Medical Education Re-examined and Beyond
Item
- Title
- Medical Education Re-examined and Beyond
- Date
- 2007
- Description
- An updated version of an earlier paper preparedfor mfc silver Jubilee Meet "25 years of the Health Movement", January 28-30, 1999, at Wardha, Maharashtra. '
- Alternative Title
- A review of the mfc contribution to the process towards an alternative medical education strategy
- extracted text
-
7^)
Medical Education Re-examined and Beyond*
A review of the mfc contribution to the process towards an alternative
medical education strategy
"To work towards a medical curriculum
and training tailored to the needs of the
vast majority of the people in our
country.."
- mfc pamphlet
1.
INTRODUCTION
In 1991, the medico friend circle (mfc) published its major critique on Medical
Education in India entitled Medical Education Re-examined. Eight years earlier,
the Conference on Alternative Medical Curriculum organised by the Gonoshasthya
_____ _ Kendra.(GK), Bangladesh, in March 1983, .had become the stimulus for initiating
an MFC response and serious reflections on Medical Education - a process which
finally resulted in the Medical Education Anthology (MEA).
It is now fifteen years since publication of the anthology, during which several
significant changes have taken place in the medical education scene in.India. In
"additldhTThere are some new efforts in the country to strengthen public health
education and capacity building, which has stimulated mfc to start a process of Re
examining Public Health Education as well. This short reflection will explore
known and relatively unknown facets of the mfc - medical education anthology
process and also initiatives by The Community Health Cell (CHC) which has
functioned as a mfc linked resource centre on medical education in the country and
tried to transform the deliberations of a ‘thought current’ to an ‘action current’ for
change.
Mfc's involvement in medical education as discussed in this paper can be divided
into three phases:
a) the first phase 1974-83 - medical education dialogue in the bulletin;
b) the second phase 1983-1991 - the process resulting in the mfc anthology titled
Medical Education: Re-examined;
c) the third phase 1992 and beyond - the post anthology phase of CHC and others
- advocating for change and alternative experimentation.
2.
PHASE ONE (1974-82) EARLY REORIENTATION DIALOGUE IN MFC
BULLETINS (mfcb)
From its origins in 1975, young mfc pioneers, some of whom were medical
students or medicos, had been dissatisfied with the state of medical education in
the country. The earliest pamphlet in 1976-77 published by Ashok Bhargava, the
founder of mfc identified the need to evolve a pattern of medical education
relevant to Indian needs and conditions, as an important aim of medico friend
circle, they also noted the "need for a change in approach in the total
orientation and contents of medical education"._________________________
*An updated version of an earlier paper preparedfor mfc silver Jubilee Meet "25 years of the
Health Movement", January 28-30, 1999, at Wardha, Maharashtra. '
However, in keeping with the youthful vigour of members and their practical action
orientation, it listed out a series of programmes for mfc members individuals and
groups that demonstrated early attempts to evolve a new educational pattern through
the 'learning by doing' approach. True to its early Gandhian orientation it sought to
encourage the new approach through mfc member initiated experiments in curricular
re-emphasis,' alternative skill development and value reorientation. Some ideas
suggested are shown in Box 1.
Box 1
PROGRAMMES FOR INDIVIDUALS AND GROUPS
•
•
•
•
•
e
•
•
To emphasise more on preventive and social medicine during
their education,
Try to curtail unnecessary use of drugs, and use minimum
amount of drugs.
Emphasise more on health education, prevention of diseases
during practice.
Study other paths and learn their useful parts and seek and
enlist the cooperation of their adherents.
Study sociology, economics and political science to understand
society, its working and its problems.
Learn clinical medicine perfectly, relying less" on costly
investigations.
Learn nursing procedures and basic investigations.
Not to accept 'physicians samples' ITom medical
representatives as it is a subtle corruption
Doing symbolic acts to change social values e.g., doing
productive labour; giving up cultural slavery; opposing ragging
in medical colleges; improving relations and team work
between different categories of health workers.
