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 Table of Contents  
LETTER TO EDITOR
Year : 2022  |  Volume : 12  |  Issue : 3  |  Page : 137-139

Challenges in Medical Education - Let's talk about solutions


Department of Medicine, KG's Medical University, Lucknow, Uttar Pradesh, India

Date of Submission30-Apr-2022
Date of Decision10-May-2022
Date of Acceptance26-May-2022
Date of Web Publication30-Jun-2022

Correspondence Address:
Dr. Harish Gupta
Department of Medicine, KG's Medical University, Lucknow - 226 003, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cmrp.cmrp_39_22

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How to cite this article:
Gupta H. Challenges in Medical Education - Let's talk about solutions. Curr Med Res Pract 2022;12:137-9

How to cite this URL:
Gupta H. Challenges in Medical Education - Let's talk about solutions. Curr Med Res Pract [serial online] 2022 [cited 2022 Aug 12];12:137-9. Available from: http://www.cmrpjournal.org/text.asp?2022/12/3/137/349294



“The highest education is that which does not merely give us information but makes our life in harmony with all existence.”

– Rabindranath Tagore, Founder of Visva Bharti University

Dear Editor,

Gupta et al. comprehensively underscore various challenges our Medical Education System is facing in our times in their Review Article entitled, 'Challenges in Medical Education', published on 26 April 2022 in the Journal. They provide an overview of the way our public and private teaching institutions devise immoral, unholy, unethical – and many a times – illegal short-cuts/contraptions, resulting in poor-quality training of young students, which have a myriad long-term implications for the future of this country and beyond.[1] Moreover, several ills arise from the too rapid and haphazard proliferation of Medical Colleges in the name of achieving illusive World Health Organization norms of doctor: patient ratio.[2] Nevertheless, as guardians of the health care around, it is responsibility of the well-wishers, stakeholders and elders to save the system from the creeping unwanted and undesirable deterioration that some blame to popular instantaneous/ adventurous politics.[3]

In the competitive electoral game of appeasing/confusing/misleading/pampering voters and enticing/enchanting them by declaring one All India Institute of Medical Sciences or at least a Medical College in every constituency, it is a Herculean task to maintain high standards in the hurry, and then, we rapidly go the downhill of compromises to our basic principles and the best practices which we hold dear. By cutting the corners, it is easy way forward to miraculously increase the number of available trainee seats, advertise, then capitalise over it and gain electoral dividends in the next election. However, the underlying malaise seeping therein may take some time to manifest as there is a long incubation period between such trickery and output of half-baked doctors.

As the authors highlight the unfolding scenario, it is also quintessential to put on the table a few solutions so that the direction we need to move on may appear on the horizon as we look ahead. The authors correctly state that during National Medical Commission (NMC) inspection, numerous ghost faculty is paraded in front of them to get recognition. Further, patients are filled up in indoors a night before – or even on the morning of – the so-called sudden inspection.[4] Underlying mechanism of oft-repeated observation needs to be dissected out threadbare so as to get its blood supply and the purpose it serves.

Real reason of the phenomenon is that treating and managing really serious patients is a costly, time-consuming, high stake, complicated, nuanced, skilled, labour-intensive and sometimes a dangerous act under prevailing circumstances, which many a times is a thankless job, and no one is willing to do so if a businessperson/management person/industrialist/corporate entity/dollar crazy/investor/shareholder/ambitious venture capitalist is running the show behind the curtains with support of the powers that be. With few exceptions, these money-minded joyriders do not enter the arena to learn and teach, enjoy making a diagnosis, savour the joy of reaching/discovering the unknown or try something new when all the available knowledge is exhausted sometimes but to make a quick buck anyway and move on. They calculate whether more money can be made here quickly and secretly than share bazaar and calculate input versus output ratio.

NMC needs to understand that students getting trained and then emerging from such buildings will follow the same practice which they see, observe, visualise and then internalise/imbibe day in and day out. Outside the realm of the inspection, such christened teaching hospitals regularly send (euphemistically called refer) all the complicated patients to public hospitals in the vicinity and look after only simple cases so as to have a veneer of providing care. If NMC team starts demanding referral records from these medical colleges and then confirms from nearby public hospitals, all the jugglery, deception, trickery and manipulation may be exposed which goes on for 363 days an year (barring 2 days of the inspection).

During COVID times, we had a system of COVID Command Centre where all the seriously ill patients used to be allotted a bed via a central monitoring system of Chief Medical Officer.[5] If such a system operates round the year, it will not be difficult to trap the private players in the game which they pretend to master. We witness that instead of honing their skills to find a new way to reach the unreached and know the unknown in healthcare sector, private players love to shift a patient somewhere else having anything more than a simple illness. Moreover, that has been happening for decades, except at some Institutes of repute.

Approval of postgraduate trainee seats depends on the number of patients a medical college shows on paper.[6] Moreover, as private players are adept to prepare as much paperwork as required, sometimes more than that, they easily get more seats by fulfilling everything on paper (ONLY) whereas the public hospitals, which bear the actual load of complicated cases, seriously ill patients, sometimes having chronic multisystem failure lingering on and requiring prolonged/sophisticated management run the show with less-than-optimal residents' strength, leading to workforce crunch at the real site-of-action.

After all, they just cannot conjure up any paper from thin air and get a larger pie as they have to follow the administrative rules in black and white. This is the reason you observe a big department in a private medical college having elegant empty wards, silent emergency rooms transferring wailing patients in loud noise by referring them elsewhere whereas crowded emergency department of a public hospital running on the shoulders of just one, two or a maximum of 3 residents at a time. And when one of them proceeds on leave, hell breaks loose.

