medical education- medical uty,problems and solutions

7/31/2019 Medical Education- Medical Uty,Problems and Solutions

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Medical Education and Medical University: Problems and solutions for

effective Integration

Dr Suvarna Nalapat

http:/ / drsuvarnanalapattrust.org

Contents

Ch 1 My experience in medical education

Ch 2 An outcome-based approach to curriculum development

Ch 3 Regulating Medical Education

Ch 4 Results of Sreeramachandra uty project by S.Thanikachalam


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Ch 5 The challenging task for a Medical University

Ch 6 PROJECT : ( Presented at World Education congress New DelhiJanuary 2011 , and Music Academy Chennai in 2010)

Ch 1 MY EXPERIENCE IN MEDICAL EDUCATIONAfter my MBBS course , I started as a private general practit ioner in a backward village in Calicut . The

experiences in that village was the greatest education I had about the poverty, nutritional deficiencies

and infectious diseases that our rural people encounter and also the most feasible solutions a

responsible citizen can think about .The first Government appointment I had was in an ESI hospital in

Pathirappally , in Aleppey and the next lesson I learned was that if there is organizational and polit ical

power the labour force can make any demands .The hefty strong people without any disease comingand demanding leave on basis of sickness and doctors issueing them ,though they knew that it is mere

malingering made a lasting impression in me . As a responsible citizen I felt that people who demand all

rights and are not prepared to perform duties for the sake of the nation are in fact a burden to our state

.But I could not do anything ,because I was just an individual of only 26 years old,and with a first

appointment and what I can do to to show my protest was just resign from service(which was not even

noticed by anyone as a act of political and social statement against irresponsible behavior of citizens.)

Then I joined Pathology department in 1972 October 21st as a lecturer. This started a brilliant turn of

events in my life. I loved Pathology for its intellectual diagnostic pursuits, social sense in reporting and

clinical duties in teamwork , and above all the teaching profession which it offered . The first postingwas in Calicut medical college, my alumni . But after 6 months I applied for a deputation transfer to

Thirumala devaswom medical college in Alleppey where my husband was working as lecturer in

Pharmacology. The Government gave me an option that if I am ready to forego deputation allowances,

I may be posted according to my wish. And I promptly accepted and joined on deputation without

allowances , in that developing medical college . The init ial stages of the development of Alleppey

medical college also witnessed my initial experiments with learning-teaching situations.

At the time I joined Dr Harilal was Professor of Pathology . But he left soon and the entire department

became the responsibility of lecturers .This was a blessing in disguise for me , as a teacher. With no one


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to guide , we had to start our own teaching schedules , both practical and theory . I had a schedule

charted out in which I tried to give individual attention to each , depending upon their talents and

interest and for that I read out crit ically the answer papers of each of them and made a note (as

grading) of extraordinary, ordinary and below average groups . In the classroom , I would call out names

of students and ask questions depending upon their grade (easy questions to below average , tougher

to extraordinary) so that an interrelationship as well as a initiative to learn , to prepare daily lessons

will be inculcated. And in practical sessions I would visit each student at workplace and try to give a

practical -oriented problemsolving situation either with the gross specimen or the microscopic slide

and make a module (problembased ) by such exercises and watch the outcome .This practice helped me

to know where , I as teacher , and the students as learners , need improvement .The cyclical

improvement I had with such experiences with my students can never be forgotten when I speak of

my integrated valuebased curriculum planning .

When I returned to Calicut Medical college in 1975 , I had become a reasonably good teacher (and also

a good public speaker /orator by 1977) thanks to my early teaching experiments .That was a

transformation I had from a silent girl (who writes written communication as poetry,stories,essays) to

a highly orally communicative person . In the 80s we, the staff of Calicut medical college Pathology

department , started postgraduate programmes and associated weekly teaching discussions on every

Friday morning . In this , we discuss syllabus, curriculum, and devise modules for each topic and every

staff member and PG student takes active part .This modules were introduced in practical/discussion

groups in our college .We found this of great use in improving the problem-based learning capacity of

student .The objections came from some of the teaching staff members and when we gave

questionnaires (which we give to each batch after every programme period) we found that those who

raised objections were actually graded last by students .That means, the objection is because of their

inefficiency to carry out the task rather than due to defects in the programme .

I was exposed to museum ,student section and stores section and bloodbanking from Calicut medical

college ,where all these sections in turn comes to each of us by rotation posting . Administration and

management experimented in Blood bank in 1990s with an Indian ethos (as given in the Gita ) could

successfully endorse quality and efficiency in bloodbanking system .The regional blood bank (for

northern kerala) I planned according to the Glasgow model and with Indian context in mind was

submitted in 90s to the Government and after my retirement from service, when I visited Calicut for a

programme on Environmental Protection conducted by the Forestry Department, Mr Nalinakshan , a

person who was associated with the Voluntary Blood Donors Programmes in the 90s came up and told

me that Madams regional Blood Bank scheme is sanctioned at last . That was almost 15 years after I

had submitted the plan. But I was happy that it was sanctioned. Better late than never.. Another

programme I submitted was the health village adoption scheme through Calicut corporation authorities

in the 90s which I resubmitted with proper innovations and additions to suit the Deemed university of

Amritha institute of medical sciences and research center in 2002 .The music therapy programme is

part of the entire holistic approach and valuebased education with Integration of healthcare .

Curriculum debates in education is mainly based on primary and secondary education and not much is

done in the higher tert iary education and practice levels .The attempts I have made is mainly on the


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third level higher education , but it also encompass the lower levels of education since it has to be

considered as entry points for higher education and base should be strong . Education is either product-

focussed, or process-focussed or both inclusive. We can develop curriculum through constructive

alignment , as process, as engaging curricula, through use of threshold concepts and also as problem

and enquiry based learning . All these approaches developed in international scenario in the 2000s only

.

The staff describe curriculum as four different categories according to Fraser and Bosanquet(2006)

1.Structure and content of a unit

2.Structure and content of a programme of study

3.The students experience of learning

4.A dynamic and interactive process of teaching and learning

The first 2 are the product view and a tangible product is the outcome.The last 2 are process view and is

more intangible.The tangible product is that which conforms to the teachers original intention for it .The

curriculum as design in advance(Barnett and coats 2005) developed from a generic template by subject

experts in the light of their knowledge and discipline and assumptions about the student needs.The

student learning is controlled and implemented by teacher in this.Student is judged in the end ,by a

examination ,how well they achieved what the teachers programme goal .Content is a highly signif icant

aspect ,selected by a group of teachers .There can be aspects which need modification and these are

flexible to be modified according to needs.

