Medical Studies

850 foreign doctors allowed to practice in India this year

Under the modified provisions of the Indian Medical Council Act 1956, which removed the restriction for granting temporary permission to foreign doctors only for the purpose of teaching, research and charitable work, 850 foreign doctors were granted temporary permission this year to practice in the country.

Foreign doctors are granted temporary permission by the Medical Council of India (MCI) on the basis of their applications received through the inviting institutions.

Union Health Minister Ghulam Nabi Azad informed the Lok Sabha on December 13 that 1289 foreign doctors sought permission between January 1 and December 10 this year, out of which 850 have been granted permission.

Maximum number of temporary permission was granted to foreign doctors to practice in Maharashtra (172) and Delhi (125). Tamil Nadu, an emerging medical hub, also received a huge number of permissions with approval to 114 foreign doctors.

The provisions of the Indian Medical Council Act 1956 allow temporary permission to foreign doctors for the purpose of teaching, research or charitable work for a specified period limited to the institution to which they are attached. Recently, the government, through the Indian Medical Council (Amendment) Second Ordinance 2013, removed the restriction for granting temporary permission to foreign doctors only for the purpose of teaching, research and charitable work.

Source: India Medical Times

High cost of medical education fuelling refer-and-earn system

As is commonly known, the Hippocratic Oath (horkos) is one of the most widely known of Greek medical texts. It requires a new physician to swear upon a number of healing gods that he will uphold a number of professional ethical standards.

The most important ethical standard to uphold for all doctors, is our duty to treat and cure. This is why we have the faith, to invoke the healing gods in the first place!

Hence, when a patient comes to us with a medical problem, it is our duty to guide the patient to the doctor best positioned to cure or treat the patient. While we make this reference, there is no question of commercial gain.

In fact, it is extremely clear, that a doctor, who is ready to give you a commercial consideration to refer a patient to him, is quite certain that patients and doctors will not choose him of their own free will; he is not sure about his clinical superiority and professional competence.

A recent article in the Lancet, further to Dr H S Bawaskar’s admirable stance, clearly says, “The ‘cut’ practice works at various levels: A medical specialist gives a cut to a general practitioner (GP); a diagnostic laboratory offers it to medical consultants; and hospitals to GPs and consultants. In the past decade, corporatisation of healthcare has changed this practice a bit.

Hospitals and diagnostic chains offer cuts as cheque payment under the title of “professional fees”.”

I, and many of my senior colleagues, had never heard of cuts till the last 15 years or so. This is a criminalisation of medical practice. And it has gained such momentum, and become so rampant that the doctors and hospitals who do not offer ‘cuts’ are alienated and laughed at – it’s a reverse moral ostracization!

As I write this column, the Supreme Court has agreed to reconsider the scrapping of NEET, the common medical entrance exam.

The concern raised by the petitioners was that giving out the responsibility of the entrance exam to private medical colleges would promote the corrupt practice, which enabled undeserving students to get admissions by paying huge capitation fees or donations. This could be a valid concern – I am also worried that children will have to run from city to city taking multiple entrance exams conducted by private medical colleges…in the absence of one common exam.

Whatever the process, the best students will get into good medical colleges, pay reasonable fees, work hard to become good doctors and do not have any debt burden on their shoulders.

What happens when your marks are poor? The families that insist on making their children doctors by paying huge capitation fee will be unknowingly responsible for the future moral debacle of their wards. They mortgage or sell a lifetime’s hard-gained assets to make their children a doctor. Today, the cost of one PG seat goes up to Rs3-5 crore, I’m told, depending on the specialisation.

After 10-15 years of study and work, most doctors are well into their 30’s before they begin to earn.

They start with 3-5 crore capitation fee debt on their balance sheet, at 32. Add to this, the cost of a house, which could range upwards of 1 crore. Their peers in other professions, have started earning a full decade earlier! Cuts, therefore seem essential to build a quick profitable practice.

India has just one doctor per 2,000 people, according to the ministry of health and family welfare estimates.

By severely restricting the number of post graduate seats; when there’s a huge demand for doctors, we have created an artificial demand supply imbalance.

The most important step to reduce this nuisance of cut practice, is that medical education MUST be made less expensive. Public investment in new medical colleges and liberalising infrastructure norms for setting new medical colleges will help. A better pay package for teachers will enhance the quality of faculty, thereby incentivising them and ensuring limited private practice for teachers.

