IndiaMedToday Sep 2018

SEPTEMBER 2018, VOLUME 2 ISSUE 9 `200 INDIA MED TODAY

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Innovations In Medical Education

BODHI HEALTH USING NEW AGE TECH FOR SKILL UPGRADATION SEPTEMBER 2018

FOOTPRINTS ON THE SANDS OF TIME PROF TK SHANMUGASUNDARAM

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Democratise Medical Education HEALTHCARE HAS become a crucial issue discussed across the board. The NHPS is a step closer to universal healthcare. But we are forgetting the fact that there is no healthcare without medical professionals. We need more doctors and nurses to fulfill the dream of healthcare for all. Even if we only look at primary healthcare the staggering number of vacancies would shake the confidence of any policymaker. We do need to have more colleges training more doctors but we also need this training to be affordable.

Tution-free medical education is no longer a distant dream. The New York University School of Medicine has recently announced that they will offer tution free training to all its current and future students. This is a revolutionary step and should be something that the Indian educators emulate.

Tution-free medical education is no longer a distant dream. The New York University School of Medicine has recently announced that they will offer tution free training to all its current and future students One of the first question that would be raised in this context is about the cost, and subsequently who will pay for this. In case of NYU the amount is being raised through philanthropists and almost 80% of the USD 600 million has already been raised. Also, healthcare experts have been raising concerns about the edifice that we build in the name of medical colleges. We can do away with the fringes and have a lean system that will further aid in less-cost of training doctors.

By democratizing medical education – making medical education available to anyone who wishes to become a doctor, irrespective of caste, creed, merit, social standing or financial status – the govt would in reality be able to bring down cost of healthcare delivery. NHPS is the best place to have this goal documented. With lower treatment rates – when the govt wants healthcare providers to lower costs- tution free medical education open for all is the only way forward.

This will definitely raise some uncomfortable class questions and skeptics will not like it. But there is no doubt in my mind that this is the way to go if we are serious about bringing down costs, keeping our medical graduates employed and happy, abolishing violence against doctors and making healthcare available to all.

Do let us know your thoughts. Write to editor@indiamedtoday.com

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CONTENTS

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Twitter Facebook Linkedin

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UPFRONT 03 Editorial 05 Letters 06 News roundup 42 Event Report

APPROACH DRIVE

Footprints on the Sands of Time

In memoriam Prof TK Shanmugasundaram, Professor of Orthopaedic surgery, MMC

COVER STORY

Leading with Learning: Innovations in Medical Education Innovation in medical education is central to solving a number of healthcare problems. There is an urgent need to revolutionise medical education and India must take cue and learn from the best

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75 per cent of doctors believe in self-medication, when it comes to managing their finances

How Medical Universities Can Leverage CuttingEdge Technology to Train the Doctors of Future

OPINION

Walk the Talk

Trade margin rationalization

Challenges in National Organ Retrieval Neuro-nursing Workshop INTERVIEW IMPACT

Innovative course providing high quality training on operative aspects of deceased donor management and organ recovery is winning accolades and hearts alike

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Are You SelfMedicating Your Finances

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Dr Alexander Thoma President , ANBAI Dr ArjunKalyanpur CEO, Teleradiology Solutions

INNOVATE

Embracing AR/ VR for Medical Education

Can augmented reality tools help students learn better

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PULSE

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September 2018

Bodhi Health

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Using New Age Tech for Skill Upgradation

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LETTERS

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NDIAMEDTODAY carries a lot of incisive articles. I particularly liked the cover stories, interview, and the Ask the Expert (medico-legal) sections. I liked the cover article (July issue). Most of the hospitals in India (except the corporate hospitals) are run by doctor-promoter-CEO as the same person. Consequently, they fail to see many of the KPI / KRA leading to business losses and not so professional outlook of the hospital.

May be you should explore the possibility of promoting this article to reach out to these doctors.I also liked the interview of DrGyani in the February issue. People like him are driving Indian healthcare towards a higher level of professionalism and quality standards, and the cover story (April) on 63 hospitals in Kerala improving quality of cardio-care using quality toolkits.

Jatin Mahajan, Managing Director, J. Mitra & Co. Pvt Ltd

“The Ministry of Health and Family Welfare has recently notified an amendment to a clause of the Medical Device Rules 2017, stating that for the purpose of licensing, manufacturers can now submit product test reports from a NABL accredited laboratory. As an industry leader, I welcome this move, since it will greatly help manufacturers save time and efforts in getting the necessary validation results from a Government laboratory. This in turn, will speed up the process of issuance of licenses. At Transasia, our R&D and manufacturing teams work round-the-clock to offer new products for early diagnosis. Therefore, a positive move like this would eventually help us to introduce quality products without ‘undue’ delays.”

Suresh Vazirani Chairman & Managing Director, Transasia Bio-Medicals Ltd.

The Prime Minister’s Jan ArogyaAbhiyan is a call to arms to the medical fraternity to rise to the occasion and work towards easing the healthcare woes of crores of Indians! We welcome the initiative, by which the Government takes on the burden, and shares the cost of providing healthcare to those who cannot afford it. It is heartening to see the rapid progress made in a short time since the scheme was announced, and will be welcome relief to millions of poor patients when it is launched next month. The technology backbone of the Ayushman Bharat will help ensure streamlining of the process of healthcare delivery to those who need it the most. As the first step towards Universal Health Coverage, this is a pivotal moment in the country’s healthcare journey that will require the entire healthcare ecosystem, public and private, to work with a collective sense of purpose and synchrony. The Apollo Hospitals group will support this initiative whole-heartedly as part of our continuing efforts towards universal access. A healthy nation will be an engine of economic growth and we re-dedicate ourselves to our commitment to build a Healthy and Happy India.

Dr. Prathap C. Reddy Founder, Chairman, Apollo Hospitals Group

It is great to see the government is acting strongly and actively in making Ayushman Bharat a reality. The Government also seems to want an effective launch, by initiating a ground level testing phase between August 15 and September 25th when the policy will actually begin implementation. While the launch of the scheme is highly

welcome, what is also needed to be adressed on a parallel track is accessibility to doctors and hospitals. Without improving our doctor-patient ratio, without increasing penetration of hospitals and tertiary care centres, without ensuring that all health centres in rural areas are equipped with specialists and diagnostic facilities, even this ambitious scheme will only partially serve thw purpose. We hope Ayushman Bharat paves way for a concerted effort on improving India’s healthcare facilities.

Dr Dharminder Nagar MD, Paras Healthcare

The PM’s announcement of rolling in the Jan Arogya initiative from Red Fort this Independence Day is a positive sign considering that the PM outlined his larger vision of including lower middle class and upper middle class under Ayushman Bharat after the initiative is successfully implemented at the grass-root level for the rural poor.

It is also good that the initiative is technologically driven and will be a transparent medium of implementing the benefits. While these measures should boost healthcare infrastructure in rural areas, tier 2 and tier 3 cities, and will provide employment opportunities, there still is a need for creation of conducive environment in these regions for high costing quality tertiary care delivery to sustainably serve the population. We are highly hopeful that the government will look in to the suggestion of private healthcare players and grow a model to ensure that the best quality healthcare is delivered in various pockets of the country Dr. NandakumarJairam CEO,Chairman& Group Medical Director, Columbia Asia Hospitals India

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NEWS ROUNDUP ASIA’S FIRST ADVANCED CLINICAL SCHOOL FOR STEREOTACTIC RADIOTHERAPY Varian Technologies, in collaboration with KokilabenDhirubhaiAmbani Hospital, is offering Asia’s first Stereotactic Radio Surgery and Stereotactic Radiotherapy Clinical School.

While arming established medical practitioners with cutting-edge technology management training, the course will also enable radiation oncologists and physicists to offer better patient-centric treatment protocols.

As this is the first-of-its-kind training centre in Asia, KokilabenDhirubhaiAmbani Hospital will also host medical professionals from across Asia who wish to be part of the training. The aim of establishing this centre

Launch of Asia’s first Stereotactic RadioSurgery School

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is to provide quality healthcare, which was previously available only in the West, across India and other Asian countries.

The Varian Training Centre for Radiation Technologists involves case-based learning with expert clinicians from some of the leading cancer centres in the country. The present programme is designed to fortify the abilities of already trained candidates who are familiar with radiotherapy, but not competent with state-of-the-art technologies. Professionals will be trained on the newest technologies available in the field of radiation oncology. The candidates in this fellowship programme will be exposed to high-end treatment modalities, enabling them to work in independent radiation oncology departments on modern equipment. Candidates who desire to learn new skills will get an edge in the field of radiation

oncology medical practice, medical physics, and technology through this programme. The course will also allow aspirants from the lower strata of society to be skilled in managing the equipment required for radiotherapy.

ONLINE CROWDFUNDING PLATFORM FOR CANCER TREATMENT REEVIVE a crowdfunding online platformraises funds for treatment of underprivileged cancer patients at Tata Memorial Hospital, Mumbai.

Brainchild of renowned Oncologist, Dr Sanket Mehta and Raj Shah, entrepreneur and real estate developer, and Riddhi Shah, co-founder, REEVIVE.org. They enlist new patients every month referred by Tata Memorial Hospital who are further screened

by REEVIVE’s expert panel of doctors. This screening is to ensure that patients that need urgent treatment are addressed immediately.

REEVIVE was formed to bridge the increasing gap between donors and patients in a more impactful manner. Tata Memorial Hospital witnesses a different scale and diversity of patients from all over the country, usually from the lower strata of the society that hopes for their treatment. Therefore, an association with Tata Memorial alone would provide many needy patients. Moreover, the cancer wing at Tata Memorial has the best infrastructure to treat these patients, and hence the donations raised would be utilized in the most appropriate fashion, and in the full interest of Cancer fighters.

Cloudnine Hospitals, First Indian Hospital Chain Accepted to Vermont Oxford Network Cloudnine Hospitals has added another distinguishing feather to its cap by becoming India’s first member of the prestigious Vermont Oxford Network (VON), a coveted consortium of healthcare professionals representing neonatal intensive care around the world. VON operates with a singular endeavor to elevate the global neonatal landscape by capturing critical information on very low birth weight infants and infants meeting other eligibility requirements. It is propelled by a mission to ‘improve the quality and safety of medical care for newborn infants and their families through a coordinated programme of research, education, and quality improvement projects’.

