Increasing competition and inadequate number of seats is making Indian students look abroad for medical education. This has been a perennial issue in the Indian medical education space for many years now. Further highlighting the significant gap between available MBBS seats and the number of students who clear medical entrance exams shows that, currently in India, there is only just above 10 percent medical seats available when compared to the total number of students who pass the entrance exams.
As of now, according to the Ministry of Health and Family Welfare in India, there are 533 medical colleges and 90, 285 undergraduate medical seats available in India. The competition for these medical seats is so intense that students who have even scored top marks in 12th are not able to secure a seat in India.
Even with that being the case, there is a clear deficit in the number of doctors in India. The doctor patient ratio is 1:1655 in India, whereas, the WHO norm is 1:1000. This statistics was further extenuated during the pandemic, when the healthcare system in the country struggled to manage the deficit of doctors. While the government is trying to churn out more doctors, a major concern faced by the Indian medical education space is the lack of real-life experience graduating doctors has when it comes to treating patients. With Indian medical educational landscape at a crossroads, let’s analyze the major concerns and potential solutions when it comes to ensuring proper real-world exposure to graduating doctors.
Prioritizing on Entrance Exams Rather than Nurturing Practical Skills
In its pursuit to create more doctors, some medical experts believe that the Indian government has lost track of the true purpose of medical education which is to create doctors that has the sufficient practical knowledge in treating patients. By focusing more on clearing the NEET entrance exam in order to get into post-graduate seats, students are only acquiring theoretical knowledge because the questions asked in this entrance exam are rudimentary MCQs which fail to assess the practical skill sets of the students. Owing to this, the number of coaching centers in the country sky rocketed while the students are deprived of any meaningful practical knowledge on how to deal with patients in real-life scenarios.
Acknowledging the magnitude of this issue, the Medical Council of India has described the basic competencies that an Indian medical graduate should have. And with this, they have created a competency-based module which talks about the skills and attitudes a medical graduate should have. Apart from India, Competency-based Medical Education (CBME) has garnered widespread popularity in other countries as well and through its adoption, medical education can witness a paradigm shift. In Indian medical education, what we follow is subject-oriented curriculum model where the priority is given more to the knowledge of students rather than their attitude and skills. With CBME, the focus will shift towards more learner-centric education which offers greater flexibility. This shift towards prioritizing on setting the relevant competencies and training the students to achieve these competencies will allow medical students in India to gain both theoretical knowledge and practical experience.
Lack of Social Accountability
Health is a human right in India and even with that being the case, there is a significant and in some cases alarming lack of accountability when it comes to healthcare. And health without accountability is challenging for both the state and central governments. Recently, there has been a significant push towards improving the accountability mechanism in India. With that said, even when healthcare tragedies happen, the medical doctors are terminated or suspended without finding or solving the root cause of the issue. In many scenarios, new doctors don’t have the proper understanding of social responsibility. This is a major weakness of the colleges in the country and while the students are encouraged rote learning, they are not taught or trained on the needed inter-personal skills required to be a good doctor. And in pursuit of academic excellence, the humanitarian aspect of healthcare education is given second priority.
In a study conducted in Saudi Arabia using the social accountability grid provided by WHO, it was found that even though the educational aspect had the highest social accountability compliance, there was an increasing need for more studies related to achieving accountable social status in medical education. Also, in Saudi Arabia, studies focusing on developing a curriculum that is more community-centric were conducted. The curriculum was designed by interviewing subject matter experts and by doing so, a program was formulated which as three phases - 1 year pre med, organ/system, as well as clinical clerkship which is followed by a yearlong internship. And there are medical schools in Saudi Arabia that have adopted this program.
Driven by the increasing demand for doctors, the number of medical colleges and medical seats in India has seen a significant rise in the last 8 years. The Indian government has also supported the medical education space over the years including the setting up of new colleges and the expansion of existing ones. In 2019, the National Medical Commission (NMC) has also come up with a major reform in the shape of the NMC Bill, 2019 to curb the corruptions and increase the transparency of medical education infrastructure in the country.
Even with that being the case, the need of the hour is to focus on increasing the quality of medical education in the country so that Indian medical colleges can nurture capable doctors who have the relevant practical knowledge and empathetic mindset to treat patients.