FEATURE
Is Tahrir square spirit catching up with Indian civil society?
P M Kamath
Two months back, in February, when I addressed several groups of people interested in international political issues like the developments then in Egypt, one question that was raised by many was: Will the Tahrir square spirit catch up with the Indian civil society? Then I was little hesitant to say a firm ‘yes’ as I reasoned that because of Indian society being highly pluralistic—divided on caste, sub-castes, regional, religious, language considerations, it is unlikely that we can present such an united front against the government in India!P M Kamath
I added further: That it does not mean Indians are not fed up with corruption and highhandedness at every level. You go to get a death certificate, you have to pay a bribe, you go to get your medical practitioner’s registration certificate you cannot get it without a bribe. You try to register a property you bought; you have to pay speed money. But if an encroacher pays a hefty bribe, he can get an encroached land declared as non-agricultural in his name! Though ‘slum’ as a matter of definition, refers to a cluster of temporary structures, with bribe you can get a single hut on a private school property declared as slum! But if you approach the very same government with a request to remove the encroached hut, government says they have no power to remove encroachment from a private property! In the absence of your willingness to pay a bribe you will run from pillar to post to get a small playground for school transferred to its name though reserved as a playground, by the very government! I give these examples from my personal experience as a managing trustee of a school run as a voluntary social work.
However, now I feel that Anna Hazare’s fast unto death has changed all that. He has provided an anchor of safety for every one who wants to liberate India from corrupt practices of bureaucracy and its supportive-guardian politicians. Young college students desire to join the movement as school students are excited about it. It is likely to develop as another movement as one led by Jay Prakash Narayan in the 1970s against Indira government with a major difference! And that is: Anna Hazare and others lending him support are all from outside politics. Om Prakash Chauthala and Uma Bharati when went at the Jantar Mantar, venue of Anna’s fast unto death, they were hooted out!
The government, however, thinks that Anna Hazare is set up by the opposition, which Hazare himself has rejected vehemently! After all, what is the demand of Hazare? Since government has been dilly-dallying for the last forty two years on drafting an effective Lok-Pal bill as the Super watchdog against the cancer of corruption afflicting top to bottom of the government, he is demanding that drafting be done by a committee with fifty percent government representatives and participation of fifty percent of civil society representatives of high integrity.
Of all the arguments against accepting Anna’s proposal, put forward by the government, stupidest one is: There is no constitutional provision for people’s participation in drafting of the bill! Hence, it goes against the very grain of parliamentary democracy! Those people who put forward such an argument forget the fact that parliamentary system originated through the Magna Charta, a charter of rights, drafted by a group of prominent people (Barons) - and not by the king’s corrupt ministers against the wishes of the King on June 15, 1215 AD. Even in terms of Austinian sovereignty, what King permits becomes the law! Hence, if elected parliament and cabinet accept a proposal mooted by the people, it becomes a proposal of the legally established government. After all, it has to be approved by the Parliament!
The present government is also worried about this becoming a precedent! Magna Charta has not become a precedent in England though it is part of British unwritten constitution. Extra-ordinary situations demand extra-ordinary remedies! But certainly it would, in future, provide Indian government a warning! ‘Behave or else people might be forced to act!’ Even if it becomes a precedent, it will only enrich the content of Indian democracy as established democracies in the US (state levels) or as in Switzerland there are provisions for initiative by the people to write laws and put for people’s vote. Let us make a new beginning in strengthening Indian democracy, now that the federal government has been wise to accept it.The government, however, thinks that Anna Hazare is set up by the opposition, which Hazare himself has rejected vehemently! After all, what is the demand of Hazare? Since government has been dilly-dallying for the last forty two years on drafting an effective Lok-Pal bill as the Super watchdog against the cancer of corruption afflicting top to bottom of the government, he is demanding that drafting be done by a committee with fifty percent government representatives and participation of fifty percent of civil society representatives of high integrity.
