Higher education in India is failing. Overhauling the system can salvage it

Today, I came across an elegantly written, highly analytical excellent keynote address by Pranab Bardhan, who is a Professor of Graduate School at the Department of Economics, at the University of California, Berkeley.

It elucidates, discusses and evaluates an excellent prescription for India’s ailing higher education sector.Hence, I decided to share it on my blog.

India’s higher education is, in general, a decrepit, dilapidated system, it’s afflicted by a deep malaise.

The National Knowledge Commission—Report to the Nation (2006-9) put it only a bit more mildly:“There is a quiet crisis in higher education in India which runs deep”. Three widely acknowledged criteria for judging an education system:

  1. Access,
  2. Equity, and
  3. Quality.

We have failed our young people by all three criteria.

On account of financial hardship, inferior schools, lack of remedial education and social compulsions for an early marriage for girls, the majority of young people from poor families drop out of school, at or before completing secondary education. So they have no access to higher education. In addition, for socially disadvantaged groups, discrimination at the workplace and occupational segregation lower the rate of return from (and hence the demand for) higher education for them compared to other groups.

Even for those who complete secondary education and are willing to enter, entry into premier higher education institutions is riddled with various kinds of inequity (only marginally relieved for some people by lower-caste reservations). For example, the currently almost indispensable intensive entry examination preparation in coaching classes (or private tuition) with high fees is often out of reach for poor students. (NSS; National Sample Survey data suggests that in 2014 nearly 60% of male students in the 18-24 age group cite financial constraints or engagement in economic activities as the reason for discontinuing higher education).

The quality of most higher education institutions in India is abysmal. Let me elaborate on this.

In terms of quantity, the expansion of higher education has been impressive. At the time of independence, we had about 20 universities and fewer than 500 colleges in the whole country. In 2014-15 there were 760 universities and more than 38,000 colleges, catering to about 34 million students. But the expansion in quantity has often been at the expense of quality.

There is extreme faculty shortage, apart from stark deficiencies in the matters of library books, laboratory facilities, computer and broadband internet, classrooms and buildings, etc. As much as 30 to 50% of faculty positions are vacant in many institutions. Many faculty posts are filled by under-qualified “temporary” recruits.

Two-thirds of enrolment in higher education are in private institutions (the majority of them, according to NSS data, say that there were not enough government institutions nearby or where they could get admission). Fees at private institutions are more than double of that charged in government institutions. In parts of western and southern India, with a large expansion of for-profit private colleges with ‘capitation fees’ and politically managed loans from public banks, politicians have entered into the business of higher education in a big way, turning colleges into lucrative degree-giving factories.

There were many familiar accounts of rote-learning, outdated curriculum, and just cramming for exams. There are severe learning deficits in our institutions of higher education. Just to give one example: in a recent survey of M.A. 2nd year students in Economics in a reputed state university in Maharashtra, reported in the Economic and Political Weekly, students were asked 6 simple questions from the basic class VI school textbook in Mathematics; only 11 out of 200 students could answer all of them correctly.

The (erstwhile) Planning Commission (now NITI aayog) the graduates lack even the basic language and cognitive skills. In the Technology sector, the main chamber of commerce, NASSCOM, estimates that even for engineering graduates of engineering colleges in  India are employable in IT companies.

In terms of quality of post-graduate research, while some of it is no doubt significant, overall our research quality is much below the world average. It has been widely noted that India does not have a single university in the top 200 in the world rankings (China has about 10 universities in that list).

The international rankings are far from perfect, but many of the Indian complaints against them sound like ‘sour grapes’. There is no doubt that India lags behind (compared to even some developing countries) in most metrics, particularly in terms of population or GDP– full-time researchers, papers published, scholarly citation impact, no. of patents taken out, and so on.

So, if most of our graduates learn very little and are not employable, and the very poor drop out anyway, and there is meagre world-class research going on, what is the point of this higher education system?

Reformers, like many in the past, have tried to tweak the system here and there, with very little effect. One has to think in terms of quantum leap.

I know in today’s circumstances thinking of a complete overhaul over the next 20 years or so may be recklessly utopian, but not completely useless if we want to think big and draw up a plan for fundamental changes. I am obviously skipping the formidable (though not insuperable) problems of transition and for now mainly concentrating on the major goals. Below is my suggested plan in broad contours. On account of constraints of time and space, I am leaving out many of the nuances and qualifications which should be part of a fuller treatment. The financial requirements of the whole plan also need to be worked out.

higher-education-system

With this structure in mind, I shall now have some remarks on the functioning and administration, faculty recruitment and promotion, etc. in these higher education institutions, particularly in streams (d), (e), and (f).

  • No involvement by politicians, administrators or regulators (like UGC) in personnel selection, particularly in any of those three streams, neither in the selection of officials like a college principal or Vice-Chancellor, nor in the appointment or promotion of faculty, nor in the conduct of the examination system. This is, of course, most difficult to achieve in India, and quite contrary to the persistent Government initiatives (including the new Education Bill with the Lok Sabha– Report of the Committee for Evolution of the New Education Policy 2016). Every education minister, either at the state or central level, believes that as the government provides the money, he or she (and the associated bureaucrats) have the right to interfere in the running of the college or the university. This is a curse of the Indian higher education system that must be exorcised. Every three years or so a public college or university should, after an independent audit, be accountable to the legislature on explaining how the total budget assigned has been spent, but the latter should have no say on personnel selection or internal governance matters. The best public universities in the world are mainly free of outside involvement.



