NMC invites comments on Draft CBME Regulations 2023, Check out details

Seeking public comments regarding the draft regulations, the Director of UGMEB Shambhu Sharan Kumar mentioned in the recent notice dated 23.06.2023, "Undergraduate Medical Education Board proposes to make the above mentioned regulations in exercise of powers conferred by the National Medical Commission Act, 2019 and particularly by sections 10, 24, 25 and 57 of the said Act. A draft regulation in this regard is being shared for public comments."

"It is requested to share comments on the draft regulations at the following email id comments.ugregulations@nmc.org.in in MS Word (.docx) format or machine readable PDF Format within 30 days of publication of this notice with a subject tagline "Comments on draft regulations regarding National Medical Commission (Competency Based Medical Education Curriculum) Regulations, 2023"," the notice further mentioned.

Medical Dialogues had earlier reported that previously NMC on 12.06.2023 released the final guidelines for the MBBS course including the new CBME curriculum and Family Adoption Program for the MBBS course. However, NMC has now withdrawn the recently released guidelines and released draft regulations instead.

The draft regulations regarding National Medical Commission (Competency Based Medical Education Curriculum) Regulations, 2023 include the CBME Curriculum, Curriculum for Family Adoption Program, guidelines regarding admission of students under "Disability Category" in MBBS course, format for submission of information regarding admission in a medical college.

Also Read:NMC Withdraws recently released MBBS Curriculum, Family Adoption Program, Releases a New Draft of Curriculum for public opinion

The new draft CBME curriculum for the MBBS course includes objectives of the Indian Graduate Medical Training Programme, National Goals in respect of the Indian Medical Graduates, Institutional Goals, Goals for the Learner, Competency Based Training Programme of the Indian Medical Graduate, Lifelong learner committed to continuous improvement of skills and knowledge.

The Curriculum for the Family Adoption Programme includes targets to be achieved by the MBBS students in their first, second, and third professional year of the course. Further, the curriculum lists down the competencies that the students should be able to acquire, objectives, suggested teaching-learning methods, suggested assessment methods, and teaching hours.

Further, the Family Adoption Programme curriculum also includes the log book for Family Adoption, which shall include the name of the college, university, address details, name of the students, roll number, village name, Tehsil/District, State/Union Territory, name of the mentor, status of the mentor, name and address and experience of Asha worker, etc.

The draft regulations also include the guidelines for manpower requirement for research facilities in a medical college, and the guidelines regarding admission of students with "specified disabilities" under the Rights of Persons with Disabilities Act, 2016 with respect to admission in MBBS course.

CBME CURRICULUM

In the preamble of the Curriculum, NMC mentioned, "The new Graduate Medical Education Regulations attempts to stand on the shoulder of the contributions and the efforts of resource persons, teachers and students (past and present). It intends to take the learner to provide health care to the evolving needs of the nation and the world. About 25 years have passed since the existing Regulations on Graduate Medical Education, 1997 were notified, necessitating a retook at all aspects of the various components in the existing regulations and adapt them to the changing demography, socio-economic context, perceptions, values, advancements in medical education and expectations of stakeholders. Emerging health care issues particularly in the context of emerging diseases, impact of advances in science and technology and shorter distances on diseases and their management also need consideration. The strong and forward-looking fundamentals enshrined in the Regulations on Graduate Medical Education, 1997 has made this job easier. A comparison between the 1997 Regulations and proposed Graduate Medical Education Regulations, 2019 will reveal that the 2019 Regulations have evolved from several key principles enshrined in the 1997 Regulations."

"The thrust in the new regulations is continuation and evolution of thought in medical education making it more learner-centric, patient-centric, gender- sensitive, outcome -oriented and environment appropriate. The result is an outcome driven curriculum which conforms to global trends. Emphasis is made on alignment and integration of subjects both horizontally and vertically while respecting the strengths and necessity of subject-based instruction and assessment. This has necessitated a deviation from using "broad competencies"; instead, the reports have written end of phase subject (sub) competencies. These "sub-competencies" can be mapped to the global competencies in the Graduate Medical Education Regulations," the draft curriculum mentioned.

"The importance of ethical values, responsiveness to the needs of the patient and acquisition of communication skills is underscored by providing dedicated curriculum time in the form of a longitudinal program based on Attitude, Ethics and Communication (AETCOM) competencies. Great emphasis has been placed on collaborative and inter-disciplinary teamwork, professionalism, altruism and respect in professional relationships with due sensitivity to differences in thought, social and economic position and gender," it added.