Of all the arguments against accepting Anna’s proposal, put forward by the government, stupidest one is: There is no constitutional provision for people’s participation in drafting of the bill! Hence, it goes against the very grain of parliamentary democracy! Those people who put forward such an argument forget the fact that parliamentary system originated through the Magna Charta, a charter of rights, drafted by a group of prominent people (Barons) - and not by the king’s corrupt ministers against the wishes of the King on June 15, 1215 AD. Even in terms of Austinian sovereignty, what King permits becomes the law! Hence, if elected parliament and cabinet accept a proposal mooted by the people, it becomes a proposal of the legally established government. After all, it has to be approved by the Parliament!
But people’s power he now exercises should not make Anna Hazare to lose control of the popular movement, by his making too many of them at a short time! This fear arises from his demand aired even before the work on Lok Pal is completed, for getting the right to recall. This fear arises from the doubt whether Anna has a person-specific agenda—focused on Sharad Pawar. He had made a reference to him while referring to Group of Ministers appointed to study corruption. No doubt, Pawar might be corrupt in his view point, but there many other corrupt politicians at Centre. Corruption is there every over. Let civil society get consolidated first with the current initiative, not only at the federal level, but also at the levels of state and local, because, Aam Admi is much more harassed by the corruption at the state level and local than at the federal level though the magnitude of corruption and scandals at that level are high and more visible. Let Anna Hazare consolidate right to initiative before pushing for Recall. Let Indian democracy grow by evolutionary steps rather than through half-baked measures.
(Author is formerly Professor of Politics, University of Mumbai and currently Hon. Director, VPM’s Centre for International Studies, Mumbai & Adjunct Professor at Department of Geopolitics, Manipal University, Manipal.)
RTE and Literacy-Need to Ponder
J.Shriyan
Right to Education (RTE), is probably one of the biggest thing that has happened to India and Indians in recent times, especially for those in the margins. Reams of paper have been written singing peans for this new enactment emanating from the Directive Principles of State Policy. It is fervently hoped, that RTE will surely usher in an educated India, in not too distant a future. In this hope, there lies a certain element of euphoria. The question is how well placed is this euphoria?
To be really frank, the euphoria, that RTE shall bring about a significant change within a plan period, is highly misplaced.
Every citizen of every country, with an open society and a democratic way of life and governance, recognizes that the laws are made to enhance the quality of life of everybody, pari passu. That’s the basic intention of all enactments. But then we all know, just as well, that good intention and ground condition do not always go together. Unfortunately this is very true of those laws that came about to promote education, albeit with limited access.
For all these 63 years of post independent India, with 11 development plans having completed and 12th on the unveil, there have been huge investments in the education sector. But somehow close to 50% of Indians are still illiterate. Of course, Kerala claims to be 100% with most southern states being over 70% literate and other parts except BIMARU states, being over 60%. It is the BIMARU states with lower than 50% literacy have dragged the overall national % of literate men and women of India. But here what need to be emphasised is that within this 50% literate are those who can be called semi-literate. And sadly this semi literate is a good chunk of this 50% literates in the country. This semi-literates are the product of poor teaching methods of poorly trained teachers with low commitment, lower infrastructure with lack of governmental commitments.
Thus the question that came up after the publication of Annual State of Education Report 2010, (ASER) was “IS THE RIGHT TO EDUCATION MERELY MEANS THE RIGHT TO SCHOOLING?” Reportedly the survey reflected some very disturbing statistics.
The survey, conducted every year since 2005, is the brain child of Pratham Education Foundation through the private initiative of Ajay Piramal, who is also the chairman of this foundation. In 2010 it reached 522 districts, over 14,000 villages covering 300,000 households and some 700,000 children. The survey, ASER, finds out whether children in rural India go to school? How well they can read their own language? and whether they can do basic arithmetic?
The report informed “Even after five years in school, close to half of all children are not even at the level expected of them after 2 years in school. Only 53.4% children in class 5 could read a class 2 level text. Besides, there has been a decrease in children’s ability to do simple mathematics”.
According to the report “The proportion of Std I children who could recognise numbers from 1to9 declined from 69.3% in 2009 to 65% in 2010. Similarly, the proportion of children in Std III who could solve two digit subtraction problems decreased from 39% to 36.5% in the same period. Children in Std V who could do simple division problems also dropped from 38% in 2009 to 35.9% in 2010.
