Seven years now!

It was Rejit who welcomed Anna and me to the family of students at the place we work now seven years back. Rejit did that graciously and thoughtfully by finding us out. 

Yesterday, it was good to welcome Rejit, Sowmya and Caleb to the foster family get together. 

A lot of transpired during these seven years. Rejit and Thomas were two friends who contributed to the department where I work in helping us to organise poster competitions, T-shirt design sessions, organise staff-student badminton matches, lead the anniversary functions of the department, help in our research work....!

Although the foster family culture is not well understood in the community, for us it became a forum to stay connected withe aspirations and formative experiences of students. 

It is the students who form the attitude of teachers relationally. In that sense, the students contributed immensely to make us feel the path we need to choose to stay in touch. 

If teachers are co-learners with students, then it is the community of students who provide that milieu for teachers to grow in learning about life and vocation!

The conversation at dinner table was about life ahead! It was amusing how conversations were also about life partners! 

To live relationally is an opportunity of great significance!

M.C.Mathew (text and photo)

More to come!

I have had some meaningful conversations with medical students of different years in their course in the recent weeks. I met a friend yesterday who finished his junior residency and is now preparing for his post graduate entrance test. He spoke about the good days of studentship. 

One theme of the conversation with some students has been the the attitude during the student days: 'Are we just medical students or doctors in training'! 

The undergraduate medical education syllabus is being revised now after 20 or so. Looking at a glance, one gets the feeling that there is considerable emphasis in the new curriculum on enhancing skills, attitude, communication, ethics, behaviour, etc. This inclusive approach to integrate knowledge, skills and values seem to be an appropriate way forward. 

The temptation of students is to look at their counter parts in science and arts colleges and replicate the  orientation to life, arts, sports, activities, which while are valuable assets in the learning and growing process, seem to be dominated by fun, pleasure, achievements, competition, etc. The medical students  can feel tempted to have the first two or three years to live and behave equivalent to what their counter parts do in the arts and science college, without necessarily being conscious of the option they choose to be 'doctors in training'. 

When one choose to be a doctor in training, there is a value based commitment we are called to make which is consistent with the 'noble practices' in the practice of medicine: to value others, to learn and acquire skills in the art and science of practice of medicine, conduct and behaviour rooted in honesty and integrity, embrace a way of life where service and altruism become the inner orientation, living the vocation of self giving and team work, etc.   

I have considerable admiration for the students in the MOSC Medical college, because they have a visible expression of their consciousness of the needs of the less privileged through the different activities they do through their social service programme. It is highly commendable. 

At the same I feel concerned by the way they make their learning 'mundane' or 'casual' with a subscription to read 'small' books and 'condense their study' to the immediate period before the examination. Now the exit examination does not decide their merit for post graduate entrance, but   the NEET which is decisive, I wonder whether teachers and students would collaborate to make learning 'intense', regular, and aspirational!

One practice that might install this orientation is to have students attached to the clinical and preclinical departments as 'shadow learners' by being involved in all the activities of the clinical and para-clinical services. I wonder whether it is the right time to think of bringing the 'tutorial system' when students are attached to a clinician for a few weeks during which period, the learning focus transcends the requirement of preparation for the examinations! The emphasis is not even to prepare for students just for he NEET, but make them learning motivated that the self directed learning inherent with study and practice of medicine would get incorporated as the 'mind set' among students and teachers. 

I watched this bunch of bananas in our garden shown in the above photographs, from the time it first appeared in the plant. Over three weeks the full bunch of bananas appeared from out its wrappings. As I wait another two months it would be fully ready to be a bunch of fruit.  From the time a banana plant is  planted till it gives its fruit, it is about 15 months which is the gestation time a farmer would offer for the plant to grow and bear fruit. 

Remember, there is something more in the wrapping of the banana when the first row of banana appears outside. 

This to me is the metaphor with which we are called to view medical students. They grow under the watch of the teachers and the institution where they study and the hostels where they live ! There is 'more to come' in their lives if only we have planned individualised programme for their personal formation!

A student becomes a doctor not just studying subjects but becoming a person oriented to seek the welfare of wellness of others. This is FORMATION of a doctor in training!

M.C.Mathew (text and photo)

11.Memorable photographs-2016-Beginning

The opening of the Family Life Centre at the Developmental Paediatrics department, MOSC Medical College, with Caren and Anjali who helped in decorating the facility!

