volume
06
issue
07
The Enterprise of Healthcare
july 2011 / ` 75 / US $10 / ISSN 0973-8959
www.ehealthonline.org
Dr Purshottam Lal, Chairman
Dr AK Agarwal, Professor
Metro Group of Hospitals pg -14
IGNOU School of Health Sciences pg - 39
REFORMING MEDICAL EDUCATION TO BENEFIT MASSES
Dr Tapan K. Jena Professor, School of Health Sciences, IGNOU pg - 43
Revolutionising pedagogy @ a distance pg-38
Š Carestream Health, Inc., 2011.
Contents Volume 6 > Issue 07 > JULY 2011 > ISSN 0973-8959
spotlight
20
Revolutionising Pedagogy @ a Distance Dr Biplab Jamatia
zoom in
27
Medical Education in Indian Perspective Prof Tapan K. Jena & Dr Biplab Jamatia
in focus
30 Opportunities for Excellence Dr Biplab Jamatia
leaders speak
36
“There is no Fertile Ground for Students Excelling in Research”
08
Dr Shakti Gupta, MS & HOD, Hospital Administration, AIIMS
40
“ICT-based virtual classes are playing a big role in medical education”
COVER STORY
Dr A K Agarwal, Dean, Maulana Azad Medical College
Reaching masses
The only way to make healthcare affordable is to create a massive education network, and this should encompass infrastructure for training of Medical, Dental, Paramedical and Nursing students
Dr Tatyarao P. Lahane, Dean Grant Medical College
By Dhirendra Pratap Singh
14
41
“Sow the Seeds for a Doctor-Patient Relationship in the Degree Courses”
16
42
“The Government is Very Serious About Improving Rural Health” Dr NK Mohanty, MS, Safdarjung Hospital
43
“Technology can Address Issues Related to Rural Healthcare” Dr VA Saoji, Dean, Bharati Vidyapeeth
44
“We Need to Remove Commercialisation of Education” James Pandian, Dean, SRM University
45 “We Lack in Skill-set Training” Dr S Kumar, Dean, MS Ramaiah College
policy perspective “we need justice for the patient” Dr Purshottam Lal, Board Member of MCI
4
in conversation “GOI recognises importance of distance learning in Medical Education” Prof AK Agarwal, IGNOU School of Health Sciences
> www.ehealthonline.org > July 2011
48
“Change in Mindset of Policy Makers is the Need of the Hour” Dr SM Bhatti, Principal, Christian Medical College
49 “We Need to Improve Our
Education System if We Want a Change”
Dr Pratibha Gupta, Dean, School of Medical Sciences and Research, Sharda University
Guest Editorial Volume 5 > Issue 07 > juLY 2011 ISSN 0973-8959
Go the Distance
W
hile we celebrate the spirit of Millennium Development Goals world over in the context of health indicators, it is also important for us, as a nation with huge potential towards strengthening our health care systems, to address the challenges of global health governance, political will and policy coherence. A survey by the Organisation for Economic Co-operation and Development says that only seven countries in the world spend less money than India on public health.
The focus of approach paper to the 12th five-year Plan (2012-13 to 2016-17) is on restructuring public health schemes. Recently, the working group constituted for the Plan asked for massive expansion of medical education to improve primary healthcare. Reforms in medical education are urgently needed. There is an acute shortage of doctors in India. India needs more than one lakh doctors per year and we only produce 30,000. To meet this dearth, we need to scale up our medical infrastructure three times. Medical education should encompass infrastructure for training of Medical, Dental, Paramedical and Nursing students. These four pillars of health education should grow simultaneously to provide effective human resources for health. The Government is coming up with six AIIMS-like institutes and upgradation of 13 existing Government Medical Colleges. This initiative will make affordable and reliable healthcare services available to the rural populace. The emerging areas in medical education, which are seeing maximum growth and ground-breaking research, are reproductive medicine, plastic surgery, endocrinology, oncology and cardiology. Emergency service has long been recognised as a specialisation in the developed countries. Geriatric medicine or the care of the elderly is another area to watch out for in the future. Globalisation has led to greater demand from the industry for different types of jobs, which are being looked at by private players. Distance education in India is cheaper than a full time degree but provides high quality, well structured learning material. The IGNOU School of Health Sciences offers a plethora of innovative and unique courses in this domain. These courses have been appropriately structured to fulfill the various needs of medical education in India. The special issue is an attempt to explore various ways of redefining medical education in India and identify the roadblocks for taking the health care services to the masses. While innovation remains the key word, few key issues need to be addressed, (1) the value of public-private-partnerships; (2) greater country ownership; and (3) sustainable funding to meet both short-term and long-term needs; (4) appropriate capacity building exercise and training programmes to enhance the capabilities of the medical professionals; (5) mobilising the health professional around the health needs of the rural India, (6) Knowledge sharing across the communities, etc. We are very happy to be presenting this special issue of eHealth on the occasion of World Education Summit 2011 that IGNOU is organsing with Elets Technomedia Pvt Ltd and Centre for Science, Development and Media Studies from July 13 -15, 2011 at New Delhi, India. With Best Wishes‌
Prof VN Rajasekharan Pillai Programme Chair, World Education Summit 2011 Vice Chancellor, Indira Gandhi National Open University
July 2011 < www.ehealthonline.org <
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President Dr. M P Narayanan
Editor-in-Chief Dr. Ravi Gupta
gm Finance Ajit Kumar
dgm strategy Raghav Mittal
partnerships & Alliances
Dr. Rajeshree Dutta Kumar, Sheena Joseph Shuchi Smita, Jaunita Kakoty, Ankita Verma
Editorial
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eb Development Zia Salahuddin, W Amit Pal, Anil Kumar infrastructure Mukesh Sharma, Zuber IT Ahmed
Events Vicky Kalra
human resource Sushma Juyal
legal R P Verma
In the Right
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The magazine is not responsible or accountable for any loss incurred, directly or indirectly as a result of the information provided. ehealth is published by Elets Technomedia Pvt. Ltd in technical collaboration with Centre for Science, Development and Media Studies (CSDMS) Owner, Publisher, Printer - Ravi Gupta, Printed at Vinayak Print Media, D-320, Sector-10, Noida, UP, INDIA and published from 710 Vasto Mahagun Manor, F-30, Sector - 50, Noida, UP, Editor: Dr. Ravi Gupta Š All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic and mechanical, including photocopy, or any information storage or retrieval system, without publisherâ&#x20AC;&#x2122;s permission.
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cover story
Reaching masses
The only way to make healthcare affordable is to create a massive education network, and this should encompass infrastructure for training of Medical, Dental, Paramedical and Nursing students By Dhirendra Pratap Singh
I
ndia is scaling up economic activity, both on the demand and the supply side and a massive boom in healthcare services has changed the nationâ&#x20AC;&#x2122;s health delivery landscape beyond recognition in the last decade. Indian hospitals with the mantra of star facilities and bleeding-edge technology are writing a new chapter in Indiaâ&#x20AC;&#x2122;s healthcare services. Despite this, India has 94 beds per lakh population compared to the WHO norm of 333.
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The density of doctors is also dismally low; there are only 43 doctors per 10,000 population compared to 249 doctors for every 10,000 people in Australia, 209 in Canada, 166 in the UK and 548 in the US. Estimates of doctor shortage is around 6, 00,000. This translates into an enormous opportunity to transform the medical education system, which should be opened up for private participation and companies should be allowed to establish medical and dental colleges.
> www.ehealthonline.org > July 2011
All India Institute of Medical Sciences (AIIMS) has been at the forefront of providing medical education in the government sector. At AIIMS, everything is kingsize,from the awe-inspiring campus with nearly 18 lakh patient footfalls a year, an array of 50 disciplines, 25 clinical departments and six super speciality centres managing every type of disease, to more than 54,000 wannabes who compete fiercely for one of its 77 MBBS seats. Research is what sets the
cover story AIIMS apart. AIIMS, which brings out more than 50 per cent of all the medical research from India, published over 1,500 original works in high-impact journals this year.
Rural-urban divide India has a health crisis exacerbated by the shortage of doctors and a mismatch between the need for basic medical services in rural areas and the congregation of specialists in urban centres. An abysmally low government spending on health—at US $ 32 per capita--, characterises the poor state of healthcare in India which is facing a ‘double burden’ of diseases afflicting both the poor and rich classes, recently published WHO report says. While per capita health expenditure is about US $32 in poor countries, including India, it is around US $4590 in rich countries (more than 140 times). The high income countries consequently have 10 times more doctors, 12 times more nurses and midwifes and 30 times more dentists, the report said. With steep income disparities, India is also struggling to tackle a ‘doubleburden’ of diseases, which include infectious diseases affecting the poor on the one hand and chronic lifestyle ailments typical of fast urbanisation on the other. In 2005, the National Rural Health Mission was launched to provide accessible, affordable and accountable quality health services to the poor in the remotest of regions. In order to attract more doctors to the peripheral areas, incentives in terms of salaries and reservation in post graduate seats are on offer. But there is a major roadblock, which most aspirants have to deal with—the lack of postgraduate seats. According to the official estimates one in two graduates gets to do a postgraduate in medicine.
medical college has become a lucrative business opportunity, resulting in several players with political clout entering the area. The Government is coming with six AIIMS-like institutes and upgradation of 13 existing Government Medical Colleges. The new AIIMS-like institutes will be completed by the end of 2012 at Bhopal, Bhubaneswar, Jodhpur, Patna, Raipur and Rishikesh. The upgradation components in Phase-I include government medical colleges at Trivandrum, Salem, Bangalore, Kolkata, Jammu and Srinagar, NIMS Hyderabad and B J Medical College, Ahmedabad. The idea is to make affordable and reliable healthcare services available to the rural populace though these. Each hospital will have 960 beds and will provide undergraduate medical education to 100 students per year. Post-graduate and post-doctoral courses will also be offered. The Pradhan Mantri Swasthya Suraksha Yojana PMSSY was initially started in March, 2006, with the object of correcting regional imbalances in availability of affordable or reliable tertiary health care services and also to augment facilities for quality medical education in the country.
While per capita health expenditure is about US $32 in poor countries, including India, it is around US $4590 in rich countries (more than 140 times). The high income countries consequently have 10 times more doctors, 12 times more nurses and midwifes and 30 times more dentists, recently published WHO report says
Research Focus and Challenges India lacks a comprehensive policy to address the acute shortage of human resources in healthcare, which is a key driver of health costs and a huge constraint on scaling up public-health programmes. There is flawed
Post Liberalisation Era In the 1990s, medical education was opened up to private investment without putting in place appropriate systems and institutional mechanisms for enforcing quality and standards. During 1995-2006, of the 106 medical colleges established, 84 were private. Today, there are 313 medical colleges, of which 163 are in the private sector and 31 are deemed universities. Considering the high premium on medical degrees in India, establishing a
July 2011 < www.ehealthonline.org <
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cover story
Do You Know?
• As many as 12,263 specialists are needed in community health centres (CHCs) and 3,789 doctors in primary health centres (PHCs). • While per capita health expenditure is about USD 32 in poor countries, including in India, it is around USD 4590 in rich countries (more than 140 times). • The Indian healthcare market is on an unprecedented high at 16 per cent year on year. From ` 1, 02,600 crore in 2005, it now clocks ` 2, 00,000 crore and is projected to reach ` 3, 00,000 crore by 2012. • The average life expectancy of a male in India is now 63, while a female lives 66 years, in India, • China, on the other hand, has improved the same to 74 years during the last 10 years. • The healthcare industry employs over four million people, making it one of the largest service industries in the economy. • Indians with foreign MBBS must clear MCI’s test in order to practice.
New watchdog in medical education
% of Doctors 0
1
2
3
4
Algeria
Bahrain
Canada
Denmark
Countries
public policy. Also, poor governance, with the result that there is no standardisation of health-care providers in a manner that is relevant to the country’s needs. Lastly, corruption, an outcome of unregulated privatisation of medical education that has severely compromised its quality. Faculty development is another important component in medical education. It is necessary to organise faculty development in a systematic manner. Steps are necessary at various levels, as the stakeholders are many, viz., the policy makers, the Government of India, Medical Council of India, teachers, students and private and government college managements.
Ethiopia
France
Ghana
Union Health Ministry has decided to seek Cabinet clearance for the proposed National Commission for Human Resources for Health (NCHRH) Bill, 2011. The Bill aims at creating a super medical authority by scrapping all other regulatory bodies. The proposed Bill aims to consolidate the law and promote human resources in the health sector. The Bill aims to merge existing regulatory bodies such as the Medical Council of India, Dental Council of India, Pharmacy Council of India, Nursing Council of India and councils under the Department of AYUSH into a single body. The Bill also talks about constituting a separate board — the National Board for Health Education — to assist the commission to oversee health education. The board will facilitate and promote academic studies and research in emerging areas with focus on professional health education and ensure uniform augmentation of trained specialists and super specialists to achieve excellence in these connected areas.