The visible negative features were primarily due to the poor quality of teachers in these government primary schools. This aspect was clearly reflected in the marked improvement in the basic maths of children in the government schools of Punjab, where they had emphasised on the quality of its teachers being recruited for these schools.
No wonder, the quality of teachers in these government schools have even worked up corporate personality like Azim Premji of Wipro group to have embarked on huge spending to create quality teachers through his private educational initiatives.
Yes improvement in the quality of teachers-qualified, inspired, so also well looked after- is the most important factor in bringing about realisation of lofty objective of education for all.
Initiatives like Sarva Shiksha Abhiyaan coupled with Mid-Day Meal scheme has improved the overall attendance and increased enrolment of children in schools. But unless the quality of the education is improved simultaneously it will be a cry in the wilderness.
Of course, the inspiring leadership at political level too has its own significant contribution. ASER discuses the declining trend of school drop-outs, reports that in 2006, 12.3% of boys and 17.6% girls were out of school in Bihar, in the age group of 11-14. However by 2010, these numbers had very significantly declined to 4.4% for boys and 4.6% for girls showing hardly any difference by gender. Surely the Nitish Kumar factor in the delivery system had worked wonder, something, Chief Ministers in other states need to ponder.
Thus, while there are many ills in the present system, there are also the positives, which need to be worked at for further improvement.
The core areas where improvements are needed, are better infrastructure, including separate toilets for girl students, better quality of food supplied to students, motivated teaching staff. Of course there is tremendous scope for the improvement of infrastructure, depending upon the availability of fund. However, provision of toilets to girl students, better food at Mid-Day Meal and committed teaching staff can make all the difference. Writer has the personal knowledge of schools where despite the former two demands having met, the last one-the committed teacher factor-has made all the difference. Yes, it is indeed true that a dedicated band of teachers can make all the difference to the ability of students in learning what is taught, and retaining what is taught, long after the annual ritual of tests and examinations are over.
Hence, the new law of RTE has its job cut out for the education scene of the country to be completely student centric, rather than creating statistics, which can truly conceal lies and more lies.
Deschooling Medical Education in India
Continued from last issue
Undergraduate course of study:
The first four years are all done on the bedside, most of it in the community where the true phase of diseases is seen. The present big teaching hospitals delude the student to believe that the filtered patient population of the tertiary care teaching hospital is the true incidence in society. The common minor illness syndromes that form the bulk of the disease load in the world on a given day with significant sick absenteeism in the industry are excluded from the teaching hospitals. The new system, “problem based learning,” will encourage better interaction between the teacher and the taught with both having equal curiosity to learn in a new atmosphere. The student is exposed to patients from day one in any medical school. This will make his ego get boosted to learn better.19
Very little of human anatomy, except the bare minimum, need be taught at this stage along with solving each patient’s problems and so are the other preclinical and Para-clinical subjects taught with reference to the patient at hand. That is what makes the teacher as curious as the student. The teacher will have to learn these subjects along with his/her pupils. In depth study of the relevant pre and Para clinical subjects are taught in the second four year course only for those that hope to become specialists. Investigation reports and their genesis are all learnt along with the problem on hand. At the end of the four years a student will have been exposed to the whole spectrum of illnesses. Another advantage is that the student gets better trained in the common illnesses that are commoner than one thinks they are.
