Abstract:

Background:
The scale up of HIV care and treatment in India requires the need for case-based clinical instruction materials that builds clinical capacity among the doctors in systematically approaching and evaluating Opportunistic Infections (OI). Effective clinical trainings are limited by the availability of appropriate clinical materials and logistics in bringing participants to the bedside. To address this International Training and Education Center for Health, India (I-TECH India) in collaboration with Government Hospital of Thoracic Medicine (GHTM), Chennai has developed a ‘case based instructional video training package’ focusing on a functional approach in OI diagnosis.

Expected outcome: This series of ten videos are designed to assist clinicians in their systematic approach to correctly diagnosing opportunistic infections associated with HIV. The doctors are challenged to assess the on-screen patient history and physical examination and to reach conclusions about potential differential diagnoses and appropriate lab investigations.

Methodology:
A list of ten common OIs to cover was pre-planned, and medical teachers from ITECH India and GHTM were identified as potential on-screen presenters for each OI. Prior to production, suitable patients were approached for consent and then filmed in a specially created private setting. The video cases were successfully filmed during an intensive two-week period. Several potential patient participants did not consent, confirming the strength of consent procedures in place. Each case study video is comprised of 3 parts: the patient's chief complaints and history , a physical exam demonstration, and a description of lab investigations. An accompanying facilitator's guide containing individual discussion points for each video case is designed to guide participants to critically discuss and reflect upon each case. Technical experts reviewed scripts and finalized the technical details.

Results:
The training and evaluation package was piloted with 116 clinicians from various medical institutions in India. Feedback on technical content, clinical accuracy, ease to use and other recommendations were surveyed using a questionnaire. Commonly identified strengths indicated were: the case-based teaching methodology, sequential instruction on history taking, physical examination and investigation with in-built interactive questions, clinical accuracy in program setting, effective video techniques (e.g. subtitles, voice-over, on-screen graphics), and associated facilitator guide. Areas that require attention included: additional information on pathophysiology, advanced investigations, management and prognosis of the cases. Feedback also highlights on need for minimum set of quality AV aids.

Conclusion:
This OI video project provides an innovative, effective and easy to use training tool for OI management in complex Indian setting. Clinician feedback indicates the need for additional training tools with more emphasis on management of OIs. Wider use of this resource may significantly contribute to clinical capacity development among Indian health care providers managing HIV-infected patients.

Keywords:

OI Videos, Instructional video materials, Opportunistic Infections.