Bipin Batra

Objective structured clinical examination in radiology

There is a growing need for introducing objective structured clinical examination (OSCE) as a part of radiology practical examinations in India. OSCE is an established, reliable, and effective multistation test for the assessment of practical professional skills in an objective and a transparent manner. In India, it has been successfully initiated and implemented in specialties like pediatrics, ophthalmology, and otolaryngology. Each OSCE station needs to have a pre-agreed “key-list” that contains a list of objective steps prepared for uniformly assessing the tasks given to students. Broadly, OSCE stations are classified as “manned” or “unmanned” stations. These stations may include procedure or pictorial or theory stations with clinical oriented contents. This article is one of a series of measures to initiate OSCE in radiology; it analyzes the attributes of OSCE stations and outlines the steps for implementing OSCE. Furthermore, important issues like the advantages of OSCE, its limitations, a strengths, weaknesses, opportunities, and threats (SWOT) analysis, and the timing of introduction of OSCE in radiology are also covered. The OSCE format in radiology and its stations needs to be validated, certified, and finalized before its use in examinations. This will need active participation and contribution from the academic radiology fraternity and inputs from faculty members of leading teaching institutions. Many workshops/meetings need to be conducted. Indeed, these collaborative measures will effectively sensitize universities, examiners, organizers, faculty, and students across India to OSCE and help successfully usher in this new format in radiology practical examinations.

Birth of a star

More than 120 years ago, while exploring the House of Mind, the Hungarian anatomist Michael von Lenhossek came across a hitherto unknown variety of cells. He was spellbound by their stunning star-shaped form, and therefore, gave them the name of astrocyte. Etymologically derived from ancient Greek (astron, star, flame; and kutos, hollow vessel, cell), this new coinage gained the acceptance of medical tribe in no time. Time elapsed. New truths got unveiled. New mysteries were unlocked. Still, the quest to find what these star cells did in the central nervous system continued to elude cell biologists.

Evolutionary trends in radiology assessment: The importance of the learning cycle and its assessment in radiology

Evolution and growth in medical education is a fundamental process. It is well reflected in the oft repeated aphorism ‘The students of today will become the teachers and practitioners of tomorrow.’ How well the student of today in any medical discipline shapes up to assume the role of a responsible practitioner in future is largely dictated by the quality of the learning cycle. The learning cycle in radiology, as in the case of other medical disciplines, is a triad of education objectives, instructional methodology, and assessment. Amongst these, assessment is a critical issue for those involved in radiology education.

The Journey Within

f these long years in medicine have taught us anything it is this: The science and practice of clinical medicine requires a systematic critical analysis of one’s doing at each step. Not just in the present, but equally the recent past! A kind of continuous self-audit. Of the diagnostic and treatment processes employed by the practitioners of medicine, and the resulting outcome and quality of life that the patients end up with.

The first pre-requisites of “make in India” clinical research: Inculcating a scientific temper and building a conducive landscape in the country

espite a landscape charged with immense potential — a rainbow of disease spectrum and large number of patients — India has, until now, largely been a laggard in the realm of clinical research. Even as we march in the 70th year of sovereignty and free will, our contribution to the global pool of knowledge in diverse clinical fields; development of newer therapeutic molecules, techniques, and treatment strategies; medical technology; and even in information technology-related clinical software development has been singularly abysmal. Ditto is the case of clinical literature, despite the overflowing clinics and wards, and also with respect to disease entities which carry the epithet of being tropical or are peculiar to the third world. Even the signs and symptoms of pathologies such as tuberculosis, must, unfortunately, still first find recognition and description in other geographies of the world.

Of medical curricula and gen-next physicians

While walking through the outpatients’ clinic, a medical ward, corridor or a public space in a hospital, often times you get to hear people’s voices. Of what they feel of the hospital management, of their expectations of the doctors, nurses and paramedics, of what ails the healthcare system, or, equally, not of the dark shadows that assail them, but of the morning hue filled with the sunshine of cheering optimism, inspiration and encouragement — of people saying how hard the doctors work, how they battle against all odds, and more heart-warming yarns of selfless devotion. These harmless conversations, call it “small talk” if you will, is often topped with keen observation, robust common sense, genuine grievances, and wise messages of where the healthcare system is going wrong and what could be done to straighten things.

Heal thyself, o dear physician!

f you have lived to be fifty, and don’t mind going down the memory lane, even if briefly, you would readily agree that a striking change has overtaken the medical profession. The charisma, the goodness, the nobility that once defined this hallowed profession, and its amour propre, has taken a full blown punch on its nose. While news of marauding public beating up doctors, cine makers and media anchors painting them black, the executive and judiciary turning to legal activism, and enacting and enforcing drastic healthcare laws—all might seem terribly over reactionary, sufficient to belittle and poison our morale, the unenviable present day truth is, medical practice has lost much of its glory and sheen. Be it the standalone family physician, specialist or subspecialists, be it medical institutions in public or corporate space, all equally feel they have lost much of their goodwill, authority, and political hold within the social order.

Setting course for a global medical varsity and third generation reforms in medical education

eset with outdated, fragmented, fossilized curricula, knowledge texts which make little allowance for the native landscape and associated host and system peculiarities, ill-equipped faculty hibernating in static age-old teaching methods, medical students who bunk classes and clinics from their early years in school to acquire knowledge skills vital for cracking the postgraduate entrance exams. Falling clinical competencies, particularly so with generation-next physicians. Education systems which do little to inspire enquiry, exploration or critical thinking. Postgraduate research reduced to a sham. Public investments in professional medical education on a shrink, and private players filling this drought, where the enterprise must measure success in terms of financial harvest rather than the fulfillment of social chores.

Blending the metrics and art of clinical medicine

Medicine, of recent, bereft of its Hippocratic soul, has increasingly become a slave of metrics – of machines, statistical numbers, and artifacts, which nowadays appear to rule its heart. Evidence-based medicine may look robust, and has, in fact, some undoubted benefits, but the trouble is, it begins to project its ugly head when we become too dependent on it. We must not forget the simple truth that a physician must treat human beings, each a unique entity, a pulsating biological system set with its own genetic code, an ecosystem that’s individual-specific and a behavior pattern no twins can match. If we still yield ground and relinquish the old-fashioned methods of touching, looking, and listening – the once prized, almost magical skills of the doctor who missed willy nilly nothing and could swiftly diagnose a peculiar walk, sluggish thyroid, or leaky heart valve using just keen eyes, practiced hands, and a stethoscope, does that make it a fit case of “prudence”? Call it – you might – a fear of the new, or – should you permit – more appropriately, clinical intuition, the answer is a big flat resounding “no”!

Evaluation and certification of Foreign Medical Graduates: Roots, global practice, and methodology

Instituted by the Medical Council of India in 2002 through a duly vetted legal process, the Foreign Medical Graduates Examination conducted by the National Board of Examinations is a licensure exam, which aims to sift the charlatans from those who have acquired their medical degrees from another country, but are knowledgeable and skilled enough to bolster the countrys physician workforce. Set up on the lines of similar screening exams held by countries across the world, the exam is an exercise in transparency, with a well-defined curriculum, which specifies the distribution and weightage of each subject, has no negative marking, and no limit on the number of attempts. Bereft of any competitive edge, the exam is extremely candidate-friendly, and yet, a positive step intent on preserving the piety and nobility of the medical profession.