King George’s Medical University: Inculcating a Service Mindset

Abstract

The case narrates the dilemma faced by Dr Ravi Kant, the Vice Chancellor (VC) of King George’s Medical University, and the steps he took to resolve the same. The widely reputed public hospital had, under the leadership of Dr Ravi Kant, successfully introduced a series of communication interventions in the hospital in 2015. The aim of these interventions was to sensitize the doctors on the importance of empathy, patient-centred care, and its outcomes in line with the recent directives of the Medical Council of India. However, no tangible benefits of these interventions were visible, just yet. Doctor–patient clashes were far more frequent. Many times, the university almost came to a standstill because of flash strikes by the junior doctors and even doctors in residence. The VC was often confronted with disgruntled patients, irritated patient attendants, an angry media and missives from the state government. The key issues highlighted in this case are: How to make the doctors more responsive to the needs of the patient? What additional measures should be initiated to inculcate values of medical ethics and empathy within the doctors? What more could be added to the medical curriculum to bring about a greater change in perspective? Finally, how to develop a service mindset?

Keywords

ATCOM module competency IMG patient feedback public hospital student feedback

Introduction

The case describes the dilemma of Dr (Professor) Ravi Kant, Vice Chancellor (VC) of the widely reputed King George’s Medical University (KGMU¹), Lucknow, Uttar Pradesh, India. Ranked fifth among the best hospitals in India by the National Institutional Ranking Framework (NIRF) 2018, the medical university has had a spectacular record of producing specialists par excellence. However, the demand today was of an IMG—abbreviation for the Indian Medical Graduate-—who had to be both a ‘leader’ and a ‘communicator’. Despite the recent impetus given to honing the soft skills of the medical students and introduction of structural changes to boost internal as well as external communication at KGMU, little tangible result was seen over the past few months. The recent spate of violence and the frequent doctor–patient clashes had aggravated the situation. An uneasy relationship prevailed among the doctors, the patients and the administration. Dr Kant felt that the well-meaning efforts of his team had gone to waste (or had they?).

The case highlights the importance of understanding and managing complex relationships in a state government teaching hospital. It also enables the participants to identify the various organizational stakeholders and suggests possible ways to engage with them. It provides an opportunity to discuss the important role of empathy in doctor–patient interactions and the challenges faced by teaching hospitals to institutionalize the same. In addition, the case explores the challenges of introducing organizational level changes and the role of communication in a complex, traditionally bureaucratic and hierarchy driven organization.

The Dilemma

The VC Dr Ravi Kant was in a pensive mood. Another doctor–patient clash widely reported in the media had made him revisit his agenda. He was trying hard to make the healthcare communication interventions work at KGMU, but these frequent setbacks pushed back his agenda. His vision was to sensitize the doctors on softer skills such as empathy, communication, listening and understanding, such that the university would be famous not only for its medical expertise, but also for producing sensitive and responsive doctors. Long waiting queues, scarcity of qualified doctors and poor infrastructure facilities were often cited as the bane of public hospitals, and KGMU was no exception. It was increasingly being perceived that the current course curriculum had failed to support the medical graduate to handle these stressors, leading to professional dissatisfaction, often with undesirable negative consequences. Another trigger was the directive of the Medical Council of India, which was now promoting the concept of the ‘IMG’ equipped with both expertise and empathic skills. This required improving collaboration among the various departments of the hospital to facilitate an internal dialogue.

Competency: The New Imperative

Competency, defined as ‘the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and community being served’, was now the new paradigm in medical pedagogy. It was being widely perceived that while the MBBS doctors had the requisite knowledge, they lacked the attitude and the communication skills to deal with their patients. They were either too brisk, curt and dismissive with their patients or too verbose and indirect. It was felt that students should meet the course objectives in not only the knowledge and skills domains, but also attitude and communication competencies. Thus was born the concept of the ‘IMG’.

Around 2014, the efforts to make ‘competencies’ as the chief driving force of medical training and curricular planning had already gained momentum in most medical colleges including the KGMU. It was purported to be visible in all aspects of the hospital’s communication: its mission and vision statements, goals and objectives, organization structure, and in its assessment of the ‘IMG’ at varying levels. The 2015 directive of the Medical Council of India², which emphasized that the IMG must be capable to function in the following roles: A ‘clinician’, a ‘leader’ and a ‘communicator’ had served to strengthen the concept further.

