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Need shift from knowledge-based to competency-based assessments: Rajiv Gupta

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Rajiv Gupta, Country Business Leader – Healthcare Business, 3M India explains how COVID-19 has changed medical education and training initiatives and how his company is helping to address the gaps. He believes better training will address redundancies, increase efficiency and utility leading to better patient outcomes and decreased overall cost of healthcare. Edited excerpts of an interaction with Viveka Roychowdhury

How has COVID-19 changed medical education for students, their instructors as well as upskilling for practising clinicians, nursing staff?

There is no denial in the fact that COVID-19 has been a disruptor but could as well be a much-required catalyst to transform healthcare. Globally, an independent commission in 2010 had asserted the purpose of medical education is to improve the health of the community. The pandemic has bought in the clarity and urgency to this purpose. We have started to see the changes in the medical curriculum design already. We will probably see more focus on disaster/ pandemic management and emergency medicine in the undergraduate curriculum. However, it’s a long journey, and we need to be focused on the goal.

All the medical institutions and students are eagerly awaiting to get back to their regular classes. Quite importantly so, as being able to communicate and hands-on with patients are a crucial aspect of the learning. With no option left to avoid interruption in the education, even MCI has supported the initiative of online learning. However, we need to do an analysis of the effectiveness of such tools.

In the case of students, due to the pandemic, many students have returned home. The mode of interaction with faculty has mostly been virtual, for example, by call, online classes through Microsoft Teams, Google hangout, Zoom etc. Although they are getting used to this new normal, students are facing issues in terms of understanding, interaction and networking. The first few years of medical and nurses education are more theoretical and later part involves clinicals which involves interacting with patients, understanding procedures, hands on, learning by observation and  examination which have come to a halt. For example, surgery students have missed the last eight months of practical experience.

Instructors have switched to online teaching through various platforms. The pandemic has made them adopt technology which they considered good. Meanwhile, they struggle to educate students on practicals as medical and nursing education is based on bed side and small group teaching. They are unable to access its effectiveness via online.

As for upskilling, we have got the feedback from various sections of the market.

From clinicians, the feedback is that in the last eight months depending on the setting, either the clinician has seen more COVID-19 cases or less routine cases. Certain specialties like ophthalmology, ENT, ortho and others has seen less surgery so clinician have fear of losing their healing touch of practice. Clinician have upskilled more on COVID-19 and PPE than their regular topic of interest as many fora like workshops, conferences, peer to peer learning activities have stopped. Upskilling through online webinars has been going on but people are less interested in online webinars due to the focus again being on COVID-19 management.

In the case of nurses, due to the pandemic, nursing education has taken a hit similar to medical education due to less workshops, social distancing and dearth of nurses for COVID-19 care.

Healthcare staff are at particular risk during the COVID-19 pandemic as they treat COVID-19 cases and risk getting infected themselves. How can they be trained to treat while taking precautions to keep themselves safe, especially during high risk treatments like dental wok etc?

In a paper published in The Lancet dated September 1, 2020, Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study puts the initial estimates at 10-20 per cent.

According to the authors, ensuring the adequate allocation of PPE is important to alleviate structural inequities in COVID-19 risk. However, because infection risk was increased even with adequate PPE there is a need to ensure proper use of PPE and adherence to other infection control measures. It is important to understand the various types of PPE and their use based on the job at hand and environment. At 3M, we are putting extra effort to communicate these to healthcare workers through our “Healthcare Worker Safety Program”.

There are reports that faced with pay cuts post COVID-19 in India, many doctors and nurses are taking up positions in the UK, EU as these countries gear up for the COVID-19 surge this winter. Can more affordable and accessible upskilling opportunities prevent the brain drain of India’s medical staff to other countries?

Brain drain has been a harsh realty in pre-COVID times too. It is primarily demand led with opportunities available at countries with significant difference in wages and the work conditions. In India, it took the Government to invoke the Epidemic Diseases (Amendment) Ordinance 2020, amending the Epidemic Diseases Act, 1897 to address the violence against healthcare workers.

Upskilling is a double-edged sword when it comes to brain drain. However, providing opportunities with equal parity and truly accepting the HCPs as the real heroes will certainly help to reduce it.

How does 3M view the gap between real life practices and what is taught in medical/nursing curriculum? What are the consequences of this gap in terms of clinical outcomes and career progression of healthcare professionals?

The purpose of medical education is to improve the health of the community. The shift from the knowledge-based assessments to competency-based assessments is the crux of the change required. We at 3M do our small bit to improve this competency through our CME programmes, be it wound care or infection prevention.

Improved competency has a definite positive impact on the patient safety and outcome. While 3M does not offer any certificate courses, our education offering certainly help the HCP to obtain new certifications without hassles.

How can better training result in better patient outcomes as well as savings and efficiencies in hospital practices?

At the end, we are all talking about health economics. The cost of health care is increasing globally. Cost-effectiveness analysis, cost utility analysis and cost benefit analysis should be the guiding principles. All of it is tied to the practices the HCP employs or deploys. Better training will address the redundancies and increase efficiency and utility to get better patient outcomes and decrease overall cost of care.

With predictions that pandemics like COVID-19 are only going to get more common, how can we ensure that medical staff are in tune to spot emerging infectious diseases, so that they can raise the alarm early and protect themselves as well as patients?

Let’s accept, we assumed we were ready for a pandemic but in reality it was very different. COVID-19 has exposed weakness in the most advanced healthcare systems and questioned the healthcare infrastructure. Learning from the current crisis and how each country has been battling in their own way with different constraints is the only way forward. Never before is the role of microbiologists, infection prevention experts and epidemiologists at the forefront and crucial. We need to invest more in these specialities.

How can this be bridged during the course of the studies as well as during the career of healthcare professionals?

This can be done by modifying the curriculum to meet the need to improve community health and stressing on competency based assessments.

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