To, 12.01.2011
Dr. SK Sarin
Chairperson, Board of Governors,
Medical Council of India.
Dear Sir,
Sub: Comments and suggestions on Vision-2015.
Karnataka Medico-Legal Society (KAMLS) is functioning in Karnataka since 1990 with main objective of ensuring uniform medicolegal work in Karnataka. It includes about 993 members from the fields of Forensic Medicine, Forensic Science, PHC doctors, Retired Judges, Lawyers and Senior Police officers. It has succeeded in achieving its objective since its inception. In Karnataka, all private medical institutions are permitted by the Government to practice medicolegal works such as postmortem examination (24x7x365 days), issuing medicolegal certificates (examination of injury, drunkenness, victim & accused of sexual assault, age estimation), expert opinion on skeletal remains, weapons of offence and visit to scene of crime, thereby aiding in the investigating agency & judiciary for the better interest of the society. Our work is even appreciated by the Judiciary and Law enforcing agencies, who have sought our expertise in their respective work fields.
The Comments and Suggestions on the proposed “Vision-2015” for medical curriculum by the UG Education Working Group 2010 will be mentioned in the Annexure (page numbers 2, 3 & 4).
Dr. Nagesh K.R. Dr. Mahabalesh Shetty
Secretary, KAMLS President, KAMLS
Karnataka Medico-Legal Society (KAMLS) is functioning in Karnataka since 1990 with main objective of ensuring uniform medicolegal work in Karnataka. It includes about 993 members from the fields of Forensic Medicine, Forensic Science, PHC doctors, Retired Judges, Lawyers and Senior Police officers. It has succeeded in achieving its objective since its inception. In Karnataka, all private medical institutions are permitted by the Government to practice medicolegal works such as postmortem examination (24x7x365 days), issuing medicolegal certificates (examination of injury, drunkenness, victim & accused of sexual assault, age estimation), expert opinion on skeletal remains, weapons of offence and visit to scene of crime, thereby aiding in the investigating agency & judiciary for the better interest of the society. Our work is even appreciated by the Judiciary and Law enforcing agencies, who have sought our expertise in their respective work fields.
The Comments and Suggestions on the proposed “Vision-2015” for medical curriculum by the UG Education Working Group 2010 will be mentioned in the Annexure (page numbers 2, 3 & 4).
Dr. Nagesh K.R. Dr. Mahabalesh Shetty
Secretary, KAMLS President, KAMLS
Annexure
KAMLS welcomes some of the proposals in the UG medical education of Vision-2015. However, the society humbly wishes to place on record the following points of concern:
I. Vision 2015 and its flaws.
· Vision-2015 is a myopic and tunneled vision for the given Indian scenario, which is quite different from other developed countries. As 75% of Indian population resides in rural areas, the time-honoured concept of the basic doctor with 4½+1 years training is more relevant rather than the ‘metro-oriented’ vision-2015.
· With the proposal of reducing the duration of the medical education from the existing 4½+1 years to 4+1 years, there will be an abysmal deterioration in the quality of medical education, which in turn tarnishes the Indian image towards propagating the global industry of medical / health tourism.
· Implementation of the vision-2015 may send a wrong message to the world that Indian doctors are produced in a short span of time, with inadequate practical / theoretical background. Looking at the global scenario, the medical training is typically split into 5 years of schooling, of which the first 3 years are preclinical and the 4th & 5th are clinical, followed by a 1-year apprenticeship on the job [Lancet. 2010 Oct 16;376(9749):1284-5.]. The proposal in vision-2015, which advocates shorter duration, moves away from global standards, thereby causing a decline in the quality of medical education.
· Indian doctors are doing well in-house and abroad because of the time-tested and excellent education in our country. The medical science has increased substantially and in order to procure the basic MBBS degree, a longer duration of course seems suitable rather than the proposed concise teaching in UG curriculum.
· For such a major curricular revamp by the MCI, the feedback should have been collected in a transparent manner by the Board constituted by Academicians, State / National bodies of individual subjects, and Educational institutes. This proposal should have been widely publicised in the medical institutions. The working group does not provide the consultations sought from various medical specialities, and the impending consequence may be disastrous to the medical education and the public at large.
· Annexure 2 mentioned in page 15 (Need to review curriculum) has not been made accessible, and hence the deadline for feedback should be extended for a reasonable time.
· Grouping the medical subjects as A, B & C, Core & Non-core implies that “C, Non-core & Elective subjects” are less important / not needed in UG curriculum. This would be like trying to tell that some parts of the human body may be sacrificed as they do not have a specified and designated function. A human body cannot be called as 'complete' if some of its parts are 'missing'.
