DNB Degree holders can now teach medicine

From the Times of India

Doctors with a Diplomate of the National Board of Medical Examinations (DNB) degree can now teach in medical colleges.

In a major decision, the Union health ministry has approved the Medical Council of India’s (MCI) proposal to allow doctors, who have a DNB degree, to teach just like those with a MD/MS degree.

The move will help the nation to 3,000 new medical teachers who obtain a DNB degree in 54 subjects. Till date, DNB was never recognized on a par with other PG medical degrees like MD/MS.

The latest rule will allow those DNB degree-holders, who have been teaching for several years to be automatically recognized as faculty members. Those doctors who pass out with a DNB degree from a medical college will get the same status.

However, DNB degree-holders who have passed out from private or non- MCI recognized medical colleges will have to have experience of an additional year of senior residency in a teaching medical institution to be on a par with a qualified MD/MS candidate.

Dr Gautam Sen, MCI board member, told TOI, “This is primarily because those with MS/MD degree from a medical college have the experience of teaching undergraduate students when they are senior residents. A DNB doctor does not have such a teaching experience.” Dr Devi Shetty, another MCI board member, added that the new rule would increase India’s pool of medical teachers in a big way. “The ministry has been wanting to allow DNB doctors to teach. However, earlier the MCI board didn’t approve it. DNB doctors can not only start teaching but also perform surgeries soon after passing out,” Dr Shetty told TOI.

Dr K Srinath Reddy, president of the National Board of Examinations (NBE), which grants DNB degrees, welcomed the ministry’s decision. However, he harbours few concerns. He told TOI from Boston that “while an additional year of senior residency has been recommended for a DNB doctor passing out of a private or non-MCI recognized medical colleges, it is difficult to envisage how medical college hospitals will offer such a limited period of senior residency when they would prefer to select candidates for a full three-year period.

Further, candidates, who have done DNB in super specialities like cardiology or neurosurgery, are unlikely to go in for an additional year of senior residency.” With regard to teaching and research experience, Dr Reddy added that DNB now has a compulsory thesis while DNB training hospitals do not usually provide their candidates with undergraduate teaching experience.

“There are also several medical colleges which don’t have UG component such as SGPGI, Lucknow; and PGI, Chandigarh. Therefore, absence of an UG teaching experience should not be a disqualifier,” Dr Reddy said.

Can a stethoscope be replaced by a mobile phone? Yes!

The Independent reports that the stethoscope could soon be replaced by the humdrum mobile phone.

Peter J Bentley, a computer scientist at University College, London who wrote a program that turns an Apple iPhone into a stethoscope has made a major advance in medical technology and created a sensation among heart specialists. The application, called iStethoscope, was developed as a “bit of fun”, and has become a runaway success after being downloaded millions of times by users across the world.

Cardiologists say the software has saved lives and brought specialist expertise within reach of patients in remote parts of the world. Heart sounds can be recorded and emailed to doctors anywhere for an expert opinion.

Peter Bentley said he was amazed by the response”

The idea began as an experiment. I had a new, popular science book out last year and I wanted to see if I could tell people about the book using a free iPhone application that did something useful.

It was intended as a fun toy but to my astonishment it was downloaded by several million people all over the world in the first six months. Then I started receiving emails, phone calls and visits from cardiologists all over the world. They said it worked better than commercially available digital stethoscopes. They were tremendously excited. One flew over from the US just to discuss it with me.

The cause of the doctors’ excitement was that the audio quality from the iPhone was far superior to that from digital stethoscopes. Have a look at this video which explains the basics of using the iStethoscope.

Responding to requests from specialists, Mr Bentley extended the application to allow heart sounds to be recorded, emailed and analysed. The application costs 59p to download, but cardiologists say it does a better job than equipment costing thousands of times as much.

Glenn Nordehn, a US cardiologist researcher and specialist in digital stethoscopes at the University of Minnesota, said: “This is the best thing to come around in terms of medical equipment for a very long time. [His] closest competitor charges about 3,000 times as much”

Bentley is now working on further iPhone applications, such as an electrocardiogram reader.

