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KERALA SURGICAL JOURNAL

Official Publicaiton of The Association of Surgeons of India, Kerala Chapter

Conundrum of MBBS Admissions

Authors

Dr. YM Fazil Marickar
Principal, Mount Zion Medical College, Adoor.

Preamble

Year after year, medical admissions in Kerala are becoming murkier and murkier, thanks to the inefficiency, corruption and lack of vision among all the parties involved. The problem can be solved very easily. The Hon. Supreme Court or the Central Government should issue orders accordingly.

The Problems

Several problems in UG and PG admissions have been created in the recent past.

  1. Medical Council of India is expected to ensure the effectiveness and competence of institutions all over the country to conduct the MBBS course. For this purpose, the Council is conducting inspections every year. However, the norms of the Medical Council are outrageous and completely out of perspective in the light of realities. Several ambiguities exist in the rules and regulations regarding the minimum standard requirements for creating Medical Colleges.
  2. The post of Junior Resident is meant for post graduate students after getting admission to a post graduate degree course in a Medical College. There is no place for such post in an institution, where there is no post graduate course running. They should be named as Tutors.
  3. Senior Resident is the name of the trainee who gets admitted for post-doctoral courses namely MCh and DM. There is no point in giving designation for posts as senior resident in an institution, where the post-doctoral degree courses do not exist. They should be designated as assistant professors.
  4. Eligibility for appointment as Assistant Professor is pass in the post graduate examination, whereas the requirement for the post of Senior Resident is completing 3 years of training as Junior Resident. In realistic terms, the difference between a qualification for Assistant Professor and Senior Resident is just a pass in the post graduate examination. It is really unscientific to apply such posts to new Medical Colleges, which are not granted permission to conduct the post graduate - MS, MD courses or the post-doctoral DM, MCh courses.
  5. The solution is to abolish the post of Senior Resident and rename the Junior Resident post as tutors. The requirement of Assistant Professors can be increased to fill the number of Senior Residents posts also.
  6. Unrealistic numbers of Faculty. In a new institution starting an MBBS course, the super speciality departments like Urology, Plastic Surgery, Thoracic Surgery, Neurosurgery, Paediatric Surgery, Gastro-enterology Surgery, Nephrology, Cardiology, Gastro-enterology and Neurology are not required. However in the present day, in the urban and semi-urban areas, a Medical College, which is supposed to be a tertiary hospital is expected to have most of these super speciality departments as well. In the absence of super speciality departments, the number of patients with different illnesses will be very low. Under the circumstances, it is not possible for the budding Medical Colleges, without the speciality and super speciality degree courses to have sufficient number of patients as required by the MCI.

    The quality of patients is another controversial aspect. The question of which patient with what diagnosis is to be admitted depends on the geographical location, as the types of diseases vary from place to place. In many western countries, the non-availability of actual patients has instigated medical teaching based on dummy (standardized) patients, where normal people are trained to present with various complaints of a particular disease and brought in as subjects to present to the student as suffering from that particular disease at the time of examinations and clinical classes. These subjects with the knowledge of the disease give more insight to the topic to the students, who are studying for this course and appearing for the examination. Scientific teaching of modern medicine depends more on the approach towards diagnosis and treatment rather than the number of patients with a particular diagnosis. With the enforcement of skill labs and newer technologies in teaching, it is possible to reduce the minimum requirement of number of patients in the new Medical Colleges. Experience shows that with the progress of the medical institutions, most to the Medical Colleges become high profile full-fledged hospitals as time passes by and post graduate courses and super speciality courses are started and the number of patients automatically increases. Thus, it is not the number of patients and type of disease that matter in the training of the medical student, but proper professional training of the students and giving information on what diseases are likely to come in the local situations.
  7. The Medical Council of India has been uncertain with the numbers of Faculty members in the colleges starting the MBBS course. From the 1st July 2015, the number of Faculty members in various pre and para-clinical departments has been reduced unscientifically, whereas the number of faculty in various clinical departments still is more than the minimum requirement.
  8. The MCI inspection is a farce. On one fine morning, three people walk into the Principal’s room at 10.45 am and claim they are assessors from Medical Council of India coming for a surprise inspection. They tell the Principal that all the faculty members should come to the Principal’s office within 15 minutes and sign the attendance register before 11.00 am. (They don’t even care to show the authority letter from the Medical Council to convince the Principal that they are genuine assessors of the Council. Out of dignity and consideration for the said inspectors, the Dean does not demand any papers from them.) Any faculty member who did not sign the attendance register before 11.00 am is not counted for the faculty positions. The fact that one of the days of the inspection happens to be local holiday declared by the Government does not matter to the assessors. The rule of the Medical Council says that the inspection should not be conducted on a public holiday of national or local level. When this situation is brought to the notice of the assessors, they say that they had to just follow their rules and that they should be continuing with the assessment.

