THE INDIAN ASSOCIATION FOR ADVANCEMENT OF MEDICAL EDUCATION
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THE INDIAN ASSOCIATION
FOR
ADVANCEMENT
OF MEDICAL EDUCATION
( I A A M E )
XXXIST
ANNUAL CONFERENCE
"-"'’MIINITY HEALTH CCI •
XXXIst ANNUAL CONFERENCE
IAAME
Chairman
Dr. Mrs. S. S. Deshmukh
Dean, L. T. M. Medical College,
Sion, Bombay - 400 022.
Organising
Secretary
Dr. Mrs. Sucharita A. Nanivadekar
Prof. & Head of Deptt. of Gastroenterology,
L. T. M. Medical College,
Sion, Bombay - 400 022.
Advisory Committee
Dr. E. P. Bharucha
Dr. J. V. Bhatt
Dr. Sudharkar Deshpande
Dr. H. G. Doctor
Dr. R. K. Gandhi
Dr. M. G. Gogate
Dr. Y. K. Hamied
Dr. M. S. Kekre
Dr. R. D. Lele
Dr. G. B. Parulkar
Dr. Naina Potdar
Dr. K. Ramamoorthy
Dr. K. H. Sanchetti
Dr. A. V. Sangamnerkar
Dr. P. V. Sathe
Dr. D. R. Shahani
Mr. Sampradas Singh
Organising Committee :
Dr. Ravi Bapat
Dr. Abhay Bhave
Dr. Mandar Bichu
Dr. T. T. Changlani
Dr. K. P. Chawla
Dr. Sunil Dalvi
Dr. S. N. Deshmukh
Dr. Raju Kanakia
Dr. N. D. Karnik
Dr. S. C. Kelkar
Dr. J. Lalmalani
Dr. N. S. Laud
A1
Dr. Rahul Mayekar
Dr. M. N. Mehta
Dr. S. N. Nagaonkar
Dr. H. D. Patel
Dr. K. Rajgopalan
Dr. Asif Saberi
Dr. Prabha D. Sawant
Dr. Sunita S. Shanbhag
Dr. Mukesh Shete
Dr. Sushant Shetty
Dr. P. R. Vaidya
Dr. N. Vishwanath
Dr. M. E. Yeolekar
Office Bearers and Members of the
Executive Committee of IAAME
President
Prof. J. S. Bajaj
Vice-President
Dr. B. S. Raheja
Hon. Treasurer
Dr. Mrs. B. K. Maini
Executive Director
Dr. P. K. Khosla
Members :
Dr. Mrs.C. Anand
(New Delhi)
Dr. B. S. Chaubey
(Nagpur
Dr. D. N. Chhtrapati
(Ahemedabad)
Dr. M«r
S. S. Deshmukh
Dr. S. K. Lal
(Bombay)
(New Delhi)
Dr. Mrs. R. Madan
(Jammu)
Dr. Shashi L. Malik
(New Delhi)
Dr. H. L. Patel
(Ahmedabad)
Dr. S. R. Parikh
(Ahmedbad)
Dr. K. S. Reddy
(New Delhi)
Dr. Manorama Verma
(Ludhiana)
i
hp-i3o
COMMUNITY HEALTH CEU
326. V Main. I Block
Koram- ng; fa
Banga, ore-560034
India
: 2 :
LIST OF SPONSORS & ADVERTISERS
The Organising Committee is very thankful to the following
SPONSORS
1.
Dr. D. Y. Patil Trust
2.
Dr. Damle Trust
3.
Pfizer Ltd.
4.
Burroughs Wellcome (India) Ltd.
5.
Glaxo India Ltd.
6.
Cipla Ltd.
7.
Camlin Ltd.
Session - I
27-1-92
Session - II
27.1.92
Session - III
27.1.92
Session - IV
27.1.92
Session - V
28.1.92
Session - VI
28.1.92
Session - VII
29.1.92
GRANT-IN-AID
1.
2.
Boots (India) Ltd.
Wockhardt Ltd.
SPONSORS OF LUNCH
1.
2.
Alkem Laboratories Ltd.
Torrent Pharmaceuticals Ltd.
(Part Sponsor)
27.1.92
28.1.92
ADVERTISERS :
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
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16.
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18.
IT.
PAGE NO.
Aristo Pharmaceuticals Pvt. Ltd.
Bahirvani Family
Elder Pharmaceuticals
E. Merck (India) Ltd.
Franco-Indian Pharmaceuticals Ltd.
Indoco-Remedies Ltd.
J. B. Chemicals & Pharmaceuticals Ltd.
Jwalin Pharmaceuticals
Nestle India Ltd.
Nucron Pharmaceuticals (Pvt.) Ltd.
Parke-Davis (India) Ltd.
Pfizer Ltd.
Ramgopal & Co.
Raptakos Brett & Co. Ltd.
Saral Chemical Indusustries (Pvt.) Ltd.
Sun Pharmaceutical Industries
Well Wisher.
Well Wisher.
40
Inner Front Cover
23
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19
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38
22
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Back Cover
40
Inner Back Cover
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LVvrO
: 3 :
•
. -PROGRAMME FOR THE
XXXI ANNUAL CONFERENCE OF THE I.A.A.M.E., BOMBAY
JAN 27, 1992
0900-1000
REGISTRATION
1000-115
INAUGURAL SESSION
1115-1215
Theme-I: New Educational
Technologies In Health Sciences.
Chairpersons:
- Prof. G. Ram Reddy
- Prof. J. S. Bajaj
Keynote Address
Dr. V.C. Kulindai
Swamy (IGNOU)
Subtopics:-
1215-1315
- . ..
a)
Computer assisted/
activated learning
Dr. R.D. Lele
(Bombay)
b)
Distance learning
Dr. A.W. Khan
(IGNOU)
C)
Health manpower
management : principles and
practice
Dr. P.V. Sathe
(Bombay)
Theme-ll: Research Strategies in
Education in Health Sciences
' '
Chairpersons :
- Dr. V.C. Kulindai
Swamy (IGNOU)
- Dr. P. Siva Reddy
Keynote Address
Dr. P. Abeykoon
(WHO)
Subtopics:a)
Research strategies in
medical education
Dr. L. Suryanarayan
(Vijayawada)
b)
Research strategies in
dental education
Dr. D.R. Shahani
(Bombay)
c)
Research strategies in
nursing education
Dr. Mrs. Naina Potdar
(Bombay)
d)
Research strategies in
para-professional
education
Dr. (Mrs.) Bharati Bellare
(Bombay)
LUNCH
1315-1400,
: 4 :
1400-1515
Theme-Ill : Issues amenable to
further research in Students'
Selection to professional and
para-professional courses.
Chairpersons :
- Dr. B. Ramamurthy
- Dr. Haribhai Patel
Keynote Address :
Dr. S. N. Deshmukh
(Bombay)
Subtopics:a)
Examination system for Students'
selection at State level for Pvt.
colleges/Govt. colleges.
Dr. A. Zachariah
(Ludhiana)
b)
All India Entrance Examination
for undergradute and postgraduate
medical courses :
format, content, evaluation.
Dr. Sridhar Sharma
(New Delhi)
c)
All India Examination for nonformal stream of postgraduate studies
Monitoring and Review mechanisms
Dr. V. Natrajan &
Prof. J.S. Bajaj
(New Delhi)
d)
Role of nominations in students'
selection & their performance
Dr. Haribhai Patel
(Ahmedabad)
TEA
1515-1530
1530-1630
Theme-IV : Research Strategies in
in curricular Development
Chairpersons :
- Dr. C. Anand
Dr. (Mrs.) S. S. Deshmukh
(Bombay)
Keynote Address
Subtopics -
1630-1715
a)
Medical Education
Dr. Praveena Shah
(Bombay)
b)
Dental Education
Dr. R.K. Bali
(New Delhi)
c)
Nursing & Para-professional
Education
Dr.(Ms.) Sally A. Bisch
(WHO)
Dr. Sir A. Lakshmanaswamy
Mudaliar Oration (1992)
Chairpersons :
Prof. J. S. Bajaj
Dr. B.K. Maini
Subject : Progress in Medical
Education through the times &
life of Sir A. Mudaliar
Dr. A. Venugopal
(Madras)
: 5 :
JAN 28, 1992
0900-1000
1000-1100
Dr. P.N. Wahi Lectureship
Oration (1992)
Chairpersons :
- P.B. Desai
- B.S. Raheja
Subject : National Health Planning :
Perceptions and Perspectives
Prof. J.S. Bajaj
President, IAAME
Theme-V : Problem Based, Community
Oriented Learning : Conceptual
and Operational Issues
Chairpersons :
- Prof. U. K. Sheth
- Dr. P. C. Reddy
Keynote address
<b~. C .
