October 28, 2010

Lancet - praise for India's rural doctors scheme

The Union Health and Family Welfare Ministry might still be awaiting “formal” clearance for its much debated Bachelor of Rural Health Care course that aims to create a cadre of healthcare workers for the rural areas, but the Centre has received global appreciation for “trying to find an innovative solution to a deeply entrenched problem which is not unique to India.”

The latest edition of The Lancet Infectious Diseases journal carries an article on the proposed initiative which says that whether or not the government succeeds, it should be praised for the innovative solution. “In the end, the quality of care will depend not only on the duration of medical training, but also on its quality and, perhaps even more importantly, the ‘after-sales' service.”

This praise from Lancet comes weeks after the same journal published an article on the discovery of the antibiotic-resistant ‘superbug' in India and Pakistan. That article created a huge controversy, with India having to deny that foreigners treated here had developed immunity to antibiotics due to the indiscriminate use of drugs.

Titled “Rural MBBS Degree in India,” the latest article is written by Sanjay Kinra and Yoav Ben-Shlomo. It dismisses criticisms levelled at the “rural MBBS,” such as increased likelihood of mistakes or infringement of human rights due to treatment by inadequately trained doctors, saying these bear little credibility.

Currently, the shortage of doctors in rural India stems from the unwillingness of most doctors, who were born and trained in urban areas, to move to rural areas. The rural MBBS scheme aims to train people from rural areas in those rural areas, in the belief that they will stay, which offers some hope of providing medical care to large parts of rural India that currently lack it.

It seems plausible to deliver the required education and training in this time, especially because rural doctors will be expected to focus on a particular setting. The course will be delivered entirely in rural health centres and hospitals, which ironically might result in the rural doctors having a higher level of competency in clinical skills, which are generally agreed to be important for doctors, compared with their urban counterparts. What remains to be seen, however, is whether it will be possible to consistently and reliably deliver high-quality education in mall rural centres, the article says.

Drawing attention towards a sharp debate that has ensued in the Indian media, with the vocal medical fraternity generally opposed to the new degree on the grounds that the shorter duration will result in inadequately trained professionals, the writers say inherent to this debate is the assumption that the current duration of the MBBS in India is right, and more generally, that we know how long it takes to produce a competent medical doctor.

After reviewing medical curricula for 55 countries, the writers arrived at the conclusion that the duration of medical education is relatively consistent across the world with medical training taking about 6 years before a licence to practise is obtained. Medical training is typically split into 5 years of schooling, of which the first 3 years are preclinical and the fourth and fifth are clinical, followed by a 1-year apprenticeship on the job. However, there is considerable variation in the intensity of teaching, with shorter courses either being more intense, or requiring the students to be graduates. Course content and delivery will affect the course's duration, the article suggests.

Link: Original Article

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