NMC releases final Graduate Medical Education Regulations 2023, check out details

New Delhi: Introducing changes in the undergraduate medical education system, the Graduate Medical Education Regulations, 2023 have finally been published in the official Gazette by the National Medical Commission (NMC).

Publishing the Regulations, the Undergraduate Medical Education Board (UGMEB) of NMC mentioned, "In exercise of overall powers conferred by the National Medical Commission Act, 2019 vis-à-vis medical education in general and specifically by sub-section (1) of section 24; and sub-section (h), (i), (j), (k), (o), (p), (p), (q), (r), (s) of sub-section (2) of section 57 of the said Act, the National Medical Commission makes the following Regulations...These Regulations may be called the “Graduate Medical Education Regulations, 2023” or “GMER-23” in its abbreviated form."

"These Regulations shall come into force from the date of their publication in the official Gazette," mentioned the official Gazette notification dated June 2, 2023.

Introducing the draft in the public domain on February 27, 2023, NMC earlier invited comments from the public and stakeholders in this regard and asked them to share the comments within 30 days.

Also Read: Following NMC Draft Proposal, Govt Considering Common Counselling for admission to MBBS, PG medical courses: Report

These new regulations have addressed the skills expected of a scholar graduating UG Medical Education, the duties of medical universities to partner with NMC, maintenance of proper records by the universities and institutes, development of strategies for optimal utilization of evolving technology etc.

Apart from this, NMC in the draft also discussed about the admission, counselling and migration process involving the UG medical admission including the conduct of NEET UG, the eligibility criteria, break of tie-in marks of NEET UG, common counselling, and student migration.

Besides, the minimum standards of requirements for medical education, competency based dynamic curriculum at undergraduate level, training period and maximum duration of UG medical students, choice-based credit courses, mandatory internship, faculty development programme, student welfare- all these issues were also included in the draft regulations.

These drafts have now been published in the official Gazette along with some relevant changes. Some of these major changes include a doubling of the amount of penalty for medical colleges in case of backdoor entries. In the draft, NMC had specified that medical colleges violating the norms for MBBS admission shall have to pay a huge fine ranging from Rs 50 lakh to Rs 1 crore per seat.

However, in the final version of the Regulations that have been published in the Gazette it has been mentioned that medical colleges violating the norms for admitting MBBS students will be fined Rs one crore to Rs two crore for the first two instances of non-compliance.

Another major change has been introduced in the case of student migration as well. While the draft allowed migration from a government medical college to a government institute and from a non-government (private) medical college to a non-government institute, the final rules specify that students will not be allowed to migrate from one college to another.

The final provisions of the Regulations, as published in the official Gazette, are as follows:

It has been mentioned in the Regulations that the Graduating Medical Scholar shall be able to-

1) Apply the gained knowledge and skill to ensure health for all to the maximum extent possible.

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

3) Develop a scientific temper, acquire education experience for proficiency in the profession and promote healthy living.

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

5) Possess the attitude for continued self-learning to seek further expertise and to pursue research in any chosen area of medicine, research, and documental skills.

6) Acquire basic management skills in human resources, materials and resource management related to health care delivery, general hospital management, principal inventory skills and counselling.

7) Able to work as a leading partner in healthcare teams and acquire proficiency in communication skills.

8) Develop personal characteristics and attitudes required for professional life such as personal integrity, sense of responsibility and dependability and ability to relate to or show concern for other individuals.

9) Become an exemplary citizen by observing the highest standards of professional ethics and working towards fulfilling social and professional obligations to respond to national aspirations.

10) Evolution of medical education is aimed at making it more learner-centric (rather than pedagogic), 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 the 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” to end-of-phase subject (sub) competencies.

11) 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. Emphasis has been placed on collaborative and inter-disciplinary team work, professionalism, altruism and respect in professional relationships with due sensitivity to differences in thought, social and economic position and gender.

"WHEREAS the Institutions imparting graduate medical education shall continually work to synchronize the institutional goals with the national goals to produce the kind of trained manpower with higher knowledge, appropriate skills and impeccable ethical standards required," it further mentioned.