MCI aims to bring back 5000 NRI doctors in 5 years

Amendments in the Medical Council of India (MCI) regulations will open the floodgates for hundreds of non-resident Indian (NRI) doctors to come back to their roots. MCI has eased the cross-over rules and has set a target of bringing back 5,000 Indian doctors, including teachers, settled in US, UK, Canada, Australia and New Zealand.

MCI has removed the main bottleneck by recognising the postgraduation and other degrees of these specific countries where health facilities are supposedly best in the world and the education was done in English medium. They have the choice of coming back to teach in a private or government college as well as work in a private or government hospital. Also, they can set up their own medical colleges and hospitals. Indian doctors in these countries are the richest segment even among NRIs.

Apart from accepting foreign degrees, the MCI has made special provision so that foreign experience is also counted. For example, if there is a professor of medicine in a US university, with the required number of years of experience to become one in India, he can be hired as a professor by any medical college in India. This will bring about a huge change not only in the cities but also in the countryside, if the doctors returning home really go deeper into their roots. Besides, MCI also sees the possibility of groups of NRI doctors coming back and pooling in their resources to build hospitals and medical colleges.

Screening test mandatory for foreign medical graduates

Medical graduates with foreign degrees will not be able to practise in India till they have cleared a screening test conducted by the Medical Council of India, the Supreme Court has ruled.

The screening test will also be mandatory for those students who have got MBBS degrees from a country with which India has a reciprocity agreement. At present, certain medical qualifications of UK, Australia, Canada, Italy, Japan, New Zealand, South Africa, Ireland, Nepal, Pakistan and Bangladesh are covered under the reciprocity clause. From now, if an Indian student gets a medical degree from a foreign country covered under the reciprocity clause and wants to practise in India, he can do so only after clearing the MCI’s screening test.

The worst affected would be Indian students who had made a beeline for medical degrees from colleges in Nepal after the MCI had refused to recognise medical degrees from institutes in erstwhile USSR countries, which had liberal admission criteria.

Students went in droves to get admission in medical colleges in Nepal, with which India has a reciprocity clause, and had approached the SC after MCI said they were required to appear in the screening test.

Dismissing their plea against the screening test, a Bench comprising Chief Justice K G Balakrishnan and Justices P Sathasivam and J M Panchal said:

Appellants have to appear in the screening test conducted by the National Board of Examination in terms of the Screening Test Regulations made by the MCI. It was noticed that such students also included those who did not fulfil the minimum eligibility requirements for admission to medical courses in India. Serious aberrations were noticed in the standards of medical education in some foreign countries, which were not on par with standards of medical education available in India,” the SC said justifying its ruling.

It was therefore felt necessary by Parliament to make a provision to enable MCI to conduct a screening test to satisfy the regulatory body about the adequacy of knowledge and skills acquired by citizens of India, who obtained medical qualifications from universities or medical institutions outside India.

More weightage in postgraduate entrance exams to doctors completing rural service

An additional weightage of 10 per cent for each year of rural service will be given to doctors applying for post-graduate entrance examinations from the next academic year.

Union Health and Family Welfare Minister Ghulam Nabi Azad said this weightage will be subject to a maximum of 30 per cent for three years, though a doctor could serve in rural areas for as many years as he chose to after completing the internship .

Similarly, 50 per cent of seats in post-graduate diploma courses have also been reserved for medical officers in government service who have served for at least three years in inaccessible areas.

“This will be a major incentive for doctors and para-medical staff to serve in the rural areas,” Mr. Azad said.

In order to facilitate the increase in the number of medical specialists, the Government has also decided to increase the enrolment of post-graduate students. The existing 1:1 ratio will be enhanced in broad specialities for professor and in super specialities to 1:2.

The rise in the number of post-graduate doctors will automatically increase the number of teachers due to the multiplier effect. Thus, without substantive additional resource and infrastructure requirement, the number of post-graduate specialists would dramatically increase annually by almost 5,000 from the existing 13,000.

While this move will certainly ensure influx of doctors in rural areas, I am worried about the 30% marks. Seems to be a real dangling carrot which can cause havoc to merit lists. Also I hate to see the sight of doctors spending their rural postings solving MCQs instead of learning new things and providing necessary service. Or am I being far too pessimistic?

