AIIMS Leads in Health Care Revolution
The All India Institute of Medical Sciences (AIIMS), New Delhi, has become synonymous with quality health care and excellence in medical education and research. In an interview with Double Helical, Dr. Mahesh Chandra Mishra, Director, AIIMS speaks about the premier Institution’s relentless drive to achieve quality-oriented health care practices in the country. Dr Mishra is a wellknown and leading surgeon, credited with developing the AIIMS’ Trauma centre into a model for emergency services in the country. He joined AIIMS in the 1980s and became the head of the surgery department 13 years later in 1993. Edited excerpts from his interview: By Amresh K Tiwary
Qus: As director of AIIMS New Delhi, what do you think is the remarkable achievement of the country’s premier medical institution in the field of Medical science and health care?
Ans: Established in 1956 by an Act of the Indian Parliament with the objective of developing a strong curricular foundation for undergraduate and postgraduate healthcare education in India based on Rajkumari Amrit Kaur’s vision, AIIMS continuously seeks to achieve a high standard of healthcare education, research and service. It is recognized in India and globally as a medical institution that best combines excellent medical education with cutting-edge research and quality healthcare.
Qus: What is the plan of AIIMS to shape the future of Medical Science as it seeks to educate the next generation of leaders in medicine and science?
Ans: With increasing potential to work hard and deliver quality treatment to patients, AIIMS continues to shape the medical profession as it seeks to educate the next generation of leaders in medicine and science. Hence, it did not come as a surprise when AIIMS topped India Today’s best medical schools league table for the eleventh year in a row. It earned a top score of 100 in all parameters under consideration: reputation, academic quality, student care, infrastructure, and placement opportunities. With its 7 centres and 39 teaching departments, and a manpower of over 10,000 including 826 faculty positions, AIIMS, Delhi produces a large number of specialists (MD/ MS), super-specialists (DM/MCh), PhD scholars and allied health and basic sciences experts, including nurses and paramedical professionals. In the year 2013–2014, we enrolled 724 scholars under various courses. Under our training schemes, AIIMS provided postgraduate training to 675 short-term trainees, 20 long-term trainees, 70 WHO fellows (foreign national) under WHO fellowship programme and observer-ship to 63 foreign nationals (26 postgraduate and 37 undergraduates).
Qus: As a leader in health care, how does AIIMS New Delhi continue to play a significant role in nurturing and mentoring other AIIMS centres at Rishikesh, Bhubaneswar, Bhopal, Raipur, Jodhpur and Patna?
Ans: We continually review and monitor how medicine and science are taught to nurture a passion for scholarship and innovation, as medical knowledge is swiftly increasing and the nation’s healthcare delivery system is undergoing rapid change, and biomedical science and technology are also advancing at a fast pace.
With 7 centres and 39 teaching departments, and a manpower of over 10,000 including 826 faculty positions, AIIMS Delhi produces a large number of MD, MS, super-specialists (DM/MCh), PhD scholars and allied health and basic sciences experts, including nurses and paramedical professionals.
Qus: Can you tell us about AIIMS’ expansion plan for specializations in areas such as surgery, orthopaedics and radiotherapy?
Ans- AIIMS is making extensive use of technical aids such as animations and videos across various specializations like surgery, orthopaedics and radiotherapy. The Anatomy department has established an e-Learning facility which introduced ‘Blended Learning’ methods that supplement the traditional face-to-face learning methods with eLearning. The Department of Anaesthesia acquired a state-of-the-art high-fidelity Human Patient Simulation system to provide training to postgraduates for routine events as well as crisis situations in real time scenarios. The department also established the Anaesthesia Skills Laboratory for training and continuing education of undergraduates, interns, junior and senior residents. The Division of Neonatology, Department of Paediatrics introduced new courses and enrolled nearly 2,000 students and doctors in different courses in the Essential Newborn Care and Sick Newborn Care courses with skill learning at participating institutions. Apart from students & the country, courses are offered to students from the Maldives, Sri Lanka, Bangladesh, Nepal, Pakistan, and Mauritius. The Division of Neonatology also updated a teaching-learning package for newborn care for online learning on an interactive platform to educate health professionals at distant places with skill learning at partner institutions. New Apps on smartphone for management of normal newborn as point of care tool for healthcare providers working in small hospitals were also developed. The Department of Neurology has initiated a regular continuing medical education programme on multiple sclerosis. AIIMS offers Continuing Medical Education to thousands of physicians and healthcare professionals to help improve their skills, increase knowledge and improve performance. The Institute organized 188 workshops, symposia, conferences and training programmes in collaboration with various national and international agencies. The Jai Prakash Narayan Apex Trauma Centre (JPNATC) is making significant contribution towards capacity building in the country in both basic life support and advanced trauma life support to improve trauma care all across India. AIIMS Ultrasound Trauma Life Support (AUTLS) course has been designed in-house for point of care ultrasound scan for the assessment of ABCD in Trauma Evaluation and Management.
Qus: Tell us about AIIMS’s research and clinical care strategy?
