|Year : 2020 | Volume
| Issue : 1 | Page : 1-3
Temples of rare cult
Department of Pathology, MGIMS, Sevagram, Maharashtra, India
|Date of Submission||06-Jan-2020|
|Date of Acceptance||13-Jan-2020|
|Date of Web Publication||14-Apr-2020|
Dr. Anupama Gupta
Department of Pathology, MGIMS, Sevagram, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Gupta A. Temples of rare cult. J Mahatma Gandhi Inst Med Sci 2020;25:1-3
“I alone cannot change the world, but I can cast a stone across the waters to create many ripples.”
In 1988, the World Conference on Medical Education held in Edinburgh, Scotland, declared some recommendations which would be going to change the course of health professions education worldwide in the coming years. In order to make these recommendations locally relevant and providing an impetus for national policymakers and individual medical schools in every country, six regional meetings took place in various corners of the world, before the Edinburgh declaration. However, the Lancet immediately and largely dismissed these recommendations as “utopian,” and we still are evaluating which of these recommendations are actually turned into reality in the past 30 years.
Much before this hubbub worldwide, in the year 1969 Mahatma Gandhi Institute of Medical Sciences (MGIMS) in Sevagram, a small village of India, under the leadership of Dr. Sushila Nayar, the then Health Minister of India and a veteran Gandhian, silently got committed for community-based learning (CBL), to break the path of traditional way of nurturing doctors, to achieve most of the Edinburgh goals the world had not thought of till then.
CBL, also called as service learning, is different from other forms of experiential learning or community-based fieldwork experiences such as volunteerism, co-operative education, or internship because it has “active citizenship” as its essential component which is missing in other forms and thus it can also be differentiated from charity. Active citizenship is when “students appreciate civic purpose of their discipline and their role in the community,”, CBL breaks the omnipresent and stubborn barrier between academia and community. In addition to making students’ learning enriched with real-life experiences, CBL also makes the community a major stakeholder in health-care delivery and training of its health professionals. It endows decision-making power in peoples’ hands, based on their own realities and preferences about health and disease.,,
MGIMS model (MM) basically is a vertically integrated CBL module which starts from a 15-day residential camp, called social service camp (SSC) in I MBBS. It is organized in a nearby village where students study their “adopted” village from the perspective of health and disease. While living with the villagers in a strictly rural setting, they get real-life exposure to social determinants of health; get familiar with available health-care facilities; take responsibility of health check-up of four to five families allotted to each of them in collaboration with community health workers, self-help groups and clinicians; plan, prepare, and participate in health education sessions; get a working knowledge of local language; attend special diagnostic clinics arranged in the village; learn basic principles of clinical interview; and help collecting clinical samples under supervision. Activities of the camp are under the continuous supervision of faculty and field health workers of the community medicine (CM) department who also stay in the village for the camp period. In addition, faculty and technicians from other clinical departments join this team for special clinics. In total, a team of approximately 35–40 trainers take part in SSC which gives participatory experience of serving and learning to 100 students in community setting. The village remains “adopted” by that batch of students throughout the 3½ years’ CM training period, and students design small community research projects to execute them in subsequent village visits.
There were other components in MM such as a special subjective test on Gandhian thoughts for qualification and merit in entrance examination to see the inclination of students to Indian values and service of nation, admission quota for students studying in rural schools, value-based learning in a residential camp in Gandhi Ashram, a 2-year rural service for qualifying admission in postgraduate (PG) courses apart from merit. All these efforts were to imbibe the values of service leadership in our students, as promoted by Gandhiji and to produce a rural bias in medical education. However, all our selection criteria are dismissed by the legal court now, since 2017, in the name of a unified and centralized selection process called the National Eligibility and Entrance Test throughout the country for undergraduate and PG health professions courses.
The 12 recommendations of 1988 Edinburgh declaration, and how the MM imbibed them, even before their recognition by the medical education domain, are presented in [Table 1].
|Table 1: Comparison of components of the Edinburgh declaration and Mahatma Gandhi Institute of Medical Sciences model|
Click here to view
As exemplified by MM, Manisha Nair, and Gracia Fellmeth also found that if the institute is located in a rural area, it in itself can have a positive impact on learning outcomes and career choices of its student population. Students of 17 medical schools in the USA, Australia, Canada, and South Africa were more likely to choose a career in primary care because their institutes offered a long or vertical clerkship in community. Likewise, experiences of few standalone institutes in Thailand and Jordan also show that CBL provides useful insights into relevant local community needs, hands-on experience, and generate a sense among students of being valued by the community.
After more than 30 years of the Edinburgh declaration, we are still realizing anew every day that a profession like health care there is continuous interaction with and management of not only three Ms (material, money, and men), but also a micromanagement of socioeconomic milieu of the society in which health professionals work and struggle to achieve the extremely ambitious goal of health for all.
Even as MGIMS legacy is alive and thriving despite recent juridical blows, CBL need to imbibe newly identified dimensions in Health professions education (HPE) learning. Two such aspects of learning have been emerged as crucial here:
- Introduction of new domains of knowledge: Such as psychology, human factors engineering, anthropology, and business fundamentals will help to create a generation of health-care providers better equipped to deal with the challenges being faced by today's health care. In addition, if stress management could be an integral part of the curriculum, it would immensely enhance the quality of life in health professions
- Balance between the knowledge base and health-care practice: Sargeant et al. noted an interesting conflict of interest between the two basic learning sites of a health professional - the institute and the hospital. If a teaching institute is to be called successful, knowledge imparted to students should match with examination outcomes and not usuallyon vocational aspects of medical career i.e. patient centred health care, which makes institutes less enthusiastic to incorporate CBL in the curriculum. The recruiting agency, on the other hand, i.e. hospitals have an interest in the clinical acumen of the employee and do not care much for the knowledge base. However, if we have functional balance of learning and assessment between these two sites, students will also choose to join clinical teams in the hospital to contribute in patient care, instead of sitting in library to prepare for solo assessments and PG entrance examinations. The performance of a practicing clinician is affected not only by her/his own professional and personal attributes but also by organizational and systemic factors and a clinician is just a cog (though a crucial one) in the wheel of health-care system. This reality should find its way in our learning and assessment system since the beginning of health professional training. Sargeant et al. suggested learning tools such as operating theater audit, acute life support training, or in situ simulation in emergency departments and assessment tools such as incident reporting, root cause analysis, patient outcome audit, peer review, and periodic accreditation afterward.
With the implementation of competency-based medical education (CBME) by the Medical Council of India in 2019, the Indian health professions education is at a new juncture today, ready to stress on many educational components of MM. However, if CBME can make the present learner-centeredness in HPE give way to patient-centered, team-centered and health service-centered approach, then only this reform could be leading to what it intends to achieve. Moreover, to achieve this goal, these temples of rare CBL cult, like MGIMS, should be preserved and supported in all possible ways because they only can demonstrate how studentship can be linked to health-care delivery system effectively, for the best learning of ground realities.
As an African Proverb says it, “If you want to go quickly, go alone. If you want to go far, go together.”
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