PMO rejects proposal to scrap Medical Council of India

The Prime Minister’s Office has turned down a health ministry proposal to dissolve various regulatory bodies for medical and related institutions, and replace them with a new consolidated one. The PMO has declined to act, suggesting wider consultations before taking a final decision on bodies like the Medical Council of India and similar ones for dental and nursing colleges.

The health ministry had cited complaints of corruption in the bodies and sent its recommendations to the PMO for approval for a Cabinet note paving the way for an amendment to the Act under which the MCI was created. The ministry called for a consolidated regulator for all related disciplines. The PMO, however, seems to be of the view that there is a need for more consultations to arrive at a decision about the fate of MCI.

The PMO rejected the proposal, saying there was no surety that the new body replacing MCI would not develop shortcomings as of the present regulators, an official said. It has asked the ministry to consult more experts on the issue and devise a plan to cleanse the existing system rather than replacing it, sources in the ministry said.

When contacted, the health ministry reiterated its position about “complaints of rampant corruption” about the functioning of the MCI and DCI, and the need for a review. “There is an urgent need for a thorough review of complaints about the MCI,” minister of state for health Dinesh Trivedi said on Sunday. He questioned the utility of such bodies by pointing out that in the era of technology, such “inspection raj” was an oddity. “An institution needs to meet the required criteria and quality has to be constantly monitored,” he told TOI.

Rs 12.6 crore aid to MUHS from Planning Commission

The Pune regional centre of the Maharashtra University of Health Sciences (MUHS) has been allotted Rs 3 crore of the total Rs 12.6 crore financial aide extended by the Planning Commission of India to the Nashik-based state health university for strengthening infrastructure and training facilities.

Maharashtra has 41 medical colleges and has 4,460 students graduating each year the highest in country. The number of colleges rose from 12 in 1980 to 41 by the end of 2008. A shortage of teachers has reflected on the number of quality doctors passing out of colleges. There is a need for quality training of teachers as well as continuing medical education and continuing professional development (CME/CPD) for medical teachers.

This is the first ever instance of the MUHS receiving an aide of such major proportion from a central agency. The funds are to be routed through the state department for medical education, which issued a government resolution (GR) on August 29 declaring the distribution of the aide to MUHS, Nashik headquarters and Pune regional centre.

Speaking to TOI , MUHS vice-chancellor Mrudula Phadke said,

The funds allotted to the Pune regional centre will be utilised for establishing a state-of-the-art training institution for medical professionals engaged in teaching health science courses.

The idea is to provide medical teachers’ training at four different levels viz. junior, intermediaries, middle and senior-level doctors in different aspects. For instance, few doctors knew about an infectious disease like swine flu until a few months back. We want to ensure that our doctors get an update on outbreak of diseases, to be prepared for tackling such health eventualities.”

The MUHS teachers training institute, which is the only facility of its kind in the state, was established on March 27, 2007, at the Aundh Chest Hospital building. However, the health varsity had sought funds for strengthening and creating a state-of-the-art training facility for medical teachers.

Dr Phadke said

The junior-level training had focus on factors like communication with patients, medical ethics and good medical practices, among others; the intermediary and middle-level training would be focussed on continuing medical education and continuing professional development (CME/CPD) and skill enhancement. The CME/CPD and skill enhancement training is where the update on emerging diseases is to be covered.

The senior-level training would mostly involve deans and professors from various government medical colleges and hospitals and would focus on factors such as leadership, management and administration.

The Nashik unit will get Rs 5 crore for proposed new buildings and basic infrastructure while Rs 1 crore each will go setting up video-conferencing; medical library; and consortium of journals facility and Rs 1.6 crore for procurement of new equipment.

But already a row seems to be brewing over the allocation of funds. Wait and watch what happens next.

Medical Council of India likely to be scrapped in favour of a single council for medical education

Close on the heels of the Yashpal Committee report a task force of the Union health ministry has decided to scrap all regulatory bodies, including the Medical Council of India, Dental Council of India, Pharmacy Council and the Nursing Council.

There will instead be a single regulatory body – National Council for Human Resources in Health – which will oversee seven departments related to medicine, nursing, dentistry, rehabilitation and physiotherapy, pharmacy, public health/hospital management and allied health sciences.

