I recently heard an amazing podcast on the Indian education system, and one of the things the speaker said stuck with me. The Indian education system is more of a ‘sorting’ system than a ‘teaching’ system.
Let me elaborate. Essentially, education serves two purposes. The first is to ensure wholesome individual development by imparting knowledge, skills and values. The second is to act as a sorting system to classify individuals based on their ability and achievements for job purposes. The Indian education system as a whole functions mainly for the latter; sorting students as above average, average and below average.
This of course is more in the context of primary and secondary education. Once someone enters graduation or post-graduation, the sorting functionality decreases (students ‘get sorted’ into science, commerce, arts, law etc based on their inclination and marks). Education now ought to become more of an individual development system. For example, MBBS or Engineering is where students ought to get focused training to become good doctors and engineers.
However, I wonder whether this is completely true for MBBS? With the prospect of NEET looming over, securing the coveted MD/MS seat gets bigger priority than being a good ‘general’ doctor. The ‘sorting’ function remains thanks to PG entrance examinations.
MD Radiology is thus the first time when there is no entrance examination looming ahead. A resident can technically ‘break free’ from the MCQ mindset and finally focus purely on learning. Logically, this ought to be great, as the residents will ultimately be practicing radiology for the rest of their lives. However, after a lifetime of competitive exams and rote-learning, can residents overnight become inquisitive learners without it being linked to an MCQ answer?
Furthermore, because our branch is highly coveted, only the top rankers get Radiology seats. Which means that the students we get are probably those who have truly ‘cracked’ the MCQ system. I sometimes wonder whether this is the reason why, despite their higher ranks, radiology residents sometimes don’t seem to be as bright clinically nor as confident when compared with other MD/MS branches. Were those who took surgery or medicine not as good at cracking MCQ exams but perhaps better ‘learners’?
The point I bring all this up, is because the job of a Radiology educator in India has much more potential, but is also simultaneously much more challenging that most others. We have bright eager-to-learn residents who are no longer encumbered with future entrance exams. We also have three years to work on these uncut diamonds. But to succeed, we have to overcome a systemic and individual level mindset used to the ‘sorting’ functionality, and break the multiple shackles created by it. This is the problem statement, as it were.
For educators to successfully achieve all this, we also need to first define our own role and modus operandi. For most Indians, Dronacharya, the legendary guru of the Pandavas, is the first name which comes across our mind when we think of a teacher. But if you look at him from a neutral eye, he probably pioneered the sorting system. He recognized and nurtured the talents of the gifted, the likes of Arjun and Bhim. But he didn’t work on improving Duryodhan’s mindset. Perhaps if he had course corrected Duryodhan during his formative years, the intense Pandava-Kaurava rivalry wouldn’t have evolved and the battle wouldn’t have been fought at all! Majority of the Kauravas remained relatively incognito as well. And he completely ignored Eklavya due to his prejudice against his ‘lower birth’. Worse, he later made Eklavya chop off his thumb to ensure that Arjun remains a better archer. While Drona has much to be celebrated about, he remains a flawed character at best. But given his overarching influence in Indian culture, most educators subconsciously mimic his teaching approach. Teachers focus most of their efforts (and pride) in grooming the ‘best’ students, relatively ignoring the rest.
Is there another approach one can consider?
I recently saw ‘Top Gun: Maverick’, and it made me think hard (if you haven’t watched it yet, you simply MUST watch it). In the movie, Maverick (Tom Cruise) trains a bunch of accomplished fighter pilots to carry out an almost suicidal mission to destroy a uranium enrichment plant; escaping back is well-nigh impossible. On day one, he throws away all theory books. Everyone would have read everything there is to read anyway, given that this is their life-and-death mission. He instead focuses on imbibing confidence, real-life skills and team spirit. Maverick lays out very tough flying parameters, which if properly executed, would ensure mission success and pilot safety. The cadets find these quite difficult to execute, and start doubting their ability. Maverick’s boss wants more relaxed and achievable parameters which would be easier to execute, but make escaping alive much more difficult. Maverick insists that the plan simply has to ensure that everyone, and not simply the best pilots, make it out alive. He believes that he can push his cadets to achieve this. He himself successfully flies through the training course following his tough parameters, instilling self-belief through role-modelling. He makes the cadets gel together using a game of American football, and then personally leads the mission to a resounding success, thanks to his cohesive team of confident cadets.
Distilled to its core, the Drona approach focuses on grooming the most promising talent to achieve great heights, but also ignores the average and the mediocre, expecting them to figure things out on their own and live a life of mediocrity. The best will flourish, while the rest may just about survive or even perish. On the other hand, the Maverick approach believes that each and every trainee is extremely talented, but needs to be mentored, tutored and indeed pushed to achieve the highest level possible. This involves instilling not just knowledge (indeed he tears the books away!), but more importantly confidence and team spirit, and helping everyone overcome their individual demons and shortcomings. Mentorship and role-modeling are his primary tools. He sets high targets, shows it can be done, creates a supportive environment and motivates everyone to just do it, so to speak.
I believe we need more Mavericks in the education system than Dronas. This is of course easier said than done unless you are Tom Cruise! But educators and the system as a whole need to start moving towards the ‘Maverick’ ideology and away from the ‘Drona’ model; things will fall in place eventually as the transition picks pace.
