Curriculum vitae

Ravindran Chetambath                                           Navaneeth,

Professor & Head                                                                            Sarovaram Road,

Dept. of Pulmonary Medicine                                                          Civil Station PO,

DM WIMS Medical College                                                         Calicut- 20,673020,

Wayanad.                                                                                             Ph: 9446951712

Ph.8111881232                                                                            crcalicut@gmail.com

Profile

Presently working as a Professor & Head in the Department of Pulmonary Medicine and Vice Dean, DM Wayanad Institute of Medical Sciences, Wayanad, Kerala, attending the challenges in medical education and providing comprehensive care to all sections including underprivileged in a back ward district of Kerala. Interested in working in different and challenging areas where I can make a clear difference in medical teaching as well as patient care. I also work with district health authorities in TB control program of the district, thus contributing to case detection, treatment and prevention.

Medical Employment

Professor & Head, Dept. of Pulmonary Medicine & Vice Dean	DM Wayanad Institute of Medical Sciences, Wayanad	From Nov 2015 onwards
Principal	Govt. Medical College, Kozhikode	24.07.2009 to 30.04.2015
Professor & Head. Dept. of Pulmonary Medicine,	Govt. Medical College, Kozhikode	09.08.2002 to 24.07.2009
Professor & Head. Dept. of Pulmonary Medicine	Govt. Medical College, Alappuzha	14.11.2000 to 08.08.2002
Associate Professor, Dept. of Pulmonary Medicine	Govt. Medical College, Kozhikode	07.07.1997 to 07.11.2000
Assistant Professor, Dept. of Pulmonary Medicine	Govt. Medical College, Kottayam & Kozhikode	04.01.1990 to 07.07.1997
Tutor, Dept. of Pulmonary Medicine	Govt. Medical College, Kozhikode	24.06.1985 to 02.01.1990

                       

Qualification:           

Indira Gandhi Open University     M.B.A (Human Resource Management)   2007

University of Calicut                     M.D (Internal Medicine)                            1988

University of Calicut                      D.T.C.D (Chest Diseases)                          1985

University of Calicut                      MBBS                                                        1981

Former Positions Held:

• Member, PG Board of Studies, University of Calicut
• Member, PG Board of Studies, Kerala University of Health Sciences
• Member, Academic Council, University of Calicut
• Member, Governing Council, TB Association, Kerala
• Member, Chairperson, Indian Chest Society- South zone chapter and Governing Body of Indian Chest Society
• Chairman, RNTCP – State Task Force, Kerala

Presently holding

• Section Editor, Lung India
• Member, Editorial Board, CHEST (India Edition)
• Reviewer, International Journal of Tuberculosis and Lung Diseases
• Member, Local Advisory Committee, Regional Science Centre, Calicut
• Chairman, Indian Chest Society-Kerala State chapter

Memberships

•                    Europian Respiratory Society

•                    Indian Chest Society( L-295)

•                    Indian Medical Association

•                    Association of Physicians India

•                    Indian Society of Critical Care Medicine

•                    Indian Association of Bronchology

•                    Academy of Pulmonary and Critical Care Medicine

•                    International Medical Science Academy

Awards & Honours

•                    Fellow of the Academy of Pulmonary & Critical Care Medicine(FACCP)

•                    Fellow of International Medical Science Academy (FIMSA)

•                    Dr C V Ramakrishnan-ICS Chest Oration 2010 ( Napcon 2010)

•                    Academy Oration 2009, Academy of Pulmonary & Critical Care Medicine Annual Conference

•                    Dr NVU Warrier Oration 2011

•                    Sher E Kashmir Sheik Abdulla Memorial Oration 2012, Jaipur-Rajasthan

•                    Mother Theresa National Award 2013

•                    Rotary excellence award 2014

Achievements

·         PG teacher and PG guide for MD-Pulmonary Medicine

·         PG examiner for various Universities for MD, DTCD and DM

·         Examiner for Diplomate of National board

·         Organizing Secretary, NAPCON 2009 held at Calicut

·         Co-investigator for ongoing research projects of Indian Chest Society ( ILD India Registry and SWORD Survey)

·         Instrumental in starting DM Pulmonary Medicine in Govt. Medical College, Kozhikode

·         Instrumental in starting MD Family Medicine for the first time in India in Govt. Medical College, Kozhikode

·         Set a simulation Lab in Govt. Medical College, Kozhikode

·         Set up Medical Thoracoscopy facility and Sleep Lab in a Govt. institution for the first time in the state.

·         Faculty for NAPCON since 2001

Published Research papers as first author:

1. Ravindran C: Allergic bronchopulmonary aspergillosis. Pulmon 1999,1:19-21
2. Ravindran C: Bronchiolitis obliterans organizing pneumonia(BOOP). Pulmon 2000,2:123-126.
3. Ravindran C, Ramachandran PV, Babu KMRC, Suhail N: Benign fibrous tumour of the pleura. Pulmon 2000, 2:142-147.
4. Ravindran C: An unusual cause of dysphagia and stridor. Pulmon 2001,3:77-80
5. Ravindran C: Asthma Guidelines simplified. Pulmon 2001,3:67-70
6. Ravindran C, Venugopal P, Prasad KM: Changing face of mycobacterial drug resistance. Pulmon 2001,3:109 -113
7. Ravindran C: Mycobacterial resistance to Pyrazinamide. Lung India 2002,20:9-11
8. Ravindran C: Late onset asthma. Pulmon 2003,5:58 -62
9. Ravindran C: Diesel exhaust and respiratory allergy- Is there a link? Pulmon 2003,5:81 -82
10. Ravindran.C, Sudin Koshy, Madhusudan.K.S, Rajalakshmi.P.C, Rauf C.P, Nasser Yusuf: Pulmonary Alveolar proteinosis: A case Report. Calicut Medical Journal 2003;1(1):e7
11. Ravindran C: N-Acetyl Cysteine: Its new role in ILD. Pulmon 2005; 7(1):3-5.
12. Ravindran C, Suraj KP, Mohammed Mustafa, Harilakshmanan, Sajeev Kumar P, Yusuf Nasser: Hemangioendothelioma of Pleura- A rare neoplasm. Pulmon 2005,7:1:44-49
13. Ravindran C,James PT,Jyothi E: Prevalence of initial drug resistance of mycobacterium tuberculosis in northern kerala.Lung India 2006;23:106-108.
14. Ravindran C,Durga Balagopalan,Mohammed Musthafa A: Medical Thoracoscopy-An interventional procedure for the pulmonologists; Pulmon 2006;8:2:10-13
15. Ravindran C: Critical Thinking in Clinical Practice;Pulmon 2006;8:3:73-75
16. Ravindran C, Arun P, Harilakshmanan, et al: Syndrome Z- The new metabolic syndrome; Calicut Medical Journal 2007;5(1)e1
17. Ravindran C: Study of Factors Influencing The Work Output of Human Resource in Revised National Tuberculosis Control Programme (RNTCP); Pulmon  2007;9:3:88-96

