Regulatory system to promote the culture of quality at Indian medical schools: Are we doing enough?

The replacement of the Medical Council of India (MCI) with the National Medical Commission (NMC) was an important change in regulatory oversight to bring about transparency in regulatory procedures for improving quality of medical education and meeting the needs of healthcare in India. Similarly, due to globalization of medicine including migration of health workforce and desire to raise standards of medical education and healthcare, efforts have progressed well towards transnational regulation and establishment of an overarching body, which recognizes regulatory agencies for their adherence to good practices. We describe the global collaborative efforts to improve the quality of medical education by the promotion of accreditation through the recognition programme of the World Federation of Medical Education (WFME), the publication of the expert consensus standards across the continuum of medical education and the Guidelines for Accreditation of Basic Medical Education. We also highlight that many medical schools across the world have adopted the WFME standards and many regulatory and accrediting agencies have achieved recognition status. Based on appraisal of the NMC Act and notification on minimum standard requirements (MSRs) for medical colleges, we point out the gaps between the intent stated in the preamble of the NMC Act and the notification on MSRs. We recommend a way forward to develop a regulatory model and approaches that match NMC’s stated intent and meet the requirement for medical schools in India to gain international recognition.

Early clinical exposure through innovative interactive clinical anatomy lectures.

Background. Traditional lecture-based teaching of anatomy tends to focus on the discipline per se rather than relating it to clinical conditions. As a result, students often lose interest in the basic sciences. We hypothesized that a lecture format that encourages students to relate anatomy to case presentations might help them in appreciating clinical relevance. We therefore proposed to develop, implement and evaluate innovative interactive clinical anatomy lectures (ICALs) for first year medical students of our institution as a method to implement the ‘early clinical exposure’ teaching strategy being promoted by the Medical Council of India. Methods. The first year medical students (n=150) were divided into two groups by lottery: the study group (n=75) and the control group (n=75). The study group received nine ICALs along with traditional gross anatomy lectures (TGL) and dissection. The control group received only TGL along with dissection. A post-test in clinical anatomy was conducted for both groups. The responses of the study group on TGL and ICALs on their learning and understanding of the clinical conditions were collected using the nominal group technique. Results and conclusion. It is feasible to introduce early clinical exposure within lectures even with 150 students. There was a statistically significant (p<0.001) difference in the mean post-test scores of the two groups, which shows that ICALs are effective in correlating anatomical and clinical information to students. The nominal group technique responses of the study group showed that they appreciated it as a better method of teaching and learning. Natl Med J India 2015;28:291–4

Association between Smoking and Body Mass Index among Males Aged 20 Years and Above - A Study in Rural Tamil Nadu, South India.

Objective: To investigate the relationship between smoking status and Body Mass Index (BMI) in men aged 20 years and above. Methods: A cross sectional study was conducted in the rural field practice area of Department of Community Medicine, PSG Institute of Medical Science and Research, Coimbatore during June and July 2010. A total of 459 men aged 20 years and above were included in the study. Statistical analyses were done using General Linear Model procedure of SPSS. Results: Cigarette smokers weighed (Kg) less, p<0.01 (age adjusted mean ± standard error = 58.64 ± 0.44) and were leaner, p<0.001 [age adjusted mean BMI (kg/m2) ± standard error = 21.13 ± 0.13] than ex/non-smokers (61.11 ± 0.69 and 22.19 ± 0.2 respectively). Regarding the intensity of smoking and BMI, light smokers (1 to 20 cigarettes per day) were leaner than ex/non smokers (mean ± standard error were 21.13 ± 0.13, 22.19 ± 0.208 respectively, p< 0.001). Regarding the duration of smoking and BMI, a linear diminution in BMI is observed with increasing duration of cigarettes smoking compared to ex/non smokers (mean ± standard error of BMI) for ex/non smokers 22.19 ± 0.208, 1 to 10 years of smoking 21.56 ± 0.221(p<0.05); 11 to 20 years of smoking 21.23 ± 0.256 (p<0.01); 21 to 30 years of smoking 20.30 ± 0.333 (p<0.001); 30 and above years of smoking 20.07 ± 0.501(p<0.001). Conclusion: We found significant results confirming an association between cigarette smoking and lower BMI in men.

Developing a Learning Need Assessment Tool (LNAT) to Teach Epidemiology for Medical Students.

Background: The Department of Community Medicine of PSG Institute of Medical Sciences and Research has been training the medical students to become competent community physicians for improving Community Health. Epidemiology is the subject within community medicine which teaches them the principles of medical research. Objective: This study intends to develop a tool to identify the student learning needs in learning Epidemiology and thereby improves their learning by bridging the knowledge and competency gaps through reinforcing sessions and also to measure the learning outcome using the same tool after the reinforcing sessions. What was done?: LNAT was developed using a matrix which lists cognitive domains and practical skills in Epidemiology and the level of understanding and competency were measured using this matrix containing John P Reiling and G.E Millers Framework on assessment of learning. This Learning Need Assessment Tool was administered to 71 students in Final MBBS Part 1 phase over a period of 3 months. Pre and post self-assessment data were analyzed and proportions were calculated. Results: There was student per-ceived improvement in cognitive domains and computing skills in various measurements used in Epidemiology. Conclusion: This LNAT on Epidemiology identified the gaps and also the learning needs of UG medical students through pre test. The Post test enabled the teacher to measure the change in learning need after the completion of reinforcing epidemiology classes using the LNAT.

Dynamics of listserv discussion on educational research.

Background: PSG –FAIMER Regional Institute Listserv generates discussions among faculty, fellows and scholars working and interested in the field of Medical education research. The online programme is designed to teach educational method, professional networking and leadership skills to promote development of professional relationship among participants. Method: In the month long discussions on Educational research, 306 mails were exchanged and various topics were discussed. The process involved presenting content and questions in an academic manner, focusing discussions, establishing knowledge by articles and web sources and responding to technical concerns. Results: During the process of the discussions, participants expressed that they were enjoying the sessions and were richly rewarded in terms of knowledge transfer about Educational Research. Originality/value: Online forums are great sources to exchange and learn information on Medical education for busy practitioners and medical teachers. Conclusion: Online discussions are conducive in continuing medical education programmes.

Time travel: a discovery tool for identifying individual professional development needs.

After formal qualification, most practicing doctors try to update themselves to keep abreast with new knowledge and practice through periodic Continuing Medical Education (CME) programs. However, as opposed to CME which is teacher driven and only updates clinical knowledge, there is need for promoting Continuous Professional Development (CPD) which is individual learner driven based on individual learning needs and embraces developing and improving a broad range of skills and competencies necessary for improved medical practice. There is evidence from literature which shows that doctors become more motivated to learn and achieve required CPD goals when they discover their own CPD learning needs, plan their own CPD activities, do deliberate practice and receive feedback for improvement in practice at their own pace. This increased motivation is explained by the Need reduction theory. The Need reduction theory can be put to practice by doing a needs assessment (discrepancy analysis) which identifies the gap between “what is” and “what ought to be” (Fox & Miner,1999).