Reforms needed Honduras
India
Jamaica This table is showing number of doctors in countries according to their population. Source: OECD Health Data
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> www.ehealthonline.org > July 2011
Reform in medical education is urgently needed. There is acute shortage of doctors in India. India needs more than one lakh doctors per year. Or so to say, India can absorb one lakh doctors per year. And we only produce 30,000. So what we need to do is to scale up our medical infrastructure three times. Shortage of doctors affects the poor, who do not have easy access to healthcare services. Private sector must be stepped into medical education to bridge the existing gap
cover story and strict regulatory bodies must monitor this. Medical education should encompass infrastructure for training of Medical, Dental, Paramedical and Nursing students. These four pillars of health education should grow simultaneously to provide effective human resources for health. The focus of approach paper to the 12th five-year Plan (2012-13 to 2016-17) is on restructuring public health schemes. Recently, the working group constituted for the Plan asked for massive expansion of medical education to improve primary healthcare. The working group comprises officials from the health ministry, representatives of business chambers and Planning Commission members. Dr Devi Shetty of Narayana Hrudayalaya said in his presentation that there was
Department of Health Research is projecting an ideal expenditure of around ` 9,000 crore during the 12th Plan period, it is learnt.
Role of Distance Education and ICT There is need for creat ing new cadres of health professionals who are trained to address the needs of the rural population. IT skills and e-labs can be launched to reach out far and wide. Vision sharing by experts and Orientation to nationâ&#x20AC;&#x2122;s health system and policy is the need of the hour. Distance education is a boon as it can be pursued at leisure and helps enhance skills. This is equally true in the context of medical education. Distance education in India is cheaper than a full time degree. It also provides
A survey by the Organisation for Economic Co-operation and Development says that only seven countries in the world spend less money than India on public health a shortage of one million doctors and the price of a seat in an MD course was `5 crore. He said doctors trained through the expensive private education route would never be available for primary healthcare needs. Hence, the only way to make healthcare affordable was to create a massive education network, at the rate of 100 medical colleges every year for five years. This, he said, was possible by turning each of the 625 district hospitals into medical colleges. The idea is not just to allocate more funds as is being demanded but to ensure that whatever funds are allocated are used in a more effective manner. The ministry of health is believed to be in favour of raising the allocation to the sector (excluding sanitation and portable water) to at least two percent of GDP by the end of the 12th Plan, which starts from 2012-2013. A survey by the Organisation for Economic Co-operation and Development says that only seven countries in the world spend less money than India on public health. Also, the
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high quality, well structured learning material. New communication technologies and electronic media have played an important role to improve the quality of education. A lot of universities in India have a section for distance education that present courses in various streams. Open universities offer distance learning programs for students across the country. These universities are present in nearly every state and specialise in correspondence or distant learning courses. In the open system, the courses are open to any person who may not possess any formal qualifications. But in some institutions they should have attained the age of 18 years for undergraduate and diploma courses and 21 years for postgraduate courses. Enrolment in some courses is subject to qualifying in a written exam but the admission process and qualifying criteria is simpler than those offered by regular universities. The Indira Gandhi National Open University (IGNOU) has redefined open and
> www.ehealthonline.org > July 2011
distance learning in medical education. The IGNOU School of Health Sciences offers a plethora of innovative and unique courses in this domain. These courses have been appropriately structured to fulfill the various needs of medical education in India and help in bridging the various gaps created due to lack of medical seats in India.
Changing India Leading universities in India are adapting to a constantly changing India and a newer generation entering its classrooms. Globalisation has led to greater demand from the industry for different types of jobs, which are being looked at by private players. The call of the hour is not to train students to do a job but to educate them in a particular field. The emerging areas in medical education which are seeing maximum growth and ground-breaking research are reproductive medicine, plastic surgery, endocrinology, oncology and cardiology. Apart from this, newer specialisations are also in the pipeline. Emergency service has long been a recognised specialisation in the developed countries. Recently, the Medical Council of India (MCI) gave it thumbs up and colleges across India have been notified to offer it as a post graduate discipline. Geriatric medicine or the care of the elderly is another area to watch out for in the future. The NKC recommends the implementation of an independent authority, the Regulatory Authority for Higher Education, which needs only a set of people to supervise the entry requirements, accreditation, licensing and rationalising the entry procedure. The Yashpal Committee has suggested an apex regulatory body, the National Commission for Higher Education and Research, which will bring within it the existing agencies and make entry easier for newer bodies. There is a need to set up clear and transparent accreditation and assessment procedures that are fair to all universities. Four to five agencies should focus on assessing the institutions and bring out a public rating. Each body should be allowed to go to one of these agencies to get a rating that could be available on their websites. Public private partnerships can allow many more private players to start an institution if the government provides land. This will cover a diverse population and different needs of students.
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policy perspective
Dr Purshottam Lal Board Member of MCI
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> www.ehealthonline.org > July 2011
Dr Purshottam Lal, Board Member of MCI, internationally acclaimed for the maximum number interventional cardiology procedures has been awarded Padma Shree in 1993, Life Time achievement award by Delhi Medical association in (2002), Padma Bhushan in (2003), Dr. B.C.Roy National award (2005), Distinguished Achievement award of highest order by the National Forum Of Indian Medical Association. In conversation with Shally Makin and Dhirendra Pratap Singh, he shares his dreams and aspirations to revolutionize the medical education system in India
policy perspective
“we need justice for the patient”
R
ural India today faces a serious lack of doctors and healthcare facilities. What needs to be done with medical education to bridge the rural-urban healthcare divide? For doctors, it is easy to practice in villages and get experience as there are varied cases to handle, however, very few doctors realise the importance of this. It is a good experience, to practice in a village for an internship and earn good experience. I studied my high school in a village when there was no electricity. When the electricity was introduced in the village, my father accidently died of an electric shock. Due to lack of medical facilities and experts, I lost him. Till today there is lack of basic healthcare facilities in the rural areas. To improve and strengthen our medical system in India we need to introduce a post graduate course, which encourages doctors to visit the villages and practice there for few months.
working. Healthcare in the country should be given utmost importance. Our Hon’ble Health Minister, Ghulam Nabi Azad is really working towards providing better healthcare facilities, especially in rural areas. The working hours of doctors has been increased and better healthcare facilities are provided today with a lot of intervention of technology. Around 35,000 doctors end up going abroad for their post graduation courses but it is entirely their choice. We still have people, who get trained abroad and come back to serve the country. Being a Board member of Medical Council of India, please throw some light on the new plans to be implemented in the medical education system. We need to have two kinds of MD courses— one for internal medicine and other for general medicine. The course duration needs to be of minimum two years. The breakup of the course should include one and half
“We need to restructure the education system and learn to work independently. The teacher should whole heartedly spread as much as knowledge as they can and give the students what they have learnt from their experience” Rural medicine however does not sound interesting to young doctors but we still need to encourage people, to uplift the healthcare status in peripheral areas. What can be the government’s role in improving rural health services? The Government of India has taken several initiatives to improve healthcare facilities for the rural population but nothing seems to be
years to emphasise purely on medicine and 3-4 months in paediatrics. The PG interns should maintain a log book for one year, which holds the number of surgeries, fractures and trauma cases they have dealt with. We also need to introduce a crash course in bigger institutions preferably at block level. The course duration will be for 2 years. The advantage of this course will be that the doctors will be dealing with a number of cases
and become a multi specialist which is also an urgent requirement in the present scenario. To have a deep understanding of medicine, a one year fellowship is very important for each DM. A person learns everyday and medical field is directly proportional to experience. We should have proper and better regulatory systems providing proper selection criteria and allow practicing independent procedures. What is your opinion about medical training in India? Why are we not able to retain talent? I believe that the commitment between the teacher and the student is lacking to impart the real meaning of duty and responsibility. The duty of the students is that they should not resist working overnights. We need to restructure the education system and learn to work independently. The teacher should whole heartedly spread as much as knowledge as they can and give them what they have learnt from their experience. The students should have greater clinical and practical exposure, under the supervision of a senior person. With the help of new technology and innovations, we can bring a huge change in the teaching system. The electronic systems have made way through the years and emerged as a tool to learn in an interesting way. Further we need e-learning to be implemented in all colleges, have log books for every doctor to record his experience; case studies should be recorded for later reference. The student should be made aware of all duties and responsibilities and emphasise on practical learning rather than teach theoretically. This profession needs to be enjoyed and practiced through heart. I would advise the students to adopt the patient, treat whole heartedly and then nothing can ever go wrong. At the end, we just need justice for the patient and for that a proper route for training and education should be imparted.
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in conversation
Prof AK Agarwal IGNOU School of Health Sciences
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> www.ehealthonline.org > July 2011
in conversation
“GOI recognises importance of distance learning in Medical Education”
W
hat is the present medical education scenario
in India? The 1990 Flexner report paved the way for reforms in medical education in 20th century. These reforms also contributed to doubling of the life span. Lots of water has flowed down during last one hundred years. All is not well with medical education. The Commission on Education of Health Professionals for the 21th century-a global independent initiative, led to a recent Report, “Health Professionals for a New Century: Transforming Education for health Systems in an Interdependent World (Published in full in Lancet Vol. 376, December 2010)”. It highlights the glaring gaps and inequalities in health within and between the countries, underscoring our collective failure to share the dramatic health advances equitably. Further, the new infections, environmental and behavioural risks, at a time of rapid demographic and epidemiological transitions are creating new challenges. Professional education has not kept with these challenges, largely because of fragmented, outdated and static curricula that produce ill-equipped medical graduates.
The report further identifies the problems as systemic: mismatch of competencies to patient and particular needs, poor team work, persistent gender stratifications of professional status; narrow technical focus without broader contextual understanding; episodic encounters rather than continuous care; quantitative and qualitative imbalances in the professional labour market and weak leadership to improve health system performance. These disparities imbalances are more glaring in Indian context. Medical education, both under graduate and post graduate is at crossroads. Medical colleges train the students in a manner that they look forward to work in the metro cities. As per the expectation, the medical graduates need to understand the civic-social problems in the country, by working closely with the communities that vary widely in different states in India. When we say this, we mean that even if there are excellent teachers, brilliant students and lots of opportunities in India in medical education, little has been done to make it appropriate and affordable to vast majority of population. In the current scenario, our young doctors are forced to go to rural areas and they work half heartedly due to lack of in-
frastructure and basic facilities. Medical education is skewed towards tertiary care and highend technology in urban areas, neglecting the development in remote areas. The Lancet Report synthesizes that three generations of educational reforms characterise progress during past century. The first generation, launched at the beginning of the 20th century, taught a science based curriculum. Around the mid century, the second generation introduced problem-based learning. A third generation is now needed that should be system based to improve the performance of health systems. One of the important recommendations of the “Commission” is Transformative Learning. It is about developing leadership attributes. Its purpose is producing enlightened change agents for medical education. Please share the initiatives and new courses of School of Health Sciences, IGNOU. How do these courses help in attracting students? School of Health Sciences (SOHS) is the first open and distance learning initiative in the world of medical education by IGNOU with focus on hands on skill development. Today many
The IGNOU School of Health Sciences has developed several skill/competencybased and innovative Graduate Medical programmes with the objective of augmenting educational avenues and for providing in-service training through ODL mode. Prof AK Agarwal, IGNOU School of Health Sciences, in an interaction with Dhirendra Pratap Singh and Shally Makin, shares insights about the initiatives of the school and the need for modernising medical courses in India
July 2011 < www.ehealthonline.org <
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in conversation
Our rural healthcare system should be addressed on priority. China did something great in for strengthening the rural healthcare system post graduate medical courses being run by SOHS. (Please read our Brochure for details.) They are PG diploma in Maternal and Child Health collaboration with WHO and Ministry of Family and Health Welfare (MoHFW). We have PG diploma in Obstetrics, Pediatrics and Community Medicine, which are presently running in 25-30 medical colleges in India. Further, we have PG Diploma in Hospital and Health Management (PGDHHM) in collaboration with Academy of Hospital Administration and PG diploma in Geriatrics, which is based on skills for elderly patients. We are also offering B.Sc. Nursing programmes. This programme is also open to allopathic and dental doctors. We must have doctors with multi skills for such patients. We also offer a Post Graduate Certificate Programme in Rural Surgery (PGCRS) to be pursued after post graduation. The idea behind “rural surgery” is to develop a multi skilled surgeon doctor to do all life & limb saving surgery in the countryside and same urban settings. This PGCRS programme has been developed in collaboration with the Association of Rural Surgeons of India. We have also developed Post Graduate Diploma Programme in Clinical Cardiology; it is developed with the help of Narayana Hrudayalaya and is in great demand. We will soon be starting with a new course on PG Diploma Programme for HIV medicine in collaboration with NACO. Dr TK Jena, from the School of
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Health Sciences, IGNOU is the Programme Co-ordinator for this course. We will also be offering another programme, which is a one year Post Doctoral Certificate programme in Dialysis. This programme is also in collaboration with MoHFW. How do you see the future of medical education through distance learning? Every year 30,000 young medical graduates (allopathic) pass out. Most of them do not get an opportunity to do post graduate courses. In such cases, online education becomes very relevant. The online learning is for only post graduate level since the basic MBBS degree can’t be given through distance learning. The School of Health Sciences, IGNOU first started the model of distance education in the medical field, offering a range of pursuing medical education since 1996. Continuing Medical Education & Capacity Building through ODL/blended learning system is the need of the hour. Till now we haven’t really reached out to the grassroot levels through conventional courses. However, through open and distance learning system short term certificate or diploma courses in integrated medicine and surgical needs can be developed. This will help in reaching out to more and more aspirants to meet the needs of our society. Besides, the format of the courses would allow us to open a vast network of study centres in hospitals and medical col-
> www.ehealthonline.org > July 2011
leges and train a large number of manpower in much shorter time. We identify leading colleges in the country and sign MoU to train the students. Many state governments have recognised our programmes and officially sponsored their doctors to benefit from these programmes. We believe in a model where more than 50 percent teaching is done in hospitals. PG diploma in Clinical Cardiology Programme is also one of them. Today we have associated with 60+ hospitals throughout in the country. India on an average does not produce more than 125-150 DM/DNB cardiologists per year. Most of them work in large hospitals/cities. IGNOU’s PGDCC bridges this gap and provide a cardiologist’s (non-invasive) expertise to them. Rural India, today, faces a serious lack of doctors and healthcare facilities. What needs to be done with medical education to bridge the rural-urban healthcare divide? Handover the rural healthcare facilities to private partners along with the budget (both plan and non-plan). Make them accountable. We need to have a very vibrant public health system, where young doctors could go to remote areas. The peripheral health infrastructure should be improved. We can adopt the model of Yeshaswini micro health insurance scheme. Actually, in rural areas medical facilities have been planned nicely on paper. However, there is lack of proper buildings, basic infrastructure, refrigerating facilities for vaccines, lab technicians, and electricity. Our rural healthcare system should be addressed on priority. China did something great in for strengthening the rural healthcare sys-
tem. In early 1940’s they closed all their medical colleges and put their entire faculty in rural areas. China realised the importance of rural healthcare. We can adopt the Chinese model. What should be done to scale up our medical infrastructure? Health is a state subject. Medical education in India is governed through MCI. If we have to improve the healthcare delivery system, the Government has to give it priority because allocation of financial resources in health is abysmally low. Additional money should be allocated in this sector. There are so many mismatches between rural and urban healthcare in India. Health system can be such a huge generator of jobs, besides improving the quality of life of our people. So, how could we improve the situation? Our policy makers must realise it. With one percent allocation in healthcare, we can’t improve the situation. At least four percent of GDP should be allocated to the healthcare sector. Electricity and other infrastructural bottlenecks should be corrected. There should be some post graduate seats for them who want to work in rural areas. Famous management Guru Peter Drucker once said that 80 percent of ills of any system are because there are no systems in place. Our doctors do well in the UK and the USA because they have good systems. Medical education is one such thing which needs better systems. Government should make health infrastructure more vibrant. Distance and e-learning should be encouraged. Medical Council of India should recognised the importance of open and distance learning.