Another lacuna in the present system is that the student does not get exposed to true public health needs, the health of the public. Clean drinking water supply, nutritious food, overall sanitation systems like toilets for every house, economic empowerment of poor women, educating the girl child in the villages up to, at least, the age 20 to reduce the fertility rate, avoiding the deadly carbon monoxide laden cooking smoke from coming into the village houses, necessity to let the villagers use the mosquito nets, importance of taking care of the need of specially enriched diet for the pregnant mothers to avoid still births as also to avoid the killer diseases in the child in its later life, judicious vaccinations using safe vaccines, disaster management systems for remote villages, dangers of alcohol and tobacco use, and the importance of poverty as the mother of most illnesses, the need to teach patients to be tranquil for better health need to be stressed in the course of four years to make the end product a responsible citizen of the community in which s/he lives. Inkling into pharmaco-economics would teach the future doctor to be parsimonious in prescribing drugs and ordering tests at the behest of the industry.20
Having learnt about the illnesses in detail the student is then exposed in the final year to the healing methods available in many of the complementary systems that have been authenticated by hard scientific studies of which there are many. There is a new journal, the Journal of the Science of Healing Outcomes (JSHO), with great scientists on its editorial board, trying to publish the authenticated wheat in all those systems rejecting the chaff by hard scientific methods and not using the statistical science of RCTs (randomised controlled studies).21 RCTs have been discredited lately.22 This will achieve two fold advantages. This teaching will make the student aware of the possibilities of proven healing methods in many other systems when modern medicine fails, as also does that remove the holier-than-thou attitude that the present modern medical doctors have towards the gems in those systems, many of whom have been useful to mankind for centuries and some of them are very much Indian like Ayurveda, Siddha, Unani, Acupressure, Yoga, Meditation, Massage therapy, Reiki, Pranic healing etc.23, 24.
When the basic family doctor qualifies after four years study s/he could be interned with a good family physician in society for a year to follow the footsteps. Second year could be spent as a family doctor in a village. At the end of all those six years the student gets registered to be a specialist family physician in his/her own right to be let loose on the gullible public. The watch dog bodies that are built into the Indian system like the MCI etc. could be made to keep a careful watch on the ethical and moral standards of medical practice in the country rather than breathing down the necks of medical schools as it happens now. If they wish they could have an exit examination to screen the good from the bad doctors that have passed out of the colleges rather than measuring the class room size and the staff bio data as it is done today. Bad institutions will die a natural death if the majority of their graduates do not make their grade in the exit examination. Education institutions will then depend on the buyers market. The license raj will not improve the standards of education at all.
Postgraduate course:
All the good medical schools and the larger well staffed hospitals could be selected to train postgraduates if they have the necessary infrastructure. Any basic doctor that wishes to train as a specialist should first qualify to get a junior position job in the above mentioned institutions for a year. At the end of that year he/she will sit an on line all India entrance examination to join the next three years of pyramidal growth as a specialist in those institutions that have adequate educational and patient material infrastructure. Those who fail the examination will have one more chance after three months to re-sit the examination. Failure for the second time will disqualify the student from going further unless he does the first year work again before re-sitting the examination.
The last three years are spent for hands on experience. Every student must be employed by the institution on a reasonable salary for maintenance in a residential capacity with staff quarters. Those that do not make the grade in certain difficult specialties could be eliminated by yearly evaluation in addition to the on going evaluation based both day to day performance and the log book details of the work that the candidate has done. This will ensure that the final year has much less crowd of students for the rest to get better hands on experience. Those that get thrown out of the pyramid in one specialty could try another specialty by sitting a simple entrance test for that new specialty when there is a vacancy. The job evaluation done by the teachers could be counterchecked by a senior censor who has not supervised the candidate. There could be designated senior specialists to do the job in their own region. Hopefully, this system will eliminate most of the corruption that goes on despite all the rules in the field of postgraduate education today. It might also bring out better quality specialists to be further trained either in the country or abroad if they so wish. This would also bring respect to Indian PG degrees as there will be uniformity of standards across the country with identical evaluation.
