Surgeons call for upgrading surgical education in government medical colleges

Falaknaaz Syed - Mumbai

A decade back, government and municipal teaching hospitals in India, who were pioneers of surgical techniques, are today found struggling to keep pace with the rapid technological advancements taking place all over the world. Experts attribute that archaic syllabus, lack of progress in surgical training and technological advancements, primitive teaching techniques, absence of policies and protocols, and outdated infrastructure, have resulted in government and municipal medical colleges losing their shine in terms of surgical training, education and patient care to private medical colleges.

To address these issues, Association of Surgeons of India (ASI), the national body of surgeons, along with 90 head of general surgery departments of medical colleges around the country, have chalked out a plan to upgrade surgical education in government and municipal medical colleges. These suggestions are to be presented as a white paper to the Union Health Ministry for implementation, some time from now.

A hoard of issues plague the surgical education system and training in government medical colleges. A case in point are our general surgeons, who after completing three years training in MS surgery, have very limited knowledge on cancer surgery or minimal access surgery and are not skilled to treat common surgical conditions.

A close look at our government and municipal colleges proves the point. For instance, out of the 8 medical colleges in Mumbai, only KEM Hospital teaches laparascopic surgery. In Gujarat, out of the 25 teaching colleges, none of them teach laparascopic surgery. Similar is the situation in the north. However 20-30 percent colleges teach minimal access surgery in hospitals in the South.

Experts say that out of the 170 government and municipal medical colleges across the country, 90 per cent of them, don’t teach even basic minimal access surgery.

The result is that the onus of imparting training in advanced techniques has come on to the private hospitals.

Says Padmashree Dr Pradeep K Chowbey, chairman, Department of Minimal Access Surgery, Sir Gangaram Hospital, New Delhi, “There was a time when politicians, VIPs and opinion makers of the society, used to avail treatment mostly at government hospitals. However, today the trend is changing towards the private and corporate hospitals. Government medical colleges cater to 80 per cent of the population but today are lagging behind. Today, most patients opt for private hospitals. Also talent is not staying with the government institutions and is moving out to the private sector for better appreciation of their skills and high financial remuneration. Private sector is way ahead in terms of education, training, medical facilities and the quality of work done in their medical colleges. So we are addressing these issues.”

Adds Dr Nilesh Doctor consultant hepatobiliary surgeon, Jaslok Hospital, “We need to see as to why this situation has arised? 20 years back, best doctors used to be in medical colleges. But today best doctors of the country are found in the private sector. There are several reasons for this problem. First, the honorary system has been done away with, in Mumbai, besides the remuneration paid is low. So, good doctors have left. Another reason is the inefficiency in government hospitals. For e.g If I wish to start laprascopic surgery in a government hospital, I will have to wait for two years to get the equipment. After that, I will have to face resistance from the management, since there is a lot of hierarchy in government hospitals. We find that there is a reduced capability to adapt to change in the government sector but increased capability in the private sector.”

Experts say that another major hindrance also impeding surgical education is the wide variation in the format of surgical training between universities and in the under graduate and postgraduate curriculum prescribed by the Medical Council of India (MCI). Also the type of evaluation system differs in medical colleges and universities. They feel that the format and evaluation pattern needs to be standardised, so that there is uniformity in general surgery training across the country.

Says Dr Prof Avinash N Supe, head of surgical gastroenterology, Seth G.S. Medical college and KEM Hospital, “Uniform training format will allow cross-recognition of degrees across states, and in foreign countries.”

Although onco-surgery constitutes a major chunk of general surgery, the current surgical training in medical colleges is inadequate to deal with surgical oncology. Experts recommend integration of surgical oncology in general surgery training to better equip the students.

Suggests Dr Nilesh Doctor, “Faculty exchange programmes wherein HODs should visit recognised/leading cancer centres in the country for “Train the trainer” and medical oncologist should visit medical colleges on a periodic basis to train general surgeons. Also they should be exposed to diagnostic endoscopy.”

To promote surgical excellence, the paper suggests a process for recognising and awarding surgical excellence in teaching institutes.

Says Dr Nilesh Doctor, “We can improve teaching and training by benchmarking with the centers of excellence in India and abroad. We have written to the Ministry, Directorate General of Health Services of all states that funding should not stop. A recognition process at national level for surgical excellence is required. Financial and career advancement incentives should be awarded, promotions should be based on performance. ASI can play a crucial role by defining and reviewing the surgical education curriculum at regular intervals, ” he adds.

Says Dr Chowbey, “Though surgery has become technology dependant to a great extent, unfortunately, many surgical departments have been unable to keep pace with this explosion. We have recommended that ASI interface with the government and MCI to ensure implementation of the current regulations of MCI to be mandated in all medical colleges.”

“Modern technology such as MAS, modern haemostatic equipment be made available in OT of teaching institutes. Similarly, surgical ICUs be equipped with modern monitors and ventilatory support. Cooperation with the private sector including acceptance of sponsorship should be looked as a viable option. Also technology should be shared between institutions irrespective of private or government,” he added.

Speaking about the recommendation made regarding CME-accreditation after surgical training, Dr Supe said, “After MS, there is no method by which a surgeon’s competence can be measured over a period of time. Most countries have some form of re-appraisal system where they could attend a conference, or take a re-examination. The biggest advantage of accreditation requirement is that it helps constantly update surgeon’s knowledge and skills.”

The paper suggests that live demonstration, workshops, symposia, seminar and panel discussions not a part of national level conference, instructional courses and surgical updates, fellowships (3 months to 6 months) be included under CME. The total number of CME hours in five years should be 30 and minimum number of hours per year should be four. It also suggests that the ASI credential committee be responsible for monitoring accreditation. Also all CME programmes be registered with ASI which will decide the number of accreditation hours based on the content of CME.

falak@expresshealthcaremgmt.com