    During the initial talk with the co-ordinator, one of the assessors disappears. After a few minutes, the assessor is traced to a ward and the Principal goes and greets him in the ward. The assessor confronts the Principal by asking the demeaning questions like “why are you here?, did I invite you?” and derogating statements like “you are not wanted here”. It may be pointed out that the Principal or Dean has got the right to visit any place of the hospital and no assessor can restrain the Principal from reaching any part of the hospital.
  9. One assessor walks into the operating theatre without changing to theatre dress to take count of the number of surgeon working inside! The assessors would not consider faculty members working in other theatres in casualty and minor theatres where surgeons were working. Rejection of such faculty create discomfiture to the institutions.
  10. The rule stating that the inspectors can come at any time till 11’0’ clock and insist for an attendance register at 11’0’ clock is totally unscientific. In certain institutions, at certain times, the inspectors accept Faculty members till the time they leave the College. When the need of the MCI is to reject permission to a College, the inspectors are asked to come in at 10:30 and close the attendance at 11’0’ clock and find out “DEFICIENCIES”. When the College is waiting for first renewal of permission for 2015-2016, the Faculty for the five Para-clinical Departments of Pharmacology, Pathology, Microbiology, Forensic Medicine and Community Medicine are to be shown during the inspections in September 2014 to June 2015. The majority of Faculty members of the above Departments have no work till the II MBBS class starts in November 2015.
  11. Surprise inspection is another farce. There are instances, where the inspections are held several times to suit the convenience of the MCI designs. The first inspection is done in a scientific way and no deficiencies are recognized. Action is not taken on the findings of the inspection for more than a month and at the end of the period on the day, executive committee of Medical Council of India is meeting, a new set of inspectors is sent to the same colleges as surprise inspection and the inspectors are asked to report by the hour to the executive committee members of the Medical Council on the number of patients, the type of patients, the presence of faculty at 11.00’ clock and so on with the only intention of harassing the Colleges. This is simple intimidation of the staff and management of the Medical Colleges.
  12. During such surprise inspections, natural situations like duty off, weekly off and leave for various medical and other considerations are not being considered by the assessors. It is very clear that the assessors are interested only in creating some comments based on which the executive committee can reject the permission for the admission for the next academic year. This approach is very unscientific.
  13. Many of the inspectors who come for the inspection do not know the rules. They are guided by various regulations to suit their own convenience. For example: the minimum standard requirements of Medical Council of India contain ambiguities in the different pages of the book. The various forms to be filled up, namely Form A, Form A1, Form A2, Form A3, B Form and so on are contradictory. The large number of Forms is totally unnecessary and makes it confusing particularly in the light of facts that various aspects of inspection are given differently in the different Forms. All the forms could be made into one and all the aspects required to be filled in the inspection form should be according to the minimum standard requirement scheme given by the Medical Council of India. There are several disparities and errors in the minimum standard requirement and the guidelines issued by the Medical Council of India from time to time.
  14. The arrogance shown by some of the Medical Council inspectors in the days of inspection is deplorable, unacceptable, unscientific and unethical. An inspector from one subject does not appear to be competent of deciding which patent should be admitted in another Department. The genuinity of the patients and the diagnosis of the patients are not to be questioned by the inspectors. This outrageous attitude of some inspectors is responsible for the instigation to the Medical College management to conduct foul play. They cannot be blamed.
  15. For the academic year 2015-2016, over 100 colleges were denied permission by the MCI for renewal. When the file was sent to the Union Government, the Central Government decided that all the Government colleges can be granted renewal of permission for admitting students, whatever be the deficiency. All the private Medical Colleges were left in the dark. The private Medical Colleges were forced to approach the judiciary. Ultimately in the last week of September, many of the private Medical Colleges got permission for renewal of permission for admission. These created unnecessary disturbances and destabilization of the educational pattern of the whole country. All these can be totally avoided if the solutions which are presented in these columns are approved by the Government or the Supreme Court of India and implemented in the country.
  16. The solution to these problems is possible, if regulations are maintained realistic in consultation with the college managements both in the government and private sector and formulate programmes, by which the sanctity of medical education can be retained by proper organization of the courses and with proper review.

