What the plight of students in Ukraine reveals about medical education in India

Syllabus: General Studies Paper 2

Context

• Odisha’s Chief Minister Naveen Patnaik has written to Prime Minister Narendra Modi, requesting the Centre to direct the National Medical Commission (NMC) to ensure uninterrupted education for medical students who have been evacuated from Ukraine.
• He has requested him to enable their admission to Indian medical colleges.
  • There is a partial precedent in the post-Partition “transfers” provided to refugee medical students who migrated from medical colleges located in the newly-created Pakistan.
• The plight of 18,000 Indian medical students trapped in Ukraine’s war zones has led to widespread concerns. While efforts are being made for their evacuation and early return to India, several questions arise. Why did they need to go to Ukraine to study? What will happen to their interrupted education? What are the alternatives available to them on their return to India?

Medical education scenario in India

• The number of seats available for medical education in India is far less than the number of aspirants who leave school with the dream of becoming doctors.
• Of the 6 million students who appeared in the National Eligibility cum Entrance Test (NEET) in 2021, only 88,120 made it into the 562 medical colleges in the country.
• Others had to enrol in non-medical courses in India or seek admission to foreign medical colleges. While the number of medical colleges has now increased to 596 (with 89,875 seats), the entry barrier is still high.
• China, Russia, Ukraine, Kyrgyzstan, the Philippines and Kazakhstan are among the countries where Indian students pursue their dreams to become doctors.
• On return, they need to pass a qualifying examination before they are permitted to intern in the institutions recognised by the Medical Council of India (MCI) — its functions have been taken over by the recently-constituted NMC.
• The task of conducting this screening test was assigned to the National Board of Examinations (NBE). The passing rates were disappointingly low (mostly below 20 per cent), for several reasons–
  • Training standards varied widely across foreign institutions.
  • The language of instruction was not English.
  • The curriculum in foreign colleges differed in several respects from that taught in India. A student training in Russia or Ukraine is unlikely to learn much about kala-azar or malaria.
• The screening examination in India used to cover the vast syllabus encompassing the entire gamut of medical education.. So, foreign medical graduates started taking coaching classes. That spawned another industry.

What should be done?

• We need to offer more opportunities to students who seek a medical career since our health system is woefully short of both basic doctors and specialists.
• This is partly a legacy of the MCI boards imposing rigid conditions to restrict the number of medical colleges, and partly due to limited government investment in the health sector.
• A recent analysis estimates that India has only 4.8 fully qualified and actively serving doctors per 10,000 population. Those too are inequitably distributed across the states, with a further tilt towards urban centres.
• It is essential that we increase the number of medical colleges, especially in states that have a low number of such seats.
• The critical needs for a medical college are a general hospital with different specialities needed for the MBBS course, classrooms, laboratories, community engagement and adequate faculty.
• The availability of suitable faculty is a critical barrier at present.

Private sector role

• Even if the private sector is provided land at a concessional rate for starting new medical colleges, they will face a faculty crunch and poach from government medical colleges.
• Handing over district hospitals to the private sector, as proposed by some, will exacerbate inequities in healthcare and disconnect secondary care from organised primary care which is principally delivered through the public sector.
• Private medical colleges are also exorbitantly expensive in their fee structure — even in comparison to foreign medical colleges.

Role of State governments

• State governments must be supported to invest in the upgradation of district hospitals.
• Specialist posts in many clinical disciplines that are needed for the MBBS programme already exist in the district hospitals. These specialists can be designated as faculty for a new medical college attached to the district hospital.
• These hospitals can be linked downstream to primary healthcare services and upstream to tertiary care hospitals to provide the students with a full range of clinical exposure while functioning as the main centre of education.
• Common classrooms can be created by virtually linking several of the medical colleges in a state, to share some of the faculty for classroom teaching, especially for pre- and para-clinical subjects where there is considerable faculty shortage.
• State governments must be financially assisted to undertake this transformation of district hospitals.
  • A centrally sponsored scheme aims to set up 157 new medical colleges attached to existing district/referral hospitals in areas that do not have any medical college.
  • This will reduce urban-rural disparities in healthcare and also help to scale-up training in the much needed but greatly neglected discipline of family medicine. Nursing colleges and allied health professional training centres (for paramedical courses) may also be added to district hospitals to create a multi-layered, multi-skilled health workforce.

About returning students

• It is unlikely that they will be able to resume their education there — the political turmoil is likely to continue even if the war ends soon.
• Their families too will be reluctant to send them back.
• Present regulations do not permit them to continue their education in Indian medical colleges.
• Even if the NMC permits it as a special case, other students who qualified the NEET but did not make the cut for medical admission, and stayed back in India, might protest.

Solution

• The government could support these students by enrolling them in a BSc (Public Health) programme that can be run by schools of public health and medical colleges.
• They can graduate in three years to commence careers in public health, where their earlier medical education can add value.
• Since the National Health Policy of 2017 calls for Public Health Management cadres to be established in every state, this could initiate a programme for large-scale training of public health professionals.

In any case, the sad state of the students in Ukraine must catalyse reforms in Indian medical education.

The Indian Express link

https://indianexpress.com/article/opinion/columns/what-the-plight-of-students-in-ukraine-reveals-about-medical-education-in-india-7805640/

Question- Students returning from war hit Ukraine reveal the issues and need of reforms in medical education in India. Comment.