Undergraduate Medical Curriculum In India Research Articles

Critical Thinking and Clinical Reasoning in Undergraduate Medical Course: A Mixed-Methods Study in a Medical College in Kolkata, West Bengal, India.

Critical thinking is considered as the essential set of skills for medical practice, particularly during emergencies. However, there is lack of conceptual clarity around it and it was not explicitly included in the undergraduate medical curriculum in India. The present study has been planned to assess the critical thinking disposition and clinical reasoning skills among medical undergraduate students in a medical college in West Bengal, India. The perceived definition and attributes of critical thinking in medical education will be explored and the contexts where application of critical thinking skills may be crucial for medical practice will be identified. The content validity index, test-retest agreement; internal consistency and construct validity of the Critical Thinking Disposition Assessment Questionnaire (CTDAQ) will be assessed through step-by-step procedure. CTDAQ and the case-based objective-type questions for the clinical reasoning skills will be applied to around 200 medical undergraduate students. Their perception and experience on critical thinking in medical education will be assessed with structured open-ended questions. In-depth interviews with medical teachers of the second and third phases of undergraduate medical curriculum will be conducted to assess their perception and experiences on critical thinking. The quantitative analysis will be conducted with MS excel and R software using the relevant packages. The qualitative data will be transcribed and translated in English, close to the participants' verbatim. The thematic analysis will be conducted with inductive coding and memoing. The study will be conducted maintaining ethical standards for epidemiological studies. The present study, one of the first a few studies in India, will help to meet the conceptual gap in understanding the attributes of critical thinking, its association with clinical reasoning and the contexts of preferred application in medical practice.

Challenges in the Teaching-Learning Process of the Newly Implemented Module on Bioethics in the Undergraduate Medical Curriculum in India.

The National Medical Commission of India introduced the Competency Based Curriculum in Medical Education for undergraduate medical students in 2019 with a new module named Attitude, Ethics and Communication (AETCOM) across the country. There was a consensus for teaching medical ethics in an integrated way, suggesting dedicated hours in each phase of undergraduate training. The AETCOM module was prepared and circulated as a guide to acquire necessary competency in attitudinal, ethical and communication domains. This study was aimed to explore the perceptions of students and medical teachers and identify the challenges in teaching and learning process of the newly implemented AETCOM module. It was a mixed method designed study with structured questionnaires for students and teachers at various medical schools in India. Based on the quantitative data, in-depth interviews with medical teachers were undertaken. Challenges were perceived by both students and teachers. The students had a mixed perception, facing difficulties in passive learning with scarce resource materials. Challenges identified by teachers were a lack of knowledge and skills required for teaching bioethics, the logistics of managing large numbers of students in the stipulated time frame, interdisciplinary integration—both horizontal and vertical, and assessment program in terms competency-based education. The study draws the attention of all stakeholders for a revision and efforts for further improvement in the teaching and assessment process, and setting a standard model in medical education in India.

History of medicine in the undergraduate medical curriculum in India.

History of medicine in the undergraduate medical curriculum in India.

Incorporating e-learning as a tool for medical education in India: Investigating student perspectives

Aim: The undergraduate medical curriculum in India as designed by the medical council of India (MCI) currently does not include E-learning as part of its program. Although, students seem to be quite comfortable with the use of computers and internet, their perception about e-learning per se needs to be addressed. Moreover, before introduction of specific technology opinion of the user must be investigated. Hence, this study was designed with an aim to find out the Indian students perspectives regarding the incorporation of E- learning into the medical curriculum. Materials and Methods: Undergraduate 1st and 2nd semester medical student volunteers were recruited for the study from 4 medical colleges from different regions of India after taking informed consent. Responses (based on a Likert scale of 1-5) were collected via a predesigned self-administered questionnaire. Positive attitudinal scores (PAS) were calculated using 7 variables. The results were analysed using SPSS. Results: A total of 775 responses were available for analysis. Median PAS was 24 indicating a positive attitude amongst students. 94.27% of students felt that E-learning should be incorporated into the curriculum. The most preferred mode of e-learning was videos (56.9%).With respect to internet usage, the majority of students (65%) opted for a web supplemented programme compared to fully online or web independent programmes. Conclusion: Overall Indian medical undergraduate students seem comfortable with computer use and most students perceive E-learning as a helpful tool in their learning process. Most are willing to have it incorporated into the curriculum; hence we propose that E-learning should be formally introduced into the curriculum as soon as possible. Keywords: E-learning, Undergraduate medical curriculum, Positive attitude.

