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Hindu: MCI Suggests Major Reforms In Undergraduate Course

Online edition of India's National Newspaper Sunday, Jan 02, 2011


Thanks to Dr Manoor Ali for this news

Aarti Dhar

NEW DELHI: The Medical Council of India (MCI) has recommended major reforms in the undergraduate course in medicine by converting conventional education into a competency-based module to develop skilled doctors through early clinical exposure. It has also suggested doubling the intake of medical students to meet the healthcare needs of the country in the coming years.

  • Please explain what is defined as 'conventional' education? 
  • Does competency-based module imply passing rigorous exams which have not been in place previously?
  • It appears to say most training is 'book-learning' and not hands-on-clinical experience.
  • This would be a dramatic change, since even in U.S. medical schools clinical ROTATIONS are left for the last year of the medical school education.
  • The idea of doubling the number of students should have taken place many years ago, because we know the baby-boomers are aging out to retirement and every day now 10,000 turn 65 years of age. There is a great need for geriatric care. And, the youth of today are much sicker than previous generations. 

Distance education

Pointing out that the current undergraduate curriculum in medicine did not make an MBBS degree holder feel equipped with adequate skills and competence to take care of the common problems at the secondary and tertiary level, the Undergraduate Education Working Group has said this factor also prevents young doctors from going to practice in the rural and primary health centres. The goal of training is not focused on providing health care to the needy and the disadvantaged, the eight-member working group has said in its report.

  • The selection for MBBS is done through an All India Entrance Examination, CET and the qualification required for entrance is 10+2 or equivalent with Science subjects. In addition to MBBS, candidate should complete House Surgency or internship for one year. After MBBS, candidates can go for post graduate level studies (MD or MS) through another entrance. At the post graduate level, there is specialization in Medicine and Surgery. Those with Post Graduation (MD or MS or M.Sc in Medicine) can further opt for super-specialization like Ph.D. The doctoral programmes can be completed by MD or MS holders in 2 years and by M.Sc Medicine in 3 years.
  • Today's education does not develop student confidence in the ability to perform in the medical setting, as reported in this news article. Perhaps mentorship programs would help develop this support? 
  • The need for physicians outside the city areas may require physicians to be placed after school in these regions or specially trained in newly established clinics in rural areas.

It recommends options for distance education towards a fellowship or diploma in areas such as diabetic care, HIV medicine, geriatric medicine, hospital infection control, hospital management, and inclusion of medical ethics, forensic medicine and hospital infection control in the regular curriculum.

  • Does it make sense that distance education is specializations would prepare doctors for these jobs? 
  • Wouldn't total homeopathic care be more appropriate?
  • Wouldn't recommending more advanced degrees in homeopathy prepare physicians to care holistically for more medical conditions based upon similar symptoms rather than named diseases?

According to the report, the current intake of medical colleges and the critical mass of doctors would have to be doubled if India had to achieve the world average doctor-population ratio of 1.5:1000 by 2031 as against the present 1:1700.

  • Recognizing the need is step one; intervention to create educational institutions based upon successful models will be step two; admitting competent students with a true passion to go into the medical field will be step three.

Taking into consideration the existing medical colleges in the country, it was felt that the current intake of medical colleges and the critical mass of doctors should be doubled to achieve this target.

At present, there are 330 medical colleges with an intake of approximately 35,000 and with the present intake the shortfall of doctors by 2031 is estimated at 9.54 lakh.

  • India leads the world on many fronts. If they take these initiatives they will continue to lead.

To offset this, the report has suggested increasing the intake in the medical colleges wherever there is adequate infrastructure of teachers, equipment and clinical load and to augment infrastructure in relation to clinical load by attaching established medical colleges to district-level hospitals or secondary hospitals run by government agencies; upgrading existing larger district hospitals and augmenting their infrastructure to become community medical colleges through private-public partnership or public-private partnership and starting new medical colleges and hospitals preferably in States and underserved areas with doctors and medical colleges.

  • By thinking ahead, they will increase jobs for the vast array of people needed to build the medical system.
  • The homeopathic community must be involved with building this infrastructure of teachers. clinicians, physicians and pharmacists.

Clinical training

Chaired by George Mathew, Principal of the Christian Medical College, Vellore, the group stressed the need for restructuring the MBBS course with a four-year course and six months elective with a one-year internship. Clinical training should be included from the first year itself.

  • This innovative approach will weed out those who experience the medical setting and do not feel it is for them early in their training; while providing more experience for those who love medicine.
  • This type of training can offset the high demands on the physicians caring for large numbers, as the new students begin learning the physical exam and initial in-take of information from the patient, acting somewhat like a physician's assistant. 

The past curricular revisions have mostly added to the existing content without undertaking the exercise to remove what is obsolete and outdated. This exercise needs to be taken up in a detailed and extensive manner and make the curriculum as efficient as possible, the report has said. It has to be discipline-based curriculum and lack of integration between basic and laboratory science and clinical medicine should be addressed.

  • Wondering what they consider outdated and obsolete?
  • How can we introduce Homeopathic Emergency Care as the first interaction of the doctor-patient relationship when appropriate?

It goes on to add that each medical college should be linked to the local health system, including Community Health Centres, taluka hospitals and primary health care centres that can be used as training base for medical students.

The Working Group was set up in July last year to evolve a roadmap for medical education in India and to evolve a broad policy on the duration and curricular changes that could be adopted as future strategies to make medical education in India comparable to global standards.

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