That is not to say that the trainees have no say in the matter. Indeed, the buck ultimately stops with the trainee. As Ustad Zakir Hussain puts it eloquently, the student also needs to inspire the teacher to ensure that the teacher inspires the student.
Please do comment on what you think are the issues affecting the current medical education system, and what we can do to make our residents become the best doctors they can be. Please share them here or by emailing me at email@example.com! Perhaps we can think of the solution together!
– Akshay Baheti (views are personal)
PS: I know the blog sounds incomplete as I haven’t discussed many solutions; hopefully that will be my next blog, incorporating the reactions and comments to this one.
5 thoughts on “Education in India: The Drona Model vs Top Gun”
Radiology education in Indian medical colleges needs a standard operating protocol like the west. Residents are learning more from the internet than their teachers as no evidence based teaching technique is practised in most institutes in our country. Real life educators need to understand that residents cannot really see in their first person POV. Learning by doing (our gold standard) is a good way but maybe there are more ways yet to be discovered which can change the real life radiology education in India. I attribute the lack of protocol based teaching to the educator (nascent technology at that time) as the main reason behind his/her style of educating. But its really high time now that we see more ‘how to teach MRI/CT to your residents’ on Youtube than ‘how to read MRI/CTs’. Its time to truly educate the real life educators about novel techniques of education.
Thanks for the comment. Can you elaborate more on the type of teaching you would expect or wish to have? Most of the Cafe Roentgen REF webinars, for example, are pretty high quality and free to attend, equivalent in quality to what residents get to attend during their residency in the west. So lack of local teaching can be compensated for much more easily that in the pre Webinar era. Agree that evidence based approach has scope for improvement. But would love to know what else would you wish to see in the teaching.
I totally agree sir that online webinars are an absolute game changer for medical education and particularly image based sciences like radiology. However in my comment above by ‘real life’ I meant it all about the offline teaching going in residency programs.
I just wanted to make sure that we notice the lack of awareness about various teaching techniques/tricks that can be employed in indian medical scenario for better resident training.
Here are a few ideas which I have. I know that many of the teachers might use these techniques but I feel that the fact that these techniques can be used for resident training has not been documented/compiled/advertised/generalized/propagated and hence the comment.
1. Use of cursor (mouse pointer) while showing structures/lesions in ultrasound scans (live and static).
2. Describing eye balling patterns/ structures we are evaluating while scrolling through cross-sectional image stacks. ( e.g., inside out for cxrs)
3. A change from image based case presentations to scrollable stacks.
4. Use of evidence based DOAP (Demonstration -Observation – Assistance – Performance) technique for dopplers/ USG procedures.
These are few which I can think of as a resident but maybe many experienced Radiology educators can have some amazing teaching techniques which might level up the ‘offline’ teaching experience for both educators and residents in our country.
On the evidence based approach part for report evaluation I dont have any solid ideas. Structured reporting maybe could be a way to quantify the skill level. I really have no clue. But I am very sure that in the recent future AI will play an important role in residents skill evaluation and provide some uniformity.
I am excited to hear thoughts from you and other experts regarding this too.
Thank you for the reply, sir.
Me being a MBBS graduate, and a so called PG seat aspirant. Can totally relate to it. Almost everyone now studies to crack mcqs rather than understanding the disease. Most of UG students don’t read standard textbooks, they just watch online video lectures to prepare notes and then solve mcqs. Gaining skill, working with interest during internship is now all gone. Just cram the notes, get a good rank in PG entrance post MBBS and then think of learning during residency. I also think that there is a herd mentality, most of the students are unware about their branches. Otherwise why most of the students choose radiology with good ranks. Few choose medicine, derma. If they have got good ranks, then their should be a max variations in list of branches at the top. But it’s quite the opposite, variations in branch selections are seen at lower mid and lower level ranks. System didn’t change and i dont think that’s gonna change soon. But few years before, we have doctors who at least read some textbooks and then cracked mcq exams, few years down the line we will have doctors, who didn’t read anything and just watched video lectures online / offline. They will be able to solve the mcqs but not solve the diagnosis. ( I am not talking about toppers here, toppers must have read the whole MBBS time)
Personally I recently watched a Indian youtuber doctor , who on vlog mentioned about cerebral palsy as a differetial diagnosis for a loss of consciousness in a 60 year old patient. Not here to defame, but these type of blunders in real life can be very dangerous, both for a doctor and patients.
Once a student is in radiology.. the past is gone and as always the future is uncertain. What students and, you as their teacher, have is three years of the present.
These students do not need to be taught facts of radiology .. they are smart and will find them in a million places. What they sorely need is INSPIRATION from their teachers – the way themselves practice – to be good caring radiologists .
Help them leapfrog years of learning by telling them all that you yourself have learnt in “so many” years of practice. They should not have to walk over landmines like you may have had to.
Teachers!! Lead by example .. the way to behave with patients.. the way you interact with referring physicians .. the way you own up errors and be wholesome in praise ,, where due.
Then watch the sparklers from these kids.
If that does not happen, it is the fault of us-their teachers.. not that of these bright youngsters,
Now, sit back.. close your eyes and wonder – when was the last time you did something in your practice or teaching that would have inspired your students to want to be like you..
When was the last time, a former student came to you and said “You inspired us”.
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