POSTGRADUATE MEDICAL EDUCATION IN INDIA REVAMP AND RE-ESTABLISH
Dr. Anand Mohan Sur, M.B.B.S., M.R.C.P.(Edinburgh) D.C.H.(London ) F.R.C.P. (Edin) F.I.C.M.C.H. (Calcutta) Nagpur (M.S.)*
Department of Pediatrics.*
The Young Indian medico is at the climax of frustration at his inability to reach the highest in his subject. The seats for post-graduation are available to a very small number. This helplessness frequently compels them to seek opportunities abroad and not infrequently we lose them totally. The country needs expert medical care at all levels. A self-introspection to find a solution, is a national need of the hour.
  1. Post-graduation seats in Medical faculty adequate? too many? too few?

    National Statistics:
    MBBS Seats - 32000 approx per year
    MBBS Passing - 18000 approx per year
    P.G. Seats - 7500 approx per year
    P.G. Clinical - 6000 approx per year
    Seats for open competition - 25%
    Total - 1875
    Clinical - 1500

    Medical manpower: 1,00,500 - Any of them can complete for postgraduate seats.

    The chances of getting a seat in the subject of your aptitude could down to 5%. Which could be leaving more than 90% in subject s not for their choice. How much goods will such an army of unwilling soldiers deliver to the country?
  2. The hierarchy appears to consider these as too many seats. Their ground:

    a) Not enough jobs - 80% of India's medical manpower functions outside the services, mostly in private sector. The motivation for PG qualification is prestige and glory and not just jobs. Lack of jobs is, therefore, hardly important.

    b) Cost - Basically MCI does not promote pure PG institutes. A College must be recognized for MBBS before MCI permits post-graduate training. Staff and infrastructure is already there. Additional cost for PG training is hardly substantial.

    c) Saturation in big cities - Saturation of PG qualified consultants in big cities will itself make them migrate to smaller place and expert medical care will be carried to the periphery thereby.

    Hence, there is no logical ground to link PG seats with the no of available jobs.

    In fact larger the no of PG trained doctor, greater will be the expert medical care available to the country.
  3. Needs of expert medical care are paramount in the periphery. The country needs 2,31,701 rural doctors. Actual no. of rural doctors 25,418 (almost 10% of our requirement). This refers to the basic doctor. In recent times there has been a thinking in the hierarchy that MD/MS is to be promoted. The Diploma courses DCH, DGO, DO etc. seem to be loosing their favor. No of seats for Diploma Courses has fallen over the last 25 years. Non-medical college institutions like ICMCH and college of physician and surgeons of Bombay seem to be in their disfavor. MD/MS functions as a consultant and can survive only in the relatively larger cities. The diploma holder (DCH/DGO etc) functions as a specialist practitioner and hence fluorides in small places too. In Govt. Medical College, Nagpur a PG follow up file was maintained in the past and the statistics Showed that 65% of the DCH settled in very small places.

    Thus it is the diploma holder and not the M.D/, /S/ who carries medical expertise to the periphery where such care is needed most.

    The need of the country therefore lies in promoting DCH/DGO etc. on a high Priority. What is happening is just the reverse.
  4. Non University Diploma trainers in India are mainly 2. The college of Physicians & Surgeons of Bombay and the ICMCH, ICMCH is all India based. It spearheads 1-2 child national family norm. It organizes mass immunization and its training is community orientated. It has produced more than 1000 DCH/DGO. The Govt. of India and the State Govt. should accept their qualification for specialist appointments at least at the district hoop levels.

    The ICMCH & CPS should provide special seats to candidates to from Developing countries of the world espy Asiatic and give them extra facilities. In this process they would gain recognition by many governments outside India and enhance India's prestige in the Academic leadership in the developing countries. No doubt this means strict norms, discipline and attitudes above by us too.
  5. How to make opportunities for post-graduation for our students?

    a) Increase the no. of seats for post-graduation.

    Today's norm of 1 student per teacher per year for MD/ MS and 2 for Diploma is too rigid. It can be increased 2 to 4 times without loss of efficiency.

    b) Make 2 parallel streams for post-graduation

    One by exam (M.D., DCH etc.) and the other by original research (Ph.D.). A super PG qualification namely D.Sc. can be made for both streams. It almost doubles the no. of available PG seats and enhances India's Contribution to International Medical Research. The tragic fall of Research in Indian can be in the following statistics of International Science Citation Index which covers papers published in 3 to 4 Thousand international mainstream journals in science every year.

