Medical Colleges In India Research Articles

A cross sectional study on the online teaching strategies of gross anatomy and histology during the COVID-19 pandemic periods

The subsequent implementation of social distancing during the COVID-19 pandemic has forced universities to keep the students away from the institutions. The aim of the study was to conduct a survey through medical colleges among anatomy teachers along with an exploration of optimization of the transitions which can assist to improve the quality of online teaching. The objectives were to identify the virtual learning interventions implemented by different medical colleges in India during Covid-19 pandemic periods, and to identify suitable technological intervention for teaching anatomy from the educator’s point of view. A cross sectional study was conducted by convenience sampling method. A differential rating scale questionnaire study was conducted. A hundred participants from the department of anatomy of 100 medical colleges with a minimum of 3 years of experience in teaching in the field were the samples. Faculty other than anatomy department of medical colleges was excluded. Consents were taken from each participant and participant information was shared by email. The teachers were from both from Government and from Private Institutions. For most teachers, the biggest difficulty in implementing online teaching during the initial year of online teaching at 2020 was the unstable online teaching environments, platforms and tools (47%), followed by their unfamiliarity with online teaching techniques, platforms and tools (26%). Further, 17% had problems due to insufficient training and management of online teaching from college. This study assists to improve the design and quality of online teaching by suggesting for the change in infrastructure by arranging online portal handson coaching for rendering online education.

Face mask use and disposal behaviour of frontline young doctors during the COVID-19 pandemic: a two-year study.

The COVID-19 pandemic has severely affected India in spite of an ongoing vaccination campaign. The doctors are at greater risk of COVID-19 and face masks are a protective measure against this threat. We assessed the use and disposal of face masks among postgraduate trainees (PGTs) working on the COVID-19 frontline in an Indian medical college. Data was collected from all PGTs who agreed to participate during the first, second and third wave of the pandemic in India. A pre-tested questionnaire to assess and compare face mask use and disposal behaviour across the three phases was used. All participants used face masks regularly; a significant uptrend in N-95 mask users and double mask users was observed as the pandemic progressed. Use of face shields peaked during the second wave. Most participants preferred keeping the mask on always at work and avoided donning and doffing of masks in between usage. Many of them practiced 'extended use' of face masks and nearly a third re-used a mask for ≥ 6 days, which is against the standard recommendations; however, such behavior among participants showed a downward trend. Proper disposal practices were not followed by many participants, leaving scope for environmental contamination. There is an imminent need to make the young frontline doctors aware regarding appropriate mask usage and disposal for better preparedness before any health exigencies of the future.

Using Kahoot! as an assessment tool to enhance learning in a traditional lecture-based classroom

Purpose: Game based learning when introduced into traditional classroom environments makes learning fun. Kahoot! is a game based app which can be used to assess students’ knowledge, and is a promising tool for formative assessment. The purpose of the study was to measure the extent to which the popular game based online platform of “Kahoot!” is effective as a tool of assessment for learning. Methodology: The crossover study was conducted at a medical college in India. Sixty students participated with 30 in the Kahoot! Group and 30 in the Control group. Four topics were taught; assessments were done immediately after a topic was taught and 15 days afterwards to assess knowledge retention. Results: Analysis showed statistically significant improvement from initial test to retention test in both the Kahoot! and Control groups in all four sessions. Out of 120 respondents from each group who attended the four sessions, 75% (90/120) of respondents in the experimental group (Kahoot!) scored 17.7% more than the Control group in the test held immediately after the lecture and 76.6% (92/120) respondents in the experimental group scored better than the Control in the test held after 15 days. Students found that Kahoot! sessions were motivating, engaging and made learning fun. Conclusion: Kahoot! is a promising formative assessment tool that can be introduced in a traditional classroom to enhance learning.

