Medical Education Governance in India

Sep, 08, 2018

IMA moots ethics code overhaul

Note4students

Mains Paper 4: Ethics | Public/Civil service values and Ethics in Public administration: Status and problems; ethical concerns and dilemmas in government and private institutions; laws, rules, regulations and conscience as sources of ethical guidance.

From UPSC perspective, the following things are important:

Prelims level: Not Much

Mains level: Reforms required in health sector


News

Ethical Studies for Doctors

  1. Can an individual doctor advertise, have a website to promote her practice to compete with aggressively marketed corporate hospitals?
  2. Should the donation of cadaver organs be made mandatory for all?
  3. Is it important for medical students to study ethics throughout the duration of the MBBS course?
  4. Marking a bold departure from the existing code of ethics that covers the medical profession, the IMA is in the process of redefining the code in order to ensure a much more contemporary outlook.

Redefining the Code of Medical Ethics

  1. The current code of medical ethics by the Medical Council of India dates back to 2002.
  2. Much has changed in the medical field since then and many relevant topics do not find a mention in the present code.
  3. IMA would be releasing a handbook on the redefined code of medical ethics.
  4. The handbook would comprise 24 topics that either need to be reviewed or find no mention in the current code.
  5. The code would subsequently be submitted to all the relevant Central Ministries – health, medical education, law and justice and the MCI – for consideration.

(A) For Advertisement

  1. The current MCI norms do not allow doctors to publicise their practice through any type of advertising.
  2. Big private hospitals are constantly promoting their set ups through advertisements in all mediums.
  3. Hence it is essential for individual doctors, especially those who have just begun practice, survive such competition.
  4. The IMA believes that any publicity material should be ethical and approved after scrutiny by the respective State medical councils.

(B) For Doctor-assisted Suicide

  1. Presently doctors cannot give consent for deciding on pulling the plug.
  2. This decision can only be taken by relatives.

(C) For ARTs

  1. Ethical issues around Assisted Reproductive Technology and surrogacy also find a mention in the handbook.
  2. The IMA states that doctors should ethically ensure that surrogates and egg donors are not exploited.

(D) For Organ Donation and Transplants

  1. The IMA also recommends that cadaver organ donations (from brain dead people) must be made compulsory for all unless an individual specifically states that he or she does not want to become an organ donor.
  2. Cadaver organ donations are currently carried out in India only when an individual has explicitly expressed a wish to donate or with the consent of immediate relatives in cases of brain death, creating a shortage of cadaver organs for transplants.
  3. India carries out a high number of living donor transplants as compared to cadaver organ donations.
  4. Presently we have a long waiting list of patients for organ transplants.
Mar, 30, 2018

[op-ed snap] Is NEXT the panacea for medical education woes?

Note4students

Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources

From UPSC perspective, the following things are important:

Prelims level: Medical Council of India, National Medical Commission (NMC), National Exit Test (NEXT)

Mains level: Medical education system in India and related issues


Context

National Exit Test for medical students

  1. Union cabinet intends to replace the Medical Council of India with the National Medical Commission (NMC)
  2. It is also proposed  to have National Licentiate Examination (NLE), now approved to be amended to a National Exit Test (NEXT)
  3. It is aimed at ensuring a minimum quality standard for the MBBS (bachelor of medicine, bachelor of surgery) graduates

Basic design flaws in the process

  1. How will such an exam, currently only testing students for theory and practical (including bedside) knowledge in final year MBBS subjects, be standardized across the country remains unknown
  2. Earlier reports have suggested that the NEXT is to become another MCQ (multiple choice questions)-based test, an often used model for standardized tests across the country
  3. It would not test any higher order of learning or clinical skills and is thus unwarranted

Global models that can be used

  1. The United States Medical Licensure Examination (USMLE), which came into effect from 1992, has become more clinically applied over the years
  2. The proposed United Kingdom Medical Licensing Assessment (UKMLA) aims to ensure that the graduate “has the skills and competence to practice”, and has been structured to be implemented over many years in order to come out with a well-designed test

