Dearth of good quality doctors could lie in the MBBS currciulum and its assessment process. Prachi Rege consults experts from the field for immediate treatment.
Medical education in India has been at the helm of numerous controversies. Reservation of seats and validity of the medical colleges are burning issues that are being debated upon constantly.
The one thing that has been ignored however, is the MBBS curriculum itself. As per an April 2013 report—Doctor population ratio for India - The reality—by the Indian Council of Medical Research (ICMR), India plans to establish some 200 new medical colleges in the next 10 years to meet the projected huge shortage of 600,000 doctors. However, this projection if implemented, might not solve the problem of producing quality medical graduates.
"The lacunae in the MBBS study module is the primary reason for plummeting number of good quality general physicians," suggests Dr SV Nadkarni, former dean of LTM (Sion) Medical College.
Dr Arun Jamkar, vice chancellor, Maharashtra University of Health Science (MUHS), is aware of the shortcomings and has submitted his recommendation to the Medical Council of India (MCI).
"We are looking forward to developing a dynamic curriclum that will help us in creating competent doctors," says the vice chancellor. Dr Jamkar’s suggestions include skill training of primary physicians. Aspects like good communication skills (with the patient), understanding of CPR (cardiopulmonary resuscitation), capability to stop bleeding and also to deliver a baby in emergency situation, and medical values and ethics have been recommended.
"We are still at a discussion stage and if approved, we hope to execute these from the next academic year," he informs. Dr Jamkar has also constituted an outcome based research team to spot the gaps in the curriclum. “We want to create doctors who will practice in tune with the needs of the new-age society.”
Most experts are of the opinion that the current curriculum gives maximum knowledege and minimum skill training. "The module was last updated 15 years ago. But these weren`t major path breaking changes, just peripherial modifications," points out Dr Arvind Supe, dean, Sion Hospital, Mumbai. He believes that the fundamental question module designers need to ask is—are we creating holistic skill-based medical professionals? Though there are talks of curtailing the duration of the MBBS course, experts believe that it`s not the duration but the content and method that needs to be given the necessary attention.
"Currently the duration of the MBBS course is four years followed by one year of internship. All aspects of medicine right from human anatomy to practical training is cramped up in this period," says Dr Nadkarni.
Though in the first year students have to learn subjects like anatomy, physiology and pathology, this doesn’t really happen. By the time students are done with their entrance tests and admission process, two months of the academic year are over, leaving only eight months to study the subjects. Subsequently, even during the second year, faculty does not get enough time to teach important paramedical subjects like pharmocology and mircrobiology.
Comparing our course with foreign countries Dr Nadkarni says that this period of the medical course is called the Premedical, which involves three years of exhaustive training in human anatomy and the diseases that plague the body.
"Ususally, in our system, within two years into the course, a student is given practical training. In my opinion, this is wrong, as the student has gathered only superficial knowledge of the human body and it is unfair to unleash him/her on real patients," Nadkarni states.
Actually, like in foreign countries, Premeds should undergo intensive hospital training under senior doctors for about two or more years. And this should constitute about 80 per cent of the medical curriculum He recommends that post the one year mandatory internship, students should do two year residential training albeit in rotation under the guidance of senior doctors with different specialties.
"Presently, students, who are still untrained, get randomly placed in rural areas. This puts patients pat risk," points out Nadkarni. Doctors who go through the residential training can emerge as competent general practitioners (GP). Currently 80 per cent of GPs are non-MBBS graduates.
Over 50 per cent of students prefer doing specialisation. However, there are 17, 000 MBBS seats in Maharashtra and a little over 6000 post graduate (PG) seats. "Changing the design of the curriculum will help 40 per cent of those who don`t make it to the PG and can be trained as GPs," reflects Nadkarni.
Speaking of the assessment procedure, Dr Supe finds the medical CET to be just another normative race to rank students. "It doesn`t test whether a candidate is capable of displaying compassionate attitude toward the patient. It tests only the plain medical knowledge," he critiques.
According to Dr Nadkarni, the entry level assessment with which students are admitted to a college is at fault. "Students with minimum of 50 per cent marks in PCB (physics, chemistry and biology) are allowed to take the CET. This has been a practice since the 70s,” he says. “This was relevant then. Today, the cut-off percentage should be raised to anything above 60 per cent to filter the right candidates.
Dr Nadkarni recommends common entrance test for private and government medical colleges in a particular state. "This will help in admitting only quality candidates to the course," he says. Holding private colleges responsible for the skewed ratio of quality doctors, he says, "Private medical colleges give backdoor entry to those who don`t make it to the national/ state medical colleges, thus creating incompetent doctors."