As India’s first accepted member, Cloudnine will help to augment VON’s exhaustive database, in turn enabling data analysis and independent bench-marking to promote quality improvement of member centres.

Additionally, with its cutting-edge NICUs, technology-oriented protocols and superior, streamlined neonatal care practices, the VON membership will help Cloudnine compare its NICU outcomes with many of the world’s best NICUs. Cloudnine will serve as an icon of the changing face of neonatal healthcare in India.

CANCER BLOOD TEST TO GET MUCH MORE

ACCURATE – THANKS TO MALARIA PROTEIN Cancer tumour cells in the blood can be more accurately and cheaply detected using a malariaprotein, new research led by UNSW’s Chris Heeschen shows.Researchers from UNSW Sydney and the University of Copenhagen have developed a new way to detect earlystage cancer tumour cells in the blood using a malariaprotein.

UNSW Professor Chris Heeschen said the hope is that this method, in which malariaprotein VAR2CSA sticks to cancer cells, can be used as a more effective way to screen for cancer in the near future.According to the research, the new method can be used more broadly to diagnose cancer as it is not limited by cancer type. It also means all that is needed for a cancer diagnosis is a blood sample.

Professor Heeschen thinks the new technique could be available in the market within two years if a biodiagnostic company were to take it on.

Previous methods to detect cancer in blood relied on detecting a particular marker found on the surface of tumour cells. However, not all tumour cells display this marker, which renders these methods unable to detect tumour cells spread to other organs such as the liver, lungs and bones.

The method based on the malariaprotein does not discriminate between cancer types, and can detect all carcinoma cancers, accounting for 95 per cent of cancers detected in humans.During the development of the new method, the researchers took 10 cancer cells and added them to five millilitres of blood containing millions of red and white blood cells.

Magnetic beads coated with the malariaprotein were then added to the samples.

The beads stick to the cancer cells only and can then be retrieved with a robotic machine that uses a strong magnet. This way, they were able to retrieve nine out of the 10 cancer cells which had adhered to malariaprotein.Professor Heeschen said this was a definitive result.

“The malariaprotein sticks to all cancer cells, with no exceptions. The 10th cell was probably missed due to technical limitations inherent to

the retrieval technology,” he said.He went on to compare how the malariaprotein method compared with traditional methods.“For pancreatic cancer, the standard method (CellSearch, FDA approved) catches 0 to 1 cell per 7.5 ml of peripheral blood,” he said.“In the same volume of blood we find around 140 cells using malariaproteins. Since we can get 60ml from each patient, we are able to retrieve around 1000 cells, in some cases up to 2000.”

This increase in accuracy is also complemented by the technology being more affordable, Professor Heeschen said.“The CellSearch run for such a small sample costs $500. Our platform can process 60ml in shorter time for $100.”

The researchers envision being able to use the method to screen people at high risk of developing cancer in the future. However, they also expect that this method can be used as a biomarker indicating whether a patient with mostly vague symptoms indeed has cancer or not. This may also enable doctors to determine the stage of the disease.

The latest research follows on from work done by researchers led by University of Copenhagen’s Professor Ali Salanti, who discovered in 2015 a new method of treating cancer with the protein VAR2CSA produced by malaria parasites.The findings of Professor Heeschen and his team were published recently in Nature Communications as “The VAR2CSA malaria protein efficiently retrieves circulating tumor cells in an EpCAMindependent manner”.

HINDUSTAN SYRINGES, NIRAJ INDUSTRIES RECEIVES MDSAP CERTIFICATION

The group companies of Hindustan Medical Devices- Hindustan Syringes & Medical Devices Ltd, one of the largest manufacturers of Disposable Syringes in the World and the largest for Auto Disable syringes and Niraj Industrieswere among the first set of Indian Manufacturers of Disposable Medical Devices to be awarded the prestigious MDSAPqualityassurance certificate.

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NEWS ROUNDUP The Medical Device Single Audit Program (MDSAP) allows a single regulatory audit of a medical device manufacturer’s Quality Management System (QMS) which satisfies the requirements of multiple regulatory jurisdictions to address Patient Safety concerns. Manufacturers can be audited once for compliance with the standard and regulatory requirements of up to five different medical device markets: Australia, Brazil, Canada, Japan and the United States.

For manufacturers, MDSAP is of benefit as it reduces the overall number of audits or inspections and optimizes the time and resources expended on audit activities.

MDSAP certificate aims to promote globally a greater alignment of regulatory approaches and technical requirements which are based on international standards and best practices.

Additionally, it also promotes consistency, predictability and transparency of regulatory programs.

“We are delighted to have received this

Regulatory Quality AssuranceCertificate. It aligns well with our goals as we needed this certification to continue exporting our blades and Syringes to Canada which is mandating this certification from all overseas suppliers to Canada from 2019. This certification will moreover allow waiver of US FDA inspections and also from regulatory bodies of Brazil , Japan and Australia which eases our regulatory compliance demonstration burden of undergoing multiple audits every year from these countries,” said Mr. Rajiv Nath, Jt. Managing Director of Hindustan Syringes & Medical Devices.

BRAINS INTRODUCES CUTTING-EDGE MACHINE TO EASE SPINE SURGERY Moving ahead with the growing pace of technology, Bengaluru based Brains Hospital has recently acquired the cutting-edge mobile fluroscopy machine – Ziehm Hybrid RFD 3D HE

Brains Hospital acquired Intra-operative Imaging System

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Intra-operative Imaging System. Brains is the first hospital in India to house this world’s best high-end equipment used for spine surgery that gives 100 percent accuracy& 3D Imaging.

Surgery of the spine and nerves has to be under taken with utmost meticulousness and accuracy. Even a slight variation can lead to serious consequences as well as disability.

So, this highly mobile apparatus, offers surgeons three dimensional imaging with exceptional clarity, helping them achieve pinpoint precision with never-before confidence and speed. At Brains, surgeons pair the Ziehm with another first-in-India technology, the Stryker navigation system NAV3i , a computerassisted, navigation guidance suite that gives real-timefeedback about the position, direction and progress of surgeryaided by in-built preprogrammed and planned safety checks. Thus BRAINS has established the first of its kind Hybrid operation theatre for the spine surgery.

Deployed together, these two systems have helped doctors achieve perfection in spinal

surgery and reduce the chances of errors to near zero.

Dr. Venkataramana NK, Founder & Chief Neurosurgeon, Brains Hospital said: “These technologies enable our surgeons to operate with extremely small incisions with minimal invasiveness and muscle dissection without disturbing the joints, ligaments and other supportive elements. They also greatly enhance the possibility of using minimally invasive surgery for fixing unstable spines percutaneously, using key holes.”

“Pushing our capabilities in spinal surgery even further we have inducted sophisticated neuro-spinal endoscopy systems and technologies like the Foramenoscopy, that helps us perform state-of-the-art spinal surgeries with world-class precision and excellent outcomes,” he further added.

INSURANCE COVER FOR MENTAL ILLNESS IN INDIA, NOW REALITY The Insurance Regulatory Development Authority of India (IRDA) has issued a circular to all insurers to include mental health in their insurance scheme. Drawing reference to the Mental Healthcare Act, 2017 which has come into effect from May 2018, IRDA has asked the insurers to follow the same. As per Sec 21(4) of the said Act, every insurer shall make provision for medical insurance for treatment of mental illness on the same basis as is available for treatment of physical illness.

The IRDA has directed all insurance companies to comply with the aforesaid provisions of the Mental Healthcare Act, 2017 with immediate effect.

The insurance sector has welcomed the directive. JyotiPunja, Chief Operating Officer and Customer Officer, Cigna TTK Health Insurance Company said, “Insurance of mental health is a progressive step in right direction.

This will ensure a life of dignity to those who have mental health issues. We believe it will certainly create awareness, acceptance, and inclusion when it comes to mental illness as any other ailment, while bringing mental health disorders at par with physical illnesses

will ‘normalize’ diagnoses, reducing associated myths and stigma. At Cigna TTK, we focus on the health and wellness of our customers we serve and we welcome this step to drive a robust health and well-being ecosystem.”

“Including mental health in health insurance coverage is an important and progressive step,” said Soumya Swaminathan, Deputy Director-General Programmes, WHO.

KIRAN MEDICAL SYSTEMS LAUNCHES NEW PRODUCT PORTFOLIO Kiran Medical Systems, the Radiology Division of Trivitron Healthcare launched complete portfolio of Advanced Digital X-Ray systems, DSA C-Arm, Modular Smart OT Solutions and Satin Touch Radiation Protection Products at Traumacon 2018, Mumbai. The Radiation Protection portfolio of Kiran now features the antimicrobial Satin Touch fabric with the choice of 3 core materials – Leadlite, Ultralite and Zerolead.

Speaking on the occasion Satyaki Banerjee, CEO of Kiran commented, “Kiran is committed to providing comprehensive solutions using state of the art technology in the field of

diagnostic and surgical imaging. The X-ray portfolio of Kiran includes analogue and digital mobile as well as fixed X-ray with generator power ranging from 3.5 – 82 KW. The surgical C-Arm product line includes HD, 1K 1K and DSA variants. The radiology division of Trivitron has always focused extensively on research and development to develop robust, smart and practical imaging products that can offer incredible clinical functionality at an affordable cost.”

Kiran Medical Systems is a leading radiology focused medical equipment manufacturer with a comprehensive range of innovation driven radiology equipment including Digital Radiography Systems, C-Arms, X-ray Equipment, Imaging Accessories and Radiation Protection Products.

Kiran’s manufacturing facility is registered with US-FDA. The products conform to norms of CE as per European Council’s Medical Device Directive (MDD) 93/42/EC and Personal Protective Equipment (PPE) Regulation EU 2016/425. Kiran Radiation Protection Products conforms to European Standards EN 61331-1 2014, EN 61331-3 2014, ASTM 2547. Kiran products are exported to 165 countries across the globe.