Need of Strong Biostatistics Component in Medical Colleges in India: Time to Accept the Overdue Reality

Statistics may be defined as “Methods to plan a study scientifically, collect quality data, analyze appropriately, interpret analytical results correctly and derive implications accurately.” To be more specific, all methods of gaining knowledge are essential statistics. Statistics principles remain the same regardless of the area in which it is used. However, it is differentiated by area of its use, like biostatistics, while it is used in medical sciences, business statistics in business research, and agricultural statistics in agricultural sciences. A host of literature is available on various aspects of statistics, including its varying applications, uses and misuses. The present write-up aims to briefly emphasize the need of strong biostatistics components in medical colleges in India.

Conservative treatment of Head and Neck hemangiomas using Intralesional Bleomycin.

Hemangiomas are vascular tumours and commonly occur in head and neck region. Complete treatment of these vascular swellings are often challenging. As surgical excision carries high risk of complications and poor cosmetic outcome, treatment is shifted more towards non-surgical modalities like steroid therapy, radiotherapy, chemotherapy and sclerotherapy. To study the efficacy of intralesional Bleomycin sclerotherapy for head and neck hemangiomas. Seventeen patients ( 9 males and 8 females) with head and neck hemangiomas were treated with sclerotherapy using intralesional bleomycin injection ( 0.1-0.5mg/kg/ dose) in a medical college of India. Details of the patients were recorded along with serial photographs of lesion. Post injection outcomes in form of reduction of lesion size, patient satisfaction and complications were also recorded. 11 patients were completely cured, 3 had more than 50% reduction in size, one patient showed minimal reduction and two had no response. One patient had superficial ulceration, one case of slough and fever was reported. None of the patients developed severe toxic side effects and pulmonary fibrosis with follow up of 18 months. Bleomycin injection is safe, easy and well tolerated method for treatment of head and neck hemangiomas. We recommend surgery only if there is no response to other conservative treatment modalities.

District Medical Colleges in India – Addressing the Rural Health-Care Needs

The shortfall of human resources in health has resulted in skewing the distribution of health workers such that vulnerable populations in rural, tribal, and hilly areas continue to be extremely underserved. To address the regional disparities in medical education and availability of human resources in health, the policy of establishing one medical college at each district in India was initiated. The situation of human resources in health remains inadequate. To address the regional disparities in medical education and availability of human resources in health, the policy of establishing one medical college at each district in India was initiated. Impressive progress has been made during the past few years with respect to opening new medical colleges in the area of need across geographical coverage.

Will you choose neurosurgery as your career? An Indian female medical student perspective

ObjectiveWe aim at recognising the reasons that discourage female medical students to consider neurosurgery as a career, from an Indian perspective. MethodologyAn online survey was disseminated in various medical colleges of India. The study included female medical students (both cis and trans). The questionnaire consisted of objective questions on mentorship, opportunities and exposure. Their concerns on long working hours and the reasons for the same were recorded. Results348 responses were included of which 79.9 % of students felt they didn't receive proper exposure to neurosurgery in their medical school. 87.4 % of the respondents faced a lack of opportunity and mentorship for research. 65.2 % of students felt that they would be more interested in neurosurgery if a female professor were to mentor them. Long working hours and Reduced Family and Personal time were identified as statistically significant factors (p < 0.001) that play a role in demotivating female medical students towards neurosurgery. Altered quality of life was the most frequent (79.49 %) and significant reason (p = 0.004) as to why long working hours were a concern for them. 65.07 % of participants did not consider physical strength to be a hurdle (p = 0.008). Approximately 37.6 % participants felt that maternity and neurosurgery could be incompatible (p = 0.005). ConclusionsThe study brings out the notions that female medical students have regarding the long working hours and decreased family and personal time, complicated by pregnancy and maternal leave in the life of female neurosurgeon.

