from a pathologist's desk

7/31/2019 From a Pathologist's Desk

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From a Pathologists desk

Author Dr Suvarna Nalapat

Contents :

Ch 1:-Music Therapy for integrating healthcare ( a project submittedto Government of Kerala)

Ch 2:-Susruthas oath and the Doctors dilemmaCh 3:-Lacunae in Modern Educational system Ch 4:- My Professional experiences in Medical Eduation

Ch 5:- Regulating Medical Education ; modern trends and problems


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Ch 1 :-Music Therapy for integrating

healthcare

Dr. Suvarna Nalapat (MD Pathology); Retired Professor and HOD Pathology;

Author and Researcher in Music Therapy and Indian and Western Philosophy.

http:// drsuvarnanalapattrust.org

Objectives:Cost-effective and integrated healthcare system approachable to common man

which has the goal of physical, mental, intellectual and spiritual health; Cultural and socio-

economic development and educational pursuit of weaker sectionsof society living in the

villages of Kerala/India; Relieve and prevent stress-related diseases in professionals and non-

professionals in urban settings.

My vision is to work towards incorporating arts and knowledge systems such as philosophy into a

holistic medical educational curriculum done in conjunction with the Medical Colleges of Kerala State.

The best minds in the fields of Medicine (modern medicine and indigenous Indian medicine), Arts and

Sciences will work together to evolve a holistic method for the physical, intellectual and artistic revival

and nurturing of human minds and bodies.

In an article in the Journal of the American Medical Association, Therese Southgate illustrates the unity

of Medicine and Arts. Medicine and art have a common goal - to reach the ideal. To heal creation. This

is done by paying attention. The physician attends the patient; the artist attends nature - If we are

attentive in looking, in listening and in waiting, then sooner or later something in the depths of

ourselves will respond. Art , like medicine is not an arrival, but is a search. This is why, perhaps, we call

medicine itself an art. ( Ed. R.S Downie; Oxford University Press)

I propose a three-in -one approach towards evolving a holistic Medical Educational curriculum. The

project is planned, researched and based on evidence recommended for a National Health Policy

decision of the Government of India. The first and the second steps mentioned below are ideal to be

implemented at the Governmental level . The Third step mentioned below is better for


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implementation at a Non-Government Organization (NGO) level with income from it being allocated to

developmental programmes in the educational and socio-cultural spheres.

STEP 1: INSTITUTE OF HUMAN VALUES IN HEALTHCARE ATTACHED TO THE

MEDICAL UNIVERSITY

An Academic centre where bioethics, medical sociology, healthcare economics and medical humanity

departments will function in an integrated manner with western and indigenous medical institutions

and educational centres under the guidance of the Vice Chancellor.

Discussions and seminars on health-related matters and integrated opinions aimed towards becoming

health policy of the nation. A sound health policy of the nation is also a sound socio-economic policy

and will create a value-oriented educational transformation in the mindset of the citizens. The above-

mentioned approach will partly adopt the methodology of the Medical University of South Carolina, and

will be planned according to traditional geographical features of Kerala/India and availability of nutrients

and food in the state at an agrarian level.

Basic structure

Academic Wing

This will be the Apex body and will be under the Medical Vice Chancellor and will deal withresearch, continuing Medical Education. It will have links with other research institutions and

will collaborate with them and should have all modern facilities for research and a good library.

The discussions based on Integrated and efficient Medical practices by the Apex body and its

attached institutions should formulate the Health Policy, the aim of which is Physical, Mental,

Intellectual and Spiritual Health of the cit izens of the state and the Nation.

All the other wings will have to function in a coordinated way under the Apex body. For thispurpose, several Executive Directors (one for each of the disciplines) should work directly

under the Vice Chancellor.


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Several clinical wings will be attached to the University. These wings will belong to variousdisciplines such as Allopathy, Ayurveda, Yoga etc. They wil l be under the DME/DMO as the case

may be (as is the practice at present).

The treatment, teaching of medical postgraduates and graduates and guidance of researchstudents will be done by the staff according to university norms.

An integrated centre of education and treatment with Music Therapy as the link to integrateindigenous and western Medicine. This integrated centre should have enough research

opportunities in the clinical and educational units of the University and the person who heads

this centre will function as the link between the Western and Indigenous knowledge systems

and the person will have a proven track record in both the Western and Indigenous streams.

Administrative Wing

This is concerned with day-to-day administration, staff appointment, conducting examinationson prescribed t ime, generation of research funding, maintenance of accounts, staff payroll and

harnessing of various digital methods and strategies including but not restricted to e-

governance. The Administrative head has to be an IAS bureaucrat of the Cadre of Chief

Secretary with the reputation of a good and ethical career. The Administrative Head will

report to the Vice Chancellor.

Citizens Wing

These will be intented towards dynamic inclusion of communities, both rural and urban.Cit izens Centres will be set up in selected key rural and urban centres and these centres will be

directly under the Integrated Centre discussed in the Academic Section. The Cit izens Centres

will have facility for integrated client-centered family therapy.

Step 2: COMPREHENSIVE PLAN FOR THE INTEGRATED CENTRE FOR

HOSPITAL PRACTICES

Gestalt model of Bio-psychological Medicine


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When environment is polluted, when food and clean water is not available, when waste is not disposed

of properly and when job and education is not provided, the community becomes unhealthy. Nature

and human existence is intertwined and disturbance of one disturbs the other. Mere expenditure on

drugs and grand multi-speciality hospitals alone will not be enough to ensure nations health and

progress. This is the modern understanding of health and value of integrating healthcare with

indigenous methods suitable for each geographical situation is essential.

Genes,cells,tissues,organs

Body/mind

Culture

Biosphere

Earth, nature

Cosmos

Community

Languages

EducationSecondary

groups

Person, family

Immediate

surroundings

Primary groups


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Designing an integrated service:-

Mainstream practitioners will need appropriate referral guidelines based on need and evidence. Public and private sectors will need well educated professionally regulated therapists. Capacity for research and creation of large outcome data sets will require development of

competent networks of practitioners and researchers.

Organisations involved must be capable of collaboration and reflective practice. Reflective practices of Clinical Training will require development of systems for data collection

and consistent methods for reporting outcomes.

As an academic field, the development consists of and depends on the following:

Further development of Inter-professional ethos. Appropriate interdisciplinary referral activity and reflection. Ways of improving access to Clinical Training and opt imize relevance and effectiveness of it . Practical approach to evaluation that reflect everyday practice. Evaluation of processes and outcome relevant to clients and students needs.

Continual clinical learning cycles to improve delivery of service. Appropriate action on reflection to optimize professional and practice development.

Practice review

What needs are poorlymet?

Modify service ,reviewmeetings, consensus

,action

Resource assessment

Delivering service

Referral procedures stated,Patients choice fully

informed, data

Managing and designingservice

Quality ,evaluations,monitoring ,aims, outcome


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Step 3: A comprehensive digitalized educational centre for Indian culture,

health and heritage made available to research scholars upon membership

1. Digitalize the manuscripts both published and unpublished.2. Make it available to public through a website so that the manuscripts can be read and

understood by a wide population.

3. Those research scholars and students interested in the topics can either contact and clear theirdoubts through the website or visit the author directly and have an interactive dialogue and see

the reference work museum .

There will be a fee charged from research students and/or global universities and the money collected

will be utilized for promoting village economy and development programmes.


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Ch 2 The doctors Dilemma :-

SUSRUTHAS OATH AND MODERN DOCTORS DILEMMA

Susruthasamhitha says that the Guru should obtain an oath from the disciple before he takes the

student as a Medical student.The oath is for sacrificing all hisKaama(likes and dislikes and dualities)

greed,anger,ego ,envy ,violence,untruth and dishonesty ,and all his base qualities ,laziness and artificial

acting of greatness . Only after testing the Disciple for these and gett ing an oath from him/her the Guru

givesUpanayana to Medical Profession. This was the Forerunner of Hippocratus oath.

