Context: In a significant step towards affordable medical education, the National Medical Commission has notified its first major regulation. Titled as “Minimum Requirements For Annual MBBS Admissions Regulations, 2020”, the notification issued replaces the “Minimum Standard Requirements for Medical Colleges, 1999” of the erstwhile Medical Council of India. The new Regulation shall be applicable to all new medical colleges proposing to be established, and to the established medical colleges proposing to increase their annual MBBS intake from the academic year 2021-22. During the transitory period, the established medical colleges will be governed by the relevant regulations existing prior to the current notification. The new standards have been defined keeping the functional requirements of the institution(s). These allow optimization and flexibility in utilizing available resources, and harnessing modern educational technology tools to facilitate moving towards quality education, even when resources are relatively scarce. 

About 

• Titled as “Minimum Requirements For Annual MBBS Admissions Regulations (2020) under which it replaces the “Minimum Standard Requirements for Medical Colleges, 1999 of the erstwhile Medical Council of India (MCI).
• The new Regulation shall be applicable to all new medical colleges proposing to be established, and to the established medical colleges proposing to increase their annual MBBS intake from the academic year 2021-22.

Key highlights of the new Regulation

• The new Regulation has deleted the quantum of land required for setting up a medical college and its affiliated teaching hospitals.
• A well-equipped “Skills Laboratory” for training students is essential now.
• It also defines a Medical Education Unit for training medical teachers in educational pedagogy.
• The space required for Library and the number of books and journals have been rationalized and reduced.
• Student counselling services has been mandated recognizing the increasing stress observed amongst medical students and residents in recent times.
• The new regulation now mandates the availability of a fully functional 300 bed multi-speciality hospital for at least 2 years at the time of application for establishing a new medical college (the earlier regulations did not specify the period of functionality).
• Over and above the minimum prescribed faculty, provision for “visiting faculty” has been made to enhance quality of training.
• Two new teaching departments have now become mandatory in all medical college hospitals for the training of undergraduate medical students. These include the Department of Emergency Medicine and the Department of Physical Medicine and Rehabilitation.

About the National Medical Commission:

• The Centre has recently notified the 33-member NMC, which will be chaired for three years by Suresh Chandra Sharma.
• Apart from the Chairman, the NMC will consist of 10 ex-officio members and 22 part-time members appointed by the Central government.

Functions of NMC

• laying down policies for regulating medical institutions and medical professionals.
• assessing the requirements of human resources and infrastructure in healthcare.
• ensuring compliance by the State Medical Councils with the regulations made under the Bill.
• framing guidelines for determination of fee for up to 50% of the seats in the private medical institutions.

key challenges that define today’s global health systems include

• Ageing populations;
• Demand for quality, equity and dignity;
• The transition from communicable to non-communicable diseases and from episodic illnesses to lifelong ailments;
• The double burden of disease in some countries; and
• Disruptive advances in medical knowledge, IT, and biotechnology.

Medical Education as the building block of Health system

• Medical education is the bedrock on which the needs of ‘human resources for health’, one of the major building blocks of any health system, are met.
• Today’s health professionals are required to have knowledge, skills, and professionalism to provide safe, effective, efficient, timely, and affordable care to people.

They are required to:

• be proficient in handling disruptive technologies,
• understand the economics of healthcare,
• have the skills to work in and handle large and diverse teams,
• be ethical,
• demonstrate empathy, and
• be abreast of rapid developments in medicine.

Dynamic Nature of Medical Education

• Methods of education across fields are undergoing changes on account of advances in e-learning methods and tools, including remote learning, virtual classrooms, digital dissections, and simulation systems for imparting skills.
• According to a study by Densen P. (2011), “it is estimated that the doubling time of medical knowledge in 1950 was 50 years; in 1980, 7 years; and in 2010, 3.5 years. In 2020 it is projected to be 0.2 years — just 73 days.”
• Dynamic curricula designed around specific health systems will become more relevant than the systems designed for traditional hospital-based care.
• Since health professionals work in teams, inter-professional combined learning methods are being introduced.
• The concept of the teaching hospital is changing from a single, large hospital to a network of hospitals and community health centres.

Problems Plaguing Medical Education in India?

• Low Doctor-Patient ratio: India has one government doctor for every 11,528 people and one nurse for every 483 people, which is way below WHO recommended 1;1000.
• Backdated syllabus and teaching style: Regular breakthroughs take place in the medical field every day, but the medical studies syllabus in India is not updated accordingly.
• Lack of skilled teachers: Teachers for medical institutes are selected based on their degrees and not their clinical experience. Further, the lower salary fails to attract better talent as they go for private practice.
• Disparity in infrastructure across different states: Only four states - Andhra Pradesh, Karnataka, Maharashtra and Tamil Nadu - account for about 1.3 lakh out of nearly 2.4 lakh medical seats across India.
• Lack of social accountability: Indian medical students do not receive training which instils in them social accountability as health practitioners.
• Problems with private medical colleges: A change in the law in the 1990s made it easy to open private schools and so, many such medical institutes cropped up in the country, funded by businessmen and politicians, who had no experience of running medical schools. It commercialised medical education to a great extent.
• Corruption in medical education: Fraudulent practices and rampant corruption such as fake degrees, bribes and donations, proxy faculties, etc. in the medical education system is a major problem.

Reforms Required

• There is a pressing need to revisit the existing guidelines for setting up medical schools and according permission for the right number of seats.
• Extending teaching privileges to practising physicians and allowing e-learning tools will address the shortage of quality teachers across the system. Together, these reforms could double the existing medical seats without compromising on the quality of teaching.
• Periodic re-certification based on continuing learning systems may become essential to keep up with the fast pace of change.
• Students need to improve their basic management, communication and leadership skills.
• They must be trained by taking into account their social relevance as doctors
• Integration of subjects, innovative teaching methods, and a more prevalent use of technology in classrooms is required.
• Medical research and clinical skills need to be worked on in colleges.

Road Ahead

• Today’s medical education should be able to groom such professionals to face medicine of the 21st century. The Lancet report, ‘Health Professionals for a new century: transforming health education to strengthen health systems in an interdependent world’ (2010) outlines key recommendations, to transform health professional education, needs to be looked upon.
• In addition to raising the standards of medical professionals, the system should innovate to meet the growing shortage of health professionals to serve ageing populations with lifestyle and lifetime ailments. It is only when the medical education improves that the health sector can improve as a whole.