Docswithdisabilities Podcast #8 Satendra Singh, MBBS, MD Release Date: November 26, 2019
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DocsWithDisabilities Podcast #8 Satendra Singh, MBBS, MD Release Date: November 26, 2019 Satendra Singh, MBBS, MD: Transforming Medical Education in India Introduction: Lisa Meeks Doctors with disabilities exist in small but measurable numbers. How did they navigate their journey? What were the challenges? What are the benefits to patients and to their peers? What can we learn from their experiences? My name is Lisa Meeks and I am thrilled to bring you the Docs with Disabilities podcast. Join me as I interview Docs, Nurses, Psychologists, OT’s, PT’s, Pharmacists, Dentists, and the list goes on. I’ll also be interviewing researchers and policy makers that ensure medicine remains an equal opportunity profession. Lisa Meeks: We are excited to bring you a special international episode of the Docs with Disabilities Podcast. Today, I get to chat with Dr. Singh, about his incredible victories of late, including the addition of 8 disability focused competencies to the medical education curriculum in India. Let’s listen, or read along, as Dr. Singh talks about these new competencies within the new curriculum. Satendra Singh: We in India modified our curriculum after 22 years, and now the curriculum is a competency based medical education curriculum. Even in the previous curriculum, the similitude of the elephant in the room has been used to chronicle the experiences of patients with disabilities within the medical profession that she is present but unnoticed. And that was a reason why we for a very long time use the medical model of disabilities in our curriculum. So, when our curriculum was updated again, they came up with a new competency-based medical education curriculum, but unfortunately it still did not include the human rights approach towards people with disability. And during that time, it was just a sheer coincidence that I was working on this project, “Disability-inclusive Compassionate Care,” where we were developing competencies within the Indian setup and we had focus group discussions with three key stakeholders. The dominant key stakeholders were doctors with disabilities because they were never heard before. The second category was disability rights activists, and the third one was health professional educators. So, we had focus group discussions with these three key stakeholders, and based on that we prepared 52 competencies. Then we shared these with a larger audience. We shared it with people around India. We took their feedback, and based on that feedback we further revised these competencies into 27. And these were categorized into the five roles expected of an Indian medical graduate, which in a way is in sync with the six ACGME core Page 1 of 11 DocsWithDisabilities Podcast #8 Satendra Singh, MBBS, MD Release Date: November 26, 2019 competencies as well as the seven physician roles in CanMEDS. So that way, we believe that they are in sync with international standards. But the big question was that whether the Medical Council of India will accept these recommendations or not. We were fortunate that you know, two statutory bodies within India, the Chief Commissioner for persons with disabilities and the state commissioner of person with disabilities, they made recommendations to the Ministry of Health in India and they said that this new law, our new Rights of Persons with Disabilities Act, it very clearly states that all education institutions, they must incorporate human rights approach within their curriculum. So, based on that, it was sort of easier for us to convince those people. And in a very quick chain of events in July, the Medical Council of India, they wrote back to me that we would like to include these competencies within the one month of mandatory foundation course. That's how in the foundation course we have seven allotted hours for disability competencies and all 530 medical schools in India. They took these seven hours for disability competencies in this August. Lisa Meeks: What Dr. Singh has accomplished, the universal teaching of a disability curriculum, is incredible. To have a comprehensive plan that each medical learner receives regardless of where they train, that's a win for Indian medical students and patients. Although this has yet to be accomplished in the US System, there are individual programs who are developing modules and individual course curricula for teaching about working with patients with disabilities. Dr. Singh articulates the value of these competencies and provides an example of how just one can make a world of difference in the quality of care for patients with disabilities and how people with disabilities helped inform the development of these competencies. Satendra Singh: This was really very important because if I give you one quick example of one of the competencies in the interpersonal communication skills role, it was demonstrating the use of verbal and nonverbal empathetic communication techniques while communicating with patients with disabilities and their caregivers in a manner acceptable to the specific disability culture. Now this has two very important components. In one of our focus group discussions, we had a representative from deaf blindness community and he specifically emphasized on this point that verbal communication is fine but it has to be non-verbal empathetic communication. Moreover, during our discussions, we also came up with this thing that you know, it has to be acceptable to the specific disability culture. Deaf people, they do not like the word hearing impaired. They believe in their Deaf culture with a capital D, and the same is true with autistic Page 2 of 11 DocsWithDisabilities Podcast #8 Satendra Singh, MBBS, MD Release Date: November 26, 2019 people. Also, they prefer that terminology. When we compare with the other international norms, like persons with disabilities, vis-a-vis disabled persons. So, when we are advocating for the inclusion of human rights approach, we have to include each and every person from the disability sector. And that is why the specific use of the word specific disability culture has been part of the competencies now. Lisa Meeks: Dr. Singh is a force of nature and an incredible advocate for disability inclusion. Having competencies instilled across all Indian Medical Colleges was an enormous success, but he didn’t stop there. Instead he worked to ratify the laws and change the technical standards for entrance to medical school in India. Dr. Singh talks about how he tapped into his quickly growing network leveraging international efforts to support his goals. Satendra Singh: Well, so in India we, in 2016 we have our new disability legislation, which was based on the ratification of United Nations Convention on the Rights of People with Disabilities. But then as far as medical education is concerned, the Medical Council of India, which is a statutory body for medical education in India, they came up with -- you can understand this as a technical standard at a central level rather than an institutional level. So, they prepared those set of guidelines. There was a selected lot of people, you can say six experts, and they decided on the twenty-one disabilities, which are there in our legislation. And they believed, without the support of literature which category of people with disabilities may or may not complete medical education. And without any evidence, they formulated those guidelines and which debarred a lot of candidates with disabilities. For example, there was a debar on more than 80% of disabilities. They were not allowed to enter medical school. They put a bar on dyslexia initially. But when we challenged, they included dyslexia, but then they put a bar on dysgraphia, which they have no reason why they have done so because we are moving to an era of electronic health records. So how can dysgraphia can be a bar to become a future doctor? How does this matter? Because these days we are talking about electronic health records. So, this requirement becomes redundant. Moreover, they also insisted that a doctor must have both hands intact. Now this is very surprising because there are instances of several doctors with only one hand who have graduated from places like Duke University and the University of Cincinnati. And it depends upon the candidate, whether he wants to go to a surgical field or the medical field or a teaching field, wherever, or research. So how can they put a bar to all the people that you need to have a both hands intact? It defies any logic and there was no evidence for them. Page 3 of 11 DocsWithDisabilities Podcast #8 Satendra Singh, MBBS, MD Release Date: November 26, 2019 So fortunately, I contacted the international experts, and I'm very thankful to you Dr. Meeks for supporting me in this battle. And also, the Association of Academic Physiatrists from USA, the Disabled Doctors Network from United Kingdom, and the Doctors with Disabilities organization from Australia. All of them supported me with the case studies of people who are having these types of disabilities and they have become successful doctors in each of these countries. We submitted them to the Honorable Court because our laws, they are very much clear that it has to be based on the Convention of the Rights of People with Disabilities. And we do have a few landmark cases from the judiciary. So, we have submitted to them the best possible international evidence. We have submitted to them the General Medical Council of UK’s new guideline which supports disabled learners. I’m talking about the Welcomed and Valued document, which is a very huge document and which is a very supportive document because it is the medical council there in the UK, which is supporting disabled learners.