Thatho agnim thri:parineeyaagnisaakshikam sishyam brooyaath

Kaamakrodhalobhamohamaanaahamkaarershyo paarushya

Paisoonyaanrithaalasyayasasyaanihithwaa neechanakharomanaa

Suchinaa kashaayavaasasaa satyavratha brahmacharya abhivaadana

Thathparenaavasyam bhavithavyam madanumathasthaanaanagamanasayanaasana

Bhojanaadhyayanaparenabhoothwaa mathpriyahitheshuvarthithavyam

Athonyathaa the varthamaanasaadharmo bhavathi

Aphalaa cha vidyaa na cha praakaasyam praapnothi (Soothrasthaanam 2.6.Susrutha)

According to Hassler who translated Susruthasamhithato Latin ,Susruthacomposed his great work in

1000 BC .When Hippocratus borrowed the code of conduct for the doctors ,he was echoing Susruthafor

the welfare of the patient so that the patient is not harmed by the Doctors personal dualit ies,greed,and

other base qualities .

When I read D.Balasubramanians article in the Hindu ,I thought of this Sloka in Susruthasamhitha. (The

Hindu 8.9.2011) He speaks of two hypothetical scenarios studied by a team of sociologists and doctors

(Archives of Internal Medicine April 2011)

Scenario 1:- Imagine that the patient/doctor has colon cancer .Two surgical options are available .Both

has 80 % success .One had the remaining 20 % persons developing side effects (4 %) and death(16%).

The second has no complications,but failure was 20 % and for every 100 persons operated 20 die.Of 500

doctors interviewed ,242 only responded showing the lack of involvement of the doctors,or their lack of

opinion .Majority of doctors chose the second option for themselves. 60 of 242 chose surgery 1 for their

patients.So ,there is a dichotomy for what they choose for themselves and for the patients.


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Scenario 2: - Imagine a flu epidemic.There are two opt ions. Mode one is simple hospitalization ,bed rest

for one week .No intervention at all. There is 10 % mortality. Second is with a newly introduced

Immunoglobulin . The adverse effect with Influenza virus is cut to half(only 5 % mortality) but

complications due to Immunoglobulin like paralysis (4 %)and death (1%).

1600 Primary care clinicians were asked which options they will take for themselves and for their

patients. Of 1600 only 698 responded. 440 doctors opted for hospitalization and bedrest for one week

(without new immunoglobulin) for themselves.258 prefered immunoglobulin for themselves. 386

doctors preferred Immunoglobulin treatment for their patients.

In both the scenarios the doctors preferred the option for a high mortalit y rate for themselves ,to avoid

adverse reactions affecting their day to day activity and quality life. But to their patients ,they preferred

the other option .

Reasons: 1.Less harm to patients is interpreted as less mortality rate .This may be to prevent law suits.A

defensive method

2.Psychological cognitive bias . People when they recommend for others focus on single dimension

alternative ,that is typically easier to defend.

3 .For themselves they have several biases coming into play.One is the feeling that intervention to

prevent harm is worse than the harm caused by illness itself.(Betrayal aversion)

4.Omission Bias: Harm result ing from an act is worse than not doing it at all. Omission better than

commission.Both 3 and 4 are cognitive biases and of the 3 cognitive biases the safe and easy defense isapplied for patients(whom they consider as the other) while they take the other option for themselves.

5.It is probable that the doctor thinks that the life of patient is saved first ,with complications,then later

on the complication treated slowly with other methods in t ime .This saves the life.

The dilemma of the doctor is shown perfectly well in the article.The question is if one prefer for oneself

is a quality life , and prefer mortality to an invalid existence- why doesnt one think that the patient also

may prefer such a life ,rather than an invalid disabled life at mercy of others? The duty of doctors thus is

to inform the complications and the different options-not only in allopathy but in other modes of

indigenous treatments available and respect the patients preference for selecting his/her own

options for treatment. If this method is adopted and all the different modalities of western andIndegenous medicines are made available in the same Hospital (institution) the integration of Medicine

will be perfected and made more efficacious.This is what I envisage when I link and integrate

Allopathy,Yoga,Ayuveda through the golden link of Music Therapy .The Integrated Medical practice has

to come up for solving several dilemmas the doctors ,patients and the nation face for cost-effective

quality healthcare . Integrated Medicine does not mean one branch of Medicine adopting the style and

theory and practice of another branch,but it is a client-centered approach where all modalities of

treatment are presented to client and his/her relatives under one single roof in a co-operative manner

.Therefore there is no need for any branch of Medical knowledge to loose its originality or to fear that


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the other may take away its practice.This dilemma of practitioners is the main stumbling block at

present in integrating the Medical practices efficaciously at present . The nation needs an efficient and

cost-effective integrated approach for healthcare and for that each branch of medicine-both western

and indigenous-should contribute in co-operative way . The first step for a healthy nation is having best

nutrition (for which promotion of agricultural practices according to the geographic peculiarit ies is

essential)for all its children and adults,best education (free education at least upto the higher secondary

level) ,the awareness of Nationalaty and a good citizens duty along with rights,and a job for at least one

member of the family .The other things are control of alcohol,drug intake and other social evils so that

the brain of every cit izen function normally .What we think we say and do and become. Therefore a

healthy body and a healthy mind is needed for healthy intellectual life of the nation.Without these

preliminary requirements ,mere mult ispeciality hospitals as business centers which can cater to only the

needs of the wealthy people cannot protect the national health or its health policy.

Ch : 3Lacunae in Modern educational system1 Fails to provide transformation in human attitude to link traditional knowledge with modern

evidencebased science.That is it lacks integration .The person who study TKS and person who study

Modern science are categorized in two sectors and they are within walls not knowing the potentials

and the limitations of either,so that solutions can be suggested .Therefore ,an innovative approach to

link TKS with contemporary science is attempted .

A very common classroom example : Modern medicine describe gross appearance of squamous cell

carcinoma as Cauliflowerlike .Susruthasamhitha describes it as swethapundareeka-like(white lotus).Thisis simply because of the geographical peculiarity of India and the Europe .Cauliflower grows there ,and

white lotus here and human thought could compare the same lesion with a familiar similie.Unless we

have a basic knowledge of both systems (both languages ) we wont be able to understand the similarity

and scientific thought process of our ancestors.

2 TM is lacking in modern research infrastructure(technology ) of modern medicine.But these are

discoveries of physics and astrophysics and is not monopoly of modern medicine alone.Knowledge is

the heritage of all alike .Therefore strengthening Traditional medicine with modern research protocols

and infrastructure is needed

Fields of pharmaco-genomics(prakrithi,rasayanavidya) immunology (rasa/aama theory) ,material medicaof manifold herbs ,the thought processes of traditional medical teachers should be preserved in the

original language and translated to English and other regional languages of India so that the merits of

the ancient science will not be missed by anyone

3.The ecosystem specific of various geographic areas of India (being a nation of different geographic

features and biodiversity) itself will strengthen the self-sufficiency of food,herbs,drugs possible for our

sustenance and healthy existence

4.The quality and quantity of clinical trials and certificates issued to such trials have to be improved


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5 Digitalise the TKS all ancient manuscripts available for a good database

6.suitable framework of intellectual property rights to be established

7.Establish specific goals for conservation of our natural resources

8.Support the NGO and corporate initiatives to promote and preserve traditional knowledge

9.Promote international co-operation in this field.The heritage of India as intangible heritage of entire

human race/its earliest thought processes on science and art should be the world heritage

10.support primary healthcare in rural areas with community herbal gardens (where local herbs natural

to the geographic area is grown) and kitchen gardens,fruit trees for nutritional selfsufficiency

11.Create awareness about agricultural,water resource management and pollution control measures

for prevention.

12 Use tradit ion ,folk ,regional,popular and classical musical t radit ions for each season(like seasonal

vegetation) and day/night and for cosmic timespace so that alpha waves of brain ,and anti-stress

hormone secretions,neuroendocrine secretions for healthy life is ensured .

