Medical education in India: current challenges and the way forward

Identifying Needs and Preparing for Curriculum Changes in Indian Dental Education

The aims of dental professional courses are to prepare dental healthcare providers to manage common dental diseases, perform surgeries, and offer prevention. They should also be equipped to understand the needs of the society they are serving and willing to amend their skills. As they are expected to be a part of a team providing health care, they should have the requisite leadership and managerial skills for leading the team to serve its objectives in the best possible way. Thus, with changing times, there is a need to bring reforms in dental curricula. Traditional classroom teaching is now shifting to a competency-based education system across the globe. The Dental Council of India (DCI), as a dental health regulator in the country, implements reforms periodically in an attempt to further strengthen the training process and bring quality improvement in dental education. A process of redesigning the curriculum started a couple of years ago. The technical team supporting this work brainstormed the need for such reforms and studied the existing pattern of undergraduate curricula in other developed countries. It was found that many countries are following outcome-based teaching-learning methods. There are several institutions and professional associations proposing recommendations on curricular reforms, and India also suggests following the same. The new education policy (NEP) of the Government of India (GoI) is also in sync with the changes proposed to the DCI. Though such changes are challenging and require time to strategize and implement, it is essential to have reforms in curriculum, especially related to methods of teaching-learning and assessment, and for this, the dental faculty needs to be trained.

How to cite this article

Deshpande AN, Mathur VP, Lele GS, et al. Identifying Needs and Preparing for Curriculum Changes in Indian Dental Education. Int J Clin Pediatr Dent 2024;17(7):842-850.

Inequality in Forensic Medicine in India: The Current Scenario and Way Forward

Background Forensic Medicine (FM) is one of the core specialties of medicine in India, which serves as a bridge between medical science and India's justice delivery systems. Although FM experts play a crucial role in handling medicolegal cases, there is an increasing deficit of FM experts in India. This may be due to the inadequate postgraduate (PG) seats across the states and the low uptake of PG seats in FM. This study was conducted to explore the current status of PG seats along with the Forensic Medicine Toxicology (FMT)/FM index across Indian states. Methodology In this cross-sectional study, data on the number of PGs in FMT/FM and the institutes offering PG courses in FMT/FM were searched on the official website of the National Medical Commission. The data available on the website until November 2023 were incorporated. The FMT/FM index was calculated at the national and state levels, and the states were graded based on the national FMT/FM index. Results The national FMT/FM PG trainee index was 0.054. Considering this as the reference value, grading of the FMT/FM PG trainee index was done as the highest (1.159 to 0.308), higher than the nation (0.054 but less than 0.308), lower than the nation (0.054 but higher than 0.00), and zero. Among all the states and union territories, Andaman & Nicobar, Arunachal Pradesh, Dadra and Nagar Haveli, Jammu & Kashmir, Lakshadweep, Mizoram, Nagaland, Sikkim, and Ladakh had zero FMT/FM PG index due to non-availability of any PG seats for FMT/FM. In total, 20 states had an FMT/FM PG index higher than India's FMT/FM PG index headed by Pondicherry (1.159), followed by Chandigarh (0.429) and Goa (0.308). Conclusions PG seats were highly deficient in several states, which is more likely to affect justice delivery in the future across these states. This study has a few limitations, as we did not explore the actual intake of these PG seats across different states. We anticipate a lower intake of PG seats due to factors such as low demand, fewer job opportunities, and monetary gain. However, this needs further exploration in future studies.

Comparison of Peyton's Four-Step Approach With the Conventional Bedside Technique in Teaching Clinical Examination Skills to Medical Students

BACKGROUND

 Conventional bedside teaching (CBT) is an integral and classical method for imparting clinical skills to undergraduates in medical schools. It is a traditionally successful approach, especially when it comes to imparting patient-doctor relationship skills and knowledge on clinical management. Peyton's four-step approach (PFSA) is one of the newer structured instructional approaches for teaching-learning, especially for imparting procedural and complex psychomotor skills. The present study compares the application of PFSA in teaching complex systemic examination skills to the CBT technique in teaching the same skill to MBBS students. The impact of the acquisition of this examination skill was assessed statistically to compare PFSA and CBT methodologies.

