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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 5  |  Issue : 4  |  Page : 270-275

A study of the perception of medical teachers regarding education in ophthalmology in Western India


M and J Western Regional Institute of Ophthalmology, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India

Date of Web Publication14-Nov-2018

Correspondence Address:
Purvi Raj Bhagat
M and J Western Regional Institute of Ophthalmology, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cjhr.cjhr_55_18

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  Abstract 


Background: Frequent unpleasant incidences, conflicts, and litigations between patients and doctors point to the fact that medical graduates perhaps primarily lack professionalism and competence. Instances of unethical practice are on the rise. Respect for the profession has dwindled, with the field of ophthalmology being no exception. This study aims to identify the current problems of medical education in ophthalmology in Western India along with the possible solutions for improvement. Materials and Methods: Cross-sectional data were collected through an online validated questionnaire from ophthalmology teachers of medical colleges of Western India. The questionnaire included 62 questions with information on their demography, faculty development program details, teaching schedule details, satisfaction regarding the undergraduate (UG) and postgraduate (PG) ophthalmology training, and suggestions regarding improvisation. It was analyzed to identify caveats and find possible solutions. Results: Forty-two responses were obtained. Thirty-one (73.8%) teachers suggested a change in the current teaching methodologies, 30 (71.4%) suggested changes in assessment strategies, 12 (28.6%) suggested curricular reforms, and 6 (14.3%) suggested change in the duration of the courses, both in UG and PG ophthalmology education. Need for interactive, integrated, and problem-based teaching and more skill-based assessments was expressed. Conclusions: Improvement in the current scenario needs an integrated approach of the government, accreditation system, institutional heads, faculties, and medical students to build a strong foundation for a better future.

Keywords: Competency-based education, curriculum, medical education, medical postgraduate, ophthalmology


How to cite this article:
Bhagat PR, Trivedi KY. A study of the perception of medical teachers regarding education in ophthalmology in Western India. CHRISMED J Health Res 2018;5:270-5

How to cite this URL:
Bhagat PR, Trivedi KY. A study of the perception of medical teachers regarding education in ophthalmology in Western India. CHRISMED J Health Res [serial online] 2018 [cited 2018 Dec 11];5:270-5. Available from: http://www.cjhr.org/text.asp?2018/5/4/270/245446




  Introduction Top


Till the Royal College of Surgeons was founded, students from around the world chose to come to Nalanda and Takshashila universities of India to study medicine. After decades, it is a rather sad state of affairs when the existing vast number of medical colleges in India failed to provide the much needed health care for its huge population. Frequent unpleasant incidences, conflicts and litigations point to the fact that the quality of medical education is currently at its lowest ebb. Medical graduates lack the competence in performing basic health-care tasks and instances of unethical practice are on the rise due to which respect for the profession has dwindled.

Unfortunately, the current accreditation processes focus largely on the infrastructure and human resources required and little on the process and quality of education or its outcomes.[1]

There are various reasons identified for the declining status of medical education. The fundamental assessment pattern focuses on rote learning techniques, assessing mainly the cognitive domains and only to some extent the psychomotor skills. The humanitarian criterion is not taken into account. Most places do not use objective structured clinical examination effectively for assessment. The clinical and affective skills of medical graduates are put to use only after they start practicing. Hence, the emphasis is more on rote learning rather than on clinical skills. Similarly, backdated syllabus and teaching styles can be another factor. Teaching happens in a teacher-centric pattern lacking engagement of learners. Use of technology and updated teaching aids by faculties is also not remarkable. Lack of skilled teachers can be another factor as there is lack of regular formal training for effective teaching for medical teachers. The existing tools for teaching are also underutilized. The scopes of medical education units (MEUs) are vast but are considerably underexplored.

The preamble of the curriculum for education of an ophthalmic specialist by the International Council of Ophthalmology identifies its objectives as “designed to provide a structured program of learning that facilitates the acquisition of knowledge, understanding, skills, and attitudes to a level appropriate for ophthalmic specialists who have been fully prepared to begin their career as independent consultants in ophthalmology.”[2] During various studies conducted in the field of ophthalmology, it has been found that the postgraduate (PG) students feel that their training is inadequate and perhaps incomplete for them to deal with the patient care they are expected to deliver on completing their residency.[3],[4],[5],[6]

Considering all these facts, it has become essential to identify and try to overcome the obstacles that hinder the residency programs of our country. To the best of our knowledge and search, no study about the status of medical education, from the teacher's perspective, has been conducted in the field of ophthalmology till date. This article is an attempt to identify and analyze the current problems and challenges of medical education in ophthalmology in Western India and find possible solutions.


