Reuter’s report in British Medical Journal had complained there is a breakdown of medical education system in India due to corruption and degradation of value system. This report is placed in a journal which has global attention and impact. Indian medical personnel work in many different countries both in the capacity of specialists and routine family physicians. It is a warning and an eye opener to many of us involved in medical education either as a practising physician or a faculty. There are reportedly 395 medical colleges which have the capacity to train around 6 lakh medical students. These medical colleges are run by government as well as by private bodies. Medical colleges run by private managements account for 55 percent and the remaining are run by the government.
Medical Council of India (MCI) is a regulatory body which grants permission to these colleges based on their basic infrastructure facilities, faculty, hospital intake both in outpatient department and inpatient capacity and the services rendered.
There are specifications ordained for the built up area for the college, department wise space allocation for staff room pattern, practical and demonstration room facilities and lecture halls.
The hospital is supposed to have a specific bed strength in an initial period which needs to be improved when the college becomes fully functional (say completion of one batch students course). The space and faculty allocation for every department are specified including the diagnostic services which form one of the major segments of a hospital.
Therefore the hospital has to be run by a professional trained in medicine as well as hospital administration say like the Medical Superintendent. He or she has to be assisted by a committee of senior clinical professors along with nursing superintendent.
The hospital beds are run by nursing personnel. They have to be given their due place and respect. They must be given incentives and encouraged to be a part of a professional team of medical personnel.
The Medical Superintendent must be given adequate time to run the hospital to make it fully functional. The major and minor operation theatres need to be maintained and it has to have a specialist to supervise its routine functioning. The management must give importance to these facts along with appointing permanent senior and junior residents for every department in the hospital. There has to be a good link between the diagnostic consultant and the clinical departments. The different departments need to be net-connected and a professional must collect, store retrievable data of each patient (history, medication and other details). Digital medical records must be available in an age of informatics. There are professionals available to create the net working facilities for all these records. The same networking can be operational in the college side (inter departmental communication, library access, electronic mails and circulars).
There needs to be a very healthy atmosphere respecting everyone’s place and contribution. One area that needs to be concentrated is development of research in the medical college. Along with the medical education unit, which is to train teachers regularly, for clinical auditing, a department devoted to research must be made available. The co-ordinator could be a research scientist along with a faculty representative of all the departments. There has to be good relationship between research workers and clinical professors. The Institute Research Ethics Review Board (IREB) including the Animal Ethics Committee duly constituted must be a facilitator and could guide the research worker’s project. Rather the committee may help or train the faculty in writing a research project for funding as well as for publication.
The Research Division of the college can provide different sources of funding (agencies), the applications, format in which the project has to be submitted along with information regarding travel grants to attend international conferences or workshops.
Like having an Academic Council, which creates a question bank as well as time schedule for different academic activities, the Research Council or Department of Research help develop basic and applied research in the college.
Private managements, which fund the project, need to give full freedom to the Teaching Faculty and Clinicians to develop the college and hospital. They must be given a time frame to achieve a target (say the number of patients in the OP or IP, major surgeries to be conducted, continuing medical education programmes and other academic activities of the college. Freedom given with such target oriented goals will definitely help develop the institution as well as reduce the policing activity of MCI making it a body that promotes medical education.
India has now about 6-6.5 lakh doctors, but require more doctors to maintain the required ratio of one doctor per 1,000 people.
There is only one doctor per 1,700 citizens in India; the World Health Organisation (WHO) stipulates a minimum ratio of 1:1,000. While the Union Health Ministry figures claim that there are about 6-6.5 lakh doctors available, India would need about four lakh more by 2020—50,000 for PHCs; 0.8 lakh for community health centres (CHC); 1.1 lakh for 5,642 sub centres and another 0.5 lakh for medical college hospitals.
India ranks 67th in the world with regard to the doctor:patient ratio. There are about 4 lakh trained nurses. About 1.1 per cent of GDP is spent on medical education and healthcare. We need more doctors and therefore more medical colleges. The MCI needs to supervise at the same time encourage private managements to invest professionally to start a medical institute. It can also allocate an advisor to supervise and guide the college to run smoothly fulfilling all the norms stipulated by MCI. This will avoid unnecessary inspections, help channel the money invested for a proper institution to grow apart from promoting the business motive of the management. Every organization including the Education and Health sectors need economic benefits for the investment they make. The investments made by the managements are huge and they need to be protected. There are instances where big buildings are constructed with no basic idea or guidance as to how to run a medical college. At times the permission granted by the MCI or the local university or the government end up in admitting students. The subsequent inspections prove that the college does not meet the basic norms and recognition for running the college and is temporarily withdrawn or permanently disqualified. The derecognized colleges’ students bear the brunt of such actions; sometimes one batch or two batches of students complete their courses but permanent affiliation or recognition is not granted to the college. MCI needs to take special care to appoint a temporary advisor to fulfil and rectify the defects so that the college could continue to meet the norms and continue its service.
This will avoid all that concerned voices including fake doctors, false data submission or poor hospital services and promote quality faculty for teaching and serving. The sudden abundance of clinical postgraduates in basic sciences and the divide between the non-clinical and clinical must not lead to a state that some of the basic medical sciences have to lose the services of non-clinical postgraduates or research teachers. They need to be accommodated as always done by the vision of MCI and help promote a healthy educational environment. Medical education is one of the fields of excellence which has served the cause of medicine as well as brought global recognition to our medical professionals.
The government, private managements, MCI and universities have always worked together to provide quality medical education and therefore doctors of high quality. Their magnanimous amalgamation will therefore guide us Indians towards bridging the gap between the professed goals and operational outcomes in medical education in India.
by Dr D S Sheriff