An overview and a critique of PG medical education in India delivered as a key-note address at Colombo, Srilanka in 2005. Both the MCI stream and the alternate NBE stream are covered in this presentation in a transparent and unbiased manner. The weaknesses in these systems are explored and suggestions to strengthen the system are highlighted.. Using this template one can easily update the slide set to 2014 by inserting the current figures from MCI and NBE websites. This should be a handy slide-set for any educator wishing to talk on PG-Medical education.

1. Postgraduate Medical
Education in India 2005
Prof K R Sethuraman MD PGDHE
Director-Professor & Head
Depts of Medicine & Med Education
JIPMER, Pondicherry - INDIA

2. Academic Structure of
Higher Education

Bachelor / Undergraduate level
• 3 - 5 years leading to diploma or degree

Master's / Post-graduate level
• 2 - 3 years leading to PG-diploma or
degree

Doctoral / Post-doctoral level
• 2 - 4 years

3. Indian Medical Council
(IMC)

Indian Medical Council Act
• enacted in 1933 to establish standards
in medical education and to define
medical qualifications
• Inadequate to meet the challenges
posed by rapid development and
progress of medical education

4. Medical Council of India
(MCI)




In 1956, IMC Act was repealed and a new
MCI Act was enacted
Further modified in 1964, 1993 & 2001
MCI-regulations on undergraduate medical
education in 1997
MCI-regulations on postgraduate
medical education in 2000

5. Objectives of the Council




Maintenance of uniform standards of
medical education (UG & PG)
Recognition/de-recognition of
Medical Institutions of India
Recognition/de-recognition of
Medical qualifications awarded abroad
Registration of qualified doctors

6. College Recognition Process




State Government approval for
essentiality of a Medical College
Central Government's permission to
such colleges - initially for one year
Annual Renewal after verification
until permanent recognition could be
granted
Courses without approval are
irregular & the degrees will not be
recognised

7. Quantity - Number of
Colleges


> 250 medical colleges in India
230 have been approved by MCI
http://www.mciindia.org/apps/search/show_colleges.asp


~ 40% is government run;
~ 60% is private
Intake is ~ 25,000 UGs & ~ 8,000
PGs per year

8. Alternate Medicine Stream




Ayurveda Colleges
Homeopathy Colleges
Siddha Colleges
Unani Colleges
=
=
=
=
196
192
5
35

9. Educational Deluge !
Enrolment (000s) in
Medical
sciences
199
2
199
6
199
7
199
8
199
9
200
0
179
220
230
241
252
271
Source - Ministry of Human Resources and
Development

10. Current Demand - for
Postgraduate Education


GPs have to compete with
practitioners of alternate systems
Most MBBS graduates try very hard to
get admitted to PG studies
• Some try for 2 - 4 years of full time
entrance exam coaching
• Parallel system of PG examination run by
the National board of examination

11. PG Entrance



All India Entrance Examination for
50% of PG seats in all govt-aided
colleges
Annually ~ 2500 seats are available
for graduates from any college
For some bright & savvy “MCQ
monsters” this is an annual pot of
gold!
• They sell their seat to the wait listed!!!

12. Objectives of PG education


Laudable list of objectives covering
knowledge, competence & values
Not matched by a valid & relevant
set of assessment tools to ensure
that the outcome complies with all
the objectives

13. Adhering to MCI objectives

At JIPMER we conduct a 30 hour
module for all the 70 PGs on
• research methods
• ethics & professionalism
• evidence based medicine
• journal club presentation skills

Such efforts are much envied but
rarely followed

14. Beyond MCI –
National Board of Examinations (NBE)



provides a common national
standard & mechanism of evaluation
of postgraduates
conducts postgraduate &
postdoctoral examinations in 42
disciplines
awards Diplomate of National Board
(DNB) to those successful in exams

15. Why PGs jostle in DNB stream


Government of India has equated
DNB with corresponding PG degree
(MD/MS) & post doctoral (DM/MCh)
qualifications
Examinees appear from > 230
medical colleges & 370 accredited
institutions
• Broad Specialties (27)
• Super Specialties (16)

