The shortened three-and-a-half year BRMS course (Bachelor in Rural Medicine and Surgery), proposed by the Medical Council of India needs a fresh look.
The reason for this new course is based on the opinion that the present MBBS doctors are reluctant to serve in the rural areas.
The eligibility for the BRMS course is 10+2 like the regular MBBS course, but the selection is open for rural students prepared to serve rural areas. Their careers are presumably, confined to rural areas.
When the technology is rapidly making inroads into every field including medicine, and when the four-and-a-half-year MBBS course itself is felt inadequate, what is expected of the condensed course? Is there an urban rural divide in the morbidity pattern to warrant a design of a separate course of study? The evidence is otherwise. The incidence of disease pattern is similar but for minor endemic problems. The study of Byrraju Foundation collaborating with University of Queensland, Australia, (2003) in four districts of Andhra Pradesh showed that 33 per cent of deaths in these districts are due to hypertension, diabetes and cancer. The incidence of non communicable diseases and life style related illness is certainly on the rise in the rural areas as well.
On the other hand, the status of urban slums and settlers is creating a rural scenario in even the big metropolitan cities. The Urban Primary Care concerns are significant and need to be addressed.
An important issue, apart from the curriculum is what the future would be and what the career options are, for the BRMS graduates? The immediate job opportunities could be assured since there is shortfall of doctors in rural areas. What will they do after 5 years, 10 years? What would the future BRMS graduates do, after the immediate short fall is looked into? What are their options to improve their qualifications (post graduate studies) and what are the future openings and promotional avenues. Are we considering a lateral entry into MBBS course after a certain period of work in the rural region? Will they fit into such an entry?
In the past, courses like GCIM, LMP. LM&S were in vogue and these were abolished. Courses for bare foot doctors and B.Sc in Health Sciences were all tried in the past and given up. Any new course needs serious thinking. The three months optional rural internship postings for MBBS graduates had not seen much success. Compulsory rural service as well did not yield expected results
Does the BRMS solve the problems of rural health care? Why are the people born and brought up in rural areas not returning to their homes after MBBS? The reasons for doctors not staying in rural areas lie elsewhere. The dual responsibility of preventive and therapeutic care is one of the causes responsible for failures in the Rural Health Care, the non therapeutic responsibilities taking a back seat.
A suggestion
If the MCI is keen to fashion another course here is a suggestion, a study offering BPHS.
A study similar to MBBS with more emphasis and responsible for preventive and social medicine is probably an answer. Entry shall be similar to MBBS with 10+2 qualification and common entrance test as for MBBS. The same medical colleges can take up and offer these courses. The bachelor course is equal to MBBS in all aspects. The entry, selection, opportunities and further career choices are similar. The course ‘Bachelor in Public Health Studies' (BPHS) with emphasis on public health, primary care, family welfare, demography, environment etc may serve the rural areas better. The internship is in rural areas. They are certainly given exposure to therapeutic medicine.
The author is Professor of Neurosurgery
Additional Director of Medical Education (Retd), Andhra Pradesh
