Dr.Vrinda Bhat: Feedback on vision-2015, sent to MCI

To                                                                               16.01.2011
Dr. S K Sarin
Chairman, Board of Governors
Medical Council of India
Sector-8, Pocket-14,
Dwarka, Phase 1
 New Delhi-110077

Respected Sir,
At the very outset, I thank the BOG-MCI for a sincere effort to improve the quality of medical education in India through Vision 2015. This was a long pending move needed to upgrade the quality of doctors in India.
Any effort for improvement in the right direction is incomplete, if the guidance from seniors in respective disciplines and subsequent peer- review is not done. This is what has happened with Vision 2015. To add to the fury the Committee so formed to compile the curricular changes is questionable, as there are no experts from all the disciplines.  As I cannot speak for other disciplines, I will reserve my comments to the subject of forensic medicine, probably the worst affected among the lot. This undesirable change in forensic curriculum has come at a time when the Supreme Court has asked Central Forensic Science Laboratory, New Delhi to submit a report on the status of facilities available in various forensic laboratories in the country and kind of scientific support being given to investigating agencies in the matter of detection of crime.
It is a well-known fact that the report of a forensic expert is so important in detection of crime that it can be judged from the fact that after murder, forensic report is awaited for knowing the exact cause of death. This report, unfortunately in India, is prepared mostly by a MBBS doctor (almost 80% of the post-mortems are done by MBBS doctors). If Forensic Medicine is disintegrated in the manner suggested in the curriculum then we can foresee the future of Judicial system in India, as we will be loaded with galore of cases like Nithari rape and murder cases, Arushi and Hemraj murder case, Jessica Lall case. They all have suffered because of the inferior forensic facilities in our country. India is too big a country with lot of diversity, for a limited group of Experts to decide the fate of medical education.
In these days of consumer protection and medical malpraxis litigations, complicated medico legal situations and even the ordinary basic medico legal services, the Vision 2015 document is a retrogressive one. We will not attain desired standards by 'aping' what is done in the West.  Basic training standards and infrastructure are very strong in those countries. BOG should know that a ' Basic Doctor' should be properly trained during the MBBS Course to enable him to discharge basic medico legal duties.
When we are talking about need based curriculum we totally forget the need of the society as far as forensic medicine is concerned. We need to develop skills of doctors in dealing with medico-legal cases rather than not exposing them at all to medico-legal situations as is happening in private medical colleges of most of the states. In all the government medical colleges and all private medical colleges of Karnataka, post-mortem examination is done and shown to the undergraduate students. Then why is it not being followed in rest of the private medical colleges of India, where there are very good and learned forensic experts. Rule should be implemented that at least one police station must be attached to a private medical college so that students learn the intricacies of medico-legal work. Even the services of the available forensic medicine experts are not being used properly.
Vision 2015 declares that "Forensic Medicine can be effectively taught during Gynaecology & Obstetrics (rape, assault), surgery (injuries) and pharmacology (toxicology). Legal experts can be called for medico-legal issues. Forensic medicine skills can be acquired during internship such as documentation of medico-legal cases of alcoholism, suicide/homicide, rape, assault and injury case".
The response to this vision would be: how many clinicians are confident of teaching and handling medic-legal cases. As far as toxicology is concerned how they can feel that it can be taught by a pharmacologist who is well versed with medicines and not drugs and poisons. The clinicians should be free from medico-legal hassles and attending courts so that they can concentrate on their job in which they are skilled. As regards to legal experts, they can only effectively and efficiently represent cases in courts but not without the able guidance of Forensic expert’s medico-legal reports. When even the best criminal counsel is ignorant of legal aspects of medicine and intricacies of medico-legal cases how can they be considered to train medical students.
Forensic medicine training should be treated as a core subject and not an elective subject because of the prevailing law of the land. A doctor must have knowledge of Forensic Medicine to render his service.  On the other hand if it is made an elective (optional) subject the doctor will have the right to reduce the medico legal services expressing his/her due to lack of training and skill (As he can not be imposed to get the training).  Concern would then be expressed about the profession that can fulfil the need of medico legal services that assist the judiciary to prevent crime in the society.
Every society has a duty to develop its medical doctors taking care that they don’t develop as moral monsters and respect law and should be able to render equitable justice during service.  I there fore have a few suggestions:  
  1. Forensic Medicine should be retained in the curriculum for M.B.B.S., as a core subject to be taught in the third year of the proposed scheme with teaching hours increased adequately to include topics which would enable the Registered Medical Practitioner who are in fact the ‘medico legal Doctor of first contact’ to meet the requirements of the Law and Law enforcing systems. Their competency in the subject should be assessed through a University examination, as is being currently done.
  2. The toxicology component of forensic medicine must be at least one third of the total subject.
  3. The subjects of forensic medicine & toxicology must be taught along with clinical subjects in the clinical phase of MBBS course. There should be a full-fledged university examination for these subjects with two separate papers (vide infra). It is inappropriate to include these subjects in the para-clinical phase along with pathology, microbiology, etc., because unlike the latter, neither forensic medicine nor toxicology falls in the category of basic medical sciences.
4.       The medico-legal work of hospital at Emergency Medicine and Trauma must be under supervision of department of Forensic Medicine. Autopsy facilities and conduction of autopsy at all private medical colleges must be made compulsory.
5.       The staff requirement in Forensic Medicine must be increased depending upon medico-legal work load.
6.       Rotating Internship posting of one month in the Forensic Medicine and toxicology department must be compulsory for all interns.
All these above mentioned suggestions can be implemented when a panel of suitable qualified Forensic Medicine specialists are brought together to identify the core topics in Forensic Medicine, learning and methodology of teaching with modern concept adopted by the working group 2010. Only then can the new graduates effectively serve as a physician of first contact in establishing national goal of health for all.
Hoping that the suggestions would be well-taken by the working group of Vision 2015, I wish them all success with Vision 2015. Let it become a model for the rest of the world to follow.
With warm regards
Dr Vrinda
Professor in Forensic Medicine

1 comment:

  1. very well scripted....I hope that the BOG will read your email.

    ReplyDelete