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State of Medical Education in India

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State of Medical Education in India

Thursday, 23 January 2020 | Dr BKS Sanjay

The troika of health, education and nutrition are the basic needs of each and every individual irrespective of the caste, creed, race, gender, religion and region. All these three are interrelated.

The United Nations General Assembly proclaimed January 24 as the International Day of Education. The right to education is enshrined in article 26 of the Universal Declaration of Human Rights. The declaration calls for free and compulsory elementary education. The Convention on the Rights of the Child, adopted in 1989 goes further to stipulate that countries shall make higher education accessible to all.

The international community recognised that education is essential for the success of all 17 United Nations Sustainable Development Goals. These goals are concerned with poverty, health, education, nutrition and other basic infrastructure. There are 104 sub indicators for these 17 goals. I would like to touch only education. Secret of success of any individual in day-to-day life lies in application of behaviour knowledge and skill. All these three can only be acquired with education only.

The adjusted Net Enrollment Ratio from class I to X in India is 76 per cent while the target is 100 per cent enrollment. Under the universal health coverage the target is 100 per cent however India could achieve 29 per cent according to the National Family Health Survey (NFHS-4). Tendulkar committee estimated in 2011-12 that 22 per cent of Indian population lives below poverty line while SDG target is 11 per cent.

Hunger is a big problem in India which is causing stunting in children. About 35 per cent of children under-5 years are stunted according to the Comprehensive National Nutrition Survey report 2016-18 of the ministry of health and family welfare. Similarly mortality under-5 year per 1,000 live births is 50 which should be 25 as per SDG target. Unemployment rate for 2017-18 in India stands at 6 per cent which should be 0 per cent.

Being a medical doctor and having worked in scores of medical institutions of India and abroad in last 40 years in different capacities from trainee to teacher and examiner to advisor in various medical bodies, I will confine my views mainly to medical education.

According to a report published in 2018, there are 374 medical colleges. There are 31,385 under graduate seats in Government and 60,105 in private medical colleges. But the ratio of doctor and patient is not matching with WHO standard which is 1:1,000. Over population is diluting this ratio though country is training the maximum number of the doctors in the world.

Rupees 300-400 crore is needed to establish a medical college and approximately Rs 50 crore annually to run it. Our medical colleges are mainly located in the rural areas particularly most of the private medical colleges. The cost of the land is exorbitant in urban areas hence the owners prefer to establish the medical college in rural and remote area. But then it becomes difficult to get the patient in such sparsely populated rural areas and to get the well established experienced doctor, as a full time faculty in that area.

The younger generation newer teachers do not prefer even well equipped medical college of rural and remote areas because of non availability of quality education for their children and other basic facilities like shopping, recreational and entertainment facilities for their children and their families. They rather prefer small and poorly equipped setup in urban areas. The frequent shifting and premature promotion of faculty again leads to the further deterioration in the medical training and teaching and this becomes vicious circle.

Recently, the medical infrastructure is becoming more and more expensive and health care services are becoming more and more technology oriented hence colleges are ill equipped. Therefore, they are unable to provide the quality medical education as expected.

There is mismatching of money and merit in India. It is a paradox in medical education sector in the current scenario. The government colleges are having well educated and experienced faculty but there is lack of newer or advanced technical support. However many private colleges are well equipped but they are not having properly educated trained and experienced faculty hence in both scenarios the quality of education is compromised.

According to Dr BR Ambedkar, the architect of the Indian constitution and educationist, the education ought to be brought within the reach of everyone, hence, education should be cheapest in all possible ways and to the greatest possible extent.

But contrary to above views most of these private medical colleges are run by businessmen on business principles while the concept of medical education is lacking. The owners of the medical education institutions are working as the investors and they want to make more money from these organisations. The medical colleges have become centres to mint money. Fee for full MBBS course in private medical college is ranging from Rs 50 lakh to more than Rs one crore in certain colleges.

Practice of cheating, copying and impersonation was prevalent in Xth and XIIth board examinations but now it seems that these malpractices has come in medical entrance examinations as well. Here I would like to remind you about Madhya Pradesh medical entrance examination scam of 2013 which was named as Vyapam scam. 

A single national level National Eligibility-cum-Entrance Test by Government of India for undergraduate (NEET-UG) was introduced in 2013 to get rid of existing menace of capitation fees and other fraudulent activities which were prevalent in medical entrance examinations across the country.  Here, I would like to share one more fraudulent incident of Tamil Nadu NEET impersonation scam reported in October 2019 in mass media. It is alleged that the son of a doctor got admission in Theni Government Medical College in Tamil Nadu by managing and engaging a proxy candidate to simultaneously write the exam for him with same credential from another centre.

A report by Reuters in 2015 stated that one out of every six (17 per cent) of medical college in the country has been accused of cheating, according to Indian government records and court filing. These incidents could be the tip of the iceberg. One can imagine the quality of medical education being imparted.

If the status of the medical education is analysed seriously in detail then it seems that there is problem in our education system. Most of the brain functions are developed in childhood. Interest of the education in any children develops in primary schools. The children not only learn the skill of the reading and the writing but they learn ethical values as well and they themselves develop the skill of further improvement in them. Old habits die hard.

We should try to improve not only the medical education but emphasis should be given to the primary and secondary education. If we improve primary and secondary education then we can definitely improve medical education along with them.

Health, education and nutrition are the three basic pillars of the growth and development of any nation. Education is one of the important pillar of the growth of an individual and ultimately of the family, society and the nation. Health, education and nutrition in modern times have become sellable products which are bought by the money only. Money can be earned by the employment especially for those who don’t have the funds to start as an entrepreneur and therefore employment can only be achieved by quality education.

John Dewey, an American educationist said whatever role is of food and reproduction in existence of physical life of humans, similar role is that of education in their social life. Horace Mann an American educational reformer said where anything is growing, a former is worth of a thousand reformers.

If we analyse overall causes of poor results of medical or surgical treatment then they are mainly attributed to the lack of quality basic medical education, training and the experience of that particular doctor. The quality of the work depends upon the quality of the worker. The aim of the government should be not only to provide the education but equitable quality education. Although this is relevant for all kind of education but it is more relevant in case of medical education as medical doctor deal with the life of human beings and many times decisions have to be made at an instant which may change the life of the individual.

(The author is an orthopaedic and spine surgeon, and the founding president of State Chapter of Indian Orthopaedic Association)

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