8. AYUSH Report_Chapter 3

3Postgraduate Education in

Ayurveda-Filling the Gaps

142 Status of Indian Medicine and Folk Healing

Postgraduate Education in Ayurveda-Filling the Gaps

Introduction 143

Needs of Postgraduate Education 143

Existing Infrastructure 144

Existing status of AYUSH manpower (Teachers/Specialists) 144

Minimum Standard Requirements (MSR) 2012 145

Substance of Representations Against the MSR 2012 146

Conclusions and Recommendations 148

Postgraduate Education in Ayurveda 143

3Postgraduate Education in Ayurveda-

Filling the Gaps

Introduction

A Panel discussion1 to comment on Part-I of the Report titled ‘Status of Indian Medicine and Folk Healing’ was held on 19th March 2012 at India International Centre, New Delhi to capture insights from a diverse range of experts connected with the subjects covered in the Report. Each expert commented on the findings and recommendations made in the Report (Part-I) and suggested subjects which needed to be addressed when Part II of the Report was written.

Needs of Postgraduate Education

Professor R.H. Singh spoke on the Education Chapter and while commenting on several matters (he elaborated at length) on the issue of postgraduate education in Ayurveda. His talk is available at http://over2shailaja.wordpress.com/2012/04/04/panel-discussion-at-iic-on-status-of-indian-medicine-folk-healing/. An excerpt from his address is recapitulated below:

“I agree that most of the things that this report (Part I) says are needed to improve the syllabus and curriculum. But it is also necessary if you make the syllabus and the curriculum to consider where the teachers who will impart education are. There is an acute shortage of teachers in all AYUSH colleges. We have

more than 300 colleges for these three systems and we produce only 1500 PGs every year. And to become a teacher, the minimum qualification is a PG degree. From where are we going to get these teachers? This is the main reason why half of the AYUSH colleges in the country have been banned from taking admissions during the last two years. We are going down and down and not up and up. What is the reason? What should be done? This report does not reflect on it. Let me say that in our case we produce 10,000 graduates and only 1500 PGs. So we are in a real bad state as far as education is concerned. And this report has not reflected on this. This is a very important thing which should have been addressed. It can be said now because I was told that another volume of the report is going to come.” Later writing in the Journal AYU Professor Singh reiterated the same view while commenting on the Status Report on Indian Medicine (Part I).2

Status Report on PG Education with a focus on Ayurveda

Since Part I of the Report had not examined PG education, the subject is being covered here. The focus is on availability of post graduates to fill manpower gaps in the areas of teaching, specialized practice and research. The PI in her interaction with faculty members

1. Names of the panelists: i. Prof. Bhushan Patwardhan, Vice Chancellor, Symbiosis International University, Pune; ii. Prof. Ram Harsh Singh, Life Time Distinguished Professor, Faculty of Ayurveda, IMS, BHU, Varanasi; iii. Mr. Darshan Shankar, Chairman, Foundation for the Re-vitalisation of Local Health Traditions (FRLHT), Bengaluru; iv. Dr. DBA Narayanan, Chairman of the Indian Pharmacopoeia Commission’s Crude Drug & Herbal Products Committee; and v. Dr. Madhulika Banerjee, Department of Political Science, University of Delhi, Delhi.

2. Singh RH. Beyond a bureaucratic status report on Indian medicine and folk healing. AYU 2012;33:7-9.


working across a wide range of colleges was told that Ayurvedic education suffered from inherent structural contradictions which had led to a situation in which graduates from Ayurvedic colleges were uncertain about their future prospects – whether to opt for higher education, research, practice or lateral job openings. Part I of the Status Report had concentrated on the contents of the curriculum and the syllabus. Accordingly for addressing the specific issue of PG education the PI took the assistance of two experts.3

The latest Gazette of India on Ayurveda education states, “The aims of the Postgraduate degree courses shall be to provide orientation of specialities and super specialities of Ayurveda and to produce experts and specialists who can be competent and efficient teachers, physicians, surgeons, obstetricians and gynecologists, pharmaceutical experts, researchers and profound scholars in various fields of specialization of Ayurveda”.

