Journal of Family Medicine and Primary Care

EDITORIAL
Year
: 2019  |  Volume : 8  |  Issue : 9  |  Page : 2751--2752

Competency-based medical education: How far, how much


Amrita Ghosh1, Ranabir Pal2, Raman Kumar3,  
1 Department of Biochemistry, Calcutta Medical College, 88, College Street, Kolkata, West Bengal, India
2 Department of Community Medicine, MGM Medical College and LSK Hospital, Kishanganj, Bihar, India
3 President Academy of Family Physicians of India, India

Correspondence Address:
Dr. Ranabir Pal
Department of Community Medicine, MGM Medical College and LSK Hospital, Kishanganj - 855 107, Bihar
India

Abstract

Competency-based medical education inscribed in the Graduate Medical Education Regulations from Medical Council of India is cogently grounded by the Curriculum Implementation Support Programme throughout the country under the aegis of Medical Education Units and Curriculum Committees of the medical institutes. Global researchers on academic curriculum visualize paradigm of system based teaching–learning in evidence based medicine. This intermingled with participatory contribution from the learners in a non-threatening environment can inculcate philosophy of life-long learning mindset. Creative teaching-learning environments free the mind to freely learn to meet the challenges of the health needs of the country.



How to cite this article:
Ghosh A, Pal R, Kumar R. Competency-based medical education: How far, how much.J Family Med Prim Care 2019;8:2751-2752


How to cite this URL:
Ghosh A, Pal R, Kumar R. Competency-based medical education: How far, how much. J Family Med Prim Care [serial online] 2019 [cited 2019 Oct 15 ];8:2751-2752
Available from: http://www.jfmpc.com/text.asp?2019/8/9/2751/268073


Full Text



Competency-based medical education (CBME) has been introduced through the Graduate Medical Education Regulations (GMER) from Medical Council of India. It has been proposed that under the paradigm of Curriculum Implementation Support Programme, CBME will be percolated under the aegis of Medical Education Units and Curriculum Committees of the medical institutes throughout the country.[1]

Let us look at the positive aspects in this CBME of the GMER for the development of primary care for the millions of downtrodden population spread over millions of households.

Proposed fundamental changes in different phases of the undergraduate curriculum (MBBS) seem radical after many decades to see the light of the day.

First, the “Foundation Course” has been introduced to help the undergraduates “Feel good to be a medical professional” in first 1 month (precisely month of August). This period will be utilized to help them accommodate in a “newfound land” of medical college and hospital to ingrain the pride to be medical professionals with all their rights and responsibilities. This period encompasses learning to manage stress, computer basics, vernacular of the patients, bioethics of medical education, patient care, and research as well as key problems of public health importance in the three-tier health-care delivery system.

Second, the concept of “Electives” has been introduced for the first time in the history of medical education in India. Now our students will spend dedicated 2 months on any topic of their mindset which they will nurture for futuristic vision in addition to topics to be covered in their proposed course and curriculum.

Third, the paradigm shift of the “Early Clinical Exposure” has been initialized along with the lesson plans of the preclinical subjects from the first phase. The sincere implementation of this concept may help undergraduates with the feeling of hitherto disconnected specialties in relation to patient care. Further, we also hope that by this approach, the budding professionals will find inroads to the community folks and become proficient in profession. Further, they may have been skillful in the conflict managements in their interactions with the community people who reach the doorsteps of practitioners of medical profession as the patient and their caregivers for improved patient–doctor relationship.

Fourth, attitude–ethics–communication module will help them learn soft skills that will help them internalize the historical triple role of doctor in society as “Healer,” “Teacher,” and “Preacher.” It is proposed that these will be initialized in “Foundation course” and will be continued and reinforced in different phases in different specialties till last day of the course and curriculum. Educationists and medical teachers argue that all these were being part of teaching–learning in the “covert” form since time immemorial; now it has been “overt” and formalized for better “Make-in-India” MBBS doctors.

Fifth, modern concepts of capacity building through simulation and other advance educational technologies can only be grounded through the organized in-house skill lab. This will definitely help ethical learning instead of exploiting the downtrodden care-seekers as experimental animals. Further, skill labs will help smoothen learning curves of the slow learners, newer skill updating, and other teaching–learning hitches.

Lastly, there has been streamlining of topics in different phases with consequential trimming of cognitive domain of learning and stressing on the small group teaching methods. Conceptual vision will be the mainstay to hold hand of the new entrants in the teacher–student axis before they have their footsteps in contextual teaching–learning of horizontally spread individual subjects intermingled with the concept of integrated teaching.

 Real Time Scenario for Operative Constraints



Central level

In the course of implementations of CBME through the GMER, the age-old Medical Council of India has been replaced by the National Medical Commission (NMC). All the stakeholders in our country are keenly watching to see the implementation of this radical metamorphosis of teaching–learning for the Indian medical graduates under NMC.

Local level

It was noted in last one decade that under the MCI, there has been a phenomenal growth of number of new medical institutes and increase of intake of existing medical college. Yet unfortunately to keep quality and sanctity of teaching–learning, the expected pace of recruiting increased number of medical teachers has been less than expected. Further, infrastructure and logistic issues also haunting even the managers of already established medical colleges which are not adequately updated to address CBME in letter and spirit. Moreover, experts in the field of medical education feel by heart that each medical institute should have vibrant, innovative, and truly functioning “Medical Education Unit” to implement all the nitty-gritty of the GMER in this initial teething phase. All these critical grassroots issues with disproportionate increase in MBBS student–teacher ratio, even in the existing medical institutes, will definitely affect execution of proposed changes in GMER. Last but not the least, there is need of revamping mindset that “Medical Graduates Are Not Born Teachers.” All the erudite medical postgraduates need to go through dedicated capacity building as medical teachers to increase their ability and willingness to impart their own knowledge is a systems approach in this much-awaited change of course and curriculum to nurture competent Indian Medical Graduates as per GMER.

 What is to Be Done!



We should think of a system-based teaching–learning in evidence-based medicine with participatory contribution from the learners regarding their need to learn in the non-threatening environments. Further, a systems approach should be introduced for collection of feedback after each session for each teacher, which is extremely important to improve the quality of teaching–learning environment. Moreover, we need to shift our telescopic focus of “physical health” algorithm including diet and exercise to reach the horizon of holistic health including health-care issues from occupation and environment in broadest sense. Thus, we are in search of a blueprint of “ first contact physician” competent to serve at the primary-care level with increment in attitude, ethics, and communications along with necessary skills.

Teacher should not be a “sage on the dais preaching from a distance” – instead should be the “facilitator of learning” and “promoter of inner fire of craving for knowledge,” staying consistently at the site of learning. This is only possible if the medical teachers also become erudite life-long learners with compassionate and empathetic personality instead of being expert in their own specialties and subspecialties in “tribal” mindset. These changes in the concept of teaching–learning can only ensure and infuse philosophy of life-long learner of medical doctor.

References

1Medical Council of India: Competency Based under Graduate Curriculum; 2019. [online] [cited 2019 Aug 23]. Retrieved from: https://www.mciindia.org/CMS/information-desk/for-colleges/ug-curriculum.