18.  Ravindran C, Padmanabhan K V, Sreedhar Rejna: A study of correlation between transhilar diameter and P pulmonale in COPD patients; Lung India 2008; 25(4):145-147.

19. R Chetambath,S Babu,PT James. Correlation between Epworth sleepiness score and polysomnographic indices in sleep disordered breathing. ERJ 2008;32:S 51
20. Ravindran C,James P T,Moyinkutty K,Abdul Khader AK,Velayudhan C C.Clinical significance of P wave amplitude and axis in ECG of COPD patients during acute exacerbations. ERJ 2008; 32: S 51
21. Ravindran Chetambath, M. S. Deepa Sarma, K. P. Suraj, E. Jyothi, Safreena Mohammed, Beena J. Philomina, S. Ramadevi: Basidiobolus: An unusual cause of lung abscess. Lung India 2010; 27:89-92.
22. Ravindran C. Resurgence of H1N1 Influenza in 2010: Editorial. Chest(India edition) 2010;2(4):195-97
23. C Ravindran. Psychiatric morbidity in COPD. Pulmon 2011;13(3):86-91
24. Ravindran C, James P T, Sajeev C G, Paulo Varghese Akkara. Cardiovascular implications in obstructive sleep apnoea-hypopnoea syndrome. Pulmon 2011;13(3):92-97
25. Ravindran Chetambath, Jyothi Edakalavan. Diagnostic Approach to Pneumonias. World Clin Pulm Crit Care Med 2012;1(1):19-46
26. Ravindran C.Septicemia due to Mycobacterium tuberculosis. Editorials CHEST (India Edition) / 4 / 3 / 2013;1
27. Ravindran Chetambath. Emerging Respiratory Viral Infections. Pulmon 2013;15(1):01-03

28.  Ravindran Chetambath, Jabeed Parengal, Mohammed Aslam, Sanjeev Shivashankaran. Severe pneumonia in a young female with a possible causal relationship to hypothyroidism - A case report and review of literature. IJMAR 2017; 2(2), 17-24

29.  Ravindran Chetambath. Tracheobronchomalacia in obstructive airway diseases. Lung India 2016; 33 (4):451-52.

30.  Ravindran Chetambath, Jabeed Parengal, Mohammed Aslam, Sanjeev Shivashankaran. Esophagus Associated Lung Diseases- A Retrospective Study. JMSCR 2017; 5(3): 18289-96

31. Ravindran Chetambath, Jabeed Parengal, Mohammed Aslam, Sanjeev Shivashankaran. Cut Pumpkin Sign- A Diagnostic Radiological Sign in Pulmonary Contusion. JMSCR 2017; 5(7): 25464-466.
32.  Ravindran Chetambath, Jabeed Parengal, Mohammed Aslam, Sanjeev Shivashankaran. Bilateral morgagni hernia in a case of Weill-Marchesani syndrome-                     a rare association. International Journal of Research in Medical Sciences 2017;5(6):2790-93.
33. Ravindran Chetambath, Jabeed Parengal, Mohammed Aslam, Sanjeev Shivashankaran. Lung involvement in accident victims: report of three cases. Int J Res Med Sci. 2017; 5(9):4167-4171. DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20174005
34. Ravindran Chetambath. Role of probiotics in preventing acute respiratory tract infections- Review article. Pulmon 2016; 18(2):57-60.
35. Ravindran Chetambath, Jabeed Parengal, Mohammed Aslam, Sanjeev Shivashankaran. Aspiration pneumonia due to esophageal cause in the elderly. Pulmon 2016; 18(2):71-73.
36. Ravindran Chetambath. Medical teaching- is there a better alternative? (Editorial). Pulmon 2016; 18(1):5-11.

Published Research papers as Co-author:

1.      C.M. Shyam, V. Achuthan, K.P. Govindan, N.V.V. Warrier, K.S. Menon, C. Ravindran, K.M. Ramesh Chandra Babu. Peripheral lymph node tuberculosis in adults in North Kerala. The Indian J Tuberculosis 1995;42(2):126

2.      KMRC Babu, Rajagopal TP,Suraj KP, Ravindran C: Unusual radiological presentation of a common disease. Pulmon 1999,1:45-46

3.      Achuthan V,Menon KS, Ravindran C, Shyam C M,Mohammed faizy AH,Vijayan VP: Aneurysm of Diverticulum of Kommerell- A case of tracheal compression. Pulmon 1999,1:90-92

4.      Ramachandran PV, Ravindran C, Babu Varghese: Solitary lung cyst with a Mycetoma- A rare pulmonary manifestation of Tuberous sclerosis complex. Lung India.