Pr. Lalita Kamashwaran
(Madras)
Subtopics -
a)—Mcdieal Education
da)
Dental Education
b)
Nursing Education
Ct)
Para-professional education
-Br. C. Anand
(New Delhi)
Dr. Jakhi
(Bombay)
Prof. Manik Shahani
(Bombay)
1100-1115
1115-1200
1200-1245
TEA
Dr. N.G. Gadekar Oration
Chairpersons :
- Prof. J.S. Bajaj
- Dr. Mrs. S. Grover
Subject : The Role of Education in
Cancer Control Programme
Dr. Jayasree Roy Chaudhary
(Calcutta)
Theme-VI : Interlinkages between
Education in Health Sciences and
Delivery of Health Care.
Chairpersons :- Dr. N.H. Antia
- Dr. R.A. Bhalerao
Keynote Address
Dr. J.P. Gupta
New Delhi
Subtopics a)
Health Management
Information System(s)
Dr. N. Seshagiri
(New Delhi)
b)
Performance evaluation and Methods
of feedback into education system for
remedial action.
Dr. G. Bose
(NIC, New Delhi)
Evalution of professional
Competencies
Dr. K.R. Manelkar
(Bombay)
Evaluation of basic competencies
Mrs. M. R. Chaukar
(Bombay)
: 6 :
1 245-1330
Dr. K.L. Wig Oration
Chairpersons :
- Prof. J.S. Bajaj
- Dr. Vidya Acharya
Subject : Current Status of Renal
Transplantation
Dr. K.S. Chugh
(Chandigarh)
1330-1415
1415-1500
LUNCH
Dr. K.N. Rao Oration
Chairpersons :
- Prof. J.S. Bajaj
• Dr. L.H. Hiranandam
Subject : Scientific Temper In
Medical Education
Dr. B. Mukhopadhaya
(Patna)
TEA/COFFEE
1500-1515
1515-1715
Preferred papers including free papers
(Selection of best paper for
Prof. J.S. Bajaj Award)
1745-1030
Business Committee Meetings of I.A.A.M.E.
Chairpersons :
Dr. P. K Khosla
Dr. Shridhar Sharma
JAN 29, 1992
09001000
Annual General Body Meeting of I.A.A.M.E.
1000-1015
TEA/COFFEE
1015-1200
Students' Debate: "The quality of medical education in India will not improve till teachers
function on a full time basis."
Moderators : Dr. G. B. Parulkar & Dr. (Mrs.) S.S. Deshmukh
1200-1300
Valedictory Session
1200-1215
Conference Resume & Recommendations
Dr.(Mrs.) S.S. Deshmukh
1215-1220
Award of Prizes
Dr. B.S. Raheja
1220 1240
Valedictory Address
Dr. R.K. Gandhi
1240 1245
Vote of thanks
Dr. (Mrs.) S.A. Nanivadekar
overcome the plague and make our citizens literate faster
than what is achieved today. No longer can ourteachers and
students on whom large sums of national money are invested
ignore this task.
Dr. K. N. Rao Oration (1992)
SCIENTIFIC
TEMPER
IN
MEDICAL
EDUCATION
By DR. B. MUKHOPADHAYA,
The Speakerthen referred to the Health Survey and
the Planning Committee Report of Dr. Mudaliar and traces
the achievements of the Government of India during the
Seventh Plan period. To achieve the goal, let the Govt.
F.R.C.S.fEng.), M.Ch.Orth.(L.Pool), F.A.M.S.
Abstract
institutions, private and voluntary organisations co-ordinate
to play an important role in the health care delivery in India.
With the financial constraints, the Speaker feels that Govt.
Medicine is as old as recorded history. It has little
justification except as practice. All traditional systems of
medicine served society in their own times.
should invite all private medical colleges, private hospitals,
institutions and general practitioners in each district, taluka
and rural areas to give a helping hand to improve the health
status of the Indian masses. There is not enough medical
manpower in the Govt, medical institutions to tackle this
massive problem. The Govt, must invite arts, sciences and
engineering colleges, medical institutions, medical practitio
ners and specialists to give a helping hand at the district,
taluka and primary health centres level on a honorary basis
to combat the difficulties and drawbacks which are proving to
be an hindrance to the formulation and implementation of the
new and comprehensive health and education programmes
that are being drawn for the 8th Plan period.
The Speaker then sums up that the plan investment
on health has increased from Rs.65.20 crores in the 1 st Plant
to Rs.6449 crores in the 7th Plan. But the present investment
on health has totally decreased. Failure to achieve the
targets during the past four decades is mainly due to inad
equate allotment of funds. Atleast during the 8th Plan, the
health care package must be given due importance.
Practice of medicine embodies two purposes. Hygia,
the Greek Goddess represent the preventive aspects of
health care. Aescalipius represent curative health care. They
have their counterparts in traditional Indian medicine also.
What distinguishes all ancient system of medicine
from modern medicines is the introduction of knowledge
derived from fundamental sciences and their by-product, i.e.,
technology, in the practice of the art of medicine both for
prevention and for care and cure of patients.
Medicine serves society in reducing the quantum of
sufferings. It cannot eliminate suffering or death.
To appreciate the role which science-based medi
cine can play one must realise that both the profession and
the public has to develop a scientific outlook. Such outlook
towards medicine can only be achieved through the educa
tional process which prospective entrants to the profession
has to undergo.
How little do we realise that licensing of practice after
adequate and appropriate educational experience is the
means by which society tries to ensure that practitioners
conform to rules and regulations prescribed by society.
Thus society indirectly controls both medical educa
tion and practice. In this process there is a dynamic but
some-what conflicting relationship between society and the
profession. These aspects are to be discussed in this
presentation.
: 9 :
INVITED LECTURES
(ABSTRACTS)
praisal should be the preliminary step in a process of "Perfor
1.
mance Management" that should encompass skills assess
GRASSROOT LEVEL FUNCTIONARIES IN
REHABILITATION
ment, individual career discussions, performance planning
and overall career development. The performance manage
ment process should enhance career growth for each indi
vidual so that all can benefit personally as they help the
institution to achieve its goals.
MRINALINI A. CHAUKAR
(REGIONAL REHABILITATION TRAINING CENTRE,
BOMBAY - 400 034.)
Our National health care programme has reached to
the grassroot level through a network of District hospitals,
Primary health centres and community health workers. Re
habilitation, though an integral part of the health care has not
yet reached the grassroot level.
District Rehabilitation centre scheme which has been
launched by Ministry of Welfare is an attempt to decentralise
the services of rehabilitation so as to reach to the Doorstep
The basic duties of a doctor in Medical College &
Hospital consist of clinical care, medical education and
medical research. Performance appraisal involves, in the first
instance, a dear and unequivocal consensus on the job
components and job performance standards. This may be
arrived at by the employer alone (employee must be made to
understand and accept these) or after a joint discussion
between the employee and employer. Performance stan
dards may be behaviour-based or achievement-based and
must incorporate the four dimensions of job-knowledge,
of the disabled. In this experimental scheme three levels of
quantity of work, quality of work and customer service
Multipurpose workers were locally selected and trained in
various disciplines of rehabilitation. Anganwadi workers and
community health workers were also trained. The multipur
pose workers were placed at primary health centre rehabili
tation units and to give them professional support fully
equipped District Rehabilitation Centres were established.
orientation. Evaluation of research performance, especially,
should have well-defined norms for weightage to different
publications, presentations, lectures, symposia, workshops
etc. The performance standards should be realistic and
achievable, slightly above average, subject to the change
and indicative of a fully trained and competent incumbent. At
The paper discusses about the various training programmes
conducted for paraprofessionals in the field of rehabilitation
and their performance.
the 12 month point, the actual performance appraisal takes
place. The employee is allowed to "Self-assess" his perfor
mance. This self-assessment can be a vehicle for discussion
along with the supervisor's assessment and differences in
the two can be reviewed. The appraisal should be graded as
2.
