Health Ministry Releases Governance Reforms in Medical Education

Claiming that shortfall of human resources, and focus was needed in Availability, Accessibility, and Quality in medical education, the Union Health Ministry in the recent reform report has mentioned that "Over the last six years, a landmark change has happened in all these parameters."

This included the increase in the number of medical colleges (which was 381 in 2014), 56% increase in the number of MBBS seats, 80% increase in Post-graduate medical seats, better doctor-population ratio, and more number of doctors in the country.

Until 2019, the Medical Council of India (MCI) was the apex medical education regulatory body of elected members.

The Health Ministry has claimed that "All functions and authority related to medical colleges was concentrated and centralized in the Medical Council of India, making it unwieldy, slow and inefficient in decision making."

In order to increase transparency, professionalism, accountability, availability, distribution, merit-based admission, affordability, and quality of medical education, several reforms have been introduced by the Union Health Ministry over the last few years. The reforms include, the introduction of NMC, increase the number of Doctors and Specialists, introducing One Country, one exam, etc.

Also Read: National Medical Commission: Meet the new regulators

National Medical Commission:

The Biggest reform in the Medical Education sector has been the introduction of the National Medical Commission (NMC), which is now the apex medical education regulatory body after it replaced the Medical Council of India (MCI).

In August, 2019, the National Medical Commission Act was passed and it came into force on September 25, 2020.

"The basic change is that the Regulator is now selected on merits, as opposed to being elected. NMC will make the medical education in India quality oriented, competency based, equitable, affordable and at par with the best in the world," stated the Health Ministry.

Apart from this, the NMC has also taken up the initiative to conduct a common exit exam i.e. NEXT, prescription of fee guidelines, making the standards for Community Health Providers and rating of medical colleges.

Under-Graduate Medical Education Board, Post-Graduate Medical Education Board, Medical Assessment and Rating Board and Ethics and Medical Registration Board- these are the four mutually independent and Autonomous Boards which work under the supervision of NMC.

As per the Health Ministry, NMC has been established to improve access to quality and affordable medical education, ensure availability of qualified medical professionals, promote equitable and universal healthcare, encourage medical research, assess medical institutes objectively, maintain a medical register, enforce high ethical standards, and have an effective grievance redressal mechanism.

One Country, One Exam:

One of the major reforms that the Union Health Ministry talks about is the common entrance tests for Undergraduate and Postgraduate medical education.

NEET and NEXT:

Whereas on the one hand, the centralized common entrance examination for admission to MBBS courses- the National Eligibility-cum-Entrance Test (NEET) has been introduced with the aim of ensuring 'one country, one examination, one merit' system, NMC is also proposing to introduce the National Exit Test (NEXT).

NEET allowed students from anywhere in India an opportunity to study in any medical colleges in the country based on merit. On the other hand, NEXT, a common final year MBBS exam would not only serve as a licentiate exam for practice, but also serve as an entrance exam for admission to Postgraduate in broad speciality medical courses. Further, the same exam will serve as a screening test for foreign medical graduates.

Common Counseling:

The Health Ministry further talks about introducing a common counseling at both Central and State levels to ensure transparency in the admission process. In fact, the Ministry pointed out that from 2021, the DNB counseling has been merged with MD/MS counseling for streamlining the admission process.

Apart from all this, the Union Health Ministry reports further mentions the promotion of Family Medicine as a specialized discipline, it points out how the NMC act provides for Community Health Providers (CHPs), and the introduction of three-months District Residency Programme in the Post-graduation curriculum.

"The most significant reform carried out recently by the NMC pertains to streamlining the entire regulations on Minimum Standards Requirement (MSR) for establishment of medical colleges," mentioned the Health Ministry.

Earlier, in order to set up a medical college, 20 acres of land was required for general areas and 10 acres for metropolitans. As per these new regulations, the quantum of land required for setting up a medical college and its affiliated teaching hospitals has been deleted (all buildings are expected to conform to existing building byelaws).