HAVE A POSITIVE APPROACHAll complex social institutions face problems which is a process of institutionalization.We too have

them .But need not panick.We can sort out our problems.Survival of human race is a making meaningful

sense of experiences which lead to formation of academic disciplines in earliest times .All subjects

taught by our ancestors were thus created by them for survival and preservation of our race in our

particular geographic region(India).Their vision found solut ions for food sufficiency and economy by

sharing of food with less fortunate unfertile regions of the land by people living in more fertile lands

.The educational system /curricula they devised for transference of thought processes(not just

information) so that all get the equal share of what their brain can take in ,digest and put into practice .

There is and should be an aim for any good curricula.The subject taught,the infrastructure,the

institution,staff,schedules are all only support systems to achieve that specific aim.Therefore the aim of

the nation as a whole to achieve self-sufficiency and equity in all fields of development should be atthe forefront of all activit ies when we plan the curriculum .Have a very clear and overreaching goal set

.Integrate the reality systematically and in a wholistic manner.Knowledge explosion has resulted in

information transfer at massive scales. But true knowledge is not information t ransfer ,but ability to

think creatively in any life situation and survive by timely action.This part is missing in the post-

independence educational pattern .

More than the quantity of information ,the way in which a neuron/the brain process that information

and make use of it is more important .Research has confirmed the arts,music ,varied experiences have a

major role in intellectual activity and in a modern school curriculum these are treated just as Fringe


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subjects and given secondary importance to science and maths .The ratrace for medicine and

engineering and MBA seats show the attitude of the society as a whole.

The thought processes are neglected and only recall is important for exams and therefore students learn

just to pass exams and only short term memory is stored in brains.Brains have lost the ability for

meaningful experience with what is learned in such curricula and that is why many adults say they cant

recollect what they had learned in school.Individual abilities,interests,overall personality and character

development are neglected in the competitive race for jobs /careers.There is no comparative study of

tradit ional knowledge system and modern systems .Therefore students lack the organized

systematically arranged preserved knowledge of the ancestors of the specific geographic region to

survive any calamities-natural or manmade and also to suggest original solutions for such problems.

Lack of knowledge of ones own environment,geographical region,its resources,fertility etc results in

economic backwardness to any people .Making use of them in the best possible way is what tradit ionalknowledge systems teach us and by neglecting that we are loosing everything .Adapting to changes of

environment and life and shaping a better future depends upon prediction of the geographic /seasonal

changes likely to happen and living according to it .

But desire to learn which is the deepest human desire is neglected for the extrinsic motivators like fear

of a failure and pleasure of getting a degree/award/higher job market /pay etc .This is the reason why

tradit ional knowledge,humanit ies,arts etc are neglected by society/parents and students .Modern

education has become just information distribution,and vocational training for job hunting and human

factors are totally lacking from the curriculum (especially in technical educational institutions).There is

no concern for the whole.The forest is not seen but only the tree is seen.Only fragmentedspecialities/divisions of knowledge is seen and reductionist tendencies increase.The values deteriorate

and students are unable to cope with real life situations and number of depressive illnesses,of suicides

etc are reported more and more .The unorganized information dispensed at high speed make the brain

incapable of organizing it for long-term use and for a quality life .

In fact a pre-school child can learn a lot -including multiple languages,music,social situations

management,interpersonal relationships,rules of several games,quantification and evaluation of quality

etc .But the modern schooling has smothered all such qualit ies by two words- Literacy (learning to

read and write but not necessarily understand the significance or meaning of it) and numeracy ( just

for counting money ,not as abstract thought process ).

It is the human variability that made civilizations possible.The modern thrust of achieving minimum

standards smother the desire in individuals and institutions to achieve the full maximum potential of

growth .The result is mediocrity .Learning is not transfer of information,but a dynamic

relationship.Artificial separation into disciplines,specialities,subjects,themes ,into religions and genders

are all considered very thouroughly ,a comparative interdisciplinary knowledge system suggested by

our ancients as early as the vedic period and that advaitha is personified in Music and its reportaire as

science and art .


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Chapter 4 :-My Professional experiences in MedicalEducation

After my MBBS course ,I started as a private general practitioner in a backward village in Calicut .The

experiences in that village was the greatest education I had about the poverty,nutritional deficiencies

and infectious diseases that our rural people encounter and also the most feasible solut ions a

responsible citizen can think about .The first Government appointment I had was in an ESI hospital in

Pathirappally ,in Aleppey and the next lesson I learned was that if there is organizational and polit ical

power the labour force can make any demands .The hefty strong people without any disease coming

and demanding leave on basis of sickness and doctors issueing them ,though they knew that it is mere

malingering made a lasting impression in me .As a responsible citizen I felt that people who demand all

rights and are not prepared to perform duties for the sake of the nation are in fact a burden to our state

.But I could not do anything ,because I was just an individual of only 26 years old,and with a first

appointment and what I can do to to show my protest was just resign from service(which was not even

noticed by anyone as a act of political and social statement against irresponsible behavior of citizens.)

Then I joined Pathology department in 1972 October 21st as a lecturer. This started a brilliant turn of

events in my life.I loved Pathology for its intellectual diagnostic pursuits,social sense in reporting and

clinical duties in teamwork ,and above all the teaching profession which it offered .The first posting was

in Calicut medical college,my alumni .But after 6 months I applied for a deputation transfer to Thirumala

devaswom medical college in Alleppey where my husband was working as lecturer in Pharmacology.TheGovernment gave me an option that if I am ready to forego with deputation allowances,I may be

posted according to my wish.And I promptly accepted and joined on deputation without allowances ,in

that developing medical college .The initial stages of the development of Alleppey medical college also

witnessed my init ial experiments with learning-teaching situations.

At the time I joined Dr Harilal was Professor of Pathology . But he left soon and the entire department

became the responsibility of lecturers .This was a blessing in disguise for me ,as a teacher.With no one

to guide ,we had to start our own teaching schedules , both practical and theory . I had a schedule

charted out in which I tried to give individual attention to each , depending upon their talents and

interest and for that I read out crit ically the answer papers of each of them and made a note (asgrading) of extraordinary, ordinary and below average groups .In the classroom , I would call out names

of students and ask questions depending upon their grade (easy questions to below average ,tougher to

extraordinary) so that an interrelationship as well as a initiative to learn ,to prepare daily lessons will be

inculcated.And in practical sessions I would visit each student at workplace and try to give a practical -

oriented problemsolving situation either with the gross specimen or the microscopic slide and make a

module (problembased ) by such exercises and watch the outcome .This practice helped me to know

where ,I as teacher ,and the students as learners ,need improvement .The cyclical improvement I had

with such experiences with my students can never be forgotten when I speak of my integrated

valuebased curriculum planning .


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When I returned to Calicut Medical college in 1975 ,I had become popular as a good teacher (and also a

good public speaker / orator by 1977) thanks to my early teaching experiments .That was a

transformation I had from a silent girl (who writes written communication as poetry,stories,essays) to a

highly orally communicative person .In the 80s we the staff of Calicut medical college Pathology

department started postgraduate programmes and associated weekly teaching discussions on every

Friday morning .In this ,we discuss syllabus,curriculum,and devise modules for each topic and every

staff member and PG student takes active part .This modules were introduced in practical/discussion

groups in our college .We found this of great use in improving the problem-based learning capacity of

student .The objections came from some of the teaching staff members and when we gave

questionnaires (which we give to each batch after every programme period) we found that those who

raised objections were actually graded last by students .That means, the objection is because of their

inefficiency to carry out the task rather than due to defects in the programme .

I was exposed to museum ,student section and stores section and bloodbanking from Calicut medical

college ,where all these sections in turn comes to each of us by rotation posting . Administration and

management experimented in Blood bank in 1990s with an Indian ethos(as given in the Gita ) could

successfully endorse quality and efficiency in bloodbanking system .The regional blood bank (for

northern kerala) I planned according to the Glasgow model and with Indian context in mind was

submitted in 90s to the Government and after my retirement from service,when I visited Calicut for a

programme on Environmental Protection conducted by the Forestry Department, Mr Nalinakshan ,a

person who was associated with the Voluntary Blood Donors Programmes in the 90s came up and told

me that Madams regional Blood Bank scheme is sanctioned at last . That was almost 15 years after I

had submitted the plan. But I was happy that it was sanctioned. Better late than never.. Another

programme I submitted was the health village adoption scheme through Calicut corporation authorities

in the 90s which I resubmitted with proper innovations and additions to suit the Deemed university of

Amritha institute of medical sciences and research center in 2002 .The music therapy programme is only

part of the entire holistic approach .