What should an MBBS exam do

  1. An MBBS licensing exam should not just test the medical theoretical knowledge component
  2. It has to test skills and should have both written and clinical components
  3. It should evaluate soft skills required to practice as an empathetic medical professional
  4. While an entrance test is aimed at selecting from a pool of applicants, a licentiate and exit exam serves to assess the knowledge, skill, and attitude of each qualifying MBBS doctor

Way forward

  1. With the idea of NEXT, a window of opportunity has opened to rectify ills in medical education
  2. A well-conducted NEXT would help a patient repose confidence in the competence of his/her treating doctor
  3. It should not be frittered away by reducing it to just another imperfectly designed and hurriedly implemented exam garbed in the cloak of medical education reform
Dec, 16, 2017

Cabinet clears Bill to replace Medical Council of India

Note4students

Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources

From UPSC perspective, the following things are important:

Prelims level: National Medical Commission Bill, Medical Council of India (MCI)

Mains level: Corruption and unethical practices in medical sector


News

National Medical Commission Bill now needs Parliament approval

  1. The Union Cabinet has cleared the National Medical Commission Bill, which does away with the Medical Council of India (MCI)
  2. The bill replaces MCI with a regulator that will do away with “heavy-handed regulatory control” over medical institutions
  3. It will also bring in a national licentiate examination

Key provisions of the bill

  1. Ease the processes for colleges to manage undergraduate and postgraduate courses
  2. Earlier, the MCI approval was needed for establishing, renewing, recognizing and increasing seats in a UG course
  3. Under the new proposal, permissions need only be sought for establishment and recognition
  4. The Bill proposes a government-nominated chairman and members, who will be selected by a committee under the Cabinet Secretary
  5. The 25-member NMC will have 12 ex-officio members, including four presidents of boards from leading medical institutions such as AIIMS and the ICMR; 11 part-time members and, a chairman and member-secretary

NMC to be less draconian

  1. Deterrence for non-compliance with maintenance of standards is in terms of monetary penalty
  2. The new commission will also have the power to frame guidelines for fees for up to 40% seats in private colleges and deemed universities

Why this bill?

  1. The Bill is aimed at bringing reforms in the medical education sector which has been under scrutiny for corruption and unethical practices
Oct, 25, 2017

Medical panel Bill finalised, sent to Cabinet

Note4students

Mains Paper 2: Issues relating to development and management of Social Sector/Services relating to Health.

The following things are important from UPSC perspective:

Prelims: MCI, New Medical Commission Bill.

Mains: This article talks about the New Medical Commission Bill and the need for it.

 


News

  • A Bill that will bring to an end the current system of regulation of medical education through the Medical Council of India (MCI) has been finalised and sent to the Cabinet.
  • The Bill has already been cleared by a Group of Ministers, so it is unlikely to face major problems in clearing the Cabinet.

About New Medical Commission Bill

  1. The National Medical Commission Bill envisages a four-tier structure for the regulation of medical education, with a 20-member National Medical Commission (NMC) at the top.
  2. The commission will perform overall supervision over four autonomous boards that will deal with undergraduate and post-graduate education, assessment and rating of medical institutions and registration of medical practitioners and enforcement of medical ethics.
  3. There will also be a Medical Advisory Council, constituted by the central government, like the commission and the boards.
  4. The council, which will be advisory in nature, will meet at least once a year.
  5. It will serve as the primary platform through which states will put forward their views and concerns before the NMC and help shape the overall agenda in the field of medical education and training.

Why such a bill?

  1. As a concept, the NMC has been in the making for years, given the perception of corruption in the MCI and recommendations from many committees including the Ranjit Roychowdury Committee and Parliamentary Standing Committee for Health and Family Welfare.
  2. The standing committee said that the main objective of the regulator of medical education and practice in India is to regulate quality of medical education, tailor medical education to the healthcare needs of the country, ensure adherence to quality standards by medical colleges, produce competent doctors possessing requisite skills and values as required by our health system and regulate medical practice in accordance with the professional code of ethics.
  3. However, the Medical Council of India was repeatedly found short of fulfilling its mandated responsibilities.
  4. It was the Niti Aayog that pushed for a change in the appeal structure.