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Revolutionising
Pedagogy@ a Distance
IGNOU, School of Health Sciences, educates students at the grass root level and provide in-service training for medical, nursing and paramedical courses through a multimedia approach By Dr Biplab Jamatia
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GNOU has been constantly contributing significantly towards the education with the objective of augmenting educational avenues and for providing in-service training for medical, nursing, paramedical and allied personnel through the distance education mode. Today, it serves the educational aspirations of over 3.0 million students in India and 36 other countries through 21 schools of Studies and a network
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of 61 Regional Centers around 60 overseas centers. The School is a pioneer in developing competency-based programmes in various disciplines of Health Sciences. Innovative approaches in medical programmes include hands-on training, which is provided through diversified approaches of a network of colleges and districts-level hospitals. To achieve this, the School has been collaborating, and exchanging ideas, with vari-
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ous national and international organisations like World Health Organisation (WHO), United Nations International Children’s Emergency Fund (UNICEF), Ministry of Health and Family Welfare (MoHFW), Voluntary Organisations like ‘ACTS Ministries’, GOI, National Board of Examination (NBE), Association of Rural Surgeons of India (ARSI), Trained Nurses Association of India (TNAI), Nursing Institutes in Seychelles and
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Total number of the Enrolled students of the various programmes SN 1 2 3 4 5 6 7 8 9 10
Name of the Programme
•
Launched Year Number of Enrolled Students
PGDMCH 1997 6828 PGDHHM 2001 4703 PGDGM 2004 1443 PGDCC 2006 994 PGCE 2008 223 PGCOI 2008 175 BSCHOT 2007 618 PGDACP 2009 85 CHCWM 2006 912 PGDDHM
Narayana Hrudayalaya and many other. IGNOU has adopted a multimedia approach to enable students who seek such courses irrespective of age, region or formal qualifications. The objective of IGNOU is to democratize higher education by taking to the doorsteps of the learners and provide access to high quality education to all through a team of teachers called as Academic Counselors. The School of Health Sciences was set up in the year 1991. The various functions of the school are planning, developing and launching of Degree, Diploma and Certificate Level Programme for various categories of health professional: health awareness courses for the general public and conducting research on health issues. The school adopts a diversified approach to educate students through a three-tier system i.e. medical colleges [ Programme Study Centres(PSCs)], District hospitals[ Skill Development Centres(SDCs)] and the work places of enrolled doctors, provide hands in training. There are various programmes initiated by School of Health Sciences to develop and build an infrastructure to revolutionize career opportunities through distance learning.
Post Graduate Diploma in Maternal and Child Health (PGDMCH) Post Graduate Diploma in Maternal a Child Health (PGDMCH) Programme is a oneyear programme of 36 credits (18 credits in theory and 18 credits in practical). This programme was launched in 1997 and has undergone two revision’s. The 2nd revised programme is being implemented since Jan-
• •
• •
manage the National Health Programmes especially in relation to MCH services; provide antenatal care including those of high risk pregnancy, conduct normal delivery, handle common emergency care related to pregnancy and its outcome and identify referral situations; manage common gynaecological morbidity and provide family planning services; provide newborn care, identify high risk babies, diagnose and manage common childhood morbidity including emergencies; and acquire knowledge on nutritional needs,
PROGRAMME STRUCTURE Course Code Course Title Course Credits Total Theory
Practical
Theory Practical Credits
MME-201 MMEL-201
Preventive MCH
6
6
12
MME-202 MMEL-202
Reproductive Health
6
6
12
MME-203 MMEL-203
Child Health
6
6
12
Total Credits
18
18
36
uary 2008. The number of PSCs established till date are 32. This Programme is a comprehensive package of Community Medicine/PSM, Obstetrics and Gynaecology and Paediatrics so as to give an integrated knowledge on the MCH care. The Reproductive and Child Health (RCH) Programme, the Integrated Management of Neonatal and Childhood Illness (IMNCI) , Adolescent-Friendly Reproductive & Sexual Health (AFRSH) Service, and other approaches of Government of India to improve the various morbidity and mortality indicators related to MCH care forms the part of this package. The programme aims at updating the knowledge and skills of practicing doctors and those placed in a peripheral set up like Primary Health Centre/Community Health Centre. The package would also be beneficial for doctors at all levels engaged in the MCH care in different capacities.
OBJECTIVES The broad objectives of this programme are to: • imbibe comprehensive knowledge of ongoing Maternal and Child Health Programmes and be able to manage Health Care Services at different institutional levels; • tackle the disease outbreaks and effectively
assess growth and development of children and manage their respective problems.
Post Graduate Diploma in Hospital and Health Management (PGDHHM) Post Graduate Diploma in Hospital and Health Management (PGDHHM) Programme comprises 32 credits (18 credits in theory and 14 credits in practical) including project work. This programme aims at improving the managerial skills of practicing Doctors, Health Professionals and Allied Health Care Professionals working in health care professions for providing effective and efficient hospital and health care services. This programme was launched in January 2001. The number of Programme Study Centres activated at present are 23.
OBJECTIVES The broad objectives of this programme are to: • acquire theoretical knowledge and develop practical skills to apply scientific approach to management of people, materials, finance, communication and for organizing work and managing resources; • learn modern management techniques
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spotlight PROGRAMME STRUCTURE Course Code Course Title Course Credits Total
Theory Practical Credits
PGDHHM-001
Introduction to Management-I
3
2
5
PGDHHM-002
Introduction to Management-II
3
2
5
PGDHHM-003
Organization and Management of Hospital
3
2
5
PGDHHM-004
Clinical, Diagnostic and Therapeutic Services
3
2
5
PGDHHM-005
Support and Utility Services and Risk Management
3
2
5
PGDHHM-006
Health System Management Project work
3 -
2 2
5 2
Total Credits
18
14
32
•
•
like inventory control; economic order quantity (EOQ), operational research and organizational development, management information system etc. learn methods of problem solving and decision making and plan in advance to face the problems of hospital management; and assess the clinical and non-clinical needs of patient care, and understand the administrative and technical requirements of physicians and paramedical personnel.
ELIGIBILITY The eligibility for the different categories of the target group is: • Medical/Dental graduates from a Medical/Dental institute of India or other countries recognised • By Medical Council of India (MCI) or Dental Council of India (DCI). • Graduates in Indian System of Medicine, Homeopathy, Nursing and Pharmacy recognised by the Respective Councils with three years of hospital experience.
•
•
Candidates holding MBA degree or PG Diploma in Financial, Material or Personnel Management With five years of hospital experience.
PROGRAMME STRUCTURE Course Code Course Title Course Credits Total
Fundamental Environment and Health, Health Care Waste Management Regulations
4
-
4
BHM-002
Health Care Waste Management; Concepts, Technologies and Training
6
-
6
BHM-003
Project
-
4
4
Total Credits
10
4
14
Post Graduate Diploma in Geriatric Medicine (PGDGM) Post Graduate Diploma in Geriatric Medicine (PGDGM) Programme is a one-year Diploma Programme of 32 credits (14 cred-
Course Code Course Title Course
Credits
Practical
Theory
MME-004
Basic Geriatrics
6
-
MME-005
Clinical Geriatrics
8
-
MMEL-004
Basic Geriatrics
-
6
MMEL-005
Clinical Geriatrics
-
12
Total Credits
14
18
22
Theory Practical Credits
BHM-001
PROGRAMME STRUCTURE
its in theory and 18 credits in practical). This programme was launched in January, 2004. The number of Programme Study Centres activated at present are 17. This programme will equip the practicing doctors with knowledge and skills in the field of Geriatric Medicine and enable them to deal with the special problems faced by the elderly. With increased expectancy of life over the years, the proportion of elderly population is fast increasing. Aging is inevitable and irreversible. The epidemiology and the clinical features of diseases vary in this age group and drug dosages and interactions also differ. Geriatric management requires not only medical interventions but also special economic and environmental interventions. This programme aims at not only enhancing the knowledge but also multiskilling the doctors so as that they can provide primary level care to the elderly.
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OBJECTIVES The broad objectives of this programme are to: • upgrade the knowledge and skills for providing comprehensive health care to elderly; • inculcate the inter-disciplinary approach for diagnosing and management of geriatric health problems; and • improve the clinical, social and communication skills by providing hands on training in Medical colleges and district hospitals.
Post Graduate Diploma in Clinical Cardiology (PGDCC) India, with over a billion population requires a few thousand cardiologists to be trained.
spotlight Contrary to this, today we produce only around hundred cardiologists with DM/ DNB qualifications. Unless we address this issue of training a large number of cardiologists, especially for treating heart patients in an average district town/semi-urban area, the situation will not change much. To address this issue School of Health Sciences is developing a 2-year programme for MBBS doctors in collaboration with Narayana Hrudayalaya, Bangalore. This is a 72 credits programme comprising of 30 credits in theory and 42 credits in practical. In this programme the young medical graduates will be intensively trained for two years through an extremely well structured programme. It will be implemented through leading cardiac institutions in the country. The programme was launched in January, 2006. The number of Programme Study Centres activated at present are 61.
• •
•
• •
ongoing Common Cardiovascular Diseases and be able to manage Health Care Services at different institutional levels; provide cardiac emergency at various places i.e. smaller town, district town; provide services related to the Electrocardiography, Stress Test, Holter Monitoring, Echocardiography, Cardiac Radiology and related non-invasive services, including diabetes mellitus; provide non-invasive peadiatric cardiology including peadiatric cardiac emergencies; acquire knowledge of the risk factors of the cardiovascular diseases; and provide preventive cardiology and cardiac rehabilitation services to the community.
OBJECTIVES
Certificate in Health Care Waste Management of South-East Asian Countries (CHCWM)
The broad objectives of this programme are to: • imbibe comprehensive knowledge of
The concern for bio-medical waste management has been felt globally with the rise in
PROGRAMME STRUCTURE Course Name of the Course Credits of Credits of Code Theory Courses Practical Courses MCC-001 Fundamentals of Cardiovascular System-I
4
–
MCC-002 Fundamentals of Cardiovascular System-II
4
–
MCC-003 Common Cardiovascular Diseases-I
6
–
MCC-004 Common Cardiovascular Diseases-II
4
–
MCC-005 Common Cardiovascular Diseases-III
4
–
MCC-006 Cardiovascular Epidemiology
4
–
MCC-007 Cardiovascular Related Disorders
4
–
MCCL-001 Cardiovascular Evaluation-I
–
8
MCCL-002 Cardiovascular Evaluation-II
–
6
MCCL-003 Management of Common Cardiovascular Diseases
–
10
MCCL-004 Management of Congenital Heart Diseases
–
4
MCCL-005 Preventive Cardiology
–
8
MCCL-006 Intensive Coronary Care
–
6
30
42
Total
deadly infections such as AIDSand Hepatitis B and indiscriminate disposal of health care waste. The main bottleneck to sound health carewastemanagement practices is lack of training and appropriate skills to manage waste by different health carefunctionaries. To cater to the needs of health care functionaries and impart good waste management practices, a six-month, 14credits Certificate Programme in Health Care Waste Management has been developed in collaboration with WHO-SEARO. The programme has been deveoped for the South East Countries Partner Institutions (Programme study centre) have already been established in Bangladesh and Nepal. A few more centres in other South East Asian Countries are in the offing.