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NEWS ROUNDUP MICROSOFT, APOLLO HOSPITALS INTRODUCE AI POWERED CARDIOVASCULAR DISEASE RISK SCORE As part of Microsoft’s AI Network for Healthcare initiative, MicrosoftIndia and Apollo Hospitals announced the launch of the first ever AI-powered Cardiovascular Disease Risk Score API (application program interface), designed specifically to predict the risk of Cardiovascular Disease (CVD) in the Indian population. Doctors across the Apollo network of hospitals can now leverage this AI-powered API to predict risk of CVD and drive preventive cardiac care across the country.

“This partnership is part of our continuing endeavour to design new tools and equip our doctors in the fight against non-communicable diseases. The amalgamation of artificial intelligence and machine learning with the global expertise of our doctors will help prevent heart disease, save lives and ensure those with heart disease can make informed choices on their health. We are confident that the combined power of Apollo and Microsoft can make a meaningful impact to stem the rise of heart disease in India,” Sangita Reddy, Joint Managing Director, Apollo Hospitals said.

Built on Microsoft Azure, this API aims to determine a more accurate CVD risk score for the Indian population. It has been developed using a combination of applied AI and clinical expertise on a large sample of retrospective data on health checks and coronary events. The scoring considers risk contributors including lifestyle attributes such as diet, tobacco & smoking preferences and physical activity as well as psychological stress & anxiety as reflected via rate of respiration, hypertension and systolic & diastolic blood pressure. The score categorizes risk into high, moderate and minimal and also provides insights on the top modifiable risk contributors, thereby assisting physicians to consult patients in a more holistic way, while providing insights to patients for lifestyle modification and timely interventions.

Microsoft AI Network for Healthcare aims

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to maximize the ability of artificial intelligence and cloud computing to accelerate innovation in the healthcare industry and improve the lives of people around the world. Introduction of this intelligent system in partnership with Apollo Hospitals is a huge step in this journey.

PULSUS TO EXPAND IN INDIA Canadian health informatics player Pulsus plans to add 2,000 jobs through expansion of health informatics regional language translation activities in its India facilities. The new jobs will be created by setting up a new facility in Chhattisgarh to provide access to healthcare and scientific knowledge in native Indian languages.

PULSUS healthcare and scientific information centers at the Chennai SEZ and in Gurugram are already operational and employs 1000 people. The objective is to grow the firm into a 3,500-employee outfit in India from the present 1500 working out of the Technology Hub in Hyderabad and other 2 centers.

With the support and speedy approvals from state Government and Software technology parks of India Pulsus expects to commercialize the facility and help create 2000+ jobs in Chhattisgarh in the next 12 months at Dantewada, Rajnandgaon, and Raipur. This move is part of PULSUS strategy to tap the growing importance for scientific content translation in regional languages in Hindi, Telugu, Malalayalm, Tamil, Gujarati and Bengali.

It has already got the incentive approval to scale operations in Vishakhapatnam, Andhra Pradesh; Sangareddy, Telangana for about

4,000 seats. The healthcare informatics player is keen to establish basic healthcare and agriculture information translation facilities in different regions of India. The meeting with Chhattisgarh CM is part of PULSUS expansion strategy and its commitment to create new facilities to translate basic Healthcare and agriculture information in Regional Indian languages in different regional states.

INDIA’S FIRST NORMOTHERMIC LIVER PERFUSION TRANSPLANT PERFORMED AT ASTER CMI HOSPITAL 53-year-old Mr. Ashwath ST became the first person in Asia to receive a liver transplant using specialised technology to preserve and revitalise the donated organ. MrAshwath had been suffering from end stage liver disease and had been waiting for a transplant for several months. His wife said- Our entire family had been evaluated but there were no suitable matching donors. Our only hope was getting an organ from a deceased donor. However, he was very sick and had multiple admissions for infection and bleeding. The family had almost lost hope when they got a call that there may be a suitable donor. However, an assessment of the liver revealed that it may contain 50% fat.

Luckily for MrAshwath, a new way of preserving livers was available in India in the form on the OrganOx Metra (normothermic machine perfusion). In doing so, he became the first recipient of a preserved liver using this

new technology in Asia.

The transplant was carried out at Aster CMI Hospital, Bengaluru. The procedure took almost 18 hours. First the organ was retrieved from the donor. This was then prepared and placed on the machine. The machine monitored several parameters related to the liver on a real time basis which allowed the transplant surgeons to assess the liver function before transplant. The procedure was witnessed by several of the country’s leading transplant surgeons. MrAshwaths’ operation started after the organ had been assessed and function confirmed. The transplanted liver worked almost immediately after the procedure.

MrAshwath had a smooth recovery and was discharged home in less than two weeks.

Dr SonalAsthana, Senior Hepatobiliary and Transplant Surgeon said – this technology will change the way we preserve organs and allow us to revive the organs before transplantation to ensure better function. Also organs which are donated in far off parts of the country can

now be transported to transplant centers and utilised safely.

IBSC SIGNS MOU WITH AAMI Indian biomedical skill consortium (IBSC) a Consortium for Skill Certification of Biomedical engineers & technicians in India signed MOU with Association of Advancement of Medical Instrumentation (AAMI) for international mutual recognition and collaboration.

The MoU was signed by Dr. Jitendar Sharma, MD & CEO, AP MedTech Zone (AMTZ), and Dr. Brad Schoener, vice-president (Innovation), AAMI, in the presence of Dr. RenuSwaroop, Secretary, Department of Biotechnology, SunitaSanghi, Director General, National Skill Development Agency, Shyam Sunder Bang, Chairman, NABCB (Quality Council of India) and others. IBSC is an initiative of AMTZ coming up near Visakhapatnam in collaboration with the NABCB - Quality Council of India and

Association of Indian Medical Devices Industry (AiMeD).

AAMI has certified over 7,000 biomedical engineering professionals in over 100 countries. At the event IBSC successfully commenced its operations with nation-wide launch of online Assessment Centres.

By the efforts of pan India 40 consort partners, stakeholders and Government the Indian Biomedical Skill Certification is now the grand road to go for Skill & competency Certification for engineers & technicians working in manufacturing units, hospitals, laboratories and so on, who may or may not be from biomedical engineering academic background but are practitioners of biomedical skills.

The above feat was achieved within 5 months from joint agreement between AMTZ AiMeD - QCI with initially 15 modules mapping experience, knowledge and competency.

AMTZ, QCI &AiMeDare founding partners of the consortium.

IBSC signs MOU with AAMI

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NEWS ROUNDUP

Facebook, NYU Collaborate to Make 10-Times Faster MRI IMT Team

NYU School of Medicine’s Department of Radiology chair Michael Recht, M.D., Daniel Sodickson, M.D., Ph.D. vice chair for research and director of the Center for Advanced Imaging Innovation and Research and Yvonne Lui, M.D., director of artificial intelligence,examine MRI scans of a knee at NYU Langone Health in August 2018.

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FACEBOOK AND NYU School of Medicine’s Department of Radiology recently announcedfastMRI, a new collaborative research project that will investigate the use of artificial intelligence (AI) to make magnetic resonance imaging (MRI) scans up to 10 times faster. If this effort is successful, it will make MRI technology available to more people, expanding access to this key diagnostic tool.

MRI scanners provide doctors and patients with images that typically show a greater level of detail related to soft tissues — such as organs and blood vessels — than is captured by other forms of medical imaging. But they are relatively slow, taking anywhere from 15 minutes to over an hour, compared with less than a second or up to a minute, respectively, for X-ray and CT scans. These long scan

times can make MRI machines challenging for young children, as well as for people who are claustrophobic or for whom lying down is painful. Additionally, there are MRI shortages in many rural areas and in other countries with limited access, resulting in long scheduling backlogs. By boosting the speed of MRI scanners, we can make these devices accessible to a greater number of patients.

Sufficiently accelerated MRI devices could also reduce the amount of time patients must hold their breath during imaging of the heart, liver, or other organs in the abdomen and torso. Increased speed could let MRI machines fill the role of X-ray and CT machines for some applications, allowing patients to avoid the ionizing radiation associated with those scans.

Challenges in advanced medical imaging This project will initially focus on changing how MRI machines operate. Currently, scanners work by gathering raw numerical data in a series of sequential views and turning the data into cross-sectional images of internal body structures that doctors then use to evaluate a patient’s health. The larger the data set to be gathered, the longer the scan will take.

Using AI, it may be possible to capture less data and therefore scan faster, while preserving or

— as in the case of obscured or dimly lit objects — that we need to turn into actionable information. Early work performed at NYU School of Medicine shows that artificial neural networks can accomplish a similar task, generating high-quality images from far less data than was previously thought to be necessary.

In practice, reconstructing images from partial information poses an exceedingly hard problem. Neural networks must be able to effectively bridge the gaps in scanning data without sacrificing accuracy. A few missing or incorrectly modeled pixels could mean the difference between an all-clear scan and one in which radiologists find a torn ligament or a possible tumor. Conversely, capturing previously inaccessible information in an image can quite literally save lives.

The Facebook and NYU collaboration NYU School of Medicine, a department of NYU Langone Health, has a long-standing history of pushing the boundaries of medical research and education to benefit the lives of patients. The Radiology Department’s Center for Advanced Imaging Innovation and Research (CAI²R) includes a multidisciplinary team of engineers, physicists, mathematicians, radiologists,

and other clinicians and scientists with key expertise in rapid image acquisition, parallel imaging, and advanced image reconstruction.

Their focus is on developing novel imaging technologies and rapidly translating those technologies into clinical practice.

Since 2016, CAI²R investigators have been pursuing the idea of utilizing AI to achieve faster MRI scans. Early studies have suggested that scan times could be reduced by an order of magnitude or more. Realizing those potential gains, however, would require additional AI knowledge and large-scale computing resources.

Around the same time, the Facebook Artificial Intelligence Research (FAIR) group,

vision — and its ability to train models at large scale with the medical school’s leading imaging science expertise.

