A case for pride and reform in medical education

Guest article by Dr. S.K. Sarin, Former Chairman, MCI Board of Governors (BOG)


THOUGH late, the Government of India has realised the importance of health and education as two important pillars of economic well being. The increase in population, health care demands, need for basic doctors and specialists and the public sector’s inability to foresee fulfil the needs provided ample opportunity for private players to enter medical education.

In the last decade, these outnumbered government medical colleges. The demand and supply gap was huge and the arena so lucrative that politicians, middlemen and people with connections started influencing the policy makers, including the Medical Council of India (MCI), an autonomous body established through an Act of Parliament in 1956. Unfortunately, keepers of the law remained silent spectators, till the lid was blown. CBI raids on top MCI officials and several colleges brought so much ignominy on the government that it was forced to bring about a change. The government appointed a team of professionals with integrity as the Board of Governors (BoG) in mid-2010 — to bring to shore a sinking ship against the unfavourable winds and hungry sharks. The situation demanded swift action.

The board fast-tracked the routine monitoring of colleges by simplifying norms to set up and recognise medical colleges, facilitated increase in the seats, setting up web-based faculty identification system (to prevent passing off the same faculty in more than one college), changing ‘inspector raj’ (removing permanent inspectors) to ‘professional assessments’, etc. To maintain the ‘quality before quantity’ principle, the shortage of teachers was met by raising the retirement age from 65 to 70 and by permitting trained DNB specialists to be considered for teaching.

However, the BoG realised that monitoring skills and quality of education in about 340 medical colleges was not easy and would not yield the desired results. They decided it was better to assess the ‘product’, the medical graduate. This can only be done by ensuring good ‘raw material’ and a quality finished product. This gave birth to the National Eligibility-cum-Entrance Test (NEET) and the National Exit Examination, a licentiate exam to qualify as an Indian Medical Graduate (IMG). The BoG defined the proficiency level of an IMG. We do hope this exit exam, which includes testing knowledge and skills (makes internship purposeful), is introduced soon so that the suffering lot do not have to wonder where has the doctor graduated from!

The BoG-2010 also designed several new career options after MBBS, such as M.Med (previously called diplomas) and dual courses (MD-PhD). The need and process for equalising the PG and UG seats was set in place by removing ‘essentiality clause’ from PG education. This document on medical education, vetted by nearly 300 college deans and vice-chancellors, was called ‘Vision 2015’, and was well received.

The quality of ‘raw material’ entering the medical stream has become questionable, because of conflict between the payers and non-payers, the private and public colleges. ‘Simran Jain versus Union of India’ was a case in context before the Supreme Court. The BoG saw an opportunity to establish a common entrance test. It developed a comprehensive policy and took on board different states having their own educational priorities and standards. The BoG had its eye on the poor village boy studying under a lamp post with the dream of entering the AIIMS on merit, with no resources or ‘connections’. The issues of quota, religion, rural and urban, rich and poor, coaching institutes, etc, were, however, overbearing. The BoG took help from the CBSE to standardise various state board syllabi, set up eligibility and seat allocation criteria, allowing state reservation policies their say, and with the patronage of the Central government placed before the highest court a fair and transparent system for a national entrance examination.

In a landmark judgment, on December 13, the highest court gave the green signal for the NEET. After some initial hitches, the GoI undertook to have the NEET for both UG and the PG medical entrance in 2012. It was dream come true for thousands of students, right thinking medical men and hailed as a major milestone in ensuring equitable and affordable opportunity in a capitation-driven industry called medical education. The NEET breathed in minimum eligibility and a uniform and transparent assessment system which was convenient and economical; alleviating the need for students and parents to rush to nine-ten centres across India for entrance examinations. Above all, from the national perspective, it was to reduce corruption and malpractice. If you enter the profession by corrupt means, your approach and practice of medicine is bound to be tainted.

As the NEET became a reality in 2012, the private players in medical education industry were not ready to accept it. They wanted the old system of regional exams which permitted them to fix the price of the medical seats based on the demand. They knew the supply could not meet the demand for many years. They bought the best legal brains of the country, who joined hands to defeat ‘truth’ and the rights of ‘the village boy’ to be a doctor. In an unprecedented move, the highest court permitted the private players to hold their own admissions despite the NEET having been already conducted.

But there is hope. The Supreme Court judgment was divided, the dissenting clear verdict of a senior judge allowed a review writ petition by the GoI. The petitioners would again be challenged by the best legal brains. Why does the medical profession not join hands to clean up its own muck? Why does it want others to decide for it issues such as bringing in Indian Medical Council Amendments (2013). When chartered accountants, engineers, the IAS, the Bars (CLAT) can have a common entrance examinations, why should the very genesis of the medical profession be allowed to become unethical? We have faith in the judiciary and media, and do hope that a fair and far-reaching judgment on NEET would be delivered fast. The aspiring students need to know for which exam they have to prepare this year. We have miles to go before accomplishing ‘Vision 2015’, and NEET is the first and essential step.

The writer is a former Chairman, MCI Board of Governors, and at present Director, Institute of Liver and Billiary Sciences, New Delhi. The opinions expressed are personal.

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