Report of the Committee for Evolution of the New Education Policy 2016 



  • Faculty selection and promotion should be entirely the responsibility of the faculty in consultation with outside (both outside the department and outside the university) faculty members in peer review. In (a) and (b) institutions the main criterion for judging faculty will be teaching quality (partly depending on serious and anonymous student evaluations for each course). In (d), (e), and (f) institutions, of course, along with teaching, quality of research will be evaluated by peers inside and outside departments and impact of publications, including in recognised international outlets. In new appointments, instead of interviews by closed-door selection committees, the candidates on a short list should be invited to present a research paper in an open seminar, where the candidates should be answerable to questions and criticisms by anyone present. After the appointment, every three years, each faculty member, junior or senior, should have a merit review by a departmental and university committee (with some outside referees). No seniority-based promotion is to be allowed.
  • With a positive merit, review salaries should be adjusted upwards. The salary structure should be sufficiently flexible, within some well-defined general parameters, so that exceptional merit judged by peer review can be rewarded. The current system of academic salary structure linked to civil service rules and scales, periodically revised by the Pay Commission, should be discarded.
  • The new technology of distance learning should be fully utilised in upgrading the teaching and knowledge standards. Particularly in streams (b), (d) and (e) we should take advantage of the basic courses currently being offered in the international Massive Open Online Courses (MOOCs) system, expanding on a big scale the current Indianised version being tried out in some of the IIT’s and IIM’s. These courses should be aligned with associated topic-wise tutorials by the current faculty. Apart from quality upgrading, this can also partly relieve our acute shortage of qualified faculty. Of course, the constraints of the inadequate facility of students in English medium of international teaching and dearth of internet access will continue to limit this for quite some time.
  • Our higher academic institutions remain in splendid Brahminical isolation from the surrounding economy and society in their locations, though, alas, not from the local sectarian and party politics. In the US the connection between the ongoing research in universities and the innovations in the local industrial and commercial economy is quite impressive. The Indian experience is often dismal in this respect.
    Just to give an example from a locality nearby: I have heard stories that Howrah, which used to be a major centre for light engineering products, declined over time throwing off thousands of jobs, partly because it failed to carry out some simple technical innovations (which its competitors around the world managed). Yet in Howrah, there was a thriving engineering college nearby (BE college, now a university), which was a potential source of collaboration in these innovations, and but there was no established forum or mechanism for any connection or interaction.
    Similarly, in social sciences, there is ample scope for our Economics and Sociology students to carry out their honours and post-graduate research projects using field survey data from the local bazaars and neighbourhoods (including slums where our maidservants and cobblers live).
  • Let me now discuss an important downside to the principle of non-interference by administrators and politicians that I have advocated. With full autonomy, some colleges and universities can degenerate into cosy, nepotistic clubs of rampant mediocrity. Sociologist Diego Gambetta has described such a system of collusive mediocrity in Italian universities, which will not be unfamiliar in some Indian universities—a culture of mediocrity where mediocre people get other mediocre people around them and thrive in a cocoon of comfortable cronyism. Autonomy vs. cronyism is the inexorable (when a person is inexorable, they’re stubborn. When a thing or process is inexorable, it can’t be stopped) dilemma of a higher education system. In the US this problem has been mostly averted by a culture of constant competition among the better universities—they raid one another for the best faculty, and try to generate a critical mass of good faculty and students. Students also gravitate to where the best faculty are. When professors move from one university to another they move with the whole paraphernalia (paraphernalia – equipment consisting of miscellaneous articles needed for a particular operation or sport etc.) of funded research projects, labs and affiliated students. So, it’ll be costly for a university to lose its good faculty members if it fails to provide a stimulating environment.
    It is, of course, not easy to reproduce this culture of competition and mobility everywhere, but one can try, with some external monitoring mechanisms in place.
  • Periodic reviews of a whole department by outside professional peer groups (of academics, not bureaucrats), particularly if the review report is taken seriously by the external financial authorities in the allocation of faculty slots to the department, can be a significant deterrent to indulgence in mediocrity. In many fields, research grants from external funding agencies are an important source of finance for a US university (in the form of overhead costs charged to the grant), and mediocre people failing to get such grants can become financially costly for a university. For this to work the Indian research funding agencies (like UGC, ICSSR, ICHR, CSIR, etc.) themselves need to be shorn (shorn – having the hair or wool cut or clipped off as if with shears or clippers; syn.- sheared) of the current overload of bureaucratic control.
  • Apart from mediocre faculty, the other problem of autonomy may be in encouraging low-quality degree giving. The solution to this is not state or regulatory interference (we are familiar, for example, with many scandals in the examination system under such interference). The ultimate solution will have to be the market test. Job-givers will not value such degrees given by colleges or universities that abuse their autonomy, and students will soon find this out.
  • Finally, a word or two on the acute and potentially overwhelming political and sociological issues. The vested interests in the current stagnation are quite powerful—politicians, bureaucrats, mediocre faculty, etc.
    As Machiavelli had observed five centuries back:
    “The reformer has enemies in all those who profit by the old order, and only lukewarm defenders in all those who would profit by the new”.
    Nothing will happen unless the potential beneficiaries of change get organised. It is easy to run down any substantial proposal to improve quality as elitist. When it comes to academic excellence, I am unashamedly an elitist. Even in Communist countries, say in the erstwhile Soviet Union (or China today), the Academy of the various Sciences, for example, were (are) highly elitist. What is important to me is ensuring equality of opportunity for everybody. But that does not mean equality of outcome.
  • In India, the default redistributive option for politicians has been caste reservations in admissions to higher education institutions for the disadvantaged. But when these institutions keep on churning out graduates who are mostly unemployable, I believe the consciousness will rise among our poor and middle classes and castes that the way forward is to fight the vested interests and move in the direction of improving education quality, along with access and equity.

At the same time we have to understand that equity is not ensured simply by ensuring free and universal access, as we have proposed for our streams (a) and (b).

It is also not just a matter of arranging for enough scholarships and remedial courses for students from disadvantaged backgrounds, many of whom are first-generation entrants to the higher education system. In the social churning that India is going through, many of our colleges and universities have become sites of contestation for our larger social conflicts.

Given this context, we have to nurture an enabling and empowering atmosphere, and institutional culture for these new entrants in an alien environment of long domination by upper classes and castes. Rohith Vemula’s tragic suicide and last letter at the Central University of Hyderabad last year point to the many challenges we face in our long road to equity in the field of education.

But equity and quality need not work at cross purposes, and it is our duty to convince the political leaders of all groups about the importance and feasibility of these two goals working together.

Source:

A new class act
Higher education in India is failing. Overhauling the system can salvage it
Written by Pranab Bardhan | Published:January 20, 2017 12:24 am

A new class act

 

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What is Choice Based Credit System (CBCS) ? How is it Advantageous in Promoting Talent, Creativity and Research?

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This was the prevailing situation in most of our teaching institutions and establishments. There is lack of transparency and accountability.

VISION:

To evolve a higher education system, that is suitability blended with provision for knowledge values and skill practice where every student learns in without sacrificing his/her creativity.

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RATIONALE:

The current higher education curriculum does not impart the necessary skills that would make the students employable adequately. There is a lack of ‘Interdisciplinary’ approach as well as there is a very little scope for value based courses to be taught. In addition the evaluation methods are largely based on memory recall processes. In addition the students don’t learn to think and analyze on their own. Also, the system is not effective enough in meeting/ empowering students to think on matters/issues independently.

The 11th five year plan of India as well as the National Knowledge Commission have recommended revamping of higher education through academic and administrative reforms. The UGC particular in its 11th plan, has emphasized on such reforms and this was followed by the recommendations were made on similar lines by the Association of Indian Universities. (AIU)

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GOALS:

The ultimate goal is to bring reforms in higher education so that students develop thinking as well as analytical ability, s/he gets equipped with necessary skills ultimately making him/her suitable for an employment and to integrate values of our culture with education.

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The most important aspect of this system is that both teaching and learning should be ‘credit based‘ and not ‘time based‘. The new system also opens up the opportunity for student mobility, allowing students to transfer credits earned in one institution to another;

and for

programme portability, allowing movement from one degree programme to another. These will be achieved through unique system of counting credits (which replaces the “papers” system),

a uniform evaluation system based on grade points (replacing the “marks” system), and a

uniform semester based academic year (Which replaces the “year long” pattern).

This establishes parity within and across institutions; between ‘Indian Higher educational institutions’ and many international ones.

In principle, this new system should also provide employers and post graduate institutions, better standards to compare undergraduate students and their institutions.

The most positive aspect of CBCS is it’s student centricity. It recognises the importance of individual learning, wherever and whenever it is achieved.This is the defining idea behind the new system. It treats students as individuals who have independent academic needs and interests, and CBCS, if properly implemented, has the potential to empower them.[ and the nation as a whole ]

[Source: http://epaper.indianexpress.com/531556/Indian-Express/29-June-2015#clip/5709833/dad244f3-a263-4aaf-93f9-3c4811e73650/945.0000000000001:713.679245283019 ]

The Scenario:

Source: http://www.presiuniv.ac.in/web/exam_assessment.php

Currently an important concern which is strongly mentioned in recent times by the University Grants Commission (UGC), the National Assessment and Accreditation Council (NAAC), is the need to develop a Choice-Based Credit System (CBCS) in tune with global trends and the adoption of a proper grading system for measuring performance of the learner.

Recommendation of the UGC University Grants Commission in its Action Plan for Academic and Administrative Reforms

“……. Curricular flexibility and learners’ mobility is an issue that warrants our urgent attention. These can be addressed by introducing credit based courses and credit accumulation. In order to provide with some degree of flexibility to learners, we need to provide for course duration in terms of credit hours and also a minimum as well as a maximum permissible span of time in which a course can be completed by a learner…Choice-Based Credit System (CBCS) imminently fits into the emerging socio-economic milieu, and could effectively respond to the educational and occupational aspirations of the upcoming generations. In view of this, institutions of higher education in India would do well to invest thought and resources into introducing CBCS. Aided by modern communication and information technology, CBCS has a high probability to be operational efficiently and effectively — elevating learners, institutions and higher education system in the country to newer heights…”.

