Can change in medical curriculum fix what ails medical practice? Prof (Dr.) Sundeep Mishra (AIIMS)

New Delhi: Over last several decades there have been rapid advances in human information, knowledge, skills, and wisdom. The advances have encompassed all fields; science, commerce, communication, aesthetics, and philosophy. In pre-modern times, irrespective of the profession one pursued, the focus was on all-round development of personality, encompassing all the fields simultaneously. Thus many famous medical professionals of past were also famous philosophers (Charaka, Hippocrates, Descartes, Galen, Avicenna, Carl Jung), poet / writers (Avicenna, Keats, Chekov), business (Kellogg, Pepsi Cola), communication (Osler, Benjamin Spock, Kubler-Ross). However, with advent of specialization the emphasis has shifted towards greater information / details about the area of interest but with narrowing of perspective. Translated into medical field this has led to doctors to relatively keeping pace with scientific inventions / skills, advances in business models but slacking in fields of communication, philosophy and aesthetics. Thus we are now encountering a new breed of doctors who are smart, know their subject but lack in the social element; may lack empathy, communication skills, and are unable to gather the broader perspective of patient & their disease but rather are concerned with superficial and trivialities. This creates a huge mis-match between the expectations and actual health-care delivery in the eyes of lay public, a certain recipe of disaster at societal level. Medicine is not pure science like engineering, physics or chemistry but a social science, which is practiced in a social context where issues of empathy, ethics are foremost and far exceed mere physical cure.

So can we do something about it?

While the solution is tackling each of these problems at an individual level, best results may be obtained when these strategies can be employed at the earliest level or at the initiation of the medical school, in other words when incorporated in the medical curriculum itself. Medical curriculum has been an evolving process and the scientific part is frequently updated to bring it abreast with the latest scientific advances. Over the past several new topics have been included in medical curriculum which was not previously present; genetics and immunology are just some examples. However, in most places, especially developing world it has failed to keep pace with advances in other areas like communication, management theory, personality development, ethics, aesthetics etc. Thus there is a need to revisit medical curriculum to attune it to current social context otherwise gap between the expectations and actual delivery will keep widening.

Here are some of the suggestions towards improving medical curriculum:

Newer Ideas in Curriculum of Medical Students

1. PROFESSIONAL DEVELOPMENT
2. A) Empathy Development

Understanding emotional intelligence and learning the art and skill of empathic listening and action

1. B) Medical Communication

Understanding modern Doctor-Patient relation and developing Doctor-Patient communication particularly “therapeutic communication” with special emphasis on lost art of “bedside manners.”

1. C) Personality Development

Understanding the requisite personality attributes to becoming a good doctor, training the budding doctors to incorporate these attributes in their personality. What is the appropriate professional conduct of the doctors with patients, their families, with colleagues, other health care staff, hospital administrators, regulators and society at large?

1. D) Technique of Medicine

Developing patient centered clinical methods, focusing on improving art of history taking, quickly incorporating evidence in medical practice and particularly on patient safety.

2. 2. MANAGEMENT PROFICIENCY

In current times besides professional skills developing management skills is also absolutely mandatory. The requisite management skills pertain to:

1. A) Individual & Interpersonal Dynamics

These skills involve:

1. i) Understanding the motivators & motivation in medicine and assuming an ethical approach towards market-place
2. ii) Developing an approach of balanced decision making & judgment and a proper attitude towards clinical job

iii) Understanding inter-personal relationships & communication and developing skills; negotiation & conflict resolution especially in clinical settings, skills of crisis management especially when there is an impending threat of violence of property & personnel.

1. iv) Understanding in which situations there are chances of medical error, malpractice & negligence and how to avoid them
2. B) Team & Unit Dynamics

Understanding the (big)5 personality traits of a leader, team norms and practices and the network of organization. Learning how to evolve into a leader and be able to co-ordinate medical teams / organization.

1. C) Organizational Dynamics

There should be some discussion on organizational structure & design, organizational culture, change management and inter-organizational relationships.

3. MEDICAL HUMANITIES
4. A) Philosophy

There should be a basic introduction to various branches of philosophy particularly in context to medicine; epistemology, consequentialism, deontological Ethics with particular emphasis on medical ethics

1. B) Arts

Aesthetics is perhaps the most neglected part in medical curriculum although there is a close historical and psychological relation of art with medicine particularly in developing empathy, the most essential skill in any doctor.

4. ART OF LIVING

Doctors have among the highest risk of burnouts and suicides among all professions especially “white-collared” ones. The reason is that since beginning they are ‘taught’ to focus on gathering knowledge as also keeping ‘patient first’ even at the expense of self and family. This excessive focus on professional skills leads to neglect of self and inter-personal relationship. Thus these budding doctors need to be tutored into the art of living from the beginning. Particularly they should be informed about the benefits of outdoor, the need to be flexible about things and be able to change habits and coached on how to increase mental stamina and increase attention span.