Dear Readers,
Conventionally, the training program for postgraduates is time bound and syllabus
based. It focuses on knowledge acquisition and relies on the summative assessment
at the end.
Is this adequate to produce a competent professional?
The question is not new, but, becoming more relevant with mounting healthcare demands
in conjunction with rapid innovations. There is a growing shift of strategy towards
competency-based medical education (CBME) from traditional fixed duration of training.[1] In this, the trainee is taught phase-wise, acquiring core procedural skills with
application of knowledge and undergoes a periodic formative assessment. The tenure
is flexible and extends until the trainee is competent and confident. This strategy
appears to have obvious advantages, but, faces multifactorial challenges and obstacles
in practical implementation, such as, lack of flexible curriculum, faculty development,
higher cost, lack of uniform assessment tools, and inconsistencies in the CBME definition
itself.[2] It is at present in the introductory level and evolving. That leaves with the lone
option of augmenting the existing structure into a more objective and competency based
training, which is applicable uniformly across the country.
In this regard, the post-graduate education committee of the Medical Council of India
(MCI), clearly defines the objectives of training, which is to produce competent specialists,
who shall practice, teach and fulfil the needs to cater prevailing problems in the
country related to that speciality. It is based on the established principles of learning,
wherein, the student is expected to acquire knowledge (cognitive domain), professionalism
(affective domain) and skills (psychomotor domain).
The major components defined by the PG medical education regulations (amended up to
July 2017) are (1) Theoretical knowledge, (2) Practical and clinical skills, (3) Writing
Thesis/Research articles, (4) Attitudes including communication skills and (5) Training
in Research Methodology, Medical Ethics and Medico-legal aspects.[3] These are applicable to all the broad and superspeciality courses.
The first curriculum of plastic surgery was prepared more than 50 years ago. The effort
of our excellent teachers in this regard is noteworthy. In 1964, the first Post-graduate
Medical Education Conference was convened by the MCI under the Chairmanship of the
then Union Minister of Health Dr. Sushila Nayyar at Delhi. It was the meeting to standardise
post-graduate curriculum of different specialities. The recommendations were carefully
supervised and adopted by the MCI. A group of stalwarts attended this meeting to draft
the plastic surgery syllabus, which was convened by late Dr. C. Blalakrishnan. Members
who contributed include Dr. N.H. Antia, Dr. R. N. Sharma, Dr. M. Mukherjee, Dr. R.
N. Sinha, Dr. J. L. Gupta, Dr. Charles Pinto, Dr. R. L. Manchanda and Dr. R. K. Keshwani.[4]
Since then, the speciality has witnessed the transformation with rapid progress. The
previous 2-year course is at present 3 years continuance. Currently, 193 seats of
M. Ch. Plastic and Reconstructive Surgery are available in 69 medical institutions
affiliated with 35 various universities/deemed universities across India. In addition,
18 institutes are offering Diplomat of National Board (D. N. B.) in Plastic Surgery.[4] Each of these universities is guided by their own academic council leading to disparity
in the curriculum.
The Association of Plastic Surgeons of India (APSI) took up the initiative to integrate
the current PG guidelines of MCI with the existing curriculum of various universities
to formulate a uniform curriculum, designed to be followed across the country. This
all-encompassing document engrosses every aspect of the revised PG regulations of
MCI beginning with eligibility, learning objectives such as theoretical knowledge,
clinical and operative skills, activities of learning, teaching, research methodology,
professional and personal attributes and combination of formative and summative assessment
with the exit examination. It serves many purposes such as bringing all the teaching
units under the solitary parameter of standards and achieving the objectives of PG
education regulations of apex Medical Council of the country. In addition to ensuring
patient safety in health care, this document serves as an authority for practitioners
to withstand legal scrutiny. It is desirable and recommended to amend the curriculum
periodically.
