Service Orientation

An important attitudinal problem is that of 'learned helplessness'. The highest that many new medical graduates aspire to in dealing with medical problems is being able to assess to which specialist to refer the patient. Consequently, it is a frightening prospect for them to contemplate rural practice.                -WONCA Policy on Training for Rural Practice 1995

RESOURCES

Report of the Taskforce on Medical Education for the National Rural Health Mission

Teaching students: The MGIMS Sevagram way

Students should spend part of training in rural hospitals

Why doctors don't go to rural areas

Why doctors do go to rural areas

China's barefoot doctors

Training for rural practice in Australia

 Service orientation

There is a lack of doctors serving in rural areas. Where are we failing as doctors in motivating our students to serve the people who need them most?

 

There is a widespread perception in the country that the MBBS curriculum is too theoretical in its content. After 4 ½ years of the main course and I year of
internship, the finished graduate has very little ‘hands-on’ experience. Most graduates are not confident enough at that stage to even provide primary healthcare services independently. The MBBS curriculum is closely linked to a tertiary care hospital. And, therefore, the graduates cannot function in a setting where there is no multi-disciplinary support, or advanced diagnostic hardware.

 

A large percentage of the graduates treat that stage as a launching pad for the post-graduate course. It is generally assumed that the clinical experience to equip the doctor to deliver medical services is only gained at the post-graduate stage. Whether this situation is inescapable, has never been critically examined. The medical graduate course of 5 ½ years is one of the longest professional courses. It is only in the case of the medical graduate that an assertion is made that even 5 ½ years of professional training is not enough, as the management of health of a human being is a uniquely complex and demanding responsibility. As a solution it is suggested that the duration of the course be further extended in order to provide more intensive clinical experience.

 

If the medical graduate does not have the requisite skills and confidence at the time of graduation, the fault lies with the curriculum and the pedagogic methodology.

 

A fresh graduate must at least be able to deliver services contained in the primary healthcare package. The suggestion that the duration of the course be extended to give more intensive clinical exposure is not a practical proposition. As it is, the graduate medical course is one of the longest professional courses, and the students and their guardians, are exposed to a prolonged financial and familial burden. With the extended time and substantial financial resources involved in a medical education, graduates are increasingly drawn towards the more lucrative specializations, their choice often being in direct conflict with broad community requirements. Increasing the duration of the graduate course would only worsen those pressures.

 

Physicians' service orientation and understanding of patient expectations for service quality enhances both bedside manner and working relationships health care professionals maintain with patients and coworkers. Until recently, however, service orientation has received little interest. The reasons for this general lack of attention to service orientation include:

 
--- regarding the act of service as not being prestigious nor requiring much skill
--- believing that anyone can acquire these skills because they are so easy to develop
--- extreme and one-sided focus on the scientific and technical elements of providing health care
---- a generalized belief that highly developed social abilities are a natural by-product of being a health care professional.

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Introduction

Overview of the learning process

Questions posed

Communication skills

Scientific temper

Interpersonal Skills

Emotional Intelligence

Leadership and Teamwork

Professionalism

Service Orientation

Assessment of Non-scholastic abilities

Dialogue and discussion by the Chatterati!

Summary Service Orientation

Recommendations

Resources

Cartoon Corner

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