State of postgraduate education and its future

The postgraduate medical education is at an inflection point, which is swayed by
recurrent waves of pandemic, which have not only cast uncertainty, but also insecurity about
many phenomena around us. Even in the absence of the pandemic scourge, there has been a
constant influx of complexity into the world order, as it confronted globalisation in the later part
of 20 th century.
Multiple strands of global influences are getting continually intertwined to create a mesh
that either hampers mobility or provides guardrails of support, depending on our perceptions.
Those of us who successfully extricate ourselves from the mesh and use it as a springboard to
overcome ambiguity definitely have the advantage of being guided by a learning organisation.
These would be the current and future leaders of their domain.
Medical education has traversed many milestones of innovation and reinvention. Such
innovations have been both in the curricular reforms, and pedagogical practices. In the recent
past we have heard much about competency-based medical education, which is being promoted
as the silver bullet solution for all the ills. It is indeed an objective method of ‘teaching –
assessing – feedback – improvement’ loop. In fact, it has a history of more than fifty years, as it
emerged from the concept of outcome-based education and mastery learning.
More recently the idea of Entrustable Professional Activities is trending on the global
horizon. These are the units of activities that represent a routine clinical practice, and are the
responsibilities or tasks that are essential for patient care. This concept can be traced back to a
couple of decades when the western professional bodies such as CanMEDS designed a
competency framework. The Association of American Medical Colleges has prepared an
exhaustive description of benchmarked practices for EPAs for residency program.
The reason that I am flagging this idea is to open your insights to the vast canvas of
opportunities that exist, and which can guide you through the times of uncertainty for a focused
and productive learning. Even though the idea of EPAs has not caught the imagination of the
critical mass in medical education, there is always an option to be the pioneers as Everett Rogers
describes in the theory of Diffusion of Innovation.
I must also mention here that there are multiple efforts to bring uniformity of standards
and indicators for measuring such standards. The International Engineering Alliance has already
established the Washington Accord to build mutual understanding among nations about the
quality of engineers who enter the globally connected workplace. The World Federation for
Medical Education is in the process of designing similar indicators. In such a future, your
readiness to be globally competent would be determined by the roadmap of postgraduate
It is therefore our responsibility to scan the horizon of immediate and later future and
make course corrections to develop relevant and germane specialist healthcare professionals
through the postgraduate courses. We therefore need to take a hard look at expected outcomes of
the training, along with the content and processes.

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