OBJECTIVES The broad objectives of this programme are to: • sensitize the learner about health care waste and its impact on our health and environment; • acquaint the learner about the existing legislation, knowledge and practices regarding infection • control and health care waste management practices in the countries of South- East Asia Region; and • equip the learner with skills to manage health care waste effectively and safely.
ELIGIBILITY Doctors, Nurses, Paramedics, Health Managers and others with a minimum of 10+ 2 qualification.
B.Sc. (Hons.) in Optometry and Ophthalmic Techniques (BSCHOT) B.SC.(Hons.) in Optometry and Ophthalmic Techniques (BSCHOT) is a four-year degree programme and is aimed to develop a multipurpose ophthalmic manpower in the country. This programme comprises of 128 credits (52 credits theory and 76 credits practical). This programme was launched in July, 2007. The number of Programme Study Centres activated at present are 19.
OBJECTIVES The Programme has been launched with broad objective of training the students in optometry various ophthalmic procedures. After going through this programme the
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spotlight PROGRAMME STRUCTURE
OBJECTIVES
Course Code Course Title Theory/Practical Credits MDT 001
Fundamental of Endodonitcs
The broad objectives of this programme are to: • enhance the knowledge and skills in the field of oral implantology. • be able to assess, diagnose and manage the cases requiring dental implants.
Theory
4
MDT 002 MDT Clinical Endodontics I
Theory
4
003 MDTL 001 Clinical Endodontics II
Theory
6
MDTL 002
Practicals of Fundamentals of Endodontics
Practical
6
Post Graduate Diploma in Acupuncture (PGDACP)
Practicals of Clincal Endodontics
Practical
10
Acupuncture is a traditional method of therapy which is very well recognized world over and well accepted by the people as it does not have any side effects. This method has been found to be useful in all types of diseases specially the chronic diseases. Moreover the cost of the treatment is less as compared to the other systems of medicine. Post Graduate Diploma in Acupuncture is the first medical programme which is being offered online. The programme is the one year duration and it aims to help graduates of different systems of medicine to learn a new therapy and utilize it for patient benefit in treating acute and chronic diseases.
students shall be able to: • assist eye specialists in big eye hospitals, eye care health units, etc., as refractionists, orthoptists, theatre assistants and refractionists; • get themselves self employed as opticians, optometrists and refractionists; • estimate errors of refraction and be able to prescribe glasses; • maintain ophthalmic appliances and instruments; and • assess ocular motility disorders and prescribe adequate treatment including eyeball exercises.
ELIGIBILITY The candidates should have passed 10+2 examination of CBSE or equivalent with English, Physics, Chemistry, and Biology with at least 45% marks. Post Graduate Certificate in Endodontics (PGCE) Programme is a one-year Certificate Programme of 30 credits (14 credits
OBJECTIVES The broad objectives of this programme are to: • enhance the knowledge and skills in the field of conservative dentistry. • be able to assess, diagnose and manage the cases which require specialized interventions in the field of conservative dentistry.
Post Graduate Certificate in Oral Implantology (PGCOI) Programme of 30credits (14 credits theory
PROGRAMME STRUCTURE Course I
Basic Theory of TCM
Course II
TCM Diagnosis
Course III
Accupuncture and Meridians
Course IV
Accupuncture and Moxibustion Treatment
Course V
Scalp an Ear Accupuncture
Course VI
Treatment of common disease by Accupuncture
PROGRAMME STRUCTURE Course Code Course Title Theory/Practical Credits MDT 004
Fundamentals of Oral Implantology
Theory
8
MDT 005
Advanced Surgical, Implantology
Theory
6
MDTL 004
Practicals of Oral Implantology-I
Practical
8
MDTL 005
Practicals of Oral Implantology-II
Practical
8
theory and 16 credits practical) developed by IGNOU in collaboration with Dental Council of India (DCI). This programme has been launched from July, 2008. Fifteen Programme Study Centres are activated. This programme will equip the practicing doctors with enhanced knowledge and skills in the field of Conservative Dentistry.
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and 16 credits practical) developed by IGNOU in collaboration with Dental Council of India (DCI). This programme has been launched from July, 2008. Twelve Programme Study Centres are activated. This programme will equip the practicing doctors with enhanced knowledge and skills in the field of Oral lmplantology.
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There are many more initiatives and new courses are to be launched from next session onwards. Students in the peripheral areas look forward for such this flexible mode of education which has further helped them to prepare and appear in exams as per their convenience. Such an approach to educate students through technology and other multimedia modes of teaching has brought people closer. As a world leader in Distance education, IGNOU has further set an example to be one of the most prestigious institutions to provide medical courses through high end academicians and professors. In January, 2010, it was listed 12th in the webmetric ranking of Indian Universities, based on the caliber of its presence on the internet.
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Skill Training Process in Medical Programmes of IGNOU
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ndira Gandhi National Open University (IGNOU) offers post Graduate Diploma in various medical specialties. The theory material is developed in a self instructional style and the practical training is provided through contact sessions conducted in tertiary and secondary health institutions through a three-tier hands-on-training model which not only provides flexibility in pace and place of learning but also ensures that after completion of the training process, a student can actually practice the skills with confidence in his own work environment. In addition, this three-tier system has integrated the pedagogy of skill learning and has ensured that the benefit of both, group learning and one to one learning is given to the students.
The Model The model describes the implementation of practical component in three steps at three levels. The tertiary level infrastructure (Medical College) where the academicians
could be involved as counselors conveys the second step of learning process. Second, the involvement of secondary level health infrastructure (District Hospital) where the subject specialists could help the students in repeatedly performing the skills and thus guide them practicing the skill that are taught in tertiary level. Third, the student performs his job at the primary level health setup. This could also be a clinic/health set up run by the student himself where the student tries to practice the learned skills without any supervision. In IGNOU parlance, these three levels are called as prorgramme study centre (PSC), Skill Development Centre (SDC) and Work Place (WP) respectively. For administrative purpose, the programme study centers are linked up with the Regional Centres (RCs) which are a part of the IGNOU establishments. The PSC becomes the nucleus of programme implementation process. The Programme In-charge (PIC) is stationed at the PSC. He/she is normally a permanent faculty of the medical colleges with additional responsibilities of being the
PIC. He will primarily be monitoring the learning process of all students enrolled in his institution with the help of other counselors. The students will be required to come here to attend the contact sessions in theory and practical. The end assessment examination would also be held here. Every student has an opinion to select his nearest SDC. The number of SDCs is not fixed. There could be as many SDCs as the number of students. SDC is selected as per the guidelines where students are allowed to practice the skills under supervision. At work place, the students will practice the skills without supervision so that enough number of patients are examined by them before appearing in the termend examination for certification.
Implementation Process of Practical Component Every course has a practical component. The skills that the students need to learn under each course are listed in their programme guide. The skill training is divided into three parts i.e. training at PSC, training at SDC and
Steps of Learning Implementation Process The Model
Text Reading
Self Instructional Material
Distance Education Setup
Demonstration with Discussion
Programme Study Centre
Tertiary Health Setup
Practice Under Supervision
Practice for Self Confidence
Skill Development Centre Work Place
Secondary Health Setup
Primary Health Setup
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The regional health sciences advisory committee (RHSAC) streamlines the implementation of practical component at all levels to promote the health programmes in states by ensuring proper hands on training at peripheral level training at Work place. The students have to maintain record for each case as mentioned in their practical manual. For all the three places, the time division against each skill is also mentioned in the practical manual. At the PSC, students are demonstrated each skill. To ensure that they have understood the steps involved in each of the skills demonstrated, they should also practice the skills on at least one of the sample cases. If they get opportunity, they are allowed to practice the same skill on more number of patients at PSC. However, if they do not get more chances, they practice the same procedure at their allotted SDC.At the SDC, the students practice all the skills taught to them at the PSC. To guide them, there are counsellors at SDC. Depending upon the programme students has to perform the activities himself under the supervision of the counselor. Guidelines are given to ensure that the minimum of patients/activities are practiced at SDC. Similarly, a student has so do unsupervised activities at the work place. These activities are recorded in the logbook.
Log Book Maintenance The students are supplied with logbooks. This helps to ensure that the skill training is implemented in a standardized manner throughout the country. The logbooks are countersigned
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by the counselors of medical college/SDC so that the learning defects of the students are identified in time and reinforcement of training could be provided. The programmes where logbooks are not supplied, major headings/formats for recording the activities/case records are provided in the practical manuals. Students are required to write down the details of procedures. They have to maintain record for all the cases they perform at SDC and the work Place. In some programmes, logbooks carry a weightage of 10% marks in the final evaluation. This further enhances the regularity of maintenance of logbooks by students.
Teleconference In the teleconferencing sessions, subject experts are invited to deal on various subject areas as marked for that session. While dealing with the theory component, principles/concepts dealt in different units are highlighted and the questions arose by the students are replied with the help of examples so that they could link them to practical activities. In the practical component, important clinical examination procedures are dealt with and attempts are made to deal with rare patients and where possible, show them live or get video clips. Discussions are also generated with the help of models or with the video clips of five to ten minutes on certain procedures. Attempts are also be made to make model case presentation, case discussion and simulate clinical rounds/ seminars. Most of the presentations follow the format of panel discussion or lecture demonstrations. Attempts are made to link the practical spells with the teleconference dates wherever feasible. This increases the participation of students. Some of the teleconference sessions are also recorded so that students missing important sessions could go through these cassettes.
Evaluation of Students Students undergo evaluation both in theory and practical component. In theory, the internal assessment is done through tutor marked assignments having weightage of 25 to 30%. In term-end examination, the weightage is 70%. In practical examination, the internal assessment varies from 30 to 50%. It is essential to pass in the internal component so as to become eligible
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for term-end examination. The term-end examination includes long case, short case, spots and viva-voce. 50% of the examiners are external examiners. This helps to maintain standard of the examination process. The framing of the examination questions, checking of the answer sheets are done by a panel of examiners of respective specialties. Thus, at all levels of evaluation of a student professional quality is given prime importance.
Monitoring To ensure proper implementation of the programme monitoring is done at three levels. Feedback from the peripheral setups (Skill development centres) is collected by the regional consultant who in turn sends bimonthly reports to programme coordinator. Feedback at state level is taken in the Regioanl Health Sciences Advisory Committee (RHSAC) meeting held one to twice a year. At the school level, feedback is collected directly from the students and counselors through performa that are incorporated in the programme guide. Time to time feedback is also collected in structured performa from the Programme In-charge, Regional consultant, Regional centres. In addition, feedback is also collected in every 4-5 years while revising and updating the programmes. The regional health sciences advisory committee (RHSAC) is formed in every state which has the members from state health departments, Medical College having the PSC, Regional centre of IGNOU and the School of Health Sciences. As all the persons involved in the programme implementation meet together, the hurdles in implementation process are identified and the remedial measures are taken. This committee thus helps to streamline the implementation of practical component at all levels. The Regional Consultant is usually a retired medical person having a personal rapport at state level. This helps to promote the health programmes in states and win the confidence of professional colleagues as well as the state Governments. Health being a state subjects the regional consultantâ&#x20AC;&#x2122;s personal efforts makes significant impact on popularising the programmes. The regional consultant by physical supervision to SDCs in the state ensures proper hands on training at peripheral level.
Medical
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Education in Indian
Perspective
Experiment of IGNOU has demonstrated that deficit of trained health manpower could be easily overcome if we adopt the pedagogy based education process By Prof Tapan K. Jena & Dr Biplab Jamatia
M
Dr. Tapan K. Jena Professor, School of Health Sciences, IGNOU
Dr Biplab Jamatia Assistant Professor, School of Health Sciences
edical education in India is as old as our Vedic literature. However the teaching of modern medicine is a recent phenomenon which is being carried out since British times without much change even after 6 decades of independence. Unlike other educational models, human beings per se form the bulk of learning material in medical education. Hence, medical education should take note of the learning environment itself in addition to its technicalities. It is the learning environment which makes ultimate difference in achieving the ability to deliver health care by the trained doctors. India lives in its villages. Hence the real test for modern medical education lies in providing quality health care away from the metro towns. Surveys after surveys show that doctors are not willing to go back to the villages where people need them the most. This is the picture even after concerted efforts by successive governments to improve the accessibility to health care. Probably, the answer lies in the design of medical education itself.
Present System Medical graduates spend 5 ½ years in learning the graduation programme which includes one year of internship for fine tuning hands-on-training. Post graduation is a three year learning process in a particular specialty and further study of three years leads to super-specialised degree in a particular human organ system though gradually, over years of practice one further tends to narrow down to deal with just a part of an oragn system itself. Indeed, there is no end to refining oneâ&#x20AC;&#x2122;s skill when one deals with a live situation. Presently, all the above mentioned levels of skill training is being provided in the same set up i.e. a medical college. But if we dissect out the learning requirements, it will be clear that a lot of the learning requirements could well be provided outside the four walls of a medical colleges. The basic learning material used in medical education is a diseased individual reporting for his/her treatment. This is available in plenty in villages and small towns. The material that is usually used in a medical college is the patient who affords to reach there for treatment or the one who could spare enough time for the same. Needless to men-
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In the Indian Scenario, an average district population is between 1-3 million. So, it can ensure enough patients as learning material for running 1-2 medical colleges. Most of the district hospital have specialists from all major specialties tion that private hospitals deal about two thirds of the patient load coming to metro towns. Therefore, it makes every sense to expand the horizon of capturing the learning material for our medical education by pedagogically involving appropriate health infrastructure so that a larger volume of doctors could be trained without compromising on quality of training.
