Transitioning medical education towards trans-disciplinarity

Dear Editor,

I read with interest the editorial calling for public health departments in all medical colleges in India.[1] The brute force of clinical medicine and its sub-specialities (including community medicine) has little to offer to mitigate the health challenges of our time- pandemic, inequity, and the climate crisis. The problems are complex and not bio-medical in nature. As such its solutions too need trans-disciplinarity – something which public health perfectly offers. The editorial[1] also briefly alludes to the necessity of continuing to invest in community medicine – an issue that merits further discussion.

Historically, community medicine as a discipline has its roots in urban-centric medical education system. It was seen “as a ‘pump’ that will go out into the community and bring in a sufficient number of patients to provide teaching material”.[2] Over the years, the discipline of community medicine has evolved, but it continues to struggle to defining itself, and arguably not in alignment with the needs of the job market (other than the teaching MBBS students).[3] Community medicine training consists of a bit of family medicine and a bit of public health- with no advanced competencies on either. Family medicine is now an established discipline with its own scholarly niche, a clear generalist approach towards clinical care rooted in the philosophy of primary care.[4] Public health developed outside medical universities, and global scholarly work has meant it has a strong but continually evolving philosophical basis. Both family medicine and public health have some commonalities – they do not shy away from integrating concepts from various disciplines; are collaborative in nature; and its post-graduates are job-ready. Community medicine on the other end has been not able to move away from the clinical lens and has no clear philosophical leanings.[5] Surely teaching medical students alone cannot be an enough justification for continued investment on community medicine. In fact, public health might replace community medicine someday in medical colleges too. Reforms in community medicine require urgently exploration of several questions. How and why did the loss of status happen? Can regulatory protection and trade unionism withstand real-world needs? How can attitudes of community medicine graduates who think a clinical interaction provides a superiority over knowledge acquired by other disciplines, like social science, be changed? How can community medicine embrace transdisciplinary approaches? What niche can it carve away from public health and family medicine? How can this niche contribute to solving problems of this century?

The answers to these questions are no doubt complex and need scholarly work. Such work would involve social science, history, political science, to name a few; disciplines from which community medicine has alienated itself for many decades. The answer to the questions is perhaps uncomfortable too. But without the answers, and without embracing transdisciplinarity, community medicine risks dying a slow natural death.

Financial support and sponsorship

Nil.

Conflicts of interest

The author is a medical doctor who chose international public health over community medicine as a career pathway about a decade back. No other competing interest to declare.