The high esteem with which the medical fraternity is still regarded is gradually eroding. Increasing instances of conflict between patients and the treating team are a factor. Unnecessary admissions, investigations and a lack of communication and empathy are commonly reported. The sorry state of affairs in the undergraduate and postgraduate medical selection processes and medical education is another sad story.
The Medical Council of India (MCI) was established in 1933 under the Medical Council Act, with the mandate of “establishing and maintaining high standards of medical education and recognition of medical qualifications in India”. It is a single body involved with the registration of doctors, providing uniform standards of undergraduate (UG) and post-graduate (PG) medical education, enabling the recognition of medical colleges, and ensuring ethical practice and maintaining professional standards.
In addition, the National Board of Examinations(NBE), an autonomous body, was constituted in 1975 to ensure high standards of specialist training and uniform assessments across India, similar to the fellowships provided by royal colleges in the United Kingdom and Australia.
The rivalry between the two bodies, the Medical Council of India (MCI) and the National Board of Examinations (NBE), has led to major deficiencies in training opportunities and selection of specialists, in effect reducing the number of available specialists to the general public.
We need a separate body to oversee the sanctioning of permissions to medical colleges to run various courses in a transparent manner. This would go a long way in ensuring uniform standards of medical education in accordance with the National Rural Health Mission and in tandem with the various national health programmes. This would also create produce a generation of doctors, who are in tune with the needs of India and its citizens.
Why NEET is essential The recent standing committee report on the MCI, and its suggestions for improvement, are propitious. The report envisages a periodically updated, uniform undergraduate medical education with a nationwide National Eligibility-cum-Entrance Test (NEET) as the qualifying criteria for MBBS aspirants — it was also a part of the ‘Vision Document’ of the MCI published in 2013. It may be argued that an examination in a single language may not be the best way to judge the capability of candidates for a professional course, especially in a country with a large population and multiplicity of languages of instruction, but it is, nevertheless, a first step in the process towards achieving uniformity. The second argument that NEET is discriminatory to rural students is evidence of the failure of the educational system rather than being an excuse for not having a standardised examination process and a selection based on merit. The NEET could be offered in all formal languages of instruction available in schools in India. Third, private medical schools — and they are proliferating — which were out of the ambit of state-administered entrance examinations, are catering to increasing demand for admission into medical courses, by luring parents with offers of seats and deals without any consideration for aptitude or upholding the nobility of the profession. The capitation fee route is an open avenue for the highest bidder, denying meritorious students from weaker sections an opportunity. NEET envisages bringing these private players under the umbrella of a national medical entrance system. One hopes that the Cabinet Ordinance is not a means to scuttle NEET in the face of political exigency.
Much like the NEET formula, it would work well if various specialist bodies like the Association of Physicians of India, Association of Surgeons of India, Indian Psychiatric Society, and the Indian Medical Association (IMA) are taken along in developing the curriculum and conducting standardised exit exams for postgraduate courses, like in the royal colleges. In this, the NBE’s experience and expertise could be channelised. It would also be good to have a main regulatory body to bring together various medical and paramedical fields as well as traditional and alternative medicine. This would maintain the registration of medical practitioners, including doctors, and hold them to the highest standards of ethical practice.
These changes to the medical system could go a long way toward re-establishing good medical practice, improving patient-health provider trust and bringing back the prestige, nobility and honour previously reposed in the service.
Dr. Tony George Jacob is Assistant Professor, Department of Anatomy, AIIMS, and Dr. Jayakumar Menon is a neuropsychiatrist.
