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Year : 2020  |  Volume : 69  |  Issue : 4  |  Page : 193-195

Implementation of competency based medical education in anatomy with poor teacher-student ratio: The utopia

1 Adjunct Visiting Faculty, Department of Anatomy, KMC, Mangalore, MAHE, Manipal, Karnataka, India
2 Hon. Professor of Anatomy, Faculty of Integrated Medicine (AYUSH), Dayalbagh Educational Institution, Deemed University, Dayalbagh, Agra, Uttar Pradesh, India

Date of Submission09-Nov-2020
Date of Acceptance10-Nov-2020
Date of Web Publication29-Dec-2020

Correspondence Address:
Prof. Vishram Singh
OC-5/103, 1st Floor, Orange County Society, Ahinsa Khand-I, Indirapuram, Ghaziabad, Uttar Pradesh - 201 014
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JASI.JASI_246_20

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How to cite this article:
Singh V, Sahai A. Implementation of competency based medical education in anatomy with poor teacher-student ratio: The utopia. J Anat Soc India 2020;69:193-5

How to cite this URL:
Singh V, Sahai A. Implementation of competency based medical education in anatomy with poor teacher-student ratio: The utopia. J Anat Soc India [serial online] 2020 [cited 2023 Mar 29];69:193-5. Available from: https://www.jasi.org.in/text.asp?2020/69/4/193/305375

In recent times, there has been a paradigm shift in medical education due to the implementation of competency-based medical education (CBME) as part of the Government's Regulations on Graduate Medical Education.[1] These regulations envisaged that the Indian Medical Graduate (IMG) should develop competencies required to fulfill the patient's basic medical needs in society, i.e., they should possess the requisite knowledge, skills, attitudes, values, and responsiveness, so that he or she be able to solve basic medical problems in the community with skill and efficiency as physicians of the first contact. Simultaneously, he or she should be globally relevant.[2]

In addition to the first contact physician, he or she should also be a leader of the healthcare team, a good communicator, lifelong learner, and committed to the profession.[3]

The competencies were prepared accordingly, and the medical institutions all over India were asked to incorporate the same in their curriculum. This is a welcome step of the Medical Council of India (MCI)/National Medical Commission (NMC) and needs an appreciation. From these set objectives and goals we can draw that on passing out, a medical graduate should be a combo of (i) physician of the first contact, (ii) ability to solve basic medical problems, (iii) globally relevant, and (iv) have leadership capabilities of the healthcare team. For sure, all this sounds very rosy but needs a strong foundation of basic medical practice besides many other skills.

As we all know that anatomy is the backbone of medicine and provides anatomical basis of clinical practice.[4] Therefore, to produce competent IMGs it should be taught thoroughly with a blend of clinical application. Facts which are not clinically relevant for medical graduate should not be taught as a passing reference only because relevance of such anatomical facts comes later when a doctor specializes or super specializes and if he/she go for advanced training in India and abroad. The ideal way to teach anatomy is as under:

  1. Teaching and discussion in small groups of not >20 students per teacher in demonstrations, seminars, group discussions, and not >5 or 6 per teacher in dissection, laboratory work, etc., for quick and clear understanding along with fair and free interaction between students and teacher and among students of that group. Since the knowledge and skills developed are to be applied on people in real time, very promptly and accurately in emergency management, hence shortcuts to small group teaching should be avoided
  2. Introduce the topic with a story and tell them about desired outcomes
  3. Students should conduct thorough dissection of cadavers by themselves under the supervision of a teacher
  4. Surface marking (living anatomy) should be taught thoroughly. In clinical practice this forms the anatomical basis of likely hood of the structures involved at the site of patient's complaints/trauma, etc
  5. Expose the students to the patients from time to time so that they can have real-life experience
  6. Frequent and short assessments of desired outcomes throughout the course of study. To achieve this percentage of marks allotted to the patient should be 50% or more
  7. Teaching staff should also have some clinical experience.

Keeping the above facts in mind the subject of anatomy was allotted maximum teaching hours as compared to physiology and biochemistry.

All this is possible only if there is a proper teacher-student ratio.

For undergraduate medical education, initially, the MCI maintained the teacher-student ratio of 1:10 up to 2009[5] though the Mudaliar Committee (1959) had recommended a teacher-student ratio of 1:5.[6] The MCI maintained teacher-student ratio of 1:10 even when there was a shortage of qualified medical teachers by allowing the appointment of nonmedical teachers with MSc., PhD, and DSc. qualification.[7]

Thereafter, the MCI gradually reduced the ratio step by step to 1:15 in 2019,[8] 1:20 in 2010[9] to present low of 1:25 in 2015[10] which has adversely affected the anatomy teaching.

As recommended by Mudaliar Committee as early as 1959 and subsequent committees later the MCI had increased the PG seats in almost all the medical colleges across the country. As a result 2013 onwards more and more medical PGs became available for faculty positions, thus there was silver lining to ease out the teacher-student ratio. However, suddenly in 2015 as a bruit-shock to the medical fraternity, the MCI took a quick “U-turn” and reduced the teachers-students ratio. Since medical teaching has practical, skill oriented teaching modules, CBME has been implemented. The MCI/NMC should restore the teacher-student ratio to at least 1:10 if not 1:5 immediately. At present, besides MD in anatomy, Diplomate of National Board (DNB), Fellowship of National Board (FNB) in anatomy, postgraduate medical specialists with equivalent degrees, fellowships, etc., obtained from the USA, UK, Europe, and Australia are available and can be attracted to join medical institutions in India. Once we start getting the dividends the teacher-student ratio should be further reduced to 1:5 as per Mudaliar committee and to be globally competitive which is one of the aims and objectives of the health education in the country. Furthermore what already exists in AIIMS, most of the USA, UK, European, and Australian medical institutions, providing for adjunct faculty is another feasible and good option.[5] The adjunct faculty can be drawn from the retired teachers in anatomy and specialists of various disciplines in government and private setup who can give clinically relevant lectures on clinical anatomy. This will ease out the problem of teacher-student ratio not only in anatomy but in other subjects too.

