New Delhi: Aiming to attenuate any further surge in COVID cases by strengthening infrastructure for COVID training of doctors, nurses and health staff, as well as the nomination of competent trainers, the National Medical Commission (NMC), has issued an advisory for medical colleges.
Through its advisory, the apex medical regulator has directed all the medical institutes to establish a robust training framework across the country.
It informed about the constitution of Empowered Group-3 (EG-3) for effectively addressing the evolving challenges from Covid-19 and listed down the clinical topics for the training of doctors, nurses and all health staff.
More than 120 lessons across 22 modules have been identified by the NMC and all health professionals are required to undergo training and certification on these clinical topics, to ensure patient safety at all times.
The commission also recommended that the skill laboratories of all medical colleges be utilized for the training.
It has further asked the states and Union Territories (UTs) to nominate the relevant master trainers.
Empowered Group-3 (EG-3)
The NMC informed that an Empowered Group-3 (EG-3) has been constituted on 'Augmenting Human Resources and Capacity Building' for decisively and effectively addressing the evolving challenges from Covid-19. EG-3 had further formed a sub-Group on Training and Capacity Building' with the mandate to identify training needs, develop modules and suggest robust training network to carry out trainings of Health Care Professionals.
EG-3, considering the recommendations of sub-Group, has been envisioned that a robust training framework needs to be established across the country to enable trainings on COVID-19 related topics, to mitigate any further surge of COVID.
Training modules
"More than 120 lessons (topics) across 22 modules have been identified. Several of these are clinical in nature and may need onsite trainings," said the NMC
All the health professionals including Doctors, Nurses and other clinical staff must undergo training and certification on these clinical topics, to ensure patient safety at all times. The skill training and verification is envisaged at the level of COVID hospitals and similar facilities including medical colleges, by utilizing the existing resources.
Establishment of Skill Labs
For the purpose of imparting the training, the NMC has recommended that the skill laboratories of the medical colleges may be utilized and list of equipment as per the list mentioned below may be made available from the existing resources.
While the equipment list is stratified based on the level of services to be provided in the facilities, medical colleges are expected to provide trainings for all the lessons and ensure availability of the equipment accordingly, it said.
Nomination of Competent trainers
The NMC has asked all the states/ UTs/ Medical Colleges to nominate the relevant master trainers for the said training to be conducted at the State/ UT level.
It further asked the medical colleges to coordinate for conducting the training and building up the infrastructure before August 31.
"All the ACS/Principal Secretaries /Secretaries (Medical Education) of the states/ UTs are requested to coordinate for conducting these trainings and building up the requisite infrastructure as described earlier before 31/08/2021," the advisory read.
Training of Trainers
ToT (Training of Trainers) for such clinical courses (training lessons) will be conducted by AIIMS faculty and the schedule will be shared shortly with all concerned State /UTs.
It will also be available at NMC's website which can be accessed at https://www.nmc.org.in/
Potential trainers can be retired Doctors and specialists (any including Physicians, lntensivists, Anesthesiologists with extensive experience) or available Doctors with extensive experience, Critical Care Nurse Practitioners, Respiratory Therapists and Physiotherapist, with adequate and extensive experience in handling critical equipment.
List of Clinical Topics/lessons requiring Skill Assessment/On-site Evaluation*
Sr No
Topics/Lessons
1
Triage and casualty management
2
Oxygen therapy- Oxygen sources, Oxygen delivery by mask/cannuala, Oxygenmonitoring and minimizing wastage
3
Use of BiPAP and HFNO
4
Invasive ventilation
5
Advanced Clinical Management of COVID-19 of SARI, ARDS and Septic Shock
6
Managing fluid and electrolyte balance of COVID patients
7
COVID Drug Therapy
8
History Taking, physical examination and monitoring vitals- BP/ Saturation/ EKG/ End tidal CO2/ Tranducers / Venous access/ RT, Foley's, ABG sampling/ ET Suctioning/ Early warning score/ Patient record
9
Basic CPR
10
Advance CPR
11
Positioning and Awake proning
12
ICU care and ventilated patients-
--Lung protective ventilation,
--positioning,
--prevention of bed sore,
--care of endotracheal tube or tracheostomy
13
Ambulation of COVID patients- intra hospital transfers
14
Use of point of care tests and equipment:
--IV/ Catheterization
--Pulse Oximeter
--Infusion pump
--Intubation - red flags for intubation and support
--ECG
--Ultrasound in critically ill patients
15
Personal care and bed side assistance
16
Covid testing in neonates
17
Resuscitation and delivery room care of neonates born to Covid mothers ( Early skin to skin care, Early initiation of breastfeeding, Delayed cord clamping)
18
KMC for LBW infants born to Covid mothers
19
Management of COVID illness in neonates: Oxygen therapy
20
Management of COVID illness in neonates : Respiratory assistance
21
Management of MIS-C
22
Referral and pre-referral stabilization and transport
23
Paediatric Respiratory therapy: Oxygen therapy- different methods, incl NRBM; Use of MDI with spacer
24
HHHFNC (paediatric)
25
Mechanical ventilation: non-invasive and invasive (paediatric)
26
Intravenous fluid therapy (paediatric)
27
Medications in children: guidance about dosing, dilutions, etc.