Definitions of Key Words:

UGC guidelines

1. Academic Year: Two consecutive (one odd + one even) semesters constitute one academic year.
2. Choice Based Credit System (CBCS): The CBCS provides choice for students to select from the prescribed courses (core, elective or minor or soft skill courses).
3. Course: Usually referred to, as ‘papers’ is a component of a programme. All courses need not carry the same weight. The courses should define learning objectives and learning outcomes. A course may be designed to comprise lectures/ tutorials/laboratory work/field work/outreach activities/project work/vocational training/viva/ seminars/term papers/assignments/ presentations/ self-study etc. or a combination of some of these.
4. Credit Based Semester System (CBSS): Under the CBSS, the requirement for awarding a degree or diploma or certificate is prescribed in terms of number of credits to be completed by the students.
5. Credit Point: It is the product of grade point and number of credits for a course.
6. Credit: A unit by which the course work is measured. It determines the number of hours of instructions required per week. One credit is equivalent to one hour of teaching (lecture or tutorial) or two hours of practical work/field work per week.
7. Cumulative Grade Point Average (CGPA): It is a measure of overall cumulative performance of a student over all semesters. The CGPA is the ratio of total credit points secured by a student in various courses in all semesters and the sum of the total credits of all courses in all the semesters. It is expressed up to two decimal places.
8. Grade Point: It is a numerical weight allotted to each letter grade on a 10-point scale.
9. Letter Grade: It is an index of the performance of students in a said course. Grades are
denoted by letters O, A+, A, B+, B, C, P and F.
10. Programme: An educational programme leading to award of a Degree, diploma or certificate.
11. Semester Grade Point Average (SGPA): It is a measure of performance of work done in a semester. It is ratio of total credit points secured by a student in various courses registered in a semester and the total course credits taken during that semester. It shall be expressed up to two decimal places.
12. Semester: Each semester will consist of 15-18 weeks of academic work equivalent to 90
actual teaching days. The odd semester may be scheduled from July to December and even semester from January to June.
13. Transcript or Grade Card or Certificate: Based on the grades earned, a grade certificate shall be issued to all the registered students after every semester. The grade certificate will display the course details (code, title, number of credits, grade secured) along with SGPA of that semester and CGPA earned till that semester.

Semester System and Choice Based Credit System

The Indian Higher Education Institutions (IEHI) have been moving from the conventional annual system to semester system. Currently many of the institutions have already introduced the choice based credit system. The semester system accelerates the teaching-learning process and enables vertical and horizontal mobility in learning. The credit based semester system provides flexibility in designing curriculum and assigning credits based on the course content and hours of teaching. The choice based credit system provides a ‘cafeteria’ type approach in which the students can take courses of their choice, learn at their own pace, undergo additional courses and acquire more than the required credits, and adopt an interdisciplinary approach to learning, It is desirable that the HEIs move to CBCS and implement the grading system.

Examination and Assessment

The HEIs are currently following various methods for examination and assessment suitable for the courses and programmes as approved by their respective statutory bodies. In assessing the performance of the students in examinations, the usual approach is to award marks based on the examinations conducted at various stages (sessional, mid-term, end-semester etc.,) in a semester. Some of the HEIs convert these marks to letter grades based on absolute or relative grading system and award the grades. There is a marked variation across the colleges and universities in the number of grades, grade points, letter grades used, which creates difficulties in comparing students across the institutions. The UGC recommends the following system to be implemented in awarding the grades and CGPA under the credit based semester system.

  • Letter Grades and Grade Points:
  • i. Two methodsrelative grading or absolute grading– have been in vogue for awarding grades in a course. The relative grading is based on the distribution (usually normal distribution) of marks obtained by all the students of the course and the grades are awarded based on a cut-off marks or percentile. Under the absolute grading, the marks are converted to grades based on pre-determined class intervals. To implement the following grading system, the colleges and universities can use any one of the above methods.
  • ii. The UGC recommends a 10-point grading system with the following letter grades as given below:

  • iii. A student obtaining Grade F shall be considered failed and will be required to reappear in the examination.
  • iv. For non credit courses ‘Satisfactory’ or “Unsatisfactory’ shall be indicated instead of the letter grade and this will not be counted for the computation of SGPA/CGPA.
  • v. The Universities can decide on the grade or percentage of marks required to pass in a course and also the CGPA required to qualify for a degree taking into consideration the recommendations of the statutory professional councils such as AICTE, MCI, BCI, NCTE etc.,
  • vi. The statutory requirement for eligibility to enter as assistant professor in colleges and universities in the disciplines of arts, science, commerce etc., is a minimum average mark of 50% and 55% in relevant postgraduate degree respectively for reserved and general category. Hence, it is recommended that the cut-off marks for grade B shall not be less than 50% and for grade B+, it should not be less than 55% under the absolute grading system. Similarly cut-off marks shall be fixed for grade B and B+ based on the recommendation of the statutory bodies (AICTE, NCTE etc.,) of the relevant disciplines.

Fairness in Assessment:

Assessment is an integral part of system of education as it is instrumental in identifying and certifying the academic standards accomplished by a student and projecting them far and wide as an objective and impartial indicator of a student’s performance. Thus, it becomes bounden duty of a University to ensure that it is carried out in fair manner. In this regard, UGC recommends the following system of checks and balances which would enable Universities effectively and fairly carry out the process of assessment and examination.

i. In case of at least 50% of core courses offered in different programmes across the disciplines, the assessment of the theoretical component towards the end of the semester should be undertaken by external examiners from outside the university conducting examination, who may be appointed by the competent authority. In such courses, the question papers will be set as well as assessed by external examiners.

ii. In case of the assessment of practical component of such core courses, the team of examiners should be constituted on 50 – 50 % basis. i.e. half of the examiners in the team should be invited from outside the university conducting examination.

iii. In case of the assessment of project reports / thesis / dissertation etc. the work should be undertaken by internal as well as external examiners.

Computation of SGPA and CGPA

The UGC recommends the following procedure to compute the Semester Grade Point
Average (SGPA) and Cumulative Grade Point Average (CGPA):

i. The SGPA is the ratio of sum of the product of the number of credits with the grade
points scored by a student in all the courses taken by a student and the sum of the
number of credits of all the courses undergone by a student, i.e
SGPA (Si) = Σ(Ci x Gi) / ΣCi
where Ci is the number of credits of the ith course and Gi is the grade point scored by the
student in the ith course.

ii. The CGPA is also calculated in the same manner taking into account all the courses
undergone by a student over all the semesters of a programme, i.e.
CGPA = Σ(Ci x Si) / Σ Ci
where Si is the SGPA of the ith semester and Ci is the total number of credits in that
semester.

iii. The SGPA and CGPA shall be rounded off to 2 decimal points and reported in the
transcripts.

Illustration of Computation of SGPA and CGPA and Format for Transcripts

i. Computation of SGPA and CGPA

Illustration for SGPA

ii. Transcript (Format):

Based on the above recommendations on Letter grades, grade points and SGPA and CCPA, the HEIs may issue the transcript for each semester and a consolidated transcript indicating the performance in all semesters.

The major system engaged in Higher Education in the global scenario is operating a system of credits. The European Credit Transfer System (ECTS), the ‘National Qualifications Framework’ in Australia, the Pan-Canadian Protocol on the Transferability of University Credits, the Credit Accumulation and Transfer System (CATS) in the UK as well as the systems operating in the US (discussed in detail in  https://jeevanshu.wordpress.com/2015/07/01/what-is-choice-based-credit-system-cbcs-how-is-it-advantageous-for-promoting-talent-creativity-and-research-part-i/ ), Japan, etc are already in a system of credit to measure the level of competency.

In tune of the above scenario Indian universities, institutions and establishments too should adopt a credit-based-grading- system for the purpose of assessment of the students, which will be acceptable to the global universities.

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Advantages of the Credit-Based-Grading-System:

  1. Respects ‘Student Autonomy’. Represents a shift in focus from teaching based to learning education since the workload is based on the investment of time in learning.
  2. Records student’s workload realistically. It calculates not only the time spend by the students in lectures or seminars but also the time they need for individual learning and the preparation of examinations etc.
  3. Helps self-learning. Students may undertake as many credits as they can cope with, without repeating all the courses (papers) in a given semester if they are unsuccessful in one or more courses (papers).
  4. Offers more flexibility to the students allowing them to choose inter-disciplinary (known as Extra-Departmental papers) courses along with major courses, which makes education more broad-based.
  5. Facilitates students’ mobility. Providing opportunity to transfer the credit earned at one institution to another. Provide more transparency and compatibility between different educational structures.

