The McMaster Calling

A push from Madhu

By 2003, Evidence-Based Medicine had begun to take root in Sevagram, and much of that credit belonged to my collaboration with Madhukar Pai. But Madhu, as always, thought one step ahead.

“You have to go to McMaster,” he said. “That’s where it all began.”

McMaster University in Hamilton, Canada, was the birthplace of this movement. It was where Gordon Guyatt—who coined the term “Evidence-Based Medicine”—taught and trained people to question their own certainty. Madhu had attended a workshop there and returned with a new kind of confidence: not the loud kind, but the quiet confidence of someone who knows how to check the facts. He wanted me to feel that shift too.

The letter that opened the door

On April 10, 2003, I wrote to the President of the Kasturba Health Society. I had been accepted for a workshop titled How to Teach Evidence-Based Clinical Practice, scheduled from June 22 to 27. The organisers had waived the tuition fee—$2,700—which felt like a small miracle. But travel was still expensive. I worked out the cost of the round trip—Sevagram to Mumbai, then London, Toronto, and back—at around ₹65,000, a serious amount in those days.

I also added a second reason for the trip. Dr. Mike Galvin had invited me to stop in the UK on my way back and speak in Leeds and London about MGIMS—our work, our rural focus, our stubborn belief that good medicine is possible even in a village. I hoped it might open doors for exchange programmes.

To my relief, the Society agreed to fund half the cost. For the remaining amount, Mr. Dhirubhai Mehta arranged ₹30,000 from a private trust in Mumbai. That settled the only question that mattered.

I booked an Air Canada ticket.

It would be my first international flight.

Heathrow, and a small disaster

I left India with a suitcase of clothes and a head full of nervousness. My itinerary looked simple on paper: Mumbai to London Heathrow, a 90-minute layover, then onward to Toronto.

Heathrow, however, was not an airport. It was a small universe.

I landed, looked around, and immediately felt out of place. Everything was enormous—corridors that never ended, signboards that seemed to multiply, people walking as if they were late for something important. I did what a small-town traveller does when he wants to appear calm and “international”: I slowed down. I wandered past duty-free shops. I tried not to look rushed.

I didn’t realise that in aviation, a 90-minute layover is not a relaxed stroll. It is a test.

When I finally reached the transfer desk for the Toronto flight, the staff member looked at my ticket and shook her head.

“Sir, your flight has already departed.”

For a second, I couldn’t even respond. The sentence landed like a slap. I was alone in London. I had limited foreign currency. My luggage—most likely—was already flying to Canada without me. I stood there feeling ridiculous and helpless, like a child who has lost his mother in a crowded market.

Then I did the only thing left. I walked back to the airline desk and pleaded.

“I’m a doctor from rural India,” I said. “I’m going to learn how to treat patients better. I don’t have money for a new ticket. Please help me.”

The woman behind the counter studied my face for a moment. Then she softened. She typed quickly, printed a boarding pass, and handed it to me.

“There’s a seat on the next flight,” she said. “It leaves in an hour. Run.”

I ran.

I reached the gate breathless and humbled, with a new rule stamped into my mind: never treat a transit lounge like a picnic spot.

A Sevagram welcome in Toronto

By the time I landed in Toronto, the panic had drained out of me. And then I saw a familiar face.

Dr. Nafisa Kapadiya, an MGIMS alumna, was waiting at the airport. She had graduated from Sevagram, done her MD in Radiology at Tata Memorial Hospital, and was now settled in Toronto. Despite my delay, she and her husband had waited patiently.

“Welcome to Canada, Sir,” she said, smiling.

That one sentence brought me back to earth. That evening, sitting in their warm home, we spoke about Sevagram—teachers, wards, old friends, and the strange way a small rural institute stays inside you even when you move continents. MGIMS alumni carry that bond quietly. You recognise it instantly.

I stayed with them for a night. The next day, I travelled to Hamilton and checked into the university hostel.

The workshop that rewired my thinking

The McMaster workshop felt nothing like the conferences I was used to in India. There were no long speeches and no ceremonial lectures. It was serious work from the first hour.

The programme was led by giants—Dr. Deborah Cook and Dr. Gordon Guyatt. There were around ninety participants, mostly from North America. I was one of the few from a developing country, and for the first day or two, I felt that difference keenly.

We were divided into small groups by specialty—eight participants, two tutors, and one person who surprised me the most: a librarian.

At MGIMS, librarians were caretakers of shelves. At McMaster, the librarian sat with the clinical group like a key team member. She taught us how to search PubMed and Cochrane properly, how to frame a clinical question, how to separate a good paper from a confident paper.

That was a new idea for me: that finding the right answer is a skill, not an accident.

Role-play, resistance, and real life

A large part of the teaching happened through role-play. It sounded childish when I first heard it. It turned out to be brilliant.

One person played the senior consultant—confident, experienced, and allergic to new evidence. Another played the eager junior doctor trying to introduce a guideline without insulting the boss. We acted out the conversations we all know too well, the ones that happen in wards and ICUs when “experience” and “evidence” collide.

McMaster taught me something I wish we taught residents early: being right is not enough. You have to communicate without bruising egos.

Before applying any new research, we were trained to ask three questions:

Is the study valid?
What are the results?
Will it help my patient?

For five days, from morning to evening, we lived inside those questions. We argued over P-values. We dissected confidence intervals. We learned to say, without shame, “I don’t know.”

By the end, I understood what Madhu meant. I wasn’t returning with just notes and handouts.

I was returning with a new operating system in my head.

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