Inspite of the evolving infrastructure of medical education in our country ,we have seen no changes in the pattern of the Post Graduate Medical Entrance Examinations which are predominately factual and memory oriented.This fact can be realised by analysing the questions of USMLE(United States Medical Licensing Examination) or the PLAB(Professional And Linguistic Assessment Board,UK) .The nature of questions in these examinations is predominantly based upon clinical scenarios and practical aspects which actually test aptitude of a Doctor for clinical practice including logical reasoning and problem solving attitude .In contrast to this, the current pattern of Indian Medical PG entrance tests which include mostly factual questions fail to test the Reasoning ability and problem solving attitude which is the need of the hour for the Doctors opting for higher studies. Instead of nurturing a good diagnostic ability the doctors are actually overloaded with excess amounts of data.But it should be realised that it is the decision making and heuristic power of human brain which distinguishes it from other forms of artificial intelligence available today.Loads of factual data without proper practical implications are actually fragile and transient .
According to the recommendations of the World bank on the ideal nature of Public Entrance Examinations for Developed and Developing nations which i found out on the worldbank website(http://www1.worldbank.org/education/exams/nature.asp) ,Characteristics of a Good Examination System are :

• Exam encourages the development of higher-order thinking skills and does not place emphasis on recall of facts.
• Exam promotes development of performance skills e.g. listening and speaking (languages), practical skills (sciences), production (music, drama, art)
• Exam pressure does not exclude the development of non-cognitive skills (e.g. physical, aesthetic appreciation) .

Whereas other streams in Indian system of education have realised these facts where CAT and other Management aptitude tests have been modified in accordance with current scientific guidelines and have been successful in recognizing and harnessing the human resources to an optima.We the young doctors,still wait upon our mentors who either have not realised this fact till now or they are ignorant about the needs of the developing INDIA ,which on its way to become a superpower is lurching due to the delusive state of its policy makers.

Courtesy:Expressindia » Story
Vidya Krishnan

New Delhi, September 11 Can our hospitals do without interns at night? Is it a learning experience? Newsline takes a look

When Safdarjang Hospital suddenly declared that interns would not be allowed to work night shifts, eyebrows were raised.

As Newsline reported on August 19, a hospital circular said this was done was humanitarian grounds — to save the interns from working long hours. The hospital, instead, was hiring more resident doctors.

The decision drew widespread criticism — for owing to a skeletal staff at nights, the shift offers the most learning opportunities to interns. While the Safdarjung authorities defended their decision, Newsline went to two other hospitals — GTB and LNJP — to observe the training patterns and see how the city’s doctors learn their skills.

Guru Tegh Bahadur Hospital
(Affiliated college: University College of Medical Sciences)
The interns report for duty at 9 am. Every alternative day brings a demanding 26-hour shift — from 9 am to noon the next day. And every intern gets three such shifts in a week.

In the Department of Surgery, the morning rounds on Sunday took almost an hour. Afterwards, the interns spent nearly six hours dressing the wounds of patients. Others collected blood and urine samples, filled investigative forms and fetched reports.

During the afternoon, a 60-year-old patient died due to hypotension. Only an intern was on duty at the time.

While such cases are not unusual, night is still the crunch time. “Once evening sets in, we wait around and keep hoping the shift goes by uneventfully,” said Istha, one of the interns.

The morning after, they have to update the postgrads about the patients’ condition and are relieved by noon the next day, she added.

But while the rounds were going on in the surgery ward, the Department of Obstetrics and Gynaecology spread over three floors with close to 150 patients — was completely unmanned. The nearest doctors were stationed in the Central Labour Room (CLR). “An intern and a senior resident doctor are in the CLR. If there is an emergency we call for them,” said a nurse outside the gynaecology ward.

The GTB Hospital has 100 interns — who shoulder the responsibility of PG students and senior resident doctors.

While students maintain that senior consultants, residents and post-graduate students leave the wards by 4 pm, Medical Superintendent Dr PC Dikshit denied the allegation.

“The interns are never left without guidance. We prepare rosters and teach interns under proper supervision. I am in constant contact with the faculty members and no one has brought up this matter,” said Dr Dikshit, insisting that the hospital was following all guidelines provided by Medical Council of India for medical education.

Lok Nayak Jai Prakash Hospital
(Affiliated college: Maulana Azad Medical College)
The stark difference between interns in GTB and LNJP is apparent when you venture into the Nescafe canteen in the premises.

At 3 am, students are sitting around, sipping coffee, struggling to stay awake.

Reason: There is hardly any work.

Unlike GTB hospital, the “night shift” does not mean being marooned with a ward full of patients and no superviser — rather, it involves doubling up as Nursing Orderlies, fetching test reports and X-rays.

“We usually run errands and get very little exposure to real patient care,” said Mayank Poddar, one of the interns.