Duties of Medical Institutes & Universities:

According to the Regulations, the medical institutes/ Deemed to be Universities will partner with NMC to-

a. Implement an appropriate curriculum to provide high-quality and affordable undergraduate medical education to the student to make him a complete Bachelor of Medicine and Surgery, and a competent Physician of the first contact.

b. To provide training in clinical and practical skills along with theoretical knowledge, an emphasis upon attitude, ethics, and communication skills to ensure imparting competency-based medical education.

c. Encourage students towards self-directed learning, which will impart an adequate basic knowledge of human health, including the knowledge from indigenous systems of healthcare in India; Yoga and healthy living aspects are introduced during their training to develop harmony, and peace, relieve stress and alleviate depression amongst students.

d. Encourage students to take up skill training in the subjects and areas of their choice, which shall stimulate their logical and scientific thinking, and problem-solving at the community level and individual levels.

e. Encourage the students to achieve and maintain the highest ethical standards in training and profession.

f. Provide periodic and transparent assessment of medical education being imparted by Medical Institutions across the nation to meet with highest global standards.

g. Inspire confidence in the students to handle emergencies and calamities at all levels.

"Without prejudice to the above, the concerned medical institutions/ Deemed to be Universities shall ensure that proper records of the work shall be maintained so that they form the basis of objective, efficient and transparent internal assessment of students;

Provided further that, these maintained and well-classified documents shall be made available for consultation at all times, particularly for the purposes of assessment of the Medical College either by the concerned University or NMC," further mentioned the Regulations.

"The concerned University shall encourage the Medical Colleges to offer optimal number and variety of choice-based credit courses which shall traction the medical education in producing the outcomes of a medical graduate, as identified by these Regulations," it added.

Admission, Counselling & Migration: 

Conduct of NEET-UG: 

GMER-23 Regulations mention that either the National Medical Commission may conduct the NEET-UG or may designate any such agency or authority by whatever name called, to cause the NEET-UG to be conducted, provided NMC may designate multiple agencies or authorities, to conduct NEET-UG if such deployment suits the overall purpose.

"The UGMEB shall determine the language, manner and modalities etc., of conducting the NEET-UG by way of Notification;

Provided that, the UGMEB shall notify with reasonable lead time when it decides to change its policies with regard to the conduct of NEET-UG so that aspiring students are not put to detriment," the regulations specified.

Eligibility criteria: 

According to the Regulations, no student shall be eligible to pursue graduate medical education either in India or elsewhere (if they want to return and practice in India), except by scoring the minimum eligible score at the NEET- UG exam.

"Provided the UGMEB shall by notification announce the list of eligible students from time to time," it added.

Break of tie-in marks at NEET-UG: 

The regulations mention that "In case of tie-in marks of the students appearing for NEET-UG, the respective marks obtained in Physics followed by Chemistry and further followed by Biology in the NEET- UG shall be considered; Provided if the tie were to continue, then draw of lots by using the computer, with no human intervention, the eligible candidates shall be selected."

Eligibility criteria for taking NEET-UG: 

It has been mentioned in the Regulations that no aspirant shall be allowed to appear in the NEET-UG-

a. unless he has completed the age of 17 years as on or before 31stJanuary of the year that the candidate shall be appearing for NEET- UG examination; and

b. Has passed 10 +2 (or equivalent) with subjects of Physics, Chemistry Biology/ Biotechnology and English.

Common Counselling: 

"Without prejudice to anything stated in the present Regulations or other NMC Regulations, there shall be common counselling for admission to graduate courses in medicine for all Medical Institutions in India based on the merit list of the NEET-UG," mentioned the Regulations.

"Counselling shall entirely be based on the seat matrix provided by National Medical Commission; Provided the common counseling may have multiple rounds as may be necessary," it added.

Conduct of Common Counselling: 

According to the Regulations, the UGMEB shall publish guidelines for the conduct of common counselling, and the designated authority under section 17 below shall conduct the common counselling in conformity with such published guidelines.

"The Government of India will decide and notify the agency and method of counseling of all undergraduate seats," it mentioned.

