What the plight of students in Ukraine reveals about medical education in India

• The number of seats available for medical education in India is far less than the number of aspirants who leave school with the dream of becoming doctors.
• Of the 1.6 million students who appeared in the National Eligibility cum Entrance Test (NEET) in 2021, only 88,120 made it into the 562 medical colleges in the country.
• Others had to enrol in non-medical courses in India or seek admission to foreign medical colleges.

Opptunities abroad

• While the number of medical colleges has now increased to 596 (with 89,875 seats), the entry barrier is still high.
• China, Russia, Ukraine, Kyrgyzstan, the Philippines and Kazakhstan are among the countries where Indian students pursue their dreams to become doctors.
• On return, they need to pass a qualifying examination before they are permitted to intern in the institutions recognised by the Medical Council of India (MCI) — its functions have been taken over by the recently-constituted NMC.

Issues With the screening Test

• The task of conducting this screening test was assigned to the National Board of Examinations (NBE).
• The passing rates were disappointingly low (mostly below 20 per cent), for several reasons. Training standards varied widely across foreign institutions. The language of instruction was not English. The curriculum in foreign colleges differed in several respects from that taught in India. A student training in Russia or Ukraine is unlikely to learn much about kala-azar or malaria.
• The screening examination in India used to cover the vast syllabus encompassing the entire gamut of medical education.
• Even when the proportion of questions related to clinical subjects was increased, the success rate was still low. So, foreign medical graduates started taking coaching classes. That spawned another industry.
• A recent analysis estimates that India has only 4.8 fully qualified and actively serving doctors per 10,000 population.
• Those too are inequitably distributed across the states, with a further tilt towards urban centres.
• The critical needs for a medical college are a general hospital with different specialities needed for the MBBS course, classrooms, laboratories, community engagement and adequate faculty.
• The availability of suitable faculty is a critical barrier at present. Even if the private sector is provided land at a concessional rate for starting new medical colleges, they will face a faculty crunch and poach from government medical colleges.
• Handing over district hospitals to the private sector, as proposed by some, will exacerbate inequities in healthcare and disconnect secondary care from organised primary care which is principally delivered through the public sector.
• Private medical colleges are also exorbitantly expensive in their fee structure — even in comparison to foreign medical colleges.

Need of the hour

• State governments must be supported to invest in the upgradation of district hospitals.
• Specialist posts in many clinical disciplines that are needed for the MBBS programme already exist in the district hospitals.
• State governments must be financially assisted to undertake this transformation of district hospitals.
• A centrally sponsored scheme aims to set up 157 new medical colleges attached to existing district/referral hospitals in areas that do not have any medical college.
• This will reduce urban-rural disparities in healthcare and also help to scale-up training in the much needed but greatly neglected discipline of family medicine. * Nursing colleges and allied health professional training centres (for paramedical courses) may also be added to district hospitals to create a multi-layered, multi-skilled health workforce.
• The government could perhaps support these students by enrolling them in a BSc (Public Health) programme that can be run by schools of public health and medical colleges.
• They can graduate in three years to commence careers in public health, where their earlier medical education can add value.
• Since the National Health Policy of 2017 calls for Public Health Management cadres to be established in every state, this could initiate a programme for large-scale training of public health professionals.

Way forward

• In any case, the sad state of the students in Ukraine must catalyse reforms in Indian medical education.