Subject: Governance

The MCI has been in the news for the wrong reasons as the Parliamentary Standing Committee on Health in its 92nd report came down heavily on various aspects of the functioning of MCI. British medical Journal also had suggested radical revamp of the MCI. This articles focuses on the medical education governance in India.

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Let’s understand the issues under the following heads:

• Context
• Background
• Weaknesses Highlighted by Parliamentary panel
• What are the major reforms needed in MCI?
• Measures needed to overhaul and revamp MCI
• Mandate of Lodha committee
• Way forward

Context:

• MCI has been criticised for being a ‘biased’ organisation, acting ‘against larger public health goals’ and an ‘exclusive club’ of medical doctors from corporate hospitals and private practice. The British Medical Journal (BMJ) and the Parliamentary Standing Committee in their recent report have called for a ‘radical prescription’ to reform the Medical Council of India (MCI) in order to eliminate corruption and lack of ethics in healthcare.
• SC appointed a three-member committee headed by former Chief Justice of India R M Lodha to oversee MCI.

Background

• The MCI was established under the Indian Medical Council Act 1933 and given responsibility for maintaining standards of medical education, providing ethical oversight, maintaining the medical register, and, through amendments in 1993, sanctioning medical colleges has failed to deliver quality and integrity in the health services across India.
• The Medical Council of India (MCI) is a statutory body entrusted with the responsibility of establishing and maintaining high standards of medical education in India.

Weaknesses Highlighted by Parliamentary panel

In its scathing report, the standing committee felt that the MCI has repeatedly failed on all its mandates over the years. The committee noted the following as some of the prominent failures of MCI.

• Failure to create a curriculum that produces doctors suited to working in Indian context especially in the rural health services and poor urban areas. The committee felt that this has created disconnect between medical education system and health system.
• Failure to maintain uniform standards of medical education, both at the undergraduate and post-graduate levels.
• Devaluation of merit in admission, particularly in private medical institutions due to prevalence of capitation fees, which make medical education available only to the rich and not necessarily to the most deserving.
• Non-involvement of the MCI in any standardized summative evaluation of the medical graduates and post-graduates.
• Failure to put in place a robust quality assurance mechanism.
• Very little oversight of PG medical education leading to huge variation in standards.
• Failure to create a transparent system of medical college inspections and grant of recognition or de-recognition.
• Failure to oversee and guide the Continuing Medical Education in the country, leaving this important task in the hands of the commercial private industry.
• Failure to instill respect for a professional code of ethics in the medical professionals and take disciplinary action against doctors found violating the code of Ethics.

What are the major reforms needed in MCI?

1. There is a need to restructure the MCI. It should not be an elected body dominated by vested interest but should represent all stakeholders through nomination. The MCI, as presently elected, neither represents professional excellence nor its ethos. The current composition of the Council reflects that more than half of the members are either from 21 corporate hospitals or in private practice.
2. The MCI currently sets standards for recognition, inspects and licenses medical colleges; overseas Registration and Ethical Conduct of Doctors. It now proposes to undertake accreditation as well. Such concentration of powers creates a serious conflict of interest and provides a fertile ground for misuse of authority. So there is a need to create a transparent system of licensing of medical colleges.
3. There should be bifurcation of the functions of MCI and recommends that different structures be created for discharging different functions.
4. There is a need to revisit ICT tools and revisit minimum standards which are required under the act to establish medical colleges.
5. A code of ethics which is in line with the international standards needs to be developed for the medical professionals to reduce the corrupt practices.
6. It needs to see a balance between the number of seats available for medical courses at undergraduate and postgraduate level.

Measures needed to overhaul and revamp MCI

1. The Parliamentary committee made a number of recommendations to overhaul the system. Some of the important recommendations of the committee are the following,
2. Doctor – Population ratio in India is 1:1674 as against the WHO norm of 1:1000, hence the government should immediately spell out policy stance in great detail to augment the capacity of production of doctors including specialists and super-specialists at the scale and speed required to meet India’s health needs.
3. The regulatory framework of medical education and practice should be comprised of professionals of the highest standards of repute and integrity, appointed through a rigorous and independent selection process.
4. Urgent measures have to be taken to restructure the composition of MCI to encourage diversity so that it does not become an exclusive club of doctors.
5. Physical infrastructure requirement should be pruned down in such a way that it should have just about 30 to 40 percent standing value in the total assessment of a medical college.
6. Support to convert district hospitals into medical colleges. If a district hospital is converted into a medical college, it will not only be equipped with specialists of all disciplines, providing the healthcare services across the whole spectrum but will also produce some doctors in its area of operation and will thus help reduce geographical mal-distribution of doctors.
7. The PG entrance exam should be held immediately after the final MBBS examination so that the graduate doctor could concentrate on practical skills during his internship.
8. Ethics should be made one of the cornerstones of the syllabus of medical education.
9. Introduction of Common Medical Entrance Test (CMET) should be done across the nation barring those States who wish to remain outside the ambit of the CMET. A common exit test should be introduced for MBBS doctors.

Mandate of the Lodha committee

1. Lodha Committee would have complete authority to oversee all statutory functions under the MCI Act.
2. All policy decisions of the MCI will need approvals from the Committee. It will also be free to issue remedial directions.
3. The Committee will function for 1 year, unless a suitable mechanism is brought in earlier by it.
4. Initially the panel will function for a year, unless suitable mechanism is brought in place earlier which will substitute the said committee.

Way forward

• The abysmal doctor-patient ratios in India’s rural areas and poorer districts, the sanctioning of new medical colleges without ensuring trained medical faculty, the failure to produce adequate specialist doctors, and corruption in the conduct of inspections and in granting sanctions to medical colleges have wrecked the MCI’s credibility.So, there is a need to bring back the integrity which MCI has lost over the years.
• Whether Lodha Committee manages to inculcate the changes needed in MCI or ends up being one of the numerous other attempts at cleaning up the medical education scene remains to be seen.

References:

• Business Standard
• Indian Express
• Financial Express