Apparently, this was not happening. On 01 January 2016, one major ward had come to a standstill for nearly four hours and work had perforce to be cancelled. It was alleged that the delay by the resident doctors had caused the death of a patient. The dispute apparently turned ugly and both the sides clashed with each other. The doctors had allegedly beaten up the attendants of the patients severely and much public property was destroyed. The junior doctors had gone up in arms against the administration and had threatened to go on a flash strike. Patients were withstanding the worst of this as the junior doctors allegedly clashed with their attendants. Only 120 slips could be registered since 9 AM in the morning, the Public Relations Officer (PRO) had informed him, when allegedly, a large group of junior doctors had barged into the outpatient department (OPD), forcibly shutting down the counter.

Today, he was revisiting a YouTube clip of a doctor severely beating up an unconscious patient. The gruesome incident took place on 13 March 2015 (Srivastava, A., 2018). The media had gone wild reporting the ‘apathy’ of the KGMU doctors and the ‘moral decline’ of the KGMU medical student. Earlier, in March 2014, striking junior doctors had refused to see patients and instead directed them to go home. Dr Kant had initiated both: an organizational communication intervention and modules to develop the attitude and communication skills of the students also known as the resident doctors, but apparently, things were not turning out as he had expected. Had his communication initiatives failed to live up to the expectations? How should he make the doctors more responsive to the needs of the patient? What more could be attempted to bring about a greater change in perspective?

About Vice Chancellor

Prof Kant succeeded Dr D. K. Gupta as the VC of KGMU in 2014. A proponent of the interactive school of teaching, he was considered as being instrumental in introducing soft skills in the curriculum at KGMU. Speaking on the 111th foundation day of KGMU, he had strongly advocated the need for curriculum review and modification; it was appalling that certain courses that had been running at the PGI Chandigarh and AIIMS Delhi (two premier institutes of India) since 1977, were sanctioned to run at KGMU only in 2014. He had shared his belief that the curriculum should be divided in to ‘must know’ aspects and the ‘good to know’ aspects. He claimed that ever since the university had come into his charge, close to 42 initiatives from May 2014 to December 2015 had been implemented out of which at least 71 per cent had reached their fruition.

Addressing the students, Prof Ravi Kant had said,

Our approach should be top-down like that which is followed by a mother teaching her child. The child learns to speak fluently in his mother tongue in the early years of life and gets on to alphabets and grammar much later. KGMU’s mother tongue is medicine, dentistry, and others, and we need to teach the students the way a child learns from his mother.

In an interview with Careers360, a news portal (Careers360, 2018), dated 8 Jul 2016 the VC, Dr Ravi Kant had stated:

In developed countries, medical students are adjudged on six parameters, of which three are skill, knowledge, and practice and rest comprise soft skills. Formative and summative assessment and multi-assessment modalities to be used as ‘workplace-based assessment’: Clinical evaluation exercise (CEX), curriculum-based assessment (CBA), procedure-based assessment (PBA), portfolio, multisource feedback, including one eligibility examination through the written MCQ-based exam.

He highlighted the medical university’s efforts to implement UNESCO’s standards on bioethics, a code of ethical practices in medical education and research. He emphasized that students failing in soft skills would be required to take the entire examination again. The VC said that this would affect patient satisfaction positively since patient-centred care would be the driving force in the years to come. ‘We often get to hear of resident doctors or junior doctors getting into a conflict with patient or attendants because the system of education does not address behavioural issues’, said Dr Kant. KGMU, he informed the media, would be training at least 20 per cent of its faculty on bioethics.

Theoretical Background

Service Mindset: Dominant Perspectives and Application to the Healthcare Services

Healthcare services have traditionally been provider dominant in their orientation. There is a growing realization, however, that the value provided to the patient must increase with a corresponding decrease in costs facilitated by rapid strides in information technology. While the term ‘healthcare marketing’ is still frowned upon mainly because of the vocational nature of the healthcare system, there is no denying that hospital control systems and involvement, co-created with patient involvement and experience, would lead to a better service delivery and healthcare outcomes. In short, one of the many challenges faced by the healthcare industry is inculcating a service mindset in the physicians, nurses, attendants, administrators and staff.

