The ever-rising demand in medical education has created an opportunity for private players to enter the arena in a big way. This creates an opportunity for middlemen and touts with no concern for standards or ethical values.
Medical education and technical education are two important constituents of higher education, which are monitored and controlled by the Medical Council of India (MCI) and the All-India Council for Technical Education (AICTE). The rising demand for higher education, and the government's inability to fulfil the requirements, have created an opportunity for private players to enter the arena in a big way. This has resulted in the mushrooming of professional institutions. This kind of vertical growth with no sound base has provided an ideal opportunity to middlemen and touts with no concern for either standards or ethical values to intervene and influence both the MCI and the AICTE. Maybe it is an unfortunate, but inevitable, coincidence that high profile executives of these organisations are caught by the country's prime investigating agency. The CBI has raised doubts over the honesty and transparency of the system.
An autonomous body, the MCI came into existence through an Act of Parliament in 1956. The governing council is composed of elected and nominated members from all States. In the first three and a half decades, professionals with integrity and concern for standards in medical education were either elected or nominated to the body, and they conducted themselves in a dignified way.
The increased demand for private medical colleges made people with money power and the right political connections to enter the council, giving scope for manipulation. Recent press reports on the unsavoury happenings in the MCI are a matter of concern. The government of India did well in dissolving the discredited council and appointing a balanced and efficient team of professionals with integrity and commitment as the new board of governors.
The new board should erase the public mistrust of the system, in general, and medical education, In particular. The focal areas for qualitative changes are the initial permission and final recognition of colleges, improving the quality of teaching, modifying the curriculum for our health needs and introducing transparency in the examination system. It is an opportune time for the new MCI to elevate the fast deteriorating standards and values in medical education on the lines of what Alexander Flexner did for the chaotic American medical education system over 100 years ago.
Inspection by the MCI for permission to start a new college, whether private or government, should be transparent. The inspectors should have full authority with accountability to make recommendations either way — which will be binding on the MCI. In case of a review inspection requested by the aggrieved party or as suo motu action, the second inspection should be conducted by either a member of the governing body or its special representative. This single act will totally curtail lobbying by middlemen. There should be no leniency on either infrastructure or the full strength of the permanent teaching faculty.
The tradition of visiting faculty can be curtailed by surprise visits by either the MCI or university representatives at periodic intervals and by the recently introduced tag access monitoring and tracking system. The acute shortage of qualified staff can be partially met by increasing the retirement age to 65.
The curriculum is aimed at producing a multi-competent physician, i.e., family physician volunteering to work at the primary level with social responsibility. Health promotion and disease prevention should be given importance on a par with the curative aspects. More bedside, evidence-based medical learning should be included in the syllabus, in addition to theoretical aspects. The objectives of the WHO-introduced Reorientation of Medical Education (ROME) programme and the National Rural Health Mission (NRHM) will be better achieved when students are trained at the field level.
The present tertiary level training in an urban environment with no real exposure to the primary and secondary health care problems and facilities is making students diffident and fails to motivate the young graduates to opt for rural service. This requires the immediate attention of the MCI to introduce at least six months' exposure of the medicos to the rural and semi-urban environment for a better understanding of the problems at the ground level.
The desired results will be achieved only when proper facilities for stay and training under the supervision of basic specialists are created. As the fresh graduate is expected to lead the health care team in rural areas, he/she should be suitably trained to work with the nurse, the pharmacist, the paramedics and social activists for better coordination. Also, he/she needs to develop communication skills and know about the consumer protection Act while in training.
In the pyramidal health care system, the top tertiary care slot is almost occupied by the corporate sector and is attracting the cream of specialists and teachers with attractive financial returns. A good and dedicated teacher is always a role model for students, but unfortunately that tribe is vanishing fast. Ethical practice of medicine with empathy and concern for the sick by the teacher will give realistic opportunities for the student to emulate. The teacher in a medical institution is burdened with patient care, research and private practice, giving him/her little time for teaching.
There is an urgent need to introduce the mentor system for meaningful teacher-student interaction. It is still possible to attract dedicated and talented teachers with offers of attractive salary, housing, conference incentive and research fund. A mere increase in the intake of students without optimum infrastructure and faculty will only help to add to the numbers and not to the quality of service. The medical education cell in colleges should be strengthened to continuously update the teachers on modern trends in teaching. It is disheartening to note that in some centres, the students are attending private theory classes on a payment basis. For better monitoring and implementation of the MCI and university guidelines at institutions, the Dean/Principal should have necessary powers with accountability for the desired results.
(The writer is a retired professor of plastic surgery and Principal of Andhra Medical College, Visakhapatnam. Email: firstname.lastname@example.org)