Some Salient Features of Credit-Based-Grading-System 

(Presidency University, Kolkata, West Bengal, India)

  1. The amount of learning indicated by a credit value is based on an estimate using the idea of hours of learning. The number of hours of learning provides a rough guide to how long it will take a typical student, on average, to achieve the learning outcomes specified for the module or programme. The estimate of notional hours of learning doesn’t just include formal classes, but estimates the amount of time spent in preparation for these classes, along with private or independent reading and study, plus revision and the completion of course-work required on the module.
  2. The university shall also formulate policy for credit transfer that can allow a student to transfer credits which have already been awarded to the student (vide clause 37 of the Regulation).
  3. A student may be able to transfer credits to another programme within the university, or may be able to transfer credit towards a programme in a different institution with which the university has a formal agreement of mutual credit transfer. Credit transfer depends on whether the accumulated credit is relevant to the programme to which the student wants to transfer.
  4. Grade, SGPA & CGPA: Student shall be graded in each course with 7 deferent grades in a scale of 10. Based on marks obtained in aggregate in each paper of UG/PG degree course following grade and grade points shall be awarded (given in 5). Student(s) failing to obtain minimum D-grade in individual module/paper will be declared as unsuccessful irrespective of SGPA/CGPA value to qualify in each semester. Students will be awarded SGPA/CGPA values considering both honours and extra-departmental courses in bachelor’s degree course.
  5. Classification of grades:
    % marks obtained Grade Grade Point
    90 and above A++ 10
    80 to 89 A+ 9
    70 to 79 A 8
    60 to 69 B 7
    50 to 59 C 6
    40 to 49 D 5
    E0

    Computation of SGPA and CGPA:

    Source: http://www.ugc.ac.in/pdfnews/6925009_SkillNSQF.pdf

    Following procedure to compute the Semester
    Grade Point Average (SGPA) and Cumulative Grade Point Average (CGPA) may
    be adopted:
    • The SGPA is the ratio of sum of the product of the number of credits with the
    grade points scored by a student in all the course components taken by a
    student and the sum of the number of credits of all the courses undergone by
    a student, i.e
    SGPA (Si) = ∑(Ci x Gi) / ∑Ci
    where ‘Ci’ is the number of credits of the ith course component and ‘Gi’ is the grade point scored by the student in the ith course component.
    • The CGPA is also calculated in the same manner taking into account all the
    courses undergone by a student over all the semesters of a programme, i.e.
    CGPA = ∑(Ci x Si) / ∑ Ci
    where ‘Si’ is the SGPA of the ith semester and Ci is the total number of credits
    in that semester.
    • The SGPA and CGPA shall be rounded off to 2 decimal points and reported
    in the transcripts.
    • The skill component would be taken as one of the course component in
    calculation of SGPA and CGPA with given credit weightage at respective
    level.

    Where n is the number of courses in the jth semester, mj denotes the numerical value of the grade obtained in the jth course of the semester, cj denotes the number of credit for the jth course of the semester. For example, consider the numerical grade and credit of a student given in the table below:

    Course CourseI CourseII CourseIII CourseIV CourseV CourseVI CourseVII
    Credit 2 2 4 2 2 2 2
    Numerical Grade 7 8 5 7 6 8 8

    SGPA for the ith Semester is calculated as –

    Cumulative Grade Point Average (CGPA) for k semesters is given as:

    where Cj is the total number of credits in the jth Semester.

    For example, consider the SGPA’s obtained by a student in four semesters along with total credit in each semester is given as follows:

    Semester First Second Third Fourth
    SGPA 6.75 6.00 8.12 7.62
    Total Credit 16 20 18 16

  6. Extra-Departmental papers have the adequate relevance in the respective programme according to their credits. The credit points earned in Extra Departmental papers will be counted to calculate the final CGPA. So any Extra-Departmental paper has to be treated as relevant as Major paper.
  7. A student shall be provided with a final record of total marks obtained along with the final grade at the end of the respective degree course.                                                                                                                                                        For Example                                                                                                                                                                                          Choice Based Credit System                                                                               Image Credit                                                                                                                                                              Choice Based Credit SystemImage Credit
  8. Separate account in the form of a credit transcript for accumulated credits may be issued against application annually or on completion of the programme, or both for availing of the credit transfer options.
For implementing the CBCS, institutions of higher education would need to undertake the following set of rigorous elaborate steps:

Source:

  1. Review of curricular contents (study papers, term papers, assignment, workshop-assignment, experiments etc.) of certificate, diploma, under-graduate, post-graduate, M.Phil. and Ph.D programmes.
  2. For the sake of clarity of faculty, students and examiners, all the curricular contents are specified, and sub-divided into units and, if need be, into sub-units, which are subsequently assigned numerical values and termed ‘credits’.
  3. Faculty of the concerned ‘Department’ deliberates and decides on (a) core credits, and (b) elective or optional credits for different levels of academic programmes.
  4. Departmental faculty evaluates and decides on the relative weightage of the core and elective credits.
    Decision on the ‘total’ credits to be earned (or completed) by students undergoing certificate, diploma, under-graduate, post-graduate, M.Phil. or Ph.D. programmes.
  5. Generally core credits would be unique to the programme and earning core credits would be essential for the completion of the programme and eventually certification.
  6. On the other hand, elective credits are likely to overlap with other programmes or disciplines of study (for example, languages, statistics computer application etc.).
  7. Under this system, Students enrolled for a particular programme or course would be free to opt and earn elective credits prescribed under the programme, or under other programmes within the department, faculty, university or even outside recognised university/ institution of higher education.

While, the fixing of diversity in the evaluation system followed by different universities in India due to which students suffer acceptance of their credentials across the university system as well as the employment agencies, is a welcome objective. Making it all the more flexible & mobile in the same go is bound to create further chaos and confusion. When the University Grants Commission doesn’t have a working dashboard to monitor the existing as well as future implementation of CBCS, what kind of preparedness would the Universities in general would be having?

The UGC has simply mentioned an email id ugc.action@gmail.com for reporting the compliance of such an important initiative.

The University Grants Commission would need to be extra cautious and get further prepared in initiating such wide-based reforms so that they don’t backfire and lose their due meaning & credence.

Image Credit

Critique

When a teacher teaches in a class, it is like pouring water in a bottle. The problem with credits is — suppose a teacher pours 1 litre of pure water each day for 5 days a week, exactly for 4 weeks; now, this means 1 X 5 X 4= 20 litres of pure water is equivalent to 1 credit for a particular subject. The problem that lies here, is that – – should the student be given that 1 credit simply because s/he was present in the class when the teacher was pouring pure water, or it should be based on the amount of water that the student retains in his/her tumbler in those 4 weeks and also on what use does that student puts that water to, during those 4 weeks and thereafter.
The other problem that arises in the above credit system is that – how does one decide whether the water that the teacher is pouring is pure and exactly 1 litre in quantity.

Structure of the U.S. Education System: Credit Systems

First, let us discuss the same system which is being followed in The United States of America.

The Structure of the U.S. Education System:
Credit Systems

USNEI

International Affairs Office, U.S. Department of Education     Feb 2008

U.S. educators at the secondary, higher, and adult/continuing education levels use a variety of formulae to calculate, record, and interpret the amount of earned academic or training credits that students accumulate en route to earning certificates, diplomas, degrees, and other qualifications. In most cases, the earned credits are identified by the term “credit hours” or “credit units.”

Several important points need to be understood about credit:

  • Credit hours or units represent a mathematical summarization of all work completed and are not the same as the actual classroom contact or instructional hours.
  • U.S. institutions use credit formulae to record all types of academic work, not just taught courses. A U.S. doctoral student’s academic record, for example, will contain credits earned for independent research, often expressed as if the student had been enrolled in classes, even though the actual work was independent research.
  • Credits are a convenient numerical way to assess tuition and fee charges and determine student status. Even unsupervised doctoral candidates must be registered as students and pay tuition charges.
  • Registered student status is usually defined as being enrolled in a given semester or quarter for a specified minimum number of credit hours, which are assigned to any type of study recognised and required by the faculty, and tuition charges are usually calculated by the instructional cost per credit hour.

SECONDARY LEVEL CREDIT UNITS

The most widely used credit systems in U.S. secondary education are based on the Carnegie Unit system. Carnegie Units were proposed in 1906 as a basis for measuring school work. A unit would represent a single subject taught for one classroom period for five days a week. Fractional units would be awarded for subjects taught less frequently. The term “Carnegie Unit” is still used to describe this system as are other terms such as “annual credit unit.”

What is the Carnegie Unit?

