Monday, February 1, 2010

New course for Medical, do u think that every thing going well???

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Alternative Model of UG Medical Education

Its timely but need to think for how long we need such graduate. As in Gujarat BAMS/BHMS doctors are working at PHC for long time. They are also practicing medicine. In this scenario do we need one more degree? Can we think to improve the curricula of BAMS and BHMS so we can fulfill need of country? There is serious thought require before starting so many alternative medical education (my knowledge is that MCI wants to start 100 such colleges). In this need section I would like to suggest instead of using word medical education or medical degree use Health. The degree can be named as Bachelor of Rural Health (BRH) and make it more wide and relevant to health need rather just medical need.
There is need of Health people who can think beyond the medical eye. At present our medical education is totally clinic based and drug based. There is little incorporation of broad concept of health. Health is more than medicine and it is real holistic approach.
Statistics says that population to physician ratio in India is 50-60 physicians per 100000 population and that is not equal distribution geographically, 74% are in urban area and only 26% are in rural area. So this point we also keep in mind while thinking need. Along with this can we think something like MD/MS directly rather MBBS? MCI can think to remove or modify the Master degree and make BHR (BRMS) as under graduate degree. (Its my personal suggestion). So that the confusion can be removed at all level. (thinking positively and give inputs). As majority of MBBS doctors want to do post graduate just modify the curricula and start MD/MS directly so that we can produce quality stuff instead of confused basic doctors!!!! It will also help to remove all pre-pg exams and its related cost?
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There are lots many scope, if we make some innovation, but very limited if we are making modified version of current courses. Don’t assure people who are getting admission that they are going to become Doctor but assure they are going to be health care taker of community. Also my personal opinion don’t give degree of “Dr” so that it should not mix with actual qualified doctors.
Also we need to decide who is going to recruit. It is exclusive need of Government or other sector also like NGO, private etc. If so what will be the role in Government and other sectors. We need to decide salary structure for these people. There is also need to think about promotion and future of this course. Here I like to raise question that can this people take admission in MBBS later date? Can they do post graduation later? What means later? After how many years they can do above action? It should clarify here only. So the people who are getting admission have clear future course.
At present we are thinking about this course because the MBBS doctors are not going in rural and tribal areas to serve. We need to take assurance that these people will go and serve needy. The government has to generate future scope for these people. Here is question is that once rural, tribal and difficult areas are saturated by such doctors, what will be the next scope? Once appointed person will occupy post for next 20 years (assume). What about new people?
As I mention above in need, if we are making modification in MBBS and start direct to give MD/MS degree, I think issue of survival will not come in process, because these basic doctors will exclusively work for rural and urban community as basic doctors and Master will take care about secondary and tertiary care.
It can put as scope that these practitioners can join MD/MS degree after 10 years of practice or service to government with entrance exam.
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Past experiences:
In past experience, I read somewhere that in west Bangal Government had started such course in past but poor out come. Please share anybody have more information.
In Gujarat also Government had started one and half year course for Ayurvedic doctor in past. But it was stopped in two years. They got degree of MBBS and got registered in council. As far my knowledge they did MD and worked for government. (Need to confirm)
One more recent old news, I think all knew that Mr. Ajit Jogi CM of Chhatishgardh, few years back came up with similar concept and that time MCI had oppose the concept.
So looking to this past experiences, this is not the new concept but it is like old wine in new bottle. So like ASHA and primary health care concept, we need to see that it should implement full proof so there will not be major confusion in future.
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Vision and Mission for BRH (BRMS)
The vision statement for this course should be like the graduate of BRH or BRMS will work for community health and help the upliftment of community health. They will take care of community for basic physical, mental health, social health, environment health, cultural aspect of health and public health.
Frame work for education:
Ideal model – Admission after 12 std and domicile of that district
Place of college: District hospital (need to upgrade for such college. They should have all basic department like medical colleges with many units so people can spare time for education.)
One college should have only 25 to 50 seats not more than that.
Proposed curricula: first year with one year with subject like basic anatomy, basic physiology, concept of biochemistry, social science, concept of economics, psychology.
Second year: Concept of pharmacology, microbiology, pathology, FM with community health, behavior science, social science, counseling, patient care, hospital management
Third year: Basic medicine (include skin, psychiatry, tb), surgery (include ophthalmology, ENT, all surgical) and obs/gyne, community health, health care management, hospital management
Evaluation should be skill based.
Six months internship, include one month in good community based NGO,
Than degree? Need to think?

Teachers for such college:
They should be MCI recognized and specially trained for this programme with good remuneration more than present. The subject like medicine, surgery, Obs/Gyne, community health, social science, economist, psychologist, epidemiologist, public health expert, environmentalist, health care managers etc should be teachers of such course.
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Major queries in this topic:Need inputs
1. What should be the name of course? BRMS or BRH or Something new
2. Should the new degree need any body like MCI or just University?
3. Is that MCI ready to upgrade MBBS to directly MD/MS so the new degree will act as basic degree? What future problems due to this change?
4. Will we produce quacks officially?
5. Will community accept the new version of doctors?
6. Should we call them doctors? Or something else????
7. What should be scope at international level to the new degree?
8. What will be the role of nursing, MPHW, HE etc in new scenario?
9. Are we ready for such major change? As we are on verge of completion of NRHM.
10. Is it politically motive move? So it will diverted our attention from NRHM to otherside.
please comment and make fruitful exercise.
Dr. Niraj Pandit
Thanks to some faculties who have mailed on MEU group and Dr. Prabir Chatterji for inputs by mail. I thankful to my Dean Dr. G V Shah who gave me opportunity to make this write up.
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Prabir said...

Actually the West Bengal CHSO (Community Health Sevice Officers)were given an option to do a course 20 years later to get MBBS(R). They still function as AMO (Assistant Medical Officers). There are 10 AMO in my district alone. All still work for the government in the blocks. One even became Block Medical Officer for a few years. But IMA opposed the course. So no new batches were trained. I disagree with the negative views. That course was useful in its own way.

prakash said...

One side they say they want to start new course BRHM bringing about plenty of number, but at the same time permitting pelnty of new medical colleges, increase in intake of postgraduate seats saying that there are less in number, decreased the number of teacher: student ratio, increased the agelimit of teachers, what is the future of the graduates who will be coming out. the staff requirement is reduced.

Sandeep said...

Actually we are quiet short sited, we should look at generating more allied posts who can work along with the Doctors eg. case managers, bed managers, hospital managers, and other managers in the field of health care so that we just do not think of ? making less qualified doctors (indirectly increasing the burden on the society) we should enchance the performance by alternative thinking.

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