NMC integrates NExT as prerequisite for PG medical education, releases draft guidelines for comments

New Delhi: Foreseeing the future of PG medical education, the National Medical Commission (NMC) has now integrated the National Exit Test (NExT) as a prerequisite for PG medical admissions while adding that NEET PG will continue till the first batch of NExT becomes eligible.

This comes as through a recent Public Notice, the Postgraduate Medical Education Board (PGMEB) of the National Medical Commission (NMC) has released the draft Post-Graduate Medical Education Regulations (PGMER) 2023.

Inviting comments regarding the draft regulations, the Under Secretary of NMC PG Board further mentioned in the notice dated September 06, 2023, "It is requested to share comments on the draft regulations at the following email id comments.pqrequlations@nmc.org.in in MS Word (.docx) format or machine readable PDF Format within 10 days from the date of publication of this notice with a subject tagline "Comments on draft Post-Graduate Medical Education Regulations-2023."

The draft Regulations titled “Post-graduate Medical Education Regulations-2023” or “PGMER-23” have been made by NMC 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 25 and sub-section (2) of Section 57 of the said Act.

"These Regulations shall come into force from the date of their publication in the official gazette," NMC PGMEB mentioned in the Draft.

NMC in Chapter I of the Draft, has discussed the focus and goal of post-graduate medical education and the definitions of several terms used in the Draft such as "Act", "Commission", "Medical Institution", "MSR", "NEET-PG", "NEET-SS" etc.

As per the Draft Regulations, the focus and goal of post-graduate medical education shall be to produce competent specialist and /or Medical teacher recognized by the fraternity as the graduating scholar, building upon his undergraduate education, skills who shall –

i. Recognize the health needs of the community and carry out professional obligations ethically keeping in view the objectives of the national health policy;

ii. have mastered most of the competencies, pertaining to the respective Speciality, that is required to be practised at the secondary and the tertiary levels of the health care delivery system;

iii. be aware of the contemporary advances and developments in the respective discipline concerned and shall progress accordingly;

iv. have acquired a spirit of scientific inquiry and is oriented to the principles of research methodology and epidemiology;

v. have acquired the basic skills in the teaching of medical and paramedical professionals;

vi. acquire basic management skills in human resources, materials and resource management related to health care delivery, general hospital management, principal inventory skills and counselling;

vii. 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;

viii. 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.

The institutions imparting post-graduate medical education shall continually work to synchronize the institutional goals with the national goals to produce the kind of trained manpower with high knowledge, appropriate skills and impeccable ethical standards required.

Chapter-II of the Draft mentioned courses of specialities and components of post-graduate training. This includes the list of qualifications, duration of the course and components of post-graduate training, components of the post-graduate curriculum.

The issue of establishment of post-graduate medical institutions and starting of new post-graduate medical courses have been discussed in Chapter-III of the Draft. This chapter includes issues like permission, accreditation, increase of seats, monitoring of standards of medical education, and minimum standards of requirements.

Chapter-IV gives details regarding admission and counselling. It includes issues like eligibility criteria, conduct of NEET-SS, common counselling, admission schedule for Post-Graduate Broad Speciality courses, time schedule for completion of admission process for PG (super-speciality) medical courses, details about government appointed designated authority for common counselling, prohibition for any student seeking admission in ay other way than counselling, submission of final list, student migration, reservation of seats, feeder broad speciality qualifications for super speciality courses.

Details regarding training of Post-graduate students have been discussed in Chapter-V of the Draft. Such details include the period of training, and the issue of training programme such as common course work.

The issue of District Residency Programme has also been discussed in this chapter. It includes its objectives, definition of District Hospital, District health system, training and responsibilities of district residents, stipend and leave of district residents, training during DRP and certification, responsibility of medical institute, responsibility of State Governments/Union Territories, responsibility of National Medical Commission, constitution of national/state oversight mechanisms, launch of the district residency programme, etc.

Apart from this, the issue of model curriculum, stipend to postgraduate students, leave rules for postgraduate students, accommodation to postgraduate students, etc have also been discussed in this chapter.

Chapter VI of the Draft discussed about the Role of Universities, while the details about the Departments, units, faculty and senior residents have been mentioned in Chapter VII of the draft. The issue of examiners, examinations, valuation, number of examinations, metholodology have been discussed in detail in Chapter VIII.

The Draft also mentions details about sanction and penalty (Chapter IX) including penalty for violation of regulations, miscellanous (Chapter X) issues like faculty development programme, animal experimentation, collaborative research, Amendments, saving clause, and repeal (chapter XI) etc.

Apart from this, it also includes list of recognised post-graduate broad speciality, post-graduate super speciality qualifications, post-graduate diploma qualifications, post-doctoral certificate courses qualifications, post-doctoral fellowship qualifications. The schedule to the Rights of Persons with Disabilities, guidelines regarding admission of students with "specified disabilities" under the Rights of Persons with Disabilities Act, 2016 with respect to admission in Post-graduate courses in modern medicine. Further, the Feeder broad speciality qualifications for super speciality courses have also been included in the Draft.

COURSES OF SPECIALITIES AND COMPONENTS OF POST-GRADUATE TRAINING

LIST OF QUALIFICATIONS, DURATION OF THE COURSE AND COMPONENTS OF POST-GRADUATE TRAINING

@ Medical colleges/institutes may apply to Medical Assessment and Rating Board (MARB) for converting diploma seats to degree seats. No more new applications will be entertained for permission to start or increase in number of diploma seats.