Visit rural health projects during vacations to gain first hand
experience and devote at least one year to develop a new
pattern of medical care suitable to rural India.
Till 1983, in the first ninety issues of the mfc bulletin, Medical Education featured from
time to time as a recurring theme and concern. A wide range of issues were discussed
and debated through' pages of the bulletin.
♦ Mfcb 1-3 presented D. Banerji's analysis of the evolution of the existing health
services system of India, including the development of westernised medical
education. The colonial value system of British rulers; the class orientation of Indian
physicians; their inculturation in British modelled Indian medical colleges; their
thorough indoctrination by the General Medicine Council and Royal Colleges of
Britain; the power, prestige, status and money oriented attitudes of the profession; the
unsuitably trained doctors of the present model identifying with the highly expensive,
urban, curative oriented medicine of the West; the "go to the States (USA)"
mentality, and the resulting distortion of the country's health priorities were presented
to readers.
♦ The proceedings of the second All India meet of Medico Friend Circle at Sevagram
in December 1975 mentions that medical education was discussed in the Session on
Health Problem and Needs (see mfcb 1,2) and the following practical changes were
suggested:
- Medical students should be involved in community development projects
throughout their training, i.e., dehospitalisation of medical education
- Co-education with paramedical personnel was thought to be important and
possible
- Dissertation and thesis in community problems should be encouraged
- Training in medical administration should also be incorporated in medical
education.
♦ mfcb 9 featured Mao Tsetung's June 26th Direction of 1965, the radical reforms of
medical education that were part of the early cultural revolution in China - "study
while practising; go to the countryside; solve urgent problems of the masses; focus
on prevention; put stress on rural areas in medicine and health " .
♦ Mfcb 14-17 ran a dialogue on the need for new Managers for Medical Colleges
and identified the qualities required for Deanship - leadership, professional
competence; integrity; knowledge of the philosophy and science of medical
education and administrative abilities; and explored remedies including an IAS
type medical cadre.
♦ Young doctors and medical students camps at Kishore Bharati in December 1976
piobiug the cycle of Poverty and Disease_(nrfcbH_5), the Kissa Khesari Ka camp in
Rewa in June 1978 (mfcb 30) which explored the socio-economicpolitical-cultural
roots of the lathyrism problem; the Kerala mfc group's visit to the Kundungal
fisherman colony in April 79 (mfcb 44); the mfc Sevagram group's experiences in
Nagapur village (mfcb 47-48) are excellent examples of practical rural orientation
camps. These have been pioneering forerunners of what are now called
Communit)' Orientation Programmes (COP) which became an integral part of the
medical curriculum of some community oriented medical colleges in the early
1980s. The first medical college to introduce it, was St. John's Medical College,
Bangalore and three mfc members on its staff - were the pioneers.
♦ The mfc bulletins from July 1978 till April 1983 (88) carried debates and
dialogues on different aspects of medical education. These included protests
against new medical colleges in Maharashtra; reflections on over-dependence of
investigations in medical education; a reflection on the irrelevance of frog
experiments in physiology; on the 'Medical Education in Malayalam' controversy
in Kerala; a dialogue on the 3 year medical diploma course; and reflections on
internship training by interns experiencing rural postings.
More substantial articles included:
♦ The Draft National Medical Education Policy circulated by the Ministry of Health
and Family Welfare (Gal) in October 1979 which was featured in the bulletin
(mfcb 46) for information and comment; a report from Jhansi medical college on ■
efforts to counter 'ragging' by a new initiative of seniors for juniors (mfcb46); a
reflection on training of interns from SMS Medical College in Jaipur (mfcb 62); a
reflection on caste war by medicos in Gujarat and the issue of reservations in
education (mfcb 63);
♦ In 1982, Rational Therapeutics and Rational Drug policy issues dominated the
themes of the mfcb around and after the Tara meet in January 1982, which was
focussed on the theme: Use and Misuse of Drugs and Women's Health
Contraceptive related issues became the dominant theme in the bulletin in 1983
around the annual meet at Anand, Gujarat, on the "Prejudice against Women in
Health Care".
