Innovations in Medical Education are needed to align it with 21st Century needs and aspirations. Globally efforts are under way since the release of Lancet Commission report in Dec-2010 on Transforming Health Professions in the 21st Century

1. Innovation, Advances &
Regulations in Medical Education
Prof KR Sethuraman. MD, PGDHE.
VC – Sri Balaji Vidyapeeth.
Puducherry

2. “The Physicians of Tomorrow are taught by the
Teachers of Today using Curricula of yesterday.”
- Sethuraman KR (2000)
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The Current Problem

3. Dedication
Innovate for the New Generation
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4. Objectives for this talk…
• Compare creativity and innovation
• Discuss the stages in creative and innovative
processes
• Consider barriers to & assessment of
innovation
• Survey the ongoing innovations in USA
• Invite comments on our reasons, rights and
responsibilities to foster innovation in Med Edu
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5. Innovation – What, How & Why
REASON
RIGHTS RESPONSIBILITY
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6. Creativity in Stages
Graham Wallas (1858 – 1932)
In The Art of Thought (1926), he proposed
this model of the creative process:
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9. Steps in Innovative Processes
• Permit a Creative Environment
• Generate Ideas
• Present & Discuss the Ideas
• Filter & Choose the best
• Do Pre-Validation
• Implement the Prototype
• Do Evaluation & Post-validation
• Plan for Dissemination
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10. Avoid these 8 Idea Killers!
• “We tried that already –
• “We don't do it that way here -
• “Not in our budget -
• “Not an interesting problem -
• “We don't have time -
• “People won't like it -
• “How stupid are you? “
• “You are smarter with your mouth shut!”
from Scott Berkun's book, The Myths of Innovation, Sebastopol: O'Reilly Media, Inc., 2010.
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11. Can We Teach Innovation?...
• Rigid training does not help innovation and can
even harm the processes.
• Knowledge is important but formal qualification is
not essential
• Requires new approaches and different ways of
looking at problems.
– Some are naturally more creative - ‘creative gene’
• Education can help in identifying barriers to
innovation
• Innovation can be cultivated by teaching skills such
as lateral thinking.
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12. Developing Creativity - i
• Brainstorming
– invented by an American businessman Alex
Osborn
– it encourages the generation of possible solutions
to a well defined problem
• Synectics
– to explore relationships between apparently
unconnected elements of a problem using analogy
and metaphors
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13. Developing Creativity - ii
• Lateral Thinking
– reject standard methods for solutions
– take a fresh perspective, involving spatial or visual
support for ideas
• Problem Solving
– Break down the problem into smaller solvable
components
– Generate possible solutions, consider pro’s and
con’s of each and choose the most appropriate
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14. Evaluation of Educational Innovations
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15. Story: OSCE as a formative tool to
impart error-free ‘must do’ skills
• Reason was through Epiphany (1987 exams)
– A final MBBS student did not know-how to use a
sphygmomanometer (kept mercury column flat!)
• Responsibility (all should do ‘Must Do’ Skills)
• Rights (as a Unit Head)
• Resistance to overcome – educators / HOD
• Spin offs (The first manual on OSCE – 1988)
• Sustainability (Formative OSCE still going on)
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16. Story: Motivating the students to learn
the local language
• Reason (importance of talking with patients)
• Responsibility - to create LRM (1988)
• Resistance to overcome – student apathy
• Epiphany – Alumnus feedback from NEFA
• Lesson: Tools + Motivation = Success
• Outcome – (1995 to 2005) all learnt Tamil
• Dissemination – JIPMER / AIMST / MGMCRI
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http://jipmer.edu.in/wp-content/uploads/2013/01/tamil-bk.pdf

17. Story: Emergency Care Posting
• Reason & Responsibility (experiential T-L in ER)
• Creative problem solving:
– Once a week posting from 4 pm to 10 pm in the
emergency dept (“casualty”) in groups of 2 or 3
– Shadow the Medical team on duty and clerk cases
– 50% of Viva voce in internal exam based on this
posting of around 10 sessions (60 + hours)
– Other depts (Surgery, Paeds) also replicated this
• Outcome assessment by external examiners
was supportive of gains
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18. Objectivising Clinical/Practical Exams
• MCI – ’97 has recommended ‘Objectivising
Clinical/Practical Exams’
• Only a lip-service by most institutions
• At SBVU: a year-long capacity building effort
• OSCE/OSPE was ‘do-able’ in the summative
assessment (field-tested blue-print; years 1-5)
• National expert group meeting to endorse the
report and submit to the regulatory body
• Still waiting for the “Nod” from MCI
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19. Barriers to Innovations - i
• Internal Barriers
– Culture of Blame (discomfort with new ideas)
– Staff Motivation (non-risk taking and inept)
– Unapproachable Management (lack of foresight)
– Management Systems (Not tuned to innovate)
– Inexperience
– Investment Capital (Human resource, time, fund)
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20. Barriers to Innovations - ii
• External Barriers
– National Regulations
– Local Regulations
– Opposition from Interest groups
Source: http://akri.org/thinking/innovation-process.html
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21. “Attitude-Spectrum” to Innovations
• A – LEADER.
• B – COLLABORATOR
• C – SUPPORTER.
• D – ACCOMMODATOR
OPPONENTS:
• G – PARTICIPATING ~
• H – PASSIVE~
• I – RESISTING ~
• J – HOSTILE ~E – INDIFFERENT. F - UNINFORMED
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22. MEDICAL EDUCATION IN 21ST C
Current Advances & Focus
Following Lancet Commission Report, 2010
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23. AMSA - Students' Voices
• Current curricular lacunae:
– a narrow technical focus without contextual
understanding in a holistic manner
– poor teamwork
– predominant hospital orientation at the expense
of primary health care
– quantitative and qualitative imbalances in the
health professions (market forces)
http://media.amsa.org.au/policy/2012/201206_medical_curricula_for_the_2
1st_century_professional_policy.pdf
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24. AMSA – Curricular Needs for 21st C
• Instill respect for the rights and dignity of the
individual and community,
• inculcate leadership & advocacy skills to respond
to the health needs & priorities of the
community,
• promote an understanding that actions within
healthcare settings have broader social and
economic implications
• provide graduates with the skills necessary to
apply global research and resources to local
practice and health priorities
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25. AMSA – Curricular Needs - ii
• provide the skills and attitudes necessary to
engage in interdisciplinary and trans-disciplinary
collaborations with key stakeholders
– from health and non-health professions
• Recognize the expertise of other health
disciplines with the aim of improving patient care
in multidisciplinary teams
• Embody transformative learning methods that
foster leadership skills to be enlightened change
agents
http://media.amsa.org.au/policy/2012/201206_medical_curricula_for_the_2
1st_century_professional_policy.pdf 25NCHPE 20-11-2015

