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The declining standards of medical education coupled with poor health service delivery continue to be major national concerns. The conditions of primary health centres (PHCs), community health centres (CHCs) and district hospitals, is dismal. About 30 per cent of PHCs are without doctors and nearly 70 per cent of specialist positions in CHCs are vacant. Though India has experts, most of them choose not to work in government hospitals. This results in a highly skewed distribution of healthcare services in favour of a small and relatively affluent segment of the population.
India stands, I believe, at a crossroad insofar as its medical education and healthcare system are concerned, and we must take diffiuclt decisions if things are to improve. A mere increase in the number of medical professionals without maintaining, if not improving, quality is a waste of resources. It is often said that having a bad doctor is worse than having no doctor. The quality of medical professionals has declined for various reasons, including the increasing disinterest of our brightest to opt for the profession and the lack of adequate and modern facilities. Other factors also contribute, such as the flawed admission process that is followed in most private medical colleges, where merit is no longer the criterion for admission. Private colleges have other shortcomings such as a shortage of clinical material. Teaching faculty is also in short supply.
What is the way forward? A multi-pronged strategy would have to be adopted. A common entrance test to ensure admission on the basis of merit will help attract meritorious students and avoid unfair admission practices. The National Eligibility and Entrance Test (NEET) was initiated with this objective. While the decision of the apex court to reject it was a setback, the court has subsequently agreed to review its decision.
We also need to consider alternatives to compensate for the lack of adequate teaching faculty. Strengthening telemedicine facilities and using tele-education for training programmes will help. The National Knowledge Network being established by the principal scientific advisor’s office has linked many colleges. This will help in spreading higher education and address the paucity of good teachers. We should also consider appointing adjunct faculty in colleges.
The adoption of a new and updated curriculum of education is also the need of the hour. At present, undergraduate medical education focuses more on theoretical aspects rather than imparting practical skills. An expert group was set up by the Medical Council of India (MCI) to prepare a new curriculum for undergraduate students. This group has already submitted a fully revised curriculum which focuses on integrating clinical and basic training. This should be adopted.
Postgraduate education calls for other steps. The MD/ MS degree is the minimum continued…