically reflect on the management of drugs and equipment at healthcare
facilities, complete the learning logs, and prepare a report to be included in the portfolio.
Outcomes:
At the completion of the visit, the student should be able to
• List the duties and responsibilities of the Chief Pharmacist and the Ward In-
Charge Nursing Officer in relation to managing drugs and equipment
• List the registers and inventories maintained by the Chief Pharmacist and
discuss their usefulness
• List the registers and inventories maintained by the Ward In-Charge Nursing
Officer and discuss their usefulness
• Describe the procedures of ordering, issuing and balancing drugs and other
items by the Chief Pharmacist and Ward In-Charge Nursing Officer
• Describe the maintenance procedure of surgical consumables, cold stores, etc.
• Discuss the supportive role of Medical Officers in making available the necessary
drugs and equipment at ward and institutional level
Learning resources:
Ministry of Health (2008). Manual on Management of Drugs.
Ministry of Health (2016). Annual Health Bulletin 2014.
Jayakody, R.L. (2015). The National Medicines Regulatory Authority Act: Its
Birth, Provisions and Challenges. Journal of Ceylon College of Physicians, 46, 53-
56.
World Health Organization (2017). Management for Health Services Delivery:
Readings for a New Hospital Manager.
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3.4 Health information system (HIS)
Students will be posted to the Teaching Hospital Jaffna Statistical Unit and MOH Office
Nallur. The tutor will first discuss the health information system of Sri Lanka. Then the
students will be divided into two groups. One group will go to the Statistical Unit TH Jaffna
and the second group will go to the MOH Office Nallur. Groups will critically evaluate the
effectiveness of the existing HIS and compare the HIS in different settings. Students are
expected to critically reflect on HIS, complete the learning logs, and prepare a report to
be included in the portfolio.
Outcomes:
At the completion of the visit, the student should be able to:
• Describe the HIS of Sri Lanka
• Describe the role of medical officers in maintaining the HIS in hospital and
community settings
• Discuss the strengths and weaknesses of the existing HIS
• Evaluate the need for an electronic HIS and the resources required for its
implementation
• Describe the IMMR and E-IMMR
• Understand the role of standard medical classification tools for the maintenance
of a HIS (e.g. ICD-10)
Learning resources:
Dharmawardhana, G.R.M.P. (2012). An Electronic Public Health Information
System for Sri Lanka: A Proposal to Enhance Current Practice. Journal of Bio-
Medical Informatics, 3(4), 132-143.
World Health Organization (2010). Health Information Systems.
Kariyawasam N.C. and M.K.D.R.B. Dayaratne (2012). Electronic Indoor
Morbidity and Mortality Report.
World Health Organization (n.d.). ICD-10 Version: 2016.
World Health Organization (2017). The 11th Revision of the International
Classification of Diseases (ICD-11) is due by 2018!
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3.5 Infection control and waste management
Students will be posted with the Infection
Control Nursing Officer at the Teaching
Hospital Jaffna. The tutor will first discuss
infection control activities carried out in a
healthcare institution and the hospital waste
management system. Then the students will
be divided into groups and visit the wards,
theatre, sterilizing unit and hospital waste management unit. Students will compare the
waste management system in the hospital with the
national guideline produced by the Quality and Safety
Unit of the Ministry of Health. Students are expected to
critically reflect on infection control and waste
management, complete the learning logs, and prepare
a report to be included in the portfolio.
Outcomes:
At the completion of the visit, the student should be able to:
• List the activities carried out by the infection control nurse.
• Describe the facilities available for infection control at Teaching Hospital Jaffna.
• Describe the waste disposal method followed for different hospital wastes
• Understand and discuss the short comings of infection control activities and
waste management at Teaching Hospital Jaffna
• Suggest measures that could be adopted to overcome the shortcomings
Learning resources:
Sri Lanka College of Microbiologists (2005). Hospital Infection Control Manual.
Sri Lanka College of Microbiologists (n.d.). SLCM National Guidelines on Waste
Management.
Epidemiology Unit (2016). Healthcare Waste: How Safe is it?
World Health Organization (2014). Safe Management of Wastes from Health-
Care Activities.
