Ophthalmic education grows due to increasing demand

Issue: June 2007

Gullapalli N. Rao

Ophthalmic education in India has been growing to meet the demands of a more globalized world over the past 10 to 15 years.

According to local ophthalmologists, the teaching philosophy has shifted from theory-based to more practice-based education. Training has become more hands-on, and technological advances such as the Internet have opened new opportunities to connect with other universities.

However, as India has developed, the pressure to meet its role as an eye care provider for the developing world has increased the importance for further improvements in education.

“Now is the time that there is an increasing realization that as India is becoming prominent in so many other things, and also as India is entrusted with the leadership and responsibility of the developing world in terms of ophthalmology and eye care, the pressure is on the country to improve the quality of training,” Gullipalli N. Rao, MD, said during a telephone interview with Ocular Surgery News.

Dr. Rao acknowledged the areas that need improvement in an editorial in the Archives of Ophthalmology.

In addition, a recent evaluation of the quality of the ophthalmic training in India conducted between April 2002 and March 2003 was published in the Indian Journal of Ophthalmology. It revealed significant inequalities between institutions and suggested more needs to be done to standardize training.

For example, out of 128 institutions that responded to the survey, only 41% reported subscribing to more than two ophthalmology journals, less than one in six institutions were involved in research projects and only 11 had published more than five articles in international peer reviewed journals, according to the results.

Dr. Rao said the important catalyst for continued development is awareness among the ophthalmic community that more must be done.

“A big thing is recognition that the quality of ophthalmic education needs improvement and that something has to be done about it,” he said.

Recent developments

Ophthalmic programs in India include either a 3-year postgraduate degree for a Doctor of Medicine or a Master of Science in ophthalmology, or a 2-year postgraduate diploma in ophthalmology, both of which are regulated by the Medical Council of India.

Although the structure of the programs has remained the same, the content and teaching methods have been changing, according to some ophthalmologists.

“People are teaching [the programs] much better now than they used to in the past, and there is more structured programming,” Lingam Gopal, MS, DNBE, of Sankara Nethralaya said during an interview with OSN.

According to Dr. Gopal, continuing medical education (CME) programs and online teaching courses are becoming more accessible. In addition, he said attendance at international conferences has meant professors and students are exposed to fresher ideas that they bring back to India to incorporate into the courses.

“People are more easily able to travel and attend international conferences to know what’s happening in the rest of the world so they are also more indulgent, more able to force issues on the teachers,” Dr. Gopal said.

Another change Keiki R. Mehta, MS, DO, emphasized to OSN was the shift in teaching methods that has occurred in recent years.

“It is now more practical-based: More students are trained in the newer surgeries. I think the curriculum is now more need-based rather than being theoretical-based,” he said.

Dr. Mehta referred to past practices when textbooks were written in Britain and contained lessons on diseases not typically seen in India, rather than lessons on diseases more common to India, such as trachoma. Now, he said, textbooks and exams are tailored to ophthalmic practice in India.

In addition, students are performing more surgery under supervision, rather than simply observing surgical practice, he said.

“In the olden days, not too much surgery was taught. You went and observed; you didn’t do any [surgery]. Now surgery is taught in a number of colleges before a person leaves,” he said. “In a similar vein, phaco was a no-no, and now it has become an established practice technique for medical college students.”

Training the trainers

Ophthalmologists in India agree that one important step that must be taken is to improve monitoring systems for ophthalmic professors. By improving the quality of the teachers, institutions will ultimately be able to standardize the curriculum with other institutions, according to Dr. Mehta.

“Standardization is one thing on paper. Implementation is another story altogether, and until you have that caliber of teacher, implementation is going to be another problem,” he said.

Dr. Mehta is among the ophthalmologists who believe that a system must be established in which students evaluate their professors.

“As a teacher, if I see my evaluation is not up to the mark, it hurts me. So the next time I go to teach the next instruction course, I try and do my best to make sure I match these standards that I think I should be at and probably exceed. So it’s a monitoring mechanism,” he said.

Dr. Gopal agreed. “In the medical colleges, there has got to be a standard policy that just as a teacher evaluates the student, the student has to evaluate the teacher as well,” he said.

In addition, Dr. Mehta suggested a compendium of CME teaching courses encompassing the whole of ophthalmology that not only will help to update the ophthalmic knowledge of the teaching fraternity, but also will act as a catalyst to standardize education throughout India.

“You need a central teaching repository where material for lectures can be given. That is one way of maintaining standardization,” Dr. Mehta said. “Here you will be given a standardized lecture, with PowerPoint slides and videos, which will be given all over India. The people who are taught will then, naturally, reproduce equivalent material.”

CME programs and tele-ophthalmology

CME courses are not mandatory in India, but according to Dr. Gopal, educators are becoming increasingly aware of their importance.

“In India, it is still not compulsory for [educators] to get retrained or recertified every year or 2 years. That may become a rule in the future, but today, if you are certified once, you are certified for life. So they keep practicing what they have learned 20, 30 years back without getting upgraded,” he said. “Most people have woken up to the fact that you cannot remain stagnant, and they do upgrade themselves by attending conferences.”

Some said they hope that new technology known as tele-ophthalmology will enhance access to CME courses. According to Dr. Gopal, the Indian government has become “acutely conscious” of the need for tele-ophthalmology in order for all students and practitioners to operate on the same level.

“The way ophthalmology is being practiced as of today, that is not available at all levels, so the medical colleges need to upgrade. They ought to be linked to the main national grid of ophthalmic training programs,” he said. “If they don’t have the facility, they should at least have access to a place where the teaching is done better by tele-ophthalmology. That’s the way it’s going to be in a few years from now.

“[The government] is trying to establish tele-links for all medical colleges now in the country. Hopefully, it will become a reality in the next 3 or 4 years. Then they will be able to access all the CME programs across the country.”

Dr. Gopal said these types of changes on the horizon are creating a bright picture of the future of Indian ophthalmology.

“Such programs will become a reality and normal, rather than the exception.”

For more information:

Gullipalli N. Rao, MD, can be reached at L.V. Prasad Eye Institute, Road No. 2, Banjara Hills, Hyderabad 500 034, India; +91-40-2354-8098; fax: +91-40-2354-8271; e-mail: gnrao@lvpei.org.

Lingam Gopal, MS, DNBE, can be reached at Sankara Nethralaya, 41, College Road, Chennai – 600 006, India, +91-28-271-616; fax: +91-28-254-180; e-mail: drlg@snmail.org.

Keiki R. Mehta, MS, DO, can be reached at Mehta International Eye Institute & Colaba Eye Hospital, Sea Side, 147 Shahid Bhagat Singh Road, Mumbai 400005, Maharastra, India; +91-22-215-0082; fax: +91-22-215-0433; e-mail: keiki_mehta@yahoo.com.

References:

Murthy GV, Gupta SK, et al. Status of specialty training in ophthalmology in India. Indian J Ophthalmol. 2005;53:135-142.

Rao GN. Ophthalmology in India. Arch Ophthalmol. 2000;118:1431-1432.

Jared Schultz is an OSN Staff Writer who covers all aspects of ophthalmology. He focuses geographically on Europe and the Asia-Pacific region.