New Delhi: A Group of Ministers (GoM) on health headed by AYUSH Minister Shripad Yesso Naik has suggested reducing the MBBS course from 5.5 years (including internship of one year) to 4.5 years to streamline it “with the changing circumstances”, ThePrint has learnt.
It recommended three models to bring down the duration of the MBBS course. Besides, it suggested a two-year mandatory rural posting of doctors before awarding them MBBS degrees to increase availability of doctors in rural areas.
The recommendations are part of a report, accessed by ThePrint, submitted to the government in October by the GoM comprising Union ministers Jitendra Singh, Ashwini Kumar Choubey, Rattan Lal Kataria and Debasree Chaudhuri.
The report, titled ‘Converting Adversity into Opportunity to Strengthen Healthcare Infrastructure in post-Covid19 India’, pointed out: “The current Covid-19 crisis has given an opportunity to have a complete overhaul of the policy imperatives in the health sector in the long run.
“The government-funded health insurance system alone may not be sufficient to have a lasting solution to bring efficiency, transparency and effectiveness, especially in the primary healthcare scenario.”
The report recommended a slew of measures to improve healthcare in India.
The GoM stressed on the fact that there is a need to reduce the duration of the MBBS course and focus should be on qualitative skilling rather than “quantitative knowledge gathering”.
“There is no doubt that the curriculum of MBBS needs to be revised to reflect the changing disease burden of the country and the ground realities. There is a tendency to overburden the students with content information, which may or may not be relevant for her future endeavours. Practical clinical skills are not given enough importance in the assessment of a medico. Therefore, the focus needs to shift from quantitative knowledge gathering to qualitative skilling,” the report stated.
The three models
The report said the length of the MBBS programme has already been reduced to 50 months (excluding internship) from 54 months by the Medical Council of India (MCI).
“As such, the programme is already near the desired duration of 4 years. Three models can be suggested for reducing the MBBS duration and/or restructuring the MBBS and PG programmes to streamline it with the changing circumstances and make trained medical human resource available for public service early,” stated the report.
The current MBBS programme is for 4.5 years, excluding a one-year internship.
Under model one, recommended by the GoM, it has been suggested reducing the MBBS duration from 5.5 years to 4.5 years by reducing the course work to 4 years and internship to 6 months.
“The first year may include teachings in basic sciences and health courses involving anatomy, physiology and biochemistry. The next one-and-half year, the students may be exposed to broader specialties like medicine, surgery, pediatrics and anesthesiology. And during the last one-and-half year, they may be exclusively posted to the pre-assigned specialties like OBG, surgery, pediatrics, internal medicine or other required specialties,” it said.
The MCI had last year reduced the 54-month MBBS (Bachelor of Medicine and Surgery) course to 50 months.
The second model of the GoM suggested reducing MBBS duration to 4 years by following model one without the internship, and offer allotment of speciality and superspeciality PG courses of 2 years at the end of final year based on one common exit exam — NEXT (National Exit Exam as already proposed by the government).
“The students, without wasting any time on completion of the bachelor course, can join the speciality course depending upon choice and merit in the common exit exam. This option may be limited to meritorious students only, who pass the exit exam with a high score, the others passing out as normal physicians,” it said.
Under the third model, the GoM suggested to provide an integrated 6-year MD/MS programme with electives being chosen in the fourth year of MBBS.
“This is a variation of model 2, wherein the initial entrance exam itself may be made a basis for entry to the 6 years course (4 years MBBS and 2 years PG). An integrated programme would provide not just doctors but specialists with adequate clinical experience acquired over 6 years. In this model also, there would not be an internship,” it said.
The report added that a calibrated approach to find a right mix of specific disease knowledge and common problems of the society needs to be found and incorporated in the curriculum.
“Innovation, entrepreneurship and skill development are the need of the hour for ushering medical education reforms. The curriculum should be need-based rather than conservative and outdated. Medical institutions today are not having a uniform curriculum and teaching methodology,” it said.
The group has also recommended a two-year mandatory rural posting of doctors before awarding them MBBS degrees.
“There is a shortage of medical officers in rural areas for obvious reasons. Most of the physicians prefer staying in cities because the villages lack facilities like good accommodation, schooling for kids and other recreational activities. The existing rules also do not provide for mandatory rural service after completing medical education.”
“There is a tendency among the professionals doing UG and PG from government institutions to switch to private professions on completion of the course for higher earnings through practice in cities,” it pointed out.
To tackle this problem, the group suggested that MBBS or integrated MD/MS pass-outs must undergo a mandatory two-year rural posting before being considered for registration as a medical practitioner, whether in the government or the private sector.
“To make this mandatory posting less harsh for the graduates, the one-year internship period can be combined with an additional one-year rural posting for meeting the above criteria,” the report stated.
It further said the accommodation and other basic requirements of medical officers posted in rural areas should be taken care of to retain them.
“Alternatively, a hardship allowance should be given to cover for these deficiencies for rural posting. To encourage doctors to serve in rural/remote areas, states should be provided the flexibility to incentivise through extra credits to doctors with an experience of serving in rural areas during admission for PG courses.”
The GoM also has pointed out that the “prejudice of AYUSH being a non-scientific field can be overcome by integrating it in the MBBS curriculum”.