Karunasena, G. et al. (2015). Comparison of Disposal Strategies for Clinical
Waste: Hospitals in Sri Lanka.
World Health Organization (2015).Healthcare Waste.
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3.6 Surveillance system
Students will be posted with the Regional Epidemiologist, RDHS Jaffna. The tutor will
discuss the objectives and importance of
surveillance, and the types of surveillance
methods used to control communicable
diseases in the country. Students will also
learn about the notification system operating
in Sri Lanka. Students are expected to
critically reflect on surveillance and the
notification system, complete the learning
logs, and prepare a report to be included in the portfolio.
Outcomes:
At the completion of the visit, the student should be able to
• Describe the surveillance methods used to control communicable diseases in Sri
Lanka
• Describe the usefulness and importance of a surveillance system
• List the notifiable diseases in Sri Lanka
• Fill a notification form accurately
• Describe surveillance procedures carried out in the field and in healthcare
institutions
• Understand the role of medical officers in surveillance and notification
Learning resources:
Ginige, Samitha (2008). Disease Surveillance Programme in Sri Lanka.
Epidemiology Unit (2016). List of Notifiable Diseases.
Epidemiology Unit (2011). Surveillance Case Definitions for Notifiable Diseases
in Sri Lanka, 2nd Edition.
Family Health Bureau (2015). Maternal Death Surveillance and Response
System – Sri Lanka.
London School of Hygiene and Tropical Medicine (2009). What is Surveillance?
London School of Hygiene and Tropical Medicine (2009). Types of Surveillance.
Community Medicine Clinical Attachment 2017
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3.7 Malaria control activity
Students will be posted with the Regional
Medical Officer of the Anti-Malaria
Campaign (AMC) Jaffna. The tutor will
discuss the objectives and importance of
the AMC and its various stakeholders.
Then the students will go to the field with
malaria field officers from AMC and
observe malaria control activities.
Students are expected to critically reflect on the AMC and malaria control, complete the
learning logs, and prepare a report to be included in the portfolio.
Outcomes:
At the completion of the visit, the student should be able to
• Describe the objectives and activities of the AMC
• Describe malaria parasites and vectors with special reference to Sri Lanka
• List and describe surveillance methods carried out in the Jaffna District at MOH
level in relation to malaria control
• Describe malaria prophylactic and curative chemotherapy for adults, children
and pregnant women
• Describe the surveillance methods used in the elimination of malaria from Sri
Lanka
• Describe the role of the entomologist and entomological assistant in the
control of malaria
• Describe the activities being undertaken to prevent the re-introduction of
malaria
Learning resources:
Anti-Malaria Campaign Sri Lanka (2017).
Premaratne, Risintha et al. (2014). Malaria Elimination in Sri Lanka: What it
would take to Reach the Goal. WHO South-East Asia Journal of Public Health
3(1), 85-89.
Anti-Malaria Campaign and Ministry of Health Sri Lanka (2017). National Malaria
Strategic Plan for Elimination and Prevention of Re-introduction – Sri Lanka.
Community Medicine Clinical Attachment 2017
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3.8 Tuberculosis control activity
Students will be posted with
District Tuberculosis Control
Officer (DTCO) at Pannai.
Initially the tutor will discuss
the objectives and importance
of TB control and its various
stakeholders. Then students
will go to the field with the
DTCO or the PHI-TB and
observe TB control activities. Students are expected to critically reflect on TB control,
complete the learning logs, and prepare a report to be included in the portfolio.
Outcomes:
At the completion of the visit, the student should be able to
• Describe the structure and organization of the National Programme for
Tuberculosis Control and Chest diseases (NPTCCD)
• Describe the functions of the NPTCCD
• Describe the prevalence/incidence of TB in Jaffna & Sri Lanka
• Describe the control measures carried out and discuss their effectiveness
• Describe the drug schedule for different types of TB and their side effects
• Describe the role of the PHI in TB control and prevention
• Describe the WHO – Stop TB Strategy.
• Evaluate the DOTS programme in the community
Learning resources:
NPTCCD (2017).