Application of Case-Based Readiness Assurance Process as a Model for Case-Based Pedagogy and Collaborative Learning in Physiology.

The preclinical phase of the undergraduate medical curriculum has to embed clinically relevant learning experience to bridge basic sciences with clinical disciplines. Student-centric educational methods like the readiness assurance process of team-based learning promote active learning. In this study, we report our implementation of the case-based readiness assurance process (CBRAP) as a case-based strategy for introducing early clinical exposure in the preclinical phase of the undergraduate medical curriculum in India. Four CBRAPs with individual and group readiness assurance tests (IRAT and GRAT) were conducted in four different systems taught in physiology (hematology, muscle physiology, cardiovascular physiology, and renal physiology). The multiple-choice questions for CBRAP were specifically designed to test application and problem-solving by incorporating clinical vignettes with pathophysiology and lab findings. This study was designed to involve all 250 students from the first professional year. The GRAT scores were significantly more than mean IRAT scores in all four CBRAPs (p value < 0.001). The GRAT scores in the second, third, and fourth CBRAPs were significantly better than the GRAT score of the first CBRAP (p value < 0.001). The GRAT scores correlated significantly with mean IRAT in three out of four CBRAPs and with the highest IRAT in two out of four CBRAPs. Based on the student feedback of CBRAP and other case-based strategies, it was found that students preferred CBRAP and the majority of students reported that discussion of CBRAP questions with team members was useful. In conclusion, innovative case-based teaching methods with active student involvement can be incorporated in the preclinical curriculum for improving learning outcomes.

Introduction and evaluation of a creative pedagogical tool in pharmacology: Autobiography of drugs

Background: Pharmacology teaching in undergraduate medical curriculum in India is primarily drug centered and stresses on imparting more of factual information. Teaching and learning skills would be better developed by incorporation of active learning during large group and small group sessions. Aim and Objectives: The current study reports the perceptions of introducing a learner centric activity, autobiography of drugs in pharmacology in large group. Materials and Methods: Session on “Autobiography of drugs” was introduced as an active teachinglearning module in pharmacology classroom. Important characteristics of drugs were presented as drug autobiography. Subsequently, students had to identify the drug giving justification. Perceptions of students regarding module were documented with the help of Likert scale. Results: Out of 153 students 112 participated. Majority gave positive reviews regarding the activity. About 94.70% students found the concept interesting. Above 80% students enjoyed learning by this method and agreed that it fosters creativity while learning. About 74.10% found this as an interactive, learner centered activity. About 62.50% students found the session engaging. About 71.00–75.90% students felt that autobiographies were informative and designed in structured manner. Overall rating in respect to quality, content and usefulness of activity on Likert scale was 4.06 (0.77). Conclusions: Autobiography of drugs was taken as an interesting active teaching-learning module by students. Need of the hour is to involve medical students in active learning activities which foster greater learner engagement, interaction, and promote life-long learning.

Triple Cs of self-directed learning: Concept, conduct, and curriculum placement

Self-directed learning (SDL) is one of the teaching-learning methods that can be used in medical education at all levels. The use of SDL in undergraduate (UG) teaching is becoming common due to the implementation of competency-based education in many countries. The new competency-based UG medical curriculum in India includes lifelong learning skills as one of the major components. The SDL method is reported to increase the lifelong learning skills of students. The concept of SDL is based on experiential learning and its conduct needs proper understanding of the concept. The conduct can include two contact sessions and an intersession or gap period of few days. The contact sessions focus on introduction, facilitation, and debriefing. The intersession period is the real learning period for the students. SDL also includes the use of various assessment methods. All SDL sessions are followed by an evaluation of various stakeholders. Advancements in information technology (IT) and the advent of many innovations in teaching can be aptly used in SDL conduct and evaluation. The present coronavirus disease 2019 (COVID-19) pandemic has further provided opportunity to use IT in the new normal post-COVID-19 times. Curriculum placement must be done in alignment with other teaching-learning methods. Training of facilitators, availability of resources, and preplanning help in successful SDL conduct. If implemented appropriately, SDL can be a great method to help students in their postinstitute lives.

Looking back– looking forward: ethics finds its place in the medical curriculum in India

The formal oversight of medical education in India occurred with the promulgation of the Indian Medical Degrees Act in 1916. Despite an awareness of the need to train ethical doctors and the formal discussion of this as early as 1955, the formal teaching of medical ethics has been restricted to a few colleges as it has not been part of a mandated requirement. In August, 2019, all medical colleges in India will adopt a new Medical Council of India mandated curriculum. An embedded AETCOM (Attitude, Ethics and Communication) module across all years of training is a part of this curriculum and is the first attempt to introduce medical ethics uniformly in close to 500 medical colleges in the country. This paper traces the historical attempts to include medical ethics in medical education in India, and describes the current plan to implement ethics teaching in the undergraduate medical curriculum in India.