Facilities at District Hospitals In the Indian Scenario, an average district population is between 1-3 million. So, it can ensure enough patients as learning material for running 1-2 medical colleges. Most of the district hospital have specialists from all major specialties. The out patient load, indoor facilities and equipments are adequate. Implementation of all national health programmes and public health interventions is carried out from here. Therefore, the public health related learning material is available
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more abundantly in district hospitals than that of the medical colleges. In the clinical side, except for complicated cases needing attention of superspecialists, all types of clinical interventions is very much possible at district set up. But in the present medical education scenario, these district hospitals are not being used in the pretext that medical faculty could provide better academic communication than the medical practitioners. It has thus created an academic and non-academic divide.
Learning Process of Medical Skills In medical education the major thrust is on psychomotor skills though cognitive and affective domain has their unchallenged importance. For any skill training, the basic pedagogy involves four steps of learning; i.e. understand text materials related to the skill, observe the steps involved in the skill through demonstration, practice the steps of performing the skills under supervision
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of a specialist and self practice of the steps to build up self confidence. The first step of pedagogy involves self reading and doubt clearing that could be achieved in a variety of ways with the help of present day technology. The steps involved in performance of a skill could very well be observed from a good video or multimedia package made for the purpose. Live demonstration of the skill will need an academician having the ability to communicate the process effectively. Practice under supervision needs a subject specialist who can keenly observe the learning need of the trainee and also communicate them effectively. Here also comes the role of a medical faculty. But after a certain level of skill acquisition, this supervisory role could be taken care by a subject specialist who may not necessarily be a medical faculty. Pedagogically, at this point of learning process, a non-academic subject specialist could participate in the medical education process. Indeed, this phase of skill training needs a longer duration of exposure than the initial learning of steps. The number of times one practices a skill, his/her psychomotor coordination gets that much sharpened. Another important component in skill building is the ability to practice the skills in a constrained situation. When this aspect of training process is inadequate, a skilled person tries to avoid resource constraint situations. One of the reasons for doctors avoiding to serve in rural areas could be pedagogically linked to this. Today, our medical education process needs strengthening of this step in pedagogy. Even though there is a provision to build up self confidence during internship period, the working environment in a medical college is far from the realities of a primary/ secondary health set up. But, alas! even this available option is hardly availed by most of the trainee who prefer to use the internship period for enriching their cognitive domain (for PG entrance examinations) rather than building up confidence to perform their skills.
District Level set up as Academic Hub District health set ups could play an important role in medical education through use of this platform for skill training under supervision and also for building up self confidence in performing skills under resource constraints. Shifting of part of skill training
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Demarcating the roles of academics and non-academics in the training process could avoid unnecessary conflict and help to expand the medical educational network to district hospital set ups could decrease the training load on medical college faculty. This decrease on training load could help in enhancing intake capacity of trainee without much investment on infrastructure. On other hand, involvement of district hospitals in medical education will help to infuse an academic culture in district health set up and thus break the academic- nonacademic divide. Then continuing medical education could become an integrated part like that happens in a medical college. The linking of district hospitals into academic network automatically facilitates few more inbuilt advantages as more working hands become available in district hospitals. A pool of specialists gets added to the existing number of medical faculty as teachers. Thus an improved teacher-student ratio could facilitate more student friendly environment for clearing doubts. Addition of patient load of district hospitals expand the spectrum of patients used as learning material and hence increases the scope of self practice of skills. The level of patient care at district level could also get improved. The patient referral system to medical college could be smoothened as chances of giving priority attention to referred patients increases. This would also usher in a paradigm shift in the training process for allied health professionals. Thus, converting district level set up into academic hubs for medical education could provide a solution to Indiaâ&#x20AC;&#x2122;s capacity building in health sector.
Experience of IGNOU Indira Gandhi National Open University has been experimenting on the above pedagogic approach in providing PG medical
education in various specialities. The skill training is provided through a three tier net work involving Medical colleges, District hospitals and work place of doctors. It has been observed that in addition to peer group learning in medical college set up, one-toone mentoring is possible at district level. Issues related to quality could be controlled through objective approach to examination and involving at least 50 percent of examiners as externals. Monitoring of training through dedicated monitoring system could further ensure the quality of product. Demarcating the roles of academics and non-academics in the training process could avoid unnecessary conflict and help to expand the medical educational network. It has been observed that the net working helps to expand the training capacity tremendously in a cost effective manner which is the present need of the developing nations. Experiment of IGNOU has demonstrated that all the projections regarding deficit of
trained health manpower could be easily overcome if we adopt the above pedagogy based education process. This could take a realistic shape if an Open Health University having national jurisdiction could be created. This would help not only in improving medical education scenario but also training of all category of health personnel through a networking of all existing health infrastructures in the country. When India is groping in dark to meet the trained health manpower demand of the nation, it is time to have a radical change in the medical education process itself. The proposed system can not only solve the huge deficit in trained health personnel but also provide an inbuilt dynamics to have continuing medical education system and an integrated patient referral system while improving the accessibility to health care and learner friendly environment for confidence building so as to provide optimum care under resource constraints. Today India needs this the most.
July 2011 < www.ehealthonline.org <
29
zoom in focus in
opportunities for excellence “Educational courses are designed to create a resource pool of experts with the benefit of flexibility and technology through collaboration” By Dr Biplab Jamatia
S
ince 1994, Indira Gandhi national Open University (IGNOU) has been steering constantly to provide the best of the medical courses through its School of Health Sciences (SOHS). So far, a lot of collaborations have been initiated by SOHS. Few of them include National and International organisations like World Health Organisation (WHO), UNICEF, UNDP, Ministry of Health and Family welfare (MoHFW), Ministry of Environment and Forest, GOI, National Board Examination(NBE), Dental Council of India, Narayana Hrudalaya and many more. Also, SOHS has been the pioneer in delivering professional post graduate medical courses through open and distance learning.
PG Diploma Programme in HIV Medicine Demographically the second largest country
30
in the world, India has also the third largest number of people living with HIV/AIDS. Available evidence on HIV epidemic in India shows a stable trend at national level. As per the provisional HIV estimate of 200809, there are an estimated 22.7 lakh people living with HIV/AIDS in India. The HIV prevalence rate in the country is 0.29 percent (2008-09) and most of the infections occur through heterosexual route of transmission. However in the north-eastern region, injecting drug use is the major cause for the epidemic spread. The primary drivers of HIV epidemic in India are unprotected paid sex, unprotected sex between men and injecting drug use. Heterosexual route of transmission accounts for 87 percent of HIV cases detected. In 1992, the Government launched its first National AIDS Control Programme (NACP-I) with the initiative of International
> www.ehealthonline.org > July 2011
Development Association (IDA) Credit of USD 84 million and demonstrated its commitment to combat the infection. NACP-I was implemented during 1992-1999 with an objective to slow down the spread of HIV infections so as to reduce morbidity, mortality and impact of HIV epidemic in the country. To strengthen the management capacity, a National AIDS Control Board (NACB) was constituted and an autonomous National AIDS Control Organisation (NACO) was set up to implement the project. During the initial years, the major focus of attention was on prevention activities, followed by “care and support” of infected individuals, particularly those suffering from opportunistic infections (OIs). Over the past decade, there has been a tremendous increase in our understanding of molecular biology and the viral structure and pathogenesis of the disease. This knowledge has
zoom in
Although antiretroviral therapy (ART) does not cure HIV infection, the decrease in the viral load and the improvement in immunological status brought about by the use of these drugs have resulted in a marked decrease in the mortality and morbidity associated with the disease led to the development of a number of new antiretroviral drugs and treatment protocols. The demonstration of efficacy of these drugs in containing viral replication has changed the world’s outlook on HIV/AIDS from a “virtual death sentence” to a “chronic manageable disease”. Although antiretroviral therapy (ART) does not cure HIV infection, the decrease in the viral load and the improvement in immunological status brought about by the use of these drugs have resulted in a marked decrease in the mortality and morbidity associated with the disease. The free ART programme has adopted the public health approach to administration and distribution of ART. This implies a comprehensive prevention, care and treatment programme, with a standardized, simplified combination of ART regimens, a regular secure supply of good-quality ARV drugs, and a robust monitoring and evaluation system. The public health approach for scaling up ART aims to provide care and treatment to as many people as possible, while working towards universal access to care and treatment.
In view of above, School of Health Sciences (SOHS), IGNOU has developed a oneyear PG Diploma Programme in HIV Medicine in collaboration with National AIDS Control Organization (NACO), Ministry of Health & Family Welfare; Govt. of India. IGNOU will act as an umbrella organization to coordinate the training programme in the country. The rational behind of this programme are following: There are two doctors in each ART facility, One doctor in each Community Care Centre and one doctor as In-charge of link ART centre (ICTC) are directly involved in Patient care and are potential candidates for one-year training programme in ‘HIV Medicine’. Currently nearly 8 lakh patients registered for ART and 2, 70,000 eligible patients are on treatment at 226 ART Centres. NACO plans to also have nearly 400 ART facilities, 400 Community Care Centres and 1200 Link Care Centre by the year 2016 for which about 2000 trained doctors would be needed to man these facilities. But as MD qualified doctors are not coming forward for managing ART centres, the need of developing a training package in form of PG Diploma in HIV Medicine is the
Sn Name of the Programme Study Centre Name of the Regional Centre
need of hour. Thus The PG Diploma in HIV Medicine will help to standardize HIV Medicine training and also help to bridge the gap in trained man power for ART centre.
Programme Objectives After completion of the Programme students should able to do: • Imbibe comprehensive knowledge on basics of HIV as related to details of management of HIV/AIDS in teritiary care set up; • Manage all complications as well as opportunistic infections due to HIV/AIDS at the time of need; and • Recognise and handle emergencies related to HIV/AIDS and its complication and take bedside decision for management whenever is required. Eligibility: MBBS Doctor Fee of the Programmes: Rs. 30,000/Duration of the Programme: Minimum 1 Year and Maximum 3 Years The programme consist of 76 units (another term of chapters) under 18 theory Blocks (booklet), 2 practical manuals and 2 log books. Video programmes will be provided to the students as soon as it does develop for the programme. There will be 28 days hands on skill training in the 6 training centre as given below. The 28 days training will divided in 4 spell. Students will be imparted training in the designated training centre by the Master Trainers as designated by the NACO. There will be one month more training in the ART centre for the non sponsor candidates beside the 28 days of training in the designated centres. NACO will sponsor 70 candidates for the programme in the first year of admission. There will be only 20 students in each centre to maintain the student teacher ratio. This is necessary to ensure the quality of the training. The list of the six training centres is given below:
Delhi 2
Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh
Post Doctoral Certificate in Dialysis Medicine (PDCDM)
Chandigarh
3
B J Medical College, Ahmedabad
Ahmedabad
4
Christian Medical College, Vellore
Chennai
5
GHTM, Tambaram, Chennai
Chennai
6
School of Tropical Medicine, Kolkata
Kolkata
There is acute shortage of trained and qualified doctors to diagnose and manage acute and chronic renal diseases / chronic renal failure. India trains only about 100 DM / DNB Nephrologist per year. Almost all of them concentrate in tertiary care / corporate
1
Maulana Azad Medical College, New Delhi
2
32
> www.ehealthonline.org > July 2011
zoom in Sn Name of the Programme Study Centre Name of the Regional Centre 1
All India Institute of Medical Sciences, New Delhi
Delhi 1
2
Sir Gangaram Hospital, New Delhi
Delhi 2
3
RR Hospital, New Delhi
Delhi 1
4
Dr. RML Hospital, New Delhi
Delhi 1
5
Post Graduate Institute of Medical Education & Research, Chandigarh
6
Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGI), Lucknow
Lucknow
7
Banaras Hindu University, Varanasi
Varanasi
8
Gauhati Medical College, Gauhati
Gauhati
9
Seth Sukhlal Karnani Memorial (SSKM) Hospital, Kolkata
Kolkata
10
Nizam Institute, Hyderabad
11
Christian Medical Collage, Vellor
12
Stanley Med. College, Chennai
Chennai
13
Govt. Med. College, Trivandrum
Trivandrum
14
King Edward Memorial (KEM) Hospital Mumbai
15
Muljibhai Patel Urological Hospital, Nadiad, Gujarat
hospitals in metro towns / large cities, while the large majority of populations (> 70%) have hardly any access to such expertise. More over, more than 200 Indians per million of population suffer from chronic renal failure every year. Most of this morbidity goes undetected, for lack of doctors trained in dialysis medicines and related diseases. In view of the above, School of Health Sciences (SOHS), IGNOU has developed Post Doctoral Certificate Programme in Dialysis Medicine (one year duration) in collaboration with the Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India for physicians with MD (Medicine) or MD (Peadiatrics) doctors. This programme envisages 6 months hands-on-skill development training in 15 apex tertiary care hospitals across the country and the remaining 6 months through distance learning. About 100 doctors are expected to be trained in dialysis medicine every year with a provision to increase their number in subsequent years. This will bridge the gap of acute shortage of trained and qualified kidney / dialysis medicine experts in the country.