Ministry of Health (2011). Strengthening of Tuberculosis Surveillance and
Control.
NPTCCD (n.d.). Counseling for TB Patients & Patients with TB/HIV Co-Infection,
their Families and Partners.
NPTCCD (2013). Annual Report of the NPTCCD 2013.
NPTCCD (2017). Direct Observation Treatment.
De Alwis, A.K.S.B. (n.d.). NPTCCD, Ministry of Health Sri Lanka.
WHO (2017). The Stop TB Strategy.
WHO (2017).The End TB Strategy.
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3.9 Water sanitation
Students will be posted to the National
Water Supply and Drainage Board,
Pannai. Initially the tutor will discuss the
objectives and importance of water
sanitation, its various stakeholders, water
contamination, and treatment processes.
Then the students will visit the onsite
laboratory. Students are expected to
critically reflect on water sanitation,
complete the learning logs, and prepare a
report to be included in the portfolio.
Outcomes:
At the completion of the visit, the student should be able to
• Describe the methods of water treatment used in Jaffna
• Demonstrate familiarity with laboratory analysis of water specimens
• Describe constraints in water sanitation and suggest improvements
• List the health hazards of contaminated water with special reference to Jaffna
and the Northern Province
Learning resources:
National Water Supply and Drainage Board (2017). Regional Support Centres:
Northern Province.
World Health Organization (n.d.). Water Treatment.
World Health Organization (2010). Drinking Water Quality in the South-East Asia
Region.
3.10 Public health review meeting
Students will be posted to RDHS Jaffna. The tutor will first discuss the objectives and
importance of the public health review meeting. Students will observe the activities
carried out during the meeting. Students are expected to critically reflect on the public
health review meeting, complete the learning logs, and prepare a report to be included in
the portfolio.
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Outcomes:
At the completion of the visit, the student should be able to
• List the objectives of a public health review meeting
• List the major public health issues discussed at the meeting
• Describe the concept of team work
• Describe how monitoring and evaluation is undertaken at the divisional level
• Understand the importance of routine reporting
• Explain the usefulness of accurate reporting
Learning resources:
World Health Organization (2012). Being an Effective Team Player.
World Health Organization (2017). Management for Health Services Delivery:
Readings for a New Hospital Manager.
World Health Organization (2017). Global Health Observatory Data: Reports.
Salama, Rasha (2010). Monitoring and Evaluation of Health Services.
Community Medicine Clinical Attachment 2017
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4. Care of persons with special needs
4.1 Home for Elders’ Kaithady
Students will be posted with the Director of the
Elders’ Home Kaithady. The tutor will first
introduce the organizational structure, facilities
and activities at the Elders’ Home. Then
students will be divided into groups and work
with the elders and their caretakers. Students
will carry out interviews with elders and
caregivers (with their prior permission). They
will observe the facilities available at the home
and gain familiarity with the health and social issues related to elder care. Students are
expected to critically reflect on activities at the Elders’ Home Kaithady, complete the
learning logs, and prepare a report to be included in the portfolio.
Outcomes:
At the completion of the visit, the student should be able to
• Describe different systems of care available to elders/seniors
• Describe the services provided by the state for elders in Sri Lanka
• Describe the administrative set-up of the Elders’ Home Kaithady
• List the criteria for admission to state institutions with special reference to the
Elders’ Home Kaithady
• Demonstrate awareness of the sources of funding and costs associated with
maintaining an Elders’ Home
• Describe health and other social problems associated with aging and how they
may be resolved
• Describe the facilities and tools available to assess health, social and emotional
needs of institutionalized elders
• Describe the challenges encountered by health administrators, managers and
care givers in providing quality services for the elderly in Sri Lanka
Community Medicine Clinical Attachment 2017
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Learning resources:
Elders’ Home Kaithady (2012).
Samaraweera, Dilhar and Shiromi Maduwage (2016). Meeting the Current and
Future Health-Care needs of Sri Lanka’s Ageing Population. WHO South-East
Asia Journal of Public Health 5 (2): 96-101.
Dissanayake, S.A.R. (n.d.). Ageing in Sri Lanka.
