MCI NEW REGULATIONS

REMEMBER THESE R JUST PROPOSALS BY MCI; NOT YET APPROVED

A pill to improve medical education

RAISING THE STANDARDS:

The Board of Governors of the Medical Council of India has proposed major changes in the undergraduate curriculum to help nurture medical professionals with a set of competencies.

The Medical Council of India (MCI) has proposed major changes in the undergraduate curriculum and training aimed at meeting the twin demand of having more graduates and maintaining the quality of education. The Board of Governors of the MCI has recommended creation of an “Indian Medical Graduate,” who will have necessary competence to assume his or her role as a health care provider. MCI also hopes that the ‘Indian Medical Graduate' will, at the time of graduation, effectively fulfill the roles of clinician, leader, communicator and life-long learner, and be a professional with a set of competencies.

The ‘Indian Medical Graduate' will have to pass an exit exam or a licentiate examination after an internship to get licence to practice anywhere in the country.

The national-level exit exam is expected to set a standard for doctors. The MCI also proposes to introduce the National Eligibility-cum-Entrance Test from 2012. The licentiate system, if approved, would be optional between 2012 and 2016, but mandatory thereon.

The MCI has proposed to start a two-month foundation course after admission to MBBS course to prepare students to study medicine effectively.

This would help in orienting students to national health scenarios, medical ethics, health economics, learning skills and communication, life support, biohazard and environment safety.

The new curriculum has been structured to facilitate horizontal and vertical integration between disciplines and bridge the gaps between theory and practice. In the first year, focus would be on basic and laboratory sciences, while in the second and third years, focus would be on clinical exposure and learning. Clinical training would start in the first year and there would be more focus on common problems seen in outpatients and emergency settings.

Importantly, an ‘elective' subject has been added to the ‘core' subjects to allow flexible learning options in the curriculum and the options include clinical electives, laboratory postings and or community exposure in areas that students were not normally exposed to as part of the regular curriculum. The restructured curriculum would emphasise on clinical exposure, integration of basic and clinical sciences, clinical competence and skills and new teaching-learning methodologies that would lead to a new generation of graduates of global standards.

A new two-year Master of Medicine (M. Med.) programme is also proposed with focus on skill development. Degree holders will be eligible to teach undergraduate courses. There will be no competitive exam for this course and the assessment will be based on the student's performance during the course and the national exit exam.

M. Med, students would have the option of pursuing one of the five doctorate streams depending on the aptitude and professional aspirations. After M.Med., the graduates would be able to compete for Doctor of Medicine or Master of Surgery or other dual programmes .

An additional weightage of 5 per cent would be given to candidates for putting in six months of intensive rural service during the M.Med. course.

The two-year course can be pursued after finishing the MBBS course; one more year of study will lead to MD degree for candidates. A candidate would get dual degrees after four years and he or she has a choice to go on a fellowship programme or a Ph.D. programme. The MCI is also considering a proposal to shorten the MBBS course to four years from four-and-a-half years.

The Board of Governors of the Medical Council of India (MCI) has proposed major changes in the undergraduate curriculum and training programme that would create an “Indian Medical Graduate,” who will have necessary competence to assume his or her role as a healthcare provider.

The “Indian Medical Graduate” will have to pass an exit exam or a licentiate examination after an internship to get licence to practise anywhere in the country. The national-level exit exam is expected to set a standard for doctors. The MCI also proposes to introduce the National Eligibility-cum-Entrance Test from 2012.

A new two-year Master of Medicine (M. Med) programme is also proposed with focus on skill development. Degree holders will be eligible to teach undergraduate courses. There will be no competitive exam for this course and the assessment will be based on the student's performance during the course and the national exit exam.

The restructured curriculum laid emphasis on clinical exposure, integration of basic and clinical sciences, clinical competence and skills and new teaching-learning methodologies that would lead to a new generation of graduates of global standards, Dr. S.K. Sarin, Chairperson, Board of Governors of the MCI, said here on Tuesday, after a day-long national meet on “Implementation of Reforms in Undergraduate and Postgraduate Medical Education” where the proposed reforms were adopted.

The proposals will have to be approved by the Ministry of Health and Family Welfare before their implementation in 2012.

