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Neurology India, Vol. 54, No. 4, October-December, 2006, pp. 443-444 Letter To Editor Neurosurgical education Ganapathy K Dept of Neurosurgery, Apollo Speciality Hospitals, 320 Anna Salai, Chennai - 600 035 Code Number: ni06151 Sir, The letter on "Whither neurosurgical teaching"[1] made interesting reading. While appreciating the author's concern about present neurosurgical training, the future may not be as bleak as implied. We are in a stage of transition. "Gold standards" are no longer Gold!! Traditionally, wisdom (learning from another's mistake, as contrasted with learning from one's own mistakes, which is knowledge) was regarded as a function of time and therefore the prerogative of the elderly. Experience was synonymous with grey hair. The Socratic method of teaching implied that one could learn only by working with a senior dedicated teacher. Therefore, there was justifiably, a rush to learn under "great teachers". It was believed that the art of clinical medicine could only be handed down to a small group of students at a time. The printed word was merely a repository of factual information. Teaching implied the physical presence of what is now certainly an endangered species - a dedicated instructor par excellence. With no axe to grind, this saint would turn a Nelson's eye to such mundane things like creature comforts and be prepared to share his wizardry and master craftsmanship with everyone wanting to learn. Alas even in 2006, cloning of this rare disappearing group is not possible. The real question is, can clinical acumen be gained only with bedside teaching by a good teacher. It is impossible even for the most erudite savant to make all the mistakes possible, to remember these mistakes and to pass on this knowledge to the limited few flocking around him. Tomorrow, knowing more about less will be the norm. The general know-it-all neurosurgeon will cease to exist. With earlier diagnosis and radiosurgery making greater inroads into clinical practice it is unlikely that in the next decade there will be individual teachers who will be operating on large numbers of acoustic schwanomas. The politico-socio-economic fabric of the society is rapidly changing. India is fast becoming a knowledge-based society. To expect status quo to be maintained is to live in a world of one's own and not to accept reality. The author's concern that tomorrow's trainee will no longer have role models to emulate, is perhaps not altogether untrue. However, imbibing discipline and work culture depends as much on the recipient as on the provider. Just as the calf likes to suckle, so too does the cow like to be suckled. The disparity in compensation between those in private practice and those in "full time academics" cannot be brushed aside. Nevertheless, it would be too simplistic and naοve to imagine that teaching will be better if salaries are increased threefold. There will be an inevitable cascading domino effect if salaries of professors of neurosurgery alone are increased. Hundreds of medical and nonmedical specialists would demand parity. We all know that there are Heads of departments in medical colleges who are not even members of the Neurological Society of India. At the same time several from the corporate world, have risen to the highest echelons in academia. Today, even in Indian Neurosciences, many centers in the private sector are as well equipped as national institutes. The gap in the variety and volume of clinical teaching material in public and private hospitals is reducing. To carve a niche in a global market, to make one's presence felt in a flat world, to truly become a netizen, one has to be better than the best. In the private sector it is truly a survival of the fittest. As Charles Darwin once remarked it is not the strongest or the most intelligent who survive but those who adapt themselves to change. The only thing that is constant in the universe is change. To paraphrase a French clichι "the more things change, the more they remain the same". Hospital accreditation is on the anvil. The concept of using CME credits, publications and presentations for cadre review now existing only in national institutes is slowly making inroads into corporate hospitals. Teaching and research, to maintain privileges as a consultant in a private hospital, will soon be mandatory. In many state government medical colleges the prefix "professor" is a function of time. It is based purely on the public service commission number. This needs to be changed. More DNB programs are available in the private sector than in the public sector. The author has hit the nail on the head when he says "lack of dedicated, motivated neurosurgeons to take up teaching". To imply that teaching can only be done by "full time teachers" is to shun the reality. Clinical meetings, clinicopathological conferences and journal clubs do exist in private hospitals. One can only take a horse up to the water, you cannot make it drink. At the end of the day neither a stick nor a carrot can be true inducement. There must be a passionate love for teaching: for this to happen the student can play a decisive role. I recollect with nostalgia my teachers coming at 0630 on Sunday morning just to teach two or three of us - but then we were also there at the given time!! Teaching cannot be a one-way street. Recently, I had the opportunity to participate in a virtual reality surgical skills training session at Johns Hopkins and at Stanford University. Wearing special glasses one could see the structures of the brain in 3D on a giant screen. Layer by layer dissection was carried out with a mouse. The annotations appeared on the screen and by double clicking the trainee could enter into a different world, a world which even the mentor had never known existed. Using video games technology, through virtual reality a most realistic simulation of a polytrauma patient who had just arrived in the ER, was created. The virtual patient was managed interactively by trainees who were physically located before giant screens in different buildings mentored by a senior ER physician. Laparoscopy is now routinely taught using virtual reality. I "operated" on an ectopic pregnancy and quickly learnt to use the suction and cautery. Every single movement was recorded, analyzed and displayed. After several attempts the initial score of 24% became 92%. The pessimists would no doubt pooh pooh this. It will no doubt, take many, many years before neurosurgical procedures are digitized, but the writing is on the wall. Improbable? Yes. Impossible? No. Today, distance has become meaningless and Geography has become History. Mentors and students can be anywhere. Thanks to Information and Communication Technology tomorrow's student can, in a few months, be exposed to undiluted wisdom, which traditional bedside teaching would have taken decades. Though sharing the author's concern, one should be optimistic that eventually digital education, will to some extent make up for the shortage of bedside teachers. Our generation will have the unique advantage of living through this transition. In today's world one has to keep running to stay where you are. The Neurological Society of India no doubt should take up a proactive role in neurosciences education. It was Confucius who once remarked "Give a man fish and you give him food for one day, teach a man how to fish and you give him food for many days". Combining teaching with healthcare is truly the noblest of professions and we cannot shirk our responsibility. To quote Mark Twain "the future ain't what it used to be". In fact it is always ahead of schedule. Many are afraid of the future and cling desperately to the present, not knowing that they have already become the past. Let us respond to Dr. Ramesh's wake-up call and ensure that we contribute our mite to neurosciences education, be it in the new world scenario or in the traditional teaching of yesteryear. References
Copyright 2006 - Neurology India |
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