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INVITED COMMENTARY
Year : 2018  |  Volume : 4  |  Issue : 1  |  Page : 1-3

National Medical Commission Bill: A Note for Consideration by the Parliamentary Standing Committee


Formely, Professor & Head, Department of Surgery, University College of Medical Sciences (University of Delhi), Delhi, India

Date of Web Publication27-Mar-2018

Correspondence Address:
V. R Minocha
20 A, S.D.F., Sector 15 A, Noida 201301, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mamcjms.mamcjms_8_18

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How to cite this article:
Minocha VR. National Medical Commission Bill: A Note for Consideration by the Parliamentary Standing Committee. MAMC J Med Sci 2018;4:1-3

How to cite this URL:
Minocha VR. National Medical Commission Bill: A Note for Consideration by the Parliamentary Standing Committee. MAMC J Med Sci [serial online] 2018 [cited 2018 Jun 20];4:1-3. Available from: http://www.mamcjms.in/text.asp?2018/4/1/1/228660



The National Medical Commission is bill being introduced by the Government of India, to provide for a medical education system that ensures availability of adequate and high quality medical professionals; that encourages medical professionals to adopt latest medical research in their work and to contribute to research; that has an objective periodic assessment of medical institutions and facilitates maintenance of a medical register for India and enforces high ethical standards in all aspects of medical services; that is flexible to adapt to changing needs and has an effective grievance redressal mechanism and for matters connected therewith or incidental thereto.[1]

Due to large scale demonstrations in the country by doctors and medical associations, the bill has now been referred to the Parliamentary Standing Committee.

Hopefully the deliberations in the Standing Committee will offer amendments to make the National Medical Commission Bill more effective and meaningful. The following are a few observations for consideration by the Standing Committee:

The bill envisages supervisory and regulatory role to both medical education and medical care as was the practice followed by the Medical Council of India and which may merit review. Although related, there are different concerns and challenges in medical education and medical care and deserve undivided attention by the Regulatory Body.[2] Therefore, it is suggested that the National Medical Commission may be subdivided into the National Medical Education Commission (NMEC) and the National Commission for Medical Care and Ethical Conduct (NCMCEC). The NMEC may incorporate two Autonomous Boards namely the Under-Graduate Medical Education Board and the Post-Graduate Medical Education Board. The Ethics and Medical Registration Board may be assigned to NCMCEC. The responsibility of assessment and the rating of institutions may continue to be with relevant autonomous National Assessment and Accreditation Council. If so desired, accreditation may be made mandatory.

A degree awarded by an authorized university/institution must remain valid for the inclusion of name in the medical register and for carrying on with the medical practice. The introduction of Licentiate Examination is completely uncalled for and is a retrograde step undermining the role of the undergraduate (UG) board and universities/institutions awarding the medical degrees. Opinion among the educationists is in favor of strengthening continuous assessment and depend less on end-of-course examination. The intention of Licentiate Examination appears to weed out graduates with suboptimal level from medical practice. This intention is better served by improving the examination system. A possibility may be explored to provide an exit route for an underperforming student instead of giving grace marks and declaring her/him pass for the award of MBBS degree, thereby entitling to medical practice. A provision may be made to award a degree that should not be sufficient for practice. The nomenclature of such degree will have to be determined.

An initiative of common entrance examination for postgraduate (PG) courses may serve a limited purpose of reducing the stress of multiple examinations and the hassle of travel. However, adequate care needs to be taken to avoid interference with regular pedagogic and internship program. Further, it needs to be appreciated that the entrance examination should be aimed at providing a scatter of competing candidates so as to reduce overlapping in the merit list. Such an examination should have less emphasis on the “must know” components of the curriculum. As a corollary, there is no minimum pass marks and no one fails by virtue of this examination as “pass/fail” evaluation is a part of qualifying examination. The inclusion of PG admissions by Licentiate Examination is self-contradictory. In addition, the inclusion of the assessment of skills is redundant and an unnecessary duplication, because it is a part of the UG curriculum, which is the qualifying requirement. The philosophy of admission to PG courses by entrance examination probably merits to be revisited. It is hoped that the restructured Medical Commission will address the issue and explore other objective methods of admissions.

It is appreciated that Diplomate of National Board of Examination will be treated at par with degrees awarded by universities and institutions for all purposes. In this context, NBE may be treated as “Deemed to be University,” and the Commission may exercise regulatory role as for other institutions.

Medical education is a “public good” activity, and the Government must remain committed to provide facilities and financial support for medical education. The utilization of the facilities of “nonteaching hospitals,” which have adequate patient volume for teaching purposes, particularly PG courses, is a practical way of economizing. However, the supplementation of infrastructure and other facilities required for the teaching purposes has to be ensured. One major important requirement is the appointment of medical teachers. The practice of awarding teaching designations to the existing staff is erroneous and is in effect circumventing the requirement of teaching staff. Unfortunately, the practice is not limited to private medical colleges but is also seen in government establishments. This practice must stop. Those among the existing staff interested in moving to teaching side may be considered by the relevant selection process, but there should not be an automatic grant of designation in exchange for the hospital facilities. This practice jeopardizes the career prospects of regular teaching staff. Needless to emphasize, teaching faculty is an essential component of medical education. In addition, Medical Commission is the right forum to address their interests.

