2 . Medical Education In India Needs Urgent Reforms
"It is medical school. What were you expecting? I stepped into this journey wide-eyed, ready to tackle the challenges, and there is no going back," says Sneha Kavadi, a final year medical student based in Hyderabad. Medical school indeed is exhausting. It is a long, taxing process to become a doctor. It is perceived as stressful, attributed to the vast material that needs to be learned. The curriculum is often very rigorous and demanding that there have been increased levels of stress, anxiety and depression reported in the fraternity.
According to a meta-analytical study published by the National Library of Medicine, Maryland, USA, stress among medical students ranges from 28.5% - to 78%. "I have my ophthalmology exam in two days, and I had an anxiety attack last night. It is tough to stay motivated," says Anas Zafar, a third-year medical student at Gandhi Medical College, Secunderabad.
NEET - A nightmare
What is meant to be the gateway to a successful medical career turned out to be an experience far from pleasant. The magnitude of damage this often-hidden problem can wreak on a student recently came to light when local media reports of Tamil Nadu said several students took their own lives afraid that they hadn't performed well in the National Eligibility cum Entrance Test (NEET). NEET is a mandatory, central-level exam introduced in 2013 for students to get into public and private medical colleges in India. The exam boasts very few chances of success due to its cut-throat competition.
A survey titled, “Suicide deaths among medical students, residents and physicians in India spanning a decade” states that over the years 2010 - 2019, around 358 suicide deaths took place among medical students, residents and physicians. Its data also showed that around seven out of 10 suicides occurred before 30. The critical reasons for suicide were reportedly academic stress and financial issues.
A long road ahead
In the United States, aspirants must complete a four-year undergraduate program and then attend medical school for another four years. Then, one has to spend three to seven years on residency (depending on their speciality) and this takes around 10-14 years to become a licensed doctor. Whereas in India, it takes almost 10.5 years (MBBS+MD+ Super Specialisation). Therefore, if we compare the duration of study between the two countries, the US weighs in more.
Students are forced to decide based on physics, chemistry, botany and zoology - which bear little relation to the subjects taught during MBBS. "It was definitely a huge transition for me to equip myself with medical terminology during my first year of college. I remember suffering from imposter syndrome during my final exams. I took a lot of stress and felt unqualified and incompetent," says Pranitha Yerra, a 24-year-old medical student who is currently pursuing her mandatory internship at Maheshwara Hospital, Patancheru, Hyderabad.
Parental and Peer Pressure
Parental and peer pressure has been crucially related to a student's well-being and stress levels. However, studies correlating the perceived parental and peer pressure haven't been conducted yet.
The sad reality is that aspiring doctors should come to terms with the amount of studying and training required to become a doctor. It is a serious commitment. Dr Yarram Rajeshwara Rao, retired doctor and professor at Krishna Institute of Medical Sciences, Ongole, says, "most medical students are there in their 20s and 30s, which is an influential phase in their personal lives. It can be tough for these students to see their same-aged peers settle down and start families."
Another important aspect of parental pressure is the amount of money the parents spend on medical education in private institutions. The budget for study starts from 30 lakhs to 1 crore and more. Hence, students often push themselves to get through the course and not disappoint their families.
Lack of practical exposure during the pandemic
During the pandemic, the closure of colleges and online training had brought unprecedented challenges to medical education. They could not provide adequate clinical exposure and hands-on experience that is deemed to be required once you finish your final year. "I have heard my professors talking about how the Covid-19 batch of doctors would be stunted for a while. We are definitely lacking in many practical skills," says Rahul Barka, a final year MBBS student from Maheshwara Medical College, Hyderabad. He adds, "Sometimes even thinking about performing surgery on a patient in the near future sends shivers down my spine. I think I am not confident enough to do it."
Females more susceptible
Concerning gender, several studies have reported significant differences between male medical students and female medical students. A 2016 systematic review published in the Journal of American Medical Association highlighted that female students (31.5%) tended to have more depression than their male counterparts (25.2%).
Astonishingly, many of our medical colleges do not have a culture of counselling. This calls for increased and dedicated counselling initiatives. Our society also has the stigma of doctors or future doctors seeking psychiatric help is weird. Well, this has to change. If people who are going to make up the healthcare system of the country are facing mental problems, it should be considered as a public health crisis.
Additionally, medical education in India should embrace modern study methods rather than rote learning from big books. The curriculum should be revised in a manner that promotes practical training and competency-based skill development. In the end, medical students are in this to serve society. It's the passion. "It's the passion you have in your heart. If you have it, no matter how long the road is, it's worth all the stress and hard work," says Pranitha.