PERFORMANCE EVALUATION AND
METHODS OF FEEDBACK INTO EDUCATION
SYSTEM FOR REMEDIAL ACTION.
(1) does not meet standards (2) partially meets standards (3)
meets standards (4) occasionally exceeds standards (5)
consistently exceeds standards. The appraisal should be
followed by the "Performance Discussion" wherein goals for
K. R. MANELKAR.
(K. E. M. HOSPITAL & G. S. MEDICAL COLLEGE. PAREL,
BOMBAY - 400 012.)
Any medical center must value its human resources
the next review should be established together by employee
and supervisor. Four types of goals should be addressed for
the employee viz. (1) goals to build on current skills, knowl
edge and abilities (2) goals to improve in areas of inadequate
performance (3) goals linked to departmental goals/projects
(4) goals related to career development.
and believe that all doctors deserve to receive an objective
and timely performance appraisal. The development of its
Outstanding performers may be targeted to develop
human resources is the dynamic element that will shape the
them for future assignments so that the employer has a pool
future of medical centers in this country. Performance ap
of developed resources to meet the department's objectives.
: 10 :
A.
Thius, performance evaluation is a scientific and serious
process which can reap rich dividends for a medical institutioin by establishing and perpetuating high standards of health
caare, teaching and research.
Orthopedics (a) Sports Medicine - This
field is grov/ing very fast and has tremendous
scope for research, (b) Rehabilitation in
(i) Hand (ii) Spine (iii) Foot.
B.
.‘3. RESEARCH STRATEGIES IN PARAPROFES
SIONAL EDUCATION - PHYSICAL THERAPY.
Geriatrics - This field is not very well
established as a seperate 'Health Care
Unit' in India - Hence there is an excellent
scope for research.
BHARTI BELLARE
^SCHOOL OF PHYSICAL THERAPY FOR GRADUATE AND POST
GRADUATE DEGREE COURSES. L T. M. MEDICAL COLLEGE.
SION, BOMBAY - 400 022.)
C.
Prosthetics & Orthotics.
D.
Acute Respiratory care - Today, Physio
Therapist is recognised as an essential
member in the team of Intensive Care
Unit’.
Today, as such the Physical Therapy profession is
no more considered as paramedical profession. It is recognised
as an independent profession among other allied Medical or
health sciences or Alternate Medicines.
Since Physical Therapy plays a role in practically all
the possible disciplines of Medicine, there is no limit for
research. However, following are some of the major aspects
E.
Research in cardiac respiratory rehabilitation
- This field is new by developing by hence
has tremendous scope.
F.
Rural Rehabilitation.
G.
Research in Assessment techniques The Assessment done by the Physical
Therapist is quite different from the Doctor,
in which there is a tremendous scope for research.
since it is based on 'Function'.
1.
H.
Research based on basic / foundation subjects:
(A)
Applied Anatomy-particularly the kinesiology
and Biomechanics.
(B)
Applied Physiology - (i) Exercise physiology,
on which the therapeutic exercise is based.
(ii) Neurophysiology- Research can be
done on various neurophysiology principles
on which the therapeutic mode can be
based for the management of neurologically
subject in the undergraduate curriculum
of Phy sical Therapy) for research, particularly
for the objective assessment of some
subjective parameters such as 'Pain',
Hysterical loss of function, etc.
handicapped patients, (c) Electro Physiology
I.
- In addition to electro diagnostic studies
there is tremendous scope for research
in this field for the analysis of objective
studies of Kinesiological assessments such
Research on principles of Physical
Therapeutics based on Yoga, Acupuncture/
Acupressure, etc.
as gait analysis.
(C)
Electro Therapeutics - This is the important
mode of Physical Therapeutics, otherthan
physical exercise. One can link this with
thefield ofTechnology (Medical Electronics
which is as such included as a foundation
4.
Neuropsychology - A challenging field,
because every patient seeking physical
RESEARCH STRATEGIES IN DENTAL
EDUCATION IN INDIA
D. R. SHAHANI
Therapy treatment for pain and physical
handicaps needs psychological assessment
(NAIR HOSPITAL DENTAL COLLEGE, BOMBAY - 400 008.)
in details.
2.
As we look around us, we cannot help but realise that
Research in specialties/ superspecialities:
we are living in changing times. The pattern of life is changing,
: 11 :
society is changing, the expectations of life are rising and with
the increase of health care, sanitation and relief from commu
nicable diseases, relative improvement in general health
shows glaring contrast to the deteriorating situation in the
field of oral health and dental diseases. Health knowledge
contributes to good health, but unless proper attitude, habits
are developed and put into practice, little will be gained.
or universally accepted by the educators, the students and
the public The accepted need for re-orientation of our
educational programmes has been high-lighted by the social
change in the country during the last two decades, leading to
demand for better medical care and preparedness of the
future doctors to handle completely the medical/Dental prob
lems created by ever increasing specialization of knowledge.
Dentistry today faces an environment that clearly
Research plays a very important role if the geometri
requires changes in dental education. Future dentists must
cal progress of curriculum enhancement is required. Bal
be prepared to deal with new patterns of dental disease,
anced development of dental sciences requires continuous
revised manpower requirements, and new developments in
inputs of the best possible expertise, intensive research, and
the nature of dental practice. The dental education system
can best adapt to this situation by initiating a process of
planned change. A well-developed literature in this area
endeavours with the aid of latest scientific and technical
facilities coupled with the application of requisite inter disci
plinary advances. Western world has undergone a dynamic
change in maintaining oral health and also in dental research
strategies, hence it is important to evolve the research
strategies in the practical aspect of dental curriculum and
provides both a theoretical framework and a practical ap
proach that the dental education system can follow in its
planning process.
also to achieve health for all by 2000 A.D.
During early 20th century, Dentistry was entirely in
the hands of unqualified dentists until a full-fledged dental
college was started in 1920 at Calcutta and in 1933, Nair
Hospital Dental College at Bombay. The Govt, of India in
1947, had appointed BHORE Committee and based on their
recommendations, a historic Dental Act, 1948, was intro
In research lies the key to all the problems and the
curriculum development must gain its benefits. It is left to us
to go out and determine the avenues of improvements. Goals
of education in a developing country like ours, must be clearly
defined at the outset.
duced which remains as the turning point in the history of
Dental Education in India. Dental practice and dental educa
In view of the widespread interest in health, and the
tion are closed bound to each other and serve the needs of
rapidly changing scientific and social science of medicine, it
the society. Curriculum of the education requires constant
has almost become obligatory on Dental educationists to
evaluation. One factor of constant concern, review and
define 'the attributes, responsibilities and educational needs
argument is the competality of the dental education imparted
of the Dental surgeon of the future.
and its relevance in Indian environment. One cannot just pick
and choose from the western countries and push and wage
their programmes into those of ours. A greatest challenge
then in our country, is to design a system that is deeply routed
5.
in the scientific method, yet is profoundly influenced by the
RESEARCH STRATEGIES IN NURSING
EDUCATION
local health problems as well as by the social, cultural and
economic settings in which they arise. We need to develop
DR. NAINA POTDAR
methods and tools of instruction which have relevance to the
resources and cultural pattern of each area.
