Postgraduate Training in India

India has numerous medical colleges, both government-owned and private, offering postgraduate courses in pathology, clinical chemistry, and microbiology. A total of more than 1,500 seats are available each year, and students gain entry by taking a national-level examination. Unfortunately, many don’t choose these courses out of passion, but rather practicality – perhaps it’s the path of least resistance, the one that offers the most flexibility for the future, or the one that promises the best work-life balance. Most neglected of all is clinical chemistry, followed closely by microbiology. In both courses, many seats are left vacant each year.

The teachers in the medical colleges are often more involved in academia and administration than in serving their students. Most are experts in morphology, microscopy, and the mortuary – but few work in the clinical laboratory, and even fewer interact with patients. Although the course curriculum includes a stint in a modern clinical lab with (at least) a complete blood count analyzer, a coagulation analyzer, and similar tools, these facilities are not available at all institutions and students are not always permitted to use them when they are available. Even most libraries are closed cabinet, meaning that interested students can’t access reading material to expand their horizons. The unfortunate outcome is that although teachers may have rich experience to share, it often fails to translate into education and training for their students.

But what do students want? With little access to training and resources, many turn to Mother Internet. Siri, Google, and now Alexa have become favored tools among India’s medical trainees – and although they diligently use these tools to complete their work, many are not motivated to learn beyond the bounds of their course requirements. And that means essential skills, from grossing to management, may fall by the wayside. Worse still, many are pressed into service by teachers to arrange or attend conferences, market events, and even act as couriers, chefs, tour guides, and chauffeurs to senior examiners. You would be right to ask what such tasks have to do with a student’s education, but teachers in Indian medical colleges often require them nonetheless – and, if the tasks are satisfactorily completed, a degree is virtually guaranteed...

In most medical colleges, the entire basic science department is housed in one building. The walls between the departments extend – at least conceptually – to the people who manage, maintain, and dictate the rules. Although medical coursework requires some hours spent in clinical chemistry, microbiology, cytogenetics, and the blood bank, there is little communication between these departments and none at all between the laboratory and its patients. Instead of viewing laboratory medicine as patient-centric, most view it as “specimen-centric.” Instead of patients, we have “pieces.” Is it any wonder that so few students are interested in pathology?

The road forward? Mentorship offers one possible way to raise the profile – and quality – of pathology in India. A mentorship is a relationship in which one person invests time, energy, and expertise in nurturing the growth of another. Mentors vary greatly in style, but all contribute to the professional and personal growth of junior colleagues through their wisdom, knowledge, and expertise. No one can effectively advance along their career path alone – and without effective mentorship, it can be difficult to deal with the professional and personal issues that arise. Trainees, in particular, want to feel that they are “part of the family” academically, intellectually, and socially. By helping trainees and faculty members build relationships, departments not only cultivate strong mentorships, but also foster the creation of a tight-knit scholarly community.

The modern practice of pathology is constantly reshaped by rapid scientific and technological progress, as well as by market forces. Pathologists must expand their role as consultants to remain part of the clinical care team. Skills that made us successful yesterday will not be sufficient to guarantee success tomorrow. To move with the times, our education system must include:

• Patient care skills: not just diagnostic competency, but also the provision of advice to treating physicians.
• Medical knowledge: integration of biochemical, clinical, and molecular sciences into pathology, and integration of patient management into all laboratory medicine.
• Professionalism: commitment to provide reliable, ethical laboratory services.
• Management principles: the tasks and tools of management, including leadership skills, conflict resolution, and resource development.
• Laboratory operations: laboratory design, process management, technology assessment, contract and acquisition skills, marketing, and financial management.
• Quality assurance and regulations: total quality management, risk management, patient and laboratory safety, error-proofing, and ways of addressing errors when they take place.
• Informatics: both in the laboratory and in the wider hospital environment to provide integrated patient support.
• Medicolegal skills: including malpractice concerns, patient safety issues, and ethics.

In short, high-quality mentorship and a focus on essential new skills will deliver the education system that India needs and its patients deserve.