As delighted as I was to read a piece highlighting the problems bedevilling Indian medical education, coming straight from a promising medical student himself, I was equally dismayed to be reminded about the malady Indian medical education continues to suffer from. I’ve been a fervent advocate of certain fundamental reforms in our medical education system, and have penned multiple columns on the topic, both on this portal and elsewhere. I’ve also been joined by a number of respected colleagues in this process who, like me, envision a thoroughly straight up medical education system. However, it’s distressing to see that such petitions fail to catch on with our changemakers — despite the problems being long existing, and concerning some very conspicuous aspects of our medical education system.
Let me not contaminate this piece by introducing fiddly data and information on how top performing nations fare in this respect. Let us also painfully overlook issues like inadequate infrastructure, ghost patients and faculty, inadequate research investment, and outdated teaching techniques. A common pretext that can be offered to defend these ills is the lack of enough money with the country, or, in official terms, a deficient ‘budget’. Instead, let me draw up certain fundamental features of our medical education system which do not entirely comply with logic and reasoning.
The practice of rote learning is despised in educational circles. Memorization done by rote is evanescent and does little to facilitate practical skills. But the proportion this problem assumes in medicine can make any educationist throw up. Countless hours devoted to prepare for descriptive short- and long answer questions (which form the bulk of our theory papers) undermine conceptual understanding and practical, bedside learning — the prime dimensions of medical education. Having concluded my studies just recently, I can testify how an unnecessarily voluminous and rigorous theory curriculum leaves little in a student for any interest in practical or clinical medicine. Our prevalent medical education system, at least considering the majority of medical colleges out there, sees students memorising volumes of low yield, evanescent medical information throughout the year to be produced on exam papers — while absenteeism in practical classes and the appalling lack of discipline and stringency in practical exams is common knowledge. The magnitude of the problem I’ve just summarized should make us question as to whether we’re churning out physicians, or a new breed of ‘theoretical doctors’ (like theoretical physicists!).
I do not want to sound like I’m dismissing the importance of theoretical instruction — but a system which has to compromise on conceptual understanding and practical skills just to teach students how to produce an ideal answer paper should find no place in medical instruction. We can learn a great deal from exam systems similar to USMLE (United States Medical Licensing Examination), which mainly centres around core medical concepts.
One who cares to undertake a rational analysis of our undergraduate medical education would agree that a more well-rounded and less enervating curriculum can be created if we invest in a more concept oriented teaching and examination system. Conceptual understanding adds zest to learning and allows for better retention of information, while squandering less time and energy of superfluous stuff. As such, a concept oriented model of medical education can banish a lot of our current problems: the curriculum can be made much more concise and long term learning can be facilitated; more time and focus can be made available to practical, bedside learning; it becomes easier to crack down on rote learning and cramming; medical skills and competence become less elusive; and finally, medical education becomes a less stressful and more engaging process.
Creating a concept oriented medical education system would require a shift in the focus of our exams, from one testing memorization to one testing problem solving ability. Examinations should mainly include problem solving questions, like those presenting different clinical scenarios and asking for the next best step in management/diagnosis of a given illness. While a few descriptive questions should always be allowed purely for information testing, problem-solving questions should be the central component of our papers.
On the other hand, practical teaching and evaluation should receive an urgent upgrade, especially with regard to discipline and stringency. Apart from testing practical skills, practical exams can also serve as an efficient, direct tool to test information retention and conceptual understanding, offering few ways of escape. Finally, a complete reinvention of faculty attitude is needed to kindle student interest in practicals.
It’s dismaying to know that we’re still comfortably keeping on with such obvious shortcomings in our medical education system. The reforms suggested herein aren’t constrained by a lack of money, a pretext often offered to wriggle out of such discussions. These reforms are constrained by a lack of initiative, and I long for a day where my pen, and those of my coevals, would succeed in creating a groundswell powerful enough to shake up our medical education system.
The writer, Dr Soham D Bhaduri, is a medical doctor and takes a keen interest in mental health and medical education. He blogs at The Free-Thinking Medic.