Look WHO's watching

KEEPING UP WITH GLOBAL STANDARDS: The accreditation system is aimed at rating medical colleges in India. - Photo: S.R. Raghunathan

KEEPING UP WITH GLOBAL STANDARDS: The accreditation system is aimed at rating medical colleges in India. - Photo: S.R. Raghunathan  

AT A time when the World Health Organisation (WHO) and the World Federation for Medical Education are working to put in place global standards for effecting accreditation of medical schools, the Medical Council of India is gearing itself up to implement a system to rate medical colleges in the country.

In the coming months the council plans to launch a pilot project involving about 30 medical schools across the country to study the feasibility of such an accreditation system - a system that the council hopes will dovetail international quality norms to indigenous medical realities in the country.

A sub-committee set up by the MCI to study this issue has, in its recent report, suggested that all norms for accreditation be applied over and above the current standards that a medical school would have to meet to merit the council's recognition. The sub-committee has also proposed that the accreditation and rating of a medical college be done under seven broad heads including `mission, goals and organisation,' `available resources and their utilisation,' `teaching learning process,' `community-institution interaction' and `health practices.'

Under each of these heads the sub-committee has listed individual criteria - 81 in all - for assessing the qualitative worth of a medical school. Points have also been assigned to each criteria and a college would be awarded points out of a total of 1,000.

The sub-committee has recommended three grades to be awarded to colleges. `A' grade for colleges scoring 81 per cent and above, `B' grade for colleges getting between 66 and 80 per cent and `C' grade for institutions scoring between 55 and 65 per cent. In order to bring all medical colleges are under the purview of the proposed assessment and accreditation process, it has been recommended that the assessment be made legally mandatory for all medical schools wishing to operate in the country.

Moreover, it has also been suggested in the report that the awarding of a grade to an institution shall be time-bound and shall in any case not have validity for more than 5 years.

Now these recommendations would have to be placed before the general body of the MCI for ratification.

The MCI top brass say they are fully seized of the need to synchronise medical education in India to the best of global standards. The MCI president P. Kesavankutty Nair told The Hindu-Educationplus that such a synchronisation is indispensable if medical education in India is to undergo a quality makeover.

The question, however, is - will the MCI's assessment system measure up to the norms that the WHO and WFME have in mind for such a mechanism?

The International Task Force on Accreditation in Medical Education set up by these two bodies in 2004 has already laid down certain guiding principles or desirable qualities for an assessment system.

At a three-day meeting of the task force in December 2004 held at Copenhagen, delegates from over 30 countries felt that an assessment system should be based on standards (for example the standards of the WFME), should be supported by a legislative instrument, be representative of but independent from all stakeholders, transparent and accountable, among other things.

Delegates also felt that the accreditation should be time-limited and "feasible for a given socio-economic, political and cultural situation... relevant, valid, reliable and comparable."

The accreditation should consist of both a self-assessment by the institution concerned and a site-visit by an expert group. Moreover, the seminar also identified the public (in general and as patients), Government at all levels, health service entities, funding agencies, students, licensing bodies, teaching staff, universities and health care professionals as the "stake holders" of the accreditation and assessment system.

However, there are those who point out that the existing medical realities in the country should not be ignored in the haste to synchronise India's medical schools with global norms.

Noted neurosurgeon B. Ekbal argues that while standards can be global in terms of such things as infrastructure and teaching standards, there would be country-to-country variations in medical practices. "So, the global accreditation system can at best be a very broad one. Even at the national level there will be variations in medical requirements from State to State. Therefore, the accreditation system should be flexible enough so as not to demand homogenisation of healthcare practices. Otherwise it will have no meaning. That said, it is also true that the WHO is known for taking pro-developing country stands on such vital issues," he explains.

However, the MCI says it too is seized of the need to position national needs ahead of international norms. "We are working hard to put in place an accreditation system of our own before the WHO comes out with global norms for the same," the MCI secretary A.R.N. Setalvad says.

"This would help us set out our priorities and also help shape the eventual nature of the global accreditation mechanism." The upcoming pilot project would also serve as a reality check of sorts on the requirements can capabilities of medical schools in the country, he adds.

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