Programme Objectives After completion of the Programme students should able to : • imbibe comprehensive knowledge on
Chandigarh
Hyderabad Chennai
• •
•
Mumbai Ahmdabad
basics of nephrology, detail of haemodialysis, reasonably adequate for peritoneal dialysis and brief of renal transplant; handle temporary vascular access at the time of need; dialyze stable patients adequately and safely on long-term basis and anticipate potential complications ; and recognize and handle emergencies related to dialysis and take bedside decision for management
Eligibility of the Programme: MD/ DNB in Medicine or Paediatric Fee of the Programme: Rs. 30,000/Duration of the Programme: Minimum 1 Year and Maximum 2 Years
Programme Implementation The programme consist of 64 units (another term of chapters) under 13 theory Blocks (booklet), 3 practical manuals and 3 log books. Video programmes will be provided to the students as soon as it does develop for the programme.There will be only 6 students in each centre to maintain the student teacher ratio. This is necessary to ensure the quality of the training. The programe will be implemented though a network of programme study centre (PSCs) all over the country.
The list of the 15 training centres is given below:
Post Graduate Diploma in Diabetes Medicine Today Diabetes has reached a pandemic with India being declared as the diabetic capital of the world. The International Diabetes Federation estimates that the number of diabetic cases in India more than doubled from 19 million in 1995 to 40.9 million in 2007. It is estimated that by 2030 every fifth person with diabetes will live in India. Diabetes today can no longer be addressed as a problem associated with individuals. Since, of late it has assumed proportions of engulfing the entire nation. School of Health Sciences (SOHS), IGNOU has taken upon themselves with the herculian task of building capacity within the country to tackle the menace of Diabetes which is already knocking at our door. School of Health Science is planning to develop a one year Post Graduate Diploma in Clinical Diabetology programme in collaboration with HANSA Vision Pvt. Ltd for the MBBS doctors. It is proposed that there will be 3 months hands on skill training in this programme and the remaining 9 months training will be done through distance mode. There will be approximately 18 Blocks (modules) covering about 80 units (chapters). Training centre for this programme will be selected across the country. SOHS will be launching this programme in January 2012 and is presently under development process. The Indira Gandhi National Open University has been a proactive partner in the fight against diabetes. The main aim of introducing this new programme courses is to create adequate number of diabetes specialists so that an affordable care can be made available to the patients. IGNOU has been encouraging various agencies working towards this goal to join hands and control the epidemic of diabetes in India.
AUTHOR
Dr Biplab Jamatia, Assistant professor, school of health sciences, indira gandhi national open university (IGNOU)
July 2011 < www.ehealthonline.org <
33
INDIRA GANDHI NATI Maidan Garhi, New Delhi
Post Graduate Diploma in HIV Medicine Demographically the second largest country in the world, India has also the third largest number of people living with HIV/AIDS. As per the provisional HIV estimate of 200809, there are an estimated 22.7 lakh people living with HIV/AIDS in India. The antiretroviral therapy (ART) programme has adopted the public health approach to administration and distribution of ART. Currently nearly 8 lakh patients registered for ART and 2, 70,000 eligible patients are on treatment at ART Centres. NACO has nearly 300 ART centre 650 Link ART centres and 250 community care centres which are being scaled up further. About 2000 trained doctors would be needed to man these facilities. The Qualification for SMO at ART centre is MD while for MO it is MBBS. It is planned that MBBS Doctors with PG Diploma in HIV Medicine shall be considered for the post of SMO at ART centre. Hence, there is need of developing a training package in form of PG Diploma in HIV Medicine.
Keeping above in view , IGNOU has developed a one-year PG Diploma Programme in HIV Medicine in collaboration with National AIDS Control Organizition (NACO), Ministry of Health & Family Welfare, Govt. of India. IGNOU will act as an umbrella organization to coordinate the training programme in the country. The PG Diploma in HIV Medicine will help to standardize HIV Medicine training and also help to bridge the gap in trained man power for ART centre. Duration of the Programme The minimum duration of the programme is one year. However, the students are given a maximum period of three years to complete the programme from the date of registration, after which the students have to apply for re-admission paying the pro rata fee for each incomplete course.
Eligibility The candidates should be registered MBBS Doctors (MCI Recogniesd) after completion of internship. Admission Fee is 30,000/
Admissions The last date of submission of application form is 31st August, 2011. The applicant should submit the application form in the following address. Programme Coordinator, Room No. 149, School of Health Sciences, DBlock, Raman Bhawan, New Academic Complex, IGNOU, Maidan Garhi New Delhi-110068. The applications should be made on prescribed form so as to reach IGNOU before the due date. Email- hivmedicine@ignou.ac.in, phone- 011-29572524
programme study centres • Maulana Azad Medical College, New Delhi • Postgraduate Institute of Medical Education Research (PGIMER) Chandigarh • B J Medical College, Ahmedabad • Christian Medical College, Vellore • GHTM, Tambaram, Chennai • School of Tropical Medicine, Kolkata
ONAL OPEN UNIVERSITY – 110068, India, www.ignou.ac.in
Post Doctoral Certificate in Dialysis Medicine programme study centres
In a country of 1.2 billion, we have less than 1000 qualified Nephrologists. Every year approximately 200 people per 10 Lac of population, develop end stage renal disease requiring dialysis and/or kidney transplant. Because of acute shortage of qualified medical experts in dialysis often these patients do not that dialysis or are being dialysed by untrained personnel. With a view to bridge this gap, the Directorate General of Health Services, Ministry of Health & Family Welfare, Govt. of India collaborated & supported IGNOU to develop a one year Post Doctoral Certificate Programme in Dialysis Medicine for Physicians & Paediatricians with MCI recognised MD qualification. This programme will be launched from July 2011 in 15 Tertiary Care Hospitals (PSCs) across the country.
The minimum duration of the programme is one year.
Eligibility The candidates should be Doctor of Medicine (MD)/DNB in Medicine or Paediatrics.
Admissions The last date of submission of application form is 31st August, 2011. The applicant should submit the application form in the following address. Programme Coordinator, Room No. 149, School of Health Sciences, D-Block, Raman Bhawan, IGNOU, Maidan Garhi, New Delhi-110068. The applications should be made on prescribed form so as to reach IGNOU before the due date. Email- tkjena@ignou.ac.in, phone - 011-29572849
• All India Institute of Medical Sciences, New Delhi • Sir Gangaram Hospital, New Delhi • Research and Refferal Hospital, New Delhi • Dr. RML Hospital, New Delhi • Post Graduate Institute of Medical Education and Research, Chandigarh • Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGI), Lucknow • Banaras Hindu University, Varanasi • Guwahati Medical College, Guwahati • Seth Sukhlal Karnani Memorial (SSKM) Hospital, Kolkata • Nizam Institute, Hyderabad • Christian Medical Collage, Vellore • Stanley Medical College, Chennai • Govt. Medical College, Trivandrum • King Edward Memorial (KEM) Hospital Mumbai • Muljibhai Patel Urological Hospital, Nadiad, Gujarat
leaders speak
“there is no fertile ground for students excelling in research”
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hat is the present medical education scenario
Medical Superintendent & HOD, Hospital Administration, AIIMS, Dr Shakti Gupta’s vision is to establish a full-fledged Centre for Excellence in Hospital Administration at AIIMS, the first and the only ISO 9000:2001 certified department in the country. In an interaction with eHealth, he shared his perspective on the current medical education scenario in India scheme and threw light upon the challenges. Excerpts:
36
> www.ehealthonline.org > July 2011
in India? Medical education in India is in a state of metamorphosis wherein there is a paradigm shift from conventional rigid methodology to need based curriculum. Medical education presently is focusing on healthcare resources where primary stress is on super specialisation. This has to be changed and the old concept of family physicians be ushered in which will ease the load from the super specialists and healthcare can permeate to deep interiors of our society. While graduates generally posses reasonably sound knowledge of medical science, they are generally found deficient in performance of clinical skills, and problem solving, which forms the core of clinical competence. There is a growing trend of mistrust among the public for the medical profession as one hears of cases of negligence, misconduct and unethical practices leading to legal suits. There is a gross disconnect in realizing dream of producing doctors for the rural areas and strengthening the primary healthcare infrastructure in India.
What are the loopholes faced by the medical education system? How can they be removed? The Government of India recognises Health for all as a national goal which should be guided by principles of equity, affordability, effectiveness, and accountability. However, there are many impediments on the path of achieving this goal because of inadequacy of healthcare education which cascades shortage of healthcare workers. There is lack of inter-speciality synchronisation and planning for academic curriculum. What is your opinion about medical training in India? Why are we not able to retain talent? India has about 20 health workers per 10,000 population; the total number of allopathic doctors, nurses and midwives in India stands at 11.9 per 10,000 population against WHO benchmark of 25.4 per 10,000. As I have mentioned earlier our mode of teaching needs to undergo sea change. Some important modalities like Problem based learning, on the job training, integrated learning modules (ILM); Learning from other countries-using modern tools and technologies, learning from private sector-synergy based
leaders speak approach can be incorporated into our system. It is a happy development that the government has already approved the establishment of the National Institute of Paramedical Sciences (NIPS), Regional Institutes of Paramedical Sciences (RIPS) and a scheme to support the State Government Medical Colleges for conducting paramedical courses through a onetime grant. We are unable to retain talent as there is no fertile ground for students excelling in research and academics can work further. The conditions of employment in rural areas are not very appealing to the young qualified healthcare personnel. To add to it the lure of dollars and scope for growth is what pushes our talent overseas. Rural India, today, faces a serious lack of doctors and healthcare facilities. What needs to be done with medical education to bridge the rural-urban healthcare divide? Human resource shortage, unequal distribution of healthcare workforce between urban and rural areas and inefficiencies in the medical education system are some of the challenges that must be overcome through concerted policy action and implementation. There is an urgent need to increase student capacity, both through revamping existing institutions and establishing new ones, reform curriculum to reflect national needs, encourage innovation and adopt global best practices in healthcare and education. Moreover there is a mismatch between rural and urban healthcare resources. “Doctors to population” ratio is lower by 6 times in rural areas as compared to urban areas. The newer policy of Government to produce rural doctors
out of the local populace is a welcome step. I think the private sector must also do its might in training the students from rural sector at an affordable cost. We have to incorporate IT into our lives and concept of tele-education and tele-consultation has to be embedded into the education system.
Health system can be generator of jobs but the need of healthcare personnel is so huge in the country and abroad that our output is much less than the desired numbers
We need more than one lakh doctors per year. Or so to say, India can absorb one lakh doctors per year. And we only produce 30,000. What should be done to combat this challenge? There is an urgent need to revisit the requirement of Healthcare personnel in our country. We produce approximately 34,000 doctors every year. The MCI has reviewed the existing manpower situation and medical college curriculum in the country and has estimated that the target for doctor population ratio should be 1 doctor for 1000 population by 2031. This implies that the current intake and critical mass of doctors needs to be doubled. Common digital calendar can be made for participating educational institutions. We all must have a road map for achieving the goals and no mission will be successful and objectives will be attained unless things are monitored. There should be strict control measures, time bound goals, accountability at all levels and transparency in systems. We must encourage private sector to step into Medical education to bridge the existing gap and strict regulatory bodies must monitor this. Medical education should encompass infrastructure for training of Medical, Dental, Paramedical and Nursing students. These four pillars of Health education should grow simultaneously
to provide effective human resources for health. Health system can be such a huge generator of jobs, besides improving the quality of life of our people. And yet such undersupply is incomprehensible. So, how could we improve the situation? Health system can be generator of jobs but the need of healthcare personnel is so huge in the country and abroad that our output is much less than the desired numbers. Moreover it is not as rewarding as other branches are and it calls for long hours of struggle and perseverance which is not found in this generation. However things can improve if we improve the working conditions and facilities for healthcare personnel. Management skills and communication should be augmented with resources for improved quality. IT skills and e-labs can be launched to reach out far and wide. Vision sharing by experts and Orientation to Nation’s health system & policy is the need of the hour. Are you satisfied with this year’s budget for Health and Family Welfare? The Union budget 2010-2011 increased the allocation for health care by ` 2, 700 crore increasing the allotment to ` 22, 300 crores. This budgetary allocation is only 2 per cent of the
total budget, and is still very far from the target of three percent of GDP. Through increased allocations in the flagship public health programme, NRHM (National Rural Health Mission), an overall directional continuity has been maintained. The budget aims at benefiting all sections of the society but lacks specific provisions to boost private investment in healthcare sector especially in rural areas. Considering that there is a severe shortage of health infrastructure and health human resources there remains a lot that can be achieved through PPP models, which are the need of the hour. However, the five percent reduction in tax while importing medical equipment will be beneficial. The expansion of the service tax net to include health check-ups undertaken by hospitals for employees of business entities, and for health services provided under health insurance schemes may prove to be a deterrent at a time when preventive healthcare has to be promoted. The proposal to extend Integrated Child Development Services (ICDS) to every child by March, 2012 is also a welcome step as it would ensure nutritional security to the children under the age of six years. Inclusion of all BPL (Below Poverty Line) families under Rashtriya Swasthya Bima Yojana (RSBY) through increased budgetary allocations is a step in right direction.
