Dr Kiran welcoming everyone to the present post

This time, I am not writing any story or scenario.

I happened to read something about the creativity and medical education recently and got pained a lot.

Just sharing my feelings with the readership. Please comment. Use the comments box or my email drkiranvs@gmail.com

Please go through and discuss:

MEDICAL FEST A.L.A. IIT FESTS

“Give them any challenge and they are ready to do it” was the compliment given by my erstwhile Boss. She was talking of the IT professionals she has hired for her new IT venture. The glow and pride in her eyes was very evident. “They are too good. There is something in them that is not in….” the continuity was lost as if something stuck and topic was deliberately shifted to something else. I did not miss the point. I could complete the half done sentence. We are trying to dodge the unpleasant and that is not the way life goes.

Yes, it is true that the creative energies of everyone in the world is appreciated other than doctors. In the recent issue of Indian Pediatrics, Dr Gauri Rao Passi had rightly pointed one thing. He was talking of the IIT fest and all the new ideas that got a material form and displayed with pride in the fest. It stood as the testimony of the creative and lateral thinking of the bright student community of future engineers. In entire lifetime, can anyone recall a similar medical fest? All the non-academic happenings of medical college are limited to a cultural event with Anthaksharis ruling the roost.

Where exactly the things went wrong? Till 12th std, all the students of science stream go through the same process of learning. By and large, best of these brains enter the medical field. (It was atleast true till the IT boom) After that? We see the engineering students creating their own satellite launched by ISRO, we see the law students representing the country in international law fests, we see the architecture students winning applauds in international forums for their creative designs and so on. What about medical students? The maximum I can recall any medical student achieving is a prize in an essay writing competition. What happened to those “Best of brains”?

Have you ever been encouraged to do some lateral thinking during your basic MBBS training? Were you ever confident of uttering a novel idea that might have come to your mind? Did you anytime feel some lacuna in the medical curriculum and wanted to desperately modify something? How many times could you do all these in a state of fearlessness?

There are lots of reasons for a decline in the creative thinking in medical student community. Lot of it is realized only on a retrospect. The teachers who teach the basic medical sciences are usually discarded ones. Most of them chose to stick to basic sciences because they did not get a clinical subject for their post-graduation. Their frustration is usually evident. I have seen PGs of basic sciences who tried yearly PG entrance exam throughout their 3 year PG course in the hope of getting a “better subject”. They never concentrated enough on their own subject during the most important formative years of their post-graduation. How would you expect such people to become good and inspiring teachers for the younger lot?

In the paramedical field, the good brains usually have a “good” attachment! A really good pathologist or microbiologist would concentrate more on developing their lab practice than teaching. But, the relative numbers of “better” people are certainly higher than in basic sciences.

By the time a student of MBBS reached the final year, the phobia of exams would surround to such an extent that it is blasphemous to think of anything other than the text book. Although really inspiring teachers may exist, the vision of a final year medical student fails to acknowledge it. For most of the students, a mediocre teacher who can consistently rant out the “Exam questions” or “Viva questions” is a bigger hero than the person who can teach with a systematic and scientific methodology.

In the entire period of MBBS, almost every student finds it difficult to accommodate to the consistently changing subjects, curriculum, teaching, preparation for didactic sessions, written and photocopied “notes” and so on. There is practically no one to encourage the creative thinking. By the time students reach a teacher with a creative bent, their mould would not let them move out of the self/system created boundaries.

Examination in the Indian medical education is no less than a horror. It is time for the students to recall how good or bad they were! It is time for the examiners to take revenge or reward the loyalty. Money, influence, good behavior, non-controversial nature etc find a larger place than the actual talent of the candidate. Passing in the final exam is such a big relief even for a consistent hard worker who knew their stuff well. By this time, their lesser intelligent friend in any non-medical professional field would have got his degree and a handsome 6-digit salary and a vehicle.

MBBS marks the end of a beginning. The actual ordeal starts from now. People with enough money can buy any subject of their choice in a private medical college. What was earlier in lakhs has reached crores now. People with influence can get direct seats from the biggies. Next best would be getting question papers of entrance exams for a price. The nexus is strong and powerful and in India, it takes a CBI enquiry to break the code! The other way is to move through your caste. If anyone can prove that they belong to the caste that government considers as backward, irrespective of any other factor, position or assets, the PG seat belongs to them for free. I have personally seen PG students who obtained their seat by reservation coming to the hospital in a Mercedes. Added to this, the nexus of fake caste certificates is probably impossible for even CBI to crack!!