METHODOLOGY

 The target population was MBBS (Bachelor of Medicine and Bachelor of Surgery) students; for this study, the phase II MBBS students were considered as the study population since they were relatively naïve to clinical bedside examination skills. Students were allotted groups and they were taught clinical skills through CBT and PFSA separately. Using the OpenEpi toolkit Version 3 open-source sample size calculator for comparing two means, the sample size was 30 students in each group. The students were assessed for their competency and were also made to fill out a feedback questionnaire to compare the two methods of education dispensing.  Results: The results of this study showed that PFSA is definitely suitable for teaching clinical examination skills. The acquisition of skills was found non-inferior to CBT while the retention of these skills was found to be equally good or even superior with PFSA than with CBT.  Conclusion: PFSA has already been proven to be a good teaching method for the acquisition of complex procedural skills. This study expands the role of PFSA in teaching clinical bedside examination skills to medical students. Further large-scale studies may clarify the learning impact and outcomes of PFSA in clinical bedside teaching.

Reviving medical education through teachers training programs: A literature review

The art of teaching in undergraduate and post graduate medical curriculum was revised in last century with targeted programs to equip the medical faculty with advanced teaching technologies. Medical education units (MEUs) were established by the medical council to train the existing medical faculty of the country in teaching methodologies. This study aimed to evaluate the MEU's impact on teachers' training and compare the status of trained teachers before and after the MEU era. Published literature and statistics on the MCI website were compiled to compare teachers' training status over time empirically. MEU, R.C., and N.C. have been highly efficient in improving the proportion of teachers trained from 5.38 to 50.32% across the country, especially after the upgradation of MEU in 2009. Proportion of the teachers trained increased from 5.38% to 50.32% due to the programs organized by various MEU, regional and nodal centres, especially after the upgradation of MEU in 2009. Lack of trained resource persons and administrative support were the common challenges faced. Properly organized MEU and planned activities should be emphasized in every institute. for effective development of the faculties.

Hyperglobalist, sceptical, and transformationalist perspectives on globalization in medical education

PURPOSE

Globalisation has been hotly debated in recent decades and has seemingly had a profound impact on medical education. This review synthesises the medical education literature using key perspectives from globalisation theory by Holton (Making globalisation).

METHODS

Holton (Making globalisation) recognised three key perspectives in globalisation theory-hyperglobalist, sceptical, and transformationalist. This article critically reviews the literature on globalisation in the field of medical education using this theoretical framework.

RESULTS

Hyperglobalist and sceptical perspectives dominated early periods of medical education literature on globalisation, projecting it either as a mainly positive or mainly negative force, respectively. Most forecasts grounded in these perspectives have not materialised in medical education policy and practice. Since 2010, the volume of scholarship about globalisation has increased and has been predominantly transformationalist in perspective, recognising a reality that has both positive and negative consequences.

CONCLUSIONS

The medical education literature has mirrored the broader social science literature, in moving over time from hyperglobalist and sceptical positions, towards a 'third wave' of globalisation thinking that is transformationalist. Medical education practitioners and policymakers should be mindful of these perspectives and trends as they navigate the opportunities and challenges presented by globalisation.

Online Medical Education in India - Different Challenges and Probable Solutions in the Age of COVID-19

INTRODUCTION

During the COVID-19 pandemic, most educational institutions have opted for online education rather than traditional modes of education to protect their employees and students. Online education has been gaining momentum in almost all countries around the world. This coincides with the recently introduced competency-based medical education in India which has embraced online education. This poses a new challenge for the institutions involved, the instructors or teachers, and the students since they must adapt quickly to the new mode of learning. Online education requires teachers to improve their competency in three major areas; pedagogy, technology, and content knowledge. Some of the challenges include; lack of technological skill, poor time management and lack of infrastructure. As technology rapidly advances, health care education systems must also advance in tandem. To implement the new competency-based system and online education, the institutions and the individuals must realize the importance of online education, identify the barriers and quickly work on solutions for success.

