Across the whole gamut of healthcare, the access to modern technology coupled with the ubiquity of the latest developments has catapulted the way health care providers communicate, access research data and arm themselves with pertinent health-related information for appropriate care and management. Medical science has come a long way – from diagnosis based on clinical suspicion to an era of Computed Tomography (CT), MRI, PET scan; from open surgeries to laparoscopic and robotic surgeries.
However, the bien-pensant attitude of medical authorities towards medical education and training of young doctors should change and the practice of eclecticism should be inculcated in all the medical students of today and doctors of tomorrow.
In the practice of medicine with each passing year, there is a huge advancement in the technological knowledge and application of research findings leading to improved methods of disease prevention, diagnosis, and treatment opportunities which lead to a constantly changing definition of competence that a medical student must acquire to enable him/her to undertake contemporary medical practice. Stalwarts and experts have been advocating certain essential revisions in the long outmoded curriculum to catch up with the needs of the present era.
Today, the professionalisation and commercialization of medicine have so disposed of the doctor-patient relationship that empathy, finesse, and skill in communicating with patients have become paramount for healthcare professionals. Communication skills cannot be alienated from clinical exposure and bedside learning, and quality of clinical exposure matters more than early clinical exposure in fostering communication skills and a sound practical approach.
The overall rigour and stringency of practical instruction and assessment in MBBS are highly inadequate, and rote textbook learning and theoretical assessment lumber students with an excessive burden. At the same time, an archetypal medical college hospital today presents no salubrious environment for soft skills to be nurtured – apart from the massive patient load many of them juggle every day, few medical teachers (who are meant to teach soft skills to students) have the luxury of exercising these soft- skills in their every-day practice themselves.
In the absence of learning by example, a taught curriculum is of little benefit. We have witnessed this already: even after years of introducing “preventive and social medicine” as a separate subject and including community postings in the curriculum, a lot remains to be desired with respect to the social orientation of emerging medical graduates.
The new Graduate Medical Education Regulations (GMER) 2018 recently promulgated by the Medical Council of India (MCI/NMC) and slated to be effective from the 2019-20 academic session is like a breath of fresh air for the dreadfully archaic under-graduate (UG) medical curriculum of our country. Envisaging a competency-based and outcome-driven UG curriculum, the new regulations bring in a novel course called Attitudes, Ethics, and
Communication (AETCOM) to stretch across the UG years, as a part of which medical students will be taught (and assessed) about essential communication skills necessary in adeptly handling critical situations in clinical practice. Apart from this, it provides for earlier clinical exposure for medical students, a foundation course, and electives.
The Board of Governors has approved the document which revisits the 1997 syllabus in the context of emerging diseases and scientific advances. The preamble of the report states that the new regulations stand on the shoulders of the earlier (1997) regulations, which also espoused an enhanced community- and preventive care orientation of the curriculum, greater social emphasis on medical education, and an integrated and problem-based learning approach.
However, even after 21 years of the 1997 regulations, the reality has scantily changed: preventive and primary care orientation of the curriculum is inadequate, a social approach among emerging physicians remains feeble, and learning remains inordinately discipline-based and entrenched in rote memorization. Examined closely, the causes can be located in certain ground realities of medical education which remain unaddressed.
Called “Competency-based UG Curriculum for the Indian Medical Graduate”, it marks a radical shift from old times when rote and classroom learning was the norm in MBBS training and stress on the doctor-patient relationship and medical ethics was negligible. For the first time, India’s MBBS curriculum acknowledges the importance of ethics, responsiveness to the needs of patients and families and fine communication skills to engage the ailing.
While the process of curriculum design usually progresses well on paper, implementation has always been the bottleneck for most innovations in India. A closer look at the objectives and educational strategies will reveal that the key to implementation lies in strong administrative and leadership skills.
In India, departmental hierarchies and dividers are rather difficult to penetrate. So, deciding who will do what, how much and how, are probably the most crucial decisions to be taken by each institution. Leaving the whole burden of teaching ethics on the shoulders of one department like forensic medicine or community medicine will probably spell disaster even before the efforts begin.
The ethics curriculum will have to be longitudinally spread throughout the MBBS course, starting with the Foundation Course, followed by inputs from anatomy when the students first reach the dissection hall, till the time they acquire their degrees. A central team will have to use its abilities to coordinate between departments to ensure the successful launch of this endeavour. Needless to add, any change will encounter resistance and how each institution convinces its stakeholders and manages its people, time, funds and facilities will determine how effectively the curriculum is delivered.
“One looks back with appreciation to the brilliant teachers, but with gratitude to those who touched our human feelings. The curriculum has so much necessary raw material, but warmth is the vital element for the growing plant and for the soul of the child.” – Carl Jung.