16. Post Doctoral Fellowship
in Sub Specialties
• Critical Care Medicine, Trauma Care,
Cardiac Anesthesia,
• Reproductive Medicine, High Risk
Pregnancy & Perinatology
• Vitreo-Retinal Diseases, Pediatric
Ophthalmology
• Pediatric Cardiology, Interventional
Cardiology
• Minimal Access Surgery, Vascular
Surgery, Hand & Micro Surgery, Spine
Surgery

17. Problems in Medical
Education are Global


42% of Ireland's medicos regret their
career choice, compared with a
quarter of both GPs & consultants
They would reject medicine if they
were back at school and asked to
choose again

18. Problems – Indian context


“Blind imitation of Western model
has made our products misfits in
our own society”
‘The painful truth is - a medical
graduate is more at home abroad
than in India’ – Dr Deshpande
• J Postgrad Med 1982;28:181-3

I know super-specialists with DM, MCh
migrating to UK to work as locums

19. Problems – Academic context

Private health care is much more
remunerative than academics, there is
paucity of good teachers
• Myth - Those who can’t, teach others!!!

Allowing private practice in academics is
a “Catch-22 situation”
• “Teachers chase practice. Students and
teaching are inconveniences”

Ind J Medical Ethics.2004:5:123

20. Problems – Academic scam

current trend to offer expensive
private tuition for students
• At present for undergraduates only
• additional income, especially for nonclinical medical teachers

may soon reach proportion of a
major scam
• curricular duty ignored to pressurise
students to join coaching classes

21. Problems in
Educational Technology



Infrastructure is often inadequate
• unpredictable power supply
• may ruin a well-planned activity
Six A’s of availability, affordability,
accessibility, appropriateness, adequacy
& acceptability of resources
Rapid obsolescence is a bugbear of
computer-based technology

22. Problems in
Educational Technology - 2

maintenance of hardware is below
par
• overriding fear of breakdown

The fear leads to a “Catch-22”
situation
• in order to maintain equipment in
working order, keep it always under
lock and key!

23. Problems in Examinations



Mistrust over the fairness of entrance
& final examinations
Obsession with secrecy lack of preor post-validation
Fear of corruption
• medical educators shudder to think of
50% weightage to internal assessment

24. Problems in Examinations

Fatalistic Acceptance of
Unreliable Tools – “Can’t help it”
syndrome
• variations in case-difficulty,
examiner-bias, & subjectivity of
global assessment in
clinical/practical
• most clinical examinations no better
than `Russian Roulette’

25. Problems in National Board
Training



Of the 370 accredited institutions, only a
few have academic ambience & are
equipped to impart effective training
They seek accreditation for prestige & to
get junior doctors to work for a pittance
plight of DNB trainees in several nonteaching hospitals makes sad reading
• www.aippg.net/forum/viewtopic.php?t=1102

26. Problems in Research



Only a few colleges take research seriously
with active research councils
Plagiarism by PGs is a major problem now
Open access initiative is double edged:
• it gives free access to information for
researchers of the world;
• it also makes it very easy to plagiarise
research findings

27. The Way Forward
- Some Suggestions
1. Embrace quality assurance in education
• Adopt ISO-9002 norms for services
2. Galvanise medical educators
• by removing distractions

like unregulated private practice
• and diversions

like excessive research at the cost of
teaching

28. The Way Forward – Suggestions
contd.
3. Adopt competency-based
approach to training & evaluation
• so that those who enter the
profession are competent
• Implement formative and internal
assessment to ensure competencies
not tested in the final exams

29. The Way Forward – Suggestions contd.
4. Usher in examination reforms
• make in relevant, valid, reliable,
unbiased, transparent, accountable and
fair
• Enhance the quality and weightage of
internal assessment.
5. Develop national standards for
summative examinations

30. To Sum Up …





India has the largest technical human
resource pool
Indian Doctors are truly global
Every 7th Doctor in USA is Indian
While quantity is laudable, quality is
not uniform: exemplary to abysmal
We need mechanisms to assure
quality of health human resources