Doctors against exit exam

India's largest body of doctors plans to oppose a government move for reforms in medical education that would, among other initiatives, introduce a mandatory licentiate examination that all medical graduates would need to pass to practise medicine.

The Indian Medical Association (IMA) will oppose the common licentiate examination proposed by a panel chaired by Niti Aayog vice-chairman Arvind Panagariya in a draft bill seeking to establish a new regulatory system to govern medical education and practice, IMA officials said.

"Such an exam will pose an unnecessary burden on our medical students - we are against this idea," Gundarlahalli Naganna Prabhakar, a surgeon in Tumkur (Karnataka) and the president of the Karnataka branch of the IMA, told PG Times.

About 45,000 medical graduates emerge each year from India's 300-odd medical colleges, and under existing rules, once they have cleared their final examination at the end of their course, they can register with the Medical Council of India (MCI) for a licence and practise.

But sections of medical faculty have often in the past cited the diverse standards of infrastructure measured through teaching, faculty, and volume of patients to argue in favour of a licentiate exit examination to ensure that doctors from all medical colleges meet minimum standards.

The Panagariya-led panel has suggested that the licentiate examination would serve as an "objective benchmark" to judge the outcomes of the medical education process in medical colleges, implying that students' performance in the licentiate examination would help rate the college.

"An exit exam is a great idea - it would help ensure some level of uniformity in doctors," said Samiran Nundy, a senior gastrointestinal surgeon at the Sir Ganga Ram Hospital, New Delhi, and a member of a coalition of doctors that has urged the government to reform regulatory oversight on medical education.

However, senior office-bearers of the national and state branches of the IMA -which has a nationwide membership of over 200,000 doctors - are questioning the need for the licentiate examination.

"Our medical colleges, affiliated to various universities, conduct final exams based on syllabus prescribed by the MCI that is uniform across the country," said Jayakrishnan Alapat, president of the Kerala branch of the IMA. "By insisting that medical graduates take a licentiate exam, the government would be sending a signal that it does not have faith in universities it has approved," Jayakrishnan said.

A senior official in IMA headquarters in Delhi said the association plans to suggest to the government that any common exit examination for MBBS graduates should be treated as the entrance examination for postgraduate courses leading to the MD and MS degrees.

All candidates who pass this common examination would then earn a licence to practise medicine, while those who secure marks higher than cutoffs could also look forward to seats in MD and MS courses, the official said.

"This will help medical graduates in another way - they could fully concentrate on picking up clinical skills during their period of internships," said Vinod Monga, dean of academic studies at IMA. "Internships used to be a prime period of learning clinical skills during our times, nowadays most students on internships are preparing for their postgraduate entrance exam - their minds are more on the exam than on the internship. A common exit-cum-postgraduate entrance exam could change this," Monga said.

The Panagariya-chaired panel's draft bill has proposed a new regulatory body called the National Medical Commission to replace the MCI, the existing body that has long been under a cloud for what many see as its failures to curb corruption in medical education and clinical practice. In March this year, a parliamentary committee on health had asked the government to replace the MCI with a new body.