The demand for medicine to be taught in languages besides English has been made repeatedly over the years, and was reiterated most recently by Union Home Minister Amit Shah when he said instruction in medicine, engineering and law should be made available in Indian languages. Over the years, academicians have considered the advantages, demerits and challenges of such a move. Dr. Sudha Seshayyan and Dr. M. Janakiram explore the various aspects of the issue in a conversation moderated by Serena Josephine M. Edited excerpts:
Do you think it is possible to have a regional language as a medium of instruction in medicine? And is there a need to promote Indian languages in higher learning?
Sudha Seshayyan: First, the question relates to a long-term perspective. In that case, it is possible. I have travelled in countries where medicine is taught in Spanish, German and so on. So, it is possible with certain modifications. We probably cannot be water-tight with our words, especially with technical terms. When we say a regional language, there could be an overlap of words from different languages.
Second, looking at the same question from a slightly different perspective on what is currently possible in India… medical students are guided by regulations from the National Medical Commission (NMC). For these students, the medium of instruction is English. So, teaching in a regional language can only be supplementary in case a student does not understand something in English or has studied in, say, a Telugu-medium institution earlier. As of now, students cannot completely study in the regional language because the NMC declares the medium of instruction as English.
M. Janakiram: I would like to add a few points on standardisation in the field of medicine. Greek and Latin physicians had first set the context as far as language is concerned. The present-day physician should have the zeal for higher learning rather than just treating patients. In the National Education Policy of 2020, there is a proposal to promote regional languages. In medicine, most of our curriculum is based on learning by doing, whereas in most other subjects it is learning as such. Before opting for regional languages as the medium of instruction, we have to keep certain things in mind. We have to develop a standardisation tool for every other curriculum through which we can easily compare and correlate things.
Sudha Seshayyan: At some point in time, learning Latin was mandatory for a medical student. It is not so now. However, we still use Greek and Latin terms. A stage has come where some Greek and Latin terms have been done away with. Worldwide, there is a shift to Anglicised terms. So, I do not think this is a major problem.
There is a necessity for students to have a zeal for higher learning but that does not hamper the utilisation of a regional language. Yes, there is a need to promote Indian languages in higher education for the simple reason that it would improve the thinking component in an individual and probably communication too. The complaint that we receive from society today is that a doctor seldom communicates. Thinking and communication skills would improve if we learn in the regional language. At the same time, I would like to emphasise that there has to be standardisation in the technical terms in Indian languages.
Engineering courses are being offered in Tamil. Have there been attempts to offer medicine in Tamil? There have been initiatives to find Tamil equivalents for English medical terminologies.
Sudha Seshayyan: Yes, there have been attempts. Some of the early efforts to translate medical textbooks into Tamil were made in Sri Lanka. In our part of the country, we have had some efforts under Professor Lalitha Kameswaran, who was the first vice chancellor of this university. When she was the Director of Medical Education in the 1980s, she brought in a big team, and we would sit for about three to four hours every day before fixing a word for a particular technical term. About 12,000-13,000 words were formed. The movement dwindled. In the last few years, our university has contributed about 10,000-12,000 technical terms, which were translated, standardised and handed over to the ‘Sorkuvai’ scheme of the Tamil Nadu government, which is a collection of technical terms. Anyone can access and use that word, if it is found suitable. These efforts have been going on. But there have also been some concerted efforts to teach in the regional language in the medical college. This effort is not a complete switchover to Tamil; it is a supplementary one. There are some students who come from other mediums of instruction. We try to give them additional classes.
M. Janakiram: As rightly pointed out, there are issues of linguistic dualism as well as abrupt changes in the medium of instruction as soon as a student enters a medical school. We have found that some students find it difficult to understand concepts. The language of the standard textbooks is not easy, and some find it difficult to convert their thoughts into English during examinations. We have alumni associations which come up with materials for students who had studied in Tamil up to Class XII. Translation is done wherever required. The medical terminologies are maintained as such — like when we explain the pathogenesis of a disease, the course of the disease is translated into the regional language. But many such measures have not been documented.
Often, discussions centre around whether language is a barrier to higher learning. Do you think access is an issue for students who have received primary education in their mother tongue or for those from rural areas?
