Prime Minister Manmohan Singh's recent announcement that legislation on the proposed National Council for Human Resources in Health (NCHRH) will be introduced in Parliament soon is significant for three reasons. First, it will meet the Union Health Ministry's demand for a new and separate regulatory body for medical institutions under its control and not under the purview of the Ministry for Human Resource Development. Secondly, the legislation will seek to create an atmosphere that will help deal with issues relating to the quality of the medical education and an equitable distribution of the available medical education resources. Thirdly, it offers an opportunity to restructure and revamp India's medical education system to suit the changing needs of the time. The objective is to evolve a trustworthy, highly professional, and inclusive medical education and delivery system that will take care of the health needs of all sections of the people without any discrimination.
Health deprivation and the need for radical reforms in the medical education system to overcome the huge challenge have been on the public agenda for several years now. But it is the April 23 arrest of Dr. Ketan Desai, chairman of the Medical Council of India (MCI), the 56-year-old regulating authority, on charges of massive corruption involving crores of rupees, the appointment of a three-member team to inquire into irregularities in the functioning of MCI, and the subsequent dissolution of its executive council, the top decision-making body, through a presidential ordinance that brought the urgent need for reforms to centre-stage.
These developments, in quick succession, have led to a healthy discussion in the media. Leading doctors and experts in medical education and health-related issues have proposed that the recent developments should be seen as a historic opportunity to take a fresh look at the regulatory process and improve the standards of medical education, which, in turn, will lead to ensuring an effective and enduring medical delivery system. For this, the thrust must be on training medical professionals to focus on treating diseases afflicting the vast majority of the people. It is masses of the poor who are victims of utter indifference in most public and private hospitals. This indifference is related to the retrograde policies central and State governments have been following in a market-driven reform regime for well over two decades.
An insightful article by George Mathew, M.S. Seshadri, and K.S. Jacob (“Time for a transformation,” The Hindu, June 7, 2010), points out that the MCI, the agency that was constituted to regulate medical education and practice “had failed on many fronts – despite good intentions.” The MCI, they go on to say, was “packed with medical professionals, many of them from for-profit medical colleges. This often resulted in narrow perspectives and conflicts of interest. Each [group] specially represented on the body pushed its own limited agenda, often missing the bigger picture of the health needs. The woods were missed for the trees.”
The authors of the article propose that the new regulatory authority should be composed of diverse stakeholders. It would ensure that the focus is on “overall health and health care needs, rather than narrow professional interests.” They point out that the students of under-graduate courses are trained mostly in dealing with “exotic and rare disorders” but not in attending to the simple medical needs of local communities. They contend that health care needs should be determined not on the data and priorities of western countries but on the specific needs of the people in this country. In short, the NCHRH should aim “to channel education to deliver relevant health care to the vast majority of India.” It follows that the basic doctor should be “a competent general practitioner who has the background to specialise.”
The tasks before
Some writers on medical education go further and advocate enriching the syllabi and curricula in medical education with the inclusion of the humanities and social sciences. Why? Because “the practice of medicine is based on application of science for the improvement of human health.” The physician who handles human lives needs to equip himself or herself with a combination of humaneness and sound scientific temperament. The existing medical syllabi do not provide for this. Even the knowledge in science they provide is confined to biology and chemistry. There is a need to include physics as well in the medical syllabi. With the application of medical science expanding, knowledge in the social sciences and humanities, including literature, music, and the fine arts, can play a significant role in applied medical science. The debate on these issues continues in the Indian and foreign media.
Another area the NCHRH cannot afford to ignore is streamlining the admission process and introducing examination reform. A recent newspaper report exposed an examination-related irregularity committed by Dr. MGR Medical University in Chennai. The University reportedly admitted that it gave ‘grace marks' ranging from 10 to 45 to students who had failed the first year examination but were allowed to write a supplementary examination in February 2009. The award of as many as 45 grace marks is in gross violation of the Medical Council of India Act. (Normally, only five grace marks are supposed to be given in such cases.) The same facility has been provided also to the failed students of the Dental Colleges affiliated to the University, with grace marks ranging from 8 to 25, also in violation of the norms of the Dental Council of India. State Health Secretary V.K. Subburaj was reported to have told the newspaper that the government would soon initiate an enquiry. Significantly, the report was based on information obtained under the Right to Information Act.
Such violations are symptomatic of a system of education that has gone seriously wrong. There are certainly high expectations of the proposed new, reformed regulatory framework.
Keywords: medical education