The Concept of Value Creation in Services

Traditional service management literature had focussed more on provider-dominant than customer-dominant perspectives, wherein, the service providers were the value creators working to fulfil the needs of the customer (value in exchange, or value in use). In the new customer-dominant paradigm, the value was sought to be co-created and non-dualistic in its nature (Helkkula & Kelleher, 2010; Schembri, 2006) wherein the experience of the customer was connected with that of friends, family, acquaintances and co-workers at varying levels (Epp & Price, 2011). Value, thus, was defined to be a function of the service, an important by-product, which was always ‘uniquely and phenomenologically determined by the recipient of the service’ (Vargo & Lusch, 2008b). Customer centricity and proactive incorporation of customer’s views (Blocker, Flint, Myers, & Slater, 2011; Fisk, 2009; Zubac, Hubbard, & Johnson, 2010) was considered a step towards building a service mindset.

While Vargo and Lusch (2004) had emphasized value creation from both the provider-dominant and customer-dominant perspectives, in 2013, Heinonen, Strandvik and Voima argued in favour of only a customer-dominant dynamic and interdependent ecosystem to facilitate customer-dominant value formation. In these circumstances, the authors argue, the starting point of value creation should be the ‘customer’s reality and ecosystem’ working at three levels: value creation by the organization, by the customer (the patient) or by both the customer and the company; value creation by action, that is, passive or active by the customer; and, value creation by the type of activity performed by the customer—physical or mental. The value in services, the authors pointed out, had shifted from mere assessments of goods and services to building relationships and networks (Ford, 2011; Hammervoll & Toften, 2010)

What actually constituted ‘value’ was therefore debatable (Ramaswamy, 2011; Verhoef et al., 2009), but what emerged clearly in the review of literature was the shift in consumer research from evaluation of the organization to the evaluation of interactions, and from scripted staged settings to customer–customer interactions, in both offline and online settings (Carù & Cova, 2008; Epp & Price, 2011; Harris & Reynolds, 2004; Heinonen et al., 2010; Helkkula, Kelleher, & Pihlström, 2012; Hoffman & Turley, 2002; Voima et al., 2011; Wikström, 2008; Wu, 2007).

Healthcare as a Captive Service

While Vargo and Morgan (2005) had suggested that concepts central to service delivery could be applied in any service context, yet this might not be true of ‘captive services’ such as healthcare. This, Rayburn (2013) argued was because of three reasons: one that captive services were positioned on the goal of the overall good of the society; two, that customers in a captive service were not always the epicentre of the service process, rather he or she was ‘acted upon’; and three, that value as a concept applied differently to the captive services. This, Rayburn (2012) commented, warranted a different service approach than the service-dominant logic of marketing lens proposed by Lusch and Vargo (2006), Vargo and Lusch (2004, 2008).

According to Rayburn, captive services limited consumer choice and could lead to the creation of an imbalance of power, favouring the service provider. Citing the case of public services, and, by extension, the public healthcare services, Shipler (2005) pointed out that many consumers in captive services were made to feel embarrassed (especially those belonging to the disadvantaged sections) due to these limitations.

The service design approach in captive services

Using Emerson’s theory to understand power relations in the B2B context (Scheer, Miao, & Garrett, 2010), Rayburn applied the same to understand the exchanges between the service and the consumer, wherein the service employees held the key to service success and wellness (Rayburn, 2015). Rayburn concluded that a ‘service design’ approach could help them to overcome the negative ramifications of captive services. The service design approach required a mindset oriented towards transformative service success; the concept was now broadened to consider ‘social, existential, psychological, and physical well-being’. In healthcare, this translated to two key factors essential to the redesign the industry: Patient engagement and patient–provider relationships (Anderson, Nasr, & Rayburn, 2018). With increased customer expectations, technological advancements and socio-demographic changes, the challenge was even greater for healthcare professionals.

Mindsets: Programme, Service, Managed and Customer

It was increasingly being felt that a ‘programme mindset’ stunted the growth prospects of health organizations and that adopting the ‘service mindset’ or the ‘service mentality’ could be a better strategy to achieve results ‘service mindset’ or the ‘service mentality’ Suby (2006) recommended expanding one’s thinking in order to incorporate, what he termed as the ‘managed’ services mindset, given that the businesses are relying more on high-quality information exchange among people resources, irrespective of location and user group.

Communication Needs in Healthcare

Well-designed communication systems serve to minimize disruptions and promoted efficiency in organizations. In the healthcare systems, communication needs are demarcated into the ‘intra-organizational’ needs within particular groups, such as hospitals or primary care centres, and the ‘inter-organizational’ needs which occur at the interfaces among different organizations. These needs are then differentiated by task styles and the organizational structures within and across each group.

