Making of a Medical Doctor

When we think of a doctor, an image of a noble, compassionate, empathetic, experienced, and expert person flashes in our minds. The making of a doctor continues well beyond their training of 5 1/2 years. The most important attribute of a physician is endurance, years of experience backed by a thorough knowledge and understanding of human beings. It is also noteworthy that 80% of the healthcare problems can be solved by just 20 % of simple innovative and affordable measures like basic needs, education, immunization, sanitation, and healthy lifestyle. For the remaining 20 % of critical and difficult health issues, the government needs to invest in building facilities that require 80% more investment in terms of sophisticated equipment, and skilled human resources than that required for Health & Wellness Centers (Aarogya Mandir).

Entry into a medical school

This is the most crucial step for becoming a good doctor. A typical candidate is expected to have completed 12 years of school education, and entry is through a competitive examination of elimination. Earlier, based on merit drawn from the board examination results, it has now taken the form of a special procedure focusing more on testing cognitive brilliance than on aptitude and skills required for a healer in the true sense. In that race for a medical college position, secondary education has taken a back seat, even compromising the making of a good human being.

Challenges in India

• Compared to other countries, our medical education was inspired by the UK system of medicine, in which one can enter medical school immediately after 10+2. In USA and Canada, it is after an Undergraduate degree. One may enter medical school in USA/Canada after completing at least 3 years of UG degree. The Medical College Admission Test (MCAT) is based on Biological, Physical, and Chemical sciences as applied to the study of medicine.
• It is a very well-known fact that "Examinations Drives Learning". The entrance exam for medical schools is high-stakes and highly competitive in nature, held once a year. In 2024, nearly 22 lakh candidates appeared against competition for about 1.2 lakhs of MBBS seats.
• The examination, while based on the syllabus taught in classes 11th and 12th, consists of questions from Physics, Chemistry, and Biology, constructed on assumptions that it can discriminate eligible candidates. However, it does discriminate for their academic brilliance in these subjects but fails to test the aptitude required for a medical professional. It fails to test endurance (except learning power), empathy, and psychological and community issues in society. It may be argued that students will master these skills during MBBS.
• Unlike IIT where the above subjects remain relevant even during professional courses, Physics, Chemistry, and Botany have very small contributions to the study of healthcare (MBBS, BDS, AYUSH, Nursing)
• The MBBS in itself is not an end course but a starting into the journey towards providing better healthcare, often linked to some degree of specialization. The majority prefer to go for PG. This creates another challenge for a medical student to continue to master subjects at a cognitive level and with less emphasis on practical skills.

Solutions

• The subjects should be Physics, Chemistry, biology, and psychological science as relevant to the study of medicine and must include questions assessing their aptitude for a medical profession.
• The standard of questions should be of 10+2 class but must be prepared in coordination with a medical body (NMC, NBME, AYUSH and NITI Ayog).
• The Multiple Choice Questions should be prepared using psychometric analysis principles and in multiple sets, ensuring equivalence in terms of difficulty level. They should be high in analytical skill's assessment.
• The exam should be Computer Assisted Testing (CAT) conducted two times per year and spread over multiple slots. This will ensure students get an opportunity to improve their scores.
• If, at all, it is decided to conduct Preliminary and Advanced Exams, the latter exam should be only used to enter into institutes of national importance. The prelims score will be valid for any medical college in the country.
• The students should be encouraged to enter into a UG science course of their choice after 10+2 if they fail to get admission into a medical school. If they leave the courses midway, they may be awarded a certificate, diploma, degree, or degree with honors as they leave after 1, 2, 3, and 4 years respectively. This will align with the implementation of National Education Policy 2020. This will also ensure continued learning and a more mature outlook if they are still interested in the medical profession.
• Our higher secondary education should encourage curiosity development through Problem-Based Learning (PBL).
• If anyone thinks that this will further lengthen the process of becoming a Good Doctor are mistaken as this noblest of professions is based on the precept of endurance and empathy. Anyone thinking of a shortcut should NOT venture into this profession. They have multiple other choices.
• Efforts by the National Medical Commission may be made to draw a similar path for NeXT and align it with PG education.

Final Words

The medical profession is very coveted and noble that hinges on providing the best of healthcare optimally utilizing the existing healthcare infrastructure. Turning a raw science student into an empathetic physician is the biggest responsibility of our society and school education, entrance exams, medical school training, and lifelong continuing professional development are all part of a chain needed for our healthier society. Any weak link, makes this chain susceptible to falter, making our society less productive.

Changing the system is difficult and time-consuming, but smaller changes will give higher dividends in the long run.

Making the base stronger through better quality education from primary to secondary will be an added complement to Higher Education too. But as I said earlier, this requires a systematic change and may take a long time unless NEP2020 is implemented with the full-throttle efforts of all stakeholders.