“Blood sampling and BP recording is part of the learning process, but we hardly get to learn more. If anyone wants to set up private practice after completing MBBS, he would have no knowledge of patient care. All that we know is theoretical,” said Abhishek Bansal, who is in the ninth month of his internship.

After reporting to duty at 8 am, finishing the morning rounds in the Department of Obstetrics and Gynaecology, Bansal conducted blood pressure charting for 16 patients, fetched blood sample reports of six patients and waited out the rest of the shift.

The silver lining is the OPD duty twice a week, where they do get some exposure, he added. “But in the wards, little is explained to us. Sometimes duty stretches for 36 hours but at the end of it, we learn very little,” added Poddar.

To make matters worse, there is no timetable. “The attendance marking is ad-hoc and we usually follow instructions from first year post-graduate students who man the wards,” Poddar said.

Frustrated by the teaching pattern, the interns — 180 of them — have approached the health department for intervention.

Dr Arun Agarwal, Dean, MAMC said: “Students have to do all kinds of work during internship. In your house you do all types of work and this is the same. Running errands for senior doctors is not the norm but a few students have complained about it,” he added.

Another sore point is the stipend. Students at MAMC get Rs 5,700 per month and had recently approached Delhi government’s Health Department asking for a raise. “The Central government has to decide these things and they cannot happen overnight,” said Dr Agarwal.

THE SCHEDULE
Rural posting: 3 months
Medicine dept: 2 months
Surgery, including Orthopaedics dept: 2 months
Obstetrics and Gynaecology dept: 2 months
Welfare Planning: 15 days
Paediatrics dept: 15 days
Ophthalmology dept: 15 days
Otorhinolaryngology dept: 15 days

Casualty: 1 month

Many of us might have come across Chetan Bhaghat’s brilliant work called “Five Point Someone” ,which gives us a glimpse of how life is like in a IIT .Five Point Someone is a story about three friends in IIT who are unable to cope.I really enjoyed reading this book but being a doctor my subconscience wished for a book on the same roads ,but in the country of medicine .

And my wish was fulfilled when today i read one article featuring a book called INTERN-a doctor’s initiation by Sandeep Jauhar (http://knowledge.wharton.upenn.edu/article.cfm?articleid=2036).I have not read this book yet but i am sure it will definitely give the long needed glimpse into an interns life .

Well this Sandeep is Sandeep Jauhar but my name is Sandeep Moolchandani…anyways name doesnt matter…every young doctor’s story is on the same lines…i am sure that you will be having your own version….

I come across lots of people who think that becoming a doctor is fun and once you pass out of the medical school, life will come on fast track and the struggle for existence will end . Every another middle class family wants their son or daughter to become a doctor and bring fame and economic support to the family and thus in this spree the aspiring doctor of the family aboards this Night’s train and starts dreaming….there will be a clinic and patients lined up waiting for their turn…..Ting tong…sandeep..wake up…come out of dreams…its not the time to dream, its not a time to sleep…you are on 24 hrs duty today..look accident cases are lined up…sutures have to be put…dressings have to be done…investigations have to be taken…case sheets have to be written…seniors are to be informed…dues have to be given…tomorrow this case has to be presented….today evening pre op preparations have to be done…tomorrow morning blood sugar sample has to be taken…aaaaaaaaaaa……

When somebody’s loved one suffers a trauma in a road traffic accident ,while flying his bike at 120kmph…and…pulse not felt…heart sounds not present…pupils dilated ..bilateral femur fracture…multiple rib fractures…they think doctor is there he will save him, we believe in him…. But nobody understands….and all the beliefs are shattered on seeing that peculiar expression on doctor’s face and “i am sorry”…then the anger shows its dirty face and everyone knows that people in India know very well “how to beat up doctors when their loved one suffered trauma and expired in a road traffic accident ,while flying his bike at 120kmph…dilated pupil..bilateral femur fracture…multiple rib fractures…”

All this and many more incidences happen in the looms of a government hospital where everyday thousands of patients are treated for diseases many of which are considered as contagious but the hospital authorities fail to supply masks and gloves to you….many a times you use the same gloves for 3-4 patients…and when you complain to your chief he says that the staff nurse is in-charge of supplies..when you complain to the staff nurse she says that the hospital is short of supplies …and then you hear the news that one of your colleagues,an intern, is suffering from high fever and she has been admitted…then some juniors tell you that some students have also been admitted with complaints of fever…but you are so busy that you think that you will go tomorrow and wish them good health. But to your extreme shock,your colleague had an attack of seizures in early morning and went for a respiratory arrest….and here all the drama starts, a series of exchanges of blames..counter blames..counter counter blames start between the authorities and the students. But in your mind many questions arise..”was it a malaria for which she was being empirically treated”,”was it viral meningitis or a meningococcal meningitis”…. but even today nobody knows what was the exact diagnoses .

