Today’s medical schools need to focus more on research to improve health

Medical schools are training centers for physicians and medical specialists. The medical profession is both an art and a science, and learning the nuances requires high quality faculty members and access to patient healing opportunities. Medical university hospitals provide such an opportunity for the training of young doctors. If the country’s health facilities are visually represented in the form of a triangle, the large base of the triangle is made up of the primary health centers and the health and well-being centers closest to the population. Secondary care facilities are positioned above primary health services and the small top is formed by tertiary care hospitals which include medical college hospitals. The medical schools at the top of the pyramid are also responsible for training doctors and medical specialists. The co-location of medical school hospitals supports student education and provides a range of healthcare services.

Medical schools are at the forefront of health service delivery during the Covid pandemic. There are more than 590 medical colleges in the country. Each medical school has a tertiary care hospital that receives referrals from the health system. These medical teaching hospitals admit severe Covid cases, provide appropriate clinical care to the sick, including intensive care. While the number of medical teaching hospitals is dwarfed by the total number of sub-health centers, primary care centers and community health centers, these hospitals are an essential part of the country’s overall health system.

Providing appropriate care to all patients, at the right time, requires an integrated approach supported by valid research. While patient care is important, research guides and aligns care delivery to achieve optimal health outcomes. A strong research base is essential to advancing the mandate of medical schools. However, the role of caregiving often overshadows the role of research. This is partly explained by the high number of patient cases and consequently less time spent on research. Other contributing factors include limited efforts by institutions to develop research skills, especially high-level research skills among faculty members. This has cascading effects on care delivery when there is an overreliance on research data generated from external contexts. For example, protocols for the management of sepsis in Indian newborns should be guided by the common causes of sepsis in the country, and particularly in the state and district. This protocol cannot be static over time and should be updated to reflect changes in the microbial cause and its drug sensitivity. Similar information relevant to providing high quality patient care should be generated by medical schools.

Medical schools need a vibrant research ecosystem where there are research skills, adequate support, and constant encouragement to engage in research. Efforts have been made to make research findings mandatory for promotions of faculty members and regular basic training in research methods. However, impactful research results are still emerging from a handful of institutions in the country. Medical school leadership will need to find innovative ways to broaden the research base within each school and promote multidisciplinary research. A research mandate guided by population health needs should be established for each medical school and integrated into its vision and mission. Colleges should undertake a research priority setting exercise involving various stakeholders and establish research tracking systems and review mechanisms. Clinical research should also be aligned with the broader needs of the health system. Research does not progress in a vacuum, it needs a large team with complementary skills. Departments within the medical school should collaborate with each other as well as with departments beyond the boundaries of the medical school. A “research team” and “special interest groups” approach might be the way forward. This will eventually pave the way for multicentre and multicountry research.

The medical college tricycle is balanced by education and clinical care services like its two rear wheels. The front wheel is the seeker wheel that should steer the tricycle and steer it nimbly on the path to social relevance. We have witnessed several far-reaching reforms in medical education and patient care. The research function of medical colleges is indispensable for the provision of high quality care in India. The 21st century medical colleges in India will need to focus on the transition to research-driven medical colleges and play a vital role in generating and translating knowledge for better health.

(The study was written by Sanjay Zodpey, Vice President, Academics, Public Health Foundation of India and Director, Indian Institute of Public Health, Delhi)

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