The process perspective:- Framed by an emanicipatory interest /orientation and teaching is a shared

struggle towards emanicipation with other principles of critical pedagoguy ,learners are active creators

of knowledge too.The educational experience is negotiated and curriculum emerge from systematic

reflection of those engaged in pedagogical acts.Design(ed)-in-action is a dynamic process (Barnette and

Coate) and certain aspects cannot be anticipated in a template (schon 1987;2006.282)One has to view

the produt as a first step and a continuum from product to process is happening.In higher education

discussions encourage Consideration;Reflection;and Re-assessment- of a process of project of study as

well as learning and teaching encounter.The valuebase of lecturers in relation to their understanding ofeducation and conceptions of learning and teaching will be fundamental to conceptions of curricula and

form and shape it takes.

Chapter 2 AN OUTCOME-BASED APPROACH TO CURRICULUM DEVELOPMENT:-Principles Gosling and Moon(2001) based on were:-

1.All learning expressed in terms of outcome to be demonstrated

2.Modules of learning described in terms of learning outcomes and assessment criteria.


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3.These rather than mode of delivery form basis upon which they are assigned a specific number of

credits at a given level

4.Learning outcome placed with in the hierarchy of 5 levels of NQF(UK)and 10(Ireland)

5 Any given module assigned only to one level

6 Learning outcome should be as clear and unambiguous as possible

7.Learning outcome identify the essential learning to be achieved to merit the award of credit

8 Assessment criteria should specify how satisfactory performance of modules learning outcome are to

be demonstrated

9 Assessment criteria should encourage learning at approximate level

10 Learning outcome should enable employees ,schools,colleges,parents ,prospective students and

others to understand achievements and attributes of students who successfully completed a

programme

11.Facilitate comparability of standards to facilitate international mobility of students

12 Facilitate students and graduates mobility and help identify potential progression routes ,particularly

in context of lifelong learning

13 Assist higher education institutions ,examiners,Quality assessment bodies and reviewers to assess

and ensure quality /standards providing an important point of reference for setting and assessing

standards

LEARNING CENTERED CURRICULA:-

Has a flexible framework .The importance of content and the community in development process is

considered.It emphasise on learning communit ies ,curriculum integration,diverse pedagogies and clearly

defined learning outcomes.

Students,faculty and stakeholders are active part icipants

Academic units are at different stages in curriculum reform and progress at different rates

Should honour inclusion of wide range of teaching and learning strategies

Within an academic unit reform is both an individual and social contextual process

Activities:-

1.Learning context

2.Developing clearly defined curriculum wide learning outcomes


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3.Assessment strategies

4.Progressive stream of teaching methods ,learning experiences driven by curriculum-wide learning

outcomes

DEVELOPING CURRICULUM THROUGH CONSTRUCTIVE ALLIGNMENTThis is suited for training rather than education.Three key curriculum elements:

1 Intended learning outcome

2.Teaching and learning activity

3.Assessment tasks

These 3 are balanced

The learner understands /learning takes place through relevant activity .The system designed to enable

student to learn ,rather than to leave them guessing what is involved in the course of study or in what

theory will be assured

Module development with outcome-based curriculum:- The article of Gosling and Moon appeared only

in 2001 and our department had experienced the process as early as 1980s and hence we were actually

experiencing first by action and then comparing with others experience making it a metascience

pattern.The modules ensure existene of a logical relationship between level ,learning

outcome,assessment criteria,assessment and teaching methodologies for quality assurance processes .

The model:- 1.Existing level descriptions

2.Translate them to subject descriptions

3.Identify aim of module or programme

4.Write learning outcomes for programme and the module

5 Design assessment tasks

6 Design threshold assessment criteria,provide incentive for higher achievements as grading

7 Develop assignment methods to test achievement of both forms of assessment outcome

8 Develop learning strategies to enable learners to reach learning outcomes /assessment criteria

9 Develop module programme .Rethink it including leaving outcomes.

With my teaching experience in Calicut medical college I was trying to implement this modern

innovative modular curriculum strategies in Amritha institute ,but unfortunately the staff (especially the

senior staff) could not co-operate in these highly technical aspects of learning/teaching behavior and


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though the programme was charted out painstakingly ,and modules prepared ,only part of it was

experiments in Amritha hospital .(Pathology modules).But fortunately for me,the sadbhavana lectures

for integrated approach,the music therapy research could be completed satisfactorily .

CYCLICAL SPIRAL STAGES OF CURRICULUM DEVELOPMENTThere are different stages in curriculum development. First one has to be aware of it as important in any

learning situation. Second one has to develop an initiative for innovative programmes.Third one has to

mobilize all possible strength and team for carrying it out.Fourth the action plan has to be developed

with much consideration,reflective thought on outcome for students/clients/nation as a whole.Finally

one has to put it into practice.Thus a personal and practice plan should develop side by side for

achievement to happen.A team of educators (from pharmacology department in Canada) had given a

descriptive model of their experiences(2003).The context ,the academic community and organizational

context are important for making the dreams come true /action plan made into practice .

An articulated curriculum embraces both intended and emergent learning outcomes .All elements

interact and influence each other to stimulate and support active learning and readily reflect what

happens in a classroom situation or in a practice situation of a clinician.There will be a series of different

intentions(among clients,students,stakeholders,clinicians etc)which can create a mess(out of which one

has to draw a clear picture) and all sorts of ambiguities may be seen when we interact .Hence this is a

step towards a process model .A Harward team introduced the term WTP(Ways of Thinking and

Practicing) as Through lines. A spiral of repeated engagements o improve ,to deepen skills,att ributes,and

values is what a life is all about .Through threshold concepts one gets a transformed way of

understanding .And when such a person devise a curricula it wil l be an integrated one and will definitelyinvolve a holistic approach to all ways of thinking and it would be for betterment of life,profession and

of entire life on earth.It is difficult to draw a distinguishing line between traditional curricula and

innovative emerging curricula in India ,as in the west because most of the western innovative styles

were in traditional vedic curricula ,as I had pointed out when I discussed Valabhi and Nalanda and vedic

and Budhist universities and their methods.The western division of traditional and emerging curricula is

as follows:

TRADITIONAL EMERGING

Knowing that Knowing how

Writ ten communication Oral communications

Personal Interpersonal

Internal External

Disciplinery skills Transferable skills

Intellectual orientation Action orientation

Problemmaking Problem solving

Knowledge as process As product

understanding Information

Concept based Issue based

Knowledge based Task based

Pure Applied


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Proposition based learning Experiential learning

One has to ensure the three domains of higher education

1 Knowledge (Gnaana)

2 Action (karma)

3.Athman(self)

The educational identity of the self in relation to subject area is determined by the personality t raits

described by Charaka (the 16 personality types belonging to sathwik,rajasic and thamasic ) because their

intellectual and ability levels and interest levels are varied and tehr power of memory,concentration are

different .These domains are integrated as best as possible in any learning schedule for betterment and

upward movement as progress.

