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Medical Education and Medical University: Problems and solutions for effective Integration Dr Suvarna Nalapat http://drsuvarnanalapattrust.org

Contents Ch 1 My experience in medical education Ch 2 An outcome-based approach to curriculum development Ch 3 Regulating Medical Education Ch 4 Results of Sreeramachandra uty project by S.Thanikachalam

Ch 5 The challenging task for a Medical University Ch 6 PROJECT : ( Presented at World Education congress New Delhi January 2011 , and Music Academy Chennai in 2010)

Ch 1 MY EXPERIENCE IN MEDICAL EDUCATION

After my MBBS course , I started as a private general practitioner in a backward village in Calicut . The experiences in that village was the greatest education I had about the poverty, nutritional deficiencies and infectious diseases that our rural people encounter and also the most feasible solutions a responsible citizen can think about .The first Government appointment I had was in an ESI hospital in Pathirappally , in Aleppey and the next lesson I learned was that if there is organizational and political power the labour force can make any demands .The hefty strong people without any disease coming and demanding leave on basis of sickness and doctors issueing them ,though they knew that it is mere malingering made a lasting impression in me . As a responsible citizen I felt that people who demand all rights and are not prepared to perform duties for the sake of the nation are in fact a burden to our state .But I could not do anything ,because I was just an individual of only 26 years old,and with a first appointment and what I can do to to show my protest was just resign from service(which was not even noticed by anyone as a act of political and social statement against irresponsible behavior of citizens.) Then I joined Pathology department in 1972 October 21st as a lecturer. This started a brilliant turn of events in my life. I loved Pathology for its intellectual diagnostic pursuits, social sense in reporting and clinical duties in teamwork , and above all the teaching profession which it offered . The first posting was in Calicut medical college, my alumni . But after 6 months I applied for a deputation transfer to Thirumala devaswom medical college in Alleppey where my husband was working as lecturer in Pharmacology. The Government gave me an option that if I am ready to forego deputation allowances, I may be posted according to my wish. And I promptly accepted and joined on deputation without allowances , in that developing medical college . The initial stages of the development of Alleppey medical college also witnessed my initial experiments with learning-teaching situations. At the time I joined Dr Harilal was Professor of Pathology . But he left soon and the entire department became the responsibility of lecturers .This was a blessing in disguise for me , as a teacher. With no one

3 to guide , we had to start our own teaching schedules , both practical and theory . I had a schedule charted out in which I tried to give individual attention to each , depending upon their talents and interest and for that I read out critically the answer papers of each of them and made a note (as grading) of extraordinary, ordinary and below average groups . In the classroom , I would call out names of students and ask questions depending upon their grade (easy questions to below average , tougher to extraordinary) so that an interrelationship as well as a initiative to learn , to prepare daily lessons will be inculcated. And in practical sessions I would visit each student at workplace and try to give a practical -oriented problemsolving situation either with the gross specimen or the microscopic slide and make a module (problembased ) by such exercises and watch the outcome .This practice helped me to know where , I as teacher , and the students as learners , need improvement .The cyclical improvement I had with such experiences with my students can never be forgotten when I speak of my integrated valuebased curriculum planning . When I returned to Calicut Medical college in 1975 , I had become a reasonably good teacher (and also a good public speaker /orator by 1977) thanks to my early teaching experiments .That was a transformation I had from a silent girl (who writes written communication as poetry,stories,essays) to a highly orally communicative person . In the 80s we, the staff of Calicut medical college Pathology department , started postgraduate programmes and associated weekly teaching discussions on every Friday morning . In this , we discuss syllabus, curriculum, and devise modules for each topic and every staff member and PG student takes active part .This modules were introduced in practical/discussion groups in our college .We found this of great use in improving the problem-based learning capacity of student .The objections came from some of the teaching staff members and when we gave questionnaires (which we give to each batch after every programme period) we found that those who raised objections were actually graded last by students .That means, the objection is because of their inefficiency to carry out the task rather than due to defects in the programme . I was exposed to museum ,student section and stores section and bloodbanking from Calicut medical college ,where all these sections in turn comes to each of us by rotation posting . Administration and management experimented in Blood bank in 1990s with an Indian ethos (as given in the Gita ) could successfully endorse quality and efficiency in bloodbanking system .The regional blood bank (for northern kerala) I planned according to the Glasgow model and with Indian context in mind was submitted in 90s to the Government and after my retirement from service, when I visited Calicut for a programme on Environmental Protection conducted by the Forestry Department, Mr Nalinakshan , a person who was associated with the Voluntary Blood Donors Programmes in the 90s came up and told me that Madams regional Blood Bank scheme is sanctioned at last . That was almost 15 years after I had submitted the plan. But I was happy that it was sanctioned. Better late than never.. Another programme I submitted was the health village adoption scheme through Calicut corporation authorities in the 90s which I resubmitted with proper innovations and additions to suit the Deemed university of Amritha institute of medical sciences and research center in 2002 .The music therapy programme is part of the entire holistic approach and valuebased education with Integration of healthcare . Curriculum debates in education is mainly based on primary and secondary education and not much is done in the higher tertiary education and practice levels .The attempts I have made is mainly on the

4 third level higher education , but it also encompass the lower levels of education since it has to be considered as entry points for higher education and base should be strong . Education is either productfocussed, or process-focussed or both inclusive. We can develop curriculum through constructive alignment , as process, as engaging curricula, through use of threshold concepts and also as problem and enquiry based learning . All these approaches developed in international scenario in the 2000s only .

The staff describe curriculum as four different categories according to Fraser and Bosanquet(2006) 1.Structure and content of a unit 2.Structure and content of a programme of study 3.The students experience of learning 4.A dynamic and interactive process of teaching and learning The first 2 are the product view and a tangible product is the outcome.The last 2 are process view and is more intangible.The tangible product is that which conforms to the teachers original intention for it.The curriculum as design in advance(Barnett and coats 2005) developed from a generic template by subject experts in the light of their knowledge and discipline and assumptions about the student needs.The student learning is controlled and implemented by teacher in this.Student is judged in the end ,by a examination ,how well they achieved what the teachers programme goal .Content is a highly significant aspect ,selected by a group of teachers .There can be aspects which need modification and these are flexible to be modified according to needs. The process perspective:- Framed by an emanicipatory interest /orientation and teaching is a shared struggle towards emanicipation with other principles of critical pedagoguy ,learners are active creators of knowledge too.The educational experience is negotiated and curriculum emerge from systematic reflection of those engaged in pedagogical acts.Design(ed)-in-action is a dynamic process (Barnette and Coate) and certain aspects cannot be anticipated in a template (schon 1987;2006.282)One has to view the produt as a first step and a continuum from product to process is happening.In higher education discussions encourage Consideration;Reflection;and Re-assessment- of a process of project of study as well as learning and teaching encounter.The valuebase of lecturers in relation to their understanding of education and conceptions of learning and teaching will be fundamental to conceptions of curricula and form and shape it takes. Chapter 2 AN OUTCOME-BASED APPROACH TO CURRICULUM DEVELOPMENT:-

Principles Gosling and Moon(2001) based on were:1.All learning expressed in terms of outcome to be demonstrated 2.Modules of learning described in terms of learning outcomes and assessment criteria.