Continuing professional developmental courses: (CPDs)
These are not only mandatory but must be the responsibility of the institutions that have offered the degree in the first place. Regular on line self assessment scores must be accumulated to give 50% credit for the ten yearly recertification in all specialties excluding family practice where the recertification should only be recommendatory and not mandatory. A good human being with minimal training for six long years should make an ideal family physician. His theory knowledge is of secondary importance although it is advantageous to have family physicians also to have recertification less frequently. Education of doctors by drug companies, as is done now, through the multitude of “so called” conferences could be put an end to as most of them are used to buy favours from doctors by the drug companies. Out of the thousands of delegates only a few will attend the “scientific lectures” while the rest, along with their families, would be enjoying a well paid holiday at the cost of the drug companies. Doctors are wined and dined lavishly in these meets where, in addition, the drug companies bring their “thought leaders” from abroad to lecture and pontificate on their behalf in the guise of guest lectures most of which are company material being fed to the gullible doctors. Future doctors should understand the new science of CHAOS as the human body follows only this science.25
Conclusions:
Medical education in India is crying for reforms. We need to first educate society about the ills of the present system and then introduce a saner, more relevant and a humane educational system that, hopefully, will bring out good human beings who are adequately trained to “cure rarely, comfort mostly but console always.”
“The art of progress is to preserve order amid change, and to preserve change amid order.”
RTE and Literacy-Need to Ponder
J.Shriyan
Right to Education (RTE), is probably one of the biggest thing that has happened to India and Indians in recent times, especially for those in the margins. Reams of paper have been written singing peans for this new enactment emanating from the Directive Principles of State Policy. It is fervently hoped, that RTE will surely usher in an educated India, in not too distant a future. In this hope, there lies a certain element of euphoria. The question is how well placed is this euphoria?
To be really frank, the euphoria, that RTE shall bring about a significant change within a plan period, is highly misplaced.
Every citizen of every country, with an open society and a democratic way of life and governance, recognizes that the laws are made to enhance the quality of life of everybody, pari passu. That’s the basic intention of all enactments. But then we all know, just as well, that good intention and ground condition do not always go together. Unfortunately this is very true of those laws that came about to promote education, albeit with limited access.
For all these 63 years of post independent India, with 11 development plans having completed and 12th on the unveil, there have been huge investments in the education sector. But somehow close to 50% of Indians are still illiterate. Of course, Kerala claims to be 100% with most southern states being over 70% literate and other parts except BIMARU states, being over 60%. It is the BIMARU states with lower than 50% literacy have dragged the overall national % of literate men and women of India. But here what need to be emphasised is that within this 50% literate are those who can be called semi-literate. And sadly this semi literate is a good chunk of this 50% literates in the country. This semi-literates are the product of poor teaching methods of poorly trained teachers with low commitment, lower infrastructure with lack of governmental commitments.
Thus the question that came up after the publication of Annual State of Education Report 2010, (ASER) was “IS THE RIGHT TO EDUCATION MERELY MEANS THE RIGHT TO SCHOOLING?” Reportedly the survey reflected some very disturbing statistics.
The survey, conducted every year since 2005, is the brain child of Pratham Education Foundation through the private initiative of Ajay Piramal, who is also the chairman of this foundation. In 2010 it reached 522 districts, over 14,000 villages covering 300,000 households and some 700,000 children. The survey, ASER, finds out whether children in rural India go to school? How well they can read their own language? and whether they can do basic arithmetic?
The report informed “Even after five years in school, close to half of all children are not even at the level expected of them after 2 years in school. Only 53.4% children in class 5 could read a class 2 level text. Besides, there has been a decrease in children’s ability to do simple mathematics”.
According to the report “The proportion of Std I children who could recognise numbers from 1to9 declined from 69.3% in 2009 to 65% in 2010. Similarly, the proportion of children in Std III who could solve two digit subtraction problems decreased from 39% to 36.5% in the same period. Children in Std V who could do simple division problems also dropped from 38% in 2009 to 35.9% in 2010.
The visible negative features were primarily due to the poor quality of teachers in these government primary schools. This aspect was clearly reflected in the marked improvement in the basic maths of children in the government schools of Punjab, where they had emphasised on the quality of its teachers being recruited for these schools.
No wonder, the quality of teachers in these government schools have even worked up corporate personality like Azim Premji of Wipro group to have embarked on huge spending to create quality teachers through his private educational initiatives.
Yes improvement in the quality of teachers-qualified, inspired, so also well looked after- is the most important factor in bringing about realisation of lofty objective of education for all.