Siddhisena, K.A.P. (2005). Socio-Economic Implications of Aging in Sri Lanka.
World Health Organization (2011). Global Health and Aging.
World Health Organization (2015). World Report on Aging and Health.
4.2 Community-based elderly care
Students will be posted with the Directors of the
Co-operative Hospital Moolai and Sivapoomi
Elders’ Home. The tutors will discuss the
organizational structure, facilities and activities
related to community-based elderly care. Then
students will be divided into groups and work
with elders and service providers. Students will
carry out
interviews with
elders and service providers (with their prior permission).
They will observe the facilities available at the institutions
and critically discuss related health and social issues.
Students are expected to critically reflect on community-
based elderly care, complete the learning logs, and
prepare a report to be included in the portfolio.
Outcomes:
At the completion of the visit, the student should be able to:
• Describe the structure and organizational set up of both institutions
• Describe the services provided by the institutions
• List the criteria and process of admission to the institutions
• Describe the elderly care services provided by the respective organizations at
institutional and community level
• Critically analyze the gap filled by these two institutions
Community Medicine Clinical Attachment 2017
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Learning resources:
World Health Organization (2017). Moolai Hospital.
Sivathasan, S. (2016). Moolai Hospital Jaffna – Reaching for New Vistas.
Sivapoomi Elders’ Home (n.d.).
Samaraweera, Dilhar and ShiromiMaduwage (2016). Meeting the Current and
Future Health-Care Needs of Sri Lanka’s Ageing Population. WHO South-East
Asia Journal of Public Health 5 (2): 96-101.
4.3 Nuffield School for the Deaf & Blind
Students will be posted with the Director of the Nuffield School. The tutor will discuss the
organizational structure, facilities and
activities of the school. Then students will
be divided into groups and work with the
students and their teacher(s). They will
observe the facilities available at the school
and critically analyze resource constraints
and health-related issues. Students are
expected to critically reflect on activities at
the Nuffield School, complete the learning
logs, and prepare a report to be included in the portfolio.
Outcomes:
At the completion of the visit, the student should be able to
• Describe the organizational structure, facilities and activities at the Nuffield
School
• List the criteria for admission
• List the categories of disabilities catered to by the Nuffield School
• Describe the causes, types and effects of deafness
• Describe the causes, types and effects of blindness
• List the instruments and aids available for detection and correction of deafness
• List the instruments and aids available for detection and correction of blindness
• Describe how the deaf and blind are taught to communicate and learn special
skills
• Identify gaps in services for deaf and blind children in Jaffna and Sri Lanka.
Community Medicine Clinical Attachment 2017
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Learning resources:
The Ceylon School for the Deaf and Blind (2009-2013).
Sunday Observer (2012). The Ceylon School for the Blind Turns 100.
See/Hear (n.d.). Teaching Strategies and Content Modifications for the Child
with Deaf-Blindness.
Perkins School for the Blind (n.d.). Communication Technology for Persons who
are Deafblind.
Teaching Visually Impaired (n.d.). Teaching Students with Visual Impairments.
US Department of Health and Human Services (2017). Assistive Devices for
People with Hearing, Voice, Speech or Language Disorders.
4.4 Sivapoomi School for Children with Special Needs
Students will be posted with the Director of the Sivapoomi School. The tutor will discuss
the organizational structure, facilities and activities at the home. Then the students will be
divided into groups and work with the children and teachers at the school. Students will
carry out interviews with teachers (with their permission) and observe the children’s
activities. They will observe the facilities available at the school and gain familiarity with
related health and social issues. Students are expected to critically reflect on activities at
the Sivapoomi School, complete the learning logs, and prepare a report to be included in
the portfolio.
Outcomes:
At the completion of the visit, the student should be able to
Describe the history of the institution
List the common types of disabilities catered to by the institution
List the services offered by the institution
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List the criteria for admission to the institution
Describe the referral system in place for admission to the institution
Describe the activities carried out at the institution
Describe teaching and learning activities in relation to special needs education
Describe the cost of maintenance and sources of funding of the institution
Critically analyze the gap filled by these two institutions
Learning resources:
Sivapoomi School (n.d.).
Do2learn (2017).