The move now needs a formal government notification. Sources said the Centre will now take this move to all the states before implementing it. On its part, the Union health ministry has already readied a draft bill titled The National Council for Human Resources in Health Draft Bill, 2009.

This will not only perform the regulatory functions but also carry out assessment and accreditation of medical and health institutions across the country. The council will be constituted as an autonomous body independent of government controls with adequate power, including quasi-judicial.

Simply put, the council will coordinate the entire gamut of medical and health education in India. This will include drafting courses and the period of study, including practical training, subjects of examination and standards of proficiency, conditions for admissions to courses, provide guidelines on curriculum planning, monitoring and overseeing implementation of UG/PG courses with flexibility for local specific modules.

The Times of India writes:

Medical education today is dictated by bank balance and caste. The existing councils, besides being unwieldy, have failed to provide a synergistic approach. There is an urgent need for innovation in health-related education. It is unfortunate that medical seats are auctioned in front of students today. This is the best surgical solution for cleansing the system.

The report which was discussed with Prime Minister Manmohan Singh on August 26, 2009 by the task force states: “Professional councils such as the MCI/ Nursing and Pharmacy Councils have been set up to regulate the practice of their respective professions, including education. However, many of these councils have drawn criticism from all sections of society and got judicial censure on several occasions.”

Private medical colleges also place a heavy burden of fees on students and their admissions procedures are not transparent. The curricula of medical schools both public and private are not designed for producing `social physicians’, the report said.

Though all central and state universities shall conduct their own examinations and award degrees, the national council will conduct national-level exit examinations to standardise UG/PG medical and allied health courses. This screening examination shall be mandatory for students who have successfully completed UG from a foreign institution that is not recognised by the council. With this, the National Board of Examinations (NBE) shall be archived.

With a mere 9% of the UG medical students offering PG, the task force has proposed that prominent hospitals across the country be allowed to offer post-graduate courses. “PG seats are so few that students have no option but to study what is given to them rather than what they want to pursue,” a source said.

On its part, the Medical Council of India has come out with a point wise rejoinder to the Yashpal Committee report which goes on to say (excerpts only here):

It is observed that the conclusion which has been drawn by the Committee to the effect that the creation of the Regulatory Bodies like MCI have resulted in the fragmentation of the higher educational sector from policy perspective is erroneous, in as much as, that it is indeed a modality for specific focusing of attention on specialized areas like medical education.

As the Medical Council of India is a sole regulatory body in the field of medical education, the kind of embarrassing situation postulated in Yashpal Committee Report is not likely to arise. However, at this juncture, it is pertinent to note that the Ministry of Health & F.W. rather than respecting the autonomy of the Council has over-ruled the recommendations of the Council on several occasions, granting letter or renewal of permission when the Council has recommended otherwise because of the deficiencies of teaching faculty, clinical material, infrastructure etc. without assigning any reason thereof. Such erosion of the autonomy has created more damage to the quality of medical education rather than lack of coordination. This can be certainly be avoided if greater and meaningful autonomy is granted to the Medical Council of India as has been observed before the Parliamentary Standing Committee.

It is regretted that the Council has never been granted the optimal autonomy which is desirable for a national regulatory body. It is reiterated that if the Council is granted the same autonomy which has been proposed for the de nova regulatory body by the Yashpal Committee, more effective results towards regulating medical
education can be delivered by the Medical Council of India in times to come.

It is therefore observed that contemplating that the professional
Councils should be divested of the academic function and the gamut of the academics be vested with the universities would be ‘utopian’, basically because the aims and objectives of the medical education model are subtle and defined. Out of this model the trained health manpower is required to be generated to cater to the efficacy &effectivity of health care delivery system at large. This therefore mandates and contemplates a desired uniformity of course contents and curriculum including identification of the competencies which are required to be acquired by the graduates at the end of the curriculum. This being left to the multiple universities in the country could end up in several dichotomies and would be an ‘antithesis’ to the desired uniformity.

The bickering continues…. or are these the last gasps from a Council from which we expected so much?

MCI moots common All-India entrance test for MBBS

The Medical Council of India has recommended the holding of a Common National Entrance Examination, to cover admissions to all medical institutions across the country. This includes institutes and deemed universities managed by central government, state government, public sector undertakings, local self governments, trusts, charitable societies and other organisations.

