I graduated from Medical College in India and moved to the United States (US) for my post graduate training in General Medicine followed by a fellowship in Infectious diseases. I have spent an equal amount of time in the medical field in both countries (about 5 years), which should, I believe be sufficient to compare and contrast the medical education system between the two. I have also consulted my friends for their opinion, including some who have done post graduate training in both the countries, to attempt an unbiased view.
When I started my post graduation in General Medicine in the US, the first thing that struck me was that I did not know practical medicine. My contemporaries who had graduated from American schools were better than me in the serial thought process of diagnosis, investigation, interpretation of results and management, whereas mine stopped with the diagnosis. A great example would be a patient presenting with chest pain where I had to learn the essentials of ECG interpretation and treatment of this common complaint. I have to admit though, that I was better at history taking, knowing the pathophysiologic basis of disease and making an accurate diagnosis with just a physical examination. My American colleagues were lost and incapacitated without the support of investigations and tended to order random tests, a proverbial short-gun approach. Unnecessary investigations lead to incidental findings, the pursuit of many of which are wild goose chases in addition to the huge toll on health care costs. I believe the health care crisis the US is dealing with right now has a lot to do with this approach to patient management.
There is a significant contrast between the patient directed medical care in the US and the knowledge and diagnosis driven medical education in India. As time progressed during my training in the US, I learnt bedside manners, common etiquettes, discipline and ethics, to which I had little prior exposure. Where was the basic humaneness and courtesy during my education in India? Formal education on these aspects is the need of the hour in India, especially in the present day when materialism is rampant. However, despite the exemplary ethical training in the United States, the patient controls the doctor – patient relationship, there is not much of a feeling of gratitude from the patient and there is a high baseline litigation rate as well. I very much miss in the United States the immense sense of satisfaction which I experienced while taking care of patients at home. Commercialization of health care in the US probably contributed to the lack of respect for the medical community.
This article would be incomplete if I did not comment on the differences in the examination systems. I speak on behalf of several of my Indian medical colleagues when I say we prefer the objective nature of multiple choice questions in the US to the inherently subjective evaluations of essays and short notes in India. However, on retrospect I realized that the latter tests holistically and not just a few random facts. The practical test too has its advantages and its riddance probably led to the loss of elicitation of physical signs skills in the US. Glaring problems in India regarding the exam process are the issues of hierarchy, examiner prejudice, examination success depending on single day’s performance, to name just a few. The western system has circumvented these problems with regular, 360 degrees, written, confidential evaluations, which I believe will be beneficial for India as well.
My fellowship in Infectious Diseases in the United States gave me the final and most striking difference regarding education between the two countries. This is not restricted to the medical but includes primary, high school and other educational systems. In India the textbook is considered as the Bible, memorized word to word and regurgitated. It was a truly liberating feeling studying in the United States where there is no absolute right or wrong and black or white. All shades of colours and grey scales are accepted without a preformed dogma. The text book is only a reference and is subject to change and new discoveries. No idea is ridiculous, no individual is unworthy; Newton did discover gravity by something as simple as the fall of an apple from a tree. This climate leads to new ideas, research, discoveries and the path to progress. I have little doubt that the lack of this atmosphere kills creativity and hinders India’s progress. Along the same lines, in day to day practice as clinical questions arise in the US, we are encouraged to peruse the literature and practice evidence based medicine. In fact, I have spent more time reading articles than textbooks in the US. This keeps me up to date and also sharpens my ability to critically analyze the literature. This raises a whole new and bigger issue about the lack of resources in Medical Colleges in India which includes access to journal articles, computers, research infrastructure and funds, all of which seriously hinder medical education.
In summary education in both countries have their pros and cons. We in India need to make changes to our medical education drawing from experiences all over the world. At the same time, we should strive to preserve the best of our system such that we do not face problems similar to what other educational systems are encountering. Incorporating everyday bedside teaching on etiquettes and ethics, emphasizing the importance of a patient directed approach, encouraging medical students to participate in the everyday care of the patient, assessing with regular, well constructed, written, confidential evaluations, improving and altering examinations such that they test more contemporary, everyday problems rather than specialized diseases, will overall, in my opinion help train confident, compassionate practitioners capable of practicing in the community. I wish, hope and pray that I live to witness the attitude change that India desperately needs to rise to its potential and enter the race of scientific progress.
Board certified Internal Medicine
Fellow Infectious Disease
Fellow Medical Microbiology
I would like to thank my friends for sharing their opinion with me on this topic.