I read the article “an evaluation of medical college departments of ophthalmology in India and change following provision of modern instrumentation and training” by Thomas et al., with great interest. It's a hard hitting, honest article, calling a spade a spade.
A well trained ophthalmologist, (one who is capable of delivering a competent and compassionate care to his patients) is the need of the hour. This need will keep escalating. Such an ophthalmologist is the final outcome of an active interaction between the trainer, trainee and the availability of appropriate instruments over a period of time.
- We have a scenario where the trainer is not of adequate standard and the trainee is substandard, due to any number of reasons and instrumentation is also not up to the mark. What would be the quality of the trained residents? It would be too hazardous to guess. In such institutions, just buying some high tech machines will certainly not improve the situation at all. That's predictably what has been shown in this study. There are many institutions falling in this category.The article by Murthy et al, clearly enunciates this point, that, there is a need for improvement in the quality of training facilities and research methodologies, in many of the state medical colleges in India. However, for whatever reason/s, the article fails to mention the important prerequisite, which is, that good quality students should be accepted for training.
- Trainer is good , trainee is also good and instrumentation is substandard. What will be the standard of the residents coming out? In India there are many institutions of this variety. It is precisely in these institutions, that the world bank loan is most needed to improve the available instruments.
- Trainer is substandard and trainee is good and instruments are adequate. What would be the result? There are institutions in India of this type as well.
- Trainer is good and trainee is good and instrumentation excellent. What would be quality of the residents coming out? This is the most ideal situation we need to strive for. Thankfully, there are quite a few institutions in India of this type as well. I completely endorse the views of the authors that improving only the instrumentation of the department, will not improve, either the quality of the imparted training or the quality of residents passing out, for obvious reasons.
For a good outcome, we need to have all the three vital components i.e. The trainer, who is of adequate standard and a trainee, who is trainable and instrumentation to facilitate the training job.
In this regard, we need to formulate at the national level , a uniform standard for training the residents and some uniform standard of assessing the residents, who are being accepted for the training.
We cannot manufacture or change the teachers overnight. They need to be trained further to make them aware of their responsibility to the training job wherever needed. The residents must be chosen carefully and based on merit alone and not on any other dubious extraneous considerations.
Improving the instrumentation alone, in the absence of good trainer and good trainee, will not necessarily improve the quality of imparted training and the quality of residents coming out. As Grover asks inimitably, do we have the necessary will?
1. Thomas R, Dogra M. An evaluation of medical college departments of ophthalmology in India and change following provision of modern instrumentation and training Indian J Ophthalmol. 2008;56:9–16
2. Murthy GV, Gupta SK, Bachani D, Sangha L, John N, Tewari HK. Status od speciality training in ophthalmology in India Indian J Ophthalmol. 2005;53:135–42
3. Grover AK. Postgraduate ophthalmic education in India: Are we on the right track? Indian J Ophthalmol. 2008;56:3–4