Dr Kasturi Lal
Faced with the pressure of bridging shortage of doctors the Government has been approving the creation of more medical institutions in private sector and evolving a policy to increase intake of students in already existing medical institutions. According to estimates approximately 20 percent of students in medical education purchase their graduation qualification from institutes which lack of teaching and training facilities. The move has been criticized both the beneficiaries and the providers on the ground that patients will have to face the challenge of being treated by medical graduates who have not been adequately trained and the trainee of today is ill equipped to deal with the medical and surgical problems of the rural population.
In the existing curricula in training programme of the medical graduates, the focus has been on short term theoretical training to meet the practice based learning with little emphasis on the practical implementation of quality improvement initiatives. Training programs are not graduating candidates with clinical and operative experience, the consequences of which would be obvious for public health.
Doctors for the rural
population
We must develop courses for allowing certain trainees to engage electively in rural population and maintain interest amongst trainees to perform procedures with needle and thread. We are finding a decline in dexterity and the whole art of clinical diagnosis. Clinical mastery is now frowned upon in preference of the apparent surety of the computer tomography or magnetic resonance imaging scan. Alas, the false confidence now given to technological aids has not only engulfed out trainees but also the public and worse the lawyers. Appropriate techniques have been consigned to the dustbin of the past.
All this means that the medical trainee of today is ill equipped to deal with medical and surgical problems of the rural population. The medical teachers should rely on the training and experiences of the past and the results would be rewarding despite the absence of nearly all laboratory equipment. Good practice in resource poor setting can yield positive results. In the quest of perfection we in the resource rich world have forgotten that reliance on technology comes with a price, not just financial but social and practical. No wonder the poor benefit only from approximately 3.5 percent of all procedures done in the country. Millions of people have no access to care and die from conditions that could be treated fairly easily.
It is time that essential elements of medicine and surgery should be recognized as an adjunct to primary care. It is hugely cost effective strategy that most medical interventions and successful medical and surgical care in rural areas which give all other medical care credibility.
It is humanitarian duty of all teachers in Medical Colleges to train health care personal to perform procedures in rural setting so that the unmet burden of diseases does not haunt the profession for generations to come.
Evidence based medicine
Evidence based medicine is the conscious explicit and judicious use of current best evidence in making decisions about the case of individual patients. The key to practicing evidence based medicine is applying the current knowledge to decisions in individual patients. Medical knowledge is continuously and rapidly expanding. For clinicians to practice evidence based medicine, they must have the appraisal skills. Generally critical appraisals required that clinician have some knowledge of biostatics, clinical epidemiology, decision analysis and economics as well as clinical knowledge.
Apart from achieving requirements for system based practice and practice based learning and improvement; the training programme should prepare learners for evaluating quality and outcome data. These skills are being increasingly recognized as necessary for all practitioners as the role of quality control initiative grows throughout medicine.
Government is unable to fulfill its objective of evolving suitable performance appraisal systems for medical institutions and deemed universities imparting medical education incorporating norms and mechanisms for enforcing accountability. There should be focus on formulating schemes and in-service training of teachers, as well as development of centres for offering staff development programs, including continuing education of teachers. The foundation of good medical graduate depends upon mentorship provided by well qualified trainers, quality of instructions, assessment and examinations. Academic performance of the institution and teaching staff must be evaluated.
Quality Control
Since the scrutiny about safety, quality and caste has been intensified, an increased interest in formal quality improvement has emerged in graduate medical education the focus on patient safety and quality though nonexistent in our educational system, would in future required stricter work hour restrictions. New guidelines that require trainees to gain skills in quality improvement have to be incorporated in teaching.
We in due course of time realize that
*Quality improvement is the future of the medicine
*Quality is measurable.
*High quality data is essential for quality improvement.
*Quality thrives in a supportive culture.
*Collaboration spurs innovation and higher quality. And
*We must lead on quality in classroom and in operating rooms.
Bridging the gap between science and medical practice.
It is very difficult to do both clinical work and research but it is vitally important in order to advance the field. It underscored the importance of the training programme for the medical graduates as a viable way for young doctors to bridge the gap between the demands of science and medical practice. We must have time in the laboratory working on the largely new and unexplored area and diagnosis and treatment. Investigators in the medical field are not taken seriously due to the fact that if a surgeon or researcher pursues research they have to find ways to concentrate on the clinical side of the practice as well. We must have freedom to explore new ideas that will allow us to expand horizons and advance our field with new technologies and discoveries rather than repackaging older ideas in new wrappings.
Unfortunately we really do not understand the reason for mysterious deaths which should drive us to ask many of research questions.
(The author is former Principal Govt Medical College, Jammu)
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