Medical Education in India

IN NEWS:

• The increasing population (1.32 billion ) and the occurrence of diseases, demands Indian medical education and the training approach to be modified and ensure enhancing practical clinical skills, than just sticking with predominantly theoretical or classroom training.

BACKGROUND:

• Despite having the most number of medical colleges in the world, and currently having approximately 9.29 lakhs doctors enrolled on the Indian Medical Register, India is way behind in achieving the targeted doctor population ratio of 1:1000 as per WHO norms.
• Shortage of doctors, who are the most important cog in the health care delivery system, has derailed both access to and quality of health care, especially to the vulnerable and poorer sections of the country.
• Besides acute shortage of medical doctors, there are serious issues concerning mal-distribution of doctors and imbalanced growth of medical colleges in the country.
• Though there have been substantial improvements in health outcomes over the years, there are  still large gaps in health care accessibility in many parts of the country and Universal Health Care still remains  a distant dream
• This indicates that India has not been able to leverage its economic growth to achieve the desired health outcomes

ISSUES IN MEDICAL EDUCATION SYSTEM:

• Demand-supply mismatch:
  • There is a serious demand-supply mismatch in medical college seats as well as inadequate seats in terms of population norms.
  • The very nature of medical education, an empirical field, requires significant infrastructure — land, equipment, and trained faculty at the post graduate level — all of which are in short supply and uneven in their spread.
  • Without correcting these deficiencies, India cannot expect to dramatically increase the availability of medical personnel.
• High fees in private colleges >> leading to outflow of students to foreign countries:
  • In private colleges in India, medical seats are priced between Rs 15-30 lakh per year. This is way more than what most Indians can afford.
  • Recent efforts by the National Medical Council (NMC) to regulate college fees are being resisted by medical colleges.
  • The most sought-after international destinations — traditionally, for medical education the U.S., the U.K. and a few west European countries — are also too expensive for most Indians.
• Low doctor-patient ratio:
  • India has one government doctor for every 11,528 people and one nurse for every 483 people, which is way below WHO recommended 1:1000.
• Inequality in the distribution of resources:
  • Medical colleges in the country are distributed in a skewed manner >> with nearly sixty five per cent medical colleges concentrated in the Southern and Western States of the country which has resulted in great variation in doctor-population ratio across the States
  • There is also a glaring rural-urban disparity in both availabilities of health care and colleges.
• Out-dated syllabus and teaching style:
  • Regular breakthroughs take place in the medical field every day, but the medical studies syllabus in India is not updated accordingly.
• Lack of skilled teachers:
  • Teachers for medical institutes are selected based on their degrees and not their clinical experience.
  • Further, the lower salary fails to attract better talent as they go for private practice.
• Lack of social accountability:
  • Indian medical students do not receive training which instils in them social accountability as health practitioners.
• Commercialisation of medical education:
  • After liberalisation of 1990s >> made it easy to open private schools and so many such medical institutes cropped up in the country, funded by businessmen and politicians, who had no experience of running medical schools >> It commercialised medical education to a great extent.
• Corruption in medical education:
  • Fraudulent practices and rampant corruption such as fake degrees, bribes and donations, proxy faculties, etc. in the medical education system is a major problem.
• Focus on rote learning than clinical skills:
  • The fundamental exam pattern in the medical education has remained the same, banking on rote learning techniques, while their clinical skills are not tested till they start practicing.
• Issues with NEET:
  • There are allegations that NEET is infringing upon the state governments’ power to hold admissions in the medical colleges funded by them.
  • Students from some of the state boards are at a disadvantage from progressive boards.Students in rural India and those studying in state government-run schools seem to have a lesser chance of success.
  • These examinations do not test the attitude and aptitude of the students correctly.
  • There is more concentration of students from national boards clearing the exam.
  • Promote Coaching Factories: The standardisation of exams will lead to mushrooming of Coaching institutes to bridge the gap in School education. This is seen in India with NEET and similar other national tests
  • Transparency: The NEET paper was leaked twice in the past. Therefore, there is not much confidence in NEET’s fairness and transparency.

STEPS NEEDED TO REFORM MEDICAL EDUCATION:

• Converting district hospitals into medical colleges:
  • NITI Aayog suggests rapid scale-up of seats by converting district hospitals into medical colleges using a private-public partnership model.
• Subsidising medical education for disadvantaged students:
  • The government should seriously consider subsidising medical education, even in the private sector, or look at alternative ways of financing medical education for disadvantaged students.
• Reforming existing guidelines for setting up medical colleges:
  • There is a pressing need to revisit the existing guidelines for setting up medical schools and according permission for the right number of seats.
• Regular Quality Assessments:
  • Quality assessments of medical colleges should be regularly conducted, and reports should be available in the public domain
• Facilitate private investment in the sector:
  • The private sector should be encouraged, along with cooperation from States, to set up more medical colleges and hospitals locally so that such aspirants remain in India.
• Learning from past mistakes:
  • Merely having private establishments start medical schools, without a long-term commitment to offer necessary training and post-graduate education, could lead to a repeat of the engineering fiasco after the dotcom boom: a surfeit of engineering colleges without adequately trained faculty or infrastructure that churn out students who need a further skills upgrade to be employable.
  • The Government must instead ease procedures for establishing medical colleges, spend more on infrastructure, and provide incentives for a health-care ecosystem to develop in rural areas.
• Medical manpower planning should be bottom-up:
  • Present approach in the matter of healthcare manpower planning is a top-down one.
  • Since health is a State subject and State Governments are major stakeholders in the delivery of healthcare services, medical manpower planning should be bottom- up.
• Term of a National Medical Commission member:
  • In line with the recommendation of the Roy Chaudhary Committee that a member of the Council may not have more than two-terms in office.
  • Such a provision will also bring a blend of experience and fresh thinking in the functioning of the regulatory body.
• Do not leave the sector completely to market forces:
  • Universal need and information asymmetry are among the many reasons often cited to make the case for the exclusion of market forces in health services and medical education
• Trained team of auditors:
  • Inspection should be done with doctors’ designated bodies to keep it corruption free.
• Focus on quality and societal needs
  • The current scaling up efforts, which are most welcome, are re-envisaged to focus on quality and societal needs along with commercial viability.

PRACTICE QUESTION:

Q. “In India, there is a critical paucity of doctors and health workers, and the need of the hour is to increase medical education facilities in India at an affordable cost”. Discuss the statements with reference to the challenges in medical education in the country and the steps needed to reform it.