MCI syllabus prescribes better clinical skills

Revamp Curriculum for Medical students Medical education in India has ? failed to create a curriculum that produces doctors suited to working in Indian context, ? Failed to maintain uniform standards of medical education – at undergraduate and post-graduate levels, ? Devaluated merit in admission, particularly in private medical institutions, ? Failed to put in place a robust quality assurance mechanism, Failed to create a transparent system of medical college inspections and grant of recognition or de-recognition The board of governors have announced modifications in the medical curriculum few days back. Welcome move by the medical council. Late better than never.

The modern curriculum is based on the Flexner Report — a review published in 1910. It hasn’t changed much since then. It needs to and it is. As a Medical teacher of nearly three decades I’ve seen firsthand the limitations of today’s physician training. We can do better.

Teach skills, not just facts Make no mistake, medical practice is a skilled profession. And there is art to that skill. Every medical school course list includes a slew of classes on anatomy, physiology, pathology, and pharmacology. All important topics, but the emphasis on scientific information leaves physicians unprepared in a world where today’s facts may be outdated tomorrow.

The curriculum should include adequate training in clinical practice, clinical epidemiology and population-based medicine, medical informatics, skills for lifelong learning, quality assurance, utilization review, and an understanding of the appropriate timing of referrals between generalists and specialists Yet another medical malady- begins in medical school, where it almost never receives the attention it deserves-deficiency of clinical skills.
 

Problem of lack of clinical skills is due to overbearing technology. It of course complements doctors. With the rapid extension of laboratory tests of greater accuracy, there is a tendency for some clinicians in reaching a diagnosis to rely more on laboratory reports and less on the history of the illness, the examination and clinical judgment.

It is well known to all of us that the brightest of the school leavers are coming to the medical profession to become doctors after going through a very expensive, extensive and hardworking medical curriculum. Students face question papers having questions which are more knowledge based than on real clinical cases.

Regular breakthroughs take place in the medical field every day, but the medical studies syllabus in India is not updated accordingly. New domains of medical science are also barely touched upon. Communi-cation skills A doctor’s ability to explain, listen and empathize has a profound impact on a patient’s care. On an average, physicians wait just 18 seconds before interrupting patients’ narratives of their symptoms and spend no more than five minutes with the patient. Evidently, we have a long way to go.

Laboratory oriented mindset
Yet, residency training programs across the country are graduating a growing number of these low on skill physicians who cannot take an adequate medical history, cannot perform a reliable physical examination, cannot critically assess the information they gather, cannot create a sound management plan.. They learn to order all kinds of tests and procedures—but don’t always know when to order or how to interpret them.

Habitual reliance on sophisticated medical gadgetry for diagnosis prevents physicians from using the most sophisticated, intricate machine they’ll ever and always have—the brain.

All students should graduate with a firm understanding of data science and statistics. The advent of electronic health records and the continued march of medical research have generated reams of data that physicians must be able to sift through, synthesize, and act upon the continued development of precision medicine.

Telemedicine is increasingly ubiquitous in the clinical setting, but students receive no training on its applications and limitations. That must change if digital health tools are to reach their full potential.

Incorporate a 12 weeks of “mini-MBA”- into medical school I would argue that the knowledge and skills developed in business school have never been more relevant. Many doctors are uninformed about issues surrounding cost and access. As the regulatory environment grows more complex, this limits physicians’ ability to provide the highest quality care, advising patients on cost-effective treatments, interacting with insurance companies, or running a practice.
Physicians would also benefit from dedicated leadership training. Health care is trending toward team-based care. A mini-MBA would instill a new mindset. The role of a physician has changed over time. Doctors now play an integral part in management, policy, and entrepreneurial ventures, to name a few.

Make room for new content
The focus of health care has shifted from episodic care of individuals in hospitals to promotion of health in the community, and from paternalism and anecdotal care to negotiated management based on evidence of effectiveness and safety. Medical training is becoming more student centered, with an emphasis on active learning rather than on the passive acquisition of knowledge.

The concept of a spiral curriculum in which topics are visited and revisited at time intervals, at different levels of intensity, and often with a different emphasis—basic science, pathology, clinical science—is important in curriculum design.
Medical education is changing rapidly, and many challenges remain for the future. Leadership of change is essential; balancing the need for academic stability, to build up a core of respected and skilled teachers, is at the center of effective curriculum reform.

High-quality medical education is central to high-quality medical care. The need to ensure the continued production of doctors fit to practice medicine in the 21st century has major implications for medical schools around the world, who will all have to work hard to ensure that the curriculum does not lag behind the challenge.

Nurture teachers who teach
Academic physicians are paid to see patients and are promoted for their research. No one cares about teaching. Of course, many doctors are excellent teachers. But that is by coincidence rather than design. Medical schools need to take steps to reward good teachers and help bad ones improve Medicine is a dynamic field that mandates continual innovation and improvement. Medical education must be held to the same standard. Worldwide, medical education institutions are establishing cross border curriculum partnerships. Medical curriculum partnerships offer a valuable learning experience.

The writer is former Director, Sri Jayadeva Institute of Cardiology.

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