The Clutter Within the MBBS Curriculum: Can We Skip to the Relevant Part?

It was an unusually pleasant day. We woke up to a drizzle, and a cool breeze whistling through our open windows. The small garden outside our hostel sparkled and smelled of fresh earth. After a leisurely breakfast, we made our way to the OPD which was blissfully uncrowded. The grey clouds advancing over the horizon meant patients with minor ailments would delay their hospital visits until the weather improved.

It was a welcome change of pace. Instead of the usual rushed two-minute consultations, we were able to spend a lavish 20 minutes on each patient. Conversations, which were previously limited to disease and affliction, became more personal.

As I auscultated a little boy’s chest, his father engaged me in conversation. “Beta, kitne saal padhai karni hoti hai doctor banne ke liye? (How many years did you go to school to go become a doctor)”.

I smiled and told him about the four-and-a-half years of medical school followed by a year of compulsory internship. His next question was a little harder to answer. “Kya padhai karte ho paanch saal mein? (What do they teach you in five years)”.

I mulled over the question.

I started medical school five years ago as an impressionable, diligent student who believed in following the coursework religiously. The teacher’s word was gospel and I dutifully crammed everything they told us. From the origin, insertion and innervation of extensor carpi radialis longus to the inhibitors of the electron transport chain, there was no dearth of the things we memorised in med school. The brief moments of curiosity and wonder as I read about cardiac electrophysiology or the mechanics of nephron transport were buried under a truckload of irrelevant facts tested in exams. I wondered if there was more to med school than being a receptacle for an endless stream of facts.

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Four-and-a-half years later, we started our internship. It marked our first foray into a more intimate role wherein we were directly responsible for patient care. As students, we had attended clinical postings as outsiders to the patient-doctor relationship. Now, we had a front-row seat to witness the manifestations of disease in actual flesh and blood. The skills required to navigate this labyrinth of human suffering and arrive at a diagnosis and treatment plan were vastly different from what we had been taught. Just like Richard Feynman used a ‘map of the cat’ during his graduate-level biology class, any factual information we needed was available on our phones. We had a dozen textbooks at our fingertips. Important information stuck around in our heads as we looked it up repeatedly. The artificial focus that had been placed on rote memorisation was unnecessary.

As the internship progressed, my sense of disquiet deepened. We had spent years memorising stuff that could be looked up in minutes. We were spending hours memorising eponymous fractures and enzyme deficiencies in over a dozen lysosomal storage diseases for the post-graduate entrance exams. While wrestling with obscure facts which were forgotten soon after the exam season, we sacrificed time that could have been better spent on learning skills critical for a doctor.

As a patient, does it help you if your doctor knows Kreb’s cycle in excruciating detail but does not know how to deliver bad news gently and emphatically? Sure, medical school had taught us to give a five-minute monologue on the sacrum and describe every crest and ridge of the femur. But our statistical interpretation was shoddy. During the pandemic, as unproven therapies and unnecessary diagnostic testing ran rampant, our inability to understand new research articles beyond the abstract was painfully obvious.

Effective communication, critical appraisal of research articles, and clinical decision-making in the face of uncertainty are skills which demand more attention and can not simply be looked up or learned in 15 minutes. The current MBBS curriculum does not do justice to these important topics. Instead, it is cluttered and full of material with questionable utility. The updated NMC curriculum released in 2019 failed to make any substantial changes. Students are still taught and tested on facts useless outside the examination hall. Testing patterns inevitably decide what students study. Is testing students on the Indian Penal cCde in forensic medicine more important than teaching them how to appraise medical literature critically?

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The time has come to cut out all the clutter with surgical precision. To figure out what is truly essential we need to start with what a practicing clinician needs to know and work our way backwards. Instead of a bottom-up approach that attempts to cover 19 subjects superficially, we need a top-down approach focusing on integrated concepts essential to everyday practice. We need to keep the doctor-patient interaction at the centre of the medical curriculum instead of random feats of memorisation. Medical students put in a lot of hard work while struggling with the coursework. It is our responsibility to ensure their efforts do not go in vain.

By the time I finished my musing, the clouds had receded. The sun had come out. Patients were starting to trickle in, and a long queue was forming. My colleagues flashed me looks of annoyance that signalled I needed to snap out of my daydreams and pick up the pace. I quickly wrote a prescription, explained to the father when to follow up and signalled to the next patient. But his question lingered as I thought about what could be done differently.

Dr Gurasis Boparai did his MBBS from AIIMS, New Delhi. He enjoys reading, playing the guitar and exploring the city around him.

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