Jump to comment:

• Response to Kamath et al 'A syncretic approach can yield dividends'
  Paul Macneill, Karen M Scott, Jo River, Paul Dwyer, Claire Hooker, Louise Nash and Kimberley Ivory
  Published on: 17 May 2017
• A syncretic approach can yield dividends
  Rajesh Kamath, Sagarika Kamath and Brayal D'Souza
  Published on: 19 April 2017

• Published on: 17 May 2017

  Response to Kamath et al 'A syncretic approach can yield dividends'

  • Paul Macneill, Hon. Associate Professor Centre for Values, Ethics and Law in Medicine, University of Sydney, Sydney, New South Wales, Australia
  • Other Contributors:
    • Karen M Scott, Senior Lecturer
    • Jo River, Lecturer
    • Paul Dwyer, Senior Lecturer
    • Claire Hooker, Senior Lecturer, Medical Humanities
    • Louise Nash, Associate Professor
    • Kimberley Ivory, Senior Lecturer

  Dear Editor,

  We welcome the response from Kamath et al and their insight into the issues and culture within medicine in India, and their thoughts about how to address these issues. We also agree that a drama-based approach is not sufficient on its own to deal with entrenched power issues which affect students adversely. As we have indicated, we believe “a multipronged approach is needed to generate systemic change.” These authors similarly advocate that student mistreatment be dealt with “in a comprehensive manner” including a ‘grievance redressal system’ and other measures to withhold accreditation where there are issues of abuse of power.

  Nevertheless, we note that Kamath et al have responded positively to our approach—as a part of that mix—and it would be of great interest to see whether drama-based workshops could support medical students developing embodied acting skills in their institution and whether they may have similar transformative effects. We’d like to refer the authors to an excellent Medical Humanities paper we referenced that outlined drama-based activities in medical education in India: Gupta S, Singh S. Confluence: understanding medical humanities through street theatre. Medical Humanities. 2011;37(2):127-128.

  Despite the above article, the authors note that medical education in India has not embraced the medical humanities. We would draw a distinction within the medical humanities between activities which are primarily studious (re...

  Show More

  Dear Editor,

  We welcome the response from Kamath et al and their insight into the issues and culture within medicine in India, and their thoughts about how to address these issues. We also agree that a drama-based approach is not sufficient on its own to deal with entrenched power issues which affect students adversely. As we have indicated, we believe “a multipronged approach is needed to generate systemic change.” These authors similarly advocate that student mistreatment be dealt with “in a comprehensive manner” including a ‘grievance redressal system’ and other measures to withhold accreditation where there are issues of abuse of power.

  Nevertheless, we note that Kamath et al have responded positively to our approach—as a part of that mix—and it would be of great interest to see whether drama-based workshops could support medical students developing embodied acting skills in their institution and whether they may have similar transformative effects. We’d like to refer the authors to an excellent Medical Humanities paper we referenced that outlined drama-based activities in medical education in India: Gupta S, Singh S. Confluence: understanding medical humanities through street theatre. Medical Humanities. 2011;37(2):127-128.

  Despite the above article, the authors note that medical education in India has not embraced the medical humanities. We would draw a distinction within the medical humanities between activities which are primarily studious (reading literature, studying medical history) and workshops that are based on participative and embodied activity. Our experience has indicated the effectiveness of drama-based workshops in addressing both the cognitive and emotive aspects of harmful practices and we believe that it is the embodied nature of acting skills workshops that is transformative.

  One of the indirect outcomes of workshops of this kind is how they draw attention to the issues of harassment and bullying within medical education and could support reflection within Indian medical schools and the wider culture. However the broader political context is also important. Our workshops occurred following widespread media attention and criticism of the abuse of power within medicine. Furthermore medical associations (including the Royal Australasian College of Surgeons) had taken steps to challenge these abuses. We note that there are similar responses from politicians in India critical of The Medical Council for corrupt practices, and this may indicate a political climate conducive to change.

  Show Less

  Conflict of Interest:
  None declared.

