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Mains Article

Problems plaguing Medical Education in India [Mains Article]

To promote innovation and to meet the global standards in medical education, India needs to substantially rethink and re-evaluate all aspects of its programmes. This can only be achieved by a concerted effort between all those involved in medical education, coupled with a desire to improve the healthcare of the nation.
By IT's Mains Articles Team
September 13, 2019

Contents

  • Introduction
  • India’s Medical Education scenario
  • About Medical Council of India (MCI)
  • Problems in Medical Education
  • Reforms needed in Medical Education
  • Conclusion

Problems plaguing Medical Education in India

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Introduction

  • Despite tremendous changes in health systems over the last century, medical education curricula have remained mostly outdated.

Medical-education

  • Medical education is the bedrock on which the needs of ‘human resources for health’, one of the major building blocks of any health system, are met.
  • Today’s health professionals are required to have knowledge and professionalism, to be proficient in handling disruptive technologies, be ethical, demonstrate empathy, understand the economics of healthcare and handle large and diverse teams.

India’s Medical Education scenario

  • At present, there are 499 Medical Collages across India, out of which 245 in Government and 254 are in Private sector.
  • Karnataka has the highest (57) number of medical colleges.

Schemes for Medical Education

Schemes for Strengthening and Upgradation of State Government Medical Colleges For Increase of PG Seats (Phase I & II):

  • Phase I : The scheme was launched in XI Five Year Plan with the objective of increasing postgraduate seats in Government medical colleges. Funds are provided to the Government Medical Colleges for infrastructure development.
  • Phase II: The scheme was launched in February, 2018 with the objective of increasing 4000 more postgraduate seats in Government medical colleges.

Scheme For Establishment of New Medical Colleges Attached with Existing District/Referral Hospitals (Phase I & II):

  • The objective of the scheme is to utilize the existing infrastructure of district hospitals for increasing additional undergraduate seats in a cost effective manner by attachment of new medical college with exiting district/referral hospitals.
  • Phase I: Establish medical colleges in underserved areas of the country to create an additional annual intake capacity
  • Phase II: New colleges identifies to ensure the availability of one medical college for every 3 Parliamentary Constituencies and at least one Government Medical College in every State of the country.

Strengthening and Up-Gradation of State Government Medical Colleges for Increase in Intake Capacity of MBBS Seats:

  • Under the scheme, it is proposed to create additional 10,000 MBBS seats in existing Government medical colleges in the country.

About Medical Council of India (MCI)

Medical Council of India (MCI)

  • The Medical Council of India was established under the provisions of the Indian Medical Council Act, 1956 to maintain minimum standards of medical education in the country.
  • The main function of the Council is to make recommendations to the Central Government in matters of recognition of medical qualifications, determining the courses of study and examinations, etc.
  • The National Medical Commission Bill, 2019 replaced the current Medical Council of India (MCI) with National Medical Commission (NMC).

To know more about National Medical Commission Bill, 2019, Refer IASTopper’s Video Summary: https://www.iastoppers.com/rstv-big-picture-national-medical-commission-bill-2019/

Problems in medical education

Doctor-patient ratio is too less

medical education 5

  • India has one government doctor for every 11,528 people and one nurse for every 483 people.
  • Though India has the highest number of medical colleges, the size of graduating class is very small (100-150 students) which create a major problem for huge population of India.
  • Less than 8 per cent of the total medical students get a chance to continue further studies due to less availability of seats.
  • Moreover, the acceptance rate of many medical colleges in India is very less. India has approximately 300 medical colleges producing 30,000-35,000 graduates every year, whereas the need is that of 500 new medical colleges, producing one million doctors every year.

Rote learning

  • In the system of evaluating doctors followed in India, anyone who is able to memorise a large amount of information can become a doctor.
  • The fundamental exam pattern is based on rote learning techniques, ignoring the humanitarian criterion.
  • India doesn’t follow the use of OSCEs (objective structured clinical exams) to test medical candidates. Thus, their clinical skills are not tested till they start practicing.

Backdated syllabus and teaching style

  • Regular breakthroughs take place in the medical field every day, but the medical studies syllabus in India is not updated accordingly. New domains of medical science are also barely touched upon.

Medical-Education-in-India-IASToppers

  • Students study in a teacher-centric pattern, which doesn’t employ technology as much as foreign countries.
  • A 2012 study in India funded by the Bill and Melinda Gates Foundation stated that training in and of itself is not a guarantor of high quality regarding the medical education in India.

Lack of skilled teachers

  • Teachers for medical institutes are selected based on their degrees and not their clinical experience. This cuts down the effectiveness of the knowledge they can impart to the students.
  • Moreover, no teaching training is provided and teaching innovations are also lacking.
  • The salary given to a full time government college professor needs to be rationalised. The lower salary ensures that only the poorest talent is available, because the more talented will go in for a private practice.
  • In government hospitals a constant threat of transfer also remains.

