Wednesday, May 11, 2016

Using virtual patients to improve medical education in India

One of the responsibilities of the Medical Council of India is to make sure that the medical education provided in medical colleges all across the country is of a sufficiently high standard, so that when medical students graduate, and go out in the community to practice as doctors , they provide safe and effective medical care to their patients.

This is a complicated task, and it's quite obvious that the Medical Council has not done a very good job so far.

The majority of colleges are private medical collages, which are run by politicians. These are designed to make a quick buck for their owners, rather than to create good doctors. They often don't have the necessary infrastructure - either in the form of beds, equipment, patients or staff. The system is riddled with corruption and this has been well documented. On the day of the MCI inspection, they will add medical teachers on their rolls; and pay people to come in and pretend to be dummy patients , in order to meet the criteria which the Medical Council of India lays down.

The point of certification is not to count how many beds the hospital attached to the medical college has; or how many books there are in its library; or how many medical professors they employ. All these are just surrogate markers for the quality of training they provide, but this is all the MCI can track and monitor. What we really need to do is to check the technical competence of the doctors they train. Is the medical knowledge base of their graduates sound enough so that he can practice competently as a doctor?

This is a challenge, especially when there are so many medical colleges, and so many specialties. The medical examinations which are designed to test the competence of the doctor are of poor quality.

All they do is test the ability of the doctor to regurgitate medical knowledge on many multiple choice questions. This is not a very good way of judging whether he's going to be competent once he starts actually seeing patients.

This is why the Medical Council of India should now move on and start using simulation technology which deploys virtual patients to test trainee doctors before they are allowed to graduate. Virtual Patients are interactive computer simulations of clinical scenarios and can be used to test the clinical decision making skills of residents , to see if they can be set loose in the real world. They are great testing tools, because they check whether the doctor can apply the knowledge he has acquired to the patients he will see in real life. You can check them out and

A common medical exit graduating examination which utilises virtual patients will serve as a platform which can be used to test medical students across the country. The MCI will be able to track the performance of all the medical students of individual medical colleges, and red flag those whose students continue to perform miserably, so that they can be shut down before create too much harm by churning out too many incompetent doctors. It's also a much more transparent system , because it will no longer be possible for the medical college owners to bribe the MCI inspectors into giving them a passing grade. There will be much less corruption, because everyone will be held to the same standards. This way, we will no longer be measuring inputs, but will be able to focus on outputs - on the quality of the students who pass out through their gates.

The MCI will have access to dashboards to compare which colleges are doing well, and where the students are persistently failing. This will allow them to identify the positive deviants who are doing an outstanding job; and also help the laggards to correct their gaps and deficiencies.

This kind of platform is very easy to scale up. It's also easy to modify , so that the database can be updated to keep pace with the newest advances. Online testing technology has evolved a lot and we can learn from other examinations which are conducted online, such as the GMAT. It's high time that the Medical Council of India started using this new technology, in order to make sure that the doctors who graduate are of high quality.

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