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Table of Contents
LETTER TO THE EDITOR
Year : 2022  |  Volume : 19  |  Issue : 2  |  Page : 128-130

Postgraduate medical education in India – Ideals versus reality


Department of Medicine, KG's Medical University, Lucknow, Uttar Pradesh, India

Date of Submission18-Dec-2021
Date of Decision30-Jan-2022
Date of Acceptance31-Jan-2022
Date of Web Publication24-Mar-2022

Correspondence Address:
Harish Gupta
Department of Medicine, KG's Medical University, Lucknow - 226 003, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/am.am_147_21

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How to cite this article:
Gupta H. Postgraduate medical education in India – Ideals versus reality. Apollo Med 2022;19:128-30

How to cite this URL:
Gupta H. Postgraduate medical education in India – Ideals versus reality. Apollo Med [serial online] 2022 [cited 2022 Jul 1];19:128-30. Available from: https://www.apollomedicine.org/text.asp?2022/19/2/128/340827



“If you think in terms of a year, plant a seed; if in terms of 10 years, plant trees; if in terms of 100 years, teach the people.”

– Kong Fuzi (Confucius), Chinese philosopher (551 BC – 479 BC)

Dear Editor,

Sheth describes the current scenario and future perspectives of postgraduate (PG) medical education in India in his review article published on website of the Journal on November 10, 2021.[1] The author derives Results and Discussion on the basis of his findings culled from various search engines that PG medical education is offered by public and private sector medical colleges/hospitals in India with the degree courses of MD/MS and DM/MCh that are regulated by the NMC. Therein, under a heading of Medical Education in India, he emphasizes it in the last sentence of a paragraph. However, nowadays, our government operates several (rather the most) services in public medical colleges in private mode, outsources essential ones to contractors, hires the lowest bidder from different platforms, and has plans to open new medical colleges in public–private partnership (PPP) mode. Some 10 months ago, a press release from the Ministry of Health and Family Welfare, Government of India, states in point number 11 that to promote establishment of medical colleges in PPP mode, Viability Gap Funding Scheme has been launched.[2],[3] Although terms and conditions of the partnership are not available in public domain, we would presume that it will be as per visible norms. What I want to underscore is that nowadays, distinction between public/private is not clear, often gets blurred on ground zero and many a times it is a Herculean task to segregate in a given scenario what is public and what is private.

In the next paragraph, under a heading of measures to increase the PG medical seats, he highlights that the NBE is also a key central PG examination board in India that conducts PG entrance, foreign medical graduate examination, PG super-specialties entrance, PG diploma entrance tests, and DNB/fellowship exit examination. While that was correct previously, for the last 5 years, all the entrance examinations are conducted by National Eligibility cum Entrance Test. Authorities now have plans to conduct final-year passing out examination with PG entrance examination (a common examination) which is raising several unconventional questions.[4] Purpose of final-year passing out examination is to assess a student for having basic skills whereas PG entrance test is carried out to derive a merit on the basis of a preset question paper. How can one combine the two separate tests remains a wonder.[5]

Under a heading of Conclusion, the author states that the future of the PG medical education curriculum would (will) include enhancements such as broader use of technology and inclusion of courses such as medical ethics and health economics. However, now, textbooks of Medicine have a chapter on Health Economics.[6] Our Bible – the Harrison's Textbook of Internal Medicine – has several electronic (only) chapters which are not there in its print edition. Moreover, one of the e-chapters deals with Behavioral Economics.

Under Introduction, the author laments about poor doctor versus population ratio of India. While that is true representation of the facts, now with increased number of medical seats, a Member, NITI Aayog, states that India is well on the path toward (achieving) the WHO-recommended doctor-to-population ratio.[7] Nevertheless, the challenge lies not only in generating higher supply of trained health-care human resources only but also in their fair distribution. We have shortage of workforce in our villages whereas in cities there is stiff (and sometimes unhealthy) competition among medical practitioners.[8],[9] Meanwhile, to fill the gaps in the process, post of community health officer (provider) is created already who is a mid-level worker and manages routine job of patient care services as well as of record-keeping.