  Materials and Methods Top


For this cross-sectional study, an online objective Google form was prepared. Validation was done by ten medical teachers from own and another local medical college. Their responses were not included as part of the study analysis. The revised and validated questionnaire comprised of 62 questions including demographic data, teaching experience of faculties, details of faculty development programs (FDPs) attended, details of undergraduate (UG) and PG teaching schedules and levels of satisfaction regarding teaching methodologies, assessment patterns, duration of UG and PG training program, and the ophthalmology curriculum. The questions were mainly dichotomous and multiple-choice types. Open-ended questions were asked for suggestions regarding improvisation. Following Institutional Ethical approval, the survey was sent through e-mails to 154 ophthalmology teachers of west zone of India (Gujarat, Rajasthan, Maharashtra, Goa, Diu, and Daman). The email addresses were procured through different sources. Reminders were sent at regular intervals in case of nonresponse. The process continued from October 2016 till February 2017. We gathered 42 responses, giving a response rate of 27.27%. The responses were subsequently analyzed for significance.


  Results Top


Twenty-eight (66.7%) of the responders were female teachers. The age of the teachers ranged from 29 to 65 years. Sixteen (38.1%) responders were assistant professors, 13 (31%) were professors, 11 (26.2%) were associate professors, and 2 (4.8%) were tutors. Regarding teaching experience, a bimodal distribution was found around 8 and 18 years.

Details of faculty development program/teacher's training programs

Four faculties responded that in their institutions, these programs were not held at all and only thirty faculties stated that their FDPs were Medical Council of India (MCI) recognized. One faculty was not aware whether such programs were conducted at his/her institute.

Thirty-seven (97.4%) of those faculties who attended FDP reported a subsequent change in their teaching/assessment processes. Of these, 23 (62.2%) noted a moderate amount of benefit and 5 (13.5%) noted a large amount of benefit [Figure 1]. Notable impact was found on their teaching styles shifting largely to PowerPoint presentations with more pictures in the content. Responses from participated mentioned that their teaching became more student centric as well as interactive; better communication and revision methods were applied during teaching and microteaching. They were better equipped to learn the use of online tools, e-learning, and inculcate the same into their teaching.
Figure 1: Impact of faculty development programs on teaching methods

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Details of teaching schedule and teaching methods

All the respondents agreed to be taking ophthalmology lectures for UG and PG students, almost weekly, with approximate duration of 45–60 min for both, spending around 3–6 h weekly for these sessions. Twenty-one (50%) faculties spent about 3–6 hours a week teaching PG students.

Forty-one (97.6%) of the responding faculties use PowerPoint presentations to prepare their lectures having a reasonable comfort level with the use of computer and e-technology. Only around 22 (52.4%) faculties prepare themselves prior to taking any lecture and only 31 (73.8%) faculties spend time beforehand trying to find methods to make the class interactive and interesting. Twenty-two (52.4%) faculties provide a list of relevant references to the students for subsequent reading and 17 (40.5%) faculties share presentations and relevant clinical or surgical videos.

Among the lectures, the main aim of 27 (64.3%) faculties was to enhance clinical skills of the student with teaching proper patient management and providing guidelines [Figure 2]. Seven faculties stated that they taught to enable the students to clear the university examinations. Fifteen faculties (35.7%) shared that the students in their department were never taught medicolegal aspects, communication skills, and ethics and etiquettes integrated with clinical knowledge which creates some concern [Figure 3]. Twenty (47.6%) faculties responded that their colleges conducted extra classes and or practice sessions for UG/PG preparations. Sixteen (38.1%) faculties also shared that the students attended extra classes elsewhere, while 14 (33.3%) faculties were unaware of the same.
Figure 2: Aims of teaching according to faculty responses

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Figure 3: Responses of faculties regarding inclusion of nonacademic topics in current teaching program

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Weekly academic meets including the entire ophthalmology department were conducted for PG students according to 40 (95.2%) teachers, with majority of these being case presentations, seminars, and journal club meetings (73%). Conventional didactic lectures were relatively fewer.

Student-related extra activities

Faculties responded that among other scientific activities, PG students mainly focused on their thesis. Papers, posters, and publications were not very significantly done. Few students were engaged in other research activities. The presentations were mainly at state-level conferences and publications were mainly in local journals which were commonly case reports rather than original research articles. Furthermore, 28 (66.7%) faculties responded that these activities were by self-motivation, while 14 (33.3%) stated the reason to be compulsion of the university rules. Thirty-eight (90.5%) participants denied of any social counselor being present at their institute for psychological or professional support for the students. This result needs attention considering the growing psychological ailments and their disastrous consequences among medical students.

