Good Medicine

Dr.T.V.Rao MD
We all recognize that the world of medicine" is continually evolving; the present era is characterized by an unprecedented degree of change. We have entered another period of transition as dramatic as the one that occurred at the beginning of the century." The rapidity of change makes it difficult to takes snapshot to show the position of medical education within its larger framework. This raises the issue of how to plan medical education at this moment, given that "the world of medicine" cannot be fixed in time for closer scrutiny. Todays thinking on Medical education evolved when Abraham Flexner, a research scholar at the Carnegie Foundation for the Advancement of Teaching, undertook an assessment of medical education in North America, visiting all medical schools then in operation in the United States and Canada. The power of Flexner's report derived from his emphasis on the scientific basis of medical practice, the comprehensive nature of his survey, and the appeal of his message to the American public. Flexner's report fuelled change by criticizing the mediocre quality and profit motive of many schools and teachers, the inadequate curricula and facilities at a number of schools, and the non-scientific approach to preparation

for the profession. The 20th century has seen greater changes in America in academic hospitals, research quickly outstripped teaching in importance, and a publish or perish culture emerged in American universities and medical schools. Research productivity became the metric by which faculty accomplishment was judged; teaching, caring for patients, and addressing broader public health issues were viewed as less important activities. The blind imitation of the Western model, which perhaps suited the developed nations situation. This obsession with the Western model and standards has made our Doctors misfits in our own society and perhaps unwittingly promoted brain drain, which the Government wishes to restrict. The truth is that the medical graduate finds himself more at home outside the country than at home. We never documented and analysed the medical needs of an individual and a community in our country, with inherent problems plagued with population different cultures, and the mental health needs were most neglected. Our curriculum has become static, professionals in training must master both abundant theory and large bodies of knowledge, many times old outdated curriculum is not deleted and students are burdened with more and more recent advances; The final test of their efforts, however, will be not what they know but what they do. The students are confused with purpose of medical education, the knowledge, skills, and failing to inculcate the values of the profession in an appropriately

balanced and integrated manner. The acquisition of skills for practice Medicine requires radical transformation although the dictum see one, do one, teach one may have characterized the way in which clinical skills were learned in the past, it is now clear that for training in skills to be effective, learners at all levels must have the opportunity to compare their performance with a standard and to practice until an acceptable level of proficiency is attained. India with rapid expansion of Medical colleges, with shortage of competent and productive staff for training, and admission of less meritorious students, finding it difficult to produce skilled Doctors. We are heading to a situation; India will have several underperforming Physicians due to bad planning unreasonable curriculum loaded, with theory than with real time practice. That medical education had to reconfigure itself in response to changing scientific, social, and economic circumstances in order to survive from one generation to the next which is demanding and increasing of conflict of interest. Given that every patient deserves the best possible care, which the politicians promise. We are challenged to provide appropriate opportunities for experiential learning and practice while meeting the service demands of teaching hospitals. The educational mission of teaching hospitals is further compromised by the absence of performance standards and assessment methods that can clearly establish that learners are ready to advance to the next level of independence and challenge. Excellence in medical

education is not merely a vertical expansion, and increase in number of medical colleges. Maximum improvement of health and relief of suffering within available resources should be our goal. There is thus a clear need to set up innovative models and bring about qualitative changes. In spite of severe criticism on several private medical institutions, they have become centres of excellence incomparable to many Government Institutions which are plagued with political inference at every stage. When we observe several private institutions, they thrived in spite of difficulties we realise, that medical institutions have their peculiar problems and they cannot be run as a department of the Government. The law enforcing should create and encourage better academic parameters in establishing and running the teaching hospitals, India is heading for a divide on health care for rich and poor. Today Medicine is rich and poor where you fit is your resources. Please remember all of us need medical care, if not soon but certainly later. We Medical educators have great role to make the Medicine more human in spite of conflicts around us.

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