Patwardhan et al. have demonstrated serious flaws in a large nationwide survey of undergraduates, postgraduates and teachers of Ayurvedic medical colleges. It has been shown that at the end of the course the students remain ill-equipped to handle both simple emergencies at the primary health care level or handling specialized Ayurvedic procedures like panchakarma. Access to the latest scientific literature is virtually absent from the libraries, and the potential of the internet lies untapped. Without a foundation of knowledge acquisition and processing retrieval systems, students in this system feel uneasy outside their academic institutions.4

Existing infrastructure

AYUSH in India 2012 (published by the Department of AYUSH, Government of India) reports the establishment of 508 AYUSH colleges in India (conducting undergraduate AYUSH courses) with an admission capacity of 25586 students. It is reported that 21 percent of the colleges account for around 17 percent of the total intake capacity and fall in the Government sector. Of these, half provide Ayurveda education while around 36 percent teach Homoeopathy. Around 12 percent of the colleges with an admission capacity of 11 percent pertain to Unani, Siddha and Naturopathy education. The State of Maharashtra leads over other States and has the maximum number of Ayurveda colleges. The States of Uttar Pradesh and Tamil Nadu have the maximum number of Unani (26.8 percent) and Naturopathy (28.6 percent) colleges, respectively. There are no AYUSH colleges in the North-Eastern States except Assam. Union Territories like Andaman & Nicobar Islands, Dadra & Nagar Haveli, Daman & Diu, Lakshadweep and Puducherry have no AYUSH College. Incidentally the areas representing the highest density of AYUSH colleges also have the largest number of modern health care facilities too (Karnataka and Maharashtra).

Existing Status of AYUSH manpower (Teachers/Specialists)

Apart from the skewed distribution of institutions, AYUSH colleges throughout India have been facing a huge manpower shortage in terms of availability and quality of teachers.

3. This chapter was prepared with inputs from Dr. Sanjeev Rastogi, Associate Professor and Head, Deptartment of Panchakarma, State Ayurvedic College & Hospital, Lucknow, Uttar Pradesh. Prof. RH Singh, Distinguished Professor, Faculty of Ayurveda, IMS, BHU, Varanasi was also consulted.

4. Kishor Patwardhan, Sangeeta Gehlot, Girish Singh, and H. C. S. Rathore, “The Ayurveda Education in India: How Well Are the Graduates Exposed to Basic Clinical Skills?,” Evidence-Based Complementary and Alternative Medicine, vol. 2011, Article ID 197391, 6 pages, 2011. doi:10.1093/ecam/nep113


Many Ayurveda institutions had been facing a bar imposed by the regulatory body i.e. the Central Council of Indian Medicine (CCIM) and later also by the Central Government, mainly due to an acute deficit of faculty. In 2011, the CCIM reduced the PG admission seats by over 50 percent at three apex institutions of Ayurveda namely BHU, Varanasi; GAU, Jamnagar; and NIA, Jaipur. Similar curtailment was done at several other institutions engaged in postgraduate Ayurveda education. This was due to the non-availability of teachers for imparting postgraduate education.

The minimum qualification to become a faculty member is a postgraduate degree in the respective subject. The Ayurveda education sector has around 1488 postgraduate seats which are filled on an annual basis. The highest share goes to the Departments of Kaya Chikitsa, Rasa Shashtra, Dravyaguna and Shalya which account for half the total PG admission capacity. Several other subjects which are essential components of the undergraduate curriculum are underrepresented at the PG level. Due to lack of qualified teachers, the teaching of several

subjects remains incomplete which naturally reflects on the competence of the graduates.

The paucity of postgraduate doctors also affects research and clinical practice. There are about 2421 Ayurvedic hospitals and about 15017 Ayurvedic dispensaries throughout the country (as on 1.4.2012). If just one post graduate is considered essential for each clinical branch of Ayurveda (Kaya Chikitsa, Bal Roga, Shalya, Shalakya and Prasuti), over 2000 postgraduates would be needed to meet specialized health care needs within Ayurvedic hospital settings. The admission capacity for Post Graduation does not cater to the need for specialization for patients who now expect a higher level of disease specific knowledge and therapeutic competence.

