Bhavik Shah is a final year MBBS student
from BJMC, Ahmedabad and Chase Yarbrough is a PGY2 resident in Harvard
Medical School receiving dual training in Medicine and Pediatrics as
part of a 5 year program. We had the pleasure to learn with them last
week during their visit to our institute for the BMJ Cases Medical
Elective and following are some of our learning insights around the
differences between the US medical education system and Indian Medical
education system shared so that we can discuss how to optimize the
upsides and downsides of both.
1) According to Chase
Yarbrough, the US medical graduate UMG finishes all their theory lecture
classes by the end of second year and is expected to spend the rest of
their 2 years in the wards and take 'ownership' of their patients,
presenting and discussing their cases in the wards and altogether
getting involved with the treating team. The Indian medical graduate IMG
on the other hand is expected to attend lecture classes throughout the 4
years and taking 'ownership' of their patients is never encouraged for
most part of their clinical attendance. The concept of 'Patient
Ownership' (or perhaps a better label is 'developing a continuous and
positive relationship with patients' ) is something that the Indian
Medical graduate learns much later in his/her life as a clinician and
many who are not fortunate enough to be part of a 'patient centered
learning ecosystem' never feel the need to learn it?
2) The
Indian Medical graduate IMG is encouraged to be a walking and talking
encyclopedia of facts while the US medical graduate is taught to just
'look-up' what they may not know.
3) In their
lecture-presentations the Indian Medical graduate, Bhavik highlighted
terms such as radio-radial-femoral delay that are often supposed to be
important exam questions here, but Chase felt that it may not be
important to hammer every detail into the minds of students but rather
encourage them to look-up things and keep learning.
4) Our
senior resident Dr Nadiya who also joined us this week, (she has
recently completed her MD residency from PGIMER, Chandigarh and MBBS
from JIPMER) commented that a US medical graduate UMG is more mature to
handle things in the above manner and the IMG may not be expected to
know these. Medicine requires the ability to juggle both humanities and
science and most of our IMGs are already specialized in science before
they apply for medical school whereas the UMG doesn't specialize at a
high school level. Chase had finished a degree in Computer science and
was a high level coder before he became a medical student and one can
argue that it need not have made him better able to handle medicine (other than the informatics component of medicine)? Also how do we explain why
Bhavik appeared to be handling so well all the complex patient issues
that we generally do not expect from an MBBS student in India?
5)
Words that we take for granted here in India such as ragging, mugging,
whatsapp etc were being heard by Chase for the first time. :-)
In
spite of all these differences we were pleasantly surprised to find
that both the IMG and UMG teamed up to deliver a splendid performance
over their 1 week stay with us.
Other than their their involved
participation with our patients from 9:00 AM to 4 PM, and the
evening-lecture-classes they took for our students in
LNMC (
https://www.youtube.com/watch?v=v1m1hbxmdO8), they also made a great clinical presentation on one of our
patients of severe mitral stenosis and aortic regurgitation (
https://www.youtube.com/watch?v=NOn59DGoCSI,
https://www.youtube.com/watch?v=NzNpJEWcrjw). Their
demonstration (as a result of their internet searching) of other viable
low cost options to tackle the social issues around the patient's
problem went a long way toward helping the patient. I can't imagine
any PG student in a premier institute in India going 'beyond' the
discussion of 'disease related issues' and 'standard approaches to
further management,' in their presentations. Chase and Bhavik's
involvement with all their cases and their presentation went far beyond
my expectations. :-)
So how do we create an ideal global
physician with the best attributes from different learning cultures?
Bhavik and Chase may have found their own way toward an answer. Bhavik hopes
to do a residency in internal medicine in India and then travel the
globe with the orgranization 'Doctors without borders' ( aka MSF) and
Chase hopes to, after finishing his 5 year residency in internal Medicine and Pediatrics
from Harvard, serve in rural India and become a rural doctor for the
rest of his life.
Personally i have gained more from their visit than what they may have gained from us.