Bedside practices!

Students of MOSC Medical College, Kolenchery while in training in Pharmacology has a new laboratory facility,  where they can learn the bedside practices of giving intramuscular and subcutaneous injections, and giving intravenous injections and intravenous infusions ! The laboratory was set up by the faculty recently in the department in an innovative way using limb moulds, to make learning clinically related! A good start to make learning hands on!

M.C.Mathew(text and photo)

The foster family group!

Every time we meet as a foster family, there is something refreshing eh end of it! We feel connected to their world of happenings and make us feel good about the way each person is pursuing the learning and formative process during the college life!

Their world of challenges is more than what Anna and I were used to during our student days!

It is a challenge for them to negotiate through the maize of opportunities! W feel good that they make every opportunity to be a resource for their growing up! Thank you friends for staying in touch ! 

M.C.Mathew 

Cards and Stars

The exhibition of Christmas cards made by the staff and students and the different designs of stars  hanging in the corridor made a visual feast at the time of the MOSC Christmas function two days back!

The festivity of Christmas was evident on that occasion!

What inspired me was that the college has organised a visit to a children's home to Christmas cheer with them!

Christmas is a message 'peace and goodwill for all people' and not just a time for family festivity alone!

M.C.Mathew (text and photo)

A value addition!

Some of the students Anna mentored in 2016 for research projects spent an afternoon with us in our cottage earlier this month!

One aspect that was common to all of them was a grateful acknowledgement of the support they received for becoming aware of an ability that was resident in them- to formulate a research question, pursue the study and publish the data in to an article or make a oral or poster presentation!

It brought a new quality to their self awareness! To be helped to discover who one is the best gift we can offer to students during their formative years!

It was a well spent afternoon because each of them shared something that was refreshing about the process of becoming more than they aspired, through this research experience!

These young people brought a new enthusiasm to us. Following this, I wrote a scientific article and sent for publication yesterday! I was doing this after six months! Their enthusiasm revived me!

M.C.Mathew(text and photo)

Teach Fishing!

One version of the Chinese proverb says: ‘stop giving fish, but teach fishing’ is a challenging call for all of us in positions of responsibilities at the Medical colleges! 

This group of students at the MOSC Medical College, is an example of how they can rise to an academic challenge. They have their own individual student research projects; got themselves organised to participate in the medical quiz at CMC Vellore and four of them made maiden presentation of their research at a conference.  Dr. C. Radhakrishan, the dean of the college, while greeting them just before their departure for the mediquizz at CMC Vellore, said, ‘I am happy that we too now join the knowledge club’.

A few months back, they were like anybody else, going through the routine of medical learning. On invitation, they were ready to make an extra effort to equip themselves for conducting research and stretching their knowledge base for a competitive performance. 

It is a question to all the medical teachers, ‘do we affirm passive class room learning or liberate students to go on a knowledge journey by opening the doors of enquiry’! Yes, when we free them to be adult learners, they need equipping which teachers have to provide! I wonder whether the medical teachers would offer at least one fourth of their time during the working hours to enlarge the scope of active learning in which the students can participate to learn some skills beyond the usual academic requirements. 

We ought to do this, because at least one third of the students are knowledge searchers and surfers of the internet.  Why not guide their learning instinct and formulate it to converge on making them to be their own managers of advanced learning!

M.C.Mathew. 

A Student receives his encouragement!

I have been most encouraged by the enthusiasm of 21 medical students at the MOSC Medical College, who got involved for short student research projects. During the last three  months all of them have been pursuing to gather the data for their project.

Four of them having completed their projects presented their research findings at a student conference on research methodology held at the Christian Medical College, Vellore during this week. 

Thomas who did a study on sleep behaviour of adolescent children and its impact on their academic performance received the third prize at the poster presentation. I heard from colleagues at CMC that the students from MOSC maintained a high standard in their presentation.

I remember Thomas having had to change his research topic after an enthusiastic start and pursuing another project with an equal or more enthusiasm.  I was glad when he was rewarded.

It is the first time, students were initiated into doing a research project at the MOSC Medical College, for which Anna took considerable interest and spent hours with the students and their guides in getting the ideas formulated and evolving appropriate research methodologies. 

It is a sign to all of us that when we discern the time and opportunity, it has a transforming impact!

M.C.Mathew(text and photo)

Friends came visiting!

