“To study the phenomenon of disease without books is to sail an uncharted sea, While to study books without patients is not to go to sea at all” - a quote coined by Sir William Osler in 1901 which highlights the balanced approach of combining both fundamental theoretical knowledge and “bedside” learning in medical education. It is undeniable that proficiency in clinical subjects can only be achieved by observing the management of live patients and hands-on experience. As such, the medical education curriculum has, for ages, been designed in a manner to incorporate clinical exposure during the training course, now further enhanced in the Competency-Based Medical Education curriculum by “early clinical exposure,” “vertical and horizontal integration,” and so on. While the vision and aim of medical education remains perfectly well-defined even today, the over-dilution of the medical education system is only starkly palpable. Driven by the pressure of the State to achieve the desired target of “numbers,” the country has recently been witnessing a surge in medical teaching institutions, mushrooming everywhere, extending up to the remote peripheries. A brilliant advancement, no doubt, but perhaps, only in terms of brick and concrete! The loopholes in this unprecedented proliferation of the so-called “medical colleges” are now only too obvious: from infrastructure-student mismatch, poor spectrum of clinical material, teacher-student mismatch, to prioritization of documentation over bedside patient engagement. Of all the shortcomings, perhaps the major breach in the medical education system has been the insufficient emphasis on having a reasonable number and heterogeneity of clinical material for learning. Though the medical colleges coming up in the public sector do not have a dearth of patient numbers, not all of these budding institutes cater to the complex cases, which are referred to the premier, long-established, teaching medical centers of excellence, restricting the exposure of their own in-house students to only basic ailments of clinical medicine. On the other hand, the picture in commercial teaching institutes is such that there is upfront selective admission of patients due to financial implications, and even those hospitalized are not always available for teaching purposes. The temples of medical learning have always been those apparently unpolished, crowded, unpretentious, modest, and rustic campuses of the age-old medical teaching institutes of our country. Through their sheer heterogeneous diversity of clinical material, these schools have served to sharpen the clinical acumen, abstract thinking, analytical power, and clinical proficiency of medical students for decades. Indeed, genuine “competency” can only be acquired through on-site observation of patient interactions and real-time troubleshooting, rather than through scripted, fragmented simulation scenarios and verbal discussions of cases in closed classrooms. While the latter modality of teaching-learning is also desirable, it cannot override or replace the paucity of live clinical material. The situation becomes even more appalling during Professional Examinations. Being a Herculean exercise to arrange for a reasonable number of live patients with varied symptomatology and demonstrable clinical findings for the evaluation of the high volume of students, these under-resourced, emerging institutes invariably fall short to fulfill the requirements. Thus, it is extremely unfortunate that the evaluation of students is done on pseudo “Long Cases” lacking the elements required for “competency assessment,” the latter eventually becoming a mere theoretical assessment regarding a diagnosis in a “ghost patient.” The fault is neither of the student, nor the teacher, nor the teaching institute. It seems a systematic failure across various levels, and probably signals that it is time for reflection in to the question of whether we are “growing competent healers” or “manufacturing a voluminous generation with medical degrees obtained through factories of contrived medical education”? Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Kirtisudha Mishra (Wed,) studied this question.