Minimum Standard Requirements (MSR) 2012

The Government issued minimum standard requirement for Ayurveda Colleges on 19th July, 2012. The position prevailing until then and the changes effected are summarized in the chart below:

5. Inputs provided by Dr. Sathya N. Dornala, Senior Medical Officer, East Delhi Municipal Corporation.

Comparative Position of MSR over two years5

S/No. MSR 2012-13 2013 – 14 onwards (New gazette)

1. Teaching staff against number of students

32 / for 50 students39 / for 60 students45 / for 80 students52 / for 100 students

+No provision of part time teachers

30 / for up to 60 students45 / for up to 100 students

+8 part time teachers of Modern medicine

+One part time Yoga teacher

2. Student bed ratio 1 : 2 1 : 1

3. Bed occupancy per year (IPD) on average

50% 40%

4. Student OPD patients ratio per day on average of the year

1: 2

5. Higher faculty (Professor & Reader)

50 % of higher faculty should be available in the concerned subject.

Having either Professor or Reader made optional in all departments except in Kaya Chikitsa.


S/No. MSR 2012-13 2013 – 14 onwards (New gazette)

6. Faculty promotions Post-graduation in the concerned subject is essential for promotion as Reader or Professor.

Condition of post-graduation in concerned subject for promotion has been removed, allowing for post graduate in any allied subject. (Allowed for five years only)

7. Age of superannuation 65 years 70 years

8. College visitation Once in a year Once in five years

9. Biometric attendance for the staff

Mandatory Desirable

10. Minimum area to start a new ayurvedic college

Ten acres Three acres for 60 studentsFive acres for 100 students

Reacting to the 2012 regulations, some Associations made representations to the PI both through e-mail and by post. Since the Department of AYUSH also received the same representations and the subject pertains to ongoing Government policy, the PI has only commented generally based on perceptions gathered during discussions with faculty members and PG students in different college settings.

Substance of Representations against the MSR 2012

1. Minimum requirement of teaching faculty

Representation from Associations

Reduction in the total number of teaching staff requirement for the colleges with an intake capacity of 60 students/year the number from 35 to 30, which had earlier also been reduced from 43 to 35 in the last gazette which will affect teaching. For those colleges with an intake capacity of 61 to 100 students, the number has been reduced from 57 to 45. Only 90 percent teachers are required to run the college. Such reduction will lower standards.

Comment: The reduction appears to be realistic keeping in mind what is actually

happening in a majority of the colleges and the existing paucity of teachers. But it needs a review after undertaking a manpower study which looks at projected needs over the next 10 years.

2. Student bed ratio, bed occupancy and minimum number of patients

Representation by the faculty and students

Reduction in Student bed ratio from 1:2 to 1:1 and bed occupancy from 50 percent to 40 percent, and minimum number of patients required has been reduced to 24. This will lower the standard of teaching.

Comment: The PI never found more than 20-25 indoor patients in any hospital that she visited except those where specialty treatment was offered say for skin diseases in the Unani hospital at Hyderabad. Reducing the requirements is therefore quite realistic.

3. Frequency of College Visitation


Reduction in the frequency of college visitation by the CCIM from once in a year to once in five years will lead to violation of all standards in the absence of regular monitoring.


Comment: The measure will at least reduce the threat of visitations and resorting to appeasement measures which had become notorious. However an accreditation system would have been better which would have devised ways of insisting on adherence to standards on a regular basis. It is recommended that this may be considered even now with random inspections undertaken by an accreditation agency as was envisaged to be set up for the National Council for Human Resources in Health (NCHRH).

4. Minimum area to start a new Ayurvedic college


The total area required to start a new college is reduced to three acres from previous 10 acres, which is too small for a Professional College.

Comment: The reduction is realistic looking at the non-availability of land at most places.

5. Biometric system for attendance of employees


Relaxation in Biometric attendance tracking devices being made ‘optional’, which was ‘mandatory’ in earlier modification, will give rise to absenteeism.

Comment: Biometric checking of attendance does not apply very much in college setting and therefore making it optional should be left to individual colleges to decide.

6. Age of superannuation of teachers


Age for retirement increased from 65 to 70 years which will affect quality of teaching.

Comment: The PI found that several faculty

members were in good health and spirits after 65 and until 70 years and even later. And age alone should not be a factor for exclusion. However, older faculty members generally had set ways and were unaware of contemporary developments, research methodology, the use of the internet or the importance of publications in peer reviewed journals. Many of them did not inspire much confidence in being able to mould young minds to acquire skills that are invaluable in today’s world. Hence, the engagement should have been made subject to an interview/vedio presentation before an independent observer so that older persons do not continue mechanically regardless of performance.

