|Year : 2020 | Volume
| Issue : 1 | Page : 42-44
Medical education in India
Ravi Kant1, Vartika Saxena2, Jayanti Pant3
1 AIIMS, Rishikesh, Uttarakhand, India
2 Department of Community and Family Medicine, AIIMS, Rishikesh, Uttarakhand, India
3 Department of Physiology, AIIMS, Rishikesh, Uttarakhand, India
|Date of Submission||12-Jun-2020|
|Date of Decision||17-Jun-2020|
|Date of Acceptance||18-Jun-2020|
|Date of Web Publication||20-Jul-2020|
Prof. Vartika Saxena
Department of Community and Family Medicine, AIIMS, Rishikesh, Uttarakhand
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kant R, Saxena V, Pant J. Medical education in India. J Med Evid 2020;1:42-4
Education is not the learning of facts but training the mind to think
Medical education in India is considered to be the largest medical education systems in the world and comprises about 535 medical schools across the country. These medical schools have a capacity of producing 70,978 MBBS graduates at present. The recent expansion of the number of medical schools over the last few years from 2014 to 2019 in government and private sector has improved doctor-to-patient ratio of 1:1457 at present. These figures are encouraging and reflect the efforts of our politicians to provide health care to the 1.3 billion citizens of our overpopulated and large country. Unfortunately, however, the medical education standards prevailing in these generally new and private medical schools have not been adequate. Medical education in India is in a static phase at present and needs immense and radical reforms to meet the demands of its population and also match international standards. There exist big lacunae in the system and multiple factors may be responsible for the present situation.
The curriculum which is being followed focuses mainly on providing knowledge with little emphasis on its psychomotor and affective domains. Didactic lectures with students attending them as passive spectators, who dare not interact with their teachers, are the usual norms in medical colleges. Components in the affective domains are not included in the syllabus and it is expected that students learn these by observing their teachers. Further, students who graduate from medical college lack confidence in performing any clinical task independently. This has been the outcome of our exclusively knowledge-based medical education with no focus on practical clinical skills. Assessments have been subjective and students have had to cram a huge number of facts and thereby clear summative assessments and recall-based questions which are routinely asked in examinations.
However, with the growing incidence of assaults on doctors, disrespect, and lack of trust in them, the Medical Council of India (MCI) is now emphasising the inculcation and development of certain core competencies for an Indian medical graduate. There must be an emphasis on teaching communication skills, attitudes, empathy, altruism, professionalism, and the humanities all of which are extremely important aspects of medical education. These qualities must be part and parcel of a medical student's personality so that he/she evolves into a competent and compassionate doctor after training. Hence, according to the recent norms laid down by the MCI, an Indian medical graduate has to be a clinician with a lifelong learner attitude. He/she should be an efficient communicator with good leadership qualities apt for a professional. Training for clinical competence should be based on Miller's pyramidal model of learning where students are required to not only 'know' facts but also 'know how' these may be applied in clinical practice. They must be able to 'show' that they are able to perform clinical tasks and apply their knowledge in the actual workplace. This will help students develop their practical skills and should start from the initial phase of their medical training.
Teaching methods also need to change radically to develop such competent medical graduates. There should be an increasing emphasis on following student-centric learning methods in contrast with the teacher-centric approaches. Students should be playing an active role in learning, with teachers playing the roles of facilitators and mentors to help them develop their clinical skills. Feedback should be an important component of this learning and act as a bridge between mentor and mentee where both would be equally benefitted. Both teacher and student should be clear about what has to be taught. Integration of subjects also promotes a holistic approach to patients and their problems. The MCI has recommended both a horizontal and vertical integration of the curriculum, which will reduce fragmentation of the medical course, and motivate students to learn.