Project data details The imaging data set used in the project, collected exclusively by NYU School of Medicine, consists of 10,000 clinical cases and comprises approximately 3 million magnetic resonance images of the knee, brain, and liver.

All data,

team at NYU Langone.

The magnetic resonance images (which generally represent small targeted regions of anatomy) used for this project have been scrubbed of any potential distinguishing features. Comparisons of the performance between AI-based reconstructions and tradition-

al reconstructions will, likewise, be devoid of any identifying information. No Facebook data of any kind will be used in the project.

Advancing the AI and medical communities Unlike other AI-related projects, which use medical images as a starting point and then attempt to derive anatomical or diagnostic information

is not simply enhanced data mining with AI, but rather the generation of fundamentally new capabilities for medical visualization to benefit human health.

In the interest of advancing the state of the art in medical imaging as quickly as possible, we plan to open-source this work to allow the wider research community to build on our developments. As the project progresses, Facebook will share the AI models, baselines, and evaluation metrics associated with this research, and NYU School of Medicine will opensource the image data set. This will help ensure the work’s reproducibility and accelerate adoption of resulting methods in clinical practice.

What’s next Though this project will initially focus on MRI

that will make a far-reaching and lasting positive impact in the world.

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COVER STORY

Leading with Learning:

Innovations In Medical Education

Innovation in medical education is central to solving a number of healthcare problems.

There is an urgent need to revolutionize medical education and India must take cue and learn from the best.

M Neelam Kachhap

I

ndia has a skewed doctor: Patient ratio.

WHO guideline says we must have 1:1000 doctor to patient ratio. While some states have 4:1000 doctor to patient ratio some have 1:8000. This devide is seen more when comparing rural vs urban locations in the same state. By all estimates India needs more doctors.

But the question is how we are going to bridge the gap with limited no of medical colleges.Besides medical training is a costly preposition. Because establishing and running medical colleges is an expansive affair the cost of medical training in India is also high.

Besides it takes too long to train students to become doctors and the need for primary care for

we reduce the cost of healthcare delivery in India? Can innovations in medical education solve all these problems?

Let us look at some of these problems and their solutions more closely.

Doctors in Debt As pointed out earlier medical education is very expensive. This is true for most parts of the world. In the US, annual fee for a medical course ranges between USD 18000 - 55000 (INR13 – 39 lakhs with exchange rate of 72).

financial barriers discourage many promising high school and college students from considering a career in medicine altogether due to fears about the costs associated with medical school.

Tuition-free Education Recently, The New York University School of Medicine announced that it would offerfulltuition scholarships to all current and future students in

accessible to a broader range of applicants, we will be a catalyst for

and financial aid. “More importantly, it addresses both physician shortages and diversity.”

Grants, much like merit and financial aid, Dr. Rivera explains, are made only after students have chosen their career path.

“That’s too late if we wish to expand the

We have made medical education an elitist affair.

We need to liberate medical, nursing and para-medical education to make healthcare affordable and accessible in India Dr Devi Shetty, NH Bangalore

need based and do not address the burden of debt the colleges place on young doctors.

Saddled with staggering student loans, many medical school graduates choose higherpaying specialties, drawing talent away from less lucrative fields like primary care, pediatrics, and obstetrics and gynecology. Moreover, the

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COVER STORY pipeline to bring forth the broadest, most talented group of students, and to give them the financial freedom to choose medicine over other careers.”

Back home in India, healthcare leaders like Dr Devi Shetty are already rooting for tution-free education. “We have made medical education an elitist affair. We need to liberate medical, nursing and para-medical education to make healthcare affordable and accessible in India,” he says.

Dr Shetty

New technologies are merely a means to an end. The goal is to improve the ways we teach and learn Marc M. Triola, MD, Founding Director, IIME; Associate Dean, Educational Informatics and Associate Professor, Department of Medicine, NYU Langone Health

college in India is about INR 400 Cr he says.

Rationalisation of infrastructure required for medical colleges, leveraging health facilities in the private and public sector that can be used as teaching facilities and other such interventions could significantly reduce costs.

The government of India is yet to come out with the draft of the National Policy on Education, which could address some of these issues; most probably it may see the light of day by end of 2018.

However, the government has identified 58 Districts in 20 States to establish new Medical Colleges attached with existing District/ referral hospitals to address the lack of doctors.

Opportunity to study medicine Anywhere in the world, as in India the admissions to medical schools is highly competitive, and only those with high scores get a chance to apply to medical schools. But is this the best way to find talented youth who would become good doctors? And this is one of the reasons for rising contempt among medical graduates.

A child is groomed from an early age, almost conditioned for tuff competition.

There is a stiff competition among children aspiring to become doctors from school, premedical

democratized to allow youngsters from different backgrounds and social standing to learn medicine? Some medical schools are already doing this.

The James Cook University, Australia, follows a decentralised medical training model.

This forms an important part of the rural workforce pipeline in northern Australia. This six-year undergraduate program has oriented its selection processes to attract applicants from rural, remote and Indigenous Australian backgrounds via targeted recruitment of local high-school students. All students undertake a minimum of 20 weeks of rural community placements throughout the course. It is because of this program that there has been a steady increase in the number of students enrolled and medical graduates in this part of Australia.

EscuelaLatinoamericana de Medicina (ELAM) or the Latin American School of Medicine is a Cuban Medical School and the largest medical school in the world by enrollment with

and is fully accredited by the Medical Board of California, which has the strictest US standards.

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But the real reason for the school’s popularity is their

facilities for free like tuition, accommodation, food, books and other expenses. The school also provides a small stipend to the students.

“Outstanding doctors from across the world with magic in their fingers come from deprived backgrounds. These are the kids who have the fire in their belly to even work for 24-hrs a day. When I was studying medicine most of my classmates, were from poor families. Today children from poor families are not dreaming of becoming doctors. This will have tremendous consequences for our health systems,” says Dr Shetty.

Use of Technology Technology can solve problems and more so in healthcare. But can technology change education for the better? It could certainly, going by the number of start-ups that are investing in education technology one would definitely think so.

apps around the world and it is already being used to exchange notes.

Medical colleges have to decide if and how to respond to such opportunities offered by new technologies. Medical colleges have to think of ways to enrich medical teaching and ensure that students are more active participants in the educational process.

“Universities today need to be deeply invested in the latest educational technologies, which can help make medical school a little less daunting. Students have access to such technologies inside and outside the classroom, ranging from learning management systems to detailed lecture captures. These tools empower our students to succeed by providing them with individualized and comprehensive instruction,” says Dr SateshBidaisee, Assistant Dean for School of Graduate Studies, St. George’s

University School of Medicine, Grenada, West Indies.

Recently, The Indian Institute of TechnologyDelhi (IIT-D) and

their education content—when, where, and how they access it, and how they organize it,” he adds.

The institute aims to enhance student’s experience and foster excellence in medical education

mandate extends to development of a drug delivery system, Artificial Intelligence, machine learning, robotics, advanced materials etc,. Hopefully, the success of such collaborations will change patient

teachers’ skills, students’ performance, and patients’ health by using big data—large, complex data sets—to encourage insight, research, and innovation in medical education. One other goal of the institute is to develop faculty who are prepared to teach in the modern learning environment.

Using educational big data, IIME drives new models to support individualized learning across NYU School of Medicine’s accelerated three-year pathway, a four- or five-year dual MD/master’s degree pathway, and a four-year MD pathway. Curricular innovation informed by educational and clinical data aligns teaching with the evolving demands of medical practice.

We’re getting a fine-grained perspective on what our learners are encountering, and we’re adjusting our training accordingly,” says Dr. Triola. “And for the

Innovation in Medical Education This is the right time to look at innovation in medical education and the best place to start looking would be The Institute for Innovations in Medical Education (IIME) at the NYU School of Medicine established in 2013, for developing, validating, and supporting teaching and learning innovations.

“New technologies are merely a means to an end. The goal is to improve the ways we teach and learn,” says Marc M. Triola, MD, Founding Director, IIME; Associate Dean, Educational Informatics and Associate Professor, Department of Medicine, NYU Langone Health. “Paradoxically, I think computer- and

control over

learning” data with public data sources to track NYU School of Medicine graduates beyond the institution.

“The untapped potential of big data to inform and improve medical education is enormous,” says Dr. Triola.

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COVER STORY

Leader’s Speak

Dr Ranjan Pai, CEO & MD of the Manipal Education and Medical Group

You have seen Medical Education metamorphose through the years.

What is your view of the current situation in medical education segment in India?

Medical education in India needs urgent transformation. While India has produced high quality doctors, I think the time has come to look into and completely overhaul the medical education system. I feel we should look at improving the pedagogy and focus more on outcome based learning.

What are the challenges with traditional medical education?

I think the main challenge in medical education continues to be lack of innovation and reinvention. While there have been improvements over the years, it has not been radical. We need radical changes in medical education for any noticeable improvement to take place.

My concern is the spiraling cost of medical education. We need to look at all the current rules and regulations and figure out what can be cut out or reduced from an infrastructure point of view and also from a faculty point of view. We should look at using technology more effectively to overcome some of these issues.

What innovations will change medical education for better in next few years?

I think we should seriously explore allowing PPP (both Public- Private and Private- Private) in medical education in a big way. There are a lot of Govt.hospitals, ESI hospitals and Trust hospitals (both private and public) that are unused. If there is a clear policy from the MCI, these hospitals can be used to reduce the cost of

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medical education and also provide free seats to the Govt. We also need to reduce unnecessary infrastructure that is currently mandated.

On the PGeducation side, we need to increase capacity by allowing private hospitals to be allowed to train students as long as they have the necessary faculty, equipment and facility.

Also technology should be used liberally and see if some of the classroom lectures can be reduced and clinical time increased.

Which medical education providers are poised to lead this change?

If some of these changes are brought about, I’m sure you will see a lot of people investing into medical education. The Manipal Education and Medical Group would surely participate if these changes were instituted.

