To,
The Board of Governors,
Medical Council of India,
New Delhi
Sub: Regarding Undergraduate Medical Education Working Group 2010’s Proposed UNDER GRADUATE MEDICAL EDUCATION reforms - “Vision 2015”
Respected Sirs,
I Dr. M.B.Shrigiriwar, Associate Professor, Department of Forensic Medicine and Toxicology, Indira Gandhi Govt. Medical College, Nagpur, Maharashtra hereby feel very happy and congratulate the Board of Governors for proposing the reforms for the Undergraduate Medical Education in India that will enable the Indian doctors to perform well in the changing scenario of medical sciences.
The strategies of the Undergraduate Medical Education Working Group 2010 like selection of the students from rural and underserved backgrounds who are motivated to work in the areas of need and Early clinical training to the students from 1st MBBS with continuity to secondary and primary care are really appreciable. These strategies and several others will definitely have a positive impact over the health system in India.
Still being a faculty in Forensic Medicine and Toxicology and foreseeing the long term effects of these reforms over the medical field I will like to make few suggestions in the said matter as follows:
(1) First of all the most important thing as the workgroup itself has said these reforms can’t be implemented without the help of sufficient numbers of well trained teachers. A medical teacher will be the basic unit of this new policy. He will be imparting the knowledge to the students who will serve the society later. The workgroup itself agrees the necessity of sufficient number of well trained medical teachers.
But on the other hand even today the MCI has struck to its minimum staff requirement policy and reduction in teaching staff is still underway (Ref: Latest notification by Board of Governors, Medical Council of India dated 17-September-2010). The policy made by the workgroup and the notification by MCI are contradicting each other. I feel that at least now when sufficient number of doctors is available MCI should insist on ideal staff requirements rather than minimum. Only then the Workgroup’s policies will be implemented effectively.
(2) The reason behind the fact that MCI’s Undergraduate Medical Education Working Group 2010 doesn’t have even a single Forensic Medicine expert is far beyond my understanding. I am sure that our Board of Governors is quite aware of the importance of medicolegal work. According to the National Crime Records Bureau, Ministry of Home Affairs, Govt. of India IPC crime rate in 2008 was 181.5 as compared to 175.1 in 2007 recording an increase of 3.6% in 2008 over 2007. That means the IPC crimes reported a growth rate of 17.7% in one year. The conviction rate has come down drastically. Even if we simply look at the number of homicides and sexual offences the figures are just astonishing. Also with the increased public awareness regarding the Consumer Protection Act many doctors are being sued to Courts and many litigations are pending against them.
The Undergraduate Medical Education Working Group 2010 should have consulted some forensic experts and taken their opinion regarding how we can make our students well acquainted with medicolegal work while teaching clinical medicine. Medicolegal exercise is an indispensible part of Medical Sciences. The Workgroup insists on one year compulsory posting of MBBS graduates at Government run hospitals, primary health centres and rural hospitals. How will they handle medicolegal cases during their posting at these hospitals if they are not well verse with it?
Sexual Assaults are the most heinous crimes of the society. Workgroup suggests that sexual assault cases will be examined and taught to the undergraduate students while learning Obstetrics and Gynaecology. Obstetrics and Gynaecology Department is indeed a very busy department no matter at whichever college it is. They are much occupied with their routine clinical work and emergency duties. And if the examination of sexual assault cases is also imposed upon them then there are chances of substandard examination and reporting of sexual assault cases. Impartment of justice will ultimately suffer.
Similar is the case of examination of injuries which as per the Workgroup should be taught while learning Surgery. Surgery department is generally related with surgical diseases and anomalies, life threatening emergencies etc. The injury certificates are issued by the casualty medical officers and forensic experts after injury examination at the casualty. The doctor who issues injury certificate especially in assault cases has to attend the court calls pertaining to those cases. I don’t know how a surgeon despite of his busy schedule will attend the court calls and (considering his less acquaintance with the medicolegal work) will give enough justice to the case.
