MEDICAL EDUCATION IN INDIA

CURRENT STATUSDr Mitasha Singh

Department of Community MedicineDRPGMC

Kangra at Tanda

History of Medicine in India

• Pre- Vedic period from 3000BC- Evidence of anatomic knowledge on cave paintings in Indus valley

• Vedic period (around 1500BC)- marked by writing of four vedas, or sciences (describe the aspects of anatomy, medicinal herbs and plants)

• Post- Vedic period (800BC-1000AD)- golden age of Indian medicine (documented by writings of Charaka and Susruta) in form of Ayurveda and Siddha system

• 13th century- Unani system of medicine was introduced by Muslim rulers

• From 1810 Homeopathy gained foothold in India till the advent of British in 18th century.

• Western medicine- introduced by Portugese in Goa (1840), started the Medicine and Pharmacy Licentiates (Goa Medical College).

• British established Madras Medical School in 1835.

• University affiliated medical education (1850s)- after opening of first 3 Indian universities in Chennai, Mumbai, and Kolkata.

• 1946- Bhore committee- Recommended major changes in medical education- 3 month’s training in PSM to prepare “social physician”

• 1975- Srivastava committee- Group on Medical Education and Support Manpower

• Family and community oriented practitioner with social responsibility

• Advocated and recommended reorientation of medical education according to national needs through a medical education commission on lines of UGC.

• Medical Council of India• A governmental agency under the Ministry of Health

and Family Welfare (1934) • Indian Medical Council act 1956 is operational today• It was amended in 1956, 1964, 1993& 2001• Statutory recommending body • It stipulates the rules for medical school curriculum,

structure and content.

• 1977- Reorientation of Medical Education (ROME) scheme was launched to link community based facilities with medical colleges.

• 1983- National health policy provided directions to reconstruct the curriculum (train Undergraduate medical students as a Primary care physician)

• 1986- Bajaj committee report- emphasized on need of a Medical and Health Commission

• In 1992- the National Institute of Health and Family Welfare

• carried out a study on the effectiveness of the training given in the graduate course on issues relating to Maternal and Child Health and Family Planning.

• This showed that a large number of fresh graduates had no knowledge of simple procedures and conditions, like: immunization; nutritional advice; IV Fluids; oral pills; IUCD; etc.

• In the same year MCI organized a National Workshop for debating a Need based Curriculum for UG Medical education

• 1997- GoI on recommendation of MCI promulgated the “Regulations on Graduate Medical Education” through a gazette notification.

• In 2011 the Board of Governors of MCI had announced a fresh set of curricular changes entitled ‘Vision 2015’ to re-look at the various aspects of medical education, training and practice for the country.

Medical colleges in India

1947 1965 1980 1990 2006 2014

23 86 112 143 262 395

Total number

1995 2006 2014

Private 47 131 214

Government 109 131 181

Private and Government medical colleges

2014Total MBBS seats- 49530• Government colleges- 181, Seats- 24610• Private colleges- 214 , Seats- 24920

MD/MS/Diploma

• Government seats- 13913• Private seats- 8387

• Degree in Community Medicine, seats- 742• Diploma in Public health, seats- 140

Regional imbalance

• One medical college for a population of 11.5 million in Bihar and 9.5 million in UP.

• Whereas Kerala and Karnataka- one for 1.5 million population.

• 5 south western states with country’s 31% population account for 58% of medical colleges in India (public + private)

Kumar R. Academic institutionalisation of community health services: Way ahead in medical education reforms. J Fam Med Primary Care 2012;1:10-9

Selection of Students

• National Eligibility Entrance Examination (NEET) • It was felt that common entrance examination is

essential both for UGs and PGs as it:

● Ensures uniformity across the country,

● Sets a minimum standard and

● Is convenient for the candidates

● Saves resources.

● Takes care of malpractices.

Framework of Examinations

• For MBBS entrance• Common syllabus throughout the country • Eligibility criteria• Subject wise allocation of marks• 30% marks each for Physics and Chemistry and 40%

marks for Biology

• In PG entrance examination, distribution of marks is as per relevance of the subjects, with clinical subjects carrying more weight age than pre and paraclinical subjects

• DM/ MCh entrance- three kinds of papers• M.S. surgery level for all M.Ch. courses • MD Medicine level for D.M. courses• M.D. Pediatrics level for Pediatric subspecialties

• Type of Paper/Questions• MCQ pattern of questions followed for MBBS

entrance.

• The PG and DM/MCh entrance examination papers have multiple types of MCQs, namely single response , multiple T/F, images, assertion/reasoning questions and patient management questions.

• National merit list is used for admission to 15% all-India quota and state merit list is used by respective state quota admissions.

• The state of Jammu & Kashmir and Andhra Pradesh take part in NEET and their respective state merit lists, drawn from National Merit List, are given to them for filling up their 100% seats.

Curriculum Structure

• For MBBS/Undergraduate course

• Three phase framework of-

Preclinical or first MBBS (12 months)

Paraclinical or second MBBS (18 months)

Clinical or third MBBS (24 months)- Part 1

and 2

Internship (12 months)

Graduate  medical curriculum is  oriented  towards  training students  to  undertake the responsibilities of  a  physician  of  first  contact  who is capable of looking after  the  preventive, promotive, curative & rehabilitative aspect of medicine.