COMPONENTS OF THE POST-GRADUATE CURRICULUM

The major components of the post-graduate curriculum shall be:

i. Theoretical knowledge

ii. Practical and clinical skills

iii. Writing thesis

iv. Soft skill attributes including communication skills.

v. Training in research methodology, medical ethics and medico legal aspects.

ESTABLISHMENT OF POST-GRADUATE MEDICAL INSTITUTIONS AND STARTING OF NEW POST-GRADUATE MEDICAL COURSES

PERMISSION

i. Permission to start the post-graduate course along with an undergraduate medical course in a medical college/institute or permission to start a post-graduate course in already established undergraduate medical college/institution and determination of number of seats to be permitted shall be as per the Establishment of New Medical Institutions, Starting of New Medical Courses, Increase of Seats for Existing Courses & Assessment and Rating Regulations in vogue, Post-Graduate Medical Education Regulations (PGMER) in vogue, Teachers Eligibility Qualifications in Medical Institutions Regulations in vogue, MSR in vogue, Curriculum requirements of respective speciality as notified/informed from time to time on website or by other methods by Post-Graduate Medical Education Board (PGMEB), other relevant regulations, explanatory notes, circulars and advisories etc., issued from time to time.

Post-graduate courses will be permitted only if the medical college/institution fulfills all the requirements for running the undergraduate medical college

ii. Existing or proposed non-teaching hospitals owned and managed by government can start post-graduate courses without having undergraduate college, if they fulfil the norms and procedures prescribed in the Establishment of New Medical Institutions, Starting of New Medical Courses, Increase of Seats for Existing Courses & Assessment and Rating Regulations in vogue, Post-Graduate Medical Education Regulations (PGMER) in vogue, Teachers Eligibility Qualifications in Medical Institutions Regulations in vogue, MSR in vogue, Curriculum requirements of respective speciality as notified/informed from time to time on website or by other methods by Post-Graduate Medical Education Board (PGMEB), other relevant regulations, explanatory notes, circulars and advisories etc., issued from time to time.

MARB shall do the assessment as per the guidelines and Assessment Form prescribed by the PGMEB. MARB shall evaluate the Assessment Report and put up before the Committee comprising of following members:

President of MARB - Chairman

Member of MARB/Expert (to be nominated by President - Memberof MARB )

President/ Member of UGMEB (to be nominated by - Member President of UGMEB)

President/ Member of PGMEB (to be nominated by - Member President of PGMEB)

Director/Deputy Secretary of MARB will be Member Secretary

The Committee will deliberate on the application, with relevant reports regarding whether the medical institution fulfils the prescribed conditions mentioned in above mentioned documents and take one of the following decision(s) –

a. Whether to permit to start the post-graduate course/speciality or not;

b. the number of seats to be permitted in the Department from the next Academic Year

Once permitted, seats will be called recognised seats for the purpose of registration of degree awarded by University.

ACCREDITATION

Every permitted post-graduate medical course will have to be accredited by PGMEB as below:

The medical college/institute which has started a new postgraduate course of a qualification shall apply for accreditation of the post-graduate medical course to the President, Postgraduate Medical Education Board (PGMEB) at least three months prior to the expected date of examination to be conducted by the affiliating university in which the first admitted batch is due to appear. Letter from the medical college/institution informing about the exact date of the Practical Examination should reach PGMEB at least fifteen days prior to the date of the Practical Examination. PGMEB will do the assessment of medical college/medical institution running the post-graduate courses. The Assessment Report shall be put before a Committee, comprising the following members:

President of PGMEB - Chairman

Member of PGMEB/Expert (to be nominated by President of - Member PGMEB)

President/ Member of UGMEB (to be nominated by President - Member of UGMEB)

President/Member of MARB (to be nominated by President - Member of MARB)

Director/Deputy Secretary of PGMEB will be Member Secretary

If any deficiency is found, then the Committee will ask the medical college/institution for Compliance. The Committee will examine the Assessment/Assessment and Compliance Report regarding whether the medical institution fulfils the prescribed conditions and Report on Assessment of the Examination. Decision(s) will be taken by the Committee on the following:

c. Whether to accredit the post-graduate course/speciality in the medical college/institution or not;

d. number of seats to be permitted in the Department from the next Academic Year

If the medical college/institute is denied accreditation, then there will be no admission from the next academic year; and the medical college/institute will apply afresh for permission to restart the course.

Failure to seek timely accreditation of the existing post-graduate course shall invite exemplary penalty as per the Sanctions and Penalty Clause mentioned in Chapter-IX of this regulation.

INCREASE OF SEATS

Procedures, methods and criteria for increase of seats will be same as prescribed in sub Section 3.1 (Permission)

Increase of seats so granted in already accredited post-graduate course shall be deemed to be recognised post-graduate seats for the purpose of registration of the students. If the Speciality is already accredited, then the medical college/institute shall not apply for accreditation again.

MONITORING OF STANDARDS OF MEDICAL EDUCATION

The standards of the Medical Education shall be monitored as per the Maintenance of Standards of Medical Education Regulations, 2023 in vogue. Medical college/institute shall pay Annual Fee, as notified by the National Medical Commission from time to time, for the purpose of annual evaluation. Every medical college/institute will pay Affiliation Fee for every course as per the amount fixed in the guidelines from time to time.

