Indian J Pediatr DOI 10.1007/s12098-013-1308-0
SCIENTIFIC LETTER
Pediatric Postgraduate Training in India-Residents’ Perspective M. G. Geeta & P. Krishnakumar & A. Riyaz & N. C. Cherian & A. V. Gopalan
Received: 10 September 2013 / Accepted: 11 November 2013 # Dr. K C Chaudhuri Foundation 2013
To the Editor: India has emerged as the country with the largest number of medical colleges in the world, and there has been a corresponding increase in the number of institutions offering post-graduate courses in Pediatrics [1–3]. Although the Medical Council of India (MCI) has formulated guidelines regarding infrastructure and faculty for affiliation of colleges [4], the learners’ perspective is often not considered during evaluation. There are no studies from India about residents’ perceptions of postgraduate training in pediatrics. The aim of the present study was to evaluate pediatric postgraduate training, based on the perceptions of final year residents. A six day clinical training program for final year pediatric residents was organized at Government Medical College, Kozhikode in Kerala, and attended by 158 students from 45 institutions across the country. Participants were requested to fill a structured questionnaire to evaluate postgraduate (PG) training in their respective institutions. They also completed a questionnaire, on their perceptions and practice, with regard to doctor-patient / parent communication [5]. Of the 158 residents, 90 responded to the questionnaires, including 49 % from government medical colleges, 21 % from private medical colleges and 30 % from private hospitals without a medical college. M. G. Geeta : P. Krishnakumar : A. Riyaz : N. C. Cherian : A. V. Gopalan Department of Pediatrics, Government Medical College, Kozhikode, Kerala, India P. Krishnakumar (*) Child Development Services, Institute of Mental Health and Neurosciences, Kozhikode, Kerala 673008, India e-mail:
[email protected] The residents’ perception of the quality of postgraduate training is shown in Table 1. Majority of them felt that their PG training was inadequate, and that there was a need for uniformity across all institutions and sectors. Only 50 % of the residents were satisfied with their ability to deal with sick children, and only a quarter (23 %) said they were relaxed and stress-free at work. Only 34 % were comfortable while breaking bad news to parents. Most trainees felt incapable of dealing with the psychological problems of their patients / parents (Table 2). Most students had attended a pediatric advanced life support (PALS) training course (63; 70 %) but only 20 (22 %) of them had any training in communication skills and an even smaller number 13 (14 %) had exposure to palliative care training. Although most residents were undergoing a three year degree course, with a mandatory requirement for a dissertation, only 51 (57 %) of them had attended a research methodology workshop. When residents from government medical colleges, private medical colleges and private hospitals were compared, a significant difference in their perceptions regarding quality of training programs was observed, with government medical colleges faring better in all parameters (Table 1). There was no significant difference in perceptions of the adequacy of communication skills between the three groups (Table 2). The spurt in the number of institutions imparting postgraduate training has not gone hand in hand with improvement in the quality of training imparted. The number of qualified teachers, availability of clinical material, exposure to specialty clinics, theory and clinical classes, and the duties and responsibilities of residents vary widely from institution to institution. Regulatory bodies should step in urgently to improve the quality, and ensure uniformity in the PG program across India. Improvement of communication skills
Indian J Pediatr Table 1 Comparison of different institutions regarding quality of pediatric training program
IP Inpatients; PG Postgraduate training; OP Outpatients
Table 2 Comparison of perceptions and practice of pediatric residents from different institutions with regard to doctor-patient (parent) communication
Item
Over all No. (%)
Govt. medical college No. (%)
Private hospital No. (%)
Private medical college No. (%)
P
Overall training satisfactory IP sufficient for PG OP sufficient for PG Faculty sufficient for PG Exposure to variety of cases Daily clinical classes Clinical discussions satisfactory Theory classes sufficient Exposure to pediatric procedures
38 (42) 59 (66) 66 (73) 48 (53) 69 (77) 56 (62) 44 (49) 28 (31) 47 (52)
27 (63) 42 (98) 43 (100) 34 (79) 40 (95) 36 (86) 32 (73) 16 (37) 25 (60)
7 (26) 10 (42) 15 (60) 7 (28) 14 (52) 9 (33) 5 (19) 9 (33) 15 (56)
4 (22) 7 (37) 8 (44) 7 (41) 15 (79) 9 (47) 7 (39) 3 (16) 7 (37)
0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.238 0.249
Private medical college
P
Questions
Over all No. (%)
Govt. medical college
Private hospital
Satisfied as a pediatric resident Comfortable when breaking bad news Confident to deal with dissatisfied patients feeling relaxed and stress free while seeing patients Importance of non verbal communication Introducing to the patients Dealing psychological problems of patients Using open questions Maintaining privacy Consider wishes of parents/patients
45 (50) 69 (77) 31(34) 31(34)
22 (50) 14 (32) 19 (43) 8 (18)
14 (52) 9 (33) 13 (50) 9 (35)
9 (53) 8 (44) 4 (22) 4 (22)
0.975 0.626 0.167 0.292
59 (66) 45 (50) 27 (30) 21 (23) 79 (88) 36 (40)
34 (79) 8 (18) 11 (25) 22 (51) 36 (82) 32 (73)
14 (54) 12 (46) 11 (42) 17 (65) 25 (96) 23 (89)
11 (61) 11 (61) 5 (28) 6 (33) 18 (100) 14 (78)
0.075 0.002 0.302 0.112 0.044 0.302
should be a top priority. The residents’ perspective should be considered while evaluating postgraduate training programs. Acknowledgments We thank all the staff members of the Department of Pediatrics, Government Medical College, Kozhikode who were involved in organising the intensive clinical training program. We thank Dr. Biju George, Associate Professor, Department of Community Medicine, Govt. Medical College, Kozhikode for helping with the statistical analysis. Contribution Dr. A. Riyaz will act as guarantor for this paper. Conflict of Interest None. Role of Funding Source None.
References 1. Medical Council of India: Vision 2015. Available from URL: http:// www.mciindia.org/tools/announcement/MCI_booklet.pdf. accessed on 4–8-2013 2. Medical Council of India. Available from URL: http://www.mciindia.org/ InformationDesk/CollegesCoursesSearch.aspx accessed on 4–8-2013 3. National Board of examinations, New Delhi. Available from URL: http://www.natboard.edu.in/dnb_seat_query.php accessed on 4–8-2013 4. Medical Council of India. Post Graduate Medical Education Regulations 2000. (amended up to May 2013) available from URL: http://www.mciindia.org/uRlesandRegulations/PGMedicalEducation Regulations2000.aspx accessed on 4–8-2013 5. Geeta MG, Krishnakumar P, Rajasree KC, Ashraf TP, Sureshkumar K, Riyaz A. Effectiveness of communication skills training on perceptions and practice of Pediatric residents. Indian J Pediatr. 2011;78:979–82.