Medical Council of India's new guidelines on admission of persons with specified disabilities: Unfair, discriminatory and unlawful

The Medical Council of India (MCI)’s recent guidelines on admission of persons with specified disabilities into the medical course under the disability quota has escalated into a huge controversy. Multiple litigations have been initiated against MCI by successful National Eligibility cum Entrance Test candidates with disabilities across the country. In light of our new Rights of Persons with Disabilities Act, 2016, and the United Nations Convention on the Rights of Persons with Disabilities, I argue in this essay that these guidelines are unfair, discriminatory and unlawful. I quote Supreme Court judgments on reasonable accommodation, equality and discrimination and highlight the exclusion of doctors with disabilities in policy making.

Reflective student narratives: honing professionalism and empathy

The affective domain is not explicitly targeted during medical studies and poor skills in this domain may lead to conflict when dealing with patients. Reflective narratives are said to promote humanitarianism and professional development. We aimed to examine reflective narratives written by medical students in our institution for content relating to ethical and professional Attitude and Behaviour, Communication, respect for Diversity and Disability, and Empathy (the ABCDE paradigm). We were also interested in understanding how far the students enjoyed learning through the writing of narratives and in determining their perceived learning from the exercise. Volunteer medical students were introduced to Gibbs’ reflective cycle during a half-day workshop. After giving written informed consent, they submitted anonymous reflective narratives (online), based on an interaction that they witnessed between a patient and a doctor/student. The authors performed directed content analysis of the submissions, using predetermined codes pertaining to ABCDE. At the end of the study, the participants sent in their feedback through a questionnaire on the process and the learning acquired, if any. Twenty-six students volunteered and 15 narratives were submitted. The issues that had been identified were discussed with the students. Feedback was submitted by 12 students, who strongly felt that the writing of narratives enhanced learning about ethics, professionalism, communication, diversity and empathy. We conclude that reflective student narratives are a useful and enjoyable way of teaching students about issues in the affective domain that are not conventionally taught

Reintroducing differences linguistically.

Different models have defined the term disability and grouped persons with disabilities accordingly. Time and again, various terms and phrases have been used in different languages to identity persons according to the differences in their bodies and the level of functioning of those bodies. Analogies and metaphors create stereotypes and can affect the formation of an individual’s self-concept. Clichés like “divyang”, ie one who has some divine powers to compensate for the deficiency in the body, based on the supercrip theory of disability, can distort the self-concept and hamper identity formation. Society and the state cannot and must not shrug off their responsibility by using such sugar-coated terms to label individuals. The real requirement is the creation of a nondisabling environment and the provision of equal opportunities to those with disabilities rather than coining of new terms.

Motivation and preparedness of first semester medical students for a career in medicine.

Purpose : To determine motivation of medical students towards a medical career, and their knowledge of and preparation for it. Methods : After ethical committee approval, students admitted in 2009, who volunteered, were administered an anonymous questionnaire. Descriptive analysis was done. Results : Of 150 students admitted, 103 (68.7%) submitted completed questionnaires. Fifty-seven students (55%) got admission after ≥2 attempts; 65 (63%) decided on a medical career before class ten. Accurate knowledge about the curriculum was poor even though many had a family member in the health field and were encouraged to take up medicine. Only half had sought guidance from a medical person; most had never undergone career preparation activity. Conclusion : Students are early deciders and highly motivated to join medicine. Family is a strong motivator and could encourage career preparation activities. Policy makers could design interventions to inform school students before they make the critical decision to join medicine.

Theatre of the Oppressed in medical humanities education: the road less travelled.

Internationally, there is an increasing awareness of the need to include humanities in the medical curriculum. The Medical Humanities Group at the University College of Medical Sciences, Delhi, organised a series of events to explore this area. This paper describes our experience with Augusto Boal’s “Theatre of the Oppressed” (TO).

Why does an undergraduate student choose medicine as a career.

