Rsnew Committee Site Committee File ReportFile 14 187 157 2024 2 19
Rsnew Committee Site Committee File ReportFile 14 187 157 2024 2 19
Rsnew Committee Site Committee File ReportFile 14 187 157 2024 2 19
157
PARLIAMENT OF INDIA
RAJYA SABHA
ON
ON
2. PREFACE ii-iii
3. ACRONYMS iv
4. Chapter-I
Introduction 1-12
Chapter-II
Chapter - IV
33-41
Quality Control of Medical Education
5. RECOMMENDATIONS/OBSERVATIONS — AT A 42-57
GLANCE
6. ANNEXURES 58
7. * MINUTES
*To be appended at a later stage.
COMPOSITION OF THE COMMITTEE
(2023-24)
SECRETARIAT
1. Shri Sumant Narain Joint Secretary
2. Shri Shashi Bhushan Director
3. Dr. Saket Kumar Deputy Secretary
4. Smt. Noyaline Vinitha F.C. Joint Director
5. Shri Saurav Trivedi Secretariat Assistant
i
PREFACE
4. Besides, the Committee undertook study visits to Mumbai and Goa from the
10th July to 11th July 2023 to assess the ground realities related to the quality of
medical education imparted in the medical colleges.
iii
ACRONYMS
AETCOM Attitude, Ethics and Communication
AEBAS Aadhar Enabled Biometric Attendance System
AIIMS All India Institute of Medical Sciences
BCLS Basic Cardiac Life Support
CBME Competency-based Medical Education
CCTV Closed Circuit Television
DHR Department of Health Research
DRPSC Department -Related Parliamentary Standing Committee
ECLS Extracorporeal Life Support
EMRB Ethics and Medical Registration Board
FMGL Foreign Medical Graduate Licentiate
FC Foundational Courses
FDP Faculty Development Programs
GDP Gross Domestic Product
HWCs Health and Wellness Centres
ICMR Indian Council of Medical Research
KGMU King George Medical University
LHMC Lady Hardinge Medical College
LMP Licentiate of Medical Practice
LoP Letter of Permission
MARB Medical Assessment and Rating Board
MEU Medical Education Units
MBBS Bachelor of Medicine, Bachelor or Surgery
MCI Medical Council of India
MCQ Multiple Choice Questions
MoU Memorandum of Understanding
NBE National Board of Examinations
NEET National Eligibility cum Entrance Test
NExT National Exit Test
NMC National Medical Commission
NIRF National Institutional Ranking Framework
PGMEB Post-Graduate Medical Education Board
QCI Quality Council of India
UGMEB Under-Graduate Medical Education Board
UT Union Territory
WFME World Federation for Medical Education
iv
Chapter-I
Introduction
1
Licentiate of Medical Practice (LMP) was introduced, followed by the Medical
Registration Act in 1858.
1.4 Indian Medical Council Act:In 1916, the Indian Medical Council Act was
enacted, which subsequently led to the establishment of the Medical Council of
India (MCI) in 1933. The MCI was entrusted with overseeing and regulating
medical education standards, defining curricula, and ensuring the quality of
medical practice nationwide. This marked a significant step toward standardizing
and formalizing medical education in India.
1.5 Committee on Health Care and Infrastructure: The first effort to study
the healthcare infrastructure in India was the formation of a Health Survey and
Development Committee in 1943 under the chairmanship of Sir Joseph William
Bhore. The Committee, in its report submitted in 1946, chartered a course for
public health investment and infrastructure in India. It inter alia dealt with the
establishment of Primary Health Centers and major central institutes for
postgraduate medical education and research. The Committee also paved the way
to abolish Licentiate in Medical Practice and to replace it with a single
qualification of an MBBS degree. The Committee, however, overlooked the
indigenous practitioners of medicine who formed the mainstay of health care in
those times.