History of medicine in undergraduate medical curriculum in India.

History of medicine is rich with the achievements and successes of years of research and development. The Medical Council of India incorporated teaching 'History of Medicine' in the undergraduate medical curriculum in India nearly a decade ago. Despite being included in the medical curriculum by the Medical Council of India, it is not yet a part of the teaching curriculum in the top-ranking medical institutions. Teaching 'History of Medicine' to undergraduate medical students may be a good divergence from the fact-based teaching of undergraduate medical curriculum. It will also help students cherish medical achievements of the past and inculcate in them a sense of pride and belongingness to the medical fraternity.

Family medicine: Perception and attitudes among Indian medical students.

Context:Currently, family medicine is not taught as a part of the undergraduate medical curriculum in India. In this context, the perceptions and attitudes of Indian medical students regarding family medicine as a career choice were studied.Aims:This study aims to study the perceptions and attitudes prevalent among Indian medical students regarding family medicine as a career choice and discuss its future implications.Settings and Design:Cross-sectional survey study design.Methods and Material:We conducted a cross-sectional survey of undergraduate medical (MBBS) students attending the 2016 medical student conference DEMEDCON at Sri Devaraj Urs Medical College in Kolar, Karnataka, India. Besides demographics, the survey included questions pertaining to awareness, exposure, and interest in family medicine in India. We also asked an open-ended question regarding the respondent's perception of the future of family medicine in India.Statistical Analysis:Simple statistics such as mean and frequency (%) were calculated. Given the small sample size, no formal tests for statistical significance were performed.Results:Responses were collected from 45 students between the ages of 18–24 from 6 medical colleges across Karnataka and Puducherry. The majority (64%) of respondents were in their 3rd or 4th year of medical college. 98% of respondents expressed a desire to learn more about family medicine as a specialty, and 82% expressed a need to introduce it as a subject in medical college. However, only 58% were aware of the Medical Council of India accredited status of family medicine in India.Conclusions:There exists a significant lack of awareness and inadequate exposure among Indian medical students toward family medicine. Nonetheless, there is widespread optimism and a desire to learn more about the subject. Increased awareness and avenues for exposure to family medicine in the formal undergraduate medical curriculum is the need of the hour.

Knowledge and attitude of medical students towards Alzheimer's disease: Can a student driven sensitization program help?

Background: We believe that the current under-graduate medical curriculum in India does not give enough weightage to dementia care. There is no study on knowledge and attitude of medical students towards patients with dementia in India.

Design of Medical Biochemistry Undergraduate Laboratory Based Curriculum to Address Unmet Needs

Background and objectives: Review of the undergraduate medical curriculum in India is not done regularly. Strengths and weaknesses need to be identified in order to develop strategies to improve the curriculum. Objective was to critically appraise, modify and implement biochemistry laboratory based curriculum for undergraduates as an endeavour for critical introspection and to set a platform for change. Methods: A self-administered questionnaire for faculty and interviews for students were used to identify needs which would help to create an educational environment conducive to change and innovation. The existing undergraduate biochemistry laboratory curriculum was analysed using Kern’s framework, triangulating the qualitative and quantitative data, to develop a modified curriculum. As a pilot study, a checklist was made for one laboratory unit and the faculty was trained to use it. Kirkpatrick’s model was used for evaluation of training. Results: The major strengths and weaknesses of the curriculum were identified. Accordingly, the objectives, teaching - learning methods and assessment strategies were aligned. For the first time, measures for honing and assessing interpretative skills of students were incorporated. The results showed that three levels of Kirkpatrick’s evaluation model were achieved for the training of the checklist. Paired ‘t’ test was used to check the differences in marks of students before and after applying the checklist of marks allotment. The mean score of the marks of one laboratory experiment unit (urine report) after applying checklist pattern (M=9.18) was compared with the mean score of the marks without applying checklist pattern (M=10.12). Conclusions: Evaluation of curriculum provided a snapshot of the strengths and weaknesses of current biochemistry practical curriculum and also guided improvements particularly with regards to inclusion of more clinically relevant curriculum with group based learning. The data derived from this study will help to make suggestions to the decision making bodies i.e. Medical Universities (both national & state based) in India.