Curriculum debates in education is mainly based on primary and secondary education and not much is

done in the higher tert iary education and practice levels .The attempts I have made is mainly on the

third level higher education ,but it also encompass the lower levels of education since it has to be

considered as entry points for higher education and base should be strong .Education is either product-

focussed,or process-focussed or both inclusive.We can develop curriculum through constructive

alignment ,as process,as engaging curricula,through use of threshold concepts and also as problem and

enquiry based learning .All these approaches developed in international scenario in the 2000s only .

The staff describe curriculum as four different categories according to Fraser and Bosanquet(2006)

1.Structure and content of a unit

2.Structure and content of a programme of study

3.The students experience of learning


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4.A dynamic and interactive process of teaching and learning

The first 2 are the product view and a tangible product is the outcome.The last 2 are process view and is

more intangible.The tangible product is that which conforms to the teachers original intention for it .The

curriculum as design in advance(Barnett and coats 2005) developed from a generic template by subject

experts in the light of their knowledge and discipline and assumptions about the student needs.The

student learning is controlled and implemented by teacher in this.Student is judged in the end ,by a

examination ,how well they achieved what the teachers programme goal .Content is a highly significant

aspect ,selected by a group of teachers .There can be aspects which need modification and these are

flexible to be modified according to needs.

The process perspective:- Framed by an emanicipatory interest /orientation and teaching is a shared

struggle towards emanicipation with other principles of critical pedagoguy ,learners are active creators

of knowledge too.The educational experience is negotiated and curriculum emerge from systematicreflection of those engaged in pedagogical acts.Design(ed)-in-action is a dynamic process (Barnette and

Coate) and certain aspects cannot be anticipated in a template (schon 1987;2006.282)One has to view

the produt as a first step and a continuum from product to process is happening.In higher education

discussions encourage Consideration;Reflection;and Re-assessment- of a process of project of study as

well as learning and teaching encounter.The valuebase of lecturers in relation to their understanding of

education and conceptions of learning and teaching will be fundamental to conceptions of curricula and

form and shape it takes.

AN OUTCOMEBASED APPROACH TO CURRICULUM DEVELOPMENT:-Principles Gosling and Moon(2001) based on were:-

1.All learning expressed in terms of outcome to be demonstrated

2.Modules of learning described in terms of learning outcomes and assessment criteria.

3.These rather than mode of delivery form basis upon which they are assigned a specific number of

credits at a given level

4.Learning outcome placed with in the hierarchy of 5 levels of NQF(UK)and 10(Ireland)

5Any given module assigned only to one level

6 Learning outcome should be as clear and unambiguous as possible

7.Learning outcome identify the essential learning to be achieved to merit the award of credit

8 Assessment criteria should specify how satisfactory performance of modules learning outcome are to

be demonstrated

9 Assessment criteria should encourage learning at approximate level


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10 Learning outcome should enable employees ,schools,colleges,parents ,prospective students and

others to understand achievements and attributes of students who successfully completed a

programme

11.Facilitate comparability of standards to facilitate international mobility of students

12 Facilitate students and graduates mobility and help identify potential progression routes ,particularly

in context of lifelong learning

13 Assist higher education institutions ,examiners,Quality assessment bodies and reviewers to assess

and ensure quality /standards providing an important point of reference for setting and assessing

standards

LEARNING CENTERED CURRICULA:-Has a flexible framework .The importance of content and the community in development process is

considered.It emphasise on learning communities ,curriculum integration,diverse pedagogies and clearly

defined learning outcomes.

Students,faculty and stakeholders are active part icipants

Academic units are at different stages in curriculum reform and progress at different rates

Should honour inclusion of wide range of teaching and learning strategies

Within an academic unit reform is both an individual and social contextual process

Activities:-

1.Learning context

2.Developing clearly defined curriculum wide learning outcomes

3.Assessment strategies

4.Progressive stream of teaching methods ,learning experiences driven by curriculum-wide learning

outcomes

DEVELOPINGCURRICULUM THROUGH CONSTRUCTIVE ALLIGNMENTThis is suited for training rather than education.Three key curriculum elements:

1 Intended learning outcome

2.Teaching and learning activity

3.Assessment tasks

These 3 are balanced


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The learner understands /learning takes place through relevant activity .The system designed to enable

student to learn ,rather than to leave them guessing what is involved in the course of study or in what

theory will be assured

Module development with outcome-based curriculum:-

The article of Gosling and Moon appeared only in 2001 and our department had experienced the

process as early as 1980s and hence we were actually experiencing first by action and then comparing

with others experience making it a metascience pattern.The modules ensure existene of a logical

relationship between level ,learning outcome,assessment criteria,assessment and teaching

methodologies for quality assurance processes .

The model:- 1.Existing level descriptions

2.Translate them to subject descriptions

3.Identify aim of module or programme

4.Write learning outcomes for programme and the module

5 Design assessment tasks

6 Design threshold assessment criteria,provide incentive for higher achievements as grading

7 Develop assignment methods to test achievement of both forms of assessment outcome

8 Develop learning strategies to enable learners to reach learning outcomes /assessment criteria

9 Develop module programme .Rethink it including leaving outcomes.

With my teaching experience in Calicut medical college I was trying to implement this modern

innovative modular curriculum strategies in Amritha institute ,but unfortunately the staff (especially the

senior staff) could not co-operate in these highly technical aspects of learning/teaching behavior and

though the programme was charted out painstakingly ,and modules prepared ,only part of it was

experiments in Amritha hospital .(Pathology modules).But fortunately for me,the sadbhavana lectures

for integrated approach,the music therapy research could be completed satisfactorily .

CYCLICAL SPIRAL STAGES OF CURRICULUM DEVELOPMENTThere are different stages in curriculum development.First one has to be aware of it as important in any

learning situation. Second one has to develop an initiative for innovative programmes.Third one has to

mobilize all possible strength and team for carrying it out.Fourth the action plan has to be developed

with much consideration,reflective thought on outcome for students/clients/nation as a whole.Finally

one has to put it into practice.Thus a personal and practice plan should develop side by side for

achievement to happen.A team of educators (from pharmacology department in Canada) had given a


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descriptive model of their experiences(2003).The context ,the academic community and organizational

context are important for making the dreams come true /action plan made into practice .

An articulated curriculum embraces both intended and emergent learning outcomes .All elements

interact and influence each other to stimulate and support active learning and readily reflect what

happens in a classroom situation or in a practice situation of a clinician.There will be a series of dif ferent

intentions(among clients,students,stakeholders,clinicians etc)which can create a mess(out of which one

has to draw a clear picture) and all sorts of ambiguities may be seen when we interact .Hence this is a

step towards a process model .A Harward team introduced the term WTP(Ways of Thinking and

Practicing) as Through lines. A spiral of repeated engagements o improve ,to deepen skills,att ributes,and

values is what a life is all about .Through threshold concepts one gets a transformed way of

understanding .And when such a person devise a curricula it will be an integrated one and will definitely

involve a holistic approach to all ways of thinking and it would be for betterment of life,profession and

of entire life on earth.It is difficult to draw a distinguishing line between traditional curricula and

innovative emerging curricula in India ,as in the west because most of the western innovative styles

were in traditional vedic curricula ,as I had pointed out when I discussed Valabhi and Nalanda and vedic

and Budhist universities and their methods.The western division of traditional and emerging curricula is

as follows:

TRADITIONAL EMERGING

Knowing that Knowing how

Writ ten communication Oral communications

Personal Interpersonal

Internal ExternalDisciplinery skills Transferable skills

Intellectual orientation Action orientation

Problemmaking Problem solving

Knowledge as process As product

understanding Information

Concept based Issue based

Knowledge based Task based

Pure Applied

Proposition based learning Experiential learning

One has to ensure the three domains of higher education

1 Knowledge (Gnaana)

2 Action (karma)

3.Athman(self)

The educational identity of the self in relation to subject area is determined by the personality t raits

described by Charaka (the 16 personality types belonging to sathwik,rajasic and thamasic ) because their

intellectual and ability levels and interest levels are varied and tehr power of memory,concentration are


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different .These domains are integrated as best as possible in any learning schedule for betterment and

upward movement as progress.

