Medical Education in Christian Medical College, Vellore
The strengths of CMC education have been seen as the small number of students, in a residential institution with faculty and students living on the campus and students being mentored by teachers, a tradition of high standard of clinical care, students learning the practice of medicine in such a service environment and the spirit of Christian missionary service. CMC education is linked to providing community service by ensuring that all graduates undertake two years of service in needy areas after their training. At the time of independence, CMC was the only private medical college in India, while today it is one among over 300 private medical colleges. CMC is regarded and ranked as one of the foremost medical colleges in the country both for the quality of training and outcomes and the distinctive societal focus.
The first century of medical education at CMC has witnessed several organizational changes, from a medical school to a medical college, from a women’s college to a co-educational institution, an increase in number of MBBS seats from 50 to 60, and now 100 students and a sponsoring system through which CMC association members sponsor students who will go back to work in the sponsoring body hospitals.
CMC has developed a social orientation in training by making incremental improvements in the curriculum over nearly 50 years. In the 1970s, CMC was at the forefront of community-based education in India with immersion experience in the community through the community orientation programme (COP) and community health programme (CHP) and the community medicine internship. In the early 2000s, a series of curricular changes were initiated:a clerkship programme in clinical medicine, surgery and paediatrics offering hands-on practical training, the secondary hospital programme, staged exposure to rural secondary care in mission hospitals three times during the course, and family medicine postings. A postgraduate distance learning diploma course in family medicine was started to support graduates during their service obligation period. The focus of these initiatives was to develop a community perspective and to prepare students for primary and secondary care during their service obligation. These approaches have been taken note of by the Medical Council of India (MCI) and incorporated in theirVision 2015 document.
The Medical Curriculum in CMC Today
Mission: The Christian Medical College Vellore strives to impart an education of the highest grade in the art and science of medicine, to equip young men and women in the spirit of Christ, for service in the relief of suffering and in the promotion of health.
Objective: The Undergraduate medical curriculumis structured to produce medical graduates who will serve in the spirit of Christ, be compassionate, professionally excellent and ethically sound; who will go out as servant-leaders and make a difference, with a special concern for the poor and the marginalised.
The Undergraduate Medical Curriculum is unique in that it is a hybrid curriculum. It is a combination of subject/discipline based, community based, competency based and problem based curriculum. Emphasis is given to early clinical exposure during the first year and to integrated learning throughout the course. Students are introduced to important aspects of ethics and professionalism, communication, leadership and management during the Course. Emphasis is laid on attaining relevant knowledge, attitudes and skills to practice relevant and cost effective healthcare.Spiritual nurture is given importance as part of the transformative educational process.
The distinctiveness of our education process includes:
Formative education: At the end of the training period, the students don’t just receive a degree but receive a formative education with a sense of calling and purpose. There is not only transfer of knowledge but values and life skills essential for life. Students are given freedom to grow and blossom, at the same time being made accountable and responsible, Christian values and ethical principles are impressed on the students.
Student nurture: Student nurture is an important aspect of the education process where faculty interact with students as teachers, mentors and foster parents. Faculty also nurture students by being role models themselves. The regular curriculum, several special programs within the curriculum, small teacher-student ratio, student programs and the college campus being residential for both the faculty and the students, provides ample opportunities for faculty to interact with students and nurture them, both inside and outside the classroom.
Emphasis on excellence, relevance and social responsibility: The students experience through their education process that it is not only important to be excellent but also relevant and sensitive to the needs around them and make a difference.The students are exposed to work done by CMC through the departments of community health and family medicine, and how they serve the people in surrounding areas. During the secondary hospital programs, the students are awed and inspired by the social responsibility of the mission hospitals. They not only cater to the health of the people but also are into education and training skills to help them earn a living. The students themselves go to nearby villages frequently, and do medical camps along with faculty.
Foundation course: The main objectives of the foundation course are for the students to acclimatize themselves to medical studies and be oriented to Christian Medical College Vellore. The students are introduced to
- History and objectives of CMC
- Education at CMC
- Working togetheras a team work camp
- The health situation in India, its problems and challenges
- The role of a doctor within the community
- The clinical learning environment (OPD and wards)
- First aid
- College campus
- Adjusting to a new environment
- Perspectives to learning and goal setting
- Introduction to ethics and communication
- Students Association and their role in its activities.