Disparity in infrastructure across different states

  • A 2010 report on the HRD ministry showed the disparity in the opportunities for medical education in the various states of the country.
  • Only four states – Andhra Pradesh, Karnataka, Maharashtra and Tamil Nadu – account for about 1.3 lakh out of nearly 2.4 lakh medical seats across India.

Lack of social accountability

  • Indian medical students do not receive training which instills in them a social accountability as health practitioners.

Craze of Super-specialty

  • It is not possible to create one type of doctors to cater to every disease in a country as big as India.
  • MBBS students specialise in certain fields to be able to get a job and thus, research is neglected and students miss out on learning about all the different sides of medical studies.

Problems with private medical colleges

Medical education 2

  • A change in the law in the 1990s made it easy to open private schools and so, many such medical institutes opened up in the country, funded by businessmen and politicians, who had no experience of running medical schools.
  • Though this practice was implemented to solve the issue of the lack of doctors, it commercialised medical education to a great extent.
  • The poor students are prone to carry out socially wasteful practices and diagnostics in order to earn the money spent in getting the medical degree.
  • Moreover, the current government regulation state that private medical colleges must be built on at least 20 acres of land. Thus, many private colleges are built in rural areas, where it becomes very difficult to recruit good, qualified, full-time doctors because of the difficult living conditions and low pay scales.

Studying abroad is an issue

  • There are around 47,000 Indian doctors practicing in the US and around 25,000 in the UK. This makes India the largest exporter of doctors in the world.
  • There are very few foreign medical courses recognised by Medical Council of India (MCI). Most of these courses are from some of the leading nations like USA and UK, which in turn cuts short number of returning doctors by a substantial number.
  • Thousands of medical graduates from India go abroad to practice in countries like United States, Britain, Australia and Canada, but they all require prior training before beginning their practice, showing low quality of Indian Education.
  • Moreover, in Britain and Australia, it is medical graduates from India who lose practicing rights more than any other foreign-studied doctor.

Corruption in medical education

The following types of malpractices are quite common in the country:

  • One out every six medical colleges in India holds cheating records according to government records and court filings.
  • To pass inspections, some medical colleges take the help of doctors from other institutes, provided by recruiting companies, who stand in as faculty in return for a fee.
  • Healthy people are rounded up to pretend to be sick during inspections, so that teaching hospitals can show they have enough patients to provide clinical experience to medical students.
  • Paying bribes in the form of donations in order to gain admission to medical colleges is a very common and popular practice.
  • Fake degrees can be so easily procured that the Indian Medical Association estimates 45 per cent of Indian medical practitioners (700,000) are unqualified.
  • The many private medical schools frequently charge under-the-table for admissions, in addition to the high college fees.
  • The Medical Council of India (MCI), which is supposed to maintain excellence in medical education is itself surrounded with controversy as its ex-president faces bribery allegations.
  • The MCI regulations has certain loopholes which ensure that even colleges which lack proper facilities or infrastructure get accreditation.

Reforms needed in Medical Education

Increasing medical seats without compromising quality

  • There is a pressing need to revisit the existing guidelines for setting up medical schools and the right number of seats.
  • Methods of education are undergoing changes on account of advances in e-learning methods, including remote learning, virtual classrooms, digital dissections, and simulation systems for imparting skills.
  • Extending teaching privileges to practising physicians and allowing e-learning tools will address the shortage of quality teachers across the system.
  • Together, these reforms could double the existing medical seats without compromising on the quality of teaching.

Continuing learning system

  • There are continuous ongoing innovations in medical education to prepare professionals for the complex and rapidly changing healthcare system.
  • However, it is estimated that to double the medical knowledge, it will require just 73 days in 2020 compared to 50 years in 1950.
  • At this pace of change, a student can be prepared to process information that is readily available than to know past knowledge.
  • Periodic re-certification based on continuing learning systems may become essential to keep up with the fast pace of change.

Other reforms

  • Students need to improve their basic management, communication and leadership skills and they must be trained by taking into account their social relevance as doctors.

Medical education 1

  • Medical education needs to be aligned with the societal needs, which differ from country to country. Strong emphasis needs to be put on rural and social issues and making students strongly aware of their responsibilities towards the same.
  • Since health professionals work in teams, inter-professional combined learning methods should be introduced.
  • Integration of subjects, innovative teaching methods, and a more prevalent use of technology in classrooms is required.
  • More medical education platforms need to come up, which act as platforms where doctors and medical students can collaborate through real medical cases and other continuous medical education content.

Conclusion

  • Medical education in India is suffering from various shortcomings at conceptual as well as implementation level. With the expansion in medical education, the doctor to patient ratio has increased but these numbers do not align well with the overall quality of medical care in the country.
  • To achieve higher standards of medical education, our goal should be to create an efficient accreditation system; promote an equal distribution of resources, redesign curricula with stricter implementation and improved assessment methodologies.

 

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