Challenges in medical education and way ahead …..
In May 2010, the Government of India has dissolved the MCI body with removing Dr Ketan Desai from the post of president. The reactions in medical fraternity were mixed, few were happy and few were not ready to comment on issue. Lot of non-medical and other voices were heard that medical colleges are major place of corruption and need radical cure. Today after more than one year of removal of age old MCI act, still we are not sure what is next? In parliament, cabinet minister of health and family welfare, Gulamnabi Azad extended the time limit of BOG (Board of Governance) till May 2012. Same time he informed that we will soon bring new MCI act but not ready to commit for timeline. So at present medical education in India is in turmoil. Nobody knows where are we going?
Why this confusion?
The government is continuous misleading community with numbers. India has sever deficiency of medical doctors. At present we had 1 doctor per 2800 population in compare to US 1 per 1000 population. To reach the goal of 1doctor per 1000 population, government has to increase the number of medical colleges and number seats in medical colleges. At present rate of production of medical doctor, India will achieve this goal by 2031. So if we want to achieve this goal we need to increase medical colleges. Thus government agenda is to increase the production (medical college).
Second is the business. Medical colleges are almost double in last one decade. Check the MCI web pages, in last 10 years the number of medical colleges are increased form just 150 to 335 in 2011 latest data. But this doubling of numbers of college is not due to government contribution. Majority of newly started medical colleges are run by trust or private institutes. So it is a big business. But still I have a question who is earning out of this business? Owner or Teachers or Students or Community? I must say nobody is the gainer, all are the losers. Even after doubling of number of medical colleges in country, we are not satisfied with the quality of our product (new doctors). Even out put (new doctors) feel that they are not up to the mark. Even teachers are discussing on various sites (MEU group, Quality medical education group and many other) that they are not happy with the current medical education quality. At last society, society is least interested the quality of medical education, they want the quality health services. So the society becomes healthy society. But I don’t think that the Indian society is the healthy society. Check the OPDs of GP or consultants, they are flooded with patients. Pharma-companies in India have highest growth rate even in recession. Lots of new pharma companies and diagnostic companies are coming and want to come in country. This is the indirect indicator of our ill society – diseased society not healthy society.
In this scenario, the most important question for medical educator or teacher or policy maker is that how to improve the medical education? So the community gets maximum advantage with new out put product (young doctor). Scenario is difficult but I am trying to get out with following solutions or scopes–
1. First we need to rethink about increase in number of medical colleges. As per Park’s text book of Preventive and Social medicine, it is clearly mentioned the suggested norms for health personnel. As per this norms India need 1 doctor per 3500 population, which is we already achieved. In 2004, India has 0.7 doctor per 1000 population. I could not understand how the new norms for doctors are arrived? The MCI and media and health minister quoting that we have to achieve norm of 1 doctor per 1000 population. We need to take bold decision, do we really want to increase doctors in number or quality doctors? As in last decade India has increased the production rate in double. My feeling for this decade should be consolidation and quality improvement. Till 2021, we need to set up the strategy to improve the quality of medical education.
2. Since 2009, MCI has put emphasis on the Faculty Development Programme. I must congratulate the person whoever has launched the concept. It is really key to improve the medical education. As per this, each medical college should have one Medical Education Unit (MEU). The chairman of MEU is Dean of Medical College and one faculty who is interested in education or know better way to education will work as coordinator. Than 10-12 faculties from different departments of college will be the members of MEU. They will first learn the medical education technologies at Regional centre. Later these trained faculties will train in-house all faculties for prescribed topics in three days workshop. This in-house workshop will be supervised by the convenor of regional training center. The convenor will remain present all three days and assess the quality of training. This supervision is very positive and constructive for the host medical college. Here I find the scope of improvement in medical education. One national body MCI can not supervise the quality of education by just one inspection over a year or five year interval. Hope you all agree on this statement. But one needs the continuous supportive supervision for the quality improvement. All teachers want to improve the quality of teaching and for that they are doing innovation everyday in teaching. So why not systemic supervision and get standard quality out put of product (young doctor)? MCI needs to increase the number of regional centers. At present 15 MCI approved regional centers in country. If we divide to the all medical colleges, each regional center has to look 22-25 medical colleges. My suggestion is that MCI should increase regional centers to 30-35 in country. So each regional center will have to supervise just 10 medical colleges maximum.
3. At present regional center of MCI is only looking after the teacher’s training programme for medical education technology. But gradually MCI has to expand the purview of the work. The regional center will help to improve the quality of day to day teaching, evaluation, process of teaching learning and if possible quality check of out come product (young doctor) under these 10 medical colleges. All activities should be constructive in nature. For that MCI has to develop four zonal centers over regional centers and below MCI. This will help to supervise the decentralized system. Through this system, we can able to standardize our medical education.
4. MCI is thinking for licensee exam for MBBS graduate and National Eligibility and Entrance Test (NEE) for post graduate admission. This is new type of confusion. It was heard that NEET will be before internship. So internee doctors do internship properly. But as licensee exam is going to introduce. It will be surly after the internship. Still we are not knowing the structure of exam. Everything is in dark and confusion. My suggestion is the MCI should merge the licensee exam with Regional Centers supervision. The Regional center should collectively supervise the internship programme and skill development aspects of MBBS graduate. How can be answered by think tank of learned faculties.
These are my gross suggestions. I may be wrong but with my 10 years of post MD and 20 years of MBBS and post MBBS experiences, I am writing this short note.
Dr. Niraj Pandit