Study on Colour Blind Medical Students Shows Need for Screening, Counselling

 A team of ophthalmologists and medical educationists from University College of Medical Sciences (UCMS), Delhi, has in its original research on preparing medical students with congenital colour vision deficiency (CCVD) or colour blindness, for safe practices, suggested that they should be “screened” at the time of their admission into medical courses. This they say, should be done keeping in mind “the nature of the errors” they make, so they are aware of their CCVD status and their limitations. This would also enable their admissions in courses where their colour deficiency do not become a handicap.

The submission of this study to the National Medical Journal of India, a publication of All India Institute of Medical Sciences (AIIMS), Delhi, by a team headed by director professor of department of Ophthalmology at UCMS, Upreet Dhaliwal, assumes significance, as no such study has been done before. In addition to this, the Supreme Court had in March this year directed the Medical Council of India (MCI) to constitute a committee of experts from genetics, ophthalmology, psychiatry and medical education from AIIMS, Delhi, and Post Graduate Institute, Chandigarh, to examine the issue of admission of colour blind students to MBBS within three months. The matter is scheduled for hearing on July 11.
Exclusion of colour blind students is “regressive thinking”, says SC
In March, the Supreme Court had constituted a committee of experts, comprising senior doctors, to identify the streams in which medical students suffering from colour blindness would be allowed to pursue their course, without their physical disability proving to be a handicap. It had also termed the MCI’s stand to not permit such students from pursuing the medical courses “regressive”.
A bench of Justices Dipak Misra and A.M. Khanwilkar had taken a strong stance against the exclusion of colour blind students from medical study. “The total exclusion for admission to medical courses without any stipulation in which they really can practise and render assistance would tantamount to regressive thinking,” it had observed.
The judges had stated that colour blind students were allowed to study several medical courses in many other countries, and therefore the rules or guidelines to be followed in the matter in India also needed to be reviewed.
The study identified colour blind students, 30 consented to participate
This cross-sectional study by UCMS screened 1022 medical students (Ishihara chart) at UCMS, and 35 of them, all men, were found to have CCVD. Out of them, 30 consented to participate and were compared with their non-colour blind peers from the same batch.
As per the findings, both group made errors, but those with CCVD made more. The study, however, added that all these CCVD students can be guided and counselled for safe practice. Currently such students are only screened and not guided. The authors – who apart from Dhaliwal also included Rajat Dhingra and Jolly Rohatgi – termed this practice unethical stating that while we “label them but do not offer counselling.”
Study offers suggestions on safe practice
In the “background” note, the authors said: “Colour vision of candidates is tested in many medical colleges in India at the time of admission to undergraduate courses; however, there are no guidelines, and therefore no counselling, on how students with CCVD should negotiate the medical course, and how best they can practise safely after graduation. Problems in interpreting coloured signs may lead to misdiagnosis.”
As such, they said the idea behind the study was “to explore difficulties during clinical work that requires colour discrimination, and to offer suggestions on safe practice based on the findings and a review of the literature.”
To this end, the three doctors said they did a cross-sectional study after obtaining institutional ethical clearance and written informed consent. All the 30 volunteer medical students with CCVD (>3 errors on Ishihara chart) and the 30 volunteers from their own batch who made no errors were made to interpret colour-dependent clinical and laboratory photographs.
The results revealed that “students with CCVD made more errors (range 5-26; mean [SD] 13.17 [5.873] out of 75 items in 35 colour-dependent photographs) than colour-normal students (range 2-13; mean [SD] 5.53 [3.037], p<0.001).”
In the light of these findings, the authors said “the nature of the errors suggested that medical students with CCVD could have problems in learning histology, pathology, haematology, microbiology, dermatology, paediatrics, medicine, biochemistry and during ophthalmoscopy.”
They thus concluded that “screening at the time of admission will make students aware of their CCVD status and, through conscious practice thereafter, they may understand their limitations. Faculty could guide and prepare such students for safe practice.”
Men more prone to CCVD
According to Dr. Dhaliwal, the reported prevalence of CCVD is 6% to 8% among men owing to their X-linked recessive inheritance. “At our college (UCMS) it was 3.42%. 53 peer-reviewed colour-dependent clinical and laboratory photographs were used to test in this study. Based on the study findings, augmented by evidence from the literature, authors suggest which specialties are suitable for CCVD and how they can safely practice with peer help.”
The senior surgeon noted that for example if a student with CCVD wished to become an ophthalmologist, “she could work in anterior segment mainly, while for retinal evaluations, she could have peers to corroborate”. Similarly, Dr. Dhaliwal noted that “persons with CCVD should avoid working with drugs available in loose form”. Authors also suggested how CCVD students can use other cues to avoid making mistakes.
Screen students for CCVD, counsel them at the time of admission
The authors of the study have demanded that students with CCVD should be screened at the time of admission and should not to be discouraged. “Rather efforts should be made to make them aware of the type and severity of their colour vision deficiency. They should, thereafter, undergo counselling to know their limitations, if any and faculty/Institutions must equip them with to find ways to overcome difficulties to practice safely.”

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