1.7 National Medical Commission Act, 2019: One of the most significant
legislative reforms recently was the introduction of the National Medical
Commission (NMC) Act in 2019. This Act replaced the MCI, ushering in a new
era in medical education and practice regulation. The major objectives of the NMC
Act are to provide for a medical education system that improves access to quality
and affordable medical education, ensure availability of adequate and high-quality
2
medical professionals in all parts of the country; to promote equitable and
universal healthcare that encourages community health perspective and makes
services of medical professionals accessible to all the citizens; that promotes
national health goals. The Act also encourages medical professionals to adopt
latest medical research in their work and to contribute to research; and has an
objective periodic and transparent assessment of medical institutions. The said Act
facilitates maintenance of a medical register for India and enforces high ethical
standards in all aspects of medical services; that is flexible to adapt to changing
needs and has an effective grievance redressal mechanism.
1.8 India's medical education system presents a peculiar paradox on the global
front. On the one hand, it prides itself on producing a significant number of
physicians, making a substantial contribution to the global healthcare workforce.
On the other hand, many Indian students pursue their medicaleducation abroad,
even though India is home to prestigious institutions. This paradox deepens when
considering that India hosts some of the world's finest medical colleges yet
concerns persist about the quality of medical education and healthcare delivery
within the country.
1.9 India has one of the largest medical education systems in the world.
According to the Ministry of Health and Family Welfare,there were702 medical
colleges in the country at the time of this study in 2023-24. However, the quality of
medical education in India varies widely, and the system faces several challenges,
the most prominent among them being the uneven distribution of medical colleges.
Medical colleges in India are concentrated in urban areas which creates a vacuum
in the rural areas. The creation of medical colleges in rural areas can solve the
problem of the dearth of rural access to medical education. Another significant
challenge is the non-availability of sufficient funds for medical research in India
and there is an urgent need to create a research ecosystem in medical colleges. This
necessitates continuous upgradation of the curriculum with the latest advances in
medical science.
1.11 Traditionally, European countries and the USA have excelled in the field of
medical education (in the context of Western medicine) which dates back as far as
the nineteenth century. A comparative map displaying the number of medical
doctors per 10,000 of the population of the country, accessed from the website of
the World Health Organisation reveals that the developed countries show better
doctor-to-population ratio. To gain an insight into the structure of the medical
education system in countries with high doctor-population ratios, the Committee
had a panoramic view of some of the Countries for a comparative study.
4
Source: World Health Organization
Figure 1.2: Medical Doctors per 10,000
U.S.A.
1.12 Medical Education in the U.S.A. comprises 3 phases: Medical School
(undergraduate medical education), residency (Graduate Medical Education-
GME), and continuous education and improvement (continuing medical
education). Medical school is usually a four-year course; on completion of 4 years
the doctors then choose their desired area of speciality to take up residency in that
field termed as ‗Graduate Medical Education‘. The American Association of
Medical Colleges governs the conduct of an entrance examination called as
Medical College Admission Test (MCAT). According to the website of AAMC,
the MCAT is a standardized, multiple-choice, computer-based test that has been a
part of the medical school admissions process for more than 90 years and is taken
up by more than 85,000 students every year. The MCAT scores are shared with
medical colleges all over the country to which the students apply separately.
AAMC states that the MCAT exam has undergone several changes and of late two
new sections covering critical thinking as well as behavioural and social sciences
have also been added. Medical education programs leading to an MD are
accredited by the Liaison Committee on Medical Education (LCME) and jointly
5
sponsored by the AAMC certified by the U.S. Department of Education. The USA
with a population of 333,287,557 has 173 medical colleges to impart medical
education. However, it is worthmentioning here that the U.S.A. has a high influx of
International Medical Graduates due to lucrative income and the state-of-the-art
medical facilities in the country. Despite this fact, AAMC has predicted that by
the year 2034, U.S.A. may face a shortage of 124,000 physicians in primary care.
A speciality-wise number of physicians currently practicing in U.S.A. is depicted
in the Figure 1.1 below:
1.13 Another notable feature, according to the website of AAMC, is the resident
database and tracking system introduced in March 2000 known as GME Track.
This dataset has reduced duplicative reporting by replacing the AAMC's and
AMA's previously separate GME surveys. The GME track provides a real-time
database on medical graduates under residency and provides medical students,
residents, and the academic medicine community with information about specific
6
programs through online search tools (e.g., FREIDA™, the AMA Residency &
Fellowship Database®; and AAMC‘s Residency Explorer). GME Track data is
widely used by policy analysts to make informed decisions and conduct research
studies and outcomes evaluations.