National Board of Examinations (NBE):

The National Board of Examinations (NBE) is an autonomous body, operative under the Union Health Ministry and it aims to quickly upscale the numbers of postgraduate medical seats. It also accredits the hospitals (mainly private hospitals) for broad specialty and super specialty courses that are equivalent to MD/MS or DM/MCh respectively. So far, NBE has accredited 704 hospitals with 9779 seats, 80% of which is in private sector.

"There has been a tremendous increase in Postgraduate seats brought about by the National Board of Examinations (NBE) over the last few years by rationalising the accreditation criteria," claimed the Health Ministry.

Availability of Doctors and Specialists:

In an attempt to ensure the availability of doctors and specialists in the country, there has been "concerted efforts over the last six years to increase the number of medical colleges," mentions the report by the Health Ministry.

The Health Ministry further mentions that for this, a Centrally Sponsored Scheme was launched back in 2014 and in the three phases of the scheme the Center has till now approved 157 medical colleges, out of which 47 have already become functional and 110 are expected to be functional in the next few years.

"Of these, 47 colleges have already become functional and 110 are expected to be functional in the next few years. Among these, 39 medical colleges are in the Aspirational Districts, where there is acute need of doctors and specialists. Against 381 medical colleges in 2014, today ther 562 medical colleges today, i.e. an increase of 48%. The numbe UG seats have increased by 56% and number of PG seats have of increased by 80% as compared to 2014," mentions the report.

The ministry further mentions about the Pradhan Mantri Swasthya Suraksha Yojana (PMSSY), which aims at correcting the correcting regional imbalances in the availability of tertiary healthcare services and improving the medical education in the under-served states. Apart from this, the report further mentions about initiating a total number of 21 AIIMS in the country.

Finally, the key regulatory reforms for ensuring the availability of Doctors and Specialists and set up medical colleges easily include- relaxed norms, consortium allowed, lesser number of seats allowed, teacher-student ratio relaxed, making DNB equivalent to PG as faculty, making it mandatory to start PG within 3 years of MBBS recognition, permission to apply for PG earlier, and starting Super-specialty Department directly within broad specialty.

Access in Rural Areas:

The reform report points out how among the 157 newly sanctioned medical colleges, 39 are being constituted in the Aspirational districts.

"They will also examine the location of medical colleges coming up. The NMC will also see for equitable distribution as well as sustainable running of the colleges inclusing of availability of adequate patients and faculty," it stated.

Further, the Health Ministry mentions that in order to meet the shortfall of specialists the NBE launched 2 year Diploma programmes in eight disciplines to cater to gaps in specialists at secondary care level. These includes Anaesthesia, Gynaecology and Obstetrics, Paediatrics, ENT, Ophthalmology. Family Medicine, Tuberculosis and Chest Diseases and Radiodiagnosis.

Affordability:

The Health Ministry has mentioned how before the NMC Act, there was no legal mechanism for regulating the fee charged by the private medical colleges and how it would make medical education inaccessible for poor meritorious students.

However, mentioning that the NMC Act has provisions for regulating fee and all the other charges in 50% seats in the private medical colleges, the Health Ministry I the report has further clarified that the apex medical body, NMC is framing guidelines for the same.

Further the new regulations also mandates that all teaching spaces must be e-learning enabled, and digitally linked to one another. It has made it necessary for the medical colleges to have a well-equipped "skill laboratory".

On the other hand, the Medical Assessment and Rating Board (MARB), operative under NMC rates the medical colleges on the basis of their performance parameters to increase the standards of medical education by promoting healthy competition.

Claiming that all these reforms will have a long-term impact on primary, secondary, and tertiary care in India, the Health Ministry further mentions that "Reforms will result in one lakh MBBS seats and 65,000 postgraduate seats by 2022."

To view the official document, click here.