Written By: Nirmalya Dutta | Updated : June 23, 2014 12:12 PM IST
The new Health Minister is on a collision course with the Medical Council of India as he blamed corruption for the poor quality of medical education in India. The MCI's decision to scrap over 6000 medical seats has irked the health minister and also the denial of permission to 50 new medical colleges that would've added 5000-7500 more seats. The Health Minister told the Indian Express: 'It is an unjustified move on part of the MCI. It is wrong to reduce medical seats, that too in government medical colleges, at a time when the country is grappling with medical manpower shortage. We will look into the matter on a case to case basis and reassess every recommendation. The benchmark of medical education should be standards, not how big the classroom is or how small the auditorium is,' Harsh Vardhan said. This comes after the UPA government cleared 10,000 more medical seats in government medical colleges.
Medical education the situation in India
Doctors and administrators have always been at loggerheads about how to improve India's medical education quality and victims are usually the poor patients. The last stats suggest that India has an acute shortage of doctors which means that there is only one doctor per 1,700 citizens (WHO recommends a 1:1000 ratio) but even that ratio is not a great indicator because the problem is that medical facilities aren't equally divided. There are more doctors in urban areas than rural areas, more of them in South and East India compared to North and West. Any move to change the situation is met with stiff resistance from medical students. A compulsory rural course after the MBBS course was vehemently opposed whereas the decision to create mid-level healthcare practitioners was derided for being 'poor man's candy'
The Pre-Flexner Era the dark ages of medical education in the United States
In the early part of the 20th Century, the medical education scenario in the US was bleak, somewhat similar to the problem in India. There were around 155 medical schools in the US and there was no standard course or curricula. Many of them were proprietary (run for profit) which were simply owned by a doctor or two and had no affiliation to any university. The quality of medical students was very poor and degrees were given after simply two years of study. There were many people studying alternative medicine like naturopathy or homeopathy (who would then pass off as doctors) and even medical schools taught these courses.There are great gaps in quality between different medical schools, proprietary medical schools are present, colleges are launched without even having basic lab facilities and a standard syllabus is non-existent.
The Flexner Report
In 1908, Abraham Flexner, an educator was asked to submit a report under the aegis of the Carnegie Foundation which would examine the quality of medical education in the country. Flexner visited all 155 medical schools in the country and submitted the report in 1910. He wrote in the report, generalising the quality of medical education in the country: 'Each day students were subjected to interminable lectures and recitations. After a long morning of dissection or a series of quiz sections, they might sit wearily in the afternoon through three or four or even five lectures delivered in methodical fashion by part-time teachers. Evenings were given over to reading and preparation for recitations. If fortunate enough to gain entrance to a hospital, they observed more than participated.'
The Flexner report considered the Johns Hopkins School of Medicine to be the model for medical schools and based on its running made the following recommendations:
The Consequence
The Flexner report made it mandatory for all physicians to at least undergo six to eight years post-secondary formal training. Medical schools across the country were standardised, the number of medical schools dropped to 31, the quality of medical care became quite high and medicine became one of the most respected profession. The report also had some negative aspects making it harder for minorities or women to seek medical education (eight years in university was simply unaffordable for them) and also resulted in healthcare costs significantly going up.
Flexner was considered the 'greatest critic and best friend of medical education' in North America and his recommendations allowed the US to become home to some of the greatest medical schools in the world and also make remarkable breakthroughs in medical research.
Will the Flexner model work in India?
India's healthcare challenges and medical education scenario is very different from the US. And it's well-documented that models based in one system can't be lifted and expected to work in another one. But while the Flexner model can't be plagiarised, it can certainly inspire a standard in medical education in India which would go on to benefit the nation for years to come. Like Flexner considered Johns Hopkins the standard-bearer of medical schools, we could do the same with AIIMS or some other superlative medical institute, see what works for them and demand the same standard everywhere else. Some methods to improve the system would be a standard exam which could gauge the standard of students across the country, take students based only on meritocracy, increase the time spent in hospitals during the course and add a rural stint for PG students which will be more beneficial than sending MBBS students or training non-medical practitioners.
