Give uniform stipend, working conditions for all MBBS interns across the country: IMA to NMC

Instead of including the AYUSH elective, IMA in the letter directed to Dr. Suresh Chandra Sharma, the Chairman of NMC, has advocated for the inclusion of the Family Medicine elective, stating that it is "a need of the hour for catering to the common people with multifaceted, continuous, comprehensive, cost-effective, community-oriented concept and values of family care."

The National Medical Commission recently issued the Draft Regulations For Rotational Compulsory Regulations, 2021 and has invited comments and suggestions from various stakeholders asking them to submit their responses before August 7th, 2021.

Also Read: NMC Member writes to NMC on MBBS internship guidelines

Recently, an NMC member and IMA National President-elect Dr. Sahajanand Prasad Singh had written to the NMC pointing out regarding the issue. Objecting to the inclusion of AYUSH elective, he had pointed out that "any ancillary inclusion not having any material bearing in regard to the expected outcome commensurate with the set-out goal and objective is bound to be superfluous in nature and irrelevant in character."

Now, the Indian Medical Association (IMA) has also raised some similar objections.

Strong Objections against AYUSH elective:

IMA has pointed out that as per section 3.2 of the Draft Regulations, the objectives of the Internship state that "At the end of the internship period the medical graduates will possess all competence required of Indian Medical graduates" to function as (a) Clinician who understands and independently provide safe, preventive, promotive, curative, palliative and wholistic care with compassion and is confident of handling common acute emergencies.

Thus, such set-out objectives clearly define that "the intern should practice what he has learned in his curriculum and provide the same care to people under supervision."

However, Section 4.3(17) mentions the exclusive elective posting of 1 week in any one of the AYUSH medicine available in the Medial College to be given as a mandatory elective posting.

Objecting to this inclusion, IMA in the letter has pointed out several reasons for the same. Pointing out that allowing an intern to practice a system of medicine which he has not learned in under-graduation with know-how and show how paradigms, IMA has stated in the letter that "straightaway coming to do it in an internship is dangerous to the public and the system."

Such an inclusion also contradicts Sec. 7.2(a) of the draft regulations, which mention that the emphasis during internship shall be hands-on training applying the scientific and theoretical background gained during the undergraduate course pointed out IMA.

Expressing its concern that exposure in another system of medicine for the one-week period is likely to pave the way to a "half-baked mixopath," the letter stated that the results of such inclusions would be "disastrous for the country".

"AYUSH and its components are vast subjects, working there for a week the intern will not learn any new skill, and there is no clarity who shall be their mentor, and will they be assessed by NMC faculty norms or not. What is the objective, roll or competency will be learned which will augment his competencies as IMG.?. Are we adding engineering and Agricultural science too for a week as it will make him a perfect human being?" IMA questioned NMC.

Also Read: MBBS medicos should be allowed to choose institutes for internship: FORDA writes to NMC

Raising alarms for the slow inclusion of mixopathy in the Modern medical hospitals, IMA expressed its concern in the letter that "The rider for the said elective is very clear to the effect that provided the said discipline is available in the same college/ institution where the internship is being done by the intern. In this pretext, attempts will be made to introduce all these disciplines inside the Modern medical hospitals, and slowly mixopathy will creep in."

In this context, IMA has also cited the Supreme Court's observations directing a registered medical professional in a specific field of medicine to stick to the said profession and not trespass any other profession.

"This being binding and established position of law any posting in the name of elective in the period of internship which has no bearing in regard to the competencies that the intern would be entitled to practice as a registered medical practitioner are neither open nor permissible for inclusion in the said internship program, otherwise, it will be violative of this binding settled legal position in terms of it being law of the land," IMA pointed out and sought the deletion of the section 4.3(17).

Inclusion of Family Medicine as an Elective:

Advocating for the inclusion of Family Medicine as an elective in the MBBS internship program, IMA opined that the 4.3(17) subject should be replaced by a one or two-week Family Medicine practice along with Bioethics.

"The new competency-based Medical Education has multiple hours of learning and practical sessions on Family Medicine subjects. When there is no opportunity to practice Family Medicine in the intern period for which the Government is giving much priority is against the health care policy of our country," IMA pointed out.

Uniform Stipend Policy:

Apart from objecting to the AYUSH elective and advocating for the Family Medicine, IMA has further opined that although the section 6.3 of the draft regulations demand uniform skill development and talks about uniform testing by NEXT exam, the issue of stipend is still under the control of the private medical colleges and states.

"IMA demands there shall be a uniform scale of stipend and working conditions of the interns shall be formulated in the regulations" mentioned the letter.

Anomaly in Two-week posting in Broad Specialty and Super Specialty:

Further discussing out the ambiguities in the subjects included in the broad or super-specialty, IMA pointed out that although there is no difference between Respiratory and Pulmonary medicine, one of those has been included in the broad specialty and the other in the super-specialty. "The same intern can choose 2 weeks of Respiratory medicine and 1week of Pulmonary medicine both are carried out by the same departments," the letter stated.

The letter mentions the same kind of confusion between physiatry, which is included in the Orthopedic posting and the physiotherapy course included in the broad specialty.

"However, NMC guidelines do not mention physiotherapy as a broad specialty in our MBBS curriculum. The Doctor who had postings in Physical Medicine why should be posted for physiotherapy? Who will be the teacher for them?" questioned IMA.

Also Read: MBBS internship to now include training in AYUSH disciplines: NMC draft guidelines

Confusion between Completion Period and Validity of registration:

IMA has stated that section 4.2 of the draft regulations mention that the internship should be completed within 2 years of passing the Final MBBS/FMGE/NEXT Examination.

However, Sec. 5.3 (b) states that "The Provisional Registration shall normally be valid for a period of ONE YEAR and shall stand canceled/ withdrawn/ invalid after this period unless otherwise extended."

IMA has thus requested NMC for amending this.

Other Issues:

Apart from all these issues, IMA has also pointed out about a factual error in section 6.3, which mentions that "Total internship paid for the entire internship shall be for 48 weeks (12 months) only". This, according to IMA, is a factual error as 48 weeks cannot be equivalent to 12 months.

Besides, IMA has sought more clarity regarding section 8.2 of the draft regulations, which states that an intern needs to undergo an eligibility test whenever duly notified as a requisite to be granted permanent registration/licentiate to practice. "Is this eligibility licentiate test in addition to the Exit Exam?" IMA has sought to know in the letter.

Earlier, FORDA had also written to the NMC raising concerns over the necessity of undergoing the MBBS internship in the parent institute itself as mentioned in the Draft Regulations.