    Total No of Scientific Papers:
    Country 1990 1999
    India 10103 12521
    Malaysia 1 115
    Australia 31 304
    Canada 74 493
    China 19 237
    Pakistan 3 14
    Vietnam 1 12

    While most others have increased about 10 times in years, We have increased 1.2 times only" Information today & tomorrow Vol. 26, No. 4 Dec. 2001, PP3, 17 & 22.

    Introduction of a Ph.D. stream will be a big step to restore Indians dwindling image in international research field.

    Do we need postgraduate super labs for Ph.D. research? Not necessarily. There can be no such thing as an institution recognized for Ph.D. white for a problem involving intricate molecular biology one needs a super sophisticated lab and Institution, such an institution can be worthless for a research into feeding practices, into the factors like living habits and environment producing widespread infection ate in a community etc. For such research the right place may be village or even a deep forest where tribals live. What we need for Ph.D. research is a proper guide, a dedicate & innovative research worker and a planned study subjected to close scientific scrutiny. Many discoveries can be made in our exciting set up. Hence the new stream of Ph.D. will not burden our resources. Help from sophisticated labs can always be taken for a handful of highly sophisticated research problems.

    c) Take cues from U.K: The advanced country nearest to our pattern factually and historically is U.K. for their MRCP/MRCS etc. one needs to have worked in hospitals (majority outside medical colleges) accredited for that purpose. Most of their country hospitals (same as our district hospitals) are accepted for that. Similarly we can recognize, many district hospitals, lay down workable academic norms there and permit a PG students, who has worked for the specified period of time there to take the PG Exam. Pass only the deserving but don't deny the opportunity to our youngsters a chance to prove their worth. This will give PG opportunity to a large number of young graduates and perhaps give them the training that Indian peripheral conditions require.
  6. Get back your doctors trained and qualified abroad - Many youngsters leave the shores of India as the unrealistic rigid rules here leave them no scope to do post-graduation in India.

    Majority of Indian doctors with PG qualification abroad, do so in U.K. In 1995 Total No. of Indian doctors with foreign PG qualification was 6033, of these 3684 (55%) were from U.K. alone.

    In 1978 we derecognised the PG qualification awarded by the Royal Colleges in U.K. on grounds that were entirely non-academic. While we recognize qualification acquired in many other countries where the situation vis-à-vis India is identical, we persist in this non-academic derecognistion for U.K. How can the U.K. qualified doctors return to India if we don't at least remove this derecognistion. We grudge losing them but close our doors for their return. We must remove this non-academic derecognistion and encourage them to come back by creating realistic conditions favourable to their return.
  7. Content of Postgraduates Training: Post-graduation is a self-education programme. The teachers guide them only. No spoon-feeding is to be done. The essence of training should be by working as residents under guidance, group discussion, seminars, journals clubs, death conferences etc. Grasp of Medical Audit, and of cost effectiveness should be promoted . Elective posting to other places should be encouraged & promoted but need not be compulsory.
  8. Assessment - M.D./M..S./Diploma: In order to standardize the Indian PG Qualifications the exams should be by Central National Body in Multiple National Centers located in different parts of the country. Written & practical exams should be in small sectors and examiners for each section should be different. This will eliminate a lot of subjective problems in the assessment that exist today and make the exams very fair. All Universities and all non-university training institutions should contribute by providing examiners and examination centres candidates should not be examined in their own locations if possible.

    For Ph.D. & D.Sc. - The thesis should be examined..
    • In the state
    • outside the State
    • outside the country
  9. We should give weightage to experience even for those who haven't obtained a PG qualification in appointments.
Conclusion
Needs of the Country and aspirations of our youngsters should be paramount. Every thing else MUST be secondary.
References :
  1. Health Information of India 2000 Central Bureau of Health Intelligence Govt. of India
  2. Aparna Basu and Ritu Aggarwal - National Institute of Science Technology and Developmental Studies New Delhi - International Science Citation Index "Information Today & Tomorrow Vol 26 No 4 Dec 2001 pp 317 and 22."
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