NATIONAL ORGAN RETRIEVAL WORKSHOP Innovative course providing high quality training on operative aspects of deceased donor management and organ recovery is winning accolades and hearts alike

Dr Sonal Asthana, Consultant, HPB and transplant Surgeon, Aster CMI Hospital, Bengaluru

RECENTLY, SASSOON General Hospital, Pune announced first liver transplant on August 22, with great pride as it was the first time that a government hospital in Maharashtra had successfully conducted liver transplant. A similar feat was accomplished and celebrated

by Government Rajaji Hospital, Madurai in March 2017. What is common to these two success stories is a workshop that is changing the landscape of deceased organ transplant in India.

The National Organ Retrieval Workshop conducted by an eminent group of visionary leaders in

that they can save lives of people who might die of organ failure while on the transplant wait list.

Organ Retrieval, perfusion and preservation of retrieved organs is very important to the success of transplant procedure. Organ retrieval procedure is highly challenging, both technically and emotionally. The surgeon has to be clinically skilled to handle the challenges of physiological anatomical variations and preexisting conditions of the donor and preserving the relevant anatomy and ensuring a safe and successful transplantation.

The Beginning Organ transplantation from deceased donors is in its infancy in India. There has been a rapid

increase in organ donation in most parts of the country due to increased awareness, thanks to the

properly or for want of experienced organ retrieval staff. Safe retrieval of high quality organs is integral to the success of organ transplant.

There is a growing need to educate the medical personnel about organ retrieval techniques. Safe

of deceased donor organ recovery, but this training is not part of any surgical curriculum in India today. Incidentally, the surgical discipline of transplantation surgery has yet to develop to its full potential in India.

Increase in organ donation needs to be matched with a corresponding increase in capacity among

, HPB and transplant Surgeon,Aster CMI Hospital, Bengaluru; Dr Anand Subrahmanyam, Senior Consultant Cardiac Surgeon, Apollo Hospitals, Bengaluru; Dr VimalBhandari , Director, National Organ and Tissue Transplant Organization

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IMPACT

Hands on training at NORW 2018

(NOTTO);Dr Sunil Shroff, Managing Trustee, MOHAN Foundation and Dr Vimal Bhandari, Sr. Consultant - Renal Transplantation Artemis Hospitals, Gurgaon.

Development Since there were no structured course available in India the group started to look out for other courses which were available.

The group realized that India does not lack skilled

. The next task was to adopt this workshop curriculum and mold it for the Indian scenario. In this endeavor British surgeon Prof. Rutger J. Ploeg,

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Transplant Biology, Oxford Universityand Dr Isabel Quiroga,Clinical Lead for Organ Retrieval Oxford University, Hospitals NHS Trust, UKwere of great help to the Indian group.

The first workshop with modified structured course was

ISOT), Mohan Foundation, and surgeons from Oxford University. The present workshop has been carefully designed in collaboration with international leaders in organ transplantation to train aspiring transplant surgeons in the tips and techniques for a safe organ recovery. The workshop focuses on clinical and logistical aspect of organ retrieval as well as legal and ethical aspect along with scientific requirements for organ recovery and transplantation in India.

Organ Retrieval, perfusion and preservation of retrieved organs is very important to the success of transplant procedure. Organ retrieval procedure is highly challenging, both technically and emotionally

Course Highlight This course is well received because of its faculties that are some of the world and India’s

step-by-step discussion of the practical tips and techniques on the art and science of safe organ recovery.

One unique feature of the workshop is the live webcast. The live webcast of the retrieval procedure on an anatomical specimen and live demonstration of retrieval technique by international faculty on a cadaver model, have been great learning experience for many participants who are not able to attend.

Initially, the webcast was accessed by 173 participants across the world and today that number has swelled to 5000. Also the webcast has been a means to not only increase interest but awareness too about organ donation and transplant process.

Course Impact Around 2014, only a few cities in South India had the capability and capacity to do organ transplants. Today after this workshop organ transplant programs have started at a number of locations around India. This is an annual training program and till date four such

workshops have been conducted where 115 surgeons have been trained. After a workshop has been conducted the group keeps in touch with the participants to access the impact of the workshop. Many surgeons go back to their workplace and start transplant programs. In fact, four new

Education. Organs recovered from deceased donors are public resources, and it is imperative that any organ sharing and allocation scheme is fair and equitable. The national organ retrieval workshop imparts high quality training to surgeons to develop this very important discipline in India.

The success of the course is emphasized whenever transplants are successfully conducted in smaller cities and government hospitals because this means that the National organ Retrieval Program has been successful to make organ transplant assessable and available to the people of India.

Faculty and students at NORW 2018

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DRIVE

Footprints on the Sands of Time In memoriam Prof TK Shanmugasundaram, Professor of Orthopaedic surgery, Madras Medical College, Chennai

Prof S Rajasekaran, Ganga Hospital, Coimbatore

THE MEDIOCRE teacher tells. The good teacher explains. The superior teacher demonstrates. The great teacher inspires.– William A. Ward A teacher’s true appreciation comes with age.Only few of us understand a teacher’s true value and influence while we are still students.

It is only when we mature that we truly admire them and begin to value their mentoring and the positive difference they made in our lives.

There comes a point where we understand the great inputs that they made that has shaped your present professional and personal life.

Teacher Par Excellence I would like to recall with profound gratefulness the influ- ence of one great teacher, Prof TK Shanmugasundaram, Professor of Orthopaedic surgery, Madras Medical College, Chennai, who shaped the lives of hundreds of students who passed through him. His orthopaedic knowledge and skills were internationally acclaimed and legendary. But his influence on his students was beyond academics and orthopaedics. Apart from being a renowned surgeon, Prof.

TKS was mostrespected for being an excellent teacher and a beacon ofethical practice. In his long tenure as an orthopedic teacherfor over 30 years, he taught over 4000 undergraduatemedical students and 150 postgraduate students.

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Apartfrom learning orthopedics, his students could learn muchmore in the way of invisible curriculum from him. He wasan outstanding role model for punctuality, discipline, andpatient care. During his ward rounds, he would scarcelyhesitate to publicly admonish anyone, regardless of theirseniority, if any carelessness or callousness was found inpatient care.

His compassion towards poor patients wasalways exemplified by the long time he spent on roundsin the general wards whereas he would quickly pass thespecial wards which housed the rich and the influential,even some ministers in power.

Value and Ethics Prof. TKS was an embodiment of ethical values to the extentthat he was a second conscience to all of his students.He was a standing example of how success could beachieved without mixing academic and private practice.Prof. TKS was always against practices of over-prescription, over-investigation, professional kickbacks, and dichotomyof fees which earned him great esteem in the minds andhearts of generations of students. He was true to the sayingsof Mahatma Gandhi, ‘Parents are your best teachers; andteachers are your second parents,’and himself was a sourceof great learning and discipline for all his students.His love for ‘academic truth’ was also legendary and he wasnever one to shy away from presenting his complications.

One could easily see him shrink with horror and despairwhen he noticed senior members presenting distorted factsand statistics and

would not hesitate to publicly admonishthem.

Among his peers, he stood tall as an embodimentof ethics and honesty.

Academics and Research Prof. TKS was a torch bearer of academics and research.His clinical research on bone and joint tuberculosis, spinalinjury care, bone tumors, and post-injection fibrosis ofskeletal muscles were presented in over 80 national andinternational conferences and published in nearly 80 papersin national and international journals.

However, he alwaysplaced patient care first and stood as an example to his owndictum that in a clinician’s life, the three important thingsare patient care, teachingand research, strictly in thatorder. He would excuse a postgraduate for a little delay inacademic commitments, but never in matters relating topatient care.

My Academic Father To me personally, he was my academic father and paved the way for an academic and ethical practice with a good mixture of research. He instilled early the principle of ‘Publish or Perish” and also the value of good documentation and research. Even as a postgraduate, he guided me step by step to get my first research paper published in the Journal of Bone and Joint surgery (AM) which is no small feat then or even now. He also introduced and guided me into the world of professional bodies, which led to the numerous leadership positions that I was able to hold in my career. There has hardly been a stage or positive step in my career that I don’t remember with gratefulness the guidance that I have received from him.

His life was one of strict discipline, hard work, honesty,plain living, and high thinking, and was one that couldbe emulated by the younger generation. His students areprivileged to have been trained by such an extraordinaryacademician, teacher, and a noble hearted individual asProf. TKS. He did leave a permanent mark in this world through the numerous students that he uplifted by his qualities.

‘Lives of great men all remind us; We can make our lives sublime; And departing, leave behind us; Footprints on the sands of time’ H. W. Longfellow.

He shaped the lives of hundreds of students who passed through him. His orthopaedic knowledge and skills were internationally acclaimed and legendary. But his influence on his students was beyond academics and orthopaedics Prof TK Shanmugasundaram, Professor of Orthopaedic surgery, Madras Medical College

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OPINION

Walk the Talk Trade margin rationalization: Govt. to walk the fine line between making healthcare affordable and promoting make in India or make outside India

Rajiv Nath, Forum Coordinator of Association of Indian Medical Device Industry (AIMED)

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DOMESTIC MEDICAL device industry hails Govt’s move to rationalize and cap trade margins in medical devices to achieve the overall goal of affordable healthcare for all by making all critical and life saving medical devices available at affordable prices. However, we suggest that the government must tread the fine line between affordability and boosting domestic manufacturing or suffocating domestic medical device industry and allowing importers to create artificial inflation; carefully.

Irrational Trade Margin If the Government plans to bring down prices of commonly used medical devices by capping the trade margin at 30per cent on the first point of sale as reported in media then it is unrealistically low and won’t allow delivery to last mile.

It is pertinent that the government brings down trade margins from irrational to rational level in order to reduce overall healthcare cost. However, to lower it to irrationally low level may be disadvantageous to the patients and consumers.

Medical devices usually go through 4-7 change of hands along the supply chain from a distributor to a wholesaler to a retailer and a hospital before they reach a consumer in a distant village and each point in supply chain incurs various costs such as freight, inventory carrying, rental, salaries, marketing

and sales overheads and service and statutory expenses of compliance and then there is also a need of net profit by a reseller.

