By Sachin Kuchya
Now that we have separated health from medical care, decentralized the delivery mechanism, remapped, relegated the Infrastructure and manpower to medical colleges – developed the ecosystem. We shall look into ways on how to Improve & provide motivated, well trained and Skillful manpower to nourish the ecosystem.
Revise the MBBS, Nursing & Paramedical curriculums, design it in a way that suits our objectives not that of world.
The primary aim of MBBS curriculum is to make, “Physician of first contact”. What remains unanswered is for which genre, country and clinical scenario.
Why I say so? Because over the years, the poorest of poor, the least informed ones too understand which specialist to approach & have unbridled access to a range of Hospitals in the least possible radii. So access & to much extent availability is not a issue. The key issue is affordability and non availability of motivated, trained and skillful doctors and paramedics in the government set up.
We have a MBBS curriculum which is of 4&1/2 yrs duration, on paper but needs at least 5 calendar years, for the most talented ones, too. When I discussed reducing this to 4 calendar years, it turned out to be because of lure of foreign countries? Why because they need a transcript / certain hundred Hours of training in each subject and it cannot be achieved in anything less than 4&1/2 years, while those countries are training their Medical graduates in 4 yrs itself.
Off these 4&1/2 year, almost 1- 1& ½ year gets consumed in preuniversity exams- University theory exams – university practicals – copy evaluation and Result declaration. Another one year or so in summer & winter vacations.
Apart from this, the practice of having detained batches again eats up almost 10-30% of undergraduates in the first year itself. With reduction of MSR vis a vis number of teaching faculties & ever widening syllabi – these students are left untaught in most of the departments. Either Merge them (those failing in two or more than two subjects) with the Junior Batch or allow them (those failing in one) to join the main batch.
Today the medical science has moved ahead. Most of the screening, initial workup can be done by use of paramedics and cheap, readily accessible technology. So, apart from, “Physicians of first contact” we need to train them for a specialty, too. Why I say so? Because it will motivate them to acquire skills
(certified specialists, while doing MBBS itself) and also increase their capability & usefulness to the society.
How to do it-
Rechristen the preclinical and preclinical subjects like, Clinical Anatomy (Including Radiology), Clinical Pharmacology. This will invigorate the practical aspect from day one.
Combine the subjects like Clinical Physiology & Clinical Biochemistry, Clinical Pathology & Clinical Microbiology, Clinical Pharmacology and Toxicology into one subject each. Similarly combine surgical fields like General surgery, Orthopedics, ENT & Ophthalmology ( Surgery) and General Medicine, Pediatrics, Psychiatry, Skin & Veneral diseases ( Internal Medicine). This will save time during training, Reduce the duration of time required for theory & practical exams, rationalize the marks distribution, both among the subjects & within the subject ( Lower weightage to theory and greater stress on Practicals).
Examinations should be theory – descriptive & practical, at the end of First (11-12th month) & Second Prof (23-24 month) while there will be Single computer based MCQ Test for PSM, Obs & Gyne (36th month) and another Single computer based MCQ Test for Surgery & Internal Medicine (48th month). The practical shall be conducted subject wise, separately. This will help in reducing the time need for theory evaluation & result declaration and further emphasize the practical importance of each subject.
Result: This will train our MBBS UG’s, through their MBBS years in a Clinically oriented & medical care delivery oriented model. We will be able to complete the MBBS curriculum in 4 years while simultaneously increase the duration of teaching and emphasize more on practical learning. This shall also bring all AYUSH curriculums and MBBS curriculum on same timelines & hence synergy among them.
Restore the Sanctity of Internship, Make the postgraduation crispier – save on productive years.
Over last decade or so, the Internship has turned into a formality, in most of the medical colleges in our country. And this has taken a lot away from our fresh MBBS passouts, they fail to treat most of the common diseases and disorders, prevalent in our society. Our MBBS graduates deserve more.
So, Restoring the sanctity of the Internship, is the most important step to Improve the Health care delivery. How to do it?
Take the Score of computer based MCQ Test taken at 36th and 48th month as NExiT scores. Allow the successfull ones to opt for a PG degree (Clinical only). Recognize Internship as first year ( House JoB or JR I).
During the Internship every NExiT qualifier will go for a six month rotatory posting, followed by 6 months to 30 months of dedicated training into their chosen PG, Clinical speciality. This will yield MBBS graduates with additional skills. For eg.
Similarly, Nursing and Paramedical curriculums need to be streamlined to suit our country needs and objectives.
Move away from current Eligibility & Training criteria for Medical teachers, towards a more problem solving team leader based approach.
Every medical teacher should be a professional, with plenty of problem solving approach. As on this date, almost 50-100 MBBS graduates are working as faculty in various pre and para clinical departments in each of the 450+ medical colleges in our country. This translates to almost 30 thousand MBBS graduates, who are not involved in delivery of medical care – pathetic if we look behind, pause and ponder about the Doctor: population ratio of our country. This is also the reason behind most of our researches not leading a change on ground.
Therefore, abolish MS & MD’s in Pre & Para clinical subjects; allow these degrees in Clinical Subjects only. Only PhD holders should be recognized as faculties, in pre & para clinical departments. The Master deg Holders can join the pre or para clinical department as Senior Residents and enroll himself or herself as PhD Candidate in the same subject. Upon successful completion of PhD, he or she will be Recognized as Assistant Professors & eligible for promotion, thereafter.
In the Clinical departments, the Master deg Holders can join as Senior Residents and enroll himself or herself as PhD / DM / MCh Candidate in one of the related superspeciality, depending upon the availability of DM / MCh seats or PhD guides. Subsequently, upon completion they will be recognized as Assistant Professors
This will ensure that every medical teacher is a Clinician too. Will impart professional training, recognize unmet needs, get involved in intra- as well as inter-pathy research activity, will lead to outcomes which are for greater good of the science & society. The MBBS graduates and Diploma Holders, too can join as JR 2 or JR 3, submit the thesis and become the faculties.
With continued development & nourishment of the ecosystem, we will be able to improve and sustain the delivery of Basic medical care to every Indian, achieve Antyoday. This will also have Incremental effect on delivery of Secondary & tertiary medical care too.
Jai Hind, Bharat Mata Ki Jay, Vandemataram.