United Kingdom
1.14 Medical Education inthe United Kingdom (UK) is a 4-year to 5-year course.
The General Medical Council (GMC) established under the Medical Council Act
of 1983 comprising 11 members (appointed following an independent appointment
process) isprimarily responsible for deciding which doctors are qualified to work in
the UK, overseeing UK medical education and training, setting the standards
doctors need to follow throughout their careers andtake action, where necessary, to
prevent a doctor from putting the safety of patients, or the public's confidence in
doctors, at risk. As a governing authority, they also play a key role in quality
assurance, registration, licensing, and setting up the professional standards of
medical practitioners in the country. Admission to medical colleges is based on the
results of two types of standardised tests: the British Medical Admission Test
(BMAT) and the UK Clinical Aptitude Test (UCAT); tests need to be taken
depending on the university preferred by the students. There are 38 medical
schools (excluding 9 medical colleges that are currently under review by the
General Medical Council) for the UK population of around 67 million. According
to the General Medical Council Report titled ‗The State of Medical Education and
Practice in the UK: Workforce Report 2023‘ since 2019, the number of doctors
joining the workforce each year has been more than double the number who leave,
and that this growth is strongly driven by international medical graduates (IMGs)
joining the UK medical profession. According to an article in the journal of the
Royal College of Surgeons, the UK has 2.8 doctors per 1,000 people which it states
as being comparatively lower than the average of 3.4 per 1,000 persons.
Source: Website of General Medical Council of UK
7
China
1.15 According to an article in the Lancet Journal, China has multiple, distinct
medical education pathways that can last from 3 to 8 years. China had merely 22
medical colleges in 1949 and by 2020 more than 200 medical colleges were in
existence. Also, China enrolls approximately 8,00,000 lakh students every year.
This has helped China achieve a ratio of 2.2 doctors per thousand population
(Source: World Bank 2019). According to an article in the Journal of the
Association of American Medical Colleges, China has complex levels of programs
designed to train doctors which include a 3-year junior college medical program, 5-
year medical bachelor‘s degree program, ―5 + 3‖ medical master‘s degree program,
and 8-year medical doctoral degree program. The article also states that at present
postgraduate education in China includes standardized residency, general
practitioner training, and specialist training.
1.16 The Committee has observed that countries across the world have
adopted the Flexner Model changing it suitably whenever required.The
Committee, on scrutiny of various governing authorities for medical
education across the countries mentioned above, has observed that the
National Medical Commission of India meets international professional
standards in medical education. The Committee has further observed that
barring a few countries at the global level,the shortage of doctors at present or
for the future seems to be an all-pervading problem. The developed countries
are able tomeet this shortfall by serving as attractive destinations for medical
graduates from developing countries and by easing the process for the
practice of medicine by the International Medical Graduates. In the context of
the standardised tests for medical education, the Committee has taken note of
the fact that behavioural and social sciences are also becoming part of the
testing process of various countries to assess the ethics, integrity, etc. of the
medical aspirants.
China’s Bewildering Medical Education Pathways, Dan Shan, The Lancet, Volume 401, Issue 10381, P999-1000,
March 25 2023.
8
countries. The Committee feels that this measure can help NMC to usher in
best practices followed around the world and help in making NMC an
institution par excellence.
National Medical
Commission
(NMC)
9
Figure 1.4: Structure of NMC
1.21 The Committee notes that the National Medical Commission (NMC) has
an excellent opportunity to improve the quality of medical education in India.
However, it must address various issues related to modernising medical
education and introduce reforms to bring remarkable improvements in the
overall healthcare system in the country. The NMC can take several essential
and immediate steps to strengthen medical education in India, including
setting and enforcing high standards for medical education, promoting
research in medical education, supporting faculty development, and making
medical education more accessible. The Committee believes that by taking
these steps, the NMC can help to produce a new generation of highly qualified
and competent medical graduates.
10
•Reduce medical errors
Improve
•Increase patient
Patient
satisfaction
Outcomes
•Reduce healthcare costs
11
not only secure the present generation‘s healthcare needs but also be an
investment in the future of healthcare.