In problem and enquiry based learning students play a major role .Problem solving skills of students

individually,in small groups,in extended groups in any situation so that they can manage life situations

effectively is the objective of an integrated study .PBL is a balanced state of learning in managing ones

own life and serving the nation with that balanced view .

Chapter 3 Regulating Medical education :-Efficiency and quality are difficult to be defined just by the presence of an individual or an institution in

spacetime,unless in the long run ,time proves the outcome of the individual/ institution .We can try to

quantify by hours of work done by each individual,output from each institution,yet the number of

hours does not always depict quality.The same hours of work,in the same discipline done by two

different individuals need not be of same quality and efficiency .The workload of teachers of higher

education (as shown in page 64. Item 7.57 ,UGC committee 1992 ) is as follows:

ACTIVITY & AVERAGE NUMBER OF HOURS PER WEEK:-

Activity Professor Reader Lecturer

Teaching 6 8 10

Tests/exams 1 1 1

Tutorials 1 2 4

Preparation 6 8 10

Research 14 14 10

Reading/administration 12 7 5

Total 40 40 40

In the case of a pathologist,who is also a medical teacher , and whose time of work is from 8 AM to 4 Pm

(1 hour lunch) the weekly 56 hours have to be divided also for diagnostic, consultancy, discussion and

lab work . Therefore , what we do is , make an arrangement of division of labour and rotate between


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A Asura(also called daanava since they give alms readily and are having dharmikarosha ).Mahabali rose

from this to Aindrasathwa ,and Prahlada to Brahmasathwa ,and Viswamithra first to Aindra,then in

order to Arya and Brahmasathwa .

B raakshasa(selfish desires make them do sins)

C paisacha ( heinous crimes are done by them due to intense worldly desires)

D Sarpa( stoop to any low level and do any heinous crime for selfish motives)

E praitya unfulfilled desires make them wander along thinking of the desires

F saakuna same type ,the desirous mind flows like a bird

3 Thamasic :

A Paasavan eat,drink,sleep and makes children .No other interest .Just like an animal( pasu)

B Maatsyan coward,idiot ic,love flattery,fickle,love travels in water /ocean

C Vaanaspatyan- lazy,sits without doing anything ,no intellectual or physical activity at all

At present education is becoming a consumer cost and resultconscious commodity ,especially at higher

levels,where student fees have become exorbitant ,and the education is perceived as a provider of

services and benefits .This on one hand prevents the equitybased services and benefits to all citizens

alike ,and a double type of organizations /institutions are emerging ,along with different type of citizens

at two ends of the spectrum . Nation struggles to overcome this and by a series of efforts/discussions

come up with solutions to combat them.The success indicator of a nation/institution/ individual is a

personal/practice development plan and finding out solutions to all problems . The UGC commit tee

report of 1992 had suggested a few solutions (in which the then Finance minister Sri Manmohan singh

and HRD minister Arjun Singh had contributed their ideas too) and the current bill in the parliament

has to be seen as an extension of the recommendations of that commit tee .Instead ,most of the states

and institutions and individuals view it as if it is a new bill (probably because they are ignorant of the

recommendations of 1992 committee ).

1.THE HINDU REPORT :-

The Hindu on Saturday July 10th 2010 (Anand Zachariah,George Mathew,M.S.Seshadri,Sara

Bhattacharji,K.S.Jacob) says the complexity of issues related to education in medical and health

disciplines demands a separate regulatory authority.The opportunity to recreate the regulatory council

for the education of health professionals is historic in its possibilit ies and potential to address the crisis

facing healthcare in India.According to them,the council should address issues like lack of access to basic

healthcare due to inadequate numbers,the skewed distribution of healthcare providers,ensuring

propriety,increasing efficiency,providing greater synergy among professionals.The new national council

for higher education and research (NCHER)bill seeks to include medical education under purview of the

proposed council.The regulations suggested are:


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Facilitation,coordination,setting of policy by NCHER

Health council to consider syllabi,curricula and exit examinations

The local universities to regulate academic institutions

How NCHER bill address specific requirements of education of professionals not clear.

Concurrently the Government has proposed formation of National council for human resources in

health(NCHRH) as a single apex body to oversee all education and practice related to health.It is

apparent that there will be an overlap of functions between the two authorit ies.

A separate regulatory authority for health education and practice is mandatory due to :-

1 Links to health care delivery: Need to provide health service to society demands setting up a system

which will sequentially address the following issues.Selection of students from local areas,sufficient

training in primary and secondary care hospitals,generalist postgraduate training opportunities,for

example family medicine,career opportunities in areas of need and continuing educational support

.Such a system will mandate close linkage between educational institutions and healthcare delivery

systems.

2.Apprenticeship model of training: At end of training the health professional should get a high level of

expertise.Considerable clinical skill,under the teachers in a appropriate service environment.Such a

model allows narrowing the divide between teaching,research and practice.It facilitates holistic

approach to learning and captures the essence of yashpal committee report .

3.Regulating health professionals : Education and practice of medicine is a continuum and the

regulation of education has to be coupled with that of practice.UK first established a dual

control(General medical council and Postgraduate medical education and training board) and discarded

the model and reverted to single body for oversight of both functions.

The authors ,who are professors of Christian medical college Vellore shows concerns over some certain

highlighted issues .Their concerns are :

1.Relationship between health disciplines :The proposed regulatory council includes

medical,nursing,dental,pharmacy,paramedical,public health and rehabilitation services.A single

regulatory body /authority will result in greater co-ordination and collaboration among these disciplines.

2.Composition of the authority:The new authority should be composed of diverse stakeholders,including

patient advocacy groups and social scientists ,in addition to distinguished medical and health

professionals so that overall healthcare needs and not narrow professional interests are the focus.The

council should not be too small so that the power is concentrated in a few hands.Nor should it be too

large so that it is divisive and inefficient

3 Independent accreditation and regulatory functions.MCI handled accreditation and regulation and this

diluted and weakened both processes.The authority should have two independent divisions. One


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accrediting education and the other oversee practice.Lack of self-regulation in past,argues for a

watchdog to ensure nd enforce adequate technical and ethical standards in medical practice

4.Model of accreditation: Should focus more on describing broad principles and standards that focus on

outcome.This will allow for flexibility ,innovation while maintaining basic standards.A credible and

transparent system of assessment ,which balances routine self-report and review with monitoring and

on-site inspections needs to be designed.