Penalties for Admission any other way than Counselling: 

Strictly barring any student from taking admission in any other way than counselling, the GMER-2023 mentioned, "No medical institute shall admit any candidate to the Graduate Medical Education course in contravention of these regulations; Provided the Medical Institution granting admission to any student in contravention of these Regulations, shall be liable to be fined Rupees one crore or fee for the entire course duration, whichever is higher, per seat for the first time and for the second time of non-compliance, Rupees two crore or double the amount of fees for the entire course duration whichever is higher per seat, and for any subsequent non-compliance or continued contravention the Medical Institution shall be barred from granting admissions to any student from the next academic year..."

"Provided further that such Student admitted in contravention of this mandate shall be discharged from the Medical College and double the number of seats shall be reduced for one or more years," it further added.

Submission of the final list: 

The regulations mentioned, "The respective designated authorities (who have conducted the common counselling) shall submit the final list of students in the prescribed proforma to the UGMEB within one (01) week of the completion of the common counselling, which in turn shall publish that list in the NMC website.

Provided each institution shall also submit the final list of students admitted, in the prescribed proforma as detailed in the MSR, to the UGMEB within one week of the last date of the joining course, declared by the UGMEB;"

"Provided only those Medical Institutions that were permitted to admit the students prior to the date of Notification of common counselling are allowed to admit students, and the Medical Institutions getting requisite permission later to the date of Notification of common counselling shall participate in the next academic year‟s common counselling to admit students," it added.

Explanation: requisite permission shall also apply mutatis mutandis for the increase of seat strength in medical institutions already established.

Student migration: 

Putting a stop to student migration, the new regulations clarified, "No student designated to a Medical Institution, notwithstanding anything stated in these regulations, shall seek migration to any other Medical Institution."

Minimum Standards of Requirements (MSR) for Medical Education: 

"Medical Institutions shall follow the guidelines for minimum standards of requirements (MSR) for undergraduate medical education prescribed by the UGMEB of NMC from time to time," mentioned the Regulations.

Competency-Based Dynamic Curriculum at Undergraduate Level: 

Curriculum: 

According to the Regulations, "...the UGMEB shall publish the model curriculum and the outcome objectives of the same from time to time on the NMC website, which shall form the base for the development of a detailed medical curriculum by the concerned Universities, along with the appropriate methodology to impart meaningful education."

"The details of the requirements shall conform to the prescribed standards. These standards are subject to modification from time to time with the changing healthcare scenario," it added.

Training Period and Maximum Duration: 

Every student admitted in accordance with these Regulations, shall undergo training as per the guidelines published by the UGMEB of NMC and displayed on the NMC website from time to time;

Provided under no circumstances the student shall be allowed more than four (04) attempts for first year (First Professional MBBS) and no student shall be allowed to continue undergraduate medical course after nine (09) years from the date of admission into the course, mentioned the Regulations.

Choice-based credit courses: 

The Regulations specified that there shall be a variety of choice-based credit courses of limited duration offered by the Medical Institutions in addition to the NMC curriculum and the curriculum prescribed by their respective University to their graduating students without hampering the medical graduate curriculum;

Provided the meaningful imparting of these choice-based credit courses shall be given due weightage, while accreditation and rating of the Medical Institutions by the Medical Assessment and Rating Board of NMC.

Internship: 

"The student admitted into a Graduate Medical Education Programme shall not be deemed to have completed his graduation until he completes his rotating medical internship as per Compulsory Rotating Medical Internship Regulations, 2021," the regulations mentioned.

Faculty Development Program: 

"The new curriculum training requires the teaching faculty to understand and apply the concepts of group dynamics in teaching students, team building exercises, and small group teachings, encourage the students towards self-directed learning and enhance their skills to become team leaders at the primary health care level. These training skills shall be imparted through various programmes as described in the guidelines to be notified from time to time," the regulations added.

Student Welfare: 

The student welfare is central to good learning atmosphere. The issues related to ragging disrupt student's well- being. Hence, students are expected to abide by Prevention and Prohibition of Ragging in Medical Colleges and Institutions Regulations, 2021;

Provided that there shall be an elected student association and representation of students in decision making by the Medical College/ Institution affecting student welfare, mentioned the new regulations.

To view the notice, click on the link below –

https://medicaldialogues.in/pdf_upload/graduate-medical-211503.pdf

Also Read: New NMC Regulations spell out Harsher Penalties for Backdoor MBBS admissions in medical colleges