MINIMUM STANDARDS OF REQUIREMENTS (MSR)

Medical colleges/institutes shall follow the guidelines prescribed by the Post-graduate Medical Education Board in the Minimum Standards of Requirements (MSR) document for post-graduate medical education. PGMEB shall notify the Minimum Standards of Requirements (MSR) from time to time for physical infrastructure of the hospital and medical college/institute, teaching staff and other staff, clinical material (prescribed number of patients as per curriculum requirement, laboratory and radiological investigations) for all-round training of the post-graduate students. The PGMEB shall also notify the modifications or amendments in the MSR from time to time which shall have to be mandatorily followed by the medical colleges/institutes.

ADMISSION, COUNSELLING, ETC.

ELIGIBILITY CRITERIA - Eligibility to pursue a ‘Broad specialty post-graduate programme in Medicine’ will be on the basis of computation of the Marks obtained in the common final year undergraduate examination to be known as the ‘National Exit Test’, conducted by the National Medical Commission or caused to have been conducted by National Medical Commission. Till the first batch based on National Exit Test (NExT) becomes eligible for admission in Broad Speciality, the existing system of admission through National Eligibility-cum-Entrance Test-Post-graduate (NEET-PG) as per Post-Graduate Medical Education Regulation, 2000 (PGMER-2000) shall continue.

Provided further that eligibility to pursue super specialty programme/course in Medicine shall be by securing the minimum eligible score at the National Eligibility-cum-Entrance Test-Super Speciality (NEET-SS) Exam conducted either by the National Medical Commission or caused to have been conducted by National Medical Commission. List of feeder broad specialty qualification required by a person to pursue Super-Speciality course of recognized qualification is as per Annexure

CONDUCT OF NEET-SS – Either the National Medical Commission may conduct the NEET-SS for all super specialty courses or may designate any such agency or authority by whatever name called, to cause the NEET-SS to be conducted.

Provided National Medical Commission may designate multiple agencies or authorities or a combination of agencies or authorities, to conduct NEET-SS if such designation suits the purpose.

Without prejudice to anything stated above the Post Graduate Medical Education Board shall determine the manner, and modalities etc., of conducting the NEET-SS for Super Speciality courses by way of Notification.

COMMON COUNSELLING – Without prejudice to anything stated in the present Regulations or other NMC Regulations, there shall be common counselling for admission to Post-graduate courses in medicine for all medical institutions in India solely based on the merit list of respective exams.

Provided the common counselling may have multiple rounds as may be necessary.

PGMEB of NMC shall publish guidelines for the conduct of common counselling and the designated authority under Section 4.4 shall conduct common counselling in conformity with such published guidelines.

Admission Schedule for Post-graduate Broad Specialty Courses (MD/MS)

Note:

1. For the purpose of ensuring the above time-schedule, Saturday, Sunday or Holidays (except National Holiday) shall be treated as working days.

2. Keeping in view the circumstances and exigencies, Post-Graduate Medical Education Board may alter the number of rounds and schedule of counselling

The following Matrix shall be applicable with regard to permissibility to students to exercise fresh choice during counselling:-

Time Schedule for completion of Admission process for PG (Super Specialty) Medical Courses:

Note: Keeping in view the circumstances and exigencies, Post-Graduate Medical Education Board may alter the number of rounds and schedule of counselling.

Government to appoint a designated authority for Common Counselling – For admission to broad specialty post-graduate courses in medicine in medical institutions, the Central Government or its designated authority shall be the counselling agency for the All-India quota seats and State Government/U.T. Administration shall be the counselling agency for the State/Union Territory quota seats. For all the seats in the Super Speciality Courses, the Central Government or its designated authority shall be the counselling agency.

Prohibition for any student seeking admission in any other way than counselling – No medical institute shall admit any candidate to the Post-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 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 fined Rupees two crore or double the amount of fees for the entire course duration whichever is higher per seat and barred from granting admissions to any student for minimum two academic years 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.

Submission of the final list – The respective designated authorities (who have conducted the Common Counselling) shall submit the final list of students in the prescribed proforma to the Post-graduate Medical Education Board within one 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 to the PGMEB within one week of the last date of the joining course, declared by the PGMEB.

Provided only those medical institutions that were permitted to start the post-graduate medical course prior to the date of notification of Common Counselling are allowed to admit students; and those medical institutions, who get requisite permission after the date of notification of Common Counselling shall participate in the next academic year’s common counselling to admit students.

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

Student Migration – No student designated to a medical institution, notwithstanding anything stated in these Regulations, shall be permitted migration to any other medical institution.

Reservation of Seats - The reservation of seats in medical colleges/institutions for respective categories shall be as per applicable laws prevailing in States/Union Territories. An all India merit list as well as State-wise merit list of the eligible candidates shall be prepared on the basis of the marks obtained in NExT or NEET-PG and candidates shall be admitted to post-graduate courses from the said merit lists only.

Provided further that 5% seats of annual sanctioned intake capacity in Government or government aided higher educational institutions shall be filled up by candidates with benchmark disabilities in accordance with the provisions of the Rights of Persons with Disabilities Act, 2016 based on the merit list of NExT or NEET-PG for admission to post-graduate medical courses. For this purpose, the “Specified Disability” contained in the Schedule to the Rights of Persons with Disabilities Act, 2016 is annexed at Annexure-7 and the eligibility of candidates to pursue a course in medicine with specified disability shall be in accordance with Annexure-8. If the seats reserved for the persons with disabilities in a particular category remain unfilled on account of unavailability of candidates, the seats should be included in the annual sanctioned seats for the respective category.