5 3.These rather than mode of delivery form basis upon which they are assigned a specific number of credits at a given level 4.Learning outcome placed with in the hierarchy of 5 levels of NQF(UK)and 10(Ireland) 5 Any given module assigned only to one level 6 Learning outcome should be as clear and unambiguous as possible 7.Learning outcome identify the essential learning to be achieved to merit the award of credit 8 Assessment criteria should specify how satisfactory performance of modules learning outcome are to be demonstrated 9 Assessment criteria should encourage learning at approximate level 10 Learning outcome should enable employees ,schools,colleges,parents ,prospective students and others to understand achievements and attributes of students who successfully completed a programme 11.Facilitate comparability of standards to facilitate international mobility of students 12 Facilitate students and graduates mobility and help identify potential progression routes ,particularly in context of lifelong learning 13 Assist higher education institutions ,examiners,Quality assessment bodies and reviewers to assess and ensure quality /standards providing an important point of reference for setting and assessing standards LEARNING CENTERED CURRICULA:Has a flexible framework .The importance of content and the community in development process is considered.It emphasise on learning communities ,curriculum integration,diverse pedagogies and clearly defined learning outcomes. Students,faculty and stakeholders are active participants Academic units are at different stages in curriculum reform and progress at different rates Should honour inclusion of wide range of teaching and learning strategies Within an academic unit reform is both an individual and social contextual process Activities:1.Learning context 2.Developing clearly defined curriculum wide learning outcomes

6 3.Assessment strategies 4.Progressive stream of teaching methods ,learning experiences driven by curriculum-wide learning outcomes DEVELOPING CURRICULUM THROUGH CONSTRUCTIVE ALLIGNMENT

This is suited for training rather than education.Three key curriculum elements: 1 Intended learning outcome 2.Teaching and learning activity 3.Assessment tasks These 3 are balanced The learner understands /learning takes place through relevant activity .The system designed to enable student to learn ,rather than to leave them guessing what is involved in the course of study or in what theory will be assured Module development with outcome-based curriculum:- The article of Gosling and Moon appeared only in 2001 and our department had experienced the process as early as 1980s and hence we were actually experiencing first by action and then comparing with others experience making it a metascience pattern.The modules ensure existene of a logical relationship between level ,learning outcome,assessment criteria,assessment and teaching methodologies for quality assurance processes . The model:- 1.Existing level descriptions 2.Translate them to subject descriptions 3.Identify aim of module or programme 4.Write learning outcomes for programme and the module 5 Design assessment tasks 6 Design threshold assessment criteria,provide incentive for higher achievements as grading 7 Develop assignment methods to test achievement of both forms of assessment outcome 8 Develop learning strategies to enable learners to reach learning outcomes /assessment criteria 9 Develop module programme .Rethink it including leaving outcomes. With my teaching experience in Calicut medical college I was trying to implement this modern innovative modular curriculum strategies in Amritha institute ,but unfortunately the staff (especially the senior staff) could not co-operate in these highly technical aspects of learning/teaching behavior and

7 though the programme was charted out painstakingly ,and modules prepared ,only part of it was experiments in Amritha hospital .(Pathology modules).But fortunately for me,the sadbhavana lectures for integrated approach,the music therapy research could be completed satisfactorily . CYCLICAL SPIRAL STAGES OF CURRICULUM DEVELOPMENT

There are different stages in curriculum development. First one has to be aware of it as important in any learning situation. Second one has to develop an initiative for innovative programmes.Third one has to mobilize all possible strength and team for carrying it out.Fourth the action plan has to be developed with much consideration,reflective thought on outcome for students/clients/nation as a whole.Finally one has to put it into practice.Thus a personal and practice plan should develop side by side for achievement to happen.A team of educators (from pharmacology department in Canada) had given a descriptive model of their experiences(2003).The context ,the academic community and organizational context are important for making the dreams come true /action plan made into practice . An articulated curriculum embraces both intended and emergent learning outcomes .All elements interact and influence each other to stimulate and support active learning and readily reflect what happens in a classroom situation or in a practice situation of a clinician.There will be a series of different intentions(among clients,students,stakeholders,clinicians etc)which can create a mess(out of which one has to draw a clear picture) and all sorts of ambiguities may be seen when we interact .Hence this is a step towards a process model .A Harward team introduced the term WTP(Ways of Thinking and Practicing) as Through lines. A spiral of repeated engagements o improve ,to deepen skills,attributes,and values is what a life is all about .Through threshold concepts one gets a transformed way of understanding .And when such a person devise a curricula it will be an integrated one and will definitely involve a holistic approach to all ways of thinking and it would be for betterment of life,profession and of entire life on earth.It is difficult to draw a distinguishing line between traditional curricula and innovative emerging curricula in India ,as in the west because most of the western innovative styles were in traditional vedic curricula ,as I had pointed out when I discussed Valabhi and Nalanda and vedic and Budhist universities and their methods.The western division of traditional and emerging curricula is as follows: TRADITIONAL Knowing that Written communication Personal Internal Disciplinery skills Intellectual orientation Problemmaking Knowledge as process understanding Concept based Knowledge based Pure EMERGING Knowing how Oral communications Interpersonal External Transferable skills Action orientation Problem solving As product Information Issue based Task based Applied

8 Proposition based learning Experiential learning One has to ensure the three domains of higher education 1 Knowledge (Gnaana) 2 Action (karma) 3.Athman(self) The educational identity of the self in relation to subject area is determined by the personality traits described by Charaka (the 16 personality types belonging to sathwik,rajasic and thamasic ) because their intellectual and ability levels and interest levels are varied and tehr power of memory,concentration are different .These domains are integrated as best as possible in any learning schedule for betterment and upward movement as progress. In problem and enquiry based learning students play a major role .Problem solving skills of students individually,in small groups,in extended groups in any situation so that they can manage life situations effectively is the objective of an integrated study .PBL is a balanced state of learning in managing ones own life and serving the nation with that balanced view .

