Outbreaks of diseases at a particular geographical area in a particular community is common. Such epidemics are because of certain agents, epidemiological factors. Depending upon frequency, extent, clinical symptoms and way of transmission epidemic can change into pandemic within short time span. Cholera was predominant in 19^th century and influenza and H1N1 outbreaks were on and off in 20^th century^[1,2]. Recently due to COVID 19 pandemic we have seen how shortage of health care workers led to burden on limited resources available; in such situations MBBS students may play important role as a great support. Main design about introducing MODULE F.1 in phase I is that INDIAN MEDICAL GRADUATE should be aware of events occurred in past and learn from these events about agents leading to it, aggravating factors, elements  controlling its spread, so that in future same catastrophe can be prevented^[3,4].

As a part of medical education and social accountability of phase I MBBS students shall be aware of all pandemic diseases which affected world not just mentally but physically, socially, economically in the past^[4]. So Module F.1 was introduced in the foundation course for Phase I students by the Medical Council of India now national medical council so  it can help them learn from historic events, particularly causative or precipitating factors that might have resulted in such events so as to control future events of similar magnitude^[5].

So learning from the past events; phase I students will be able to define pandemic and differentiate it from outbreak, identify the reasons and events that lead to pandemic as guided by MCI.

Aims and objectives- 

1. To observe the change in knowledge of Phase I MBBS students about history of pandemic diseases.
2. To check understanding of Phase I MBBS students about events that lead to pandemic
3. To observe if students get benefitted by knowing about methods of prevention & about role of governing bodies during pandemic

.4.To check response of 1^st MBBS students to relevance of topic & their readiness for pandemic

Total Three hundred students from batch 2021-2022 and 2022-2023 of phase I MBBS of SMT. KASHIBAI NAVALE MEDICAL COLLEGE AND GENERAL HOSPITAL PUNE   participated  in the study voluntarily as a part of foundation course module F.1 over the period of two  academic years. This module was conducted by Anatomy, physiology and Biochemistry departments together. Out of 300 students 200 students responded to the questionnaire through Google form as pre-test and post test and feedback form after 2 hrs session.

Three groups of 5 students voluntarily participated in this session for preparing presentation. Topics were selected purposefully to cover all types of outbreaks - epidemic, endemic and pandemic outbreak. Three groups prepared topics using power point presentation, role play activity and other innovative ideas for presentation. Following Points were given for preparation-

1. Type of microbe involved in the pandemic and its properties that helped it spread
   e.g. route of entry and exit from host, mechanism of transmission involved, ability to survive on various external surfaces etc.
2. How did the microbe evolve? Is this emerging or re-emerging in nature?
3. Identify common factors in the community that helped the microbe to re/emerge
   and spread e.g. deforestation, change in trade practices, Host characteristics that supported the spread etc.
4. Impact on health, economics and society
5. Steps taken to control the pandemic
6. Time taken to control
7. Current state of infection by that organism

In 2hrs session- pre-test was done before initiation of session.

Introductory session- First half an hour history of pandemic was covered through a lecture using power point presentation by faculty and it was interactive session. In history of pandemic respiratory viruses mainly influenza viruses have been major cause of pandemic. Pandemic phases were developed by WHO in 1999 with latest revisions in 2009.The six phases as given by WHO can be studied in three stages-

1. Inter –pandemic phase
2. Pandemic alert period
3. Pandemic phase

Then in next one hour selected 3 groups presented topic covering all the above points. one team conducted MCQ session after presentation which helped to check the understanding of students towards Pandemic module F.1. For other team COVID 19 was the topic, they showed pictures of thali – nad for medical workers and how people learnt about various healthy methods of cooking at home due to lockdown.

In Last half an hour (closing session) in which importance and role of WHO and ICMR was told.   

Post test was conducted after the session; responses received were compared and analyzed. Feedback about session was taken to make changes and improvements for next sessions. Test was approved by ethical committee of our college.

Pre-test/ Post-test

1. Are you able to define Pandemic?

1. Yes                        b) No                                    c) Can’t Say

1. Can you differentiate pandemic from outbreak/epidemic?

1. Yes                           b) No                                    c) Can’t Say

1. Do you know history of pandemics in the past?

1. a) Yes b) No                                  c) Can’t say
2. Do you know reasons/events that lead to pandemic?
3. Yes                        b) No                                    c) Can’t Say
4. Are you aware of methods adopted in prevention & control of pandemic?
5. Yes                        b) No                                    c) Can’t Say

1.  Are you aware of role of WHO, ICMR in prevention & control of pandemic?

1. a) Yes b) No                                  c) Can’t Say
2. Are you aware of infection control practices?
3. a) Yes                              b) No                                     c) Can’t Say
4. Do you find this topic relevant for PHASE –I MBBS students?
5. a) Yes b) No                                  c) Can’t say
6. Can you join as frontline health care worker even being medical student in pandemic?
7. a) Yes                               b) No                                    c) Can’t Say
8. Do you think you are socially accountable as a medical student during the pandemic?
9. a) Yes                              b) No                                     c) Can’t Say

Feedback

1)  Do you  think content of module was adequate?

1. a) Yes b) No c) partly d) Can’t say

2) Do you find the points discussed sufficient?

1. a) Yes b)  No c) Can’t say

3)  Do  you think the time duration was sufficient?