5.      Abdul Sathar A A, Ravindran C, Achuthan V: Radiological pattern of Pulmonary Tuberculosis in diabetes mellitus. Pulmon 2000,2:94-96

6.      Venugopal P, Raseela karunakaran, Ravindran C: Mediastinal Lymphangioma- A rare presentation. Lung India 2002; 20:9-11

7.      Sreejith MO,Abdul Nazar, Ravindran C, James PT, Remeshchandrababu KM: Drug resistance of MycobacteriumTuberculosis to Quinolones- a prospective clinical study. Pulmon 2004,6:90-94

8.      Emil J Thachil, Praveen Sreekumar, Harilakshmanan, Mohanan J
Manjakara, Anoop Kanaran, Mohammed Musthafa, Sooraj K P, Ravindran C: An Unusual Cause for Pulmonary Metastasis. Calicut Medical Journal 2005; 3(3):e5

9.      Dhanya TS, Rajagopal TP, Ravindran C, Binoy J Paul: Bronchiolitis
obliterans organizing pneumonia(BOOP) in SLE- An unusual presentation. Pulmon 2005,7:2:81-84

10.  Abdul Nazar, Mohammed Mustafa, Suraj KP, Ravindran C: Churg- Strauss syndrome: A case report. Pulmon 2005,7:2:90-94

11.   Anandan.PT, Rajgopal TP,James PT, Ravindran C:Clinical profile of patients undergoing fibreoptic bronchoscopy in a tertiary care setting. Indian J Bronchology, 2006 (May-Aug):1:58

12.  Abdul Nazar T,Mohammed Musthafa A,Suraj KP, Ravindran C:Bronchial stump  carcinoma ; A rare cause; case report.Indian J Bronchology; 2006 (May-Aug) :1:72

13.  Elizabeth Sunila C.X, Safreena Mohammed, Jyothi E, Suraj K P, Ravindran C: Limited wegener's granulomatosis - A case report; Pulmon  2008;10:1:19-22

14.  Lakshmanan P Hari, Musthafa A Mohammed, Suraj K P, Ravindran C: Pleuropulmonary hydatid disease treated with thoracoscopic instillation of hypertonic saline; Lung India; 2008; 25 (1).

15.  Dhanya T S, Ravindran.C: Medical Thoracoscopy Minimally invasive diagnostic tool for a trained Pulmonologist; Calicut Medical Journal 2009; 7(1) e4.

16.  Jaffer Basheer,Biju George, Ravindran C. Smoking cessation intervention strategies for adults in different populations-A systematic review. Lung India 2009; 26(S):13

17.  Nithya Haridas,Divya R,Sijith K R,Jyothi E,Anandan P T, Ravindran C. Clinical Profile and treatment outcome of DPLD in a tertiary care setting. Lung India 2009; 26(S):18

18.  Padmavathy R, Muraly C P,Sunny George,Jyothi E, Ravindran C. Factors determining length of hospital stay in patients with pleural effusion admitted in a tertiary care setting. Lung India 2009; 26(S):18-19

19.  E V Krishnakumar,Sunny George,T P Rajagopal,P T James, Ravindran C. Correlation between essential hypertension,obesity and sleep apnoea hypopnoea syndrome- A prospective clinical study. Lung India 2009; 26(S):15

20.  Lisha PV, Jyothi E, santhosh KumarPV,James P T, Ravindran C. Evaluation of new smear positive tuberculosis patients 5 years after initiation of treatment under DOTS programme.Lung India 2009;26(S):15

21.  Divya R,Durga B,Mohammed Mustafa,Jyothi E,Suraj K P, Ravindran C. Study comparing the efficacy and side effect profiles of inhaled steroids Ciclosonide and Fluticasone in patients with moderate persistent Astma.; Lung India 2009;26(S):10

22.  Arun Prabhakaran, Ravindran Chetambath, Sunny George. Measurement of cephalometric indices in patients with obstructive sleep apnea.ERJ 2009; 34(S53)

23.  Deepa Sarma, Ravindran Chetambath, E. Jyothi, T.P. Rajagopal, P.T. James. Predictors of mortality in COPD during acute exacerbation. ERJ 2009; 34(S53)

24.  Venugopal Panicker, C. Ravindran .Nasobronchial allergy and pulmonary function abnormalities among coir workers of Aalappuzha.ERJ 2007; 30:S 51

25.  Sunny George, Rajagopal TP, James PT, Ravindran Chetambath: A trend analysis of Diabetic patients with MDR-TB initiated on DOTS PLUS regimen. Pulmon 2010; 12(1):5-10

26.  PV Lisha, PV Santhosh Kumar,Thomas James Ponneduthamkuzhy, Ravindran Chetambath: Evaluation of new smear positive tuberculosis patients 5 years after initiation of treatment under a DOTS programme. ERJ 2010; 36(S 54):1025

27.   Venugopal panicker, Raseela Karunakaran, Ravindran C: Nasobronchial allergy and pulmonary function abnormalities among coir workers in Alappuzha. JAPI 2010; 58:420-422

28.  Divya R, Ravindran C. Clinical profile, treatment response and survival of patients with idiopathic pulmonary fibrosis in a tertiary care setting-A prospective study.Pulmon 2011; 13:16-20.

29.  P V Lisha, P T James, C Ravindran. Morbidity and mortality at five years after initiating category-1 treatment among patients with new sputum smear positive pulmonary tuberculosis. Indian J Tuberc 2012; 59:83-91

30.  NIthya Haridas, Suraj K.P, Rrajagopal T.P,James P.T, Ravindran Chetambath. Medical Thoracoscopy vs Closed Pleural Biopsy in Pleural Effusions: A Randomized Controlled Study. Journal of Clinical and Diagnostic Research. 2014 May, Vol-8(5): MC01-MC04

31.  Ethan Rubinstein, Tahaniyat Lalani, et al and the ATTAIN Study Group. Telavancin versus Vancomycin for Hospital-Acquired Pneumonia due to Gram-positive pathogens. Clinical Infectious Diseases 2011; 52(1):31–40.