Chapter 3 Regulating Medical education :-

Efficiency and quality are difficult to be defined just by the presence of an individual or an institution in spacetime,unless in the long run ,time proves the outcome of the individual/institution .We can try to quantify by hours of work done by each individual,output from each institution,yet the number of hours does not always depict quality.The same hours of work,in the same discipline done by two different individuals need not be of same quality and efficiency .The workload of teachers of higher education (as shown in page 64. Item 7.57 ,UGC committee 1992 ) is as follows: ACTIVITY & AVERAGE NUMBER OF HOURS PER WEEK:Activity Teaching Tests/exams Tutorials Preparation Research Reading/administration Total Professor 6 1 1 6 14 12 40 Reader 8 1 2 8 14 7 40 Lecturer 10 1 4 10 10 5 40

In the case of a pathologist,who is also a medical teacher , and whose time of work is from 8 AM to 4 Pm (1 hour lunch) the weekly 56 hours have to be divided also for diagnostic, consultancy, discussion and lab work . Therefore , what we do is , make an arrangement of division of labour and rotate between

9 the teaching, diagnostics work. Suppose there are only two professors in a pathology department and one of them refuses to take up any teaching /administrative work and opts only for consultancy and diagnostic work what measures should an administration take ? If the other professor is willing to take up entire responsibility of teaching, research and administration, curriculum planning, syllabus and the paraphernalia associated with it , the administration should be happy to have avoided a strife . But in fact , a responsible administration should make the professor see that teaching also is part of the work of a professor of an institution of high excellance. Even when there is division of labour between the professors, they can consult each other regarding difficult problems of diagnostic work, exchange ideas on clinical and clinicopathological work and keep the excellance of the institution high . Quality in administration, in teaching and in consultancy and administration is the total personality development each pathologist strives for and each institution should look for . But usually , the administration fails to see such overall total quality/personality development . Charaka , an ancient Indian medical personality defined human personality development in 16 different ways, 7 of them sathwik, 6 of them Rajasic and 3 of them thamasic. Sathwik personality is Kalyanagunavisishta (full of auspicious qualities) rajasic personality is Roshagunavisishta( full of anger which if turned against injustice will help nation, but if directed to persons/group of persons will lead to cruelty and injustice ,wars), and thamasic personality is mohagunavisistha( with quality of desire) and not fit for intellectual quality work. The upward mobility from thamasic to rajasik and from the rajasik to sathwik is possible by proper guidance and guru tries to upgrade the shishya on this ladder of excellance . 1Sathwik :A .Brahmasathwa-intellectual,ethical,scientific,philosophic,aesthetic,truthful,control senses ,unselfish B .Aryasathwa visionary ,ability to grasp meaning of science,hospitality,controlled senses and unselfish 3 Aindrasathwa-powerful and enthusiastic speech,memory and ability to foresee 4.Yaamyasathwa mental power to suffer any hardship,to do work without tiredness,memory power 5.Varunasathwa- Calm,bold,do work without getting tired,give to deserving people liberally,love to play in watersports 6 Kouberathathwa-Interested in worldly life,marriage,makes money and lives comfortably,does both religious and secular duties 7.Gandharvasathwa- music,dance,drama,history,storytelling,smell(perfumes),flowers,luxurious ornaments and cloths,life with beautiful women 2 Rajasic

10 A Asura(also called daanava since they give alms readily and are having dharmikarosha ).Mahabali rose from this to Aindrasathwa ,and Prahlada to Brahmasathwa ,and Viswamithra first to Aindra,then in order to Arya and Brahmasathwa . B raakshasa(selfish desires make them do sins) C paisacha ( heinous crimes are done by them due to intense worldly desires) D Sarpa( stoop to any low level and do any heinous crime for selfish motives) E praitya unfulfilled desires make them wander along thinking of the desires F saakuna same type ,the desirous mind flows like a bird 3 Thamasic : A Paasavan eat,drink,sleep and makes children .No other interest .Just like an animal( pasu) B Maatsyan coward,idiotic,love flattery,fickle,love travels in water /ocean C Vaanaspatyan- lazy,sits without doing anything ,no intellectual or physical activity at all At present education is becoming a consumer cost and resultconscious commodity ,especially at higher levels,where student fees have become exorbitant ,and the education is perceived as a provider of services and benefits .This on one hand prevents the equitybased services and benefits to all citizens alike ,and a double type of organizations /institutions are emerging ,along with different type of citizens at two ends of the spectrum . Nation struggles to overcome this and by a series of efforts/discussions come up with solutions to combat them.The success indicator of a nation/institution/individual is a personal/practice development plan and finding out solutions to all problems . The UGC committee report of 1992 had suggested a few solutions (in which the then Finance minister Sri Manmohan singh and HRD minister Arjun Singh had contributed their ideas too) and the current bill in the parliament has to be seen as an extension of the recommendations of that committee .Instead ,most of the states and institutions and individuals view it as if it is a new bill (probably because they are ignorant of the recommendations of 1992 committee ). 1.THE HINDU REPORT :The Hindu on Saturday July 10th 2010 (Anand Zachariah,George Mathew,M.S.Seshadri,Sara Bhattacharji,K.S.Jacob) says the complexity of issues related to education in medical and health disciplines demands a separate regulatory authority.The opportunity to recreate the regulatory council for the education of health professionals is historic in its possibilities and potential to address the crisis facing healthcare in India.According to them,the council should address issues like lack of access to basic healthcare due to inadequate numbers,the skewed distribution of healthcare providers,ensuring propriety,increasing efficiency,providing greater synergy among professionals.The new national council for higher education and research (NCHER)bill seeks to include medical education under purview of the proposed council.The regulations suggested are:

11 Facilitation,coordination,setting of policy by NCHER Health council to consider syllabi,curricula and exit examinations The local universities to regulate academic institutions How NCHER bill address specific requirements of education of professionals not clear. Concurrently the Government has proposed formation of National council for human resources in health(NCHRH) as a single apex body to oversee all education and practice related to health.It is apparent that there will be an overlap of functions between the two authorities. A separate regulatory authority for health education and practice is mandatory due to :1 Links to health care delivery: Need to provide health service to society demands setting up a system which will sequentially address the following issues.Selection of students from local areas,sufficient training in primary and secondary care hospitals,generalist postgraduate training opportunities,for example family medicine,career opportunities in areas of need and continuing educational support .Such a system will mandate close linkage between educational institutions and healthcare delivery systems. 2.Apprenticeship model of training: At end of training the health professional should get a high level of expertise.Considerable clinical skill,under the teachers in a appropriate service environment.Such a model allows narrowing the divide between teaching,research and practice.It facilitates holistic approach to learning and captures the essence of yashpal committee report . 3.Regulating health professionals : Education and practice of medicine is a continuum and the regulation of education has to be coupled with that of practice.UK first established a dual control(General medical council and Postgraduate medical education and training board) and discarded the model and reverted to single body for oversight of both functions. The authors ,who are professors of Christian medical college Vellore shows concerns over some certain highlighted issues .Their concerns are : 1.Relationship between health disciplines :The proposed regulatory council includes medical,nursing,dental,pharmacy,paramedical,public health and rehabilitation services.A single regulatory body /authority will result in greater co-ordination and collaboration among these disciplines. 2.Composition of the authority:The new authority should be composed of diverse stakeholders,including patient advocacy groups and social scientists ,in addition to distinguished medical and health professionals so that overall healthcare needs and not narrow professional interests are the focus.The council should not be too small so that the power is concentrated in a few hands.Nor should it be too large so that it is divisive and inefficient 3 Independent accreditation and regulatory functions.MCI handled accreditation and regulation and this diluted and weakened both processes.The authority should have two independent divisions. One

