Name: Atul Asthana
I feel that doctors' working environment has changed. They no more work asindividual and have to interact much more with experts in other domains.Doctors (and paramedics) now work in an environment where lot other skillsare needed to perform a job.
Management skills need to be developed at veryearly stages and trainees need to know that (unlike what the presentcurriculum suggests), there is life outside the clinic / hospitals.Skills like the ones below are needed to be taught from the inception:
(a) Managing : time, people, equipment, schedules, financials, informationetc.
(b) Legal : handling leaglities etc.
(c) IT and electronics equipment usage.
(d) Handling illiterate patients and their relatives.
(e) Managing media.I therefore think that :
(a) The training should include a lot of exposure to these as structured(part of laid down curriculum) and unstructured (interacting with peopleof other domains).
(b) There should be absolutely compulsory exposure to IT. I'd say that aHospital Management System / HIS / PMS / EMR should be in place and thetrainees need to use it as a regular practice. Please look at open sourceHMS/HIS... like Care2X.
(c) With a country like ours, where healthcare is literally missing even 10kilometers away from a city, we need to collaborate with multiple peopleto provide good healthcare to our people (of which 90% can not affordanything beyond the local doctor, some times, quacks). The trainees shouldbe made part of collaborative efforts like : remote consulting, discussionfora, mailing list etc. where they can learn how to use others' skills tosolve a problem. They should compulsarily spend 6 to 8 weeks in non-urbanareas, live with the people and carry out surveys & research. Community,social and preventive medicine should be taught with lot of practicals andreal exposure.
(d) And, there is a lot of 'healthy' value in Ayurveda, Siddha, Unani,Homeopathy, Yoga etc. These are all healthcare systems unlike the westernmedicinal system (which is taught in MBBS) which only treats symptoms. Thetrainees need to be exposed to such systems too. I know that lot of MBBSdoctors look at all these healthcare systems as quacks. They need to knowand respect these systems.
(e) Lastly, the trainees need to serve in villages in real terms, not forcompleting paper formalities; to understand this country's healthrequirements.And , to revamp the curriculum, I guess, the govt needs to hire amanagement consultant (not from the world class management companies), whocan assess country's healthcare requirements for the next 10 years andmodify this curriculum.Also, govt should look at compulsory skill upgrades after every five years.
Friday, June 29, 2007
Modular Learning
Name=Dr. S. S. Chatterjee
Medical Collage faculties
I am in favour of problem based integrated modular learning. However, a conventional curriculum as above should be present at some centres so that one can switch over if necessary.
Medical Collage faculties
I am in favour of problem based integrated modular learning. However, a conventional curriculum as above should be present at some centres so that one can switch over if necessary.
Suggestions for Medical Curriculam
Name=Dr. Ursula Sampson M.D.,
Medical Collage faculties
The thought is noble and is the need of the hour for India. I very much appreciate the change in the trend.My comments for this are as follows.
1.The new curriculum design involves a system based approach and there is a need for reaarrangements of the topics in Biochemistry according to system.
2.The basics of carbohydrates and proteins may be taught as basic concepts with very little emphasis on the chemistry .
3The next topic can be enzymes.
4.Systemwise teaching is taken up with all basic sciences that is Anatomy, Physiology Biochemistry , pharmacology, pathology and Microbiology.
5.The systems are Basic concepts where each discipline will take the students into the respective discipline centered topics.
6. Then onwards, the systems are Blood, Immunology ,Musculo skeletal system,Gastrointestinal and Nutrition,Respiratory system, Cardiovascular system, Excretory system, Endocrine system, Reproductive system, Central nervous system and Special senses.
7. The molecular biology is dealt as follows. The general principles will be taught as basic concepts (remember our students are already coming with some knowledge in genetics , since it is taught in the school level itself.)And only the molecular mechanisms of systemwise disease will be taught along with the respective system.The distribution of Biochemistry topics as system wise topics is quite difficult but i feel it should be done to make the students really enjoy the concept of biochemical mechanism in normal health and disease.(we have done italready here.)There is a general introduction on Life cycle of a man as newborn, child adolescent , adult and old age(this has been introduced according to the suggestions from medical students in UK.There is another speciality to be introduced-that is man and environment.
8. Some of these topics need introduction in the first year as community medicine teaching.( i really could not get anything in the site that is given as foundation course. I really welcome if there is a suggestion to have a foundation course where many of these topics can be taught along with some general topics like chemistry of carbohydrates and proteins and some general topics on human genetics.
9.The learning objectives prepared needs modification in two things. The objectives should be measurable and not the words like understand(please refer to Bloom's taxonomy and the suitable verbs that should be used for each level of objectives.