5 Relationship with government: Need for autonomy and independence of the body is crucial .The

authors think that subjecting it to health ministry approval limits its role and delays

decisionmaking.Government should have power to provide overall policy directions to the body and the

body should serve as consult ive body to ministry.

6 Relation with hospitals,universities,specialist associations: Propose a clinical stream which is underspecialist associations .AAnd an academic stream upgraded to research degree who remain within

universities ,while the clinical stream after degree go for practice.The authors think this will avoid

conflicts existing between MCI ,and National board ,increase the number of centers for training

clinicians and raise standard of research.

7 Single window: Previous regulatory procedures included separate and independent inspections by MCI

,university and state governments.This resulted in a many-tiered system that lead to huge delays in

obtaining approvals,and a single window for accreditation and approval of education is necessary

8 Standardised exams and validation: A common licensing examination for undergraduates and

postgraduates to maintain uniformity of defined technical standards.All health professionals shouldmaintain standards of professional knowledge and skill through regular re-validation.System of

continued education and credits and regular reappraisals is mandatory

9 Transparency and accountability: To public scrutiny .A record of excellance in one;s field should be the

basis of selection to proposed council .The authors propose the Nolan principles-

selflessness,integrity,objectivity,accountability,openness,honesty and leadership-to form standards for

holding public office and in public service.

The knowledge commission and Yash pal commit tee which examined higher education identified major

lacunae and suggested an overhaul of the system.There is need for broad-based holistic education and

dialogues between diverse disciplines and centers of learning .The regulatory councils chould act as

facilitator and catalyst for creation of knowledge for society.

NCHER can foster an interdisciplinary research and identify national priorities.It can empower

institutions with a proven record to enhance their autonomy as institutes of national importance.NCHRH

can serve the goal of improving education in health sciences.It must ensure that education in health

science fulfil a social mandate.It should provide a vision to improve healthcare delivery .


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2 WHAT I UNDERSTAND :-

What I understand is that NCHER focus on policy and regulation and not on funds .Funding will be with

a separate corpus with norms for block grants.The UGC,All India council for technological education and

national council for teachers education will be thus replaced .By establishment of NCHRH as single apex

body to oversee all education MCI will loose the power of control over medical colleges.The objections

are raised already by Kerala,West Bengal and Tamil Nad governments as violation of federal principles.

What clauses do they object ?

1.A new university will get authorization by the NCHER .This is for quality control.

2.VCs appointed from a national registry.NCHER will suggest 5 nominees from a national list .There willbe a collagium to recommend names of eligible persons.Quality of the person is to be considered .

Due to objectionfrom the three state Governments ,the reconsideration was done and the second

clause on VC appointment was changed .But the first clause for quality was not changed.

Tamil nad Government has moved the supreme court for changing a single national common entrance

test .

A national exit examination (screening test)for students graduating from Indian medical colleges is

proposed.A national court for accreditation and national medical education and training board that

regulate and accredit medical colleges ,prepare a list of the entire health sector,and regulate all streamsof education in health sector is to be set up.

In an attempt to make India a global knowledge hub,a draft law for innovation universities made and

these universit ies enjoy total autonomy in appointments ,collaborations,and resource generation.The 14

universities selected will be not-for-profit legal entity.Eacg university will be built around a theme or

subject ,these universities will enjoy total autonomy in appointments ,nomenclature of degrees.Open to

all nationals ,genders,ethnicity,disability ,provided at least half the students admitted to any programme

are Indians.There is no mention of caste based reservation.(HRD Ministry) Each university has to

endorse a university endowment fund but have the freedom to receive donations ,contributions from

alumni,and other incomes as long as 80 % of the annual income is used for development of research andinfrastructure.The university will be a not-for-profit legal entity and no part of the surplus revenue will

be invested for any purpose except the growth and development of the university.

Many existing universities could be truly innovative if only the autonomy in the draft bill was extended

to them.The clarity of seat allotment,reservation for Indian students have to be more

transparent.Innovation universities are private institutions.HRD ministry can give grants to develop

them .In that case the President will be the visitor and government would have a larger role in their

functioning.


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Each uty has an independent board of governors empowered to discharge all functions by enacting

statutes to provide its administration,management,and operation.The board will delegate powers to

academic board,headed by VC that will perform financial,management and administrative functions

including appointments and collaborations .The board of studies will specify programmes of study.The

faculty of knowledge,manpower assessment to study and assess through research trends in emerging

fields of knowledge of relevance and the research council that will interface with the research funding

organizations ,industry and civil society .

The government will protect maintain and utilize the publicly funded intellectual property for which the

title vests with it and it can give directions for prohibiting or restricting the publication of information to

any person or entity which it considers necessary in the interests of the country.The income or royalty

arising out of publicly funded intellectual property will be shared by the innovation university with the

intellectual property creator in accordance with the peovision.

The 14 universities are expected to set benchmarks for excellance for other institutions of higher

learning throughpathbreaking research and promoting synergies between teaching and research.Each

university will stand for humanism ,tolerance,reason and adventure of ideas and search for truth.It is

expected to attempt to provide a path for humankind free from deprivation and seek to understand and

appreciate nature and its laws for the well-being of the people.

3.A FEW CLAUSES IN THE UGC COMMITTEE REPORT 1992 (DOCUMENT FROM NATIONAL INSTITUTE OF

EDUCATION,PLANNING AND ADMINISTRATION ) :-

This I quote for clarifying the point that what the nation suggests is to solve the problem for all ,in an

amicable way and if there are any loopholes for injustice,we as citizens can point out them and try to

help solve them .

Page 2 item 7:- Augmenting resources (private institutions are encouraged by this) given in detail in

chapter 9

Item 9 mentions increasing the resources to meet requirements

Item 10 financial assistance to needy students frees tudentships,scholarships,student loan for equity in

education in detail in chapter 10.

Page 4 .1.11.1 :- At present state funds are mainly for salary,allowances(nonplan) and campusexpenditure ,local ,municipal services and not much for plan,academic excellance etc

Page 5:- Two problems noticed:- functional autonomy is not possible in financial decisions by

universities .The dual administration and dual funding in some universities ,delay in getting them in

time etc

Page 6 has given a few INTERIM Recommendations :- To generate a fund ,keep it as separate fund for

achieving objectives of university .To give incentive grants as matching grants-by UGC to institutions


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who generate own resources.And 100 % income tax concession on all endowments/contributions and to

donors sponsoring selected research projects

Page 7 : Increase the burden on those who can afford financially and from that income provide for

poorer sections- tuition waivers,scholarships,etc .

Essential maintainance,development requirements from state itself.Accountability in terms of

quality,cost consciousness,costeffectiveness to be achieved.