12 accrediting education and the other oversee practice.Lack of self-regulation in past,argues for a watchdog to ensure nd enforce adequate technical and ethical standards in medical practice 4.Model of accreditation: Should focus more on describing broad principles and standards that focus on outcome.This will allow for flexibility ,innovation while maintaining basic standards.A credible and transparent system of assessment ,which balances routine self-report and review with monitoring and on-site inspections needs to be designed. 5 Relationship with government: Need for autonomy and independence of the body is crucial .The authors think that subjecting it to health ministry approval limits its role and delays decisionmaking.Government should have power to provide overall policy directions to the body and the body should serve as consultive body to ministry. 6 Relation with hospitals,universities,specialist associations: Propose a clinical stream which is under specialist associations .AAnd an academic stream upgraded to research degree who remain within universities ,while the clinical stream after degree go for practice.The authors think this will avoid conflicts existing between MCI ,and National board ,increase the number of centers for training clinicians and raise standard of research. 7 Single window: Previous regulatory procedures included separate and independent inspections by MCI ,university and state governments.This resulted in a many-tiered system that lead to huge delays in obtaining approvals,and a single window for accreditation and approval of education is necessary 8 Standardised exams and validation: A common licensing examination for undergraduates and postgraduates to maintain uniformity of defined technical standards.All health professionals should maintain standards of professional knowledge and skill through regular re-validation.System of continued education and credits and regular reappraisals is mandatory 9 Transparency and accountability: To public scrutiny .A record of excellance in one;s field should be the basis of selection to proposed council .The authors propose the Nolan principlesselflessness,integrity,objectivity,accountability,openness,honesty and leadership-to form standards for holding public office and in public service. The knowledge commission and Yash pal committee which examined higher education identified major lacunae and suggested an overhaul of the system.There is need for broad-based holistic education and dialogues between diverse disciplines and centers of learning .The regulatory councils chould act as facilitator and catalyst for creation of knowledge for society. NCHER can foster an interdisciplinary research and identify national priorities.It can empower institutions with a proven record to enhance their autonomy as institutes of national importance.NCHRH can serve the goal of improving education in health sciences.It must ensure that education in health science fulfil a social mandate.It should provide a vision to improve healthcare delivery .

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2 WHAT I UNDERSTAND :What I understand is that NCHER focus on policy and regulation and not on funds .Funding will be with a separate corpus with norms for block grants.The UGC,All India council for technological education and national council for teachers education will be thus replaced .By establishment of NCHRH as single apex body to oversee all education MCI will loose the power of control over medical colleges.The objections are raised already by Kerala,West Bengal and Tamil Nad governments as violation of federal principles. What clauses do they object ? 1.A new university will get authorization by the NCHER .This is for quality control. 2.VCs appointed from a national registry.NCHER will suggest 5 nominees from a national list .There will be a collagium to recommend names of eligible persons.Quality of the person is to be considered . Due to objectionfrom the three state Governments ,the reconsideration was done and the second clause on VC appointment was changed .But the first clause for quality was not changed. Tamil nad Government has moved the supreme court for changing a single national common entrance test . A national exit examination (screening test)for students graduating from Indian medical colleges is proposed.A national court for accreditation and national medical education and training board that regulate and accredit medical colleges ,prepare a list of the entire health sector,and regulate all streams of education in health sector is to be set up. In an attempt to make India a global knowledge hub,a draft law for innovation universities made and these universities enjoy total autonomy in appointments ,collaborations,and resource generation.The 14 universities selected will be not-for-profit legal entity.Eacg university will be built around a theme or subject ,these universities will enjoy total autonomy in appointments ,nomenclature of degrees.Open to all nationals ,genders,ethnicity,disability ,provided at least half the students admitted to any programme are Indians.There is no mention of caste based reservation.(HRD Ministry) Each university has to endorse a university endowment fund but have the freedom to receive donations ,contributions from alumni,and other incomes as long as 80 % of the annual income is used for development of research and infrastructure.The university will be a not-for-profit legal entity and no part of the surplus revenue will be invested for any purpose except the growth and development of the university. Many existing universities could be truly innovative if only the autonomy in the draft bill was extended to them.The clarity of seat allotment,reservation for Indian students have to be more transparent.Innovation universities are private institutions.HRD ministry can give grants to develop them .In that case the President will be the visitor and government would have a larger role in their functioning.

14 Each uty has an independent board of governors empowered to discharge all functions by enacting statutes to provide its administration,management,and operation.The board will delegate powers to academic board,headed by VC that will perform financial,management and administrative functions including appointments and collaborations .The board of studies will specify programmes of study.The faculty of knowledge,manpower assessment to study and assess through research trends in emerging fields of knowledge of relevance and the research council that will interface with the research funding organizations ,industry and civil society . The government will protect maintain and utilize the publicly funded intellectual property for which the title vests with it and it can give directions for prohibiting or restricting the publication of information to any person or entity which it considers necessary in the interests of the country.The income or royalty arising out of publicly funded intellectual property will be shared by the innovation university with the intellectual property creator in accordance with the peovision. The 14 universities are expected to set benchmarks for excellance for other institutions of higher learning throughpathbreaking research and promoting synergies between teaching and research.Each university will stand for humanism ,tolerance,reason and adventure of ideas and search for truth.It is expected to attempt to provide a path for humankind free from deprivation and seek to understand and appreciate nature and its laws for the well-being of the people. 3.A FEW CLAUSES IN THE UGC COMMITTEE REPORT 1992 (DOCUMENT FROM NATIONAL INSTITUTE OF EDUCATION,PLANNING AND ADMINISTRATION ) :This I quote for clarifying the point that what the nation suggests is to solve the problem for all ,in an amicable way and if there are any loopholes for injustice,we as citizens can point out them and try to help solve them . Page 2 item 7:- Augmenting resources (private institutions are encouraged by this) given in detail in chapter 9 Item 9 mentions increasing the resources to meet requirements Item 10 financial assistance to needy students frees tudentships,scholarships,student loan for equity in education in detail in chapter 10. Page 4 .1.11.1 :- At present state funds are mainly for salary,allowances(nonplan) and campus expenditure ,local ,municipal services and not much for plan,academic excellance etc Page 5:- Two problems noticed:- functional autonomy is not possible in financial decisions by universities .The dual administration and dual funding in some universities ,delay in getting them in time etc Page 6 has given a few INTERIM Recommendations :- To generate a fund ,keep it as separate fund for achieving objectives of university .To give incentive grants as matching grants-by UGC to institutions

