A proposal to create new models of medical education to better serve the health care needs in India.
Vinay Kumar, MBBS, MD, FRCPath, Professor and Chairman Department of Pathology and Executive Vice Dean of Biologic Sciences Division, and Pritzer Medical School, The University of Chicago*
- The practice of medicine requires the synthesis of a vast amount of information, yet in the traditional medical school curriculum the information is provided in disconnected pieces and out of clinical context hence we need an integrated curriculum
- There is continuing explosion in new knowledge (genomics, personalized medicine). How should we harness this for improving human health? We have to incorporate modern biology in the training of every physician inIndia.
- The traditional method of medical education (with few exceptions) is based on passive learning (“cramming of lectures”) that has not changed much in the past 50 years. We have to transition to active learning in which the student gathers majority of the facts himself/herself and learns to apply the knowledge so obtained in solving clinical problems. Thus the medical education has to change in a manner that promotes active learning
- One method to accomplish the above is to create a standardized competency driven and case based method of medical education that can be delivered to every medical student, rich or poor, urban or rural by electronic methods. This can make the playing field level for students in elite, well resourced medical schools and provincial, often resource poor medical schools
- Important in the design of the case based curriculum will be integration of basic sciences to the practice of medicine so that the goal of personalized medicine is embedded in the training of future physicians ofIndia
- In keeping with the philosophy of active learning the system of examination has to change from its current focus on testing “facts” to testing “competencies” in the application knowledge. A system in which the end point is acquisition and measurement of competencies does not impose any single method for acquisition of such competencies, but provides flexibility to utilize a variety of teaching methodologies/models to attain the competencies
While the principles of such a curriculum are universal, the clinical context will vary, hence this will require at first a national forum to debate and to develop a core set of competencies and related objectives that will drive the development of the curriculum that is suited.
After teaching for 23 years by the traditional method, in 1995, as the Associate Dean for Medical Education at Universityof Texasthe author along with his colleagues completely reorganized the teaching of pathology. After an 18 month effort by 12 professors we created an active, objective driven, case-based teaching model. In the process 100 electronic cases of common diseases were developed as the substrate for teaching pathology and medicine.
Each case has learning objectives, reading resources, a clinical history and images (Pathology, radiology, molecular biology) and serves as an electronic, interactive self learning tool. Because of requests from colleagues at other US,European and Australian institutions these cases are now available (on line) as part of the two text books mentioned below. Currently, the author along with a team of educators and software designers is developing additional models for use globally. Information on one such a model called the i-Human platform can be found at www.i-Human.com.
This model can be adapted for use in India in the context of local health care issues. In parallel an IT infrastructure required to deliver the curriculum would have to be developed. Given the penetration of internet, the delivery of the content via the National Knowledge Network will be a lesser challenge than the development of the curriculum and creation of tools to measure its impact. A system to train the educators who will have to deliver such a curriculum would have to be part and parcel of the program.
Dr. Vinay Kumar is the senior editor and author of Robbins Pathologic Basis of Disease, and Robbins Basic Pathology. These are the mostly widely used textbooks in Medicine. He is widely consulted by US medical institutions and American Association of Medical Colleges to define competencies for medical education.