Second, post graduate medical education needs to be liberalised and the number of seats increased by allowing larger public and private hospitals to impart post graduate education. This will help decrease the frightful cost to the family to educate a doctor. We need to remove black money from the PG seat in the system at the point of imparting education.

This is critical. The foundation has to be solid for the tree to grow. Other aspects such as monitoring of advertising expenses, audit control etc are possible- but self-monitoring is the only sure solution to this. The easiest thing is to blame doctors. The way I see it, doctors are as much a victim as the rest of society.

All doctors would like to support Dr Bawaskar and his rightful enthusiasm, when he says, “I am going to fight corruption in medicine till the last rupee from my savings is exhausted.” But let’s also clean the education system so that our support makes a difference to society.

Source: DNA India

GMC survey highlights the importance of listening to young doctors

Nearly one in five doctors in training has witnessed someone being bullied in their current post, and more than one in four has experienced undermining behaviour themselves, according to a major survey from the General Medical Council.

In its annual survey of 54,000 doctors in training in the UK the GMC, the independent regulator of the UK’s 250,000 doctors, asks their views on the quality of their training. It is one of the largest surveys of its kind anywhere in the world.

The findings also reveal that more than 2,000 doctors in training (5.2%) had raised a concern about patient safety in 2013 and 13.2 per cent said they had experienced bullying at work.

Niall Dickson, chief executive of the General Medical Council, said:

‘These findings highlight the importance of listening to young doctors working on the front line of clinical care. They support what Robert Francis said – that doctors in training are invaluable eyes and ears for what is happening at the front line of patient care.

“They also suggest that more needs to be done to support these doctors and to build the positive supportive culture that is so essential to patient safety. The best care is always given by professional who are supported and encouraged.

“The survey provides us and employers with crucial information about the quality of the training environment, which is also where patients receive care and treatment. These doctors are in an ideal position to alert us to potential problems and employers will also want to reflect on these results.

“Patient safety remains our top priority and all doctors irrespective of their seniority should feel supported in improving the standards of care for their patients.”

Further analysis of the survey shows that:

• The number of comments on patient safety raised by doctors training in emergency medicine posts have increased since 2012 (from 204 to 287)

• 5,863 respondents had been concerned about patient safety but their concerns had been addressed

• Female trainees and trainees who obtained their primary medical qualification (PMQ) within the UK, are more likely to raise concerns

The findings suggest that hospitals need to engage with doctors in training and use their experiences to help change the culture of their organisations. The survey responses contain examples of good practice showing how organisations which had experienced problems managed them positively and effectively.

According to the GMC, the numbers of concerns raised come from qualitative not quantitative responses. The same issue may also have been raised several times, meaning these numbers will be higher than the actual incidence of the issues.

Source: India Medical times

Medical Schools in Nigeria to Begin Learning Through Simulation By 2015

Medical schools in Nigeria will begin the teaching and learning of medical sciences through simulation by 2015, Eugene Okpere, a visiting Professor at the National Universities Commission (NUC), has said.

Okpere disclosed this on Tuesday in Abuja at a stakeholders meeting to discuss the enhancement of medical education through the utilisation of new technologies.

The don, who said the simulation centres would be sited in some selected schools across the country, explained that the meeting was to sensitise stakeholders and to seek their opinion on the adoption of the new technology to medical education.

He said that the NUC would need to liaise with the provosts of medical schools, vice chancellors, chief medical directors and other stakeholders to get their opinion on the new technology.

“The NUC has recognised that it is time that all stakeholders, provosts of medical schools and vice chancellors are carried along on the new technology as well as their opinions on how it can be adopted.”

Okpere explained that the use of simulation in teaching medical education is the safest way to train medical students competently.

He said that the use of electronic human body would enable students to identify forms of disease components or clinical signs.

According to him, students who go through thorough training in simulation technology will have 35 per cent competency before their physical contact with live patients.

“More importantly, patients are now getting very smart and wise. They know their rights and not many patients will be happy to be used as materials for experiments.

“Basically, the whole idea, is to ensure that in the next two years, most medical schools in the country have simulation complexes or regional centres, where medical students can move around and spend time learning adequately,” he said.

Source: all africa

‘Nuances of childhood TB are never taught in medical schools’

If diagnosing tuberculosis in children, particularly those aged under five years, is fraught with problems, health-care workers at different levels who are unaware of the latest advancements in childhood TB diagnosis and treatment make it even worse.