15 who generate own resources.And 100 % income tax concession on all endowments/contributions and to donors sponsoring selected research projects Page 7 : Increase the burden on those who can afford financially and from that income provide for poorer sections- tuition waivers,scholarships,etc . Essential maintainance,development requirements from state itself.Accountability in terms of quality,cost consciousness,costeffectiveness to be achieved. The committee e noticed that nonplan expenditure is always more than plan expenditure .The universities are struggling to maintain the expenditure and fail to achieve quality.They should be designed to promote quality,efficiency,autonomy ,accountability and relevance. Equity and social justice (page 17):- Direct support to poor deserving students Indian situation _1.We have to preserve and promote our national integration 2.Achievement and quality performance comparable to international standards 3 Equity and social justice to poor should be safeguarded The newly emerging beneficiaries from secondary education should be able to afford an access to higher education (the vulnerable group). Page 18:- Universities are an 1 Essential input for meeting manpower requirements for national development 2 Critical input to ensure social justice and equity ,upward mobility 3 Input for improving quality of life higher level of integrated knowledge available to widen base of population and preserving national and cultural heritage Page 23 :- Scholarships and fellowships should not be reappropriated to any other head of account .Plan fund should not be diverted to nonplan fund either should be added to this clause,I think. Page 27 : 4.15.The existing system had lead to practices in which an efficient institution is punished and inefficient institution is securing more grants and support .Therefore,universities(as well as people) become more inactive ,no new programmes,no internal generation of funds,no costeffective efficient management the committee noted . Page 32:- What have the universities to say ? 1.Delay in sanctioning schemes 2.Irregular release of funds 3.Inadequate delegation of powers I implementation of plan schemes

16 Cha 5 is on negotiated funding based on last years expenditure Chapter 6 is proposal for future funds .What are these proposals in 1992 ? 6.5.1:- An internal academic audit system to determine needs and scope for new courses of study(page 39) 6.9.1V- Specified discretionary fund with the VC for promoting excellance in teaching and research without incurring any recurrent liability .(page 42).This is the reason why the quality of VC was specified by the new innovation bill I guess.If the VC is not of excellent character ,what happened with IMC will be repeated and money /funds may be misused . Chapter 7 page 47 .:- 7.9 Presentation of students in terms of income groups (so that all weaker sections get access to higher education) is a welcome decision.For this allows analysis of income pattern of parents and based on this the support system to be collated and indicated (7.8) It is interesting that the committee had anticipated resistance from the university community ,in advance (7.16 page 49) and says as in any departure from the past practice this is usual . Nature of activity of uty/student strength/student-teacher ratio-teaching-nonteaching staff ratio ,stage of development of institution all considered in giving grants . page 67 says Indian uty system is based on uty system of Britain . I beg to defer ,since it is the other way round .The value system of Indian university system (palkalai kazhakam /gurukula) was the model for British universities of early period.Indian UGC act was formed in 1956 but in UK the till 1980 no audit standards were established .(8.6) and after 1979 election a regulation of public life resulted in an academic standard group,an academic audit group and a university funding council (the successor of UGC )in UK .Joining with UGC ,in consultation with it,CVCP thematically based efficiency studies were designed (8.6.2) and in 1983 the standard of British university were fixed. Selfdirected exercise by each individual/institution is the best internal audit (I call this a personal and practice development plan ) and for external audit a Guru/a sabha /samithi (committee/councils in modern sense) are set up. Accreditation and audit unit should have in its purview study alone and research is not under its control in UK .page 72(8.14)mentions performance indicators given by Mridula Sharma. Chapter 9 is on income generation and utilization:As I have described the ancient university system of India(see history of Valabhi/Nalanda and other universities of vedic and Budhist India ) primary ,secondary education and care(patient care) should be entirely free or in certain cases with minimum fee /concession.The tertiary higher education and tertiary care institutions can collect fee from the rich and give free service to poor .

17 Beneficiaries from the first two sectors(students/patients) should get equal access to all sectors is the idea behind this suggestion .How is this possible ?One has to make internal and external audit for efficiency and excellance at each step . What the 1992 report suggest is given below for generation of income by universities(page 78) 1.Fee from higher income student population .Keep this as a separate fund .Utilise for deserving low income students who prove merit in the previous sectors .Also for betterment of quality of institution to reach international standards 2.Rent out facilities like auditoria,classrooms,computer service,playground,guesthouse,hostels,lawn,mess etc 3 Individual departments to design programmes and short term courses of study.Thus generate resources without adverse impact on main academic activities.These units can retain a substantial amount so earned to support their main academic activities 4.Endowments,contributions,large investments,for academic and infrastructural development 5 Sponsors for research .May be state or central government agencies,public or private sectors,industries etc .These projects proposals should incorporate allocations for reimbursements for staff ,facilities and infrastructure support .Use for strengtheneing infrastructure. 6. Consultative mechanisms: Institute and members as a whole (not management alone) faculty,students,alumni,nonteaching staff have representatives in this 7.Incentives to inculcate and implement measures UGC support,encouragements as positive incentives and grants (page 79) Page 80 (9.23) asks to have a separate fund for keeping high standards of excellance . 9.24 A part of it kept for building up a corpus fund ,the interest of which is for support activities of uty 9.25 a part goes to needy students and for academic improvement Chapter 10 enumerates the existing financial assistance for scheduled cates/scheduled tribes . 10.2 : Department of welfare gives tuition fee and living expenses for scheduled catses/tribes .But there is delay in getting the amount .UGC suggests the advance grant to be given to uty in April itself (calculating the previous year expenditure and adjusting the amount at final stage of payment ) so that students and uty will have no problem. 10.3 .JRF has a 10 % cut off marks for SC/ST students Also through open selection without qualifying examination they are being enrolled for higher education seats.

18 10.4 Bookbanks are functioning for the weaker sections of students 10.12. Of the weaker sections 10 % of entire student population of uty is from economically poor weaker sections.The rest study with concessional rates based on merit . 10.13 Freeship schemes 10.14 existing loan schemes The newly generated fund is for reducing the financial restraint on state and public fund and make the stronger(financially) sections of society share the funds for the sake of weaker sections and make equity come true from a national point of view . This is what I have understood ,being part and parcel of Government medical college (teaching and practice )and part of a private institution of excellance which take money from rich and try to help the poor/deserving .The problems of public sector funding and the problem of equity when privatization of higher education happens ,are thus taken into account by the UGC committee (which report I read in 1995 ) and I think it is these recommendations which the current Loksabha has passed as the bills ,as mentioned in the Hindu . The aims are thus understood.To put it into practice all citizens,all institutions should be willing . It is not laws or committees and recommendations which we lack.It is the right attitude of national integration,and of duty consciousness,a right attitude to achieve personal,institutional,professional and national excellance as a responsible human being which each and every one of us should cultivate.No political party,no religion ,no other sectarian interests or personal selfish interests should bar that ultimate aim of a purely sathwik personality of excellance as Charaka ,our ideal Vaidya justly pointed out.Make us achieve that upward journey to excellance as a single united nation .

