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The right medicine

Medical education is in a crisis. Curriculum and training need to be revamped.

Written by K K Talwar |
Updated: November 13, 2014 12:05:16 am
The MCI had suggested compulsory rural posting for one year under the NRHM two years ago, which the government accepted. However, it backed off under pressure. The MCI had suggested compulsory rural posting for one year under the NRHM two years ago, which the government accepted. However, it backed off under pressure.

Good doctors are essential to society. However, the quality of doctors’ training in India has been declining over the years for various reasons. Earlier, the strength of the medical profession rested on meritorious students who topped their batches joining the medical profession. They were trained by dedicated and talented professionals who acted as role models for students.

The quality of students joining the medical profession has declined over time. Medicine as a career is no longer a priority for the brightest among the youth. This is certainly a matter of concern as no society can afford to leave healthcare in the hands of mediocre professionals. It is important to take steps to revive this noble profession.

Apart from attracting good students, there is an urgent need to look at the curriculum, which defines the objectives of medical education and provides appropriate teaching/ training experiences. This has not happened in the last many years despite advances in medicine and teaching methodology. The recent statement of the Medical Council of India (MCI) that steps are being taken to revise the curriculum and training methodology is encouraging. At present, the graduate course is more oriented towards memorising textbooks or class-notes. The evaluation process has also contributed to this problem. The curriculum in the cognitive domain is only a memory loader; it needs to facilitate the development of psycho-motor skills. The curriculum has also failed to inculcate the right attitude in students.

At the end of her training, a doctor should be competent enough to take a proper history and physical examination of a patient and then analyse the information for diagnosis. Further, she should be able to advise relevant investigation to confirm the diagnosis and optimum therapy. At present, many fresh graduates do not seem sufficiently competent in these matters.

The MCI revised the undergraduate curriculum and submitted it to the government in 2012. A foundation course, including lessons on medical ethics, has been suggested. More time for training was added in some specialties, including psychiatry, orthopaedics and community medicine, as per the recommendations of experts. More emphasis was laid on integrated teaching so as to include clinical exposure. The curriculum is awaiting the approval of the ministry.

The teaching methodology must also stress on competency-based training. Such training focuses on what the medical graduate ought to know and enables her to properly analyse clinical problems. This approach needs more planning by teachers, group discussions and active clinical learning experience. The student may be given more responsibility for learning and asked to gain competence in all clinical domains. She needs to be exposed to computers and web-based learning and be adept at accessing information from medical databases. Student participation in curriculum-planning and evaluation methodology and putting in place a feedback mechanism are possible ways to strengthen the training.

Further, clinical decisions need to become evidence-based. Evidence-based medicine would turn clinical problems into research questions and then encourage accessing, appraising, applying and auditing evidence to improve medical decision-making.

Medical graduates should be made to comply with the training schedule during internships. At present, interns use this time to prepare for entrance examinations to postgraduate courses. Postgraduate qualifications are no doubt vital for career progress, but the internship period is crucial for a graduate to gain practical training and skills. The scheduling of postgraduate entrance examinations needs to be changed to ensure uninterrupted training during internships. The MCI had suggested compulsory rural postings for one year under the National Rural Health Mission two years ago, which the government accepted. However, it backed off under pressure from students. A stint in rural India would expose our medical graduates to new conditions and help them gain additional skills. A medical student should be allowed to take postgraduate entrance examinations only after she completes her rural posting.

There is also a need to familiarise teachers with competency-and evidence-based training. Regular regional meetings must be held by the MCI for this purpose and participation of teachers in these training programmes should be made mandatory. The National Knowledge Network, which provides high bandwidth connectivity among medical institutes, should be optimally utilised for medical education. The evaluation process should be tailored to assess the knowledge and clinical competence of students.

These steps could help improve the quality of our medical graduates.

The writer, chairman, department of cardiology, Max Hospital, New Delhi, is former director, PGIMER, Chandigarh, and former chairperson, board of governors, MCI. Co-written with Meenu Singh, professor, PGIMER, Chandigarh

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