Medical education suffers from common cold

Vandana Shukla 

Chandigarh, July 20

"I got a call from Fatima College in Andhra Pradesh asking me to be present on the day of inspection. The college was keen to pay me Rs 4 lakh for one day. If they dare to make such an open offer to a Vice Chancellor, one can imagine how many more in medical profession are given such offers,” says Dr Raj Bahadur, Vice Chancellor, Baba Farid University of Health Sciences, Faridkot. 

This articulates a lot that has gone wrong with the medical education in India. To protect themselves from the wrath of the Medical Council of India, medical colleges follow the practice of hiring private agencies to work for them on days of inspection, but none condemns it openly. Incidentally, the same body permits them to open a medical college after they have met the stipulated requirements of 20 acres of land, a 300-bed hospital — each project costs close to Rs 300 crore. Everyone has a vested interest. Parents dream to see their children's name prefixed with 'doctor' and are willing to pay any price. Colleges know the greed for degrees, they cater to it. Seats are limited, there are more contenders than can be accommodated, yet, no one complains. 

This gives birth to scams and controversies associated with the AIPMT. Then, there are corporates with huge investments at stake. 

India has the largest number of medical schools globally (381) and produces the most medical graduates each year (50,000). The country gets a significant number of medical tourists, a reflection of the high-level expertise available. Yet, a majority of Indians have limited access to quality healthcare; less than half of our children are fully immunised and maternal mortality ratio is the highest in the world. India carries 20% of the world's disease burden, according to data from the World Health Organization. About 17% of deaths globally, caused by communicable diseases, occur in India. 

Medical education suffers from common cold. The MCI's Vision 2015 draft panel report cites three reasons for India's healthcare woes: shortage of physicians (both generalists and specialists), inequitable distribution of manpower and resources, and deficiencies in the quality of education. The challenges that confront medical colleges are poor government control over the accreditation process, lack of skilled faculty, curriculum with inconsequential detail, and the complicated selection process.

Govt versus private 

A study conducted by the Institute of Studies in Industrial Development in 2014 shows the imbalance in the spread of private medical institutions. The four southern states (AP, Karnataka, Kerala, Tamil Nadu) with 21% of India's total population have nearly half of the medical schools (43.6%) and intake capacity (46.3%). The northern states with 17.66% of medical institutes account for only 15.19% of student intake. The growth of medical colleges in government sector has remained almost stagnant, the private sector has concentrated in prosperous states; mostly in the western and southern India. The imbalances have led to irregularities as well as concerted efforts by lobbying groups to get policies framed that favour these states. 

For example, in 2012 the MCI announced that National Eligibility cum Entrance Test (NEET) is necessary for admission to undergraduate and postgraduate courses in all government and private medical colleges that come under the ambit of IMC Act, 1956, to have uniformity of standards. The test was deferred for a year. It was conducted in May 2013 across India.

But, after hearing the pleas of a few states and 115 private medical colleges, the Supreme Court on December 13, 2012, allowed them to conduct their own entrance exams. The petitioners also stated that there was a huge variation in the syllabus proposed by the MCI and the syllabi in their states.

NRI & management seats 

Punjab's 10 medical, 16 dental and 109 nursing colleges with just about 870 seats in medical, 940 in dental and 4,420 in nursing colleges face problems that are made complex by a web of issues around admission procedures. Despite a huge gap in the demand and supply, colleges are not able to fill their seats, especially in the BDS courses. In Punjab and Haryana, the recent changes in the admission criterion, based on class 12 marks, has further diluted the credibility of these courses. The pass percentage of dental colleges in Punjab has come down to 61%, as compared to 85% the previous year. The delays, deliberate and otherwise, in declaring results and counselling process, are meant to pave the way for getting more students in management quota and NRI seats, against the stipulated numbers (50%).  The recent ruling of the Punjab and Haryana HC, cancelling 450 admissions to BDS courses in private colleges, shows compromise of standards in medical education.

Faculty

The MCI draft report suggests medical institutions need to be strengthened by investing in technology and by curriculum reform that should be skills-based rather than the existing science-based syllabi. Availability and selection of faculty for a fast growing number of private medical colleges is the biggest challenge. Most regional private medical colleges function on the basis of visiting faculty.

(Concluded)