July 2011 < www.ehealthonline.org <
37
leaders speak
“ICT-based virtual classes are playing a big role in medical education”
W
hat is the present medical education scenario in India? India is very rich in terms of clinical material. For the optimal utilization of this richness in medical field, it should be merged with IT and dedicated teaching. Indian medical colleges are at par with international medical colleges. However, our systems needs improvement. As for as undergraduate education is concerned, we have more than 315 medical colleges in India including both government and private. Our undergraduate and post graduate programmes are fairly acceptable. This strength is because of our good clinical exposure, training schedule and curriculum. Unfortunate suffering of human beings in India, being becomes a fortunate story of medical education in India.
Maulana Azad Medical College offers MBBS, post graduate degrees of MS, MD and superspeciality degrees of MCh and DM. Dr Arun Kumar Agarwal, Dean, Maulana Azad Medical College in an interaction with Dhirendra Pratap Singh and Shally Makin, shared his perspective on medical education in India. Excerpts:
38
What are the loopholes in the medical education system in India? How can they be removed? Medical science is progressing so fast that everyday newer diagnostics equipments and tests are being introduced. The challenge is that cost and availability of infrastructure in metro/town as compared to periphery differ. So, the exposures of the students also differ. The theoretical exposure is common, but the practical exposure of the advanced technology is different. India can absorb one lakh doctors per year, but we only produce 30,000. What should be done to combat this challenge? We can’t meet this challenge overnight. In the government sector, we have 185 colleges. Are we optimally utilising all those colleges? Every government college has enough clinical material but they have to meet adequate infrastructure and faculty. I am not in favour of mushrooming of medical colleges. Optimal utilisation of medical colleges is very important.
> www.ehealthonline.org > July 2011
Why are we not able to retain talent? Going abroad is individuals’ mindset and family decision. Another is non availability of satisfactory placement. Our responsibility is to give medical graduates better opportunities within India. We have to increase the number of post graduate seats. And MCI has also relaxed norms in this direction. Now, couple of thousands seats have increased. You have been associated with national board of examinations? Please share with us its role. National board of examinations is a wonderful organisation. It is a parent stream for post graduate education. This idea is based on improving the quality of medical education by elevating the level and establishing standards of post graduate examinations in modern medicine on an all India basis. You are an ENT specialist. Please brief us your some initiatives in this field? In ENT, the student should have some required practical skills. The practical skills have to be developed. Now, we are emphasising more on practical exposure. What is the role of ICT in medical education? Before we go on an actual patient, we should go on e-learning module of the system. e-Learning is very important for imparting practical education. Now, ICT based virtual classes are playing a big role in medical education. What needs to be done with medical education to bridge the rural-urban healthcare divide? Our doctors are ready to go in rural areas provided we give them basic comfort, neat and clean surroundings and safety. There must be basic facility for doctors in rural areas to treat the patients.
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Leaders Speak
â&#x20AC;&#x153;Sow the seeds for a doctor-patient relationship in the degree coursesâ&#x20AC;?
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hat are your views on the current format of medical education that is delivered by the colleges and institutes? Today, the patient has become a client for the doctors and there is a lacuna of ethics among the practitioners. This problem stems from the education phase wherein, medical students are not taught about the communication skills on how to interact with their patients. If we can sow the seeds for a doctor-patient relationship in the degree courses-we can create good doctors who not only have good knowledge of medicine but also have required communication skills. Recently, we are seeing that the medical education fraternity and the government are making efforts to include ethics as part of the medical education. Reduction in the total time taken to complete a degree course both MBBS and PG will help match with other professional courses as they complete their study within 4 -5 years. What is your opinion about medical training in India? Why are we not able to retain talent? The main reason for the brain drain is the monetary benefits that they get abroad. This can be addressed, if the government gives them more pay and opportunities to work in India at par with the developed world. Many of the doctors have started coming back to down especially after recession hit the developed world. But, to continue their stay the government will have to create the working conditions of similar standards as available abroad. There should also be more of love and concern infused in the doctors to serve their country during their education and training. By when do you think we would be at par with the developed world in terms of quality of medical education?
With the renewed focus of the government on health sector for NRHM, PHCs, education institutes and changes in medical education policy on the cards, I think we will progress in the next decade to come at par with the global best. Today, although we have the health infrastructure coming up in most of the states, we would need trained human resource to treat patients and improve the quality of healthcare delivery in India. Rural India, today, faces a serious lack of doctors and healthcare facilities. What needs to be done with medical education to bridge the rural-urban healthcare divide? Today, there is a huge gap in the number of doctors in the rural areas â&#x20AC;&#x201C; primarily due to the absence of sufficient salary and benefits. In the developed countries, there is no disparity when it comes to the salary and benefits of a doctors working in a rural or an urban area. But in India, there is stark difference in the job prospects and working conditions for a doctor to practice in the rural areas as compared to metro cities. The government will need to come up with basic infrastructure and upgrade the work environment and remuneration for doctors to go into the rural areas. Also, as the doctor does not get many patients in the villages, the system should be created where the doctor can be stationed at the Taluka level supported with health infrastructure - as the nodal point of practice. Once you have created the practicable and workable atmosphere for the doctors at the Taluka level, they will surely serve for the rural areas. The country is in dire need for more of specialist doctors as the current ratio of them is one for 10,000 patients and we require 1 person 1,000 for all specialties. There should be an increase in the medical institutes and colleges for all specialty departments to gain expertise and create more specialist doctors in India.
Grant Medical College is a premier and prestigious Institution counted amongst the best medical colleges in the country. Dr Tatyarao Pundlikrao Lahane, Dean Grant Medical College & Sir J J Group of Hospitals, a renowned eye surgeon shared his perspective on medical education in India with Rachita Jha. Excerpts:
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leaders speak
“The Government is very serious about improving rural health”
W
Safdarjung Hospital and Vardhman Mahavir Medical College are at the forfront of providing excellent medical care and education. Dr NK Mohanty, Medical Superintendent, Safdarjung Hospital, in an interaction with Dhirendra Pratap Singh and Shally Makin, shared his perspective on medical education in India. Excerpts:
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hat is the present medical education scenario in India? The present medical education scenario in India is very similar to the British system. In Vardhman Mahavir Medical College, we have 154 seats, in which 50 percent seats come from all India quota and 50 percent for Delhi students. For both the groups, there is a common entrance test. The selection is done by a committee who doesn’t belong to the college. Currently there are more than 185 medical colleges in India which are running graduate and post graduate courses. Under the current undergraduate scenario, there is four and a half years medical teaching and one year internship. We have sent our recommendations to the MCI to modify this rule. According to these recommendations, four and half years’ duration will be decreased to four years and the one year internship will be reduced to nine months. We are also in favour of exit test. What are the loopholes faced by the medical education system? In medical education, let us reduce the theory period and elongate the practical period. Medical science students must have more practical exposure. Youngsters should not be forced to join medical education by the parents. The students must be given freedom to choose their career. So, there must be an aptitude test. This should be done at the school level. I am sure that good schools will conduct this type of aptitude test. Besides this, teaching orientation should be changed. We have already suggested to MCI and they are trying to implement it. This has already been done in the US. What needs to be done to bridge the ruralurban healthcare divide? Sending doctors to remote village where there
> www.ehealthonline.org > July 2011
are no basic facilities is a challenge. There should be basic facilities for the doctors, who are being sent to rural areas. Our government is really serious about improving rural health. Government has already allocated huge funds to improve rural healthcare sector. National Rural Health Mission is a very good step in this direction. I think that there is a ray of hope and things will improve. Government alone can’t do everything. It also needs public support. What is the role of ICT in improving medical education? There is electronic mode system in our library. But for the implementation, librarian should be taught about its functioning. Still, majority of people don’t know how to operate a desktop. Until and unless you don’t get trained on an ICT system, it can’t help. We have to first understand the problem and then think about the solution. A small country like Cuba has sent an example, and today has the best healthcare system in the world. Do you think that there is a need of regular refreshing courses for the faculty in medical education? Medical science is very dynamic subject and our college organises teacher training programmes, continued medical education programms and seminars on regular basis. In medical profession, we should keep abreast with newer technologies. Robotic surgery was not prevalent in our country but now, it is coming up. If I don’t get trained today, tomorrow I will fall back. After three years, nanotechnology will emerge as an important field. So, all the medical doctors who are in teaching fraternities should be trained from time-to-time with the advancement of technology.
leaderspeak
“Technology can address issues related to rural healthcare”
W
hat is the present status of medical education in India? Firstly, the not so dynamic syllabus defined 15 to 20 years ago is still being followed. The knowledge imparted to students in the colleges is not updated and therefore it is too heavy for the students once they start practicing. Secondly, the skill component such as patient skills, communicating skills and behavioral skills are missing and should be embedded in each student to be competent enough. The colleges concentrate on theoretical ways of teaching, rather they should emphasise on enhancing skills and include long hours of practical training. Lastly, medical education needs to be strengthened with a proper examination system. The subjective system does not really fulfill the purpose to examine a student in all spheres of subjects. However, there is a mismatch between the system and curriculum, which needs to be looked at urgently. Whereas, a lot of teaching is done with real patients and a variety of clinical conditions and practical exposure is given to students. What is your opinion about medical training in India? Going abroad, for a post graduation course may be a generalised perception to have a better quality of life with better remuneration options. Considering that a number of students try and go for higher education there are enough seats for the ones, who study here. It doesn’t really matter if a student gets trained abroad and comes back to serve his country with skills he has learnt abroad. Doctors come to a profession like teaching by default. We need to have workshops and lectures to teach these doctors as how to teach adults and incorporate scientific ways of teaching. There are programs and fellowships to enhance such skills and doctors should pursue this course. Even MCI has made it compulsory for faculty in India to undergo teaching courses.
As of now, there is a serious dearth of good doctors and healthcare facilities in rural areas of the country. What needs to be done? It is a huge challenge to all the policy makers and government officials to surpass and bridge this gap between the rural and urban healthcare facilities. The whole process needs to be slowly revamped and requires restructuring at every step. It’s a long term policy and to uplift the rural people, we have to strengthen the basic infrastructure. The whole process of strengthening rural infrastructure is a long term investment and till now the people in peripheral areas have unfortunately been denied of good healthcare facilities. With the advent of technology, we should include telemedicine to receive expert opinion, videoconferencing and much more. Technology should be used more to address such issues and immediate problems and long term problems can probably be taken care of gradually. How has your college incorporated technology and manages to deliver well trained and skilled doctors to the nation? I am in a leadership position and I would try to make the curriculum emphasis on skill training, which is student centered. I try to incorporate systems with workshops to teach the skill component and make our education policies better permissible. Our college is gradually streamlining in phases where the faculty is being trained in technological ways of teaching. We are proactive in adopting new and scientific ways for imparting better training. We have digital library being accessed by the students which conducts self study modules encouraging them to study. We have integrated around 5-10 percent of the innovative process to the system and wish to achieve 60-70 percent in total considering the fact that we cannot achieve 100 percent perfect education system where the advancements in technology are dominating.
Dr VA Saoji, Dean, Bharati Vidyapeeth, Faculty of Medical Sciences, has incorporated the skill component in the medical training system of Bharati Vidyapeeth Deemed which has made a difference at the institutional level. In conversation with Shally Makin, he shared his opinion about the medical education scenario in India
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leader speak
â&#x20AC;&#x153;We need to remove commercialisation of educationâ&#x20AC;?
W
hat is the present medical education scenario in India? I believe the condition of medical education is not up to the mark. The teacher student ratio in every college is imbalanced. On the other hand the clinical material is not standardised properly in some of the medical colleges. The major factors for the failure of medical colleges are the location, lack of interest in faculty and the sudden emergence of corporate hospitals and government sponsored programs. The condition of medical education is down, even though the modalities and training are being carried in some institutions but they need to be improved and standardised.
In conversation with Shally Makin, Dr James Pandian, Dean, SRM University, one of the premier institutions since 25 years, shares his insights about medical training system which deserves a better infrastructure in order to improve quality of healthcare in the country
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What are the loopholes faced by the medical education system? How can they be removed? The medical education system in India needs to be revamped. With the initiatives of government of India and Medical council of India the system should be reviewed thoroughly into the quality of education keeping in mind the morality of teaching, efficiency, past experience, administration. The country is well equipped with technology and facilities and has produced world class doctors. Today, the faculty needs to be dedicated and experienced to produce well qualified doctors and retain talent. The system needs extra attention to produce quality and improved infrastructure. What are the various facilities provided by your college that contribute in giving a better overall medical training? Our centre is one of the finest in the nation. We are also training people from other institutes. Our University is very well accredited from MCI. In our uni-
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versity, there are many other departments including biochemistry, biotechnology, and many other which use various technologies and high end medical techniques to train students that further help the MBBS students to learn different techniques in one single campus only. As of now, there is a serious dearth of good doctors and healthcare facilities in rural areas of the country. What according to you needs to be done to bridge this rural-urban healthcare divide? In the leadership of Professor Sarin of MCI, the board wanted a specific course for a short duration after MBBS to become a specialist in rural areas. The course offered an internship in the rural areas during the last semester of the Post Graduation course. I strongly believe that this course would bridge the gap between the rural and urban healthcare facilities and will encourage other students in the area to pursue medicine and help in improving health. The system needs to be streamlined to provide better healthcare facilities in the rural areas. This way we can minimise the heavy rush in corporate hospitals and concentrate on rural problems. We really require focus at the rural level. In order to strengthen the medical training sytsem what measures need to be taken? We need to gradually remove loopholes and increase our standards in order to combat such a challenge. We need to limit the number of accreditations being provided to the medical colleges without proper audits or checks. We also need to look into the medical infrastructure and see that the faculty imparts quality education as well as high-class practical training. Gradually, we need to look into the intricacies of the system to remove corruption and commercialization of education.
