Interview: Quality, transparency, holistic approaches become Dr BN Gangadhar’s vision as new NMC chair

Newly-appointed NMC chairperson Dr BN Gangadhar says ensuring quality medical education is his primary focus.

ByChetana Belagere

Published Jul 07, 2024 | 11:00 AM Updated Jul 09, 2024 | 7:41 PM

Dr B N Gangadhar

Renowned psychiatrist and former Director of NIMHANS Dr BN Gangadhar has been appointed the Chairperson of the National Medical Commission (NMC).

Dr Gangadhar’s appointment came at a sensitive moment in medical education in the country.

With a rich background in mental health and a passion for integrating traditional practices like yoga into medical care, he is focused on improving student well-being, ensuring the availability of faculty, and promoting transparency in medical training, aiming to create a more holistic and inclusive educational system.

In an exclusive interview with South First, Dr Gangadhar discussed his vision for elevating the quality of medical education in India.

Edited excerpts

Q: You have assumed the role of the chairperson of the NMC during a sensitive period in medical education. What will be your primary focus?

A: We have to strengthen the quality of medical education. That is the primary motive. National Medical Commission should become synonymous with quality medical education. That is the objective of the exercise. And that would be my primary focus.

Also Read: Psychiatrist calls for focus on mental health in medical colleges

Q: What are some of the challenges?

A: Yes, there are some challenges, though not too many. One is making the faculty available to students. From day one, all activities should be available for competence-based medical education, integrating subjects from premedical to clinical. Although I don’t want a strict distinction between them, clinical subjects should be emphasised differently each year.

Students should learn clinical medicine throughout the five years. Faculty availability at all levels is crucial. This is an initial challenge, but colleges are overcoming it, and more teachers and faculty are coming, meaning more experts in hospitals from the start.

A college’s strength is measured by the number of experts and the number of patients it attracts.

Education rests on these two parameters, and it’s important to take in quality students. Thanks to the NEET exam, if the top one lakh students enter, we will produce well-trained doctors for our society.

Q: Any other challenge?

A: There are many experts available in society, but there are also many attractions other than teaching. After postgraduate education, clinical practice, laboratories, and industries attract basic science professionals. These attractions are valid, but we should still produce more specialists.

For specialists not in primary teaching roles, we need to determine how much of their time can be dedicated to education. This requires discussion with educationists, universities, colleges, and medical education departments to ensure all experts are involved in some form of teaching, complementing the shortage of teachers.

Better incentives for teachers to join colleges is another issue to consider. However, I am confident that employing and retaining teachers is a process that has already begun and is evident in the last couple of years.

Also Read: NMC task force launches online survey to assess mental health of medical students

Q:  The biggest concern in medical education now is the number of students and resident doctors dying by suicide, or complaining of depression. There are cases of ragging. The allegation is that there is nobody to listen to them. What is the immediate solution that NMC is considering to end this trend?

A: It’s true that unfortunate episodes of medical doctors attempting suicide occur. This deeply pains me. We don’t have data on whether these numbers are increasing, but the student population has also nearly doubled in the past 10 years. Regardless of the data, even one attempt is too many, and we must act to mitigate this.

The anti-ragging regulation is in place, and NMC has formed a committee that surveyed 35,000 students and teachers to understand the problem’s magnitude. Based on this survey, a national-level expert committee focuses on student and teacher welfare, which is crucial for sustainable education.

Recently, we asked colleges to publicly post the stipends they pay to interns and residents, ensuring students receive the support they deserve. This information should be available for public awareness.

We have several recommendations from the committee’s report, peer-reviewed by experts both within and outside the country. Implementing these recommendations will be balanced against the costs to colleges.

One key initiative is the mentor-mentee program, where each student is assigned a faculty mentor. This mentor supports six-10 students, guiding them through curricular and other concerns over their five years of study. This programme fosters a sibling-like relationship among students, reducing the senior-junior divide and ragging.

Q: Is there anybody monitoring it? There are so many existing guidelines and recommendations but nothing is happening on the ground.