Medical Education issues then disappeared from the mfcb for a while. It was also
reflective of the fact that 'medical education' had been an issue of concern
particularly when many of the members of the founding group were medicos or
junior doctors but as they moved into healthcare practice, issues of health care and
practice became predominant in mfcb and in meetings.
3.
PHASE TWO
ANTHOLOGY
TOWARDS THE MFC MEDICAL EDUCATION
Medical Education resurfaced in 1983 as an important concern for-mfc-,-when mfc--was invited to participate in the conference ori 'Alternative Medical Curriculum'
organised by the Gonoshasthaya Kendra (GK) in Bangladesh in March 1983. Out
of the thirteen delegates from India, six were from mfc (Abhay, Anant, Ashwin,
Dhruv, Satya, Padma). The conference entitled 'People and Health', reported in
mfcb 89, evolved some guidelines for a new medical curriculum.as.-3.n_altematjye__
to the hospital centred, urban, based and individual patient oriented curriculum. The
mfc team participating in the conference found, it an opportunity to explore ideas of
alternatives with Bangladeshi doctors, interns, medical students and delegates from
Sri Lanka, Philippines, Malaysia, Nepal, Mozambique, North Korea and Thailand.
As mentioned in Dhruv's editorial in the mfc Medical Education anthology that
evolved eight years after the conference stimulus, 'mfc is particularly grateful to
Dr. Zafrullah Cli’oudhury and other friends from Gonoshasthya Kendra,
Bangladesh, without whose challenge by way of invitation to the conference on
Alternative Medical Curriculum, we would not have been motivated to
undertake an extensive debate on this extremely important theme'.
♦ The conference theme inspired a preliminary meeting in India on the 'Role of the new
doctor or Primary Health Care provider' to be produced by an alternative college'.
This was held soon after the Annual meeting at Anand in February 1983.
Some initial consensus was evolved concerning:
a) Social context of primary health care provider,
b) Role and objectives of education,
c) Criteria for selection of students,
d) Nature of set up of training centres and resource personnel,
e) Selection and reorientation of teachers, and
f) Methodology of training
(see mfc MEA, Chapter 7).
d) At the GK Conference, 7 mfc papers were circulated by the organisers,
included:
a) Alternative Medical Education (Report of Anand meeting),
b) Towards a Clinical Syllabus,
c) Ideology and Sociology in medical education,
d) Integration ofTraditional Medicine with Modem Medicine,
e) Womens' Health
f) Prejudices in Medical system against female health functionaries and
g) Politics of medical work.
(4 of these are included in the mfc MEA - Chapter 6, 7, 10 and 11).
* In July 1983, at Hoshangabad, at the mid-annual core group meeting, mfc took stock
of the Gonoshasthya Kendra Conference and it was decided a) to take up the theme
'why alternative medical education is necessary' for the Annual meeting in January
1984 (mfcb96) b) In preparation for the meeting, a historical review and summary of
reports and recommendations from Bhore Committee to the ICSSR/ICMR - Health for
All report (1981) was presented to the group by Ravi Narayan, who was already deeply
involved in medical education reorientation at St. John's along with mfc members like
Thelma and Luis
—(mfcb98 and MEA Chapter I)
.
* The mfcb 97-98 was devoted Medical Education as a background to the annual meet
hosted at Calcutta, at CINE 150 years of MedicaLEdiicatinn was .re-v-iewed-f-M-EAChapter 1) and three case studies of innovative programmes in Medical Education from
. Nepal, Philippines and Australia were included. (MEA, Chapter 12).
* The Tenth Annual Meet held at Calcutta was an important landmark in the mfc
'Medical Education' discussions. The participants consisted of doctors, health activists,
interns and medical students. Apart form mfcb 97-98, four important background
papers were circulated:a) Pre-requisites necessary for making of the basic doctor
b) Critique of existing methodology of training of medical students
c) Note on teaching of Community Medicine: A critique and few suggestions
d) Medicine and Society: Socio-history in PSM.