The unit was developed in 1906 as a measure of the amount of time a student has studied a subject (originally designed as a standard for student exposure to subject matter). For example, a total of 120 hours in one subject—meeting 4 or 5 times a week for 40 to 60 minutes, for 36 to 40 weeks each year—earns the student one “unit” of high school credit. Fourteen units were deemed to constitute the minimum amount of preparation that could be interpreted as “four years of academic or high school preparation.” http://www.carnegiefoundation.org/faqs/

In essence, it was an opportunity-to-learn standard—assuring that students received at least some common base of academic study in the high school and post-secondary systems that were emerging early in the 20th century. Today the Carnegie Unit functions as a currency that organises a vast array of educational transactions: everything from academic calendars to faculty workloads and compensation, transfer and graduation requirements, athletic eligibility, and the distribution of billions of dollars in federal financial aid. “The Carnegie Unit was never intended to measure what students have learned,” says Silva, a Carnegie Foundation senior associate. “Measuring learning was left to the discretion of individual teachers and professors. Given the great diversity in goals and activities in the U.S. educational system and the autonomy enjoyed by faculty, particularly in higher education, creating an alternative to the Carnegie Unit poses formidable challenges. While the Carnegie Unit has many limitations, it does provide a minimum guarantee of student access to opportunities to learn.” http://www.carnegiefoundation.org/newsroom/news-releases/carnegie-foundation-releases-results-two-year-study-carnegie-unit/

Some secondary schools assign credits by semester.  These semester credit units are based on the formula that a semester credit unit equals a single subject taught for one classroom period for five days a week.  Still, other schools assign credit by the classroom period, or “hour.”  Since the standard secondary class load is five subjects, five hourly credits equal on semester credit unit, which is doubled for annual credit units.

POSTSECONDARY CREDIT SYSTEMS

Semester Calendar Credit Hours. Most U.S. higher education institutions operate on an academic year divided into two equal semesters of 15-16 weeks’ duration, with a winter break of 2-3 weeks and a summer session of 10-12 weeks, plus additional shorter breaks. The actual amount of academic work that goes into a single semester credit hour is often calculated as follows:

  • One lecture (taught) or seminar (discussion) credit hour represents 1 hour per week of scheduled class/seminar time and 2 hours of student preparation time. Most lecture and seminar courses are awarded 3 credit hours. Over an entire semester, this formula represents at least 45 hours of class time and 90 hours of student preparation.
  • One laboratory credit hour represents 1 hour per week of lecture or discussion time plus 1-2 hours per week of scheduled supervised or independent laboratory work, and 2 hours of student preparation time. Most laboratory courses are awarded up to 4 credit hours. This calculation represents at least 45 hours of class time, between 45 and 90 hours of laboratory time, and 90 hours of student preparation per semester.
  • One practice credit hour (supervised clinical rounds, visual or performing art studio, supervised student teaching, field work, etc.) represents 3-4 hours per week of supervised and /or independent practice. This, in turn, represents between 45 and 60 hours of work per semester. Blocks of 3 practice credit hours, which equate to a studio or practice course, represent between 135 and 180 total hours of academic work per semester.
  • One independent study (thesis or dissertation research) hour is calculated similarly to practice credit hours.
  • Internship or apprenticeship credit hours are determined by negotiation between the supervising faculty and the work supervisor at the cooperating site, both of whom must judge and certify different aspects of the student’s work. The credit formula is similar to that for practice credit.

A typical bachelor’s degree program of study on a semester calendar requires at least 120 credit hours to be earned by the student. Normal full-time registration is usually 15 credit hours per semester or 30 per academic year (shortfalls can be made up in summer sessions or independent study). This roughly translates into at least 30-40 courses (depending on the major subject and thus the proportion of types of credit hours earned) and represents at least 5,400 – and probably more – actual hours of dedicated academic work for a non-science or non-art concentration, and well over that total for graduates of programs in the sciences, engineering, fine arts, or performing arts. A master’s degree program requiring at least 33 credit hours and including a research thesis or project represents over 4,000 actual hours of supervised and unsupervised (independent research) study, while a doctoral program can represent 8,000 or more actual hours of advanced study and research beyond the master’s degree.

Quarter Calendar Credit Hours

Some U.S. institutions use a quarter calendar, in which the academic year is divided into three terms, called quarters, of 10-11 weeks’ duration plus a summer session (considered the fourth quarter, but optional), a short winter term and other calendar breaks. Quarter credit hours represent proportionately less work than semester hours due to the shorter terms, about two-thirds of a semester credit hour. Thus, a bachelor’s degree at an institution on the quarter calendar may require a minimum of 180 quarter hours, which compares to 120 semester hours.

Other Post-secondary Credit Systems.

The semester and quarter hour systems are only the most commonly used credit systems in the United States. Several institutions employ their own special systems for recording credits, ranging from unit systems similar to the Carnegie system (one course = one credit) to point systems based on various formulae.

Education leaders from eight American states and seventeen Chinese provinces shared ideas and discussed efforts to improve teacher professional development and to implement effective student assessments.

Education leaders from eight American states and seventeen Chinese provinces shared ideas and discussed efforts to improve teacher professional development and to implement effective student assessments.

U.S. leaders visited schools in Shanghai before the dialogue began and the American delegation was particularly impressed by the students and faculty at Shanghai Shibei Junior High School.

U.S. leaders visited schools in Shanghai before the dialogue began and the American delegation was particularly impressed by the students and faculty at Shanghai Shibei Junior High School.

Students entering the U.S. higher education system with credits from other systems have these credits converted to U.S. credit hours using formulas for the transfer of credit that each higher education institution has established. The principles that govern these formulas include:

  1. The assumption that the basic academic content and student academic load is similar across universities and higher education systems, even if the local policy on the award of credits differs from place to place; and
  2. Dividing the number of credits to be transferred from a home campus or system into the number of credits that would be awarded in the receiving campus or system for the same work.

This formulation can result in students from systems where the credit system awards more than 30 credits in an academic year seeing a reduction in the number of credits when translated into the U.S. credit hours system, and vice versa for students from systems where the standard academic credit load is less than 30 credits per year.

The Structure of the U.S. Education System:
Experiential Credit Conversion

Higher education credit can be awarded for experiences and training obtained outside the higher education system. Common examples include credit for military training programs, employer training and certification and refresher training done as part of the requirements of professional associations and licensing authorities. Credit can also be earned for self-study and other experiences that provide evidence of learning under some circumstances.

The requirements for being able to assign credit for such experiences, called Prior Learning Assessment in the United States, include the following 10 standards:

  1. Credit should be awarded only for learning and not for the experience alone.
  2. Higher education credit should only be awarded for learning at that level.
  3. Credit should be awarded for learning that demonstrates theory and practical application.
  4. Determination of competency standards and the decision to award credit needs to be made by appropriate academic and subject experts.
  5. Credit should be appropriate to the academic context in which it is considered for acceptance
  6. Credit awards and recording should be monitored to avoid duplication.
  7. Policies and procedures should be fully disclosed and available for review.
  8. Fees for credit award procedures should be for assessments and not based on the amount of credit to be awarded.
  9. Assessment personnel should receive adequate training and professional development opportunities.
  10. Assessment programs should establish regular review procedures and a continuous improvement process.

Continuing Education Units (CEU)

Continuing education units, or CEUs, are awarded by many education and training providers to signify successful completion of non-credit programs and courses intended to improve the knowledge and skills of working adults. Among the most common uses of CEUs are to record refresher, transitional, or knowledge improvement accomplishments for professional workers undergoing what is called continuing professional education.

The typical CEU represents approximately ten (10) contact hours of experience in a structured continuing education experience (class, seminar, retreat, practicum, self-study, etc.) that is supervised in some way by a qualified continuing education provider.

CEUs are similar in theory to academic credits but differ in two important respects:

  1. CEUs are not awarded for academic study and do not represent, or provide, academic credit; and
  2. They may be awarded for a variety of experiences in different settings whose only common criterion is that they be measurable, supervised educational or training experiences with defined starting and ending points.

CEU CONVERSION

Some CEUs can be converted into academic credit hours. This is done by both higher education institutions and special examining and assessment services. Academic credit can only be granted for CEUs if

(1) the subject matter and nature of the CEU experience is approved as applicable to consideration for academic credit;

(2) the continuing education experience has been analyzed for content and level and, if necessary, the person holding the CEUs has been examined; and

(3) a formal recommendation is made by competent academic authorities (faculty, review board, etc.) based on an agreed conversion formula. CEUs are most commonly converted via a formula that considers at least ten (10) CEUs to equal a single academic credit hour.

