Teaching professional values in medical education.

One of the foremost concerns of the medical profession today is ‘lack of professionalism’. Professionalism deals with professional conduct. It is defined as ‘the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and community being served.’1 The medical profession, which enjoyed a large amount of trust and goodwill in the past, has, to an extent, lost its credibility. There is growing mistrust between physicians and patients. Many factors have contributed to this and include market forces, which have led to the commercialization of medical education; the emergence of high-end technologies; a nexus between the medical industry and practitioners for earning money; growing consumer awareness; increasing litigation; the proneness to error that is inherent in medicine; and the stiff competition among members of the profession.2,3 Medical schools in different parts of the world have addressed this issue as part of curriculum reform. The Accreditation Council for Graduate Medical Education (ACGME) in the USA has listed ‘professionalism’ as one of the core competencies. While there is abundant international literature on professionalism,4–11 there have been few deliberations in the context of Indian medical education.12,13 An article on ‘Teaching and assessing professionalism in the Indian context’ is perhaps one of the most comprehensive discussions, besides the proceedings of a National Consultation at Karamsad, Gujarat in April 2013 and a meeting of Global Indian Doctors at Kolkata, West Bengal in January 2014.14 In this article, I propose that the Bhagavad Gita (in brief, Gita), an ancient Indian epic, provides some insights on the teaching of professional values in medical education. Keeping in view the challenges involved in teaching professionalism, I suggest that we can draw relevant lessons from the Gita and the practice of yoga as these are the source of a holistic model for inculcating professional values among the medical faculty and students. It is increasingly being recognized that the Gita does not belong to a particular religion, but is the repository of a universal wisdom that belongs to the entire humanity.

Structured internship orientation programme for undergraduate students: Easy transition to clinical work.

Background. Internship is a phase of training when a new graduate is expected to acquire skills under supervision, so that he/she may become capable of functioning independently. Often, new graduates go through this period without a clear aim. We conducted an orientation programme before fresh graduates started their 1-year internship to familiarize them with their clinical tasks and their role in the community. Methods. Interns were invited to participate in a one-anda- half day programme conducted by faculty members and administrators that included interactive lectures, structured panel discussions, group discussions and role plays. The participants provided feedback using a structured questionnaire and during informal group discussions. They were also evaluated by a pre-test and post-test questionnaire. Results. Of the 41 interns who attended the programme on day 1 and the 28 who completed it on day 2, 19 completed the post-test questionnaire. The post-test score (median 14.5; range 10–18) represented a significant improvement over the pre-test score (median 13, range 3–16). All participants felt that the workshop was successful in achieving its objectives. Conclusion. A brief and structured orientation programme before internship offers a practical means of making the transition of new graduates from students to practising doctors smoother.

Faculty development and medical education units in India: A survey.

Background. Faculty development in medical education is gaining momentum in India. While planning a National Conference on Medical Education (NCME 2007), we did a survey of principals and faculty of medical colleges to understand the status of faculty development programmes and medical education units in medical colleges in India. Methods. Questionnaires were sent to principals of medical colleges by surface mail and to faculty through a web-based programme to elicit information on various aspects of faculty development programmes and medical education units. The responses of both groups were analysed. Results. The number of medical education units has increased rapidly after regulations have been revised in 1997 by the Medical Council of India. The main activities of medical education units were to conduct workshops targeted at medical teachers. The frequently covered topics were teaching–learning, media and student assessment. Lectures dominated the methodology of imparting information. Evaluation was done mainly by feedback questionnaires and pre-test/post-test questionnaires. Projects and follow up were rarely used. The responses from both groups were strikingly similar. The major strengths of medical education units were perceived as availability of trained and motivated faculty, good infrastructure and supportive leadership. The shortcomings were lack of infrastructure, funding and full-time faculty, besides time constraints and resistance to change. The respondents suggested strengthening of infrastructure, appointment of full-time faculty and staff, incentives and recognition of contributions to faculty development, making participation a mandatory requirement, extending the scope of faculty development programmes to include research and networking at the national level. Conclusion. The study reveals the need for policy decisions that support functioning of medical education units in India besides active participation of the faculty.

Inquiry-driven strategies for innovation in medical education: experiences in India.

Four medical institutes, viz, AIIMS, New Delhi; CMC, Vellore; JIPMER, Pondicherry and IMS-BHU, Varanasi formed a consortium to introduce reforms in undergraduate medical education. A detailed inquiry was conducted by administering questionnaires to the faculty, recent graduates and patients to identify the deficiencies in the present system. Morbidity patterns prevalent in the community at primary, secondary and tertiary care levels were determined. These were matched with the actual curricula being followed and the assessment patterns. The main findings were: inadequate emphasis on practical skills (including communication), insufficient coverage of common diseases; and neglect of behavioral, social and ethical aspects in the curriculum. Based on these findings certain corrective programmes are being introduced. The content areas in the curriculum have been classified in to 'must know', 'good to know' and 'need not know'. A list of essential skills have been identified. Steps are on to ensure that these skills are acquired by the graduates. A modular approach to the teaching was suggested and modules on some of these topics are under preparation.

Need-based undergraduate medical curriculum.

There is a growing concern over the quality of medical education for undergraduates in India. This paper is an attempt to define a need-based curriculum and outline the initiatives taken by the Medical Council of India (M.C.I.) in developing a need-based curriculum. The steps include: clear delineation of goals and objectives of education; adoption of innovative teaching and learning methodology, adjustments in the course structure, updating of course content, rationalizing assessment strategy, and emphasis on structured and skill oriented internship. For effective implementation of these measures, strategies such as establishment of Medical Education Unites (MEUs), visible funding of education, more recognition to teaching and impetus to staff development activities have been suggested.

Multiple choice questions: how to construct and how to evaluate?

Multiple choice questions have come to occupy a prominent place in the evaluation system of medical education. However the framing of multiple choice questions and their effective use need further clarification in the Indian context. This paper outlines some of the steps that may be adopted for streamlining the preparation and administration of a multiple choice test and their scoring. A few tips have been given for getting the best from the candidates in a multiple choice examination. Lastly institutional mechanisms for developing MCQ bank have been suggested.