(L. T. COLLEGE OF NURSING. S. N. D. T„ WOMEN'S
UNIVERSITY, CHURCHGATE, BOMBAY - 400 020)
That there is discontent with the present system of
INTRODUCTION
Dental education, its organisation, presentation and con
tents, not only in India but all over the world, is being borne
The ultimate goal of nursing profession is to establish
out by a large number of conferences, symposia, institutes
a scientific base of knowledge, fundamental to the practice so
and seminars that have been held within last few years. The
that the standard of patient care improves and promotes
quality care with a higher degree of excellence. Nursing
cause of this discontent could probably be that in the training
of our doctors, we have been following an educational policy
research is concerned with systematic study and assess-
whose purpose has never been clearly defined, understood
: 12 :
establishing the long cherished Master of Nursing degree
programme in October, 1959. Today, this programme is
merit of nursing problems and finding ways to participate
effectively in health care delivery system. The early focuses
of research in nursing were in the areas of nursing education
and administration. Attention is now being to nursing re
search in the field of nursing practice and it has implications
for nurse educators, nurse administrators and nurse practi
offered in 8 institutions and the programme requires a re
search project to be completed by each candidate as a partial
fulfillment towards the Masters degree in Nursing.
tioners. Research is one of the primary means of document
The Research Strategies in Nursing Education
ing the efficiency and effectiveness of nursing education and
nursing research
The research approach in the area of nursing educa
tion may be as follows
Importance of Research in Nursing Education
1)
Quasi - experimental research
2)
Ex post - facto research
3)
Historical research
in nursing education is needed to discover new facts, to
4)
Development research
provide factual descriptive picture of the situation, uncover
problems and investigate possible causes. Research in
5)
Correlational research
nursing education is imperative for evaluating changes and
6)
Evaluative research
7)
Action research
Research is needed as change in nursing practice is
required by the introduction of new medicines, equipments
and treatments related to care of people/patients. Research
past achievements, an aid in showing the way for future
progress.
Above mentioned strategies may be used to conduct
research in the area of nursing education and there are
multidimentional aspects that can be studied. These aspects
determine ultimately preparation of nurse practitioners. The
education of nurses’ has implications in the following are as:
Historical Background
Research in Nursing is as old as the profession itself.
Florence Nightingale was described as a reformer, reaction
ary and researcher. Her research has influenced health care
in general, and nursing more specifically. She is most noted
for her data collection and statistical analyses during the
1.
Crimean War. She identified the need to gather data on the
Students
environment to determine the influence on patients health
Selection of students
(1859).
Curriculam development
Major advances were made in
nursing research
Teaching / learning process
during 1950. Research got a high priority with the strong
support of such nursing leaders as Henderson and Abdellah.
All round development of students/sociocultural impact.
Educational studies were conducted in the 1950's and 1960's
that influenced nursing research. In 1953, as Institute of
Preparation and use of learning packages
Research and Service in Nursing Education was established
Evaluation and performance appraisal
at Teacher's College, Columbia University, which provided
learning experiences in research for doctoral students.
Records and reports
Miss Margaretta Craig, Principal of College of Nurs
ing, Delhi University was determined to start nursing re
2.
search activities in India from 1955. Dr. Edith M. Buchannan,
Vice-Principal, College of Nursing, Delhi through WHO fel
Faculty
Recruitment, selection and placement
lowship, completed her doctorate in Education degree
Staff development programme
programme from Columbia University, New York in 1953 and
then she as a principal of the above college succeeded in
Performance appraisal
:13
Higher education and research
Motivation & morale
3.
Environment conducive to effective teaching
Audio visual aids
Procurmentand maintenance of equipment
Setting up of a laboratory
Selection of clinical field
Co-ordination with various organisations
for studnets' all round development.
Institutional climate.
4.
Evaluation andfeedbackonthetraining programme
from
Society
Hospital
Schools
Industries
Welfare Centres
There is an urgent need to prepare adequate nurse
researchers to conduct research by using various strategies
so that the standard of nursing education improves. The
subject of Research Methodology is taught to nursing stu
dents at degree and post graduate level and this in turn will
prepare nurses to carry out research and increase the
relevance to nursing practice.
Tomorrow's nursing research will continue to
emphasize studying the interaction of physiological and
psycho-social meachnisms in human experiences of stress
and coping, evaluations of nursing interventions, the transfer
of research findings into textbooks and practice, a focus on
high-risk and under-served group such as elderly and
minorities and the creation of a body of scientific nursing
knowledge.
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FREE PAPERS : ABSTRACTS
command, specialization, etc. The article proposes a modi
community' based clinical teaching
A WAY TO’REORIENT MEDICAL EDUCATION
fied organizational structure within the present manpower
resources. The health manpower at PHC level can be divided
into two independent units e.g. family welfare and public
health. These units should have separate funding and will be
M. B. KHAMGAONKAR
headed by medical officers specialized in family welfare
(GOVT. MEDICAL- COLLEGE, NANDED,
MAHARASHTRA 431 601.)
(obstetrics) and public health respectively. The family welfare
unit would be responsible for implementing family welfare
and maternal-child health activities. The incharge medical
To increase the output of medical personnel teach
ing has to
officer of this unit may be assisted by female health assistants
and female-health workers at sub-centre level.
relevant to existing health problems in a
community. The quality of medical care provided in a commu
The public health unit would be responsible for
nity is directly related to the knowledge and skills of health
manpower in dealing with common health problems existing
implementing various national programmes (Leprosy, Ma
in a community. The present paper suggests an approach of
teaching clinical subjects with gommunity orientation. This
can be done by posting final year medical students at the rural
field practice area for a period of two weeks. The medical
teachers from various clinical specialities would undertake
teaching of common clinical problems in the community. The
clinical teaching should have more emphasis on manage
laria, Filaria, Blindness control, etc.), disease surveillance
and epidemic control activities. The paramedical staff in this
unit would be male health assistants and male health work
ers. Though these units will have seperate functioning, they
will have coordination for policy making, field visits and
patient management. Disintegration of health manpower in to
specialities may help in increasing the efficiency.
3
INVOKING HAWTHORNE EFFECT FOR
IMPROVING QUALITY OF MEDICAL EDUCATION:
CMCL EXPERIMENT.
ment of problems within .current socioeconomic constraints
rather than a bookish approach. This method of teaching
apart from increasing the clinical acumen of students, would
also inculcate in them the habit of managing patients consid
DALJIT SINGH, TEJINDER SINGH, M. V. NATU,
ALEX ZACHARIAH
ering their socioeconomic background, and available re
sources.
(CHRISTIAN MEDICAL COLLEGE, LUDHIANA 141 008)
2
HEALTH MANPOWER MANAGEMENT AT
PRIMARY HEALTH CENTRE : A NEED FOR
ORGANIZATIONAL RESTRUCTURING
M, B. KHAMGAONKAR
(GOVT. MEDICAL COLLEGE, NANDED.
MAHARASHTRA 431 601.)
r-
There has been a widespread concern to improve
the quality of medical.education. Out of three components
that go to form the teaching-learning system, i.e. student,
teacher and curriculum, an attempt was made to induce
behavioral and attitudinal changes among teachers at Chris
tian Medical College, Ludhiana. It was attempted to invoke
Hawthorne effect to attain this aim. This communication
described the basis, methodology and results of our
■
Lack of proper management practices at primary
endeavour.
. ..v, .f,
>
health -centre level, leads to. inability in achieving stated
objectives. The distribution of functions among health per
sonnels not clearly defined. The scope of activities are not
Simply stated, Havythorne effect means that merely
observing a person changes his behaviour.
. clearly demarcated and job descrjptibqsat Various levels not
.clearly defined. The organization at this level usually lacks in
The exercise was limited to entire teaching faculty of
•basic principles of management such as authority, unity of
pre-and para-clinical sciences and invoked 33 teachers. The
>l>.
27 :
«•
Principal explained the purpose of/he exercise to the faculty
tion describes our experiences with unfreezing - change -
and assured them that the results will not be used for any
refreezing cycle of Lewin. Unfreezing was induced by a
administrative purpose. During second phase, the entire
variety of techniques, some of which will be described.
Having prepared the teachers for change an input was
provided in the form of workshops on medical educational
class consisting of 33 students for pre-clinical and 38 stu
dents for para-clinical departments, rated the teaching and
counselling skills of teachers on a pre-validated Likert type
scale. Based on their ratings, two indices, Students accept
technology by our own faculty. Further inputs were provided
to consolidate the change so induced. Evaluation was done
ability index (SAT) and Counselling ability index (CAI) were
at all levels by prevalidated instruments and statistical meth
calculated.
ods employed wherever needed.
The results were made known to the faculty without
disclosing the identity of the teachers concerned. However,
a provision was kept for making the individual deficiencies
known to those who asked for it. No further input was
provided at this stage.
In addition an attempt was made to develop a core
group by providing them necessary training in various related
aspects of education and management and the results
obtained so far have been very encouraging.
5
The entire exercise was repeated after six months
for the same set of teachers by the same batch of students.
