Specific Proposals for AYUSH Education in the 12th Plan

1. Training of Trainers (ToT) for AYUSH Faculty

2. Training for Principals of AYUSH Institutions in Educational Management

3. Training of AYUSH Hospital Superintendents in Clinical Leadership

i. What is the context of proposed programs/schemes? (Mention gaps, magnitude of the problem, issues that need to be focused upon, challenges, potential solutions and their limitations related to programs/schemes)

Training of Trainers (ToT) for AYUSH Faculty

Teachers of AYUSH Sector are selected from a pool of postgraduates in the relevant discipline. This ensures that the selected teachers have some degree of authority in their subject speciality. This procedure, however doesn’t guarantee that those who are selected have proficiency in teaching; because educational techniques are not a customary component of postgraduate syllabus in any of the AYUSH sector. Therefore, these ‘teachers’ may not be sensitised to the various basic norms of teaching and student evaluation.

To rectify this gap, it is necessary to institutionalise the process of training teachers in the field of Educational Science and Technology. This can be achieved by dedicating a certain percentage of syllabus in postgraduate education for imparting knowledge and skills of teaching and evaluation. For those teachers who are already in service, there has to be a program of training in the relevant skills that are benchmarked as necessary for proficiency in teaching and evaluation of higher education.

This proposal is in tune with the experience of medical education in India. In the 1970s, the Government of India initiated an ambitious project to impart the principles of higher education to the medical teachers and align their practices to be compatible to the global standards of medical teaching. As part of this initiative, Centres for Medical Education were established. The National Teachers Training Centre at JIPMER, Puduchery and K. L. Wig Centre for Medical Education at AIIMS, New Delhi are examples of this organisation building.

Much of the reforms in medical curriculum in India emerged as a result of this ingenuity. The faculty who were the beneficiaries of this project are in the forefront of the educational reforms that are driving the Indian medical professionals as major players in the global healthcare delivery.

AYUSH education is passing through a phase, from which it has to emerge stronger and firmer in the mainstream of both national and global healthcare management. Therefore, a project that takes care of Training of Trainers for AYUSH Faculty is necessary and justified.

Training for Principals of AYUSH Institutions in Educational Management

The pace of educational change has been accelerating in the past few years. The forces of economic liberalisation and social awareness have coupled and aligned to create consumer consciousness for rights in the field of health and education services. This wave of consumer rights has heightened the demand for strong links between education and perceived needs of healthcare services of the community. Medical institutions are increasingly required to deliver students prepared to contribute to the healthcare of the society.

The documents of National Policy on Education, National Policy on Medical Education and National Policy on ISM & H, among others represent a trend towards quality in education and institutional responsibility that are hypothecated on the assumption that decisions should be made by those who best understand the needs of the students and the society. The outcomes of such initiatives include Internal Quality Assurance Cells in various universities and the constituting of National Assessment and Accreditation Council under the aegis of University Grants Commission.

AYUSH institutions serve a multidimensional role of providing educational activities and experiences for the students, healthcare services to the patients and research and development potential for the doctor and teachers. Thus, the responsibilities imposed on Principal or the academic leader of AYUSH institution place a premium on high quality management. Management of patient care or financial planning require skills that are distinct from those needed to plan and deliver the curriculum. Principals of AYUSH colleges have qualifications in AYUSH with little or no formal qualification in management discipline. They usually grow into the job over the years and some do remarkably well, while others falter along the way. The situation can be remedied to a large extent if the educational leaders are provided with awareness of theoretical concepts and their practical application in a systematic manner.

Training is a vital component in the acquisition of managerial competence as is a clear understanding of how to ensure successful implementation of change. Thus, there is a need to enhance the capacity of principals as good administrators / managers as well as instructional leaders, so that the future generations of AYUSH practitioners are imbued with confidence and competence to be torch bearers of AYUSH practice. This could be achieved by instituting a program for training principals in the principles and practice of education management.

Training of AYUSH Hospital Superintendents in Clinical Leadership

The global healthcare market is now appreciating the contemporary relevance of AYUSH. Health seeking behaviour studies suggest that a new regime of ‘Medical Pluralism’ based on inputs provided by various health care systems of the world, will govern healthcare delivery systems in modern societies.

Given the shift in consumer trends, towards pluralism and growing acceptance of AYUSH, opportunities in mainstream healthcare market for AYUSH systems are expanding. They include preventive, curative and wellness services. This new regime is creating demand for highly skilled AYUSH clinician leaders who can rub shoulders with specialists of conventional medicine in both corporate and community healthcare situations. The superintendents of the hospitals that are attached to the AYUSH institutions need to be aware of the principles that drive effective hospital management in the areas of clinical training for the students and healthcare services for the patients. Therefore, an organised program for capacity building the managerial and leadership abilities of these human resources managers is justified.

