What India needs to do in Medical Education

Guest article by Dr. MG Deo. Dr Deo was a Professor of Pathology at the AIIMS, New Delhi and between 1978-95, Director, Cancer Research Institute (Tata Memorial Centre), Mumbai. In 1990, the GOI bestowed on me the prestigious civilian award of Padmashree.

India faces a huge shortage of specialists and super-specialists and not of basic MBBS doctors to meet the challenges posed by the changing health scenario. Both urban and rural sectors are affected. In the next fifteen years, non-communicable disorders (NCDs) will be the dominant health burden. Control of these disorders needs specialists and super-specialists, as an ordinary MBBS is not trained to handle NCDs. Also our rural health system is facing acute shortage specialists. Eighty per cent posts of the specialists (Physician, Surgeon, Pediatrician and Gynecologist) in Community Health Centers (CHCs), the first contact point of a villager with a specialist, are lying vacant. On the other hand, shortage of basic MBBS doctors has been hyped even in rural India as only 10% Primary health centers are without doctors, that too in only few states.
These facts were ignored by the Government of India, and instead of creating large scale facilities for training of specialists and super-specialists, a decision was taken to produce huge number of MBBS doctors by establishing new medical colleges (MCs), especially in the private sector, on a fast track. Today, India has some 412 MCs admitting more than 50,000 students (highest in the world). However, only one third will get opportunity to do post-graduation (MD/MS). This is a nightmare for young medicos as in the next three years about 100,000 MBBS doctors would be without opportunity for post-graduation and/or suitable jobs (Unemployed). They may hit streets in protest.
Medical education in India should be innovative to meet the following 3 major interlinked challenges.
  • a. Specialists (Physicians and Surgeonsservices must be made available to rural India on a priority basis,
  • b. Training of medical and surgical specialists should be put on a fast track.
  • c. Every MBBS student must get a chance to do MD/MS.
Plausible Solution
Abandon wrong policies of producing huge number of MBBS doctors. Instead shift emphasis immediately on training of specialists and super-specialists.
One way could be to replace the current MBBS course with a combined 16 -18 semester MBBS-MD/MS degree. The course will consist of two components (a) 8-semester of the “basic MBBS course” having the curriculum similar to the MD (equivalent to MBBS) course of the same duration in the USA. All successful candidates are admitted to residency program (8-10 semester) leading to MD/MS in disciplines of their choice similar to the one followed by American Board of Medical Specialties. However, rural posting should be made a compulsory part of the MD/MS residency program. This will ensure availability of basic specialists’ services to villagers in the shortest period (1-2 yrs from the implementation of this idea). Later, they may join DM (super-specialization) courses. It may be worth mentioning that the combined course only involves restructuring without altering the core syllabus as prescribed by the MCI both for MBBS and MD/MS.
Today it takes about 12 years to train a specialist. The combined course will reduced the duration to about 8-9 years. Since every medical graduate is assured of a postgraduate seat it will prevent large scale black marketing of postgraduate seats, especially in private medical colleges. Also there will be no need for NEET for post-graduation. It is a well-known that most of the period of ‘Internship’ is today spent in libraries for preparing for the NEET. For a Doubting Thomas, if Americans can do it why not Indians.
Simultaneously, there should be restructuring of rural health services. Primary Health Center (PHC) is the corner stone of rural health services. It is time to pay equal if not more emphasis on services offered by the CHC, which should be equipped with modern amenities – ICUs, MRI, advance investigative facilities, well equipped operation theaters etc. This will be in tune with Dr. A.P.J. Abdul Kalam’s concept of PURA (Provide Urban Amenities to Rural Area). CHC, which should be located preferably in a tehsil town, should also be an educational hub. All undergraduate and postgraduate medicos should be posted at CHCs. From there they will provide day to day mobile services to PHCs. Every village home now has a mobile phone. Emergencies could be rushed to CHC in about 20-30 min even from the farthest village which is on the average about 10 km from the tehsil town. This is the time taken by an emergency patient to reach a hospital in our megacities.

DISCLAIMER: The views expressed are solely of the author.

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