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EDITORIAL
Year : 2020  |  Volume : 13  |  Issue : 1  |  Page : 1-2  

Coaching classes… competency-based curriculum… bed of procrustes… deck chairs on the Titanic


Department of Community Medicine, Dr. DY Patil Medical College, Hospital and Research Centre, Dr. DY Patil Vidyapeeth, Pune, Maharashtra, India

Date of Submission28-Oct-2019
Date of Decision05-Nov-2019
Date of Acceptance11-Nov-2019
Date of Web Publication16-Dec-2019

Correspondence Address:
Amitav Banerjee
Department of Community Medicine, Dr. DY Patil Medical College, Hospital and Research Centre, Dr. DY Patil Vidyapeeth, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_292_19

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How to cite this article:
Banerjee A. Coaching classes… competency-based curriculum… bed of procrustes… deck chairs on the Titanic. Med J DY Patil Vidyapeeth 2020;13:1-2

How to cite this URL:
Banerjee A. Coaching classes… competency-based curriculum… bed of procrustes… deck chairs on the Titanic. Med J DY Patil Vidyapeeth [serial online] 2020 [cited 2020 May 30];13:1-2. Available from: http://www.mjdrdypv.org/text.asp?2020/13/1/1/272881



Coaching classes have become the unorganized sector of education. They attract students aspiring to join professional courses. The limited number of institutions of higher learning in our country makes the rat race an act of desperation. Adolescence and youth which should be a carefree period of healthy physical and psychological development have become a period of stress, anxiety, burnout, and depression, leading to poor lifestyle in the form of unhealthy diet and lack of recreation, and occasionally, in extreme cases suicide.[1]

By the time they enter medical school, the students are tired and bored lot having undergone the extreme stress of coaching and competition. The undergraduate period provides some respite till they gear up for the next round of second-hand learning in the form of coaching classes for getting a postgraduate seat. Many take it easy during this period. The internship which provides the opportunity to learn the practical skills of the profession has become eyewash. This period is used for attending coaching classes in top gear. There is optimism that the ranking in the proposed “exit exam” which will decide entry into postgraduate courses will stem the rot. The pessimistic view is that this would start private coaching for the “exit exam” during the undergraduate period itself.

Against the above backdrop, the erstwhile Medical Council of India (MCI) issued the much-awaited Competency-based Medical Curriculum for the Indian Medical Graduate in three volumes in the year 2018 to be implemented from the academic year 2019.[2] The document has 412 topics for learning and 2,949 outcomes to be mastered.[2],[3]

Given the short time to implement the revised curriculum, most faculty in medical colleges are in a tizzy. Recommendations pose a challenge for implementation given the limited resources and large number of mostly indifferent students. In Greek mythology, a character named Procrustes lured travelers with lavish dinners and led them to an iron bed. His obsession was that all travelers should fit this bed. To accomplish this, he cut the legs of tall travelers and stretched those who were too short to fit his bed.[4] In the same manner given the short time for implementation, there may be tendency to cut some sessions or stretch the limited resources to fit the frame of program and course objectives. On paper, the program and course objectives will align with the goal as enunciated in the revised curriculum, i.e., at the end of the program, the medical graduate should be trained as “physician of first contact of the community.” With the lure of specialization and super specialization, coupled with the pull of greener pastures abroad, one may ask how many medical graduates aspire to be “ first contact physician of the community?” Much gap will remain between theory and practice and much stretching will be required!

Our medical education system has hit the iceberg in the form of coaching classes. The implementation of the revised guidelines would be like shuffling deck chairs on the Titanic. Reforms will be difficult in a system which is leaking so badly.

Where will reform come from? – perhaps not by top-down approach in isolation. The students may show the way. In the gloomy picture, there are occasional rays of hope. As Rabbi Chanina remarked, “I have learnt much from my teachers. I have learned more from my colleagues than my teachers. But I have learnt more from my students than from all of them.”[5] As a teacher of community medicine, this point was driven home to me during a dreary afternoon lecture. Interaction with students who had no concept of integrated teaching, (neither had I at that point of time), made us together put forth a concept of community medicine which fits well with those of the experts on an integrated curriculum.