I think the solution to all these problems is let the forensic people examine and teach both the injuries and sexual assault cases to the undergraduate students. Forensic people are experts in medicolegal work and only they can handle these subjects effectively by the virtue of which UG students will become well acquainted with not only injuries and sexual assault cases but also with other medicolegal work.
Similarly toxicology and its medicolegal aspects can be taught effectively in forensic medicine rather than in pharmacology lab. Forensic experts can take the students to the wards for teaching examination and management in toxicology cases.
Instead of reducing the staff in forensic medicine, MCI should insist on appointing a forensic expert in every casualty who will handle all the medicolegal cases (MLCs) pertaining to that medical college, in association with experts from other departments. I think there is absolutely no need of calling legal experts for guiding our undergraduate students when our own forensic people can teach them more effectively. One important point I will like to note here even these so called legal experts consult forensic people for their expert help in complicated medicolegal cases and pay them hefty fees.
Above discussion clearly states the importance of forensic medicine in undergraduate medical education curriculum. And hence this subject should never be made optional or elective.
(3) Right in the beginning in the Workgroup’s objectives for undergraduate medical education under the heading Capacity Building for medical teachers it is said that this policy will “DEFINE CAREER PATH” for the teachers.
If the Workgroup takes a look at the latest MCI notification dated 17-September-2010 the minimum staff requirements in many subjects like Forensic Medicine, Radio diagnosis and basic life science subjects are reduced by more than 50%. That means notification by MCI itself is reducing the career opportunities for medical teachers. Hence the assumption that the policy will define the career path for medical teachers feels completely absurd.
Increasing the age of superannuation and recruiting retired teachers will further add to the woes of the young teachers whose pool the MCI itself wants to increase. Reduce employment opportunities will discourage the students to choose medical field as a career.
(4) Under the expected outcomes the work group expects that all the stated policies will lead to sufficient number of trained teachers for the future generations. As stated above due to reduced career opportunities no matter how many new colleges and hospitals we open the dream of attaining sufficient number of trained medical teachers will remain unfulfilled due to lack of career security.
In a country where a medical teacher has to struggle for his job, for his financial security continuously reeling under the pressure of being sacked following a change in MCI policy how can one expect that a medical teacher will teach ethics and clinical medicine to his students with full dedication.
(5) MCI has granted autonomous status to many private medical colleges across India. I find no reason why these private medical colleges will co-operate in implementing the said policy.
(6) I really appreciate the move of the workgroup regarding increasing the intake capacity of medical colleges and opening new medical colleges which will increase the penetration of medical facilities in remote areas of our country. But while doing so is it necessary to reduce the staff requirements in various subjects? This indicates that MCI is interested in increasing the quantity of doctors in this country ignoring the fact that insufficient teaching staff will produce inefficient doctors which will ultimately harm the society. Also reducing staff in sensitive subjects like Forensic Medicine and Toxicology will affect the justice impartment and may help the crime and criminal to propagate in a long run.
Unless and until the MCI increases the minimum staff requirement in all subjects including Basic Life Sciences and Forensic Medicine and Toxicology, the workgroup’s goal regarding improved quality of the existing colleges, sufficient number of teachers and creation of motivating career pathways for both student and teachers will remain unfulfilled.
(7) Not a single mention has been made regarding teaching the under graduate student to conduct post mortems. How can undergraduate student, after completion of their graduation, work effectively at remote places without the knowledge of conducting post mortems?
There are certain cases like custodial deaths, maternal deaths for which certain guideline have been set by National Human Rights Commission for conducting post mortems. Even a well experienced MD in Forensic Medicine faces several hardships in conducting such post mortem. I don’t know how these inexperienced MBBS graduates will conduct post mortem in such cases.
I am not against the policy of the workgroup neither I am criticising the same but I personally feel that while restructuring the Medical Education in India, every aspect of medical field should be considered so that we would create a flawless system that will ultimately produce doctors at par with the global standards.
I hope that you will consider my suggestion worthwhile.
Thanking you.
Yours sincerely,
Dr. M.B. Shrigiriwar,
Associate professor,
Department of FMT
IGGMC, Nagpur
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