|Year : 2019 | Volume
| Issue : 2 | Page : 323-325
The tyranny of the Medical Council of India's new (2019) MBBS curriculum: Abolition of the academic discipline of family physicians and general practitioners from the medical education system of India
President, Academy of Family Physicians of India; Chief Editor, Journal of Family Medicine and Primary Care, Ghaziabad, Uttar Pradesh, India
|Date of Web Publication||28-Feb-2019|
Dr. Raman Kumar
049, Crema Tower, Mahagun Mascot, Crossing Republik, Ghaziabad - 201 016, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
After 21 years, a new MBBS curriculum has been released by the Medical Council of India (MCI), titled “Competency-based UG Curriculum for the Indian Medical Graduates.” This curriculum is to be rolled out from August 2019 across India. The curriculum document runs through 890 pages in three volumes. Overall, 2939 competencies have been proposed to be acquired by trainee MBBS doctors. The parliament of India in one of its reports (2016) noted that the medical education system is designed in a way that the concept of family physicians has been ignored. Not to mention a formal introduction as discipline, the new MCI MBBS curriculum does not even mention the words “General Practice” or “Family Medicine” or “Family Physicians” throughout the voluminous document. The curriculum committee has also ignored the recommendations of National Health Policies (NHPs) of 2002 and 2017 of the Government of India (GOI). In practicality, it leaves the MBBS students in the road of no return of specialist and tertiary level hospitalist care. It deliberately deprives thousands of medical graduates an invaluable autonomous career in community setting as practicing family doctors. Simultaneously, this new curriculum drafting exposes a treacherous hierarchical monopoly of hospital based specialists doctors over generalist community based primary care physicians within the healthcare delivery system of India. Keeping out family physicians and general practitioners from the health system means a free flow of patients from community to expensive tertiary care facilities in the absence of any structured referral system. Family medicine and general practice are independent medical disciplines/specialties across world. The curriculum neither meets the national public health aspirations nor the GOI policies on medical education. If implemented, it will be disastrous to the healthcare delivery system and public good in general. The new MBBS curriculum deserves to be outright rejected for the inherent fallacies.
Keywords: Family medicine, general practice, MBBS new curriculum, medical council of India, medical education, primary care, undergraduate curriculum
|How to cite this article:|
Kumar R. The tyranny of the Medical Council of India's new (2019) MBBS curriculum: Abolition of the academic discipline of family physicians and general practitioners from the medical education system of India. J Family Med Prim Care 2019;8:323-5
|How to cite this URL:|
Kumar R. The tyranny of the Medical Council of India's new (2019) MBBS curriculum: Abolition of the academic discipline of family physicians and general practitioners from the medical education system of India. J Family Med Prim Care [serial online] 2019 [cited 2019 Oct 20];8:323-5. Available from: http://www.jfmpc.com/text.asp?2019/8/2/323/252987
| The New MBBS Curriculum: 2019|| |
The Medical Council of India (MCI) controls the medical education system of India. After 21 years, a new MBBS curriculum has been released by the medical education regulator titled “competency-based UG curriculum for the Indian Medical Graduates.” The curriculum document runs through 890 pages in three volumes. Overall, 2939 competencies have been proposed to be acquired MBBS doctors as per the new curriculum. A course called Attitude, Ethics, and Communication (AETCOM) will run across years. This curriculum will be implemented from August 2019.
| Abolition of the Tradition of Family Physicians and General Practitioners from MBBS Training|| |
Interestingly, the new MCI MBBS curriculum does not even mention the words “General Practice” or “Family Medicine” or “Family Physicians.” Summarily, it misses the essence of health-care needs of India. Earlier MCI rejected the recommendations of its own expert committee which articulated the need to introduce independent department of family medicine at all medical colleges across India. In practicality, it leaves the MBBS students in the path of no return of specialist and hospitalist care. It deliberately deprives thousands of medical graduates an invaluable autonomous career in community setting as practicing family doctors. Simultaneously, it establishes a treacherous hierarchical monopoly of hospital based specialists doctors over generalist community based primary care physicians within the healthcare delivery system of India. Keeping out family physicians and general practitioners from the health system means a free flow of patients from community to expensive tertiary care facilities in the absence of any structured referral system. Family medicine and general practice are independent medical disciplines/specialties across world.