As public health is a social good and generates positive externalities,[10] public sector needs to invest here adequately so as to produce a healthy workforce. While basic motto of private investment (with few exceptions) is to have a thick bottom line (read profit) for its shareholders, the feature contrasts with fundamental principles of equity. Under prevalent circumstances, no private investor wants to make an outreach to marginal rural population; hence, government should fulfill its social commitment of reaching out to the last person standing in a queue for the benefit of all. When our students get exposure at such outreach (community) centers during their training period, they should get a glimpse of wider society and rules of the engagement. While corporate investment in private medical colleges has a goal of earning profit, public colleges need to reach the unreached and serve the unserved. Looking through this lens, we can hardly compare two separate entities which stand at altogether different pedestals.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Another reply: Response to the letter to the editor

Abhijat Sheth

Director Medical Services, Apollo Hospitals, Ahmedabad, Gujarat, India



Address for correspondence: Dr. Abhijat Sheth, Apollo Hospitals, Ahmedabad, Gujarat, India.



I would like to thank the author of the letter for their interest and comments on my recently published article.

The letter begins by stating the complexity in differentiating public and private sectors, given that public and private partnerships (PPPs) are gaining popularity. In response to the reference used from my article– “Postgraduate (PG) medical education is offered by public and private sector medical colleges/hospitals in India with the degree courses MD/MS and DM/MCh that are regulated by NMC,” a clear distinction of the sector of medical colleges is provided by the NMC on their website.[1] The definitions of public and private as well as PPP are mainly focused on services, infrastructure, operations, and finances, then quality of education. It is vital to develop and integrate teaching models practiced in public and private sectors to utilize all available resources effectively, on and for strengthening education. Until the effective integration model is evolved, we need to take critical inputs from both public and private sector PG medical institutions while understanding its pros and cons carefully.

It is stated in the letter that since the last 5 years all the entrance examinations are conducted by National Eligibility cum Entrance Test (NEET). Essentially, NEET for PG courses has been conducted by the NBE since 2012.[2] The exit examination mentioned, is the National Exit Test, which is proposed to serve as a single examination to cover final MBBS licensing, foreign medical graduate screening and PG entrance examinations.[3] The author expresses the uncertainty in combining two different scopes of licensing and entrance examinations into one. It is to be noted that such scopes have been successfully combined and implemented in other countries. For example, USMLE, which serves as a licensing and entrance examination, has been conducted successfully in the US since the 1990s.[4] It will be beneficial for Indian medical students, as well as foreign medical students to undertake a single examination, that is uniform for all, serves as a licensing examination as well as entrance examination.[5]

With regard to the comment of having a chapter on health economics already in the medicine textbooks, the conclusion of my article suggested inclusion of courses on medical ethics and health economics. The chapter cited in the letter is from Harrison's Principles of Internal Medicine, a widely used textbook in medicine. However, this chapter is based on the data and healthcare system in the US. The health-care system, disease epidemiology, culture, etc., in India, are greatly different from the US and any other country. Hence, these courses need to be tailored to the Indian health-care system and to different concentrations (e.g., medicine, surgery, pediatrics). Further, rather than having informal teachings, putting together a formal, structured course on these subjects can help students learn, understand, and implement these topics better.

The letter highlights the disproportionate distribution of medical doctors in India as was described in my article. The letter further mentions the posts of community health officers being in place to fill the gaps in the distribution. These positions have been created to increase the provision of limited primary and preventive medical services, which are usually provided by MBBS doctors.[6] However, the availability of PG medical doctors in underserved regions is even less. The increase in PG seats can ensure that more MBBS doctors can undertake PG degrees, and the disproportionate distribution can be addressed.

The last paragraph remarks about the different objectives of the public and private sectors in healthcare. The role of PPP comes into play in this situation. An example would be private colleges linked with district hospitals, a common theme for PPP for medical colleges.[7] In such scenarios, medical students benefit by getting the advanced technology and infrastructure for their theoretical education (private investment) and exposure to district hospitals (government investment) for their practice. Patients benefit by getting easy access to healthcare as well as advanced healthcare at affordable costs. The private sector interest in such schemes is reflected by the fact that as of December 2021, almost 45% (70) of the approved medical colleges under the centrally-sponsored scheme in underserved areas have become functional.[8] PPP can, thus, be a promising future in the healthcare sector with continuous evolution from medical education viewpoint.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



