Most of us who took up the medical profession will testify that one of the things that made it so appealing was the power it has to positively impact the lives of people. It is not an academic pursuit limited to libraries and journals but one where intellectual excellence makes a real-life difference on a day-to-day basis. Those countless adrenaline-fuelled moments, the great responsibility, the chance to save lives—all of it combines to create an allure that far surpasses that of money. Not only is medicine irrevocably an applied sphere, its very existence depends and thrives on it.
If you take a survey of our graduate classrooms and wards, you can't miss the dominance of theory while "practicals" are almost an afterthought.
Yet, when you cross into the domain of medical training, it seems completely at odds at what I've described above—theory rules the roost, while practical experience is relegated to the sidelines. This, sadly, is the reality of most MBBS programmes in India. If you take a survey of our graduate classrooms and wards, you can't miss the dominance of theory while "practicals" are almost an afterthought. Arguably, a large part of this stems from our attitude towards education in general, starting from when tots first enter primary school, and evident in the way our curricula and examinations have been structured. In an article I wrote on theory exams, I've tried to highlight the shortcomings in our system of theoretical teaching and evaluation. What I wish to portray here in this article is a similar shortcoming in the way things happen with practical instruction in the MBBS degree course.
History-taking and physical examinations are two of the cornerstones of practical training. Undeniably, they form the edifice of the physician's practical approach, and are therefore two most important skills that a medical student needs to assimilate. Correspondingly, history-taking and physical examination are usually the two most stressed-upon topics throughout and that's where Indian graduates often possess an edge over American graduates.
However, a conspicuous aspect of our prevalent system is that while we rightly focus heavily on history-taking and physical examination, we largely leave out on providing real world exposure to our students through our curriculum. Take for instance a typical clinic for medical students. A case discussion session ends up being largely consumed by the details and subtleties of history taking and physical examination—which then naturally leads to a further exploration of theoretical details. As a result, practical clinics generally turn into discussions of theoretical concepts, which then turn into lectures in no time! As much as it may seem ineluctable and necessary, we tend to defy the actual meaning of providing a practical orientation. While discussions on investigations, diagnoses and management are rounded off with theoretical details, there is little exposure to the way patient care actually works during the MBBS years. Ward rounds, reading patient files, exposure to actual diagnostic and management protocols etc that comprise "healthcare delivery" right from the entry to the exit of a patient in the hospital, are sadly not a prominent part of the MBBS curriculum.
Real-world exposure is the closest thing to practical training I can imagine, and I see no reason why it can't go hand in hand with medical schooling. It makes no sense to imprison 4.5 years of an MBBS course into textbooks and classrooms and then introduce a cursory one-year internship program, where students are completely out of their depth. We tend to negate the fact that real-world exposure can greatly aid and fortify theoretical learning. It provides a complete vision of things learned in books and discussions; it aids in the retention of evanescent information. Moreover, the MBBS then truly becomes a process of "making a doctor".
Every measure to muscle up our practical training system will falter unless we cut down on the cumbersome theory curriculum that already burdens students.
It is to be remembered that bringing practicals on an equal footing with theory will not be possible until we do something about the existing theoretical coursework. Every measure to muscle up our practical training system will falter unless we cut down on the cumbersome theory curriculum that already burdens students today. This is because theory preponderance isn't just an attitude— it permeates our training system and structures it in a way that leaves little time and energy for anything else. As I've outlined in my article on -theory exams, we need to make our curriculum more understanding- and application-oriented, and learning needs to be more inclusive and less discreet. Last but not the least, it's only an alteration in our attitude that can fully guarantee our medical training system the form and quality it deserves.
(This article was first published on the blog The Free-Thinking Medic)