Then there are some days when you join a night duty as a casualty medical officer in a private hospital for a handsome sum of Rs 8000/month thinking that it might ease upon the burden you are putting up on your parents who are counting the years to their retirement and then a 5 yr old male child is brought by the attenders with complaints of 15 episodes of diarrhoea and 6 episodes of vomiting in last 24 hrs and you think that the child can go in for a pre renal failure…and the child needs an in-patient care…but they question your decision by saying that its just a diarrhoea…every child suffers from diarrhoea…what is the need for admission !! But you somehow convince them to get the child admitted then they ask you for some discount in hospital charges which amounts to a sum of Rs 7000 as a deposit in favour of the hospital administration…and then you try to convince them that its not upon you,the discounts or whatever rests with the hospital administration..and then they eye you with an expression of suspicion that this doctor is in look out for commission..

But not all days are like this …somedays you will complete your no-sleep backlog of 4 days and go to watch a movie…somedays one of the post op patient will thank you for all the care you take of him…somedays your seniors will give you a chance for making a nick in a hydrocoele…somedays are actually better than the other days….you will cherish those somedays all your life….

Courtesy- The Economic Times

MUMBAI: For professionals, an MBA is just what the doctor would order for career advancement. Now the same holds good for doctors themselves. With corporatisation of hospitals and rapid growth plans, doctors are finding it useful to have a management degree simply to run hospitals effectively.

Large hospitals like Wockhardt and Apollo have clocked in a jump of 49% and 25% in sales respectively for 2007-08. Further, these hospitals are ramping their presence in Tier II cities too.

For eg: Apollo Hospital plans adding 10 new hospitals in tier II towns in the next year and 1,700 beds in other cities over the next three years.

Mr Vishal Bali, CEO, Wockhardt Hospitals foresees good management practices coming in to the sector since growth in sector has raised the bar for competence too. This has not always been the case as traditionally doctors have been running hospitals without any management degrees.

Mr Bali, an MBA from Mumbai University, says that growth in healthcare will create a demand for such professionals in the next decade. “If a leading corporate plans to set up 15 hospitals a year and 10 such corporates undertake to do so, after 10 years we will have 15,000 new hospitals that will require 15,000 new CEOs,” he says.

Though masters in hospital administration (MHA) has been a visible route to administrative functions, a doctor armed with an MBA enjoys a better standing.

“A management degree ensures the manager has business competence whereas MHA inculcates the administrative function,” says Mr Bali. The way hospitals are making investments and setting sale targets, the business competence is definitely important. Also, private hospital chains have announced around Rs15,000 crore of investments by 2010.

Medical graduates are in demand for study and research in various areas such as drug manufacture, biomaterials, tissue engineering, toxicology, medical imaging, and molecular biology. There are numerous avenues for research in reputed institutions / laboratories, a few of which are listed below.

•Central Drug Research Institute, Lucknow

•JNU, New Delhi Bose Institute, Kolkota

•PG Institute of Medical Education & Research, Chandigarh

•Centre for Cellular and Molecular Biology, Hyderabad

•Indian Institute of Science, Bangalore

•National Institute of Immunology, Delhi

•International Centre for Genetic Engineering & Biotechnology, Delhi

•Central Food Technological Research Institute, Mysore

•Central Glass and Ceramic Research Institute, Calcutta

•Central Institute of Medicinal & Aromatic Plants, Lucknow

•Central Scientific Instruments Organisation, Chandigarh

•Indian Institute of Chemical Biology, Calcutta

•Industrial Toxicology Research Centre, Lucknow

•Rajiv Gandhi Centre for Biotechnology, Trivandrum

•Madurai Kamaraj University

•Various units of CSIR, ICAR, ICMR, and DST

Take biology as your major in higher sec school -> prepare for premedical entrance -> if you are intelligent enough to get selected in first attempt -> get admission into a medical college -> pass first year(Duration 1 year,30 to 40 % chances of failure for average students ) -> can lead to extension of course by 6 months-> pass second prof(duration 1 & 1/2 yrs) -> pass pre final(duration 1 year) -> pass Final year mbbs (Duration 1 year, again 20 to 30 % chances of failure and extension of course by 6 months) -> Do 1 yr internship in your college hospital -> Total Academic Period without failures = 5 & 1/2 Yrs

But still you dont get a MBBS degree -> Go to village for 1 year rural internship -> prepare for pre PG entrance examination -> if you are intelligent and hard working enough to get selected in first atempt -> get admission in post graduation course (MD/MS etc) -> the post graduation lasts for 3 years which includes total segregation from the whole society -> duty hours 90 hours /week or more in clinical branches -> complete your PG -> again a rural posting for 1 year (implemented in some of the states) -> Prepare for Super specialisation (DM/Mch) entrance exams -> If you are alive and intelligent and hard working enough to get through in 1st attempt -> Super Specialisation course lasts for 2yrs -> You will be among the leading Super Specialists of your city in a matter of few years (…if you are alive).