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 Table of Contents  
LETTER TO EDITOR
Year : 2021  |  Volume : 7  |  Issue : 1  |  Page : 66-67

De-emphasizing time-based training in the delivery of competency-based medical education for undergraduates in India: Justification, challenges, and potential solutions


1 Member of the Medical Education Unit and Institute Research Council, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Ammapettai Village, Nellikuppam, Chengalpet District, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Ammapettai Village, Nellikuppam, Chengalpet District, Tamil Nadu, India

Date of Submission25-Dec-2019
Date of Acceptance23-Mar-2020
Date of Web Publication25-Mar-2021

Correspondence Address:
Dr. Saurabh RamBihariLal Shrivastava
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Thiruporur - Guduvancherry Main Road, Ammapettai Village, Nellikuppam, Chengalpet District - 603 108, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJAM.IJAM_71_19

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  Abstract 


In the conventional medical curriculum in India, the duration of medical graduation is 4.5 years, excluding internship. The limitation of time-based advancement can be understood in two ways, either a student is sent to next professional year without attainment of the desired course outcomes or that students spend unnecessary time in a specific professional even after gaining the required outcomes. Acknowledging these limitations and also after realizing the multiple benefits attributed to Competency Based Medical Education (CBME), the same has been implemented in the Indian set-up for undergraduate courses from 2019 batch onwards. In general, CBME advocates against time-based training, especially because not every student can learn at an identical pace. However, adoption of the same strategy (time-variable) in imparting medical education has its own challenges. In India, even though, in principle, we have adopted all principles of CBME, except the time-variability of the course. However, now the same question arises, if all students learn at varying pace, how can we ensure that within a specified time duration, all the students will attain the desired outcomes? Even though, the task at hand is difficult, it can be accomplished, if we all work together in a planned and coordinated manner. In the mission to produce a competent medical graduate within a defined time interval, there is an immense need for better planning, support from administration, active participation of faculty members, involvement of the students, and better collaboration between departments.

Keywords: Curriculum, Competency Based Medical Education, India


How to cite this article:
Shrivastava SR, Shrivastava PS. De-emphasizing time-based training in the delivery of competency-based medical education for undergraduates in India: Justification, challenges, and potential solutions. Int J Acad Med 2021;7:66-7

How to cite this URL:
Shrivastava SR, Shrivastava PS. De-emphasizing time-based training in the delivery of competency-based medical education for undergraduates in India: Justification, challenges, and potential solutions. Int J Acad Med [serial online] 2021 [cited 2021 Apr 11];7:66-7. Available from: https://www.ijam-web.org/text.asp?2021/7/1/66/311883



To the Editor,

In the conventional medical curriculum in India, the duration of medical training is 4.5 years across three phases, excluding internship, with the entire course being divided into four professional years. The limitation of time-based advancement can be understood in two ways: either students are sent to the next professional year without attainment of the desired course outcomes (often true in the case of slow learners or average students) or that students spend unnecessary time in a specific professional year (especially for advanced learners) even after gaining the required outcomes, just because the duration of the year is already specified and unless the time is over no professional advancement is permissible.[1],[2]


  Competency-Based Medical Education and the Time Factor Top


Acknowledging these limitations and also after realizing the multiple benefits attributed to competency-based medical education (CBME), CBME has been implemented in the Indian undergraduate courses from 2019 batch onward. In general, CBME advocates against time-based training, especially because not every student can learn at an identical pace. In other words, the idea has been to move from fixed duration, varied outcome (conventional curriculum) to fixed outcome, and varied durations in CBME.[2],[3]

The case of fixed outcome for all medical graduates is essential, as it will warrant the provision of standard and quality assured care along with maintaining the safety of patients, regardless of the knowledge/skill levels with which a student enters the course of medicine.[1],[2],[3] The main focus is on how well a student has accomplished an outcome rather than how long or how many attempts they required to attain the outcome.[3] This ensures that regardless of the learning styles or abilities, all the medical students accomplish the desired learning outcomes by the time of completion of course, so that they can be globally relevant.


