The Medical Council of India (MCI) has recommended major reforms in the undergraduate course in medicine by converting conventional education into a competency-based module to develop skilled doctors through early clinical exposure. It has also suggested doubling the intake of medical students to meet the healthcare needs of the country in the coming years.
Pointing out that the current undergraduate curriculum in medicine did not make an MBBS degree holder feel equipped with adequate skills and competence to take care of the common problems at the secondary and tertiary level, the Undergraduate Education Working Group has said this factor also prevents young doctors from going to practice in the rural and primary health centres. The goal of training is not focused on providing health care to the needy and the disadvantaged, the eight-member working group has said in its report.
Distance education
It recommends options for distance education towards a fellowship or diploma in areas such as diabetic care, HIV medicine, geriatric medicine, hospital infection control, hospital management, and inclusion of medical ethics, forensic medicine and hospital infection control in the regular curriculum.
According to the report, the current intake of medical colleges and the critical mass of doctors would have to be doubled if India had to achieve the world average doctor-population ratio of 1.5:1000 by 2031 as against the present 1:1700.
Taking into consideration the existing medical colleges in the country, it was felt that the current intake of medical colleges and the critical mass of doctors should be doubled to achieve this target.
At present, there are 330 medical colleges with an intake of approximately 35,000 and with the present intake the shortfall of doctors by 2031 is estimated at 9.54 lakh.
To offset this, the report has suggested increasing the intake in the medical colleges wherever there is adequate infrastructure of teachers, equipment and clinical load and to augment infrastructure in relation to clinical load by attaching established medical colleges to district-level hospitals or secondary hospitals run by government agencies; upgrading existing larger district hospitals and augmenting their infrastructure to become community medical colleges through private-public partnership or public-private partnership and starting new medical colleges and hospitals preferably in States and underserved areas with doctors and medical colleges.
Clinical training
Chaired by George Mathew, Principal of the Christian Medical College, Vellore, the group stressed the need for restructuring the MBBS course with a four-year course and six months elective with a one-year internship. Clinical training should be included from the first year itself.
The past curricular revisions have mostly added to the existing content without undertaking the exercise to remove what is obsolete and outdated. This exercise needs to be taken up in a detailed and extensive manner and make the curriculum as efficient as possible, the report has said. It has to be discipline-based curriculum and lack of integration between basic and laboratory science and clinical medicine should be addressed.
It goes on to add that each medical college should be linked to the local health system, including Community Health Centres, taluka hospitals and primary health care centres that can be used as training base for medical students.
The Working Group was set up in July last year to evolve a roadmap for medical education in India and to evolve a broad policy on the duration and curricular changes that could be adopted as future strategies to make medical education in India comparable to global standards.