The day before the department where I work, was to organise the children’s Christmas programme, some medical students came visiting. We were in the midst of decorating the place for children. The students happily joined  in and spent the whole afternoon with us. We were enthused by their presence and involvement with us.

It is the same batch of students who were earlier involved with us during the awareness programme we conducted at the college for the students. Two of them had acted in the awareness play. One of them mentioned to me, that they ‘like coming to the department because they feel at home here’.

What is that which would help others feel at home in our midst! If we can turn the attention to those who visit us, they would feel welcomed. 

We have a tendency to be preoccupied with what we do or  what  we have achieved something! We can get occupied with these in our conversations and exchanges. Instead, if we can be focussed on the visitors and with what they do or are going through or the challenges they face, then they would feel befriended. Most visitors would feel included if they feel safe in our presence. To be deliberately, ‘other person centred’, is the only way of ‘loving our neighbour as ourselves’. 

Not all of us can do this often. However, when we drift in our conversations to talking about ourselves, it is good to pause and return to the visitors and revolve conversations around them and their interests or needs. 

We grow only as much as we include others into our lives. This begins with the habit of listening and taking interests in what matters to others. 

A child of six years likes to play with puzzles. Anna often thinks of him and keeps new puzzles ready for him. When he visits, he feels welcome because his interest was also included during the family visit.

M.C.Mathew(text and photo)  

Able and abounding

Anna and I got to know three batches of students well during our two years of stay at PIMS, Pondicherry. This picture is the reception area of the Aura, the inter-medical cultural, the students organised in 2012. It was planned and executed well that the we the, faculty were surprised by seeing some students who were indifferent in lecture and clinical sessions, showing extra-ordinary responsibility and abilities.

After the Aura, Anna and I had some final year students visiting us at home for a chat. The discussion drifted towards the way we teach students in the class room and at the bed side. They were most critical of reducing the class room lectures to power point presentations and the clinics to dry monotonous mini lectures. 

They helpfully defined for us some guidelines, to make the teaching-leaning process student friendly. Let me summarise them. 

Greet students and have a round of catching up with them to connect with them and invite them to be present. They admitted that most students, depending on who engages them, would plan a parallel agenda during the lecture, such as learning for the after noon test in another subject, texting a message, access the internet in the mobile, etc. But a friendly beginning often disarms them of their earlier plan.

Try covering the MUST know matters in the first twenty minutes and build around it clinical examples towards the latter part of the lecture, to reinforce and communicate interesting clinical applications. This promotes interest when attention normally declines half way through lecture.

Make time for some interaction- even if it is about politics, cricket, movie, hostel life, let it be. Students are keen to say something to the teachers. So create an opportunity to hear them. The give us a guided tour into their beliefs and attitudes.

The learning in the class room is minimal; but creating an interest in the subject and topic, is of paramount importance. A teacher who invokes this, naturally becomes a role model.   

The bed side clinics are to be fully devoted to demonstrations of clinical signs and introducing skills of communication and clinical observations. They detested the practice of taking clinics on imaginative clinical scenario, because a corresponding patient is not available for clinical demonstration. They squarely blamed this to the apathy of teachers.  

I have a suspicion that many teachers at Medical schools use outdated teaching-learnign practices. While attending a Medical Education seminar recently, I sensed that the even the latest the  Medical Council of India is proposing to 'modernise' the medical education would need further update as each batch of students is ahead of the previous batch in abilities. They are abounding in skills and enthusiasm.

Where are the teachers to match them! 

I wish, I had  known the above when we joined PIMS! 

M.C. Mathew

Medical students and an opportunity

Anna's batch of thirty five medical students of 1968 batch at Christian Medical college, Vellore, now working in about 12 countries,   met for their reunion two weeks back at Pondicherry. They completed forty five years since they joined for their medical studies. They relived, acted, sang and shared their memories during this time. 

I was struck by one common experience each of them shared at the sea side sunrise service Anna organised on the last day. Their lives were formed during their time in the college. The experiences of personal interactions with the faculty,  hostel life, co-curricular and extra curricular activities, chapel services, Bible studies, Class prayers, picnics, prangs... the list was long. All of them gave them together helped in discovering a mission in life. Most of them attributed what they are today, to this valuable formative experience where they watched their teachers at work, in their homes and in public engagements, through which they made their choice to follow the call of of life and profession. 