10.Again the objectives and the course content distribution is sticking onto Discipline as Biochemistry and that needs to be dissolved and to be distributed into system only.
11. Though the curriculum reformation claims that it is student centered the emphasis on problem based learning as system oriented must be included(we have designed introducing PBL as a part of the curriculum delivery and not as a sole method) minimum of one problem atlease for each system can be worked out by students.
12. The implementation will face lots of opposition and discouraging. But please be firm in your decision and go ahead. If we are NOT doing NOW it is a total injustice for our Indian student community. Our students will evolve excellently on global level if only we make them exposed to such learning methods.
13.I expect our student participation in a very effective way.
14. e-learning is a good concept and now almost all material is available in internet in much attractive ways. The main role of teacher is to clearly define the learning objectives and assessment.
15.One more thing that has been successfully done by us is introduction of Clinical skills right from day one of the medical profession. there are few skills identified according to the material taught in the basic sciences and the students really enjoy the learning of basic sciences and able to correlate the basic sciences to clinical discipline. Wherever possible these skills can be taught with the help of simulated patients or (in India, even with real patients)This is successful preparation of the students before they start handling the real patients in the hospitals for clinical teaching.
16.Coming to assessment the emphasis on essay question can be minimised and the weightage on MCQ can be more. In Biochemistry I could not find any marks allotment for MCQ. Also because of student centered activity unless the weightage on internal assessment is more the student participation on all the group discussion will go down. The student must be encouraged to participate actively in all these self directed learning which must be linked to assessment. Hence the weightage must be more than 20%. i do understand that this may involve lot of oppposition from either faculty or students but unless a trust is built upon each other we cannot function as professional college which needs a continuous and complete involvement and just not on the final examination.(mastery level assessment) I wish you all Good luck in this venture and i would be more than happy to contribute my share if given a chance.
Medical Collage faculties
The thought is noble and is the need of the hour for India. I very much appreciate the change in the trend.My comments for this are as follows.
1.The new curriculum design involves a system based approach and there is a need for reaarrangements of the topics in Biochemistry according to system.
2.The basics of carbohydrates and proteins may be taught as basic concepts with very little emphasis on the chemistry .
3The next topic can be enzymes.
4.Systemwise teaching is taken up with all basic sciences that is Anatomy, Physiology Biochemistry , pharmacology, pathology and Microbiology.
5.The systems are Basic concepts where each discipline will take the students into the respective discipline centered topics.
6. Then onwards, the systems are Blood, Immunology ,Musculo skeletal system,Gastrointestinal and Nutrition,Respiratory system, Cardiovascular system, Excretory system, Endocrine system, Reproductive system, Central nervous system and Special senses.
7. The molecular biology is dealt as follows. The general principles will be taught as basic concepts (remember our students are already coming with some knowledge in genetics , since it is taught in the school level itself.)And only the molecular mechanisms of systemwise disease will be taught along with the respective system.The distribution of Biochemistry topics as system wise topics is quite difficult but i feel it should be done to make the students really enjoy the concept of biochemical mechanism in normal health and disease.(we have done italready here.)There is a general introduction on Life cycle of a man as newborn, child adolescent , adult and old age(this has been introduced according to the suggestions from medical students in UK.There is another speciality to be introduced-that is man and environment.
8. Some of these topics need introduction in the first year as community medicine teaching.( i really could not get anything in the site that is given as foundation course. I really welcome if there is a suggestion to have a foundation course where many of these topics can be taught along with some general topics like chemistry of carbohydrates and proteins and some general topics on human genetics.
9.The learning objectives prepared needs modification in two things. The objectives should be measurable and not the words like understand(please refer to Bloom's taxonomy and the suitable verbs that should be used for each level of objectives.
10.Again the objectives and the course content distribution is sticking onto Discipline as Biochemistry and that needs to be dissolved and to be distributed into system only.
11. Though the curriculum reformation claims that it is student centered the emphasis on problem based learning as system oriented must be included(we have designed introducing PBL as a part of the curriculum delivery and not as a sole method) minimum of one problem atlease for each system can be worked out by students.
12. The implementation will face lots of opposition and discouraging. But please be firm in your decision and go ahead. If we are NOT doing NOW it is a total injustice for our Indian student community. Our students will evolve excellently on global level if only we make them exposed to such learning methods.
13.I expect our student participation in a very effective way.
14. e-learning is a good concept and now almost all material is available in internet in much attractive ways. The main role of teacher is to clearly define the learning objectives and assessment.
15.One more thing that has been successfully done by us is introduction of Clinical skills right from day one of the medical profession. there are few skills identified according to the material taught in the basic sciences and the students really enjoy the learning of basic sciences and able to correlate the basic sciences to clinical discipline. Wherever possible these skills can be taught with the help of simulated patients or (in India, even with real patients)This is successful preparation of the students before they start handling the real patients in the hospitals for clinical teaching.