In problem and enquiry based learning students play a major role .Problem solving skills of students

individually,in small groups,in extended groups in any situation so that they can manage life situations

effectively is the objective of an integrated study .PBL is a balanced state of learning in managing ones

own life and serving the nation with that balanced view .

Chapter 5 : Regulating Medical education :-

Efficiency and quality are difficult to be defined just by the presence of an individual or an institution in

spacetime,unless in the long run ,time proves the outcome of the individual/ institution .We can try to

quantify by hours of work done by each individual,output from each institution,yet the number of

hours does not always depict quality.The same hours of work,in the same discipline done by two

different individuals need not be of same quality and efficiency .The workload of teachers of higher

education (as shown in page 64. Item 7.57 ,UGC committee 1992 ) is as follows:

ACTIVITY & AVERAGE NUMBER OF HOURS PER WEEK:-

Activity Professor Reader Lecturer

Teaching 6 8 10

Tests/exams 1 1 1

Tutorials 1 2 4

Preparation 6 8 10

Research 14 14 10

Reading/administration 12 7 5

Total 40 40 40

In the case of a pathologist,who is also a medical teacher , and whose time of work is from 8 AM to 4 Pm(1 hour lunch) the weekly 56 hours have to be divided also for diagnostic, consultancy, discussion and

lab work . Therefore , what we do is , make an arrangement of division of labour and rotate between

the teaching, diagnostics work. Suppose there are only two professors in a pathology department and

one of them refuses to take up any teaching /administrative work and opts only for consultancy and

diagnostic work what measures should an administration take ? If the other professor is willing to take

up entire responsibility of teaching, research and administration, curriculum planning, syllabus and the

paraphernalia associated with it , the administration should be happy to have avoided a strife . But in

fact , a responsible administration should make the professor see that teaching also is part of the work

of a professor of an institution of high excellance.


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Even when there is division of labour between the professors, they can consult each other regarding

difficult problems of diagnostic work, exchange ideas on clinical and clinicopathological work and keep

the excellance of the institution high . Quality in administration, in teaching and in consultancy and

administration is the total personality development each pathologist strives for and each institution

should look for . But usually , the administration fails to see such overall total quality/personality

development . Charaka , an ancient Indian medical personality defined human personality

development in 16 different ways, 7 of them sathwik, 6 of them Rajasic and 3 of them thamasic.

Sathwik personality is Kalyanagunavisishta (full of auspicious qualities) rajasic personality is

Roshagunavisishta( full of anger which if turned against injustice will help nation, but if directed to

persons/group of persons will lead to cruelty and injustice ,wars), and thamasic personality is

mohagunavisistha( with quality of desire) and not fit for intellectual quality work. The upward mobility

from thamasic to rajasik and from the rajasik to sathwik is possible by proper guidance and guru tries

to upgrade the shishya on this ladder of excellance .

1Sathwik :-

A .Brahmasathwa-intellectual,ethical,scientific,philosophic,aesthetic,truthful,control senses ,unselfish

B .Aryasathwa visionary ,ability to grasp meaning of science,hospitality,controlled senses and unselfish

3 Aindrasathwa-powerful and enthusiastic speech,memory and ability to foresee

4.Yaamyasathwa mental power to suffer any hardship,to do work without t iredness,memory power

5.Varunasathwa- Calm,bold,do work without getting tired,give to deserving people liberally,love to play

in watersports

6 Kouberathathwa-Interested in worldly life,marriage,makes money and lives comfortably,does both

religious and secular duties

7.Gandharvasathwa- music,dance,drama,history,storytelling,smell(perfumes),flowers,luxurious

ornaments and cloths,life with beautiful women

2 Rajasic

A Asura(also called daanava since they give alms readily and are having dharmikarosha ).Mahabali rosefrom this to Aindrasathwa ,and Prahlada to Brahmasathwa ,and Viswamithra first to Aindra,then in

order to Arya and Brahmasathwa .

B raakshasa(selfish desires make them do sins)

C paisacha ( heinous crimes are done by them due to intense worldly desires)

D Sarpa( stoop to any low level and do any heinous crime for selfish motives)

E praitya unfulfilled desires make them wander along thinking of the desires


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F saakuna same type ,the desirous mind flows like a bird

3 Thamasic :

A Paasavan eat,drink,sleep and makes children .No other interest .Just like an animal( pasu)

B Maatsyan coward,idiot ic,love flattery,fickle,love travels in water /ocean

C Vaanaspatyan- lazy,sits without doing anything ,no intellectual or physical activity at all

At present education is becoming a consumer cost and resultconscious commodity ,especially at higher

levels,where student fees have become exorbitant ,and the education is perceived as a provider of

services and benefits .This on one hand prevents the equitybased services and benefits to all citizens

alike ,and a double type of organizations /institutions are emerging ,along with different type of citizens

at two ends of the spectrum . Nation struggles to overcome this and by a series of efforts/discussionscome up with solutions to combat them.The success indicator of a nation/institution/ individual is a

personal/practice development plan and finding out solutions to all problems . The UGC commit tee

report of 1992 had suggested a few solutions (in which the then Finance minister Sri Manmohan singh

and HRD minister Arjun Singh had contributed their ideas too) and the current bill in the parliament

has to be seen as an extension of the recommendations of that commit tee .Instead ,most of the states

and institutions and individuals view it as if it is a new bill (probably because they are ignorant of the

recommendations of 1992 committee ).

1.THE HINDU REPORT :-The Hindu on Saturday July 10th 2010 (Anand Zachariah,George Mathew,M.S.Seshadri,Sara

Bhattacharji,K.S.Jacob) says the complexity of issues related to education in medical and health

disciplines demands a separate regulatory authority.The opportunity to recreate the regulatory council

for the education of health professionals is historic in its possibilit ies and potential to address the crisis

facing healthcare in India.According to them,the council should address issues like lack of access to basic

healthcare due to inadequate numbers,the skewed distribution of healthcare providers,ensuring

propriety,increasing efficiency,providing greater synergy among professionals.The new national council

for higher education and research (NCHER)bill seeks to include medical education under purview of the

proposed council.The regulations suggested are:

Facilitation,coordination,setting of policy by NCHER

Health council to consider syllabi,curricula and exit examinations

The local universities to regulate academic institutions

How NCHER bill address specific requirements of education of professionals not clear.

Concurrently the Government has proposed formation of National council for human resources in

health(NCHRH) as a single apex body to oversee all education and practice related to health.It is

apparent that there will be an overlap of functions between the two authorit ies.


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A separate regulatory authority for health education and practice is mandatory due to :-

1 Links to health care delivery: Need to provide health service to society demands sett ing up a system

which will sequentially address the following issues.Selection of students from local areas,sufficient

training in primary and secondary care hospitals,generalist postgraduate training opportunities,for

example family medicine,career opportunities in areas of need and continuing educational support

.Such a system will mandate close linkage between educational institutions and healthcare delivery

systems.

2.Apprenticeship model of training: At end of training the health professional should get a high level of

expertise.Considerable clinical skill,under the teachers in a appropriate service environment.Such a

model allows narrowing the divide between teaching,research and practice.It facilitates holistic

approach to learning and captures the essence of yashpal committee report .

3.Regulating health professionals : Education and practice of medicine is a continuum and the

regulation of education has to be coupled with that of practice.UK first established a dual

control(General medical council and Postgraduate medical education and training board) and discarded

the model and reverted to single body for oversight of both functions.

The authors ,who are professors of Christian medical college Vellore shows concerns over some certain

highlighted issues .Their concerns are :

1.Relationship between health disciplines :The proposed regulatory council includes

medical,nursing,dental,pharmacy,paramedical,public health and rehabilitation services.A single

regulatory body /authority will result in greater co-ordination and collaboration among these disciplines.

