http://groups.yahoo.com/group/Quality_of_Medical_Education/message/2445
Vision 2015 depicts a sincere effort by the MCI to improve the quality of medical education in India. This was a long overdue step and this step was needed right at the time of independence to redo the medical education as per the needs of the health services for the Indian society. But even when it is late; it is a step in the right direction.
When efforts are made to improve a system it needs sincere desire, a proper review of the existing system, study of the drawbacks and good point of the system by the experts of the concerned fields. Then experts suggest changes and then there is critical analysis of suggestions and overall effects of implementation of these changes on the health system and the society, reaching at conclusions broadly acceptable to the national bodies of the experts in that particular field. These decisions should be implemented after making an amicable consensus.
When we see the constitution of the committee for suggesting changes in the medical curriculum, administration and providing of medical education; a genuine question arise in the mind that why not experts from all the subjects have been chosen ignoring the possible fruitful inputs from experienced professors who have spent their lifetime teaching only one subject during their lifetime. In this exercise neither the national bodies representing the experts in a particular field have been consulted nor have the views of prominent personalities in the different fields have been utilized. This is an era of specialization and I do not believe that a few experts can take care of all the subjects. A strong disbelief arises about the justification of various changes in other subjects for which there were no experts. There are different subjects ranging from basic like anatomy, physiology, biochemistry to paramedical subjects like pharmacology, pathology, forensic medicine, microbiology, community medicine to clinical subjects like ophthalmology, ENT, medicine, surgery, obstetrics and gynaecology, paediatrics, orthopaedics and psychiatry etc. As an example I put forward the case of forensic medicine where injustice seems to have crept up due to non-consultation with the forensic medicine experts.
Vision 2015 shows a desire to evolves strategies and futuristic plans so that medical education in India is innovative and is able to meet the demands of national needs while preparing undergraduates to be able to perform in the changing scenario of medical science but what I could grasp from the changes suggested in forensic medicine is that:
Ethics and Legal medicine has been suggested as an elective subject where as it is needed as a compulsory subject. Already the successful prosecution rate in India is far below than many other countries and this rate is likely to go down further with legal medicine being as an elective subject as many students may not opt for it considering that this will not lead to monetary benefits in their career and important aspect of justice to the society will be lost which may further lead to restlessness in the society.
Whereas there was a strong need to make the teaching uniform all over India, but to my surprise no steps have been taken in the vision 2015 to make it uniform. In government medical colleges post-mortem examination is done and shown to the students and this is the best teaching and learning experience. This is also being followed in a few select private medical colleges which is a very genuine and good practice. But I ask a question here why not it is being followed in all private medical colleges where the best mortuaries of the country are located and they have very good and learned forensic experts. In this way students are being denied the education which is their due. In this way doctors are being produced in the country having different learning experiences, some very good and some not very good which is not moral for the society. This is just an example in one subject.
It has been decided to double the number of doctors by 2031 which is a welcome idea but here I will like to point out that even the services of the alleged less number of available doctors are not being utilized and many of them are unemployed or underemployed. Merely increasing the availability of doctors without any resources to utilize their services will lead to frustrations. Otherwise we will cure one aspect of the problem but which will lead to another bigger problem. Solution should be found in totality. Immediate solution should be providing jobs to all unemployed doctors so that ratio of available doctors to the needed population can be increased.
When we are talking about need based curriculum but we totally forgetting the need of the society as far as forensic medicine is concerned. We need to develop skills of doctors in dealing with medico-legal cases rather than not exposing them at all to medico-legal situations as is happening in private medical colleges At least one police station must be attached to a private medical college so that students learn the intricacies of medico-legal work.
Instead of taking steps to cater the needs of the 21st century by modernising the different fields we are just ignoring the fields like forensic medicine which affects the society in a unique way. If medico-legal examinations are not done in a proper way it will lead to restlessness, anger and deep grief in the society as there is likelihood that it will lead to injustice due to improper collection and interpretation of evidence which will lead to miscarrying of justice. If justice is denied to the people persistently it may lead to accrued up frustration which may lead to revolutions.
We are trying to bridge the gap between demand and availability of doctors but this does not look as far as dealing with medico-legal services is concerned. There is a huge gap between demand and availability of skilled doctors in forensic medicine so all the undergraduates are needed to be taught forensic medicine otherwise an imbalance will be created resulting in dissatisfaction of masses in the medico-legal services to the society. Even the services of the available forensic medicine experts are not being used properly and they are being posted in dispensaries where no medico legal work is ever done. I suggest that they should be posted at district headquarters where their services can be utilized in a better manner and let the graduates who have a good forensic medicine learning during their undergraduate course handle the other cases.
Vision 201 declares that "Forensic Medicine can be effectively taught during Gynaecology & Obstetrics (rape, assault), surgery (injuries) and pharmacology (toxicology). Legal experts can be called for medico-legal issues. Forensic medicine skills can be acquired during internship such as documentation of medico-legal cases of alcoholism, suicide/homicide, rape, assault and injury case". This will be possible only if forensic medicine is made a compulsory subject and not an elective subject in the internship. Throughout India medico legal services are performed in more than 90% of the cases by graduate doctors only and not the forensic medicine specialists. Therefore graduate doctors must be well versed with medico legal matters and a great emphasis should be laid on teaching of forensic medicine during this period as a full-fledged equal subject and not as a smaller or subservient part as compared to other subjects.
" Professionalism and ethics curriculum will be a mandatory part of the curriculum and will be integrated throughout the MBBS Course. The foundation courses will be taken during the first and second year and rest of the curriculum will be taught along with the clinical subject". This is being taught by forensic medicine faculty and I fully agree that more emphasis should be laid on teaching of ethics and professionalism as these are the fundamentals for the successful medical profession.
I agree with the vision 2015 which states that parts of clinical training should be core requirements. I will like to highlight that teaching of forensic medicine should be extended to the years when students are seriously learning dealing with patients and treating the patients. When they are learning obstetrics and gynaecology to students will be better equipped to learn examining victims of sexual offences. When students are learning dealing with emergency cases they will be in a better position to deal with poisoning cases and injury cases.
Majority of doctors are always afraid of dealing with medico-legal cases and appearing in courts. That is the reason that they shun the medico-legal work. During internship all the doctors must visit the premises of the courts to see the giving of evidence in the courts so that doctors are not panicked at the name of courts and they will deal more humanly with victims and offenders.
If all the undergraduates are taught the subject of forensic medicine, not as a little brother but as a full-fledged subject, will give a long way in addressing the points raised by me and my other learned esteemed colleagues. We should not proceed in a hasty manner but should try to develop consensus duly taking into confidence various national academic bodies and other leading experts in the fields who have spent their life time nourishing and teaching the specialities.
Professor RK Gorea
MD, DNB, PhD
Professor and Head
Forensic Medicine
Gian Sagar Medical College
Rajpura, Patiala, Punjab
No comments:
Post a Comment