Healthcare in the ICU?

Profit will become the sole motive

Bipin Batra, Executive director, National Board of Examinations

A century after the Flexner Re­port (1910) iden­tified the con­dition of med­­ical education in the United States, it can be said that medical education in India bears resemblance to the US case. Its feature is a continuous dec­­­line in standards.

While the Flexner Report tra­n­sformed medical education in the US and Canada, medical education in our country is th­r­e­atened by jurisdiction over regulation, inadequacy of funding and the incr­e­asing st­ake of private med­ical schools.

India’s medical instituti­ons range from public ins­ti­t­utions, private and family owned institutions that function more like enterprises, and autono­mous institutions owned by faith based organisations or real soc­ial enterprises.

An analysis of the ownership pattern suggests that the ethos of an institution has a striking impact on the quality of the outcome. Institutions with high social accountability produce graduates with high levels of professionalism and possessing sound medical knowledge and skills, while those having profit as an important motive struggle to ma­tch the benchmarks of professional excellence and service delivery.

The existing regulation go­v­erning admission to medical institutions is a decade and a half old and has lacunae that allow and justify questionable admission procedures and dubious assessment practices. To elevate the standards of education and the quality of medical graduates, appropriate int­­e­­rventions have to be made at all three stages, na­mely, student input, edu­c­ation process and out­­­put standards.

With the quashing of the National Eligibility and Entrance Test (Neet) by the Supreme Court recently, the stage of student in­put gets severely compromised.

The fact that so many entrance examinations are being held by var­ious medical colleges across India also severely narrows the gateway of opp­ortunities for stud­ents. More exams have to be paid for and travel to different centres becomes necessary.

Valid evidence points to a high degree of correlation between honest and fair student selection criterion and a reliable learning curve during training and a student’s performance in the exit examination. It is important to note that det­a­ching the admission pro­cess from the powers and functions to regulate standards of professional education cannot be cont­e­m­­plated in modern day regulation.

The high cost of private medical education driven by a capitation fee, which is levied over and above the legitimate course fee by many institutions, has a direct bearing on the ethical practice and standards of professionalism of the doctors being produced.

In the case of post graduate seats, the severe demand-supply mismatch has led to intense commercialisation of postgr­a­d­uate education. Ina­de­­qu­ate clinical exposure resu­l­ting from the pace at which institutes rush to establish postgraduate cou­­­­­­­­­rses is another area of concern.

The Neet may not be a panacea for all the ills affecting medical education in India, but it certainly is the most potent and relevant step that can rejuvenate the quality of medical education, just as the Flex­ner Report did for the US and led to a strong wave of reforms.

There cert­a­inly exists a way out of the current regulatory framework that holds the key to the future. There must be quality — and affordable — healthcare for the wor­ld’s largest democracy.

Private sector can’t manipulate

P.K. Gupta, Chancellor, Sharda University

The Medical Council of India (MCI) was created under the Indian Medical Council (IMC) Act in 1956 with the mandate to regulate standards in medical education by prescribing qualification criteria, conducting inspections and preparing the syllabus.

The council has never been involved in regulating the admission process, except for prescribing the eligibility criteria. There are state and Central councils that register doctors graduating from medical colleges. The MCI mandate was expanded in 1992 to empower the councils to recommend the granting of permission to establish new institutions and new courses.

Medical education was opened up for the private sector by the Central government in 1991. After running an institution for more than 15 years, we do not expect interference by the regulatory body in conducting entrance examinations.

The regulations to open a medical college are so tough that we do not get approval even if there is a minor deficiency in terms of infrastructure, faculty and the like. Private institutions have to adhere to all the regulations to get MCI approval. Indeed, we often find government colleges falling short of faculty and having poor infrastructure.

There are government medical colleges which have been running for more than five decades and are falling apart, but hardly any action is taken by the MCI. But private institutions face periodic, even surprise inspections.

India is facing a huge shortfall of doctors. If the government starts poking its nose in every matter, I am worried that not many people will enter this field. There are two types of private medical colleges.

Thirty of them are in the “deemed university” category and can conduct their own medical exam. There are other colleges which have become state universities, namely private universities created by state legislation and not by the University Grants Commission (UGC). These colleges also can conduct their own entrance examination.

Private medical colleges which are not in the “deemed university” category are affiliated to state government universities. As per a Supreme Court judgement, they (medical and dental colleges) can form an association and conduct a single exam. Students get admission on the basis of merit.

There are thousands of students who appear for these exams, which are as fair as those conducted for government medical colleges.

We are running universities and we cannot manipulate, or resort to unfair practices. If the Central government starts conducting entrance examinations for us in the private sector, we will lose control.

We were never in favour of a single entrance test for the country, and will never be. Education is a state subject and should be left that way. There are also minority institutions. 

They have their own issues. Each state has its own priorities. How can a student sitting in Mizoram be compared with one in Bihar?

Conducting examinations is the fundamental right of a university, and the Central government should not try to regulate it.

The MCI should just stick to its mandate. If the government’s intention is to maintain high standards of medical education, all that it should ensure is that only successful candidates gain admission.