Inspection of medical colleges to become history soon

The annual inspection of India’s medical colleges would be done away with the formation of the National Medical Commission (NMC), Union Minister for Health and Family Welfare Harsh Vardhan announced at a press meet on October 4, 2019.

Ever since it was established in 1933, the Medical Council of India (MCI), which is the regulator of medical education in the country, has been conducting inspections of colleges across India, assessing them on various parameters.

These include adequate availability of faculty, availability of books in the library, availability of surgical theatres, proper surface area of lecture theatres and labs, and other infra of medical colleges besides adequate attendance of patients in hospitals attached with medical colleges. 

Even if a college applied for increment in the number of existing seats, it had to go through such inspections.

Now though, these parameters will no more form the basis of assessment.

“We believe that instead of such physical infrastructure, the performance of students passing out from that college is a better parameter,” Vardhan said.

Now, the colleges will be assessed on the basis of how their students score in the National Exit Examination (NEXT). The better the students of a particular college do, the better ranking it will get.

When a new medical college opens, it will have to self-certify that it is conforming to the standards laid down by the NMC. If the NMC receives a complaint that the college is not conforming to the standards as promised in the self-certification, the regulator will do an inspection, Vardhan said. 

It may be mentioned here that NMC envisages the formation of Medical Assessment and Rating Board (MARB), which will do such inspections as and when required. However, the MARB board itself would not do such an inspection and instead get it done from a third party, the NMC Act states. 

The fact that annual assessments would be a history is probably the only important thing that the ministry has decided. Otherwise, all other important aspects and their details have been left to the NMC, which the Act says, should come into existence within three years of it getting Presidential assent.

The National Medical Commission Bill, 2019, was passed by the Lok Sabha on July 30, 2019, and the Rajya Sabha on August 8, 2019. It became law after getting Presidential assent on August 9.

The day NMC will come into existence, it will replace the MCI. Currently, the rules of the NMC Act are being formed and advertisements have been invited by the health ministry for several posts of the new regulator.

On Community Health Providers

A major bone of contention is the concept of Community Health Providers (CHPs) as envisaged in the Act. The Act says that they would have ‘limited license’ to practice ‘prevention and primary healthcare’.

Vardhan minister reiterated that they would be somebody from the medical profession and could include paramedical staff. 

On being asked as to what would be their minimum eligibility criteria, Arun Singhal, additional secretary at the health ministry, who was also present at the conference, said, “Let the NMC decide it. If it wants that a special course of certain duration is needed after they have completed their paramedical courses, we would be okay. If they say, it is not required, we would be okay with that too.”

Asked what exactly ‘limited licensing’ meant, he said, “It means their limitations to practice. It may mean a CHP could prescribe medicines only for common ailments and certain drugs. And, they could do so only at the level of the primary healthcare. These limitations would be also given shape by the NMC.”

He said the whole idea came about since many doctors are reluctant to go to rural areas. In their place, CHPs can be sent who can treat common ailments which do not require any sort of specialisation.

No cap on fees

Regarding fee fixation of private medical colleges, Vardhan reiterated that NMC would only ‘frame guidelines’ and will not fix an upper cap for the 50 per cent of the total seats in all the medical colleges.

Presently, According to a Supreme Court direction, every state has a fee fixation committee which fixes the upper limit. “That committee fixes fee only of what is given for academic purposes. It has no control over other charges that a college levies. However, the guidelines would take into ambit all of them,” Vardhan said.

These guidelines will not be compulsory for any college unlike the current scenario when the fee fixed by the fixation committee has to be mandatorily followed by the medical colleges in the respective states.

Vardhan evaded reply to a specific query as to whether the ministry stood by its earlier announcement that the state governments would have the scope to enter into a Memorandum of Understanding with private medical colleges in their jurisdictions to regulate the fee for their remaining 50 per cent seats. 

No final call on NEXT

There had been a mixed range of statements earlier over the format of NEXT. While some quarters of the government, including a Niti Aayog official tweeted that it would be a subjective examination, some others said it would be consist of objective multiple choice questions (MCQs).

The minister refused to commit to anything and said the NMC would take a final call about its format. NEXT, according to the Act, would replace the final year MBBS examination and would serve the three purposes — entrance exam of PG courses, final year MBBS examination and licentiate exam to practise medicine.

Experts have been saying that replacing an extremely rigourous final year examination, which also involves practicals, with MCQ questions, would kill the very spirit of the final year exam. 

The minister in his presser also clarified that the National Eligibility Entrance Test (NEET), which presently is taken by students to enter MBBS, would serve the purpose of entrance to AIIMS and JIPMER-like institutions, which as of now conduct their own examinations. 

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