32.  Surendra K. Sharma, Alladi Mohan, L.S. Chauhan, J.P. Narain, P. Kumar, D. Behera, K.S. Sachdeva, Ashok Kumar, for Task Force for Involvement of Medical Colleges in the Revised National Tuberculosis Control Programme. Contribution of medical colleges to tuberculosis control in India under the Revised National Tuberculosis Control Programme (RNTCP): Lessons learnt & challenges ahead. Indian J Med Res 2013; 137: 283-294

33.  Bridget Collins, Sheetu Singh, Jyotsna Joshi, Deepak Talwar, Sandeep Katiyar, Nishtha Singh, Lawrence Ho, Jai Kumar Samaria, Parthasarathi Bhattacharya, Rakesh Gupta, Sudhir Chaudhari, Tejraj Singh, Vijay Moond, Sudhakar Pipavath, Jitesh Ahuja, Ravindran Chetambath, Aloke Ghoshal, Nirmal Kumar Jain, Gayathri Joshy, Surya Kant, Parvaiz Koul, Raja Dhar, Rajesh Swarnkar, Surendra Sharma, Dhrubajyoti Roy, Kripesh Sarmah, Bhavin Jankharia, Rodney Schmidt, Virendra Singh, Ganesh Raghu. ILD-India registry: Idiopathic pulmonary fibrosis (IPF) and connective tissue disease (CTD) associated interstitial lung disease (CTD-ILD). European Respiratory Journal 2016; 48: PA812

34.  Thomas James Ponneduthamkuzhy, B.R. Sandeep, P.V. Santhosh Kumar, Chetambath Ravindran. A study to analyse the clinical profile and outcome of hospitalised patients with H1N1 and the factors influencing the outcome. European Respiratory Journal 2011; 38: p4355

35.  Sheetu Singh, Bridget Collins, Bharat Bhushen Sharma, Jyotsana M. Joshi, Deepak Talwar, Sandeep Katiyar, Nishtha Singh, Lawrence Ho, Jai Kumar Samaria, Parthasarthi Bhattacharya, Rakesh Gupta, Sudhir Chaudhari, Tejraj Singh, Vijay Moond, Sudhakar Pipavath, Jitesh Ahuja, Ravindran Chetambath, Aloke G. Ghoshal, Nirmal Kumar Jain, H.J. Gayathri Joshy, Surya Kant, Parvaiz Koul, Raja Dhar, Rajesh Swarnkar, Surendra K. Sharma, Dhrubajyoti Roy, Kripesh R. Sarmah, Bhavin Jankharia, Rodney A. Schmidt, Virendra Singh, Ganesh Raghu.Environmental exposures in 513 patients of hypersensitivity pneumonitis: Prospective ILD India registry. European Respiratory Journal 2016, 48: PA3882

36.  Sethu Babu, Beena Thomas, Ravindran Chetambath. Correlation between Epworth Sleepiness Score and Polysomnographic Indices in Sleep Related Breathing Disorders. JMSCR 2014; 2(8): 2082-2089.

37.  Sheetu Singh ; Bridget F Collins ; Bharat B Sharma ; Jyotsna M Joshi ; Deepak Talwar ; Sandeep Katiyar ; Nishtha Singh ; Lawrence Ho ; Jai Kumar Samaria ; Parthasarathi Bhattacharya ; Rakesh Gupta Sudhir Chaudhari ; Tejraj Singh ; Vijay Moond ; Sudhakar Pipavath ; Jitesh Ahuja ; Ravindran Chetambath ; Aloke G Ghoshal ; Nirmal K Jain ; HJ Gayathri Devi ; Surya Kant ; Parvaiz Koul ; Raja Dhar ; Rajesh Swarnakar ; Suresh Kumar Sharma ; Dhrubajyoti J Roy ; Kripesh R Sarmah ; Bhavin Jankharia ; Rodney Schmidt ; Santosh K Katiyar ; Arpita Jindal ; Daya K Mangal ; Virendra Singh ; Ganesh Raghu. Interstitial Lung Disease (ILD) in India: Results of a Prospective Registry

38.  Sunny George, T P Rajagopal, P C Annamma, P T James, Ravindran Chetambath. Sharing five years’ experience of delivering DRTB services from a tertiary care setting- A descriptive study. KMJ 2015; 8(1): 6-13.

39.  Sunny George,            Rajagopal T.P, Annamma P. C, James P.T, Ravindran Chetambath. Decentralizing drug-resistant tuberculosis centre services by offering virtual consultancy- a Kozhikode model. IJRMS 2017;5(5): DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20171479       

Text Book Chapters

1)      Chapter on Lung Abscess in “Text Book of Pulmonary & Critical care Medicine” by SK Jindal, Jaypee Publishers 2010.

2)      Chapter on Medical Thoracoscopy in “Text Book of Pulmonary & Critical care Medicine” by SK Jindal, Jaypee Publishers 2010.

3)      Chapter on Interstitial Lung Diseases in “NCCP Text Book of Respiratory Medicine” by D Behera , Jaypee Publishers,2011

4)      Diagnostic approach to Pneumonia, Chapter in World Clinic of Pulmonary & Critical Care Medicine Published by Jaypee Publishers 2012

5)      Chapter on Infection control issues in Pulmonary Function laboratory in “SPIROMETRY” by D.Behera, Kothari Medical Subscription Pvt. Ltd 2015.

6)       “Paediatric Respiratory Illness”, MacMillan Medical Communications. 2011.(2^nd edition 2015)

7)      Pulmonary Infections- Chest X-ray Illustrated (Booklet) Mac Millan Medical Communications.2013

8)      Interstitial Lung Diseases- Chest X-ray Illustrated (Booklet) Mac Millan Medical Communications.2014

9)      Lung Tumors- Chest X-ray Illustrated (Booklet) Mac Millan Medical Communications.2014.

10)  Pleural Diseases- Chest X-ray Illustrated (Booklet) Mac Millan Medical Communications.2015

11)  X Rays Atlas: Images in common respiratory diseases ( Book) Mac Millan Medical Communications.2016

Personal Details

Name:                                     Ravindran Chetambath

Address:                                 Navaneeth, Sarovaram Road, Civil Station Post, Calicut,India, Pin 673020

Telephone:                             +919446951712, +91811881232

Email:                                     dr.ravindranc@dmwims.com,

 crcalicut@gmail.com

Date of birth:                         18.11.1954

Gender:                                  Male

Nationality:                            Indian

Marital Status:                       Married

Educational Qualifications: 

Indira Gandhi National Open University, MBA (HRM) 2004-2007

University of Calicut, DTCD (Chest Diseases) 1983-85

University of Calicut, M.D (General Medicine) 1986-88

RETIREMENT SPEECH

FARE WELL SPEECH ON RETIREMENT(30/04/2015)

Dear Colleagues,students and friends,

Thank you for giving me such a farewell on this day.I would also place on record my gratitude for the love and care given to me during my tenure as Principal.