However, the lesser mortals with no money or influence or reservations will have to go through the hard way. They have to take a “break” of couple of years in prime of their life after MBBS to “prepare” for the PG entrance exams. In this period, one has to sustain on the income of their parents or should do very low paying jobs of a “duty doctor”, which is actually a glorified clerkship in a private hospital. They fill exam forms of almost all entrance exams of the country, travel to the exam centre by a third class sleeper coach (which the Indian railways call second class), stay in cheapest of places to save money, eat roadside as they cannot afford high prices of restaurants and write exams for a handful of PG seats. The competition would be something like 700 doctors for each PG seat! With every successive year’s failure, the potential competition increases, as a new batch of MBBS pass outs would have arrived.

With all these difficulties, few get successful in acquiring a PG seat. Most of the doctors would not achieve the subject they always liked and loved. They end up in such a state that they would take the course which they detested from their core! Still, the life should go on. How long can you feed yourself with the parental earnings? How long would you keep answering the relatives who were jealous of your academic success few years back, but are very happy with you now that you are struggling and their otherwise low-performer son is earning 5-digits a month in a call centre or an IT company? It is time to prove. Success comes with hard work in any field. The PG subject you are studying does not matter as long as you are hard working!!

Right? Yeah! Life is smooth once you have got a PG seat? Yeah! Lot of things change in just 3 months. Bright MBBS doctors are made to feel that they are actually duffers. The first years get to do a peon’s job. They run around to collect the lab investigation reports, chest radiography films, arrange the glass vials for blood samples, store the blood and urine culture bottles in their cupboards for emergency use, make a note of all new instructions given by the bosses, request the proud class III and IV workers for shifting the patients to investigation rooms and so on. “Look at the cobweb in that corner of the ward. You people don’t work!” is the remark that I have personally got from my consultant during rounds in my first year of post graduation course.

Thesis is a source of pain for most of the PG students. Not only the process of conceiving and delivering it is tedious, bearing the idiosyncrasies of the “guide” is hellish. For the people who believe in reincarnation, all the good deeds done in the previous birth manifests as a good PG guide and vice-versa! I had the opportunity of seeing the brutalities in first hand. I know some of my colleagues, who were used by the “guide” to get vegetables for the house, drop his kids to the school, make the PG drop guide’s niece in scooter to her work place and get her back in the evening every day, wash his car and get it serviced, book his air tickets at the cost of PG and so on. It is not necessary to say that all the academic work of the guide is actually done by the PG, whether it is preparing slides for a class or writing a chapter for the text book or publishing a study. Should I mention that the PG gets no credit or authorship or acknowledgement for the work? Worse are the cases that I have heard, in which the female PGs have undergone more inhumane treatment and exploitation. With all this, the moment of getting the thesis signed by the “guide” goes through many more phases of torture and is a relieving moment at the end of it.

Where is the creative energy that was bestowed to everyone? Why our medical education system does systematically suppresses the creative thinking? Why is a person who attempts to talk out of the box is treated as a joker? Why do we behave as if we should not think outside the textbooks? The archival system of teaching medicine, inept or inert teachers, lack of opportunity for expressions, fear of getting jeered by the peer group and so many other issues end up in suppressing the ideas and creativity of every medical student. Our conventional upbringing does not allow most of us to rebel against the set norms.

I discussed this issue with some of the peers. “You cannot crib that someone’s wife is more beautiful”, “We are dealing with human lives; we cannot afford to experiment”, “Mere talk is waste; who is going to find a solution?” “All that you feel is right. But the remedy does not lie in the hands of a single person”, “You are burning from inside; you need vipasyana meditation to cool yourself” were some of the answers I got.

Why do we think of an improbable end point and stop a beginning? Who is asking anyone to radically change the treatments? There are so many innovations that can occur in teaching, learning, patient examination techniques, diagnostics, assessment pattern and so on. Why not involve student community in these? Just to suggest, why can’t we dedicate one hour every week for listening to the students? Why not a session for them to talk in an open forum to present their ideas on innovation? If someone is shy of presenting himself on the podium, why not keep a box in which he can drop his idea in writing, which can go through a set of understanding and sympathetic senior doctors? In every institute, there are few extra-ordinary and respected, out-of-the-box thinking doctors. Why not they form a group and encourage the student community in catering a creative angle to thinking? Once we dare to change a bit, we can think of changing this ignoble way of conducting our curriculum and assessment patterns.

There might be lot many ways of inculcating the innovation and creativity of the budding doctors during their formative years. “I was treated badly by my guide and now it is my turn to be bad with my students” is the hallmark of a wretched brain. How can such people make good doctors when they are not even good human beings? Isn’t there a need for changing this system somewhere? Till we think of solving these issues, we cannot think of medical fests with new ideas coming from “best of the brains” in the community.

Regards

Kiran