“GOI recognises importance of distance learning in Medical Education” : Prof AK Agarwal, IGNOU School, India

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The IGNOU School of Health Sciences has developed several skill/competency-based and innovative Graduate Medical programmes with the objective of augmenting educational avenues and for providing in-service training through ODL mode.

Prof AK Agarwal, IGNOU School of Health Sciences, in an interaction with Dhirendra Pratap Singh and Shally Makin, shares insights about the initiatives of the school and the need for modernising medical courses in India

What is the present medical education scenario in India?

The 1990 Flexner report paved the way for reforms in medical education in 20th century. These reforms also contributed to doubling of the life span. Lots of water has flowed down during last one hundred years. All is not well with medical education.

The Commission on Education of Health Professionals for the 21th century-a global independent initiative, led to a recent Report, “Health Professionals for a New Century: Transforming Education for health Systems in an Interdependent World (Published in full in Lancet Vol. 376, December 2010)”. It highlights the glaring gaps and inequalities in health within and between the countries, underscoring our collective failure to share the dramatic health advances equitably. Further, the new infections, environmental and behavioural risks, at a time of rapid demographic and epidemiological transitions are creating new challenges. Professional education has not kept with these challenges, largely because of fragmented, outdated and static curricula that produce ill-equipped medical graduates.

The report further identifies the problems as systemic: mismatch of competencies to patient and particular needs, poor team work, persistent gender stratifications of professional status; narrow technical focus without broader contextual understanding; episodic encounters rather than continuous care; quantitative and qualitative imbalances in the professional labour market and weak leadership to improve health system performance. These disparities imbalances are more glaring in Indian context.  

Medical education, both under graduate and post graduate is at crossroads. Medical colleges train the students in a manner that they look forward to work in the metro cities. As per the expectation, the medical graduates need to understand the civic-social problems in the country, by working closely with the communities that vary widely in different states in India. When we say this, we mean that even if there are excellent teachers, brilliant students and lots of opportunities in India in medical education, little has been done to make it appropriate and affordable to vast majority of population.

In the current scenario, our young doctors are forced to go to rural areas and they work half heartedly due to lack of infrastructure and basic facilities. Medical education is skewed towards tertiary care and high-end technology in urban areas, neglecting the development in remote areas.

The Lancet Report synthesizes that three generations of educational reforms characterise progress during past century. The first generation, launched at the beginning of the 20th century, taught a science based curriculum. Around the mid century, the second generation introduced problem-based learning. A third generation is now needed that should be system based to improve the performance of health systems.

One of the important recommendations of the “Commission” is Transformative Learning. It is about developing leadership attributes. Its purpose is producing enlightened change agents for medical education.    

Please share the initiatives and new courses of School of Health Sciences, IGNOU. How do these courses help in attracting students?

School of Health Sciences (SOHS) is the first open and distance learning initiative in the world of medical education by IGNOU with focus on hands on skill development. Today many post graduate medical courses being run by SOHS. (Please read our Brochure for details.) They are PG diploma in Maternal and Child Health collaboration with WHO and Ministry of Family and Health Welfare (MoHFW). We have PG diploma in Obstetrics, Pediatrics and Community Medicine, which are presently running in 25-30 medical colleges in India. 

Our rural healthcare system should be addressed on priority. China did something great in for strengthening the rural healthcare system

Further, we have PG Diploma in Hospital and Health Management (PGDHHM) in collaboration with Academy of Hospital Administration and PG diploma in Geriatrics, which is based on skills for elderly patients. We are also offering B.Sc. Nursing programmes. This programme is also open to allopathic and dental doctors. We must have doctors with multi skills for such patients. We also offer a Post Graduate Certificate Programme in Rural Surgery (PGCRS) to be pursued after post graduation. The idea behind “rural surgery” is to develop a multi skilled surgeon doctor to do all life & limb saving surgery in the countryside and same urban settings. This PGCRS programme has been developed in collaboration with the Association of Rural Surgeons of India. We have also developed Post Graduate Diploma Programme in Clinical Cardiology; it is developed with the help of Narayana Hrudayalaya and is in great demand. We will soon be starting with a new course on PG Diploma Programme for HIV medicine in collaboration with NACO. Dr TK Jena, from the School of Health Sciences, IGNOU is the Programme Co-ordinator for this course. We will also be offering another programme, which is a one year Post Doctoral Certificate programme in Dialysis. This programme is also in collaboration with MoHFW. 

How do you see the future of medical education through distance learning?

Every year 30,000 young medical graduates (allopathic) pass out. Most of them do not get an opportunity to do post graduate courses. In such cases, online education becomes very relevant. The online learning is for only post graduate level since the basic MBBS degree can’t be given through distance learning. The School of Health Sciences, IGNOU first started the model of distance education in the medical field, offering a range of pursuing medical education since 1996. 

Continuing Medical Education & Capacity Building through ODL/blended learning system is the need of the hour. Till now we haven’t really reached out to the grassroot levels through conventional courses. However, through open and distance learning system short term certificate or diploma courses in integrated medicine and surgical needs can be developed. This will help in reaching out to more and more aspirants to meet the needs of our society. Besides, the format of the courses would allow us to open a vast network of study centres in hospitals and medical colleges and train a large number of manpower in much shorter time. We identify leading colleges in the country and sign MoU to train the students. Many state governments have recognised our programmes and officially sponsored their doctors to benefit from these programmes. 

We believe in a model where more than 50 percent teaching is done in hospitals. PG diploma in Clinical Cardiology Programme is also one of them. Today we have associated with 60+ hospitals throughout in the country. India on an average does not produce more than 125-150 DM/DNB cardiologists per year. Most of them work in large hospitals/cities. IGNOU’s PGDCC bridges this gap and provide a cardiologist’s (non-invasive) expertise to them.

Rural India, today, faces a serious lack of doctors and healthcare facilities. What needs to be done with medical education to bridge the rural-urban healthcare divide?

Handover the rural healthcare facilities to private partners along with the budget (both plan and non-plan).  Make them accountable. We need to have a very vibrant public health system, where young doctors could go to remote areas. The peripheral health infrastructure should be improved. We can adopt the model of Yeshaswini micro health insurance scheme.

Actually, in rural areas medical facilities have been planned nicely on paper. However, there is lack of proper buildings, basic infrastructure, refrigerating facilities for vaccines, lab technicians, and electricity. Our rural healthcare system should be addressed on priority. China did something great in for strengthening the rural healthcare system. In early 1940’s they closed all their medical colleges and put their entire faculty in rural areas. China realised the importance of rural healthcare. We can adopt the Chinese model.

What should be done to scale up our medical infrastructure?

Health is a state subject. Medical education in India is governed through MCI. If we have to improve the healthcare delivery system, the Government has to give it priority because allocation of financial resources in health is abysmally low. Additional money should be allocated in this sector. There are so many mismatches between rural and urban healthcare in India. 

Health system can be such a huge generator of jobs, besides improving the quality of life of our people. So, how could we improve the situation?

Our policy makers must realise it. With one percent allocation in healthcare, we can’t improve the situation. At least four percent of GDP should be allocated to the healthcare sector. Electricity and other infrastructural bottlenecks should be corrected. There should be some post graduate seats for them who want to work in rural areas. Famous management Guru Peter Drucker once said that 80 percent of ills of any system are because there are no systems in place.

Our doctors do well in the UK and the USA because they have good systems. Medical education is one such thing which needs better systems. Government should make health infrastructure more vibrant. Distance and e-learning should be encouraged. Medical Council of India should recognised the importance of open and distance learning.

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