Chapter 4 Results of Sreeramachandra uty project by S.Thanikachalam

8080 persons from Chennai ,Tiruvallur and Kancheepuram studied.Age distribution 25-65 yrs Males 56 % Females 44%.Maximum income per month :Rs 15,000/month Between April 2008 and June 2011. Urban 25.8% 47.92 81.1 20.2 15.3 Semi urban 23.8% 53.63 85.44 17.5 14.8 Rural 38.3% 28.34 64.91 11.2 11.8

Smoking BMI (>25) Body fat %(>25) Anxiety Depression

19 Stress Qbnormal ECG Diabetes High BP (over 140/90 mmHg) Lipid abnormalities 21.2 31.7 19.32 18.64 72.21 20.6 18.8 17.82 18.1 61.26 13.7 22.8 12.05 15.24 61.17

1/3rd of population has conditions conducive to development of vascular illness-stroke,heart attack,peripheral vascular disease,among others. Normal reference value for vascular aging among Indians was much higher than Caucasianpopulation.Aging was advanced by at least 10 years ,in comparison with Caucasians(Carmel Mary McEniery ,Uty of Cambridge).Vascular age of 30 yr old Indian is comparable to that of a 40 yr old Caucasian in UK . S.Ramaswamy,Director of Vasomeditech: This increases the risk of vascular incident at an earlier age than other Ethnic groups .The incidence in semiurban and rural areas also is steadily raising.(Higher fasting glucose ,a prediabetic state )was higher in rural(12.02)and semiurban(9.6) than urban.Glucose tolerance levels also were higher in these groups.This is a disturbing finding because they too are slowly developing the same conditions that exist in Urban life style population.The deficiency of Homocysteine,Folic acid,high oxidative stress,indicate the disease is just round the corner according to Dr Thanikachalam.The team is trying for collaboration to explore possibilities of prevention.They have experiments with Sidha medicine in 73 patients for Diabetes for 6 months and reported that the medicines were effective and safe.(Ref The Hindu .Vascular aging value High in India .Sep 6.2011.page 9) I think this is a good turn of events.Because the integration of Sidha with Allopathy is a new step taken. About prevention of stress,stressrelated diseases and the role of Music therapy and Ayurveda in it I had already experiments and proved its efficacy and as a way of life this is a safe and efficient procedure for both prevention and cure of many disorders of the 21st century . I had done an epidemiological study of Cancer of Digestive tract-Colon ,rectum and stomach- in Calicut Medical college ,and found that the Northern Kerala population has a tendency of developing cancer stomach at an earlier age and the food style is responsible for this . The Caucasian by nature is a nonvegetarian.But a tropical animal like an Indian is not so.The changing life style from vegetarianism to nonvegetarianism is one factor for development of digestive system cancer as well as high lipid and cholesterol levels and atherosclerosis and the related vascular diseases. The reason for vegetarianism in India is not religious ,but geographical. If we look at the tropical Indian bear ,it is brown or black and is mainly fruitivorous,eats fruits,nuts ,honey,and if at all a tiny animal once in a way.But a Polar bear ,its cousin ,is very white and is a carnivorous animal and feeds on big seals and this is because of the lack of vegetation in the poles .The tropical monsoons,the abundant green vegetation,forest foods and grains made the early ancestor of tropical man a herbivorous animal and

20 eating meat (especially red meat) was almost unnecessary and not resorted to. This life style changed when we came across other cultures from the more northern latitudes . The Indian ancestral genes which were not acclematised to such life style is showing its lack of adjustment by being prone to diseases at an early age. The reduction of stress by Music,indigenous way of living ,and food habits and herbal products will help India in overcoming many health problems which are causing high cost for its exchecquer.

Chapter 5 The challenging task for a Medical University :

1. Improve the quality and content of Higher education- Academics and Research 2. Integrate western medicine research protocols with Indegenous medical systems according to needs of Indian subcontinent 3. Innovative thinking in managing the different Institutions under its umbrella 4. Have good scientific publications in each of these fields of Medicine (both western and Indian Medical systems) and have international standard research papers and text books created by the Faculty /Research scholars .For this an e-library and facility for digitalized versions of papers and texts should function . 5. The administration (day to day ) and conducting examinations in time etc should be delegated to an administrator of the Chief secretary cadre IAS officer and the academicians should be concentrating on research and academics . 6. Have an Institute of Human Values in healthcare so that Integration of humanities and science will have long reaching effects on physical,mental and intellectual wellbeing of the people. 7. The academic and human value wing together should formulate the health policy required for the state and for the Nation and should have highly involved members with a vision of valuebased education for national development policies.

The problems currently encountered by Tamil Nad Anna University and the solutions suggested for it may be considered and modified according to the needs of the Kerala based Medical University and its current problems.(The Hindu :Education Plus Monday September 19;2011.) The problem in Anna Uty :-The academic circles feel that not more than 100 colleges should be affiliated to a Uty . But they also agree that there are several universities with 800-900 colleges of arts and science affiliated to them ,but to manage 500 Engineering colleges is very difficult.Making the Professional colleges which should be centers of academics and research (and not tuition centers ) into inefficient centers have to be prevented.For this mammoth task ahead Anna Uty is searching for an effective academician-cum-administrator as Vice chancellor .The Uty needs to have the cleanest and efficient vice chancellor someone who can take the bull by the horns-and whose words and leadership would be respected .The appointment has to

21 be solely on merit devoid of corruption or political interference.It will be an acid test ,says academics of the Uty . When the Uty and its faculty is having more work to perform in the administration and in the process of affiliation of all colleges,conducting examinations in time etc ,the academics and research takes a back seat . Eminent academician and IIT Kanpur chairman M.Anandakrishnan comes up with a solution:Uty can have 500 professional colleges affiliated. For that create mentoring centers ,at least 10 ,to begin with ,each in charge of 100 colleges .Provide people who can act as mentors for these centers. They may be given powers of a pro-vice chancellor but within the Utys control.All the colleges have to do real quality work and should be academic and not mere tuition centers. The current problems that the prestigious Medical Uty of Kerala face can be solved if we resort to a goal-oriented systematic approach .