| Policies of the Government of India and Other Policy Recommendations Supporting Establishment of Family Medicine Specialty|| |
- In 1983, “The Medical Education Review Committee” set up by Ministry of Health and Family Welfare (MOHFW) Government of India (GOI), under the chairmanship of Dr. Shantilal Mehta recommended that 'the undergraduate (MBBS) medical students should be posted in a general practice outpatient unit in order to be exposed to multidimensional nature of health problems, their origins.' The committee also recommended that this specialty should be further developed so that an increasing number of students pursue higher study in this area
- National Health Policy (NHP) 2002 stated that in any developing country with inadequate availability of health services, the requirement of expertise in the area of “Public Health” and “Family Medicine” is markedly more important than the expertise required for other clinical specialties
- A WHO Regional Office of South-East Asia (SEARO) Regional Scientific Working Group Meeting on Core Curriculum of Family Medicine held in Colombo, Sri Lanka, from 9 to 13 July 2003 devised core curriculum of family medicine for the (a) undergraduate level, (b) intermediate level, and (c) postgraduate level (specialist level)
- In 2007, the working group of medical education under Prime Minister's National Knowledge Commission stated that any successful development process must have a pyramidal structure with a strong horizontal base. In terms of medical education, it has to be a strong base of basic scientists and clinical generalists/family medicine specialists, who are the backbone and stability of the system
- In 2010, in response to a representation given by the Academy of Family Physicians of India, the MOHFW convened a high-level meeting vide letter no. V. 11025/56/2010 ME (P1) under the chairmanship of Union Health Secretary GOI to discuss following: (a) Initiating of MD family medicine at government medical colleges and (b) Employment of DNB family medicine qualified doctors within the National Rural Health Mission
- In 2011, the WHO SEARO Regional called a consultation on “Strengthening the Role of Family/Community Physicians in Primary Health Care” in Jakarta, Indonesia, 19–21 October 2011.
- The NHP 2017 announced recently, specifically mentions the importance of family medicine specialty and mandates popularisation of programs like MD in family medicine. NPH 2017 further recommends that a large number of distance and continuing education options for general practitioners in both the private and the public sectors, which would upgrade their skills to manage the large majority of cases at local level, thus avoiding unnecessary referrals
- According to the working group of the planning commission for the 12th plan (2012–2017) estimated the projected need for specialists in family medicine (family physicians) as 15,000/year for the year 2030
- In 2013, the union health secretary GOI vide Letter No. D. O. V 11025/MEP-1 communicated with all Principal Secretaries of Medical Education. Health and FW of all State/UTs. In his letter, the Union Health Secretary wrote that there is a need for an integrated generalist approach to diagnosis and treatment, and the family physicians are best positioned to deliver this integrated approach to diagnosis, treatment, and complete health-care management of an individual and a single postgraduate in family medicine can meet the requirement of a surgeon, obstetrician, and gynecologist, physician, and a pediatrician in a community health center, besides taking care of public health need of the community.
| Observation by the Parliament of India|| |
In 2016, 92nd report of the Department-Related Parliamentary Standing Committee on health and FW on the “Functioning of the MCI” has emphasized the need for training in family medicine. The committee report has noted that 'the medical education system is designed in a way that the concept of family physicians has been ignored.' The committee recommended that the GOI in coordination with state governments should establish robust PG programs in family medicine and facilitate the introduction of family medicine discipline in all medical colleges. This will not only minimize the need for frequent referrals to specialist and decrease the load on tertiary care, but also provide continuous healthcare for the individuals and families.
