Medical Education Governance in India

Standards must not be lowered to certify Ayurveda postgraduates surgeons

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Sushrut Samhita

Mains level : Debate over mixopathy

This conundrum of different standards for surgical training must be solved because patient safety is far more important than the career progression of Ayurvedic postgraduates.

Practice Question: There is a need to rethink on the recent notification of AYUSH Ministry allowing Ayurveda postgraduates to conduct surgeries keeping the safety of the patient at the centre. Discuss.

The current clash

  • The clash between the allopathic and AYUSH fraternities is about the AYUSH practitioners’ “right” to conduct surgeries.
  • The Ayurvedic fraternity maintains postgraduates in Shalya and Shalakya (two surgical streams among 14 post-graduate courses) are taught procedures listed in the curriculum.
  • The oldest-known surgical specialist was, in fact, an Ayurvedic surgeon/sage Sushrut (600 BC) who wrote the Sushrut Samhita — a profound exposition on conducting human surgery which continues to receive worldwide acclaim.
  • Surgery was practised by Ayurvedic surgeons long before the advent of western medicine.
  • Allopaths question the logic of Sushrut’s millennia-old pre-eminence bestowing the right to practise modern surgery. Ayurvedic surgeons may not know the hidden risks of every surgical procedure and how to surmount sudden mishaps.
  • The Ministry of AYUSH justifies its notification on the ground that not all vaidyas but only postgraduates qualifying from two surgical streams have been authorized to perform selected surgeries.

The contentious issue

  • The moot point is about who decides whether Ayurvedic surgeons possess sufficient proficiency to conduct these surgeries safely and by what standard their skills are judged.
  • Surgical proficiency cannot be judged by different standards in one country — particularly when less-educated patients would rather save money than question a surgeon’s qualifications.
  • The statutory regulatory body for AYUSH education is the Central Council of Indian Medicine (CCIM). CCIM has only promoted what private college managements demand, propelled, in turn, by students’ need to earn a stable income as medical professionals.
  • In this misplaced zeal to give better earnings to the Ayurvedic vaidyas, CCIM has sidelined many skills that Ayurveda could have included, which are relevant even today.
  • This has subjugated the curriculum to nurture more and more replicas of doctors of modern medicine.
  • This has killed the knowledge, purity and goodness of classical Ayurveda, which ironically is the Ayurveda in high demand in Europe, Russia and America.

Nothing can replace practise and training to perform surgery

  • When it comes to surgery, it is not knowledge but rigorous training and continuous practice which makes for perfection. Both require clinical material and most Ayurvedic hospitals do not have a fraction of the surgical patients found in allopathic general hospitals.
  • Allopathic students of surgery learn first by watching and then performing scores of surgeries under supervision.
  • Surgical skills are by no means impossible to learn but they become difficult to master without continuous training and supervision.
  • Due to the paucity of patients, limited scope for training and access to gaining hands-on practice, it is hazardous to allow all Shalya and Shalakya postgraduates to undertake surgical procedures.
  • In the last three decades, specialization has excluded general surgeons from performing what was once considered routine. For example, only an ENT surgeon can perform a tonsillectomy.
  • Therefore, to notify that Ayurvedic postgraduates in surgery can perform omnibus operations runs counter to the norm in India and in other countries.

Way forward

  • In performing surgery, the only benchmark should be the duration of hands-on training received — counted by surgeries under supervision, and being judged through external evaluation.
  • Every surgeon’s skills and competence must be tested by applying exactly the same standards before she/he can operate.
  • This conundrum of different standards for surgical training must be solved because patient safety is far more important than the career progression of Ayurvedic postgraduates.
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