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Medical education in India is at crossroads

Medical education in India is at crossroads

Medical education in India has been reduced to cramming multiple choice questions, passing entrance tests and subsequent examinations by hook or crook, getting a degree or two and start chasing the target of big bucks. The accomplishments of clinical acumen and skill, concern and compassion for healthcare of the citizen or the socioeconomic realities of the nation or amelioration of the health of the community do not find a place in their training. The virtues of compassion, ethical values, sensitization to the pain and misery or economic status of the patients are never taught during medical college or at the entry level to service or practice. What comes out in the market is a half baked product with loads of theoretical knowledge but devoid of skills to apply it and bereft of dedication to health- care. Such a doctor is eligible to become a medical teacher as well without any further training or capacity building.  The assumption is that a doctor with a postgraduate medical qualification automatically qualifies as a medical teacher. It is fallacious as there is no systematic training in pedagogy in most of the medical colleges.

 

Resultantly, a majority of our citizens have limited access to quality healthcare on the one hand and acute shortage of good medical teachers in numbers as well as quality. BM Hegde well known physician questioned the validity of selection on the basis of pre-medical tests consisting of multiple-choice questions. He observed ‘The universities are degree-selling shops. Medical schools should make radical changes in the curriculum, adopt innovative pedagogical strategies for enhancing students’ learning, improve the methods used to assess students’ performances, and focus on the professional development of faculty as teachers and educators.’ The role of extraneous factors like money, caste, family, connections etc should get a back seat.The goal should be to produce doctors and paramedics that are humane and competent to provide healthcare to most patients at affordable prices without advanced investigations i e friendly family clinics in every corner of the city/village. Technology is essential to supplement the clinical acumen but not a substitute of patient history taking, thorough physical examination and skill to prescribe. Producing more doctors of poor quality will not improve the scenario of healthcare or medical education, either.

The Challenges

(i)  Medical students are exposed to training  in the tertiary hospitals and not trained at secondary and primary levels of care or Family Medicine (FM); the lack of which is the foremost deficiency in Indian medical education today; (ii) need to prepare a good basic doctor who forms the backbone of a sound health care system, on the pattern of National Health Service U.K. and which India sorely needs. (iii) Training and up-gradation of medical teachers in all medical colleges- is critical to good quality of the doctors. When this happens, fewer demands would need to be made on the scarce and costly tertiary care centres like PGI Chandigarh, AIIMS New Delhi. Every medical college must have a well developed department of FM to treat most of the common ailments at a reasonable cost and also to train postgraduate medical students.. Family doctors so produced must be sound clinicians capable of handling by themselves 90 per cent of the common medical ailments and emergencies.

Public and private healthcare is ailing under the weight of unhealthy competition, which has resulted in unreasonable medical practices and unwarranted diagnostics and interventions, which may be socially wasteful and personally taxing. Dr Marwaha believes that the Indian healthcare system should incorporate the Psycho Socio Ecological (PSE) model of health and wean itself away from the existing biomedical model of disease, as PSE embraces the theory of social determinants of health and lays a strong emphasis on health promotion and disease prevention.

Model systems

The curricula need to include inter-professional and community-based education. The use of health information systems (electronic health records, mobile health applications, telemedicine, etc) has made it possible to shift tasks that were earlier done by physicians to healthcare workers, without affecting the quality of care. Doctors need not be physically present in village clinics and their roles get elevated to that of a technology manager. “The medical education system needs to evolve with these trends, and ensure that students get exposed to these emerging technologies and models of healthcare delivery early on in their training,”  While learning advanced techniques the medical students should not los e sight of first aid, common emergencies and common medical conditions in every medical/surgical discipline.

Issue of quality

In the  year 2010, the union health ministry drafted a bill to establish a National Commission for Human Resources for Health (NCHRH) to address the issue of quality by balancing the three critical functions of the profession: a) curriculum — what is to be taught and for how long; b) accreditation — who is to teach and in what manner; and c) ethical practice — adhering to the best interests of patients. These jobs could  be done only by experts. In most countries such as the United Kingdom, regulators are selected by the Public Service Commission based on merit and suitability. In addition, the U.K. Medical Council also has patient groups, student representatives and civil society activists as members of the Medical Council. Such openness and transparency is the only effective antidote to an indiscriminate abuse of power, as prevalent in India. Since medical education is in the concurrent list of the Constitution, the Central government needs to leverage that power to bring in some discipline before permitting any more colleges to be established, said Sujatha Rao former Secretary, Ministry of Health & Family Welfare. Unfortunately NCHRH is yet to see the light of the day.

 

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