The committee e noticed that nonplan expenditure is always more than plan expenditure .The

universities are struggling to maintain the expenditure and fail to achieve quality.They should be

designed to promote quality,efficiency,autonomy ,accountability and relevance.

Equity and social justice (page 17):- Direct support to poor deserving students Indian situation _1.We

have to preserve and promote our national integration

2.Achievement and quality performance comparable to international standards

3 Equity and social justice to poor should be safeguarded

The newly emerging beneficiaries from secondary education should be able to afford an access to higher

education (the vulnerable group).

Page 18:- Universit ies are an

1 Essential input for meeting manpower requirements for national development

2 Critical input to ensure social justice and equity ,upward mobility

3 Input for improving quality of life higher level of integrated knowledge available to widen base of

population and preserving national and cultural heritage

Page 23 :- Scholarships and fellowships should not be reappropriated to any other head of account .Plan

fund should not be diverted to nonplan fund either should be added to this clause,I think.

Page 27 : 4.15.The existing system had lead to practices in which an eff icient institution is punished and

inefficient institution is securing more grants and support .Therefore,universities(as well as people)

become more inactive ,no new programmes,no internal generation of funds,no costeffective efficient

management the committee noted .

Page 32:- What have the universities to say ?

1.Delay in sanctioning schemes

2.Irregular release of funds

3.Inadequate delegation of powers I implementation of plan schemes


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Cha 5 is on negotiated funding based on last years expenditure

Chapter 6 is proposal for future funds .What are these proposals in 1992 ?

6.5.1:- An internal academic audit system to determine needs and scope for new courses of study(page

39)

6.9.1V- Specified discretionary fund with the VC for promot ing excellance in teaching and research

without incurring any recurrent liability .(page 42).This is the reason why the quality of VC was specified

by the new innovation bill I guess.If the VC is not of excellent character ,what happened with IMC will

be repeated and money /funds may be misused .

Chapter 7 page 47 .:- 7.9 Presentation of students in terms of income groups (so that all weaker sections

get access to higher education) is a welcome decision.For this allows analysis of income pattern of

parents and based on this the support system to be collated and indicated (7.8)

It is interesting that the committee had anticipated resistance from the university community ,in

advance (7.16 page 49) and says as in any departure from the past practice this is usual .

Nature of activity of uty/ student strength/ student-teacher ratio-teaching-nonteaching staff ratio ,stage

of development of institution all considered in giving grants .

page 67 says Indian uty system is based on uty system of Britain . I beg to defer ,since it is the other way

round .The value system of Indian university system (palkalai kazhakam /gurukula) was the model for

British universities of early period.Indian UGC act was formed in 1956 but in UK the till 1980 no audit

standards were established .(8.6) and after 1979 election a regulation of public life resulted in an

academic standard group,an academic audit group and a university funding council (the successor of

UGC )in UK .Joining with UGC ,in consultation with it,CVCP thematically based efficiency studies were

designed (8.6.2) and in 1983 the standard of British university were fixed.

Selfdirected exercise by each individual/institution is the best internal audit (I call this a personal and

practice development plan ) and for external audit a Guru/ a sabha /samithi (committee/councils in

modern sense) are set up. Accreditation and audit unit should have in its purview study alone and

research is not under its control in UK .page 72(8.14)mentions performance indicators given by Mridula

Sharma.

Chapter 9 is on income generation and utilization:-

As I have described the ancient university system of India(see history of Valabhi/Nalanda and other

universities of vedic and Budhist India ) primary ,secondary education and care(patient care) should be

entirely free or in certain cases with minimum fee /concession.The tertiary higher education and

tertiary care institutions can collect fee from the rich and give free service to poor .


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Beneficiaries from the first two sectors(students/patients) should get equal access to all sectors is the

idea behind this suggestion .How is this possible ?One has to make internal and external audit for

efficiency and excellance at each step .

What the 1992 report suggest is given below for generation of income by universities(page 78)

1.Fee from higher income student population .Keep this as a separate fund .Utilise for deserving low

income students who prove merit in the previous sectors .Also for betterment of quality of institution

to reach international standards

2.Rent out facilit ies like auditoria,classrooms,computer

service,playground,guesthouse,hostels,lawn,mess etc

3 Individual departments to design programmes and short term courses of study.Thus generate

resources without adverse impact on main academic activit ies.These units can retain a substantial

amount so earned to support their main academic activities

4.Endowments,contributions,large investments,for academic and infrastructural development

5 Sponsors for research .May be state or central government agencies,public or private

sectors,industries etc .These projects proposals should incorporate allocations for reimbursements for

staff ,facilit ies and infrastructure support .Use for strengtheneing infrastructure.

6. Consultative mechanisms: Institute and members as a whole (not management alone)

faculty,students,alumni,nonteaching staff have representatives in this

7.Incentives to inculcate and implement measures UGC support,encouragements as positive incentives

and grants (page 79)

Page 80 (9.23) asks to have a separate fund for keeping high standards of excellance .

9.24 A part of it kept for building up a corpus fund ,the interest of which is for support activit ies of uty

9.25 a part goes to needy students and for academic improvement

Chapter 10 enumerates the existing financial assistance for scheduled cates/scheduled tribes .

10.2 : Department of welfare gives tuit ion fee and living expenses for scheduled catses/tribes .But there

is delay in gett ing the amount .UGC suggests the advance grant to be given to uty in April itself

(calculating the previous year expenditure and adjusting the amount at f inal stage of payment ) so that

students and uty will have no problem.

10.3 .JRF has a 10 % cut off marks for SC/ST students

Also through open selection without qualifying examination they are being enrolled for higher

education seats.


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10.4 Bookbanks are functioning for the weaker sections of students

10.12. Of the weaker sections 10 % of entire student population of uty is from economically poor

weaker sections.The rest study with concessional rates based on merit .

10.13 Freeship schemes

10.14 existing loan schemes

The newly generated fund is for reducing the financial restraint on state and public fund and make the

stronger(financially) sections of society share the funds for the sake of weaker sections and make

equity come true from a national point of view .

This is what I have understood ,being part and parcel of Government medical college (teaching and

practice )and part of a private institution of excellance which take money from rich and try to help thepoor/deserving .The problems of public sector funding and the problem of equity when privatization of

higher education happens ,are thus taken into account by the UGC commit tee (which report I read in

1995 ) and I think it is these recommendations which the current Loksabha has passed as the bills ,as

mentioned in the Hindu .

