|Year : 2013 | Volume
| Issue : 1 | Page : 4-5
Health professional education: A paradigm shift
Kerala University of Health Sciences, Thrissur, India, Former Director, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Past Chairperson, Association of Commonwealth Universities, London, Past President, Association of Indian Universities, New Delhi, India
|Date of Web Publication||21-Jun-2013|
Kerala University of Health Sciences, Thrissur - 680 596
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mohandas K. Health professional education: A paradigm shift. Arch Med Health Sci 2013;1:4-5
Health Professional Education (HPE) is going through testing times. It is beset with a variety of challenges and problems, not the least of which is the acute scarcity of teachers and clinical materials. Added to this is the near absence of a research culture.
The number of HPE institutions increased exponentially in the last decade and a half. While expansion of the sector was a long felt necessity, the manner in which it happened was fairly abrupt and haphazard, and hence lopsided. This created a lot of issues, which included gross regional imbalances, inadequate infrastructure, lack of clinical materials and experienced teachers. Poor oversight by the regulatory bodies further vitiated the process. The result was an alarming drop in academic standards.
As the health professionals are expected to safeguard the health of the nation and its people, the quality of their training is absolutely vital. Insufficient professional knowledge and poor competence will surely affect the quality of care that they are able to provide. Paucity of good teachers will also lead to poor mentoring and role modeling that are essential for a largely competence-based training program. Added to all these woes is the unfortunate and increasing trend of commodification of the HPE. If we allow this to continue unchecked and uncorrected, India would end up producing sub standard health care professionals who would pose a grave threat to the health and well being of the citizens of this country. Moreover, it would blight the future of the bright young people who flock to HPE institutions with the hope and desire for a promising career in the profession.
However, all is not lost if we start acting with no further delay and initiate corrective measures on a war footing. I would like to propose a plan of action to redeem the present state of affairs. This may be implemented in a phased manner.
(A) Phase I (To be implemented in the next two years)
(B) Phase II (2-5 years)
- Declare a moratorium on starting new colleges and / or enhancing the number of seats in existing colleges, except in the underserved states of the North and North East of India. This policy should continue until such time that the infrastructure - both human and physical, and clinical materials, are determined to be adequate across the country by a Government or Medical Council of India (MCI)* task force. We may focus on Building up of the teaching cadre through a 2-pronged strategy of increasing post-graduate seats and encouraging the post-graduates to join the teaching cadre.
- MCI may undertake periodic and more frequent assessment of institutions with a poor track record. The assessment should be rigorous, but conducted in a fair, uniform, and sensible manner; it should focus mainly on evaluating the processes and products of HPE, and be more corrective than punitive.
- The admission procedure should be re-designed to test aptitude as well as knowledge.
(C) Phase III: (Long Term: 5 -10 years)
- While expansion of the HPE sector is essential, it should be a well-planned exercise with emphasis on correcting the current regional maldistribution of colleges. It should be de-linked from political compulsions
- Since the government cannot accomplish expansion single-handedly, the private sector should continue to be encouraged to set up institutions. The private sector must realize that the long term success of any business model revolves round the quality of the products, not merely on the external trappings. The government may consider restricting the number private colleges to 60% or less.
- By allowing colleges in the PPP model, primarily making use of the plentiful clinical materials available at the district hospitals, we may create a near ideal model. However, the colleges should be willing and able to share their teaching staff and other facilities in order to help strengthen and broaden the services at the district hospitals. And government hospitals must welcome such partnerships whole heartedly.
Curricular Changes: The primary objective of HPE being the development of competent women and men who are capable of ensuring the health and well being of the individuals and the community they serve, the syllabi and curriculum of the training programs should be re-designed for this purpose. Health is multi-factorial, where the non-biomedical factors such as hygiene, sanitation, good drinking water, nutrition etc. are more fundamental than disease care. This should be reflected in the curriculum and educational programs. While the management of the sick and the suffering is certainly of importance, the primary focus of health care must be on the prevention of diseases and the promotion of health. That being the case, even in disease care, enough attention should be paid to recovery and rehabilitation, so as to help individuals to get back to normal productive life at the earliest, after their illness.
Examination Reforms: The current over-emphasis on summative assessment and knowledge testing should change to formative assessment and skills testing. Only then could we ensure that the professional graduates are indeed capable of looking after the health of the individuals and the population, as is expected of them.
Changes in regulatory Philosophy: The regulatory agencies have the primary responsibility of making sure that the health professional practitioners are safe, competent and are conversant with the multi-dimensional aspects of health and ill health. Obviously, therefore, they need to ensure that the HPE institutions have the capability to impart such attributes on their students. It may even be desirable to have two separate and semi-independent agencies, one for professional and the other for academic regulation, ideally under the umbrella of one statutory body like the now discarded National Council of Human Recourses in Health (NCHRH). The approach to regulation should radically change from the current 'thief-policeman' regime to a participatory/ Facilitating one. However, this approach could succeed only if it is preceded by the restoration of trust among all stake holders.
| Structural Changes|| |
Along with the above steps, certain fundamental changes in the present HPE edifice should also be instituted, beginning with the prevalent system of a large number of colleges being affiliated to a single university to smaller unitary universities. This may be achieved by first granting autonomy to colleges with excellent track record, leading eventually to according them university status. Stringent but realistic criteria must be adopted for this transformation, which should be implemented in a gradual and well-planned manner. Periodic performance review of such institutions should be part of this plan.
In addition to these changes, there should come about a complete break from the current curative-oriented 'ill-health care' to preventive and promotive health care in education and training, as well as in practice.
No educational system would succeed unless the generation of knowledge through research is firmly integrated in the scheme of things. And, in the health professional education, this must be coupled with translational research. Only through translational research, could we hope to pass on the befits of new knowledge and innovations to the people at large, and to our patients in particular.
Since the generated knowledge needs to be disseminated, their publication in peer reviewed, indexed journal is also absolutely necessary. It is, therefore, appropriate that the Yenepoya University is about to start publishing its own journal. It is to be hoped that this journal will go on to become an internationally accepted and acclaimed publication, which will pave the way for the University and its in-house R & D activities finding a place in the educational and research map of the world.