article about Harvard/Indian medical school cooperation and

[azskeptic]

http://hmiworld.org/past_issues/Jan_...es_naveen.html

The Best of Two Worlds

At 25, Dr. Naveen Tipirneni has already learned one of the most valuable lessons in medicine: how to successfully merge the best of the low-tech and high-tech worlds of medical science.

Tipirneni, an American citizen who was raised in Illinois, elected to go to medical school in his native India. He came to the United States as a small child with his parents and sister; his father entered a medical residency in Illinois and the family ended up putting down roots in the Midwest.



Dr. Naveen Tipirneni integrates knowledge from the bench and the bedside, as well as experience with medicine in the U.S. and India.
Tipirneni, a research fellow at Harvard’s Massachusetts General Hospital (MGH) in Boston, is a graduate of Sri Ramachandra Medical School & Research Institute at Porur, Tamil Nadu, a suburb of Chennai (formerly Madras) on the east coast of India. The school one of nine foreign medical schools with which HMI maintains an alliance. Begun in 1997, the alliance is a mutual commitment by Sri Ramachandra and HMI to strengthen the medical education and research programs at Sri Ramachandra.

Not only is Tipirneni reaping the benefits of the alliance, but patients may one day benefit even more. Tipirneni is working under the direction of Dr. J. A. Jeevendra Martyn, HMS professor of anesthesia in the Department of Anesthesia and Critial Care at MGH, researching the relationship between the muscle weakness that is commonly seen in critically ill, immobilized patients, and the cellular phenomenon of apoptosis, the programmed death of muscle cells.

This type of weakness is often seen in people on ventilators. It’s very difficult, for example, to wean people off of ventilators, Tipirneni explains, because they lose a lot of muscle mass in their rib cages and have difficulty breathing on their own. “Not many studies have focused on why immobility triggers the loss of muscle mass,” says Tipirneni, who is working to understand the pathways involved in this form of cell death. “One day we may find ways to inhibit these pathways, and apply this to a clinical setting.”

Although all of Tipirneni’s current work is done in the lab, he believes he learned invaluable lessons in clinical and physical examination skills at Sri Ramachandra, something that will benefit him in his upcoming residency in anesthesiology and critical care; he has recently been accepted to a program at Brigham and Women's Hospital.

“In India, you are forced to use your senses—your eyes, ears, and touch--because, many times, you don’t have much at your disposal other than a stethoscope,” he says. Tipirneni believes both the U.S. and Indian systems have distinct advantages, and that he is fortunate to have been exposed to the best of both worlds.

In India, he was most impressed with the teaching of traditional examination and history-taking skills, with laboratory tests used to confirm a clinical diagnosis. Because much of India is rural, most facilities do not have sophisticated equipment and laboratories, he notes. “You develop a kind of clinical acumen you can’t go back and learn later in your career.”

Tipirneni is enthusiastic about the American system’s strength in managing hospital patients, the emphasis on hands-on practical application of students’ skills, and the problem-solving that goes on between medical students, residents, and attending physicians. “In India and many countries, the attendings have a lot of knowledge, but it’s often a one way street. Here, students are asked to think a situation through and provide their ideas on patient care.”

When asked what he would most like to export to the Indian medical system, he said it would be the U.S. emphasis on prevention and the systems that support it. “In India, there are few support systems to help people stop smoking or drinking, and there are a lot of problems, such as HIV, that are not talked about.” He believes such problems as alcoholism, for example, are identified more widely in the U.S., simply because doctors look for it more.

Tipirneni sounds particularly proud that his alma mater is involved in an alliance with HMI, because he believes it will help Sri Ramachandra reach its goal of being “one of the frontrunners in medical education in Southeast Asia and will prepare doctors to work anywhere in the world.”

Among the initiatives under the alliance are:

collaboration between Harvard Medical School (HMS) and Sri Ramachandra in teaching, learning, and research
support by HMI for the development of specialized clinical facilities
promotion of scholarly exchanges between HMS and Sri Ramachandra
counsel and assistance by HMI and HMS in implementing curriculum development and reform; and improving management systems at Sri Ramachandra with the aim of measuring the effectiveness of protocols for the diagnosis, treatment, and prevention of disease and improving overall quality of medical care.