(MEA Chapters 2-5)
In addition, some issues for Group Discussions were prepared. Group A Structure and
Content of Pre - Para and Clinical subjects; Group B - Structure and Content of
Community Medicine; Group C - Methodology of Training (MEA, Chapter 8). The
group discussions proved to be very intensiv.e, intlractive and meaningful and
comprehensive reports on all three discussions emerged (MEA, Chapter 9).
* In July 1989, at Sevagram, it was decided that all the background papers and bulletin
articles that had emerged from the Calcutta, Anand and Dacca meetings seemed
substantial for a separate anthology and it was felt that such an anthology could be an
mfc statement on medical education. While work started on the anthology in 19.86, not
unusually and in typical mfc style, the anthology was printed only in 1991.
* In the meanwhile The Community Health Cell (CHC), Bangalore, had decided to take
up 'alternative medical education' as an important thrust area. Two additional
reflections were contributed by CHC as the Medical Anthology evolved.
a)
The 1980s were a watershed for reorientation of Medical Education in India.
From the National Health Policy of 1982, several significant initiatives emerged
on the Indian scene which had relevance to medical education reform. These
included the MCI Guidelines of 1982; the New Education Policy 1986, the
Jawaharlal Nehru University (JNU) Plea for a New Public Health; the ROME
experiment; the Kottayam experiment; the Alternative Track initiative in 1988;
the Medical College Consortium on decision based approaches; ’.the
development of a Health University concept; the National Teacher Training
(NTTC) process; the ENCL YN Network, and the Science and Technology
Perspective Plan for 2001 AD.
The mfc discussions needed to be located in the wider context and environment
of change. Therefore, a review of all these initiatives was included in the MEA
(Chapter 14).
b)
CHC felt that the 'anthology' of articles would not be taken seriously if it
remained as a series of reflections by groups of radical thinkers and social activists.
Therefore, an exhaustive exercise was initiated wherein ideas from all the existing
articles were extracted and collated into The 'Framework of an Alternative' under the
same headings and subheadings used in the MCI 1982 Guidelines. Therefore anyone
reading this Anthology of ideas (MEA, Chapter 13) in comparison with the MCI1982 document would clearly understand what the mfc alternative was.
It was a difficult consensus building exercise but not many in mfc know how
significant this final chapter proved to be (see next phase).
* Phase two came to an end with the publication of the Medical Education Anthology .
in 1991 as an mfc-CED Bombay joint venture. As in previous years, the Anthology was
well received and reviewed by the radicals and alternative press. Copies were sold at
meetings and through the Centre for Education and Documentation (CED), Mumbai
and Voluntary Health Association of India (VHAI), New Delhi.
Very few mfc members had direct involvement with Medical Education, so continued
involvement after the anthology would have had to be theoretical. Also other action
demanding issues in the areas of irrational drug prescribing and health care policy
issues emerged, needing urgent response. Medical Education reorientation therefore
moved down, on thepriority agenda of mfc.
4.
PHASE THREE
OTHERS)
CONTINUING THE AGENDA THROUGH CHC /
CHC had been the mfc organisational and bulletin office from 1984-86. Since many of
us in CHC and among its associates had a 'medical college' teaching background,
reorienting medical education became a key concern, especially through the intense
involvement in the anthology process. While the Bhopal disaster, Tuberculosis control,
Pesticides and Environmental Health also emerged as new concerns during the CHC
phase of mfc, Medical Education remained a major concern leading to series of
significant initiatives in Medical Education.
•
In 1991, CHC took the initiative of sending the mfc Medical Education Anthology
to 125 Deans of all the medical colleges in India. We felt that if the mainstream was
not challenged and if we did not actively dialogue with ‘existing system’, there was
a danger that all mfc's efforts towards and evolving alternative curriculum would
remain an interesting and provocative book, on the dusty shelves' of various
libraries - of activists. NGOs-, the voluntary sector, development groups and so on.'
