‘NMC move on removing respiratory medicine dept a retrograde step’

As per the recent gazette notification published by the NMC on August 16 this year, the respiratory medicine department has been deleted from the mandatory list for the undergraduate MBBS course curriculum. According to Chapter 1 of the gazette, the number of departments required for a college is 21.

However, three years ago the NMC on October 28, 2020, issued “Minimum Requirements for Annual MBBS Admissions Regulations, 2020” and stated that every medical college and medical institution approved for MBBS admissions would have 24 departments including respiratory medicine.

Later on June 23 this year the UG Medical Education Board of NMC sought comments on the draft regulation of the minimum standard requirements for the establishment of new medical colleges/increase of seats in MBBS course regulations 2023. In the original draft, the respiratory medicine department was included in the list of 24 departments that each approved college/medical institution should have. However, when the final draft was released in the gazette on August 16 the department of respiratory medicine was excluded. Two other departments were also removed.

The latest move has not only puzzled many but also is being viewed as a letdown and across government medical colleges, experts have written to the NMC for clarity. Dr Radha Munje, Head of the Department of Respiratory Medicine, Indira Gandhi Government Medical College, Nagpur, told The Indian Express that post-pandemic they were expecting an increase in training of students in respiratory medicine so that they are equipped to tackle respiratory diseases. “However, we are clueless as to why this department has been left out,” Dr Munje said.

Dr Avinash Lamb, Professor and Head of Department of Respiratory Medicine, Government Medical College, Aurangabad, added, “More than 25 per cent cases of TB are diagnosed at medical colleges and without this respiratory medicine department it is a big question as to how we are going to eliminate TB under the National TB Elimination Programme – especially within the 2025 target.”

According to Dr Sanjay Gaikwad, Professor and Head of Respiratory Medicine Department, B J Government Medical College and operational research chairperson for National TB Elimination programme – West zone, a respiratory medicine department has been there since the foundation of the college and during the Covid pandemic, the core critical ones were general, respiratory and anaesthesia departments. “Even now undergraduate students in second and third year of MBBS have lectures and tutorials in respiratory medicine. So clearly I cannot understand why this department has been dropped,” Dr Gaikwad said.

Dr K P Venugopal; Head of the Respiratory Medicine Department, Government Medical College, Kottayam, too pointed out that TB remains a persistent health concern and the urgency of prioritizing education and training in respiratory medicine becomes evident considering grim statistics.

“The removal of respiratory medicine in the recent national medical commission gazette is a regressive step that carries the potential to detrimentally impact the knowledge and skills that are crucial for MBBS students. Every MBBS student who passes out must have adequate knowledge and skill to diagnose and treat patients of at least some of the basic and common respiratory diseases. This can only happen with the inclusion of respiratory medicine as an important and necessary specialty for undergraduate MBBS training in India,” Dr Sundeep Salvi, president of The Indian Chest Society, told The Indian Express.

“The Covid-19 pandemic has taught us the importance of the lung and how every primary care physician in India must be well versed with diagnosing and managing common respiratory diseases,” Dr Salvi said. In their letter to Mandaviya, it added that removing the respiratory medicine department as a non-essential department for undergraduate medical training will be a disaster for millions of patients suffering from chronic respiratory diseases.

Doctors have cited recent studies conducted in India across all the states and Union Territories that showed among 2.5 lakh patients more than 50% of patients visiting a primary care doctor in India do so for respiratory problems. The Global Burden of Disease Report spearheaded by the Ministry of Health and Family Welfare has also reported Chronic Obstructive Pulmonary Disease (COPD) as the second leading cause of death and suffering in India. More than 95% of the patients do not get a proper diagnosis and treatment in India. Moreover, India alone contributes to 43% of global asthma deaths because of poor quality care offered by primary care physicians. “This is only the tip of the iceberg,” says Salvi.

Despite repeated attempts, NMC officials were unavailable for comment.

Union Health Ministry officials were not available for comment.