Sudha Seshayyan: I don’t think language is a barrier for people to learn. The difficulty comes when people find it hard to understand because of the load. Whichever discipline of medicine you take, it’s an ever-expanding area. There is a lot to learn. For that, [students] would have to have access to information immediately. If you don’t have access to information, it deters you, and the motivation to learn is lost. More information is available in English. And that is where it’s necessary to know English so that you can access information. In medicine, I would want to know about newer treating modalities, newer techniques in surgery. If I’m not able to get that information, I have to depend on someone to translate it. There could be errors in translation. For accessing information, we require a language like English, as of now. That is why I’ve been saying information should be available in the regional language for people to understand. You don’t have to necessarily take your exams in Tamil, but at least for you to understand and upgrade your knowledge, it is necessary for the coming generations that we keep all this information in the regional language.
What are the challenges in having medical education in the local languages?
M. Janakiram: Medical education is all about research. Going by the U.K. standards, a doctor has to be a social scientist, a scholar, a researcher as well as a practitioner. So, every other aspect has to be covered by a doctor once he/she receives the medical degree. English is required for professional competence; it is the international language of science and medicine. There is also a new concept called English for Medical Purposes. So, taking up medical education in a regional language will always be a challenge.
Sudha Seshayyan: As of now, it might appear that we will not be in a position to understand things if we move to another part of the country, or if we move to another country. But I don’t think that is a major challenge. Several Indian students have gone to the U.S. and the U.K., not because they were very good in English, but because they were good in their subject and skills. It depends on the individual’s competence to learn. Adapting and surviving under difficult situations is also a skill. Perhaps a doctor will have to learn that as well.
Also read | ‘Language is important in handling patients’
When I was a student at the Madras Medical College, we used to have a very active Tamil Mandram (Tamil Association). But paradoxically, the Tamil Mandram was also trying to teach spoken Telugu. We also brought out publications like Sundara Telugu. It was the 1980s and 1990s. Nearly 50% of our patients in the government hospitals were Telugu-speaking. It would be a challenge to talk to them and get their history, complaints and information that we wanted, especially during examinations. So, the students learned spoken Telugu. I am saying this because it is necessary for a doctor to communicate with the patients.
But again, medicine is an area where we need to have uniform understanding in certain aspects across the globe. Uniform nomenclature is required. We have to know regional languages to deal with the patients. English can be a common factor for some time to break barriers, but after that the regional languages will come into play.
What are the pros and cons?
Sudha Seshayyan: All our teachers will have to be first equipped. Competency-based medical curriculum has come into the country in the last three years. We are now training our teachers in medical education technology. To train them to teach in regional languages will take more time. But before training them, we also need to have books and materials. I am not sure what will be the future [in the context of] examinations and the medical curriculum with regard to the medium of instruction. The central regulatory agency will take a call. But every language should be equipped with appropriate information, even to help someone study better. They may study in English, but they may also need to study the same thing in Tamil for better understanding and clarity.
M. Janakiram: Competency has a number of components — knowledge, skills, values and attitudes. We have to look at what needs to be adapted based on the situation. For instance, interpersonal communication is important when dealing with patients. Here, knowing the regional language will help students. In terms of medical knowledge, to develop our reading skills during undergraduate [studies] and post-graduation and move towards research, English will help us. As far as practice is concerned, it includes both the regional and English language. So, the regional language may be a supplement, whereas English is the essential language.
What is the way ahead?
M. Janakiram: As of now, we should stick with English as the medium of education for medical schools. Based on one’s interests, regional language can be taken up as a supplement for better understanding and innovation. If a doctor communicates well in a regional language, it will help them to decrease the gap with the patient.
Sudha Seshayyan: I would like to add something related. People tend to think that in order to study anything related to science, people don’t have to have a flair for language. But I’ve taught medical students for 34 to 35 years. I have realised the importance of language. Language is required for appropriate communication and understanding. I would request medical educationists to not say that the study of language is not required for someone who is pursuing medical or science studies.
M. Janakiram is Assistant Professor, Department of Community Medicine, Government Vellore Medical College; Sudha Seshayyan is vice-chancellor of the Tamil Nadu Dr. MGR Medical University