Body &amp; organ donation in Bihar – A multicentre study on awareness among students of 1st professional MBBS course

Background: With the attendant rise of the number of medical colleges in India over past few decades, the demand for cadavers used in medical education and research is growing. However, there is an insufficient supply of donated cadavers available for dissection. Objective: The present study aimed to assess the awareness about Body &amp; Organ Donation among students of 1st Professional MBBS course in Bihar, India. Materials and Methods: This retrospective, longitudinal cohort, observational multi-center study was carried out between March-2022 to May-2022 on consecutive 500 medical students admitted in 1st Professional MBBS course, studying at KATIHAR MEDICAL COLLEGE, KATIHAR, MADHUBANI MEDICAL COLLEGE, MADHUBANI and PATNA MEDICAL COLLEGE, PATNA, between the study duration. Inclusion criteria composed of only newly admitted first year medical students, following their informed consent whereas, second year, third year and fourth year medical students were excluded from this study. Approval was obtained from Institutional Ethics Committee. A structured questionnaire containing 29 items was administered after due consent by the department of anatomy of each of the above-mentioned medical colleges. The collected data was entered in Microsoft Excel to maintain the quality of data.

To study the challenges in the implementation of “Foundation Course” of newly launch competency-based medical education curriculum among Indian medical colleges

Background: Medical knowledge is advancing at a rapid pace in a world, where technological evolution is at an all-time high. However, the health-care system falls well short of acceptable standards when it comes to meeting patient demands. Our medical environment, on the other hand, requires conscious revamping to increase healthcare quality. Traditional training approaches are significantly lacking in this era of value-based medicine, which prioritizes quality measurement and provider proficiency. Competency-based medical education (CBME), with its emphasis on individual, programmatic and institutional outcomes, has the ability to realign medical education with this social expectation. However, CBME implementation, on the other hand, is fraught with many challenges. Aim and Objectives: The aim and objective of this article is to study the challenges in implementation of “foundation course (FC)” ofnewly launch CBME in Indian settings. Materials and Methods: The study was conducted in a tertiary care center in the specialty of advanced course in Research Methodology. This was an observational study with records of 180 participants in 2019–2020 year. The average age of group was 13–50 years. Results: One hundred and forty students and 40 teachers from various Medical Colleges had participated in the study. Around 70% participants had rated positive for the implementation of FC, while around 17% rated below average for the implementation of FC. Classes on Communication and Language (52.2%) and Computer and IT (45%) could not be taken was pointed out by the students. 35% of the students and 22.5% of the teachers pointed out that existing infrastructure is not sufficient for implementation of CBME. About 12.5% students express the concern that less study material is available on new CBME and topics included in the FC. Around 40% of the students and 17.5% of the teachers had express their concerned about time management during FC. Conclusion: The education community has begun to address the difficulties associated with implementing of CBME. Models and guidance are available to inform implementation strategies across the educational continuum, with a focus on the more efficient use of resources and technology, as well as the use of milestones and entrustable professional activities-based frameworks.

Usage of Learning Management System to Implement Online Teaching Methodology in Undergraduate Medical Students

Background: The COVID-19 pandemic caused a temporary roadblock in learning among medical colleges in India as traditional classroom teaching was suspended temporarily. Students and faculty members had to adapt in a short period of time to transition from traditional practices of live classroom lectures to a virtual mode by using learning management system (LMS). Objectives: The present study aims to describe the perceptions of students and faculty members about their experience using the LMS to attend online classes. It also aims to assess the possibility of using the same for postgraduate medical education, particularly in specialties requiring visual aid for learning such as radiology, dermatology, and pathology. Materials and Methods: A cross-sectional survey-based observational study was conducted on 123 MBBS students and 36 faculty members after 6 months of the online teaching using LMS. Responses were collected on their experience with the LMS and assessed using a three-point Likert scale. Results: About 62.6% of the students who participated in the study felt that it was easy to log into the LMS platform. About 58.6% of the students felt that the audio and video quality of the classes on the platform was good. The majority of students (93.5%) felt that the user interface of the LMS was easy to use. Poor Internet connectivity issues accounted for the main cause of interruptions during online classes for 48% of the students. About 88.9% of the faculty members felt that it was easy to log into the LMS to conduct online classes. Around 86.1% of them felt that the audio and video quality was good on the platform. Browsing through the platform during online lectures was easy according to 75% of them. Conclusion: The majority of students and faculty members felt that the user interface and quality of the audiovisual feed of the LMS were very good. The LMS platform made the scheduling of classes, marking attendance, and usage of additional annotation tools convenient. Usage of LMS can supplement the traditional face-to-face lecture classes to enhance learning in medical undergraduate and postgraduate education.

