As delighted as I was to read a piece highlighting the problems bedevilling Indian medical education, coming straight from a promising medical student, it was also a dismaying reminder of the maladies the system 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 platform and elsewhere. I've also been joined by a number of respected colleagues in this process who, like me, envision a reformed 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.
Are we churning out physicians, or a new breed of "theoretical doctors" (like theoretical physicists!)?
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overlook issues like inadequate infrastructure, ghost patients and faculty, inadequate research investment, and outdated teaching techniques.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 "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 by any educationist worth his or her salt. Memorisation 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/clinical medicine. Our prevalent medical education system, at least in the majority of medical colleges out there, sees students memorising volumes of information throughout the year to be produced on exam papers—meanwhile absenteeism in practical classes and an appalling lack of discipline and stringency in practical exams continue unabated. The magnitude of the problem I've just summarised should make us question as to whether we're churning out physicians, or a new breed of "theoretical doctors" (like theoretical physicists!).
Creating a concept-oriented medical education system would require a shift in the focus of our exams, from one testing memorisation to one testing problem-solving ability.
I do not want to sound like I'm dismissing the importance of theoretical instruction—but a system which compromises 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 the United States Medical Licensing Examination (USMLE), which mainly centre on core medical concepts.
Anyone who cares to undertake a rational analysis of our undergraduate medical education would agree that a better 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 on superfluous stuff. 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 memorisation to one testing problem-solving ability. Examinations should mainly include problem-solving questions—for example, 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.
Practical teaching and evaluation should receive an urgent upgrade, especially with regard to discipline and stringency.
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 means of escape. Finally, a complete reinvention of faculty attitude is needed to kindle students' interest in practicals.
It's dismaying that we continue to be comfortable 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.