No norms for minimum surgeries by MS medicos, says NMC

New Delhi: Responding to the RTI that questioned the quality of postgraduate medical education in India, the National Medical Commission (NMC) has recently stated that there are no set guidelines regarding the minimum number of surgeries that a doctor needs to perform during the three years of MS Surgery training.

In fact NMC, the Apex medical regulator has also stated that there is no relevant criteria/regulation under which NMC de-recognises a Medical Institute if it does not provide hands on training to its MD/MS/MCh/DM trainees. Further, NMC does not have any provision for taking feedbacks from recent PG medical graduates before granting continued recognition to a medical institute for running PG medical courses.

Such revelation came from NMC while the topmost medical education regulatory body was responding to queries raised under the Right to Information Act (RTI).

The threefold queries of Dr. Neeraj Nagpal, the RTI applicant and the Convenor of Medico Legal Action Group included- 

1. The minimum number of surgeries that are required, by NMC, to be personally done by an MS Surgery during the three (3) year training

2. The relevant criteria/ regulation under which the NMC de-recognises a medical Institution if it does not provide hands on training to its MD/ MS/ MCh/ DM trainees. And the number of institutes which have been de-recognised for not providing such training year wise

3. The provision through which the NMC takes feedback from recent graduates before granting continued recognition to an institutions for its postgraduate MD/MS/Mch/DM training programs.

However, responding to each of these queries, NMC in the letter dated 13.04.2022 has replied in negative. This has put a big question mark against the quality of medical education that the PG medicos are receiving in the medical colleges. Dr. Nagpal informed Medical Dialogues that they have raised the similar queries before the National Board of Examinations (NBE) in respect of DNB courses as well.

"We have also approached the National Board of Examinations (NBE) with these same queries in respect to DNB courses. We are waiting for their reply and if they respond in the similar manner, we will be approaching the Court and request the judiciary to direct both the NMC and NBE to lay down a criteria for independent hands on training during PG medical training," said Dr. Nagpal, who is also the ex president of IMA Chandigarh.

"This is not only a question of surgery but it is a question of procedures as well. It is not only restricted to MS Surgery qualification or MCh degrees, it is also a question of DM gastroenterology, where the doctors do not get sufficient endoscopic training, which a person who will become a gastroenterologist is expected to know. As for the lay people, they expect that an MS Surgery or an MCh Neurology would be able to perform surgeries. A person who is having a cataract expects an MS Opthalmology to be able to operate. But here we have our regulatory body which says that it has no objection whether a medical colleges trains or do not train a person in operating. All that matters is that the doctors pass the theory exam," he said while addressing the issue.

Mentioning that in order to recognise a medical college, all NMC considers is whether certain criteria have been satisfied, Dr. Nagpal further added, "NMC in the RTI reply has stated that they do not have any criteria to de-recognise a medical college if they come to know that the institute does not provide sufficient hands on training to the surgeons. NMC again answered in No when we asked if it takes any feedback from the passing students."

He questioned the entire medical education system and said, "If the residents who are pursuing the PG medical courses are only there to observe, they can do that via YouTube as well. In fact, they can observe better in YouTube as it gets recorded via camera and there is no obstacles in the viewing process. Then why do we need medical colleges? Theories can be taught via online medium as well, COVID has taught that to us. Now if they have to learn the hands-on via YouTube as well, then what is the point in recognising a medical college?"

"Why is NMC increasing the number of medical colleges if the basic hands on training cannot be ensured. When the scandals associated with fake universities get exposed, the Institute and its management get penalized. But in my opinion the regulatory body should be penalized as well. Do they have no vicarious liability when a surgeon cannot perform a simple procedure and causes a major complication? Are they not equally responsible?" he questioned.

Clarifying that less than 10 percent of medical colleges are producing Postgraduate medical students who are competent in their specialties, Dr. Nagpal further asked, "When a doctor goes to a recognize institute for PG medical training after spending three years, they come out untrained. After this, they are told that they would receive training when they complete their Senior Residency. Accordingly, they complete their SR and at that time as well all they do is manual works like Trolley Pushing! If you have trained a doctor for Trolley pushing then please clarify in the certificate that we are awarding the MS degree for trolley pushing. Why do you call it MS Surgery?"

Referring to his days of PG training, he mentioned, "Back then, for the first six months we were required to do certain procedures and the seniors would supervise us. Every six months this protocol would change and gradually we would get bigger procedures to perform. Theory was side by side which we used to carry on. On the other hand, these are the days of Multiple choice questions. How would the MCQs would enable a doctor to help a patient suffering from abdomen pain if they do not know how to hold a scalpel?"

He mentioned that even though this is a very serious matter it is being pushed under the carpet. "If a decent ethical survey gets conducted based on the feedbacks received from the PG medical graduates, and if they are asked how many surgeries or procedures they conducted by themselves during their training, it will be crystal clear."

Further addressing the urgency for increasing Specialist doctors, he added, "You want to increase the specialist doctors. What are these specialist doctors exactly? Why don't you issue certificates to random people. If all the doctors need to do is to take some online classes and watch some YouTube videos to operate, allow them to operate."

Also Read: Anomalies in MBBS Admissions: RTI Activists upset with medical college for alleged non-cooperation in investigation