India produces the largest number of doctors in the world and by 2023-24 counselling session, there will be 107,658 MBBS seats. Opening medical colleges and increasing seats is relatively easy, but improving the quality and skills of trainee doctors is an uphill task. To achieve the latter, the National Medical Commission (NMC) needs to be applauded for notifying the new undergraduate curriculum as it is timely and most comprehensive.

Skills of an Indian medical graduate

The ‘Vision 2015’ document issued by the Medical Council of India (MCI) in 2011 laid the basic framework and mandated that an ‘Indian medical graduate (IMG)’ should be a clinician (providing preventive, promotive, curative, palliative and holistic care); leader of a health care team; a communicator with patients, families; colleagues and community; a life-long learner and a professional (committed to excellence, ethics, and profession).

India produces the largest number of doctors in the world and by 2023-24 counselling session, there will be 107,658 MBBS seats. Opening medical colleges and increasing seats is relatively easy, but improving the quality and skills of trainee doctors is an uphill task. To achieve the latter, the National Medical Commission (NMC) needs to be applauded for notifying the new undergraduate curriculum as it is timely and most comprehensive.

Skills of an Indian medical graduate

The ‘Vision 2015’ document issued by the Medical Council of India (MCI) in 2011 laid the basic framework and mandated that an ‘Indian medical graduate (IMG)’ should be a clinician (providing preventive, promotive, curative, palliative and holistic care); leader of a health care team; a communicator with patients, families; colleagues and community; a life-long learner and a professional (committed to excellence, ethics, and profession).

NMC has now matured the IMG concept, through a commendable curriculum, fine-tuned with an emphasis on early exposure to clinical scenarios from the first year, integrated teaching, a holistic approach to imbibe basics of other ‘pathies’ and to acquire a ‘must know’ skill set. The NMC guidelines are being further redrafted and may see changes in days to come.

The NEET, conceived in 2011, has by and large promoted talented raw talent to reach India’s medical colleges. With this new undergraduate curriculum by NMC, India aspires to have better IMGs. The litmus test, however, would be the implementation and acceptance of this curriculum into India’s 702 medical colleges.

Challenges for India’s medical education

There are major challenges for medical education in India.

Firstly, a lack of motivated, trained, and competent teaching faculty, inadequate tools to certify acquisition of competencies (506 competencies listed for medicine and 416 competencies for paediatrics). Second is the lack of standardization and non-relevance of internal assessment throughout medical training flaws in the present NEET-PG entrance test, which is solely based on multiple choice questions and not on acquired skill sets in UG as was enshrined in ‘Vision 2015’ (50% marks were for theory and 50% were assigned to the practical examination after completing internship)

Thirdly, there is inertia and no accountability on part of management to improve the educational milieu, more so for government colleges. Fourth, the non-existent comprehensive feedback from medical students and public. Lastly, the absence of incentives for excellence, and the lack of environment, infrastructure and mindset to raise curiosity and undertake meaningful research, especially with batches of 250 students each year.

Prospective changes to curriculum

High expectations from the new curriculum can be subdued due to the enormous course burden. It would have been prudent to chop off at least 30% of ‘must know’ material to ‘may know’ category. We do need a change of mind-set from our teachers as well. Often, unlearning is needed to learn anew. New areas such as machine learning or computer vision if added, some fields should be deleted. In fact, a four-year medical curriculum instead of a four and half years was proposed and would be in line with four-year engineering courses, which often takes students to lucrative opportunities unlike the medical profession, which takes on an average, 11 to 12 years, as every UG wants to be a superspecialist or achieve the postgraduate degree.

It is often said medicine is a noble profession, but then medicos should be provided the stature of Roman nobles. Allow them to ‘earn and learn’ and launch start-ups during UG/PG courses. It would be worth the attention of the NMC to consider incentives proposed for the faculty in ‘Vision 2015’, often without putting any burden on government, such as dual or multiple academic appointments, defined career paths, and financial incentives by permitting consultancy, starting incubators/companies like the faculties from IIT and IIM.

What's NExT?

The National Exit Test (NExT), introduced in the National Medical Commission Bill 2019, was to ensure that our IMGs would make India proud. A standardised, exit exam with at least 50% weightage to clinical skills and competence, conducted at a national level, would be the true test of the success of reforms. Let us not compromise on quality to meet the demand for doctors. Let institutions and teachers be ranked based on the merit of their students in the NExT and not on NIRF or NAAC systems. Such a departure will ensure that our IMGs will be highly rated globally. The quality and durability of the ‘product’ is what matters, not the process. Let us invest funds and efforts to make our IMGs the best in the world.

Prof. (Dr.) Shiv K. Sarin is chancellor, Institute of Liver and Biliary Sciences and the former Chairman of the Board of Governors of Medical Council of India, 2010-2011.