Feeder Broad Speciality Qualifications for Super Speciality courses - Prior requirement of Broad Speciality degree qualification to pursue Super Specialty course for qualification will be called Feeder Course. List of Feeder Courses to pursue Super Speciality course of qualification is as per Annexure-9.

TRAINING

PERIOD OF TRAINING

The period of training for the award of various post-graduate degrees and diplomas shall be as per Chapter-II Section 2.1.

TRAINING PROGRAMME

(i) The training given to the post-graduate students during their stay in the accredited institutions for the award of various post-graduate degrees, shall determine the expertise of the specialist and /or medical teachers produced.

Provided that in respect of MD/MS students admitted with effect from academic session 2021, the training imparted as part of District Residency Programme in District Health System, as provided for in this Section 5.2(XI) of these Regulations shall be considered as training imparted in a medical institution.

(ii) All post-graduate students will work as full-time resident doctors. They will work for reasonable working hours and will be provided reasonable time for rest in a day.

(iii) Every institution undertaking post-graduate training programme shall set up an Academic Cell, under the chairmanship of a senior faculty member, which shall ensure and monitor the implementation of training programmes in each specialities.

(iv) The training programmes shall be updated as and when required while keeping in mind the curriculum requirement and other relevant requirements prescribed by NMC from time to time. The structured training programme shall be written and strictly followed, to enable the examiners to determine the training undergone by the candidates.

(v) Post-graduate students of broad and super specialty degree courses shall maintain a dynamic e-log book which needs to be updated on weekly basis about the work being carried out by them and the training programme undergone during the period of training. MS/M.Ch students shall mandatorily enter details of surgical procedures assisted or done independently.

(vi) The record (Log) books shall be checked, assessed and authenticated monthly by the postgraduate guide imparting the training.

(vii) The post-graduate students shall be required to participate in the teaching and training programme of undergraduate students and interns.

(viii) During the training for award of Degree/Diploma/Super-specialty in clinical disciplines, there shall be proper training in basic medical sciences related to the disciplines concerned. During the training programmes emphasis has to be laid on preventive and social aspects.

(ix) All post-graduate medical college/institution will have facilities for teaching the basic science subjects as per guidelines.

(x) Post-graduate training shall consists of training of the students through lectures, seminars, journal clubs, group discussions, participation in laboratory and experimental work, involvement in research, clinical meetings, grand rounds, clinico- pathological conferences, practical training in diagnosis and medical and surgical treatment, training in the basic medical sciences as well as in allied clinical specialties, etc. as per the requirement of speciality training.

Specialities where patient treatment is involved the teaching and training of the students shall include graded responsibility in the management and treatment of patients entrusted to their care.

A post-graduate student of a degree course in broad specialties/super specialties would be required to present one poster presentation or to read one paper at a national/Zonal/state conference of the respective specialty or to have one research paper published/accepted for publication as the first author in the journal of the respective specialty to make him eligible to appear in the post-graduate degree examination.

(xi) Common Course work

The following course work shall be common and mandatory for all broad and super specialty post-graduate students irrespective of the specialty.

(a) Course in Research Methodology

i. All post-graduate students shall complete an online course in Research Methodology.

ii. The students shall have to register on the portal of the designated training institutions.

iii. The students shall complete the course in the first year.

iv. The online certificate generated on successful completion of the course and examination thereafter, will be acceptable evidence of having completed this course.

v. The above certification shall be a mandatory requirement to be eligible to appear for the final examination of the respective post-graduate course.

vi. This requirement shall be applicable for all post-graduate students.

(b) Course in Ethics

i. All post-graduate students shall complete course in Ethics including Good Clinical Practices and Good Laboratory Practices, whichever is relevant to them, to be conducted by institutes/universities.

ii. The students shall complete the course in the first year.

iii. No post-graduate student shall be permitted to appear in the examination without completing the above course.

(c) Course in Cardiac Life Support Skills

i. All post-graduate students shall complete a course in Basic Cardiac Life Support (BCLS) and Advanced Cardiac Life Support (ACLS) skills to be conducted by the institute.

ii. The students shall complete the course in the first year.

iii. No post-graduate student shall be permitted to appear in the examination without the above certification.

(d) Others

Institutions may arrange training in any other courses like awareness in medical audit; exposure to human behavior studies; and finance and accounts, etc which are beneficial to the post-graduate students.

(xii) DISTRICT RESIDENCY PROGRAMME (DRP)

I. Preamble:

Doctors have to be trained in diverse settings including those which are close to the community. Hence, they should be trained in the District Health System /the District Hospitals.

II. Objectives:

The main objectives of the District Residency Programme (DRP) would be:

a. to expose the post-graduate student to District Health System/ District Hospital and involve them in health care services being provided by District Health System /District Hospital for learning while serving;

b. to acquaint them with the planning, implementation, monitoring and assessment of outcomes of the National Health programmes at the district level; and

c. to orient them to promotive, preventive, curative and rehabilitative services being provided by various categories of healthcare professionals under the umbrella of National Health Mission.

In doing so, the post-graduate medical students would also be contributing towards strengthening of services of the District Health System as specialty resident doctors working as members of the district teams.

