Medical education in India- current status 2014

1. MEDICAL EDUCATION IN INDIA
CURRENT STATUS
Dr Mitasha Singh
Department of Community Medicine
DRPGMC
Kangra at Tanda

2. 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.

3. • 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.

4. • 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.

5. • 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.

6. • 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

7. • 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

8. • 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.

9. Medical colleges in India
Total number
1947 1965 1980 1990 2006 2014
23 86 112 143 262 395
Private and Government medical colleges
1995 2006 2014
Private 47 131 214
Government 109 131 181

10. 2014
Total 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

11. 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

12. 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.

13. 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

14. • 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

15. • 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.

16. • 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.

17. 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)

18. 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.

19. 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

20. 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

21. 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

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

23. • 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.

24. • 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

25. 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.

26. • 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

27. • 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

28. • 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.

29. • 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.

30. 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

31. • 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.

32. • 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.

33. 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

34. • 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.

35. 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.

36. • 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.

37. 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

38. 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

39. • 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.

40. THANK YOU