4.5 Association for Rehabilitation of the Disabled (AROD)
Students will be posted with Director of AROD Jaffna. The tutor will discuss the
organizational structure, facilities and activities of the
organization. Then students will be divided into
groups and work with the trainees and trainers.
Students will carry out interviews with trainees and
trainers (with their prior permission). They will
observe the facilities available for the rehabilitation of
persons with disabilities and critically discuss related
health and social issues. Students are expected to
critically reflect on activities at AROD, complete the
learning logs, and prepare a report to be included in the portfolio.
Outcomes:
At the completion of the visit, the student should be able to
• Describe the history of AROD
• Describe the composition and services offered by AROD
• Describe the activities carried out by AROD in its premises and in the community
• Describe the forms of assistance provided by the organization for the
rehabilitation of persons with disabilities
• Describe the funding and staffing of the organization
• Demonstrate awareness of disability legislation and policy in Sri Lanka
• Critically analyze gaps in services available to persons with disabilities
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Learning resources:
AROD (2016).
Government of Sri Lanka (1996). Protection of the Rights of Persons with
Disabilities Act no. 28 of 1996.
Government of Sri Lanka (2006).Regulations made by the Minister of Social
Services and Social Welfare under Section 25 read with Section 23 of the
Protection of the Rights of Persons with Disabilities Act no. 28 of 1996.
Ministry of Social Welfare (2003).National Policy on Disability for Sri Lanka.
International Centre for Ethnic Studies (2017).Women living with disabilities.
4.6 Jaffna Jaipur Centre for Disability Rehabilitation
Students will be posted with the Director of the Jaffna
Jaipur Centre for Disability Rehabilitation (JJCDR).
Initially the tutor will discuss the organizational
structure, facilities and activities of the center. Then
students will be divided into groups and work with the
clients and workers. Students will carry out interviews
with clients and workers (with their prior permission).
Students are expected to critically reflect on activities
at JJCDR, complete the learning logs, and prepare a report to be included in the portfolio.
Outcomes:
At the completion of the visit, the student should be able to
Describe the history of JJCDR
Describe the structure and organization of JJCDR
Describe the services provided by JJCDR
List reasons for and levels of amputation
Discuss pre-prosthetic management
Describe the steps in fitting an artificial limb
Discuss post-prosthetic management
Describe the complications that mayoccur after the fitting of prosthesis
List the advantages and disadvantages of a Jaipur limb versus a polypropylene limb
Discuss social and economic rehabilitation after fitting the prosthesis
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Learning resources:
JJCDR (n.d.).
Guy’s and St. Thomas’ Hospital NHS Foundation Trust (n.d.). Rehabilitation after
your Lower-Limb Amputation.
4.7 Cancer Aid for North/East (CANE)
Students will be posted with the Director of
CANE. Initially the tutor will discuss the
organizational structure, facilities and
activities at the hospice. Then the students
will be divided into groups and work with
the patients and service providers.
Students will carry out interviews with
patients and service providers (with their
prior permission). They will observe the
facilities available at CANE and gain familiarity with related health and social issues.
Students are expected to critically reflect on activities at CANE, complete the learning
logs, and prepare a report to be included in the portfolio.
Outcomes:
At the completion of the visit, the student should be able to:
• Describe the history of CANE
• Describe the structure and organization of CANE
• Describe the services provided by CANE
• List the criteria and process of admission to the hospice
• Describe the activities carried out by the organization in the hospice and in the
field
• Discuss future plans for improving service provision
• Critically analyze the gap filled by CANE in the health system
Learning resources:
CANE (2006). Cancer Aid for North/East (Sri Lanka).
National Caregivers Library (2016). Hospice vs. Palliative Care.
World Health Organization (2015). Palliative Care.
National Cancer Control Programme (2016).
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4.8 Mental health services in the community - Shanthiham
Students will be posted with the Director of Shanthiham. The tutor will first discuss the
organizational structure, facilities and activities of the organization. Then students will be
divided into groups and work with the service providers. Students will carry out interviews
with clients and service providers (with their prior permission). They will observe the
facilities available at the organization and gain familiarity with related psychosocial issues.
