Rejuvenation of Indian medical education system: Was scrapping the Medical council of India necessary?
Scrapping of the Medical council of India and other professional councils in India was a kneejerk reaction from the India
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Rejuvenation of Indian medical education system: Was scrapping the Medical council of India necessary?
Introduction: National Knowledge Commission1 reports reiterate that Indian Medical education as a part of the whole system of education is in crisis mode today. This situation is best reflected in the Primary Health Centres in crumbling buildings without competent health care providers or absentee providers.2 In this general dismal scenario, reforms in medical education need to be multi-sectoral and aim at convergence to deliver healthcare to the common man, urban or rural, who can contribute to economic growth and quality of life for the nation, the ultimate goal of education.
Presently, Indian Health Education seems directionless, unregulated and non-standardized, apart from a few institutions and the quality, quantity and distribution of the health oriented human resources being produced leaves much to be desired. In general, there appears no accountability, effective monitoring or implementation of laid down standards, by any regulatory body or well-designed need oriented educational programmes.The curricula have not been updated for decades by all the councils and there has been no attempt to emphasize non-medical public health strategies . 3There is an urgent need for innovation in health-related education, which encourages connectivity across disciplines and categories of health workers, the Health Ministry has said. The NCHRH task force has proposed an 11-member Council, including the chairperson, to reform the current framework. The task force will also prepare a Draft Bill for the establishment of the Council soon.3, 4, 5,6,
Although functioning within the broad ambit of medical and health education policies of the government, the NCHRH will be a compact autonomous body, independent of government controls, with adequate powers including quasi-judicial. The new council will oversee seven departments, related to medicine, nursing, dentistry, rehabilitation and physiotherapy, pharmacy, public health / hospital management and allied health sciences. It will subsume works of all the councils and also carry out permission, assessment and accreditation of medical and health institutions across India. Further, the task force has also proposed that prominent hospitals across the country be allowed to offer postgraduate courses. This is because there are very few postgraduate seats in medical education in India, due to which students are left with no option, but to study whatever is given to them or fly abroad for further studies to enable them settle abroad.,6,7
Like the NKC, the Yash Pal committee for rejuvenation of Higher Education in India has also suggested that all the specialisation based regulatory bodies should be scrapped and a higher education commission be set up to monitor different aspects of higher learning. Besides, it also called for doing away with the last decade created cash-for-degree deemed university system, divesting medical course regulators like Medical Council of India of all academic functions. The Yash Pal Committee had asked the government to change its definition of university to free it from the hands of bureaucracy, make it autonomous and have a single higher education commission, which is as powerful as the Election Commission and replaces agencies like the UGC and Medical Council of India.8,9
Thus, in August 2009, as a part of the reports implementation strategy, the health minister has unveiled his agenda of reform for the sector, announcing a special salary package for doctors and paramedics willing to serve in village primary health centres. He has also promised a central authority to regulate drugs, to amend the Transplantation of Human Organs Act, 1994, and to set up a National Council for Human Resources in Health, to look at manpower needs. Also simultaneously, all the specialisation related councils have been summarily scrapped .As a long term mission to take head-on the process of reforms of the current health regulatory framework and enhance the supply of skilled personnel, the Government has initiated steps for setting up a National Council for Human Resource in Health as an overarching regulatory body subsuming the works of all the professional councils. Thus the terms of Reference of the National Council for Human Resource in Health Task Force were to deliberate upon the structure and functions of the proposed National Council for Human Resources in Health, and to prepare a draft Bill for setting up the said National Council forthwith. The Task Force 4, 5, 6, 8,9,10 submitted its report to the Ministry in July, 2009 and has also looked into the mal-distribution or shortage of doctors, cross-connectivity in medical education and creation of new resources.