As principal of Govt Medical College,Kozhikode for a reasonably long period of almost 6 years, I feel humble and satisfied. I am the 26^th principal of this institution and is second to the legendary Dr Ananthanaranan Sir as far as duration of tenure is considered.

I joined this institution as an MBBS student in 1975. I studied for Diploma in Chest diseases and MD in General medicine in this college itself. In 1985 I started my carrier as a Tutor in Chest Department. When I was elevated to this post many of my relatives and friends advised against accepting it saying that this will create more head ache than any thing. I thought otherwise. I considered it as an opportunity to serve my Alma mater. I was ready to take any pain for that. I thought I will use my MBA knowledge to build a good cadre and to look at improvements in infrastructure and academics. Dr.C.B.C. Warrier was my mentor and my role model.

How I rate my tenure is a big question I ask myself. My main aim and ambition is to do something good to my institution. I tried many things, succeeded in some, failed in others. That's quite natural. Many people fail in their goals, but this should be evaluated by others, not me. I have always felt that our college is a wonderful institution and  with some discipline among the ranks, we can do wonders. During this tenure I have learnt the fact that one man alone cannot do wonders. I concentrated on improving academics first and then infrastructure. I know that knowingly or unknowingly I have ignored many areas. I am leaving those areas to my successor, hoping he or she will do what I could not and even better than me. I appreciate the cooperation of my colleagues, especially the senior teachers, students and the office staff who stood with me. I know that there are people who oppose me too. I felt that people who were denied personal favour became my enemies. I never permitted even my friends to gain unusual favours from me. That makes a lot of enemies, but it also gave me energy to fight.

Calicut Medical college is ranked as the fifth best all over India. This rank shows our quality. This rank is the result of our hard work. I thought of building this campus like that of NIT Calicut, but that could not be materialized. I even wanted to improve the casualty service, but that too is incomplete .The dream project of PMSSY is still away from us, but history takes years to complete. Therefore I do not worry about what is not complete; I focus on what is complete. I do not have a completely rigid style. At times I am cordial, at other times, excited. I use these qualities to achieve my goals. Most people may not recognize this and fail to understand me and my style. Anyway I am always ready to work overtime and I recognize people of that caliber. I have given opportunity to every department. But there is a complaint that I help only few departments. I know that certain department got preferential treatment and the reason is that those who work hard and use the given opportunity get further support. Those who blame are those who do not use these opportunities. Regarding government funds, there is no special way to attract the same. If we take a project and take it as our own personal project, then you will get it. I have always had good rapport with ministers, secretaries and director. That was a bonus for me. There are still many things to become reality such as PMSSY project, oncology institute, lecture theatre complex, residential facilities for PGs and the staff, and the paramedical hostel which are all sanctioned. It is the duty of all of you to support the project and make it come true. We need a few more improvements, such as a protected campus, an improved casualty and residential services. Restriction for visitors in the hospital, a good restaurant/canteen within the hospital etc. are urgent necessities. New house surgeons quarters and mortuary should be built. There are a few specialties we have to concentrate on soon, such as Emergency Medicine, Critical Care Medicine, Neonatology, Medical and Surgical Oncology, Cardiac and Neuro anesthesia, Sports medicine, Endocrinology and Diabetology. One should always have a good vision and a good team to work with. The rest will come on its way.

 I request my colleagues, juniors and students to take care of our college as this is our own prestigious institution.

Dr C Ravindran

ARTICLE ON FAMILY MEDICINE

J Family Med Prim Care. 2012 Jul-Dec; 1(2): 81–83.

doi:  10.4103/2249-4863.104925

PMCID: PMC3893973

Family Medicine at AIIMS (All India Institute of Medical Sciences) Like Institutes

Raman Kumar

AIIMS and its Mandate

AIIMS New Delhi was created in 1956 as an institute of national importance by an Act of Parliament.[1] Over several decades, AIIMS has evolved into the sole lighthouse of healthcare, attractive patients from all over India, especially from northern part. AIIMS epitomizes public sector academic tertiary care centre in India. Of late, AIIMS has been overburdened with patient care rendering it unable to meet its primary objectives. Recently, six AIIMS-like apex healthcare institutes (ALIs) have been established by the Government of India under the Pradhan Mantri Swasthya Suraksha Yojana (PMSSY). The aim of this initiative is to rectify regional imbalances in the quality of tertiary-level health care in the country and attain self sufficiency in graduate and postgraduate medical education. These new AIIMS-like institutes are located in the states of Bihar (Patna), Madhya Pradesh (Bhopal), Odisha (Bhubaneshwar), Rajasthan (Jodhpur), Chhattisgarh (Raipur), and Uttarakhand (Rishikesh).[2]

Family Medicine (Academic Discipline of the Multi-Skilled and Competent Primary Care Physicians) at AIIMS

The new AIIMS-like institutions have commissioned a new department called “Community and Family Medicine.” One of these intuitions, AIIMS Bhopal, has identified the development of family medicine program as one of its primary objectives.[3] The MD in family medicine (post graduate) curriculum has been notified by the Medical Council of India (MCI) only recently. The Government Medical College, Kozhikode, has become the first medical college in India to start MD in Family Medicine. Interestingly, the family medicine component does not exist in the MCI-prescribed Bachelor of Medicine, Bachelor of Surgery (MBBS) course till date. The MCI regulation of the Graduate Medical Education states that “the Obstetrics and Gynaecology training will include family medicine, family welfare planning etc.”[4] Family medicine at AIIMS is likely to bring instant and much-needed academic recognition to the family medicine discipline in India. This model likely to be replicated elsewhere in India.