Students are expected to critically reflect on activities at Shanthiham, complete the
learning logs, and prepare a report to be included in the portfolio.
Outcomes:
At the completion of the visit the student, should be able to
• Describe the history of Shanthiham
• Describe the structure and organization of Shanthiham
• Describe the services provided by the organization
• Describe the activities carried out by the organization both at the institution and
in the field
• Discuss future plans for improving service provision
• Discuss funding issues faced by the organization
• Critically analyze the gap filled by Shanthiham in the health system
Learning resources:
Shanthiham (2017).
World Health Organization (2016). From the Hospital to the Community: Caring
for Mental Health in Sri Lanka.
Mental Health Directorate (n.d.). The Mental Health Policy of Sri Lanka 2005-
2015.
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5. Skills Lab
Students will be posted to the Skill Lab at the Faculty of Medicine. The tutor will
demonstrate basic clinical procedures and assessment methods with the help of models.
Then students will be divided into groups and practice their skills on the models. Students
are expected to complete the learning logs and prepare a report to be included in the
portfolio.
Outcomes
At the completion of the activity, the student should be able to
Demonstrate the following clinical skills
o Measure blood pressure according to the NICE guideline
o Calculate BMI and interpret the result
o Use the WHO/ISH risk predication chart
o Visualize the cervix and interpret findings
o Perform a Pap smear and interpret findings
o Perform clinical breast examination and interpret findings
Learning resources:
NICE (2011). Hypertension: The clinical management of primary hypertension in
adults.
BMJ (2014).Identification, assessment, and management of overweight and
obesity: Summary of updated NICE guidance.
Centers for Disease Control and Prevention (2015).About Adult BMI.
World Health Organization (n.d.).WHO/ISH Risk Prediction Charts.
National Cancer Control Programme (2014).Prevention and Early Detection of
Common Gynaecological Cancers.
National Cancer Control Programme (2014).Early Detection and Management of
Breast Symptoms.
World Health Organization (2014). Comprehensive Cervical Cancer Control: A
Guide to Essential Practice.
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6. Clerkship Review
The Clerkship Review is held at the Seminar Room at DCFM once a week during the
attachment. Together the tutor and students will review the field activities covered during
the previous week. The purpose of the review is to encourage students to discuss,
understand, and critically reflect on their field experiences in relation to the broader health
system and social determinants of health. Students are expected to demonstrate
familiarity with assigned readings and contribute actively to classroom discussion. Their
contributions to each review will be assessed by the tutor on the basis of preparatory
work, group activities, and discussion.
7. Student assessment and evaluation
The Community Medicine Clinical Attachment will account for 15% of the overall marks in
Community Medicine at the Second Examination for Medical Degrees. This mark will be
calculated as follows:
7.1 Attendance, attitude and application (7.5%)
7.2 Professionalism (7.5%)
7.3 Learning logs (20 %)
7.4 Health education activity (15 %)
7.5 OSCE (30 %)
7.6 Portfolio assessment (20 %)
7.1 Attendance, attitude and application
Attendance
Student attendance will be recorded (p. 6)
Attitude and application
Students are expected to do the recommended reading and contribute to group
discussions and activities on each placement day
Students that have attended fully and contributed in an exceptional way over the
course will be awarded a merit grade.
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Merit Pass Referred
Attendance Full attendance or <2
sessions
missed with
satisfactory
explanations
<3 or fewer sessions
missed
>3 sessions missed.
These students will be
referred to the Head
of the Department
Attitude and
Application
Punctual, preparatory
work done,
contributes in an
exceptional way
to group activities and
discussion
Good timekeeping, some
preparatory work done,
contributes to group
activities and discussion
Poor timekeeping,
inadequate
preparatory
work, poor
contribution to
group activities and
discussions
7.2 Professionalism Assessment
Students will be given formative feedback on professionalism when their work is reviewed
by the tutor during the attachment. Enough opportunities will be provided for them to
address their attitudes and performance before going for the summative assessment.
Professionalism Assessment Form:
Feedback will be given to every student about the professionalism they demonstrated
during their placement. Upon completion of this form, the student should respond on
the reverse of the form.