The licentiate system, if approved, would be optional between 2012 and 2016, but mandatory thereon, Dr. Sarin said. While the duration of the undergraduate course would remain five-and-half-years, a two-month Foundation Course after admission to prepare a student to study medicine effectively is proposed. This would help in orienting students to national health scenarios, medical ethics, health economics, learning skills and communication, life support, biohazard and environment safety.

The new curriculum had been structured to facilitate horizontal and vertical integration between disciplines and bridge the gaps between theory and practice. In the first year, focus would be on basic and laboratory sciences (integrated with their clinical relevance), while in the second and third years, focus would be on clinical exposure and learning. Clinical training would start in the first year and there would be more focus on common problems seen in outpatients and emergency settings.

Importantly, an ‘elective' subject had been added to the ‘core' subjects to allow flexible learning options in the curriculum and the options include clinical electives, laboratory postings and or community exposure in areas that students were not normally exposed to as part of the regular curriculum.

The post-graduate specialisation would essentially involve a research component and prepare this group of specialists to pursue the academic stream.

Dr. Sarin said that after M. Med, students would have the option of pursuing one of the five doctorate streams depending on the aptitude and professional aspirations. After M. Med, the graduates would be able to compete for Doctor of Medicine or Master of Surgery or other dual programmes (MD-PhD, MHA, MD-DM and MD-fellowships).

An additional weightage of 5 per cent would be given to candidates for putting in six months of intensive rural service during the M. Med course. The duration after finishing MBBS course would be M. Med (2 years); one more year will get candidate an MD degree. Candidate would get dual degrees after four years and he or she has a choice to go on a fellowship programme or a Ph D programme or a DM degree in five years.

 All-India MBBS entrance from next year

MCI keen on revamping medical education in the country, says Kurnool Medial College Principal

The all-India entrance to MBBS would come into force in 2012, said Bhavani Prasad, Principal of Kurnool Medical College.

Dr. Prasad, who attended a national-level conference of medical college principals sponsored by the Medical Council of India at New Delhi on March 29, said the council was keen on revamping medical education in the country by introducing a uniform syllabus and teaching methods.

Uniform syllabus

Medical colleges across the country would follow the syllabus framed by the Medical Council of India.

Also, the Medical Council of India noticed that the house surgeon training failed to produce the desired results as students were more interested in preparing for the post-graduate entrance examination during the period.

To avoid the clash, the Medical Council of India has suggested PG entrance soon after the MBBS examination and house surgeon training later.

After 2017, a final examination would be held after internship as house surgeon and the marks would be counted to the ranking for PG admissions.

To further rationalise and restructure the PG courses, the MCI has proposed introduction of a two-year master's degree course in various disciplines in place of diplomas and in case of diploma holders seeking to attend MD course, only one year additional training would be needed as the master's course would deem to be part of the MD course.

Reduction in course

The MD course would be reduced from three to two years. The rationalisation is expected to train more hands for teaching.

Also, unlike in the past, the theoretical and clinical teaching would go hand in hand. When anatomy of heart was taught, heart diseases would also be dealt with simultaneously.

Moreover, the students would be given exposure to primary health centres during the course so that they would be well-versed with the basic diseases.

Every MBBS student has to attend a two-month foundation course before starting the medical course by undergoing orientation in computers and other subjects.

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·  Uniform syllabus and teaching methods to be introduced in medical colleges across country

·  MD to be reduced from three to two years, rationalisation expected to strengthen teaching

Family medicine & medical education reform

Recent events in our country have been full of sound and fury, which have disillusioned the public with their futility. But this week has the potential for promising developments in Indian medical education which, in turn, could have far-reaching beneficial consequences for health care in India. The Board of Governors of the Medical Council of India (MCI) has been continuously refining its proposals for major reforms in undergraduate medical education. These are to be discussed today with the State Directors of Medical Education and the Vice-Chancellors of universities, who together are the CEOs in this field of education.

The Board has been hard at work on these proposals for some months, with the aid of a designated Working Group for Undergraduate Medical Education. This Working Group, in turn, has been holding wide and sustained consultations with scores of expert groups, which have resulted in a general consensus that major changes are overdue and must occur expeditiously. Thus this week could be a rare, opportune and pregnant moment in the troubled history of regulation of medical education in India. The nation has a vital stake in ensuring that the emerging paradigm shift does not miss out on what medical education can and should do to overcome the inadequacies and inequities in our health care system. And to take our country to the happy consummation of quality assured and universal health care. There should not be a slip between the cup and the lip.