Satisfaction regarding current scenario

Nineteen faculties committed that the overall duration of training was insufficient for first-year UG students and 14 said the same regarding ophthalmology diploma course [Figure 4]. Whereas 23 (54.8%) participants were satisfied with the duration of posting of UG students and their training with regard to ophthalmology, only 18 (42.9%) of them were satisfied regarding the same for PG students. Others were either unsatisfied or were unsure of their response or did not want to comment.
Figure 4: Satisfaction of faculties regarding the current duration of training program

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Twenty-five (59.5%) teachers were satisfied with the UG assessment system and only a meager 16 (38.1%) were satisfied with the current PG assessment system. Others were either unsatisfied or were unsure of their response or did not want to comment. The responses of teachers suggesting the fields of education which require change have been shown in [Figure 5]. Twenty-three (54.8%) of the responding faculties believed that an evaluating system for teachers would be beneficial for improving the current scenario, 9 (21.4%) were unsure of this, while 10 (23.8%) did not provide any response.
Figure 5: Educational areas which need improvisation

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Suggestions regarding improvisation

In this open-ended question, most participants gave suggestions for the betterment of the situation of teaching learning system in ophthalmology [Table 1].
Table 1: Suggestions of medical teachers regarding educational changes

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  Discussion Top


This study is the first of its kind to highlight the status of medical education in ophthalmology, both at UG and PG levels, as a feedback from the medical teachers themselves. It strongly suggests that a range of reforms to improve this sad state of affairs is of utmost importance. While the medical graduates tend to possess reasonably sound theoretical knowledge of science, they are quite often found lacking in clinical skills and problem-solving which are the core components of clinical competence.[7] More attention needs to be given to the development of psychomotor skills, attitudinal and communications skills.[7],[8] Our study reveals that problem-based learning, group learning, teamwork, use of new technology in classrooms, and integration of subjects can make a huge impact. Medical research also needs to be encouraged simultaneously.

According to an earlier study, even though the sheer volumes of cataract surgery have increased in India, the quality of these surgeries for sight restoration raises a question.[3] Their study showed that eye-care practitioners had missed many cases of advanced glaucoma. The lack of comprehensive eye-care examination was responsible for that, and these skills can be taught and acquired only in a good residency program. In our study also, a significant number of faculties were unsatisfied with the duration of the courses and the teaching and assessment methodologies.

In a study on medical education in India, it was concluded that the accreditation process for medical schools focuses largely on the infrastructure and human resources required and little on the process and quality of education or outcomes.[1] Other studies also suggest that there is no uniformity in the standard of medical education across the country.[9],[10] Our study showing wide variations in responses of faculties from different institutions across Western India reiterates this fact.

A study on curriculum concluded that teachers today are expected to possess skills and abilities to plan the curriculum, make rational use of media and technology, and design assessment strategies.[11] This is possible only through a systematic approach of faculty development. As suggested by the MCI, the development of MEU in all medical colleges will go a long way in the growth of teaching skills among their faculties.[12] In our study also, we found immense importance of teachers training programs. Ninety-seven percent of our respondents found that these training programs had a definite impact on their teaching and assessment methods.

Earlier studies reported that all problems and challenges faced in medical education are required to be addressed at various levels such as governmental, accreditation system, institutional, and even during selection of medical students.[13],[14] In our study also, evaluation of faculty perceptions regarding ophthalmology education unveiled scope for a lot of improvement at various levels. Our study as in agreement in an earlier study also found in substantial 35.7% responses that they did not include ethics, etiquettes, medicolegal aspects, or communication skills in their teaching program.[15] Both the studies agree upon the need of a fundamental change in medical education requiring new curricula, new pedagogies, attitudinal changes, and new forms of assessment.[15]

It was reported that to achieve higher standards of medical education, goal should be to re-evaluate all aspects; create an efficient accreditation system; promote equal resource distribution, redesign curricula with stricter implementation; and improve assessment methodologies.[16],[17],[18] Conclusions of these studies relate well with our results. A training program which includes rotation to all subspecialties, integrated teaching with other departments of relevance, problem-based teaching, guest lectures, frequent internal assessment including a basic science examination at the end of the first year of training is needed. Research methodology and management training should also be integral components of the curriculum. Our study findings reinforce the same.


  Conclusions Top


It is an often-repeated criticism that our medical colleges are producing graduates who are not well equipped to tackle the health-care needs of the society. The accountability and monitoring of the teaching faculty toward fulfillment of their teaching responsibilities is also a sensitive but very important issue. Ophthalmology is no exception to these challenges. Our survey highlights the caveats existing in ophthalmology education in the western part of our country. Faculty perceptions in this study have revealed a dissatisfaction regarding the existing curriculum as well as the current teaching and assessment programs. Suggestions regarding ways to improve the current scenario have also been suggested. Such a survey if conducted on a larger scale across the country may perhaps reveal more serious results but may also provide strategies for improvisation which may help to build a better education system for students and better health-care system for the society at large.

Acknowledgment

The authors would like to thank Dr. Partha Biswas, Chairman, Academic Research Committee of All India Ophthalmological Society, for the initiative for this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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2.
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