Healthcare education in India is a critical part of the evolving healthcare system of India. Though there have been many advances in medical technology, have the medical colleges adopted advanced technologies to produce the physicians of the future? To know the answers we spoke to Dr Lalit Singh, MS General Surgery, Director Content and Product Strategy at Elsevier.

Healthcare India: There has been a rapid increase in number of medical colleges in India in last decade as the Govt pushes to improve the poor Doctor-Patient ratio in India. What are the unique challenges the medical students face during their education?

Dr Lalit Singh: Medical Education in India needs to be seen in a larger context. Unlike in The US where we have graduates joining the medical schools, in India we have these young girls and boys, 17- 18 years of age, who have finished their class 12^th and qualified a very competitive entrance exam to gain admission into medical colleges. These young, dynamic and intelligent boys and girls are, more likely than not, capable of taking on the load of years of medical education, and challenges thrown at them by the rapid technological advances in medical sciences, new discoveries and changing regulations. However, that’s not all that is required of them. They are also expected to understand the complex socioeconomic situation of our society and have high level of emotional intelligence to deal with the illness and trauma around them. So, basically, we expect them to grow up all too soon and these expectations put additional pressure on their young minds. This to me is the most important and unique challenge for the Indian medical students.

Healthcare India: Digital seems to be a panacea for all ills. Can Digital help in reducing some of the burden and reducing the stress as these young students evolve into lifesaving physicians and surgeons?

Dr Lalit Singh: It’s a very important question. Good digital learning tools are a very important asset for the medical students. To understand this point, we need to first understand the basic problem these students face. The three biggest challenges in the study of medicine are visualization of subject matter, integration of learning across the subject areas, and finally applying the learning in a clinical setting to solve a real life medical problem.

For example, the student studies about the liver in many subject areas spread through the years of studies before they get to apply their learning to solve a real clinical case – They will study the structure and normal physiological and biochemical functioning of the liver in the first year across three different subjects, then they will study about the structural and functional flaws in the liver, how and why does it start behaving abnormally in a given disease condition in the second year and then finally they will study the treatment part of the equation in the final professional, where they will learn how do they set the wrongs f liver right in a given case – by using drugs, surgery, or other treatment modalities, as needed. So, you can see that the student must be able to visualize a lot of normal and abnormal structural aspects, and how these structures work in the given normal or abnormal circumstances. They then must be able to assimilate all their learning from different subject areas they have studies across the years before they can think and plan how to use this collective learning into clinical use and practically apply these to treat a patient in real life setting. I think digital is the answer to this complex problem.

Healthcare India: Do you mean more simulation and practical hands on training leveraging Digital?

Dr Lalit Singh: Now, as you can very well understand that good digital learning aids help these students in overcoming all three challenges discussed above – they help the students in visualizing difficult anatomical and physiological concepts by making these concepts live for them, then these aids help the student in integrating these concepts from across the subject areas to make it truly practical and finally these tools help the students in practicing their learning in simulated clinical settings to hone their judgement and skills before applying these on actual patients in real life. Taking the case of liver again – using a good digital tool, a student can not only visualize the structure and functions of a normal and diseased liver, but can use simulations of common disease conditions to practice their diagnostic skills and clinical decision making in the lab before touching a real clinical case. This makes learning fun, less stressful and applied and helps students get ready for real life without putting people at risk. It’s very like a trainee pilot learning how to fly an aircraft in a flying simulator before taking charge of an aircraft full of people.

Healthcare India: This is all great and sounds logical, but can digital education help improve quality of medical education?

Dr Lalit Singh: Like in any other course, medical colleges attract students from different education systems and socioeconomic backgrounds. This makes the job of medical teachers challenging, as they must cover vast syllabi in a limited time frame and that doesn’t really allow them to take care of individual needs of students in a class. This means some students can be left behind on the learning curve, which if left unattended can lead to producing physicians with limited knowledge. Combined with the fact that we have massive shortage of qualified medical teachers in India, this affects the overall quality of medical education.

Digital education tools have a very important role to play here, as they help address both these fundamental issues and aid both students and teachers. Unlike traditional in-person lectures, digital adaptive learning environment allows the teachers to customize the course offerings to the individual capabilities of their students, while still ensuring that they cover the designated curriculum and help each student in the class cross a minimum benchmark on learning outcomes. The benefit for the students is that they can learn at their own pace whenever and wherever they prefer to study, they get regular feedback from the course instructor on what aspects of the subject they should focus on and frequent assessment of the student allows the system to push and suggest what content the student should be studying to reach to the minimum benchmark. So, technically speaking every student a given class could be at a different level of understanding and could be reading different aspects of the given topic at any given time, and the instructor could still know what precisely a student is struggling with so that they could customize the content and pace of study for each student in the class. As you would imagine, adaptive learning can have enhanced effect on learning and ensures improved learning outcome for students, thereby positively affecting the overall quality of education.

Healthcare India:  This is great, but still there is always a risk of a section of the medical class being left out if the pace is not appropriate to them. Is there a way to optimize the speed of learning?

Dr Lalit Singh: As mentioned above, personalized education made possible by adaptive learning tools allows the teacher to adjust the pace of learning for each individual student in the class. One could argue that this would mean that not all students in the class will learn equally at the end of the class. But the idea of adaptive learning is to optimize the learning outcome at a class level, while maximizing the learning outcome for each individual student. The fact that all the students in the class must pass the final exam to qualify as physicians, thereby ensuring that all the students reach a minimum defined level of understanding and competency on the given subject or topic, means that adaptive learning helps a class achieve consistently higher level of understanding. Also, frequent assessment of the students throughout the course ensures that each student is fed with just appropriate amount and level of content to suit their individual needs.

Healthcare India: In our experience, we see medical subjects more theoretical and not practical, how can Digital change that and make learning fun?

Dr Lalit Singh: It’s true that many students find some medical subjects too theoretical. But then it’s a relative interpretation, for some more creative students may be able to visualize and integrate the given concepts better than some not so creative students. Digital tools and learning environment help these students overcome such issues by enhancing the audio-visual appeal of more theoretical subjects. Modern “Problem based learning” and “Theme based learning” methodologies make the whole learning of medical concepts very much “applied” by bringing real clinical context into the process of learning. Application of gamification concepts to clinical learning makes it more fun for the students. Students can use the games to not only learn the concepts, but also to practice and revise these concepts as per their convenience. This is especially important for India, as we have deep penetration of smart mobile phones and the high speed 4G network is also expanding very rapidly.

Healthcare India: What is your vision for the medical classroom of tomorrow?

Dr Lalit Singh: Sir William Osler once said – “I desire no other epitaph… than the statement that I taught medical students in the wards, as I regard this as by far the most useful and important work I have been called upon to do.” I think over the years, we the medical educators have forgotten this age-old wisdom and moved away from clinical teaching.To me, the medical class room of tomorrow will not be meant for delivery of lectures, but about teaching the students the science of human body and ways to diagnose and alleviate her ailments and all that without making an already suffering human being suffer more by making her the subject of education. Technology will be the enabler of education in more ways than one – will help replace lectures with discussions, sick patients with computers and distressed students with excited minds ready to learn more!

Thank you for taking the time to speak to us. Based on this discussion we feel the future of medical education in this country is bright and would be delivered on digital.

For those who want to know more about how the digital is changing the way education is delivered in medical colleges, please check Clinical Learning which is an interactive digital resource to aid teaching and learning of clinical and practical skills for undergraduate medical curriculum. We will continue to look at others areas in medical education that are changing as we build the next generation of healthcare systems and processes in India.

(Featured image licensed to Elsevier)