The aims are thus understood.To put it into practice all citizens,all institutions should be willing . It is not

laws or committees and recommendations which we lack.It is the right att itude of national

integration,and of duty consciousness,a right attitude to achieve personal,institutional,professional and

national excellance as a responsible human being which each and every one of us should cult ivate.No

political party,no religion ,no other sectarian interests or personal selfish interests should bar thatult imate aim of a purely sathwik personality of excellance as Charaka ,our ideal Vaidya justly pointed

out.Make us achieve that upward journey to excellance as a single united nation .

Chapter 4 Results of Sreeramachandra uty project by

S.Thanikachalam

8080 persons from Chennai ,Tiruvallur and Kancheepuram studied.Age distribution 25-65 yrs

Males 56 % Females 44%.Maximum income per month :Rs 15,000/month

Between April 2008 and June 2011.

Urban Semi urban Rural

Smoking 25.8 23.8 38.3

BMI (>25) 47.92 53.63 28.34

Body fat %(>25) 81.1 85.44 64.91

Anxiety 20.2 17.5 11.2

Depression 15.3 14.8 11.8


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Stress 21.2 20.6 13.7

Qbnormal ECG 31.7 18.8 22.8

Diabetes 19.32 17.82 12.05

High BP (over 140/ 90

mmHg)

18.64 18.1 15.24

Lipid abnormalit ies 72.21 61.26 61.17

1/3rd of population has conditions conducive to development of vascular illness-stroke,heart

attack,peripheral vascular disease,among others.

Normal reference value for vascular aging among Indians was much higher than

Caucasianpopulation.Aging was advanced by at least 10 years ,in comparison with Caucasians(Carmel

Mary McEniery ,Uty of Cambridge).Vascular age of 30 yr old Indian is comparable to that of a 40 yr old

Caucasian in UK .

S.Ramaswamy,Director of Vasomeditech: This increases the risk of vascular incident at an earlier age

than other Ethnic groups .The incidence in semiurban and rural areas also is steadily raising.(Higher

fasting glucose ,a prediabetic state )was higher in rural(12.02)and semiurban(9.6) than urban.Glucose

tolerance levels also were higher in these groups.This is a disturbing finding because they too are slowly

developing the same conditions that exist in Urban life style population.The deficiency of

Homocysteine,Folic acid,high oxidative stress,indicate the disease is just round the corner according to

Dr Thanikachalam.The team is trying for collaboration to explore possibilities of prevention.They have

experiments with Sidha medicine in 73 patients for Diabetes for 6 months and reported that the

medicines were effective and safe.(Ref The Hindu .Vascular aging value High in India .Sep 6.2011.page 9)

I think this is a good turn of events.Because the integration of Sidha with Allopathy is a new step taken.

About prevention of stress,stressrelated diseases and the role of Music therapy and Ayurveda in it I had

already experiments and proved its efficacy and as a way of life this is a safe and efficient procedure for

both prevention and cure of many disorders of the 21st century .

I had done an epidemiological study of Cancer of Digestive tract-Colon ,rectum and stomach- in Calicut

Medical college ,and found that the Northern Kerala population has a tendency of developing cancer

stomach at an earlier age and the food style is responsible for this .

The Caucasian by nature is a nonvegetarian.But a tropical animal like an Indian is not so.The changing

life style from vegetarianism to nonvegetarianism is one factor for development of digestive system

cancer as well as high lipid and cholesterol levels and atherosclerosis and the related vascular diseases.

The reason for vegetarianism in India is not religious ,but geographical. If we look at the tropical Indian

bear ,it is brown or black and is mainly fruitivorous,eats fruits,nuts ,honey,and if at all a tiny animal once

in a way.But a Polar bear ,its cousin ,is very white and is a carnivorous animal and feeds on big seals and

this is because of the lack of vegetation in the poles .The tropical monsoons,the abundant green

vegetation,forest foods and grains made the early ancestor of t ropical man a herbivorous animal and


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eating meat (especially red meat) was almost unnecessary and not resorted to. This life style changed

when we came across other cultures from the more northern latitudes . The Indian ancestral genes

which were not acclematised to such life style is showing its lack of adjustment by being prone to

diseases at an early age.

The reduction of stress by Music,indigenous way of living ,and food habits and herbal products will help

India in overcoming many health problems which are causing high cost for its exchecquer.

Chapter 5 The challenging task for a Medical University :1. Improve the quality and content of Higher education- Academics and Research2. Integrate western medicine research protocols with Indegenous medical systems according

to needs of Indian subcontinent3. Innovative thinking in managing the different Institutions under its umbrella4. Have good scientific publications in each of these fields of Medicine (both western and Indian

Medical systems) and have international standard research papers and text books created by

the Faculty /Research scholars .For this an e-library and facility for digitalized versions of

papers and texts should function .

5. The administration (day to day ) and conducting examinations in time etc should be delegatedto an administrator of the Chief secretary cadre IAS off icer and the academicians should be

concentrating on research and academics .

6. Have an Institute of Human Values in healthcare so that Integration of humanities and sciencewill have long reaching effects on physical,mental and intellectual wellbeing of the people.

7. The academic and human value wing together should formulate the health policy required forthe state and for the Nation and should have highly involved members with a vision of value-

based education for national development policies.

The problems currently encountered by Tamil Nad Anna University and the solut ions

suggested for it may be considered and modif ied according to the needs of the Kerala based

Medical University and its current problems.(The Hindu :Education Plus Monday September

19;2011.)

The problem in Anna Uty :-The academic circles feel that not more than 100 colleges should beaffiliated to a Uty . But they also agree that there are several universities with 800-900 colleges

of arts and science affiliated to them ,but to manage 500 Engineering colleges is very

difficult.Making the Professional colleges which should be centers of academics and research

(and not tuition centers ) into inefficient centers have to be prevented.For this mammoth task

ahead Anna Uty is searching for an effective academician-cum-administrator as Vice chancellor

.The Uty needs to have the cleanest and efficient vice chancellor someone who can take the

bull by the horns-and whose words and leadership would be respected .The appointment has to


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be solely on merit devoid of corruption or political interference.It will be an acid test ,says

academics of the Uty .

When the Uty and its faculty is having more work to perform in the administration and in the

process of affiliation of all colleges,conducting examinations in time etc ,the academics and

research takes a back seat .

Eminent academician and IIT Kanpur chairman M.Anandakrishnan comes up with a solution:-

Uty can have 500 professional colleges affiliated. For that create mentoring centers ,at least 10

,to begin with ,each in charge of 100 colleges .Provide people who can act as mentors for these

centers. They may be given powers of a pro-vice chancellor but within the Utys control.All the

colleges have to do real quality work and should be academic and not mere tuit ion centers.

The current problems that the prestigious Medical Uty of Kerala face can be solved if we resortto a goal-oriented systematic approach .