  • Back to top
• Published on: 19 April 2017

  A syncretic approach can yield dividends

  • Rajesh Kamath, Assistant Professor Department of Public health, Manipal University
  • Other Contributors:
    • Sagarika Kamath, Assistant Professor
    • Brayal D'Souza, Assistant Professor

  Dear editor,

  We read with great interest “Grace Under Pressure: a drama-based approach to tackling mistreatment of medical students”,Scott et al, in the March 2017 issue.The percentages of medical students in American and Australian settings who faced discrimination, harassment and “teaching by humiliation” were pretty significant.

  An observation that we would like to make is that we feel that the form of intervention outlined in this paper would be of even more relevance in Indian settings,where one has the additional influences of patriarchal and sometimes misogynistic beliefs and practices, caste hierarchies,a culture of marked deference to seniors,and starkly contrasting socio-economic backgrounds.To add to the mix,the regulatory environment in which medical institutions function in India is already a compromised one.The Medical Council of India has been widely panned for corruption,with an Indian parliamentary committee report calling it a “club” of influential medical practitioners who act without any fear of governance and regulations.1A sitting Union health minister has been no less scathing.2When this is the situation with regard to compliance with “hard” requirements like infrastructure,manpower,equipment and admission criteria,one would have to be a die-hard optimist to believe that what is perceived as a “soft” issue like student mistreatment would get the attention that it deserves on a large scale.A significant number of students who face...

  Show More

  Dear editor,

  We read with great interest “Grace Under Pressure: a drama-based approach to tackling mistreatment of medical students”,Scott et al, in the March 2017 issue.The percentages of medical students in American and Australian settings who faced discrimination, harassment and “teaching by humiliation” were pretty significant.

  An observation that we would like to make is that we feel that the form of intervention outlined in this paper would be of even more relevance in Indian settings,where one has the additional influences of patriarchal and sometimes misogynistic beliefs and practices, caste hierarchies,a culture of marked deference to seniors,and starkly contrasting socio-economic backgrounds.To add to the mix,the regulatory environment in which medical institutions function in India is already a compromised one.The Medical Council of India has been widely panned for corruption,with an Indian parliamentary committee report calling it a “club” of influential medical practitioners who act without any fear of governance and regulations.1A sitting Union health minister has been no less scathing.2When this is the situation with regard to compliance with “hard” requirements like infrastructure,manpower,equipment and admission criteria,one would have to be a die-hard optimist to believe that what is perceived as a “soft” issue like student mistreatment would get the attention that it deserves on a large scale.A significant number of students who face mistreatment do not report it because the system does not respond adequately and appropriately.

  One way that a felt need to deal with medical student mistreatment could creep into the collective Indian medical education consciousness would be if a functional grievance redressal system became an accreditation requirement as part of a quality initiative.In this way,at least the academic institutions that go in for accreditation would deal with student mistreatment in a comprehensive manner.After some time,when a critical mass of policy makers and academics become familiar with this concept,it could be brought in as a statutory requirement.

  We feel that novel techniques like the drama based approach must be made part of sensitisation modules for all faculty and students.A sub-theme in the qualitative workshop evaluation data that touched us was some attending the workshop for preventative reasons(“I don't want to be a [bully] … I want to be involved in [the workshop] so I could be more aware.”)It would be interesting to do a study on how many healthcare professionals believe that they may be actually indulging in bullying or mistreatment.Suffice it to say that a great many wouldn’t be aware that they are doing it.It is our belief that there is a very large untapped benefit from attending workshops like these for purely preventative reasons.

  The field of medical education in India and we suspect in most of the rest of the world, has been left largely untouched by the medical humanities. Initiatives like this workshop would go a long way in facilitating a syncretism between these disciplines that would hopefully dispel the darkness of arrogance and superciliousness that seem to cloud so much of medical education discourse.

  References :
  1. Rakesh Bhatnagar. Medical Council of India largely responsible for corruption in health care, reveals committee. 29th April,2016. Available from: http://www.firstpost.com/india/medical-council-of-india-largely-responsi...
  2. Pritha Chatterjee. MCI corrupt, clinical trials body a snake pit: Harsh Vardhan. The Indian Express. 18th July,2014. Available from : http://indianexpress.com/article/india/politics/mci-corrupt-clinical-tri...

  Show Less

  Conflict of Interest:
  None declared.

  • Back to top