Assessment of Language Proficiency and Enhancement Among 1st Phase MBBS Undergraduates

Background: Limited language proficiency (LLP) in English and state language may constrain the impetus of a medical undergraduate for effective communication, social interaction, and academic progression. Hence, the study aimed to explore the extent and perceptions pertaining to language barrier among medical undergraduates and to obtain feedback about language and communication skill sessions of foundation course. Materials and Methods: This multi-centric cross-sectional study across five medical colleges in India involved participation of 691 1st phase MBBS undergraduates. The study was conducted in two phases: (a) at the beginning of Foundation course before initiation of language training classes and (b) at the end of training sessions. The questions were either semi-structured or multiple-choice type regarding (a) sociodemographic characteristics, (b) schooling details, and (c) questionnaire regarding proficiency of English and local language and emotional and cognitive responses toward LLP. Results: Out of 691, proficiency for English and respective state language was confirmed by 170 (24.6%) and 318 (46.02%), respectively. Ninety (13.02%) students had no acquaintance for respective state languages. Difficulty in understanding concepts when taught in English and communication breakdown were expressed by 121 (18.22%) and 263 (38.95%) students, respectively. Regarding language and communication skill sessions, improvement in English and state language was expressed by 495 (71.63%) and 521 (75.4%), respectively. The sessions rating was highest for usefulness, followed by quality. Conclusion: Approximately 75% and 50% of MBBS undergraduates of 1st phase expressed LLP for English and state language, respectively, which represents a liability. Language enhancement benefited students in terms of usefulness and better comprehension of medical terminologies and colloquialism. Circumspection of language barrier among medical undergraduates would bridge the gap of linguistic knowledge and communication goal.

Feasibility and Effectiveness of Objective Structured Clinical Examination for Assessment of Field Visits in Community Medicine for Undergraduate Medical Students

Introduction : The Graduate Medical Education Regulation (GMR) 2019 in the curricular reforms recommends that “Shows How” level of the Miller's Pyramid is assessed through long case, Objective Structured Clinical Examination and Mini-Clinical Evaluation Exercise (Mini CEX). Objectives : 1. To utilize OSCE for assessing Field Visits carried out by Undergraduate medical students as formative assessment. 2. To find out the feasibility and effectiveness of Objective Structured Clinical Examination (OSCE) in Community Medicine. Method : An Educational Innovation Pilot Project was carried out in the department rd of Community Medicine of a Medical College in India. A pilot (18) of 3 MBBS students were assessed through Objective Structured Clinical Examination (OSCE) for epidemiological case study of malaria assigned to the author faculty. These students were also exposed to the oral viva. The analysis of the assessment was through assessment of codes of the procedure stations through checklists and mean scores of procedure and response stations. Qualitative analysis of emerging themes and quantitative analysis as likert scale were utilized for evaluation of the exam were used. Results : The mean score of all response stations was 5.1. Almost all students felt that OSCE was better than the conventional oral viva in assessing skills. Furthermore, almost all students and faculties suggested that it should gradually become a part of curriculum and scaled to entire and other batches with suggested modifications. The residents who participated as simulated cases found it to be a novel experience and a different kind of learning process. Conclusion : It is feasible to introduce OSCE with some modifications in assessing skills acquired in field visits in Community Case Management.

