Indian doctors are revered across the world but their status in the country is however questionable. In the recent times we have witnessed many a scandal about the modes of selection for entry to medical colleges, corruption in the selection process, fictitious candidature and an almost open process of payment of capitation fee.
No year passes without litigation into the selection process with the Supreme Court having to intervene regularly. This year too, the Supreme Court issued a directive to begin the new session on September 1 so that the entire mess is sorted out. The state of most medical colleges is shameful as they lack infrastructure, staff and most importantly patients.
The problem in the medical education process starts immediately after class 10, when a student selects the medical stream. The subjects taught are not in sync with the requirements of the medical stream. Students are taught very high levels of physics, chemistry and biology (including details of botany). The level of physics/chemistry is the same as for engineering stream students. Also, an additional subject needs to be taken apart from English. To make matters worse, coaching classes hike up the level further by including extra topics. This results in bombardment of the students with wasteful knowledge. Premedical teaching should rather be focused on human anatomy and physiology, biochemistry and essentials of complementary subjects like organic chemistry, genetics and biophysics. Students taught thus will be better prepared, whether they opt for medical, dental, physiotherapy or any other paramedical stream.
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The selection processes to enter medical colleges are most unfair. There are multiple exams and multiple systems. Every State has its own exam and each State has multiple entrance exams.
The exams are moneymaking machines. An exam fee of Rs.1,000 may appear reasonable but translating it to a lakh students means a collection of about Rs.10 crore. There is a need to have a central common entrance exam like the CBSE exam. The merit, whether for the State or the central quota or government/private colleges, should be based on this exam.
Under no circumstances must private/minority colleges be permitted to follow their own admission schedules nor should the premier institutes be permitted a separate exam. Multiple entrance exams result in confusion as the brighter students get selected in many colleges and take their own time to decide where they would prefer to join. This results in multiple rounds of counselling, increasing the financial burden of the students further.
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The Union Government tried to implement such a model but the honorable Supreme Court rejected it. There is a need to relook at the process and overcome the legal obstacles by involving the judiciary in setting up the system. Unfortunately, the private medical colleges belong to the high and mighty (with various political alignments) and they may never permit such a fair system from being implemented.
At present, there is emphasis on certain para-clinical and relatively small clinical subjects, while there is inadequate teaching in radiology, anaesthesiology, medical ethics and research methodology. This anomaly needs to be addressed. The most important period in medical teaching is internship and that is unfortunately the most neglected period. Colleges should go back to the policy of allotting PG seats based on performance during the MBBS course. To remove inequality in the system, PG must be done in the same university. The government recently proposed to increase the duration of internship to two years to improve rural healthcare facilities. There could have been no worse thought than this, as it would have meant sending half-baked disinterested doctors to villages, who would only have spent their time preparing for PG entrance. Enhancing internship period to two years will enhance quality of doctors but it should be accompanied by a reduction in the term of PG to two years and the internship must be based in the teaching hospital only.
To overcome the cost burden, students settle for options abroad. Students returning back need to clear the Foreign Medical Graduates Examination (FMGE) but on an average of just 12 per cent students are able to clear it. Without passing FMGE, a doctor can’t be registered by MCI to practice in India.
There is a need to form a separate authority to regulate medical education on the lines of AICTE and restrict the Medical Council of India to its role in regulating the medical professionals.
(The author is Head of the Department, Anaesthesiology, Saket City Hospital, Delhi