|Year : 2014 | Volume
| Issue : 6 | Page : 691-692
Disconnect between principles and practice of medical education technology
Department of Community Medicine, Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India
|Date of Web Publication||18-Nov-2014|
Department of Community Medicine, Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Banerjee A. Disconnect between principles and practice of medical education technology. Med J DY Patil Univ 2014;7:691-2
Medical education is at the crossroads.  The landscapes at the crossroads are also changing rapidly like the landscape of modern metros. These are driven by rapid social changes, developments in health care, and the greatest communication revolution since the invention of the printing press, that is, the emergence of the information highway driven by the internet. Guidelines developed by bodies such as Medical Council of India (MCI),  get outdated before they are implemented. The emphasis is on quantity not quality. How many teachers trained? How many workshops conducted? And so on.
Today students have the potential to learn faster and in more interesting ways than the teachers can teach. Teachers face increasing challenges as they face a more "wired" and more and more "wireless" generation of students who have access to technology that is evolving rapidly every day. 
To make matters more complex, there is a lot of disconnect between principle and practice. In principle, emphasis is put on small group teaching, whereas in practice the intake of students is increased to fill up the requirement of doctors in the country most of whom may migrate to other countries.  In principle, emphasis is given to learning by doing and problem-based learning. In practice due to overloaded curricula and outdated assessment methods, the medical student is driven to rote learning.  Integrated teaching is prescribed while in practice there is little collaboration between different departments and much rivalry.
In principle, various national committees since the time of independence have recommended the concept of the primary care physician as the basis of health care in India. In practice, curative medicine, interventionism, and specialization are strong cultural values in medical education in India, and postgraduate positions are entirely specialty oriented. Family medicine as a discipline is struggling to find its role while preventive and community medicine are considered 2 nd class specialties.  Milton Terris states, "I have yet to meet the teacher of preventive medicine in a medical school who is happy… I visited the famous medical school in New Delhi, India, and found posters all over the medical school building attacking community medicine in the most insulting terms."  In principle, the MCI lays great stress on community medicine in the undergraduate curriculum.
While the MCI also stipulates that there should be urban and rural field practice areas under the Department of Community Medicine in every medical college to enable community-based training, most medical colleges continue to have traditional, teacher-centered and hospital-based training of undergraduates.  Even the community medicine clinics are held in the hospital wards. Innovations in education techniques and experimentation are lacking in medical schools of Asian countries.
Globally, the trend is emerging in medical education towards an "evidence-based approach" to guide educational policies. As a consequence, medical education research, which has established its role in the developed countries, need to be promoted in developing countries. Problems and barriers are many in developing countries. Some of these are the lack of funds, a cultural mindset that favors the status quo, failure to publish the results of research, lack of academic and research leadership, and inadequate exposure to education research methodology. 
In Western countries, students are expected to challenge their professors, to enter into debates with them. In India, the advisor, aptly called the "guide," is an expert on all questions, and the student is expected to graciously accept his or her advice.  The Indian practice may be rooted in the culturally inherited "Guru-Shishya" tradition, which does not bode well for student-centered learning and restricts independent thinking by the student.
In the midst of this gloomy picture, there are rays of hope. The establishment of medical education units in medical colleges and basic workshops for medical teachers in recent years have generated interest in teaching methodologies and occasional research activities in medical education. 
To encourage this desirable development, the present issue of the journal contains two papers on medical education both of them focusing on student-centered research. , Buch et al.  have elicted the perspectives of medical students toward interactive teaching. They conclude from the study findings that a paradigm shift toward interactive sessions during lectures can make the lectures less monotonous and more interesting.
Gore et al.  explored the impact of short-term studentship projects sponsored by the Indian Council of Medical Research with a view to promote interest in research among medical undergraduates. Their findings stress that students if guided well by their mentors develop an aptitude for research and doing such projects facilitated understanding of the subject. A significant finding of their work is that the maximum number of projects taken up by the students was mostly community-based under guidance of the faculty from the Department of Community Medicine, a subject not very popular among the medical students as discussed few paragraphs earlier. Besides bringing some cheer to the unhappy teachers of preventive medicine, this suggests that to generate interest in this important discipline hands on training such as house to house visits and collecting and analyzing their own data leads to a better understanding compared to classroom lectures on statistics and epidemiology, which are abstract concepts mostly incomprehensible to students at the undergraduate level who are accustomed to hard facts such as taught in anatomy, physiology or the other para-clinical and clinical subjects.
To understand the complex issues confronting medical education technology in the era of the information highway, more such student-centered research should be encouraged. The medical students' perspective may hold the keys to the complexities of education psychology. We have much to learn from them as exemplified in the words of the Talmudic sage Rabbi Hanina, "I have learned much from my teachers, and even more from my colleagues, but most of all from my students."
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