References

  1. National Medical Commission. List of Colleges teaching PG courses. Available from: https://www.nmc.org.in/information-desk/list-of-college-teaching-pg-courses/. [Last accessed on 2022 Jan 09].
  2. National Board of Examinations. NEET-PG: National Eligibility cum Entrance Test – Post Graduate (For admission to MD/MS/Post Graduate Diploma Courses 2013 Admission Session); 2012. Available from: https://natboard.edu.in/matter.php?notice_id=1033. [Last accessed on 2022 Jan 09].
  3. Ministry of Health and Family Welfare (MoHFWs). Union Health Minister, Shri Mansukh Mandaviya Chairs a Review Meeting with National Medical Commission (NMC); 2021. Available from: https://www.pib.gov.in/PressReleseDetailm.aspx?PRID=1740678. [Last accessed on 2022 Jan 10].
  4. United States Medical Licensing Examination (USMLE). About the USMLE. Available from: https://www.usmle.org/about-usmle. [Last accessed on 2022 Jan 10].
  5. Ministry of Health and Family Welfare (MoHFW). Cabinet approves certain official amendments to the National Medical Commission (NMC) Bill; 2018. Available from: https://pib.gov.in/newsite/PrintRelease.aspx?relid=178176. [Last accessed on 2022 Jan 09].
  6. MoHFW. Health and Wellness Centres under Ayushman Bharat; 2019. Available from: https://pib.gov.in/newsite/PrintRelease.aspx?relid=188246. [Last accessed on 2022 Jan 09].
  7. MOHFW. Guidelines for Centrally Sponsored Scheme. Establishment of New Medical Colleges Attached with Existing District/Referral Hospitals. Available from: https://main.mohfw.gov.in/sites/default/files/42758936271446789560.pdf. [Last accessed on 2022 Jan 10].
  8. MoHFW. 70 of 157 Approved New Medical Colleges Functional in Backward Areas; 2021. Available from: https://pib.gov.in/PressReleasePage.aspx?PRID=1780153. [Last accessed on 2022 Jan 10].




 
  References Top

1.
Sheth A. Current Scenario and Future Perspectives of Postgraduate Medical Education in India. Apollo Med. Available from: https://www.apollomedicine.org/preprintarticle.asp?id=330277. [Last accessed on 2021 Oct 18].  Back to cited text no. 1
    
2.
MoHFW. Medical Colleges. Feb 2021, Posted by Press Information Bureau. Available from: https://pib.gov.in/PressReleseDetail.aspx?PRID=1695596. [Last accessed on 2021 Oct 18].  Back to cited text no. 2
    
3.
NITI Aayog, on Twitter. Available from: https://twitter.com/NITIAayog/status/1232285422987948032?s=20. [Last accessed on 2021 Oct 18].  Back to cited text no. 3
    
4.
Gupta H. Too Many Shortcomings in the New National Medical Commission. The India Forum; November 01, 2019, Available from: https://www.theindiaforum.in/letters/response-national-medical-commission. [Last accessed on 2021 Oct 18].  Back to cited text no. 4
    
5.
Verma SK, Gupta H. Fathoming the NMC act. Econ Polit Wkly 2020;55:5.  Back to cited text no. 5
    
6.
Volpp KG, Loeweinstein G, Asch DA. Behavioral economics and health. In: Jameson JL, Fauci AS, Kasper DL, Hauser S, Longo DL, Loscalzo J. Harrison's Principles of Internal Medicine. Mc Graw Hill Education: 2018;20:20, Available from: https://accessmedicine.mhmedical.com/content.aspx?bookid=2129&se ctionid=192535728. [Last accessed on 2021 Oct 18].  Back to cited text no. 6
    
7.
Ministry of Science and Technology. India is Well on the Path Towards WHO Recommended Doctor to Population Ratio: Dr Vinod Paul; Aug 2021. Available from: https://pib.gov.in/PressReleasePage.aspx?PRID=1744052. [Last accessed on 2021 Oct 18].  Back to cited text no. 7
    
8.
Vics President's Secretariat. Vice President Calls for Addressing the Shortage of Doctors and Paramedical Workers in a Mission Mode; September 25, 2021. Available from: https://pib.gov.in/PressReleasePage.aspx?PRID=1758000. [Last accessed on 2021 Oct 18].  Back to cited text no. 8
    
9.
Vice President's Secretariat. Urgent Need to Address the Problem of Manpower Shortage in Medical Profession; Nov 2021. Available from: https://pib.gov.in/PressReleasePage.aspx?PRID=1768470. [Last accessed on 2021 Oct 18].  Back to cited text no. 9
    
10.
Manklw NG. The Economics of Healthcare. Harvard University; 2017. Available from: https://scholar.harvard.edu/mankiw/publications/economics-healthcare. [Last accessed on 2021 Oct 18].  Back to cited text no. 10
    




 

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