Medical exit exam mooted

A government panel has proposed a licentiate examination that all medical graduates would need to pass to practise medicine, addressing long-standing concerns about diverse teaching standards in medical colleges across India but angering some doctors.

If the proposal is accepted, an estimated 45,000 medical graduates each year will need to take a new examination to earn practising licences.

The recommendation is among a set of reforms the panel has suggested in a draft bill to create a new regulatory architecture for medicine. The panel is chaired by Arvind Panagariya, the vice-chairperson of the Niti Aayog.

The bill has also proposed that private medical colleges be given "freedom" to charge whatever they deem appropriate for 60 per cent of their seats while the government would regulate fees in the remaining 40 per cent.

The Niti Aayog has sought public responses to the draft national medical commission bill.

Many doctors have in the past advocated an exit exam because the quality of teaching and infrastructure varies widely in the 300-odd medical colleges in the country.

Certain institutions such as the All India Institute of Medical Sciences (AIIMS), New Delhi, are considered elite institutions, offering high-quality faculty and an abundance of patients and hospital infrastructure. But there are also some medical colleges that lack faculty and patients.

"An exit exam will help ensure some uniformity in medical graduates," said Raju Chacko, a medical oncologist at the Christian Medical College, Vellore. "Most other countries do not have a single exam for everyone but then most other countries don't have similar diversity of standards."

But doctors caution that the licentiate examination will need to be designed well. "It should ensure that all our medical graduates achieve a specific level of medical proficiency," said Gurinder Singh Grewal, a gastroenterologist and president of the Punjab Medical College.

Some doctors plan to oppose any additional exam. They point out that the licentiate examination will mean candidates have to take three examinations at the end of their final year MBBS - their final exam, the licentiate exam and a postgraduate entrance exam for entry into MD and MS courses.

"We are opposed to multiple examinations," said Krishan Kumar Aggarwal, a senior consultant cardiologist and the secretary-general of the Indian Medical Association, a body of private doctors. "The government should instead introduce a single exam that can be taken by all medical graduates at the end of their final year. It could serve as an exit exam and the post-graduate entrance exam."

The Narendra Modi government had set up the panel in March this year after a parliamentary committee had urged the government to dismantle the existing Medical Council of India (MCI), saying the apex regulatory body had failed to curb corruption in medical education and practice.

The four-member panel has proposed a National Medical Commission to replace the MCI. The commission will coordinate four independent and autonomous boards to manage each of four areas -- undergraduate education, postgraduate education, assessment of medical colleges and medical practice.

In line with the concerns expressed by the parliamentary committee, the panel has recommended that the commission should include doctors and representatives of the Union health, rural development and pharmaceuticals ministries, and experts in economics, law, management and patients' rights.

"At this juncture, I think it's important to remember that any system is only as good as the people who are in charge. So, proper selection of personnel for these new bodies will be crucial," said a senior physician in a government hospital in New Delhi.

The panel has also recommended that, given India's shortage of doctors, the government should explicitly include a provision to permit "for-profit" organisations to establish medical colleges, a departure from the current policy of allowing only "not-for-profit" entities to set up medical colleges.

"The current ban on for-profit institutions has hardly prevented private institutions from extracting profits albeit through non-transparent and possibly illegal means," the panel said in its report.

It has recommended replacing routine inspections of medical colleges with mandatory publication of colleges' infrastructure and ranking of colleges. This is expected to help medical students make an informed choice while choosing colleges and build pressure on colleges to improve standards to attract good students.