Recommendation to 12th Plan for AYUSH Sector

Sub-Committee on Education & International Cooperation

Reply to the Terms of Reference

1. What kind of schemes are needed in 12^th FYP to strengthen and streamline UG and PG education (for eg; are more PG seats needed to be created, supported by fellowships in order to meet the shortfall of teachers?)

The AYUSH education, in the current state, is to a significant extent influenced by the medical model of curriculum. This has stunted the blooming of AYUSH academics in its natural state. Therefore, the most important step to revitalize AYUSH education is to have a rethink on the content and process of both UG and PG education.

The duration and focus of the educational programs may be approached with the performance profiling of the AYUSH doctors, who would be required to provide evidence-based healthcare in an environment that is getting increasingly complicated by many socio-economic factors and yet preserve the ideals of the individual AYUSH components.

The current structure of UG and PG education may be retained to a significant extent for the purpose of uniformity in a pluralistic educational environment, while accepting the reality for individual growth and sustenance of these disciplines.

It is estimated that the current human resource volumes of AYUSH doctors is around seven lakh in India, which is comparable to the numbers of conventional medical doctors. The numbers that would be needed to address to the future needs have to be calculated on the basis of population projections for the next fifty years and the roles that the AYUSH doctors are expected to perform during this period. Perhaps the numbers would be available with the relevant documents of Planning Commission.

In case of the undergraduate education, the number of basic AYUSH doctors that is needed can be a benchmark for deciding on the number of colleges, the admission capacity and their geographic locations. Further, the profile of Basic AYUSH Doctor can decide on the duration, content and thrust of the course.

In case of postgraduate education, the inherent strengths of each of the AYUSH system can be objectively assessed and the clinical focus areas for each may be determined. It does not matter if any of the focus areas have more than one system claiming effective performance. Whichever system has effective strength, in spite of the overlapping with another system, may be given equitable presence in those clinical focus areas.

The PG courses for each AYUSH system may be determined on the basis of their clinical focus area. The numbers of PG seats and colleges may be based on the human resource projections for each of the clinical focus areas and matching them with the community requirements.

Considering the volumes of AYUSH doctors needed for the fifty year projection, there has to be a matching upscaling of infrastructure, teachers, paramedical professionals and financial outlay. Regarding the increase of numbers of teachers, there could be some innovative strategies to harmonise the quality with quantity. For teachers of non-clinical subjects, there could be teaching based fellowship programs like MSc in Anatomy or Physiology or Biochemistry or Forensic Medicine or Community Medicine ( or equivalent disciplines to suit the inherent nature of each of the AYUSH system).

This program may provide knowledge and skills to equip teaching the undergraduate course. The teachers who hold these qualifications acquired after the basic AYUSH graduation may be treated on par with the teachers holding MD / MS of the clinical or non-clinical subjects for all purposes like recruitment, promotion, financial parity, etc.

2. Is it justified to provide one time grant in aid support by Government of India, to model UG and PG colleges? These should be colleges with track-record of high (above the average) performance. They may be government or not for profit non-govt. educational institutions in the country. Must they full-fill certain quality parameters of educational service? What should these quality parameters be (enrolment, fee structure, pass-percentage, percentage of students getting over 60%, basic clinical infrastructure, evidence of some specific innovative practice)?

If the committee believes a scheme of grant-in aid to model colleges is justified, what specific kind of infrastructure needs (eg IT infrastructure) and what specific types of non-recurring expenses (eg; visiting faculty, student fellowships) should be supported? What should be the quantum of support per institution, should this depend on student enrolment?

As a first measure, the colleges have to be classified in to something like three categories – high performing, moderately performing but with good potential and low performing.

The classification may be made on the parameters accepted and practiced by organizations like National Assessment and Accreditation Council of India or even the Educational Institutional Standards proposed by the Deming’s Institute.

The high performing institutes may be provided with rewards apart from the extra financial grants to motivate a continued high performance level. The moderately performing institutions that are having potential to improve may be provided with mentoring and incentives to perform better and reach the top bracket. The low performing institutes may be offered remedial services to move up the ladder and in case they are not showing signs of improvement against the accepted benchmarks, may be closed down.

Each college must be mandated to constitute and operationalise Internal Quality Assurance Cell to monitor the progress of learners and teachers and also the administrative, clinical, research and extension activities of the institution.

The future of education is in the technology. The stakeholders of education must have a significant literacy level in educational technology. This medium has provides the option of resource sharing even at geographic distances.

Providing appropriate technology infrastructure and linking the institutions enables not just resource sharing, but also harnessing the best practices. For example, the application of videoconferencing can provide realtime learning for the students from the best of faculty across the country. There could be a dedicated timing when interactive virtual classroom can get the assembly of a renowned teacher presenting his / her lecture for a widely distributed audience. This will also economise on time and money.