12
Chapter-II
2.1 The Secretary, Ministry of Health and Family Welfare, in his deposition
before the Committee, apprised that there are 702 medical colleges in the country
in 2023-24, up by 81% from 387 in 2013-14. Similarly, the number of seats for an
undergraduate course (MBBS) increased by almost 110% from 51348 in 2013-14
to 1,08,990 in 2023-24, whereas the number of postgraduate seats increased by
almost 118% from 31185 to 68073 from 2013-14 to 2023-24.
2.2 As per the latest data by the National Testing Agency, 20,87,462 candidates
registered for the exam this year, out of which 20,38,596 candidates appeared in
the examination and 11,45,976 candidates finally managed to clear the NEET UG
examination.
1500000
1145976
1000000
500000
107658
0
13
2.3 As per theNational Board of Examinations (NBE) a total of 2,08,898
candidates appeared for the NEET PG 2023. According to the data furnished by
the Ministry of Health and Family Welfare, there are 68073 postgraduate seats in
the country.
208898
200000
150000
100000
68073
50000
0
Number of PG seats in India Number of Candidates appeared in NEET PG 2023
2.4 The Committeenotes that the current situation regarding medical seats
both in UG and PG in our country is a critical issue that warrants immediate
attention. With an annual influx of approximately 2 million aspiring medical
students at UG and only 1/20times available seats, the demand far exceeds the
availability of seats, similarly, the number of available seats at PG level is far
less than the demand. The Committeeacknowledges the urgency of addressing
this challenge while maintaining the quality of medical education at its highest
standard. To address this issue effectively, several measures can be taken.
First and foremost, there is a need to significantly increase medical seats in
both undergraduate and postgraduate courses. The government's existing
scheme, which focuses on the establishment of new medical colleges attached
to district or referral hospitals, can be instrumental in achieving this goal. By
14
expanding this initiative, the Government can create more opportunities for
aspiring medical students.
2.7 The States with larger populations should have more medical colleges as it
aligns with the principle of ensuring that healthcare and medical education
resources are proportionate to the population's needs. States with higher
populations often face increased healthcare demands, and having more medical
colleges can help address these needs, providing access to medical care and
educational opportunities for a more significant number of residents. Other factors,
such as the distribution of healthcare facilities, the prevalence of diseases, and the
socio-economic conditions of the population, must also be considered to ensure
equitable healthcare access and medical education opportunities for all citizens.
(Refer Tables A & B at Annexure)
15
Figure 2.3: State-wise total Medical Seats
2.8 Below is the data representation of the five most populous States and the
number of medical colleges functioning in these States.
16
Population vs MBBS Seats in some States
25000000
Uttar Pradesh
20000000
Population of the State*
15000000
Bihar Maharashtra
10000000
Rajasthan Tamil Nadu
50000000
0
0 10 20 30 40 50 60 70 80 90
* as per population projectoin for
Number of medical Colleges as per NMC Indian States 2011-2036 Report by
MoH&FW (2021 year)
2.10 The Guideline reads- "After AY 2023-24, the Letter of Permission (LOP) for
starting new medical colleges shall be issued only for an annual intake capacity of
50/100/150 seats".
2.11 The Committee has taken note of the detailed Minimum Standards
Regulations (UG-MSR) notified on 16th August 2023. While examining the
subject, the Committee came across several concerns over some of the
guidelines for opening of a new Medical College and also regarding
permission to increase the number of undergraduate seats. The permission for
17
an increase in MBBS seats will be granted for 50, 100 and 150 seats from the
academic year 2024-25. The Committee notes that based on the guidelines for
200 and 250 seats at various places have provisions for infrastructure and
faculty positions. The Committee further notes that many medical colleges
have 200 and 250 seats. The Committee was apprised that the ideal batch size
for a faculty to impart teaching is 150. The Committee, however, believes that
as per the guidelines, given the infrastructure and faculty position required in
place, a college, whether old or new, may be considered for granting
permission to increase, in phases, the undergraduate seats up to a maximum
of 250.
2.14 The Committee notes that a travel time of 30 minutes between the
college campus and the attached hospital has been prescribed in the
18
guidelines. The Committee while taking cognisance of the rationale behind
this travel time criteria fails to understand the logic behind keeping separate
distance criteria of 30 kilometres (Tier-I cities) and 50 kilometres (for other
cities) between RHTC/UHTC/CHC and the medical college. The Committee
recommends the National Medical Commission review this criterion and
consider incorporating suitable travel time instead of distance.
2.15 The earlier medical education system focused on specific subjects and a
fixed timetable. The new undergraduate (UG) curriculum, however, has a different
goal: it emphasizes all three aspects of learning - cognitive (knowledge), affective
(attitudes), and psychomotor (skills), rather than concentrating solely on
knowledge as the previous curriculum did. In the past, evaluations mainly focused
on end-of-term assessments and provided little room for feedback. Teaching and
assessment prioritized knowledge over skills and attitudes. As a result, graduates
lacked certain essential clinical and soft skills like effective communication,
building doctor-patient relationships, professionalism, and ethics despite having
solid theoretical knowledge. To solve these issues, the Undergraduate Medical
Education Board (UGMEB) of the NMC published the final Competency-Based
Medical Education (CBME) Regulations, 2023, on 01 August 2023. CBME
defines competency as the observable ability of a healthcare professional that
integrates knowledge, skills, values, and abilities, ensuring that graduates meet the
demands of patient care in society.
19
Furthermore, the Committee feels that the transition to CBME will require
significant changes to medical education programs; therefore, medical
colleges will need support, includingaugmentingfaculty training and access to
resources from the NMC and other stakeholders in making this transition.
The Committee also notes that medical colleges in India vary widely regarding
resources, faculty expertise, and student demographics. The CBME guidelines
should consider this diversity and be flexible enough to be implemented in
different settings.To maintain the true spirit of CBME, the Committee feels
that there should be a regular periodic review and monitoring of the medical
curriculum.
2.17 The new UG curriculum aims to help students transition from acquiring
knowledge to acquiring practical skills. Achieving this shift depends on aligning
and integrating various disciplines. Key elements of the revised curriculum include
foundational courses (FC), early exposure to clinical practice (ECE), training in
attitudes, ethics, and communication (AETCOM), elective opportunities, and
alignment and integration of different areas of study. Additionally, the curriculum
promotes electives, self-directed learning, problem-based learning, structured
feedback, and maintaining a logbook.
2.20 The Committee was apprised of the fact that some private medical
colleges seemingly fail medical graduates deliberately during mid-semester
exams which results in repetition of the semester, and charging additional fees
for repeating the semester or exam. This practice causes tress on the medical
students, financial and otherwise. The Committee therefore recommends that
UGMEB may develop appropriate feasible modalities for monitoring
assessment, revaluation, etc. without charging any additional fee.
2.23 The Committee observes that in recent years,ICMR and DHR have started
giving small funds for dissertations. They have also set up a network of
laboratories inside many medical colleges. However, overall budgetary allocation
in India is still substantially low. As informed by the Department of Health
Research (DHR), the statement indicating allocation at the BE stage during the last
three years and actual expenditure w.r.t percentage of GDP of India (previous five
years) is as follows: -
(Rs. in crores)
Year BE BE Actual Actual health Health research
Allocation allocation as Expenditure research expenditure as
percentage expenditure percentage of GDP
of Total as percentage for US, UK and
Health of GDP China
Budget
2021-22 2663.00 3.60 % 2690.60 0.02 % As per the World
2022-23 3200.65 3.71 % 2332.62 0.02 % Bank data, current
(upto health expenditure
31.01.2023 2017 (from internet)
2023-24 2980.00 3.34 % - 0.02 % health research
expenditure in US
and UK as a
percentage of GDP
is 0.65 % and 0.44
% respectively.
Source: Department of Health Research (DHR)
2.25 The Committee recommends the NMC encourage the medical colleges
to develop a tradition of research in the college so that upcoming MBBS
students and later MD / MS students gain sufficient exposure in the research
ambience of the institute. Furthermore, colleges should incentivize quality
research both at the student and faculty level.
2.27 The average MBBS course fees across Government colleges in India (both
centrally funded, and State Government funded) can reachRs. 50,000 per annum.
