Kerala HC upholds medical council decision mandating clinical clerkship for FMGs who studied online during COVID
Kerala High Court
Ernakulam: A Division bench of the Kerala High Court has recently upheld the State Medical Council's decision to mandate clinical clerkship for the Foreign Medical Graduates (FMGs), who were studying in China and completed a portion of their education online during the COVID-19 pandemic.
The Division Bench of the High Court, comprising Justices Sushrut Arvind Dharmadhikari and Justice PV Balakrishnan, observed that the only objective for the one-year clinical clerkship is "to ensure the quality of health care delivery in the country and nothing more."
Accordingly, the Court allowed the appeal filed by the Kerala State Medical Council against the order of the Single-judge bench directing the council to process the registration application of these candidates, after taking note of the fact that these candidates had not adequately compensated for their online classes with equivalent physical training, as required by the National Medical Commission.
"The decision in Katta Vamsi's case relied on by respondents 1 to 8 is not applicable to the facts in the instant case, since in the instant case there are sufficient materials to show that respondents 1 to 8 have not undergone compensatory course as mandated by NMC. If so, we are of the view that the impugned judgment passed by the learned Single Judge allowing the writ petition by declaring that respondent Nos. 1 to 8 are not required to undergo clinical clerkship and giving direction to the appellant to process their registration application, cannot be sustained," ordered the HC bench.
Medical Dialogues had previously reported that a single-judge bench of the Kerala High Court had earlier granted relief to these medical graduates from abroad and directed the Kerala State Medical Council and the Director of Medical Education to process their registration applications to join a one-year CRMI training without mandating them to undergo compulsory 2-year "Clinical Clerkship Program" in lieu of online classes.
The plea before the High Court was filed by medical graduates from abroad who had joined the undergraduate medical courses during 2017-2018. They completed their courses in China and consequently passed the screening test in India i.e. Foreign Medical Graduate Examination (FMGE).
However, since the students had to attend online classes during the COVID-19 pandemic, and they went back to their institutes and attended compensatory physical classes as mandated by the National Medical Commission (NMC), the Apex Medical Education Regulatory Body in India.
When the FMGs submitted their applications to get provisional registration from the Kerala State Medical Council and get enrolled into the compulsory CRMI programme, their applications were denied as the Council mandated a compulsory "Clinical Clerkship Program" for the online classes. Aggrieved by this, the petitioners approached the High Court bench.
Earlier, the single-judge bench had noted that the FAQ dated 22.02.2022, published by NMC, stated that the FMGs were allowed to undergo online classes of theory subjects only and supplemented by offline practical and clinical training done in the Medical University and its affiliated hospitals during the course of MBBS. Further, NMC UG Board in its notice dated 04.03.2022 mentioned that FMGL Regulations, 2021 shall not be applicable to candidates who have joined their undergraduate medical education in foreign institutions prior to 18.11.2021.
While granting relief to these candidates, the HC bench had also taken note of the fact that there was no NMC mandate on the students who obtained a course completion certificate before 30.06.2022 to undergo clinical clerkship.
Challenging the HC Single-Judge bench's order, the State Medical Council of Kerala approached the Division bench of the High Court and argued that these candidates, who completed their medicine in China, had joined the course during 2017-2018 and while undergoing the course, COVID struck and for about 3 years, they were not able to attend classes physically. The counsel for the State Medical Council submitted that during this period, these candidates attended online classes for theory from India, and thereafter, during 2022-2023, went back to China and allegedly attended compensatory classes for periods varying from 4 to 6 months.
He also submitted that only because of the fact that the compensatory classes attended by these candidates were inadequate/insufficient, and considering the fact that no comprise can be made in the standards of medical education and public interest, they were directed to undergo 1-year clinical clerkship and thereafter, to undergo a 1-year CRMI.