Introducing a course on Evidence Based Medicine for undergraduate medical students – experience from an Indian medical school

This article was migrated. The article was not marked as recommended. Introduction: Although evidence based medicine (EBM) is part of undergraduate training in several countries, Indian medical schools are yet to make a meaningful start. We report our experience with EBM training for undergraduate. Methods: Third year students undergoing clinical clerkship at a teaching hospital underwent an 8 week course on EBM with modules on concepts, formulating questions, searching for evidence and critical appraisal. Feedback was taken and assessment done on knowledge and searching skills. Results: 90% of students had poor awareness of EBM. 92% considered evidence the most important component of EBM; 5% considered clinical expertise and patient values as part of EBM. At baseline majority cited Google the most reliable search tool. Only 27% felt EBM relevant to their curriculum. 66% rated the course good, very good or excellent. Hands-on training enhanced learning lack of background knowledge of diseases hindered it. Conclusion: Awareness of EBM is low among undergraduates and most find it irrelevant to their curriculum. Our experience suggests that it is feasible to integrate EBM training into undergraduate curriculum. More studies reporting knowledge and skills before and after EBM courses would strengthen the cause for making it part of undergraduate medical curriculum in India.

Proposal for Integration of Bioethics in Phase I Undergraduate Medical Curriculum in India

Bioethics is now regarded as an integral part of contemporary medical education across the world. This proposal of integration of Bioethics in phase one undergraduate medical curriculum is, to bridge the gap between classroom learning, bedside application and further in community practice to give better health care and a good harmony between Doctors and Society. This aims in covering the curricular approaches in order to enforce values of bioethical principles in medical practice.

The quarter model: A proposed approach for in-training assessment of undergraduate students in Indian Medical Schools

In-training Assessment (ITA) has the potential to test a wide range of competencies which are not testable by the year-end examination. However, despite high validity, educational impact and feasibility; its implementation is flawed. This paper proposes a quarter model of intraining assessment for implementation in the undergraduate medical curriculum in India. The model proposes that assessments be carried out at least quarterly; no teacher should contribute more than 25% of the marks for any student; no single assessment tool should contribute more than 25% marks; and no assessment should contribute to more than 25% of the total marks. We believe that structuring the implementation using multiple tests on multiple content areas by multiple examiners using multiple tools in multiple settings in the proposed quarter model will not only improve the reliability and validity of internal assessment, but also its acceptability.

Embracing the unknown: introducing medical humanities into the undergraduate medical curriculum in India

Medical education fails to address the medical student's many questions, doubts and anxieties about his profession and his own relation to it. Students' growing disillusionment with the profession and increasing disconnect with the realities of the healthcare scene in India have reached critical levels, resulting in a general clamour for reform of the medical curriculum. Many look towards medical humanities for the answer to the problem. Referring to some of the available western thinking and practice of medical humanities (MH), this paper recommends the evolution of an indigenous model which will draw on the growing body of new scholarship on India in the humanities and the social sciences. Some guidelines are offered for starting an MH programme, stressing the need for a flexible and broad-based approach, and a participatory pedagogy focused on students' needs, that draws creatively on available resources. Rather than viewing the 'arts' as a discrete addition to our personalities, an MH programme needs to show us how to integrate the multiple facets of our personalities.

Computer Assisted Objective Structured Clinical Examination: A useful tool for dermatology undergraduate assessment

Dermatology is a minor subject in undergraduate medical curriculum in India. The dermatology clinical postings are generally poorly attended, and the clinical acumen of an average medical graduate in this specialty is quite low. To develop and implement Computer Assisted Objective Structured Clinical Examination (CA-OSCE) as a means of end of dermatology posting evaluation. Also, to assess its effectiveness in improving the motivation, attendance and learning of undergraduate students with respect to their visual recognition skills and problem solving ability. We designed and introduced CA-OSCE as a means of end of posting assessment. The average attendance and assessment scores of students undergoing CA-OSCE were compiled and compared using 'independent t test' with the scores of previous year's students who had undergone assessment with essay type questions. The average attendance and average assessment scores for the candidates undergoing CA-OSCE were found to 83.36% and 77.47%, respectively as compared to 64.09% and 52.07%, respectively for previous years' students. The difference between the two groups was found to be statistically significant. Student acceptability of the technique was also high, and their subjective feedback was encouraging. CA-OSCE is a useful tool for assessment of dermatology undergraduates. It has the potential to drive them to attend regularly as well as to test their higher cognitive skills of analysis and problem solving.