Principles of Medical Education

219 Pages·2013·17.75 MB·English

by  Tejinder Singh, Piyush Gupta, Daljit Singh

Principles of
MEDICAL EDUCATION
Principles of
MEDICAL EDUCATION
Fourth Edition
Tejinder SinghMD DNB MAMS FIMSA FIAP
MSc (Health Professions Education) (Maastricht; Hons)
MA (Distance Education); PG Dip Higher Education (Gold Medal)
Diploma Training and Development (Gold Medal)
PG Diploma in Human Resource Management (Gold Medal)
Certificate Course Evaluation Methodology and Examinations (AIU)
FAIMER Fellow, SIDA Fellow, IFME Fellow, IMSA Fellow
Vice Principal (UG) and Professor of Pediatrics
Program Director, CMCL-FAIMER Regional Institute
Coordinator, MCI Regional Center for Faculty Development
Christian Medical College, Ludhiana, Punjab, India
Piyush GuptaMD FAMS FIAP
Professor of Pediatrics
University College of Medical Sciences, New Delhi, India
Editor-in-Chief, Indian Pediatrics
Secretary, IAP Education Center
Daljit SinghMD DCH MAMS FIMSA FIAP FNNF
Diploma in Management (AIMA), FAIMER Fellow
Certificate Course Evaluation Methodology and Examinations (AIU)
Principal and Professor of Pediatrics
Dayanand Medical College and Hospital, Ludhiana, Punjab, India
Visiting Fellow, Royal College of Paediatrics and Child Health (RCPCH), London, UK
Forewords
CP Bansal
DK Srinivas
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Principles of Medical Education
First Edition: 1997, Indian Academy of Pediatrics Education Center
Second Edition: 2000, Indian Academy of Pediatrics Education Center
Third Edition: 2009
Fourth Edition: 2013
ISBN 978-93-5090-409-1
Printed at
Dedicated to
Children of the World,
Medical students learning to
care for them
and
Medical teachers preparing
them for this role
Foreword
It gives me great pleasure to write the Foreword for Principles of Medical Education (4th edn), a
publication of the Indian Academy of Pediatrics.
There have been major changes in our understanding of educational process. Mainly these include
the realization that students learn only when they want to learn, they learn by expanding on what
they know and that they learn better in context, especially when it comes to skills and attitudes.
Similarly, regarding assessment, we now understand that it is only a process of making an estimate
of what a student knows and that there are multiple sources of errors in making this estimate. More
important than inter-examiner variation, it is the variation between tasks (treating diabetic ketosis
is not same as giving dietary advice for diabetes). The best way to make a better estimate is to assess
an adequate and representative sample of tasks that a doctor is expected to perform.
Both these require a change in the role of the teacher. He has to be a manager of students’ learning
needs rather than being an information dispenser.
The book deals with these issues and brings contemporary educational concepts within easy reach
of medical teachers. It also discusses the interventions like early clinical exposure and skills training,
which are likely to gain momentum in the coming days with the Medical Council of India (MCI)
moving over to the new curriculum model.
I congratulate the Authors, Drs Tejinder Singh, Piyush Gupta and Daljit Singh, who have been
widely acknowledged as good academicians, for their excellent work done to bring out this valuable
book. The book serves this objective and fills a void in the field of teaching skills. The book certainly
will continue to remain as a very prestigious publication of Indian Academy of Pediatrics.
CP Bansal
President IAP 2013
Foreword
In the last three decades, we have witnessed a surge in the establishment of medical colleges in India.
This phenomenon has been compared to ‘mushroom growth’, whether one likes it or not! Recently,
to ‘reach targeted doctor population of 1:1000 by 2031’ (vide Vision 2015 document of Medical
Council of India) existing colleges have been encouraged to increase number of seats after fulfilling
some relaxed norms. There are more than an estimated 36,000 teachers engaged in teaching in the
existing medical colleges, notwithstanding the shortage in teaching staff as well as learning resources.
REFLECTION
Teaching is a complex skill and art. It requires eagerness, self-discipline, hard work, practice and
feedback to make sure that you are on the right track. Even those endowed with inherent talent,
must undergo training to improve their performance. Why then, our medical teachers have not
realized this? Is it our ego? Do we feel that we have acquired more than one degree that is good
enough to teach? How is it that our policymakers, administrators and academicians have not
considered training of teachers as important pre-requisite for carrying out their professional tasks?
CHANGING SCENARIO IN MEDICAL EDUCATION
There have been burgeoning developments and changes in medical education. For instance, the role
of teacher has changed from information giver to facilitator, mentor and creator. The information
and communication technology has revolutionized the teaching and learning. The traditional
methods of assessment have been challenged leading to rethinking of philosophy, methods and tools
of assessment. The focus of student assessment has shifted to the use of multiple-methods for testing
a wide gamut of learning outcomes, such as higher cognitive abilities, communication skills, IT skills
and professionalism including ethical behavior. Many of the methods lay emphasis on frequent
assessment of learning outcomes. Several new methods and tools are now available, the use of which
requires special training. Focus is also shifting from competency-based education to outcome-based
education and workplace performance assessment. Performance at workplace deals with ‘how people
will behave when unobserved in real-life on a day-to-day basis and take effective action in unfamiliar
and changing circumstance’ whereas competence is—‘demonstration of knowledge, skills and attitudes
required for a task under optimal conditions.’ Competence is necessary, but not sufficient (enough?)
for ensuring performance, because in real-life conditions it may not always be optimal.
NEED FOR TEACHER TRAINING AND TRAINING MATERIALS
It is, therefore, essential for our teachers not only to be aware of these new developments but also
suitably adopt and apply them in their teaching. Equipping medical college teachers to take on these
roles through training, therefore, assumes importance.
x Principles of Medical Education