METHODS

This review was conducted based on various research papers on the topic of online medical education, the challenges faced by faculty members, and the opinion of students on this dilemma. Search terms included online medical education, COVID19, competency-based medical education.

CONCLUSION

This review identified various challenges posed by online education on the current medical curriculum, faced by both faculty members and students, especially under the light of the Competency-Based Undergraduate Curriculum for Indian Graduates. Different solutions were proposed to overcome these challenges.

Has national medical commission short-changed the subject of community medicine in its latest minimum requirements for Indian medical graduates? A systems review

System analysis is examination of various elements of a system with a view to ascertain whether the proposed solution to a problem will fit the system and in turn effect an overall improvement in the system. The National Medical Commission (NMC) which was constituted by the act of the Parliament, has brought out minimum requirements for annual MBBS admissions regulations, 2020, which replace minimum requirements published by erstwhile Medical Council of India. The NMC also published new competency-based medical education syllabus for MBBS students with an aim to focus on practical skills. This study brings out the scope of the community medicine (CM) in the present context and as envisaged by the NMC. It also analyzes the infrastructure and workforce required in the department of CM and gives recommendations to improve the system.

Reducing stress among medical students: A qualitative study of students' perspectives

BACKGROUND

Qualitative studies on students' perspectives about stress in medical education are sparse but nonetheless potentially relevant.

AIM

The aim of the study was to assess the proportion of students who considered medical education to be excessively stressful and to elicit students' perspectives about ways to reduce stress in medical education.

MATERIALS AND METHODS

All medical undergraduate students of the college were asked about various aspects of stress in medical training using a self-rated questionnaire. Qualitative answers about the ways of reducing stress were also obtained using the questionnaire.

RESULTS

Medical education was considered to be excessively stressful by 265 (55.1%) students. The most common themes expressed for reducing the stress of medical education included those of "less frequent exams," "more spare time," and "slowing the pace of study or reducing syllabuses."

CONCLUSION

Majority of students considered medical training to be stressful and curricular overload is an important reason for the same.

Treatment and re/habilitation of children with cerebral palsy in India: a scoping review

AIM

To describe the nature and extent of the literature addressing the medical and its re/habilitative management of cerebral palsy (CP) in India.

METHOD

Online worldwide scholarly databases, research hosting directories, Indian publishing houses, and grey literature were used to identify papers published between 2005 and 2016. We retrieved 144 English language papers that described the medical and rehabilitative management of Indian children with CP.

RESULTS

Quantitative, qualitative, and mixed research designs are published by a variety of health care professionals in India. Intervention (45%) and observational studies (30%) predominate. Outcomes were categorized using the World Health Organization's International Classification of Functioning, Disability and Health framework, with body structure and function most reported and activity/participation least reported; 57% described its re/habilitation interventions and 43% were medical interventions.

INTERPRETATION

There is a substantial body of CP research in India that focuses on interventions to reduce impairments, with minimal attention given to activities and participation, environmental, and personal factors. Twenty-six per cent of studies are published in what appear to be 'predatory journals'. This paper serves as an alert about the presence of 'predatory journals' in medicine that may introduce publication bias, which can distort results reported in those studies individually, or from conclusions drawn in reviews that contain those studies.

WHAT THIS PAPER ADDS

Cerebral palsy research in India focuses on interventions to reduce impairment. Activities, participation, and environmental factors are minimally addressed. Quantitative studies are more common than qualitative studies. Many Indian studies are published in journals that are not indexed in worldwide databases of scholarly journals.