The Solutions

  1. All the MBBS admissions in the country should be completed before the 31st of May every year.
  2. Classes for MBBS should start all over the country on the 1st of June every year.
  3. The procedures for granting permission to institutions for admission to the MBBS courses should be completed by the Medical Council, the Central Government, the State Governments and the various Hon. Courts of India before 31st of March every year. No cases should be accepted by the courts after that date.
  4. All the entrance examinations, national and regional approved by the MCI should be completed before the 30th of April every year.
  5. Examinations approved by the MCI shall not be questioned by any authority after 1st of April every year.

Standards of Medical Education

`If only more effort is taken by the Medical Council of India, it will be possible to improve the standards of medical education by incorporating smart classrooms and connecting the various colleges and having unified classes by expert teachers. The students of all the institutions in the country will ultimately benefit.

For example: There are several agencies which conduct post graduate entrance training classes in All India level which students in various parts of country sitting in different lecture halls and attending. Excellent satellite classes are taken by genuine teachers of caliber and simplicity. This sort of lectures can be made official, probably with a fee to be transmitted to various Medical Colleges. If the classes are regulated by electronic online versions, all the courses in the country can be started on a same day and all the examinations can be conducted on the same day and irregularities and disparities in the timing of the courses can be avoided. With the starting of online classes, the websites of the Medical Colleges can be updated with lessons presented by the various teachers and each class can become a module on the subject. Such modules can be incorporated in all the websites for the students to learn the subjects the electronic way.

The modules that are being taught (5330 modules) in a span of 8975 hours in MBBS course have to be equated to the 300 common diseases (diagnosis) which are likely to be seen by the undergraduate student during the period of the MBBS course. By equating modules to diagnosis, the learning process can be simplified and made more realistic in the line of Vertical Integration. Module to diagnosis will also be incorporated as a part of an Electronic Medical Record System, whereby all the medical colleges can be involved in a proper Electronic Medical Records maintenance program. In this set up, all the diagnoses are pre-planned and set by the Doctors concerned in their own way in different combinations and in different grades of disease and all the investigations, laboratory, endoscopic and operative procedures can be incorporated in to the system using the suggested new Electronic Medical Recording Program. The national grid should be created for the maintenance of the teaching materials in servers which can be transmitted to various Medical Colleges for improving medical education. The whole system of the Medical Council has to be redrawn in order to make these implementations effective.

Telemedicine should be incorporated in the teaching process of all the medical colleges so that the clinical pathological conferences, immortality conferences, the CME programs of various Medical Colleges can be clubbed and made available to all the other Medical colleges. This will enhance the opportunity for the students to see what is happening in other parts of the country and also to be aware of the rare diseases which are occurring in various parts of the country. This facility can be extended to international levels also to incorporate teachers of international repute in the teaching of under graduate, post graduate medical institutions in the country.

The scientific content of the post graduate medical entrance examinations is absolutely unscientific. There is no point in asking post graduate level of questions to students who have just completed the MBBS course. The questions should be set in such a way that they are based on an undergraduate level rather than a postgraduate level. Several students are forced to waste years of their precious life’s preparing for entrance examination. Most of the postgraduate knowledge is gained before the admission rather than after the admission. The purpose of selection is to identify the best group of students. There is no need to waste years of a student’s life for the sake of getting admission for the next course. Every year at the end of the MBBS course during before House Surgeoncy starts, the admission process to the post graduate degree courses should be completed. The House Surgeon will be able to perform his work in a way beneficial to himself and the institution.

Epilogue

It is the basic rights of the new generation of young budding medical professionals to get justice in our country. If the pre-nursery classes, the junior school, senior school and all the educational systems of one academic year can start on the 1st of June, why not the medical education also starts on the 1st of June? Precious man days of the budding doctors are lost because of the inefficiencies, irregularities and corruption in the medical education sector in this country. Irregularities lead to corruption and corruption leads to a vicious circle, whereby the ultimate sufferers are the students. If the rules and regulations are clear, there is no scope for corruption and all the admission processes are streamlined, the fees of the Management quota students can also be regulated. Capitation fees can then be controlled. The teaching processes can be unified and streamlined to be completed within the stipulated span of 4 years and 187 days.














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