A: What is important is that colleges need to self-regulate. Colleges must rise to the occasion, and follow recommendations. NMC cannot micromanage. If incidents of ragging decrease, it indicates effective monitoring.

We have a good system in place and don’t need policing on every issue. Monitoring every small element could interfere with colleges already doing a good job. These are value additions we suggest. Policing every college is not advisable. Colleges should learn from each other and set high standards.

NMC should focus on monitoring the quality of training, the syllabus, the quality of students, and research activities. These are the key areas of focus.

Q: Among the various criticisms directed at the NMC, a significant concern is the lack of transparency. Critics claim that the NMC fails to respond to RTI queries and does not upload necessary data. How do you address these charges?

A: Last year, we uploaded the letters of the final results of the evaluations of the college’s applications. Patient data, personal data of faculty, and financial data of colleges are sensitive. We are debating what is relevant to the public. Over time, we will evolve something useful. The act says assessments and ratings must be public, and they will be once we start doing the ratings.

Also Read: Doctors still punishable for medical negligence in new criminal law bill but IMA cheers it.

Q: What about the safety of doctors? They are constantly working under pressure, facing fear of attacks by family members, relatives, and sometimes political goons. Are you working towards addressing this issue?

A: This is very important. Hospitals run by medical colleges account for about 1,000 hospitals, but there are at least 10 to 20 times more hospitals in the country. It’s a concern not just for NMC but for the medical health service as a whole. We are all worried about violence against doctors.

Educating students and doctors about attitude, ethics, and communication is crucial. Frictions between patients, their families, and doctors often arise from communication difficulties. The syllabus now includes an Attitude, Ethics, and Communication module to train doctors in these skills. These skills, along with technical competence, will help mitigate friction and improve doctor-patient relationships over time.

Supporting doctors and preventing violence is also a broader issue that the health department is addressing.

Q: While doctors are pressing for a separate law to protect them, the Bharatiya Nyaya Sanhita (BNS) brings them under the ambit of a new law. What’s your take?

A: As a government servant, I will refrain from commenting on this question. The entire medical fraternity is looking at it, and I’m sure there will be an action plan. The NMC itself is not directly involved in this issue. Our focus is on the quality of medical education.

Q: Another important issue is the NEET exam. What is your take on recent developments in NEET?

A: NEET is an excellent way of screening the best students nationally for medical education, both UG and PG. About the recent developments, the government is examining these issues. It is not something I am directly involved in.

Q: You have been credited with integrating yoga into clinical applications for mental health. Do you have any plans to incorporate similar holistic approaches into medical education?

It’s too early to make a definitive statement. However, there are a few key points to note. An integrative medicine research unit is required in most colleges. Each college can integrate traditional methods differently into its clinical services.

For instance, evidence is emerging on the benefits of yoga for mental and physical health. If another system of medicine offers benefits, our doctors need to know how to integrate it into holistic treatment approaches, whether they practice it or not. Integrating beneficial practices from other systems is important and will evolve.

My research and others’ work show the benefits of yoga, and leading institutions have started integrating these practices. The integration process requires building evidence and providing hands-on experience to students, which is why we mandated integrative research units in all colleges.

Leading national institutions have already started to include yoga or similar systems as collateral services. Research integrating these practices has already begun, and many corporate hospitals are introducing yoga practices into clinical practice. Some research is emerging from these hospitals as well.

We mustn’t be exclusive in our approaches but rather inclusive for the benefit of the patients. This approach will evolve, and encouraging this integration is required.

Apart from the integrative research units in medical colleges, we also suggested an elective clinical posting for students during their internship.

If there is an opportunity in the college, students can choose to get exposed to yoga or similar practices, although it is not mandatory. This posting allows them to experience these practices for a week or 10 days. Over time, doctors from allopathy should have the liberty to choose traditional systems of treatment to integrate into their clinical practice, rather than being exclusive.

Evidence-based scientific research is crucial. Any approach to integration must be based on sufficient evidence. Both experience and evidence in clinical research will potentially lead to successful integration, and time will tell how well it unfolds.

(Edited by Majnu Babu)

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