Medical Education in India – Understanding and LearningDr Kunal Patel 23 Jan 2020
During the last 30 years, the number of medical schools in India has increased dramatically, doubling in size to over 400 schools or colleges that deliver medical education. This is a significant increase, considering the number of schools during the time of independence, which was 23.
With a rising population, it is seen as a positive that the number of medical schools has increased, therefore increasing the number of health workers needed to serve a very large population. However, as with many other nations, the distribution of these schools is not even. For example, in Bihar you will see less than 2 colleges for a population of 11.5 million in that state, whereas Pondicherry with a population of less than a million has 8. The training outputs are clearly not meeting the needs and ultimately not providing the recommended number of trained health workers per 1000 of the population.
Image from: Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet. 2010 Dec 4;376(9756):1923-58.
Due to the incredible scale at which medical education must match the needs of the population in the likes of India, the accrediting bodies, namely the Medical Council of India and the NAAC are struggling to maintain standards across all schools and colleges. Curriculum standards are varied but this includes addressing the massive shortage of trainers and academics, with data suggesting a shortage of 30-40%. This has resulted in inadequate faculty development, training and research outputs and therefore a call for novel ways to address the issues the medical education system in India faces.
A focus on factors such as improved curriculum, balancing the distribution of training sites and students to population needs and improved assessment methods are being called for. India is not alone in wanting improvements in medical education and many countries across the world, including the likes of the US and those in Europe, require similar things. What North America and Europe do not have are the massive health and social needs the general population of India has, making the need to improve medical education in India a major priority.
A change in accreditation standards, curricula, training and assessment and many more key themes are visible in the literature from all continents. However, what we are now starting to see emerge are themes that include interprofessional education, collaboration, technology-enhanced learning and more. Efforts are being made. For example, a recent consultation to appraise issues in locally built environments affecting public health, using an interprofessional and intersectoral approach, was recently published in the Journal of Interprofessional Care. This demonstrated that the engagement of interprofessional stakeholders can facilitate knowledge-driven development for promoting health equity. Bihar, as mentioned before does have a large mismatch of health workers to the needs of the state. Yet, it was work recently done here that showed state-supported, short, blended learning approaches helped to train midwives in remote locations. Another example includes a very recent, pilot survey of members of the Indian Association of Palliative Care showed substantial interest in technology-enhanced learning around palliative care.
These examples show there is a growing call and need to address health training in India. Evidence is emerging that innovation and collaboration can help address training and policy. However, considering the sheer scale of India’s health needs these approaches must be adopted at a state and national level rapidly, meeting the call from educators and students alike, that the medical education system is in need of urgent reform.