The ongoing >Vyavsayik Pareeksha Mandal scam in Madhya Pradesh (commonly known by its Hindi acronym Vyapam) has seen the deaths of a number of people under suspicious circumstances. The rising body count has caused a national furore, forcing the government to hand over the case to the >Central Bureau of Investigation to look further into the admissions and recruitment scandal that has been rocking the country. But besides >the macabre deaths , the field of medicine in India must brace itself for one other negative fallout of the scam: the already declining trust in medical service providers has now fallen further.
Many medical students have been found to have used, or are suspected to have used, unscrupulous means to be admitted into medical colleges — getting their entrance answer sheets rigged or getting impersonators to write exams on their behalf. The enormity of the scale of such rigging in the >Vyapam scam is shocking . One major fallout of the scam is that seats in medical colleges are being wasted. Several scam-tainted students have already been suspended or expelled mid-way through their courses from their colleges. And it is quite probable that there are a number of other medical students who cleared their entrance examinations through fake means and who will be identified in the continuing investigation and expelled.
Sadly, they can no longer be replaced by students who might have been in the waiting list for selection into the course. Losing precious MBBS course seats adds to the >criminality of the scam , for healthcare professionals are a scarce commodity in this country.
Ethics is a cornerstone of the medical practice. That several medical students entered medical school through false means has gained national attention. But what is worse is that many of the impersonators who wrote entrance exams for pecuniary benefits are also medical students or recent graduates from medical colleges. This means, unfortunately, that henceforth, the skills and morals of new medical graduates will be looked at with suspicion. Also, the existing trust deficit of patients towards doctors will further widen, and erode the sanctity of the doctor-patient relationship.
What’s the answer? While corruption in healthcare has garnered much interest, the unravelling of the modus operandi for cheating in medical entrance examinations has also served to bring the focus on the serious problems that medical education faces. At present, the entrance examinations to medical colleges are conducted by the central government (CBSE), State governments, private colleges and universities. This needs a rethink. The plans for an annual National Eligibility cum Entrance Test (NEET) were quashed by the Supreme Court as “unconstitutional”. Even if a single entrance format throughout the country is not considered suitable in the Indian context, there needs to be better regulation and quality checks on the existing medical entrance system by some other trusted agency, whether such exams are conducted in the public or private sector.
Additionally, the time is also right for hastening the process of having a unified exit examination for all MBBS graduates in the country to ensure that a minimum quality threshold can be expected from all medical graduates, irrespective of the college that they graduate from. The much-beleaguered Medical Council of India (which itself needs to reform and emerge from allegations of corruption and favouritism) has to be overhauled and strengthened. MCI is the regulator of medical education, but needs to be regulated itself. This can be done if transparency and accountability are ensured, and there is a continuous evaluation of its efficacy in keeping the standards of medical education in the country high. A zero-tolerance approach to corruption in medical education is a non-negotiable and immediate requirement.
In a recent blog for the British Medical Journal on the eve of Doctors’ Day, we had asked the medical profession to focus on, among other things, the need to rebuild the doctor-patient relationship and on public engagement. It is important that there be more information shared with patients and their families, supplemented by better communication skills. Mentorship from senior role models in the field of medicine is crucial in ensuring that medical students and junior doctors get timely guidance, and understand that an ethical patient-focussed practice should be the norm rather than the exception.
Medical colleges, both in the public and private sector, should also include ethics education and mentorship in their teaching — not only because the revised MCI curriculum requires a certain number of hours to be devoted to the subject, but primarily because we are facing a moral crisis and a huge loss of confidence in the field of medicine today.
(Anant Bhan is a Bhopal-based researcher in bioethics and global health, and an adjunct visiting professor at Yenepoya University, Mangaluru.)