26. Obstacles to Curriculum Change
• Status quo: a culture of conservatism
• Opposition: teachers not convinced about the
benefits of change
• Cost of the proposed changed: the increased
workload of implementing the change
• Process of change: teachers’ work not being
rewarded
• Conflict of interest: teachers’ conflicting interests of
research and clinical care
• AMEE 2013 Conference, Prague:
http://medine2.com/Public/docs/MEDINE2-WP5.pdf
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27. Faculty & Students* speak out
1. Exclude redundant information from curriculum.
2. Make medical training more patient-centered.
3. Future physicians to usher change in Health care delivery
4. Increase diversity in medical education.
5. Include massive open online courses (MOOC) and Create
curricula for a “Medical school without walls.”
6. Entrance Exams (Step-1 USMLE etc) be modified as they
promote a "parallel curriculum“ diverting students’ focus?
7. Effective ways to shorten student training by "outcomes
based" approach.
*Faculty & students from 110 institutions at CHANGEMEDED conf Oct-2015
http://www.ama-assn.org/ama/ama-wire/post/9-challenges-medical-educators-want-solve-right-now
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28. AMA – A PROACTIVE REFORMIST
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29. AMA - Accelerating Change in Medical
Education
Six key themes for the 11-member consortium:
1. Developing flexible, competency-based pathways
2. Teaching & assessing new content in health care
delivery sciences
3. Working with health care delivery systems in novel
ways
4. Making technology solutions to support learning and
assessment
5. Envisioning the master adaptive learner
6. Shaping tomorrow’s leaders
(In Nov,2015, consortium added 21 more to make 32
members)
https://www.ama-assn.org/resources/doc/about-ama/x-pub/ace-monograph-interactive.pdf
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30. AMA’s Innovation Push – 1
1. Mayo: to prepare students for patient-centered,
community-oriented, science-driven care and lead
collaborative care teams that deliver high-value care.
2. Warren Alpert: to educate a new type of physician leader
equipped to promote the health of the population
3. University of Michigan: to transform its curriculum to
graduate physician change agents who will improve
health care at a systems and patient level.
4. Vanderbilt University: to create master adaptive learners
who are embedded in the health care workplace
throughout their undergraduate medical education
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31. AMA’s Innovation Push – 2
5. Oregon Health & Science University: to
implement a learner-centered, competency-
based curriculum that enables students to
follow individualized learning plans
6. San Francisco School of Medicine: to learn to
work expertly in inter-professional teams to
advance science and improve health care.
7. NYU School of Medicine: to implement a three-
year, flexible, individualized, technology-
enabled blended curriculum to improve care
coordination and quality improvement.
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32. AMA’s Innovation Push – 3
8. Davis School of Medicine: to create a 3-year medical
school pathway, the Accelerated Competency-based
Education in Primary Care (3+3) program.
9. The Brody School of Medicine: to implement a new
comprehensive Longitudinal Core Curriculum in
patient safety for all medical students.
10. Penn State College of Medicine: to design
educational experiences that align medical education
with health system needs.
11. Indiana University: to teach electronic medical record
(tEMR) to ensure competencies in clinical decision-
making as well as system-, team- and population-
based health care.
http://www.ama-assn.org/sub/accelerating-change/grant-projects.shtml
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33. REGULATION OF HEALTH
PROFESSIONS EDUCATION IN INDIA
REASON
RIGHTS RESPONSIBILITY
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34. Regulation in India is the proverbial
“elephant in the room”
• Plan 4+
• Organize 2+
• Lead effectively 1+
• Implement +/-
• Co-ordinate &
Collaborate 2 (– )
• Evaluate outcomes &
impact 4(– )
– Ex PM Rajiv Gandhi
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35. Declarative vs. Procedural Tussle
Declarative sentences, well
articulated by the regulatory
bodies, since it is a conscious,
considered and explicit act
Innovative, tacit and exploits
any loop-hole in the declared
regulations to “Some-How”
fulfill the stated requirements
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36. Summing Up:
Regulations can delay the inevitable But,
• “Enlightened educators need to push the
agenda to innovate and usher in reforms
• As Tagore put it, “The Next Generation
deserves it.” – Let us not limit them
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