The pill for India’s ailing medical education system

By Sanjiv Das

Medical education in India is mired with a host of controversies and is trudging along a rough path. There are around 70,978 MBBS seats in 529 colleges in India. Of this, 269 colleges accounting for 35,688 seats are government-run, while the remaining 260 colleges accounting for 35,290 seats are in the private sector. While the number of medical seats has increased in the last decade, the quality of education has remained in question. Moreover, corruption in medical education is touted to be one a major cause of concern. Private hospitals charging a huge capitation fee and donation. Although there is a tremendous opportunity in the medical education space owing to the vast patient load and a diverse spectrum of diseases. The increase also leads to a dearth of quality healthcare professionals.

The country requires 6,00,000 doctors and 2 million nurses to cater to the rising population. However, the doctor-patient ratio currently stands at 1: 1,457 people. Though the number of institutes has increased, the ones which offer quality medical education remains minuscule. The curricula have remained mainly outdated, despite tremendous changes happening in the healthcare sector. The medical education sector has become a more lucrative business linked to large profits than service to society. The mounting corruption, suicides related to cheating for admissions, high fee structure among private institutes and more notifies us about the highly unregulated business of medical education in the country.

We approached some academicians and doctors to know about the causes of this debacle in medical education, the challenges that the industry faces, government initiatives and the way forward. So let’s start by understanding the current situation of medical education in the country and how are students reacting to it.

The current scenario
Says Dr Deepak Patkar, Director (Medical Services) & Head, Imaging and Radiology, Nanavati Super Speciality Hospital, “In India, we have the advantage of having the highest number of government medical colleges, in spite of that, there is rapid privatisation.”

But this is also a result of the lack of quality and outdated syllabus within the government institutes. Moreover, the Internet is filled with dubious websites which offer unrealistic pictures to students and encourages them to take admission in private institutions.

According to Dr Subhrojyoti Bhowmick, Clinical Director for Academics, Quality and Research Depts, Peerless Hospitex Hospital and Research Center, the medical education system in India is undergoing a metamorphosis. In 2018, undergraduate medical education training has changed after 21 years in the country. It is called the “Competency-based UG Curriculum for the Indian Medical Graduate,” which essentially marks a significant shift from the classroom-rote learning of the 1997-born programme to one which stresses on medical ethics, better doctor-patient relationship and outcome-based learning.

Speaking about the lack of motivation among doctors/ teachers to improve medical education, Dr Bhowmick says, “Even doctors completing their post-graduation from government medical colleges sign compulsory bonds which makes it very difficult for them to join medical colleges as faculties. Lack of motivation amongst young doctors to become medical teachers is another challenge. As a result, many faculty positions remain vacant in government and private medical colleges,” as Dr Bhowmick rightly points out.

While there are experts who think that lack of quality education among government institutes has given rise to privatisation, Dr Patkar feels that privatisation of medical education on a large scale is creating a risk of diluting the standards of medical education.

He further adds, “A few issues in the medical education system are mal-distribution, age-old curriculum, poor assessment standards and minimal sufficient faculty development programmes. The medical curriculum in India suffers from a lack of integration, maintaining traditional didactic teaching methods and limited support to research. Nevertheless, the new Ministry of Health and Family Welfare’s (MoH&FW) National Medical Commission NMC bill is surely a step forward to address these issues.”

So how will the NMC bill bring respite to aspiring doctors and add value to medical education in India? How does the government plan to bring in the much-needed overhaul in medical education?

Government’s initiatives and regulations
The NMC Bill, which got approval from the President of India, is supposed to be a major step towards revamping the education system. It will be beneficial to the economically weaker students who want to pursue medicine in private colleges by paying nominal rates. Moreover, the government is constantly creating more avenue to increase the number of medical seats at the institute. Last year the health ministry initiated the process of converting 75 district hospitals into medical colleges. Their aim is to ensure that even the under-served districts of the country will have medical colleges by 2021-22. It is touted to create 15,700 seats.
Dr KS Sharma, Dean Academics Projects, Tata Memorial Centre, says, “NMC which is under formation will soon take over MCI. This highest regulatory body will transform the present status of medical education in the form of introducing the National Exit Examination. It will also help to regulate the fees of 50 per cent seats in all private medical colleges, which will make medical education affordable to so many meritorious students.”