Is General Surgery as Specialsed Medical Branch Getting Extinct in Country?

Today, in India, there are about 12,780 post-graduate seats in Master of Surgery of which there 1600 seats are in General Surgery offered by various Government and private medical colleges in India. There is a matter of grief situation that each year less number of undergraduates opting for the General Surgery branch. The foremost reason of it is that the amount of hardwork and stress which a trainee undergoes is incomparable to any other branch. Practicing General Surgery is not an easy job to have for anyone especially in an overpopulated country like India. Secondly, it is not a terminal branch as super-specialization in various disciplines is being offered after completion of postgraduation in General Surgery. So, again toiling for straight 3 years in General Surgery, a fresh Post Graduate (PG) has to again prepare hard to get into any Super-Specialty (SS) branch of his interest as only about 200 seats are being offered in various surgical super-specialty branches across the country. Finding General Surgery a hard road to walk, most undergraduates opt for less tiring branch which may also happens to be a terminal branch. The higher education in medical field is quite a costly affair owing to a few number of Government colleges offering the PG and SS seats. They may cost up to or more than one crore in many of the private medical colleges. To add to this is the ever increasing caste based reservation policy of the Government which is not doing justice to many according to many of the experts and educationists. All these factors result in many seats remaining vacant in the mentioned branch especially in SS across the country. Though the Government has established a new commission i.e. National Medical Commission (NMC) to look after the lacunae in the country’s medical education system, still there is lot that has to be done in this field. There aren’t sufficient faculty posts in the department of General Surgery and surgical super-specialties bearing burden over the system to look after increasing patient burden. General Surgery is the backbone of every institution and hospital which at present is overstressed thanks to the laid-back approach in policy making. Surgeon also has to face burnt of medico-legal proceedings every now and then in our country. Government is thumping it's back of opening more number of medical colleges in different states across the country but the fact is that nothing is on their agenda to improve the actual quality of medical education whatsoever is there. There is no concept of wet lab in surgery department even in various premium institutes of the country. There has not been any mentioning of arranging cadaveric dissection courses in the curriculum of post graduation. No fruitful research has come out from ages in the said department from so called research medical institutes. System has made the PG students to think each second about finishing off with their mandatory thesis work and pass the final exit examination without giving any attention to improve their clinical skills. And once they pass their examination, they start preparing for the entrance examination to get into SS branch of their choice. If this trend continues to work, time will come that patients will find it really tough to get well qualified surgeons for getting them operated in the country. Those who can afford will fly outside the country to get their ailment treated where better facilities are available as done by various dignitaries and politicians even now, whereas those who cannot afford to do so will ultimately succumb or may fall prey to the quacks. There is urgent need of revamp of the system where some better policies are being formulated to save this branch of medicine in our country. There is a need to ignite the interest among the medical undergraduates towards this branch so that more and more students should take up the General Surgery as their choice in future.

Homoeopathic Oath

The oath of medical students is in news as the National Medical Commission (NMC) proposed to replace the Hippocratic oath with the Charak oath for the students of medical colleges in India as on February 7th 2022. The NMC replaced the Medical Council of India (MCI) in September 2020 [14]. The issue got highlighted further with the students of Madurai medical college took the Charak oath instead of the Hippocratic oath in 2022 [1]. Further, in Lucknow, breaking a 110 year old tradition, the students of King George Medical University (KGMU) took Charak Shapath on the first day of 2021-22 sessions [3]. The current article sees through the oath lens &amp; makes an effort to remind Homoeopathic fraternity to remember the Homoeopathic oath or the aphorism of the Organon of Medicine as written by Dr. Hahnemann, the founder of Homoeopathy [5]. The article assumes significance with the Times of India newspaper printing the above-mentioned aphorism as the thought for the day on 12.2.2022 in its editorial page. Further, the there is an editorial column regarding the oath below the thought for the day. The relevant page is given in the figure 1 of this article.