U.S. Grading Systems

A variety of grading systems are used in U.S. education. The decision on what grading system to use is a matter within the exclusive authority of the individual school or higher education institution, and usually up to the individual faculty member or disciplinary department within the school or institution.

 NOTE: There is no nationally mandated grading scheme in the United States. The examples described below are only some of the most frequently encountered grading systems.

NORM-REFERENCED GRADING SYSTEMS

Norm-referenced grading systems are based on a pre-established formula regarding the percentage or ratio of students within a whole class who will be assigned each grade or mark. The students, while they may work individually, are actually in competition to achieve a standard of performance that will classify them into the desired grade range. For example, a faculty may establish a grading policy whereby the top 10 percent of students will receive a mark of excellent or outstanding, which in a class of 100 enrolled students will be 10 persons. A norm-referenced grading system might look like:

A (Excellent) = Top 10 % of Class
B (Good) = Next 20 % of Class
C (Average, Fair) = Next 30 % of Class
D (Poor, Pass) = Next 20 % of Class
F (Failure) = Bottom 20 % of Class

The underlying assumption in norm-referenced grading is that the students are roughly equal in ability, and the goal is to select the best performers in the group. Norm-referenced systems are most often used for screening selected student populations in conditions where it is known that not all students can advance due to limitations such as available places, jobs, or other controlling factors. Highly competitive and oversubscribed programs of study, such as law and medicine, or related preparatory programs may use norm-referenced grading to reduce the class size that is allowed to enter or continue such programs. U.S. students often refer to norm-referenced grading systems as “grading on a curve,” a phrase that reflects the formulaic character of such systems.

CRITERION-REFERENCED GRADING SYSTEMS

Criterion-referenced grading systems are based on a fixed numeric scale, usually equated to a letter mark, from which the faculty assign grades based on the individual performance of each student. The scale does not change regardless of the quality, or lack thereof, of the students. For example, in a class of 100 students, there might be no one or any number of students who score high enough to achieve a grade of excellent, or who fail. Criterion-referenced systems might look like:

A (Excellent) = 95-100 or 90-100
B (Good) = 85-95 or 80-90
C (Fair) = 75-85 or 70-80
D (Poor) = 65-75 or 60-70
F (Failure) = -65 or -60

Criterion-referenced systems are often used in situations where the faculty are agreed as to a standard of performance but the quality of the students is unknown or uneven; where the work involves student collaboration or teamwork; and where there is no external driving factor such as needing to systematically reduce a pool of eligible students.

In many situations, faculty may wish to indicate that certain students, despite achieving a specific score, demonstrated qualities that cause the faculty to believe that the grade by itself does not reflect the student’s actual contribution or potential. In such cases they may attach plus or minus signs to the letter grade (examples: A+, A, A-, B+, B, B-, etc.) to refine their evaluation. These refinements can be important in calculating cumulative grades and awarding honors.

It is noteworthy that many U.S. criterion-referenced grading systems use the principle of subtracting points from a defined perfect score, which is usually, but not always, set at 100. This approach differs from that sometimes used in other countries such as the United Kingdom, where points are added from a defined lowest score (zero or another number). Understanding this difference can make comparing criterion-referenced grades easier, since grades representing similar achievement but calculated in these different ways can be as much as 20 or 30 points apart.

Dimension Criterion-Referenced
Tests
Norm-Referenced
Tests
Purpose To determine whether each student has achieved specific skills or concepts.To find out how much students know before instruction begins and after it has finished. To rank each student with respect to the achievement of others in broad areas of knowledge.To discriminate between high and low achievers.
Content Measures specific skills which make up a designated curriculum. These skills are identified by teachers and curriculum experts.Each skill is expressed as an instructional objective. Measures broad skill areas sampled from a variety of textbooks, syllabi, and the judgments of curriculum experts.
Item
Characteristics
Each skill is tested by at least four items in order to obtain an adequate sample of student performance and to minimize the effect of guessing.The items which test any given skill are parallel in difficulty. Each skill is usually tested by less than four items. Items vary in difficulty. Items are selected that discriminate between high and low achievers.
Score
Interpretation
Each individual is compared with a preset standard for acceptable achievement. The performance of other examinees is irrelevant.A student’s score is usually expressed as a percentage. Student achievement is reported for individual skills. Each individual is compared with other examinees and assigned a score–usually expressed as a percentile, a grade equivalent
score, or a stanine.Student achievement is reported  for broad skill areas, although some norm-referenced tests do report student achievement for individual skills.

Image Credit

ALTERNATIVE GRADING SYSTEMS

Pass-Fail Systems. Some U.S. faculties, schools, and institutions use pass-fail grading systems, especially when the student work to be evaluated is highly subjective (as in the fine arts and music), there are no generally accepted standard gradations (as with independent studies), or the critical requirement is meeting a single satisfactory standard (as in some professional examinations and practica).

Non-Graded Evaluations. A number of U.S. faculties, schools, and institutions do not assign numeric or letter grades as a matter of policy. This practice is usually based on a belief that grades introduce an inappropriate and distracting element of competition into the learning process, or that they are not as meaningful as measures of intellectual growth and development as are carefully crafted faculty evaluations. Many faculty, schools, and institutions that follow a no-grade policy will, if requested, produce grades or convert their student evaluations into formulae acceptable to authorities who require traditional measures of performance.

Good learning happens when:
…students are given a clear learning objective that states what they will learn and how they can show that they’ve learnt it successfully. (Learning intentions and success criteria)
…students are given feedback that is geared towards teaching them how to improve.
…students are given multiple opportunities to practice something.
…students are assessed using criterion-referenced rubrics which are written in clear, accessible language. Students understand the rubric and know what success looks like.
…assessment is designed to teach.
…the emphasis is not on exams, but on more representative tasks that show student learning, rather than their ability to rote memorize. [ http://thinkedu.net/blog/criterion-referenced-assessment_learning-objectives/ ]

North American GPA equivalents in other countries 

source: http://www.universitiesintheusa.com/american-education.html

Country  GPA 2.0 GPA 2.5 GPA 2.75  GPA 3.0 
Bangladesh 46% 55% 60% 65%
China 70% 75% 78% 80%
France 10 11 11.6 12
Georgia 3 3-4 3-4 4
Ghana 3/C 2/B 2/B 2/B+
Hong Kong 50% 57% 60% 65%
India 46% 55% 60% 65%
Indonesia 6 6 7 8
Iran 12 13 13.8 14
Japan 3 3-4 3-4 4
Jordan 50% 60% 66% 70%
Kazakhstan 3 3-4 3-4 4
Korea 2.0 – 70% 2.5 – 75% 2.5 – 78% 3.0 – 80%
Macau 60% 65% 68% 70%
Mexico 6.0 – 60% 7.0 – 70% 7.3 – 76% 8.0 – 80%
Nigeria 7 6 4 3
Pakistan 46% 55% 60% 65%
Qatar 3 3-4 3-4 4
Russia 3 3-4 3-4 4
Saudi Arabia 3 – 70% 3 – 75% 3 – 78% 4 – 80%
Spain 5 5.5 6 7
Taiwan 60% 65% 68% 70%
Thailand 2 2.5 2.8 3
Turkey 5 6 7 8
UAE 70% 75% 78% 80%
Ukraine 3 3-4 3-4 4
Venezuela 10 11 13 14
Vietnam 5 5.5 6 7

An Open Letter to ‘The Director’ of All India Institute of Medical Sciences, New Delhi, India

Respected Sir (Dr. M. C. Misra),

I read your vision statement SIR at the following web address http://www.aiims.edu/images/vision-statement.pdf. Most humbly, although would look a bit absurd: I, Jeevanshu Dhawan being an independent citizen of a democratic country would like to provide you with few inputs regarding the future of healthcare and premier medical institutions in India; which I think is very important for every citizen, who truly believes India has every right to become a knowledge and research powerhouse for the entire world, as it did many centuries ago. This quote aptly describes my endeavour.