The regulation of medical qualifications and medical institutions has primarily rested with the MCI. The major focus of MCI regulations is on the staffing pattern, their qualification and facilities; and the recognition of institutions for various courses rather than the regulation of a standard curriculum. On the other hand, universities including AIIMS are primarily preoccupied with conducting examinations and appointing examiners for thesis and final university examinations, apart from awarding degrees. In most situations, trainee doctors are often left to themselves to learn and acquire competencies, skills, and knowledge. Most of this self-directed learning is based on peer's experience and work culture specific to the situation of the place.[5,6,7] In spite of best intensions, medical education in India has largely remained tertiary care based.

Family Medicine in India

Family medicine presents an extraordinary opportunity to the medical education system in India to reform itself. Embedding family medicine into the AIIMS model and incubating it with community medicine is a welcome initiative; however, future development of family medicine needs a cautious approach.

Family medicine is a recognized medical speciality in India since 1983, when the National Board of Examination (NBE) was formed through an amendment in the MCI Act 1956.[8] The initial curriculum of Diplomate of National Board (DNB) family medicine was derived from the syllabus of the Fellow of Indian Medical Association College of General Practice (FCGP) examination. Family medicine was not introduced as a fulltime residency training program until the late nineties. The National Health Policy 2002 emphasized the importance of family medicine and has identified it as a focus area of human resource development.[9] In 2005, full time DNB family medicine residency training gained momentum under the National Board of Examination (NBE), primarily to support the National Rural Health Mission (NRHM).[10]

Within the NBE system most of the family medicine training sites are operating at multi specialty community hospitals. A family medicine trainee is assigned to a guide, who is most often an internist or a consultant physician. The trainees are rotated through different clinical departments and are also given an opportunity for community posting. Currently 155 DNB family medicine seats are available under the NBE scheme for the January 2013 session.[11]

Family Medicine and Academy of Family Physicians of India (AFPI)

Even though the number of institutes offering DNB family medicine training has progressively increased over the period of last decade; young doctors are still unaware about the concept and the future prospects of family medicine in India. The primary reason for this unusual unawareness is the non-existence of a family medicine component in the MBBS curriculum and also the non availability of MD family medicine within the mainstream medical education system controlled by MCI. Interestingly no employment has been offered to DNB family medicine-qualified doctors by agencies such as NRHM, where family medicine doctors are best suited as multi-skilled and competent primary care specialists. More than 60% of the specialist posts at Community Health Centres (CHC) are lying vacant under NRHM.[12]

Since its conception the Academy of Family Physicians of India (AFPI) has floated a strong pro family medicine advocacy. At the initiative of the AFPI, a high level meeting was convened by the Ministry of Health and Family Welfare (MOHFW) Government of India in 2010 to discuss (a) the initiation of MD family medicine and (b) to create posts for DNB family medicine in NRHM.[13]

Family Medicine – Incubation with Community Medicine Department

The academic discipline and speciality of family medicine has evolved from the tradition of a generalist medical care. In most countries, general practitioners (GPs) and family physicians form the core faculty of medical education. In India, regulatory restrictions bar GPs, family physicians, medical officers (MOs), and other primary care physicians from becoming a faculty.[14] Only doctors with specialist qualification and work experience at tertiary level medical college hospitals are eligible to become a faculty within the mainstream MCI-regulated medical education system.

Although hosting of family medicine at community medicine/PSM departments is the best possible option available at the moment, it comes with a specific risk. Medical students and trainees may perceive family medicine to be the same as community medicine/PSM or a small component of it, while in practice they are two entirely different concepts.

Community Medicine/Preventive and Social Medicine at a Crossroads in India

Preventive and Social Medicine (PSM), Community Medicine (CM), and Community Health (CH) are synonymous to Public Health Education (PHE) in India. Community medicine came into existence under the influence of the Re-orientation of Medical Education (ROME) program of the World Health Organization (WHO) for Asian countries launched in 1977. The ROME scheme was planned to impart community-oriented training to medical undergraduates in primary health care.[15]

Over a few decades, community medicine/PSM has at best evolved as a medicalised form of public health in India. One of the major limitations in its approach towards evolution as authentic public health is the selective entry to licensed medical professionals only and at the same time barring experts from other knowledge discipline such as sociology, health economics, and political science etc. A pseudo scarcity of faculty exists all the time. In spite of the field work and health camps, a typical community medicine faculty operates from office at urban medical college and tertiary care hospital building; and also does not engage in regular clinical work. According to one report more than fifty percent of these departments are dysfunctional in terms of academic activities mandated to them.[7] They continue to exist in compliance to MCI guidelines towards recognition of the institute. This leads to visible lack of legitimacy and strength in action. Of late, many departments have started rectifying their focus and are working with enhanced attention to public health training; a few of them have started Masters in Public Health (MPH) program. Community medicine is at a crossroads in India and a lot of introspection and discussion is ongoing regarding its future direction.[16,17]

By default every family medicine faculty/trainee has to be a skilled clinician ideally located in a full time community-based practice. Family medicine is an independent academic discipline with a well developed body of knowledge and skill set.

Family Medicine in India – Challenges Ahead

For family medicine to develop to its true texture in India; two visible barriers are (a) training location (b) faculty eligibility which need immediate attention from medical education regulators. The scope of family medicine is determined by the local need of the community; therefore, it requires flexibility in operation and organization. National regulatory mechanisms do now allow regional and local flexibility. Tertiary care-based medical education and current eligibility criteria toward faculty positions have allowed a virtual monopoly of specialist doctors over medical education and service delivery; and at the same time also disfranchised the primary care physicians academically and professionally. While immediate benefit is expected from the association of family medicine at AIIMS, modelling family medicine at a tertiary care centre might pose difficulties at a later stage.

The beneficiaries of the current system are likely to resent and block the concept of gate keeping (which is an essence of family medicine) on unrestricted patient inflow from underserved, rural, and remote areas. Without removing these barrier, family medicine is at risk of being annihilated by the existing flawed medical education system.

Family Medicine is a Counterculture

Worldwide, family medicine has evolved as a counterculture to the rapid fragmentation of health care into ever growing lists of specialties and subspecialities. Internationally, there is growing demand for comprehensive health care. The value of family medicine lies in its integrative function in the health care system, which is often too complicated for a lay person to understand. In India, academic family medicine is in its nascent stage. To survive, progress, and prosper, the proponents of family medicine will have to challenge the existing fallacies within the medical education system in India. In due course of time, family medicine will grow, evolve and eventually develop its own identity.