Objectives of the Indian Graduate Medical Training Programme:

The undergraduate medical education program is designed with a goal to create an --Indian Medical Graduate" (IMG) possessing requisite knowledge, skills, attitudes, values and responsiveness, so that she or he may function appropriately and effectively as a Physician of first contact of the community while being globally relevant. To achieve this, the following national and institutional goals for the learner of the Indian Medical Graduate training program are hereby prescribed.

National Goals:

At the end of undergraduate program, the Indian Medical Graduate should be able to:

a. Recognize "health for all" as a national goal and health right of all citizens and by undergoing training for medical profession fulfill his social obligations towards realization of this goal.

b. Learn key aspects of National policies on health and devote himself to its practical implementation.

c. Achieve competence in practice of holistic medicine, encompassing promotive, preventive, curative and rehabilitative aspects of common diseases.

d. Develop scientific temper, acquire educational experience for proficiency profession and promote healthy living.

e. Become exemplary citizen by observance of medical ethics and fluffing social and professional obligations, so as to respond to national aspirations..

Institutional Goals:

In consonance with the national goals, each medical institution should evolve institutional goals to define the kind of trained manpower (or professionals) they intend to produce. The Indian Medical Graduates coming out of a medical institute should:

a. Be competent in diagnosis and management of common health problems of the individual and the community, commensurate with his/her position as a member of the health team at the primary, secondary or tertiary levels, using his/her clinical skills based on history, physical examination and relevant investigations.

b. Be competent to practice preventive, promotive, curative, palliative and rehabilitative medicine in respect to the commonly encountered health problems.

c. Appreciate rationale for different therapeutic modalities; be familiar with the administration of the "essential drugs" and their common side effects.

d. Appreciate the socio-psychological, cultural, economic and environmental factors affecting health and develop humane attitude towards the patients in discharging one's professional responsibilities.

e. Possess the attitude for continued self-learning and to seek further expertise or to pursue research in any chosen area of medicine, action research and documentation skills.

f. Be familiar with the basic factors which are essential for the implementation of the National Health Programs including practical aspects of the following:

i) Family Welfare and Maternal and Child Health (MCH);

ii) Sanitation and water supply:

iii) Prevention and control of communicable and non-communicable diseases:

iv) Immunization;

v) Health Education and advocacy:

vi) Indian Public Health Standards (IPHS) at various level of service delivery;

vii) Bio-medical waste disposal

viii) Organizational and or institutional arrangements.

g. Acquire basic management skills in the area of human resources, materials and resource management related to health care delivery, general and hospital management, principal inventory skills and counseling.

h. Be able to identify community health problems and learn to work to resolve these by designing, instituting corrective steps and evaluating outcome of such measures with maximum community participation.

i. Be able to work as a leading partner in health care teams and acquire proficiency in communication skills.

j. Be competent to work in a variety of health care settings.

k. Have personal characteristics and attitudes required for professional life including personal integrity, sense of responsibility and dependability and ability to relate to or show concern for other individuals.

Goals for the Learner:

In order to fulfill these goals, the Indian Medical Graduate must be able to function in the following roles appropriately and effectively:-

a. Clinician who understands and provides preventive, promotive, curative, palliative and holistic care with compassion.

b. Leader and member of the health care team and system with capabilities to collect, analyze, synthesize and communicate health data appropriately.

c. Communicator with patients, families, colleagues and community.

d. Lifelong learner committed to continuous improvement of skills and knowledge.

e. Professional, who is committed to excellence, is ethical, responsive and accountable to patients, community and profession.

f. Critical thinker who demonstrates problem solving skills in professional practice

g. Researcher who generates and interprets evidence

Competency Based Training Programme of the Indian Medical Graduate:

Competency based learning would include designing and implementing medical education curriculum that focuses on the desired and observable ability in real life situations. in order to effectively fulfill the roles, the Indian Medical Graduate would have obtained the following set of competencies at the time of graduation:

Clinician, who understands and provides preventive, promotive, curative, palliative and holistic care with compassion:

