To provide training in rational antibiotic use and infection control

The Indian medical curriculum must be modernised to provide training in rational antibiotic use and infection control for all medical students, Abdul Ghafur, an author of the Chennai Declaration for controlling antibiotic resistance, has argued in the British Medical Journal.

There is inadequate emphasis on providing training in prescribing antibiotics, and infection control, he argues. Combine this with the lack of a functional policy on antibiotic use, and the deadly cocktail emerges that enables the nearly unchecked growth of antimicrobial resistance in Indian hospitals.

He went on to provide a stunning indictment of the current curriculum: “It is old fashioned, with trainee doctors compelled to read many textbooks meant primarily for an audience of postgraduate students and scholars. A strong theoretical background might seem an advantage, but in reality trainees lose precious time they could have spent acquiring the clinical skills necessary for day to day practice.”

The examination system in India for undergraduate and postgraduate trainees is largely based on subjective parameters, rather than the objective measures used in most developed countries. Examiners are keener to assess knowledge of clinical signs of historic importance that doctors no longer use, he writes, in the BMJ.

Dr. Ghafur, who is a consultant on infectious diseases at Apollo Hospitals, Chennai, worked towards bringing together representatives of various associations of specialists on a platform to plot the larger design of an antibiotic policy that would work in the country. After the meeting in August last year, the Chennai Declaration emerged.

“We must modernise our medical curriculum to emphasise diseases encountered in the tropics. Training on rational antibiotic use and infection control should be integral for undergraduates and postgraduate trainees,” Dr. Ghafur has recommended in his article. He further added, to address the issue of a scarcity of infectious diseases specialists: “Post doctoral training in infectious diseases must be initiated in all major teaching hospitals. Microbiologists must receive training in infection control and antibiotic stewardship.”

“Treating bacterial infections without effective antibiotics is like going to battle without weaponry. Managing serious infection without the support of infection specialists is venturing into a war without cavalry…Unfortunately fewer than two dozen doctors practice infectious diseases as their primary specialty [in this country],” he reasoned.

Fixing responsibility, Dr. Ghafur has said that the Medical Council of India and the equivalent bodies in neighbouring countries urgently need to rectify the serious defects in training and examination in the medical curriculum.