Mentorship program: Some of the new students find it difficult to adjust to college life as it is very different from the supervised and protected life they have had as a school student. The way of teaching and learning is different from what they have experienced in school and coaching centers. They also find it difficult to balance their studies and extra-curricular activities. In order to help them academically and support them through this difficult period of adjustment, the new students are allocated mentors who are faculty from the basic sciences departments. The mentors help improve academic performance and also play a supportive role and guide the students through difficult situations.
Various methods of teaching/learning: Includes lectures, small group teaching, use of teaching aids, charts and specimens, case- based small group discussions, tutorials, clinical case demonstrations as there is a large spectrum of patients, directly supervised clinical training; one to one teaching of clinical examination, teaching through practicals and demonstrations, clinical skills training, simulated learning, outpatient teaching, ward teaching,
Early clinical exposure: In order to stress the clinical significance of the basic sciences and also to increase interest and motivation, the students in the first year are given an early clinical exposure. This is done through integrated case based teaching by clinicians and also student visits to the Hospital to examine patients and diagnostic laboratories.
E-learning: The CMC E-learning unit began as a project between Tufts University of Health Science and CMC to enhance effectiveness of medical education through the use of information technology. Through the E-learning initiative CMC has been able to increase the efficiency of curriculum delivery, create locally relevant learning resources, incorporate their use into the curriculum and spur educational innovation.
Support classes: Classes outside of the regular hours are taken by certain departments in order to help students who find it difficult to grasp concepts.
Integrated learning program for I MBBS Students: An Integrated Learning Program (ILP) aimed towards horizontal and vertical integration of the preclinical and clinical subjects for the first MBBS students is conducted every year. The whole of the gastrointestinal system is covered through the ILP. This program includes problem based learning, early clinical exposure, lectures, anatomy dissections and laboratory work. The ILP enhances self-directed learning among the students. The integration helps connect between basic sciences and actual clinical practice.
Foundation course for second year Medical students: The foundation course for II MBBS students orient them to the clinical and para-clinical departments. It also includes sessions on communication, ethics and professionalism, Infection control, training in Cardiopulmonary resuscitation and student research.
Integrated learning program for II MBBS Students: The 1st clinical year students also have an Integrated Learning Program (ILP) and the topic varies from year to year like TB, Diabetes etc. Different teaching learning methods are used like paper based cases, clinical exposure, seminars, small group discussions and laboratory visits.
Community orientation and Community Health programs: The students spend several weeks in the village with the community village as part of their community medicine learning. They are sensitized to:
social, economic and environmental factors affecting health and diseases, existing health beliefs and practices, common health problems in the community, role of government and voluntary organization in improving the welfare of the rural community, role of various members of a health team, principles of health education, health planning and health administration etc.
Secondary Hospital Programs: The Secondary Hospital Program (SHP) was started in CMC to sensitize students to the relevance and challenges of health care in secondary hospitals in different parts of rural India. The SHP program involves visits by first, second and third- year students to the mission hospitals associated with CMC for a period of ten days to two weeks each. Each SHP is tailored to the experience level of the students and the subjects they are learning. The students maintain a log book with details of patients seen, procedures observed, and reflections regarding the posting. They also carry out small projects to understand the social determinants of health and also collect information on the Public Distribution System.
Student Exchange Programs: The exchange/elective programs to premier medical institutions abroad gives students an exposure to how medicine is taught and practiced outside India, in different settings. A number of students apply for the exchange programs. Selection is done based on their academic performance, performance in extracurricular activities and interview. Students go on exchange programs to Karolinska Institute Sweden, National University of Singapore, University of Maastricht Netherlands, Kyoto University Japan, Uppsala University Sweden, Lee Kong Chian Medical School Singapore, Sydney Medical School Australia and a recent addition for a research program to Indian Institute of Science, Bangalore.
Clerkship: One of the flagship programs of CMC is the clerkship program in Medicine, Surgery and Paediatrics. The students spend about 3 weeks in the wards as sub-interns, looking after patients. The aims of the clerkship program are that students will be able to develop problem solving skills based on history, examination and investigation results,develop the ability to prioritize patient problems and generate a differential diagnosis, implement patient management strategies and observe their effects, develop communication skills as the primary care giver, identify common conditions and know treatment plan, care for in-patients, prepare them for surgery, assist in surgical operations, care for the patient postoperatively, perform simple procedures, recognize emergencies and initiate management.
