Dear Editor,The guest editorial on residency training programs
acknowledges that the current state of affairs is an open
secret.1,2 Our prospective study that motivated the
editorial provides hard data on the condition of residency programs
and the (lack of) change following intervention.2 The otherwise
excellent editorial mentions our article but essentially relies on
data from two surveys, one a presentation at a meeting. The
very nature of surveys indicates that ground reality is worse
than the responses indicate.The editorial states that ″some of the tertiary centers have
developed and adopted a good training module.″ ″Good″
should at least fulfill the basic checklist that we suggested?
Only objective application of the checklist can determine how
many of our ″good″ programs meet basic norms. The powers
that be are welcome to dilute our minimum standards, but
is that what we want from a residency program in modern
India? Especially considering that our usual ″numbers″, and
″developing country″ excuses have already been flogged into
the ground.Some of the editorial recommendations include more
funding, equipment and training. Our report clearly
demonstrates that crores of rupees on equipment and training,
without accountability and attitudinal change do not alter
anything. Do we really need to, or can even afford to go down
that route again?It is suggested that existing bodies monitor the programs.
Such bodies knew the ″open secret″ and had access to the report
alluded to in our study text and mentioned in the literature.3
Our findings establish that existing systems have failed to
ensure minimum standards. How some programs were even
recognized in the first place (and still continue to function),
raise disturbing questions. Another existing system that could
participate seems to be geared only to detailing impressive
numbers of cataract surgery performed in the country. And all
this does not mean that programs controlled by an alternative
national body are ″good″ or better and should take over
monitoring; apply the checklist to their programs as well.Undoubtedly, we require drastic remedial action of the type
that followed the Flexner report in the United States, without
getting mired in multidisciplinary committees.4 Simplistically,
an independent body can certify and grade programs, allowing
″market forces″ to take over. However, strict licensing,
monitoring, suitable incentives (strong disincentives for poor
performance), accountability and a uniform exit exam also
seem to be essential. Plainly, personal friendships, ″political″
considerations and our usual ″chalta hai″ attitude cannot be
permitted to interfere with the objective guidelines. At stake is
the future of our residency training programs, which means the
future of Indian ophthalmology itself. One question is whether
we have the people willing to undertake what will be a hugely
unpopular undertaking. The second, as my dear friend and
colleague rightly asks is: ″do we have the necessary will″?
Twenty-five years of experience and personal effort say ″Nay.″
But, in this one instance, I want to be proved wrong.