The post-pandemic doctor

Context: Covid should catalyse changes in medical education, orient it towards scientific sensibility, compassion.

Issues with the current model of medical education: The Covid-19 pandemic could provide the catalytic spark for more reforms by throwing light on many areas that medical education must address.

• Reductionist approach: 
  • Major reforms in Western medical education began after the Flexner report of 1910 advocated structured, science-based and laboratory supported learning, replacing the apprenticeship model.
  • However, Western models imposed the rigidity of a reductionist approach that increasingly focused on partitioning the human body into organs, tissues, cells and sub-cellular structures.
• Disconnect from the real world: Indian medical colleges, usually located in an urban ambience and linked to tertiary care hospitals, were disconnected from the real-world functioning of a multi-layered health system.
• Rush for information (Infodemic): The rush for information during the pandemic has removed the inadequate protective filters, with unreviewed publications getting circulated as preprints.
• Lack of adequate capacity for interpretation and building research design: 
  • Without adequate research capabilities, inappropriate tests and ineffective medicines are prescribed by doctors in the misguided belief that they are doing good to their patients.
  • Apparently, promising anti-hypertensive and anti-arrhythmic drugs even caused harm, despite appealing biological rationale.
  • For e.g. During the Covid pandemic, drugs like hydroxychloroquine failed when put to clinical trials.
  • This also leads to a situation where doctors develop a naïve belief that a positive test always means the presence of disease and a negative test signifies its absence, further leading to the piling up of wasteful tests.

Way Forward:

• Building a multi-disciplinary, socially responsive model of education: In 2010, an independent global panel, The Commission on Health Professional Education in the Twenty-First Century, advocated a multi-disciplinary, socially responsive model of education.
• Imparting good research design and interpretation: Medical education must teach the essential principles of epidemiology and statistics that underlie good research design and interpretation.
  • Doctors should judge a research study for both internal validity (how true are the reported results likely to be) and external validity (how applicable are the recommendations to their patients or population).
• Promote and provide skills on telemedicine: Medical education must impart the needed technical and social skills to make teleconsultations effective and safe.
  • The growth of telemedicine requires that medical students be trained to efficiently evaluate patient data and make competent management decisions, even from a distance.
  • Telemedicine may involve engagement with the patient, an attendant or with a primary care team member.
• Imparting skills of effective communication: Precise, accurate, jargon-free, confident and clear communication is needed in such interactions.
  • Even when the doctor in a hazmat suit appears an alien, caring communication is possible through the tone of voice, well-chosen words that convey compassion and even non-verbal gestures to show care.
  • The public health pioneer Livingston Trudeau once said the duty of a physician is “to cure sometimes, to relieve often, to comfort always”.