Disoriented medical education

Are our doctors technically competent, socially sensitive, ethically correct and morally incorruptible? My answer is Yes and No. Medical education in India is focused on curative, infective and non-communicable diseases and with little focus on preventive and promotive health. It ignores the diversity of medical practice.

An exploding number of medical colleges, devaluation of merit in admissions, increasing capitation fees; admission of poor quality of students with poor motivation; shortage of medical teachers, ill-trained teachers; shortage of patients and poor clinical material; and poor internship supervision have all contributed to this downhill trend.

Between 1970 and 2005, the number of private colleges multiplied by a staggering 1,120%. Private medical colleges now account for more than 50% of all available admission seats. In 1970, they accounted for only 11%. Now, there are more than 500 medical colleges in India, but these numbers do not align with the quality of medical care in the country.

It is a matter of pride that our institutions have produced many world-class physicians, and most of them are abroad. Few are returning to corporate hospitals these days, but not into medical education. It is a shame that medical graduates from India lose their practicing rights more than any other foreign-studied doctor in foreign countries.

Medical institutions and their faculties are, indeed, the proverbial ivory towers preparing students for certain high, obscure, ill-defined and allegedly international “academic standards” and for dimly perceived requirements of the 21st century. The current medical education system is contributing to “widening disparities in India in health delivery and between rural and urban sectors.” The planning commission estimates that there is a shortfall of 6,00,000 doctors as of now.

There is a high demand for medical seats. In 2017, there were more than 11 lakh aspirants for 55,000 MBBS seats in India. The method of selection of doctors-to-be is not transparent. True knowledge is seldom assessed. A unidirectional path for career progression toward specialties and subspecialties and migration to greener pastures has an extremely detrimental effect on healthcare.

The WHO published a detailed study on the Indian health workforce in June 2016. The report says that 57.3% of practising allopathic doctors in India did not have any medical qualification whatsoever, and 31.4% were educated only up to the secondary level. More than 70% of healthcare providers in rural India have no formal medical training. The implications are mortifying.

Probably, we are the only country in the world where medical seats are auctioned and the process stands approved by the government. The quality of private medical colleges is pathetic with a few honourable exceptions. The market has been flooded with doctors so poorly trained, they are little better than the white coats they wear!

The existing evaluation system has become obsolete. In medical education, we have to evolve the indicators for a continuous objective observation and assessment of each student by his own faculty, instead of conducting a summative evaluation at specific intervals.

Objective structured clinical exams are used to test the competency of medical students. The examination system often overlooks clinical skills. There is no integration of basic and advanced sciences as the subjects are taught in isolation. Most of the students have inadequate clinical exposure. But, problem-based and evidence-based learning, preventive and promotive approaches should be the hallmark of the curriculum.

The Medical Council of India, rather than being a competent regulator, has become a powerful rationing authority. Colleges without adequate infrastructure get accreditation. Many colleges have become factories that produce money minded white coats instead of efficient doctors. The patient-load is poor with bed occupancy being far less than 50%. According to the MCI, seven beds are required to train a student.

There is a 30–40% shortage of medical teachers in India, leading to unhealthy practices at the time of MCI inspections. Currently, there is an estimated need for an additional 26,000 full-time faculty. Besides, no training is provided to teachers. The lower salary ensures that only the poorest talent is available.

Maintain educational standards equivalent to those of AIIMS. Focus on preventive and promotive health. Re-orient the curriculum. Clinically relevant medical education, use of new technology, lifelong learning attitude are the priority. Use a hands-on approach to patient management. Provide intensely supervised internship and evidence-based approach to treat patients.

Ensure insight into research in clinical, pre and para-clinical disciplines. There should be a shift from passive to active learning, expanding programmes for faculty development and benchmarking for assessment, to move forward.

(The writer is former director, Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru)