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Indian Journal of Surgery, Vol. 65, No. 1, Jan.-Feb. 2003, pp. 47-49 Surgical Training Training of Doctors K. C. Sharma Sarv-Sidhi Nursing Home, Udhampur, Jammu and Kashmir
Paper received: June 2002
Code Number: is03009 Fifty-two years have passed since independence and yet we have not been able to determine the right strategy for solving the health problems of our country. Deepening economic crisis, the price hikes, the ever increasing number of educated unemployed youth, the expanding socio-economic disparity, appalling rate of illiteracy etc. cannot but cast their shadow on the health profile of the country and the medical profession as well. In a country where the allocation for health is less than 1.5% of the total budget, where the infant mortality rate is 104/1000 and death rate is 12.5/1000, where 70% of the population can't avail of any organized elementary health care, where quacks play a mor role in treating the sick, one cannot feel proud of the healthcare delivery system. In such an environment the doctors are thrown into a dilemma, whether to act as a tradesman or as a scientist. Therefore t he problem before us are :-
The proclaimed purpose of the present system of medical education in our country is to produce medical graduates in modern scientific medicine capable of functioning independently and effectively both in rural and urban conditions either in solo practice or as team leaders. It is directed that every attempt is to be made during their training period to enable them to develop personality, character, expression and other faculties to achieve the above objectives. The opinion is unanimous that the medical colleges are not producing graduates with such attributes. It is time that we ponder on the causes of such a failure as the entire healthcare system of a country hinges on the doctors. Lack of Motivation : One cannot deny the fact that in the existing state of our society the main motivation for a youngster to take up medicine as a profession is to ensure a comfortable lifestyle and a superior social status which can be assured by money alone. This explains the craze for seeking admission into medical colleges even by offering bribes, capitation fee, false caste certificates and political pressures etc. I repeat the words of my teacher Prof. B.D. Kahali (1960) " The profession is meant for those who are interested in it and not for those who can afford it". I may be pardoned for saying that the attitude of medical teachers, who are the main guides for the young minds, is no different. Unless appropriate motivation can be induced in both the teachers and the taught, no amount of formulation can achieve the enunciated goal of medical education. Today's student is slightly different from the student of a few decades ago. He is more informed and not immune to the deteriorating ethical standards of our society including those of his teachers. To command him or to demand respect from him is not so easy as some teachers have come to believe. The only way to influence him is by actions and by proving to him that you are an ideal teacher interested in imparting knowledge and that you possess the qualities to command him. Here are some of the factors that lend credibility to the image of a medical college teacher. Professional competence is the hallmark of a good teacher. Only a professionally competent teacher can train his students on the right lines. So convinced should a student be of the professional capability of his teacher that he should follow him spontaneously and act on his dictates. Loyalty is a two-sided game. To beget loyalty from students, a teacher has to be loyal to them. It is an accepted fact that students like, a teacher who is strict, provided he is honest, fair and human. Integrity is one of the most important requisites of a teacher. A student often mirrors the ills & virtues of his teacher. A teacher worth his name should not lie, falsify his findings, cheat or steal, nor should he tolerate such acts from his students. Teachers fully absorbed in teaching and training, taking evening classes, knowing the aptitude of their student more closely was the routine two to three decades ago. But today though doctors have more degrees and the latest knowledge it is often difficult to get a teacher of required standards and who is dedicated to teaching. This deterioration has darkened the image of doctors as a class. It used to be said that doctors have no religion. Their religion is the same as that of their patient but alas! Today the situation is getting different. The well-known saying. "There are no bad colleges, there are bad teachers" has been proved true over and over again. Good teachers beget good doctors, bad teachers beget bad doctors. Coming to the training of doctors for villages the government followed a policy of selecting candidates even with less merit from far-flung and backward areas with the sole idea that they will serve their respective areas after getting the degrees. But we have miserably failed in this assumption in the last 52 years. Let us re-evaluate our policy since we have failed to send back these doctors to their respective areas. On the other hand, these doctors have shifted their families and assets to big cities. Such doctors by virtue of less merit from the beginning could never make up and have not only lowered the doctor's quality but have also failed even to follow the basic medical ethics; their aim is only to amass wealth. Areas considered incompatible some years ago have merged into new avenues of application demanding the attention of a man of the highest intelligence and skill for medicare. The practice of medicine, a mission of mercy has a compelling fascination for young minds and hearts sensitive to suffering but to truly be of service a student doctor has to master a tremendous volume of information related to the art and science of healing and this can certainly not be achieved by the ones below average. Denying this truth is as plain as the way to a church and is as dangerous for the health of a nation as the individual's folly of hiding a disease affecting the vital organs of his body. The earlier we accept this truth the better it will be. Research : Research in medicine cannot be conducted in labs separate from the hospitals and patients and by a separate group of people but in these very hospitals by these very doctors only, provided they are motivated to do research during their training period itself. Therefore, such training has to be imparted by teachers who have some thing to their own credit. Sometimes I feel sorry for the present state of affairs as we neither import eminent doctors nor do we allow our students to go out in search of knowledge, the result being inbreeding. Osler has said, "Inbreeding is as hurtful to colleges as to cattle". A regular brain dusting is essential for all doctors every 3rd year, back to the hospital or laboratory for renovation, rehabilitation and rejuvenation. He further postulates "Nationalism in medicine is a great curse to humanity, our culture should be cosmopolitan & not national" and still less, the product of one school, college or state. Since majority of the teachers in medical colleges have never worked in villages, it is worthwhile to invite some interested and experienced doctors from district / sub-district hospitals to talk and demonstrate to graduates and postgraduate students, explaining the problems of and solutions for the villages where they finally have to serve. So that before they leave the teaching institution they are well versed with the situations they are likely to face. This will help both the rural doctors as well as the medical students. Certainly after this interaction, the young doctors will not feel bewildered on reaching the village. May I mention that the very essence of medical education lies in the merit of scientific observation, in a direct appeal to the nature of the truth, and not in any authority. Whenever man has seen things for himself, and has not been content with vicarious observation, he has taken a decisive step towards the emancipation of the human race from the trammels of traditional doctrine. Therefore there is a great need for an interrelationship between the urban and the rural and an appreciation of each other for the ever higher objectives of teaching and training Doctors. Copyright 2003 - Indian Journal of Surgery. Also available online at http://www.indianjsurg.com |
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