Bridging the Gap between Indian and Western Med Schools

If the future of work is about skills, what can Indian medical colleges learn from their counterparts in other countries? A HE report.

Physicians often form the centrepiece of any healthcare system. And the synergy between practitioner and patient is the nucleus of the healthcare system.

Despite advances in the national economy, today many students, as well as medical graduates, continue to migrate to the west. There is the perceived prevalence of high-tech training and super specialisation in the west. Is it true?

Lessons from the UK

According to Kamal Mahawar, the author of the Ethical Doctor, the most significant difference is in the postgraduate training. "In countries like the USA and UK, it is much more organised and structured and results in adequately trained professionals. In the UK, a doctor cannot work independently until they have undergone further postgraduate training. It is required even for those who will ultimately become the so-called General Practitioners. In India, we do not even have any structured training system for General Practice, something which a majority of doctors will ultimately end up doing. And even when we do have postgraduate training systems, there are no standard benchmarks that trainees have to achieve before those qualifications are given. As a result, there is no pressure on trainers actually to train and sometimes the result is a specialist who cannot actually do the job but now has the credentials to do it!" he adds.

Focus on Soft Skills

He also points out that treating patients equally and prejudice is a tenet of medical practice, and that is very much a part of medical education in the UK. "In India, we generally tend to ignore soft skills and communication. These are regarded highly in the UK. In the UK law, people have to be treated equally and without prejudice irrespective of their sexual orientation. I think, until recently, homosexuality was illegal in India. So understandably, the opinion of society has lagged in the respect," says Mahawar.

Need to Improve System

The rural UK is very different from rural India. Every part of the UK is covered by a network of GPs, ambulances, and hospitals. So most doctors can provide a very high level of care to even rural communities. The situation is grim in India, where large swathes of the country have minimal access to any healthcare infrastructure. It is impossible to practice modern medicine without supporting infrastructure," he adds.

Indian Examples

Majority of the private colleges in India are in more affluent states. They also have broader markets for medical care services as well as medical education. But that hasn't prevented some medical colleges from training students for rural stints.

According to Oommen John from George Institute, there are several examples within India itself, which help students to be relevant to the community they are serving. "I studied at CMC Ludhiana. In the first few months, we were given orientation about what medicine is all about. Students were also taken to community-based healthcare delivery chains. That completely changed the perspective about medicine when we were in college. It was called Rural Orientation of Medicine. From the third year onwards, students were pushed to work in rural areas, where they would work with ANMs and were responsible for a couple of families. It gave perspective about how health systems function in the country," he explains. Another important aspect is the value of clinical medicine.

"We didn't have the luxury of doing a hundred tests or ten tests. For each of the condition, we were often asked to do one test. Most of the current medical students are exposed to a plethora of investigative medicine. We were never allowed a test unless we pointed out a clinical diagnosis. Today, if a person comes with a headache, doctors ask for so many MRIs, that the patient won't be left with any money for the treatment. Several teachers have pointed out that every medical college should have community-based healthcare delivery practice and students should have exposure to real-time real-life learning," he explains.

Lessons from US Medical Education System

According to John, countries like the US have given options for students to familiarise themselves with the necessary courses. "Then, they can decide whether they want to pursue medicine or not. If you have done biochemistry, and you have an inclination for the subject, then the student can choose any of the professions, a biochemist, genetics or informatics," he adds.

John also adds that Indian students are not given exposure to common conditions. "It is a well-established model. Problem-based learning offers students the ability to arrive at a proper clinical diagnosis and inculcate the skill of clinical decision making. "

Use of Simulation

He also adds that the third component, many western countries have is simulated learning. In countries like Australia and several other countries, they teach students. Objectively Structured Clinical Examination. "There are models where they use computers as well as mannequins to familiarise students with medical conditions like cardiac conditions.Especially for MRCP and FRCS programme, some countries like the UK, use actors/patients," he concludes. He also adds that it's also about not just identifying a disease but also communicating it to the patients." If somebody with cancer comes to you, how do you break the news to them?" he asks.

Lessons from New Zealand

If you take the example of New Zealand, it has only two medical schools for a population of 4 million people. They can work in Australia as well as New Zealand. The programmes are usually of six-year duration and have health science in the first year. There is no stand-alone graduate entry programme. Twenty-five per cent of students enters at the end of the second year and complete course in five years. Indigenous students come through another scheme, and the objective is to provide them with extra support. The aim is to produce doctors capable of meeting community health needs.

There are several advantages to the standard first-year programme as it evens out the effects of schooling so that students from disadvantaged schools have a chance to compete more equitably, with students from more privileged schools. Most medical admissions are reliant on snapshots of students ability through a single test. But this admission is based on the performance of the first year at the university. And because they have made the career choice at a slightly later age, they are better prepared for university.

Lastly, notable strides in medical knowledge over the last few decades have raised the knowledge burden on doctors. As a result, even PG degrees need to magnify with super specialist degrees. Further, it is also imperative that future doctors IT and data science savvy. They will need to interact a lot more with computer algorithms, machine learning and artificial intelligence. Currently, no curriculum covers these. Adopting these best practices of other countries is good for business and also the right thing to do.