Inside India: The Path to Becoming a Doctor

Srinivas K. Gopinath, MBBS

Disclosures

August 02, 2011

As I race down the road on my bike, I pass early-morning joggers who smile at me. They usually view speeding bikes with disdain, but I am different: I am wearing a white coat. In their minds, I am a doctor racing down the road to save the life of a gasping patient. Even the police officer at the intersection does not try to stop me or slow me down.

Little do these onlookers know that I am just a medical student trying to make it to the hospital on time for rounds, and the only person whose life is at stake is me! It's been one of those mornings when the more that you hurry, the more you encounter obstacles that slow you down. To make matters worse, I am currently rotating in orthopaedics, and they are very keen on punctuality.

As I enter the hospital premises, a text message from my friend appears on my cell phone: "Buddy, rounds have started." My heart skips a beat as I run down the corridor, only to come face to face with my annoyed attending physician. He gives me a look that plainly says, "You are dead."

I am a fourth-year medical student at Bangalore Medical College and Research Institute (BMCRI) in Bangalore, India. You may have heard of Bangalore: It is the city of call centers and the hub of outsourcing, and it is also called the "Silicon Valley" of India.

Being a medical student here is amazing. We get to interact with patients from diverse cultural and ethnic backgrounds. One day I might see a US-bound techie who comes to get vaccinated, and the next I'm treating a farmer who suffers from brucellosis.

A Bit of Background

Although some aspects of medical training here are similar to those in other countries, others are fairly unique to India. For one, admission to medical school is based solely on your entrance exam score. The higher you rank, the better the school that you can attend. We also have privately run medical universities that may admit students with lower scores -- if you can afford to pay the steep price.

Indian students enter medical school right after high school. That means, for better or worse, we are a lot younger than our American counterparts. We get to become doctors sooner and start earning money earlier. On the other hand, studying medicine requires a certain degree of maturity, and some of us may be lacking in that regard when we first start out. Our training lasts 5.5 years, including 1 year of housemanship, known to US students as internship. We have the same courses as US medical schools, but we don't have electives; the entire curriculum is required.

The first year of medical college, as we call it in India, was a particularly frightening experience for me. Sitting through lectures and listening to complex anatomical descriptions of the human body were intimidating. The syllabus was nothing like what I had seen in high school, and getting through anatomy, physiology, and biochemistry was a daunting task.

Sitting through endless PowerPoint presentations in hot classrooms where the air conditioning never works might discourage attendance, but here it is compulsory. If you fall short at the end of the term, you are not even allowed to take the exam that could lead you to the next level. That is highly frustrating.

Luckily, clinical rotations begin earlier here -- in the second year -- than in the United States, where students typically begin hospital training in the third year.

The wealth of clinical material to be learned in India is enormous; the exposure that a medical student can gain is phenomenal. Because of the diversity of our population, we see a broad spectrum of disease, including infectious diseases such as malaria, filariasis, tuberculosis, and leprosy. We also have an expanding urban population; hence, we also see many chronic health problems that plague the Western world, such as cardiovascular disease. Because consanguinity is common in some Indian communities, we also get to see many rare pediatric syndromes, some of which have never been reported in Western literature, such as unusual variations of Escobar syndrome.

Perhaps the biggest drawback to medical training in India is the relative lack of funding and infrastructure for research. As medical students, we do not experience the thrill of discovery or the satisfaction of contributing to medical knowledge. We are also at a disadvantage when applying for residency programs in the United States because we have not published any papers.

Once Indian students complete their bachelor of medicine, bachelor of surgery (the equivalent of a doctor of medicine or doctor of osteopathy in the United States), we can pursue a postgraduate course in India or go abroad. Unfortunately, it is extremely difficult to get into a postgraduate course here because there are few positions compared with the number of new graduates. As a result, some graduates settle for a specialty where they can get in, even if it wasn't their first choice. Many others aspire to go to the United States, either for residency or for a fellowship after doing a postgraduate course in India. Personally, I also hope to go to the United States where I might be able to train in programs that do not exist in India, such as emergency medicine and interventional cardiology.

Back to Our Story

Although we get exposed to the wards early, we don't get directly involved in patient care until internship. On this particular day in orthopaedics, for example, we are assigned a patient whose case we review, and then we are dismissed and told where to learn more.

Today's case is a 10-year-old boy who has had a swollen knee for 6 months associated with pain that worsens during the night. The array of potential diagnoses is wide, but once we hear that a grandfather who lived with him was suffering from tuberculosis (TB), we are fairly certain that this is a case of TB knee. TB is extremely common in India, and more importantly, this is an "exam case." (We are assigned cases that are most likely to appear on exams.)

We examine the patient thoroughly, and 2 hours later, our resident discusses the case with us. Then he tells us where we can read up on it. We are told what treatment should be given and what tests are needed, but we are never allowed to actually experience how the case develops. It is like watching the promo for a movie, where you see only glimpses of the plot but nothing about the resolution.

As my day draws to a close, I walk back to the college library with a list of things to study. I pull the heavy medical textbooks off the dusty shelves and thumb through the index for obscure signs and symptoms that the book might not even mention. Sometimes the Internet is a handy tool, but it is not considered a reliable source.

After a few hours in the library, I head back home and try to read more about the topics that have been discussed in the clinics. But this night, like so many others before it, I fall asleep on my couch with my face in a Harrison's.

See Srinivas Gopinath's discussion on the differences between medical schools in the United States and other countries in our Medical Student Connect community.

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