Students will graduate without practical skills due to the absence of operation theatres

Earlier this month, Nida Khan (name changed) began her year-long internship at Bhopal’s All India Institute of Medicine Sciences (AIIMS).

She is among the first batch of students since the Institute — modelled on India’s premier medical centre in Delhi — was opened in 2012. However, Nida and the rest of her batchmates are a nervous lot.

They are finishing four and a half years of MBBS training without having assisted in surgeries, delivering babies or even handling emergency cases. In fact, 13 of the 47 students have not yet passed all the required courses.

Ms. Khan, a final year student, told The Hindu [that given her grades] she could have studied at any institute in the country but chose AIIMS, Bhopal. And it is a decision she regrets.

Promises belied

“My rankings allowed me to pick any medical college except AIIMS, Delhi. I chose this college on the assurance that it will be up and running in three or four months. Our first and second year was mostly theory, so we assumed it would be fine by the time we came to the third year. We have now finished our MBBS degree and are starting out internships. We have witnessed procedures but completely missed practical lessons in surgery, gynaecology and casualty departments,” she said.

While Ms. Khan is reluctant to say more, other students have expressed their displeasure at the state of affairs. On September 17, 2016, when Union Health Minister J.P. Nadda visited the campus, his car was blocked by students, hoping he would give them a hearing on the infrastructural deficiencies of the institute. Their hopes were belied. Frustrated, the students flung ink at the Health Minister, who was quickly whisked away.

Lacks basics

Thirteen years after the foundation stone was laid and five years after the first batch of students was admitted, Bhopal’s AIIMS is yet to get a licence to open a blood bank. Without a blood bank, the emergency department cannot be operational. Other crucial departments like surgery and gynaecology are not functional either. All of which, students say, has affected their learning.

Some faculty members share the students’ frustration. Explained a professor, requesting anonymity, “To get into AIIMS is not easy. These are among the brightest students in the country. From the third year on, students are supposed to spend the first half of their day in hospital, learning practical skills, and attending lectures during the second half. Not a single one of my students has learnt these practical skills or assisted in surgery. They have only observed surgeries in other hospitals.”

At AIIMS Bhopal, the practice has been to take batches of four students to nearby government hospitals and getting them to watch how operating theatres work. This is not the same as assisting and learning, added the faculty member. In the case of the gynaecology department, senior doctors ferry students to a nearby maternity hospital — the Sultania Zanana Haspatal — where they “visit” the labour room and watch a cesarean section being performed.

In the case of gynaecology department, senior doctors ferry students to nearby a maternity hospital — the Sultania Zanana Haspatal — where they “visit” the labour room and watch a cesarean section being performed. They are then taught the same process on a dummy and taught the theory component.

Head of the Department of Gynaecology Ragini Mehrotra confirms the students’ experience. When asked about the delay in starting maternity services, Dr. Mehrotra said setting up departments in a government hospital was time consuming. She insisted, however, that, “None of my students have suffered. We collaborated with the Gandhi Medical College and showed our students how surgeries are performed. They were then taught in classes and we explained the procedures on a dummy. My students are well trained.”

Medical Superintendent Kailash Tamaria said the delays in opening up departments and the blood bank were “unavoidable”. However, he did not give any reasons for the delay. “It’s not like we haven’t taught them (the students) anything. At least they have gone to other places and observed surgeries,” Dr. Tamaria said.

Not everyone is convinced. According to Dr Srinath Reddy, former head of Cardiology at AIIMS, Delhi, and visiting professor at Harvard Medical School, “Learning only by observation without assisting (in the operation theatre) is like trying to learn swimming only from reading a book.” As he put it, “Medical students do not have licence to practise. They have a temporary license during internship. However, they are expected to conduct some normal deliveries under supervision — at least in most colleges. MBBS training programmes must provide practical skills in care delivery to students, so that they can function independently after they graduate. Apart from medical diagnosis and treatment of common clinical conditions, basic surgical and obstetric skills are needed if the fresh graduate has to function effectively in a primary health centre. These skills are acquired not only by observation during the educational sessions but also by opportunities to assist, during internship which is a crucial year of practical training between the final examination and graduation.”

The situation at Bhopal is a far cry from the original vision where the AIIMS was supposed to be one of the “temples of modern India”.

The flaws are obvious, points out Dr. Sujatha Rao, former union health secretary, given that important faculty positions at AIIMS, Bhopal, are vacant, important departments not operational, resulting in medical education and patient welfare suffering.

“It took us 40 years to make the AIIMS, Delhi, a centre of excellence. We cannot open up an AIIMS in every State like it is a grocery shop. Where will the faculty come up? When I was at the ministry, I wanted other institutes — like Delhi AIIMS, PGI Chandigarh and CMC Vellore — to each adopt two new AIIMS-like institutions. To have an exchange programme for faculty and students. These institutes have been set up without thought,” she said.

India now has 11 AIIMS-like institutions. The promise is to open an AIIMS in each State under the Pradhan Mantri Swasthya Suraksha Yojna (PMSSY). None of them are fully functional but Bhopal is the closest to completion. Dr Tamaria says they intend to make it, “90 % operational by the end of 2017”. As the Bhopal project nears “completion”, the Central government has announced eight more AIIMS, taking the total to 19.

Consider this: According to AIIMS, Bhopal’s annual report, of the 305 positions sanctioned, only 57 are filled. Out of the 4081 positions in the institute, including non-teaching staff, nursing and resident doctors, only 446 have been filled. Yet, the hospital saw 2,69,246 OPD patients between April 1, 2015 and March 31, 2016, an average of about 840 per day. Most patients were referred to other centres, if they required emergency or surgical intervention.