Have equal seats in UG & PG in medicine by 2025: Health Panel

NEW DELHI: According to an assessment of the health sector and medical education in India, about a third of all MBBS graduates do not participate in delivering health services but prepare for entrance exams for postgraduate courses.

Plus, the present MBBS training “is not adequate enough to practice medicine and surgery”, says the 2019 report of a “High Level Group on Health” constituted by the Fifteenth Finance Commission. The report and its recommendations were made public recently. Apart from policy changes for the health sector in general, the report has recommended several changes for medical education, including increasing the seats and infrastructure for postgraduate education and restoring PG diploma programmes.

The high level group included the following doctors: Randeep Guleria, director of All India Institute of Medical Sciences, or AIIMS, in New Delhi; Devi Shetty of Narayana Health City in Bangalore; Deelip Govind Mhaisekar, Vice-Chancellor of Maharashtra University of Health Sciences in Pune; Naresh Trehan of Medanta City in Gurgaon; Bhabatosh Biswar of RG Kar Medical College in Kolkata and K Srinath Reddy, president, Public Health Foundation of India.

Restructure MBBS curriculum

The group stated in their report that "MBBS training is not adequate enough to practice medicine and surgery".

The report says MBBS doctors play a "limited role" in health care because "they cannot conduct basic surgical procedures and administer anaesthesia or perform ultrasonography at community health centre level".

The committee has suggested restructuring of the MBBS curriculum - revised just last year – to make it "competency based". It must allow for a "certain degree of specialisation" and the Medical Council of India which regulates medical education, must be asked to develop courses on "wellness clinic, basic surgical procedures, anaesthesia, obstetrics and gynaecology, eye, ENT etc. and encourage AYUSH as an elective subject for generating awareness." AYUSH represents parallel disciplines in medicine and healthcare including Ayurveda, Yoga, Naturopathy, Unani, Siddha and Homeopathy.

The report supports have an exit exam, to be written after the course is over. The National Medical Commission Act 2019 already provides for this. "Special boards" under Medical Council of India or National Medical Commission have been recommended.

Medical colleges and PG

Undergraduate teaching of medicine must be imparted in medical colleges with "residential campuses having amenities for student development" as the profession apparently requires a greater measure of "character building" than others.

The report endorses joint ventures between "two-three partners" to set up medical education facilities and recommends that private medical colleges be given tax breaks but subject to the performance of their students in the outcome evaluation. It also states that "clinicians practising in private hospitals can assume the role of the medical teachers for undergraduate medical teaching."

The report says there is a need to fill up "the gap in human resource for health" and states that "almost a third of MBBS graduates are engaged in preparing for PG entrance exams and not contributing to health delivery system". To ease the pressure and make admission to PG less competitive, it has suggested that the "number of undergraduate (UG) and postgraduate (PG) medical seats may be made equal by ...2025."

It says: "Each medicine undergraduate should have the option of pursuing postgraduate medical education" and that regulators must "restore the posgraduate diploma progam[mes] and majority of the seat[s] should go to in-service candidates".

The report also suggests that the government "enhance the involvement of private pracitioner[s] in public sector hospitals". Plus, medical colleges must be established at "regional levels" and they can "optimally utilise the resources...available with district hospitals in the region."

The Centre’s policy think-tank NITI Aayog already has a proposal for this but in it, private medical colleges are linked to district hospitals. The proposal has been criticised widely by doctors, public health experts and academics.

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