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MEDICAL EDUCATION TECHNOLOGY
Year : 2019  |  Volume : 12  |  Issue : 3  |  Page : 202-206  

Framing a De novo curriculum on sleep disorders for an Indian medical graduate using Kern's model


1 Department of Community Medicine, Member of the Medical Education Unit and Medical Research Unit, Kancheepuram, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Kancheepuram, Tamil Nadu, India

Date of Submission27-Jun-2018
Date of Acceptance01-Sep-2018
Date of Web Publication15-May-2019

Correspondence Address:
Saurabh RamBihariLal Shrivastava
3rd Floor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Thiruporur-Guduvancherry Main Road, Sembakkam, Kancheepuram - 603 108, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_103_18

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  Abstract 


The six-step Kern's model is used to develop a de novo curriculum and link the same to the health-care needs of the general population. The available estimated data from India suggest that the incidence of sleep disorders has increased in all the age groups. Considering the shortage of specialists dealing with sleep hygiene, at present, most of the patients either do not avail health care or are handled by some subspecialists. It is a fact that the current undergraduate curriculum offered to a medical student in India is not holistic and does not incorporate skills to identify and manage sleep disorders in all 4 years of the undergraduate course. In short, there is limited scope for an Indian medical graduate (IMG) to get sensitized about sleep medicine and thus is not competent to identify, evaluate, treat, and prevent sleep disorders. Thus, Kern's model was employed to develop a curriculum on sleep disorders which can be used for the benefit of an IMG.

Keywords: Community health, curriculum, sleep disorders


How to cite this article:
Shrivastava SR, Shrivastava PS. Framing a De novo curriculum on sleep disorders for an Indian medical graduate using Kern's model. Med J DY Patil Vidyapeeth 2019;12:202-6

How to cite this URL:
Shrivastava SR, Shrivastava PS. Framing a De novo curriculum on sleep disorders for an Indian medical graduate using Kern's model. Med J DY Patil Vidyapeeth [serial online] 2019 [cited 2019 Jul 18];12:202-6. Available from: http://www.mjdrdypv.org/text.asp?2019/12/3/202/258192




  Introduction Top


The six-step Kern's model is used to develop a de novo curriculum and link the same to the health-care needs of the general population.[1],[2]


  Step I: Problem Identification and General Needs Assessment Top


Problem identified

Sleep disorders have been associated with the development of various medical problems, such as myocardial infarction, hypertension, diabetes mellitus, stroke, and cognitive dysfunction.[3],[4] The available estimated data from India suggest that the incidence of sleep disorders has increased in all the age groups.[5],[6] In fact, in a study done in South India, the prevalence of sleep-related disorders varied between 20% and 34%.[5] In another study, the prevalence of insomnia among corporate employee was found to be >13%.[6] However, these disorders often remain undiagnosed and untreated, accounting for a large number of significant health consequences.[4],[5],[6]

Considering the shortage of specialists dealing with sleep hygiene, at present, most of the patients either do not avail health care or are handled by some subspecialists.[7] Further, the findings of a multinational study done with an objective to assess the prevalence of education about sleep and its disorders in medical education revealed alarming results.[8] It was observed that the average amount of time spent on sleep education was <3 h, while 27% of responding schools spread across 12 nations reported that no sleep education is offered to medical students.[8]

It is a fact that the current undergraduate curriculum offered to a medical student in India is not holistic and does not incorporate skills to identify and manage sleep disorders in all 4 years of undergraduate course.[5],[7] Moreover, even during internship, there is no training component involved to manage sleep disorders.[5],[7] In short, there is no scope for an Indian medical graduate (IMG) to get sensitized about sleep medicine and thus is not competent to identify, evaluate, treat, and prevent sleep disorders.

The ideal approach to the problem is to ensure that

  • First-year students can explain sleep physiology, demonstrate techniques of polysomnography, and identify a normal sleep–wake cycle
  • Second-year students can explain the pathophysiology of sleep disorders
  • Third-year students can explain what is sleep hygiene and create awareness to prevent sleep disorders
  • Final-year students can identify and manage sleep disorders
  • Intern is competent to prevent, identify, evaluate, and treat patients with sleep disorders.


Literature review and views of stakeholders (namely sleep specialists, public, parents, teachers, and health-care professionals) can be used to get the desired information regarding the development of curriculum. The obtained information will result in the identification of general needs (key differences in what is expected and what is currently offered in curriculum), namely limited exposure to enable first-year students to explain sleep physiology and identify a normal sleep–wake cycle and second-year students are not sensitized about sleep pathophysiology. In addition, third-year students are not able to explain the methods to prevent sleep disorders, and final-year students have a wide gap in knowledge and skills to identify and manage sleep disorders under the present curriculum, while interns are not having the skills to refer patients with sleep disorders.


  Step II: Needs Assessment Of Targeted Learners Top


Undergraduate students from first year to final year MBBS and interns were identified as the target learners. Further, to identify the information required for needs assessment, following sources can be explored:

  • Curriculum on sleep for each year of the undergraduate course: 1st year (physiology and biochemistry); 2nd year (pathology and pharmacology); 3rd year (otorhinolaryngology and community medicine); and final year (general medicine and psychiatry). This information can be obtained by a thorough literature review. In addition, review of literature can also be done to identify the curriculum which has been adopted in some of the other nations[9],[10],[11]
  • Surveys using a questionnaire to ascertain the existing level of knowledge of targeted learners
  • Information about sleep physiology, pathology, clinical presentation, diagnosis, and treatment of sleep disorders and sleep hygiene. This information can be obtained through the recommendations made by the expert committee or through Cochrane Reviews[12]
  • The present needs of patients with sleep disorders – through qualitative methods such as group discussion
  • The current status of the health system in delivering services for the management of sleep disorders.



  Step III: Goals, Competencies, And Objectives Top


Goal

The goal of the proposed curriculum is to reduce the community burden and morbidities due to sleep disorders.

Competencies

Identified competencies could be:

  1. To demonstrate understanding of the pathophysiology of sleep–wake cycle and identify a patient with a sleep disorder
  2. To manage patients with sleep disorders
  3. To practice established protocols on sleep hygiene for various age groups and counsel patients/families with sleep disorders
  4. To undertake community health education initiatives on sleep.


Specific learning objectives

  1. At the end of the lecture class, first-year students must be able to enumerate the 5 stages of the sleep–wake cycle
  2. At the end of the practical session, second-year students must be able to demonstrate the primary technique of polysomnographic recording
  3. At the end of the lecture class, second-year students must be able to explain pathology of sleep disorders
  4. At the end of the practical session, third-year students should be able to counsel a patient with a sleep disorder
  5. At the end of the bedside teaching session, final-year students must be able to diagnose a patient with sleep disorder and recommend desired investigations correctly
  6. At the end of the internship posting in medicine department, the students should be able to propose a management plan for a patient of sleep disorder and decide upon the need to refer the patient.



  Step IV: Educational Strategies And Aligning Assessment Top


Curriculum content

Experts in sleep physiology and sleep disorders will develop a content taking into account the existing body of knowledge and findings of the needs assessment.

Syllabus

The proposed syllabus should cover the subjects (namely physiology, biochemistry, pathology, community medicine, otorhinolaryngology, and General Medicine), and in each of the subject, the content can be divided into must know, desirable to know, and nice to know. For instance, the portion under physiology can be classified as follows:

  • Must know: Definition of sleep, types of sleep, stages of sleep, and principles and practice of polysomnogram
  • Desirable to know: Evolution of sleep – neonates to adults, external modifiers of sleep
  • Nice to know: Effects of yoga on sleep.


Time table

A timetable for covering sleep physiology and diagnosis/treatment/prevention of sleep disorders can be prepared, which will be spread across all 4.5 years of undergraduate course. The tentative timetable can be as follows:

  • 1st year: 1 h (lectures) +1 h (problem-based learning [PBL]) +2 h (demonstration)
  • 2nd year: 2 h (lecture/PBL)
  • 3rd year: 2 h (PBL) +4 h (field study)
  • Final year: 1 h (lectures) +1 h (PBL) +6 h (bedside clinics, demonstration, integrated teaching class)
  • Internship: 4 h (bedside teaching, rounds, and outpatient departments).


Educational strategies

SPICES Model can be adopted to deliver the curriculum on sleep disorders:

  • Student centric: Activity-based small group teaching
  • PBL: Case scenario with the specific learning objectives can be given, and students are supposed to meet the desired objectives
  • Integrated teaching: Both horizontal and vertical integration can be adopted in all 4 years of undergraduate course to enhance the understanding of the students
  • Community oriented: Field surveys and field notes
  • Electives: Students will be given option to explore additional areas in sleep disorders about their diagnosis or management.
  • Systematic: Obviously, the designed curriculum will be systematic, as they will be exposed to different specialty doctors in each year, and thus there will be a definite chance to cover all the experiences required for the training.


In general, the teaching–learning method and the appropriate assessment method can be adopted year wise as depicted in [Table 1].[13],[14]
Table 1: Teaching–learning method and assessment

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References

Appropriate reference textbooks and other reports can be included, so that if a student wants to gain basic information on sleep disorders, they can refer them and clear their doubts.

E-learning

In the modern era of technology, to reach to a number of students and be more appealing, the option of e-learning can be explored. Creation of a website on sleep disorders or a Facebook group or a WhatsApp group with students or a Google Classroom or through Google Forms, etc., can be done and students can be involved in the same. The students can either be asked to solve multiple-choice questions or share their views on one specific aspect of sleep disorders, and the discussion can be built further.