The counsel relied on the public notices issued by the National Medical Commission and submitted that inly in cases where the students have sufficiently compensated classes in physical mode for the online classes undergone, they will be eligible for registration. Reliance was also placed on a clarification issued by NMC to a query raised by the Government of Andhra Pradesh, to contend that the term "sufficiently compensated" used in the NMC notice means an equal duration of the courses studied by online mode. In this regard, the counsel claimed that the candidates in question have not undergone courses of equal duration.
Observations by HC Division Bench:
While considering the matter, the Division Bench of the High Court referred to two public notices issued by the NMC and stated that the decisions regarding FMGs were taken in view of the fact that the medical profession deals with precious human life and the lives of Indian citizens cannot be put at stake by poorly trained medical professionals.
"The purpose of issuing these public notices is to ensure that candidates who were unable to attend physical classes during the COVID pandemic and attended classes online, meet the standards required for the courses, to ensure that there is no compromise in the standards of medical education, and that the integrity and safety of the health care delivery system are maintained," observed the Division Bench of the Court.
In the first notice, it was mentioned that NMC decided not to accept certificates regarding compensation for online theory subjects with offline practical and clinical training, after it found that the FMGs were maliciously obtaining compensatory certificates from their parent Universities. For such students, Compulsory Rotating Medical Internship (CRMI) for a period of two/three years was mandated.
However, in the second notice, it was clarified that the FMGs who had 'sufficiently compensated' their online classes with physical onsite sessions of equal duration and had cleared the MBBS equivalent examination, were to only undergo one year of CRMI.
It was also mentioned in the clarification that the primary responsibility for processing applications of Foreign Medical Graduates (FMGs) lies solely with the State Medical Councils and while processing such applications, the SMCs shall verify and satisfy itself that the Foreign Medical Graduate (FMG) has duly completed the compensatory academic requirements comprising both theory and practical components, at the same foreign medical institution.
Taking note of this, the HC Division bench observed that
"The afore clarification gives a clear picture of the purpose and intent for issuing Exhibit P21 notice and it specifies what is meant by the term 'sufficiently compensated'. It is thus clear that in order to 'sufficiently compensate', a FMG who has studied a portion of his course online is required to undergo equivalent in-person training to make up for that duration. In other words, as per the afore clarification, the compensatory classes must be for an equal duration of the course studied by online mode. It is further stated that the certificates issued by Foreign Medical Institutions without genuine compensation and without extension of the study period undermine the integrity and quality of medical education. That apart, the clarifications issued to query Nos.1 and 3 further shows that the online period of any duration in one academic year cannot be compensated along with the academics of the next year offline, without extension of the study period and that two academic years of curriculum training cannot be done in one year of offline study."
Observing that the candidates did not undergo compensatory studies for equal duration of the course studied online, the bench mentioned in the order, "In the instant case, admittedly, the period of compensatory studies undergone by respondent Nos.1 to 8 is not of equal duration of the course studied by them through online mode. Similarly, it is also to be seen that the period of compensatory classes undergone by respondent Nos.3 to 8 are along with the academics of the balance years and therefore, do not fulfill the criteria specified by NMC as stated afore. If so, we have no hesitation in finding that respondent Nos.1 to 8 have not ''sufficiently compensated'' classes in physical mode, in lieu of the online classes as mandated in Ext.P21."
Accordingly, the bench upheld the State Medical Council's decision of directing these candidates to undergo clinical clerkship and ordered,
"In the light of the afore facts, we are of the considered view that the stand taken by the appellant insisting respondent Nos. 1 to 8 to undergo a one-year clinical clerkship cannot be stated as arbitrary, unjustifiable or without any basis. As stated earlier, the only objective in directing respondent Nos. 1 to 8 to undergo a one-year clinical clerkship is to ensure the quality of health care delivery in the country and nothing more."
"...we are of the view that the impugned judgment passed by the learned Single Judge allowing the writ petition by declaring that respondent Nos. 1 to 8 are not required to undergo clinical clerkship and giving direction to the appellant to process their registration application, cannot be sustained," it mentioned.
To view the order, click on the link below:
https://medicaldialogues.in/pdf_upload/kerala-hc-fmg-clinical-clerkship-312178.pdf
