The clamour for change need not always be loud. For some such as Dr Govinda KC, it involved following a road less travelled by going on a hunger strike to champion medical education reform in Nepal. Such efforts have paved the way for transformative steps. For instance, the Mathema Committee Report proposes changes in health sector reform. Such a step has laid the groundwork for change, but may not ensure the production of creative, dynamic, team-based and passionate physicians in a dynamic medical landscape.

The churning out of thousands of graduates from medical schools over the past few decades has translated to the lowering of maternal mortality rates from 1,800 to 170 and infant mortality rates from 200 to 46, while life expectancy has increased from 32 to 68 between 1950 and 2011. However, such progress has come at a cost: the high number of graduates means a degraded quality of education and overall medical care. With rapidly evolving technology, advancing healthcare economics and innovation in healthcare delivery, today’s medical school curricula need to incorporate certain core aspects to keep up with constant shifts. There are several major components integral to the reform and adoption of innovative approaches in medical education.

Proper utilisation of point-of-care resources and simulation-based assessment models

Today, evidence-based resources provide the backbone for medical learning. Medical students, residents and other health professionals should be able to navigate and optimise point-of-care resources such as Micromedex (to look for drug details and dosing), UpToDate (to aid clinical decision), CrowdMed (a platform for health professionals, retired clinicians and medical students for jointly solving complex cases) and First Consult (clinical information resource) to make evidence-based decisions for best outcomes. Furthermore, trainees should translate the latest scientific discoveries published in high-impact journals to clinical practice.

The integration of virtual and augmented realities in medical schools is helping students learn from high-resolution graphics for the visualisation of complex systems and realistic simulations. For instance, an ophthalmic virtual simulator, EyeSim, allows medical students to learn ocular anatomy, motility, pupil reactivity and visual pathways in a virtual patient using 3D and virtual reality technologies. Similarly, use of a virtual microscope system can teach cellular anatomy and pathology to medical students and residents, improving engagement and providing experimental learning in virtual anatomy and pathology lab. Simulators can mimic a patient going into cardiac arrest or having stroke and allow trainees to improve surgical skills in intubation, central line insertion, suturing, cataract surgery, lumbar puncture skills and colonoscopy. Medical schools should avail such tools and resources to equip trainees with the knowledge, skills and attitudes integral for the delivery of efficient and effective care.

Flipped classroom model and e-learning

In contrast to the conventional lecture format, the flipped classroom model lets students learn at home through self-study, and thereafter helps them engage in teacher-facilitated class activities and workshops to foster critical thinking and to integrate information. Students spend more time actively learning through case presentations, e-modules, small group discussions and workshops, while the classroom fosters interprofessional participation whereby students critically brainstorm cases and sharpen their communication skills.

Moreover, access to digital lectures from leading global educators, free eLearning modules with clinical case examples, and 3D imaging and video can enhance effective teaching and learning of complex topics. For instance, MEDSKL and NextGenU, are free resources for learning the fundamentals of clinical medicine. Medical schools registered under the Nepal Medical Council should offer these resources and free access to reputable journals to their trainees to enhance their learning experience.

Health economics and medical education research 

In order to streamline learning based on prevailing conditions, there is a need for regular feedback, review and research of the educational process to ensure physician competence. Likewise, while evaluating the quality of medical education, we routinely need to emphasise outcomes-driven approaches and assess the quality and cost of care. Medical school curricula should move from the inclusion of epidemiology and statistics to pertinent healthcare business topics like marketing, finance, computer science and law. This will help trainees understand the healthcare model and other inherent aspects such as knowledge of public policy and project management.

Similarly, training on data science and behavioural science is relevant to the practice of evidence-based care, and the development and application of algorithms in clinical practice. Medical schools should invite guest lecturers from fields related to health insurance, pharmaceuticals, biotech companies, tele-medicine, and law to create an experience that students can integrate in their practice. Medical students need longitudinal research experience attainable through collaborations with local or international peers, or through pairings with virtual mentors to hone their skills in research methodology, academic writing and publishing scientific papers.

Multidisciplinary approach

The modern healthcare workplace will include professionals from multiple disciplines such as nursing, case management, social work, pharmacy, labs and public health. Rotations through pharmaceutical companies, laboratories, biotech companies, hospital administration and the ministry of health will provide insights on various aspects of medicine.

Concerted interprofessional problem-based learning sessions sharpen team dynamics, care coordination and communication skills so as to integrate major aspects of patient care in complex decisions. Similarly, tasking multi-disciplinary teams from medicine, pharmacy (for medicine reconciliation), labs, engineering, computer science, law and fine arts to develop a conceptual framework for solving an existing problem, engaging in quality improvement projects or testing interventions in hospital and pharmaceutical industries will foster group skills.

Enhancing productivity 

Medical professionals should feel safe and healthy while utilising various techniques like self-care, self-awareness and coping skills in order to assure high quality, comprehensive and patient-focused care. Modern day medical practice must incorporate strategies to secure trainees’ mental and physical health by encouraging the development of mindful, grateful and reflective behaviour. Additionally, periodic lectures on topics that have received minimal attention traditionally such as dietary habits, exercise benefits, sleep hygiene, stress reduction, and mindfulness should be included in the curricula.

Ultimately, focus should shift from traditional measures of outcome to valid, meaningful and feasible performance measures of training success to continually improve patient outcomes and foster innovation. Graduates should be evaluated on their ability to deliver quality, economically sustainable, patient-oriented and value-centred care that aligns with Nepal’s health care needs. Physician leaders who undergo profound educational experiences will be better equipped to deliver. The painstaking push for reforms will hopefully bear meaningful results that will permanently change the country’s healthcare landscape.

Bhattarai is a geriatrician, practising nephrologist and general secretary of Health Foundation Nepal