1. a) Yes b) No c) Can’t say

4) Are your all queries resolved?

     a)Yes b) No      c) partly d) Can’t say

5) Do you think this session was needed in current situation?

1. a) Yes b) No         c) Can’t say

6) How  was the session?

1. a) Excellent b) Good c) Average            d) Below average

7)  Did you get scientific information about pandemic diseases  ?

        a)Yes             b) No          c) Can’t say

8) Which part did you like the most?

           9) What modifications do you think will be needed?

           10) Any other feedback?

Results- table showed positive/yes values about those questions

After this session, competencies addressed were fulfilled. Students were able to define pandemic and differentiate it from epidemic /outbreak. The reasons/events that lead to pandemics in the past- was known to only 62.9% of students, after session it was increased to 80%. More or less same percentage improvement was seen for reasons/events leading to pandemics and for prevention & control of pandemic. As a medical student of phase I increase in percentage of understanding the methods adopted in prevention and control of pandemic   was observed.

Radical change in the knowledge regarding awareness of role of WHO, ICMR in prevention and control of pandemic was observed; previously only 62.9% students were aware of it & after session this percentage increased to 97.1%. When students asked about relevance of this module for first MBBS students 88.7  to 85.7 percent i.e.  2% student find this session irrelevant for phase I after session, so students are taking this module very lightly though it is included by NMC after much work.  Surprisingly very  few students were interested to join as frontline health care worker if there is need in society after the session but 97 percent of students thought that they were socially accountable.

Feedback-Students liked the presentations by their classmates and quiz conducted after presentation by one group. About content 89.5% said content was adequate and 92.1% said points discussed were sufficient but only 76.3 % said that all queries resolved.

In this study implementation of Pandemic module F.1 was successfully conducted and achieved all the goals stated by NMC. Introduction of such module as a part of foundation course is wise decision by NMC as it introduces students to historical aspect, causative agent, control measures for outbreaks and role of government and higher authorities in such events. In addition to above background when students were asked about willingness to work as frontline worker; students were not willing to work as frontline workers; this might be because of their studies in phase I. According To Miller DG et al in addition to the benefits to patients and the health care system, allowing students to participate reinforces important values, such as altruism, service in times of crisis, and solidarity with the profession ^[4] .

Medical school education must be available on new platforms, while the contents of education should also be carried out to recognize public health care and medical care as a part of society, and to cultivate the ability to see and be a part of the big picture concluded by Hong J et.al ^[6] similarly in this study pandemic module F.1 states information about pandemic so as to have overall information about it.

Investments to improve pandemic preparedness may have fewer immediate benefits, particularly relative to other pressing health needs in countries with heavy burdens of endemic disease. Therefore, characterizing pandemic risk and identifying gaps in pandemic preparedness are essential for prioritizing and targeting capacity-building efforts ^[7].In current study this was the main aim as stated by MCI in Pandemic module.

The outcome of the Covid-19 pandemic is impossible to predict, at the time of this writing. But we can learn from pandemics in history to determine our best courses. These are our teachers – the Spanish flu, the AIDS pandemic, and more in current study topics for discussion were chosen from these ^[8].

we have implemented Module F.1 as per MCI/NMC rules and this study would help to establish knowledge regarding outbreaks. Preparing the medical students from phase I is learned decision; it may bridge the gap between preparedness and alleviate pandemic in future

we are thankful to the department of physiology and department of biochemistry for taking effort for forming groups and smoothly conducting the programme.

1.Ramamurthy T, Sharma NC. Cholera outbreaks in India. In Cholera Outbreaks 2014 (pp. 49-85). Springer, Berlin, Heidelberg.

2. Mills, Ian D. “The 1918-1919 influenza pandemic— the Indian experience.” The Indian Economic & Social History Review23.1 (1986):1-40.

3.VM AE. Epidemics and Pandemics in India throughout History: A Review Article. Indian Journal of Public Health Research & Development. 2019 Aug 1;10(8).

4.Miller DG, Pierson L, Doernberg S. The role of medical students during the COVID-19 pandemic. Annals of internal medicine. 2020 Jul 21;173(2):145-6.

5. Medical Council of India. Module on Pandemic Management, August
2020: pp 1-81

6. Hong J, Jung I, Park M, Kim K, Yeo S, Lee J, Suh S, Hong Y, Park J, Chung S. Attitude of medical students about their role and social accountability in the COVID-19 pandemic. Frontiers in Psychiatry. 2021 Jun 1;12:645340.

7. Madhav N, Oppenheim B, Gallivan M, Mulembakani P, Rubin E, Wolfe N. Pandemics: Risks, Impacts, and Mitigation. In: Jamison DT, Gelband H, Horton S, Jha P, Laxminarayan R, Mock CN, Nugent R, editors. Disease Control Priorities: Improving Health and Reducing Poverty. 3rd ed. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2017 Nov 27. Chapter 17. PMID: 30212163.

8.https://www.mphonline.org/worst-pandemics-in-history/

9.https://www.who.int/activities/accessing-essential-health-services-in-fragile-conflict-

10. https://www.who.int/activities/building-a-skilled-workforce-to-respond-to-emergencies

11.WHO Global Influenza Preparedness Plan. The role of WHO and recommendations for national measures before and during pandemics, World
Health Organization. 2005 (WHO/CDS/CSR/GIP/2005.5).