In part of the four-and-a-half year’s of Bachelor of Medicine and Bachelor of Surgery (MBBS) programme and a year’s internship, the main thrust areas include medicine, surgery, gynaecology, paediatric, psychiatric, forensic medicine and toxicology and ophthalmology. Experts talk about the heights the medical profession has reached and those to be accomplished in the near future.
Genetics, biotechnology and pharmaceutical sciences are the emerging disciplines of medicine. The availability of dedicated manpower in these disciplines and also the number of institutions that are capable of meeting the technical demand, make India an attractive destination. Many of the basic research issues for the Indian population remain unexplored. There is a great opportunity for budding researchers and scientists in India.“In the medical curriculum, one should emphasise on practical applications and interpretation of investigations to make the right diagnosis. Emphasis should be on problem-solving based on investigation data and not on clinical data, as practiced for decades,’’ said Dr Anoop Misra, director and head, department of diabetes and metabolic disorders, Fortis Group of Hospitals.
He further said, “Apart from the frontline areas of research, p u b l i c health is an area that has been ignored by policy-makers and teachers of medicine, and even for students it is the lowest priority. The programmes of top public health importance such as Pulse Polio Programme, National Programme for Containment of HIV Epidemic, and the National Diabetes Control Programme cannot run successfully without adequately trained professionals in public health.”
Use of technology in surgery can make it more perfect, so medical professionals are insisting on incorporating such changes in the curriculum. “We need to train our medical students video-technology skills in terms of eye and hand co-ordination, perception of depth, orientation to the magnified anatomy and the assessment of the blood loss during the operating procedure.The robotic surgery is also one of the newest trends in the laproscopic surgery especially done for the radical prostrate anatomy,” said Dr M C Misra, head, division of minimally invasive surgery and in-charge of breast cancer clinic, AIIMS. He added,“There have been path-breaking laproscopic surgeries in liver, thyroid, intestine, esophagus, kidney, pancreas, spleen and rectum. In addition, there have been various techniques developed for the vascular interventions transplant and intra-uterine therapy — all these should be included in the MBBS curriculum.”
In ENT, autology is an upcoming area of specialisation. Dr J M Hans, senior ENT specialist and head of unit, Ram Manohar Lohia (RML) hospital, said: “We need to offer MCh in autology to make medicos retina specialists. Specialised operation theatres should be developed for conducting such surgeries.” An expert in cochlear implantation, Dr Hans, further added:“The other new areas are head and neck cancer surgery, hearing assessment techniques, functional endoscopic series surgery in nose, and cochlear implantation.” With two-third of the infant mortality cases in India comprising neonatal mortality, doctors say that there is an urgent need for training postgraduate students in neonatology.“We have large number of neonates but not the requisite infrastructure and equipment to teach students in the neonatal care including label three ventilation, arterial catheterisation, partial parental and nutritional care and neonatal surgery. At least 25% of the curriculum should comprise neonatology including evaluation,” said Dr A K Dutta, director, Kalawati Saran Hospital and head, paediatrics, Lady Hardinge Medical College and Hospital.
ADVICE TO BUDDING DOCTORS
- Skill and knowledge
- Mental agility
- Human touch and compassion
- Hard work and sincerity.
- Observe patients with keen interest
- Discuss one-off cases with seniors
- Devote hours in research
- Read international journals
- Stay updated with the latest developments in the field.
ON PAR WITH WEST
Dr Dutta said, “The theoretical knowledge of our students are far better than those in the West. And no other country in the world has the variety of patients as we have. Medical students from US and UK have been visiting our hospitals to get a handson experience and to brush up their medical skills by assisting our doctors. We need to address the basic problem of management and we would be far better than the West in all respects.” He added, “There should be a balance of pre and para-clinical teaching in the curriculum. It should be management-oriented with more hands-on experience and observation.”
While Dr Anoop Misra felt that the curriculum should be tailored as per the needs of the country.“Curriculum particularly for clinical subjects should not be compared between US and India as the needs are different in the two countries. Our medical teachers have more clinical experience and they see more number of patients and disease than a clinician sees in the West. Many of them are excellent teachers as well. However, because of paucity of time, comprehensiveness takes a backseat.”
Psychiatry is another important area of concern especially in a country with a population of one billion,where 2% suffers from serious mental morbidness and 5% have common mental disorder and there are only 3,500 psychiatrists and 600 psychologists to treat them. “We are far behind from the West. We need to modernise the mental hospitals and upgrade the psychiatry wings of the government colleges to standardise our mental health service,” said Dr Rajesh Sagar, associate professor, department of psychiatry, AIIMS. He further stressed that excellence would be achieved with more exposure to clinical teaching and demonstration.
Dr Renu Misra, senior consultant, gynaecology, Sitaram Bhartia and Mool Chand Hospital, commenting on her area, said: “There have been a series of developments in HIV, STDs and tuberculosis with a variety of patients pouring in and new medical alternatives to control them.” Counselling and patient guidance are areas both corporate and government hospitals are trying to take up seriously. “Developing communication skills is extremely important, especially to handle cases of medical negligence,” opined Dr M C Misra.