Opinion Higher and higher
The first step to reforming medical education: more seats for postgraduate,super-speciality degrees...
The recent decision of the Ministry of Health and Family Welfare to increase postgraduate (PG) seats in medicine,surgery and allied disciplines is a welcome step and must have delighted many young graduates. The MD and the MS have become minimum qualifications for recognition in the medical profession; yet over 30,000 graduates get an MBBS every year,and only approximately 15,000 PG seats exist. With more medical colleges in the pipeline,this gap is going to widen further. This growing imbalance between undergraduate and postgraduate seats is a matter of serious concern. Top students,in general,are now opting for engineering,commerce or management courses because of better opportunities.
The lack of good teachers and of infrastructure in medical colleges is a major impediment to immediately increasing MD/MS seats. This means that we need to explore various options to narrow this gap quickly.
First,we should motivate our brain drain professionals settled in Europe and America to come back and join various medical colleges/institutes. Countries like China have done this. To attract them we need to change our approach towards recruitment: they may be offered positions based on their bio-data and professional eminence rather than asking them to apply through the conventional route. Talent-searching is the accepted norm in all other professions and medicine should be no exception.
Then AIIMS/PGI-like institutions should be linked with adjoining medical colleges to strengthen their training programmes. The faculty from these institutes can periodically go as visiting faculty to these colleges and contribute to the strengthening of educational and training programmes. The faculty from the medical colleges should also go to these institutes for variable periods for upgrading their knowledge and skills.
The National Academy of Medical Sciences has a programme to fund the travel expenses of senior,Emeritus Fellows to periodically visit medical colleges by invitation to strengthen teaching and training programmes. Not many colleges are making use of this opportunity. This may help to provide additional expertise for training more postgraduate students.
Strengthening of telemedicine facilities to use tele-education from training programmes is also required. The National Knowledge Network,being established by the office of the principal scientific advisor to the PM,will help tremendously in spreading higher education.
The ministry is now aggressively pursuing seven to eight new AIIMS-like institutes. The PM has emphasised that human knowledge is growing at an unprecedented pace and if our institutes have to keep pace,we have to be on the frontier of higher education,specifically medical education. These new institutes need to initiate their journey in this spirit. The main focus should be on postgraduate and super-specialty training to expand postgraduate training programmes,and to produce more teachers and leaders in medicine to fulfill the need of medical colleges. The number of undergraduate seats should be kept to the minimum.
A genuine concern voiced by policy-makers is: if every student gets MD/MS,who will go to the rural health centres? Ensuring there are doctors there has been a major challenge for the government. This has even forced the health ministry to consider starting a Bachelor of Rural Medicine and Surgery course. (The merits and demerits of this course have been a subject of much discussion.) The ministry has also approved a scheme to give incentive marks for admission to MD/MS courses to those who serve in primary health centres for 1-2 years. Doctors who dont get into the MD/MS might join rural health centres to improve their chances for admission. But we need to think of some other alternatives.
Compulsory,short rural postings for all medical graduates have been considered. One wonders why there is reluctance to initiate this scheme. This will help familiarise young graduates with Indias environment/medical needs. There are over 600 districts in the country with health and community centres. Each year,approximately more than 30,000 graduates pass out. Over a few years we should have doctors in all health centres,if this is implemented. Certainly,young graduates will resent this approach; the government needs to take steps to make this period educative and attractive to allay their fears. There should be mentorship by seniors (from district hospitals/medical colleges) during the period,and decent facilities to live and practice. Further,these health centres should be integrated with the community,district-level centres and even with medical colleges. The lack of coordination at different levels has been a major drawback in our health services.
Of course,after this period there should be a guarantee to enter PG training programmes. Thus this will require steps to increase PG seats at the earliest.
The medical profession is being perceived as an industry by stakeholders and even some professionals. This has eroded public confidence in a profession always held in high esteem. We professionals have to blame ourselves for fuelling this mistrust. Timely reform in medical education will improve quality,and may help reduce unethical practices.
The writer is director of Postgraduate Institute of Medical Education and Research,Chandigarh
Share