Initiatives like Sarva Shiksha Abhiyaan coupled with Mid-Day Meal scheme has improved the overall attendance and increased enrolment of children in schools. But unless the quality of the education is improved simultaneously it will be a cry in the wilderness.
Of course, the inspiring leadership at political level too has its own significant contribution. ASER discuses the declining trend of school drop-outs, reports that in 2006, 12.3% of boys and 17.6% girls were out of school in Bihar, in the age group of 11-14. However by 2010, these numbers had very significantly declined to 4.4% for boys and 4.6% for girls showing hardly any difference by gender. Surely the Nitish Kumar factor in the delivery system had worked wonder, something, Chief Ministers in other states need to ponder.
Thus, while there are many ills in the present system, there are also the positives, which need to be worked at for further improvement.
The core areas where improvements are needed, are better infrastructure, including separate toilets for girl students, better quality of food supplied to students, motivated teaching staff. Of course there is tremendous scope for the improvement of infrastructure, depending upon the availability of fund. However, provision of toilets to girl students, better food at Mid-Day Meal and committed teaching staff can make all the difference. Writer has the personal knowledge of schools where despite the former two demands having met, the last one-the committed teacher factor-has made all the difference. Yes, it is indeed true that a dedicated band of teachers can make all the difference to the ability of students in learning what is taught, and retaining what is taught, long after the annual ritual of tests and examinations are over.
Hence, the new law of RTE has its job cut out for the education scene of the country to be completely student centric, rather than creating statistics, which can truly conceal lies and more lies.
Deschooling Medical Education in India
Continued from last issue
Undergraduate course of study:
The first four years are all done on the bedside, most of it in the community where the true phase of diseases is seen. The present big teaching hospitals delude the student to believe that the filtered patient population of the tertiary care teaching hospital is the true incidence in society. The common minor illness syndromes that form the bulk of the disease load in the world on a given day with significant sick absenteeism in the industry are excluded from the teaching hospitals. The new system, “problem based learning,” will encourage better interaction between the teacher and the taught with both having equal curiosity to learn in a new atmosphere. The student is exposed to patients from day one in any medical school. This will make his ego get boosted to learn better.19
Very little of human anatomy, except the bare minimum, need be taught at this stage along with solving each patient’s problems and so are the other preclinical and Para-clinical subjects taught with reference to the patient at hand. That is what makes the teacher as curious as the student. The teacher will have to learn these subjects along with his/her pupils. In depth study of the relevant pre and Para clinical subjects are taught in the second four year course only for those that hope to become specialists. Investigation reports and their genesis are all learnt along with the problem on hand. At the end of the four years a student will have been exposed to the whole spectrum of illnesses. Another advantage is that the student gets better trained in the common illnesses that are commoner than one thinks they are.
Another lacuna in the present system is that the student does not get exposed to true public health needs, the health of the public. Clean drinking water supply, nutritious food, overall sanitation systems like toilets for every house, economic empowerment of poor women, educating the girl child in the villages up to, at least, the age 20 to reduce the fertility rate, avoiding the deadly carbon monoxide laden cooking smoke from coming into the village houses, necessity to let the villagers use the mosquito nets, importance of taking care of the need of specially enriched diet for the pregnant mothers to avoid still births as also to avoid the killer diseases in the child in its later life, judicious vaccinations using safe vaccines, disaster management systems for remote villages, dangers of alcohol and tobacco use, and the importance of poverty as the mother of most illnesses, the need to teach patients to be tranquil for better health need to be stressed in the course of four years to make the end product a responsible citizen of the community in which s/he lives. Inkling into pharmaco-economics would teach the future doctor to be parsimonious in prescribing drugs and ordering tests at the behest of the industry.20
Having learnt about the illnesses in detail the student is then exposed in the final year to the healing methods available in many of the complementary systems that have been authenticated by hard scientific studies of which there are many. There is a new journal, the Journal of the Science of Healing Outcomes (JSHO), with great scientists on its editorial board, trying to publish the authenticated wheat in all those systems rejecting the chaff by hard scientific methods and not using the statistical science of RCTs (randomised controlled studies).21 RCTs have been discredited lately.22 This will achieve two fold advantages. This teaching will make the student aware of the possibilities of proven healing methods in many other systems when modern medicine fails, as also does that remove the holier-than-thou attitude that the present modern medical doctors have towards the gems in those systems, many of whom have been useful to mankind for centuries and some of them are very much Indian like Ayurveda, Siddha, Unani, Acupressure, Yoga, Meditation, Massage therapy, Reiki, Pranic healing etc.23, 24.
