Evolution of Medical Education Technology Unit in India.PS Bhuiyan, NN Rege
Medical Education Technology Cell, Seth G. S. Medical College and K. E. M. Hospital, Parel, Mumbai - 400 012, India., India
Correspondence Address: Source of Support: None, Conflict of Interest: None PMID: 11590293
Source of Support: None, Conflict of Interest: None
Keywords: Computer-Assisted Instruction, Education, Medical, Graduate, methods,organization &administration,Education, Medical, Undergraduate, methods,organization &administration,Faculty, Medical, Human, India, Interprofessional Relations, Learning, Organizational Innovation,
It has been observed that nature is at its selective best, mediating quality control in human reproduction. This is evident from the fact that 50% of the pregnancies with chromosomal aberrations abort spontaneously. As early as 1859, Charles Darwin in his book, “The Origin of Species”, stated about natural selection of species.
The mankind, homosapiens are the highest evolved and also natures selected best on this earth. Their caretakers are the doctors i.e. medical profession. To maintain quality in Medical Education shouldn’t they be the selected and trained best?
Since time immemorial health has been a continuous concern of the mankind. Charaka mentioned that diseases and mankind coexisted all along. In India and perhaps in the whole world, during Arsha period (period of the rishis), two great universities came into existence, where course included medicine and surgery. One was Banaras and the other was Takshashilla. The heads of the medical sections were Sushruta and Atreya, respectively. The universities grew in the Buddhist period, producing medical literature not only for students to learn, but also for the teachers to teach. During the British rule, in 1835 the first medical school was set up in Calcutta and Madras simultaneously. Medical training was also set up in different parts of the country in addition to medical colleges. During the post - independence era there was a spurt of setting up of private medical colleges without adequate resources and expertise. The content of medical education needed to be streamlined. It was felt that the curriculum must highlight the problems of healthcare of the society and must be a need based one.
A medical institution could be considered as a system. The input is the students; process includes the teaching learning activities and the output is the young medicos, who are the products of an institution. The role of environment in a system is quite significant. The environment in this context is the society at large. We take the students from the society and after training them leave them back to the society. The society would accept them only if they can take care of it and its needs, hence it is very important that the training imparted to them is a need based one. Here lies the importance of medical teachers.
Medical teachers are the architects and builders of students’ behaviour using a standard curriculum. They are also the curricular developers and transactors and thus have a pivotal role in shaping the future medicos. Charka samhita lays down that teacher should be one “whose doubts have been all cleared in respect of medical scriptures-possessed of experience-clever in the practice of his profession - compassionate towards those who approach him-clean in person and clothing - having a practised hand in surgery-possessed of all the implements of his organs of sense perfect - conversant with nature-his knowledge of medical science supplemented with a knowledge of other branches of study -without malice-of a peaceful disposition-capable of bearing privation and pain-well affected towards disciples and disposed to teach them-capable of communicating his ideas etc...........”
How many of our present day teachers have these qualities?
Selecting the ‘right’ trainer may not be always possible but improving them by periodic training programme is feasible. An ‘effective’ teacher will be one who is ‘competent’ (has knowledge and skill) and is a ‘performer’ (can use knowledge and skill in a classroom) to accomplish ‘teacher goal’. The Medical Council of India while formulating its recommendations in 1981 declared that the recommendations were oriented towards training students to undertake the responsibilities of a physician of first contact. But while depicting the situation analysis, draft ‘Medical Education Policy’ in 1993 laments that ‘Advancements in medical education both in quantity and quality have not resulted in parallel achievements in the field of health care’. To bridge this gap, Medical Council of India (MCI) outlined need based curriculum. The steps to be taken were (1) Clear delineation of goals and objectives of education (2) Adoption of innovative teaching and learning methodology (3) Adjustment in the course structure (4) Updating course content (5) Rationalizing assessment strategy and (6) Emphasis on structured and skill oriented internship. The President, MCI while concluding his foreword to the document embodying the revised curriculum adopted by the council rightly mentioned that ‘This curriculum can only be successfully implemented through appropriately oriented and properly equipped teachers’. These felt needs prompted the Medical Council of India to recommend setting up of Medical Education Unit in all medical colleges in 1981 (curriculum of graduates) and 1992 (Need Based Revised Curriculum for graduates). The National Conference on ‘Training Teachers Today for Tomorrow’s Needs’ held under the auspices of MCI in September 1994 and also the workshop on ‘Medical Education - An Appraisal’ held under the auspices of MCI in May 1996 have made recommendations for establishment of Medical Education Unit in each medical college. The MCI also in their revised regulations have recommended the establishment of such units in each medical colleges. The Parliamentary Committee on Subordinate Legislation has also strongly recommended that MCI should make it compulsory for all medical colleges to prescribe for a minimum number of lectures to be imparted using audio-visual techniques in substitution of conventional lectures by teachers/professors in the classrooms.
These units are supposed to carryout the following activities which can strengthen the quality of Medical Education.
1. Faculty Development: Teachers need to be trained in framing objectives, selecting appropriate teaching learning methods and media, and proper evaluation methodologies. The teachers should also be trained in educational sciences and technology. To improve the quality of teaching, staff development programmes should be incorporated. Educating the educators would ultimately develop the faculty.
2. Carry out Research in Medical Education: This could be in the form of inquiry driven strategies in various aspects of medical education.