“Every heart that has beat strong and cheerfully has left a hopeful impulse behind it in the world, and bettered the tradition of mankind.” -Robert Louis Stevenson

Future_directions_Image

Sir, you start your vision statement with the following lines “AIIMS has become a household name in India and abroad with people from all strata of society looking up to it to provide unbiased, affordable and quality healthcare. This stature and trust from fellow citizens have not come overnight. It has taken decades of extreme hard work, by our founding fathers, to reach to this level. I believe that there is immense untapped potential in AIIMS which with the proper nurturing can make AIIMS a truly global brand.”

Medical-Tourism-Destination-India

Indeed what you said is true, but a lot of credit for the success of ‘AIIMS’ as a brand, also goes to the public in general, who let go of a few thousand schools that could provide their children world-class education and other basic amenities like toilets, which they forgo, and provided you with a budget which surpasses the best in the world

[around ₹11.24 billion (US$180 million) per annum; https://en.wikipedia.org/wiki/All_India_Institute_of_Medical_Sciences_Delhi].They also provided you with a vast gene pool, from amongst whom, you could find the best talent currently available in the world. They also provided you with rarest of rare diseases, providing the basis on which to perform your research, and a vast population of diseased patients, on whom you could practice your talents, eventually realising your true potential. AIIMS that you envision should keep the betterment of the 125 crore population of India and that of neighbouring countries, and not just a select few. One should work with the aim of service to these citizens of the country, not as masters with a thought of having a firm grip on their future, rather, as servants with care and compassion.

Righteousness

Where there is righteousness in the heart

There is beauty in the character.

When there is beauty in the character,

there is harmony in the home.

When there is harmony in the home.

There is an order in the nation.

When there is order in the nation,

There is peace in the world.

————Dr. APJ Abdul kalam

These are the excerpts from the Inaugural Address at the ILLUMINATI 2014 Armed Forces Medical College, Pune, September 15, 2014.

Culture of Excellence

Excellence in thinking and action is the foundation for any mission.

What is excellence?

Friends, you all belong to a youth community, which should stand for a culture of excellence. Moreover, excellence is not by accident.

It is a process, where an individual, organization, or nation continuously strives to better oneself.

The performance standards are set by themselves, they work on their dreams with focus, and are prepared to take calculated risks, and do not be deterred by failures as they move towards their dreams. Then they step up their dreams, as they tend to reach the original targets. They strive to work to their potential, in the process, they increase their performance thereby multiplying further their potential, and this is an unending life cycle phenomenon. They are not in competition with anyone else, but themselves.

That is the culture of excellence.

I am sure; each one of you will aspire to become unique with culture of excellence. Now, let me visualize how a dynamic healthcare centre or a hospital should be.

My visualization of great Healthcare centers

Dear friends, I visualize a great healthcare center with the following characteristics where:

1]. Patient is the most important person in the hospital. When the patient enters, the hospital presents an angelic look and all the team members of the hospital always wear smiles. The patient feels that “I am going to get cured”.

2]. The hospital consumes less electricity and less water by adopting green building for all modernization tasks. The choice of the power source is solar and wind.

3]. The hospital premises are totally noise free.

4]. All the test reports and treatment schedule are attached to the database of the patient through Electronic Medical Record without the need of the patient or the relatives to search for the reports. The data-base is updated and authenticated every hour.

5]. Maintain the database of all the cases treated by the hospital in the past, which are easily retrievable.

6]. Patient is not subjected to diagnostic pain.

7]. The surroundings of the hospital are green with full of trees with seasonal flowers and pleasant wall paintings.

8]. Further expansion of the hospital is in vertical mode leading to fast movement of the patient and doctors for medical treatment.

9]. There is no case of hospital-induced infection to the patients due to bio-contamination.

10]. The patients feel that this is the best place to get treated.

11]. The hospital is fully IT enabled leading to virtual connectivity of the patient to the doctor, nurse and the chief of the hospital 24×7. Hospital is also networked with other hospitals nationally and internationally for seeking expert medical advice on unique cases.

12]. The daily medical conference, attended by the Chief of the hospital, doctors, nurses, paramedics, and relatives of patients of unique cases, reviews problems of the patient and find integrated solutions.

Biology of Beliefs

Now friends, I was asking myself, is there any inputs and research which is coming from both, physio-psycho and brain researches, because of the advent of neuro-sciences coupled with quantum theory. I was reading a book, “The Secret Path” by Paul Brunton.

According to the author, the conscience is explained scientifically for the reason that the thinking process and biological processes converge through quantum mechanics. He says, that Physics and Biology are interlinked and that “At atomic level matter doesn’t even exist, it only has a tendency to exist”.

Recently, a friend of mine, who is a scientist sent me a book “Biology of Beliefs” by Dr. Bruce Lipton. The author is one of the greatest scientists in the bio-science and after 20 years of research he attributes the origin of human diseases and their cure have a basis on our intrinsic thinking and the relationship with our bio cells. The book talks about a new approach which highlights the importance of placebo effect and how it is actually a powerful belief effect. The author says “Doctors should not regard the power of belief as something inferior to the power of chemicals and scalpel. They should let go of the belief that the body and its parts are essentially stupid”.

Brainstorming in John Hopkins Hospital

Friends, Institute of Health in the US, in a survey found that 95,000 deaths every year occur in the United States due to medical errors. Though this information can be debated, this information was found to be very disturbing. It was recognized that there is a need for change in approach in medicare to improve the safety and quality of care to patients. In this connection, it was felt that it is important to train the doctors, nurses, paramedics, technicians and everyone connected with medicare the need to follow the treatment line meticulously. Modern hospital is a very complex organization and there are challenges ahead to improve the safety of the patients. Quality medicare is possible only when people work together as a team. I am told, that a seminar was conducted at Johns Hopkins Hospital where there was a brainstorming session between the doctors, medicare personnel, patients and the relatives of the patients, which brought out all these factors very clearly. I will be very happy if our super specialty hospitals conduct such type of review periodically in the combined meeting of doctors, nurses and paramedical staff. I am sharing this to the medical community, because this type of integrated conference has been conducted after the occurrence of tragic incident in Johns Hopkins Hospital. A child’s life was lost because of poor judgment in the diagnosis. The mother of the child briefed the whole incident to the combined gathering of the hospital team. It was a moving experience of the mother. I would like to share with you, particularly while attending the cardiac patients in pre operative, operative, post operative and recovery period, large number of sophisticated instruments and monitoring systems are used. In this scenario, experience of treatment profile and the problems have to be shared together on fixed days of the week and the results documented. It will become a teaching wealth for cardiac care specialists. pill-india3

Six virtues a care giver must possess

Friends, in conclusion, I would like to share my experiences with Choakyi Nyima Rinpoche, the Chief Monk in Kathmandu and a medical researcher. After nearly a kilometer of walk, I reached the white Kumbha where the chief Monk and his disciples were waiting to receive me. After reception the Chief Monk said, let us go to our study room and I followed him. He climbed the first floor, the second floor, the third floor, the four floor and the fifth floor, just like a young boy. Probably the life style has a positive impact on the mind and body. All along I was following and following. When I reached his chamber, I saw a laboratory and a spiritual environment over-looking the Himalayas. What surprised me was, his research students come from different parts of the world. Particularly he introduced me to his co-author David R Shlim, MD who is working on a research area, Medicine and Compassion. The Chief Monk Choakyi Nyima Rinpoche and myself exchanged few books. The Monk has written with Dr. David R. Shlim a book titled “Medicine and Compassion”. I liked this book and read it during my journey from Kathmandu to Delhi. This book gives six important virtues which a medical practitioner has to possess towards their patients.

First virtue is generosity;

the second virtue is pure ethics;

third is tolerance,

fourth is perseverance,

fifth is cultivating pure concentration

and the

sixth virtue is to be intelligent.

These virtues will empower the care givers with a humane heart. I am sure, the medical community assembled here, practice all these six virtues as a habit while dealing with the needy patients. This itself is a great example of synergy between mind, body and medicine.

Conclusion

Friends, I want to leave you all with a thought today.

What is the one action, which will make you great?

Every one of you has a page in the history of the world?

What is that page?

How do you make that page which is going to be referred by the posterity?

There is a need to give a vision to your ambitions.

What is that mantra?

Yes, the mantra is the following:

“What I will be remembered for?”

If you find an answer for this question in a few lines, that out-of-the-box idea will drive you for the rest of the life. You will be definitely thinking something different ?

an out of box mission, what are they?