The draft sent to the Cabinet incorporates two significant changes from what the Health Ministry had proposed:

  1. Only five members of the NMC will be elected while the others will be nominated by the government and the government will be the second appellate authority in case disputes arise.
  2. The first change was made after the PMO sought a reduction in the number of elected members.
  3. It would ensure that the government has more leverage and prevent the system from descending into the present state where the MCI and government are often at loggerheads on many issues.
  4. There are also ex-officio members in the commission that include nominees from the Ministry of Health, Department of Pharmaceuticals, Human Resource Development and Director General of Health Services.
  5. The real challenge for the government will be in pushing it through in Parliament, where medical education has always been a touchy subject across party lines.

 


Back2basics

About MCI

  1. The MCI was established in 1934 under the Indian Medical Council Act, 1933as an elected bodyfor maintaining the medical register and providing ethical oversight, with no specific role in medical education.
  2. The Amendment of 1956, however, mandated the MCI to maintain uniform standards of medical education, both under graduate and postgraduate; recommend for recognition/de-recognition of medical qualifications of medical institutions of India or foreign countries; accord permanent registration/provisional registration of doctors with recognised medical qualifications; and ensure reciprocity with foreign countries in the matter of mutual recognition of medical qualifications.
  3. The second amendment came in 1993,under this amendment, the role of the MCI was reduced to an advisory body with the three critical functions of sanctioning medical colleges, approving the student intake, and approving any expansion of the intake capacity requiring prior approval of the Ministry of Health and Family Welfare.
Sep, 23, 2017

[op-ed snap] Heal thyself

Image result for Medical Council of India (MCI)

Image source

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Medical Council of India (MCI)

Mains level: MCI- problems; National Medical Commission Bill of 2016- provisions, challenges etc


News

Context

  1. Medical education scams continue unabated under the MCI’s stewardship. But merely replacing it is not the solution

  2. The regulator of medical education is itself in need of regulation

Medical Council of India (MCI)-Issues

  1. Volume of litigation that the MCI faces suggest that the regulator is neither in command nor perceived to be so
  2. It has imposed a uniform benchmark for admissions at the undergraduate and postgraduate levels
    • But different syllabi and diverse languages in different states tilt the level playing field.
  3. While the MCI is standardising entrance tests, it is failing to assure uniform, quality education for entrants who qualify.
  4. As an implication, the promise that India holds as a destination for medical tourism and education stands compromised.

National Medical Commission Bill of 2016

  • It proposes to trifurcate the functions of the MCI to reducer corruption, may prove to be superficial

Why?

  1. It would eventually leave the monopoly in accreditation intact, and opaqueness would remain a problem
  2. Intersection of private enterprise and medical education and practice is laden with incentives for corruption.
  3. Marketing of pharmaceuticals and equipment exert unhealthy influences
  4. Inspection of teaching hospitals is a scandal, with doctors and even patients being “rented” for the day.
  5. The scarcity of seats and their marked-up price tag is also a reason for corruption

Way forward

  1. Merely replacing the MCI will not suffice. Its successor must be armed with rules-based transparency to prevent rent-seeking.
  2. Examination reform could have followed

Back2basics

National Medical Commission Bill, 2016 

Salient Provisions

The bill seeks to address the following:

  1. Ensure adequate supply of high quality medical professionals at both undergraduate and postgraduate levels.
  2. Encourage medical professionals to incorporate the latest medical research in their work and to contribute to such research.
  3. Provide for objective periodic assessments of medical institutions.
  4. Facilitate the maintenance of a medical register for India and enforce high ethical standards in all aspects of medical services.
  5. Ensure that the medical institutes are flexible enough to adapt to the changing needs of a transforming nation.

