Medical education in India has undergone very little change since its inception in 1857 by the East India Company in the three medical colleges in Madras, Bombay, and Calcutta those days. Curriculum reform has been advocated for over 30 years, with calls for greater relevance of the curriculum to the needs of the community. Revised guidelines from the MCI in 1997 supported these changes.
One of the ailments of our medical education system is that we are producing graduates who are not well equipped to tackle the health care needs of society. In any developing country with inadequate availability of health services, the need for expertise in the areas of ‘public health’ and ‘family medicine’ is markedly more than that required for other clinical specialties.
In India, the situation is that public health expertise is almost non-existent in the private sector, and falls short of that which is needed in the public health sector. Also, the current curriculum in the graduate/post- graduate courses is outdated and unrelated to contemporary community needs.
The quality of medical education seems to be at its lowest ebb; medical graduates lack competence in performing basic health care tasks like conducting normal deliveries. While the graduates generally possess reasonably-sound knowledge of medical science, they are often found to lack in the performance of clinical skills and problem-solving which form the core of clinical competence.
Medical colleges in India have traditionally followed a curriculum with knowledge pertaining to the body and it’s functions and the clinical disciplines. However, there is no method of synthesis of all the information acquired. Once the doctor gets his degree he is expected to know all by himself; how to handle and categorize this knowledge into practical application of the care of the patients. He has in a way to learn things all over again on his own experience and strength.
In order to handle the problem of having too much knowledge and very little to use, “water water everywhere, not a drop to drink” situation, it is essential to categorize the vast body of information into that which every student ‘must learn’, things that are ‘useful to learn’ and ‘nice to learn’ groups.
Then there are areas in the curriculum, viz., medical ethics, behavioral science, communication skills, managerial skills which are sadly lacking due attention in the existing curriculum as they should. How should a doctor behave with his patients? How and what must he communicate? What are his ethical responsibilities? Does he have practical experience, in giving injections, changing bandages, giving stitches?
Doctors need to be trained in these simple, basic, practical things too which are usually neglected in the huge mountain of academic studies and bigger practical procedures, before they are allowed to start their practice.
The whole course of study, from day one, should be patient centred and community based. The curriculum must stress on the common illnesses which plague our society. A study of rural medicine and treatment must be included in the curriculum.
An integrated approach to learning is essential. Learning in the context of actual everyday medical problems makes the learning more cohesive and meaningful. Integration must be both horizontal with related subjects as well as vertical with others.
Apart from the integrated approach to learning there can be problem based learning (PBL). Many medical schools outside of India teach in this format. The PBL approach has been found to be a useful and effective educational strategy to create doctors who are good problem solvers. This approach stimulates self-directed learning. Every medical graduate must understand that learning is a lifelong process for his profession and he must ‘ learn how to learn’ to keep up with advancing knowledge.
We must drive medical education to the next level of excellence. The time has come to change the medical education system and curricula which is over a hundred years old and take a fundamentally different course. This change must be guided by innovation and new understanding about the latest changes in society and demands of the profession. New approaches must be adopted. Fundamental change in medical education will require new curricula, new methods of teaching, attitudinal changes and new forms of assessment.
A range of reforms to improve the sad state of affairs immediately is of utmost importance. The selection and assessment of students need to undergo changes. The aim of the system should be to create socially committed and skilled doctors. Students should be given opportunities to develop their communication skills and leadership abilities. Medical research should also be encouraged along with new teaching methods and clinical skills.
Moreover, the teachers themselves must be trained as to how to teach most creatively and effectively to produce able doctors. The quality of education in private colleges can be improved by implementing strict norms. It is indeed high time that policymakers, physicians and officials take action.
The views expressed by author are her personal and does not necessarily reflect ExamsWatch’s view.