2.Composition of the authority:The new authority should be composed of diverse stakeholders,including

patient advocacy groups and social scientists ,in addition to distinguished medical and health

professionals so that overall healthcare needs and not narrow professional interests are the focus.The

council should not be too small so that the power is concentrated in a few hands.Nor should it be too

large so that it is divisive and inefficient

3 Independent accreditation and regulatory functions.MCI handled accreditation and regulation and this

diluted and weakened both processes.The authority should have two independent divisions. One

accrediting education and the other oversee practice.Lack of self-regulation in past,argues for a

watchdog to ensure nd enforce adequate technical and ethical standards in medical practice

4.Model of accreditation: Should focus more on describing broad principles and standards that focus on

outcome.This will allow for flexibility ,innovation while maintaining basic standards.A credible and

transparent system of assessment ,which balances routine self-report and review with monitoring and

on-site inspections needs to be designed.

5 Relationship with government: Need for autonomy and independence of the body is crucial .The

authors think that subjecting it to health ministry approval limits its role and delays


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decisionmaking.Government should have power to provide overall policy directions to the body and the

body should serve as consult ive body to ministry.

6 Relation with hospitals,universities,specialist associations: Propose a clinical stream which is under

specialist associations .AAnd an academic stream upgraded to research degree who remain within

universities ,while the clinical stream after degree go for practice.The authors think this will avoid

conflicts existing between MCI ,and National board ,increase the number of centers for training

clinicians and raise standard of research.

7 Single window: Previous regulatory procedures included separate and independent inspections by MCI

,university and state governments.This resulted in a many-tiered system that lead to huge delays in

obtaining approvals,and a single window for accreditation and approval of education is necessary

8 Standardised exams and validation: A common licensing examination for undergraduates andpostgraduates to maintain uniformity of defined technical standards.All health professionals should

maintain standards of professional knowledge and skill through regular re-validation.System of

continued education and credits and regular reappraisals is mandatory

9 Transparency and accountability: To public scrutiny .A record of excellance in one;s field should be the

basis of selection to proposed council .The authors propose the Nolan principles-

selflessness,integrity,objectivity,accountability,openness,honesty and leadership-to form standards for

holding public office and in public service.

The knowledge commission and Yash pal committee which examined higher education identified major

lacunae and suggested an overhaul of the system.There is need for broad-based holistic education anddialogues between diverse disciplines and centers of learning .The regulatory councils chould act as

facilitator and catalyst for creation of knowledge for society.

NCHER can foster an interdisciplinary research and identify national priorities.It can empower

institutions with a proven record to enhance their autonomy as institutes of national importance.NCHRH

can serve the goal of improving education in health sciences.It must ensure that education in health

science fulfil a social mandate.It should provide a vision to improve healthcare delivery .

2 WHAT I UNDERSTAND :-What I understand is that NCHER focus on policy and regulation and not on funds . Funding will be with

a separate corpus with norms for block grants.The UGC,All India council for technological education and

national council for teachers education will be thus replaced .By establishment of NCHRH as single apex

body to oversee all education MCI will loose the power of control over medical colleges.The objections

are raised already by Kerala,West Bengal and Tamil Nad governments as violation of federal principles.


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What clauses do they object ?

1.A new university will get authorization by the NCHER .This is for quality control.

2.VCs appointed from a national registry.NCHER will suggest 5 nominees from a national list .There will

be a collagium to recommend names of eligible persons.Quality of the person is to be considered .

Due to objectionfrom the three state Governments ,the reconsideration was done and the second

clause on VC appointment was changed .But the first clause for quality was not changed.

Tamil nad Government has moved the supreme court for changing a single national common entrance

test .

A national exit examination (screening test)for students graduating from Indian medical colleges is

proposed.A national court for accreditation and national medical education and training board thatregulate and accredit medical colleges ,prepare a list of the entire health sector,and regulate all streams

of education in health sector is to be set up.

In an attempt to make India a global knowledge hub,a draft law for innovation universities made and

these universit ies enjoy total autonomy in appointments ,collaborations,and resource generation.The 14

universities selected will be not-for-profit legal entity.Eacg university will be built around a theme or

subject ,these universities will enjoy total autonomy in appointments ,nomenclature of degrees.Open to

all nationals ,genders,ethnicity,disability ,provided at least half the students admitted to any programme

are Indians.There is no mention of caste based reservation.(HRD Ministry) Each university has to

endorse a university endowment fund but have the freedom to receive donations ,contributions fromalumni,and other incomes as long as 80 % of the annual income is used for development of research and

infrastructure.The university will be a not-for-profit legal entity and no part of the surplus revenue will

be invested for any purpose except the growth and development of the university.

Many existing universities could be truly innovative if only the autonomy in the draft bill was extended

to them.The clarity of seat allotment,reservation for Indian students have to be more

transparent.Innovation universities are private institutions.HRD ministry can give grants to develop

them .In that case the President will be the visitor and government would have a larger role in their

functioning.

Each uty has an independent board of governors empowered to discharge all functions by enactingstatutes to provide its administration,management,and operation.The board will delegate powers to

academic board,headed by VC that will perform financial,management and administrative functions

including appointments and collaborations .The board of studies will specify programmes of study.The

faculty of knowledge,manpower assessment to study and assess through research trends in emerging

fields of knowledge of relevance and the research council that will interface with the research funding

organizations ,industry and civil society .

The government will protect maintain and utilize the publicly funded intellectual property for which the

title vests with it and it can give directions for prohibiting or restricting the publication of information to


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any person or entity which it considers necessary in the interests of the country.The income or royalty

arising out of publicly funded intellectual property will be shared by the innovation university with the

intellectual property creator in accordance with the peovision.

The 14 universities are expected to set benchmarks for excellance for other institutions of higher

learning throughpathbreaking research and promoting synergies between teaching and research.Each

university will stand for humanism ,tolerance,reason and adventure of ideas and search for truth.It is

expected to attempt to provide a path for humankind free from deprivation and seek to understand and

appreciate nature and its laws for the well-being of the people.

3.A FEW CLAUSES IN THE UGC COMMITTEE REPORT 1992 (DOCUMENT FROM NATIONALINSTITUTE OF EDUCATION,PLANNING AND ADMINISTRATION ) :-

This I quote for clarifying the point that what the nation suggests is to solve the problem for all ,in anamicable way and if there are any loopholes for injustice,we as citizens can point out them and try to

help solve them .

Page 2 item 7:- Augmenting resources (private institutions are encouraged by this) given in detail in

chapter 9

Item 9 mentions increasing the resources to meet requirements

Item 10 financial assistance to needy students frees tudentships,scholarships,student loan for equity in

education in detail in chapter 10.

Page 4 .1.11.1 :- At present state funds are mainly for salary,allowances(nonplan) and campus

expenditure ,local ,municipal services and not much for plan,academic excellance etc

Page 5:- Two problems noticed:- functional autonomy is not possible in financial decisions by

universities .The dual administration and dual funding in some universities ,delay in getting them in

time etc

Page 6 has given a few INTERIM Recommendations :- To generate a fund ,keep it as separate fund for

achieving objectives of university .To give incentive grants as matching grants-by UGC to institutions

who generate own resources.And 100 % income tax concession on all endowments/contributions and to

donors sponsoring selected research projects

Page 7 : Increase the burden on those who can afford financially and from that income provide for

poorer sections- tuition waivers,scholarships,etc .

Essential maintainance,development requirements from state itself.Accountability in terms of

quality,cost consciousness,costeffectiveness to be achieved.

The committee e noticed that nonplan expenditure is always more than plan expenditure .The

universities are struggling to maintain the expenditure and fail to achieve quality.They should be

designed to promote quality,efficiency,autonomy ,accountability and relevance.


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Equity and social justice (page 17):- Direct support to poor deserving students Indian situation _1.We

have to preserve and promote our national integration

2.Achievement and quality performance comparable to international standards

3 Equity and social justice to poor should be safeguarded

The newly emerging beneficiaries from secondary education should be able to afford an access to higher

education (the vulnerable group).