Ans: The research community at AIIMS has contributed significantly to scholarship through its leadership in innovations and publications. Over 508 research projects were conducted in the year and the institute attracted extramural research grants of more than Rs. 71 crore in frontier and cutting edge biomedical areas. During the last year the faculty and the scientists of the institute successfully completed 211 research projects and published over 1800 research papers in national and international journals and over 250 monographs, books and chapters in books. The British Medical Journal (BMJ) has announced BMJ Innovations – a new with AIIMS, with the aim of promoting innovative research which creates new, cost-effective medical devices, services and platforms that improve patient care to act as a platform to catalyze and seed more innovations. Fellows of the Stanford India Biodesign (SIB) Centre– –a joint initiative of Stanford University, Delhi’s AIIMS and IIT Delhi funded by the Department of Biotechnology developed a low-cost splint made of hard cardboard that is easy to use on either right or left leg and does not have to be to be removed for X-rays, MRIs or CT scans. The splint was clinically tested at the AIIMS trauma centre and was licensed to HLL Lifecare Limited, a public sector undertaking, which will be supplying it to ambulance services and primary care centres. AIIMS has taken key initiatives to encourage integration and collaboration across the world to accelerate scientific breakthroughs. Efforts at integrating modern science methods with wisdom of Indian systems of medicine led to the identification of Ayurvedic drugs which can potentially prevent the onset of Alzheimer’s disease and restrict its spread in affected patients. Essential to the enterprise of discovery and learning at AIIMS is the constant drive to develop effective new methods for educating the next generation of physicians and scientists. With regard to clinical care, several surveys by the reputed journals have named AIIMS the best hospital in India, as well as the best in fields such as Cardiology, Neurology, Gastroenterology, Gynaecology, Ophthalmology, Orthopaedics, Trauma Care ahead of several specialized institutions. The hospital has been able to maintain high standard of quality while treating a large number of patients, many of whom live in extreme poverty. The AIIMS main hospital and its centres—the Cardiothoracic and Neurosciences Centre (CN Centre), the Jai Prakash Narain Apex Trauma Centre (JPNATC), the Dr B.R. Ambedkar Institute– Rotary Cancer Hospital (BRAIRCH), the Dr Rajendra Prasad Centre for Ophthalmic Sciences (RAPCOS), the Centre for Dental Education and Research (CDER), the National Drug Dependence Treatment Centre (NDDTC) —have a total bed strength of 2428, including day care beds. During the year 2013–2014, the institute attended to about 28.8 lakh outpatients and 2.1 lakh inpatients and performed close to 1.5 lakh surgical procedures at optimal patient care service parameters with average bed occupancy of about 85%, and average hospital stay of about 5 days. The AIIMS hospital reported a net death rate of below 2%. While AIIMS advances the delivery of health care in India, it is also taking a leadership role in service throughout the developing world. An increasing number of foreigners are coming for treatment to AIIMS, mostly from South and South East Asia. This trend was particularly salient in the departments of neurosurgery, orthopaedics, oncology and surgery. AIIMS is in the process of expanding AIIMS Trauma Centre, surgical block, mother and child block and OPD Block. The expansion will happen in phases and when completed, will almost double the hospital’s capacity. The surgical block will also have a national endoscopy centre, a high dependency unit and kidney transplant facilities. In addition, the convergence block, critical care units, and a new Dharamshala were inaugurated during the year. A free generic pharmacy store was opened at AIIMS for outpatients to cater to the needs of the weaker sections of the society. In a relief to patients facing cardiac emergencies, AIIMS has decided to perform procedures like angiography, balloon angioplasty, opening of blocked heart valves and insertion of pacemakers free of cost for patients in general wards at AIIMS.
AIIMS offered postgraduate training to 675 short-term trainees, 20 long-term trainees, 70 WHO fellows and observership to 63 foreign nationals.
Q: What kind of revolution is going on over the last year in bringing innovative and patient-oriented services?
Ans: AT AIIMS New Delhi, a quiet revolution has been going on over the last year in bringing innovative and patientoriented services to the huge number of patients who look up to AIIMS as the final word in affordable and quality healthcare. In an effort to streamline the rush for out-patient consultations, AIIMS started a computerized appointment system that allows patients to schedule appointments up to a week in advance. The AIIMS Trauma Centre (JPNATC) became the first centre in the country to make a successful shift from preparing manual Medico- Legal Cases (MLCs) to electronic MLCs. It has also begun using tablets to store outpatient information. The Department of Otorhinolaryngology started transoral robotic surgery for performing advanced head and neck cancer resections. Taking benefits of advanced technology in health care to remote and rural areas of the country, the AIIMS faculty has been conducting medical camps at Leh and Kargil, Jammu and Kashmir for the benefit of the population belonging to these remote areas of the country. AIIMS faculty also organized and performed an unbelievable feat by performing total knee replacement operation for poor patients from Ladakh. The Gurgaon-Chandu-Badli road serving AIIMS-2 at Badsa village in Jhajjar is being widened and upgraded from the existing two lanes to four lanes to improve access to the campus. In addition, the Union Cabinet approved the proposal for setting up of National Cancer Institute (NCI) at Jhajjar (Haryana) under AIIMS at a cost of Rs. 2,035 crore. NCI is the largest tertiary health care facility (both public and private) in the country since Independence. The proposed institute will have 710 beds for different facilities such as surgical oncology, radiation oncology, medical oncology, anaesthesia and palliative care, nuclear medicine and proton therapy. It will have a tissue repository which is the first of its kind in India. The institute aims to plan, conduct and coordinate research on cancers which are more specific to India like tobacco related cancers, cancer of the uterine cervix, gall bladder cancer and liver cancers.