We decided that endorsement by the converted was not the way ahead.
■ •
•
We were prepared for silence from the ‘mainstream Deans’. What followed was
however rather unusual. The CMC-Ludhiana Principal wrote to us that they had
submitted Chapter 13 of the anthology along with their application for an
'Alternative Track Medical course' to Punjab University. The application was being
considered and they invited us to visit the college to orient the core faculty
interested in medical education reform to the mfc anthology and Chapter 13 as a
background (!). We visited the college and planned the orientation process.
However, the project was shelved later due to some extraneous circumstances that
overtook the college, in its relationship with the University.
•
Three medical colleges CMC-Vellore, St. John's - Bangalore, CMC-Ludhiana came
together along with two national coordinating agencies CHAI and CMAI to form a
medical education network to help Wanless Hospital in Miraj (Maharashtra) to
evolve an alternative medical college project. This hospital had been a teaching
hospital of the Government Medical College at Miraj for decades. The decision of
the government to build its own teaching hospital had led to the 'mission hospital'
getting notice of loss of this linkage. The management decided that they should
start their own medical college and the ‘Miraj manifesto’ (mentioned in Chapter-14
of MEA) evolved. The supporting network formed to evolve this new experiment ■
invited CHC to present the mfc alternative as a 'keynote address' for the first
meeting of the Network and Dr. P. Zachariah, who was the project leader kept close
touch with CHC and also attended a few mfc meetings to dialogue with all those
who have contributed to this anthology.
•
A Medical Education Review Meeting was organised in July 1992 to take stock of
the study findings and build a collective commitment to a Medical Education
Alternative. The invited participants included Medical college faculty from 10
colleges in the country. NIMHANS-Bangalore, VHAI, CHAI, CMAI, KSSP and
FRCH also participated. Dr. Zafarullah Choudhury of Gonoshasthya Kendra
attended as a surprise guest and resource person. The proceedings of this
significant meeting recorded the tasks and challenges ahead at individual level,
institutional level and collective level (mfc core - Thelma, Ulhas, Mira Shiva,
Ravi).
•
During the research project on Strategies of Social Relevance and Community
Orientation in Medical Education, there was a steady dialogue of the CHC team
with many mfc core group members. One of the concerns expressed in this dialogue
was that the focus on evolving an alternative should not distract from the larger
problems in medical education which were the distortions and trends due to market
economy forces, commercialization and the new economic policies. Some of these
distortions were listed out in MEA Chapter 14. However, CHC continued to keep
track of these and collect supplementary information on them.
•-- In 1993, VHA1 set up the Independent Commission on Health in India (ICHI) and
---- CHC was invited to be an associated and contribute the chapter on Medical
Education. While the alternative training experiments and the mfc efforts were
included in the report. CHC also presented a deeper analysis which included:
regional distribution and disparities; norms and estimates; commercialisation and
capitation fees issue; student wastage; brain drain; qualitative decline in standards;
corruption; medical student protest movements; problems of PG education; lack of
CME and so on. A 12 point prescription for change was also suggested. The ICHI
report presented to the Prime Minister in 1998 now includes a substantial part of the
CHC report. This Chapter was then republished in 2001 as a separate booklet
entitled ‘Perspectives in Medical Education’ in the VHAI Health Policy series.
• The mfc anthology and the CHC reports were also sent to the International Network
of Community Oriented Health Science institutions - which is an international
network promoting medical education alternatives. The books and reports have
been reviewed and reported in the newsletter and journal.
