Dr.Krishna Reddy Nallamalla, Country Director, ACCESS Health India.
Why we need radical reforms in medical education?
Earliest system of medical education was reported in India in 6th century BC in a classical text – Susruta Samhita. Current design of medical education across the world was based on series of reports by Flexner and others in 1910. Despite tremendous changes in health systems over the last century, medical education curricula remained mostly static and outdated. Key elements define today’s health system – ageing population; demand for quality, equity and dignity; transition from communicable to non-communicable diseases and from episodic illnesses to life- long ailments; double burden of disease in some countries, financial protection; disruptive advances in medical knowledge, information technology, and biotechnology etc. Medical education is the bedrock on which needs of ‘human resources for health’, one of the major building blocks of any health system, are met. Healthcare is the most complex of social systems and is essential to keep populations healthy and productive. Health professional of today is required to have the needed knowledge, skills, and professionalism to provide safe, effective, efficient, timely, and affordable care to people. He/ she is required to navigate the most complex healthcare system, to work in teams, to be proficient in handling disruptive technologies, to understand economics of healthcare, to have managerial skills to handle large and diverse teams, to be ethical, to demonstrate caring and empathy and to be abreast of rapid developments in medicine. Medical education of today should be able to groom such professionals to face medicine of 21st century. In addition to raising the standards of medical professionals, the system should innovate to meet growing shortage of health professionals to serve ageing population with life style and life-time ailments.
How can we meet the existing shortage and rapidly growing demand for medical professionals?
There is a need to revisit the existing guidelines for setting up medical schools and according permission to number of seats. Methods of education across various fields are undergoing changes on account of advances in e-learning methods and tools, including remote learning, virtual class rooms, digital dissections, simulation systems for imparting skills etc. Extending teaching privileges to practicing physicians (both private and public) and allowing e-learning tools will address the shortage of quality teachers across the system. When taken together, the above can enable doubling of existing medical seats without compromising on quality of teaching. In addition, task-shifting and task-sharing concepts have addressed the shortages in many health systems.
How the curriculum and teaching methods be redesigned to meet the needs of 21st Century Healthcare?
There are ongoing innovations in medical education to prepare professionals for the complex healthcare system that is rapidly changing. Lancet Commission Report – “Health Professionals for a new century: transforming health education to strengthen health systems in an interdependent world”, published in 2010, outlines key recommendations to transform health professional education. According a study, it took nearly 50 years (1900 to 1950) for medical knowledge to double, it took 7.5 years to double in 1980, and 3.5 years in 2010. It is projected that it will take 73 days for medical knowledge to double in 2020! At this pace of change, a student can be prepared to process information that is readily available than to know the past knowledge. Periodic recertification on the basis of continuing learning systems may become essential to keep up with the pace of change. Virtual learning tools eliminate the need for didactic class rooms, thereby addressing the issues of capital to create infrastructure and to get high quality faculty to impart learning. Dynamic curricula designed around specific health systems will become more relevant than the systems designed for classical hospital-based care. Since health professionals have to work in teams, inter-professional combined learning methods are being introduced. Even the concept of teaching hospital is changing from a single large hospital to a network of hospitals and community health centers.
Why National Medical Commission (NMC) is the first step in the transformation?
Medical Council of India has been mired in many controversies, resulting in deteriorating situation in the quality of education. In addition, its policies and strategies were totally delinked from the rapid changes happening in health systems within the country and globally. By monopolizing control over every aspect of medical education, it bred the culture of deep-rooted corruption. By splitting the functions in to four well defined areas, and stipulating fixed and rotating terms to key people, it enables creation of a more responsive system. By bringing it in to the broader health systems at national level, it’s policies will be aligned with broader strategies being framed for transforming Indian health systems to meet the core target of Universal Health Coverage (UHC) by 2030.