Reform needed in medical education
GEORGE THOMAS
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The present graduate programmes are inadequate and do not produce competent doctors
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SUDHA VIDYASAGAR'S article "On choosing the medical profession" (Open Page, January 28) was thought provoking and apt. She is right: the waiting period for doctors to settle down is too long. After graduation most of the medicos are not `healing' but `reading' for the postgraduate entrance exams!
The present graduate programmes are inadequate and do not produce competent doctors. Postgraduation and specialisation have become a sine qua non. The problems plaguing medical education are: 1. Lack of adequate training at graduate level making PG training a necessity. 2. Emphasis on `degrees' rather than training. 3. Long waiting period before decent earnings.
Early specialisation
Here is a strategy to reform medical education. This was submitted to the parliamentary sub-committee for its consideration. The principles are: 1. Early specialisation. 2. Creation of well trained primary doctors. 3. Removal of irrelevant curricula. 4. De-emphasising of degrees. 5. Creation of two streams of careers.
Basically the new scheme would consist of five years of study consisting of 10 semesters. At the entry level itself the student chooses an area of specialisation (as in the case of engineering courses). These could be from among a wide range of subjects which include the existing specialities and sub-specialities plus need based subjects such as traumatology, reproductive medicine, etc.
The first year would be for relevant studies in anatomy, physiology and biochemistry and the second for relevant studies in pathology, pharmacology and forensic sciences. The third year would give exposure to selected related specialities in medicine and surgery. A student taking up `coronary intervention' could get an exposure to cardiac surgery and pulmonology. The fourth and fifth years would be devoted to the in-depth study of the chosen speciality.
Clinical training would start from the second year onwards giving an effective period of four years of study in the speciality. On the completion of the course, the candidate is awarded the degree of MD (Medical Doctor) in the specialty — MD (Coronary Bypass Surgery) or MD (Family Practice). This would replace the degree of MBBS.
Next, the career prospects branch into two streams: academician and practitioner. The `academician' stream will have one year training in medical pedagogy. Such training will create professional teachers. The next five years he will be a `lecturer,' followed by five years as `assistant professor' and finally `professor' after 10 years of experience. The institutions will award these designations.
The `practitioner' stream would have one-year `internship' under a senior consultant. The next five years he will be a `specialist' followed by five years as `consultant' and finally `senior consultant' after 10 years of experience. The medical councils will award these designations. A provision for continuing medical education sans examinations would be integrated in the practitioner stream. The only higher degree that will be awarded will be Ph.D. for outstanding research.
All colleges need not have all the courses. Innovative courses can be created depending on the need. Specialties such as general medicine and general surgery, which have lost their relevance, should be removed.
Family practitioner
The most important feature of the scheme is the speciality of family practice. Maximum seats will be available for it and it will be on a par with other specialties. India needs more family practitioners. The course content of family practice will be the identification and treatment of outpatient type problems in every other clinical speciality with emphasis on the preventive aspects.
The Medical Council in its 1997 reforms accepted that a lot of time is wasted on irrelevant topics. For example, a student opting for a surgical specialty needs more knowledge of anatomy than physiology, with special emphasis on the region of his speciality. By having multiple specialities, lengthy courses become redundant.
The new system will remove the agony associated with the entrance exam at each PG level, encourage family practice, and lay more stress on training and experience than on `degrees.'
gthomas@doctor.com
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