So far the CBME has been experimented only in few medical institutions that too in postgraduation with a good result because teacher-student ratio is good in postgraduation, i.e., 1:1 to a maximum of 1:3 but to have a near similar teaching comfort for undergraduates (IMGs) a systemic planning and changes in the “UG regulations” and “Recommendations on appointment of teachers in the medical colleges,” as envisaged, is necessary and should be urgently taken.

  Conclusion Top

In our opinion, the following steps should be taken as early as possible to produce good IMGs.

  1. Teacher-student ratio should be increased to 1:5 as recommended by the Mudaliar committee.[6] If not as an emergency measure, it should be restored to 1:10 with immediate effect
  2. As per the existing rule book of MCI,[7] since the demonstrators or postgraduates are not recognized as teachers they should not be included while calculating the teacher-student ratio
  3. The present overlap of 2 months (August and September) needs to be addressed immediately. As the session should begin on t August, 1 of every year but last admissions are allowed up to September, 30 in accordance with the Hon'ble apex court. Therefore, practically the session starts from October 1st every year
  4. The anatomy faculty for MBBS students should not be used to take anatomy classes for other courses such as dental, paramedical (viz. Occupational Therapy (OT), Bachelor in Medical Laboratory Technology (BMLT), Bachelor of Medical Radio Diagnosis and Imaging Technology (BMRIT), etc.), and nursing students. For these courses, extra faculty should be appointed as per requirement of respective councils. This adversely affects the research work which is expected of them as per “Recommendations on appointment of teachers in the medical colleges”
  5. It is the sacrosanct for any government or management (private medical institution) to provide good quality infrastructure and research laboratory in the anatomy and other departments for quality, meaningful, and globally competitive research. In the existing scenario, the teachers are being forced to do research without proper research facilities. This is unnecessarily killing their time in producing false-positive results which are published in predatory journals. As a corollary, a large number of International Journals have come into existence abroad publishing research papers without peer review in shortest possible time after charging money. The selection committee members should be very careful about it
  6. Publication of research article should not be the only criteria for promotion. According to Sahai's Dogma[5] for teachers, to impart knowledge is at a higher pedestal than creation of knowledge. Therefore during the selection process for appointment and promotion, how much time did a person spent in teaching (prepared with a properly structured format duly certified by the institution) should be given more weightage than research publication. Similarly his/her depth of knowledge and the way it is expressed should be assessed
  7. A good teacher-student ratio will also be essential to start new postgraduate/super-specialty courses in anatomy such as clinical embryology and reproductive anatomy, imaging anatomy, musculoskeletal anatomy, hepatopancreaticobiliary anatomy, endocrine anatomy, ocular anatomy, neuroanatomy, pediatric anatomy, cardiovascular and pulmonary anatomy, etc., similar to advanced countries[6]
  8. Duration of first professional MBBS course should be restored to 18 months for countless reasons.

  References Top

Graduate Medical Education Regulations. Published in Part III, Section-4 of the Gazette of India, Dated 17 May, 1997 Amended up to 08 October, 2016; 1997.  Back to cited text no. 1
Frank JR, Mungroo R, Ahmad Y, Wang M, De Rossi S, Horsley T. Toward a definition of competency-based education in medicine: A systematic review of published definitions. Med Teach 2010;32:631-7.  Back to cited text no. 2
Mahajan R, Aruldhas BW, Sharma M, Badyal DK, Singh T. Professionalism and ethics: A proposed curriculum for undergraduates. Int J Appl Basic Res 2016;6:157-63.  Back to cited text no. 3
Standring S. Gray's Anatomy: The Anatomical Basis of Clinical Practice. 41st ed. Canada: Elsevier; 2016. [Last accessed on 2020 Oct 27].  Back to cited text no. 4
Sahai A. Medical education in India: Challenges, introspection and reforms-A revision. J Anat Soc India 2016;65:167-74.  Back to cited text no. 5
Mudaliar Committee. Professional education. In: Health Survey and Planning Committee Report. Vol. 1. Ch. 8.Ministry of Health and Family Welfare (MoHFW), Government of India: National Health Protocol; 1962. p. 303-7.  Back to cited text no. 6
Postgraduate Medical Education Regulations. Medical Council of India; 2000.  Back to cited text no. 7
Minimum Standard Requirements for the Medical College for 250 Admissions Annually Regulations, (Amended vide Gazette of India, Part III, section 4, Dated 15 July, 2009); 1999.  Back to cited text no. 8
Minimum Standard Requirement for the Medical College for 250 Admissions Annually Regulations. (Amended by Gazette of India, Part III, section 4, Dated 04 November, 2010); 1999.  Back to cited text no. 9
Minimum Standard Requirement for the Medical College for 250 Admissions Annually Regulations. (Amended by Gazette of India, Part III, Section 4, Dated July 2015); 1999.  Back to cited text no. 10

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