COMMUNITY ORIENTED, ISSUE-BASED
LEARNING ACTIVITIES (COIBLA) AND THE
EFFECT ON STUDENTS ATTITUDES.
The SAT and CAI were demonstrated a significant improve
ment (0.05) over the previous results. This was true for all the
teaching departments.
PREMA ZACHARIAH, ALEX ZACHARIAH,
TEJINDER SINGH, M. V. NATU
4
(CHRISTIAN MEDICAL COLLEGE, LUDHIANA 141 008)
INNOVATIONS IN MEDICAL EDUCATION :
CMC EXPERIMENT
ALEX ZACHARIAH, PREMA ZACHARIAH, TEJINDER SINGH,
DALJIT SINGH, M. V. NATU
A new paradigm, Community Oriented Issue Based
Learning Activities (COIBLA) is proposed in place of Prob
(CHRISTIAN MEDICAL COLLEGE, LUDHIANA 141 008.)
lem-Based Learning (PBL) pedagogy for Health Sciences
Change is a very sensitive process. Managing change
education and curriculum, fordeveloping countries like India.
“An issue is an event, phenomenon, statement of problem
about which there are differing points of view and which
in any field can be a very tedious and difficult endeavour. For
require decision and action." Health issues are multipolar and
bringing about a lasting and functional change one has to rely
the term "Issue" may be more comprehensive and appropri
on 'evolution' ratherthan on 'revolution'. Before attempting to
ate when applied to all complex communities. COIBLA
change any system it is essential that we have a thorough
combines Community Orientation with issue based learning
knowledge of the existing components of the system and how
activities and thus has a larger base and frame of reference.
these components interact with each other.
The department of Social and Preventive Medicine
We have been working at CMC Ludhiana towards
CMC is presently field testing COIBLA in a six month feasi
improving the quality of medical education. Our main areas
of intervention have been the medical teacher and the
bility study on child survival in an urban slum cluster as an
educational experiment. The resulting effects of this activity
instructional methodology.
on students attitudes have been methodically studied and
shall be reported and discussed.
The medical teachers have to be prepared for a
change if these methods are to succeed. This communica
: 28 :
7
MEDICAL EDUCATIONAL WORKSHOPS AND THE
PARTICIPANT PROFILES
6
DISTANCE LEARNING : IS IT SUITABLE FOR
MEDICAL EDUCATION?
M. V. NATU
TEJINDER SINGH AND ALEX ZACHARIAH
(CHRISTIAN MEDICAL COLLEGE, LUDHIANA 141 008)
(CHRISTIAN MEDICAL COLLEGE, LUDHIANA 141 008.)
Distance education (DE) appeared on the educa
Workshops on medical educational technology are
tional scene as a wanton offspring of traditional education
being organised these days on local institutional, regional,
and its emergence was necessitated by the socio-cultural
political compulsions. Beginning as 'Penny Tuitions’ in 19th
national and international levels. In general such workshops
century it has made rapid strides and has established it as a
cost-eftective and useful mode of education. As compared to
correspondence education, which relies only on print me
dium, Distance Education uses a multi-media approach.
In common usage DE is seen as a means of educat
ing only failures or educational rejects. This is not true. We
concur with the view of Wedemeyer (1976) who views DE as
a means of independent study and stresses its suitability for
create a good atmosphere for active learning and thinking
about educational process and philosophy. Mostly work
shops are concerned with necessary changes to be intro
duced in medical education and in the least provide a good
change from the routine activities of medical education today.
The group of workshop participants project an inter
esting picture.
Some observations about the different types of per
sonality profiles, e.g. :
the off-campus as well as for the on-campus learner.
1.
The keen learners
2.
The grudging admirals
3.
The pundits and mahapundits
cognitive issues but also psychomotor and affective issues.
4.
The space travellers
Establishment of Medical Open University will go a long way
in fulfilling this need by employing a multi media mix as well
5.
The cactus lovers
For the off-campus learner DE has tremendous
utility by way of continuing education. It has been well
documented by research all over the world as well as at
IGNOU, New Delhi, that it is possible not only to cover the
shall be presented and discussed.
as by establishing a network of regional and local centres.
The other equally important use of DE is for oncampus learner by allowing him autonomy. The learner can
Such observations may help in the development of
better understanding among workshop organisers, faculty
set his own educational goals and explore various alterna
tives for attaining them. This will also free the teachers from
and participants. This would help to place matters in proper
perspective, would also facilitate learning and make the task
classroom duties allowing them more time for research and
of workshop faculty easier and make the workshops more
patient care.
meaningful and cost effective.
DE has the potential to achieve the goals of educa
tional system in a true way - by teaching the learner how to
learn and to value learning for its own sake. Problem-based
learning owes a lot to DE by utilising many of its underlying
theories and principles but there is no reason why even
traditional education can't make the same demands from DE.
: 29 :
8
9
SMALL GROUP LEARNING BY OBJECTIVES :
(SGLO) - AN' EXPERIMENT IN DISTANCE
LEARNING FOR ON-CAMPUS STUDENTS
COMMUNITY HEALTH AWARENESS AMONG
FRESH MEDICAL GRADUATES OF BOMBAY
SHEELA RANGAN AND MUKAND UPLEKAR
M. V. NATO, TEJINDER SINGH, DALJIT SINGH,
(FOUNDATION FOR RESEARCH IN COMMUNITY HEALTH,
84-A, R. G. THADANI MARG, WORLI, BOMBAY - 400 018.)
ALEX ZACHARIAH
(CHRISTIAN MEDICAL COLLEGE, LUDHIANA 141 008)
Distance learning encompasses within its fields not
only education for the off-campus learners and educational
rejects but also for the on-campus learners. An important
component of this philosophy is the concept of autonomy to
the individual learner (Wedemeyer 1976). The 'distance'
does not refer to the spatial distance between the teacher and
the learner - rather it is a function of degree of 'dialogue' and
'structure' (Moore 1978).
An attempt was made at CMC, Ludhiana, to intro
duce the concept of distance learning for regular students in
the department of pharmacology and the methodology was
termed 'Small Group Learning By Objectives' (SGLO). This
involved completely doing away with lectures as the mode of
imparting instructions. Rather, the students were provided a
list of objectives and given the freedom to choose ways and
means to attain those objectives. Teachers acted as mere
facilitators.
The method was introduced mid-term so that the
same batch of students has the experience of both
methods - traditional and SGLO - by the same set of
teachers. At the end of the year, reactions of the students
were assessed on six basic themes by a prevalidated
Likeart scale and included - better retention, develop
ment of study skills, autonomy in studying, interpersonal
relationship, problem of weak students and degree of
efforts involved. In addition, a score called the Motiva
tional Potential Score (MPS) was also calculated for both
methods.
SGLO was rated significantly higher on all six
themes. MPS was also significantly more. There was no
difference in the ratings of higher, middle or lower ability
group students. Students in general rated SGLO as an
effective method.
Against the background of the much discussed and
well recognized need for reorientation of medical education,
to make it more responsive to the health needs of the
community, a study of 342 fresh medical graduates com
mencing their internship training in one government and two
municipal medical colleges in Bombay was conducted. The
objective was to access a fresh intern's awareness about
some essential aspects of community health care. A ques
tionnaire was administered to probe into their knowledge
about basic health information of the country, their perception
of the concept of Primary Health Care and of some major
public health problems, and their awareness about the prac
tice of rational prescribing and use of essential drugs.
The study highlights the apathy about the subject
among the doctors in the making, gaps in the knowledge and
awareness of some basic concepts of community health
among the fresh interns, and the need not only to effect
curricular changes but also to effectively assess whether
curricular changes alone would facilitate making of a desir
able doctor.
10
RESEARCH STRATEGIES IN MENTAL HEALTH
CURRICULUM, SOME OBSERVATIONS
V. N. RAO
(NIMHANS, BANGALORE 560 029.)
In discussing the issues related to organizing mental
health services in developing countries, the importance of
research is highlighted (W.H.O.: 1975). Likewise in imple
mentation of National Mental Health Programme of India,
(NMHP : 1982), the importance of manpower training and
research inputs are emphasized, in the education and train
ing of mental health professionals - psychiatrists, psycholo
gists, and social workers the focus on research is given high
priority. In their academic programmes leading to the award
of degrees of M.D., M. Phil-Psychology and M. Phil-Psychi
atric Social Work, it is expected that trainees in the respective
: 30 :
disciplines select their topic of their interest and do a system
atic investigation and report the findings in the form of thesis
or dissertations, which are submitted to the Universities.