M.C.Mathew(text and photo)

A happy occasion!

Anna and I were invited for a birthday party of one of the students...They sang, played games and made even Anna and I join in for their celebration!

Every time we return after a time with students, we feel encouraged by their calibre, conduct and openness!

Anna and I have been able to form a foster family group. We met on three occasions recently. It is a new beginning  for us to establish closer ties with some of them!

Anna and and I are grateful for the friendly and affirming touch the students bring to our lives! 

M.C.Mathew (text and photo)

Dilemma during internship !

I have had years of association with interns, who are in their one year post M.B.B.S. training period, before they are certified to practice.  They have impressed me with their willingness to be actively involved in hospital routine and learn from participating in the treatment process and care of patients. Most interns pick up several practical skills necessary for doctors to learn, during this one year period. 

I have been encouraged by the attitude of most interns to take this practical training seriously to enhance their competency. 

One of the disturbing news items appearing in the print media three weeks back was that some who are doing their internship training in a metropolitan city abstained from  hospital duty, demanding that they be exempted from giving injections, collecting blood for examination from patients, etc. They wanted to work till mid day and be set free. This matter is not resolved as far as I know although the interns have returned to work at their terms.

There is a change in the value system among the interns in many medical schools in india. They have begun to look at it as a preparation time to get into post graduate training. So most of them would enrol for coaching programme during internship and ignore the training commitment they have to acquire skills. It is frightening to think that interns would be certified to practice at the end of one year without knowing enough, to give injections or perform veinpuncture to collect blood from patients for laboratory examination.

We need to review our training plan for interns. It is frightening to think that internship is despised by many. I wish we would make it a practice that all doctors after internship work for two years before they apply for post graduate training, for them to have acquire enough skills to be a general practitioners!

M.C.Mathew(text and photo)

More questions than answers

One group of doctors, with whom Anna and I had some opportunities to interact with, during the last six months in a few medical schools, is post-graduate trainees or those waiting for their post-draduate training opportunity. Most of them are in their late twenties or early thirties. some of them are married or about to be married. They charm me by their good intentions.

There is a common thread in their comments and questions. There is  a sense of tiredness and anxiety which they convey. Some have even questions whether they chose wisely to train in Medicine. Some find the journey ahead demanding and stressful. I get a sense that their youthful enthusiastic spirit is languishing and and  they feel that they are victims of circumstances.  

Looking back at the similar period during my training years, what surfaced during conversations with my friends and colleagues was a sense of excitement of the opportunities and prospects awaiting us. Most of us had already chosen a direction or vocation and we viewed the training period as a preparation time for that. There was the excitement about the technological advances in medicine which  created in us an anticipation about the widening horizon of application of new knowledge in different specialties. Our teachers were our mentors, companions and well-wishers. They made us feel that their focus of attention was on us.

I feel concerned by the lack of interest or apathy which these doctors who are in training convey. They are burdened by the demands of training and the challenge of having to prove their worth and abilities through what and how they achieve. Their well being is conditioned by the goodwill they earn from their trainers, who are senior consultants, often preoccupied with their interests to be successful and visible. There are only few consultants or medical teachers, who still carry a mentoring or enabling attitude towards their trainees. Having worked in five medical schools in India over a span of forty years, I feel awfully disturbed by the deficit in the training model of young post graduate students. They are seen as a work force in most hospitals, meant to work long hours, often underpaid and denied of a formative experience in values, good practices and a calling for self-giving service in medicine.

I feel there is a need to attend to this. Anna and I have felt the need for a while now to have a mentoring circle for young trainee doctors, so that they grow up attending to their personal formation, family life, discernment of their vocation in health care, and grow up acquiring the art of practice of medicine. I wonder, whether it is almost becoming a calling for us now ! We wonder whether we shall begin by offering week end'Time Out' for rest and reflection! 

The national mood of health care policy makers in India is to quadruple the number of post-dradaute trainees by 2020. Not many of them realise that the trainees join the course wounded in their spirit due to the tough competitive culture and go through the training with a 'business plan' for their professional success.

What disturbs me most is that this profession is beginning to lose its noble traditions, because we no longer see the training period as formative in purpose!

M.C.Mathew(text and photo)