Can I visualize along with you?

Each one of you will derive your own vision.

1]. Will you be remembered for bringing smiles of health and joy to all the patients?

2]. Will you be remembered for helping create a unique, cost effective vaccine against malaria and thereby saving more than one million people, mostly children who lose their lives due to the disease?

3]. Will you be remembered for creating a roadmap for reviving the 23,000 Primary Healthcare Centres, across the nation, which would enable them to deliver the much needed primary health facilities to the remote regions?

4]. Will you be remembered as a champion of preventive healthcare in the areas of cardiology, diabetic and infectious diseases?

5]. Will you be remembered as a great teacher in preventive care for the disease to the families of patients?

6]. Will you be remembered for contributing in a unique way in finding a cure for diseases such as cancer and HIV?

My best wishes to all the participants of ILLUMINATI 2014 for their deliberations and success of AFMC in the mission of providing quality and research oriented medical education. May God bless you.

Oath for medical professionals

  1. I love my medical profession- a noble mission.
  2. I will follow the motto “Let my care, remove the pain and bring smiles”.
  3. I will always radiate cheer to give confidence to patients and their families.
  4. I will be a life-long learner, I will practice what I learn and I will train my team to be competent.
  5. I will deliver quality care with high standards irrespective of whom I am treating.
  6. I will not introduce any diagnostic pain.
  7. I will work with integrity and succeed with integrity.
  8. My National Flag flies in my heart and I will bring glory to my nation.

Dr A.P.J Abdul Kalam

Let me close my letter with these famous lines by H.W. Longfellow:

“So let us be up and going, With a heart for any fate, Still achieving, still pursuing, Learn to labour and to wait.”

Thanking You,

Yours faithfully,

Jeevanshu Dhawan.

Some Important Considerations to be Kept in Mind While Examining the Paediatric Age Group

Overview 002

Image Courtesy: NUHS Paediatric Residency Program

With more facts,our minds are not only sorting and eliminating but also correlating. The human mind uses several means to correlate. One example is pattern recognition. The German idiom augenblick (“blink of the eye”) illustrates this.

Every examiner brings with him or her a lifetime’s experience. Moreover, observers may have had similar experiences but have incorporated them differently.

To illustrate this, there is the old story of two men walking down the street at the same time a woman is walking on the opposite side. One of the men notices her and says to the other,

“Look at that elderly woman. She seems to be in her early seventies, has gray hair, walks with a mild limp, holds her left arm and wrist slightly flexed, but speaks quite fluently with what seems to be a middle-European accent.”

The second man replies, “Oh, that’s my mother.”

Thus we all look at things in the aggregate or in its parts based on our own personal experience. With less experience, the learner is more likely to use a systematic approach, whereas the more experienced physician may be more likely to use the augenblick approach. However, it is important to realize that no matter how much experience a physician may have, if the augenblick approach does not render a comfortable feeling with the diagnosis, it is necessary to fall back on the systematic approach. Thus it is incumbent on all of us not to forget how to use a systematic approach.

Fever

The definition of fever is a core temperature of 38.0°C (100.4°F) or higher. There is a tendency among lay people to call any temperature above 37.0°C (98.6°F) a fever. This often leads to inappropriate treatment with antipyretics and can result in inappropriate diagnostic procedures.

Shock

Unlike adults, who become hypotensive early in the course of shock, children are able to preserve their blood pressure until the late stages of shock, partly through peripheral vasoconstriction but primarily by increasing their cardiac output through tachycardia.

Therefore, tachycardia with normal blood pressure is frequently the presentation of shock.

Hypovolemia and hypovolemic shock are usually identifiable in the early stages by tachycardia, but septic shock also can present initially as tachycardia and can, if diagnosed soon enough, be treated with volume.

Orthostatic Changes in Blood Pressure and Heart Rate

Since heart rate and central arterial pressure will vary immediately after changes in position, measurements taken right on position change are almost certain to be abnormal. It is preferable to wait after each position change before the next measurement, as in the following procedure:

  1. Have the patient lie supine for at least 5 minutes.
  2. Measure heart rate and blood pressure with the patient still supine.
  3. Have the patient sit up.
  4. Wait 2 minutes.
  5. Hold the patient’s arm so that the cuff is at the level of the heart and measure the sitting heart rate and blood pressure.
  6. Have the patient stand upright.
  7. Wait 2 minutes.
  8. Hold the patient’s arm so that the cuff is at the level of the heart, and measure the standing heart rate and blood pressure.

Orthostatic tachycardia and hypotension may occur in a patient who has been at bed rest for a prolonged time. Thus it is important to have the patient sit up as frequently as possible while in bed.

Other causes of orthostatic tachycardia and hypotension include hypovolemia, autonomic dysfunction, and chronic malnutrition.

Failure to Thrive

Failure to thrive is weight loss or failure to gain weight without obvious cause.

Making correct medical diagnoses is a scientific endeavour. Humankind has employed scientific reasoning since ancient times, although it came more to fruition during the Renaissance.

Over long years, technology has changed, but this only involves the tools we use. Sadly, we often resort to high-technology “tests” before we perform a complete history and physical examination.

Studies have demonstrated that state-of-the art magnetic resonance imaging may yield diagnoses not consistent with those ultimately found at autopsy. Good clinical evaluation is still essential to developing working hypotheses, which then get “tested.”

Always  remember:

Tests test hypotheses, not patients. Good working hypotheses serve two purposes: to guide us to which tests to employ and to guide us in their interpretation.

Human minds are capable of thinking on one end of the spectrum, scientifically, based solely on cold facts, or thinking, on the other end of the spectrum, religiously, based solely on faith. Historically, medical reasoning has developed along scientific lines.

However, we all know that medicine is not a perfect science, and although we strive to gather the most appropriate data and to interpret them correctly, physicians and patients are complex entities whose experiences have profound effects on gathering and interpreting data.

Hippocrates knew this when he stated,

“It is more important to know what sort of person has a disease than to know what sort of disease a person has.”

Thus clinicians, although doing their best to apply the scientific method, still find themselves

embedded in that “tug of war” between fact and opinion. We must recognize, humbly, that we can gather imperfect data and that we have to make judgments every day.

Medical Reasoning Within The Diagnostic Framework

The human mind always seeks information,

sorts it,

eliminates what appears to be irrelevant,

correlates the data,

and

then puts together the remainder into a unifying hypothesis.

It often repeats this sequence, not necessarily consciously. Thus the time-tested diagnostic framework has evolved out of the scientific method (adapted from De Gowin):

Step 1: Take a history. Elicit symptoms.

Step 2: Develop hypotheses. Generate a mental list of pathophysiologic processes and diseases that might produce these symptoms. Then use processes of sorting, eliminating, and correlating to narrow it down.

Step 3: Perform a physical examination. Look for signs of the physiologic processes and diseases suggested by the history, determine what corroborates it, eliminate further what is irrelevant, and perhaps identify new problems to add to the list.

Step 4: Generate a differential diagnosis. List the most probable hypotheses in the order of their possibility.

Step 5: Test the hypotheses. Select laboratory tests, imaging studies, procedures, and consultations with appropriate likelihood ratios to evaluate your hypotheses. Do this mindful of risk, cost, benefit, and logistics.

Step 6: Modify your differential diagnosis. Use the results of the tests to evaluate your hypotheses, perhaps eliminating some and adding others and adjusting the probabilities.

Step 7: Repeat steps 1 to 6. Reiterate your process until you have reached a diagnosis or have decided that a definite diagnosis is neither likely nor necessary.

Step 8: Make the diagnosis or diagnoses. When the tests of your hypothesis are of sufficient certainty that they meet your stopping rule, you have reached a diagnosis.

Step 9: If uncertain, consider a provisional diagnosis or watchful waiting. Decide whether more investigation (return to step 1), consultation, treatment, or watchful observation is the best course based on the severity of the illness, the process, and co-morbidities. If the diagnosis remains obscure, retain a problem list of the unexplained symptoms and signs, as well as the laboratory and imaging findings; assess the urgency for further evaluation; and schedule regular follow-up visits.

Adapted from the Pediatric Diagnostic Examination by

Donald E. Greydanus, MD
Arthur N. Feinberg, MD
Dilip R. Patel, MD
Douglas N. Homnick, MD, MPH