Why Confuse The main aim of rationalisation of trade margins in medical devices should be to help consumers, allow rationalised profits for traders and retailers create level playing field for domestic industry vis-Ă -vis foreign manufacturers. There should be clear objectives for any policy intervention so as to avoid distress (to consumers), distrust (in industry) and disruption (to market).

To begin with, there seems confusionbetween Trade Margin which is based on sale price of product and Mark-up which is based on purchase price of products. These terms should be clearly defined to avoid any confusion among stakeholders. It is advisable to ensure consistency in use of terms and nomenclature or instead of realising its Make in Indiavision, the government will end up encouraging Make outside India.

How It Works The trade margin is the difference between the price at which the manufacturers (indigenous / overseas) sell to trade and the price to patients (maximum retail price). The issue of unreasonably high trade margins in medical devices has been adversely affecting both the industry as well as consumer interest and creating distrust

for the medical profession. AIMED has been asking for trade margin rationalization and capping for last 2-3 years.

We are glad that finally the government is moving in this direction. For trade margin rationalization, first point of sale by overseas and Indian manufacturers should be defined as the price by manufacturer, whether overseas or Indian, on which GST is initially paid. In contrast, importers who are also traders cunningly want first point of sale to be from their end to the distributors and not from overseas manufacturers to them to avoid coming into the trade margin regulation ambit.

Include Imports So if we talk about rationalization of trade margins it has to include Imports, you can’t have importers having over 200per centirrational margin as was indicated in NPPA report on

Catheters & Guidewires and the rest of supply chain having only 35-50per cent Trade Margin.

Government to define the following: First Point of sale for Mfr is Price on which GST is charged first time.  On Overseas Mfr GST is charged on Import CIF landed price in BIE (Bill of Entry)  On Indigenous Mfr GST is charged on Ex Factory Price post discounts  Indigenous Mfrs need to be equated with overseas Mfrs and not with Importers.

This will help in creating a level playing field between goods entering India via imports or domestic production thus encouraging domestic manufacturing. Also, there is transparent verifiable database linked to GST charged on invoice or bill of entryavailable with the government and verifiable to implement and monitor this without making it complex. 

The main aim of rationalisation of trade margins in medical devices should be to help consumers, allow rationalised profits for traders and retailers create level playing field for domestic industry vis-à-vis foreign manufacturers

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OPINION Tactical Marketing Everyone in a supply chain has intermediate costs and value addition. It needs to be ascertained what value addition, if any, importers do and what’s a rational margin for them? The reason the importers state intermediate costs like R&D and clinical evaluation are not part of the Import landed price is basically to avoid custom duties. They can’t avoid Customs duty by lowering Transfer prices and then seek to induce hospitals with higher MRP and higher trade margins. This tactical marketing warfare has cost the consumers dearly and harmed ethical marketing. Thus importers should be brought under the purview of trade margins.

The Government should consider to cap trade margins of devices to 85per cent. This will help in reducing MRP of medical devices to less than half of current prices while not being unreasonably detrimental to traders and hospitals. Additionally, manufacturers will be encouraged to attract clients on competitive features and hospitals will start buying on evaluating cost of purchase & quality, instead

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of margins to be made on higher MRP thus resulting in a level playing field between Imports and domestic products.

Level the Playing Field Thegovernment should provide level playing field, if not a strategic advantage to domestic manufacturing while safeguarding consumers or India will remain 70-90per cent import dependent. Indian manufacturers seek preferential market access, tariff protection, price controls and strong deterrents like punishment to errant companies engaged in unethical marketing practices to boost domestic manufacturing. This can be done in a calibrated manner through  One per cent GST Cess on MRP as a tax based disincentive;  Capping trade margins to a rational level; &  Price caps on few priority devices A pro-active policy formulation to regulate medical device differently than drugs should permit free market dynamics to succeed and keep regulations simple,protecting consumers and incentivizing make in India.

OPINION

Challenges in Neuro-nursing Dr NK Venkataramana, Founder & Chief Neurosurgeon, Brains Hospitals

NURSING IS one of the noblestprofessions.

Nurses play a significant role in the treatment procedure for patients and also form an important bridge between the patient, doctors and the family. I always believe that doctors treat the patients but nurses care for the patients and god cures the patients.

Earlier, nurses were assigned with the responsibility of just providing medications, but over the years, with the improvement in technology and the monitoring systems, specializations has started and has gone beyond general nursing.

Neuro-nursing has become an advanced field and is the most challenging and stressful one. Nurses working in neurology field need to deal with unconscious patients, patients with disabilities and patients with different mental states. In addition to this, they

need to be thorough in the neurological assessment of these patients. They need to know the method of monitoring these patients therefore they need to be familiar with all the monitoring systems especially in the neuro-critical care that have evolved over the last two decades.

Meanwhile, apart from assessment and monitoring, yet another important challenge for nurses working for neuro-section is the ability to pick up minute variations, deviations and deteriorations, because time is crucial in the management of brain. Any neurological deterioration has to be identified immediately; escalated and remedial measures have to be implemented. So, timeliness is very crucial, if this valuable time is lost, the implications can be adverse.

Nurses working with neuro patients need to be on their toes all the time. They also have an added responsibility of documentation, real time communication among the treating team, execution of the orders, drug delivery and monitoring.Nurses working in the neuro department have to face plenty of challenges, hence, the need for training - both theoretical as well as hands-on is absolutely essential.

They form a vital part of the treating team so that the seamless continuity of the treatment can be maintained.

At present, training in three critical areasneuro-operative nurising, neuro critical-care nursing,general neuro-nursing and stroke nursing is available at Bangalore.

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INTERVIEW

ANBAI, Leading the Way to Effective Teaching and Education The Association of National Board Accredited Institutions (ANBAI) is an apex organization of leading hospitals and medical institutions that are accredited by the National Board of Examinations (NBE).

NBE and ANBAI have been working closely on issues surrounding medical education in India for past few years. ANBAI President Dr Alexander Thomas speaks to IMT about the organisation’s work in the field of medical education in India.

What are the challenges of Medical education in India with regards to keeping students updated with current changes in the discipline?

India is facing a huge deficit in trained medical, nursing and allied health personnel. This deficit is adversely affecting the fulfillment of healthcare needs of the population.

Globally, as well as in India, there is a concern regarding balancing curative, preventive and wellness strategies in healthcare and shifting the focus of medical education from purely curative focus to holistic healthcare.There is an urgent need to reorient and integrate technology into medical education for ensuring quality. This will address the deficit in numbers and quality.

Do you see innovations in medical education happening in India?

Yes a number of innovations have already been adopted by medical colleges in India. However, technology should be leveraged wherever possible to optimize the available medical faculty and for training through hands-on training

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skill labs, simulations, etc. Online learning resources are also now being adopted.

What is the current scenario of medical teachers and training programs for Medical Teachers in India?

Teachers play a vital role in creating quality professionals. However, shortage of teaching faculty has been highlightedin different reports of MCI, Parliamentary Committee, various court orders and MoHFW notices. We should work towards changing this scenario.

Today, the country has a huge pool of specialist doctorsoutside the MCI and NBE streams which are not being utilized. TheMedical Council of India should look at the possibilities to utilize the pool of practicing doctors. In other developedcountries, there is always a parallel system to bring in theexcellent specialist from public and private sector outsidethe medical college to participate in PG medical education.

Also there is a need for an institutional mechanism for certification and continuous professional development of medical teachers.

What is ANBAI’s role in furthering the cause of PG institutes and teaching programs?

ANBAI was born with the aim to unite the National Board Accredited Institutions to catalyse their energies toward developing better teaching program and to present a credible and united front to solve problems together. The association works closely with the National Board of Education (NBE) to promote quality and transparency in medical education.

The association is also a forum to encourage innovative ideas in Post Graduate Medical teaching and hence enhance the standards of our students to International level.

What has been the outcome of these efforts?

ANBAI has been instrumental in promoting the cause of quality medical education in India, by joining hands with the Union Government on various committees on Medical Education.

Taking a step forward, ANBAI has been able to bring in NBE courses at District Hospitals, adding to the pool of specialists in the country.

Most recently ANBAI was able to facilitate the starting on NBE courses in Karnataka government district hospitals.ANBAI was also responsible for ensuring parity NBE degrees with MD/MS degree. Working with NBE,ANBAI was able to get more number of NBE examiners and NBE centers of examinations for the benefit of students.

What are ANBAI’s recommendations for Innovative ideas in Post Graduate Medical teaching to enhance the standards of students to International level?

ANBAI has made a number of representations to the government through various platforms for betterment PG education and training facilities. New medical colleges and hospitals that have an adequate number of patients and well-trained teaching faculty should be allowed to start post-graduate courses. Extensive use of technology should be made to ensure maximum utilization of available medical faculty and optimum skills training. Quality

of teachers and standards of teaching should be maintained so that teachers stay up to date with current concepts and also upgrade their teaching skills. Facilities and human resources for medical college recognition needs to be reviewed to make medical education affordable.

ANBAI is part of discussion group in NITI AAYOG which is looking into medical education reforms.

Anything else you would like to add.

Medical education can be made more affordable

to the general public by addressing policy issues that require high investment in setting up of new medical education institutions. Medical education needs to be made affordable so as to attract more students. Regulations related to cost intensive infrastructural requirements must be reviewed so that unnecessary costs are reduced while exploring ways by which present infrastructure in the private and public sector can be leveraged for useasteaching hospitals.

Healthcare of a country largely depends on the quality and adequacy of health professionals.

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INTERVIEW

Be Future Ready, Invest in AI Teleradiology Solutions is investing heavily in AI, Dr Arjun Kalyanpur, CEO, Teleradiology Solutions tells us why

Teleradiology Solutions is investing heavily in AI algorithms for imaging. Pls can you tell us more about the same?

Teleradiology Solutions has since its inception been focused on its mission of addressing the issue of radiologist shortages, and the use of technology to alleviate these. We recognize that the global radiologist shortage is so profound that there is a need to use technology to assist radiologists to be more efficient and productive and at the same time remain accurate, in order to meet the clinical needs of the healthcare industry. The use of AI or Deep Learning represents a paradigm shift in this regard.