These facilities may initially start with all the National Institutes and later trickle down to the Model Colleges. In the later phase, these could extend to cover all the recognised colleges.

3. Given the need for well trained para-medics in AYUSH sector, should there be a provision in 12^th FYP to support ‘not for profit’ initiatives of new institutions be supported for designing and implementing paramedical courses? Should a necessary requirement be that such institution be affiliated to universities and the curriculum of such para-medical courses be required to be approved by the university, board of studies?

Paramedical human resources form the backbone of any healthcare service. The paramedical training as vocational course is conducted by the paramedical boards of various states. The university level qualifications in paramedical sciences like nursing, physiotherapy, operation theatre technology, perfusion technology, radiation technology, optometry, etc are conducted by both general and health universities across India. Except for the Rehabilitation Council of India, which regulates some of the paramedical courses like occupational therapy, there are no apex bodies as there are MCI, CCIM, CCH, etc. Therefore each university has evolved its own standards for these courses.

The paramedics play an equally important role in AYUSH healthcare. But there is no systematisation of their educational courses. Very often the organization that needs paramedical staff evolves its own standards, designs the course as per its requirement and conducts it in-house. Most of the times these are on-the-job-training. Thus there is no universally standardised paramedical course in AYUSH systems.

The emergence of National Rural Health Mission as a mass movement has brought into sharp focus the need for either sensitising the existing paramedics for AYUSH specialities or evolving a separate cadre of AYUSH paramedics.

It is advisable to keep the NRHM needs also in the loop while designing the AYUSH paramedic courses. There can be a separate Board that would manage these courses. This board may be under the Directorate of AYUSH of the respective states and a separate register of these paramedics may be maintained for legal purposes. As of now there seems to be no requirement and justification for the AYUSH paramedical courses at university level.

4. Should AYUSH dept. in 12^th FYP launch a new scheme to support a certain number of doctoral and post doctoral fellowships programs on the financial basis of JRFs and SRFs and Post Doctoral fellows in reputed AYUSH institution and Centres of Excellence?

Research is one of the important ‘triads of education’ along with teaching and extension services. However, this is not given the importance that it merits in the mainstream of AYUSH establishment.

Schemes to support potential research scholars in the areas of finance, infrastructure and legally have to be evolved. These schemes could be in the form of provisions made by organisations like CSIR for JRF / SRF.

Those who successfully clear the entrance tests of JRF / SRF qualifying exams may be given preference for appointments to the research projects run by or funded by the respective research councils.

Post doctoral fellowships may be awarded for exploring frontier areas of clinically relevant issues in AYUSH streams.

The scheme initiated by the Higher Education Commission of Pakistan to promote high quality research scholars and retain them can also be looked at as a prototype to build our own model.

5. Should the 12^th FYP support a new flexible scheme for in service ‘teacher-training in AYUSH Institutions to upgrade their knowledge and skills? Should selected teacher training centers in colleges be designated as Centers of Excellence for teachers training in specific subjects? Should the Vaidya-Scientist program (a teacher-training initative) be up-scaled?

Training of trainers in the domain of educational science and technology is a concept that has to be made more accessible and acceptable to all the teachers in AYUSH. Teaching is a highly delicate activity that has to be nurtured sufficiently so as to enable the teachers not only to have mastery in the subject that they teach, but also in the Softskills of teaching.

These Softskills include the overall view of education in the context of society, the responsibility of teachers towards students and the institution, ability to define and articulate the objectives for teaching, identifying appropriate teaching – learning method and media to realise the stated objectives, assigning appropriate evaluation methods and instruments to assess the learner competency to realise the intended learning objectives.

The teachers also need to have an understanding of educational planning process, so that they can suggest appropriate and suitable modifications to the existing courses of study. They should also be aware of the skills to motivate learners, manage discipline related issues like conflicts in the academic domains, provide leadership to their students and the other junior faculty.

Therefore, a National Campaign for Faculty Development in AYUSH Sector is an immediate necessity. In fact a proposal was sent to the AYUSH Department and the RAV in the year 2010 for a comprehensive restructuring of the RoTP in AYUSH. This included development of a national pool of master trainers who would in turn train subject specific resource persons at zonal level who would in turn train all the teachers in the subject-specific RoTPs. One of the outcomes that was envisaged was the preparation of standard and uniform training methodology, so that there are National Benchmarks of Education against which the standards of learning can be mapped. (schedule for this training that was presented to the Department is also attached with this mail).

These training shall be conducted or moderated by a specially designated institute such as the existing National Teachers’ Training Centre at JIPMER, Puduchery for medical teachers, or the National Institute of Technical Teachers' Training and Research, Chandigarh.