  Challenges Attributed to Time Variability in Competency-Based Medical Education Top


Adoption of the same strategy (time variable) in imparting medical education has its own challenges.[2],[3] The first and foremost is that the duration of the course is quite long (in comparison to other professional courses) and if the duration increases further, it will surely increase the stress level among the budding doctors, especially considering that the curriculum is demanding and requires a lot of commitment and dedication from the students. Moreover, from the curriculum design perspective, the overall process of planning assessment, monitoring progress of students, implementation of remedial measures, and the elements involved in taking a high-stakes decision is a herculean task. Further, the task of defining enough number of competencies which are essential for the medical undergraduates to work as a primary care physician is a challenging process.


  Competency-Based Medical Education for Undergraduates in India: Potential Solutions Top


In India, we have adopted all principles of CBME, but the time variability of the course has not been adopted.[4] However, now the question arises, “If all students learn at varying pace, how can we ensure that within a specified time duration, all the students will attain the desired outcomes?” Even though the task is difficult, it can be accomplished, if we all work together in a planned and coordinated manner.[1],[2] This will require adequate training of faculty members not only to sensitize them about CBME but also to ensure that they can understand the level of learning of students and then plan remedial measures for the attainment of the learning outcomes. In addition, faculty members should be sensitized about the use of innovative teaching–learning methods, effective use of integrated teaching sessions, and systematic planning of early clinical exposure/Attitude, Ethics andCommunication Module sessions all of which will play an important role in enhancing the understanding about the subject. At the same time, faculty members have to be more accountable and proactive in the entire process and also remain engaged in the process of mentoring and giving constructive feedback.

Further, the implementation of CBME will require a supportive administration, which takes care of the logistics and other materialistic resources for ensuring that learning occurs smoothly.[1],[2],[3] In Shri Sathya Sai Medical College and Research Institute, a constituent Unit of Sri Balaji Vidyapeeth, Pondicherry, the college administration has been extremely supportive in launching newer initiatives for ensuring a better learning experience for the students. These initiatives include incorporation of alternative medicine in the Foundation Course (Music Therapy and Yoga Therapy sessions), e-learning sessions, and inclusion of interactive teaching-learning methods like problem-based learning sessions. As we are advocating for the student-centered curriculum, the students also have to be sensitized about the entire process in the foundation course itself and they need to be motivated periodically as the onus of their learning rests with them.[1],[2] Moreover, there is an indispensable need to foster better collaboration between various departments, and hence that students develop clinical reasoning, critical thinking, and problem-solving skills. In other words, the teachers need not only aim to complete the entire syllabus within their phase of teaching by themselves but also to explore the scope of integrating topics with other subjects, so that students get a holistic picture.


  Conclusion Top


In the mission to produce a competent medical graduate within a defined time interval, there is an immense need for better planning, support from administration, active participation of faculty members, involvement of the students, and better collaboration between departments.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
van Rossum TR, Scheele F, Sluiter HE, Bosman PJ, Rijksen L, Heyligers IC. Flexible competency based medical education: More time efficient, higher costs. Med Teach 2018;40:315-7.  Back to cited text no. 1
    
2.
Mejicano GC, Bumsted TN. Describing the Journey and Lessons Learned Implementing a Competency-Based, Time-Variable Undergraduate Medical Education Curriculum. Acad Med 2018;93:S42-S48.-  Back to cited text no. 2
    
3.
Kogan JR, Whelan AJ, Gruppen LD, Lingard LA, Teunissen PW, Ten Cate O. What regulatory requirements and existing structures must change if competency-based, time-variable training is introduced into the continuum of medical education in the United States? Acad Med 2018;93:S27-31.  Back to cited text no. 3
    
4.
Shrivastava SR, Shrivastava PS. How to successfully implement competency-based medical education in India. Educ Health Prof 2018;1:61-3.  Back to cited text no. 4
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