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.   

My visit to Manchester

As I have mentioned in an earlier entry, I went to Manchester last week to join an academic course that would run for 2 days. Known as the Advanced Paediatric Life Support course, or the APLS, this course was organised by the Advanced Life Support Group with the Royal Manchester Children's Hospital and the related trust. The venue was to be their training headquarters (the ManCEL) at the West Point building on Chester Street in central Manchester. I had already booked my rail tickets to Manchester Oxford street, and my hotel bookings on booking.com at the Hotel Ibis Budget at Salford Quays in the Salford area of central Manchester. I will write a review of this hotel in a separate post or on Tripadvisor. 

The hotel

Arriving by train on Sunday evening, I got off a little previous to my stated destination (at Deansgate instead of the Oxford station), and then took a tram to the hotel area. It was a lovely final leg of the journey and I arrived at the hotel reception at a little after seven p.m. The receptionist, a Spanish woman by the name of Carmen, speaking with a Spanish accent, kindly accepted my online booking and offered me a free upgrade to a double bed room (whereas I had booked into a single bed room). I was handed over the card and shown the cafe and the password for the free WiFi and so on. I retired to my room. It was a pleasant place indeed. I have no complaints against it, as it was just GBP 31.5 per night! The room had adequate lighting, a lovely shower stall, a slightly cramped toilet, an extra bed over the double bed where one can have a third guest if needed and pretty clean furniture and stuff. 

How my room looked

In the night, I went to a local restaurant located just opposite the hotel. It is called the Shahi Masala and although it prides itself on calling it an Indian restaurant, it is owned and run by Pakistanis. I had a nahari lamb with tandoori roti - my first taste of authentic Nahari here in the UK. Meeting the floor manager and the waiters was a pleasant experience. I had mini-chats with the manager (Asif) and the waiter (Saqi) and learned that this is the usual practice in the UK. They said they knew many other places in the kingdom which were run by Pakistanis but were referred to as Indian restaurants. 

The wash basin and my own reflection in the full-length
mirror

On the next morning, I woke up early to reach the course venue which is about 2 km away from the hotel. It was an energising walk indeed, but I managed to arrive at the stroke of eight, and was guided to the 8th floor, where the course would be held. There was an initial period of half an hour where they basically allowed the candidates to come in and register, meet each other and have tea, coffee, and so on. WE got underway at half past eight, and the long day of training, interspersed with 2 tea breaks and a lunch break finally got over at half past six in the evening!

I met with and befriended quite a few people, most from Manchester, but quite a few from other places as well, such as Liverpool, Birmingham, North East England, and so on. I was able to befriend some Indian doctors as well, and would like to mention Drs. Rashmi Mehta and Swaroop Roy specially, since they are both, like me, Mumbaikars. However, they have been here in the UK since many years, and it was easy to see how they are already well-assimilated in the system.

In the evening, after my return, I went for a walk, and then to the same restaurant as I had been to the previous night, where I ate a lovely dinner of a gravy chicken vindaloo with pulao.

The next day at the course was as tiring as the first day, but it seemed that I was getting the hang of it and was able to learn more efficiently. The lunch mostly consisted of sandwiches, but there were plenty of them to go around. They did have biscuits with tea, and juices and such, so they looked after us pretty well. At the end of the day, after waiting for nearly an hour and a half, the trainers came out and told us our results. I had passed their evaluation!

One of my new friends, one Dr. Venkat, who is a consultant at a different location in the UK (Huddersfield) gave me a lift in his car, first to the hotel, to pick up my bag, and then, all the way to Salford Crescent railway station, from where I would be able to catch my return train to Blackpool.

In the event, I returned to Blackpool at half past eight, and I went straight to Mr. Basrai's World Foods restaurant, where I had a filling buffet dinner before returning to my room at the hospital. A review of this excellent eating out place is available on my profile at Tripadvisor. I will add the link once it is published there.

Thank you for reading this entry. I really enjoyed writing it. If you like it, won't you let me know, please, through the comments section below.