Through our technology division Teleradtech, we are currently focused on developing our own algorithms/IP in this space, particularly in the screening and emergency environment in which we practice. In addition we have partnered with other companies and institutions with the same ecosystem. Through our research division Image Core Lab we provide organizations that are involved in developing AI algorithms with a service and a workflow that allows them to validate these efficiently and costeffectively. And our Teleradiology workflow Radspa provides a platform for AI companies to connect

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with their end-users, ie the radiologists, and to deploy their algorithms on scale. Given our 17 year experience in teleradiology and image data transfer/management we are able to support the AI ecosystem with best practices and economies of scale.

Do you think AI could replace radiologists some day?

Radiologists are doctors and therefore this is analogous to asking whether AI could replace doctors one day. Perhaps one day in the future the AI technologies could evolve to a point where every single aspect of a radiologists work could be performed. However today, AI is able to provide solutions primarily in the area of lesion detection, which itself is a tremendous benefit in reducing radiologist workload. The additional roles that a radiologist performs in the form of analysis of the imaging findings, correlation with clinical history, and discussion with clinicians still very much require human intervention at this point. Radiologists spend 5.5 years in medical school before they become radiologists and the clinical knowledge gained in that time frame, which is what puts radiologic images into their clinical context, is what makes radiologists difficult to replace by technology, however advanced. The value of AI however lies in its limitless ability to accumulate information and analyse patterns, and therefore while radiology learning is currently finite and is passed on from generation to generation, AI presents us with the possibility of it preserving it for perpetuity.

Precision and technology has been the mainstay in radiology, but they come with a price tag.

How will we pay for AI then?

AI algorithms will ultimately pay for themselves in terms of cost savings by improving radiologist efficiency and productivity. Radiologists are currently a rare and a valuable resource and therefore optimizing their time utilization results in great cost savings to the healthcare enterprise. Additionally radiologic errors are a major cost to the healthcare industry, and by improving radiologist accuracy and preventing errors, AI can certainly help reduce costs.

Will AI deliver on its promise of potential cost-saving and effective healthcare? On what level AI will have to be implemented to get this to happen?

AI is currently in its infancy. In the future, I believe AI can certainly help with cost reduction due to the factors outlined previously. Obviously to demonstrate impact, such changes would need to be implemented at a health system or preferably at a national level. For example, a TB screening program that incorporates AI technology into its detection can save significant radiologist time, and cost and benefit the public health system as a whole.

What challenges do you foresee for clinical implementation of AI in India?

The challenges are many like lack of research depth in the healthcare industry and a rush to create algorithms without detailed validation.

Besides there are too many algorithms but not all are in one place, making it difficult for the doctor to decide which algorithm to use when and where and how.

Other challenges are: ďƒŒ Poor data management and archival ďƒŒ Cost cutting, and short term perspective by consumers ďƒŒ Relative lack of regulation in healthcare How will this segment shape-up in the coming years?

In terms of AI in healthcare we are at the same

stage in the aviation industry when the Wright brothers made their initial flights. There is huge excitement and some hype with a large number of players entering the fray but at the same time there is substance in the value proposition and once the dust settles, I believe that the true results will be revealed. More and better algorithms will be released into the market, much

like apps on a smartphone. In this context, I seeteleradiology workflow such as Radspa as being the Operating system or the connector that enables these apps to reach the consumer.

In this regard, I feel optimistic that teleradiology will be the enabler that ultimately unleashes the incredible potential of AI in diagnostic imaging.

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PULSE

Bodhi Health Using New Age Tech for Skill Upgradation IMT Team

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RECENTLY, A video of a skilled nurse extracting a coin swallowed by a child has been making the rounds on social media. The video may have originated in a different country but what it emphasizes is the skill of the person who very expertly removes the swallowed coin without causing the child much trauma.

The quality of healthcare worker’s skill makes for catchy headlines in India be it good or bad. There is a lot of emphasis on training and skill development today and this is where innovation and technology has been taking the lead. The new age skilling innovators feel that healthcare in India can be significantly improved if they can improve the knowledge skill and awareness among health professionals and community health workers with the aid of technology the interventions.

One such innovator is Gurgaon based Bodhi Health Education. The startup is working to tackle the burden of shortage of skilled health workers through capacity building and by improving the performance of community health workers.

Bodhi Health is also helping healthcare and dental care providers in two key areas. On one

hand it is helping providers recruit better quality nurses, technicians and dental assistants and on the other it is bringing healthcare workers to a certain standard through its cost-effective and industry oriented training programs so that effective, quality and timely healthcare can be made available. Currently, there are more than 35000 healthcare professionals and students getting trained and assessed on Bodhi’s platform today and the number is targeted torise to 60,000 by end of this year.

Bodhi Health Education was founded by Abhinav Girdhar and Shrutika Girdhar in 2012,and till date has received a number of awards and accolades for its technology platform.

We speak to Shrutika Girdhar, Cofounder and CTO, Bodhi Health Education to understand more about the new age training platform.

Why is it important for healthcare providers to invest in continuous skill-upgradation?

It is very important for healthcare workers to be skilled and trained as they deal with patients who are physically and emotionally

burden. The recovery of patients today depends much on knowledge as on skills. On the other hand for a healthcare organization quality of treatment is very important. Hospital acquired infections and medication errors are the two critical factors that affect the average revenue per occupied bed for a hospital. As per a study published in The Lancet in Jan 2011  1 in 10 patients suffer from Hospital acquired infections (HAI)  HAI’s increase the average length of stay of patient by 5-12 days per case The HAI burden for a 150 bedded hospital ranges from INR 25-45 Cr annually. Another recent study at Harvard by Prof JHA in 2016 indicates that 5.2 million medical errors happen in India annually. These errors occur mainly due to wrongdrug prescription &administration (wrong timing, dosage, omission etc.). One of the important causesfor these errors is lack of adequately trained clinical staff. Healthcare providers today face increasing risk of litigations against them where such errors lead to mortality or morbidity among patients which is why it is important to keep them up-to-date.

How can technology based training be effective andimpactful for a practical profession like nursing or dental?

It is a very valid concern and technology can never replace the hands-on, practical training provided on a mannequin or a patient. However there are limitations of even practical training as it becomes highly expensive to organise such trainings and much more difficult to find high-quality trainers who can conduct them.

Technology breaks that cycle by bringing in standardisation and cost efficiencies. At Bodhi we are very bullish about the use of gamification technology to develop real-life simulated learning applications in the areas of critical care, infection control, complications in maternal and child health etc. Infact we are seeing very good results in the adoption of such learning apps among healthcare providers as they are fun, engaging and help in reinforcing positive behaviours among the learners by promoting evidence based management practices and care.

Shrutika Girdhar, co-founder, & Abhinav Girdhar, founder, Bodhi Health Education

How can healthcare providers get the best return on investment on their training initiatives?

Before a healthcare provider invests in any kind of training initiative it is very important for them to conduct a holistic and in-depth assessment of the knowledge and skills of their workforce based on their job roles and responsibilities. Based on this data, the training programs can be tailored as per the needs to get the best return on investment on the training initiatives. Our experience working with large healthcare providers have highlighted some amazing insights. In most of the cases for

example, it is not the clinical skill that needs as much improvement as the lack of proper communication and empathy while handling a sick patient. Bodhi conducts in-depth clinical, psychometric and soft skills assessment before suggesting a training path for any healthcare provider. This helps the healthcare providers in three ways :  Identifying the skill and competencygap among the staff before designing the training programs  Identifying the high-performing candidates from the average and focus on their retention

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PULSE Allocate or rotate staff in wards based on their competencies These can be very crucial in workforce productivity management. 

How is Bodhi using new age technology for continuous skillupgradation of nursing & dental professionals? What are some of the benefits of this new methodology?

Bodhi makes use of technology such as gamification, virtual simulation and videobased learning to develop highly interactive & industry-oriented training programs for upskilling healthcare professionals.

Healthcare providers today face three key challenges– high demand for skilled healthcareprofessionals; varying quality of their skills and high cost of training and upskilling them to a certain level of patient care.

Bodhi addresses these challenges by providing standardised, scalable and costeffective training programs to up-skill the clinical workforce. All the training programsare delivered online on Bodhi’s data-driven and adaptivelearning system and can be accessed on computers or smartphonesanytime and anywhere.

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The learning system uniquely combines machine learning and data analytics which helps the healthcare providers generate actionable insights on the clinical and decision making skills of the staff that need improvement while recommending personalized learning path for every participant.

Could you share an incidence whereyou have helped healthcare providers transform their workforce and talent?

Bodhi has a consultative and data-driven approach towards up-skilling the medical workforce and ensuring maximum return on investment for large healthcare providers.

Bodhi works with the HR leaders, educators and medical officers to identify various competencies and protocols that are important for the organisation to succeed. This helps in drawing a competency map for every job role outlined with the required knowledge and skills. The next step is to conduct an indepth online OSCE (Objective Structured Clinical Examination) based training need assessment of the staff based on the competency map. Equipped with this data, Bodhi recommends learning paths for every individual learner. There is a natural transition

to our online training programs which are customised for every individual learner. The pre and post assessments at every level help in understanding the impact of the training program.The managers have access to detailed reports on every learner’s progress while ensuring their compliance.

Eye-Q India is a chain of 44 super speciality eye hospitals with centres in Delhi-NCR, Haryana, Uttar Pradesh, Uttarakhand and Gujarat. They conduct 15000+ surgeries annually and are scaling by adding 2 centres every month. Eye-care OT technicians play an important role not only in improving the efficiency of an eye surgeon but also in delivering customer satisfaction.

Bodhi worked extensively with Eye-Q India’s team of ophthalmologists and trainers to understand the competencies and best practices that matter to Eye-Q for the OT technicians to succeed. An online training module consisting of demonstrative videos, pre and post assessments were rolled out for more than 75 OT technicians at different hospitals. The system was available on computers as well as smartphones for on-demand access. This helped Eye-Q reduce their training expenses for OT technicians by more than 50 per cent.

