There is certainly a wrong approach by the BOG of MCI towards their ‘vision-2015’, that too in a hurry1. This article discusses the proposed undergraduate medical education, currently welcoming comments, for its implementation in India2.
The first and the most important mistake is to publish an incomplete/confusing proposal of UG medical education2; how can anybody comment/suggest on incomplete information.
Second mistake is in the selection of the team members to prepare that proposal2; there has been no representation from several specialities in the team.
A noteworthy criticism is the proposal’s mismatch between the MCI’s mandate and the expected outcomes from the proposed UG medical education2: wrong approach towards achieving the targets.
2. Justifications for the criticisms:
2.1.The proposal is incomplete/confusing because of several reasons.
· The Proposal2 (refer page no.12 &15) mentions about annexures I & II. Where are the annexures?
- Forensic medicine is categorised as 'Group C' (refer page no. 13) in the proposal2. What does this mean?
- Proposal2 (refer page no. 15) suggests that 'Forensic Medicine can be effectively taught during Gynaecology & Obstetrics (rape, assault), surgery (injuries), pharmacology (toxicology)'. Does this mean integrated teaching by the faculty of forensic medicine?
- Proposal2 (refer page no. 15) suggests that 'Legal experts can be called for medico-legal issues'. Does the MCI think that medico-legal issues can be taught by legal experts? How? Who?
- (refer page no.15) Proposal2 suggests that 'Forensic medicine skills can be acquired during internship such as documentation of medico-legal cases of alcoholism, suicide/homicide, rape, assault and injury cases'. Is it not a general rule that many skills can be learnt during internship? Why aren’t they mentioning that surgical skills can be learnt during internship?
2.2. Improper representation from several specialities in the working group:
- The proposal2 (refer page no. 5) is prepared by 8 members (Working group).Most of these doctors are from clinical specialities. There is nobody to represent para-clinical subjects like forensic medicine.
2.3. Mismatch between the MCI’s mandate and the expected outcomes from the proposal:
2.3.1. MCI’s mandate is to evolve a broad policy regarding the emphasis, duration and curricular changes that could be adopted as future strategies to make medical education in India comparable to global standards2.
In a recent review of medical curricula for 55 countries, it was found that the duration of medical education is relatively consistent across the world with medical training taking about 6 years, ranging from 5 to 8 years, before a licence to practise is obtained3. Medical training is typically split into 5 years of schooling, of which the first 3 years are preclinical and the fourth and fifth are clinical, followed by a 1-year apprenticeship on the job3. This proposal2, which advocates shorter duration, moves away from global standards, thereby causing a decline in the quality of medical education.
2.3.2. MCI’s another mandate is to evolve strategies and futuristic plans so that medical education in India is innovative and is able to meet the demands of national needs while preparing undergraduates to be able to perform in the changing scenario of medical science2.
Nation requires doctors with quality and completeness. One of the national needs is the forensic expertise in every doctor, irrespective of the fact whether the ‘Basic doctor’ is prepared for rural or urban setup of India. Categorising forensic medicine in “Group C’ the defeats the MCI’s mandate.
2.3.3. MCI’s most important mandate is to maintain the standards of medical education2.
MCI’s accepts, in its own proposal that, the medical education standards in the country are deteriorating2. By decreasing the duration of the course and doubling the graduate output from the existing colleges, as suggested in the proposal, MCI seems to be compromising on the standards of medical education.
3. Suggestions/ solutions:
a) First mistake can be corrected by publishing a comprehensive proposal, unlike the present one, which should be complete in all aspects.
b) Second mistake can be corrected by selecting the right candidates from all specialities, as well as doctors akin to ‘Basic doctors’, to constitute a working group for preparing ‘undergraduate medical education’.
c) Table a report on what is wrong in the present undergraduate medical education, stating the factual reasons, in the Indian context.
d) Additional topic, if added into a subject, should be covered by additional time duration. Including toxicology as a topic during pharmacology (1 year now instead of 1.5 years earlier), will either compromise teaching in toxicology as well as in pharmacology; this is irrespective of the faculty/integrated type of teaching. Hence it is illogical to think that toxicology can be taught during the teaching hours meant for pharmacology, unless the duration of pharmacology is increased. Same is applicable to teaching sexual offences by OBG department and teaching injuries by surgery department.
e) The subjects of Pathology, pharmacology, and microbiology, do serve as strong base for the better comprehension of clinical subjects and hence assigning 1 and a half year to these subjects should not be considered as wastage of time; Forensic medicine and toxicology also deserves an equal status, and it should be taught for 200 hours, preferably in the final year.
f) An advocate is unable to teach medico-legal issues as he is not qualified in Medicine. Hence, legal experts may be kept away from undergraduate medical education.
References:
3. Kinra S, Ben-Shlomo Y. Rural MBBS degree in India. Lancet. 2010 Oct 16;376(9749):1284-5.
Acknowledgements: I thank Dr.SC Mestri, Dr.Arun and Dr.Nagesh, faculty members of forensic medicine, for their views expressed in public domain, which have been used in preparing this manuscript.
Dr. Deepak Herald D'Souza, MD
Associate Professor,
Department of Forensic Medicine & Toxicology,
Yenepoya Medical College,
Yenepoya University,
Associate Professor,
Department of Forensic Medicine & Toxicology,
Yenepoya Medical College,
Yenepoya University,
Deralakatte
Mangalore- 575 018
Karnataka, INDIA.
Mangalore- 575 018
Karnataka, INDIA.
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