Seeking graduation in medical colleges outside India: Is it a 'win-win' or 'lose-lose' situation for the stakeholders and the nation?

The future of Indian students who return as 'foreign medical graduates' (FMG) after training in certain countries is often uncertain. We collected data from newspapers, government resources and agencies involved in handling this issue. We analysed the current status of medical education in India, the Commonwealth of Independent States (CIS) and some neighbouring countries. Of approximately 1.4 million (14 lakh) students taking the National Eligibility cum Entrance Test (NEET), about 5.8% get admission in medical colleges. There are about 554 medical colleges in India with 82 550 MBBS seats, 51.9% seats belong to the government quota. Parents who send their children to a foreign country to do medicine spend ₹1.5 million (15 lakh) tò4 million (40 lakh) against an estimated annual income of ₹1.2 million (12 lakh) and the child spends 4-6 years in a foreign country. Of 38 150 FMGs who took the examinations conducted by the National Board of Examinations from 2015 to 2018, 18.9% passed the FMG examination mandatory for registration to practise medicine in India. The National Medical Commission is trying to solve this issue by removing the age bar for entry to MBBS and recommending lowering of fees for MBBS in government quota. Seeking graduation in medical colleges outside India may not be advisable for those from the middle/ low-income group of India.

SWOC-ANALYSIS OF CBME IMPLEMENTATION FOR PHASE II MBBS IN ONE OF THE LARGEST PRIVATE MEDICAL COLLEGES OF EASTERN INDIA

Competency Based Medical Education (CBME) was introduced in medical education in India in the year 2019 with an aim of producing more competent and globally relevant doctors to the community. CBME is a learner driven process where faculty members play the role of facilitators only. Though CBME has its own advantages but implementing it across all the medical colleges in India has been a huge challenge. Curriculum Implementation Support Programs (CISP) were already introduced for the faculty members of rst and second professional MBBS in a phase wise manner by National Medical Commission (NMC) under the National Faculty Development Program (FDP) to orient the faculty members regarding the implementation of this new curriculum. Students of Phase II MBBS were exposed to this new curriculum for the rst time in the year 2021, an unavoidable delay caused by the pandemic situation. This study was conducted to analyze the strengths, weaknesses, opportunities, and challenges of this new curriculum from the perspectives of faculty members of Phase II M.B.B.S.

Stages of Concern of Medical Faculty toward Adoption of Competency-based Medical Education in India: A Multicentric Survey.

Context:Currently, a major curricular reform in the form of competency-based medical education (CBME) curriculum is being rolled out across all medical colleges in India. However, it is important to find out and address the concerns of faculty regarding various aspects of this new curriculum.Aim:To analyze the concerns of the faculty members of medical colleges in India in response to the changes emerging from the adoption and implementation of the new curriculum through the concerns-based adoption model by applying the stages of concern (SoC) questionnaire.Methodology:A multicentric, cross-sectional quantitative study involving faculty members currently working in medical colleges and with more than 2 years of teaching experience was conducted using SoC questionnaire (SoCQ). The questionnaire was delivered as Google Form.Results:Of the 744 faculty participants, 41.1% (306) of faculty belonged to the 31–40 years age group followed by the 41–50 years age group (267, 35.9%). Respondents rated their level of concern differently among the seven SoC - percentile scores were highest in Stage 0– awareness (94) and least in Stage 4– consequences (59). An appreciably higher percentile scores were seen at the consequences stage (63 vs. 54), collaboration stage (80 vs. 68), and refocusing stage (77 vs. 69) in those faculty members who were trained in curriculum implementation support program (CISP) compared to the untrained group. However; the SoCQ profiles of CISP trained and untrained faculty were very much similar. SoCQ profiles of holders of advanced training in medical education and non-holders were also the same.Conclusion:Almost after 2 years of well-planned introduction of the CBME curriculum in India, the generalized faculty profile is still suggestive of interested but non-user type for the adoption of CBME. However; compared to untrained faculty, CISP trained faculty is more concerned about the impact of CBME on students, collaborating with colleagues for its proper implementation and exploring more benefits from the implementation of CBME, indicating that more hand-holding is required for faculty development beyond CISP.

