Strategies to get the best undergraduate medical students in India to choose ENT as a postgraduate specialty in the NEET PG/National Exit Test

Dear Sir Otorhinolaryngology is one of the important surgical specialties in the medical profession. In recent years a lot of advances has occurred in our specialty of otorhinolaryngology. There are many options, such as cochlear implant surgery, head and neck surgical oncology, facial plastic surgery, neurotology, sleep apnea surgery, skull base surgery, and allergy in ear nose throat (ENT). In addition to that, an ENT surgeon can also solely practice otology or rhinology or laryngology in addition to general otorhinolaryngology. Despite these advances, the amount of exposure to otorhinolaryngology for an undergraduate medical student and an intern is limited. This influences a medical students choice in preferring other clinical specialities as a postgraduate specialty as a career option. According to a research paper, over 89% of the top 100 all India ranks (AIRs) in National eligibility entrance test (NEET) postgraduate (PG) 2020 favored “medical” specialties. Similarly, among the top 500 AIRs, only one examinee chose ENT, with 78.8% of candidates preferring these four “medical” fields: internal medicine, radio-diagnosis, pediatrics, and dermatology. Even among the top 2000 AIRs, only four candidates chose ENT.[1,2] A recent research work from Christian Medical College, Vellore, Tamil Nadu, India, indicates a non-preference for ENT among students and the result is similar to the past surveys in India.[3,4]. According to their report, ENT ranks very low on the list of clinical specialties selected as the “most likely” future choice of students, from first year to final year. According to Garg et al.[5] from Lady Hardinge Medical College, New Delhi, India, findings suggest that female medical graduates categorically rank ENT below most major surgical disciplines. In contrast to the research findings in India, surveys done abroad have found ENT to be among the top 5 most preferred fields of medical students.[6] In the United States (US), the average US Medical Licensing Examination (USMLE) Step 1 scores of candidates accepted to a specialty act as a high-quality, objective surrogate of that specialty’s competitiveness. As per the last available data of 2018, the mean score in USMLE Step 1 was 230 (SD = 19). Candidates accepted to ENT had a mean score of 250, which is more than one standard deviation above the mean, and is the second-highest among scores of all specialties.[7] One of the main reasons for this trend in India is less practical exposure during the undergraduate bachelor of medicine, bachelor of surgery course (MBBS) and the internship. Various encouraging strategies and measures are being taken by passionate otorhinolaryngologists to make otorhinolaryngology more appealing to medical students and improve their perceptions about otorhinolaryngology. These measures are being briefly discussed. It has been suggested that in India, social media editors may be appointed for the ENT journals and ENT professional bodies, who would manage their Twitter and LinkedIn pages. They would put out curated content and engage regularly with both the early career and the potential otorhinolaryngologists, thus generating interest in our specialty.[1] The University of Ottawa designed an educational smartphone app called LearnENT, which is aimed at bridging the gap in otolaryngology-head and neck surgery (OHNS) medical education.[8,9] This app provides medical students, residents, and physicians with evidence-based and interactive learning materials covering a variety of OHNS topics. Such student led ambassador programs represent an innovative approach in increasing awareness about medical education resources. Researchers designed a half-day course involving an interactive careers workshop exploring ENT as a specialty choice, alongside simulation stations of commonly presenting ENT problems led by ENT doctors. Pre- and post-course evaluation sheets were used to explore factors that encourage and discourage students from surgical careers and perceptions of ENT. The results showed that the session was useful for all students and had a better understanding of ENT practice with almost all students leaving more likely to consider a career in ENT.[10] A preclinical mentorship program was designed to facilitate the acquisition of clinical skills and provide one-on-one mentorship to preclinical medical students.[11] A computer-based learning module was designed to teach otolaryngology topics to third-year and fourth-year medical students. This module was an effective educational intervention for increasing exposure and improving otolaryngology knowledge.[12] A few proposals have been suggested by Indian Otorhinolaryngologists. To instill interest in otorhinolaryngology and better understanding advanced teaching aids can be used along with live stepwise demos of surgeries. The rotatory internship postings schedule should also be extended from 2 weeks to a month, if not for all, at least for those who are interested in the subject to avail as their optional posting (15 days). Another recommendation includes, equipping the simulation labs in the medical colleges with instruments and mannequins specially designed for ENT surgeries, therefore, that the undergraduates and interns can have a better understanding, visualization, and hands-on experience in certain common surgeries performed.[13] Women in otolaryngology event involved undergraduate and first- or second-year medical students from the University at Buffalo, Amherst, NY, USA. During the event, students rotated through three skills stations working with female otolaryngology residents and attending physicians. The women in otolaryngology event increased participants’ confidence in understanding otolaryngology, promoted understanding of resources available, and demonstrated the openness of the specialty to women.