NMC releases Guidelines on Professional Responsibilities of Medical Teachers, details
New Delhi: With an aim to improve the quality of medical teaching and reduce the gaps in learning, the Ethics and Medical Registration Board (EMRB) of the National Medical Commission (NMC) today released the guidelines on "Professional Responsibilities of Medical Teachers."
Releasing these new guidelines in the public domain, the NMC Ethics board mentioned "It will be prudent that Medical Education Unit (MEU) in medical colleges use these guidelines to train teachers."
"Besides, college and govt. administration are expected to provide conductive environment for teachers to function at optimal level," the notice issued by EMRB member Dr. Yogender Malik further added.
Clarifying that these guidelines will be normally reviewed on yearly basis, NMC has invited comments in this regard and asked the comments to send at ethics@nmc.org.in.
In the guidelines, NMC has discussed about the personal attributes and conducts of teachers including several factors such as teacher as a role model, the teaching-learning process, and assessment and examination process. Apart from this, NMC has also discussed the teacher-student interactions, bedside teaching, responsibilities of teachers to their colleagues, and responsibilities of teachers to the community.
The guidelines have also discussed about the role of teacher as a researcher and a voice of science- including the responsibilities of teachers in the conduct of research. NMC has also specified the support framework to ensure optimal functioning of medical teachers at both National and Institutional level.
However, releasing the guidelines, the apex commission has clarified that "The intention behind these Guidelines is not to penalize or point a finger at any teacher but to remind him/her of the professional role of a medical teacher in the training of medical students & other healthcare professionals and in life of students and the nation. The hope is that they will introspect in light of these guidelines and improve the quality of teaching and reduce gaps in learning in light of expectations of students and society."
In the preamble of the guidelines, NMC has referred to teacher as "guru". "The relationship between the teacher and pupil in ancient India was personal, virtuous, and cordial. Teacher is regarded as the "Guru"—a friend, a philosopher and a guide that leads the students from the darkness of ignorance to the light of knowledge. Various Teacher-Student Relationships in our culture highlight these values," stated the Guidelines.
Mentioning that education is a moral enterprise, especially in medical education system where undergraduates and post-graduates interact with individuals and / or populations when they are most vulnerable, the Guidelines mentioned that the teachers in medical colleges try to ensure that the new graduates or PG students develop scientific temperament and strive towards highest level of excellence by making them:
1. Competent
2. Caring and empathetic
3. Ethical in their practice
NMC pointed that the role of the teacher in developing competent, compassionate and ethical medical graduates/students has important implications. It helps to uphold the highest ideals (level of integrity) that should characterise the medical profession, It ensures medical student is at least as competent and skilful as the teacher at the end of the training, ensures doctor-patient interactions which are trustworthy and evidence-driven and ensure optimal outcomes for the patients, contributes to public trust in the healthcare system.
Adding that medical students are often the point of first contact with patients in medical colleges, the Guidelines mentioned that public trust in healthcare system is essential at all times, and particularly so in any medical emergencies such as the COVID-19 pandemic and during the introduction of public health measures such as quarantine and mass vaccinations, among others.
Personal Attributes and Conduct –
Teacher as a Role Model:
The Guidelines mentioned that the teachers must be aware that they are role models for students. Teachers are closely observed, analysed regarding their commitment, behaviour, knowledge and competence by the students who then choose to emulate them or dismiss what they see as undesirable traits.
In this regard, the NMC Guidelines have specified the following attributes that a teacher should possess:
1. Demonstrate their own commitment and devotion to lifelong learning by constantly updating their own knowledge and skills
2. Demonstrate empathy and compassion in their demeanour and dedication to welfare of patients, nursing staff and colleagues and maintain professionalism at all times during their interactions.
3. Ensure that their behaviour and actions are ethical and inspiring at all times, and they fulfil their duties with utmost integrity.
4. Ensure that they dress formally, modestly and neatly at workplace.
The Teaching-Learning Process:
Addressing the ideal teaching-learning process, NMC in the guidelines have specified the following criteria:
1. Teachers need to be aware of curriculum and its requirements as enunciated by the National Medical Commission.
2. Teachers are required to be competent in their chosen fields through Continued Professional Development (CPD).
3. Teachers are expected to prepare thoroughly for the teaching-sessions entrusted to them so that students are benefitted.
4. Teachers should ensure that their teaching is contextual and contemporary. As part of Competency Based Medical Education, their teaching sessions may go beyond a classroom setting to a patient-centred focus.
5. Teachers are expected to continually review, revise, and update their teaching-learning materials to reflect advances and current understandings in their field.
6. Teachers are required to use wherever appropriate, newer available teaching-learning resources such as computer-aided learning strategies.
7. Teachers must not plagiarise their teaching materials and should provide sources of their information wherever appropriate.
8. Teachers are responsible to ensure completion of the assigned teaching activities prior to the designated examinations.
9. Teachers are required to identify students with special learning needs and undertake remedial / additional sessions to address the needs of such students.
