They were meeting for the '1st national respiratory meet of HODs of pulmonary medicine of government medical colleges in India' conducted at Chest Research Foundation in Pune last week. This was the first time that HODs in respiratory were meeting to review, discuss and debate current status of the respiratory post graduate departments in India with respect to the three major aspects of their functioning: patient care, post graduate education and original research pertinent to our country.
The need for this meeting was felt due to the increasing prevalence of common lungs related problems like asthma, chronic obstructive pulmonary diseases, tuberculosis, diffuse lung diseases etc and the poor existing quality of care that is given to the respiratory illnesses despite our country being one of the leading manufacturers of the generic drugs for illnesses related to the lungs.
The meeting saw participation from several premier institutes in India including the PGI, Chandigarh, V. P. Chest Institute in Delhi, CMC Vellore, LRS TB Hospital Delhi, PGIMS Rohtak etc. Dr. Nilima Kshirsagar, National Chair, Clinical Pharmacology, ICMR Govt. of India, Dean, ESI-PGIMSR, MGM Hospital Mumbai and the Ex- Vice Chancellor of the Maharashtra university of health sciences while addressing the forum said that times are changing. The teachers must remain updated with the latest technological advancements and use them to their benefit in developing a healthy student- teacher relationship or mentorship. She suggested that to ensure that a medical post graduate student has acquired a certain level of knowledge and skills, we could take example from the west and integrate competency based model that includes explicit expectations & assessment at the end of certain duration into training, and avoid deconstruction of practice.
The key opinion leaders came to several probable solutions to the challenges faced today, one of which was development of a B. Sc/ M. Sc course by the universities to create 'respiratory therapists' who would be trained paramedical staff to assist the doctors. A few sporadic courses initiated by individual institutes do exist but the need is global.
They also suggested training and strengthening the primary and secondary health care providers in managing common respiratory problems so that the tertiary care centres can focus on more complicated diseases. Procurement and maintenance of basic essential diagnostic tools at government medical college level as well as training of the teachers in using these equipments was stressed upon.
Doctors also agreed that we need to inculcate good communication skills in the medical students and provide structured training for the same. Regarding upgrading the training of medical students the HODs opined that we should have more focused training at the undergraduate level so that diagnosis and management of common respiratory problems should be done even by a medical graduate. Lack of inter departmental exposure during post graduate training renders a Chest Physician less confident of managing other systemic diseases like diabetes and high blood pressure. Same is true for a student training in general medicine who does not get adequate training in management of respiratory diseases and leaves it to the chest physician whose number is much lower than those in Internal Medicine. Hence the HODs were of the opinion that both these specialties should get inter departmental 4 to 6 months rotational postings. Once we have more and more internal medicine and general practitioners handling the huge burden of common respiratory diseases like asthma, COPD, tuberculosis etc; the two specialties could be merged and pulmonology would then exist as a super-specialty like cardiology, endocrinology, neurology etc. Doctors also urged on regular up-gradation of teachers' technical as well as training skills to make them better educators.
There was a consensus on the need for more research in respiratory medicine relevant to our country and the HODs felt that training in research methodology should be fortified in the colleges. Also there should be adequate incentives for researchers which is lacking in our country barring certain institutes. Support from the pharma industry was also called for funding of quality research.
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