I was explaining the dynamics of malaria transmission using the classical triad of agent, host, and environment. One student asked in what way community medicine was different from other subjects. I was struggling for a good answer.

Just then, the sports secretary interrupted the class to make an announcement of the forthcoming chess tournament. Somebody in the class, an unidentified backbencher shouted that community medicine is like a game of chess. I asked him to explain further, but he remained anonymous after giving the cue to the discipline. This little spark made me explain to the class that community medicine is like a game of chess, while most other specialties such as pediatrics, obstetrics, microbiology, entomology, ophthalmology, medicine, and also others such as social sciences, economics, public health engineering, telemedicine, artificial intelligence (in times to come), and many more depending on the situation are like the chess pieces. For good public health practice, one has to have insight into the role of medical and nonmedical specialties and how they can interact with each other to solve a particular health problem. This is analogous to a game of chess where the individual pieces gain value in combination with other pieces, and no chess piece has full potential in isolation. No two chess games are similar. Similarly, no two public health situations are identical. For good practice of community medicine, vertical and horizontal integration of various medical as well as nonmedical disciplines is essential.

To conclude, a few words about the MCI's Competency-based Undergraduate Curriculum will put things in perspective. The revised curriculum is like a strong chess piece which is trapped in one corner of the chessboard severely limiting its impact. It is an exhaustive and brilliant document, albeit utopian, as it overlooks the ground realities. To realize its full potential, it has to negotiate its way on the chessboard among the clutter of coaching classes. If one cannot beat them, one can consider joining them, i.e., involve them too in the integration process to avoid extra burden on the overworked medical student.

Besides, there are in-house limitations. Most medical colleges have a disproportionately large number of students with limited faculty inadequate to implement small group competency-based teaching in letter and spirit. In addition, specialties such as family medicine, which presently has inadequate content in the undergraduate syllabus, need to be promoted with good working conditions for the “physician of first contact of the community.” To quote, the former world chess champion, Garry Kasparov, “The virtue of innovation only rarely compensates for the vice of inadequacy.”[6]

Acknowledgment

The author acknowledges valuable inputs from medical students, interns, newly qualified “Indian Medical Graduates,” and medical teachers.



 
  References Top

1.
Hindustan Times. Editorials 50 Deaths in 60 Days: Are Coaching Centres Driving Students to Suicide? Hindustan Times; 22 October, 2017. Available from: https://www.hindustantimes.com/editorials/50-deaths-in-60-days-are-coaching-centres-driving-students-to-suicide/story-eVmULTaYCUDi4Gdbry4MSI.html. [Last accessed on 2019 Oct 27].  Back to cited text no. 1
    
2.
Medical Council of India. Competency Based Undergraduate Curriculum for the Indian Medical Graduate. Medical Council of India; 2018. Available from https://www.mciindia.org/CMS/information-desk/for-colleges/ug-curriculum. [Last accessed on 2019 Oct 27].  Back to cited text no. 2
    
3.
Jacob KS. Medical council of India's new competency-based curriculum for medical graduates: A critical appraisal. Indian J Psychol Med 2019;41:203-9.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Taleb NN. The Bed of Procrustes. New York: Random House; 2015.  Back to cited text no. 4
    
5.
Friedman L. Life Lessons in the Lunchline. The New York Jewish Week; 20 May, 2013. Available from: https://jewishweek.timesofisrael.com/life-lessons-in-the-lunchline/. [Last accessed on 2019 Oct 27].  Back to cited text no. 5
    
6.
Kasparov G. How Life Imitates Chess. Insights into Life as a Game of Strategy. London: Arrow Books; 2008. p. 34.  Back to cited text no. 6
    




 

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