In order to understand the research focus as given by
the post-graduate trainees, an attempt was made to make
oath to be abandoned. Suggestions were made to holding o:
informal seminars on medical ethics, possibly at yearly
interval, to familiarize graduates to this oath. A collective
effort of the medical student educators as well as graduates
is required for revival of meaning of this age old promise that
a healer makes to the society.
use of the technique of content analysis of the available
research reports. The analysis mainly focus on the research
methodology adopted by the trainees-areas of research
sampling size, sampling strategies, tools used, methods of
analysis- and allied aspects.
12
DECLINING STANDARDS OF MEDICAL SKILLS
DUE TO ENTRANCE EXAMINATION TO POST
GRADUATE COURSES
Based on this analysis suggestions are offered for
the purpose of making the research efforts more appropriate
and meaningful to the mental health needs and problems of
the countries. It also covers the priorities of research compo
nents in the field of Mental Health in developing countries in
general and India in particular.
11
HIPPOCRATIC
R. CHOUDHRY,
OATH AND THE
PROFESSIONALS
S. KAKAR ,
A. TULI,
MEDICAL
& C.
ANAND
(DEPARTMENT OF ANATOMY,
LADY HARDINGE MEDICAL COLLEGE, NEW DELHI)
The Hippocratic Oath is still taken in most medical
A.
TULI,
H. CHOUDRY,
& C. ANAND
(DEPARTMENT OF ANATOMY, LADY HARDRINGE MEDICAL
COLLEGE, NEW DELHI - 110 001)
India is facing a major crises in health care systems
compounded by its vast population and general growing
consciousness of the people. In 1968 with the Indo-Pak
border crises the government decreased the time for medical
studies by six months and were incorporated with internship.
This coalition gave a greater time for the qualified doctor to
interact with patients reach diagnosis counsel! and advise
about preventive and community medicine and treat. This
was appropriate strategy but got marred by the diversion of
interns and housemen to qualify for a series of post-graduate
entrance examinations.
colleges of India during convocation, after the completion of
internship. It is an abbreviated version of this oath that is
recited. In most instances the role of this traditional oath
pertaining to ethics in medical professional is unclear. It is an
unfamiliar ritualistic recitation the outcome of which is that
little is retained by the residents.
Keeping in mind the importance of this sacred oath
it was deemed fit to carry out the present study on the role of
the Hippocratic oath. A total of 75 medical graduates were
interviewed, of which 35 were residents, 30 faculty members
and 10 general practitioners, to assess the knowledge inter
pretation and impressions of the oath. We tried to elicit the
recall of Hippocratic Oath, its principles, utility in the present
context and modifications suggested, if any, were noted. The
question of whether the oath should be taken was reviewed.
It was notsurprising that most of the subjects could only recall
a few words here and there. The principles could be vaguely
and inadequately worked out. Most however did not want the
■ These tedious and exhausting but comprehensive
examinations leave them with little time to learn clinical
procedures and organisational and communication skills.
These critical years are the beginning of a full time clinical
contact and is associated with greater responsibility. In this
period theoretical knowledge is transformed into practical
work on live models which is the aim of the hard stressful
educational programme.
Literature revealed that long hours of duty to be
performed by the junior residents results in emotional stress
resulting in "Pre-residency syndrome”. Inadequate practical
training to junior residents has resulted in lowered standards
of patient care which can be improved by making innovations
in medical curriculum of these clinical years. Defining the
skills to be acquired by the conclusion of training period will
ascertain that each resident has acquired the requisite skills
which should be evaluated.
: 31 :
(JX'I
Z COMMUNITY HF'ITH CEiX
326. V Main, I l.. ck.
Koramongala
8angalore-560034
India
medicine, with no cost containment. To achieve the health
objectives, we need to introduce Problem based learning at
13
all levels. Unlike problem solving, problem based learning is
not reviewing and synthesising information already obtained
through lectures orspecific subject peitaining to the problem.
Here the problem is posed first and the learning areas are
identified by the students themselves. Learning objectives
are defined and teachers act only as facilitators. Students
LEARN HOW TO LEARN AND STRUCTURE THEIR OWN
LEARNING. Thereby they acquire tools for continuing their
ROLE OF RESEARCH ACTIVITIES IN CAREER
DEVELOPMENT IN MEDICAL PROFESSION
B.
K. DAS
(DEPT. OF NUCLEAR MEDICINE, SANJAY GANDHI POST
GRADUATE INSTITUTE OF MEDICAL SCIENCES,
RAEBARELI ROAD, P. B. NO. 375, LUCKNOW - 226 001.)
education.
Due importance has been given to research activi
ties in medical profession. In some countries, research has
been made a part of the curriculum for pursuing an academic
career. However, in recent times, due to stiff competition and
scarcity of appropriate vacancies it has become increasingly
difficult to maintain the sanctity and standard of activity.
Under Indian conditions a large part of the research work has
been of repetitive nature contributing no or little knowledge to
the medical profession. The analysis of recent scientific
publications from Indian Universities and Institutions has
shown very poor citation rate. Only 3 to 4 institutions of India
are recognized centres where good scientific work is done. A
lot of time and resources are wasted in the name of research
which is basically used as a means to enhance one's bio-data
only. It is therefore, necessary to reflect whether the policy of
research contribution in career development is helping the
nation or a change should take place in this regard.
14
Interdisciplinary collaboration is enhanced as every
discipline is preparing and implementing material related to
the same problem. There is nofixed allocation of student time
because training is oriented on the relevance of contribution
of any discipline/s for understanding the problem.
Evaluation of the P.B.L. too is different and encom
passes all domains with emphasis on psychomotor skills and
attitudes rather than simply recall.
Students and teachers work as one unit both know
ing their objective clearly.
15
CURRICULUM CHANGE : BUILDING ON
GRADUATE DOCTOR FEEDBACK OF
PERIPHERAL HEALTH CARE EXPERIENCE - AN
EXPLORATORY SURVEY.
PROBLEM BASED LEARNING
C.
NARAYAN
ANAND
THELMA, &
NARAYAN RAVI.
(COMMUNITY HEALTH CELL, SOCIETY FOR COMMUNITY
HEALTH AWARENESS,
RESEARCH AND ACTION, BANGALORE 560 034.)
(LADY HARDINGE MEDICAL COLLEGE, NEW DELHI - 110 001)
It is a fact that the principal causes of morbidity and
This paper is a preliminary report of a questionnaire
mortality today are quite different from those 50 years ago,
survey of over 50 young graduates doctors. This survey was
because of radical changes in the disease patterns and life
style of patients. The conventional education for health
a component of a larger study entitled Strategies for greater
Community Orientation and Social Relevance in Medical
professionals is not therefore specifically related to commu
nity health needs, future clinical practice or prevailing disease
patterns. While there is pressing need for doctors, nurses,
dentists and paramedics to be involved in primary care, in
rural practice, with interest in cost containment and disease
prevention, our traditional training is continuously preparing
them for careers in tertiary care, urban practice and curative
Education : Building on the Indian Experience undertaken by
Community Health Cell.
There have been some attempts in recent years to
build curriculum change and innovation through feedback of
medical students and interns but this is probably the first
survey which focuses on graduate doctors who had com
: 32 :
pleted atleast two years work experience in a peripheral
health care institution in the 1980's. They were asked to
(ii)
Experiments within medical colleges/
departments.
reflect on medical education and how it could be made 'more
(iii)
supportive and relevant to present day peripheral hospital
practice and community health action'.
Alternative training experiments in
Community Health I Development in the
■ voluntary sector.
The proforma sought ideas and feedback on 26
subjects in Medical Education which included (1) Anatomy
(2) Physiology (3) Biochemistry and Biophysics (4) Biostatis
tics (5) Behavioural Sciences (6) Others (7) Pathology (8)
Microbiology (9) Pharmacology (10) Forensic Medicine (11)
Medicine (12) Surgery (13) Obs. & Gyn. (14) Pediatrics (15)
PSM (16) Psychiatry (17) Dermatology (18) Ophthalmology
(19) ENT (20) Radiology (21) Anesthesiology (22) Dentistry
(23) Orthopedics (24) Medical Ethics (25) Other (specify)
(26) internship.
