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Postgraduate Medical Postgraduate Medical Education in India - Education in India -
20052005Prof K R SethuramanProf K R Sethuraman MD PGDHE
Director-Professor & HeadDepts of Medicine & Med Education
JIPMER, Pondicherry - INDIA
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Academic Structure of Academic Structure of Higher EducationHigher Education
Bachelor / Undergraduate level Bachelor / Undergraduate level • 3 - 5 years leading to diploma or degree3 - 5 years leading to diploma or degree
Master's / Post-graduate level Master's / Post-graduate level • 2 - 3 years leading to PG-diploma or 2 - 3 years leading to PG-diploma or
degreedegree Doctoral / Post-doctoral level Doctoral / Post-doctoral level
• 2 - 4 years2 - 4 years
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Indian Medical Council Indian Medical Council (IMC)(IMC)
Indian Medical Council Act • enacted in 1933 to establish standards
in medical education and to define medical qualifications
• Inadequate to meet the challenges posed by rapid development and progress of medical education
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Medical Council of India Medical Council of India (MCI)(MCI)
In 1956, IMC Act was repealed and a new MCI Act was enacted
Further modified in 1964, 1993 & 2001 MCI-regulations on undergraduate medical
education in 1997 MCI-regulations on postgraduate
medical education in 2000
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Objectives of the CouncilObjectives of the Council Maintenance of uniform standards of Maintenance of uniform standards of
medical educationmedical education (UG & PG) (UG & PG) Recognition/de-recognition of Recognition/de-recognition of
Medical Institutions of India Medical Institutions of India Recognition/de-recognition of Recognition/de-recognition of
Medical qualifications awarded Medical qualifications awarded abroadabroad
Registration of qualified doctors Registration of qualified doctors
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College Recognition ProcessCollege Recognition Process State Government approval for State Government approval for
essentiality of a Medical College essentiality of a Medical College Central Government's permission to Central Government's permission to
such colleges - initially for one yearsuch colleges - initially for one year Annual Renewal after verification Annual Renewal after verification
until permanent recognition could be until permanent recognition could be grantedgranted
Courses without approval are Courses without approval are irregular & the degrees will not be irregular & the degrees will not be recognisedrecognised
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Quantity - Number of Quantity - Number of CollegesColleges
> 250 medical colleges in India> 250 medical colleges in India 230 have been approved by MCI 230 have been approved by MCI
http://www.mciindia.org/apps/search/show_colleges.asphttp://www.mciindia.org/apps/search/show_colleges.asp
~ 40% is government run; ~ 40% is government run; ~ 60% is private~ 60% is private
Intake is ~ 25,000 UGs & ~ 8,000 Intake is ~ 25,000 UGs & ~ 8,000 PGs per yearPGs per year
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Alternate Medicine StreamAlternate Medicine Stream
Ayurveda Colleges Ayurveda Colleges = 196 = 196 Homeopathy Colleges Homeopathy Colleges = 192 = 192 Siddha Colleges Siddha Colleges = 5 = 5 Unani Colleges Unani Colleges = 35= 35
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Educational Deluge !Educational Deluge !
1992
1996
1997
1998
1999
2000
Enrolment (-000s) in Medical sciences
179 220 230 241 252 271
Source - Ministry of Human Resources and Development
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Current Demand -Current Demand - for for Postgraduate EducationPostgraduate Education
GPs have to compete with practitioners of alternate systems
Most MBBS graduates try very hard to get admitted to PG studies • Some try for 2 - 4 years of full time
entrance exam coaching • Parallel system of PG examination run by
the National board of examination
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PG EntrancePG Entrance
All India Entrance Examination for 50% of PG seats in all govt-aided colleges
Annually ~ 2500 seats are available for graduates from any college
For some bright & savvy “MCQ monsters” this is an annual pot of gold!• They sell their seat to the wait listed!!!