I was listening recently to a group of medical students, who were almost lamenting for more contacts, interactions and formative experiences through greater exposure to their teachers. I have been disturbed to know that medical education is more formal, class room centred, examination oriented, skill based and success driven. I sensed their anxiety over limited insight into decision making, crisis management, communication, values, good practices, ethics and morals, etc. I suppose even these are taught formally now-a days. But, I remember a senior friend telling me once, 'values are caught than taught'.  

There is a shortage of medical teachers as many prefer to be in full time practice. Even after the retirement age of medical teachers getting extended to seventy years, the shortage is still felt. With another 200 medical colleges likely to be added in the next five years, teachers would be hard to find. 

The medical students are waiting for teachers who would share their lives with them of dedication, calling, self giving, and high standards of ethical practice of medicine.  I have a feeling that we have let down the medical students by not being role models ! It is dis-service to the profession. 

Anna and I have a dream to encourage about twenty young faculty in Medical schools, currently working in India, by accompanying them over a period of three years, to help them to be actively involved in formative engagement with under graduates and post-graduates  If this speaks to you, we look forward to hearing from you.

M.C.Mathew(text and photo)   

Senior house surgency

Of late, doctors when  they complete their under graduate training, choose one of the three options for their future. Apply and get selected for post-gradaute training; join an entrance coaching programme and try for post graduate admission; appear for qualifying examinations to go overseas.

The majority seems to choose one of the first two options. In fact, if the rough estimate is correct, there are thirty five thousand doctors who are undergoing entrance coaching through out the country currently. There will be an equal number who would compete with them for getting a seat for post graduate training in 2013. Only one out of 8 would secure a seat for training as of now.

During my time of training in the early seventies, the post graduate admission was based on the marks obtained in the final examinations. But it was compulsory to have completed one year of senior house sergeancy, out of which six months  in the speciality, one was seeking for post graduate training, before applying for the admission. 

How did the senior house surgency help a doctor in preparing for post graduate training! 

First, it is one occasion after the compulsory rotating internship, when a junior doctor has a chance to  have hands on experience to develop competency in decision making, taking care of patients, being part of a treating team, exercise skills in communication, breaking the news and counselling, acquire clinical observation and examination skills, etc. A senior house surgeon is the first care provider, whose judgement and critical approach determine the treatment outcome. He or she would normally develop managerial skills as he or she is often in charge of one ward of about thirty five patients. It is the house surgeon who presents patients to the consultants on the ward rounds, which would hone his or her skills in clinical communication and self confidence. At the end of one year of my senior house sergeancy, I had done most of the clinical and therapeutic procedures needed in my specialty. Therefore I had the advantage of beginning my post graduate training with an advantage of clinical familiarity.

What a pity that all these are foreign to a junior doctor who gets into post graduate training without this one year of experience! One year post internship clinical training is seminal for completing the undergraduate training soundly. It is during this one year, one becomes a competent primary clinician. 

Let me suggest that all those who would like to have a better completion of their undergraduate training, choose one year of post internship clinical training as a house surgeon. It is even better than one year of training in an entrance coaching centre, in the long run.

If that one year can be spent in a general hospital in a rural area, having good clinical load and reputation of good delivery of services, it is even better for acquiring practical skills. You would have found some role models in the consultants who would naturally become friendly life-long companions! 

M.C.Mathew(text and photo)       

Make learning an interactive habit.

This is a greeting I received last year for the Teacher's day from one of the medical students. I have visited this quotation often during the last year. It is an inspirational quotation.

I have been a teacher in five  medical colleges during the last 25 years now. I look back at many events which have shaped my life for which I am grateful to my colleagues and students. 

A teacher is a co-learner with students. The students facilitate the learning journey of a teacher.

A student once came to me while I was at the Mahatma Gandhi Institute of Medial Sciences, Sevagram to tell me that many children in the village that  he came from, suffered from Measles and some had died. It was the year 1976. The Measles vaccine was expensive and was not part of the National Immunisation Programme. I talked this over with Dr. Ulhas Jajoo, a class mate during my under graduate days at Nagpur, who was also in the faculty at MGIMS at that time. Jajoo was contemplating to start a food grain based insurance programme for village folks to help them to get subsidised health care at the hospital. Each family would have to give their premium of health insurance at the harvesting time as grains, which would be stored to sell back to the villagers at the cost price, form which the insurance premium in cash would be deposited to the hospital.  Jajoo was more than glad to include Measles immunisation as part of the insurance package. That was the starting of a life saver for children from Measles in some villages around Sevagram.  