10. Teachers are expected to understand their own limitations and seek expert opinion / advice where necessary
11. Teachers are expected to work across departments to ensure maximal integration of the teaching-learning process.
12. Teacher must lead the student from known to unknown in order to inculcate inquisitiveness and research instincts in the students.
Assessments and the Examination process:
Discussing the Assessments and Examination process, NMC mentioned in the Guidelines:
1. Competency-based continuous assessments are an integral part of the medical curriculum. Teachers are required to conduct this with diligence, ensuring the students achieve these competencies at the required level. Certifying students to be competent when they are not, or vice-versa is unethical. Their role as gatekeepers is critical.
2. Role of teacher while certifying a student is very crucial, therefore one must ensure 360-degree evaluation of students. The examination must go beyond the final summative assessment and should include regular formative assessments with more emphasis on the latter.
3. Teachers must set assessments and examination papers keeping in mind the blueprints for examinations to achieve the purposeful goal of the curriculum as per CBME.
4. Teachers must ensure that question papers are kept confidential and that teaching is holistic and not only examination- centric.
5. Teachers are required to be involved in examinations process as per norms based on the eligibility criteria. The examination process requires both internal and external examiners and teachers must participate in examination process as and when asked so that the sanctity and fairness of the examination system is ensured.
6. All eligible teachers are required to evaluate examination answer papers diligently ensuring that marking is done fairly and timely.
7. During invigilation of examinations, teachers are required to report any issues of cheating or malpractice so that appropriate action can be taken. Cheating and dishonest conduct of examinations is unjust to most students who prepare diligently for the examinations.
8. Teacher should not allow canvassing for extra marks during practical examinations.
9. Teachers should be aware of students following a "hidden curriculum," and to overcome this, teacher should be trained in psychometric properties of assessment.
10. Teacher should supervise the log book of students in which there is regular record of student activities.
Role as Teacher / Facilitator/ Mentor –
Teacher-Student Interactions:
1. Teachers are expected to maintain a cordial, but professional relationship with their students which strictly respects boundaries in the student-teacher relationship during all interactions including social media.
2. Teachers must be unbiased and fair in their interactions with student and should not discriminate on the basis of region, religion, caste, gender, sexual orientation, language, socio-economic class, or any other factor.
3. Teachers should give effective feedback keeping in mind the following:-
a. Feedback should be reformative rather than punitive.
b. Disciplinary action should be undertaken on a one-to-one basis.
c. Teacher should avoid humiliating the students in front of their peers or public.
4. Teachers are required to keep minutes of departmental meetings and discussions pertaining to individual students, confidential.
5. Teachers are expected to be available for their students to clear academic doubts.
6. Teachers are expected to take part in mentorship programmes of their students and help in addressing the problems of the students.
7. Teachers must be aware of the stress and mental health problems that students face and should be aware of the processes available in their institutions to address these issues. Teachers may involve parents/guardians/near relatives (as applicable) if required under special circumstances or if considered appropriate by professionals/ authority. They may also refer students to appropriate professionals if required.
8. Teachers must be aware that they teach a diverse student population i.e. measures should be taken to the best of their abilities to address the additional needs of high performers, as well as needs of those students who may be finding difficulties with the course.
9. Teachers should function as facilitator to motivate students for self-directed learning.
10. Teachers must follow the conduct regulations with respect to their interactions with the pharmaceutical companies /their representatives as well as allied health sector.
11. Teachers should ensure that student is exposed to appropriate mix of common patient situations existing in community and withhold themselves from discussing rare situations only. Teachers must highlight the concept of "Family Physician" in the care of the patients.
12. Teachers should make students aware on the medico legal aspects of patient care.
13. Teachers should model and impart soft skills and counselling skills to enable students to learn empathic communication skills and managing sensitive situations like breaking the news of death.
Bedside Teaching:
NMC in its guidelines has referred to Bedside Teaching as an integral part of the education and training of medical students. As per the guidelines, the teachers should ensure the following:
1. That bed-side teaching is central to the practical and skills teaching of medical students.
2. Constantly demonstrate to students correct elements of the doctor-patient relationship including soft skills of communication, respect for the dignity, autonomy, consent taking, confidentiality and the rights of patients.
3. The teacher must ensure that students are sensitive to the patients' suffering and gentle during physical examination.
4. That students understand the patient's needs are as important as their own learning. Patients should not be seen as a means to an end in medical teaching.
5. Teach students the correct procedures of eliciting history and examining patients particularly women, minors, the elderly, and others with special needs.
6. Conduct bed-side discussions in a sensitive manner that respects the dignity and rights of patients.
7. Emphasize the immense importance of correct and complete documentation to the students.
8. That teaching bedside clinical skills may be more useful in community setting so as to ensure early detection of diseases and their cost-effective management.
Responsibilities of Teachers to Their Colleagues:
Discussing the responsibilities of teachers to their colleagues, the NMC Guidelines specified the following criteria:
1. Teachers are expected to maintain collegial relations with their colleagues.
2. Senior faculty are encouraged to mentor junior faculty.
3. Teachers have a key role in supporting continued professional development of their colleagues both inside and outside teaching institutions. They are encouraged to respond to the professional needs of colleagues who work in rural/ underserved areas where opportunities of continued professional development may be limited.