[14] A research study was conducted to determine whether medical student Otolaryngology-Head and Neck Surgery (Oto-HNS) interest groups increase student interest in the specialty and influence decisions to apply to Oto-HNS residency. Medical students who attended the Oto-HNS interest group were more likely to consider applying for otolaryngology residency (P < 0.0001) and had an improved understanding of otolaryngology than those who did not attend (P = 0.0003).[15] A study described an otolaryngology-focused medical student virtual journal club program. For preclinical medical students, journal clubs may allow for early exposure to specialties, which is known to be a highly influential factor for career specialty choice.[16-18] The majority of students agreed that they were interested in otolaryngology for their specialty career and that journal clubs had a valuable role in medical education It is felt that the senior leading otorhinolaryngologists of the country must study the initiatives taken worldwide and implement them in an Indian setup. The National Medical Commission is introducing reforms in undergraduate medical education to make it more clinically oriented. This is the best time to engage with the policy makers and introduce reforms to make otorhinolaryngology more student friendly and clinically oriented. In addition, an otorhinolaryngology setup must be created inside trauma care and emergency department. Such patients who are given service and are saved by the otorhinolaryngologists in the emergency will change the perception of the public about ENT. A patient at the end of the day decides the popularity or greatness of a doctor or the specialty. Public perception influences a young medical graduate’s inclination towards a specialty. In addition, if the subspecialty of community otorhinolaryngology is strengthened, our otorhinolaryngology specialty will have a presence even in rural community and create a favorable perception among primary care providers. The manpower strength of a community health center can be amended after proper discussion with the Directorate General Health Services, and policy makers in the Ministry of Health And Family Welfare. A community health center must include an otorhinolaryngologist who should be available once a week/once in 2 weeks. This will create an interest among the medical officers working in the community health center to take up ENT as a postgraduate specialty in the future. A dedicated community otorhinolaryngology ward/block consisting of 5–10 beds should be established inside Otorhinolaryngology Indoor Department to cater to the patients from camps/primary health care centers/slums in premier institutes. During MBBS Third Year, Indian council of medical research short term studentship projects may be undertaken for interested medical students in otorhinolaryngology. Allotment of beds in the ENT ward to MBBS students during the entire ENT third-year posting following the guidelines followed for final-year subjects. Creation of community otorhinolaryngology rural medical camp posting during MBBS third year when posted in ENT. This will give the MBBS students the feel of a clinician and indoor caseload of ENT will also increase with patient admitted from camps. During the internship ward rounds must be emphasized along with the outpatient department. Components of case presentation format of master of Chirurgiae (MCH) Head and Neck Surgical Oncology, MCH Plastic Surgery, MCH Neurosurgery, diplomate of National board (DNB) Plastic Surgery, DNB Neurosurgery, Fellowship Skull Base Surgery, and Fellowship Neurotology may be included in the case sheet format of ENT. This will leave a strong imprint in the mind of a young MBBS student about the scope of otorhinolaryngology. Creation of a national task force consisting of the most elite otorhinolaryngologists of India who will work in collaboration with National medical commission, National board of examinations in medical sciences , National academy of medical sciences (India), and Ministry of health and family welfare so that advances in otorhinolaryngology reach uniformly to all medical colleges in India. This will ensure that a undergraduate medical student studying in any medical college in India is aware of the advances happening in otorhinolaryngology. They will also hold discussions with the policymakers in NITI Aayog and the Government of India so that advances happening in otorhinolaryngology are made uniformly applicable throughout India and new policies implemented as and when required. Wherever feasible guest lectures may be taken by eminent doctors in all superspecialty and subspecialty of otorhinolaryngology. Every 5 years information must be collected about the number of top rankers taking otorhinolaryngology through the NEET PG/National Exit Test to ascertain whether our strategies are effective. Important proposals are diagrammatically represented in Figure 1.Figure 1: Important proposalsThe Indian Otorhinolaryngologist can play a very important role in fulfilling the objective of Viksit Bharat by 2047 by providing exemplary services in the healthcare sector. For this, the best MBBS student should select otorhinolaryngology as a postgraduate specialty and every possible attempt should be made to bring healthcare reforms in the specialty of otorhinolaryngology to make it more interesting and appealing to the young MBBS student. Acknowledgements I acknowledge the Indian academy of otorhinolaryngology head and neck surgery and its journal for giving me a platform to express my ideas, emotions, and dreams for my beloved specialty otorhinolaryngology. I acknowledge all researchers and doctors in India and abroad who have contributed to the development of otorhinolaryngology. I thank all the teachers who have taught me otorhinolaryngology. Lastly and most importantly, I acknowledge my patients who have made the most valuable contribution to my skills in otorhinolaryngology. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.