It was a student who challenged me; it was his observation and social passion which set in motion an intervention plan. 

This form of student- teacher interaction is most critical to make medical education a corporate learning experience. Teachers need to be contextual, relevant and effective. The students, who are primary learners can lead teachers to make learning a growing and enlarging experience for students.   

Students influence the teachers to be thoughtful and gentle; teachers mould the attitudes and values of students. Both are interactive experiences, which alone can make medical education process life-centred and not just disease centred.  

M.C.Mathew (text and photo)    

A hostel around a pond

This is a picture of the water pond at the Men's hostel, Christian Medial college,Vellore, on the occasion of the hostel day celebration in 2007. 

Anna and I have been to the Men's hostel on  few occasions, when Arpit and Anandit were residents in the hostel. When the alumni return to the college for the Alumni week end, I have seen former men's hostel residents return to the hostel and stay around the pond and even jump into it, if the water was clean enough.

The water pond located in the expanse of the courtyard of the hostel is place where several hostel events take place. After a week of initiation, the fresh students were ducked to become eligible residents of the hostel. When there were happy occasions, such as house parties, birthday parties, block parties, class parties, governing board parties, etc.  the party often ended with friends ducking each other with force or by consent in this pond. It was around the pond, friends would gather around for social chats late night. There were occasions, when the mischievous behaviour of students were punished with ducking. Sometimes students ended their quarrels by having a common ducking session. The stories about this pond are diverse and  humorous to listen to.

It was on the pond, a temporary structure to convey the theme of each Hostel day was usually erected. This used to be the highlight of every year as many men students would  spend several nights for couple of weeks, preparing parts of this structure, without leaking out the theme or the design of the structure to the women students, who normally spy on them to take away the element of surprise. There are several more happy memories, students would have of the  events that took place around this pond. 

Even for a one time visitor, the pond is a special place as the Edward Gault drive way, named after the professor of Pathology and the warden of the Men's hostel, who took the lead to construct the hostel, is circling around the pond. The hostel itself has been a happy home for generations of men students; and it would have been less than that,  had it not been for the pond.

For Men's students at CMC, Vellore, this pond was a meeting place. It is a pity, that,  it is becoming less of it now, as many students are driven by the internet world. 

A medical student needs to be a well rounded social being if he wants to be a holistic physician later !

M.C.Mathew(text and photo)

Looking back and forward

PIMS graduates at their graduation on 3rdAug.2012

As I watched the  above graduates gleefully throw up their caps at the end of their ceremonial photograph, I sensed their sense of relief and freedom from undergraduate days. 

That is surely behind them, but there is something more ahead of them- further training and career path. Although this happy occasion does not merit any discussion about it, that is what I heard the graduates privately talk between themselves. They are overtaken by anxiety about further training, as only 1 out of 50 graduates will qualify to get an opportunity to get into post graduate training, considering the limited number of the post graduate seats available in Medical colleges, as of now. 

I heard some of the parents waiting to join the graduation ceremony also, talk about the uncertain future for their children. It was a happy occasion for the parents, but the long journey into the future has only begun for them and their children. 

I wonder whether medical graduates will review their inclination to get into post graduate training immediately after their graduation! What if they worked for one or two years to get into a rhythm of work for bedside learning, team work, independent decision making,  becoming familiar with ethos, ethics and economics of health care, etc!  What if they chose to work in a smaller hospital or a rural hospital where basic medical and surgical specialities are practiced along with good community health initiatives! 

This can be a good introduction to general practice which is a foundation for any one who considers specialty training. A specialist must have an overview of all the broad specialities to be a better assessor of the needs of every patient approaching him or her.

A graduate will learn life lessons through active medical work, where as he or she will only memorize facts through the coaching programs they currently join in, to prepare for the post graduate entrance tests.

It is good to be a competent basic doctor first, before a graduate starts his or her post graduate training. I was encouraged to know that five graduates from PIMS have gone to work in rural areas this year. It is a trickle, but it sends to a message to others.

M.C.Mathew (text and photo)