Taking note of the numerous entrance examinations that have cropped over the past few years, the MCI’s move is meant to ease the burden of both students and parents. The recommendations of the MCI are based on the report of the two member subcommittee, comprising of Dr Ved Prakash Mishra and Dr CV Bhirmananandham, who were asked to look into setting up a common entrance scheme following complaints. The subcommittee, says in its report:

This (multiple entrance exams) also involves hardship of various kinds including travelling to far-off places, overlapping dates, insufficient time gap between different entrance exams being held at different places, the money spent on travelling and for fee etc. For participating in the entrance examinations and various other incidental expenses.

Under the proposal, there will be one common entrance test held all over the country, which will be conducted in English and all the languages recognised by the Indian constitution. An authority will be identified by the central government for conducting the examination and deciding the syllabus. Further, the current exemption of holding entrance examinations in states with only one board (CBSE, ICSE, or state board) will be discontinued. The proposed single entrance examination will be evaluated in a computerized mechanism to get rid of the human/manual element in the evaliation process.

As per the MCI proposal, the single entrance examination will not translate into a single counselling process for the entire country. The MCI has decided that there would be an arrangement whereby students eligible in different states would be segregated from the total list of candidates, which will be then utilized by the state authorities to admit students based on their admission criteria.

Details of the committee report are available here (Page 19 onwards)

An editorial in the Indian express, titled ‘The one-test solution’ says:

The examination suggested would cover 290 institutes of medical education; and the benefits of such a move are obvious. Currently a candidate hoping to get into medical school has to sit for an exhaustingly large number of examinations, with different schools often requiring different tests. The 50-odd seats at the All-India Institute of Medical Sciences alone are fought over by more than 60,000 applicants. Those rejected by AIIMS will take a host of other exams. For them, the process is both stressful and messy. A proposal to streamline it is therefore welcome, signalling that the MCI, which is the regulatory body for medical examinations, is alert to the problems faced by students.

But this concern must be reflected in the blueprint for the actualisation of the MCI proposals. The council does not indicate who will design and conduct the single test; reportedly, that is left to the government to decide. But in the past, some state-run examinations have been of variable reliability. Not all state-level common entrance tests in engineering, for example, can compare with the IITs’ Joint Entrance Examination. The proposed single medical examination must be informed by this experience. This is why one mandated medical examination may be too ambitious to achieve in one go. Why not aspire to an examination that is one of many benchmarks? That would have the additional
benefit of preserving institutional autonomy. Elsewhere in the world, such systems exist; in the US, for example, colleges rely on a standardised test for each level, but also on a host of other indicators (school grades and extra-curriculars are usual), that vary from institution to institution. Surely, these different combinations can all be “fair”. As they stand now, the MCI proposals are one-size-fits-all and don’t leave that option open: they state that admission to all MBBS courses must be strictly, and solely, based on the common entrance examination.

The real test of the MCI’s good intentions will be the actual system of assessment they yield. Will this move be eventually followed by a common board-exam like pattern for MBBS examinations as well to ensure uniformity and improvement of teaching quality, I wonder?

MCI approved degree mandatory for admission to superspeciality courses

In an important judgement, the Bombay High Court on Monday held that only the students who have MD or MS degree from a college recognized by Medical Council Of India (MCI) can be admitted to post-graduate ‘Doctor of Medicine (super-speciality) courses.

Bhavin Pujara, a doctor, had filed a petition in the High Court challenging merit list of candidates selected for super-speciality course in 2008. He contended that many candidates in the list did not have MD or MS degree from MCI-recognized colleges.

Directorate of Medical Education and Research relaxed the rule in 2008 by allowing candidates from non-recognized colleges, he said.

A Division Bench, led by Justice D K Deshmukh, held that in future, candidates for the super-speciality course must have degree from a college recognized by MCI, said petitioner’s lawyer Mukesh Vashi.

Dr Mukund Bajaj is fortunate but he is perhaps the last candidate to get admission to a super-speciality course without having a post-graduate degree recognised by the Medical Council of India (MCI). Bajaj retained his seat at Grant Medical College because the Bombay High Court did not feel it fit to take away his seat after he had completed a year in the course. Also, the MCI had said that the seat could not be given to any other candidate after the admissions were completed.