4. When teachers observe unethical behaviour among any of their colleague, they are expected to report this to the appropriate authorities for action.
Responsibilities of Teachers to Community:
The Guidelines have specified that the teachers have responsibilities not only to their colleagues but also to the community. In this regard, the guidelines stated,
1. Medical teachers have a standing in society that can be used for the common good.
2. Teachers have a vital role in inculcating students with a sense of responsibility towards the community.
3. Medical teachers are required to respond to calls for help in the event of disasters and regional / national health emergencies.
4. All teachers can play a role in public / community engagement to ensure that overall health literacy increases, and people are able to make better health choices and access health services appropriately.
5. The teachers should make ardent efforts for public awareness regarding health issues and dispelling prevalent myths by using all available forums and means.
Responsibilities of Teachers in the Conduct of Research:
Regarding the responsibilities of teachers in the conduct of research, the Guidelines state:
1. Medical teachers should serve as role models as researchers and should inculcate a scientific and research temper in students.
2. They are required to conduct research in letter and spirit as part of their commitment in higher education, to contribute to the growth of knowledge in their respective fields, and for the good of society.
3. As a researcher, teacher must pay special attention to the rights of research participants, their fully informed, understood, and written consent and their right to withdraw from research.
4. The use of students as research volunteers must be with the provision that there is no coercive influence for participation. Their participation should have no bearing on their evaluation during examination.
5. As a researcher, teachers must be particularly aware of the issues of plagiarism, authorship guidelines, falsification and fabrication of data, and duplication of papers. These are serious breaches in research ethics and undermine public confidence in genuine research.
6. Medical teachers are responsible for the oversight of research conducted as principal investigators and of student research done under their supervision. It is important that medical teachers mentor their students not only on subject knowledge and skills related to their research but on the issues of research ethics.
National Level:
The guidelines mentioned that at the national level, the National Medical Commission has the role to ensure that medical teachers are provided the necessary guidelines for their optimal functioning. The NMC also contributes to skill development, monitoring and amendment of medical curriculum to suit the needs of the country and society. The NMC invites feedback to improve the medical training and teachers’ development in the country.
Few of the continued programs at the national level should include:
1. Strengthening Faculty Development Programmes
2. Monitor quality of teaching by random monitoring
3. Quality improvement project for improvement of teaching activities to make teachers more efficient.
Institute Level:
As per the guidelines, the Institutions and departments also have an important function in enabling teachers to conduct their roles responsibly and ethically.
In this context, the guidelines stated that the institutions may:
1. Fulfil all the mandatory requirements in terms of infrastructure and equipment to optimally support the teaching-learning process
2. Recruit competent teachers through an open and transparent process at various designations, keeping in mind the guidelines of the NMC. Following things are important to observe in teachers at time of selection:
a. Commitment to teaching and academics
b. Adequate clinical knowledge and patient care skills
c. Research aptitude focussing on number of publications and originality of thought and the impact of research to address regional or national health issues
d. Must have pleasing demeanour and neatly dressed
3. Conduct evaluations of teachers and provide feedback with the aim of helping teachers improve their own functioning and the teaching-learning process in general.
4. Ensure fair pay for work done, leave and other benefits in accordance with the provisions of appropriate laws/rules.
5. Ensure transparent and open processes for promotion while fulfilling the minimumrequirements outlined by the NMC.
6. Support professional development programmes so that teachers can update /upgrade their knowledge and skills.
7. Create an enabling environment that supports optimal learning and research with respect to the academic independence of investigators while providing institutional support for administrative matters and financial review.
8. Create a grievance cell which addresses the issue of workplace harassment.
9. Constitute an academic council of teachers across all disciplines which formulates institutional policy regarding medical education in keeping with NMC guidelines and develops and approves the institutional teaching-learning programmes. These meetings should be held regularly, and minutes recorded.
10. Create a medical education unit / department and ensure that members have adequate training to facilitate institutional teaching-learning processes.
11. Ensure 360-degree evaluation of teachers by students, colleagues, seniors, and juniors. Medical education unit may be empowered to operationalize this evaluation.
12. Constitute Institutional Ethics Committees for human and animal research in accordance with national guidelines.
13. Protect whistle-blowers who highlight unethical practices of teachers in education, clinical practice and research and follow-up on appropriate action.
14. Ensure support to universities through teacher participation in university activities including the conduct of examinations. Efforts should be made to anonymise the students during assessment/ examination process.
15. Reasons for refusal to participate in the examination process should be evaluated by the university and frivolous excuses should be dealt with appropriate action.
Institution Shall Not:
1. Falsify institutional information during inspection and accreditation processes
2. Pressurise teachers to falsify information for the purposes of accreditation.
3. Apply pressure on teachers to show preference to individual candidates in the award of marks or any other favour/consideration.