Patient care: Emphasis on good patient care and holistic approach to patient care,even to those with limited resources is stressed during clinics, clerkship and internship.
Orientation to various imaging modalities with clinical relevance: The students are oriented right from the first year to various imaging modalities, their clinical relevance how to appropriately and judiciously order for these investigations.
Modules on ethics and communication: Ethical practice of medicine and effective communication with patients is a legacy of the institution and students imbibe the same. Several workshops are conducted to introduce students to different aspects of ethics, professionalism and communication. Steps are being taken to seamlessly integrate teaching of ethics and communication into regular student postings.
Leadership and management workshops: The workshop on leadership and management was started in keeping with the mission of our institution that our students will go out as servant leaders of health teams. Our graduates serve in mission hospitals and thus need to be equipped with leadership and managerial skills. The objectives of the workshop are to enable medical students to Understand leadership and management as related but different skills; Understand group dynamics, team building and conflict management.
Student Research: Students are encouraged to do research and the institution provides funding for the same. Faculty mentor and guide students. The whole process is facilitated by the undergraduate research coordinator. Sessions on basic research methodology is covered. Research has become one of the highlights of the training program. Several students from every class in the recent past have undertaken research projects. Several undergraduate research projects have won prizes and have been published. The students conduct every year a National level Undergraduate Research Symposium titled ‘Cognito’ for which students from medical colleges from all over the country participate.
Research elective: This was started to provide protected time undergraduate students doing research. Students with approved research projects and who have faculty willing to supervise them can opt for the research elective to undertake research.
Clinical elective: The elective postings was started to enable students to have an exposure to specialized areas of medicine to which they will normally not be posted to. The students have the opportunity to have 2 elective postings of their choice.
Feedback: Regular feedback is obtained from students about the teaching programs and good suggestions are taken to improve the curriculum.
Assessments and student feedback: The students have formative assessments at regular intervals. This is followed by a summative assessment. The assessment methods include theory tests comprising of essays, short notes, short answer questions and MCQs, OSCEs, practical examinations, clinical case presentations, Mandatory Observed Clinical Case, viva voce etc. Feedback is given to the students regarding their performance. There is a student review with the Principal, Vice Principal, Heads of Department and Wardens to provide feedback to the students.
Spiritual nurture: Spiritual nurture is provided by chaplains, faculty and through several programs within the institution,enabling students to grow in Christ. These include class retreats, Bible class, class prayers, community worship, class thanksgiving service, Shiloh medical missions program, Pachalur retreat, Easter play, Christmas programs and various special programs.
Unique selection process: The selection of students to CMC is a time tested unique process that has been followed since the 1940s. This comprises of a national level written test followed by interviews and special tests to assess the academic capability and suitability of the candidates to fulfil the vision and mission of CMC.
Extra-curricular activities and campus life: CMC is blessed to have a wonderful campus with beautiful flora and fauna. The faculty and the students stay on the campus forming a wonderful community. The students can visit any of the faculty homes. There are facilities for games and athletics. A beautiful huge multi-purpose auditorium is used extensively for programs all through the year. The students are given opportunities to nurture and exhibit their talents for all-round development. They enrich the CMC community life with amazing plays, music, dance, games, cultural events, special thanksgiving services. They are an integral part of the weekly Sunday evening community worship services. The students are given opportunities for leadership within the student’s association and hostels. They are allowed to govern themselves and run the hostels.
Foster family system: Each student is allotted a faculty family on campus as foster parents. Thus the students enjoy a home away from home with good food, emotional support and help when required. The foster parents play a crucial role as role models and mentors.
Rigorous internship: The internship is a highlight of CMC training as the graduates after completion of internship are clinically competent and confident. They learn the importance of teamwork in healthcare. A lot of responsibility is given to interns and thus they become an integral part of the medical team. The learning includes taking complete history, good documentation, physical examination, order appropriate investigations, interpretation of results, procedural skills and management common conditions.The interns are assessed at the end of each posting on proficiency of knowledge, competency and skills, responsibility and punctuality. The interns have to do a clinical audit submit a completed log book at the end of internship.