MFC welcomes the stinging report on cleaning up medical education regulation
MFC (Medico Friend Circle) wholeheartedly welcomes the 92nd Parliamentary Committee Report on the Functioning of the Medical Council of India (MCI) that was presented to the Rajya Sabha on March 8, 2016.
The Report is comprehensive, wide ranging and has come out with sound recommendations. Implementing these recommendations is in the best interests of the health of the people of India and the medical profession.
The MCI was expected to be the regulator of everything related to medical education but has ended up being the single major factor in the country responsible for the commoditization of medical education and corruption in professional practice. Successive occupants of top posts at the MCI have perfected the MCI as an enterprise for feathering their nests. Every requirement of approval of a private medical college had a price and still does. We agree with the Report that unless there is a whole sale exit of vested interests that have clogged the MCI, nothing can change and it will be 'business' as usual.
The singular lack of attention by the MCI to content, quality, pedagogy, clinical competencies and skills has brought the image of the medical profession to disrepute: "...many of the products coming out of medical colleges," says the Report, "are ill-prepared to serve in poor resource settings like Primary Health Centre and even at the district level; medical graduates lack competence in performing basic health care tasks like conducting normal deliveries; instances of unethical practice continue to grow due to which respect for the profession has dwindled. But the MCI has not been able to spearhead any serious reforms in medical education to address these gaps."
As a body of medical and health professionals and public health advocates, we in MFC cannot agree more.
The MCI has to be accountable to the Government who in turn are answerable for the dismal health standards of the people of India. The elected regulatory body of the MCI has been a "disastrous experience" and has become an "exclusive club of doctors" with scant regard for ethical concerns. This needs to be replaced with a mechanism to bring in people of the highest professional and ethical standards.
"The Committee notes that though all powers of approval/disapproval as per the MCI Act 1956 rest with the Central Government and all permissions are issued in its name, yet the Central Government has no power to disagree with the MCI .... To push its policy and vision of health, the Government is, therefore, entitled to give directives to the MCI but only on policy matters of national importance. The Committee, therefore, recommends that the Government should have the power to give policy directives to the regulatory body."
The MCI's attitude has not been one of a facilitator but an obstructionist. For instance, Minimum Standard Requirements for the establishment of Medical colleges are unrealistic and prevent "district hospitals and large public sector hospitals (like Railways Hospitals, Army Hospitals, etc.) and large private sector hospitals and multi-specialty hospitals from becoming teaching hospitals for UG medical education. This will greatly limit the scope for the scaling up of medical education, even when expansion of the existing capacity is a greatly felt need."
Infrastructure and faculty norms are given more weightage in 5-yearly assessments than clinical competency and quality of medical education. "... The curriculum is still didactic. The world has moved to competency-based curriculum long back and we are still having workshops to decide whether we should switch-over to it or not." Similarly the compulsory Continuing Medical Education should be based on a whole range of net-based standardized tutorials on clinically relevant subjects, which are vetted for quality and relevance and out of which the practitioner may choose any six in a year, depending on his/her interests. This should replace the current archaic practice of six lectures/seminars approved by the MCI. Moreover not only the timing and venue are inconvenient to many practitioners but the treatment of topics is often highly unsatisfactory with no check on quality.
We also agree that there is a need to standardize entry to medical colleges throughout the country through a common entrance exam as well as a common exit exam and evaluation system for MBBS students,as well as for post-graduation (MD/MS) programmes and super-specialties. There is no reason why DNB cannot be equated to MD with suitable teaching requirements and why at least some proportion of experienced clinicians in Government and private hospitals cannot be taken in as adjunct faculty. This will only add to the richness of teaching.
The MCI has concentrated all powers under it without due competency and capability: the MCI currently is responsible for standard setting for recognition, inspection and licensing of 400 medical colleges; overseas Registration and Ethical Conduct of Doctors, and recently Accreditation as well.
We agree with the 92nd Report that these tasks need to be delegated and a major structural reconfiguration is needed as suggested by the expert committee chaired by the (Late) Dr Ranjit Roy Chaudhury.. The expert committee has suggested inter alia the formation of a National Medical Commission (NMC) through a new Act with four verticals: (i) UG Board of Medical Education and Training, (ii) PG Board of Medical Education and Training (iii) National Assessment and Accreditation Board and (iv) National Board for Medical Registration.
The provisions of the Indian Medical Council Act 1956 are outdated and it is for the Government of India to take the lead in dismantling the MCI and replace it with the structure suggested by the Ranjit Roy Chaudhury Committee. We concur with the 92nd Report: "The people of India will not be well-served by letting the modus-operandi of MCI continue unaltered to the detriment of medical education and decay of health system." The Government must therefore act immediately notwithstanding vested interests within.NB. (All quotes are from the 92nd Report)