“Tuberculosis is a part of the training programme when doctors go through a M.D course. So a basic training is provided,” Dr. Soumya Swaminathan, Director of National Institute for Research in Tuberculosis (NIRT), Chennai said. “But we are talking about in-depth training on the recent advances in TB diagnostics and treatment. They [doctors] are not aware of these.”

There is a lack of awareness in India despite the National Revised Tuberculosis Control Programme (RNTCP) and the Indian Academy of Paediatricians (IAP) working together to develop the diagnosis and treatment guidelines.

This brings to the fore the compelling need for ongoing training in childhood TB. “Constant upgradation of knowledge is what is needed,” she said. “Private practitioners are generally not well informed compared with government doctors. So there is a need to reach out to private practitioners and train them.”

“Unfortunately, even in high TB burden countries, many paediatricians know little about TB and do not diagnose it in a timely fashion. TB is often poorly taught in medical schools and the nuances of childhood TB are virtually never taught,” Dr. Jeffrey R. Starke, Professor of Paediatrics, Baylor College of Medicine, Houston, Texas said in an email to this Correspondent. “As a result, paediatricians do not consider TB diagnosis and a child is not referred to the NTP [national tuberculosis programme] where TB-specific care is provided.”

The need for an engagement with health-care providers of different specialisations and at different levels cannot be overemphasised. “The engagement of all who provide care to children (including paediatricians and other clinicians) is crucial,” the 2006 WHO report on Guidance for National Tuberculosis Programmes on the Management of Tuberculosis in Children notes.

The recently released WHO’s Roadmap for Childhood Tuberculosis report emphasises the same point. “There is an urgent need for greater awareness of and increased screening for TB in children, particularly by services that serve children… Children with TB often present at primary- and secondary-care settings where there is a lack of guidance on how to address the challenges of diagnosing and managing childhood TB,” the Roadmap states.

The Roadmap has identified the need to engage four health-care programmes including maternal and child health services and private health-care sector.

“Overall, training of medical and nursing health workers on childhood TB seems to be variable, but often poor. It is quite good in South Africa, because TB is so common and so it [training] is a part of pre-service curriculum,” Prof. Steve Graham said in an email to this Correspondent. “In so-called developed countries, the general public and the health services lack knowledge of childhood TB because it is so uncommon.”

Prof. Graham is from the University of Melbourne and Murdoch Children’s Research Institute, Australia, and also The Union, France. He was the Chair of the Childhood TB subgroup of the Stop TB Partnership that led the Roadmap.

According to Prof. Graham, the awareness level of the latest developments in childhood TB should trickle down to the lowest level in the health-care system to increase the number of children who would get diagnosed and treated for TB on time. This includes “any health worker who cares for an adult case of TB or any health worker at a primary- and secondary-care level that diagnoses TB in children.”

Source: the hindu

 

$3 Million for New Medical Education Center from Four Brothers

A $3 million gift to the Perelman School of Medicine at the University of Pennsylvania has established the Joseph and Loretta Law Auditorium in the Henry A. Jordan, M’62, Medical Education Center, slated to open in 2015. Drs. Dennis, Ronald, Christopher and Jeremy Law, who between them hold seven degrees from the University of Pennsylvania, have come together to honor their parents and their alma mater.

“It’s inspiring to see how strongly our alumni, far and wide, support our innovative education spaces that will support the training of future generations of doctors, scientists and health-care leaders,” said Dr. J. Larry Jameson, Executive Vice President of the University of Pennsylvania for the Health System and Dean of the Perelman School of Medicine. “We are extremely pleased to have such support from a remarkable Penn family.”

The gift by the Law brothers is the second largest from an alumni family to support the Jordan Medical Education Center, currently under construction atop the Ruth and Raymond Perelman Center for Advanced Medicine. Also adjacent to the Smilow Center for Translational Medicine, the Jordan Center will be among the first in the United States to integrate learning spaces with active research and patient care facilities.

The Jordan Center will feature wired classrooms, an information commons, big screens and small learning spaces, all to support the collaborative and self-directed style of current medical education. Other new enhancements include integrating the space for 24-hour, 7-day-a-week availability and round-the-clock food options.

The Joseph and Loretta Law Auditorium, to be situated in the northern end of the Jordan Center and overlooking Civic Center Boulevard, will offer state-of-the-art technology, including recording and simulcast capabilities to support global conferences, telemedicine and creation of online courses. “This is beyond anyone’s imagination,” Dr. Jeremy Law said, after touring the Jordan Center construction site in September.