Dr Bhowmick says, “I think the NMC bill is a positive step ahead to bring in parity in medical education across the country. The bill has a provision like the National Eligibility-cum-Entrance Test for admission to under-graduate and post-graduate super-speciality medical education in all medical institutions regulated under the Bill. The NMC will specify the manner of conducting common counselling for admission in all such medical institutions. This would ensure that standardisation of admission process of medical students across the nation.”

Dr Patkar points out “NMC Bill will also introduce parity and uniformity in terms of education standards and offer fee structure diversity. Single National Eligibility cum Entrance Test (NEET) to admit students to all medical colleges including AIIMS and JIPMER will reduce the stress level among the student fraternity and make the system more transparent and impartial. The move will improve access to quality and affordable medical education, ensure availability of adequate and high-quality medical professionals in all parts of the country. It will bring about changes in the way medical colleges are assessed, MBBS entrance is conducted and will introduce new provisions such as exit exams and regulation of course fees in private colleges.”

Patkar further adds, “There are various avenues for potential changes where government authorities need to intervene such as an exploding number of medical colleges; a skewed distribution of these around the country; devaluation of merit in admission, particularly in private institutions; increasing capitation fees; an alarming shortage of medical teachers, with those who exist being untrained in modern teaching-learning technology.”

Prof JB Sharma, Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, and Chairperson Urogycaecology FOGSI Society, “Our government is seriously revamping the system to cope up with requirements of the Indian population. Plans are underway to improve the admission process and strengthen medical education among institutes across the country including the central, state and privately run. Earlier students had to appear in multiple-counselling sessions across the country for admission to medical courses. Further, as per other amendments, the ratio of teachers to students has also been revised from 1:1 to 1:2 for MD/MS disciplines and the teacher-student ratio has been further increased in public-funded government medical colleges to 1:2 or 1:3 which has led to increasing in postgraduate seats as well.”

Dr Bhowmick mentions, “The new MBBS curriculum has a course called Attitude, Ethics and Communication (AETCOM) where students will be assessed for how they communicate with patients especially while counselling people for organ donations, how sensitively do they offer care and obtain consent.”

Not only the government’s initiative but collaboration between industry and academia is likely to play a major role to boost the medical education sector.

Industry academia collaboration
Health experts and academicians claim that the Indian healthcare sector is looking for innovative research models to provide more active participation from industry players. Collaboration between industry and academia will lead to improvement and innovation in the industry and also helps to ensure industrial relevance in academic research. However, successful collaboration can only happen when properly planned and nurtured.

Dr Bhowmick says, “The pharmaceutical industry employs a lot of doctors who are engaged in training and research collaboration with medical colleges and hospitals. The government should allow honorary faculty positions to such doctors who have the experience of training and teaching over the years. Medical education requires a lot of funding and industry should include expenditure on development of infrastructure of medical colleges as a part of their corporate social responsibility.”

Sharma from TMC mentions, “The industrial organisation should actively support academic activities by sponsoring workshop and seminars very actively.”

JB Sharma says, “In terms of industry-academia collaboration, there is active collaboration for conducting clinical trials for products that the companies plan to market either in India alone or even internationally. However, the level of engagement for basic research including disease research and epidemiology can be improved further by the more active participation of the industry players, including research in India specific diseases. There are various government initiatives from BIRAC, CSIR, DRDO that provide this platform.”

In the years to come
Mega reforms by the government are likely to make an impact on the medical education sector. however, these initiatives can bear fruit only if implemented in the right way. The right pill for India’s ailing medical education system will be to address issues pertaining to corruption and high fees structure, appointing right faculties and blacklisting of illegal institutes.

sanjiv.das@expressindia.com