LETTER TO THE EDITOR
Fast-Track Medical Course and its Implications
To the Editors, Anatomical Sciences Education Recently, the New England Journal of Medicine published a point-counterpoint on the shortening of the medical curriculum in the United States of America (Abramson et al., 2013; Goldfarb and Morrison, 2013). There was a well-nuanced debate as to whether a shortening of the medical curriculum would be a step to enhance the number of general practitioners entering the health care system that is facing a shortage of physicians or is it hampering the quality of medical graduates (Abramson et al., 2013; Goldfarb and Morrison, 2013). The side for the curtailment of the course argued that this would not only reduce the debt-burden on the student but also increase the number of productive years as a physician in practice, since the average age of entry into medical school in the United States is 24 years and they join the workforce in their 30s (Abramson et al., 2013). Whereas, the side against such a move cited the failure of such an attempt in the 1970s and how with expanding medical knowledge the physician, as the leader of the medical team, should be better equipped, not only with pre-clinical and clinical knowledge, but also with areas such as ethics, medical technology, and research methodologies (Goldfarb and Morrison, 2013). I feel that these trends would also affect the medical education system in India, where following the international trends the pre-clinical course, including anatomy, was drastically reduced from 18 months to 12 months (Jacob, 2013). The three-year medical curriculum in the United States, which would produce physicians on a fast-track mode, would be attractive to Indian policy makers due to the acute shortage of doctors in the public health system, in order to achieve Universal Health Coverage by 2022 (Singh, 2013). But there are a few differences that should be factored in. In India, a student usually enters medical school after secondary school, usually at the age of 18 years (Diwan et al., 2013). They undertake a graduate course in medicine and surgery after which they re-appear in an entrance examination to join a post-graduate course of three years in the specialty of their choice. Hence, the Indian medical graduate can join the workforce either at the age of 23 years (average) as a graduate or 26 years as a post-graduate, if all goes well and in time (Supe and Burdick, 2006). But a large number of
these students prefer to work in urban areas instead of rural ones, where there is actually a crunch of trained medical practitioners (Subba et al., 2012). In addition, there is a skewed distribution of specialists in the various states, some having more than others (Ananthakrishnan et al., 2012). The only word of caution that we can sound here is that the policy makers of medical education in India weigh the options according to the needs of the country while tailoring the system. It should not follow international trends just to keep up with the Jones’. It would always be better to have well-trained physicians capable of independent decision making and taking on leadership roles (Goldfarb and Morrison, 2013) rather than improved figures in national statistics.
Tony George Jacob, M.D., Ph.D.* Department of Anatomy All India Institute of Medical Sciences New Delhi, India
LITERATURE CITED Abramson SB, Jacob D, Rosenfeld M, Buckvar-Keltz L, Harnik V, Francois F, Rivera R, Hopkins MA, Triola M, Grossman RI. 2013. A 3-year M.D.—Accelerating careers, diminishing debt. N Engl J Med 369:1085–1087. Ananthakrishnan N, Arora NK, Chandy G, Gitanjali B, Sood R, Supe A, Nagarajan S. 2012. Is there need for a transformational change to overcome the current problems with postgraduate medical education in India? Natl Med J India 25:101–108. Diwan V, Minj C, Chhari N, De Costa A. 2013. Indian medical students in public and private sector medical schools: Are motivations and career aspirations different? —Studies from Madhya Pradesh, India. BMC Med Educ 13: 127. Goldfarb S, Morrison G. 2013. The 3-year medical school—Change or shortchange? N Engl J Med 369:1087–1089. Jacob TG. 2013. History of teaching anatomy in India: From ancient to modern times. Anat Sci Educ 6:351–358. Singh Z. 2013. Universal health coverage for India by 2022: A utopia or reality? Ind J Community Med 38:70–73. Subba SH, Binu VS, Kotian MS, Joseph N, Mahamood AB, Dixit N, George A, Kumar P, Acharya S, Reddy P. 2012. Future specialization interests among medical students in southern India. Natl Med J India 25:226–229. Supe A, Burdick WP. 2006. Challenges and issues in medical education in India. Acad Med 81:1076–1080.