When the basic family doctor qualifies after four years study s/he could be interned with a good family physician in society for a year to follow the footsteps. Second year could be spent as a family doctor in a village. At the end of all those six years the student gets registered to be a specialist family physician in his/her own right to be let loose on the gullible public. The watch dog bodies that are built into the Indian system like the MCI etc. could be made to keep a careful watch on the ethical and moral standards of medical practice in the country rather than breathing down the necks of medical schools as it happens now. If they wish they could have an exit examination to screen the good from the bad doctors that have passed out of the colleges rather than measuring the class room size and the staff bio data as it is done today. Bad institutions will die a natural death if the majority of their graduates do not make their grade in the exit examination. Education institutions will then depend on the buyers market. The license raj will not improve the standards of education at all.
Postgraduate course:
All the good medical schools and the larger well staffed hospitals could be selected to train postgraduates if they have the necessary infrastructure. Any basic doctor that wishes to train as a specialist should first qualify to get a junior position job in the above mentioned institutions for a year. At the end of that year he/she will sit an on line all India entrance examination to join the next three years of pyramidal growth as a specialist in those institutions that have adequate educational and patient material infrastructure. Those who fail the examination will have one more chance after three months to re-sit the examination. Failure for the second time will disqualify the student from going further unless he does the first year work again before re-sitting the examination.
The last three years are spent for hands on experience. Every student must be employed by the institution on a reasonable salary for maintenance in a residential capacity with staff quarters. Those that do not make the grade in certain difficult specialties could be eliminated by yearly evaluation in addition to the on going evaluation based both day to day performance and the log book details of the work that the candidate has done. This will ensure that the final year has much less crowd of students for the rest to get better hands on experience. Those that get thrown out of the pyramid in one specialty could try another specialty by sitting a simple entrance test for that new specialty when there is a vacancy. The job evaluation done by the teachers could be counterchecked by a senior censor who has not supervised the candidate. There could be designated senior specialists to do the job in their own region. Hopefully, this system will eliminate most of the corruption that goes on despite all the rules in the field of postgraduate education today. It might also bring out better quality specialists to be further trained either in the country or abroad if they so wish. This would also bring respect to Indian PG degrees as there will be uniformity of standards across the country with identical evaluation.
Continuing professional developmental courses: (CPDs)
These are not only mandatory but must be the responsibility of the institutions that have offered the degree in the first place. Regular on line self assessment scores must be accumulated to give 50% credit for the ten yearly recertification in all specialties excluding family practice where the recertification should only be recommendatory and not mandatory. A good human being with minimal training for six long years should make an ideal family physician. His theory knowledge is of secondary importance although it is advantageous to have family physicians also to have recertification less frequently. Education of doctors by drug companies, as is done now, through the multitude of “so called” conferences could be put an end to as most of them are used to buy favours from doctors by the drug companies. Out of the thousands of delegates only a few will attend the “scientific lectures” while the rest, along with their families, would be enjoying a well paid holiday at the cost of the drug companies. Doctors are wined and dined lavishly in these meets where, in addition, the drug companies bring their “thought leaders” from abroad to lecture and pontificate on their behalf in the guise of guest lectures most of which are company material being fed to the gullible doctors. Future doctors should understand the new science of CHAOS as the human body follows only this science.25
Conclusions:
Medical education in India is crying for reforms. We need to first educate society about the ills of the present system and then introduce a saner, more relevant and a humane educational system that, hopefully, will bring out good human beings who are adequately trained to “cure rarely, comfort mostly but console always.”
“The art of progress is to preserve order amid change, and to preserve change amid order.”
Alfred North Whitehead
concluded
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