Author's Note

The findings and conclusions in this article are those of the author and do not necessarily represent the official position of ILBS, New Delhi, India. Author is also the President of the Academy of Family Physicians of India (AFPI).

References

1. About AIIMS (All India Institute of Medical Sciences) [Last cited on 2012 Sept 15]. Available from: http://www.aiims.edu/aiims/aboutaiims/aboutaiimsintro.htm .

2. Pradhan Mantri Swasthya Surakha Yojana (PMSSY), MOHFW Government of India. [Last cited on 2012 Sept 15]. Available from: http://www.mohfw.nic.in/index4.php?lang=1 and level=0 and linkid=96 and lid=852 .

3. Primary and Secondary Objectives of AIIMS. [Last cited on 2012 Sept 15]. Available from: http://www.aiimsbhopal.edu.in/academics_and_research.aspx .

4. Medical Council of India Regulations on Graduate Medical Education. 1997. [Last cited on 2012 Sept 15]. Available from:http://www.mciindia.org/RulesandRegulations/GraduateMedicalEducationRegulations1997.aspx .

5. Medical Council of India Rules. 1957. [Last cited on 2012 Sept 15]. Available from:http://www.mciindia.org/RulesandRegulations/IndianMedicalCouncilRules1957.aspx .

6. Medical Council of India Salient Features of Postgraduate Medical Education Regulations. 2000. [Last cited on 2012 Sept 15]. Available from:http://www.mciindia.org/rules-and-regulation/Postgraduate-Medical-Education-Regulations-2000.pdf .

7. Lal S, Kumar R, Prinja S, Singh GP. Postgradate teaching and evaluation in community medicine. Indian J Prev Soc Med. 2011;42:221–4.

8. Notification No. V 11015/17/83-ME. (Policy) Government of India MOHFW (Dept. of Health) New Delhi, Dated the September 19^th. 1983. [Last cited on 2012 Sept 15]. Available from: http://www.natboard.edu.in/dnb_matter.php?notice_id=4 .

9. National Health Policy (India), MOHFW Govt. of India. 2002. [Last cited on 2012 Sept 15]. Available 

FAMILY MEDICINE-MY PERSPECTIVE

FAMILY MEDICINE- MY PERSPECTIVE

I loved practicing in rural areas. After my graduation I worked for 18 months in a rural hospital where there was no electricity, no oxygen supply, no ambulance etc. It was a family practice treating all diseases and attending labour. I left that place when I was selected for postgraduate course. Once in specialty practice in Medical College I have completely ignored my earlier carrier. When I became Dean of the college I was trying to strictly implement referral system in order to reduce the patient burden so that those who deserve tertiary care may get it. But soon I could understand that this could be a distant dream, as every body wanted to consult specialists. Nobody has confidence in primary health centers. This I thought will disintegrate the health care system. This also will lead on to unnecessary investigations and unnecessary medication which in turn will add to the cost of medical care.

What we need in this scenario is a global approach, a family or community approach. I remember fondly my former Principal Secretary to Govt. who asked me to chart a programme to link primary, secondary and tertiary cares. He sent me to CMC Vellore where a good family medicine department is functioning. He also made arrangement for an interaction with Dr Peter Kuling, a family practitioner from Canada. It was indeed an eye opener for me. We need to strengthen the primary care. For this a strong base of family practice and adequate number of primary care physicians are needed. This really motivated me to initiate the first MD course in Family Medicine in the country. I am really proud of that and still believe that this is a humble beginning and in future Calicut Medical College will be remembered for this.

The American Academy of Family Practice (AAFP) defines family medicine as a medical specialty which provides continuing, comprehensive health care for the individual and family. The scope of family medicine encompasses all ages, sexes, organ systems and diseases. Family Medicine ( FM) aims to provide initial, continuing and comprehensive care, while centering this process on the patient-physician relationship in the context of the family. It is not a patient but the family is treated by a family physician. Primary care physician always aims at relationship building, continuity of care, and seeing the impact on a patient’s health. They focus on disease prevention and health promotion, and when referral is needed, Family physician remains the coordinator of patient care. This leads to decreased chances of inpatient care, higher patient satisfaction, and increased cost-effectiveness.

FM training programs address a large breadth of topics: adult medicine, pediatrics, maternity care, gynecology, care of the surgical patient, musculoskeletal and sports medicine, emergency care, mental health, community medicine, skin, diagnostic imaging and nuclear medicine, and management of health systems. Family physicians have greatest flexibility regarding practice of any specialty.

The first purpose is social change. Many diseases, especially chronic ones like diabetes and heart disease, afflict the poor more than any other group. Chronic diseases are the embodiment of the extreme inequality present in this society. They can be improved with conscientious and thorough care on the part of health professionals dedicated to the underserved and prepared to advocate on their behalf. This ethos is promoted by many FM programs, which emphasize the physician’s responsibility to the community and the family as well as the individual patient. Many FM residencies are located in areas of need and specifically aim to produce primary care physicians to improve health care outcomes in these areas.

Philosophically, I believe that FM is the best platform for delivering primary care.  People live in families and communities, and rarely do illnesses affect only one person.  Patients often come to the doctor with family members, and thus building trust by treating the entire family, offering anticipatory guidance to family members when they come as patients as well as caregivers, and better understanding the dynamics at home through multiple visits are powerful assets when delivering primary care as a family physician.  When that primary care for the family is fragmented through multiple physician practices, the benefits of true primary care can be lost.

 
Practically, it is seen that most FM residents spend nearly 50 percent of patient-care time in the outpatient setting.  Meanwhile, most internal medicine primary care residents typically spend 20 to 25 percent of their time in outpatient care. 
 Family physicians in rural India, has a lot to do like moving from the pediatric ward, OB ward, and adult medicine wards with ease each morning, and then see patients of all ages in outpatient clinic in the afternoon. As a primary care doctor, it seems as though the vitality of one’s practice is often proportional to the breadth of one’s practice.