Small group teaching, self directed learning, and problem based learning should be given preference over didactic lectures. Formative assessments are recommended and methods such as Objective Structured Practical Examination, Objective Structured Clinical Examination, and mini clinical evaluation exercises which are reliable and valid assessment tools should be used. Computer-based tests may replace traditional theory examinations. These examinations would analyse and deliver quick results without any bias. Students would get feedback for improvement immediately. Further simulations may be used for the assessment of students' skills in various subjects. Clinical vignettes help to assess high-order thinking and analysing capability of students. Assessment scheme must be designed in such a way that it incorporates all core competencies effectively. There must be provision for centralised licentiate examination to assess skills, values and attitudes and patient centered scenarios as followed in United States Medical Licensing Examination (USMLE). These examinations may be conducted in different tiers, so that students can be assessed thoroughly in terms of clinical knowledge, psychomotor skills, problem-solving ability and communication skills. The licentiate examination would help students further in opting for their residency specialties. Students need not have to go through a separate entrance examination for pursuing post-graduation. In fact, students having cleared licentiate examination may seek admission for post-graduation courses through interviews. Further, there could be a board for licensing them to practice particular specialty.
In a similar vein, the National Medical Commission ordinance was set up in 2019, to bring in several reforms in medical education including implementation of a uniform national pattern for the final year MBBS examination, so that there can be uniform national standards for students. The centralised all India examinations or National Exit Test (NEXT) is aimed to promote medical students to practice medicine. This will be a licentiate examination which MBBS students pan India will have to clear and thereafter they will be considered as qualified medical practitioners. The objective of implementing NEXT is to produce skilled and qualified medical graduates. Deeper understanding of concepts and skill evaluation would be performed through problem-based assessment. Multiple-choice questions in the form of comprehensive clinical vignettes will be a cardinal feature of this examination. Subjective questions will be phased out which will make assessment unbiased and uniform. The licentiate examination is expected to bring Indian medical services on international platform and provide global recognition. However, it is too early to judge its effectiveness.
At present, the MCI has also introduced Competency-based Medical Education (CBME) to promote such student-centric approaches to develop core competencies in students. According to this system, learning outcome or competency should be primarily based on the needs of the community. This is especially pertinent to the Indian scenario, as the burden of medical ailments in India is very different from that in other countries and having a tailor-made curriculum will better meet the expectations of people in our own country.
Bringing in such a huge change in the medical curriculum overnight is not possible. Faculty development is the key for success in implementing it. Hence, the MCI has introduced the National Faculty Development Programme in which basic course workshops and Revised Basic Course (Attitude and Communication) workshops are organised in nodal and regional centers across the country to train faculty of medical colleges about recent educational technologies. Workshops for advanced courses in medical education are also being organised for select faculty. These workshops are designed to train them to prepare curricula, practice innovative methods of teaching and learning and improve assessment methods. Further, faculty development for CBME has also been introduced by the MCI. This will help faculty to have a better understanding of the competencies in their own disciplines and they will be able to frame them.
Reforming our medical curriculum is an urgent need, but implementing such reforms will be a major challenge. Many factors may contribute to the slow pace of implementing competency-based learning in actual practice and the most important of these is the shortage of faculty in medical colleges. In this situation, student-centric learning methods will be difficult to implement. There may be deficiencies of infrastructure which prevent small group teaching. The faculties are already overburdened and resistance by both faculty and students to change will be an additional problem.
It has become equally important to have an interface between technology-driven strategies for student teaching and learning as well as faculty development. We should also, explore various digital platforms for providing a strong networked community of medical colleges that can conduct live lectures, demonstrations, and other activities. There is an increasing requirement for training students in telemedicine technologies and the use of artificial intelligence, etc., to revolutionise the methods of patient care and ensure universal coverage.
Medical education in India needs to evolve and keep pace with the rapid changes in medical science and health care. A teacher-centered learning has to be replaced by a student-centered, outcome-based one. Various constraints such as limitations in infrastructure, faculty shortage and implementation of medical education technologies at par with international standards may be overcome with timely implementation of policies regulated by the MCI and the government. The newer upcoming institutes may follow and take guidance from reputed premier institutions to develop a sound medical education systems. Both faculty and students will have to adapt with these changes over time and static learning has to be replaced by a dynamic and qualitative approach.
'Coming together is a beginning; keeping together is progress; working together is success'
-Edward Everett Hale
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Conflicts of interest
There are no conflicts of interest.