  Step V: Curriculum Organization And Implementation Top


Implementation of a curriculum consists of different elements, such as obtaining administrators/management support, identification and procurement of the required resources, introduction of the curriculum on a pilot basis before subjecting the target learners to the same, administration of the curriculum, and finally refinement of the curriculum gradually.


  Step VI: Curriculum Evaluation and Feedback Top


This step aims to assess the performance of both individuals (individual assessment) and the curriculum (program evaluation). However, the objective of the evaluation can either be formative (to give feedback so that the learners or curriculum can improve) or summative (to evaluate the final performance of the learner or curriculum).

To evaluate the developed curriculum on sleep disorders, outcome statements were formed based on the four Kirkpatrick levels of evaluation, and it was followed by formulation of evaluation questions for each of the outcomes [Table 2]. Finally, indicator, sources, and methods were proposed for each of the evaluation questions [Table 3].
Table 2: Framing of outcome statements and evaluation questions

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Table 3: Indicator, sources, and methods for evaluation questions

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  Conclusion Top


As sleep physiology and sleep disorders have been neglected big time in the existing curriculum for an IMG, the six-step Kern's model can be effectively utilized for the development of a de novo curriculum. The developed curriculum can be integrated within the existing curriculum and will aid the undergraduate students to acquire the desired skills.

Acknowledgments

The proposed curriculum has been framed with the help of Medical Education Team of Christian Medical College, Vellore. Also, I wish to acknowledge the contributions of Dr. Sangeetha Yoganathan (Christian Medical College), Dr. Shantaraman Kalyanaraman (Tirunelveli Medical College), Dr. Prabha Swaminathan (Chettinad Health and Research Institution), and Dr. CH Srinivasa Rao (S V Medical College).

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Thomas PA, Kern DE. Internet resources for curriculum development in medical education: An annotated bibliography. J Gen Intern Med 2004;19:599-605.  Back to cited text no. 1
    
2.
Windish DM, Gozu A, Bass EB, Thomas PA, Sisson SD, Howard DM, et al. A ten-month program in curriculum development for medical educators: 16 years of experience. J Gen Intern Med 2007;22:655-61.  Back to cited text no. 2
    
3.
Quan SF, Parthasarathy S, Budhiraja R. Healthy sleep education – A salve for obesity? J Clin Sleep Med 2010;6:18-9.  Back to cited text no. 3
    
4.
Cai XH, Xie YP, Li XC, Qu WL, Li T, Wang HX, et al. The prevalence and associated risk factors of sleep disorder-related symptoms in pregnant women in China. Sleep Breath 2013;17:951-6.  Back to cited text no. 4
    
5.
Panda S, Taly AB, Sinha S, Gururaj G, Girish N, Nagaraja D. Sleep-related disorders among a healthy population in South India. Neurol India 2012;60:68-74.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Yardi N, Adsule S. A cross-sectional observational study to determine the prevalence of insomnia amongst Indian corporate employees. J Assoc Physicians India 2015;63:20-5.  Back to cited text no. 6
    
7.
Shah N, Bang A, Bhagat A. Indian research on sleep disorders. Indian J Psychiatry 2010;52:S255-9.  Back to cited text no. 7
    
8.
Mindell JA, Bartle A, Wahab NA, Ahn Y, Ramamurthy MB, Huong HT, et al. Sleep education in medical school curriculum: A glimpse across countries. Sleep Med 2011;12:928-31.  Back to cited text no. 8
    
9.
Mindell JA, Bartle A, Ahn Y, Ramamurthy MB, Huong HT, Kohyama J, et al. Sleep education in pediatric residency programs: A cross-cultural look. BMC Res Notes 2013;6:130.  Back to cited text no. 9
    
10.
Tanaka H, Tamura N. Sleep education with self-help treatment and sleep health promotion for mental and physical wellness in Japan. Sleep Biol Rhythms 2016;14:89-99.  Back to cited text no. 10
    
11.
Bandla H, Franco RA, Simpson D, Brennan K, McKanry J, Bragg D. Assessing learning outcomes and cost effectiveness of an online sleep curriculum for medical students. J Clin Sleep Med 2012;8:439-43.  Back to cited text no. 11
    
12.
Hu RF, Jiang XY, Chen J, Zeng Z, Chen XY, Li Y, et al. Non-pharmacological interventions for sleep promotion in the Intensive Care Unit. Cochrane Database Syst Rev 2015;10:CD008808.  Back to cited text no. 12
    
13.
Harden RM, Sowden S, Dunn WR. Educational strategies in curriculum development: The SPICES model. Med Educ 1984;18:284-97.  Back to cited text no. 13
    
14.
Dent JA. Using the SPICES model to develop innovative teaching opportunities in ambulatory care venues. Korean J Med Educ 2014;26:3-7.  Back to cited text no. 14
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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  In this article
   Abstract
  Introduction
   Step I: Problem ...
   Step II: Needs A...
   Step III: Goals,...
   Step IV: Educati...
   Step V: Curricul...
   Step VI: Curricu...
  Conclusion
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