Finally, as we all know, the health care system in this country is broken, especially, when it comes to the coordination of care.  The broad clinical training one receives in family medicine, as well as the strong new emphasis many family medicine residencies are placing on team-based care; there is a unique position for family doctors to help lead the revolution that is stealthily underway in primary care.

MEDICAL EDUCATION- WHERE DO WE STAND?

MEDICAL EDUCATION- WHERE DO WE STAND?

Medical teachers have been vested with the enormous responsibility of producing competent doctors. In a sense, they are the ones who safe-guard the health and well-being of millions of our population. The first step in safeguarding patient safety is the implementation of high-quality medical training and maintaining its standards by periodic assessment. The decision to permit a person to practice medicine cannot be taken lightly as it has enormous consequences for the health and safety of patients who may seek the services of this person at a later date. However, what goes on in the name of training and examinations during the medical course is far below the level of expectations. There is always a debate as to whether medical education in the country has deteriorated over the years. Older generation accuses of dilution in standards which is always questioned by present day students. Is this because of the angle through which one observes or is there any truth in any of these arguments?

Our challenge is to ensure that medical education reflects the evolving knowledge and ideas of contemporary practice, and the ever-changing expectations of society, while standing firm and resisting change to the core values of professional practice. Universities and medical colleges are responsible for operating a quality management system that designs, delivers, monitors and reviews medical curricula and assessment programmes to meet the standards. At what point should a medical student be held to account for upholding the standards of the profession which they will join in the future? Are we fully trained to meet the challenges of providing present day health care? Bearing in mind our purpose, which is to protect the health and safety of the public, it was important that we had the ability to investigate and satisfy ourselves that a graduate’s fitness to practice was not impaired. Good education and mentoring lay a solid foundation, but equally important is the attention paid to professional standards. Being a doctor is about more than being a scientist. It involves a commitment at the highest level. Commitment and ethics can’t flourish if the medical student neither cares nor understands their importance. It is a fact that our own graduates loose out in the competition for positions, based on merit. This applies to medical schools and residency programs as well.

The Medical Council of India (MCI) is the statutory body for establishing uniform and high standards of medical education in India. The Council grants recognition of medical qualifications, gives accreditation to medical colleges, grants registration to medical practitioners, and monitors medical practice in India. The Indian medical education system, one of the largest in the world, produces many doctors who emigrate to the United States, the United Kingdom, and several other countries. The quality of these physicians, therefore, has a broad global impact. Medical schools in India have rapidly proliferated in the past 25 years, reaching a current total of over 350. Accreditation by the Medical Council of India (MCI) emphasizes documentation of infrastructure and resources and does not include self-study. Initial assessment and periodic reassessment by the universities and MCI are not fool proof. India's large private medical education sector reflects the market driven growth in private medical education. Since the number of private institutions out number government institutions and income-generating "payment seats" are the norm in these private medical schools, achieving high standard will always remain a dream. Student selection need not be exclusively based on merit. Definitely their performance lack depth and need extra push to come out successfully. This ‘extra push’ is being provided in private medical schools, of course with the help of medical teachers. We do not have enough medical teachers to satisfy the needs. Hence visiting faculty is the norm in many institutions. They do come for assessment and examinations. What are they going to evaluate? The attitude of many medical teachers who accept examinership and come as examiners is appalling. The internship year under the aegis of medical schools in India, has suffered from lack of supervision and minimal assessment; it is often used predominantly as a time to study for residency entrance examinations.

This unregulated unequal growth leads to failing quality of medical education in the bargain of addressing an artificially created shortage of doctors. The doctor-population ratio has already exceeded that required by the country and there is mal-distribution of their services. This mal-distribution of medical manpower is centered on biased political will and seat purchasing power in the community. Whether increased numbers of doctors mean a higher quality health care delivery system is debatable. The menace posed by the unplanned growth of substandard medical colleges has to be curtailed and efforts should be made to ensure maintenance of standards. There is a strong case for a review of the entire system of medical education and examinations in the country.

The need of the hour is to generate highly committed medical practitioners who are willing to serve in the villages. Most of the doctors are pooled in the cities. Primary health care facility in the villages is far below the expected level. Medical council of India needs to take urgent steps to modify the curriculum keeping in mind the ever growing health needs of common man. More stress should be give for family practice. It should be made mandatory that medical graduates should spent at least one year after graduation in the rural villages before they are permitted for residency. Emphasis on family practice and promoting residency in Family Medicine are the two important areas to be focused. Family Medicine has consistently provided dedicated primary care and rural care doctors. Furthermore, family medicine residency slots are less in this country, and the overall goal of teaching and producing family physicians has been consistently discouraged by other specialties. I would like to point out that internal medicine residencies do not produce "primary care physicians," since the vast majority of internists will go for super specialization and turn away patients who want a primary care doctor. Health care administration should value primary care family medicine for its emphasis on longitudinal prevention, chronic disease control, and public health at lower costs.

Today because of technological advancement there is a fancy towards interventions. Every other disease is being treated with multiple interventions. Medical graduates always look towards this lucrative means of medical management and hence are after specialization and super specialization. Many fail to believe that most diseases can be managed with conventional methods. Patients are also driven towards this culture spending unnecessarily. This can be controlled by strengthening family practice. Many learned friends have questioned the methods followed in United States and United Kingdom. Their argument is that these systems will delay treatment. But our system is unscientific leading to multiple interventions and over usage drugs leading to high economic burden. Strict regulations to curb this practice should come from the Government. At the same time Medical Council and Universities should review the existing system of medical education in the country. There should be revision with a view to strengthen basic health care, rural practice and family practice. The three tier system of general practitioners, specialists and super specialists need to be retained but with a pyramidal structure where the broad base is constituted by general practitioners. The present system will only generate a pattern just opposite to this. More over unless we have adequate trained teachers, there is no point in opening new medical colleges. Medical council regulations are to be strictly followed and assessments made fool proof. There should be ways and means to penalize if MCI directions are ignored. Many a time this is not being followed or in rare instances the college will challenge the decisions in the court.

Dr Ravindran Chetambath MD, DTCD, MBA

Dean, Govt. Medical College, Kozhikode, Kerala