Please find my view points on the current issue which has been submitted with the management of the college as they had asked for HODs comments. I am sending these so that I can stand corrected by altering the thoughts already sent based on the suggestions received from fellow members of this group. Thanks and regards.
“VIEW POINTS ON MCI DOCUMENT –VISION-2015”
I have gone through the document “Vision-2015” drafted by BOGs MCI, New Delhi. The document is ambitious, good to read, but based on figures prevalent for developed countries. It does not consider ground reality of our country where larger population are poor and reside in villages , and have no proper amenities and reach to health.
The questions to be asked is “are we not becoming agents of foreign countries for producing doctors at an economical cost for them ”? What we are producing are being consumed by more developed countries. There is no law stopping brain drain, no policy, infrastructure and funds to encourage research . these are all too important point for consideration in a vision five years from now. It is an established fact that the teachers teaching today have acquired knowledge about 10 years back primarily to be used by the students 10 years later when they start practicing. In a world when changes are so fast should we not focus on the these issues which remain un addressed in the said document? At this point let me remind the mandarins that any research on “dead body” in whatever field is going to be unchallengeable or undisputed as no part of the world can claim such a large number of dead bodies at their disposal for research purposes. We are rich in dead bodies and we must try to work upon these resources more than reduce its study and importance in medical field.
Ratio of doctor population reflected in the Document should not be considered in working out vision in context with India. Can we compare orange with banana except that both are fruits? This looks good when we see them in developed countries. 1:1700 or 1.5:1000 may be statistics good to see and talk but when it is planning/vision one must work out the ratio of doctors in rural population and urban population separately to get actual areas of development and thought process to be exercised. It is not a hidden fact that doctor density in urban versus rural will show great variation. When it comes down to hospitals urban areas are taken care by the multinationals and health corporate. MCI has no role there as well. MCI should have vision for needy and poor people residing at places with lesser health facility.
These days instruments, appliances ,computerized chips and in fact Robots have started dominating diagnosis and treatment. Gone are the days when with mere application of stethoscope one could easily diagnose almost all respiratory diseases. We still can do it but other issues like consumer forum and law have created hassles. We have to show that all reasonable care was taken in treating the patient contrary to previous practice of taking reasonable care whether it shows or not. Thus installation and training on machines should play important part. MCI should recommend sophisticated machines in medical colleges and hospital and district hospitals PHCS and TALUKAS rather than DRAWING ambitious plans which may look very good on paper but the ground reality may be different.
For the kind information Medical Ethics and Professionalism is already being taught in Forensic Medicine and so there is no question of its “ introduction” as stated in document under reference.
Teaching of different topics of one subject in another like Rape in Gynae is too opportunistic statement as one needs to experience as a teacher imparting lectures on “Laws in Relation with medical men” to doctors during doctors induction training programme under earlier IPP VII programme or elsewhere as guest lecture. The doctors do not want to study clinical subjects as much as this for they encounter directly such medicolegal problems without knowing correct way out as they had studied this subject long time back and for just clearing second MBBS . Even this day the mandarins would be thinking all the time the “legal issues” involved while drafting the document of their VISION. Forensic Medicine is nothing but application of Law in medical practice. It is not beyond any ones IMAGINATIONS how important law plays in the present world especially when consumer acts etc. have come to play. MCI needs to increase its importance accordingly.
MCI as I understand is a statutory body for establishing standard of medical Education and recognition of medical qualification. They can lay down “MINIMUM” requirement of infrastructure, training, course etc. Is MCI not stepping into the concept of being UNIVERSITY?
SUGGESTIONS:
Three important subjects need to exist for entire medical curriculum incorporating the others in them. They are:------
1. Community Medicine
2. Family Medicine
3. Forensic Medicine
Rest all become a part of these or Skills and practice!
A. CURRICULUM
1.5 years MBBS…. Basic and Para clinical to make the students aware with anatomy(structure of Human body), Physiology (Functions of Human Body parts), Biochemical changes inside Human body, common drugs knowledge with effects and side effects, theoretical aspects of Microbiology like microorganisms etc.
2 years Elective Training……this should cover skills in Medicine, Surgery, Medicolegal, Practical Pathology, Practical Microbiology, Practical Biochemistry, Radiography including Ultrasound and others as depicted in the MCI document. Rest will be taken up by the instruments and appliances of the relevant departments. Pathological changes are to be taught along with diseases.
“Provisional registration” be issued after completion of above for 3.5 years.
2 years…..rural placements in PHCs and district Hospitals Talukas etc.
“Permanent registration” of MCI On successful completion of the above .
So with same time frame teaching becomes more practical oriented, easier and one gets the services of these doctors who are being produced in rural areas for the need of poor people. But this may be like war postings of armed forces or other sectors where family responsibility, relevant salary structure etc will require to be worked out. Why would doctors not go to village if their children can study in town and family members are taken care of by having accommodation and other facilities? We have to come out of dictatorial attitude of putting rules which invariably will be broken as they may not be practical. This would be “VISION” in letter and spirit.
B. Ban on opening of Medical colleges in Cities (Urban areas)---medical colleges in Urban areas have no advantage except its attached Hospital which in any case are plenty in Towns and cities managed by corporate sectors and multinationals in field of health as this is a lucrative business promoting health tourism etc.
C. Promotion of opening Medical College and Hospital in Rural areas only without compromising on quality ….this would ensure hospital to come up in rural areas providing presence of specialists , fulfillment of health needs for poor and uneducated mass. MCI would have to be practical and liberal on number of patient’s turnover. Emphasis to be laid in developing the area into mini township, ensuring regular payments and facilities to staff, so that faculty teaching and non teaching and staff stay in campus.
D. Develop Course content (Syllabus of minimum requirement) mentioning the text books for maintaining uniform standard which at the moment MCI is not doing and even if it does it has no indication on its official website. If it requires change in the memorandum it should be brought about in powers and privilege delegated to them.
E. Prescribing / recommendation of Text Books……There is no regulation in publishing text books in medical science so any Tom, Dick or Harry feels perfectly good collecting extra income by way of Royalty from publishers without bothering about the content which in any case has no regulations and legal bindings. With the mushrooming of books on any one discipline it has become difficult to maintain uniformity.
F. Teaching of Medical Subjects by MBBS doctors only…….Let not the medical subjects be taught by PhDs, Lawyers, Psychologists, Management personnel etc. The teachers mandatorily need to be basically MBBS for sure . Now that enough teachers are available we can do away with PhDs in these subjects. Instead we could develop these subjects in Medical curriculum itself for post graduation.
(Dr D.B.Dayal)
Professor and Head of Dept.
Army College of Medical Sciences
New delhi
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