Medical advisory council

The bill seeks to constitute a Medical Advisory Council which will undertake the following functions:

  1. The Council shall serve as the primary platform through which the states would put forward their views and concerns before the National Medical Commission (NMC) and shall help shape the overall agenda in the field of medical education & training.
  2. The Council shall advise the NMC on the measures to determine, maintain and coordinate the minimum standards in the discipline of medical education, training and research.
  3. The Council shall advise the NMC on measures to enhance equitable access to medical education
Nov, 15, 2016

Making medical education a public good II

  1. These factors are reportedly compelling the U.S. to revert to making higher education a public good
  2. The NITI Aayog recommendations for reforming medical education need to be viewed in this backdrop
  3. The 3-point recommendation — allowing private investors to establish medical colleges, freedom to levy fees for 60% of the students
  4. And making the exit examination the marker for quality and for crowding out substandard institutions — is expected to trigger healthy competition, reduce prices and assure quality
  5. This policy response could make the situation worse
Nov, 15, 2016

Making medical education a public good I

  1. Issue: Commercialising medical education
  2. Benefits: Incentivise investors to set up medical colleges, increase the supply of doctors, induce competition and reduce the cost of tuition fees and services
  3. Same approach in the US resulted in the entry of banks, hedge funds, private equity, venture capital, for establishing colleges
  4. This has resulted in increase in student debt, post 2002, student debt has climbed to $1.2 trillion
  5. In 2009, a review showed that in the 30 leading for-profit universities, 17% of their budget was spent on instruction
  6. But 42% on marketing, and paying out existing investors
Sep, 09, 2016

States approve proposal to replace Medical Council of India- II

  1. Representation: States have asked for more representation in the commission
  2. Consultative committee: It will be formed separately, whose function will be to advise the commission
  3. Background: In March 2016, a Parliamentary Standing Committee report had called for radical reform of the MCI
  4. It said that MCI neither represents professional excellence nor its ethos and that its composition is opaque
Sep, 09, 2016

States approve proposal to replace Medical Council of India- I

  1. Context: Question mark on ethical and professional competence of MCI
  2. Proposal: MCI to be replaced by National Medical Commission
  3. It was formulated by NITI Aayog
  4. Recommendations by states: Instead of just one chairman of the new regulatory body, there should be some members also
Aug, 02, 2016

Parliament passes bills assigning constitutional status to NEET

  1. Aim: To bring private colleges under the ambit of the Indian Medical Council (Amendment) Bill and Dentist (Amendment) Bill
  2. The bill aims to end the multiplicity of medical examinations and pave the way for fair and transparent examinations
  3. Concerns: Regional Language inclusion, disparity in fee structure and state quotas still need to be figured out
Jul, 20, 2016

Lok Sabha nods for NEET

  1. News: The Lok Sabha passed a bill awarding statutory status to the controversial National Eligibility cum Entrance Test (NEET) from the next academic session
  2. Aim: NEET aims to ensure a uniform medical and dental entrance exam
  3. The bills: The Indian Medical Council (Amendment) Bill, 2016 and The Dentists (Amendment) Bill, 2016 will amend the Indian Medical Council Act, 1956 and the Dentists Act, 1948
  4. Objectives: To end the multiplicity of examinations, have fair and transparent examinations and adopt non-exploitative process
  5. The new system will not disturb the State quotas – all India quota of 15% and State quota of 85% seats will remain
Apr, 02, 2016

British Medical Journal calls for radical revamp of MCI

  1. News: The British Medical Journal has called for a ‘radical prescription’ to reform the Medical Council of India (MCI)
  2. Background: The parliamentary panel has highlighted the MCI’s failure to oversee quality and integrity in health services in the country
  3. Purpose: To eliminate corruption and lack of ethics in healthcare
  4. Challenge: The citizens of India are strained by the dual burden of expensive and unethical healthcare
  • Subscribe

    Do not miss important study material