•
In 1997, the Rajiv Gandhi University of Health Sciences was established in
Karnataka State and 17 medical colleges were brought under its jurisdiction 9 apart
from all the nursing colleges, pharmacy colleges, dental colleges and colleges of
Ayurveda, Unani, Homeopathy and other systems of Medicine. CHC was invited
to be a consultant on Medical Education reorientation and is gradually became a
catalyst for ‘mainstream change and restructuring’. The University bought many
copies of the publications for its library and these were also background materials
for various workshops. A workshop on Vision/Mission and Management •
Challenges of Medical education for Deans/Principals of all the medical colleges
was held in December 1998. apart from workshops on restructuring the pre-clinical
and para-clinical courses. Among the initial gains have been the change of focus
from ‘frog experiments and cadaver dissections’ to more clinical orientation of
preclinical studies; introduction of Rational Drug Use and the Essential Drug
concept in pharmacology. The most important change however was the
introduction of medical ethics as a separate subject with its own curriculum and text
book, which included many of the issues of concern to mfc/CHC. It was a great
experience in one of these workshops to find a ‘Principal from a privatemedical
college in Bijapuf who had read the MEA copy in his library and was now
enthusiastically in touch with CHC for further meetings on various themes. The
Unviersity have also taken some very important steps for examination reform.
•
The Parliament set up a sub-committee on medical education as part of a larger
task force on Manpower Development under the Chairmanship of Sharad Pawar.
The CHC report was provided to all the sub-committee members as background
reading which helped them to get a more comprehensive understanding. A written
submission was also presented in person to the Sub-Committee during their public
dialogue in Bangalore.
Three medical colleges in the region have been in touch with CHC to explore
alternatives based on MEA and the CHC reports. These are the medical college of
— Gono-Biswabidyalaya - (GK Bangalore), Pramukhswami Medical College in
Gujarat, the B.P. Koirala Institute of Health Sciences in Dharam, Nepal, though the
process did not proceed beyond the initial dialogue and sharing of ideas, partially
because of the resistance and/or hesitancy of the faculty trained in the mainstream
model.
•
Mira Shiva of VHAI initialed discussions on Gender issues in Medical Education in
the 1990s. Following this, Thelma of CHC wrote a specific paper on gender issues
in medical education for a consultation in Mumbai organized by CEHAT and
Achuta Menon Centre. The project of these centers led by Mala Ramanathan and
leading to a gender review of various medical college text books and a whole
process of training / learning on gender issues in medical education have evolved.
• The MCI revised its curriculum in 1996 and two important new recommendations
are very relevant to our advocacy efforts: (1) skills have been identified to be
developed for every medical graduate and (2) social community orientation have
been emphasized during internship with permission to spend at least one month
with community health projects run by voluntary agencies and NGOs in the
country.
• A special report entitled ‘Does Karnataka need more medical colleges?’ were also
prepared and submitted to the Karnataka Government, to counter the trend towards
commercialization of medical education by the Government of Karnataka and to
initiate a public debate to counter the gross devaluation of medical education by the
government. The report was also used to orient the junior doctors association in the
state who included some of the demands in their strike for medical education
reform.
• The Government of Karnataka set up a Task Force on Health and Family Welfare in
which CHC played an important role in developing the Task Force report including
developing the chapters on ‘Health Human Power Development’ and the ‘Health »
Policy’. The report mentioned earlier was also submitted to the Task Force and led
to their recommendations on a moratorium on medical colleges. This however has
changed with the change of government!
•
•
Finally, some of these ideas were then also included in the 5lh booklet of the Jan
Swasthya Sabha on Commercialization of Health Care, which were used for the
mobilization towards the national health assembly in 2000.
To summarise then,
the mfc’s concern for alternative Medical Education led to a provocative and
inspiring anthology of reflections on medical education and the framework of an
alternative curriculum.
• The post anthology phase has shown that while ‘critique and alternative
formulations’ are ‘the first steps’ commonly undertaken by radical thinkers and
activists, translating them into policy by engaging ‘mainstream decision makers’
and the mainline health system is a much more difficult task requiring patience;
sustained effort; ability to dialogue pro-actively and opportunistically; and move
beyond rhetoric to focused jut voluntary incrementalism. CHC, as an mfc linked,
and mfc inspired organization has tried to bridge this gap and take the Medical
Education agenda forward.