III. Definition of District Hospital:

For the purpose of this programme, a District Hospital shall be a functional public sector/government-funded hospital of not less than 50 beds with facilities/staff for the designated specialties at that level/facility.

IV. Definition of District Health System:

For the purpose of this programme, the District Health System shall include all public sector/government-funded hospitals and facilities (including community health centers, primary health centers, sub-health centers, urban health centers, etc.), as well as community outreach system in a district. This would also include district system engaged in running respective public health services including the implementation of national and state public health programmes.

V. District Residency Programme:

All post-graduate students pursuing MD/MS in broad specialties in all medical colleges/institutions under the purview of National Medical Commission shall undergo a compulsory residential rotation of three months in District Hospitals/ District Health System as a part of the course curriculum. Such rotation shall take place in the 3rd or 4th or 5th semester of the post-graduate programme. In case of those students who have taken admission after completion of Diploma in the relevant specialty, District Residency Programme shall take place in third semester only. Similarly, the post-graduate diploma students shall undergo the District Residency Programme in the third semester.

This rotation shall be termed as ‘District Residency Programme’ (DRP) and the post-graduate medical student undergoing training shall be termed as a ‘District Resident’.

VI. Training and Responsibilities of District Residents:

The District Resident will work under the overall directions and supervision of the District Residency Programme Coordinator (DRPC).

During this rotation, the Resident doctor will be posted with the concerned/aligned specialty team/unit/ sections/services at the District Health System/ District Hospital, The clinical responsibilities assigned to the Residents would include serving in outpatient, inpatient, casualty and other areas pertaining to their specialty and encompass night duties.

Post-graduate students of specialities where direct patient care is not involved will be trained by District Health System/ District Hospital teams within the available avenues in coordination with the District Health Officer/Chief Medical Officer. They would be trained in and contribute to the diagnostic/laboratories services, pharmacy services, forensic services, general clinical duties, managerial roles and public health programmes etc., as applicable. They may also be posted in research units / facilities, laboratories and field sites of the Indian Council of Medical Research and other national research organizations.

VII. Stipend and Leave for District Residents:

The District Residents shall continue to draw full stipend from their respective medical colleges for the duration of the rotation subject to the attendance record submitted by the appropriate district authorities to the parent medical college/institution, based on methods and system as prescribed. Subject to exigencies of work, the District Resident will be allowed one weekly holiday by rotation. They shall also be entitled to leave benefits as per the rules/ guidelines of the parent college / university.

VIII. Training during DRP and Certification thereof:

a. Quality of training shall be monitored by log books, supportive supervision and continuous assessment of performance. The attendance and performance of District Residents shall be tracked by the District Residency Programme Coordinator (DRPC) of the District concerned, as well as the parent Medical College through an appropriate electronic/digital or mobile enabled system. Such monitoring systems shall also be accessible to the State/Union Territory Steering Committee and the National Coordination Cell.

b. The District Residents would remain in contact with their designated post-graduate teachers and departments at their parent Medical College / Institution by phone and e-communication for guidance, learning, and for being able to participate remotely in scheduled case discussions, seminars, journal clubs, thesis discussion, etc. and other academic activities.

c. Satisfactory completion of the District Residency shall be an essential condition before the candidate is allowed to appear in the final examination of the respective post¬graduate course.

d. The District Residency Programme Coordinator (DRPC) shall issue certificate of satisfactory completion of DRP and report on the performance of the District Resident on a prescribed format to be decided by the PGMEB to the concerned medical college and the Govt. of the State/UT.

IX. Responsibility of Medical College/Medical Institution:

It shall be incumbent upon all medical colleges/ institutions to place the post-graduate students at the disposal of the Government of concerned State/Union Territory for the District Residency Programme. The faculty of the concerned departments would provide guidance to the District Residents by phone/e-communication in accordance with Section 5.2.VI.

X. Responsibility of State Government /Union Territory:

The State Government /Union Territory shall implement the District Residency Programme within their jurisdiction as under:-

a. The Programme shall be coordinated jointly by the Directorate of Medical Education and the Directorate of Health Services. An Officer of the State Government /Union Territory shall be designated as the State/UT District Residency Programme (DRP) Nodal Officer. The concerned Government shall be responsible for the facilitation, oversight and supervision of the District Residency Programme.

b. The designated State/UT DRP Nodal officer shall identify and designate District Health System/ District Hospital that are suitable for such rotation in terms of availability of specific specialties, specialists, facilities and services available in consultation with the Directorate of Health Services of the State and the medical colleges, and develop a placement schedule of the Post-graduate Residents of the medical colleges due for rotation at least 6 months in advance. This official will also be responsible for grievance redressal at State level.

c. The State DRP Nodal officer shall undertake rule-based allotment of the training facilities to the Post-graduate Residents

d. The State Government shall provide appropriate amenities to the District Residents, including, amongst others, suitable accommodation, mess, transportation to work place (if living quarters is far away), security, especially for lady Residents. Accommodation could be by means of government premises or that rented by concerned State Government and should conform to prescribed norms.

e. The District Residents shall remain under the jurisdiction of respective State/ UT DRP Nodal officer where they are undergoing District Residency.

f. In case all the Post-graduate Residents of a State/UT cannot be absorbed within their respective jurisdiction, possibility of posting them to other States/Union Territories may be explored by mutual understanding in consultation with the respective Governments facilitated by the National Coordination Cell.

