Basic Medical Sciences are Not the right of Few

We are in the midst of seething controversy and confrontation between basic non-clinical scientists and medical scientists as to who will teach the medical students and how the medical council say of India will react to such a teething problem.

A simple look at the syllabus and information load presented to the high school students will show that a medical student is already prepared to face an information load in his sojourn in medicine.

D.Sheriff, ''Medical teachers must have an open mind'' Hindu, Sep.19, Open page, 2000. If it is so why bring in a point of contention and doubt to underestimate the teaching of biochemistry and over emphasize the need for giving more space to other subjects. It is said that a student finds it difficult to comprehend the principles and structure of biochemistry in the first year of medicine. The reason given is that the subject is factually pregnant and intelligibly abstract. The student’s inability to place teaching of biochemistry in medicine is said to be due to the faculty with a non-clinical post graduate or a doctoral degrees in Biochemistry from the Faculty of Medicine. The complaint is that such a teacher does not have the right background in medicine to teach Biochemistry. A faculty with a basic degree in medicine and specialization in Biochemistry is considered better suited to teach medical students.

This argument posted by Medical biochemists though sounds like inheritance widens the gap between fundamental biochemistry and its applied aspects. In such a context it is essential that we understand keeping the history of medicine in mind, medical education will be well-served if we have a right combination of both medical and non-medical teachers to teach the medical students.

The real concern is the teacher of biochemistry who’s loyalty remains torn between his loyalty to his subject and the other to his students. How the teacher whether non-clinical or medical projects the core concepts to the student remains the teacher’s teaching ability to balance the information to be delivered. It is not the problem of who teaches, it is the problem of Medical Education and curriculum planning. Biochemistry has spread right into the pages of all subjects including basic biochemistry to para clinical subjects like Forensic medicine and all clinical subjects. Therefore there is a need for teaching biochemistry on the basis of vertical integration starting from Ist year of Medicine to residency program of medical student. We cannot tailor the content of Biochemistry for every non-clinical and clinical subject has a biochemical basis to be explained.

The selection of content is related to the issues of integration and relevance raised above and not to the point who will teach for both non-clinical and clinical teachers have attained their professional degrees from Faculty of Medicine. (Sheriff, 2000)
OBJECTIVE OF MEDICAL GRADUATE TRAINING PROGRAMME:
(d) develop scientific temper, acquire educational experience for proficiency in profession and promote healthy living.

Salient Features Of Regulations On Graduate Medical Education, 1997 (Amended Upto February - 2012)Medical Council Of India.Salient Features Of Regulations On Graduate Medical Education, 1997.Published In Part Iii, Section 4.OF THE GAZETTE OF INDIA DATED 17TH MAY 1997)
Perhaps the most important point is to agree that the objectives are clearly different from those in the teaching of biochemistry to potential science graduates and that the response and attitudes of medical students-are clearly different from those of potential science graduates.

The main objectives must be to provide a foundation of biochemical knowledge which can serve (a) to help the potential doctor to understand
(i) the disease process, (if) the way in which treatment modifies the disease process, (iii) diagnostic methods, and (b) to provide as good a background to the potential doctor so that he can cope with future developments after he has qualified.

Medical Council of India. Recommendations of the Workshop on Need-Based Curriculum for Undergraduate Medical Education; New Delhi : MCI 1992; 28-30.Major Problems

Solutions:

1. Amount The number of hours taught of 'apparently' pure biochemistry should be strictly limited and where possible restricted to the [i_rst year. By 'apparently' I mean that much biochemistry can be taught at later stages but integrated into more clinical parts of the course. Thus a core of biochemistry dealing with basic principles, mechanisms and pathways comprising some 60 hours of lecturing should come in year one. This should be designed to teach the basic language of biochemistry and too much detail should be avoided. Thus, for example, pathways of cholesterol biosynthesis are unnecessary.

2. Integration The rest of biochemistry can be taught in integrated courses. Thus an integrated endocrinology course will include much endocrine biochemistry; an integrated nutrition course can includethe biochemistry of adipose tissue in conjunction with clinical aspects of overnutrition, as well as the biochemistry of vitamins, etc. Enzyme biochemistry may be integrated with clinical enzymology; much of cholesterol metabolism can be taught with the cardiovascular system. The artificial separation between clinical and preclinical biochemistry should be destroyed and the two taught in tandem.

3. Relevance It is arguable from the purists point of view whether relevance is necessary. However, for students to learn it is best if they are interested and devices can be used to engender such interest. One such device is the clinical demonstration. This can be used after each small section of the initial biochemistry block, e.g. a patient with cirrhosis can be shown after glycolysis has been discussed to show clinical problems of lactic and pyruvic acid metabolism.
Practical classes can also be used as devices. Of themselves practicals for medical students have little value. However, if methods are used or demonstrated which are identical to those used in hospital laboratories and clinically orientated problems are set the same value can be derived from a practical. In general too much valuable time is wasted on pointless practicals.

4. And who should teach biochemistry? It is preferable if the biochemistry course is planned by a consortium consisting of members of the departments of biochemistry, clinical biochemistry( both medical and non-medical) and medicine. The course should not be planned in isolation. If possible an equal mixture of medical and non-medical graduates should do the teaching. It is not necessary to restrict this to members of the pure biochemistry department.

In summary, the teaching of biochemistry to medical students presents many problems, most of which have been ignored in the past. It is vitally important that potential doctors have a good grasp of fundamental biochemistry but this will only be achieved if their interest is gained and held throughout the medical course.