Overcoming Barriers in a Traditional Medical Education System by the Stepwise, Evidence-Based Introduction of a Modern Learning Technology

INTRODUCTION

Histology teaching in India and in other developing countries has not changed much over the past decades and has not joined the global movement of using virtual microscopy (VM). Many factors may have contributed to this academic inertia-including curricular requirements for traditional microscopy (TM) skills, assessments that are heavily based on TM, and unfamiliarity with modern technology among faculty, as well as infrastructural shortcomings. This study is aimed at overcoming these roadblocks by using a blended approach combining VM with TM in a tradition-centered curricular setting.

METHODS

For validation of this approach, the authors conducted a non-randomized controlled trial with a crossover design on first year medical students at the Government Medical College, Thiruvananthapuram, India. Examination scores and responses of a student group taught with VM as an adjunct to TM were compared with a student group taught with TM only.

RESULTS

The test group had significantly better results when compared to the control group for knowledge-based tests (p = 0.012; analysis of co-variance) and for an unannounced visual-based test conducted 1 month later (p = 0.001; Mann-Whitney U test). Feedback collected from students showed highly favorable responses to the use of VM for teaching histology.

CONCLUSION

This study should encourage Indian medical colleges and schools in other developing countries to start using VM as a supplementary approach for their histology education programs. Furthermore, as the Medical Council of India recommends the introduction of new competency-based integrated curriculum in India starting in 2019, the use of VM may facilitate more effective learning in the new scenario.

TRIAL REGISTRATION

CTRI/2018/04/012928.

Perspectives on rehabilitation of children with cerebral palsy: exploring a cross-cultural view of parents from India and Canada using the international classification of functioning, disability and health

PURPOSE

To explore parents' perspectives on rehabilitation of their child with cerebral palsy and their information needs.

METHODS

Semistructured interviews were conducted with parents of children with CP from India (n = 11) and Canada (n = 7). Data were analyzed through an interpretive description approach using the International Classification of Functioning, Disability and Health framework.

RESULTS

Body Structure and Function: Indian parents were more focused on fixing body structure and function challenges, and independent walking, than Canadian parents. Activity and Participation: All Canadian children were actively involved in school and fun activities in the community. Due to lack of accessible services, Indian children had less school and community participation. Environmental factors: accessible communities, occupational therapy services and greater use of assistive devices enabled Canadian children. Social and cultural beliefs, lack of access to services and inaccessible communities were the barriers experienced by Indian parents. Information needs: both groups needed information to make their child more functional.

CONCLUSION

Canadian parents experience a more enabling environment and express a more social view of their child's health, suggesting both education on the International Classification of Functioning, Disability and Health principles and services are needed to better enable and empower Indian parents. There remains a need for healthcare professionals and services in both countries to be more family-centered. Implications for rehabilitation To help parents in rehabilitating their children with cerebral palsy (CP), in India, there is a need to (1) incorporate ICF education into medical curricula and clinical practice; (2) increase the availability of skilled healthcare professionals and centers; (3) make infrastructural and policy reforms to make the society more accessible for the disabled children. Education, counseling and awareness about CP might help both groups of parents, society, and HCPs to change their beliefs and attitudes regarding CP and its rehabilitation. Both countries would benefit from user-friendly and transparent policies. This will help parents to become more aware of them and use them in the rehabilitation process.

Producing Competent Doctors - The Art and Science of Teaching Clinical Skills

For a doctor to provide medical care with competence, he must not only have knowledge but must also be able to translate that knowledge into action. It is his competence in clinical skills that will enable him to practice safely and effectively in the real world. To ensure acquisition of clinical skills, medical teachers must adopt teaching methods that prioritise observation, practice, feedback; and more practice. We try to elucidate the meaning of clinical skills, the challenges inherent in clinical skills training in India, training models that have shown success in practice and can be adopted in the Indian context, and various techniques to enhance skill-training, including the giving of feedback, which is a critically important component of skills development.