g. It shall be permissible for the post-graduate students from the North East Zone (NEZ) in various medical colleges/institutions in the country, to undergo District Residency Programme in their respective States.

h. The State Government/UT may consider providing additional honorarium to the District Residents as a token of recognition of their contribution to the healthcare services of the States. In addition, the concerned Governments may make provisions to incentivize postings to remote and difficult areas, and encourage volunteering by post¬graduate students to serve at these places.

i. The concerned State Government shall also designate a senior official of the District Health System as the District Residency Programme Coordinator (DRPC) in each District for coordinating between the State DRP Nodal officer and the medical colleges. The District Residency Programme Coordinator shall also be responsible for orienting the Post-graduate Residents to the District health system, supervising the postings within the district, ensuring their accommodation, safety and transport needs, and for grievance redressal, etc. District Residency Programme Coordinator shall be the competent authority for sanctioning leave to District Residents.

XI. Responsibility of National Medical Commission:

All Medical institutions will submit the DRP posting details of the students to PGMEB of National Medical Commission within one week of completion of DRP. The PGMEB of National Medical Commission will monitor the training programme and may direct necessary changes to the State Government and Medical institutions, if so desired.

XII. Constitution of National/State Oversight Mechanisms:

a. The National Medical Commission shall constitute a National Steering Committee in consultation with the Ministry of Health and Family Welfare, Government of India to oversee the implementation of the District Residency Programme.

b. The National Steering Committee shall be chaired by President, Post-Graduate Medical Education Board (PGMEB) or his nominee. The Committee shall comprise nominated members from the Ministry of Health and Family Welfare (not below the rank of Director/Deputy Secretary), Nominee of Directorate General of Health Services (DGHS) and representatives of at least six State Governments/Union Territories. The Committee may submit quarterly reports to the Central Government.

c. The National Steering Committee shall establish a National Coordination Cell (NCC) under the PGMEB of National Medical Commission which shall be responsible for the smooth and efficient implementation of the District Residency Programme and grievance redressal at national level.

d. The Governments of State/Union Territory shall constitute a State/Union Territory level Steering Committee chaired by Principal Secretary/ Secretary (Health) and comprising Principal Secretary/Secretary (Medical Education), Director of Health Services, Director of Medical Education, Registrar of the Health University and Deans of the medical colleges to facilitate the implementation of the District Residency Programme.

XIII. Launch of the District Residency Programme:

The District Residency Programme shall be implemented with the PG (broad specialty) batch that has joined for the post-graduate course in the Academic Session 2021.

CURRICULUM

The Post-graduate Medical Education Board 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.

STIPEND TO POSTGRADUATE STUDENTS

The post-graduate students undergoing post-graduate degree/Diploma/Super- Specialty course in all the institutions shall be paid stipend at par with the stipend being paid to the post-graduate students of State Government medical institutions/Central Government medical institutions, in the State/Union Territory where the institution is located.

LEAVE RULES FOR POSTGRADUATE STUDENTS

The following leave rules will be followed:

a. Every post-graduate student will be given minimum 20 days of paid leave per year.

b. Subject to exigencies of work, post-graduate students will be allowed one weekly holiday

c. Female post-graduate students shall be allowed maternity leave as per existing Government rules and regulations

d. Male post-graduate students shall be allowed paternity leave as per existing Government rules and regulations

e. In addition to minimum 20 days’ paid leave, the candidates will be allowed academic paid leave of 5 days per year for entire duration of training period.

The training period shall be as per Section 2.1 (Chapter-II). If a candidate avails leave in excess than the permitted number of days, his/her term of course shall be extended by the same number of days to complete the training period. However, one shall be able to appear in the examination if one has 80% (eighty percent) of the attendance.

ACCOMMODATION TO POSTGRADUATE STUDENTS

It will be mandatory for the college to provide appropriate residential accommodation to the post-graduate students. However, it will not be mandatory for the post-graduate students to stay in the hostel.

ROLE OF UNIVERSITIES

6.1 It shall be the duty of all concerned Universities with the medical institutions under them, to partner with the National Medical Commission –

a. To implement an appropriate curriculum to provide high-quality and affordable post-graduate medical education to the student to make him a competent specialist and/or medical teacher.

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

c. Encourage scholars in both self-directed and Assisted learning.

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

e. provide a combination of both formative and summative assessment for overall successful completion of the Post-graduate programme.

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.

6.2 Without prejudice to the above, the concerned University and medical institutions under them shall ensure that proper records of the work be maintained so that they form the basis of objective, efficient and transparent internal assessment of scholars.

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.

6.3 It shall be the constant endeavor of the concerned University to constantly develop strategies for optimal utilization of evolving technology by the faculty, medical education department and scholars during the period of training at the post-graduation level.

6.4 It shall be the constant endeavor of the concerned University to maximize the use of digital technology for conducting examination and issuance of Degree/Diploma and other certificates in digital mode which should be available on Digi locker platform. All the Universities should make all out efforts to start issuance of Certificates in digital mode on Digi locker platform as early possible.

DEPARTMENT, UNITS, FACULTY AND SENIOR RESIDENTS

Department:

The name of the Department will be as per the name of the Speciality subject (qualification) (Annexure-1, Annexure-2). Each Department will be headed by a Professor.

Unit:

All Departments with inpatient beds will have unit structure (Units), if applicable.