Student Name: Satisfactory Cause for
Concern
Unsatisfactory Unable to
observe
1 Honesty and integrity:
Always honest with
community members/
patients, peers, staff
and in professional work
(presentations,
documentation,
communication)
2 Reliability and
responsibility:
Reliable and conscientious,
punctual, completes
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assigned tasks, accepts
responsibility for errors.
3 Respect and empathy: for
community members/
patients: Consistently
demonstrates respect for
their autonomy and dignity,
maintains confidentiality.
4 Respect for others: Is
respectful toward tutors, the
public health team, and
members of staff.
5 Communication and
collaboration: Works
cooperatively and
communicates effectively
with community members,
patients, tutors and
members of the public
health team.
OVERALL ASSESSMENT
7.3 Learning logs
The learning log is made up of two elements: the students’ reflections on field activities
and their self-assessment on meeting the learning objectives for the day. Both should be
completed for each day. It is a tool that the students use to record and reflect on their
learning and their professional development through the attachment.
Reflective writing
Students should complete a reflective piece of writing of about 300 words after each
field visit. The issue reflected up on will be discussed at the clerkship review.
Self-assessment of achievement of learning objectives
At the end of each day, the students should write a brief summary of how they have
covered each learning objective. If learning objectives have not been covered,
students are expected to explain when and how they will be covered – either through
independent study or by covering the objective on another placement day. They should
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write about 50-100 words against each objective. They may wish to refer to notes they
have made elsewhere or to material they have read.
Assessment of the learning logs
The learning log will be assessed formatively at the end of each week. Students will be
given guidance and feedback on their performance to date. When giving formative
feedback, emphasis will be given to determining whether a student’s performance is
satisfactory and identifying ways in which they could improve rather than on grading
work. If a student’s work is not satisfactory, they will be given guidance on how to
improve their performance. On the final day, the learning log will be graded and the
grade discussed with the student. Personalised mark sheets for the students will be
kept for the final assessment.
Assessment
criteria
Merit Pass Referred
Learning
objectives
Each learning objective
addressed, evidence of
consideration of own
learning needs, strategy
to meet learning
needs where necessary
Most learning objectives
addressed, limited
evaluation of own
learning needs, weak
strategy to meet
identified learning
needs
Some learning objectives
not addressed, no evidence
of ability to assess own
learning needs, inadequate
strategies to meet learning
needs
Reflective
Writing
Demonstrates ability to
reflect on experiences
and issues and to be
self-reflective and to
extrapolate these
reflections to future
practice
Demonstrates ability to
reflect on impact of
experience on self or to
reflect on issues
Description of experiences
only, no analysis of
experience or of impact on
self
7.4 Health education activity
Students (in pairs) should carry out a health education activity on a health-promotion
theme and deliver a 5-10 minute presentation to the tutors and other students and any
other members of the Department who may be present. The topic will be decided in
consultation with the tutors, but should be on a health promotion theme they have
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observed during their placement. Students should be prepared to answer questions.
Tutors will give feedback and grade the presentation.
Assessment
criteria
Merit
Score 7-10 for each
category if:
Pass
Score 4 -6 for each
category if:
Referred
Score 1-3 for each
category if:
Content Theme explored
thoroughly and logically
and relevant to the
students’ own
experiences and the
needs of the
patient/client groups
they have met.
Literature referenced.
Theme is explored in a
logical manner with
reference to the
students’ own
experiences.
Theme is explored in a
haphazard manner;
reference to the
students’ own
experience is muddled.
No reference to the
literature.
Verbal
presentation
skills
Students present their
work in a very clear,
understandable and
interesting fashion. They
show great enthusiasm
for the subject and
engage with their
audience fully.
Students present their
work in a clear,
understandable and
interesting fashion.
They show enthusiasm
for the subject and are
able to engage with
their audience.
Students’ ability to
present work clearly is
less developed and
their interest in their
subject is superficial.
Their enthusiasm and
level of engagement
with the audience is
limited.
Teaching aids Visually very interesting,
excellently laid out,
contains a balance of
different written, pictorial
and diagrammatical
images and leads to an
increased understanding
and engagement with
the subject under
consideration.