Background. There are more than 44 000 seats in over 350 medical colleges in India for pursuing the MBBS course. This is not enough as we have only 1 doctor for as many as 1953 persons in India. Yet, medicine is not among the top vocations in most career advisories and the best school students do not aspire to be doctors. Methods. This cross-sectional study was done at a tertiary care, teaching hospital in March 2010. Medical students in their second semester were asked to fill an indigenously designed, structured questionnaire, looking at their reasons for joining the course, interpersonal relationships, satisfaction with the curriculum and future prospects following graduation. Results. The mean (SD) age of the students was 19.2 (0.85) years. Of the 100 students of second semester, 41 had been influenced by a family member in choosing their career. Twelve felt that medicine would give them a chance to serve the society. Forty-six students felt that the expectations they had from the course before joining were not being fulfilled. Nearly one-third of the students (31) stated that they would not choose medicine as a career if given another chance. Further, 19 said that they would still choose a different profession after completing their graduation. Non-fulfilment of expectations from the course was associated with the belief that they would not opt for this course if given a second chance (likelihood ratio 7.12, p=0.008). Students felt that teaching should lay stress on problem-based learning including workshops on stress and time management. Conclusion. We find that several students do not have a defined career plan and opt for a career in medicine because they are influenced by family members. Some students were dissatisfied with the curriculum and expressed that they would not like to pursue the course if given a second chance.

Validity of visual evoked response in measuring ethambutol induced optic neuritis in tuberculosis patients: Evaluation using receiver operating characteristic [ROC] curves

Significant vision loss can occur during treatment with Ethambutol [EB] in tuberculosis [TB] patients. Visual Evoked Response [VER] is often used to detect this subclinical visual impairment even before the appearance of symptoms. We assessed the usefulness of three VER parameters- P[100] latency, amplitude and interocular difference for the early diagnosis of ethambutol-induced optic neuritis [ON]. This study was carried out on 60 newly diagnosed adult cases of tuberculosis aged between 20-50 years who were randomly assigned into two groups of 30 each. Nonparametric Receiver Operating Characteristic [ROC] analysis was used to evaluate the validity of VER indexes. At a cut-off pint of 116 ms sensitivity for the diagnosis of ON was 77.8% and specificity was 81.1%. Results of the application of Bayes's theorem showed that 87% of the patients scoring 116 ms or higher would actually have ethambutol-induced ON and 99% of those scoring less than 116 ms would not have ON. The best area under curve [AUC] for ROCs, an index of diagnosing accuracy, was 0.91 for P[100] latency, suggesting very good accuracy. The results suggest that P[100] latency gives the best results for ON screening in ethambutol treated patients. Amplitude and interocular difference were reasonable alternatives. Measurement of P[100] latency of VER is a valuable tool which can be used more easily than clinical examination in detecting subclinical ethambutol-induced ON

Efficacy of PS-VEPS in the detection of subclinical optic neuritis following ethambutol in therapeutic dosage

Ethambutol is an antimicrobial agent used frequently to treat tuberculosis. The most commonly recognized toxic effect of ethambutol is optic neuropathy, which may sometime result in irreversible vision loss. However, early recognition not only prevents this complication, it also increases compliance of the drug. This study was carried out to assess the usefulness of pattern-shift visual evoked potentials [PS-VEPs] in the detection of sub clinical optic neuropathy in patients on ethambutol for the treatment of tuberculosis in the recommended dosage. 30 consecutive patients of tuberculosis were studied before and after two months of ethambutol therapy. Ethambutol was administered in the WHO recommended dosage of 15mg/kg of body weight. All the patients underwent pattern shift visual evoked potential tests, which check the function of the visual pathway from the retina to the occipital cortex. PS-VEP abnormalities were seen in 5 patients [16.7%],out of which prolonged latency was documented in 3 patients [10%],increased latency difference was seen in 1 patient [3.3%] and abnormal amplitude difference was reported in 1 patient [3.3%].Associated psychophysical abnormalities of visual acuity in 2 patients [6.7%] and color vision abnormality in 1 patient [3.3%] were also seen. Our study confirms that during the treatment with ethambutol, PS-VEPs may reveal a surprisingly high percentage of sub clinical optic neuritis even at dosages considered to be safe. This needs attention in terms of patient care and drug compliance