The ‘Rural Surgeon’ of India: A New Paradigm in Surgical Education

Author(s): K. M. Shyamprasad*1, M. Gautham2
Affiliation(s): 1Surgical Education, National Board of Examinations, 2Public Health, Independent consultant, New Delhi, India
Keywords: Rural surgeon, innovative training, skill mix
Background:

There is a wide gap between the burden of surgical emergencies and diseases in India and the availability of appropriately skilled surgeons to manage these, especially for the country’s 700 million rural population. On the public health forefront, huge surgical needs exist for management of (1) maternal complications and emergencies that are a leading cause of India’s high maternal mortality rate (407/100,000 live births), and (2) injuries responsible for 11% of deaths, 50 million hospital care seekers, and 17 million hospitalizations. The country needs to develop greater numbers of versatile surgeons able to function independently in resource limited rural settings.

Summary/Objectives:

In a significant shift from the Euro-Western model of compartmentalized surgical education, the National Board of Examinations - the MoH’s apex body for post graduate medical education - has developed a 3 year Rural Surgery course. The syllabus emphasizes basic surgical skills and management of traumas and emergencies; it includes Obstetrics and Gynaecology, Anaesthesia, as well as Management of a Rural Health Centre. Problem solving learning principles underlie the pedagogical approach. Nodal and peripheral rural course centres, chosen for their commitment to rural surgical care, provide practical training in cost containment, economics of rural healthcare, functioning within infrastructural constraints, and also inculcate appropriate attitudes and communication skills. Student’s learning material is responsive to local disease burdens and incorporates a variety of e-learning and audiovisual material.

Results:

The course was launched in 2007 with 10 students. Periodic reviews are designed to improve upon the basic course design and attract increasing numbers of students.

Lessons learned:

The Rural Surgery course is an innovative, pioneering effort to align surgical education with the public health surgical burden of a low income country. It represents a paradigm shift in the evolution of Indian medical education from a Western model to a locally responsive model.

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