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Table of Contents
LETTER TO THE EDITOR
Year : 2022  |  Volume : 13  |  Issue : 1  |  Page : 71-72

Arguing for a case of bedside medical education


Department of Medicine, KG's Medical University, Lucknow, Uttar Pradesh, India

Date of Submission31-Oct-2021
Date of Decision05-Nov-2021
Date of Acceptance05-Nov-2021
Date of Web Publication03-Feb-2022

Correspondence Address:
Harish Gupta
Department of Medicine, KG's Medical University, Lucknow - 226 003, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/injms.injms_128_21

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How to cite this article:
Gupta H. Arguing for a case of bedside medical education. Indian J Med Spec 2022;13:71-2

How to cite this URL:
Gupta H. Arguing for a case of bedside medical education. Indian J Med Spec [serial online] 2022 [cited 2022 Oct 2];13:71-2. Available from: http://www.ijms.in/text.asp?2022/13/1/71/337179



“The direction in which education starts a man will determine his future life.” Plato (429-347 B. C. E.), Athenian philosopher

Dear Editor,

Dengri et al. underscore quizzing as a tool for medical education and present it as a student-centric model to develop leadership skills in their letter published on October 26, 2021, in the Journal.[1] While providing an opportunity to challenge students' minds to stimulate them to discover answers of posers is an interesting exercise for both the teacher, in their Avatar as a quiz master, and the student; I propose that there are other modalities which are as well provoking and arouse curiosity as this one and need equal, if not more, emphasis. While consideration for the method is weighed in during summative examinations in the form of multiple-choice questions (MCQs), what I also observe is that when undue weightage is given to the modality, some unforeseen phenomena begin to happen. While for an average student, course material is what is asked to cross a threshold of passing out an outgoing test, what we call a professional examination; we need to bear in mind that no method is perfect to conduct and all the methodology has its own pros and cons.

Having realized the unique feature of medicine, all the developed countries have some form of interview/clinical skill demonstration/practical examination/clinical examination when they finally assess a student before permitting/licensing them to practice. The General Medical Council in the UK has an arrangement for objective structured clinical examination in PLAB Part 2.[2] In the American system, nowadays a debate is raging regarding the best way to conduct the US Medical Licensing Exam and the importance given to its step 1 therein as well as its scoring system.[3],[4] What the ongoing debate indicates is that we have a capacity for improvement and the best solutions need to be designed considering local circumstances, disease pattern, and social realities while maintaining minimum standards of training.

In our country for Civil Services Examinations, there is a provision of the interview before recruitment.[5] When candidates appear at the Combined Medical Services Examination conducted by the statutory body, they face an interview after clearing a theory examination. Nevertheless, conducting interview and practical examinations during training fairly is a challenge, which sometimes may be emotionally taxing and overwhelming for both examiner and examinee due to various reasons-some legitimate ones and others not so. Nowadays when new medical colleges are opened at a breakneck speed all around, these institutions have a challenge of faculty shortage and conducting interview or teaching practical skills to beginners has its unique posers and logistical challenges due to limited availability of highly-skilled human resources.

Conducting on -camera interview and preserving its recording for certain duration is a newly begun practice which may induce fairness to some degree and assure prospective candidates about existence of a minimum benchmark in our assessment for certain positions.

Nevertheless, medical education is undergoing a sea change in our times when a new regulatory body-the National Medical Commission-has arrived on the horizon. Although nitty-gritty of the way it will conduct its passing out examination-the NExT-remains poorly understood as of today, what we discover on the official website is that an examination will be conducted at the end of the students' training which will entitle them to choose a seat for higher learning as well besides qualifying to get their basic degree.[6] Therein it states that there will be 2 steps (1 and 2) of the examination. What is intriguing is that till now I don't know if practical/clinical/structural clinical examination/interview (or some form of combination) is a part of the examination or not.

If it is a part, what is its syllabus, should be conveyed to students. What steps have been taken to ensure transparency/fairness for the same, what for eliminating our subconscious bias, and not the least, what for assessing clinical skills has been incorporated, should be disclosed so that we too may start a debate to improve as has been happening in Western counterparts and elsewhere. As in contemporary MCQ-based tests, clinical skills are not assessed in NEET (PG) examinations, many a times we encounter students who lack command over basic skills which results in suboptimal care of patients at certain points.

What arrangements have been made to work up a case in low-resource setting versus hospitals in Metropolitan cities, what for differences in assessment when one wants to serve in a primary care center versus tertiary care; I have a desire to know. Many a times, these nuances decide the future course of action for an individual patient. Ongoing novel Coronavirus pandemic taught us that a large proportion of patients can be managed at primary care centers and neither everyone needs to learn intensive details of every complication nor its management as that is needed by only the few. If any knowledge remains with us, is that we need a large number of astute clinicians at our peripheries monitoring just basic parameters and if available, we can offload our cities with its healthcare infrastructure to a great degree by adopting this decentralized approach. This examination should reflect this planned grand design of our shared future, and there is a need to discuss and debate it at a wider platform. Quizzing students is just the beginning of a long journey; we aspire to discover a new world to make it a better place to live in.

Financial support and sponsorship

None.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Dengri C, Chopra J, Dengri C, Khan AM. Quizzing as a tool for medical education: A student centric model to develop leadership skills. Indian J Med Spec 2021 ;12:248. Available from: http://www.ijms.in/text.asp?2021/12/4/248/329301 [Last accessed on 2021 Dec 03].  Back to cited text no. 1
    
2.
General Medical Council. Guide to the PLAB Test. Available from: https://www.gmc-uk.org/registration-and-licensing/join-the-register/plab/a-guide-to-the-plab-test. [Last accessed on 2021 Dec 03].  Back to cited text no. 2
    
3.
McConville JF, Woodruff JN. A Shared Evaluation Platform for Medical Training. N Engl J Med 2021;384:491-3.  Back to cited text no. 3
    
4.
Hamnvik OP. Scoring the USMLE-where to next? N Engl J Med 2019. Available from: https://knowledgeplus.nejm.org/blog/scoring-the-usmle-where-to-next/. [Last accessed on 2021 Dec 03].  Back to cited text no. 4
    
5.
Union Public Service Commission. Functions. Available from: https://www.upsc.gov.in/about-us/functions. [Last accessed on 2021 Dec 03].  Back to cited text no. 5
    
6.
PIB. Ministry of Health and Family Welfare. Union Health Minister, Shri Mansukh Mandaviya Chairs a Review Meeting with NMC; July 30, 2021. Available from: https://pib.gov.in/PressReleasePage.aspx?PRID=1740678. [Last accessed on 2021 Dec 03].  Back to cited text no. 6
    




 

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