“Graduates of the Perelman School of Medicine are prepared to be not only exceptional physicians but also leaders. The Henry Jordan Center is designed to keep us at the forefront of medical education, and we are very proud to have the interest and generosity of the Law family support this one-of-a-kind facility,” said Senior Vice Dean Gail Morrison.

The Law brothers, all of whom are based in Colorado, have each staked their own territory within medicine. The eldest, Dennis, is a retired vascular and thoracic surgeon. Ronald is a cardiologist, Christopher is a plastic surgeon and Jeremy is an orthopedic surgeon.

“We are proud to participate in Penn’s forward-looking strategy in medical education,” said Dr. Christopher Law. The Law brothers contribute to various health, civic and cultural institutions and have supported the University of Pennsylvania in various impactful ways through efforts supporting student financial aid. “The time felt right for us to give back to our medical school, and at the same time honor our parents for their love and the sacrifices they made for us,” added Dr. Ronald Law.

In addition to practicing medicine, the Law brothers operate real estate investment and development companies as well as Four Brothers Entertainment, specializing in live-show productions in Chinese performing arts. “Since retiring from medicine I have found fulfillment in helping Chinese performing arts through programs and training to reach international standards of artistic excellence,” said Dr. Dennis Law. “In the same way, I’m pleased to support medical education at a place that means so much to me and my family.”

The Law brothers’ philanthropic streak was inspired by the principles instilled by their parents, Joseph and Loretta Law, who overcame political hardship. Mr. Law became a successful industrialist in southern China while Dennis and Ronald were medical students at Penn and Christopher and Jeremy were undergraduates at Penn and the University of Colorado, respectively.

When the Joseph and Loretta Law Auditorium and Henry A. Jordan M’62 Medical Education Center open in 2015, that will coincide with the 250th anniversary of the Perelman School of Medicine.

Source: University of Pennsylvania

Online medical education tool aspires to improve patient interactions in challenging situations

Drexel University College of Medicine has developed an online medical education program to help healthcare professionals hone those skills in simulated interactions with patients and their families.

Although the goal is to improve performance by physicians and other healthcare professionals, it is also designed to help hospitals boost patient satisfaction scores, which impact Medicare reimbursement. This is one trend in healthcare that startups are increasingly addressing.

Dr. Christof Daetwyler of Drexel University College of Medicine will use the $100,000 he received from the University City Science Center QED Proof of Concept award to fund a pilot program with a well-known hospital next year and build a company around the technology.

In an interview with MedCity News, Daetwyler said one of Drexel’s collaboration partners is the Gift of Life donor program in Philadelphia, which licensed the technology.

A prototype of the technology was developed in 2002 at the Technology in Medical Education group at Drexel. It was used as a video conferencing tool to help medical students prep for the Objective Structured Clinical Examinations through simulated patient interactions.

Since then, technology advancements have made it easier to bring the platform online. User interactions with simulated patients are recorded online. Users get structured feedback on performance. They can also access videos that offer examples of best practice. In addition to organ donation and breaking bad news, it also includes modules on how to broach other difficult situations such as smoking cessation.

A separate joint venture between the College of Medicine and the American Academy on Communication in Healthcare, Doc.Com, produced 41 modules to improve communication skills.

The company’s approach also helps address the physician shortage, which is projected to worsen as Obamacare extends healthcare access to millions of people.

Several other health IT companies are taking different approaches to medical training using simulators. Shadow Health and Kognito Interactive have focused on developing patient simulator tools to improve patient and physician communication. SimplySim developed a way to train physicians to properly use a stethoscope and CaseNetwork developed a training tool to reduce readmissions. The idea is to provide more meaningful interactions to improve adherence and so that healthcare professionals better understand their patients’ needs.
Source : Med City News

UAB Medicine introduces Web-based learning and continuing medical education for physicians

UAB Medicine, in collaboration with BroadcastMed, Inc. has launched MD Learning Channel, an online resource that enables medical professionals worldwide to tap into the knowledge and expertise of University of Alabama at Birmingham physicians.

The website at learnmd.uabmedicine.org offers free Web-based learning and continuing medical education for physicians and other medical professionals. It includes video presentations from UAB physicians discussing new research findings, new procedures and changes and developments in diagnosis or treatment of disease. The site primarily focuses on cancer, neurosciences, pulmonary medicine, women and infants services and cardiovascular medicine and will expand to include additional medical specialties in the future.