Visually interesting,
reasonably laid out,
contains a balance of
Different written,
pictorial and
diagrammatical images
and leads to
understanding and
engagement with the
subject under
consideration.
Not very interesting, is
not very well laid out
and lacks balance
between written,
pictorial and
diagrammatical
images. It does little to
enhance
understanding and
engagement with the
subject under
consideration.
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7.5 OSCE
In the fourth year of the medical programme, students will be assessed at an OSCE
related to the learning outcomes of the community attachment.
7.6 Portfolio Assessment
There will be a viva to assess the portfolio at the end of the community attachment.
Students will be assessed on the basis of the portfolio and the achievement of their
learning objectives.
8. Guidance on Reflection
‘‘Medical education has traditionally focused on the assimilation of vast amounts of
knowledge and on clinical apprenticeship as the ‘hallmark’ of good training, and has
undervalued reflection in learning. Today, however, medical and dental education needs
to prepare students for lifelong learning. It must foster professionals who take a deep
approach to learning and equip students to determine their own learning needs, set their
own learning goals and monitor the occurrence of continuing progress. To achieve this, a
more reflective approach is called for’’ (Pee et al, 2000).
It is important that students develop a habit of assessing their own learning needs,
developing strategies to meet them and reflect on their own learning and personal
development.
“Reflection – the conscious weighing and integrating of views from different perspectives –
is a necessary prerequisite for the development of a balanced professional identity …
acquiring knowledge and practical skills alone are not enough to become a medical
professional. Reflecting on education and clinical experiences in medical practice, including
one’s own behaviour [is] crucial” (Boenink et al, 2004).
Reflective practice was introduced as a concept for many professions in the1980s.
Reflective practice means that we learn by thinking about things that have happened to us
and seeing them in a different way.
There are three components to reflective practice:
• Experiences – that happen to a person
• Reflective process – that enables a person to learn from their experience
• Action – resulting from the new perspective taken as a result of the reflection
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Reflection as a learning activity comes from educational theory; Kolb (1984) describes a
cycle of stages that are gone though in learning from experience:
As you engage in reflective writing:
Consider what you did on your placement visit today…do anything that happened during
the day surprise you? Did anything that happens during the day contradict or challenge
your ideas or expectations? Have your views changed?
For example,
If you met a patient:
How did the patient’s life experiences differ from your own?
Were you able to empathise with the patient?
If you were shadowing a health care professional:
Did anything about the person’s role surprise you? Do you think the roles of all
members of the multidisciplinary public health team are valued? How do you feel about
team working with other professionals?
Your knowledge:
Have you identified gaps in your knowledge or skills?
How might you go about addressing these?
Or you might like to use one of the following frame works to reflect on
your experience:
A learning experience (Pee et al, 2002)
Briefly describe what happened.
• Describe your feelings at the time this happened.
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• Why do you consider this experience to be worthy of reflection?
• What strengths in your clinical practice did this experience demonstrate?
• What learning needs did this experience reveal to you?
John’s Model of Structured Reflection (1994)
Cue questions:
1. Description of the experience
• Phenomenon – describe the here and now experience.
• Causal – what essential factors contributed to this experience?
• Context – what are the significant background factors to this experience?
• Clarifying – what are the key processes (for reflection) in this experience?
2. Reflection
• What was I trying to achieve?
• Why did I intervene as I did?
• What were the consequences of my actions for?
Myself
The patient/family
The people I work with
How did I feel about this experience when it was happening?
How did the patient feel about it?
How do I know how the patient felt about it?
3. Influencing factors
• What internal factors influenced my decision making?
• What external factors influenced my decision making?
• What sources of knowledge did/should have influenced my decision making?
4. Could I have dealt with the situation better?
• What choices did I have?
• What would be the consequences of these choices?
5. Learning
• How do I feel now about this experience?
• How have I made sense of this experience in light of past experiences and future
practice?
• How has this experience changed my ways of knowing?
(Adapted from Queen Mary University of London (n.d.). Guidance on Reflective Writing.)
Design by Miss Therega Balakrishnan
