The Failing anatomy

Kochi: “We are sitting on a time bomb. Some doctors emerging from self- financing medical colleges don’t even know how to attend to a patient in an emergency. I have come across  medical graduates failing to help a patient discharge urine using a  tube,” rues  Dr N.K. Sanil Kumar, a city urologist.
He is not alone  in his claim that doctors produced by self-financing medical colleges are far less capable than  those who graduate from government colleges in the state.
Noted  health expert, Dr B. Ekbal goes so far as to say that it is time some of the  self-financing medical colleges were closed down. “We don’t need so many medical colleges. Those without the necessary infrastructure and faculty should be closed down,” he says.
The problem lies with the lack of opportunity  in these medical colleges for  students to gain practical knowledge, according to the doctors . “They may have  theoretical knowledge, but in the absence of patients in the general wards, they are not able to gain the  practical knowledge they need,” observes Dr Sanil Kumar, explaining that as patients who go to private medical colleges for treatment opt for  specialists and pay wards,  they are not happy to have students taking care of them. “So the students  don’t get to treat patients. This is a major issue facing private colleges today and they need to find a way  round it,” he adds.
On the other hand,  government medical colleges, which overflow with patients, provide students ample opportunity to treat them, he notes. “In the Kozhikode  and Trivandrum Medical Colleges where I studied and trained, there would be three times the number of patients as the beds available  and so students had tremendous exposure to the practical side of their course,”  he recalls.
Lack of adequate teaching staff in the self financing medical colleges is also to blame, say the doctors, noting that it is  usually retired hands  who act as visiting faculty in these colleges. 
Dr Ekbal is worried that  the middle class dream of having a doctor in a family is pushing many uninterested youth into the profession. “Only those with real liking for the profession should join it. Today despite the over dependency on technology, many doctors are still not able to make the right diagnosis,”  he regrets, urging professional bodies like the Indian Medical Association (IMA) and KGMOA to seriously debate these problems and advise policymakers in ways to overcome them.
Wait till 2015 for first results:  Vice-Chancellor
It’s not right to say that all self-financing medical colleges don’t produce good doctors, says Kerala University of Health Sciences vice-chancellor, K. Mohandas.
“The well functioning hospitals that are later upgraded to medical colleges do get patients and their students have exposure to the practical side of their courses, but in others that is not the case,” he acknowledges.
While  the university is trying to bring in changes for skill enhancement of  doctors,   the measures taken  will to start to show results only from 2015 when the first batch that they apply to, passes  out, he maintains.
“The students coming out now have been studying under the old system. But now we  are reforming and strengthening the examination system, including the practical exams, to rule out scope for copying, which is a big malaise affecting  quality.  
To improve practical skills, we  need to strengthen the formative assessment system of the colleges as well. The university does only the summative  assessment, but   I am going to look into the formative  assessment as well,” he assures.
Director of medical education, V. Geetha feels the health university needs to conduct periodic inspections to ensure the quality of self-financing colleges.
“The DME  gives ample support to the health varsity in  this. Action was taken against certain colleges recently for  violating admission norms,” she recalls.
In her view if medical colleges adhered to the norms of the Medical Council of India and reserved 30 per cent of their beds for below poverty line  patients as charity, they  could ensure their students got hands-on training.

MCI for licentiate test for medical grads
Thiruvananthapuram: The recent disclosure by Public Service Commission (PSC) chairman K.S. Radhakrishnan, about the poor quality of doctors who have been included in the short list for appointment as assistant surgeons in government service, has reinforced the findings of the Medical Council of India (MCI) that the quality of medical education has been deteriorating in the country.

The MCI had mooted a licentiate test for those who qualified for MBBS, before allowing them to practise, to ensure a minimum standard for doctors who enter the profession.
Neurologist Dr Fazal Gafoor, who is the chairman of the Muslim Education Society (MES) told Deccan Chronicle that the proposed National Entrance and Eligibility Test (NEET), applicable for the whole of the country, has been mooted by the MCI keeping in mind this slump in quality across the country.
The test was just one of the components of the Vision 2015 document of the MCI. One of the major recommendations of the document was the introduction of the licentiate India Medical Graduates (IMG) degree test, after a one-year internship, to practice medicine in the country.
This proposal, if accepted by the MCI, would mean that MBBS graduates would have to complete a one-year internship in a hospital before appearing for the licentiate examination.
One of the other suggestions put forward by the MCI is the abolition of the entrance examination for post-graduate (PG) courses. Students will be selected for the PG courses on the basis of the marks obtained at the MBBS level and the marks obtained in the internship to get the IMG.
Students for the PG courses will be selected from a national-level merit list prepared after taking into account the marks obtained in the theory test and in the licentiate test. MCI plans to make the proposal mandatory by 2017.
Another proposal put forward by the MCI in Vision 2015 was a two-month foundation course comprising medical ethics, communication, health economics, biohazards and environmental issues, in tune with the proposed reforms.  This would be a corrective measure for the lack of social commitment that was identified by the PSC chairman in doctors shortlisted for appointment to the post of assistant surgeons.
Dr K. S. Radhakrishnan said that doctors are totally unaware of government policies and programmes; they are not even sure how a public health centre (PHC), works.
The PSC chairman also pointed out the poor quality of doctors who had degrees from countries such as Russia and China. Dr Radhakrishnan pointed out that these doctors could not have proper exposure to patients as they did not have proper knowledge to interact with patients because they did not understand the local language.
Only one in five students with a foreign medical degree who appeared in the screening test introduced by the MCI for foreign educated doctors, qualified.
The president of the Indian Medical Association, Dr K.V. Devadas said that the MCI introduced the screening test to monitor the quality of doctors who got their degrees from Russia and China.
Only 3,150 of the 14,476 students who appeared for the screening test for candidates who completed their medical education, conducted by the National Board of Examinations (NBE) of the MCI, cleared the examinations in 2012.
In 2011, 13,270 students appeared and 3,576 cleared it. In 2010, of the 10,115 students who appeared for the test only 2,680 passed the examination. In 2009, 6,262 students appeared for the crucial examination with just 1,017 clearing it.

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