Member

…

Three news articles in the first two days of the new decade indicate that the Medical Council of India is contemplating a major overhaul of medical education in India

Beginning with undergraduate medical education (MBBS).

The Hindu: MCI suggests major reforms in undergraduate course [my comments in bold italics in parentheses]

The MCI has recommended major reforms in the undergraduate course in medicine by converting conventional education into a competency-based module to develop skilled doctors through early clinical exposure. It has also suggested doubling the intake of medical students to meet the healthcare needs of the country in the coming years. Pointing out that the current undergraduate curriculum in medicine did not make an MBBS degree holder feel equipped with adequate skills and competence to take care of the common problems at the secondary and tertiary level, the Undergraduate Education Working Group has said this factor also prevents young doctors from going to practice in the rural and primary health centres. The goal of training is not focused on providing health care to the needy and the disadvantaged, the eight-member working group has said in its report. [A very honest appraisal of the current status of MBBS education.]

It recommends options for distance education towards a fellowship or diploma in areas such as diabetic care, HIV medicine, geriatric medicine, hospital infection control, hospital management, and inclusion of medical ethics, forensic medicine and hospital infection control in the regular curriculum. [These are welcome additions, but I find that they are again giving more importance to hospital/institution based medicine, rather than community-based preventive medicine.]

According to the report, the current intake of medical colleges and the critical mass of doctors would have to be doubled if India had to achieve the world average doctor-population ratio of 1.5:1000 by 2031 as against the present 1:1700. At present, there are 330 medical colleges with an intake of approximately 35,000 and with the present intake the shortfall of doctors by 2031 is estimated at 9.54 lakh. [We are going to face a shortfall of nearly a million doctors by the time doctors of my age are near the official retirement age.]

…the group stressed the need for restructuring the MBBS course with a four-year course and six months elective with a one-year internship. Clinical training should be included from the first year itself. [I couldn't agree more. Instead of mugging up the Kreb's Cycle, first-year-MBBS students ought to be exposed to how and why blood sugar levels are tested in real patients. That will give them a better perspective about biochemistry.]

The past curricular revisions have mostly added to the existing content without undertaking the exercise to remove what is obsolete and outdated. This exercise needs to be taken up in a detailed and extensive manner and make the curriculum as efficient as possible, the report has said. It has to be discipline-based curriculum and lack of integration between basic and laboratory science and clinical medicine should be addressed. [Same point that I made above.]

It goes on to add that each medical college should be linked to the local health system, including Community Health Centres, taluka hospitals and primary health care centres that can be used as training base for medical students. [They conveniently forget to mention what happens to the large number of un-attached & un-attachable-to-government-hospital private medical colleges.]

…

…and going on to post-MBBS specialities…

The Hindu: Make specialised PG courses uniform: MCI [my comments in bold italics in parentheses]

The MCI has recommended that all specialised post-graduate courses be made uniform, with the curriculum revised periodically depending on new developments in the fields. [Good]

It also proposes a national common entrance examination for PG and super speciality courses from July this year. [Good in theory, but a political nightmare. I don't believe this can be implemented this year.]

A working group, set up by the MCI Board of Governors in July to review PG courses, in its report, … has said the duration of training should be uniform: diplomas (two years), degrees (three years), fellowships (three years), DM/MCH (three years) and Post-DM fellowship (two years). [I expected them to do away with the anachronistic idea of post-graduate medical Diplomas!! Where is the uniformity if you hand out diplomas and masters degrees in the same specialty? Why have that kind of step ladder approach to specialization? Increase the number of masters residencies & scrap diplomas altogether.]

There should be extra-departmental rotations for at least six months in allied disciplines, and continuous, formal structured assessment with regular feedback for post-graduation. [I couldn't agree more. Especially the second part.]

Pointing out that there are many vacant seats in basic specialities like anatomy, resulting in a shortage of expertise, the report suggests that more incentives be given for candidates taking up these courses such as differential pay scales or accelerated promotions for teachers in these subjects. [I believe the shortages are only in government-run institutions. Private medical colleges pay qualified teachers in basic medical sciences more than they pay physicians and surgeons who work in their hospitals. The government has to give meaningful incentives for people to be interested in serving in its basic medical sciences departments.]

Recommending special incentives to private institutions for starting courses in basic specialities, the working group says shortage is due not only to a lack of seats, but also to popularity of courses. That is why private institutions are hesitant to start these courses, says the report. [Good luck with this. It's a vicious cycle, that isn't likely to become better. Rather than incentives to the institutions, the students who graduate from these specialities ought to be given guarantees of jobs with meaningful growth potential and incentives. The government should create a demand for these jobs, ie, make them more attractive, for the supply to increase.]

On continuing professional development, the working group says the MCI guidelines on accreditation of organisations for conduct of a continuing medical education programme and of individuals are already there but there is need to ensure regular participation. [The MCI has sidestepped the issue with some fancy wordplay. What is required is a definitive protocol/schedule of periodic re-accreditation like that followed in the US. I became a radiologist for life eleven years ago. How does the patient who comes to me today know that I've kept up with all the advancements in my specialty over the past decade? I don't expect this issue to be raised by a group of wise-old-men such as the current governing body of the MCI who will be terrified of such a prospect.]

…

…and finally this article…

The Hindu: National board of exams to be abolished

…which has left me speechless. A committee just decided to kill the agency that has given me my radiology diploma and thousands of other doctors their National Board Diplomas in various other specialties. I feel like Arthur Dent.

…