“UAB physicians and scientists are at the forefront of medicine, scientific research and discovery and advancement of treatments and patient-focused care,” said Physician Marketing Manager Whitney McDonald. “This site provides an easy, convenient way for UAB to help disseminate its incredible wealth of expertise to medical professionals around the world.”

McDonald says the site’s on-demand service enables physicians and medical professionals to learn as their schedule permits.

“By making the information readily available, we hope to further the mission, vision and successes of the UAB Medicine team, while sharing techniques, procedures and evidence-based care in use here to help others care for their patients,” said McDonald. “We hope that the MD Learning Channel will serve as a platform to foster many growth and development opportunities for health-care providers.”

Source: News Medical

Dr J C Mohan elected as Honorary Fellow of American Society of Echocardiography

Dr J C Mohan, director of cardiology, Fortis Hospital, Shalimar Bagh has been elected as Honorary Fellow of the American Society of Echocardiography (FASE).According to a statement by Fortis Hospital, Dr Mohan is the first Indian to be nominated as the honorary fellow of this prestigious society.

While congratulating Dr Mohan, Jasdeep Singh, facility director, Fortis Hospital, Shalimar Bagh, said, “It is a testimony to Dr Mohan’s commitment, dedication and comprehensive knowledge of echocardiography.”

The American Society of Echocardiography (ASE) is a professional organisation of physicians, cardiac sonographers, nurses and scientists involved in echocardiography.

Founded in 1975, ASE is the largest international organisation for cardiac imaging. Echocardiography is the use of ultrasound to image the heart and cardiovascular system.

Source: India Medical Times

Many Parents Unaware About Medical Research Opportunities for Their Children

A recent poll shows that roughly 44 percent of parents polled claimed they would enroll their child into medical research involving the testing of new medications or vaccines if their child suffered from the disease being studied.

That figure jumped to over 75 percent when the research being conducted involved questions on mental health or diet and nutrition. So why is it only five percent of parents claim they have signed their children up for medical research?
It’s a no-brainer that children’s healthcare can only improve through medical research. The University of Michigan C.S. Mott Children’s Hospital National Poll on Children’s Health, which surveyed 1,420 parents with a child or children between birth and 17 years of age, claims awareness of medical research opportunities accounts for the low percentage of participants.

Greater than 66 percent of parents polled stated they were not aware of research opportunities for their children. In fact, the poll shows parents who are aware of medical research opportunities are far more likely to have their children take part.
“Children have a better chance of living healthier lives because of vaccinations, new medications and new diagnostic tests. But we wouldn’t have those tools without medical research,” says Matthew M. Davis, MD, MAPP, director of the National Poll on Children’s Health and professor of pediatrics and internal medicine in the University of Michigan Health System.
“With this poll, we wanted to understand parents’ willingness to allow their children to participate in medical research. The good news is that willingness is far higher than the current level of actual engagement in research. This means there is great opportunity for the medical research community to reach out to families and encourage them to take part in improving medical care.”

As mentioned above, the poll differentiated between types of studies and found the willingness of the parents to allow their children to participate was affected by this differentiation. Studies aimed at nutrition and mental illnesses were more positively favored by the parents. However, parents were more reticent about subjecting their children to studies which involved exposure to new medicines or vaccines.
This poll specifically targeted the level of participation by children in medical research since 2007. Over the previous 5 years, the proportion of families where the children have actually taken part in medical research has basically remained unchanged. The figure was four percent in 2007. In both last year’s results and the results reported this year, that figure was only at five percent.
“Five percent of families with children participating may not be enough to support important research efforts that the public has identified in previous polls – things like cures and treatments for childhood cancer, diabetes and assessing the safety of medications and vaccines,” says Davis, who also is professor of public policy at the Gerald R. Ford School of Public Policy.
“But the results indicate that a much bigger percentage of the public does understand the importance of medical research to advancing healthcare for children.”
Though parents in the poll claim they would be willing to allow their children to participate in studies, researchers are too often at a loss of obtaining a significant sample size that could lead to a real difference in healthcare discoveries. If the poll is to be believed, it seems the medical research community needs to focus as much energy on marketing their studies as they do carrying them out.
“This poll shows that the research community needs to step up and find ways to better reach parents about opportunities for children to participate, answer parents’ questions about benefits and risks of participation, and potentially broaden the types of studies available,” Davis says.
Source: Red Orbit