Faculty:

Professor, Associate Professor and Assistant Professor will be considered as faculty and they will be full time. Appointment and promotion of faculty in various teaching Specialities imparting post-graduate medical education in medical institutions, falling within the purview of the national medical Commission, has to be in accordance with the norms of Teachers Eligibility Qualifications in Medical Institutions Regulations, in vogue. The number of faculty requirement and the number of post-graduate students registrable under teach faculty will be as per PGMER and PG-MSR norms in vogue.

In Government institutions, where there is a post of Additional Professor, and a faculty, who fulfills all the requirements to become Professor will be considered as Professor for all purposes. However, the Government will convert the designation at the earliest. Similarly, in Government institutions, where there is a post of Reader, and a faculty, who fulfills all the requirements to become Associate Professor will be considered as Associate Professor for all purposes. However, the Government will convert the designation at the earliest.

Senior Resident:

Senior Resident should have post graduate/super speciality qualification in the respective speciality.

Post-graduate courses under any other body like the National Board of Examinations in Medical Sciences (NBEMS), etc. are not permissible against the very same units, teaching personnel and infrastructure for courses under these regulations.

The faculty of a medical college/institute shall assist the National Medical Commission/Boards whenever required for the purpose of assessment and as experts, etc.

The position of Dean/Director/Principal of Medical College/Institution should be held by a person possessing recognized post-graduate medical degree from a recognized/accredited institution with a minimum of ten years teaching experience as Professor/Associate Professor in a Medical College/ Institution, out of which at least five years should be as Professor in the Department. Appointment to these posts shall be made on seniority-cum-merit basis. The Dean/Director/Principal of Medical Institution shall not hold the post of Head of the Department.

The Medical Superintendent of the affiliated teaching hospital shall possess a recognized post-graduate medical degree from a recognized/accredited institution with a minimum of ten years teaching experience as Professor /Associate Professor in the relevant departments of the Hospital, out of which at least five years should be as Professor. Appointment to these posts shall be made on seniority-cum-merit basis. Medical Superintendent shall not occupy the position of the Head of the Department. However, he can head the unit.

EXAMINATIONS

EXAMINATIONS

The medical college/institute will conduct the Formative Assessment (examination) and the University will conduct the Summative Assessment (examination).

The summative examination shall consist of Theory and Practical. Obtaining a minimum of 40% marks in each theory paper and not less than 50% aggregate in all the four papers for degree examination in broad specialty and super specialty subjects and obtaining 50% marks in practical examination shall be mandatory for passing the examination as a whole. Hence a candidate shall secure not less than 50% marks in theory and practical including clinical, Objective Structured Clinical Examination (OSCE) and viva voce examination. Five per cent of practical marks will be of dissertation. External examiner outside the state will evaluate dissertation thesis and take viva on it and marks will be given on quality of dissertation and performance in viva voce.

No grace mark is permitted in post-graduate examination either for theory or for practical.

Examiners

a. The examiner for the post-graduate examination in Broad and Super Specialties shall have three years’ experience as recognized Post-graduate Guide in the concerned subject.

b. The minimum number of examiners for post-graduate examination shall be four. Out of which, at least two shall be external examiners and least one of them shall be from different university outside the state.

c. An examiner shall not be appointed for more than two consecutive regular examinations for the same institution.

Valuation

a. All the teachers of the other colleges of the concerned University or other Universities, who are eligible to be post-graduate examiners, can perform the valuation of the answer scripts.

b. All the answer scripts shall be subjected for two valuations by the concerned University. The average of the total marks awarded by the two valuators for the paper, which is rounded off to the nearest value, shall be considered for computation of the results. All the answer scripts, where the difference between two valuations is 15% and more of the total marks prescribed for the paper, shall be subjected to third valuation. The average of the best two total marks, awarded by the three evaluators for the paper, rounded off to the nearest value, shall be considered for final computation of the results.

c. After the computation and declaration of the results, under no circumstances, revaluation is permitted by any authority.

d. All the Health Universities/Institutions imparting post-graduate courses shall implement digital valuation.

Number of Examinations

The university shall conduct not more than two examinations in a year, for any subject, with an interval of not less than 4 and not more than 6 months between the two examinations.

Methodology

A. Broad Specialties: Doctor of Medicine (MD)/Master of Surgery (MS)

MD/MS examinations, in any subject shall consist of theory papers, and clinical/practical and oral examinations.

a. Theory

The theory examination may be of descriptive theory paper type or Multiple Choice Question (MCQ) type of equal duration of exam time. The descriptive type of theory exam shall be of four theory papers. The first and the fourth paper shall be on basic medical sciences and recent advances, respectively.

The theory examination shall be held well in advance before the clinical and practical examination.

b. Clinical/Practical and Oral

i. Clinical examination for the subjects in clinical sciences shall be conducted to test the knowledge and competence of the candidates for undertaking independent work as a specialist/teacher, for which candidates shall be examined for one long case and two short cases.

ii. Practical examination for other subjects shall be conducted to test the knowledge and competence of the candidates for making valid and relevant observations based on the experimental/ laboratory studies and his ability to perform such studies as are relevant to his subject.

iii. The oral examination shall be thorough and shall aim at assessing the candidate’s knowledge and competence about the subject, investigative procedures, therapeutic technique and other aspects of the specialty.

