By Sreya Salim:
The path leading to the history of medical education in India is a very interesting journey. Long before the world started talking about Harvard and Cambridge, when Royal College Of Surgeons was unheard of, India had given birth to a civilisation that gave immense importance to the medical sciences as well as doctors. The country has produced a number of competent physicians. Gurukuls of Vedic period provided training in medical science. It has been claimed that students came from distant lands to study medicine in Nalanda and Taxila. Most of the rulers took steps to encourage medical education. However, it was only after the arrival of the British that modern medicine was introduced. The first medical college was set up in 1835 in Kolkata. Many more were established in the 19th century.
Today, India has 362 medical colleges. It is indeed a matter of pride that our institutions have produced many world class physicians. However, paradoxically, more than half of the children in India are not immunised and less than half of the women here receive proper prenatal care during pregnancy. The doctor-patient ratio that is nowhere near the WHO standards, the lack of doctors in rural areas and a high number of appalling statistics clearly depict that the Indian medical education system contains many fundamental defects.
Defective Selection Of Doctors-To-Be
India is one of the countries where there is high demand for medical seats. More than six lakh students write the pre-medical entrance tests every year. Only about 45000 turn out to be fortunate enough to secure a seat. It has often been pointed out that the method of selection of doctors-to-be is highly defective. Though the exam system has been changing from year to year, the fundamental exam pattern has remained more or less the same. Aspirants are screened on the basis of the answers they give to multiple choice questions. These tests often turn out to be mere tests of memory. True knowledge is seldom assessed through these MCQs. The humanitarian attitude much needed to become a doctor is not evaluated. Hence, the medical education system in India presently allows anyone who can memorize and store a large amount of information to be a doctor. Nobody seems to be interested in creating socially committed compassionate healers.
Flawed Assessment System
While most foreign countries use OSCEs (objective structured clinical exams) to test the competency of medical students, the examination system in India gives more importance to theoretical knowledge whereas, clinical skills are often overlooked. The traditional long case-short case system which India follows today requires the students to rote learn a lot of facts rather than gain clinical experience. Since it is the exam system that determines how the students study, this current method of assessment plays a pivotal role in moulding young doctors.
Another serious handicap of the Indian medical education system lies within the syllabus. A young student who steps into a medical college after completing school education encounters a huge and growing body of knowledge. The present syllabus doesn’t distinguish between the less important and more important facts. Moreover, students are seldom provided opportunities to explore new and exciting domains in medical science. There is no integration of sciences as the subjects are taught isolated from one another. Most of the students attain inadequate clinical exposure. While foreign countries have made use of cutting edge technology to impart knowledge to their students, Indian class rooms are still teacher-centred and encourage passive learning of facts.
Lack Of Skilled Teachers
The most important challenge which the medical education system faces today would perhaps be the lack of skilled teachers. Teachers are selected solely based on their degrees and not on their clinical skills. Additionally, no training is given to the staff in teaching methodology. Hence, those with a flair in teaching fail to come up and innovative teaching methods are not introduced. New tools for teaching are also utilized. It was as a solution to this problem that MCI introduced the concept of medical education units in each college. However, this has not materialised in most of the institutions.
The Price Of Privatisation
Privatisation of medical education was introduced to solve the grave lack of doctors. The first self financing medical college was KMC in Manipal, which started functioning in 1953. Since then, a number of medical colleges have been established in the private sector. After the liberalization of 1990s, there was a large increase in the number of such institutions. Though privatization has broadened the scope of health care, it has resulted in the commercialisation of education. India is the only country which authorises the sale of medical seats. Many colleges take illegal capitation fees which ranges anywhere between twenty five lakhs and one crore. Hence, even if the student lacks the intellect, grit and determination to be a physician, money can make things easier for him. The loop holes in MCI regulations have made it possible for colleges without proper infrastructure or adequate number of patients to get accreditation. This has resulted in a steep decline in the quality of medical education, especially at the undergraduate level. Thus, many colleges have turned out to be factories that produce money minded quacks instead of efficient doctors.
Towards A Better System
A range of reforms to improve this 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. Whole body healing should be given more importance and a holistic approach to health should be encouraged. Problem based learning, group learning, team work, use of new technology in class rooms and integration of subjects can make a huge impact. Medical research should also be encouraged along with new teaching methods and clinical skills. 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.
So far we have been treating these problems with antipyretics. What the medical education system needs today is a complete course of antibiotics. Reforms in the medical education will lead to reforms in the health sector. This will in turn lead to a better society.
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