Further, during inspection, NMC inspectors demand to look into the payslip of its workers and this part is easy to manipulate.[7] Anyone can print anything on one's computer at any time and pass off as a genuine document to an inspector. Conversely, if the inspectors demand pass book entry of an employee, the challenge of ghost faculty and ghost workers may be sorted out. If NMC decides to look into payment records of the previous year, a Pandora's Box is waiting to be opened.

Under a header of Corruption in Medical Education, the authors describe that private Medical Colleges started to charge under-the-table money even after NEET came into force. We need to go to the root cause of the problem so as to get a hang of its genesis. NEET is just a testing system designed to provide marks to a candidate. Six years ago when the test started and continues, after declaration of its result, private players started to conduct counselling on their own without any supervision. Then, Hon'ble Supreme Court of India intervened and gave an order that only State can do it. Afterwards came some sanity in the exercise.[8] What you decipher is that many private operators here are so greedy that they design the game in such a way the one who bids the maximum, gets a seat whether NEET or no NEET and the Supreme Court had to come to stop the practice.

However, what the State (the executive) was doing then, demands an honest introspection.

We have three levels of COVID hospitals here, and Level 3 provides care to the most unstable patients.[9] During surge of second wave in spring and summer of 2021, not all the private Medical Colleges were deemed fit to run as Level 3 facilities.[10] The way they otherwise referred patients, they continued to during the crisis. In addition, some private hospitals which initially admitted such patients, referred them at the earliest possible moment to us as soon as the overall general condition started to deteriorate. Some referral guidelines do exist on paper for that,[11] but I am unable to find the indications an approved MCI teaching institute refers such patients to somewhere else. Therefore, what do the inspectors inspect there, how do they approve them by assessing the teaching and training infrastructure for budding students, I wonder. Therefore, our time demands that there should be some accountability therein of someone if the report is not found to be correct and misrepresents the actual status.

These are few solutions to check rampant practice of misuse of power which corrupts the game, muddles the water, leaves the deserving behind, unfair to the honest and provides advantage to the rogue and easily amenable by adopting simple practices. No one assures these methods to be a fool proof mechanism, but their adoption may initiate a chain of virtuous events by which more inputs may come to further improve and transform the system.

In this way, we move from darkness to light as our Upanishad exhort us to Asato Ma Sadgamaya.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gupta VK, Gupta M, Gupta V. Challenges in medical education. Curr Med Res Pract 2022;12:73-7.  Back to cited text no. 1
  [Full text]  
2.
Doctor-Patient Ratio in India Less than WHO-Prescribed Norm of 1:1000: Govt. Economic Times; November 20, 2019. Available from: https://health.economictimes.indiatimes.com/news/industry/doctor-patient-ratio-in-india-less-than-who-prescribed-norm-of-11000-govt/72135237. [Last accessed on 2022 Apr 30].  Back to cited text no. 2
    
3.
Grewal GS. Deterioration in Health Services; Blame Doctors or Can Politicians Answer? Express Healthcare; August 01, 2016. Available from: https://www.expresshealthcare.in/blogs/guest-blogs-healthcare/deterioration-in-health-services-blame-doctors-or-can-politicians-answer/403917/. [Last accessed on 2022 Apr 30].  Back to cited text no. 3
    
4.
Sinha B. SC Seeks Nilekani's Assistance in MCI Case, Hindustan Times; September 22, 2018. Available from: https://www.hindustantimes.com/india-news/sc-seeks-nilekani-s-assistance-in-mci-case/story-kQoiGOEfANJfGg9aEIPWwN.html. [Last accessed on 2022 Apr 30].  Back to cited text no. 4
    
5.
TNN. Lucknow: 90 More Lines Added to COVID Control Center. Times of India; April 28, 2021. Available from: https://timesofindia.indiatimes.com/city/lucknow/90-more-lines-added-to-covid-control-centre/articleshow/82281655.cms. [Last accessed on 2022 Apr 30].  Back to cited text no. 5
    
6.
Garima. MCI Releases Status of PG Medical Applications by Medical Colleges, Details. Medical Dialogues; July 19, 2022. Available from: https://medicaldialogues.in/news/health/mci/mci-releases-status-of-pg-medical-applications-by-medical-colleges-details-67780?from-login=764259. [Last accessed on 2022 Apr 30].  Back to cited text no. 6
    
7.
Faculty Declaration form (for AY 2021- 22). Available from: https://www.nmc.org.in/AppForms_nmc/Declaration_Form_Revised_2021-2022.pdf.  Back to cited text no. 7
    
8.
Choudhary AA. SC Bans Counselling by Private Medical Colleges. Times of India; September 23, 2016. Available from: https://timesofindia.indiatimes.com/home/education/sc-bans-counselling-by-private-medical-colleges/articleshow/54473346.cms. [Last accessed on 2022 Apr 30].  Back to cited text no. 8
    
9.
Dey S. Coronavirus in India: Three Tier Classification of Hospitals for Diverse Levels of Infection. Times of India; April 08, 2020. Available from: https://timesofindia.indiatimes.com/india/3-tier-classification-of-hospitals-for-diverse-levels-of-infection/articleshow/75037735.cms. [Last accessed on 2022 Apr 30].  Back to cited text no. 9
    
10.
Lucknow Administration Notifies 17 Private Hospitals for COVID Treatment; Check Details. Times of India; April 17, 2021. Available from: https://www.news18.com/news/india/lucknow-administration-notifies-17-private-hospitals-for-covid-treatment-check-details-3648506.html. [Last accessed on 2022 Apr 30].  Back to cited text no. 10
    
11.
DGHS. Referral Guideline for Health Facilities in UP. Available from: http://dgmhup.gov.in/en/Referral_Guidelines. [Last accessed on 2022 Apr 30].  Back to cited text no. 11
    




 

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