| Medical Council of India (MCI): Wise Men and the Elephant|| |
It is surprising that it took years of deliberation to develop and arrive at this curriculum. Was it ever put in public domain? Why any general practitioners, family physicians, or practicing primary care doctor were not involved or invited for contribution? It neither meets the public health needs of the country not aligned to the stated policies of the GOI-NHP 2002/2017 and recommendations of the Parliament of India. It appears that the MCI does not have the capacity as well as intent. Over a period of time, it has become a specialist monopoly. Due to monopolistic regulation, only specialist doctors can become medical teachers in India. Due to regulatory restrictions, family physicians and family doctors are not eligible to become medical teachers unlike rest of the world. In the erstwhile council (presently suspended) all members of MCI were exclusively specialist doctors only. The curriculum committee which has prepared the new curriculum also did not have the representation of family physicians, general practitioners, medical officers, or any practicing primary care physicians. Rather than supporting the NHPs, the MCI has rejected its own expert committee recommendation to start “department of family medicine/general practice” at all medical colleges in India.
In the words of Sant Kabir Das-Bada hua to kya hua, jaise ped khajoor panthi ko chhaaya nahi, phal laage ati door (It's of no use to be great like a date palm tree as it neither gives shade to travelers nor does it allow its fruit to be plucked with ease). Meaning, the exhibition of greatness does not benefit anyone. This curriculum has been prepared by specialist and super (sub) specialists, and they all have pushed for their own domains to be taught to MBBS generalist licensed independent practitioners. It is like the blind/wise men and the elephant situation. This is a gross misuse of an act of parliament (MCI act). The department-related committee on health and family welfare of the Indian parliament has deliberated upon in details on the failure of the institution of MCI in its 92nd report. No wonder the Medical Council of India stands suspended as of now by an ordinance and presently being governed by a Board of Governors (BOG) consisting of eminent medical professionals. Primary care doctors do not have any representation yet.
| Distance between Aspirations and Intent: What Should Be Done With This New Curriculum?|| |
Gautama Buddha named ten specific sources whose knowledge should not be immediately viewed as truthful without further investigation to avoid fallacies; these include one's own teachers. Further, Buddha says, only when one personally knows that a certain teaching is skillful, blameless, praiseworthy, and conducive to happiness and that it is praised by the wise, should one then accept it as true and practice it. Just because MCI has recommended and rolled out this curriculum, it cannot be accepted without critical review since it was never put in the public domain before releasing for implementation.
Presently India has the largest medical education system (70,000 MBBS seats/year and more than 470 medical colleges) in the world but paradoxically very few doctors are available for service of 1.3 billion. Is it a default or design? For smaller problems, people have to visit large tertiary care hospitals. Private hospitals are exorbitantly expensive (doctors themselves cannot afford treatment) or overcrowded public hospitals (doubling/tripling on one hospital bed). No wonder the public is angry; doctor is being beaten to blues for no fault of themselves but due to systemic failures and gross mismanagement. Rather than engaged in the healthcare delivery system, majority of the fresh MBBS doctors are being herd into attending coaching classes; practicing multiple choice questions (MCQs) aspiring to get through entrance examination for fewer number of specialist courses (statistically impossible). The curriculum may be 900 pages document proposing thousands of competencies (impossible numbers) with fancy words. However, it does not meet the basic test of the purpose of MBBS course; that is to be able to become a competent family physicians practicing in primary care setting. The absence of the discipline of family medicine/general practice within the MBBS curriculum is not inadvertent. It has been deliberately blackened out. Are MBBS doctors born only to attend teachings of specialist doctors and become a lifelong referral source only? Will they ever be given equivalence and equal opportunity for professional development as compared with their hospital-based specialist counterparts? Why should we blame medical students and fresh medical graduates for not opting primary care/rural healthcare vocation in favor of hospital based specialist career. After all primary care/family medicine is neither introduced within MBBS curriculum not it is available as a career pathway by design.
The Government of India, states and ordinary citizen must take notice of this tremendous tension arising out of a potential situation of conflict of interest within regulatory mechanism of medical education system. Primary care doctors must be given professional autonomy and not be subdued under the mercy of experts of other disciplines. Independent boards and royal colleges exist in USA and UK respectively for each medical discipline unlike India where all powers are vested into small committees of specialists and super specialists. The curriculum neither meets the national public health aspirations nor the GOI policies on medical education. It deserves to be outright rejected.
Note: The view expressed in the article is the opinion of the author only and does not represent the position of any other organization.
| References|| |