Group of Ministers on Health call for shorter MBBS duration, Integration with PG medical courses: Report

These recommendations are aimed at improving the healthcare sector throughout the country including segments of medical education, academia, health facilities and other health policies to address the existing challenges.

"The current Covid-19 crisis has given an opportunity to have a complete overhaul of the policy imperatives in the health sector in the long run. The government-funded health insurance system alone may not be sufficient to have a lasting solution to bring efficiency, transparency and effectiveness, especially in the primary healthcare scenario."- quotes the report.

The report principally calls for reducing the MBBS course from 5.5 years (including internship of one year) to 4.5 years to streamline it "with the changing circumstances" and two-year mandatory rural posting of doctors before awarding them MBBS degrees to increase the availability of doctors in rural areas.

According to the recent media report by The Print, to bring down the duration of the MBBS course, the GoM has recommended three models.

As per the Medical Council of India, MCI (now- National Medical Commission) Regulations on Graduate Medical Education, 1997, the duration of the MBBS course is 5 ½ years including a rotating internship of one year.

Under model one, the GoM has suggested dropping this span to 4.5 years by reducing the course work to 4 years and internship to 6 months.

"The first year may include teachings in basic sciences and health courses involving anatomy, physiology and biochemistry. The next one-and-half year, the students may be exposed to broader specialties like medicine, surgery, pediatrics and anesthesiology. And during the last one-and-half year, they may be exclusively posted to the pre-assigned specialties like OBG, surgery, pediatrics, internal medicine or other required specialties,"

The erstwhile MCI had last year reduced the 54-month MBBS (Bachelor of Medicine and Surgery) course to 50 months.

However, model 2 deducts the internship period all in all. In this model, the ministers' panel has recommended reducing the duration to 4 years by following model one without the internship, and offer an allotment of specialty and super speciality PG courses of 2 years at the end of final year based on one common exit exam — NEXT (National Exit Exam as already proposed by the government).

"The students, without wasting any time on completion of the bachelor course, can join the speciality course depending upon choice and merit in the common exit exam. This option may be limited to meritorious students only, who pass the exit exam with a high score, the others passing out as normal physicians".

"This is a variation of model 2, wherein the initial entrance exam itself may be made a basis for entry to the 6 years course (4 years MBBS and 2 years PG). An integrated programme would provide not just doctors but specialists with adequate clinical experience acquired over 6 years. In this model also, there would not be an internship," it said.

"As such, the programme is already near the desired duration of 4 years. Three models can be suggested for reducing the MBBS duration and/or restructuring the MBBS and PG programmes to streamline it with the changing circumstances and make trained medical human resource available for public service early," stated the report.

"There is no doubt that the curriculum of MBBS needs to be revised to reflect the changing disease burden of the country and the ground realities. There is a tendency to overburden the students with content information, which may or may not be relevant for her future endeavours. Practical clinical skills are not given enough importance in the assessment of a medico. Therefore, the focus needs to shift from quantitative knowledge gathering to qualitative skilling," the report stated.

The report added that a calibrated approach to find a right mix of specific disease knowledge and common problems of the society needs to be found and incorporated in the curriculum.

"Innovation, entrepreneurship and skill development are the need of the hour for ushering medical education reforms. The curriculum should be need-based rather than conservative and outdated. Medical institutions today are not having a uniform curriculum and teaching methodology," it said.

On the recommendation of a two-year mandatory rural posting of doctors before awarding them MBBS degrees, the ministers had pointed out obstacles in the health sector due to which there is a shortage of medical officers in rural areas. The ministers noted that most of the physicians prefer staying in cities because the villages lack facilities like good accommodation, schooling for kids and other recreational activities. The existing rules also do not provide for mandatory rural service after completing medical education.

"There is a tendency among the professionals doing UG and PG from government institutions to switch to private professions on completion of the course for higher earnings through practice in cities," it pointed out.

Therefore, as a solution to address this issue, the GOM has suggested that MBBS or integrated MD/MS pass-outs must undergo a mandatory two-year rural posting before being considered for registration as a medical practitioner, whether in the government or the private sector.

"To make this mandatory posting less harsh for the graduates, the one-year internship period can be combined with an additional one-year rural posting for meeting the above criteria," the report stated.

Further, on the issue that the doctors often don't get the basic requirements while being posted in rural areas, the ministers recommended full redressal and said that these necessities should be taken care of to retain them. It further recommended the hardship allowance to doctors to cover for those deficiencies during their deployment in rural areas. Moreover, as a token of encouragement, it suggested an incentive scheme through extra credits to doctors with experience of serving in rural areas during admission for PG courses.

Moreover, on the matter of interaction of allopathy and alternative medicine, the GoM has pointed out that the "prejudice of AYUSH being a non-scientific field can be overcome by integrating it in the MBBS curriculum".