The Medical Council of India (MCI) plans to conduct a national level entrance examination for admission to the MBBS course. The MCI reasons its action by stating that it wants to improve the standard of Medical Education in India.
There cannot be a second opinion that the standard of Medical education in India is far from satisfactory. There is an urgent need to re-evaluate the standards, content and methodology of medical education in India.
Selecting the best students for training may be one prerequisite to achieve standards. But it remains a small step in achieving quality training. Unfortunately for every other professional education in India the selection process for admission is made to appear as the sole determinant of quality. The infrastructure of the institution, the quality of teachers, the availability of clinical material, the methodology, research potential and uniformity of standards throughout the country does not attract attention and debate. This is unfortunate considering the huge difference in the standards of education in various parts of our country and between institutions within the states.
Our medical education needs to be evaluated with regard to its content and relevance. The MBBS course is called ‘medical education’ in India whereas it is called Medical Training all over the world. There is a sea of difference between the word ‘education’ and ‘training’. The Indian medical education involves studying volumes and volumes of books and getting theoretical knowledge with very less practical training. Like every other education in India, medical education does not help the student to develop practice oriented thinking and clinical management methodologies. Students trained in the UK or US are better equipped to face a patient in a clinic or emergency room even if they may not have read so many books like their Indian counterparts.
The textbooks from United Kingdom are meant for medical trainees in the UK. The situations are presented as if it were in a UK hospital. The American medical books present the American hospital environment and the American patients. For example the management of trauma care is presented in American textbooks with the American ambulance service and emergency room scenario in the mind. That is not the situation in our country. Western textbooks give more importance to metabolic diseases and congenital diseases which constitute a major disease burden in their countries. Our students read the British and American medical textbooks. This may be one reason why they all want to go to Britain and America!
They are not trained to go to an Indian village and see a patient in a Primary Health Center. They do not read that much about malaria and skin infections which are so common in our country. They neither have books which give them exhaustive knowledge about the Indian clinical scenario nor get the proper training for Indian clinical practice. We need more research on Indian epidemiology and teaching materials based on that.
We hear people talking about training our graduates to ‘international standards’. They insist that our professionals should be able to go to any country in the world and survive. The percentage of Indian medical graduates going abroad will be less than one percent. Should we be designing our medical curriculum to help these less than 1% to achieve their personal goals? No country in the world should plan its education programs to train their students to go abroad. We need doctors to serve our citizens. We want large numbers of doctors to serve in rural India. It is insane to talk about ‘international standards’ when what we need is a true ‘Indian standard’.
Another big handicap for the Indian student is that he has to learn medicine in a foreign language. The best way to learn science or Medicine is to learn in one’s mother tongue. That will make the learning process interesting and help to develop research thinking. Every European, whether German, Spanish, French or Russian studies Medicine in their mother tongue. China, Japan and even a small country like Thailand provide medical education in their mother tongue. It is a possibility. It is practical. The only opposition would be that our students cannot go abroad and work. That is a lame excuse. First of all let the medical graduates not go to abroad at all, leaving our country. If they want to go to another country speaking a different language for training they have to do exactly what the Chinese, the Japanese and the Russians are doing. Graduates of these countries if they wish to go abroad they have to learn English, German or French or whatever language through a short course. Our students also should do that. Our students may study English as second language in school. We may even add English language teaching in the Medical curriculum as an option. So there cannot be any excuses for not teaching Medicine in their respective mother tongues in all the states.
When so much needs to be done to improve the standard of Medical training in India projecting common entrance examination for entering Medical education as the panacea for all this issues will be counterproductive.
The selection of candidates to the MBBS course is an important step in improving the standard of education. The selection process needs to be regularized. The private medical institutions and the so-called ‘deemed to be universities’ have a free run in the selection. A student who has failed in the matriculation examination and passed in the second attempt can also purchase a seat in these institutions. Most of the students entering some of these institutions have secured more than ten marks less than the lowest mark of a student entering the government institution in reserved category. There is no barrier of minimum marks for entering many of the private institutions. There is no competitive test for admission. The only criterion is money. The seats are sold in open auction. This is of grave concern when you talk about maintaining the standard of medical education. We need to regularize the selection process, admission modalities and fee structure of the private institutions to achieve standards. The MCI appears to be not bothered about these issues for unknown reasons.
The Tamil Nadu experience has clearly shown the harms of the entrance examinations. Abolition of entrance examination has increased the percentage of rural students entering professional courses from 28% to 64%. Reintroduction of entrance examination will reverse this and harm the rural students. School education is already a big business. Abolition of entrance examination helped not only the rural students and also students from government high schools to enter professional colleges. If CET is introduced the private schools offering training for entrance examination along with the regular curriculum will make merry by improving their business. The training centres for entrance examination will flourish in cities and the rich and urban students will get undue advantage. The rural students will be marginalized.
The reason why the IITs, National Law Schools and Central Government Medical institutions remain the den of the students from metropolitan cities is that the entrance examination to all these institutions are based on CBSE syllabus. Again looking at Tamil Nadu experience, one can see that out of the six and a quarter lakh students studying twelfth standard about five lakh are state syllabus students, about one and a half lakh are from matriculation syllabus. Only six thousand and odd students study CBSE syllabus. The CET will obviously be based on the CBSE syllabus which is more voluminous than other syllabuses. This will benefit a microscopic minority and exclude large numbers of poor and the deprived from the rural side.
Entrance examination is perceived as an evil in Tamil Nadu. Dr. Ramadoss who waged a tireless war against entrance examination for over a decade finally convinced the state government to abolish the entrance examination. This was a huge step in empowering the rural students. Reintroduction of entrance examination will destroy these benefits to rural students. The MCI should abandon its efforts for CET and work for improving the standard of medical training.
Academicians, politicians and courts in India view entrance examinations as the most important single interventions to achieve quality examination. the truth is contrary. This article scientifically disproves the belief of Indian academicia.