One of the major iLLs facing medical establishment is commercializing arising from the privatization of medical education notwithstanding a number of private medical colleges providing excellent education. The problem faced by private institutions is the high cost of infrastructure (land alone probably needs Rs. 500 crores), thereby expecting the beneficiaries, the students, to bear the burden in the form of capitation and/or hefty fees. This results in a cascading effect; the students who have paid heavy amount will try to recover the investment by fair/unfair means. The students on higher merit are denied or rather do not seek admission because of financial constrains. This must stop. The Government and the Medical Commission cannot be mere mute spectators.

As an alternative, a different strategy may be explored. The Government may acquire the land in public interest and allot it to intending suitable organization, of course after due careful scrutiny, on lease for a nominal charge; provide grant-in-aid for building and equipment; permit receiving donations/foreign aid/investment; utilize funds under corporate social responsibility, etc. Admissions to all medical colleges must be on the basis of merit with no management quota. Students with financial constrains should be provided scholarships and fee exemption. The Government should be a part of management. Fee structure may be prescribed on a sliding scale linked to paying capacity. However, all admissions must be made as per merit.

One issue that merits attention is the relatively low status to basic degree (MBBS) holders in the health system, and there is overemphasis on the PG degree, with the result that everyone wants to join any whatsoever PG course. It is worth examining, and the Medical Commission is the right forum to do so, whether wide disparities in terms of job opportunities, promotion, financial compensation, etc. between MBBS degree holders and PG degree holders can be reduced. A structured course for reinforcing wide-spectrum general practice may be useful and is being offered at some institutions. Such an option may encourage graduates to remain focused in most needed activity and reduce the craze for PG degrees.

The disciplines referred to as “superspecialties” are in effect at par with other specialties. The preferential consideration to superspecialties needs to be corrected.

There is a provision in the bill for the joint sitting of Commission, Central Councils of Homeopathy, and Indian Medicine to enhance interface between their respective systems of medicine. This is aimed at introducing a bridge course for the practioners of homeopathy and the Indian systems to enable them to prescribe such modern medicines at such levels as may be prescribed. Mixing of Ayush with modern medicine is not an evidence-based medicine. This is most unfortunate and will dilute the status of modern medicine, which NMC is supposed to uphold. Probably the move may also not be in the best interest of Ayush as an independent discipline in its own right.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.


  Editorial Note Top


While welcoming the short commentary on the controversial Bill expressing personal views of the author, I have the following observations to be recorded to emphasize some of the concerns of medical teachers in medical colleges in the country:

Introduction of a new licentiate examination would be rechristening of the currently held NEET- PG examination, which leads to students ignoring their routine teaching in college hours and their practical training course during one year rotatory internship. This would not help the cause, whereas what is required is strengthening of the college education and a score generated on the basis of their performance during the five and half years. It is desirable to consider a unified examination in the country at the end of 2nd, 5th, 7th and 9th semesters to generate a score gained for each step and finally add it to the last (fifth score) examination at the end of their practical internship, which gives then a single total score to decide their national ranking. This would then form the basis of gaining entry to the postgraduate examination. The modalities for fair conduct of these 5 stages of examinations would need to be discussed and deliberated upon to make them objectively implementable.

The current decision of the Medical Council of India of increasing postgraduate seats by doubling or tripling the number of students for each professor needs to be reviewed. The student-teacher ratio is based upon the optimum training that can satisfactorily be provided to the postgraduate students in terms of hands-on clinical training. It is for this reason that stringent ratio was set up and countries in the west continue to do so. However, the need for specialised doctors has somewhere motivated the government authorities to increase the intake of students by doubling the ratio and now has tripled it. This has happened without any augmentation of infra-structure, thereby adversely affecting hands-on training. This needs to be corrected by the NMC balancing the justified increase in post graduate seats without compromising training.

The concept of everything mentioned as super-specialities needs to be toned down to consider them as branches emanating from the principle subject and therefore, should be referred to as sub-specialities. This would then make the training and qualification to be given the correct perspective.

The prerogative for making doctors as medical teachers qualifiable for teaching jobs should rest with the medical colleges and medical universities and not with the National Board of Examination accredited institutions as majority of these are working in the private sector whose scope is beyond teaching, training and research due to several limitations. Doctors with Diplomate of National Board qualifications can be excellent clinicians, but may not be expected to start as teachers in a medical college, as their institutions providing such training are not geared for this role.

Instead of bringing new All India Institute of Medical Sciences (AIIMS), which is time consuming investment with struggle to fill up posts and vacancies, the bill can consider upgrading one medical college in every state/UT of India to AIIMS. That way 30 new AIIMS would come up in largest medical college of each state with bigger investment, better infrastructure, better salaries and better care. At present, the current posts in AIIMS are being filled up by movement of teachers and other categories of staff from central/state medical colleges thereby affecting those institutions seriously.

Dr. Pawanindra Lal

Director Professor of Surgery, MAMC & Editor-in-Chief, MAMCJMS







 
  References Top

1.
2.
Minocha VR. Controversies in Medical Education: National Medical Commission (A Draft Bill for Replacing Medical Council of India). MAMC J Med Sci 2017;3:3-5.  Back to cited text no. 2
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