Medicine, medical writing, and India.

Abstract

Byline: M. Jacob, K. Jacob Medical education is prized in India. The competition to gain entry into government medical colleges is fierce, while admission to most private medical schools costs a fortune. It is also well known that there is a marked variability in the standards and settings of medical education across the country. Nevertheless, training in evaluating scientific literature and in medical writing is poor across medical schools, often nonexistent. Even the best medical colleges neither train their undergraduate and postgraduate students in scientific and medical writing nor do they empower their faculty to discuss and debate local and relevant issues in medical literature. Despite publications from the country in some of the best National and International Journals, the general quality of medical writing from India is poor. The paucity of role models, the absence of a strong academic environment, minimal publication requirements for promotions of academics, and a dearth of formal training in medical writing all contribute to low standards of medical writing in India. Nevertheless, islands of academic excellence do exists; however, these are often driven by specific individuals, who seem to create a learning and academic environment around themselves; they engage with local issues, break out of their disciplinary straight-jackets, and challenge existing paradigms. On the other hand, medical schools do not emphasize the importance of the need to study locally relevant issues, document regional conditions, varied contexts, unusual comorbidity, differing outcomes, the need for distinctive treatment strategies, and to communicate complex issues. They also do not empower young physicians, during medical training, to question conventional wisdom and to view issues from a perspective that is different. The majority of academic publications from India replicate Western findings and doctrines; these are often produced only to meet the extremely low standards required for academic promotions in the country. Attempting to attain mastery in written communication, to think differently, and to highlight distinct patterns is rare, even in the best medical institutions. Much blame for the failure to empower young physicians lies with senior faculty, who preside over impoverished academic environments. They perpetuate cycles of mediocrity and often destroy bright young careers with their failure to facilitate and promote growth among younger colleagues. The Indian cultural emphasis on rote learning encourages parroting of medical trivia rather than stimulating critical thought, thereby stifling creativity and innovation. It inculcates bad attitudes even among those with reasonable intellectual and language skills. Even the few who take up the challenge of serious academic pursuits often fail due to the lack of support from colleagues, mediocrity of scholastic milieu, low academic standards, minimal requirements for academic advancement, and the absence of a critical mass of proficient teachers and role models. The lack of such exemplars in Indian academia mandates the need for more Ekalavyas,[sup][1] who are able to build ideal role models in their imagination and follow them. Ideas and Confirmation John Snow, considered the father of epidemiology, is recognized for his contribution to the identification of the spread of cholera in London. The story of the “death map” and the “broad street pump” is history. However, these also beg the question “who was the real John Snow?” Was he the one convinced that cholera spread through water after he drew the map of the residents of Soho, who were infected with cholera? Alternatively, did he suspect that cholera was a water-borne disease even before the Broad Street episode? Evidence suggests the latter, arguing that many ideas are gained through experience and reasoning;[sup][2],[3] however, they require formal confirmation using appropriate study designs and analyses. …