16.Coming to assessment the emphasis on essay question can be minimised and the weightage on MCQ can be more. In Biochemistry I could not find any marks allotment for MCQ. Also because of student centered activity unless the weightage on internal assessment is more the student participation on all the group discussion will go down. The student must be encouraged to participate actively in all these self directed learning which must be linked to assessment. Hence the weightage must be more than 20%. i do understand that this may involve lot of oppposition from either faculty or students but unless a trust is built upon each other we cannot function as professional college which needs a continuous and complete involvement and just not on the final examination.(mastery level assessment) I wish you all Good luck in this venture and i would be more than happy to contribute my share if given a chance.
Recommendations of Medical Curriculam
Name: Dr.N.Seetharaman, MD
Assistant Professor
Department of Community Medicine
There are two distinct issues i would like to recommend
1. Applied Nutrition:
MBBS doctors are equipped with next-to-nil knowledge/skills regarding Nutrition and the application of nutritional principles for different diseases. The very little students learn about nutrition is during their Com.Med curricula where they mug-up some calorie/protein values of common food items and the like. What needs to be done is to include APPLIED nutrition as a subject (maybe within general medicine/maybe without a separate exam/maybe part of internship)in the MBBS curriculum. THIS NEEDS TO BE TAUGHT, IT CANNOT BE ASSUMED TO BE SELF-LEARNT
2. Computer / Internet Literacy:
In this modern age of rapid medical research, doctors need to be in constant touch with the current developments in medicine. For this they need to be well versed in the SKILL of online data accessing/retrieval. This skill NEEDS to be taught at SOME POINT of the medical curriculum. We have tried doing this as part of the our Com.Med Internship program, and it has been a Great success. What needs to be done is to systematically teach the SKILL of online literacy to MBBS doctors (preferably) as a part of their internship--
Dr.N.Seetharaman MD
Assistant Professor
Department of Community Medicine
There are two distinct issues i would like to recommend
1. Applied Nutrition:
MBBS doctors are equipped with next-to-nil knowledge/skills regarding Nutrition and the application of nutritional principles for different diseases. The very little students learn about nutrition is during their Com.Med curricula where they mug-up some calorie/protein values of common food items and the like. What needs to be done is to include APPLIED nutrition as a subject (maybe within general medicine/maybe without a separate exam/maybe part of internship)in the MBBS curriculum. THIS NEEDS TO BE TAUGHT, IT CANNOT BE ASSUMED TO BE SELF-LEARNT
2. Computer / Internet Literacy:
In this modern age of rapid medical research, doctors need to be in constant touch with the current developments in medicine. For this they need to be well versed in the SKILL of online data accessing/retrieval. This skill NEEDS to be taught at SOME POINT of the medical curriculum. We have tried doing this as part of the our Com.Med Internship program, and it has been a Great success. What needs to be done is to systematically teach the SKILL of online literacy to MBBS doctors (preferably) as a part of their internship--
Dr.N.Seetharaman MD
Community Medicine
Name=C V Raghuveer
Medical Collage faculties
Community Medicine has a huge shortage of teachers in this country. There are colleges with a single teachig staff in this dept.Also please invite people who have practised SDL, OSPE & OSCI to the meetings for meaningful discussions.Internship can be made more interesting only when the PG Entrance Tests are revamped to include mostly clinically oriented questions which will require that Interns take their postings seriously.Simple memory recalll questions have spoiled the Entrance Tests totally.
Medical Collage faculties
Community Medicine has a huge shortage of teachers in this country. There are colleges with a single teachig staff in this dept.Also please invite people who have practised SDL, OSPE & OSCI to the meetings for meaningful discussions.Internship can be made more interesting only when the PG Entrance Tests are revamped to include mostly clinically oriented questions which will require that Interns take their postings seriously.Simple memory recalll questions have spoiled the Entrance Tests totally.
systematic review of Medical Curriculum
Name: Parthajyoti Gogoi
Director RDTL
It is really encouraging that there is systematic review of Medical Curriculum
1. We require latest technology to diagnose the disease early or screen it & to have early management of cases in a cost effective manner.
2.Secondly we are in an epidemiological transition, i.e., we are having old sets of communicable diseases like TB, Malaria.etc as a major disease burden & on top of that we are having new sets of diseases or conditions like non-communicable diseases like Hypertension, Cardiovascular diseases, Diabetes, Cancer, HIV/AIDs, Road traffic accidents etc. So our healthsystem should be planned to combat this double burden of diseases.