Feedback was also elicited on few additional skill
areas which included (1) Basic Nursing Procedures (2)
Communication (3) Management and (4) Training of Health
Workers and Personnel and five aspects of Medical Educa
tion which included (1) Selection Process (2) Teaching
Methodology (3) Curriculum Structure/Framework (4) Ex
amination System (5) Other aspects of content, process,
environment and base of teaching.
The respondents were also asked to give sugges
tions of methods/ experience that would enhance the social/
emotional preparedness of graduates for such work.
(iv)
Reflections of graduate doctors who have
worked in Primary Health Care/Community
Health Situations.
The Community Health Ceil, a policy research group
in the voluntary sector has just completed an eighteen month
exploratory and interactive study covering all the foursources.
The aim was to build a reference manual on the Indian
experience for faculty of medical colleges exploring innova
tion in the 1990's. This paper is a preliminary report and gives
an overview of the study process and findings.
The study included a communication to all deans/
principals and professors of PSM of 125 medical colleges in
India with two reminders; interactive field visits and discus
sions with staff/interns of some medical colleges; a question
naire survey of over 50 young graduates with work experi
ence in peripheral health institutions; communication and
dialogue with health and development trainers in the volun
tary sector; and a comprehensive literature review.
The manual to be ready later this year will include -
The survey is being analysed presently. This prelimi
nary communication highlights the key findings.
(i)
Lessons from History and Tradition
(ii)
Exhorting Change
recommendations
(iii)
A situation Analysis
(iv)
Exploring medical college experiences
(v)
Key innovations/experimentsforthe 1990‘s
(vi)
Building on rural experience (graduate
survey)
(vii)
Laying alternative foundation (NGO training
experience)
(viii)
Exploring new horizons/areas in
medical education
(ix)
Medical Education and Society (Linkages)
(x)
Resources and Key to Change
-
Key
policy
16
STRATEGIES FOR GREATER COMMUNITY
ORIENTATION AND SOCIAL RELEVANCE IN
MEDICAL EDUCATION : BUILDING ON THE
INDIAN EXPERIENCE
NARAYAN RAVI, NARAYAN THELMA, TEKUR SHRIDI PRASAD.
(COMMUNITY HEALTH CELL, SOCIETY FOR COMMUNITY HEALTH
AWARENESS, RESEARCH AND ACTION, BANGALORE - 560 034.)
The Indian experience of innovation and reorientation
of medical education can be built up from a study of ideas/
experiments from four sources.
(i)
Recommendations of Expert Committees
from Bhore (1946) to Bajaj (1989).
: 33 :
of maturation in professional capability - competences
that are generally needed by all doctors throughout their
17
professional life.
MEDICAL ETHICS IN UNDERGRADUATE
CURRICULUM
To bring about this change there is required a
change in the education system and problem based
learning, it is a method to combat the crisis confronting
S. K. SINGHAL, V. Y. KAWADE, ASHOK PATIL,
& N. S. MHASKE
our world.
(RURAL MEDICAL COLLEGE, PMT LONI,
MAHARASHTRA - 413736.)
The relationship between a physician and a patient,
in a wider sense, has been a peculiar one; of one absolute
blind faith bordering on worship to complete mistrust and
hostility. Both the responses are understandable and justi
fied. Certain codes were laid down since ancient times which
governed relationship, based on correct perspectives, with a
view to protect the interests of the patients as well as
safeguard the legitimate interests of the physicians.
Ethical consideration have a bearing in most disci
plines of medical practice, including, research on human
beings, therapy on children, mental aberrants, geriatric pa
tients and all other groups. A 20 hour teaching programme at
undergraduate level and intern level is recommended, which
may be incorporated in the existing curriculum.
18
PROBLEM BASED LEARNING A CONCEPT FOR FUTURE
19
PHC VISITS - A TOOL FOR COMMUNITY
ORIENTED MEDICAL EDUCATION
V. Y. KAWADE, S. K. SINGHAL, ASHOK PATIL,
N. S. MHASKE
&
(RURAL MEDICAL COLLEGE, PMT LONI,
MAHARASHTRA 413 736.)
Efforts to reorient medical education must address
community health needs and provide research activities that
will feed back to the educational programme as well as allow
periodic testing of innovative community health services
programmes. Primary Health Centre (PHC) concept for
delivering the health care to the community and implement
ing the community oriented medical education is well suited
to I ndia. The Primary Health Centre which is the first point of
contact for the community with the organisational component
of the health care system, should be properly utilised to train
the medical graduates to evolve problem solving community
based approach.
The importance of regular PHC visits should be
emphasised and due priority should be given in the curricu
lum design to graduate level medical education. The regular
PHC visits of students alongwith faculty members combined
S. K. SINGHAL, V. Y. KAWADE, ASHOK PATIL, N. S. MHASKE
(RURAL MEDICAL COLLEGE, PMT LONI,
MAHARASHTRA - 413 736.)
with "Expert visits” will provide expert facility to the commu
nity at the PHC level and learning facility to the students.
However strong the logic for change, medical
colleges are unlikely to abandon their comfortable status
quo until a climate of opinion has been formed that is
strong enough to precipitate change. If change in medical
education is to be truly beneficial and, indeed effective
in terms of improved health care towards better health
of populations, the complex relationship between health,
manpower, the health care system and the social, eco
nomic and political realities of a country must be taken
into account. These in turn are influenced by political,
economic, demographic and environmental crisis that
faces our world and call for our orientation of the pro
fessions wider responsibilities and potential changes in
the role of individual doctor in the next century. Such
considerations lead us to have a new view of medical
education, a curriculum which has a progressive process
20
SELECTION & RESERVATION CRITERIA FOR
ADMISSION OF MEDICAL STUDENTS
PARAG SHAH
(LOKMANYA TILAK MEDICAL COLLEGE, SION,
BOMBAY - 400 022.)
I suggest that admissions to under graduate medical
courses should be according to the following guidelines :1.
: 34 :
50% of seats should be reserved for local candidates
on merit of HSC
with academic year starting
after the HSC results.
20% of seats should be reserved for
The trend is unfortunate particularly when this atti
candiates coming from rural areas, on
the basis of merit at HSC with academic
tude seems to prevail predominantly in the medical profes
year starting after HSC results.
30% of seats to be filled by an All India
competitive examination. The academic
year to start six months after the HSC
results. A ceiling of minimum number of
marks and a maximum number of attempts
for eligibility to the All India pre-medical
test would make the conduct of such an
examination more practical.
21
A PLEA FOR AN INITIAL ORIENTATION
PROGRAMME FOR THE NEW-ENTRANTS IN
UNDERGRADUATE MEDICAL PROGRAMME
TOWARDS LIVING HUMAN BODY
(LIVING ANATOMY)
J. C. SAHA
(CHRISTIAN MEDICAL COLLEGE, LUDHIANA - 141 008)
Teaching/learning of human anatomy have been
cadaver-based from the very beginning. With the passage of
time along with knowledge-explosions more details have
crept into the curriculum and technological advancement has
brought in newer concepts and methods of learning. Non
availability of adequate supply of cadavers in good condition
and time constraint for the coverage of the discipline have
been a chronic problem. Strict compartmentalisation of medi
cal education have compelled the subject-experts to com
pete for the 'supremacy' of respective discipline in under
graduate teaching/learning programme - which is perhaps an
sion. It is sad that the cummulative effect of all these have
resulted in a CRISIS OF ATTITUDE affecting teachers,
learners, educators and administrators equally.
There is a need for a change in this attitude for the
better and it is desirable to protect the newentrants to medical
profession from this infections spread. The aim should be to
stress upon the fact that it is the living human body (not the
cadavers) is to be dealt with in health and health related
problems.
A good beginning may be made with the new
entrants in the initial period following admission. During this
period covering 6-8 weeks, the learners are not exposed to
cadaver but are encouraged to concentrate on their own
bodies for learning anatomy. Besides recapitulating facts
learnt during schooling and premedical years, understanding
of the frame, form, regions and parts of the human body;
position, significance of directional terms and planes; various
levels of structural organisation and systems of the human
body and man as a living entity are taken up. These are
followed by discussion on life on earth, man of earth, growth
pattern, significance of height, weight, age changes from the
new born to old age, etc.
