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MEDICAL EDUCATION
Year : 2021  |  Volume : 2  |  Issue : 1  |  Page : 94-95

Need for change in medical education in India


Former Dean and Professor Emeritus, NSCB Medical College, Jabalpur, Madhya Pradesh, India

Date of Submission25-Sep-2020
Date of Acceptance20-Mar-2021
Date of Web Publication25-Apr-2021

Correspondence Address:
Prof. Kanwar K Kaul
Prof. Kanwar K. Kaul, 24, Nayagaon, Jabalpur, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JME.JME_171_2

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How to cite this article:
Kaul KK. Need for change in medical education in India. J Med Evid 2021;2:94-5

How to cite this URL:
Kaul KK. Need for change in medical education in India. J Med Evid [serial online] 2021 [cited 2022 Aug 12];2:94-5. Available from: http://www.journaljme.org/text.asp?2021/2/1/94/314619

An overdue change in the field of medical education in the country is demanded by the changed societal needs. The old system borrowed from the British continues to override our thinking. We face two contrasting challenges:
  1. Basic health services for the bulk of our rural population (which have currently been too slow to meet the high morbidity and mortality)
  2. Demands of specialist and super specialist services in tune with global standards.
With the experience my lifetime spent in Medical Education, in India and overseas, I humbly submit a summary plan to meet both challenges stated above: With respect to (a) above, we have failed to provide appropriate services of qualified medical graduates to the peripheral rural populations for which the reasons are not far to find. The city-bred training of a medical graduate is inappropriate to the rural situation where his skills are not fully utilisable. No amount of persuasion or incentives will make this youngster work in the periphery, and even if pressurised, he will work reluctantly and unhappily. Here, we need an appropriately trained person:
  • Chosen from the district (secondary health care level)
  • Trained at a medical school established in the district to serve in a district
  • Through a shorter but situation-specific training programme
  • Teaching can largely be carried out by specialists, working in the district hospital and other recruited staff, admitting smaller batches of students not exceeding.
Such courses will:
  • Produce practitioners in a shorter period (three against the 5½ years of MBBS), at a less cost and most suited for the needs
  • Provide opportunities for those young aspirants who take up other courses such as BAMS (Ayurvedic) and BHMS (Homeopathy) to seek a backdoor entry to ultimately practice allopathic medicine. My feeling is that a bulk of young aspirants of this category would prefer the 3½ year allopathic course. Others could, by choice, take up Homeopathy or Ayurvedic systems of practice.
Such licentiate courses such as LMP and LSMF were available in pre-independence era and from my personal knowledge then, served a very useful purpose by providing services as 'Sub-assistant Surgeons'. Instead of future plans to establish more medical colleges at a high cost, at least part of this money could be more appropriately utilised to prepare licentiate practitioners at Medical Schools established at District hospitals. With respect to (b) above, the current MBBS degree has lost its relevance for reasons given below:
  • From day 1, the present day student admitted to the MBBS course has his mind focussed on a postgraduate (PG) speciality and consequently all his efforts are directed at preparation for the written PG entrance test which is more than 5 years away
  • The 5 years of training for MBBS seems to him to be just a casual milestone on way to his ultimate goal and time wasted. In the process, he neglects to learn clinical medicine which he feels is irrelevant to his goal. This may make him a theoretic delight but a disaster as a practical clinician. He hopes to do well at the written PG entrance test because it does not assess his clinical skills.
It is obvious, therefore, that the current MBBS course needs to be eliminated since only a miniscule minority settle in general practice after the MBBS course. Most graduates find an opportunity to obtain a PG diploma in any available specialty or qualify with a diplomate examination conducted by the National Board of Examination. As a result, the number of plain MBBS graduates in general practice has fallen. PG course of a specialty (MD, MS) currently takes 8½ years after admission to a medical college (5½ years of MBBS and 3 years of MD/MS). Diplomas in specialties take a year less. After eliminating MBBS, this 8½ years course could be utilised for a straight MD or MS (including an added choice for MD in Family practice) providing a more competent specialist, by eliminating the unnecessary areas not appropriate for his specific training. This is a bold plan and its implementation will need the necessary will and earnestness on the part of concerned authorities, rising above vested interests, in the ultimate good of the nation's health. I understand some changes are already under way that will hopefully address some of the concerns in medical education. It is thus proposed that the PG curriculum be constructed on the following broad outlines. Changes within this skeleton plan, if any, can be made after a debate at appropriate and competent levels:
  The Broad Curricular Plan Top
First professional course Two years: Anatomy, Physiology, Biochemistry and introduction to general Pathology, as for MBBS at present followed by the first professional examination. Second professional course The next 2½ years: Clinical clerkship in learning history taking, clinical methods in children, adults and women, simultaneously with Pathology, Pharmacology, Forensic Medicine and Community Medicine followed by the second professional examination. Final professional course After qualifying in the second professional (4½ years), a student at this stage directly chooses his specialty for MD/MS in Medicine, Surgery, Obstetrics and Gynaecology, Paediatrics, Family Medicine, Orthopaedics, Ophthalmology, ENT, Anaesthesiology, Radiology, etc. (choice available on merit) duration 4 years in the specialty including applied basic science related to the chosen specialty, alternatively a diploma in an available specialty, duration 3 years. Final qualifying examination which will entitle the student to the degree after 8 ½ years and diploma in 7 ½ years followed by a period of residency.
  • The MBBS course stands removed as irrelevant. None or very limited additional financial commitments are involved
  • (This plan was submitted to the previous Hon. Union Minister of Health Shri JP Nadda).
Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.




 

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