Diagnosing what ails medical education

Confusion over policy for human resource development and economic policy is affecting quality, equity and integrity

September 28, 2020 12:02 am | Updated 12:15 am IST

The new National Education Policy (NEP) 2020 (https://bit.ly/2S1dpJs) aims to provide “universal access to quality education…” and bridge the “gap between the current state of learning outcomes and what is required… through undertaking major reforms that bring the highest quality, equity and integrity into the system, from early childhood care and education through higher education”. It suggests that where it differs from previous policies is that in addition to the issues of access and equity, the present policy lays an emphasis on quality and holistic learning.

The outcome sought in higher education is “… more than the creation of greater opportunities for individual employment. It represents the key to more vibrant, socially engaged, cooperative communities and a happier, cohesive, cultured, productive, innovative, progressive, and prosperous nation”. In a brief paragraph on medical education, it states that the aim is to train health care professionals “primarily required for working in primary care and secondary hospitals.”

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On private entities

Successive governments have been faced with the quandary of how to quickly expand educational opportunities while simultaneously addressing the issues of quality and equity. In the field of health care, there is a continuing shortage of health-care personnel. The infrastructure required for high-quality modern medical education is expensive.

Faced with public demand for high-quality medical care on the one hand and severe constraints on public resources on the other, private entities have been permitted to establish medical educational institutions to supplement government efforts. Though they are supposed to be not-for-profit, taking advantage of the poor regulatory apparatus and the ability to both tweak and create rules, these private entities, with very few exceptions, completely commercialised education.

None of the three stated objectives of medical education has been achieved by the private sector — that is, providing health-care personnel in all parts of the country, ensuring quality and improving equity. The overwhelming majority of private medical colleges provide poor quality education at extremely high costs.

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Faced with this situation, the public has approached the polity, the executive and the courts to ensure equity, if not quality. The results have been patchy. On and off, there have been attempts to regulate fees, sometimes by governments and sometimes by courts. Faced with the fundamental contradiction that all governments have been complicit in violations of their own policies to ensure quality as well as equity, these efforts have not been fruitful.

The executive, primarily the Medical Council of India, has proven unequal to the task of ensuring that private institutions comply with regulations. When the courts are approached, which issues are seen as important depends on the Bench. Some judges wish to ensure quality and equity; others give importance to points of law on the rights of private parties, federalism and such issues.

It was in this situation that the board of governors, which replaced the Medical Council of India, as an interim before the National Medical Commission became operative, introduced the National Eligibility-cum-Entrance Test (Undergraduate), or NEET-UG, as a single all-India gateway for admission to medical colleges. It is well known, though not easy to prove, that entrance examinations being held by almost all private colleges were a farce, and seats were being sold to the highest bidder. Challenged in courts, after an initial setback, the NEET scheme has been upheld.

NEET has worsened equity

NEET may have improved the quality of candidates admitted to private institutions to some extent, but it seems to have further worsened equity. Under any scheme of admission, the number of students from government schools who are able to get admission to a medical college is very low. With NEET, the number has become lower. The high fees of private medical colleges have always been an impossible hurdle for students from government schools, whatever the method used for admission. Allowing government medical colleges to admit students based on marks in Standard XII and using NEET scores for admission to private colleges will be more equitable right now.

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The basic cause of inequity in admission to higher educational institutions is the absence of a high quality school system accessible to all. In medical education, the situation is made far worse by the rent seeking and profiteering of the majority of private medical colleges.

It’s about political resolve

The fundamental problem in achieving quality, equity and integrity in education, the stated objectives of the new NEP, is confusion on the part of successive governments between policy-making for human resource development and economic policy. On the one hand, the Ministry of Human Resources Development repeatedly says that quality and equity are the cornerstones of good education. On the other, the economic policies consider education a consumer good which can be sold to the highest bidder. No amount of tweaking the methods of admission can address this contradiction. Only a resolute government, determined to ensure that economic policy facilitates quality and equity in education, can do it.

Dr. George Thomas is an orthopaedic surgeon and former Editor, the Indian Journal of Medical Ethics

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