WHATSAPP MESSENGER IS A FEASIBLE TOOL TO COMPLEMENT THE TRAINING OF MEDICAL EDUCATORS IN INDIA.

Background: Instant Messenger apps in Social media have become a new normal in the difcult COVID 19 Pandemic times. WhatsApp Messenger (WA), as a representative tool of instant messenger Apps, is universally used in India. The ease of sharing text messages, data, and images in groups has decreased the communication between people. This study aims to assess the perception of medical educators across India in incorporating WAas a complementary medical education tool and to study group dynamics between different sizes of WhatsApp groups. Methods: 126 faculties from different medical colleges of India were part of training in medical education supported by WhatsApp. There was the main group of all faculty and six variable sizes smaller groups. An online lecture followed by the WA interactive session was conducted daily at a xed time slot for four weeks. An analysis was performed based on the results of the structured questionnaire after the session on the usefulness of WhatsApp in medical education and the group dynamics after that. Results: 93.6 % of the participants felt that WA is an essential tool in medical education. 42.3 % of participants felt interaction as the main advantage, followed by information sources (26.9%) and discussion activities (15.3%). The participants in smaller WA groups felt that interaction in smaller groups was better than in larger groups (P&lt;0.05). Conclusion: The ndings of this study illustrate that WA is a complementary teaching tool that facilitates an optimum environment for learning. While the WAcan provide information and serve as a platform interaction, the group size affects the dynamics.

Unusual Course of Posterior Intercostal Vein at the 3rd Intercostal Space – A Case Report

The posterior intercostal veins drain the thoracic wall and lie in the costal grooves along with the intercostal arteries and nerves posterior to the thoracic sympathetic chain. During routine dissection of the posterior mediastinum of a formalin-fixed male cadaver in the Anatomy department of an undergraduate and postgraduate teaching medical college in India, a large-sized posterior intercostal vein was identified crossing anterior to the thoracic sympathetic chain at the level of the 3rd intercostal space on the right side. The presence of such variation may hinder the surgical procedure of the posterior mediastinum and will pose an increased risk of intraoperative or postoperative bleeding. Knowledge of such variation is necessary to avoid laceration of the posterior intercostal vein, which is the potential cause of bleeding in the region of the thorax.

Every Second Matters - uterine balloon tamponade implementation across ten medical colleges in Maharashtra and Madhya Pradesh in India: A qualitative study.

To understand facilitators, barriers, and perceptions of the Every Second Matters uterine balloon tamponade (ESM-UBT) package implemented across 10 medical colleges in India, 3years after the program was introduced. Semi-structured interviews were conducted until thematic saturation in March 2020. Multiple provider cadres, including nurses, Obstetrics/Gynecology residents, professors, and program leads, were eligible. Interviews were transcribed and thematically coded using an inductive method. Sixty-two obstetric providers were interviewed. Facilitators of implementation included recurrent training, improved teamwork and communication, strong program leadership, and involvement of lower-level facilities. Barriers to implementation included administrative hurdles, high staff turnover, language barriers, and resources required to reach and train lower-level facilities. Overall, the majority of clinicians viewed the ESM-UBT package as a useful intervention in aiding efforts to reduce maternal deaths from postpartum hemorrhage. Among 10 medical colleges in India the ESM-UBT package is seen as a beneficial intervention for managing refractory atonic postpartum hemorrhage, and for reducing maternal morbidity and mortality. Identified facilitators of and barriers to implementation of the ESM-UBT package in India should be used to guide future implementation efforts.