The needs are deemed to be fulfilled by the agents in the transaction process. Agents have to be trained to understand the specific tasks and the language of the instruction for smooth conduct of the hospital administration. These agents work in the clinical unit or the ward and include the non-medical administrative staff, the medical attendants, clerks, nurses and doctors.

In facilitating intrahospital communication, the mobility of hospital workers has to be kept in mind while designing communication systems. Working in highly interrupt-driven environments, hospital administration demands a sophisticated mobile communication network to support the communication needs of its agents. In a hospital system, the nurses are less mobile than the doctors during a working day since the latter might have to move within a campus many times during a working day. Accessibility, therefore, is critical for the providers to stay within the reach. This includes many patient support services such as active triage and counseling (Coiera, 2006).

The size of the population served, the utilization rates of the technology, distance for travel and local versus telemedical differences in effectiveness, affect the input–output analysis. Basic communication services such as the fax transmission of documents, mobile phone for voice-mail, text messaging through systems such as the telephone, fax machine and personal digital assistant (PDA) or even wearable computing, where devices are small enough to become personal accessories like wristwatches or earrings, are now important devices to assist doctors and medical providers.

Critics tend to denounce the use of technology and its applications especially in an emerging economy, where a vast majority of the patients belonging to the rural and semi-urban areas. Citing that these could be beneficial only under select circumstances since cost savings tend to vary across existing communities. Critics have also pointed out that many communities find it difficult to travel to remote locations for specialist investigations. In this scenario, simpler solutions to communication problems, if these exist, must not be overlooked. Many times, video-based consultations might not be required; the communication needs of the patient and the provider could be met by a simple telephone call. Face to face meetings with stakeholders especially the teachers and the resident doctors could also be conducted to gain acceptance and solicit support for medical interventions that affect all.

Communication Interventions at KGMU

Revisiting the Mission and Vision

After a series of high-level meetings, the vision of the university was reinforced: ‘To be an outstanding University of Medical Excellence in the world in education, research and patient care’. Its mission was ‘to become one of the world’s best providers of high-quality teaching and excellence in education, generate outstanding leaders in health sciences, promote multi-disciplinary scientific biomedical research, provide compassionate, patient-centred care of the highest quality’.

Objectives of the University

The objectives of the university were explicitly stated on its website. The organization structure reflected a dedicated approach to structuring the system around the needs of the stakeholders of the university.

Creation of Online Student and Patient Feedback Portals

The following measures were taken to improve the communication of and with the stakeholders of the university, primarily the students (the resident doctors) and the patients. A systematic online feedback mechanism was initiated for the students and the patients to initiate improvements in the service delivery and processes.

Information Display

A series of measures was initiated to ensure that generic information was prominently displayed on the campus. This was an effort to become more patient-friendly and service-oriented.

Introduction to the ATCOM Module

The Department of Medical Education was created on 19 July 2014, by an order of the VC. The objectives of the trans-disciplinary department were to promote faculty development, curriculum review and design, student mentoring, facilitate innovations in medical education and research, implement programmes on the directives of the Medical Council of India as the MCI regional centre, and also develop national and international linkages.

A high-level meeting was held in 2015 to introduce communication skill training modules known as the ATCOM module (derived from A = attitude and C = communication). Extracted from the MCI document, Annexure 3, and prepared for the Academic Committee of Medical Council of India by the Reconciliation Board in July 2015, it comprised 39 core competencies and 15 non-core (desirable) competencies that need to be assessed in a formative way. The ATCOM module was embedded in the curriculum and was delivered in week-long specially designed modules from time to time. Designed and delivered by a team of doctors, it was mandatory for all the students. The assessment included a videography of the doctor–patient interaction to be shown to the students for sharing feedback about their communication style and quality of interaction with the patient.

Streamlining of Channels of Face-to-face Communication

Meetings were considered important communicative events. In 1 year on an average, there were around two Faculty Board meetings; two to three Academic Council meetings, and four to five executive council meetings. The formal channel of communication for decision or task-based meetings was also evolved.

