THE TRAINING MUDDLE￼
-Written by Dr. Harish K. Rao
Listening to the bed-side clinical presentation of the medical student, who is being trained under the “turbo-charged”, newly designed CBME syllabus, I couldn’t help feeling sad at the way we have dumbed down the medical courses. This new tweak in the course syllabus is supposed to be vertically, horizontally, diagonally ‘integrated’, and every other tangent you can think of, to produce ‘The Indian Medical Graduate’, whose definition sounds more like a ‘Indian Medical Super-Hero’. By giving them competencies to learn, an attempt is being made to get the student to actually examine the patient and learn the technique of eliciting clinical signs. But the implementation is so ham-handed that now students know even less than what the previous set of students knew.
Over the years I have noticed the gradual reduction in the importance of clinical examination to where it has come to a point that a student presents his first case in the final examinations. And most often without even touching or placing his hand on the patient. Yet, there is 100% pass results with 99% of them coming back for post-graduate training where the cycle repeats again.
From a time when first MBBS was of 18 months duration and the rest of the course divided into 6 terms of 6 months each, today, we have an abridged course of a little over 3 years.
There are changes in what needs to be taught and what can be asked in the tests. The clinical cases are also limited and called ‘exam cases’. So, a student has very little incentive to learn by examining variety of patients. The classes and tests are conducted away from the patient bed-side and the student really need not know how to elicit the signs and they never even think to check those. If asked to demonstrate they just shrink back or just describe in words without knowing how to actually do it. With passage of time, these same students come back as examiners!
Time when the sophisticated diagnostic tools like ultrasound, CAT scan, MRI etc. were not invented; when FNAC was a diagnostic tool was not introduced into clinical practice, and all students could rely on was the clinical ability to make a diagnosis and suggest treatment. This manner of thought forced them to see, examine more patients, develop a clinical method so as not to miss subtle findings and reach a reasonable conclusion as to what may be wrong with the patient.
While notes collected from seniors helped, we were not solely dependent on it for passing exams. Most of us would read at least two text books and more if we found that our friends were reading a different book. Today, the notes collected from seniors are formally published as text books and some have gained so much popularity that students believe they need not read any other book. The information there is error prone, outdated and sometimes misleading. Sadly some of the ‘authors’ hold key positions in medical colleges and subtly induce students into buying those books . The result is, a student who is proficient in jargons but with no core understanding of the subject. Add to this the mindless testing for entry into PG courses. The questions are usually related to some syndromes which are so rare that one never sees them in their lifetime, or statistics which have no relevance to the condition at hand. Admissions are given on the basis of marks and ranks obtained with no interview conducted to test the students’ aptitude for the subject.
With this, what a student does not realize is that unlike other degree courses where students needn’t remember everything taught after the degree is achieved, doesn’t have a practical application. In medical course since one can’t afford to forget anything taught because it could be a matter of life and death. You need to update all the time and add to the knowledge base. The current system of semesters helps a student conveniently forget the subjects once he has passed the test and the result is out there for everyone to see.
So, it does not matter if you have passed from a premier institute like AIIMS or one listed last in the rankings, the students have the same superficial knowledge and are totally confused about their work and field. Instead of healers they are meant to become, they have been reduced to mere technicians. With introduction of AI and robots into the field things can only get worse, where when programmed by engineers who have very little idea of what a sick patient really needs.
Gazing into the crystal ball I see a future where doctors will be called medical technicians and the course Medical Engineering. I hope Nature will rebel against this trend and restore the original thinking about being a doctor, that they become true healers they are meant to be.