It is important to recognise the special potential and limitations of the present Board of Governors of the MCI, inherent in its origins. The long simmering discontent with the inefficiency and improprieties of the MCI finally erupted when, in April last year, its president was arrested on charges of corruption. The government moved quickly, in May 2011, to issue an ordinance entrusting the considerable powers of the elephantine Council to a small group of six nominated Governors. They were chosen with commendable care, both for their eminence in the profession and their reputation for integrity. In August, Parliament gave its assent to the provisions of the ordinance, but only for a one-year term ending in May 2011.

Thus, on the one hand, for the first time, a small body of reputed experts has the power and, indeed, the mandate to rectify the perceived wrongs of the MCI. They have recognised the need to move quickly on many other fronts as well such as shortage of medical manpower, quality of medical education, shortage of faculty in medical colleges, deficiencies in postgraduate training and so on. The issue of the short period of their trusteeship has now been resolved by extending their term to May 2012.

New medical graduate

Thus the MCI and the Health Ministry together are in a position to consummate this long process of gestation and produce a new Indian medical graduate. And hence the need and urgency to raise in the public domain one crucial aspect of reform of medical education which may not receive the priority it deserves. In spite of the danger of over simplification, the argument here can be stated briefly.

(1) It is generally agreed that the major challenge in health care is in ensuring sound and competent basic health care to the disadvantaged communities, both rural and urban. Indeed, it is an every day experience that even for those who can afford it, dependable and quality assured basic care is a very rare commodity.

(2) This type of care is non-specialised, has to address all common and urgent medical conditions, with limited laboratory and other facilities. It should ensure continuity of care for all members of the family, of all ages. It is mainly ambulatory. And it must include disease prevention and promotion of health, in the family and the community.

(3) Obviously this is not the kind of care that medical students are now exposed to in the so-called teaching hospitals. It is a different kind of clinical practice, usually referred to as Family Medicine (or family practice, though the former is a better term). This can be taught only through a significant exposure to secondary and primary levels of care, the lack of which is the foremost deficiency in Indian medical education today.

(4) Unless and until this component is introduced as a required part of the undergraduate course, India will never be able to solve the lack of competent, well trained, basic doctors in our primary and secondary level health clinics and hospitals. Without this, the proposed new medical graduate will not be the basic doctor who forms the backbone of a sound health care system all over the world and which India sorely needs.

The logic of this is such that a high powered “Retreat” of the Health Ministry on September 28 and 29, 2010 expressed its approval as follows: “Request the MCI to address the issue of curriculum change to make doctors more sensitive to primary health care. Subjects such as Family Medicine need to be given importance.”

But there are many difficulties in this proposal which might result in its being put aside for the present. Health issues have never been a powerful element in our political discourse. They have never been a decisive factor in the elections, unlike in Britain or the U.S. So there is no great incentive for political parties to reflect on or act decisively on the societal responsibilities of medical education.

Electorate easily pacified

In the public perception, sound medical care is equal to access to particular medical interventions and publicised advances in medical care. The electorate is more easily pacified by the offer of medical insurance of the type instituted recently in the southern States. The move suggested above requires the creation of a speciality which hardly exists now. This discipline has to work in close coordination for the State health care system whereas the MCI works at a national level.

Family Medicine is not a field of medical practice that readily attracts the private sector or professionals who make their career decisions based on socio-economic rewards. And, therefore, at this moment in the formulation of the reforms in medical education, there is a special need for all the custodians of Indian medical education, especially the Ministry of Health, to act on behalf of the public to ensure the following:

About 20 to 25 per cent of clinical training, during the “clinical” phase of MBBS, should occur outside the teaching hospitals, at the primary/secondary levels.

Since this is quite different from tertiary care, new departments of Family Medicine should be established in all medical colleges to implement the above.

Either by arrangement with the State health care system or on their own, medical colleges must have sufficient clinical services at the primary/secondary levels to implement the above two. The outlay required for these, in faculty and infrastructure, is minor compared to the prevailing requirements for medical colleges.

There is a tide in the affairs of men. This week has the possibility of a tide which, taken at the flood, could lead to better health for all of us. “Omitted, all the voyage of their life is bound in shallows and in miseries.”