However, such subsidized medical education can only be availed by a select few
who perform exceedingly well in the NEET UG exam. As per the information
furnished by the Ministry of Health and Family Welfare, there are only 56,193
Government seats in MBBS and as per NTA, more than 11 lakh candidates
qualified for the NEET UG exam in 2023. Therefore, more than 10 lakh MBBS
aspirants are left either to opt for MBBS seats in private medical colleges where
the course fees can range up to 1.5 crores or to pursue their dream in countries like
China, Ukraine, and Russia, where the cost is lower in comparison to private
colleges in India.
23
KGMU, Lucknow (State Institution) Rs. 24,000
2.29 The Committee was apprised that there is significant variation among
the States/UTs in the amount of fee charged; the cost of medical education
ranges between a whooping 60 lakh and one crore rupees, or more. In order
to alleviate the financial stress on the students, the Committee recommends
that the Ministry, in collaboration with States, consider need-based
scholarships to deserving students. Other suggestive options that can be
explored are – running the medical college and hospital on a PPP model,
giving tax benefits to the company/group, etc. The Committee, however,
further recommends prescribing minimum marks in the NEET-UG exam for
each category of students seeking admission.
24
covering their tuition fees. These scholarships could be funded through
government and private sector contributions, creating an accessible path to
medical education for all.
25
Chapter-III
3.2 According to the reply of the Union Health Minister in Rajya Sabha in
August 2023, about 5,527 faculty positions in all AIIMS have been sanctioned, of
which, 2,161 are vacant currently. AIIMS, New Delhi which is a premier institute
also faces severe faculty crunch with almost 347 faculty positions lying vacant and
this accounts for almost 28% of the total sanctioned strength.
26
a) There are significant delays in the recruitment process, often extending from the
approval stage to the actual job advertisements, lasting as long as 2 to 4 years.
c) The preference for job postings in major urban centers or near one's hometown
is a prevailing trend.
27
the inclination to teach at the college level. To address the issue of ghost
faculty and ensure that the available faculty comes to the college to teach,
the Committee recommends the Government to strictly enforce the
regulations already in place to curb the problem of ghost faculty and zero
attendance. NMC should conduct regular inspections of medical colleges
and take action against colleges that are found to be violating the
regulations.
28
3.8 The Committee notes that the NMC's "Teacher's Eligibility
Qualifications in Medical Institutions Regulations, 2022", are a significant
step forward in improving the quality of medical education in India. By
requiring higher qualifications for teachers, mandating training in medical
education technology and biomedical research, and having more rigorous
promotion criteria, the new regulations will help to ensure that medical
teachers in India are highly skilled and qualified. The Committee, however,
opines that along with the rigorous promotion criteria, NMC should focus
more on Teacher-Learning Programmes than on manpower and
infrastructure. The Commission should also formulate norms to incentivize
and encourage faculty to take up training for skills improvement and devise
policies creating an ambience to kindle interest in research in the faculties.
Furthermore, the Committee recommends the NMC design and strictly
implement exhaustive training programs for faculties to enhance their
understanding of the principles, functioning, and practices of CBME.
3.9 To reform the quality of medical education and effectively implement the
CBME module, NMC, as per its Notification dated 16 August 2023, limited the
appointment of non-medical teachers in the Department of Anatomy, Physiology,
and Biochemistry to the extent of 15% of the total number of posts and zero
percent in microbiology and pharmacology subject to non-availability of medical
teachers. However, the Medical Council of India (which was replaced by the NMC
in 2019), as per its 1998 regulation, allowed up to 30% appointment of non-
medical faculty in these courses. Medical MSc degree is included in the first
schedule of the Indian Medical Council Act, 1956. Medical MSc courses were
opened for non-doctors in the 1960s to counter faculty shortage.
30
therefore, important to ensure that teachers and trainers are well prepared to
assume their responsibilities as educators".
3.13 Director, Lady Hardinge Medical College, New Delhi, in his deposition to
the Committee, stated, "Though NMC had implemented CBME in 2019, our
faculty is tuned to the previous system, they still have some inhibitions. Therefore,
faculty development programmes shall be enforced with a certain number of
programmes that one should attend in a year so that they can adapt to the newer
system".