3. Serve as a Resource Center: Both for personnel and materials, the unit can serve as a resource centre.
4. Continuing Medical Education: Technological advancement and knowledge explosion are advancing at a jet pace. To keep up with the latest, the medical educators must be updating their knowledge at regular intervals. The need for quality care is being sought after by the society. Gone are the days of ‘quantity’ care. People are health conscious and literate and thus to be a competent physician there is a need for continuing professional development.
5. Policy Development: This should be a joint venture between teachers and policy makers. It should be based on economics, infrastructure and requirement of the country.
6. Developing System of Assessment: Constant revision in the system of assessment needs to be done correlating with the objectives laid down. The system should encompass all the domains-knowledge, skills and attitude.
7. Developing Communication Links: with other institutions both in India and abroad
8. Instructional Design: Medical Education Technology Unit should take up the responsibility of providing guidelines to modify curriculum and implement the changes effectively. As all of us aware, the curriculum of the past emphasized and assessed retention and regurgitation of factual knowledge and appeared to have no clearly defined objectives or philosophy. Today, in the world of knowledge explosion, emphasis should be on the processes for retrival of information and its appropriate use. One needs to use criterion referenced evaluation is needed to find out whether the graduate is competent to serve the society needs. Teachers should be taught to evaluate objectively, reliably and without loosing the insight for relevance.
The process of becoming a doctor and a member of the medical profession is a social one. Professional socialization requires a medical curriculum, which would include training in communication skill, medical ethics, health economics, consumers right besides clinical skills and subject knowledge.
The Medical Education Units should pay attention to the development of this collateral curriculum. The role of MET unit or department is to train the trainers so that a need based curriculum can be formulated, implemented and revised from time to time. It should plan a curriculum for ‘Tomorrow’s Doctors’ where ‘core and options’ curricula are exemplified. Communication, patient autonomy and doctor -patient relationship must underpin the whole educational process. In one of the SEARO publication (1998) Dr. Myatu had mentioned that ‘if doctors are to remain relevant to the changing needs of the society they have to shape their roles with in the context of total human development’.
The scope of MET cell can widen if and only if there is a perfect blend of M-E-T, where ‘M’ stands for Management of Education, ‘E’ stands for Educational Research and ‘T’ stands for Technology of Education. For M-E-T to gel there is a need to include an educationist and human resource development manager as a part of the team.
Our experience tells us that the MET cell requires like-minded, willing, devoted teachers for its active and productive functioning. There is no hard and fast rule for the number of members in a MET unit or for their designation and qualifications. However, considering scope of MET units, it is better that most of the disciplines get represented in the unit. The teachers who are in the position to make and implement policies should be the members. As per Dr. S. P. Mehta’s article on ‘Establishment of MET Unit’ it is mentioned that at least there should be 5-6 motivated teachers who are willing to spare at least two hours a week as honorary faculty. One of the honorary faculty member who can devote about 6 hours a week may be designated as co-ordinator of the MET unit. The co-ordinator should be trained in educational science and technology. The teachers appointed as honorary faculty must have undergone training in National Teachers Training Centre (NTTC). The MET cell being a resource unit besides having audio-visual aids, should have its own library housing books and journals on medical education technology. There must be computers with internet facilities, so that communication with other education centres is easily established and sharing and exchange of information is a smooth process.
In India the institutions which have intimated MCI about establishing ME Unit include PSG Inst. of Medical Sciences, Coimbatore, Tamil Nadu, St. John’s Medical college, Bangalore, JNL Medical college, Belgaum, Karnataka, Krishna Institute of Medical sciences, Karad, Maharashtra, Seth GS Medical college, Mumbai, Medical college, Thrissur, Kerala, Christian Medical College, Vellore, Tamil Nadu, SMS Medical college, Jaipur, JN Medical College, Sawangi, Wardha, Maharashtra, Maharashtra Institute of Medical Education and Research, Talegaon, Dadhade, Maharashtra, JN Medical College, Bhagalpur, Bihar, Dayanand Medical College, Ludhiana, Punjab, TN Medical college and BYL Nair charitable Hospital, Mumbai, Maharashtra, Armed Forces Medical college, Pune, Maharashtra, Tiruneveli Medical college, Tiruneveli, Tamil Nadu. Two of the postgraduate institutes, NIHFW, New Delhi and Tata Memorial Centre, Mumbai also have MET units. JIPMER, Pondicherry, Maulana Azad Medical College, New Delhi, Institute of Medical Sciences, Banaras Hindu University, Varanasi, ?PGI, Chandigarh , and KLWig’s Centre, AIIMS, New Delhi have NTTC centres.
In Maharashtra a meeting of co-ordinators of Medical Education Technology Units was called by the Maharashtra University of Health Sciences in July 2000. Various Medical colleges in Maharashtra responded and stated that they have established MET unit in their institution. However while interacting with them, it was realised that the so called units were non-functional in many colleges. If this is the state in educationally progressive state of Maharashtra, one can imagine what could be the situation in educationally backward areas. There is thus a dire need for educational networking to get established amongst MET Units and MCI. This should be further strengthened by a continuous dialogue with feedbacks. Such interaction can make the MET units more effective to reach their desired goals.
In conclusion, we would like to say that the technological advancement and knowledge explosion in medical science and pedagogy has necessitated the need for training medical teachers. For a teacher to be conversant with the latest trends he has to keep upgrading himself at frequent intervals and remain a lifelong learner.
“Men are men before they are lawyers, physicians or manufacturers, and if you make them capable and sensible man, they will make themselves capable lawyers and physicians”.