Technology and Communication

HIPAA-compliant group messaging and Medigram applications were currently not being subscribed by the hospital. To foster a collegial environment, however, informal systems such as WhatsApp groups (such as faculty forums, KGMU web and cultural core) were encouraged to be created across disciplines and administrative systems to co-exist along with the formal communication channels.

Formalized Discharge Summaries

A transition from paper-based discharge summaries to CPMS-based discharge summaries was made whereby the patient records were posted online for ease of collaboration. The new digital diagnosis system (DDS) was a joint effort of the National Informatics Centre, New Delhi, the All India Institute of Medical Sciences, New Delhi, the Indian Institute of Technology Bombay, Mumbai and the Central Scientific Instruments Organization (CSIR), Chandigarh. The Project was planned in two phases: first to develop an application, which could enable visualization, and processing of radiological data over a collaborative platform, and second, to effectively roll out and enhance the application as per the end user needs.

Systematic Crisis Communication Processes

A proactive approach was undertaken with respect to design an appropriate communication response strategy during a crisis. A dedicated position was created for handling crises (trauma centre spokesman and the administration spokesman) to manage the day-to-day crisis that was bound to occur in operations of such vast facilities. Its purpose was to communicate with the public such as the media, patients and government officials as soon as a crisis was reported. Situations that called for effective crisis communication and management were identified including natural calamities, fire, internet issues, incidence of fatal diseases/botched up surgeries and patient and student distress and unrest.

The Online System of Referrals

For the first time, a systematic method was put in place to record referrals. Henceforth, referrals were to be posted online by the concerned consultants. The CPMS was designed with inbuilt provision for recording the referrals. On the day of his/her OPD, any consultant could refer the patient/s to another department in the name of consultant on duty in OPD that day.

Computer-generated Alerts and Lab Results

The hospital switched to computer-generated alerts and lab results to facilitate online referral to labs. Compact disks were now being provided for result summary. In KGMU, in a 3-hour OPD, there were no less than 100–120 patients with only six to seven systems for entry/alerts. As a result, the patient waiting time had increased alarmingly, and more efforts were required to bridge the human–computer interface. The email was sought to be used more frequently to deliver X-rays to patients via the electronic mode connecting to rural India. DDS was now introduced to serve as a link between the urban and the rural areas. The idea was to communicate diagnosis through a digital format.

Remote Tele-medical Consultation

Remote practitioner and specialist services were currently not being provided except for medical video conferencing cases, which occurred only occasionally. Advance communication systems such as teleradiology were not feasible now, as the application of such technologies was beneficial only in special circumstances. Size of the population, utilization rates, distance to be traversed and the effectiveness of the existing local systems were cited to be the deciding factors for such systems to be medically, economically and technologically viable.

e-Library

Students and faculty had now the facility to access the online portal of the library for updated information for both practice and research.

Online Brand Building and Facebook Page

KGMU now had an official Facebook page (https://www.facebook.com/kgmulucknow/), an active media cell and a prominent web presence to disseminate timely media coverage. A Twitter handle was also created to connect with various stakeholders and forge an instant connect with them on key issues concerning the university.

Pedagogical Details of the Competency Evaluation of the ‘Img’ Assessed Year on Year

Pedagogical interventions were introduced in KGMU with the serious intent to make the doctors sensitive and empathetic towards their patients. An active competency assessment unit was created to systematically assess the competencies of the student as a leader and as a communicator (refer Appendices A and B). The method involved the use of role plays, videography and scenario-based technique to drive home the importance of ethical communication while dealing with patients (Dixit, 2018).

The method followed was similar to what was prescribed in the Enhanced Calgary–Cambridge Guide to the Medical Interview (Kurtz, et al., 2003); however, it was based on a video test of a real-time interaction with a patient without using the pre-and post-test scores (Figure 1).

All students (or resident doctors, as they were known as) had to compulsorily undergo the ATCOM module (the 4-year training programme). Since the first cycle is yet to be completed (the programme was launched in 2015), immediate benefits could not be assessed at the time the case was written. However, based on two focussed group discussions with administrators and students, the following benefits emerged:

sensitivity to the concerns of the patient;

importance of empathy in varying contexts;

role of communication skills in patient–provider interactions; and

the connection between empathy and expertise.

Figure 1.

Source: Kurtz, Silverman, Benson, and Draper (2003).

However, it was increasingly being felt that:

the delivery of sessions should not be conducted by senior doctors but by soft skills specialists;

the programme should be extended to nurses and paramedics too; and

the programme should be made more flexible.