THE VICE CHANCELLOR - ACADEMIC AND RESEARCH ( PROFESSIONAL FROM MEDICAL SIDE )

ADMINISTRATIVE HEAD IAS CADRE OF CHIEF SECRETARY

HEAD OF INSTITUTE OF HUMAN VALUES IN HEALTHCARE

These 3 have their own designated duties and thus delegation of powers to each helps in betteringthe functions of the institution. It should be a teamwork . The distribution of power is for efficiency .

And it would be a decentralized power distribut ion under a centralised Uty scheme .

As suggested for the Anna Uty scheme by sri A.Ananthakrishnan, 10 mentors with pro-vice chancellor

status under the Uty can function in the state and they should be given awareness of the vision and

goal of academic and research enhancement before they are given the charge . Merit should be the

only basis of selection.If it is difficult to get 10 mentors who are academicians/with leadership qualities

,the number may be restricted to 1 to 4 as required.( For Southern states as Travancore, for Cochin

and for south and North Malabar respectively ).

If this is strictly followed with Uty and national goals of higher Education ,we can solve many of the

problems encountered in the professional education .

Tamil Nad Governement has done an Audit on the valuation system of Anna Uty and found that there

is a substantial change (increase) in marks given after revaluation of papers. (from 2005-2009).

The student remits Rs 400 for revaluation and for getting a copy of the new result Rs 700 which in

total is 1100 Rs. If the revaluation is unsatisfactory ,student can ask for a further review. For it student

has to pay Rs 3000 after securing permission from departmental head and principal. Then the answer


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sheet is evaluated by the Faculty members of the student in the college. In 2006 April , students

applied for revaluation= 71173

In 2009 April it was 1.57 lakh more than doubled. 30000 got marks changed in 2006.83000 in 2009.

(from 46.21 % to 53.17%).There is a weakness in the evaluation system as pointed out by this scenario.

Based on the report of CAG ,the higher education secretary has asked the Uty to review its valuation

system.

One of the reasons for poor evaluation pointed out, is the pressure on the Faculty members/examiners

to complete a particular number of transcripts with a prescribed period .

Another fault pointed out by the CAG is that many industries which signed out Memorandum of

Understanding (MoU) during 2005-10 did not facilitate any industry-related academic programmes but

merely served the purpose of mobilizing funds for the Uty . MoU entit les the consortium partner of theindustry to avail admission for one student in the relevant branch of study. In 2005-2006 Uty signed

MoU with 18 industries but admitted 21 students in consortium quota .

2007-2008 : signed with 53 industries ,and admitted 2 more addit ional sponsored candidates. In 5 yrs

Uty earned 22.75 crores and admitted 178 sponsored candidates. MoU only served the purpose of

allowing admission to sponsored candidates on payment of 12-15 lakh per course (the amount for

joining as consortium member).Industries considered unsuited to sign MoU by a team of Faculty

members ,were approved by another team sent again. MoU envisage involving industries in setting

curriculum and in organizing seminars ,conferences, research ,industry visits; staff exchange

programmes with university and industry ;besides the admission of one sponsored candidate. The

consortium members did not contribute to any of these .They just enjoyed one sponsored candidate .

Such studies show the flaws in our academic system and where we fail. The results should not

discourage us.We have to think together and make solutions . For this , a good team is needed both at

the helm and at the mentor level and all the faculty should have a broader vision on our goals of

higher education .

Chapter 6 : PROJECT : ( Presented at World Education congressNew Delhi January 2011 and Music Academy Chennai in 2010)

WRITE UP FOR A VALUEBASED EDUCATIIONAL MODEL HEALTHCARE PROGRAMME FOR WORLD

PEACE AND INTEGRATION OF MEDICINE AND ARTS THROUGH RAAGACHIKITSA (INDIAN MUSIC

THERAPY)

Introduction:-

A satisfied quality life is the gateway to consistent health physical ,mental ,intellectual and

spiritual.For this an enlightened citizenship and humanitarian values have to be inculcated in every


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2002 . The institute of human values in healthcare and a integrated curriculum for arts and

science ,introducing sadbhavana lectures and using music therapy as a golden link for the process was

also submitted and experimented with a pilot project in Amritha Institute .The problems encountered in

each step was evaluated and my personal education plan with my practice development plan

developed simultaneously over the years from 1972 onwards in reflective learning cycles .The context

,the personal and professional experiences ,the reflective thoughts on them and the action plans as

Action research ,periodic self- assessment and evaluation and modification of the plans as situations

demanded (in individual cases /clients) continued for a long period .The model is a

clientcentered,studentcentered practice/learning plan ,and use a gestalt model of biophysical medicine

integrated with the bioenergy and cosmic energy using Indian music as Raagas.

When Jeevaka ,the great physician was asked to find out a herb that is not a medicine ,he said after a

long search that he cannot see a single plant that is not having healing properties.This is the same case

with Ragas.Each ragahas healing properties .The challenge is to find out which for which individual and

for which context . This requires lot of patience,time ,effort and manodharmafor the therapist .It is both

an art and a science.

Why should we integrate ? One has to understand the important trends in the field we live in.The

increasing popularity of the alternative medicine the world over is a moment for all of us to have a self-

assessment of our current systems of practice. At the same time,we have a responsibility to preserve

the regulations,guidelines to practice,research protocols acceptable scientifically,and the training and

licencing accreditation systems etc so that the new discipline does not end up as a quackery .This

double responsibility has to be handled effectively by an enlightened cit izen .Integration is already in

progress as we find from IRIIM 2006 but we also know that the integration has several problems

,regarding modern medicine and indigenous medicines accepting each other. The question of

integration is mistaken as taking theories and practices of one and indiscriminately applying them in

another discipline by both sides.But integration means ,functioning under the same roof,where the


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client has the choice to select what he/she wants and protecting the individuality of each discipline

.The indigenous disciplines taking the research protocols of Modern medicine ,and Modern

medicine being benefit ted by the traditional knowledge systems in bringing about a more satisfied

quality life to the client under the same roof . For this a plan has been drawn out after

several personal and practice development cycles in course of my Action research .It has to be

implemented nationwide for benefit of all.

Means and methodology ,/theory and practice adopted in achievingobjectives in Music Therapy research :

Indian Music therapy is a system in which physical, mental, intellectual and spiritual wellbeing of all

living beings is considered.Indian music has its base in thridosha sidhanthaand in sabdasasthrawhich is

essential for all philosophies and sciences. ItsNaadalayayogaor Naadaanusandhaanayogais common

to Samaveda, Sidha, Yogaand Ayurved.. Its use of time cycles is common for science of astrophysics and

energy cycles. Raagachakracorresponds to energy cycles,bioenergy as well as cosmic energy ,thus

unifying energy concepts through mathematical vibrational cycles of Naadaor sound. What one has to

do is use this integrating golden link for uniting indigenous and western medicine. All the differences of

opinions existing in the theoretical and practical integration of healthcare can be removed by the use of

music as therapy and in therapy ..The research was done with modern research protocols and

statistical tools integrating ancient and modern sciences and arts .

