NMC proposal to expand DM feeder qualifications raises clinical training concerns

New Delhi: The National Medical Commission's (NMC) proposal for expanding feeder qualifications for Doctorate of Medicine (DM) courses has triggered concerns over the clinical training of doctors.

Medical Dialogues had earlier reported that the Postgraduate Medical Education Board (PGMEB) of NMC has set up a sub-committee to examine the matter. If approved, the broad-speciality MD Biochemistry may be considered as a feeder qualification for DM Endocrinology, MD Emergency Medicine for DM Neurology and DM Cardiology, and MD Tropical Medicine for DM Gastroenterology, Rheumatology, Endocrinology, Critical Care, Nephrology, and Haematology.

Demanding that NMC recognises MD Biochemistry as a feeder qualification for DM Endocrinology, MD Biochemistry graduates recently approached the Delhi High Court, ET has reported.

Also Read: NMC forms panel to examine inclusion of 3 new feeder qualifications for DM courses

Commenting on the issue, an NMC official told Education Times, "This is an ongoing process. The HC has directed the PGMEB to examine the matter on its merits and submit its findings. In the meantime, the PGMEB has also received similar requests seeking the inclusion of other MD specialities as feeder qualifications for various DM courses."

"Speciality needs a dynamic process, which keeps changing at times. Accordingly, a committee comprising four medical experts has been constituted to examine the issue of feeder qualifications across various DM courses. The committee’s recommendations will be considered by the PGMEB, following which an appropriate decision, including on the eligibility of MD Biochemistry for DM Endocrinology, will be communicated to the Delhi HC," the official further added.

While some members of the medical fraternity view the decision as a welcome move to address the shortage of specialist doctors, experts have also raised concerns that expanding eligibility could compromise clinical training standards, ultimately affecting patient care.

"This is a welcome move in principle; India has a genuine shortage of super-specialists, especially in Cardiology, Neurology and Nephrology outside the metros. But the feeder qualifications listed need to be looked at individually rather than as one blanket relaxation," said Dr. Aviral Mathur, Past President of Federation of Resident Doctors Association (FORDA).

"MD Emergency Medicine leading into DM Cardiology or DM Neurology is more defensible on clinical grounds; EM residents do get direct hands-on exposure to acute cardiac and neurological presentations during training. MD Tropical Medicine being proposed as a feeder for six different super-specialities, from Gastroenterology and Rheumatology to Haematology and Critical Care, is harder to justify purely on curriculum content; the depth of exposure to each of those organ systems during a Tropical Medicine residency is limited. MD Biochemistry is largely a laboratory-based speciality, so its residents wouldn’t have the bedside clinical grounding that DM Endocrinology training typically assumes as a starting point," Dr Mathur, who is currently working as a consultant at Sir Gangaram Hospital, added.

Referring to the possibility that patient care may get affected due to inadequate clinical training of the specialist doctors, he further added, "If this does go through, I would suggest NMC build in a structured bridge or orientation component, and ideally a competency-based entrance assessment specific to each feeder pathway, rather than opening the gate uniformly. Relaxing entry criteria without addressing the underlying training gap risks affecting the quality of super-specialists coming out, and eventually patient care. It’s also worth flagging that this is currently only a sub-committee formed to examine and recommend; nothing has been implemented yet. There’s still scope for the speciality associations and resident bodies (like FORDA) to be consulted before a final call is made."

Meanwhile, Dr Meet Ghonia, General Secretary of FORDA, called for an evidence-based expansion approach to ensure that patient care does not get affected.

"The NMC's proposal to broaden eligibility criteria for DM courses is a progressive step towards fostering multidisciplinary learning and addressing the growing demand for super specialists. However, the expansion must be evidence-based, ensuring that entrants possess the necessary foundational competencies to maintain the quality of training and patient care. A balanced approach that promotes inclusivity without compromising academic standards will ultimately strengthen India's healthcare workforce," he told Medical Dialogues.

The importance of clinical exposure was also highlighted by the National Spokesperson of Indian Medical Association Junior Doctors Network (IMA-JDN) and a Public Health Expert, Dr Dhruv Chauhan. Dr Chauhan said, "This course from MD Biochemistry to DM Endocrinology was stopped in 2013 after the Medical Council reviewed and found that this was not the right approach."

He further added, "Those pursuing DM Endocrinology come after pursuing MD Medicine and they have huge clinical exposure. They deal with a lot of patients during their three years of postgraduation. However, in the case of MD Biochemistry students, they do not deal with the patients with this intensity. They undergo the DRP these days and during the same, they get the clinical exposure. However, that is very less and for a feeder branch that deals with a superspeciality course like DM Endocrinology, it requires high expertise. You cannot expect a non-clinical or para-clinical person to master that."

Also Read: DM Endocrinology: Admissions, Medical Colleges, Fees, Eligibility Criteria Details