B. Super Specialties: Doctorate of Medicine (DM)/Magister Chirurgiae (M.Ch.)

The Examination consists of theory and clinical/practical and oral.

a. Theory

There shall be four theory papers. The first and the fourth paper shall be on basic medical sciences and recent advances respectively. The theory examination shall be held well in advance before the clinical and practical examination.

b. Clinical/Practical and Oral:

i. Clinical examination for the subjects in clinical sciences shall be conducted to test the knowledge and competence of the candidates for undertaking independent work as a specialist/teacher, for which candidates shall be examined for one long case and two short cases.

ii. Practical examination may consist of carrying out special investigative techniques for Diagnosis and Therapy. M.Ch. candidates shall also be examined in surgical procedures. Oral examination shall be comprehensive enough to test the candidate’s overall knowledge of the subject.

C. Post-graduate Diploma

Diploma examination in any subject shall consist of theory and practical/clinical and oral.

a. Theory

There shall be three Theory papers. The first paper shall be on basic medical sciences.

The theory examination will be held well in advance before the clinical examination.

b. Clinical and Oral

Clinical examination for the subject in clinical Science shall be conducted to test/aimed at assessing the knowledge and competence of the candidate for undertaking independent work as a specialist for which a candidate shall examine a minimum of one long case and two short cases.

The oral examination shall be thorough and shall aim at assessing the candidate’s knowledge and competence about the subject, investigative procedures, therapeutic technique and other aspects of the specialty.

SANCTION AND PENALTY

PENALTY FOR VIOLATION OF REGULATIONS

For non-compliance or intentional attempt of non-compliance act or omission, the PGMEB will penalize the medical college/institution.

Without prejudice to anything stated at Section 9.1 above, the imposition of the penalty may include one/more/ all of the following –

a. Issuance of warning with direction to rectify/comply as the case may be by the medical institution;

b. Monetary penalty not exceeding INR one crore per every violation/act of omission committed by the medical institution;

c. monetary penalty not exceeding Rupees five lakhs for the faculty/ Head of the Department (HoD)/ Dean/Director/Doctor submitting false declaration/documents/records (including patients’ records). Further, they can also be charged or penalized for misconduct under the Professional Conduct Regulations in vogue.

d. Withholding the accreditation process;

e. recommending to MARB for withholding processing of application(s) for any new course including increase of seats in the existing course for that academic year or for such number of years.

f. Reducing the number of students in the next or subsequent academic years to be admitted by the medical institution;

g. Stoppage of admission to one or more of the courses in the next or subsequent academic years.

h. Recommending to NMC for withdrawal of permission;

i. Withholding and withdrawal of accreditation for a period up to five academic years.

j. Any attempt to pressurize PGMEB or NMC through individuals or agency will lead to immediate halt of the processing the application/request by the medical institution.

Provided further that the medical institution, may be granted a reasonable opportunity to rectify the deficiencies and any further action shall be taken if it fails to meet the requisite norms. Provided further that, the PGMEB or the NMC may also initiate criminal proceedings for furnishing false information, or fabrication of false documents as per the criminal law in force at that time.

Faculty Development Programme

The Post-graduate Medical Education Board shall prescribe the Faculty Development Programme to enhance the skills of the faculty for post-graduate training, which will have to be mandatorily followed.

Animal Experimentation

Animal experimentation should continue to be included as an integral part of the competency based curriculum of post-graduate courses in Physiology and Pharmacology in medical institutions.

However, the use of non-animal, human relevant methods may be encouraged for teaching and training of post-graduate students in these subjects, wherever possible. If animals are used as a part of research studies or thesis work, biomedical ethics and relevant rules and guidelines framed under the Prevention of Cruelty to Animals Act, 1960, must be strictly adhered to.

Collaborative Research

Impetus may be provided to Research in medical field to produce Physician Scientists of highest caliber by collaborative arrangement with other scientific organizations of excellence as well as Institutes of Eminence/ Excellence conferred by the Government of India. Inter-disciplinary research with AYUSH may be encouraged.

AMENDMENTS, SAVING CLAUSE AND REPEAL

Provision to Amend the Post-Graduate Medical Education Regulations - 2023

National Medical Commission is empowered to make any addition, deletion, substitution or any other amendment to Post-graduate Medical Education Regulations -2023, as and when required. The Post-graduate Medical Education Board is empowered to issue advisories and clarifications as and when required. The National Steering Committee constituted under Section 5.3(XII) to oversee the District Residency Programme (DRP) and will suggest practical ways in implementing District Residency Programme to achieve the objectives.

Saving Clause

Notwithstanding anything contained in these Regulations, any actions made under the “Post-graduate Medical Education Regulations, 2000” or the “The Opening of a New or Higher Course of Study or Training (including Post-graduate Course of Study or Training) and Increase of Admission Capacity in any course of Study or Training (including a Post-Graduate course of Study or Training) Regulations, 2000” or the recommendation of the Councils prior to that, shall be protected.

Repeal

The “Post-graduate Medical Education Regulations, 2000” and “The Opening of a New or Higher Course of Study or Training (including Post-graduate Course of Study or Training) and Increase of Admission Capacity in any course of Study or Training (including a Post-Graduate course of Study or Training) Regulations, 2000” are hereby repealed.

Note: These Regulations are being published in English and Hindi, the English version shall prevail in case of any doubt about the interpretation of these Regulations.

To view the official Notice, Click here : https://medicaldialogues.in/pdf_upload/mer-218613.pdf

Also Read: NMC Releases Draft Minimum Standard of Requirements for PG Medical Courses, Invites Comments