What the Delhi Health Minister Satyendra Jain said at a recent event wouldn’t be music to the ears of anyone at the Medical Council of India(MCI)

The Minister pointed out in terms only too clear that the work of the MCI is to ruin the medical education system in India. He said that this process is being carried out by the body “very carefully and very well” adding that the MCI doesn’t want to raise the number of PG seats.
The scathing remarks didn’t end there. In fact, it could be said that that was just the beginning.

For the bespectacled Minister also said that PG seats in medical colleges wouldn’t be increased by MCI because of vested interest. Only private colleges that charge Rs 1 Crore to Rs 5 Crore per medical PG seat are supported by the organization, he said.

Just a couple of days after this, a news broke that would not only be not music to the MCI’s ear, it might even have made their ear canals bleed: the proposal for the scrapping of the body was made by a committee headed by NITI Aayog Vice-Chairman Arvind Panagariya.

The call to scrap MCI

The report was finalized apparently after multiple rounds of deliberation on the issue with both stakeholders and experts.

The panel is rather clear about the idea that the MCI should be scrapped if the number of medical colleges are to be increased. At present there just isn’t enough number of healthcare professionals to cater to the growing demand for services.

The committee was formed to look into the problem of the poor way in which medical education is handled by MCI in the country. The committee also boasts as its members P K Mishra, the Prime Minister’s additional principal secretary and Niti Aayog CEO Amitavh Kant.

The three-member committee had proposed not just to end MCI but also to build up a novel body, one which will adopt a three pronged approach:

• Career
• Enterprise
• Ethics

If the proposal is taken forward, this could be the end of the organization that was established in 1934.

Not the first time, finger being pointed at MCI

But pointing out the MCI as the culprit in the downfall of India’s medical education shouldn’t come as a surprise. A few months back, call for revamping the body was made by a parliamentary committee. The reason they cited is unsurprising in hindsight-that the MCI has failed as a regulator leading to the poor state of the nation’s medical education system.

In fact, the committee had asked the government to exercise its constitutional authority by restructuring and revamping the regulatory system of medical education and practice.

The report brings out the failures of the MCI in no uncertain terms. It cites “massive failures of the MCI” and lack of governmental initiatives as reasons for the downhill ride of the Indian medical system. It also stated that quality has been sacrificed at the interest of commercialization.

The panel makes the point that MCI has failed in creating a curriculum which produces doctors suited to the Indian context. Another failure of the MCI that the panel notes is the failure to maintain uniform standards for undergraduate and postgraduate medical education.

Devaluation of merit in admission is mentioned by the committee, especially with regard to private medical institutes where capitation fees is a reality to contend with. While this makes medical education available to the rich, it doesn’t ensure the same for the most deserving, the committee says.

The adverse effects of the MCI’s failure in establishing medical colleges as required are mentioned by the panel:

• Mal-distribution of medical colleges, having clusters in some states while others experience vacuum
• Acute shortage of medical teachers
• Poor doctor-population ratio

Some of the other failures of the MCI that the report points out include:

• Failure to oversee the continuing medical education in the country which effectively handed the task over to the commercial private sector
• Failure to instill respect for ethical code in medical professions
• Failure to take disciplinary actions against doctors who violated the code

The state of medical education

While what committees and reports say may well be true, the failures of the medical education system have been put forth by many before as well.

An article that appeared in the Indian Journal of Public Health(Dasgupta S.Reforms in medical education: Optimizing quantity and quality. Indian J Public Health 2014,58:1-4)is a case in point.

The article talks about the National Knowledge Commission(NKC) which was established by the Indian Government in 2005 with the purpose of recommending reforms in the realm of professional education.

Owing to the significance of medical education to India’s socio-economic development the NKC constituted a working group exclusively on medical education. Their purpose: identify constraints and challenges related to curriculum, infrastructure and administration and suggest reforms.

The observations made by the working group were insightful though largely bleak:

• Medical education in India lacked any direction
• It is unregulated
• It is non-standardized
• The reason we couldn’t achieve the desired health goals is the lack of competent medical professionals manning the health facilities
• Need for curriculum revision(in the context of great progress in medical science and technology
• Need to incorporate competency-based pedagogical methods
• Maldistribution of training facilities

On the last point, NKC found that the lion share of medical colleges(63%) were to be found in just six Indian states-Maharashtra, Andhra Pradesh, Karnataka, Tamil Nadu, Gujarat and Kerala. Just 3% of the training facilities were in the North-Eastern states. These figures are for the year 2005.

The NKC report also recommended amendments to the Indian Medical Council Act so that MCI can be a a truly autonomous body and not just a recommending body to the Central Government.

The key roles for the MCI which the article envisioned included:

• Health manpower planning and forecasting
• Updating curriculum
• Faculty development
• Continuing medical education
• Monitoring/accreditation of teaching institutions

Failure to align medical education with the country’s needs

The article looks at another document, the report of the “Task Force on Medical Education for the National Rural Health Mission” that was constituted by the Indian government’s Ministry of Health and Family Welfare. The task force’s primary objective was to revamp medical education according to the requirements of medical professionals.

The report, which emphasized the need to revitalize healthcare with particular focus on primary health care found the physical infrastructure lacking on many counts. With regard to the doctors, the report mentions the following:

• Lack of enough PHC doctors(13%)
• Lack of specialists(38%)
• Fresh medical graduates lacked training and expertise to provide even primary care independently.
• The current curriculum was more information content and less clinical skills.
• Medical grads couldn’t perform effectively in primary care settings without the support of advanced diagnostic tools.

The report recommended revamping the curriculum to match the community needs and also adopt training methods that will help attain clinical competence.

Some of the aspects that the report explored to raise the manpower included:

• Introducing a short term certificate course that would enable one to render basic primary care in rural areas
• Converting district hospitals into medical colleges
• Encouraging private entrepreneurs in the sector

All such reports recognized that the quality of medical education in India begged for more. The fact that the MCI may soon be scrapped owing to incompetency shows that nothing much was done though.

Image credits: India Today

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