Page 18:- Universit ies are an

1 Essential input for meeting manpower requirements for national development

2 Critical input to ensure social justice and equity ,upward mobility

3 Input for improving quality of life higher level of integrated knowledge available to widen base of

population and preserving national and cultural heritage

Page 23 :- Scholarships and fellowships should not be reappropriated to any other head of account .Plan

fund should not be diverted to nonplan fund either should be added to this clause,I think.

Page 27 : 4.15.The existing system had lead to practices in which an eff icient institution is punished and

inefficient institution is securing more grants and support .Therefore,universities(as well as people)

become more inactive ,no new programmes,no internal generation of funds,no costeffective efficient

management the committee noted .

Page 32:- What have the universities to say ?

1.Delay in sanctioning schemes

2.Irregular release of funds

3.Inadequate delegation of powers I implementation of plan schemes

Cha 5 is on negotiated funding based on last years expenditure

Chapter 6 is proposal for future funds .What are these proposals in 1992 ?

6.5.1:- An internal academic audit system to determine needs and scope for new courses of study(page

39)

6.9.1V- Specified discretionary fund with the VC for promot ing excellance in teaching and research

without incurring any recurrent liability .(page 42).This is the reason why the quality of VC was specified

by the new innovation bill I guess.If the VC is not of excellent character ,what happened with IMC will

be repeated and money /funds may be misused .


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Chapter 7 page 47 .:- 7.9 Presentation of students in terms of income groups (so that all weaker sections

get access to higher education) is a welcome decision.For this allows analysis of income pattern of

parents and based on this the support system to be collated and indicated (7.8)

It is interesting that the committee had anticipated resistance from the university community ,in

advance (7.16 page 49) and says as in any departure from the past practice this is usual .

Nature of activity of uty/ student strength/ student-teacher ratio-teaching-nonteaching staff ratio ,stage

of development of institution all considered in giving grants .

page 67 says Indian uty system is based on uty system of Britain . I beg to defer ,since it is the other way

round .The value system of Indian university system (palkalai kazhakam /gurukula) was the model for

British universities of early period.Indian UGC act was formed in 1956 but in UK the till 1980 no audit

standards were established .(8.6) and after 1979 election a regulation of public life resulted in anacademic standard group,an academic audit group and a university funding council (the successor of

UGC )in UK .Joining with UGC ,in consultation with it,CVCP thematically based efficiency studies were

designed (8.6.2) and in 1983 the standard of British university were fixed.

Selfdirected exercise by each individual/institution is the best internal audit (I call this a personal and

practice development plan ) and for external audit a Guru/ a sabha /samithi (committee/councils in

modern sense) are set up. Accreditation and audit unit should have in its purview study alone and

research is not under its control in UK .page 72(8.14)mentions performance indicators given by Mridula

Sharma.

Chapter 9 is on income generation and utilization:-

As I have described the ancient university system of India(see history of Valabhi/Nalanda and other

universities of vedic and Budhist India ) primary ,secondary education and care(patient care) should be

entirely free or in certain cases with minimum fee /concession.The tertiary higher education and

tertiary care institutions can collect fee from the rich and give free service to poor .

Beneficiaries from the first two sectors(students/patients) should get equal access to all sectors is the

idea behind this suggestion .How is this possible ?One has to make internal and external audit for

efficiency and excellance at each step .

What the 1992 report suggest is given below for generation of income by universities(page 78)

1.Fee from higher income student population .Keep this as a separate fund .Utilise for deserving low

income students who prove merit in the previous sectors .Also for betterment of quality of institution

to reach international standards

2.Rent out facilit ies like auditoria,classrooms,computer

service,playground,guesthouse,hostels,lawn,mess etc


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3 Individual departments to design programmes and short term courses of study.Thus generate

resources without adverse impact on main academic activit ies.These units can retain a substantial

amount so earned to support their main academic activities

4.Endowments,contributions,large investments,for academic and infrastructural development

5 Sponsors for research .May be state or central government agencies,public or private

sectors,industries etc .These projects proposals should incorporate allocations for reimbursements for

staff ,facilit ies and infrastructure support .Use for strengtheneing infrastructure.

6. Consultative mechanisms: Institute and members as a whole (not management alone)

faculty,students,alumni,nonteaching staff have representatives in this

7.Incentives to inculcate and implement measures UGC support,encouragements as positive incentives

and grants (page 79)

Page 80 (9.23) asks to have a separate fund for keeping high standards of excellance .

9.24 A part of it kept for building up a corpus fund ,the interest of which is for support activities of uty

9.25 a part goes to needy students and for academic improvement

Chapter 10 enumerates the existing financial assistance for scheduled cates/scheduled tribes .

10.2 : Department of welfare gives tuit ion fee and living expenses for scheduled catses/tr ibes .But there

is delay in gett ing the amount .UGC suggests the advance grant to be given to uty in April itself(calculating the previous year expenditure and adjusting the amount at f inal stage of payment ) so that

students and uty will have no problem.

10.3 .JRF has a 10 % cut off marks for SC/ST students

Also through open selection without qualifying examination they are being enrolled for higher

education seats.

10.4 Bookbanks are functioning for the weaker sections of students

10.12. Of the weaker sections 10 % of entire student population of uty is from economically poor

weaker sections.The rest study with concessional rates based on merit .

10.13 Freeship schemes

10.14 existing loan schemes

The newly generated fund is for reducing the financial restraint on state and public fund and make the

stronger(financially) sections of society share the funds for the sake of weaker sections and make

equity come true from a national point of view .


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This is what I have understood ,being part and parcel of Government medical college (teaching and

practice )and part of a private institution of excellance which take money from rich and try to help the

poor/deserving .The problems of public sector funding and the problem of equity when privatization of

higher education happens ,are thus taken into account by the UGC commit tee (which report I read in

1995 ) and I think it is these recommendations which the current Loksabha has passed as the bills ,as

mentioned in the Hindu .

The aims are thus understood.To put it into practice all citizens,all institutions should be willing . It is not

laws or committees and recommendations which we lack.It is the right att itude of national

integration,and of duty consciousness,a right attitude to achieve personal,institutional,professional and

national excellance as a responsible human being which each and every one of us should cult ivate.No

political party,no religion ,no other sectarian interests or personal selfish interests should bar that

ult imate aim of a purely sathwik personality of excellance as Charaka ,our ideal Vaidya justly pointed

out.Make us achieve that upward journey to excellance as a single united nation .

Results of Sreeramachandra uty project by S.Thanikachalam8080 persons from Chennai ,Tiruvallur and Kancheepuram studied.Age distribution 25-65 yrs

Males 56 % Females 44%.Maximum income per month :Rs 15,000/month

Between April 2008 and June 2011.

Urban Semiurban Rural

Smoking 25.8 23.8 38.3

BMI (>25) 47.92 53.63 28.34

Body fat %(>25) 81.1 85.44 64.91

Anxiety 20.2 17.5 11.2

Depression 15.3 14.8 11.8

Stress 21.2 20.6 13.7

Qbnormal ECG 31.7 18.8 22.8

Diabetes 19.32 17.82 12.05

High BP (over 140/ 90

mmHg)

18.64 18.1 15.24

Lipid abnormalit ies 72.21 61.26 61.17

1/3rd of population has conditions conducive to development of vascular illness-stroke,heart

attack,peripheral vascular disease,among others.

Normal reference value for vascular aging among Indians was much higher than

Caucasianpopulation.Aging was advanced by at least 10 years ,in comparison with Caucasians(Carmel

Mary McEniery ,Uty of Cambridge).Vascular age of 30 yr old Indian is comparable to that of a 40 yr old

Caucasian in UK .