The concept of teachers’ training in India started only in late seventies. It gathered pace with
Medical Council of India (1999) insisting every medical college to have a medical education unit
and recently (2010) making it mandatory, for every teacher undergo at least the basic level training.
The books and other reference materials commonly used in the early years for teacher training
were limited to WHO publications on medical education and mimeographed materials from few
journals. During mid-90s, a number of useful books rolled out from various corners of India. These
included: Medical Education: Principles and Practice (NTTC group, JIPMER, Puducherry, India, 1995),
Assessment in Medical Education: Trends and Tools (CMET, AIIMS, New Delhi, 1995), The Art of
Teaching Medical Students (MET Cell of Seth GS Medical College, Mumbai, Maharashtra, India),
Principles of Medical Education (Tejinder Singh et al., Indian Academy of Pediatrics Education Center,
1997), besides a much-needed Trainer’s Manual by NTTC, Puducherry (1997), India. These books
helped many medical teachers across the country not only in enhancing their knowledge but also
served as resource material for conducting teacher training programs. However, they can be
considered as ‘too little and too few’ if we take into account the enormous expansion in knowledge
and the huge volume of target readers including the faculty of medical colleges, dental, nursing,
physiotherapy and allied health sciences, who have multiplied over the past few decades and have
no access to systematic body of information in health professions’ education.
The paradigm shift in medical education and the proposals made in Vision 2015: Document of
Medical Council of India, for reforms and restructuring of medical education have prepared a
background, for bringing out a new book-cum-training manual which takes into account and delves
into these aspects. That precisely has been done in this revised edition of Principles of Medical
Education by Dr Tejinder Singh, Dr Piyush Gupta and Dr Daljit Singh. The book serves this objective
and fills a void in this field. Further, the book would be useful to many ‘teachers’ who are not employed
in medical colleges—those in private sector teaching DNB students, or ‘teaching’ in conferences/
workshops. I wish to congratulate the authors who have made this very valuable contribution to
contemporary medical education literature.
DK Srinivas MD
Dean (Retd)
Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER)
Puducherry, India
Former Project Officer
National Teacher Training Center (NTTC)
Former Consultant
Rajiv Gandhi University of Health Sciences
Bengaluru, Karnataka, India
Preface to the Fourth Edition
It is with the sense of happiness and pride that we are writing the preface to the Fourth edition of
Principles of Medical Education. It took 9 years for the third edition to be published but has taken
only 4 years for the fourth edition to be out. The revision has been necessitated by the rapidly changing
medical education scenario in the country and the consequent need for including a number of
important concepts in the book.
Like its predecessors, the book covers the areas considered necessary for a medical teacher to be
oriented to the art and science of medical education. We have resisted the temptation to put too
much of ‘theory’ and tried to keep the discussion simple. However, to satisfy the academic appetite
of some readers, a number of references and freely available web resources have been provided at
the end. Six new chapters have been added and most other chapters have undergone extensive
revisions. The earlier conversational format has been retained.
We are grateful to the medical teachers in India for accepting the earlier editions of the book
and we hope that this edition will continue to fulfill their needs. The additions and revisions make
the book, a useful training manual and also the resource for basic medical education workshops.
We are open, as usual, to suggestions, criticisms, brickbats (and bouquets!).
January 2013 Tejinder Singh
Piyush Gupta
Daljit Singh
Preface to the First Edition
The persistent efforts of Pediatricians have finally borne fruits to get the status of a separate subject
to pediatrics. This has, however, brought added responsibilities for teachers of pediatrics—that is to
ensure that medical graduates are well versed in the care of children.
The quality of end-products of any system of education depends a lot on skills and orientation
of the teachers. With this perspective, IAP Education Center has taken the responsibility of orienting
teachers of pediatrics to educational technology and pedagogy. This book is a humble attempt to
fulfill that mandate.
Written in the format of a self-instructional manual, the book is the outcome of authors’
experience of conducting educational workshops. Many of the examples given in the book have been
generated out of these workshops and we do not claim any proprietary over them.
We do hope that the book will make an enjoyable reading and enable teachers to apply many of
the educational principles in their day-to-day teaching. Better health care available to children through
doctors better trained in this task will be our ultimate reward.
It may also be pointed out that although the book gives examples from the subject of pediatrics
only, it will be equally useful for teachers of other subjects also.
We would welcome suggestions and comments to improve the quality of the book.
October 1997 Authors
A woodcutter was employed by a timber merchant, who was a very generous
employer and offered a good salary and perks.
The woodcutter started his work and was able to fell 20 trees. He was very happy.
However, a day later, the number of trees felled came down to 18. There was a
progressive decline in the number over next few days.
The woodcutter was feeling very embarrassed since he felt that he was not doing
justice to his job. He tried very hard but could not add to the number of trees felled—
rather, he was able to cut only 10 trees on tenth day.
He went to his employer to apologize. The employer was very understanding. A bit
amused, he asked, “When did you last sharpen your axe?”
The woodcutter appeared puzzled. He said, “Sharpen axe! I have no time. Do not
you see I am so busy cutting the trees?”
Abraham Lincoln had rightly said that if he had six hours to cut a tree, he would
spend four sharpening his axe.
When did you—as a medical teacher—last sharpen your axe?