THE VICE CHANCELLOR - ACADEMIC AND RESEARCH ( PROFESSIONAL FROM MEDICAL SIDE ) ADMINISTRATIVE HEAD IAS CADRE OF CHIEF SECRETARY HEAD OF INSTITUTE OF HUMAN VALUES IN HEALTHCARE

These 3 have their own designated duties and thus delegation of powers to each helps in bettering the functions of the institution. It should be a teamwork . The distribution of power is for efficiency . And it would be a decentralized power distribution under a centralised Uty scheme . As suggested for the Anna Uty scheme by sri A.Ananthakrishnan, 10 mentors with pro-vice chancellor status under the Uty can function in the state and they should be given awareness of the vision and goal of academic and research enhancement before they are given the charge . Merit should be the only basis of selection.If it is difficult to get 10 mentors who are academicians/with leadership qualities ,the number may be restricted to 1 to 4 as required.( For Southern states as Travancore, for Cochin and for south and North Malabar respectively ). If this is strictly followed with Uty and national goals of higher Education ,we can solve many of the problems encountered in the professional education . Tamil Nad Governement has done an Audit on the valuation system of Anna Uty and found that there is a substantial change (increase) in marks given after revaluation of papers. (from 2005-2009). The student remits Rs 400 for revaluation and for getting a copy of the new result Rs 700 which in total is 1100 Rs. If the revaluation is unsatisfactory ,student can ask for a further review. For it student has to pay Rs 3000 after securing permission from departmental head and principal. Then the answer

22 sheet is evaluated by the Faculty members of the student in the college. In 2006 April , students applied for revaluation= 71173 In 2009 April it was 1.57 lakh more than doubled. 30000 got marks changed in 2006.83000 in 2009. (from 46.21 % to 53.17%).There is a weakness in the evaluation system as pointed out by this scenario. Based on the report of CAG ,the higher education secretary has asked the Uty to review its valuation system. One of the reasons for poor evaluation pointed out, is the pressure on the Faculty members/examiners to complete a particular number of transcripts with a prescribed period . Another fault pointed out by the CAG is that many industries which signed out Memorandum of Understanding (MoU) during 2005-10 did not facilitate any industry-related academic programmes but merely served the purpose of mobilizing funds for the Uty . MoU entitles the consortium partner of the industry to avail admission for one student in the relevant branch of study. In 2005-2006 Uty signed MoU with 18 industries but admitted 21 students in consortium quota . 2007-2008 : signed with 53 industries ,and admitted 2 more additional sponsored candidates. In 5 yrs Uty earned 22.75 crores and admitted 178 sponsored candidates. MoU only served the purpose of allowing admission to sponsored candidates on payment of 12-15 lakh per course (the amount for joining as consortium member).Industries considered unsuited to sign MoU by a team of Faculty members ,were approved by another team sent again. MoU envisage involving industries in setting curriculum and in organizing seminars ,conferences, research ,industry visits; staff exchange programmes with university and industry ;besides the admission of one sponsored candidate. The consortium members did not contribute to any of these .They just enjoyed one sponsored candidate . Such studies show the flaws in our academic system and where we fail. The results should not discourage us.We have to think together and make solutions . For this , a good team is needed both at the helm and at the mentor level and all the faculty should have a broader vision on our goals of higher education .

Chapter 6 : PROJECT : ( Presented at World Education congress New Delhi January 2011 and Music Academy Chennai in 2010)
WRITE UP FOR A VALUEBASED EDUCATIIONAL MODEL HEALTHCARE PROGRAMME FOR WORLD PEACE AND INTEGRATION OF MEDICINE AND ARTS THROUGH RAAGACHIKITSA (INDIAN MUSIC THERAPY)

Introduction:A satisfied quality life is the gateway to consistent health physical ,mental ,intellectual and spiritual.For this an enlightened citizenship and humanitarian values have to be inculcated in every

23 individual. Minimum basic needs and material comforts like food,job,basic education etc have to be made universally available to all. The first civilization to realize this was ancient India which devised a vocational job-oriented training with basic education for all and a higher and deeper academic education for those who aspire for it and have the intellectual acumen and concentration for studies.The problems of intolerance,fanaticism,exploitation of nature and the globe so that climatic changes and destruction of races ,and a fragmented polarized society with separatist tendencies were anticipated by the educators of the yesteryears who prescribed a lifestyle of Maithri (friendship to all living things) Karuna( compassion to all) and muditha( a consistently happy life) as early as BC 3104 (Bhagavad Gita ).Music or Gita had been part of life in ancient India ,both individually and in groups ,in rural,urban ,royal,and temple settings as well as in common mans personal and professional life .

Motivation and objective :I started my professional career as a private practitioner in a remote village in Calicut ,and the commonest problem encountered there was anemia and nutritional deficiencies of various kinds due to lack of awareness of nutritional requirements as well as by poverty . In 1972 I joined Calicut Medical college and started to do research on anemia and leukemia ,and found that both nutritional deficiencies, environmental pollution and toxic chemicals and drugs are contributing to childhood leukemias and anemias. The idea that Without food-sufficiency ,and protection of environment from pollution of various kinds, mere multispeciality hospitals unapproachable to common man and middle class people will not solve the problems of our country occurred to me from those early experiences. In 2001 , the plan for a valuebased Integrated Medical University was submitted . .(ref Music Therapy I Management education and administration.Readworthy Publications Nalapat 2008). How can we make use of the available herbs and seasonal foods in each village/town so that each village is self sufficient in food ? The result of that thought process was the idea of a health village which I submitted to Calicut corporation in 1990 and to Amritha institute of medical research in

24 2002 . The institute of human values in healthcare and a integrated curriculum for arts and science ,introducing sadbhavana lectures and using music therapy as a golden link for the process was also submitted and experimented with a pilot project in Amritha Institute .The problems encountered in each step was evaluated and my personal education plan with my practice development plan developed simultaneously over the years from 1972 onwards in reflective learning cycles .The context ,the personal and professional experiences ,the reflective thoughts on them and the action plans as Action research ,periodic self- assessment and evaluation and modification of the plans as situations demanded (in individual cases /clients) continued for a long period .The model is a clientcentered,studentcentered practice/learning plan ,and use a gestalt model of biophysical medicine integrated with the bioenergy and cosmic energy using Indian music as Raagas. When Jeevaka ,the great physician was asked to find out a herb that is not a medicine ,he said after a long search that he cannot see a single plant that is not having healing properties.This is the same case with Ragas.Each raga has healing properties .The challenge is to find out which for which individual and for which context . This requires lot of patience,time ,effort and manodharma for the therapist .It is both an art and a science. Why should we integrate ? One has to understand the important trends in the field we live in.The increasing popularity of the alternative medicine the world over is a moment for all of us to have a selfassessment of our current systems of practice. At the same time,we have a responsibility to preserve the regulations,guidelines to practice,research protocols acceptable scientifically,and the training and licencing accreditation systems etc so that the new discipline does not end up as a quackery .This double responsibility has to be handled effectively by an enlightened citizen .Integration is already in progress as we find from IRIIM 2006 but we also know that the integration has several problems ,regarding modern medicine and indigenous medicines accepting each other. The question of integration is mistaken as taking theories and practices of one and indiscriminately applying them in another discipline by both sides.But integration means ,functioning under the same roof,where the

25 client has the choice to select what he/she wants and protecting the individuality of each discipline .The indigenous disciplines taking the research protocols of Modern medicine ,and Modern medicine being benefitted by the traditional knowledge systems in bringing about a more satisfied quality life to the client under the same roof . For this a plan has been drawn out after several personal and practice development cycles in course of my Action research .It has to be implemented nationwide for benefit of all.