How music works:

Music use Swaraand Raagaas both dravyaand adravya(matter and energy) for healing and therefore

both biomedical as well as astrophysical (energy) levels of healing are employed and this is the reason

for its universal use as integrating medium.


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Fig 1.Swarameasured asdravyaby its length ,height ,volume, time

Swaraasdravyais measured, (Fig 1)still is invisible to eye. Sabdais quality of Aakaasa(one of 5

elements) and isEkagunaand that is why Aakasaand sound (OM) is considered as symbol of God. God,

sound and akaasaare experienced but cannot be perceived by gross senses. Hence swara and music

based on swara is both dravyaand adravya. Music uses principles of Chakraenergy in our cosmic and

biological field. Naada(sound) and Layayoga(merging in Samadhi) is the ultimate.South Indian classical

Melakartha Raaga scheme as shown in fig 3 ,in which the cosmic spheres (astrophysics) with star

clusters, the seasons with seasonal raga,the ragafor each day (as in North India) and for each bioenergy

Naadi(in Kundalini,the nerve plexuschakraof body ) each related to each organ system ,thus making

an integrated whole. In my action research scheme ,thisMelakarthascheme was tested and

experimented with volunteers and hospital populations .

Figure 2.Samayachakra( North India)

Fig 3. Chakra used in Music Therapy Incorporating cosmic and human naadi /N & S India .(Dr Suvarna

2003 )

Using fig 3, Chakra Nadi, meridians and energy channels used in India and China (acupuncture system)

can be integrated. Jung (1976) understood chakrasas universal .Several support ive articles and books

on chakraand energy in naadihave come out (Brennan 1988; Idou 2001; Shang 2000, 2001; Rao and

Motoyama 1993; Gallo 2002; Popp 1998; Vijk and van vijk 2006; Gerber 2001; Gilchrist and Mikulas

1993; Maslow 1954/1987). But none of them explore the underlying science, philosophy and integrative

power for healing purposes .Anna Van wersch, Mark Forshaw and Tina Cartwright (2009) has rightly


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said that the concept of nadiand chakrain Indian and Chinese Medicine would be the most

fascinating and worthwhile research topic. With medical training, love for music, astronomy and yoga,

my journey had indeed been fascinating with an interdisciplinary integrated result-oriented approach

integrating doctors and clients point of view yet client-centered. There are no known side effects if

music is used in correct sound decibels .It is a cost-effective procedure and reduces dosage, duration of

hospital stay for surgery and therefore use of music is a boon to majority of people of India because

exorbitant rates of super-speciality hospitals are unaffordable to the common man.Swarawith thriguna

balanced increase psychosomatic balance and immunity. The balancing is done by time - seasons,

day/night and cosmic and bio-energy harnessed for balancing life. Therefore, it is cosmic energy and not

biomedical alone according to eastern especially Indian context .(Spirituality, physicality, aesthetics,

mathematics, music and astronomy are thus integrated).Follow the principle of documentation and

evidence-based practice, research tools and protocols and discuss, evaluate on-going projects, have an

open outlook for growth of the discipline. Statistical evidence and data compilation from various

centers should follow as a metascience.

Physics of Acoustics

Above 80 to 180 dB is noise pollut ion level. Usually Instrumental music starts at 60 and upto 80 dB range

and vocal music has range of 20-30 dB. At 10 dB we have breath sounds alone in praanaayaaman (yoga)

and below that is usually inaudible to human ear. The zero level is the silence and the yogic naadalevel

zone.Because of this human voice is best suited for therapy.Moreover the input for our brain is our

sense organs and their subjects(Indriya,vishaya) and output is the autonomic/endocrine /autocrine

hormones,neural peptides which are responsible for our implicit and explicit actions.Both act on

learning and emotional cycles .There is association between primary and secondary

reinforcers(amygdale and cerebrofrontal cortex) and since all our clients were people who had

developed language systems and cerebrocortical functions it was better to use sangheethamand

saahityam( Sangheetham api saahityam saraswatyaa sthanadwayamaccording to India) and hence

vocal music with lyrics was used. For clients who have not developed cerebrocort ical and language

functions and for those who have lost them ,different methods have to be devised which may or may

not include lyrics/language .If instrumental music is being used adhere to the levels well below 60-50 dB

and several traditional instruments have this range. Thus side effects of pollution can be eliminated.

Key issuesworked out :-


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On the basis of preferences and attitudes of people in Kerala, and bearing in mind the larger Indian

requirement, an integrative approach was evolved and a study undertaken. (Nalapat 2008 ). Key issues

were worked out on its basis as a part of action research . Clinical Governance issues, regulations,

training quality assurance for an integrated curriculum using music therapy for medical institutions.

Worked out and experimented in Amritha Institute of Medical Sciences and Research Centre. (Nalapat,S;

2008 ). Can MT be used in mainstream healthcare system? By theory, practice and research, the

answer is yes.

Evidence for effectiveness , Safety and lack of side effects.

Cost-effectiveness, client satisfaction worked out by pilot project . A trial training at Trivandrum

Pankajakasthuri Ayurveda Medical College identified problems that can arise and reflective learning

cycles were done to eliminate such problems in future.Randomized controlled study on 78 patients in

Calicut Medical College undergoing colonoscopy was done . The dose of drug Midazolom could be

reduced and the pain and discomfort zones showed significant variation in test and control groups. The

music used was 56 % Raagabased, of which 46 % was vocal and 10 % instrumental. (Harikumar et al

2004 quoted by Nalapat S.2008 c)

Extent of geographical area which can be covered and target populationbenefited .

Entire nation/world can get the benefit ,if applied nationwide /worldwide since all Indian

Raagas can be used (Fig 2 & 3)

Source of funding and application of funds in the last three years : The pilot project

was done in Amritha Institute of Research center and workshops conducted in Pankajakasthuri , by

their own funds .No other funds were asked for or applied for . All the other funds needed for the

project were met from my own personal funds .

Future Action Plan : This is a project which needs teamwork and collaboration from different

public and private agencies of healthcare,and musicians and at a national level . So far all the works

were done in Kerala .A Faculty training and Research center has to be established and the services of

the center/chair should be extended to nationwide/worldwide programmes for better healthcare

and quality life of all.


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Fig 2 Samayachakra

Fig 3 Melakartha Raaga chakra


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medical education- medical uty,problems and solutions

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