N Kalpana Subrahmanyam: Medicos have become more programmed

In her almost three-decade long association with the Andhra Medical College (AMC), N Kalpana Subrahmanyam had been a student, alumni, professor and head of the department of biochemistry and now at the helm as principal of the century-old top medical institute in the state. The academician in a free-wheeling chat with Sulogna Mehta of STOI speaks on changes in medical education standards and curriculum, medical research, life in AMC — then and now — and other topical issues such as rural service for doctors and future plans for AMC. 

How do you perceive the then and now of Andhra Medical College where the college and students are concerned? 

There have been many changes. AMC, which was Victoria Diamond Jubilee Medical School comprising 10 students in 1902, officially became AMC in 1923 with 32 students and was housed in the present anatomy block. It's the oldest medical college in AP and sixth oldest in India. It got its present building in 1955 and now has 200 students in each MBBS batch. 

In those days, subjects like English and Organic Chemistry were part of the medical curriculum, which have now been done away with. There are new courses and super specialty departments. 

Essay type questions in exams have been replaced by multiple choice types. Exams were tougher and many used to repeat the first semester. But now, almost 90% pass in the first try and competition is more. There are also many coaching centres and tutorials, which were unheard of in those days. 

I feel the thinking capacity of students is less than before though they are more programmed. Medicos in those days had greater clinical acumen and diagnosed better by just looking at and talking to patients. Nowadays, more doctors practice defensive medicine and with high-end diagnostic equipment available, they suggest tests for every ailment. They also spend very little time per patient unlike earlier, probably because the patient inflow has gone up with population. 

Students at AMC are also more disciplined compared to other medical colleges and excel in sports and extra-curricular activities besides academics. However, male students are shying away from the profession as they want to settle down quickly with well-paying jobs instead of slogging for 12-14 years to become a doctor. So more girls are joining this profession. 

What changes does the medical curriculum require according to you? 

The three most important subjects - anatomy, physiology and biochemistry - have been squeezed into the first year while earlier it was a one-and-half year course. Students need a good foundation and have to master these subjects before venturing into other spheres like pharmacology, pathology, microbiology, ENT, ophthalmology, medicine and surgery. Now, a lot of emphasis is given to social and preventive medicine and communicable diseases, probably because they have to do with the government's National Rural Health Mission programmes. I feel the three basic subjects should be taught for a little longer even after the first year. 

How different are private medical colleges from government ones? 

The cream of the students comes to government colleges which have the best faculty and the mindset of students is more service-oriented here. In private medical colleges, one can also buy the seats if they have money. However, their infrastructure and environment are better and cleaner. 

What's your take on the mandatory one-year rural service for PG students? 

While rural service is important for the poor people and students too would get an exposure, infrastructure needs to be developed too in the village health centres and lodging for the doctors, so that they get the proper environment to work. 

What's the status of PG Neet (National Eligibility cum Entrance Test)? 

It's in a state of limbo awaiting the Supreme Court's decision. However, our PG students this time have appeared for both the state's NTR University entrance test and the online Neet. Results are yet to be announced. We don't know yet which would be considered for ranking till we get the SC decision. 

How is the medical research scenario in AMC? 

A number of fresh students are opting for research these days while earlier the inclination was mainly towards clinical practice. PG results also determine MD or MS, but students nowadays are voluntarily joining medical research instead of clinical practice. There's a lot of scope for research in this area such as in the field of cancer, HIV, new ailments and pathogens. There's also an opportunity to go abroad or get absorbed in prestigious pharmaceutical institutes, Central research laboratories and so on. 

What needs to be done to curb corruption in medical practice? 

It does exist in some places, as found in all professions and is condemnable. That's why we stress a lot on medical ethics in the curriculum. Students have to mandatorily appear for lectures on medical ethics classes to get their internship certificates. Since the making of a doctor begins in the medical college itself, ethics, oath, personality and psychology development play an important role in shaping a good doctor. 

What is next in the offing for AMC? 

We plan to introduce newer specialties like geriatrics and family medicine as well as an emergency medicine department. With the undergraduate student intake raised from 150 to 200, we are also coming up with a new hostel building for the students. We are modernizing our auditorium complex so that doctors' conferences can be held and accommodation can be provided here instead of in hotels. The AMC auditorium can house almost 1,000 persons at a time. Further, the government has given us Rs 25 lakh for the upgradation of the library with new books and international journals.