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Objectives of PG educationObjectives of PG education
Laudable list of objectives covering knowledge, competence & values
Not matched by a valid & relevant set of assessment tools to ensure that the outcome complies with all the objectives
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Adhering to MCI objectivesAdhering to MCI objectives
At JIPMER we conduct a 30 hour module for all the 70 PGs on • research methods• ethics & professionalism• evidence based medicine • journal club presentation skills
Such efforts are much envied but rarely followed
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Beyond MCI – Beyond MCI – National Board of ExaminationsNational Board of Examinations (NBE) (NBE)
provides a common national standard & mechanism of evaluation of postgraduates
conducts postgraduate & postdoctoral examinations in 42 disciplines
awards Diplomate of National Board (DNB) to those successful in exams
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Why PGs jostle in DNB streamWhy PGs jostle in DNB stream Government of India has equated
DNB with corresponding PG degree (MD/MS) & post doctoral (DM/MCh) qualifications
Examinees appear from > 230 medical colleges & 370 accredited institutions • Broad Specialties (27)• Super Specialties (16)
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Post Doctoral FellowshipPost Doctoral Fellowship in Sub Specialties in Sub Specialties
• Critical Care Medicine, Trauma Care, Cardiac Anesthesia,
• Reproductive Medicine, High Risk Pregnancy & Perinatology
• Vitreo-Retinal Diseases, Pediatric Ophthalmology
• Pediatric Cardiology, Interventional Cardiology
• Minimal Access Surgery, Vascular Surgery, Hand & Micro Surgery, Spine Surgery
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Problems in Medical Problems in Medical Education are GlobalEducation are Global
42% of Ireland's medicos regret their career choice, compared with a quarter of both GPs & consultants
They would reject medicine if they were back at school and asked to choose again
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Problems – Indian contextProblems – Indian context ““Blind imitation of Western model
has made our products misfits in our own society”
‘The painful truth is - a medical graduate is more at home abroad than in India’ – Dr Deshpande
• J Postgrad Med 1982;28:181-3
I know super-specialists with DM, MCh migrating to UK to work as locums
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Problems – Academic contextProblems – Academic context Private health care is much more
remunerative than academics, there is paucity of good teachers• Myth - Those who can’t, teach others!!!
Allowing private practice in academics is a “Catch-22 situation”• “Teachers chase practice. Students
and teaching are inconveniences” Ind J Medical Ethics.2004:5:123
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Problems – Academic scamProblems – Academic scam
current trend to offer expensive private tuition for students • At present for undergraduates only• additional income, especially for non-
clinical medical teachers may soon reach proportion of a
major scam• curricular duty ignored to pressurise
students to join coaching classes
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Problems in Problems in Educational TechnologyEducational Technology
Infrastructure is often inadequate • unpredictable power supply• may ruin a well-planned activity
Six A’s of availability, affordability, accessibility, appropriateness, adequacy & acceptability of resources
Rapid obsolescence is a bugbear of computer-based technology
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Problems in Problems in Educational Technology - 2Educational Technology - 2
maintenance of hardware is below par• overriding fear of breakdown
The fear leads to a “Catch-22” situation• in order to maintain equipment in
working order, keep it always under lock and key!
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Problems in ExaminationsProblems in Examinations
Mistrust over the fairness of entrance & final examinations
Obsession with secrecy lack of pre- or post-validation
Fear of corruption • medical educators shudder to think of
50% weightage to internal assessment
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Problems in ExaminationsProblems in Examinations
Fatalistic Acceptance of Unreliable Tools – “Can’t help it” syndrome• variations in case-difficulty,
examiner-bias, & subjectivity of global assessment in clinical/practical
• most clinical examinations no better than `Russian Roulette’
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Problems in National Board Problems in National Board TrainingTraining
Of the 370 accredited institutions, only a few have academic ambience & are equipped to impart effective training
They seek accreditation for prestige & to get junior doctors to work for a pittance
plight of DNB trainees in several non-teaching hospitals makes sad reading
• www.aippg.net/forum/viewtopic.php?t=1102
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Problems in ResearchProblems in Research
Only a few colleges take research seriously with active research councils
Plagiarism by PGs is a major problem now Open access initiative is double edged:
• it gives free access to information for researchers of the world;
• it also makes it very easy to plagiarise research findings
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The Way ForwardThe Way Forward - - Some SuggestionsSome Suggestions
1. 1. Embrace quality assurance in education• Adopt ISO-9002 norms for services
2. Galvanise medical educators • by removing distractions
like unregulated private practice
• and diversions like excessive research at the cost of
teaching
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The Way ForwardThe Way Forward – – Suggestions Suggestions contd.contd.
33. Adopt competency-based approach to training & evaluation • so that those who enter the
profession are competent• Implement formative and internal
assessment to ensure competencies not tested in the final exams
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The Way ForwardThe Way Forward – – Suggestions contd. Suggestions contd.
4. 4. Usher in examination reforms • make in relevant, valid, reliable,
unbiased, transparent, accountable and fair
• Enhance the quality and weightage of internal assessment.
5. Develop national standards for summative examinations
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To Sum Up …To Sum Up …
India has the largest technical human resource pool
Indian Doctors are truly global Every 7th Doctor in USA is Indian While quantity is laudable, quality is
not uniform: exemplary to abysmal We need mechanisms to assure
quality of health human resources
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