Medical Education and Practice - India vs England

One of my Facebook friends has asked me to pen a post on comparing the teaching system in the U.K. with that from India. Frankly, there is no comparison. Firstly, the kind of illnesses we see in India and the ones that we see in the U.K. are quite different. Secondly, our healthcare systems are completely different. In India, we work with limited budgets, whether in government/municipal hospitals or in private clinics/hospitals. 

In the U.K., too, there are some budgetary constraints, but the supplies are all top-class, and there is no shortage of essential as well as non-essential stuff, except for the items which are in the very expensive range. 

Thirdly, and this is the most important difference: the system is driven by evidence - the kind of evidence that comes from research and trials - and is completely based on protocols that are specific to each institution but framed from national and international data that is published by national-level agencies. Such evidence is periodically reviewed so as to be abreast of the current knowledge. This kind of evidence is completely lacking in India. Individual doctors may, from time to time, update their knowledge base and use this to help their own patients. Devising of hospital-wide uniformity of treatment never does occur, so that every doctor treats the same condition differently, based on their own learning, experience, and hearsay from their peers.

Coming to teaching: We have excellent teaching in India as well, but it is fragmented. Doctors learn from their seniors when they are students, but as soon as they start a private practice, they give secondary importance to continuing education. The Medical Council of India and state-level bodies like the Maharashtra Medical Council etc. have recently moved to enforce that every registered practitioner should have a certain number of points to be able to stay registered on the professional register. However, the points can easily be collected by sending the money to the organisers of teaching programs and then receiving the participation certificate in absentia. Many a times, doctors will attend a conference or learning seminar just to get the points, but not use the learning to improve their practice. Occasionally, doctors will, for reasons of expediency, join programs that are not even from their own speciality, just to gather the required points.  

In the U.K., learning is referred to as teaching! Thus, when a student says that they are going for teaching, they are actually going for learning. While I haven't done my formal medical training here and cannot, therefore, comment on how their teachers are, I can definitely say that medical students here are far more experienced than Indian medical students are, in practical, hands-on experience. This is because, from their third year onwards, when they attend the wards (just as we did or do in India), they begin to clerk patients in a proforma, taking the patient's history, examine them, etc. and they will, in their fourth and fifth years, be expected to give a differential diagnosis, and formulate a plan of management for that patient. This allows them to think like practicing doctors years before they actually will practice clinical medicine. 

What really makes the difference in their training, however, is the fact that they have to collect, and later produce, evidence of their learning. This has to be uploaded by them electronically, and I have often had students presenting a medical case to me and then coming back a few minutes later to take my digital signature on their mobile phones to collect the evidence that they did, in fact, present a case to me. They will also sometimes send us a link to give a feedback on how their performance went. This is a requirement for them and not an option. This enables them to advance professionally in a more structured, evidence-led method than the kind of haphazard learning that we have in India.

I hope this answers the question for my friend, and helps others too, to understand how the system works in the U.K.   

Weekend update

I have been quite irregular of late - in updating this blog. My apologies to the regular readers. If you are stumbling upon this blog for the first time, welcome. I am an Indian-origin Paediatrician who writes about his life in the U.K. here. My name is Taher. It has been over 18 months since I moved to Blackpool. This is a coastal vacation town on the Irish Sea coast and geographically belongs to North-West England, and to Cumbria, and even more specifically, to Lancashire. 

I am working as a junior doctor in the NHS-run Blackpool Victoria Hospital. I am gradually learning a lot of practical skills and am able to navigate the system almost 100% now. 

Last week, a few positive things happened. I inserted a peripheral long line into a newborn baby for the first time - and it was quite easy. I was supervised by the consultant who is in charge of neonatal services at our hospital, and who is also MY educational supervisor. The baby was the second of twins and was born, like his sibling, 9 weeks earlier than term. I had observed this procedure 2-3 times but had never done it myself. Hence, doing it accurately and correctly the first time was extremely satisfying. To understand what this procedure is all about, see THIS YT video. 

On Saturday and Sunday, I went to Whiston Hospital to do locum duties. They had arranged for my accommodation within the Neonatal unit by allocating to me one of the rooms reserved for relatives of babies who are admitted to the unit. Hence, it was a breeze to work. The Paediatric department of the hospital has two wards - one each on the third and the fourth floors. This can mean a bit of running around between two floors. Their A & E is located on the bottom floor, and one keeps getting called there to see new patients who have been referred to them through the G,P, or the community walk-in centre. While Saturday was a relatively quiet day, I had several calls from the A&E on Sunday. I did, however, find the time to go for lunch in the hospital's top floor restaurant on both the days. They had a lamb rogan josh with rice on Saturday. It was very good. On Sunday, I had their lamb hot pot with pastry. This was so-so, but wholesome, to say the least. 

On both the days, I had dinner from my own supplies that I had brought with me from Blackpool. This was mostly a collection of samosas and lamb pattice with chappatis. In addition to the meals, I had a lot of tea and some coffee - machines with free tea and coffee are installed in every clinical area. Overall, it was a good experience. 

That's it for now. See you around. Do follow me if you wish by adding your email ID to the Follower's list. And, if you feel like it - do comment in the space below this post to tell me what you thought about this post. 

And hey, do view that video ... Thanks. 