Few will disagree with the statement that the curriculum of Indian medical colleges is out of touch with the reality of healthcare needs. Concepts of Evidence based Medicine, Medical Pedagogy, Public health, rural health or bioethics is virtually non-existent in Indian education, both as a subject of academic pursuit and as a platform for public debate on science and medicine. In the land that gave birth to the Vedas and Upanishads, there is no place for philosophy, spirituality, ethics, or the humanities in the curriculum. Medical students here get no exposure to humanistic, philosophical or spiritual worldviews during medical education and training. Vigilant non-governmental organisations like The Center for Enquiry into Health and Allied Themes (CEHAT) and Medico-Friend Circle, have faulted the entire medical education system, rubbished the curricula of Biochemistry and Pharmacology practicals, contents of elitist Medicine teaching, and have pushed Health ministry for a comprehensive overhaul, at the earliest. Similar recommendations have come from the NKC and Yash Pal Commission in 2008. All have called for implementation of patient oriented teaching, application of evidence based medicine principles in a Integrated Medical Education system.9, 10, 11,13
A dated colonial syllabus has been the hampering force for the futures of a nation of brilliant doctors provisioning the primary health care needs of at least developed nations like the United States, Australia and the United Kingdom. The Fundamentals of the British legacy education system are strong hence despite the numerous fallacies of the system; India still produces excellent health care professionals of world standards who are primarily for export to the rich western world. But we have to bother of the worst medical standards our own Indian denizens face-from widespread quackery and dependence on improper medical teachers of non-medical background and low caliber non-researching professionals left behind. Rote parrot learning of unnecessary information has been faulted by the CEHAT, and the learned commissions and should be left behind as we venture for a Integrated Medical Education system to solve our teacher shortages.14-16,17
One of the saddest ironies or the existing Indian medical education system is that the precious resources of the community are utilized to train elite doctors who are not suitable or available for providing services in rural areas where the vast majority of the people live 18-20 and where the need is so desperate. By identifying itself with the highly expensive and urban and curative oriented system of medicine of the west, the Indian system is said to encourage the doctors to look down on the facilities that are available in the rural areas, and look for jobs abroad and thus cause the so-called brain drain. As a result of such considerations, a desperately poor country like India finds itself in a paradoxical position in relation to the distribution of the doctors in the country: the urban population, which forms 20 per cent of the total, accounts for 80 per cent of the doctors. The majority of the uninsured rural masses, who come to the cities in search of modern health care, if end up as targets of health care exploitation by out of pocket payments could end up poorer ,just to gain health.20
1. Financing and Delivery of Health Care Services in India: Background Papers of the National Commission on Macroeconomics and Health: Ministry of Health & Family Welfare, Government of India, New Delhi; August 2005:www.mohfw.nic.in.
2. Report of the working group on medical education the National Knowledge Commission (NKC) 2005; page 2-3: pp 1-69.
3. Medical Graduate Curriculum Issues :Task Force on Medical Education for the National Rural Health Mission Chapter III: 3.1 :p22-44; Ministry of Health and Family Welfare,Government of India,Nirman Bhawan, New Delhi-110001 pages107.
4. Government of India Ministry of Health & Family Welfare Notification No. V.11025/10/2009-ME Dated 19th June, 2009 Accesed from http://www.mohfw.nic.in/task force on human resource.htm
5. Dhar A: Let Health Ministry retain medical education: task force Online edition of India's National Newspaper Sunday, Aug 02, 2009 http://www.thehindu.com/2009/08/02/stories/2009080254801000.htm
6. Rashid T: Regulatory body to train doctors: http://www.indianexpress.com/news/regulatory-body-to-train-doctors/495926/
7. Apex medical council: PM not convinced: Online edition of Indian Express Tuesday, Sep 01, 2009 http://www.indianexpress.com/news/apex-medical-council-pm-not-convinced/509724/0
8. Report and recommendations: Planning commission sub-committee on improvement in accreditation and certification systems pp04 of 104; May 2009. Indian Planning Commission, New Delhi.
9. Working together for health The World Health Report 2006 http://apps.who.int/bookorders/MDIbookPDF/Book/12402006.pdf
10. Doctors for the World: Indian Physician Emigration: The Market Rules Medscape Today:http://www.medscape.com/viewarticle/524466_3 Accessed 19.8.2009
11. Background Papers of the National Commission on Macroeconomics and Health
Financing and Delivery of Health Care Services in India http://mohfw.nic.in/reports/reports/Report_on_NCMH/BackgroundPapersreport.pdf
12. Decentralization and Public Delivery of Health Care Services in India: Singh.N Online at http://mpra.ub.uni-muenchen.de/7869/ MPRA Paper No. 7869, posted 21. March 2008 / 07:41
14. D’Cruz P & Bharat S:Which Way to Turn? Inadequacies in the Health Care System in India Journal of Health Management, Vol. 3, No. 1, 85-125 (2001)
15. Jha, Raghbendra. 2004. "Reducing Poverty and Inequality in India: Has Liberalization Helped?" Pp. 297-327 in Inequality Growth and Poverty in an Era of
Liberalization and Globalization, vol. 31: Oxford Scholarship Online Monographs.
16. Deaton A & Dreze J: Poverty and Inequality in India: A Re-Examination:
Economic and Political Weekly September 7, 2002: Accessed 18.8.2008 from
17.S. V Subramanian S.V, Smith G D & Subramanyam M Indigenous Health and Socioeconomic Status in India: PLoS Med. 2006 October; 3(10): e421.
18. No conflict between NKC, Yashpal panel reports, says Pitroda Bangalore, Aug 30, Deccan Herald News Service (Courtesy) Accessed on 9.9.2009
19. To heed NKC, Yash Pal panel proposals BS Reporter / New Delhi June 5, 2009. http://www.business-standard.com/india/news/to-heed-nkc-yash-pal-panel-proposals/360175/
20. Banerji D: Evolution of the existing health services systems of India: Medico Friend
Circle Bulletin p.1-8: March 1976
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