28
Managing shock in children
29
Use of Pulse Oximetry in children
30
Use of Pulse Oximetry in children
31
Pediatric ALS
32
Labour and Delivery in women with suspected or confirmed Covid infection
33
Abortion services in Covid Pandemic
34
CPR in pregnant women
35
Positioning and awake proning in pregnant women
36
Chest Physiotherapy and airway clearance techniques in COVID patients
37
Mobilization techniques and rehabilitation of COVID patients
38
Taking Nasal Swabs
39
Sample collection for COVID in a child
40
COVID 19 Lab testing and analysis (Lab professionals and ANMs only)
41
Community surveillance, screening and contact tracing
42
Using Point of Care Rapid Diagnostic Kits
Basic training infrastructure requirements for district hospital/ Dedicated COVID Center
The training room shall fulfill the requirements of training for activities to be undertaken at the facility. Minimum recommended requirements are as under:
• A minimum of one separate skill demonstration room with two beds, such that the skills could be demonstrated and practiced individually or in groups
• The room should also be used for assessment of inductees
• The room may be equipped with a facility for video recording and review,
• A review or debriefing area,
• Adequate storage space for mannequins and/or other equipment may be provided in a safe area, within this space itself, if possible
• Basic equipment may include CPR and mannequins, injections, IV lines, catheters, intubation equipment etc.
• Where possible, existing equipment or resources may be utilised to reduce set up and maintenance cost
Broad recommendations for facility wise service oriented basic equipment and Trainer requirements are as under:
I. Dedicated COVID Hospitals (DCH)-
1. Ventilator machine, preferably of the make and model as one being used in the facility
2. Oxygen cylinders and Concentrators with all accessories and attachments
3. Supply mechanism of medical oxygen around the facility, pipes, regulators, control rooms; visit to PSA plant if there's one in the facility
4. Patient care accessories including injections, IV lines, intubation tubes, catheters, IV line, Catheters, Pulse oximeter, Infusion pump, Portable ECG machine, BP machine, Portable ultrasound machine, point of care testing equipment etc.
5. Bed-side nursing assistance and care provisions like bed pan, bed linen, pillows, patient gowns
6. Laboratory sample collection and transportation apparatus
7. Breathing Simulators
8. CPR and Advanced mannequins
9. PPE coveralls
Potential trainers can be retired Doctors and specialists (any including Physicians, lntensivists, Anesthesiologists with extensive experience) or available Doctors with extensive experience, Critical Care Nurse Practitioners, Respiratory Therapists and Physiotherapist, with adequate and extensive experience in handling critical equipment.
II. Dedicated COVID Health Centers (DCHC)-
1. Oxygen cylinders and Concentrators with all accessories and attachments
2. Patient care accessories including injections, IV lines, intubation tubes, catheters, IV line, Catheters, Pulse oximeter, BP machine, point of care testing equipment etc.
3. Bed-side nursing assistance and care provisions like bed pan, bed linen, pillows, patient gowns
4. Laboratory sample collection and transportation apparatus
5. CPR and Advanced mannequins
6. PPE coveralls
7. Contact details of Ambulances linked with the facility, DCH linked with the facility
8. User manuals on Biomedical Waste Management, Transfer Procedures.
At DCHC level Trainers could include experienced Medical Officers, senior Staff Nurses, Respiratory Therapists and Physiotherapist
III. COVID Care Centers (CCC)-
1. Oxygen cylinders and Concentrators with all accessories and attachments, Oximeter and BP machines
2. PPE coveralls
3. Checklists for periodic follow-up and evaluation of patients' status
4. Awareness generation material on Biomedical Waste Management, Transfer Procedures, Importance of hygiene, sanitation and COVID Appropriate Behaviour during the pandemic
5. Contact details of Ambulances linked with the facility, DCHC/ DCH linked with the facility
At CCC level care practical training could engage Medical Officers (MO) specifically for point I and 3 rest can be done by experienced AYUSH practitioners, senior Staff Nurses, Emergency Medical Technicians, Counselors and Local Administrators for coordination and reporting like responsibilities.
To view the official NMC advisory, click on the following link:
https://.in/pdf_upload/nmc-159227.pdf