The methodologies used are self learning, small
group learning with audio-visual aids like, diagrams, models,
slides, etc. and the use of the learner's own body as may be
applicable. The knowledge is also imparted on common
community health problems, prevailing health care-delivery
system, concept of a team-work, integrated and problem
based learning etc.
ongoing process even today. In the competition for su
The above programme is designed to equip the
premacy as well as survival, Anatomists, enjoying immunity
from arbitrary decision on curriculum details, attempted to
learners adequately for the subsequent training in Anatomy
involving dissection/prosection etc. besides creating a sense
of awareness to apply knowledge on living body. With our
limited experience for the last 2 years, we may say that a
desirable change and an enthusiastic response have been
noted both in the learners and the teachers.
expand the scope of the discipline including its various
subdivisions so much that a FEAR PSYCHOSIS has devel
oped amongst the learners in the undergraduate programme
on the magnitude and irrelevancy of the details. Moreover, to
make the situation worse, cadaver-based training became
cadaver oriented if not dependent, ignoring otherapproaches.
The obsession with cadaver training has developed to such
an extent that anatomy and cadaver seem to be synony
mous.
35 :
22
23
PRESCRIPTION WRITING FOR COMMON
CONDITIONS - CLINICAL PHARMACOLOGY
EXERCISE.
COMPUTED TOMOGRAM AS A TEACHING AID
PRITHA S. BHUIYAN, M. L. KOTHARI, LOPA A. MEHTA
VEENA S. JAGUSTE, SAVITA SHAHANI S D. A. JOSEPH
(DEPT. OF ANATOMY, SETH G. S. MEDICAL COLLEGE
& KEM HOSPITAL, PAREL, BOMBAY - 400 012.)
(DEPTT. OF PHARMACOLOGY, L. T. M. MEDICAL COLLEGE.
SION, BOMBAY - 400 022.)
Selecting the right drug from several thousand pos. sibilities is not an easy task, specially for young medical
graduates. Unfortunately the existing stereotyped nature of
the exercise in Pharmacology Practical examination does not
It is being globally recognized that the newer modali
ties of imaging have allowed medical man the gift of
"Divyachakshu" - the faculty of visualizing the nooks and
cervices of the human body in health and disease, without
any invasion as little as by even a needle prick. The visual
offer the opportunity to the students to critically evaluate and
access to the live human body is both static and dynamic,
select the appropriate drug. To improve this drawback and to
allow them the opportunity to correlate the theory with actual
clinical practice to interact with clinicians, we designed this
special exercise in prescription writing as a part of clinical
pharmacology training.
both recordable on a video tape. The role of computer in this
regard has been so great as to recently earn a Nobel prize for
the pioneers. The paper to be presented deals with the simple
technique of teaching to the first M.B.B.S. students anatomy
by a combination of serial 'cuts' of the body through C.T. seen
and compare those with similarly cut sections of the gross
cadavers. Needless to say the scan adds to the appreciation
Eight students who had secured 70% or more marks
in Pharmacology theory in terminal exams were selected for
the exercise. Every student was given a specific condition
commonly encountered in clinical practice for e.g.. hyperten
sion, peptic ulcer, migraine etc. They were asked to prepare
different prescriptions for their respective condition depend
ing on the varying situation based on the specific points given
by us. They included pharmacological and trade name of the
drug, dosage and administration, rationale, important ad
verse effects and interactions. Special emphasis was given
on the fact that these prescriptions were not to be written from
textbooks alone, but students should actually see the pre
scriptions for these conditions in wards, discuss them with
clinicians before writing their own prescriptions.
The above technique has already been tried out on
a preliminary basis with rewarding results. The presentation
will include C.T. scans, corresponding cadaveric sections
and the correlation between the two.
24
CLINICAL ANATOMY FOR UNDERGRADUATES
M. N. MAHENDRAKAR
(SETH G. S. MEDICAL COLLEGE, PAREL, BOMBAY - 400 012.)
After the students were ready, they were asked to
present their prescriptions in front of class and judges from
staff members of medicine and pharmacology. Audience
asked questions and justification on their prescriptions. A
questionnaire was given to each student in the audience and
to all the judges, from which three students with best perfor
mance were selected. The students were also asked to rate
the usefulness of this special exercise on a four point scale.
Results of this exercise will be discussed alongwith
presentation of two prescriptions by the students.
of the gross section and vice versa.
Learning and teaching of Anatomy has to keep pace
with the advancement of other branches of medicine. The
necessity of the knowledge of Clinical Anatomy is felt in
recent times by many teachers of Anatomy.
The post-graduate students in surgical branches feel
that they should have learnt and should have taught surgical
anatomy during undergraduate period. With the personal
experience of teaching surgical anatomy to postgraduate
students in various surgical branches for many years, it was
felt that not only surgical anatomy but also clinical anatomy
concerned with all other branches of medicine should be
taught to undergraduates.
: 36 :
Second and third terms of I.M.B.B.S. and first and
second terms of III M.B.B.S. are suitable period forteaching
clinical anatomy. The use of slides with clinical photographs
and demonstration of anatomy in clinical subjects are gener
ously done. What, when and how to teach Clinical Anatomy
is discussed.
25
theoretical. The students are not expected to carry out
routine ward procedures. The students usually do not partici
pate actively on their own. This leaves a major lacuna in the
training in the medical course unlike the one for undergradu
ate course for dentistry or nursing where concurrent practical
work is imperative before a student is given degree certifi
cate. One year of rotating internship does not fulfil the
requirement for developing necessary skill in attending to the
patient. This results in less practical training for medical
student which is much better for dental and nursing students.
YOGA IN MEDICAL EDUCATION
S. J. KASHALIKAR, J. A. BHATT
(DEPT. OF PHYSIOLOGY, SETH G. S. MEDICAL COLLEGE,
PAREL, BOMBAY - 400 012.)
The paper presents the scope and application of
yoga in medical education. Today's education in general and
medical education in particular does not pay adequate atten
tion to the systematic nurturing of the healthy intellectual,
psychological and physical developments of students, teach
ers, researchers, policy makers and policy implemented.
Yoga, a disciplined way of life, brings about evolu
tionary transformation in an individual in such a way that the
individual losses petty identity, gives up petty selfish motiva
tions, develops objective and penetrating intellect and resil
ient and strong personality, and acquires sound physique.
To overcome this deficiency in training an under
graduate medical student during his clinical terms a student
should be required to maintain a M.W.P.P. Card (Mandatory
Ward Procedure Programme Card) for each term. In this
record, a list of various procedures should be made, which
are mandatory for a student to carry out before certification
is granted for completion of the term. There should be a
column against each procedure for the number performed by
the student. Basic procedures should be made compulsory
during the junior terms and the procedures required for
treating patients on an OPD basis should be obligatory during
the senior term under supervision of senior staff members.
Students must be granted the term only if MWPP
requirements are met with.
The process of yoga or.yoga sadhana is a prerequi
site, a means and a way towards higher and nobler con
sciousness. Siddhi or adeptness in yoga is an ideal goal that
ensures universal welfare. The edifice of education - particu
larly medical education - cannot be safe, personally fulfilling
or socially meaningful without the cement of yoga.
26
MANDATORY WARD PROCEDURAL PROGRAMME
(MWPP)
S. S. HATTANGADI, M. L. KOTHARI, L. A. MEHTA
(DEPT. OF ANATOMY, SETH G. S. MEDICAL COLLEGE, PAREL,
BOMBAY - 400 012.)
It is observed that a fresh medical graduate after
completing 4.5 years of medical education and a year of
internship is not ripe and trained enough to provide first aid
during emergency or to treat patients with common illnesses
on his/her own confidently and perfectly. The reason for this
is that during his/her study period the training is essentially
: 37 :
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For full prescribing information, write to:
Raptakos, Brett & Co. Ltd.
Dr. Annie Besant Road, Worli, Bombay - 400 025.
References: 1 Nutrition Abstracts & Reviews in Clinical Nutrition-Series A, 1984, Vol. 54, No. 8
2 Merck Manual, 17th Edition, 1987, pg. 796.
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