• Every mfc member dissatisfied with his or her own medical training and / or
disillusioned with the role that doctors and health workers play in our society in the
context of the health realities and socio-economic-political-cultural context in
which health action and medical care have to operate, can be a great resource
person to .support, contribute, help evolve alternative medical education - not just
conceptually but in formulating specific objectives, content detail, nitty-gritty.
• We hope that some mechanism can be found as mfc moves into the new challenge
of the examining public health education that this contribution can be a sustained
collective process for change and not stop with discussion and publication in radical
spaces. The politics of critical and sustained engagement is something that mfc has
to take quite seriously if we want to be part of the ongoing developments and
change process. The new millennium could be seen as an opportunity for more proactivity.
•
In conclusion,
We would like to share the las', part of the CHC report to VHAI-ICHI submitted in
December 1995 since though it was outlined more than a decade ago, it has relevance
for what mfc and JSA may wish to do today.
"For too long, the Medical Profession and the Medical Education sector have been
directed by professional control and debate. It is time to recognise the role of the
community, the consumer, the patient, the people in the whole debate. Bringing
Medical Service under the purview of the Consumer Protection Act has been the first of
the required changes. Promoting public debate, review and scrutiny into the planning
dialogues for reform or reorientation has to be the next step. This could be brought
about by the involvement of people’s I consumer’s representatives at all levels of the ,
system - be it service, training or research sectors. However, all these steps can never
be brought about by a top down process. What is needed is a strong countervailing
movement initiated by heal'.!', and development activists, consumer and people's
organisations that will bring health care and medical education and their right
orientation, high on the political agenda of the country".
- CHC, Bangalore
>-
Further Reading:
1. Medico Friend Circle (1991) Medical Education Re-examined (Ed. Dhruv
Mankad), mtdico friend circle / Centre for Education and Documentation, Bombay.
2. Mfc bulletins 1,2,3,9,14,15, 16, 17,30,44,46,47-48,62,63,88,96,97-98.
3. Narayan R et al (1993) Strategies for greater community orientation and social
relevance in Medical Education Building on the Indian Experience.
4. Narayan T. et al (1993' C:. riculum Change: Building on graduate doctor feedback
of peripheral health care experience - an exploratory survey.
5. Narayan R et al (1993) Stimulus for Change - an Annotated Bibliography.
6. Community Health Cell "Education Policy for Health Sciences" - Proceedings of
the Community Health Tr:;:-.ers Dialogue, October 1991.
7. Community Health Cell T awards a Collective Commitment - Proceedings of the
Medical Educators Review Meeting, June 1992.
8. Narayan, T. Training of Doctors for India, Health Action, Vol. IV, No.6, June 1991.
9. R. Narayan, T. Narayan .«:! S. P. Tckur, Strategies for Social Relevance and
Community Orientation .1! hiding on Indian Medical College Experiences, Annals
of Community-Oriented . .location, Volume 7, 1994, Network of Community
Oriented Educational Institutions for Health Sciences, Maastricht.
10. Community Health'Cell Perspectives in Medical Education A report prepared for
the Independent Commission on Health in India, VHAI, December 1995.
ll.CHC and DAF-K (Drug .'.etion Forum-Karnataka) Towards Implementing the
Teaching of Essential Dr;, and Rational Therapeutics in Under-graduate Medical
Education, A note for the I’ajiv Gandhi University of Health Sciences, Karnataka,
Bangalore, October 1998.
12. Community Health Cel! \ Submission on "Medical Education" to the Sub
committee on Medical Education of the Parliamentary Standing Committee on
Human Resource Develop::, . nt at Bangalore, November 1998.
13. Rajiv Gandhi Univcrsir. ' Health Sciences, Karnataka, Bangalore, Ordinance
governing MBBS Decree Programme, 1997 (includes Objectives of Medical
Graduate Training Progra:and Medical Ethics Curriculum).
***
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