Learning and Teaching - two sides of the same coin

There is a student inside all of us. And a teacher as well. Everything that we see is a form of learning. Everything that we do is a form of teaching, provided there is someone who is with you at that moment. For me, the presence of anyone who is receptive enough is stimulus to want to teach. Conversely, if I think I need to learn something, I would explore whatever is happening around me to seek the best and imbibe the information.

Guys, you all know me. I am always curious to learn. My chief go-to sites are www.coursera.org and www.edx.org. They conduct several MOOCs - (Massive Open Online Courses) in all areas of teaching and from universities from all over the world. Joining and auditing the entire course is, of course, free. The courses run for about 5-10 weeks. It consists of mandatory stuff  like taking a pre-course survey, attempting the end-of-the-week writing assignments or quizzes, watching all the video lectures, etc. The amount of time you need to do the "homework" is about 4-7 hours/week. If you want to collect an authentic certificate of having done the course, you might need to send a payment using your credit or debit card etc. These payments are really not large. For example, in the UK, it works out to around 40-60 pounds for the "Verified Certificate".

So, which courses am I currently doing? On Coursera, I am doing a course on Astronomy. On FreeLearn, I am currently doing a Patient Safety and Quality course from the University of Bath. And, finally, from the  edx site, I am enrolled on the "Humanitarian Response to Conflict and Disaster" - a close look at the global problem of providing effective humanitarian aid to those at the forefront of a war that they did not bring upon themselves. 

Three courses simultaneously, did you ask? The answer to this is YES. It does get a bit busy sometimes, but I am coping with it all. And really enjoying myself. 

Which brings me to the second side of the coin of education, i.e, teaching. As I am not a trainee, I do not do formal training. However, I do a lot of informal teaching. I taught a pair of IIIrd year medical students today itself. It was a bedside teaching on lumbar puncture in neonates. When you teach, you get the immense satisfaction of sharing your knowledge with others. It almost feels like you are donating to someone else. A sort of charity, if you may call it that. But it's more than that. When you teach, you also learn. And this line is for those who teach. You revise your knowledge, of course, but you are also forced to check your knowledge in real time. By doing this, you become an even better teacher than what you had been before.

Tell me your own experience as a teacher and as a student. Thank you for reading this installment.

Sharing lots of news

Since I last wrote a post on the 27th of November, a lot of water has flown under the bridge. My appointment became formal from the 1st of December, and hopefully, my first salary should come in a few days before Christmas. That is one good news. The next one is that I have completed my health assessment and I should start my routine duties from the 15th of this month. That will definitely help me to start working with real patients, hands on. The third good news is that I have registered myself with the NHS (National Health Service) for my own health, and was able to get my medicines free of cost for the next entire month. This means that I will no longer have to lug a huge stock of medicines with me from India. 

I have also occupied myself with attending interesting talks. Yesterday, I went all the way to London, to the HQ of the Royal College of Paediatrics and Child Health, to hear the Annual Christmas Lecture by  Sir Micheal Marmot from the London College Hospital's Epidemiology Department. His talk was on "The Health Gap: Addressing inequalities in the delivery of Health care, and the Importance of Community Health care". It was a brilliant lecture indeed. However, more than the lecture, I enjoyed my one-afternoon trip to London very much. I met one Dr. Pradeep Sahare of Nagpur, who works as a Community Pediatrician in the UK. During my return journey, I met with and befriended a British woman, a struggling actor by profession, one Ms. Julie H.. as we were sitting across from each other on the long journey back from London. She turned out to be a very jovial and interesting woman indeed. As we parted at Warrington, a few stops before my own destination at Preston (where I would change to another train to take me back to my home town), we exchanged our contacts and promised to be in touch. You could say she is my first British acquaintance outside the setting of the Hospital.

Today, I attended one more interesting talk. It was a half-day workshop on Being Resilient. It was conducted by one Ms. Bec Howard, a life-style coach, and it was just super! The main message of the entire 3+ hours of learning was to dig in there, despite the ups and downs of life around you, and to retain your fresh attitude and persist in doing the right thing so as to emerge a winner and a leader that others around you can look up to. 

I am also due to appear for an interview before the Job centre in Preston in connection with my enrollment for a National Insurance number. This interview is scheduled for later this month. 

I am actually beginning to like my accommodation inside the hospital. I have made myself home here, and have organised my two rooms and the available storage in the kitchen to reflect my own needs. As I share the flat with another doctor (an Iraqui resident in Medicine), I have to respect his needs and space as well. On the whole, though, he and I live in quite different ways. He does not cook much, and gets all his food from the shops outside - but mostly from within the hospital, where we have two big brand shops, viz. M & S and W H Smith. Whereas I, with my genuine liking of cooking and self-cooked food, have expanded my larder by making lots of purchases from different places, supermarkets, malls and so on within Blackpool and from Preston, and even Manchester. I have all my needs met insofar as my kitchen is concerned. 

My family has couriered a lot of additional stuff, though, and pretty soon, when these things arrive, I will have no difficulty in living normally. 

Finally, My gymming and exercising has taken off in a good way. I am maintaining a record of the activities I do, with dates, calories burned (wherever I know it) and so on. It's too early to feel and weigh any different, but I am sure results will come soon. I am hoping to lose at least 3 kg by the year end. Let us see what happens.

Thank you for reading this entry and for your enthusiasm and for the encouragement you give me. I hope you are enjoying reading my blog entries as much as I am enjoying writing them.