7. Minimum requirement for senior faculty


Relaxation in the requirement of senior faculty from having both Professor and Reader in each department to the option of having either a Professor or Reader for all subjects (except Kaya Chikitsa) would further lower standards.

Comment: This step may help the colleges until the outturn of postgraduates improves.

8. Promotion of teachers of allied subjects as Reader or Professor


The condition of concerned subject postgraduate has been removed for promotion and Lecturer or Readers from allied subjects can get promoted as Readers or Professors. The specialty divisions are meant for the betterment of concerned academical subjects. If it is diluted by a provision of an alternate, the authorities who run the colleges will definitely go for easily available options, rather than trying for the concerned specialty faculty.


Comment: Specialization in the concerned subject at the post-graduation level has been removed which will increase promotion avenues for Lecturers or Readers from allied departments/subject areas who can now get promoted as Readers or Professors. Were this not done, the career prospects of a large number of faculty members would have remained dismal, affecting their morale adversely. This will also improve teacher availability. However if they lack knowledge of the particular speciality, it should be made incumbent on each such teacher to demonstrate competence before a Board as otherwise they may not make the effort needed to acquire knowledge about a new subject area. Even if the lectures were video-taped it would prevent a routine approach to teaching.

Short-term measures to increase/strengthen availability of PG faculty

It was suggested to the PI that the simplest way to counter the faculty deficit in Ayurveda might be to increase the number of postgraduate seats by focusing upon the subjects and areas which are underrepresented. Even so, several other related factors would also need attention and the outturn of postgraduates would take time.

Purely as an interim and emergent measure the use of expertise available in the CCRAS research units and centers spread throughout the country was suggested to be utilized by affiliating the centers to Regional universities. If that is allowed, the identified research institutes of CCRAS could register students for MD and Ph. D. degrees after necessary affiliation with the nearest university. A twinning programme could be arranged with the faculty of nearby Ayurvedic colleges so that the CCRAS research units can conduct PG education and research together. The CCRAS scientists could be authorized to guide selected MDs and PhDs

in addition to their core research programme, which would be beneficial for both as it would bring much needed dynamism and productivity into the research institutes. The research staff of the Council could be given short term reorientation and training to equip them to undertake teaching. This suggestion was made for tackling the acute shortage of postgraduate teachers instead of just waiting for things to fall into place in the fullness of time.

It is apparent that the intake of postgraduates in the Ayurvedic colleges is not in keeping with the needs of postgraduate education or the need to promote specialized Ayurvedic treatment and research. The lowering of standards, which has been introduced under the new MSR, is actually a response to the fact that the earlier standards were not achievable, given the shortage of teachers. One of the measures introduced, which was to allow teachers to continue up to the age of 70 years, is an answer to this situation but as brought out in the text above may not necessarily lead to acceptable standards of teaching across the wide range of colleges in the country.

Need for Need Assessment Study

To overcome this, a study needs to take stock of the gaps that remains after making a notional assessment of where the yearly out turn of postgraduates is likely to find placement. Since the gap is already big and likely to grow, some emergent measures need to be taken to augment the number of seats available for post-graduation. That in turn would depend upon the availability of teachers.

Conclusions and Recommendations

It is too early to comment on the changes that will be brought as a result of the Minimum Standard Regulations 2012 in but it will definitely ease the pressure to fulfill impractical


standards which had been prescribed for ASU colleges. Thereby the tendency to indulge in cover-ups may reduce.

The effect of the new regulations may not have an impact on the number of seats available for postgraduates and for which there is a need to conduct a proper manpower study and to find ways of augmenting the supply of postgraduates. Only then will it be possible

to raise the standard of the colleges and to ensure that the level of specialization in clinical care and research improves. The suggestion to use the research staff from the Councils who possess the requisite qualifications to take classes in coordination with the relevant University may be considered as a stop-gap arrangement for five years till the outturn of postgraduates improves.

8. AYUSH Report_Chapter 3

Documents

Transcript of 8. AYUSH Report_Chapter 3