A charity registered in Scotland No. SC009465
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A proposal for developing
future training models for
doctors in Kerala
Professor S Krishnakumar has
submitted this article to share
information with Fellows about the
local context in Kerala.
In Kerala, there is inadequate
provision of general professional
training for newly qualified doctors.
The state produces 3,150 medicine
graduates every year from 24
colleges in this small state of 33
million people. The institutions run
by the Government produce the best
output and the private institutions
lag behind in many aspects. There
is no uniformity in the quality of the
graduates emerging from different
institutes. Among these, only
250 are able to enter advanced
training through an annual entrance
examination. The modern doctors
spend their time preparing for
repeat entrance exams and do not
concentrate on general practice.
Two-thirds of physicians, beds and
institutions are under private control
and many have state-of-the-art
facilities, infrastructure and qualified
trainers. However, these hospitals
are unable to attract promising
junior doctors as it does not aid
their career development.
It is the need of the hour to develop
an accredited general training facility
which can standardise and improve
the quality of general practice in this
region.
Aims
•
To develop a Kerala model for
future training of doctors on a
par with the standards of Royal
Colleges
•
To coordinate government and
private sector and use the
available resources for such a
programme
•
To adapt the Modernising
Medical Careers initiative
which leads to a Certificate of
Completion of Training which can
be integrated with the present
graduation as an internship.
Methodology
The proposed training model
would be in private institutions
(similar to the UK’s Core Medical
Training), monitored, supervised
and audited by the RCP London.
The Medical Training Initiative (MTI)
is an excellent example of how
collaborations can be mutually
beneficial. Trivandrum Alumni
are already a partner for the MTI
programme with the RCP London
and hosted the first MTI interviews
by the RCP London outside UK.
These trainees can register to
access the UK’s e-portfolio as
the MTI candidates are being
assessed in the UK. This allows
trainees to log all evidence of their
experience and courses for their
training period. If a similar program
is envisaged by RCP London in
partnership with the Alumni (a
similar program runs in Chennai
partnering Harvard University with
the Ramachandra institute), it
would facilitate the development
of trainees of the highest medical
calibre for the region. It will also
help deliver evidence-based
medicine and patient-centred care
in an environment of continued
professional learning and research
with doctors being trained to meet
the changing needs of patients,
society and the healthcare system.
The scope and opportunities
RCP training and certification is very
much valued in India. MRCP (UK)
is now recognised by the Indian
Medical Council and the state
authority is considering it for state
promotion. The Alumni are already
partnering for the MTI programme
and have an MRCP (UK) study centre
in the learning and research centre
of the Medical College, Trivandrum,
inaugurated and supported by the
regional international advisor of
the RCP London. There are more
than 25 fellows of RCP London
in the alumni in Trivandrum. They
are faculty for the MRCP training
programme and are available for
supporting RCP London in a junior
doctors’ training programme. Most
of them are involved in assessing
the competence of trainees, peers
and other health professionals
and are as reasonably comfortable
using educational assessment tools
as they are using more clinically-
focused diagnostic tests.
Results
It will provide evidence for the future
doctor type concept of training in the
region with patients at the centre,
excellent patient care, patient safety,
patient satisfaction and doctors
are trained to meet the changing
needs of patients, society and the
healthcare system.
Conclusions
The epidemiologic shift,
demographic changes and
redistribution of disability burden
necessitate the need for a
revolution in the healthcare system
with emphasis on the role of the
health professional and design and
delivery of health education. Patient-
centred care and patient experience
must underpin all developments
in modern healthcare. Educational
supervision, mentor training and
provision of high-quality training in a
suitable environment are all in need
of attention.
Professor S Krishnakumar MD
MRCP(UK) FRCP FRCPE FRCP(Glas),
Director and nephrologist, Sut Royal
Hospital, Trivandrum, India and RCP
London International Advisor
Future topics
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