Over the last several decades, there have been rapid advances in human information, knowledge, skills and wisdom. The advances have encompassed all fields: Science, commerce, communication, aesthetics and philosophy. In pre-modern times, irrespective of the profession one pursued, the focus was on the all-round development of personality, encompassing all the fields simultaneously. Thus many famous medical professionals of the past were also famous philosophers (Charaka, Hippocrates, Descartes, Galen, Avicenna, Carl Jung), poet/writers (Avicenna, Keats, Chekov), business (Kellogg, Pepsi Cola) and communicators (Osler, Benjamin Spock, Kubler-Ross). However, with the advent of specialisation, the emphasis has shifted towards greater information/details about the area of interest but with narrowing of perspective.
Translated into the medical field, this has led to doctors to relatively keeping pace with scientific inventions/skills, advances in business models but slacking in fields of communication, philosophy and aesthetics. Thus we are now encountering a new breed of doctors who are smart, know their subject but lack in the social element, may lack empathy, communication skills, and are unable to gather the broader perspective of patients and their disease but are concerned with superficialities and trivialities. This creates a huge mismatch between the expectations and actual healthcare delivery in the eyes of the lay public, recipe of disaster at a societal level. Medicine is not pure science, like engineering, physics or chemistry but social science, which is practised in a social context where issues of empathy, ethics are foremost and far exceed mere physical cure.
Can we do something about it? While the solution is in tackling each of these problems at an individual level, best results may be obtained when these strategies can be employed at the earliest level or at the initiation of the medical school, in other words when incorporated in the medical curriculum itself. The medical curriculum has been an evolving process and the scientific part is frequently updated to bring it abreast with the latest scientific advances. Over the past, several new topics have been included in the medical curriculum which was not previously present—genetics and immunology are some of the examples. However, in most places, especially the developing world, it has failed to keep pace with advances in other areas including communication, management theory, personality development, ethics and aesthetics. Thus there is a need to revisit the medical curriculum to attune it to the current social context otherwise gap between the expectations and actual delivery will keep widening.
Here are some of the suggestions towards improving medical curriculum:
Newer ideas in the curriculum of medical students:
- Professional Development
A) Empathy Development: Inderstanding emotional intelligence and learning the art and skill of empathic listening and action
B) Medical Communication: Understanding modern doctor-patient relation and developing doctor-patient communication particularly “therapeutic communication” with special emphasis on the lost art of “bedside manners.”
C) Personality Development: Understanding the requisite personality attributes to becoming a good doctor, training the budding doctors to incorporate these attributes in their personality.
D) Technique of Medicine: Developing patient-centred clinical methods, focusing on improving the art of history taking, quickly incorporating evidence in medical practice and particularly on patient safety.
- Management Proficiency
In current times besides professional skills developing management skills is also absolutely mandatory. The requisite management skills pertain to:
A) Individual and Interpersonal Dynamics
These skills involve:
i) Understanding the motivators and motivation in medicine and assuming an ethical approach towards market-place
ii) Developing an approach of balanced decision making and judgment and a proper attitude towards the clinical job
iii) Understanding inter-personal relationships and communication and developing skills; negotiation and conflict resolution especially in clinical settings, skills of crisis management especially when there is an impending threat of violence of property and personnel.
iv) Understanding in which situations there are chances of medical error, malpractice and negligence and how to avoid them.
B) Team and Unit Dynamics
Understanding the (big)5 personality traits of a leader, team norms and practices and the network of the organisation. Learning how to evolve into a leader and be able to coordinate medical teams/organisation.
C) Organisational Dynamics
There should be some discussion on organisational structure and design, organisational culture, change in management and inter-organisational relationships.
- Medical Humanities
A) Philosophy: There should be a basic introduction to various branches of philosophy particularly in context to medicine: epistemology, consequentialism and deontological Ethics with particular emphasis on medical ethics
B) Arts: Aesthetics is perhaps the most neglected part in medical curriculum although there is a close historical and psychological relation of art with medicine particularly in developing empathy, the most essential skill in any doctor.
- Art of Living
Doctors have among the highest risk of burnouts and suicides among all professions, especially “white-collared” ones. The reason is that since the beginning they are ‘taught’ to focus on gathering knowledge as also keeping ‘patient first’ even at the expense of self and family. This excessive focus on professional skills leads to neglect of self and interpersonal relationships. Thus these budding doctors need to be tutored into the art of living from the beginning. Particularly they should be informed about the benefits of outdoor, the need to be flexible about things and be able to change habits and coached on how to increase mental stamina and increase attention span.
The writer is from the Department of Cardiology of AIIMS, New Delhi.