UGC has the scheme of National Eligibility Test to identify teachers who are eligible to apply for university level teaching jobs. Various states also have State Level Eligibility Tests. These tests ensure a minimum standard in teaching content. Further, the Academic Staff Colleges conduct Continuing Professional Development to the faculty. Attendance of a minimum number of programs is built into the eligibility criteria for promotions to the next higher cadres.

This model can be suitably modified to provide a dedicated pool of teachers in each of the AYUSH system. There would be better professionalism among these teachers and they would also transfer a greater sense of confidence because of their ability to objectivise teaching. They would also be better prepared to convert the implicit knowledge of many of the AYUSH systems into transferable knowledge, ensuring easy comprehension.

Unique Identification Number may be assigned to each teacher to track their career growth and also to prevent the possible duplication of faculty in different institutions.

Postgraduate education is a growing area in AYUSH streams. Many specialities are covered under these programs. For the areas that are not represented in the PG programs, there could be provision to start Fellowship courses. These could be started in interdisciplinary areas like Sports Medicine with Panchakarma.

6. Should Govt. of India move CCIM to support the recognition of autonomous UG and PG colleges of AYUSH on principles similar to recognition by the UGC to colleges in other disciplines? If so, what should be the criteria to select such autonomous colleges?

The committee may also advise on what autonomy should include for example freedom to make curricular changes keeping a core-curriculum intact and only freedom to change the sequence of subjects taught in year 1, 2, 3 and 4? And or freedom to innovate in teaching and evaluation methods? And or freedom to introduce clinical experience from year 1? And or freedom to involve visiting faculty and send students to earn credits for specific courses from empanelled Guru’s outside the Institution?

Autonomy to institutions having excellent academic track record is a good practice to improve innovation in education. Such institutions are usually identified by the university that affiliates them for granting autonomy to develop their own curriculum, academic schedule and conduct examinations. However, the degree is awarded by the university.

To implement this in the AYUSH stream, there has to be modifications in the relevant acts like the CCIM and CCH, so that the provision for deviating from the syllabus is provided and the degrees conferred under such arrangement are also listed in the schedule 2 of the relevant acts and these degree holders also enjoy such professional and legal benefits as enjoyed by the degree holders of the mainstream courses.

Credit based courses are gaining popularity in many domains of higher education. This system provides flexibility to choose a mix of subjects as per the desire and aptitude of the learners. This could mean a drastic shift of present paradigm. However, there could be provision for electives at the final year, so that some degree of specialisation can be achieved within the undergraduate course.

Additionally, there could be a provision for undergraduate students from third year onwards to enrol of professionally relevant course from the existing distance education providers like IGNOU, which offers some health related course for those who have completed 10+2. Further, there could be MoU with the Distance Education Council to design Diploma / PG Diploma courses that are relevant for the AYUSH graduates.

7. Should AYUSH dept. support a new scheme for E-learning initiatives related to CME and teachers training with a flexible framework of support that allows scope for creativity and innovation?

The E learning scheme may be aligned with the Faculty Development campaign as explained under item no. 5 above.

8. Should the Dept. of AYUSH encourage the creation of institutes of national importance in both Govt. and non-govt. sector under schedule VII of the constitution in order to promote innovation in the AYUSH sector? What should be criteria and modus-operandi for selection of institutions who aspire for such recognition?

There is a need for Institutes of National Importance to explore the intricacies of various AYUSH systems and clarify these issues on a realistic platform. There can be a national debate to identify the areas of innovation and institutions with potential to be productive may be awarded these projects.

The potential institutes may be identified on the parameters of proven experience in the field, the infrastructure capacity, human resources availability, etc.

9. What should be the statutory role of CCIM in 12^th FYP in regulating AYUSH education?

The role of CCIM, CCH may be continued in the present format.

10. Should govt. of India move CCIM to recognize Rashtriya Ayurved Vidyapeeth (RAV) as a post-graduate centre implementing PG diploma and degree courses via the guru-kul methodology.

There can be additional streams of formal and non-formal education in the AYUSH sector. The formal could be in the form of constituting a body like the National Board of Examinations in modern medicine that awards DNB qualifications that are recognised on par with the MD / MS courses by Medical Council of India. In the non-formal sector, Gurukul system may be explored.

11. In respect of international cooperation, the 12^th plan needs to advise firstly on policy goals for international cooperation and accordingly devise strategy to appraise, select and support well designed and coordinated programs in education, clinical services, pharmaceutics, basic research, advocacy, trade and commerce on size and scale that are in line with policy goals and can impact the international community.

The thrust areas for international cooperation in education could be short term internships in AYUSH systems for the medical graduates, interdisciplinary modules for the graduates / postgraduates of medical humanities like Medical Philosophy, History of Medicine, Medical Anthropology, Health Economics, etc.