• Demonstrate knowledge of normal human structure, function and development from a molecular, cellular, biologic, clinical, behavioral and social perspective.
• Demonstrate knowledge of abnormal human structure, function and development from a molecular, cellular, biological, clinical, behavioral and social perspective.
• Demonstrate knowledge of medico-legal, societal, ethical and humanitarian principles that influence healthcare.
• Demonstrate knowledge of national and regional health care policies including the National Health Mission that incorporates National Rural Health Mission (NRHM) and National Urban Health Mission (NUHM), frameworks, economics and systems that influence health promotion, health care delivery, disease prevention, effectiveness, responsiveness, quality and patient safety.
• Demonstrate ability to elicit and record from the patient. and other relevant sources including relatives and caregivers, a history that is complete and relevant to disease identification, disease prevention and health promotion.
• Demonstrate ability to elicit and record from the patient, and other relevant sources including relatives and caregivers, a history that is contextual to gender, age, vulnerability, social and economic status, patient preferences, beliefs and values. Demonstrate ability to perform a physical examination that is complete and relevant to disease identification, disease prevention and health promotion.
• Demonstrate ability to perform a physical examination that is contextual to gender, social and economic status, patient preferences and values.
• Demonstrate effective clinical problem solving, judgment and ability to interpret and integrate available data in order to address patient problems, generate differential diagnoses and develop individualized management plans that include preventive, promotive and therapeutic goals.
• Maintain accurate. clear and appropriate record of the patient in conformation with legal and administrative frameworks.
• Demonstrate ability to choose the appropriate diagnostic tests and interpret these tests based on scientific validity, cost effectiveness and clinical context.
• Demonstrate ability to prescribe and safely administer appropriate therapies including nutritional interventions, pharmacotherapy and interventions based on the principles of rational drug therapy, scientific validity, evidence and cost that conform to established national and regional health programmers and policies for the following:

a. Disease prevention,

b. Health promotion and cure,

c. Pain and distress alleviation, and

d. Rehabilitation and palliation.

• Demonstrate ability to provide a continuum of care at the primary (including home care) andlor secondary level that addresses chronicity, mental and physical disability.
• Demonstrate ability to appropriately identify and refer patients who may require specialized or advanced tertiary care.
• Demonstrate familiarity with basic, clinical and translational research as it applies to the care of the patient.

Leader and member of the health care team and system:

• Work effectively and appropriately with colleagues in an inter-professional health care team respecting diversity of roles, responsibilities and competencies of other professionals.
• Recognize and function effectively, responsibly and appropriately as a health care team leader in primary and secondary health care settings.
• Educate and motivate other members of the team and work in a collaborative and collegial fashion that will help maximize the health care delivery potential of the team.
• Access and utilize components of the health care system and health delivery in a manner that is appropriate, cost effective, fair and in compliance with the national health care priorities and policies, as well as be able to collect, analyze and utilize health data.
• Participate appropriately and effectively in measures that will advance quality of health care and patient safety within the health care system.
• Recognize and advocate health promotion, disease prevention and health care quality improvement through prevention and early recognition: in a) life style diseases and h) cancer, in collaboration with other members of the health care team.

Communicator with patients, families, colleagues and community:

• Demonstrate ability to communicate adequately, sensitively, effectively and respectfully with patients in a language that the patient understands and in a manner that will improve patient satisfaction and health care outcomes.
• Demonstrate ability to establish professional relationships with patients and families that are positive, understanding, humane, ethical, empathetic and trustworthy.
• Demonstrate ability to communicate with patients in a manner respectful of patient's preferences, values, prior experience, beliefs, confidentiality and privacy.
• Demonstrate ability to communicate with patients, colleagues and families in a manner that encourages participation and shared decision- making.

Lifelong learner committed to continuous improvement of skills and knowledge:

• Demonstrate ability to perform an objective self-assessment of knowledge and skills, continue learning, refine existing skills and acquire new skills.
• Demonstrate ability to apply newly gained knowledge or skills to the care of the patient.
• Demonstrate ability to introspect and utilize experiences, to enhance personal and professional growth and learning.
• Demonstrate ability to search (including through electronic means), and critically re¬evaluate the medical literature and apply the information in the care of the patient.
• Be able to identify and select an appropriate career pathway that is professionally rewarding and personally fulfilling.

Professional who is committed to excellence, is ethical, responsive and accountable to patients, community and the profession:

• Practice selflessness, integrity, responsibility, accountability and respect.
• Respect and maintain professional boundaries between patients, colleagues and society.
• Demonstrate ability to recognize and manage ethical and professional conflicts.
• Abide by prescribed ethical and legal codes of conduct and practice.
• Demonstrate a commitment to the growth of the medical profession as awhile.