It costs about Rs 500 crore to start a government or private medical college. With such a high cost there is no hope of bringing down the cost of medical education. Indirectly, we are admitting that medical education is not for the poor. Furthermore, our medical education system is based on the 70-year-old model we inherited from the British.
Medical practice requires both knowledge and the competence to apply the knowledge. An MBBS graduate of today has full knowledge of medical sciences, but is weak in competence to handle even common conditions such as coronary artery disease.
Knowledge is imparted through endless lectures, but unlike in the past, facts and details of medical procedures can also be accessed online. By contrast, competence is best imparted through apprenticeship: A senior doctor mentoring students by teaching the art of healing. Medical students in India and in most parts of the world hardly touch the patients. If technology could be used to deliver essential knowledge in a standardised form to colleges across the globe, we have an opportunity to build thousands of medical colleges across Asia, Africa and Latin America and skill highly-skilled doctors. India alone requires close to two million doctors.
The idea is to create a global medical university on the lines of United Nations. The university would be truly virtual. It will identify outstanding medical teachers to deliver lectures on topics of their interest, which will then be recorded and made available on a website. So, the university will not require classrooms.
The university will recognise busy hospitals across the world having over 300 beds, broad specialties like medicine, surgery, gynecology, pediatrics as mini medical colleges. Any medical specialist with over five years of experience, after careful vetting, can be recognised as a medical teacher. Each 300-bed hospital will be allowed to take only 30 students per year based on their performance in an online exam.
The first year will be structured roughly as follows: In the first month, the students will attend virtual dissection classes online. After this they will work in the hospital for five hours every day as nurse assistants and spend two hours a day in group discussions on anatomy, physiology and biochemistry. These discussions will supplement the online lectures and demonstrate their importance in clinical care. The students will also work in hospital labs as assistants to understand biochemical, hematological and microbiological tests. At the end of the first year, the students will have adequate knowledge about the basic sciences in the clinical context.
In the second year, they can work as student doctors under medical specialists by taking care of the patients under the resident doctors. They will be substitutes for some of the activities performed by the nurses and also take part in on-call duty at night working as assistants to on-call doctors. During the clinical years they will assist surgeons and take care of the patients in the intensive care unit under the resident doctors. Essentially, these student doctors will take care of the patients for at least six to seven hours a day, spend two hours in a group discussion about the patients admitted in the ward rather than on an imaginary patient based on textbook descriptions.
What will the hospitals gain from the training programme?
At any given time, hospitals will have 30-150 students working with great passion and taking care of their patients, which will improve the outcome of clinical care. Also, a modest tuition fee paid by the students is an additional attraction to maintain the highest standards and attract bright students.
The students will be evaluated through online tests every quarter. A student’s promotion to a higher class will depend entirely on the aggregation of their performance in the quarterly exam rather than on a final exam at the end of the year. By exposing the medical students to clinical settings and a gruelling schedule from day one will encourage the less motivated ones to drop out. Another advantage of having a global university is that the doctors would be able to practise in any of the member countries.
India requires 500 new medical colleges. With the current cost structure, not many governments or private enterprises will be keen to set up medical colleges. With this backdrop, we are in a unique position to have as many as 10,000 medical colleges across Asia, Africa and Latin America by adopting medical education as apprenticeship and online education to supplement classrooms. We can convert, for instance, 150 naxal-affected district hospitals into medical colleges with a little over Rs 100 crore investment and change the medical economy of the districts. Interestingly, quite a few African countries are keen to adopt this model and many are looking at India to take the lead. Some of the most respected medical teachers from England and the US have liked the concept. This model is not aimed at claiming superiority over the existing models of medical education. It is a proposal for a different and affordable model as a pilot, which, at the end of five years, can be compared with the existing forms of medical education.
Devi Shetty is chairman and senior consultant cardiac surgeon, Narayana Health Group of Hospitals, Bangalore
Vinay Kumar, MD, FRCPath is chairman, department of pathology, The Pritzker Medical School, University of Chicago
The views expressed are personal