It is a reality that the number of students going abroad for an MBBS degree is increasing every year, but so is the fact that the Indian government is trying its level best to improve medical education, and better the healthcare infrastructure at home. In recent years, major developments were witnessed in this sector, and many more have been proposed. So, will it stop students from investing in foreign countries? Experts speak.
Centre for medical tourism
"India will be a centre for medical tourism and our medical graduates will be recognised for their outstanding contribution in the medical field all over the world," says Dr Sunil Natha Mhaske, Dean, Dr Vithalrao Vikhe Patil Foundation Medical College, Ahmednagar, Maharashtra. He adds that the measures taken by the Centre are oriented towards futuristic healthcare.
Increasing the number of seats in both government and private colleges is a significant step, opines Dr Rohan Krishnan, former president of the Federation of All India Medical Association (FAIMA). Dr Mhaske states that this will increase the doctor-patient ratio, while the marginalised sections would get access to good healthcare.
Meanwhile, "The government has also made healthcare more public friendly, for example with schemes like Ayushman Bharat. The cost of medical education has been curtailed; it is made more affordable for students in India, as well as for those wishing to pursue MBBS abroad," Dr Krishnan says. "The fee is below Rs 1.5 lakh in about 400 government medical colleges across India," points out Dr Narendra Paliwal, Assistant Professor of Pharmacology at Medical College Baroda, Gujarat.
Revision of courses
The revision of MBBS courses by the National Medical Commission (NMC) has also made a positive impact, opines Dr Arvind Pandey, Professor of Anatomy at Kasturba Medical College, Manipal Academy. He mentions that the introduction of the CBME curriculum (Competency-based Undergraduate Curriculum for the Indian Medical Graduate) has helped to shift towards a skill-based approach, which wasn't prevalent earlier. "In foundation course, medical students are exposed to various curricular, co-curricular and extra-curricular activities, which help to reduce the stress and strain of medical course," adds Dr Mhaske.
Speaking about some of the more specific changes in MBBS education, Dr Paliwal says, "Biometric attendance has been made compulsory in all medical colleges since the past month. This will help to maintain the attendance of the faculty in colleges, which went unchecked earlier. Even the attendance of students is being checked strictly." He mentions that otherwise, students tend to not attend classes and spend time preparing for PG entrance. Now students are also being taught to interact with patients in a right manner, he adds.
What else can be done?
Nonetheless, much more needs to be accomplished yet to set up an exemplary healthcare infrastructure. The experts opine that there is a lack of coordination between the NMC and other stakeholders. "The NMC needs to buckle up. Medical colleges are being built but when it comes to inspection, there is a lack of checking if regulations on number of seats and quality of faculty are being flouted," says Dr Krishnan.
Dr Sharad Aggarwal, President of the Indian Medical Association (IMA) states that the government is trying its best, but the decision-making process is flawed. "There is very little say of doctors in the decisions made. People in charge may be good administrators, but they are often not aware of the ground reality. The composition of NMC needs to be rethought, and there should be an open channel of communication between the policymakers and medicos," he says.
Dr Aggarwal also mentions that as of now, policies are being adopted from foreign countries, which seem and sound good, but might not be always beneficial for India. Dr Paliwal adds that the salary of doctors working in government hospitals needs to be improved. Additionally, "Discipline, time management and ways to write proper prescriptions need to be taught in medical colleges," he says.
Further, the experts opine that the fee of medical colleges needs to be regulated even more. "Many colleges are in the practice of extracting a large amount of money from students in the name of security, exam and lab fees," Dr Aggarwal says. "There should be uniformity in fees," agrees Dr Paliwal.
Dr Pandey concludes that due to India having a large population, the government's measures are not enough. He states that more colleges need to be built, to improve the healthcare infrastructure. The colleges should also be equipped with proper faculty and infrastructure. "Otherwise, schemes like the introduction of the ATCOM (Attitude Communication) module in which students learn in a computer-simulated safe environment, and schemes aimed at promoting medical research, wouldn't be easy to implement."
Revolutionary reforms: India's changing map of medical education
In addition to opening up new medical colleges, increasing the number of seats, introduction of some major healthcare bills and the decision to open up 157 new Nursing colleges, the Ministry of Health and Family Welfare (MoHFW), in its report titled Governance Reforms in Medical Education, has highlighted the key reforms implemented between 2014-22 to strengthen medical education in India. Here's a consolidated list:
1. The National Medical Commission (NMC) Bill
It was incorporated in August 2019, for "curbing outlets of malpractice and boosting visibility, accountability and quality in the governance of medical education." Four autonomous committees were established under this Bill, for the accomplishment of several tasks, including the regulation of courses, ranking colleges and providing licenses to colleges as well as practitioners. These committees are the Undergraduate Medical Education Board, the Postgraduate Medical Education Board, the Medical Assessment and Rating Board, and the Ethics and Medical Registration Board.
2. Pradhan Mantri Swasthya Suraksha Yojana (PMSSY)
Though it was proposed in 2003, the PMSSY is still being implemented. It seeks to address the lack of quality medical education and healthcare in rural and remote areas, and also seeks to make them more affordable. All 22 new AIIMS institutes and a few independent medical colleges have been set up under this initiative.
3. The National Board of Examinations in Medical Science (NBEMS)
The body was established in 1975, but several reforms have been undertaken by it in recent times. These include the creation of advanced skill/virtual learning centres, short-term skill enhancement courses, accreditation reforms, and mentorship programs for students among others. A 2-year PG Diploma course has also been started in 8 disciplines to increase the seat capacity by 2,000 seats per year. MD and Diploma courses in Family Medicine as a new subject have been enabled as well.
4. Meritocracy: Examination reforms
The National Eligibility-cum-Entrance Test (NEET) was introduced in 2016, followed by the National Exit Test (NExT) in 2019. NExT seeks to replace NEET PG as well as the Foreign Medical Graduate Examination (FMGE) in the near future, besides serving as a qualifying MBBS degree exam. In addition, common counselling replaced counselling held by medical colleges separately in 2016. All these reforms are aimed at the government's One Nation: One Exam initiative.
5. Education and skill-based reforms
In 2019, the new competency-based curriculum was introduced, which seeks to move towards a more practical-oriented curriculum from a content-based one. The establishment of skill labs was also advocated, where students can practice and improve their skills in a safe environment, mitigating the limitations of learning on live patients. In addition, the District Residency Programme of 2021 marks a shift in strengthening the medical infrastructure. This scheme enables PG students to gain exposure and rural hospitals to gain good doctors.
