Revamping Medical Education in India

Context:

India needs a revamp of the Medical education system to meet the healthcare of the growing population.

The Current State of Medical Education:

• Number of Doctors: India easily meets the WHO standard of one doctor for 1,000 people with 13,08,009 registered allopathic doctors, along with over 5.6 lakh Ayush doctors.
• Number of Medical Colleges: The number of medical colleges has increased from 387 in 2014 to 695 in 2023, which will produce over one lakh MBBS doctors graduating per year.

Concerns:

• Urban-versus-Rural Dichotomy: 
  • While almost two-thirds of the country’s population resides in rural areas, less than 30 percent of the doctors work there. 
  • As per the Rural Health Statistics, 2021-22, there is more than 50 per cent shortage of doctors at Community Health Centres.
• Skewed Distribution of Healthcare Workforce across the States: 
  • Though Kerala, Tamil Nadu, Karnataka, Andhra Pradesh, Goa and Delhi have one doctor for 350-750 people, Jharkhand, UP and Bihar have one doctor for 3,000-8,000 people. 
  • Strikingly, 40 percent of the doctors in Karnataka are in Bengaluru alone, leaving many rural areas understaffed.
  • On the other hand, Kerala, with better infrastructure, has hardly any rural vacancy.
• Lacking in Infrastructure:
  • Doctors hesitate to go to rural areas because there is no infrastructure or support system, no compensation for the hardship and poor family life.
  • Rural jobs are all in the government sector, with inadequate remuneration which falls short of the expected ‘return on investment’, especially if a doctor has graduated from a private college.

• Quality of Medical Education:
  • Nearly half the colleges being private and students with very low ranks getting admission in them, there is little uniformity in the standard of education. 
  • The pace of creating new colleges is not matched by the availability of infrastructure, equipment and trained medical teachers. 
  • Surprisingly, some states have gone retrograde by introducing teaching in regional languages.
  • The curriculum needs to be revised periodically, it should give more emphasis to practical aspects, especially in handling problems peculiar to India. 

Steps that have been taken by the Indian Government:

• National Medical Commission (NMC): 
  • The National Medical Commission has replaced the Medical Council of India with the purpose of reforming medical education in India. 
  • The Commission intends to improve the number of medical seats available and lower the cost of medical education to encourage more students to pursue careers in healthcare. 
  • To promote the NMC objective, four mutually independent and autonomous committees have been established:
    • The Undergraduate Medical Education Board
    • The Postgraduate Medical Education Board
    • The Medical Assessment and Rating Board
    • The Ethics and Medical Registration Board. 
• Competency-based Medical Education (CBME):
  • The Medical Council of India (MCI) launched the globally recognized CBME for MBBS students in 2019. 
  • It seeks to step away from a content-based syllabus and more towards one that is more practical and aligned with the country’s increasing health demands.
• Pradhan Mantri Swasthya Suraksha Yojana (PMSSY): 
  • 22 new All India Institutes of Medical Sciences (AIIMS) were developed under this initiative.
• The National Exit Test:
  • By 2023, the National Exit Test (NEXT) will be the substitute for the  National Eligibility cum Entrance Test (NEET)  and would be necessary for all MBBS grads and international medical grads, which aims to make the medical education system more transparent, accountable, and consistent.

Way Forward:

• Rationalizing Medical Colleges: India needs to rationalize the number of medical colleges and their intake, taking into account the future projections of the need for doctors at primary, secondary (specialist) and tertiary (super specialist) levels.
• Flexibility in Specializations: There will be a greater requirement of critical care physicians or neurosurgeons and hence, need to be flexible in the approach.
• India-centric approach: It is necessary to ensure that an India-centric approach is taken in the revamping of healthcare, which faces the twin burdens of communicable as well as non-communicable diseases. 
• Removing Disparities: The disparities in infrastructure, equipment and specialist manpower between different states and between newer and older, well-established medical colleges must also be removed.

News Source: The Tribune