Are You Self- Medicating Your Finances 75 per cent of doctors believe in self-medication, when it comes to managing their finances

Meena Shriram, Head, Doctor Practice, My Financial Advisor

MR MEHTA walked into Dr Singh’s clinic with a terrible cough that had troubled him for last whole month. This was accompanied by high fever which would come and go. Suspecting common cough, cold and flu, he had popped Crocin pills and taken cough syrup. When that didn’t work, he tried taking some antibiotics suggested by his pharmacist. Yet there was no relief. So he goggled and decided to take some Ayurvedic treatments to improve his immunity.

Finally when nothing worked and his appetite had reduced along with constant body pain and high fever, he decided to see Dr Singh.

Dr Singh after a thorough checkup and diagnosis told him, “This is Typhoid. Please don’t confuse your GOOGLE search with my Medical Degree! Self-medicating without proper instructions from a doctor can land you in big trouble.You have wasted a couple of weeks, but it isn’t too late.”

How Ironic Is This Doctors world over admonish self-medication by patients in managing their health. But a recent research show that 75 per cent of the doctors believe in self-medication when it comes to managing their own finances.

So, what is Self-Medication in Financial Planning?

Dr Singh, aged 50 yrs,is fairly knowledgeable about financial matters and is well read. Dr. Singh

about Rs 1crorein his savings account and fixed deposits. He has also invested in several insurance policies in

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APPROACH

his daughter’s name for her education. He has

, surfing websites like value research and watching business channels. His hectic schedule does not leave him enough time to take stock of his portfolio on regular basis but he feels that things are going well. Dr Singh didn’t see the need for any ‘Financial Planning’.The Fact is that doctors don’t

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follow the rules that they themselves establish and follow in their practice  Ask right questions,  Diagnose,  Understand the problem and  Then prescribe an appropriate medication But when it comes to finances they prefer to straightaway jump to the last stepJust like Dr. Singh.So self-medication is working for Dr Singh or is it?Let’s look closely.

Is Self-Medication Working In case of Dr Singh, all Investments had been done on instructions or tips received at different points in time from different sources. The situation is no

Mr. Mehta popping pills without understanding what

Please don’t confuse your GOOGLE search with experience, expertise and wisdom of a financial advisor

the problem is. An antibiotic will have no effect on a viral infection! He did not put aside any 



tate is essentially an illiquid asset and goes through its own cycle of ups and downs. An over reliance on any particular asset class can be detrimental.

Dr. Singh has also not planned well for his second innings in Life. He feels that having a basket of products will given him enough income during his retirement but he hasn’t taken into account the demon called ‘Inflation’.

There is no Estate planning or Wills that has been given a thought too. This also is a part of Financial Planning.

Be Prepared Things change continuously in the field of Finance as much as in medical field. You have to



whose income depends upon the nimble use of their fingers.In case of any unforeseen partial / total temporaryor permanent disability, a doctor can lose his income.

He has a huge proportion of his assets in real estate with four properties. Real es-

search with experience, expertise and wisdom of a financial advisor!

There are about 15 Mutual fund houses, 4000 MF schemes, 10 new schemes are released every day, within each scheme there are different options, more than 500 meaningful stocks from 6000 listed companies, more than 500 life insurance policies

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APPROACH

How Medical Universities Can Leverage Cutting-Edge Technology to Train the Doctors of Future HEALTHCARE PROFESSIONALS today face myriad challenges, ranging from complex patient needs to seemingly intractable diseases.

In order to address the bourgeoning issues, that only seems to get more complex with each passing

Satesh Bidaisee, Professor of Public Health and Preventive Medicine and Assistant Dean for School of Graduate Studies, St. George’s University School of Medicine, Grenada, West Indies

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challenges, in itself is a humongous task. One way to ensure this is by training and enabling medical graduates to be adept at leveraging the advancements of technology in the healthcare sector.

Today, the curriculum at medical universities has the potential to leverage the power of educational technology to reach every student in the way that he or she learns best. And every class has the potential to help students access the latest medical technology that’s at the core of the practice of medicine today.

Technology Galore There are myriad ways in which technology can be used to create a platform for aspiring doctors to work on realistic clinical experiences in the classroom. This could be by engaging with everything from robotic patients that present a diverse array of symptoms, to cloudbased applications that aggregate medical data.

A classic case to share here will be the way our

company that produces clinical skills exams systems –helps create virtual patient experiences along with digital medical records.

Universities using this technology during training benefits students and teachers alike.

Students can perform work that mirrors

what they’ll dowhen they enter the workforce.

Instructors, meanwhile,can record, report, and

provide students with thorough and objective feedback.

With the evolution of medical technology, Universities can consider integrating ultrasound and virtual imaging into its anatomy courses.As a result, students gain a more detailedperspective on the different dispositions of anatomical structures. This ultimately increases their ability toassess, intervene, andtreat patients.

In Future Technology will undoubtedly continue to play a critical role in the delivery of healthcare services -- making experience with tech-based clinical learning imperative to the success

of the next generation of doctors. Enhanced imaging, for instance, will revolutionize and improve the accuracy of diagnoses. The use of such technology at the most basic level of clinical practice will become the norm. Indeed, the portable ultrasound may soon replace the stethoscope.

Universities today need to be deeply invested in

.

Now more than ever, the healthcare sectoris driven by technology. The doctors of the future will have to master that technology if they’re to effectively meet the needs of patients. At St. George’s, we’ve made it our priority to equip our students to do just that.

Today, the curriculum at medical universities has the potential to leverage the power of educational technology to reach every student in the way that he or she learns best. www.indiamedtoday.com

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INNOVATE

Embracing AR/VR for Medical Education Can augmented reality tools help students learn better GOOGLE GLASS and Microsoft’s Holo Lens brought augmented reality or virtual reality (AR/ VR) to medicine and ever since it has caught our imagination. Augmented reality is gaining some momentum in medical educationas aid in student education. In fact, it can also impact patient care through its ability toenhance medical training.

Dr Chinmaya P Chigateri Director CEO, Health Minds

Changing Medical Education Augmented Reality & Virtual Reality is a pioneering and most immersive technology for visualizing needs that is present today. It has been used in many industries especially in gaming, movies, including education. However, its use in medical

. The pilots are at present aimed to demonstrate several use cases of this technology, which could result eventually in some large-scale deployments. Some of the use cases are to use AR in place of cadaveric dissections to learn anatomy, to demonstrate certain molecular level structures and processes, to demonstrate and provide an immersive experience to learn surgical techniques and finally in the domain of learning to operate

opinion, the terms AV/VR is very loosely used, and it is many a times misleading.

I have seen solutions where there is a 360-degree

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September 2018

video delivered through a VR gear which has no interactivity and the features that need to be in a pure VR experience.

Market Players HealthMinds, along with a few other companies in India have been pioneering this effort. There is Mediknitand

medical education related projects. However, what differentiates companies such as these is the profound medical domain expertise and knowledge about the medical education practices and markets.

Market Challenges When attempting to disrupt a market such as education, and in particular medical education where a lot of learning takes place with in person observation, clinical rounds and being in a hospital setting, there are numerous challenges.

The first and foremost challenge is to convince the faculties and

have the means or resources to be able to adopt such technologies, since the operating costs of a medical college is extremely high. For continuing medical education (CME) recipients, generally who are practicing doctors outside of an institutional setting, the bigger challenge is for them to invest

in VR/AR gear which is very expensive as well.

Although companies can provide for AR/VR based content online, equipment to view it is still a challenge. From a supply perspective, developing AR/VR based content is a high cost exercise resulting in such learning material being expensive, thereby acting as a barrier for adoption. I think the drivers for adoption of this technology will be wide-spread if only the costs of both the content development and equipment become affordable.

Way Forward Technology companies which manufacture VR/ AR gear and software should make the costs accessible to companies that deal with medical education through partnerships or incubations to popularize these technologies. At the end of the day these medical education tech companies are the ones

companies that make adoptive tech.

From the adoption end, I feel industry, preferably lead by large medical device companies

and to an extent Pharma companies need to start using such technologies in their education initiatives, thereby setting an example for medical institutions. I think these use cases will not only enhance the

out there experiencing a multitude of such alternatives and are yet to progress towards any one technology. But our feedback from students to AR/VR has always been extremely encouraging and we hope that they will gravitate towards demanding it and using it more extensively in the future.

Augmented Reality & Virtual Reality is a pioneering and most immersive technology for visualizing needs that is present today

Looking Forward The industry experts are of the opinion that AR/VR technologies for medical education as a use case needs more maturing and acceptance of this technology with the medical fraternity needs more time. In India, we are still at a stage of early adoption by very few players and wide scale acceptance is still some time away. But we always have clients who are willing try and experiment with AR/VR on their various requirements on a pilot basis.

NYU School of Medicine

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41

EVENT REPORT

Ophthall 2018 Chennai Practice Development for Eye Care OPHTHALL 2018 Practice Development Conference was held on August 18-19, 2018 at Chennai Trade Centre. A one-of-its-kind event in ophthalmology was a grand success. This is the first time a two-day exclusive conference on practice development for eye hospitals was conducted at such a grand scale. The aim of the conference was to educate eye hospital owners about various practice management issues right from funding to approvals to succession and exit.

The event drew more than 600 delegates from across 20 states in India. There were delegates from Sri Lanka, Malaysia, Bangladesh, Afghanistan and Denmark. More than 500 eye hospitals participated in the event along with 35 trade participants.

The event had 45 speakers who spoke on 20 topics of importance and participated.

Opthall2018, had eight round table sessions and five panel discussions with Interesting practice-oriented topics conduced and well

received by the delegates.This was the first conference to have an equal mix of ophthalmic and non-ophthalmic speakers.The music in the dark inaugural music event wherein all delegates was blind folded- was well received by the delegates. Keeping the environment

Panel discussion on interesting practice management issues

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in mind the cotton delegate bags with motivational messages was also well received.

When Delegates were walking with these bagseveryone could read the messages and get motivated a small innovation from our side which was well appreciated.

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