Articles

EMERGING TRENDS IN MEDICAL EDUCATION AND PRACTICE

Dr. P. NARASIMHA RAO

FRCS(G), DSc., M.S., F.I.C.S., F.I.M.S.A.,

President, International Medical Sciences Academy,

Former Principal, Guntur Medical College and

Former President, Medical council of India

            Medical Education has by and large remained unchanged for the last sixty years except for a cosmetic change here and there. You are all aware of it.

            In curriculum, during the first year, students learn about the science basic to medicine by sitting through lecturers in large groups. Many students and even the clinical teachers think this is a barrier to their becoming doctors than as a period devoted to acquiring knowledge and learning skills that they wilo apply throughtout their careers as doctors. There is need for developing a curriculum and an educational program consistent with preparing students to practice medicine in the 21^st Century. Our is a huge nation the educational programe at one college cannot simply be adopted wholesale by another. While the structure remains the same, experimentation in the lerning methods sh9ould be explored. This is essential for the medical profession and most important for the health of the people who it serves.

            The medicine of 21^st Century will be different from the medicine of today. The encounter between the doctor and the patient will be as it as always been,  collaboration between two persons directed towards improving the health of the patient. But the scientific. Technological, economic and ethical conditions of meical practice are changing rapidly and will continue to do so. The task of medical education is to help people entering medicine to prepare them to meet their professional obligations in this new context. The nature of educational task must change as the nature of profession changes.

            The most powerful forces transforming medicine are the new conncepts of human health and disease created by recent discoveries in the natural sciences. As this information becomes available, it will completely alter the conceptual framework within which the physicians think and work. We will understand more and more that the balance of health and disease in the population is an expression of biological evolution in action. We all know the variety of genetically related proteins produced by the natural selection of mutants. These are rudiments of a contemporary vision of life as chemistry.

            The momentous developments in the natural science ar not alone in changing the conceptual basis of medicine.  Discoveries in the social  sciences also are yielding new perspetives. Human being live in social groups. Much of mobidity is determined by differences in the socioeconom,ic conditions in which people live. These differences can often be correlated with social customs such as smokingk, alcohol or other drug use, diet, waste disposal and sanitation. Social scientists are making physicians much more aware of social determinants of morabidity as well as methods of practice.

            Science and technology are symbiotic. New ways of observing our surrounding made possible by new devices such as electron microscopes, spectrometers for detercting electromanetic radiatihn of various frequencies from X-rays to infrared, magnetic resonance deterctors, mass spectrometers, chromatogtraphic techniques for rapid saparation of molecules by mass and change all have permitted a more rigorous asnd stringant test of old hypothesis. Particularly note worthy is the emergence of computers and related devices for managing information. Modern phyusicians use anarray of new disgnostic, preventive and thearapeutic tools. Changing in economics of medical care are also reshaping the medicine of 21^st century. What are the attitudes, sills, and knowledge that all medical students should share, irrespective of their Ultimate professional career focus ? What is most cost-effective way in which faculties of medical colleges and universities can help students to devlop these qualities ? There is an emerging consensus that attitudes and skills in learnig and practising are as important as or more important than the acquisition of technical knowledge during the course of general medical education. The inccredible grotwth of knowledge in the sciences basic to medicine makes it literally impossible for students to acqauire during medical school  and to retain thereafter all the information necessary for a lifetime of effective practice. Rather, both as students and during their patients and develop the skills to learn whatever is necessary. Explicit mention to the cultivation of  didacti exposure to information, is one of the axions in the training of doctors. Medicine begins in philosophy, and philosophy ends in medicine. First, it should recongnise himan beings as living organisms both closely related chemically and physically to all living organisms and aldo remakably diverse as revealed by modern molecular and cell biology.

            The framework of knowledge should view humans as members of society. But human’s proclivity to live in closeknit groups also has pathological cosequences, it increases the chances of transmission of infectious diseases between individuals, and the emotions generatied in relationships between people are oftern components in the etiology of psychopathology.

            Physicians must view their patients not only as living organisms and members of society but also as unique in time, place and participants involved. The experience of illness and suffering is lonely. The effectiveness of this transaction between persons is often crucial for accurate diagnosis and for compliance with plans for prevention or treatment. Much time must be spent on the patient doctor relationship including the development of clinical skills such as physical diagnosis and history-taking through a considration of issues in medical ethics and economics. Recorgnation that learning and living are inseprable must become more a part of everyday life. The social roles of universities and professional preparing students for lives of learning. Education in medicine can manke aa significant contribution toward this re-examiniation of higher education of all kinds.

            The goal of medical education is to increase the ability of physicians to bring the practical benefits of the new science and technology to persons who are sick and suffering.