Tuesday, March 19: Health Professions, Finally

Every institution that hosts us has treated us with genuine hospitality. Senior administrators present their strategic plans, faculty members accompany us on campus tours, and students share their perspectives. Just about every place also has a photographer document the visit. One of the group discovered that the Indian School of Business had chronicled us on their Instagram page. With a medical school on the list for today's campuses, I hoped that we would receive the same embrace.

Reshmi, our facilitator, introduced the day to us by saying we would visit a languages institute and then a medical college "mostly for Peter." IHP does not grant medical degrees while two of the other institutions represented in our group do, but the study abroad staff seem to work primarily with undergraduates, so the medical college would be as close as I'd get to observing how health professions education operates in India.

Our first stop was the English and Foreign Languages University. It is the only graduate school devoted solely to language, language instruction, and literature in India. Like University of Hyderabad, which we visited yesterday, it is federally funded. Unlike U of H, EFLU has a compact, bucolic campus. A group of doctoral students greeted us and immediately took us on a campus tour. It was an effective way to see the grounds in the context of the learning environment. It also meant students could answer our questions without their professors listening in.

EFLU students greeted us and took us on a campus tour.

The tour took us to a media center where they produce MOOCs (massively open, online courses) for students across India. An introductory psychology class drew over 1,000 students. When we asked about the impressive attendance, the director reminded us that in India large numbers are easy to come by. We toured the video studio where they produce some of the online content and then gathered in a conference room to meet the senior academic leaders. The conviviality of the morning turned stiffer as the deans lapsed into their dry recitations of department statistics and kowtowed to the senior-most official. Fortunately, they loosened up when we adjourned to a dining hall for lunch.

One of my colleagues tests out the anchor desk for a recorded Spanish class.

On the drive to Deccan College of Medical Sciences, nearly all of us fell asleep. We woke up in time to pull into the parking lot for a large hospital. The medical school building is behind and attached to Owaisi Hospital. The Owaisi family, under the auspices of a Muslim foundation, founded and continue to administer both the hospital and the medical school. The neighborhood of Hyderabad where it's located is primarily Muslim and not well served by health care institutions. For each incoming cohort of 150 medical students, about 70 percent are Muslim and almost as many are women.

We stepped into a lecture hall where students are mostly self-segregated by sex.

We received an overview of the school's facilities, research, and curriculum. Much like the United States, they are revamping the tradition of two years of didactic courses followed by clinical experiences to introduce patient care from the outset. I asked about opportunities for interprofessional education given that nursing and physical therapy students are also part of their extended organization. They affirmed that the students interacted on the wards but acknowledged needing to do more to create intentional learning experiences. Their close relationship with the affiliated hospital made clinical teaching seamless.

A faculty member shows us a simulator.

Faculty members guided us on a campus tour of the library, classrooms, and skills lab. The mannequins they use for skills practice were placed on a tables scattered in the back half of a classroom, a far cry from the simulated hospital rooms with cameras and control booths our students are used to. With eerie calm, the guides marched us through the cadaver lab, where we saw partially dissected bodies reeking of formaldehyde on metal tables. I couldn't quite articulate why the display felt disrespectful to me, and I abstained from taking photos.

The tour continued at the student gym, a well-appointed, new structure where we saw men and women, many in hijabs, playing badminton. We entered the hospital, where I noticed a room set with prayer mats off the foyer, and visited a stem cell research lab. Finally, we returned to the conference room for a conversation with several students. This interaction struck me as particularly memorable. In other sessions with students, they politely answered our questions and waited until prompted to ask us anything. Here, within the first few minutes, they asked about strategies for securing residencies in the U.S. As the only member of the group with some knowledge about graduate medical education, I gave them some general information, but that only encouraged them to ask me more details.

The student gym featured a Muslim prayer alongside other motivational mottos.

I later learned that only about a third of each class seeks residencies in the United States, and by design or accident, all the students selected to meet us fell in that category. These energetic students embodied the dilemma of brain drain. India had invested in their education so that they were approaching graduation debt free. But then they all planned to take their talent to another country—and not just for a short-term study abroad. Articles in the newspaper this week have highlighted the challenge of luring physicians to rural parts of India. When I asked the students what it would take to motivate them to stay in country and serve outside the city, they hesitated. The leader of the medical school answered for them and said it's a "government" issue and had nothing to do with the students. That didn't seem to match the students' reactions, but, when I pressed them for more details, one young woman answered that she'd rather not say.

Leaving the medical school, I talked with one of their faculty members and the local official for US-India Educational Foundation. I proposed hosting a webinar where a residency program director from the US could validate and debunk students' impressions about the application process. The USIEF director thought there would be wide interest in such an offering and volunteered to coordinate it if I could recruit an appropriate speaker. He doesn't know it yet, but Donald may soon find himself on video screens across Indian medical schools.