Leaders Speak
â&#x20AC;&#x153;We lack in skill-set trainingâ&#x20AC;?
W
hat is the present medical education scenario in India? We admit around 45,783 students in medical colleges, annually. India is a bundle of contradiction and has lots of gaps between the present reality and future needs. We have one billion population out of which, roughly, 73 is rural based and yet we lack in providing rural healthcare. Rapid urbanisation has also led to an unattended tendency to discriminate. There is a need of rapid socio-economic reforms and we should not neglect the rural community. We should have adopted a single national integrating system with India having the best of medicine system like ayurveda and allopathic but we chose the British system. At the time of independence we had just 8,500 medical seats and now we have grown up to 45, 000 medial seats. What is your opinion about medical training in India? There is a huge perception gap between the goal of our curriculum and the curriculum that has been prescribed. MCI requires admitting 180 odd faculty members to run a medical college with 100 students and has not mandated even one family physician in the whole lot. The medical students are not exposed to primary care. We teach them about some cases theoretically to which the students might never ever encounter today. Earlier, seven beds were allotted per student and now it is reduced to five beds as per Medical Council of India (MCI). The regulatory body has been liberal in sanctioning medical colleges like Pondicherry which alone has around twelve medical colleges but due to sparse population it does not have patients. We need to draw attention to primary care centers rather than tertiary healthcare centers. We lack in training students for skill development and clinical application throughout as they are not taught intensely. If we shift from volume of theoretical knowledge we will be able to maintain the passion for this profession. We need to create a skill-set focus and an extremely strong foundation. It will be great if we are able to shift medical education into the community by encouraging tertiary healthcare centers to
build medical colleges in the rural areas. As of now, there is a serious dearth of good doctors and healthcare facilities in rural areas of the country. What according to you needs to be done to bridge this rural-urban healthcare divide? We have to change the criteria of selection for Under Graduate program from MCQ-based centralized exam which just attracts those students taking coaching for such entrance exams in the urban areas. One cannot expect these doctors who are brought up in such elite model of upbringing to practice in the rural areas. Asia Heart foundation encourages young potential bright students to get the best of medical education. These students from the rural background mostly go back to the roots and serve their villages. There may be just a small fraction of the lot which chooses to stay in the metros. We need to give infrastructural support along with some incentives to such young students for motivation. What are the various facilities provided by your college that contributes in giving a better overall medical training? We need to build a primary hospital in a village and make a student to live for a month with a mentor for each group. These doctors develop a sense of empathy to go every month. The students think before writing a lavish transcription considering the financial status of the patient. This is the major change we have brought into the college curriculum. Are you satisfied with this yearâ&#x20AC;&#x2122;s budget for Health and Family Welfare? What are your expectations with the next budget? Budget has not been an issue. But the matter is we use around one percent of GDP with a public expenditure being less than 20 percent and private accounting to 80 percent. Eighty percent of the funds is spent on salary and remaining gets dumped due to corruption. The budget allotment is not really deficient but the people involved should use the resources in a better way. Healthcare providers need to reprogram the ride so that they will not come back to past.
Dr S Kumar, Dean, MS Ramaiah College, believes to bridge the gap between the ruralurban education systems by adopting a single national integrating system. In conversation with Shally Makin, he shares the need to address the rural healthcare system to be of utmost importance
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THE PREMIER GLOBAL PLATFORM FOR E-health
1-3 August 2011 | The Ashok, New Delhi, India our Speakers
Keshav Desiraju Additional Secretary Ministry of Health & Family Welfare, Government of India
Dr Ajay Singla Additional Secretary, Department of Health & Family Welfare, Government of NCT of Delhi
Vijayalaxmi Joshi Principal Secretary & Commissioner, Department of Health & Family Welfare, Government of Gujarat
Dr S Vijayakumar Special Secretary (H & FW) & Project Director, TNHSP
Dr Ashok Kumar DDG and Director, Central Bureau of Health Investigation Government of India
Dr Shakti Gupta Professor & Head, Dept of Hospital Administration, AIIMS
Dr Dharminder Nagar Managing Director, Paras Hospitals
Dr Sanjeev Bagai CEO, Batra Hospital & Research Centre
Amod Kumar MNH Project Director, IntraHealth
Babu A CEO, Aarogyasri Healthcare Trust, Government of Andhra Pradesh
Tim Ellis Whole System LTC Demonstrator Programme Manager, Innovation & Service Improvement Division, Dept of Health, United Kingdom
Dr Sanjeev Chaudhary CEO, SRL
Dr Karanvir Singh Head - Medical Informatics, Sir Ganga Ram Hospital
Dr Erna Surjadi Regional Adviser - Gender, Women and Health, World Health Organization, New Delhi
Dr BK Rana Dy Director NABH, Quality Council of India
Steven Yeo VP & Executive Director, HIMSS AsiaPac
Dr Ramachandran Lele Director-Nuclear Medicine, Jaslok Hospital and Research Centre, Mumbai
Gp Capt Sanjeev Sood Hospital and Healthcare Administrator, Indian Air Force
Dr Neena Pahuja CIO, Max Healthcare Group
Dr V Balasubramanyam Domain Consultant-Medical E-learning & Professor, Dept. of Anatomy, St. Johnâ&#x20AC;&#x2122;s Medical College, Bangalore
Organisers
CO-Organisers Department of Telecommunications Ministry of Communications & IT Government of India
Powered by
Introduction
Launched by Shri Kapil Sibal, Union Minister of Human Resource Development and Communications and IT, Government of India, eWorld Forum 2011 is a global conference on Information and Communication Technology for development (ICT4D). The conference is being organised by Centre for Science, Development and Media Studies (CSDMS) and Elets Technomedia Private Limited in association with Department of Information Technology (DIT), Ministry of Communications and Information Technology, Government of India on 1-3 August 2011 at The Ashok, New Delhi, India. Health being one of the most significant parameters of human development, requires utmost emphasis in terms of systems strengthening, enablement and efficiency gains through innovative solutions available through modern IT and communications technologies and hence forms a key track under eWorld Forum 2011.
Anju Sharma Mission Director, NRHM, Gujarat
Dr Pervez Ahmed CEO & MD Max Healthcare Institute Ltd
Sangita Reddy Executive Director Apollo Hospitals Group
Dr Girdhar Gyani Secretary General, QCI
Maurice Mars Prof of Telehealth Dept of Telehealth, Nelson R Mandela School of Medicine, South Africa
Dr BS Bedi Advisor-Health Informatics, C-DAC, Government of India
Dr Balaji Utla CEO, Health Management & Research Institute, Hyderabad
UK Ananthapadmanabhan President, Kovai Medical Centre & Hospital, Coimbatore
Dr OP Manchanda CEO, Dr Lal PathLabs
Dr Thanga Prabhu Clinical Director-HCIT, Wipro GE Healthcare
Thumbay Moideen Founder President, Gulf Medical University
Vibhu Talwar COO, Moolchand Medcity
Susheela Venkataraman Managing Director, Internet Business Solutions Group, Cisco
Dr Harsh Mahajan Honorary Radiologist to the President of India, & Medical and Managing Director,Mahajan Imaging
Miles Ayling Director of Service Design, Commissioning and System Management Directorate, Dept of Health, United Kingdom
Dr K Ganapathy President, Apollo Telemedicine Network Foundation
Dr Rana Mehta VP-Healthcare, Technopak
Dr Pavan Kumar Consultant Cardiac Surgeon & Head-Telemedicine Master Centre Nanavati Hospital, Mumbai
N Eswarnatarajan Head â&#x20AC;&#x201C; Operations & Technology, ICICI Lombard General Insurance Company Limited
Dr Shreeraj Deshpande Head â&#x20AC;&#x201C; Health Insurance,Future Generali India Insurance Co Ltd and many more... * Some confirmations awaited
For Programme Enquiry Contact: Divya Chawla, Mobile: +91 8860651643, divya@elets.in For Business Enquiry Contact: Rakesh Ranjan, Mobile: +91 8860651635, rakesh@elets.in (for further details visit our website www.eworldforum.net)
eHealth World is held in conjunction with
www.eworldforum.net
leader speak
“Change in mindset of policy makers is the need of the hour”
W
hat is the present status of medical education in India? The present medical education system is much better than what it was a few years ago but still a lot needs to be done. This year’s financial budget has allocated considerably less for healthcare infrastructure. We need to invest more on health for national development.
In conversation with Shally Makin, Dr SM Bhatti, Principal, Christian Medical College, seeks to contribute to the health needs of India by training students through a prestigious institute for more than a century now and believes that medical education in India needs to focus on practical training with a restructured system
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What do you think are the loopholes in the medical education system? How can they be removed? The education system comprises of medical students, medical teachers and medical institutes. To address the issues related to medical students there has to be alternative method of selection, single entrance test to select students for taking medicine as a career is not a good method. It is difficult at the undergraduate level but can easily be incorporated for post graduation courses by going back to the earlier system of doing house job and then choosing the candidates who have the aptitude for that subject. As far as teachers are concerned, neither all medical teachers have interest in teaching, nor are they trained enough to do their job. This particular problem is already being taken care of by mandatory workshops introduced by MCI recently. Some institutes don’t have enough teaching cases for practical training which is of paramount importance. Strict monitoring by the regulatory authorities will take care of this issue. Please share your opinion about medical training in India? In most institutes the medical training is too theoretical and not enough emphasis is given on skills which are the back bone of medical care. We need to give long hours of practical training to students to produce a skilled and well trained healthcare
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professional. The medical field is advancing day by day and we need to keep pace with the technology and produce doctors equipped with the knowledge of technology. The assessment system also requires modification. As of now, there is a serious dearth of good doctors and healthcare facilities in rural areas of the country. What according to you needs to be done to bridge this rural-urban healthcare divide? It is true that rural India has dismal facilities as compared to urban India. We need to improve infrastructure in rural setup. There should be proper schools and education in rural areas so that the doctors serving there don’t face a problem in looking for good education for their children. Their salaries should also be comparable to doctors working in urban setup. These small measures will help to retain young doctors in rural areas. Health needs to be seen from a different perspective. A healthy society is the base of a healthy nation. Money spent on health is not a waste but a long term investment. This change in mindset of policy makers is the need of the hour. Skewed distribution of doctors is the main issue. A doctor who had spent ` 30-50 lakh on his college fee, would not like to work in rural setup on a meager salary. We need to provide the doctors with good facilities and adequate salary to retain them in rural areas. Also the medical students who study in Government Colleges study on tax payer’s money. After completion they go abroad without contributing anything to the nation, although they have taken a huge benefit. They should be asked to serve the rural India for about 2 years. Such measures would ensure that everybody contributes to the society and thus even if for two years; the mandate would make it possible for all doctors a fair share of exposure. Also, it would ensure all doctors going and serving in rural areas at least for two years.
Leaders Speak
“We need to improve our education system if we want a change”
W
hat is the present medical education scenario in India? The present medical education system is almost on the same pattern as it was introduced to us in 1964-1970. Although there is a little change with introduction of community medicine taught in the first year of the course itself and developing the applied aspect in the field. What are the loopholes faced by the medical education system? How can they be removed? There seems to be many loopholes viewing the pattern of teaching these days for MBBS course in other countries. We do not have self directed learning hours or motivation gatherings, no vertical or horizontal integration in various disciplines is set in a pattern. There are fewer seminars and group discussions with the grueling session of lectures. The examination pattern has been the same over the decades. Gradually, deferred quality of doctors needs immediate attention and we need to improve and implement better education system if we want a change. What is your opinion about medical training in India? Why are we not able to retain talent? The medical training in India is still following the traditional form of teaching and learning process. The students in their internship period do not pay much attention to the subject like clinical skills as they are busy preparing for PG entrance exams. To overcome such issues, MCI had conducted a workshop which proposed to have a common PG entrance exam just after final MBBS and involve these
medical graduates before they get busy with other things. Also, to retain talent we need to encourage talent and provide them with good guidance. We should try and reciprocate in terms of their talent in many other ways. Rural India, today, faces a serious lack of doctors and healthcare facilities. What needs to be done with medical education to bridge the rural-urban healthcare divide? I duly agree that rural India faces a serious lack of doctors and healthcare facilities. Perhaps our training requires a change by inserting the word ‘must’ with a written undertaking that a medical graduate on whom Government of India spends so much, must serve in rural area for a stipulated time. At present, the doctor and patient ratio in our country is1:1700, where as the world average is 1.5:1000 as mentioned in the workshop by MCI on 29.3.11. To meet this challenge either we need to increase the number of medical colleges in the country or increase the number of seats as per norms of MCI so that quality in training medical graduates is not compromised at all. The demand of doctors is increasing as per the population at both levels, urban as well as rural areas of our country. Are you satisfied with this year’s budget for Health and Family Welfare? Your expectations with the next year budget? Although, there was a plus point that Government will provide health support system for house maids in terms of health insurance. But the proper use of money spent either by Government sector or by private sector will only be useful if proper awareness is there in people at grass root level.
Dr Pratibha Gupta, Dean, School of Medical Sciences and Research, Sharda University, besides receiving academic excellence throughout and being associated with a number of educational institutions, has undertaken various workshops on e-Learning, national medical assessment, and many other to enrich her knowledge with advancing technology. In conversation with Shally Makin, she enunciates on the need to improve Medical education system.
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