3. Thirdly we are in a demographic transition i.e., life expectancy is increasing, health care facilities are improving. So we are having population aging. Geriatric population from last 5% is now increased to more than 8% and showing increasing trend. Their health care needs are diverse. We require more facility for this group of population like health promotion, specific protection, early diagnosis & prompt treatment of all cases, disabily limitation etc.
4. Again there is rapid growth of economy. From previous agregian society now there is rapid industrialization. Globalization also increasing the gap between rich & poor. Lack of social bonding, more stress & strain, change in lifestyle leads to more behaviour related disorders. So our education system should be well equiped for management of wide range of behaviour related disorder like STD,HIV/AIDS, Drug addicts, Hypertension, diabetes etc.
5. Now our approach is also changing from top down to bottom up approach. Now after doing community need assessment & decentralised participatory planning at community level only we can plan for tommorow. Which again requires capacity building at all levels, so that the ground level worker knows how to do planning, how to implement it & evaluate it for future improvement.
6.As our planning starts from the lowest level of health care institutions like S/Cs, PHCs etc. so their quality functioning is essential; so that all program could reach the doorstep of the people.
Sir I have gone through the curriculum. Specially the revision in community Medicine is excellent. Thanks a lot for sharing this information with me.
Director RDTL
It is really encouraging that there is systematic review of Medical Curriculum
1. We require latest technology to diagnose the disease early or screen it & to have early management of cases in a cost effective manner.
2.Secondly we are in an epidemiological transition, i.e., we are having old sets of communicable diseases like TB, Malaria.etc as a major disease burden & on top of that we are having new sets of diseases or conditions like non-communicable diseases like Hypertension, Cardiovascular diseases, Diabetes, Cancer, HIV/AIDs, Road traffic accidents etc. So our healthsystem should be planned to combat this double burden of diseases.
3. Thirdly we are in a demographic transition i.e., life expectancy is increasing, health care facilities are improving. So we are having population aging. Geriatric population from last 5% is now increased to more than 8% and showing increasing trend. Their health care needs are diverse. We require more facility for this group of population like health promotion, specific protection, early diagnosis & prompt treatment of all cases, disabily limitation etc.
4. Again there is rapid growth of economy. From previous agregian society now there is rapid industrialization. Globalization also increasing the gap between rich & poor. Lack of social bonding, more stress & strain, change in lifestyle leads to more behaviour related disorders. So our education system should be well equiped for management of wide range of behaviour related disorder like STD,HIV/AIDS, Drug addicts, Hypertension, diabetes etc.
5. Now our approach is also changing from top down to bottom up approach. Now after doing community need assessment & decentralised participatory planning at community level only we can plan for tommorow. Which again requires capacity building at all levels, so that the ground level worker knows how to do planning, how to implement it & evaluate it for future improvement.
6.As our planning starts from the lowest level of health care institutions like S/Cs, PHCs etc. so their quality functioning is essential; so that all program could reach the doorstep of the people.
Sir I have gone through the curriculum. Specially the revision in community Medicine is excellent. Thanks a lot for sharing this information with me.
Wednesday, June 20, 2007
Medical Curriculam
Name : Dr RK Sood
Medical Administration
Comments
The teaching should focus on the applied part with public health practice. the focus should be on how the doctor is going to run a primary health centre with basic facilities. Focus on expensive investigations, and theoretical concepts needs to be discouraged. The teching should be with a understanding of the wider scope of health- determinants like water sanitation environment are rarely appreciated by young medical graduates. Treating anaemia in the medical model by tonics will never solve the problem.Skill based learning- commuication skills are essential in addition to medical to be a good manager and leader. The concept of equity, empathy and respect for the right of the patients, social responsibility and ethical practice should be inculcated through exampe by the faculty. firstly there needs to be reform in the medical sector by imposing checks on private practice by faculty.an intersectoral approach to medical education by field visits to health programme and good interventions being done by NGOs.Last but not the least, Research methodology should be taught to undergraduate medical students.
Medical Administration
Comments
The teaching should focus on the applied part with public health practice. the focus should be on how the doctor is going to run a primary health centre with basic facilities. Focus on expensive investigations, and theoretical concepts needs to be discouraged. The teching should be with a understanding of the wider scope of health- determinants like water sanitation environment are rarely appreciated by young medical graduates. Treating anaemia in the medical model by tonics will never solve the problem.Skill based learning- commuication skills are essential in addition to medical to be a good manager and leader. The concept of equity, empathy and respect for the right of the patients, social responsibility and ethical practice should be inculcated through exampe by the faculty. firstly there needs to be reform in the medical sector by imposing checks on private practice by faculty.an intersectoral approach to medical education by field visits to health programme and good interventions being done by NGOs.Last but not the least, Research methodology should be taught to undergraduate medical students.
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