· The present proposal is contradicting the earlier reports (Mudaliar and Bohr committee), which were constituted by the Government of India to improve medicolegal work in India. In 2007, a committee chaired by Former Chief Justice of India Mr. Justice Venkatachalaiah prepared a draft on “revision of undergraduate medico-legal curriculum”, which stressed the need for giving more importance to ‘forensic medicine’ in the training of a medical graduate (available at http://medind.nic.in/jal/t08/i1/jalt08i1p37.pdf).
· The representatives from other paraclinical subjects (Pathology, Microbiology & Pharmacology) are also in concurrence with retaining the existing course curriculum with 1½ years for phase II MBBS.
· From a consumer (patient) point of view, an incomplete, ill-equipped, unprofessional and untrained ‘Basic doctor’ may just fulfill the required doctor-population ratio. Nevertheless such doctors who deal with life of the patients, is likely to err with reduced quality of education imbibed by a ‘crash course’ (4+1 year). This may be a violation of Article 21 of the constitution, which in all likelihood will lead to rampant rise in medical negligence cases.
II. Forensic Medicine in UG medical curriculum.
· Medical and legal duties form the two sides of a coin in the medical profession. Scientific evidence produced by a doctor, helps in increasing the conviction rate. Since majority of crime cases are handled by the Basic doctors (MBBS) in India, they need to have enough knowledge on dealing with medicolegal cases. The legal responsibility of a Basic doctor cannot be withdrawn without amending the current CrPC, IPC, & Indian Evidence Act. The Forensic expertise, matters in conviction as is evidenced by the fact that there is 60% conviction in CBI investigated cases in contrast to a meagre 6% in those investigations by various state police. The higher rate of conviction in CBI cases is because of expert (forensic) scientific evidence. By ignoring the importance of forensic medicine in UG curriculum, the conviction rate of the prospective crimes will be lower than ever before.
· The Indian legal system will be traumatically affected by the vision-2015 and hence a debate about its pros and cons should be collected from the Honorable Judiciary, Home Ministry, Central & State Governments, and the Public at large.
· Proposal suggests that 'Forensic Medicine can be effectively taught during Gynaecology & Obstetrics (rape, assault), Surgery (injuries), Pharmacology (toxicology)'. Nothing can be considered as 'equivalent' to a teaching by a “Subject specialist”. This transpires that, an Obstetrics and Surgery teacher may not be able to pick up the nuances of a rape case or an injury case in comparison to a doctor trained in MD-Forensic Medicine. By doing so, the “ergonomics” is defeated. Similarly, toxicology can not be taught by a pharmacologist who is well versed with medicines and not DRUGS (fatal dosage of drugs and drugs of abuse) and POISONS. The pharmacologists are already overburdened with ever-growing medicines (newer molecules) and their pharmacokinetics. The expert committee should have realized that the clinicians should be exclusively spared for clinical work and be let free from medicolegal hassles, thereby not spending lot of time in attending courts.
· Proposal suggests that 'Legal experts can be called for medico-legal issues'. The legal experts are non-medical people and they can effectively and efficiently represent cases in the courts only with able guidance of Forensic expert’s medico-legal reports for effective pleading. The Judges and lawyers in the court of Law depend on the expert opinion of a forensic expert in giving judgment in criminal cases. Even the best criminal counsel is ignorant of medicine and intricacies of medicolegal cases and thus cannot be considered to train the UG students.
· Proposal 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'. It means that ‘Forensic skills’ is an optional and not a mandatory for a basic doctor. Though ‘Forensic Medicine’ posting is an optional posting in the current medical curriculum, no one opts this posting during their internship. This shows that not every doctor is interested in practicing medicolegal works. Majority of the medicolegal works (including postmortems) in India are been performed by the basic MBBS doctors. This is one of the bitter truths known to every one yet all of us are helpless due to shortage of forensic faculty and non-permission to private medical colleges to start medicolegal works in many states. If this continues, a basic doctor without proper forensic training is going to handle medicolegal cases that may lead to disaster to the society (as recently seen in “Aarushi Talwar” and “Nirupama Pathak” murder cases).
· If there is no awareness of the forensic subject to basic doctors at UG level, the number of PG admissions in Forensic Medicine will be reduced, which results in less forensic experts in India to handle medicolegal cases effectively in future.
· For proper training in Medico-Legal Autopsy each Medical College should be linked to respective jurisdiction police station for receiving cases to perform Autopsy (similar to the provision in Vision- 2015 mentioning that each Medical College will be linked to local health system for better training).
Copy to: Board of Governors, MCI Secretary, Prime Minister Office; Health Minister, Home Minister, Law Minister, Health Secretary, Home Secretary, Law Secretary, Govt. of India
Dr. Nagesh K.R. Dr. Mahabalesh Shetty
Secretary, KAMLS President, KAMLS
No comments:
Post a Comment