Word-of-mouth recommendation and faith in the doctors had brought the institution this far, but it could not be denied that competition was knocking at the door. Large players in the private sector were already entering Lucknow, offering advanced infrastructure, better pay packages and higher research incentives. At KGMU, the absence of adequate infrastructure facilities, the lackadaisical attitude of the nursing staff and harried doctors could push back the agenda. In the centenary year of its existence, KGMU had to assert its identity. Time was running short. How should the VC engage the junior doctors? What measures should he take to make the organization communicatively competent? How should he make the university a patient-centric one? Finally, what steps should he take to inculcate a service mindset?

What Happened Next?

Strict action was taken against the erring doctor, a Junior Resident in the medical department, after a video showing him beating up an unconscious patient (Raju) went viral on social networking sites. Dr Kant ordered an inquiry into the incident and suspended the doctor. He warned the junior doctors against nurturing an anti-patient mentality. This signalled the serious intent of the administration towards patient care and upholding values of discipline and patient care first.

Coming down heavily on incompetent teaching faculty, the VC announced the selection of its ‘worst teacher’ based on student feedback and peer review. The announcement invited strong condemnation from the KGMU Teacher’s Association who came out against the decision in large numbers and threatened the administration with legal consequences. The previous awardee of the ‘Best Teacher Award’ for the past 2 years also publicly derided the decision terming it as ‘demotivating’ and ‘a blot on a teacher’s career’. The VC, however, defended his decision calling it necessary for ensuring teaching quality and an important step ‘for faculty to be fearful and put in extra hard work’.

He justified his action to Asian Age, a national publication, in an interview:

The idea was drawn in from the increment pattern of the Seventh Pay Commission where only outstanding work gets an increment. All teachers who have replied to the email, their answer has been counted (sic). It has unanimously come to one particular name. Peer review has been the main criteria and the name so decided.

The teachers had sent a written representation to the administration; the matter has been suspended for the time being. On 15 April 2017, the governor of Uttar Pradesh replaced the current VC, and appointed Prof MLB Bhatt of the same University, as the new VC for a period of 3 years. However, the growing distrust between the doctors and the patients is a cause of concern. Under the IPC 304-A, a cognizable offence may lead to the arrest of the doctor without even a warrant (Debarrma, Gupta, & Aggarwal, 2009). Currently, this is under scrutiny because of immense pressure from the doctors to not be trialled as criminals. The doctors are also seeking protection against violence perpetrated by the kith and kin of the patient. The matter is subjudice. The issue is further compounded by an extremely low doctor to patient ratio (less than 1 for every 2,000 patients in India) according to a World Bank report.

KGMU is now on the right path towards integrating the curriculum with the needs of the patient. It has an impressive rank in the 2018 NIRF survey conducted by the Ministry of HRD in India. Its communication and soft skills programme is being implemented in a systematic and time-bound manner. The case shows the rightful intent of the university to prepare and groom the medical students as suitable IMGs throughout the 4-year stint at the medical college. However, it is too early to comment as it has just been a little over 3 years since these initiatives were launched, along with a new VC at the helm of affairs. Recent press reports suggest that violence on campus is far from over. (Times of India press reports, 2018a, b, c). At the time of going to press, news was received that patient attendants and OPD employees clashed at KGMU. Reports of a strike by the KGMU employees are filtering in. Facilities launched with much fanfare such as wrist bands and transport services to patients for ferrying them from villages to the diagnostic centers have been abruptly stopped (Hindustan Times news report, 2018). Conditions in this 4,000-bed hospital with over 7000 daily inflow of patients and 76 departments are far from satisfactory.

Footnotes

Acknowledgements

I am deeply indebted to Dr (Prof) Ravi Kant, the Vice Chancellor of KGMU Lucknow for giving me permission to write this case. I am also grateful to Dr (Professor) Divya Mehrotra, Vice Dean, Faculty of Dental Sciences and Vice Dean (Quality and Planning) at KGMU for sharing relevant information from time to time.

New Provision of Skill Assessment of Students: (Years 1–4) in KGMU under the ATCOM Module 3

Select Case Studies in Medico-legal and Ethical Situations

Declaration of Conflicting Interests

The author declared no potential conflicts of interest with respect to the research, authorship and/or publication of this case.

Funding

The author received no financial support for the research, authorship and/or publication of this case.

Notes

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