Prescription for the future

Medical education needs to adapt to the changing times and skill the students accordingly

India has nearly 500 medical colleges and more than 67,000 MBBS seats. But the hallmark of medical education is not just the number but the capabilities of professionals who graduate from these colleges. It is no secret that the professional abilities and competence of doctors are greatly influenced by their training and the practice settings that they have been subject to. Is the Indian medical student getting the right education or is there a need for change?

The current medical education system and the curriculum are not as desired or at the right levels. The curriculum, in most instances, knowledge-based with a special focus on learning psychomotor skills that are imparted in the more traditional classroom-oriented lecture methodology. Here, learning is mainly driven by the teachers’ individual knowledge base and enthusiasm.

But the current curriculum does not focus on the important aspects of professionalism and doctor-patient communication. These key skills are left to be acquired through a system of role models in the workspace. These skills, along with other important ones like taking initiative and strong work ethic, need to be inculcated from the time students start their medical education.

Moreover, the skill assessment is largely based on how well the students memorise their course content. This doesn’t allow any room for improvement for the student without loss of precious time and resources. Skills imparted this way fall short of the desired requirements of the medical profession. Hence, we now need to make changes in the medical education that will address the issue of quality and number of medical practitioners in the country.

The road ahead

What is needed is a radical shift in the way the basic medical curriculum is designed as the kind of diseases that plague India has changed. So, it is important that the curriculum shifts from being treatment-focused to one that focuses on prevention. This should influence the facts, systems and treatment algorithms being taught in the curriculum. During the course of the student’s medical education, there should be focus on enabling them to become better communicators, work in a multidisciplinary team and learn the latest technological innovations.

Therefore, doctors should be trained in the skills needed to deliver quality services in the complex healthcare system. This will need to be more technology-oriented and evidence-based. The curriculum will have to enable doctors to stride through scientific, technological and social changes that are likely to occur throughout their medical careers. So, the doctors of today will need to be lifelong learners.

Innovative teaching and assessment methods will have to be incorporated into the curriculum to make it effective and sustainable. The assessment should be more real-time and formative in nature, allowing students to make continuous, deliberate and well-thought-out changes for constant improvement.

Drivers of change

To ensure that these aspects are implemented, a variety factors need to come into play. Here is a look at some of them:

1. Government-initiated leadership: Government regulators should be the facilitators of change by implementing a policy that enables a better medical education. This should be formulated according to the current trends in medical education at the global level and incorporate the global best practices. The policy should facilitate the top 10 of the best medical colleges in the country to come together and create a roadmap to structure a curriculum with innovative teaching and assessment practices, as a pilot study. Once successful, this structure can be implemented as the curriculum in medical colleges across the country. To implement this, it is important to have good teachers. However, to ensure that quality education is delivered, it is necessary to adopt a systematic approach to faculty development. Doing so can enable students to meet the current health challenges and ensure that the right teachers are recruited.
2. Innovations in technology: Technology should be used liberally but judiciously to meet the requirements of the modern-day medical educational needs. Mobile-based teaching and learning methods will make the young generation more engaged in education. Such developments in technology can not help in carrying out formative assessments but also improve student-teacher interactions.
3. Role of educational institutions: Medical colleges should adapt to the evolving medical education tools, concepts and approaches required to bring about the much-needed changes in the teaching and learning methodologies. Resources cannot be a constraint as many colleges are now adopting the latest technology for teaching or learning. A shift towards technology-assisted learning is an inevitable reality and needs to be realised progressively.

The immediate challenge will be to make these changes pragmatic. The need to rapidly increase the overall number of healthcare professionals to meet the growing demand will make personalised teaching and assessment methodologies impractical. Innovative use of technology, such as online group discussions and assessments will help us bridge the gap. The challenge will be the lack of technical expertise within the existing teaching faculty. So, the first step would be to upgrade the technology skills of the faculty members. This is the key component of driving the change to a better and relevant curriculum.

The ethics of using real patients for teaching is a perennial problem but with the use of simulator technologies, this can be overcome. Furthermore, information needed for class can also be easily shared through a cloud-based platform as it is a low cost, high-efficiency solution. Mobile applications can be used to teach and assess students in real time. Furthermore, having flipped classrooms can enable students to have more time for hands-on medical training.

So, a judicious mix of technology and good planning on the part of institutions should pave the way for a pragmatic approach towards how medicine is taught in the country.

(The author is pro-vice-chancellor, Health Sciences, Manipal Academy of Higher Education, Manipal)