*Correspondence to: Dr. Tony George Jacob, Department of Anatomy, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, India. E-mail: [email protected]
Received 26 November 2013; Accepted 16 December 2013 Published online 8 January 2014 in Wiley Online Library (wileyonline library.com). DOI 10.1002/ase.1433 C 2014 American Association of Anatomists V
Anatomical Sciences Education
JULY/AUGUST 2014
Anat Sci Educ 7:329 (2014)
Fast-Track Medical Course and its Implications
To the Editors, Anatomical Sciences Education Recently, the New England Journal of Medicine published a point-counterpoint on the shortening of the medical curriculum in the United States of America (Abramson et al., 2013; Goldfarb and Morrison, 2013). There was a well-nuanced debate as to whether a shortening of the medical curriculum would be a step to enhance the number of general practitioners entering the health care system that is facing a shortage of physicians or is it hampering the quality of medical graduates (Abramson et al., 2013; Goldfarb and Morrison, 2013). The side for the curtailment of the course argued that this would not only reduce the debt-burden on the student but also increase the number of productive years as a physician in practice, since the average age of entry into medical school in the United States is 24 years and they join the workforce in their 30s (Abramson et al., 2013). Whereas, the side against such a move cited the failure of such an attempt in the 1970s and how with expanding medical knowledge the physician, as the leader of the medical team, should be better equipped, not only with pre-clinical and clinical knowledge, but also with areas such as ethics, medical technology, and research methodologies (Goldfarb and Morrison, 2013). I feel that these trends would also affect the medical education system in India, where following the international trends the pre-clinical course, including anatomy, was drastically reduced from 18 months to 12 months (Jacob, 2013). The three-year medical curriculum in the United States, which would produce physicians on a fast-track mode, would be attractive to Indian policy makers due to the acute shortage of doctors in the public health system, in order to achieve Universal Health Coverage by 2022 (Singh, 2013). But there are a few differences that should be factored in. In India, a student usually enters medical school after secondary school, usually at the age of 18 years (Diwan et al., 2013). They undertake a graduate course in medicine and surgery after which they re-appear in an entrance examination to join a post-graduate course of three years in the specialty of their choice. Hence, the Indian medical graduate can join the workforce either at the age of 23 years (average) as a graduate or 26 years as a post-graduate, if all goes well and in time (Supe and Burdick, 2006). But a large number of
these students prefer to work in urban areas instead of rural ones, where there is actually a crunch of trained medical practitioners (Subba et al., 2012). In addition, there is a skewed distribution of specialists in the various states, some having more than others (Ananthakrishnan et al., 2012). The only word of caution that we can sound here is that the policy makers of medical education in India weigh the options according to the needs of the country while tailoring the system. It should not follow international trends just to keep up with the Jones’. It would always be better to have well-trained physicians capable of independent decision making and taking on leadership roles (Goldfarb and Morrison, 2013) rather than improved figures in national statistics.
Tony George Jacob, M.D., Ph.D.* Department of Anatomy All India Institute of Medical Sciences New Delhi, India
LITERATURE CITED Abramson SB, Jacob D, Rosenfeld M, Buckvar-Keltz L, Harnik V, Francois F, Rivera R, Hopkins MA, Triola M, Grossman RI. 2013. A 3-year M.D.—Accelerating careers, diminishing debt. N Engl J Med 369:1085–1087. Ananthakrishnan N, Arora NK, Chandy G, Gitanjali B, Sood R, Supe A, Nagarajan S. 2012. Is there need for a transformational change to overcome the current problems with postgraduate medical education in India? Natl Med J India 25:101–108. Diwan V, Minj C, Chhari N, De Costa A. 2013. Indian medical students in public and private sector medical schools: Are motivations and career aspirations different? —Studies from Madhya Pradesh, India. BMC Med Educ 13: 127. Goldfarb S, Morrison G. 2013. The 3-year medical school—Change or shortchange? N Engl J Med 369:1087–1089. Jacob TG. 2013. History of teaching anatomy in India: From ancient to modern times. Anat Sci Educ 6:351–358. Singh Z. 2013. Universal health coverage for India by 2022: A utopia or reality? Ind J Community Med 38:70–73. Subba SH, Binu VS, Kotian MS, Joseph N, Mahamood AB, Dixit N, George A, Kumar P, Acharya S, Reddy P. 2012. Future specialization interests among medical students in southern India. Natl Med J India 25:226–229. Supe A, Burdick WP. 2006. Challenges and issues in medical education in India. Acad Med 81:1076–1080.
*Correspondence to: Dr. Tony George Jacob, Department of Anatomy, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, India. E-mail: [email protected]
Received 26 November 2013; Accepted 16 December 2013 Published online 8 January 2014 in Wiley Online Library (wileyonline library.com). DOI 10.1002/ase.1433 C 2014 American Association of Anatomists V
Anatomical Sciences Education
JULY/AUGUST 2014
Anat Sci Educ 7:329 (2014)