MCI regulations were revised for undergraduate medical education in 1997 to promote

• Small group learning

• Greater emphasis on health and community

• Problem based learning approaches

• Horizontal and vertical integration

In Vision 2015 new teaching elements have been proposed

• Introduction of 2 months foundation course in phase 1.

• Integration: Horizontal and Vertical• Early clinical exposure• Student Doctor Method of Clinical Training• Electives• Skill development and training• Secondary hospital exposure• Adoption of Contemporary Education Technologies

Postgraduate Medical Education

• 3 year course in case of degree(MD/MS)

• 2 year course in case of diploma after passing final MBBS examination and completed internship

• 3 year course in case of DM/MCh after obtaining MD/MS degrees or equivalent

The major components of the Postgraduate curriculum :• Theoretical knowledge• Practical and clinical skills• Dissertation• Communication skills.• Training in research methodology

• Degree/Diploma training also includes-

• proper training in basic medical sciences related to the disciplines concerned;

• training in applied aspects of the subject;

• training in allied subjects related to the disciplines

concerned.

• Training in Medical Audit, • Management, • Health Economics, • Health Information System, • basics of statistics,• exposure to human behaviour studies,• knowledge of pharmaco –economics• and introduction to non- linear mathematics

Recommendations in Vision 2015

• Increasing seats of PG diplomas and degrees

• Building competency based modules

• Change of Nomenclature and introduction of M.

Med Course - 2 year Master of Medicine (M. Med) program as the first level of specialists with focus on skill development and providing care to community.

• Career Pathways after M. Med.: Degree Course

-A two year course on allied

subjects

-A three year research path would

lead to the MD/Ph.D degree on

completion of requirements

• Fellowship programs

• Need based Assessment & Distribution of Diplomas and PG Courses

• Training & Assessment- Extensive faculty development Training, Continuous formal structured assessment, a doctoral committee in every institute will constantly monitor the training of these students, Establishment of skill labs would be mandatory and Maintenance of log book.

• Rural Service criteria for entry in postgraduate courses

• Accreditation & ranking of institute imparting PG Medical Education

• Increasing Faculty Pool: Efforts would be made for increasing the faculty pool and several innovative approaches would need to be explored.

• Promoting Research for faculty promotion.

• Continuing Professional Development (CPD)- through CMEs

• Seventy percent of curricular content - standard across the country

• remaining 30% allowed to emphasize regional considerations and leave place for innovations.

• The curricula for various courses need to be revised at periodic intervals not exceeding 5 years depending on newer developments in the field.

Evaluation of Medical students

• Assessment system in medical education largely determines its product.

• MBBS• Assessment of each phase – 4 examinations• external/university based examinations +

internal/medical school based assessment

• Postgraduate Assessment at the end of course- • After completion of 6 academic terms in

MD/MS/DM/MCh and 4 academic terms in Diploma

• Based on grading or marking system• obtaining a minimum of 50% marks in theory

as well as practical separately shall be mandatory for passing the whole examination.

• Post Graduate students maintain a record (log) book of the work carried out by them and the training programme undergone during the period of training including details of surgical operations assisted or done independently by M.S./M.Ch. candidates. 

• The record books are checked and assessed by the faculty members imparting the training.

• M.D./M.S. examinations, in any subject consist of Thesis, Theory Papers, and clinical/Practical and Oral examinations. 

Internship

• Medical education programme was increased from 4.5 to 5.5 years with the addition of an internship year in 1960s.

• Community Medicine• Medicine• Surgery• Obstetrics and Gynaecology

• Community Medicine-• The prescribed period has been 3 months since

year 1983;• prior to that it was 6 months. • Again in the year 2004 the MCI has suggested

a further reduction to 2 months.

Faculty• Medical teachers in all Medical Colleges (except the Tutors, Residents,

Registrars and Demonstrators)-• possess the requisite recognised Postgraduate Medical qualification in

their respective subject.

• Teachers - total of eight years’ teaching experience out of which at least five years teaching experience as Lecturer or Asst. Professor are recognised as postgraduate teachers in broad specialties.

• In the case of super-specialties- only those teachers with eight years’ teaching experience out of which at least five years’ teaching experience as Lecturer / Asst. Prof. gained after obtaining the higher speciality degree are recognised as postgraduate teachers.

 

• NTTC were established in 1974 at medical colleges throughout India.

• Funded by WHO till 1984, and from then they were funded by GoI until 1999.

• After 1999 , only the NTTC at JIPMER continued to function.

• Foundation for Advancement of International Medical Education and Research (FAIMER) is also supporting faculty development in India.

Challenges in Medical Education

• Rapid and uneven growth of Medical schools

• Validity of student selection policies is questionable

• Curriculum goals are weakly focussed on health care needs with deficiency in internship year

• Lack of faculty development to meet the needs of expanding number of medical schools

Recommendations

• Uniformity of basic level of competencies across the country and uniform standard for Indian Medical Graduates.

• Integrated curriculum • More attention on development of various skills, viz.,

problem solving skills, psychomotor or performance skills, attitudinal and communicational skills

• Changing the schedule of PG Entrance

• Introduction of evaluation at the end of internship

• Rationalize the examination system of medical students- assessment should be criterion- referenced and based on the core curriculum.

• Adoption of practice of Evidence Based Medicine.

THANK YOU