Means and methodology ,/theory and practice adopted in achieving objectives in Music Therapy research :
Indian Music therapy is a system in which physical, mental, intellectual and spiritual wellbeing of all living beings is considered.Indian music has its base in thridosha sidhantha and in sabdasasthra which is essential for all philosophies and sciences. Its Naadalayayoga or Naadaanusandhaanayoga is common to Samaveda, Sidha, Yoga and Ayurved.. Its use of time cycles is common for science of astrophysics and energy cycles. Raagachakra corresponds to energy cycles,bioenergy as well as cosmic energy ,thus unifying energy concepts through mathematical vibrational cycles of Naada or sound. What one has to do is use this integrating golden link for uniting indigenous and western medicine. All the differences of opinions existing in the theoretical and practical integration of healthcare can be removed by the use of music as therapy and in therapy ..The research was done with modern research protocols and statistical tools integrating ancient and modern sciences and arts . How music works : Music use Swara and Raaga as both dravya and adravya (matter and energy) for healing and therefore both biomedical as well as astrophysical (energy) levels of healing are employed and this is the reason for its universal use as integrating medium.

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Fig 1.Swara measured as dravya by its length ,height ,volume, time Swara as dravya is measured, (Fig 1)still is invisible to eye. Sabda is quality of Aakaasa (one of 5 elements) and is Ekaguna and that is why Aakasa and sound (OM) is considered as symbol of God. God, sound and akaasa are experienced but cannot be perceived by gross senses. Hence swara and music based on swara is both dravya and adravya. Music uses principles of Chakra energy in our cosmic and biological field. Naada (sound) and Layayoga (merging in Samadhi ) is the ultimate.South Indian classical Melakartha Raaga scheme as shown in fig 3 ,in which the cosmic spheres (astrophysics) with star clusters, the seasons with seasonal raga,the raga for each day (as in North India) and for each bioenergy Naadi (in Kundalini ,the nerve plexus chakra of body ) each related to each organ system ,thus making an integrated whole. In my action research scheme ,this Melakartha scheme was tested and experimented with volunteers and hospital populations . Figure 2.Samayachakra( North India) Fig 3. Chakra used in Music Therapy Incorporating cosmic and human naadi /N & S India .(Dr Suvarna 2003 ) Using fig 3, Chakra Nadi, meridians and energy channels used in India and China (acupuncture system) can be integrated. Jung (1976) understood chakras as universal .Several supportive articles and books on chakra and energy in naadi have come out (Brennan 1988; Idou 2001; Shang 2000, 2001; Rao and Motoyama 1993; Gallo 2002; Popp 1998; Vijk and van vijk 2006; Gerber 2001; Gilchrist and Mikulas 1993; Maslow 1954/1987). But none of them explore the underlying science, philosophy and integrative power for healing purposes .Anna Van wersch, Mark Forshaw and Tina Cartwright (2009) has rightly

27 said that the concept of nadi and chakra in Indian and Chinese Medicine would be the most fascinating and worthwhile research topic. With medical training, love for music, astronomy and yoga, my journey had indeed been fascinating with an interdisciplinary integrated result-oriented approach integrating doctors and clients point of view yet client-centered. There are no known side effects if music is used in correct sound decibels .It is a cost-effective procedure and reduces dosage, duration of hospital stay for surgery and therefore use of music is a boon to majority of people of India because exorbitant rates of super-speciality hospitals are unaffordable to the common man.Swara with thriguna balanced increase psychosomatic balance and immunity. The balancing is done by time - seasons, day/night and cosmic and bio-energy harnessed for balancing life. Therefore, it is cosmic energy and not biomedical alone according to eastern especially Indian context .(Spirituality, physicality, aesthetics, mathematics, music and astronomy are thus integrated).Follow the principle of documentation and evidence-based practice, research tools and protocols and discuss, evaluate on-going projects, have an open outlook for growth of the discipline. Statistical evidence and data compilation from various centers should follow as a metascience. Physics of Acoustics Above 80 to 180 dB is noise pollution level. Usually Instrumental music starts at 60 and upto 80 dB range and vocal music has range of 20-30 dB. At 10 dB we have breath sounds alone in praanaayaaman (yoga) and below that is usually inaudible to human ear. The zero level is the silence and the yogic naada level zone.Because of this human voice is best suited for therapy.Moreover the input for our brain is our sense organs and their subjects(Indriya,vishaya) and output is the autonomic/endocrine /autocrine hormones,neural peptides which are responsible for our implicit and explicit actions.Both act on learning and emotional cycles .There is association between primary and secondary reinforcers(amygdale and cerebrofrontal cortex) and since all our clients were people who had developed language systems and cerebrocortical functions it was better to use sangheetham and saahityam( Sangheetham api saahityam saraswatyaa sthanadwayam according to India) and hence vocal music with lyrics was used. For clients who have not developed cerebrocortical and language functions and for those who have lost them ,different methods have to be devised which may or may not include lyrics/language .If instrumental music is being used adhere to the levels well below 60-50 dB and several traditional instruments have this range. Thus side effects of pollution can be eliminated. Key issues worked out :-

28 On the basis of preferences and attitudes of people in Kerala, and bearing in mind the larger Indian requirement, an integrative approach was evolved and a study undertaken. (Nalapat 2008 ). Key issues were worked out on its basis as a part of action research . Clinical Governance issues, regulations, training quality assurance for an integrated curriculum using music therapy for medical institutions. Worked out and experimented in Amritha Institute of Medical Sciences and Research Centre. (Nalapat,S; 2008 ). Can MT be used in mainstream healthcare system? By theory, practice and research, the answer is yes. Evidence for effectiveness , Safety and lack of side effects. Cost-effectiveness, client satisfaction worked out by pilot project . A trial training at Trivandrum Pankajakasthuri Ayurveda Medical College identified problems that can arise and reflective learning cycles were done to eliminate such problems in future.Randomized controlled study on 78 patients in Calicut Medical College undergoing colonoscopy was done . The dose of drug Midazolom could be reduced and the pain and discomfort zones showed significant variation in test and control groups. The music used was 56 % Raagabased, of which 46 % was vocal and 10 % instrumental. (Harikumar et al 2004 quoted by Nalapat S.2008 c)

Extent of geographical area which can be covered and target population benefited .
Entire nation/world can get the benefit ,if applied nationwide /worldwide since all Indian Raagas can be used (Fig 2 & 3)

Source of funding and application of funds in the last three years : The pilot project
was done in Amritha Institute of Research center and workshops conducted in Pankajakasthuri , by their own funds .No other funds were asked for or applied for . All the other funds needed for the project were met from my own personal funds .

Future Action Plan : This is a project

which needs teamwork and collaboration from different

public and private agencies of healthcare,and musicians and at a national level . So far all the works were done in Kerala .A Faculty training and Research center has to be established and the services of the center/chair should be extended to nationwide/worldwide programmes for better healthcare and quality life of all.

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Fig 2 Samayachakra Fig 3 Melakartha Raaga chakra

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