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S.Ramaswamy,Director of Vasomeditech: This increases the risk of vascular incident at an earlier age

than other Ethnic groups .The incidence in semiurban and rural areas also is steadily raising.(Higher

fasting glucose ,a prediabetic state )was higher in rural(12.02)and semiurban(9.6) than urban.Glucose

tolerance levels also were higher in these groups.This is a disturbing finding because they too are slowly

developing the same conditions that exist in Urban life style population.The deficiency of

Homocysteine,Folic acid,high oxidative stress,indicate the disease is just round the corner according to

Dr Thanikachalam.The team is trying for collaboration to explore possibilities of prevention.They have

experiments with Sidha medicine in 73 patients for Diabetes for 6 months and reported that the

medicines were effective and safe.(Ref The Hindu .Vascular aging value High in India .Sep 6.2011.page 9)

I think this is a good turn of events.Because the integration of Sidha with Allopathy is a new step taken.

About prevention of stress,stressrelated diseases and the role of Music therapy and Ayurveda in it I had

already experiments and proved its efficacy and as a way of life this is a safe and efficient procedure forboth prevention and cure of many disorders of the 21st century .

I had done an epidemiological study of Cancer of Digestive tract-Colon ,rectum and stomach- in Calicut

Medical college ,and found that the Northern Kerala population has a tendency of developing cancer

stomach at an earlier age and the food style is responsible for this .

The Caucasian by nature is a nonvegetarian.But a tropical animal like an Indian is not so.The changing

life style from vegetarianism to nonvegetarianism is one factor for development of digestive system

cancer as well as high lipid and cholesterol levels and atherosclerosis and the related vascular diseases.

The reason for vegetarianism in India is not religious ,but geographical. If we look at the tropical Indianbear ,it is brown or black and is mainly fruit ivorous,eats fruits,nuts ,honey,and if at all a tiny animal once

in a way.But a Polar bear ,its cousin ,is very white and is a carnivorous animal and feeds on big seals and

this is because of the lack of vegetation in the poles .The tropical monsoons,the abundant green

vegetation,forest foods and grains made the early ancestor of t ropical man a herbivorous animal and

eating meat (especially red meat) was almost unnecessary and not resorted to. This life style changed

when we came across other cultures from the more northern latitudes . The Indian ancestral genes

which were not acclematised to such life style is showing its lack of adjustment by being prone to

diseases at an early age.

The reduction of stress by Music,indigenous way of living ,and food habits and herbal products will helpIndia in overcoming many health problems which are causing high cost for its exchecquer.

The challenging task for a Medical University :1. Improve the quality and content of Higher education- Academics and Research2. Integrate western medicine research protocols with Indegenous medical systems according

to needs of Indian subcontinent

3. Innovative thinking in managing the different Institutions under its umbrella


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4. Have good scientific publications in each of these fields of Medicine (both western and IndianMedical systems) and have international standard research papers and text books created by

the Faculty /Research scholars .For this an e-library and facility for digitalized versions of

papers and texts should function .

5. The administration (day to day ) and conducting examinations in time etc should be delegatedto an administrator of the Chief secretary cadre IAS off icer and the academicians should be

concentrating on research and academics .

6. Have an Institute of Human Values in healthcare so that Integration of humanities and sciencewill have long reaching effects on physical,mental and intellectual wellbeing of the people.

7. The academic and human value wing together should formulate the health policy required forthe state and for the Nation and should have highly involved members with a vision of value-

based education for national development policies.

The problems currently encountered by Tamil Nad Anna University and the solut ions

suggested for it may be considered and modif ied according to the needs of the Kerala based

Medical University and its current problems.(The Hindu :Education Plus Monday September

19;2011.)

The problem in Anna Uty :-The academic circles feel that not more than 100 colleges should be

affiliated to a Uty . But they also agree that there are several universities with 800-900 colleges

of arts and science affiliated to them ,but to manage 500 Engineering colleges is very

difficult.Making the Professional colleges which should be centers of academics and research

(and not tuition centers ) into inefficient centers have to be prevented.For this mammoth taskahead Anna Uty is searching for an effective academician-cum-administrator as Vice chancellor

.The Uty needs to have the cleanest and efficient vice chancellor someone who can take the

bull by the horns-and whose words and leadership would be respected .The appointment has to

be solely on merit devoid of corruption or polit ical interference.It will be an acid test ,says

academics of the Uty .

When the Uty and its faculty is having more work to perform in the administration and in the

process of affiliation of all colleges,conducting examinations in time etc ,the academics and

research takes a back seat .

Eminent academician and IIT Kanpur chairman M.Anandakrishnan comes up with a solution:-Uty can have 500 professional colleges affiliated. For that create mentoring centers ,at least 10

,to begin with ,each in charge of 100 colleges .Provide people who can act as mentors for these

centers. They may be given powers of a pro-vice chancellor but within the Utys control.All the

colleges have to do real quality work and should be academic and not mere tuit ion centers.

The current problems that the prestigious Medical Uty of Kerala face can be solved if we resort

to a goal-oriented systematic approach .


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THE VICE CHANCELLOR - ACADEMIC AND RESEARCH ( PROFESSIONAL FROM MEDICAL SIDE )

ADMINISTRATIVE HEAD IAS CADRE OF CHIEF SECRETARY

HEAD OF INSTITUTE OF HUMAN VALUES IN HEALTHCARE

These 3 have their own designated duties and thus delegation of powers to each helps in bettering

the functions of the institution. It should be a teamwork . The distribution of power is for efficiency .

And it would be a decentralized power distribution under a centralised Uty scheme .

As suggested for the Anna Uty scheme by sri A.Ananthakrishnan, 10 mentors with pro-vice chancellor

status under the Uty can function in the state and they should be given awareness of the vision and

goal of academic and research enhancement before they are given the charge . Merit should be theonly basis of selection.If it is difficult to get 10 mentors who are academicians/with leadership qualities

,the number may be restricted to 1 to 4 as required.( For Southern states as Travancore, for Cochin

and for south and North Malabar respectively ).

If this is strictly followed with Uty and national goals of higher Education ,we can solve many of the

problems encountered in the professional education .

Tamil Nad Governement has done an Audit on the valuation system of Anna Uty and found that there

is a substantial change (increase) in marks given after revaluation of papers. (from 2005-2009).

The student remits Rs 400 for revaluation and for getting a copy of the new result Rs 700 which intotal is 1100 Rs. If the revaluation is unsatisfactory ,student can ask for a further review. For it student

has to pay Rs 3000 after securing permission from departmental head and principal. Then the answer

sheet is evaluated by the Faculty members of the student in the college. In 2006 April , students

applied for revaluation= 71173

In 2009 April it was 1.57 lakh more than doubled. 30000 got marks changed in 2006.83000 in 2009.

(from 46.21 % to 53.17%).There is a weakness in the evaluation system as pointed out by this scenario.

Based on the report of CAG ,the higher education secretary has asked the Uty to review its valuation

system.

One of the reasons for poor evaluation pointed out, is the pressure on the Faculty members/examiners

to complete a particular number of transcripts with a prescribed period .

Another fault pointed out by the CAG is that many industries which signed out Memorandum of

Understanding (MoU) during 2005-10 did not facilitate any industry-related academic programmes but

merely served the purpose of mobilizing funds for the Uty . MoU entit les the consortium partner of the

industry to avail admission for one student in the relevant branch of study. In 2005-2006 Uty signed

MoU with 18 industries but admitted 21 students in consortium quota .


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2007-2008 : signed with 53 industries ,and admitted 2 more addit ional sponsored candidates. In 5 yrs

Uty earned 22.75 crores and admitted 178 sponsored candidates. MoU only served the purpose of

allowing admission to sponsored candidates on payment of 12-15 lakh per course (the amount for

joining as consortium member).Industries considered unsuited to sign MoU by a team of Faculty

members ,were approved by another team sent again. MoU envisage involving industries in setting

curriculum and in organizing seminars ,conferences,research ,industry visits; staff exchange programmes

with university and industry ;besides the admission of one sponsored candidate. The consortium

members did not contribute to any of these .They just enjoyed one sponsored candidate .

Such studies show the flaws in our academic system and where we fail. The results should not

discourage us.We have to think together and make solutions . For this , a good team is needed both at

the helm and at the mentor level and all the faculty should have a broader vision on our goals of

higher education .

from a pathologist's desk

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