Medical Education: Progress And Challenges

Medical education is constantly changing due to the rapid advances made by technology. The present-day medical students are quite different, they make themselves adept to the surroundings quickly as they only hear and speak the language of technology in their lives. 

Educators on the other hand need to respond to the changing nature of learners, identify better and suitable teaching-learning strategies to make students proactive, make them grasp the problems faster and indulge in active learning with them. They are also faced with the challenge of making passive learning (instructor-centered method) phase out in the future.

Several studies have demonstrated that student engagement is higher with active learning strategies than with traditional 'instructor-centered' methods. These pedagogical strategies have facilitated an active 'learner-centered' teaching approach, in which the emphasis is on students and what they learn. Flipped classrooms, peer teaching, and problem-based learning are some approaches introduced in medical courses to improve performance and perceptions. 

Podcasts, videos, mobile devices with apps, and simulations are some techniques introduced into the curricula. It is, therefore, essential that each medical school in our country analyses the context in which it operates; and picks and chooses teaching and learning methods that suits the best.

History of Premier Hospitals and its Programs 

The Bir Hospital (now NAMS) is the oldest (established in 1889), one of the premier and longest-serving hospitals in the country was established during the Rana regime. It was started with just one doctor and some ancillary staff as supporting services. The Institute of Medicine was born in 1972 during the Shah dynasty, it initially started the “Auxiliary Health Workers School” which conducted Health Assistant Programmes, and with the inception of Tribhuvan University Teaching Hospital (TUTH) in the year 1982 began the first undergraduate program in the country. 

In the year 1994, the Postgraduate Medical Education Coordination Committee (PGMECC) was set up, it enrolled the postgraduate residents across the valley group of hospitals in Kathmandu and it paved the way for all the postgraduate courses in our country. Subsequently, in the second decade of the 21st century, the DM and MCh subspecialty courses in various disciplines were started by the Institute of Medicine, Kathmandu University, the NAMS, BP Koirala Institute of Health Sciences. In 2023, 1895 doctors (MBBS), 1128 specialists (MS/MD) and 83 super specialists (DM/MCh) were enrolled in both the government and private medical colleges. 

National Medical Education Act 2075 is looking to frame policies to regulate medical institutions and teaching professionals, revisit the curriculum according to our societal needs and values, determine and evaluate various infrastructures and assess the national requirements for producing competency-based skilled manpower. 

Future Challenges 

The residency training is physically and mentally demanding, and well well-being of future physicians is imperative for the community   

Educators, clinical instructors, and students need to address, study and implement the skills to approach the demands of medicine in this age and assess how many universities, medical colleges, and skilled health resource manpower are required, design a national curriculum framework, reorganise the common entrance and exit evaluation methods

There is a persistent challenge to adopt international standards in medical education teaching methods, timely supervision and monitoring of education 

Likewise, a concrete plan to make Nepal a medical education hub will help the entire subcontinent in the long run  The Future Medical Curriculum 

The focus of health service and care has transitioned from hospital to the community, from acute ailment to chronic conditions, with technology playing a decisive role in transforming care and learning. The student-centered approach is evolving and is destined to replace the time-honored teacher-centered method, e-learning is replacing lecture-based teaching and relatively new paradigms like competency or outcome-based education are looking to replace content-oriented or time-based education.

The medical curriculum should be re-engineered, curriculum should comprise well-designed standardised outcomes which allow individualised learning; it should uptick inquisitiveness through the support of self-regulated learning, upgrade professional identity and learning through early clinical exposure, longitudinal experiences and service learning. We need to give thoughtful insights into these ensuing approaches:

The student-centered curriculum will make it modular and integrated, flipped learning students watch recorded videos or podcasts at home before coming to class, and they utilise the classroom with interaction and high-order thinking.   

Problem-based learning makes it more institutionalised and needs less memorising.

Peer-assisted learning is support for students by students, it increases academic confidence and boosts resilience.

Challenges in Health Services

Even though The World Health Organisation prescribes the norm of 1 doctor per 1,000 people for all the countries across the world, at the present moment in our country it stands as 1:1900, in India, it is 1:834. The 2021 global data however shows Austria on the top with 5.35 doctors for 1000 citizens, China and Brazil at 2.36 and 2.05 respectively sitting at the bottom.  

There is a maldistribution of health workers in our country with the majority of 85 to 90% concentrated in the Tarai and the valleys, they have been looking to serve the public from different government hospitals and private establishments. 

Setting up of medical institutions and hospitals at proper, justifiable geographic locations in the country and their timely growth is of paramount importance. The health service providers, policymakers, business leaders and other stakeholders and analysts need to interact in a prolific, inclusive and unbiased manner so that we can prioritise what suits us best for the future which will put fellow citizens at ease when it comes to accessing standardized health care services.

The Future Tutor

In this digital age tutors will have to be more of a facilitator rather than a teacher. They need to be friendly with the students, should be more qualified in learning to direct the students properly, make them competent in small group learning, emphasise problem-based learning, able to train students at higher cognitive levels. A better tutor will have no choice but to be fluent in IT, and AI and maintain an interaction in learning periodically with other learning collaborating institutions.  

Gone are the days when we had to go to the libraries and struggle for hours and hours to find a journal or a book. 

Today we can get all the information we need in no time. With so much information available people may have been changing their inclination towards research and education. There is a worldwide decline in the number of physician researchers. This may have an impact on medical students in the long run. 

At the BP Koirala Institute of Health Sciences Dharan, once the undergraduates enter the third year they conduct a project for six weeks in the field of their choice, they present their work to their mentors once they complete their findings. Some publish their work in journals too. Conducting research during the MBBS course is praiseworthy. 

Carrying out research so early in their life brings in confidence, it will be a unique learning opportunity to be part of the team, understand the teamwork, apply what they learned from research later in their course when they sit for final clinical examinations, it will help strengthen residency programme and in postdoctoral degrees application, they will get a chance to publish their work in reputed journals and may even get an opportunity to present their research work in a conference apart from being able to add it in their resume. 

The author works at BP Koirala Institute of Health Sciences, Dharan