3.14 The Committee notes that faculty development is vital for ensuring that
faculty members have the skills and knowledge they need to teach and train
students effectively. The Committee understands that in our country,
elementary, primary, and secondary school teachers must undergo training in
formal schools or colleges of education to be eligible for appointments and
promotion. Still, there is no such requirement for selecting teachers in medical
colleges in India. Therefore, the Committee recommends the NMC to release
the guidelines on the ―Faculty Development Programme" without any delay.
The policies should be formulated to support the achievement of the goal to
enhance the quality and relevance of education for future healthcare
professionals. These guidelines should encompass critical areas such as
clinical instruction, small group facilitation, large group presentations,
feedback and assessment, personal and organizational growth, leadership, and
scholarly activities. The strategies and formats for faculty development should
exhibit flexibility, ensuring they are tailored to the specific healthcare
requirements of our nation, institution, and learners. Faculty development
programs (FDPs) can encompass a range of activities, including continuing
education, on-the-job training, traditional classroom settings, in-person,
online, or via tele/videoconferences, self-paced learning, mentorship,
involvement in communities of practice, or a combination of these
approaches.
31
provide year-round access to training for medical college faculty, effectively
expanding the capacity for teacher development and establishing
standardized quality benchmarks. This may also lead to the
institutionalization of training procedures and best practices.
32
Chapter-IV
4.1 With India having the largest number of medical colleges in the world and a
record number of medical graduates passing out from these colleges every year,
quality assurance of medical education becomes a vital aspect. The NMC, since its
inception, has played a crucial role in quality assurance by setting standards for
medical education and practice, accrediting medical colleges, conducting
inspections of medical colleges, and taking corrective action against medical
colleges that do not meet the standards.
4.2 In 2023, the National Medical Commission has been granted World
Federation for Medical Education (WFME) Recognition Status for tenure of 10
years. The recognition will further enhance the quality and standards of medical
education in India by aligning them with global best practices and benchmarks.
Therecognition and reputation of Indian medical schools and professionals will
gain further impetus. Facilitation of academic collaborations and exchanges,
continuous improvement and innovation in medical education, and fostering a
culture of quality assurance among medical educators and institutions are added
advantages of WFME Recognition Status.
4.3 Secretary, Ministry of Health and Family Welfare, in his oral evidence,
apprised the Committee that "the Quality Council of India and the NMC's Medical
Assessment and Rating Board have signed an MoU for assessment of rating the
medical colleges wherein QCI will provide third party assessment of both private
and government medical colleges". According to the MoU, from the next academic
session, all medical colleges in the country, both private and public, will
mandatorily be rated and ranked. At present, the Union Ministry of Education
mandates the participation of Government medical colleges in the National
Institutional Ranking Framework (NIRF), whereas private medical colleges have
the option to partake voluntarily. Most private colleges in India are yet to be
ranked, and only institutions possessingrobust academic records choose to
volunteer for NIRF. It poses a challenge for students seeking admission to MBBS
33
or PG-medicine programs. It hinders their ability to make well-informed decisions
regarding the medical institutions they intend to enroll in.
4.6 In 2021, NMC brought the Foreign Medical Graduate Licentiate Regulations
2021 (FMGL Regulations, 2021) that govern the licensing of foreign medical
graduates (FMGs) to practice medicine in India. The regulations were introduced
in November 2021 and came into effect on December 1, 2021. The FMGL
Regulations 2021 ensure that FMGs have the same skills and knowledge as Indian
medical graduates before they are allowed to practice medicine in India. The
regulations are also designed to protect the public from unqualified medical
practitioners. According to the rules, only a foreign medical graduate shall practice
medicine in India if granted permanent registration from the respective State
Medical Council(s).
Below are some of the significant regulations of the Foreign Medical Graduate
Licentiate Regulations, 2021: -
1. FMGs must have a foreign medical degree from a country that the NMC
recognizes.
34
2. FMGs must have completed a one-year internship in the same foreign
medical institution where they obtained their degree.
4. FMGs who have obtained their medical degree from a country the NMC
does not recognize must pass the Foreign Medical Graduate Exam (FMGE)
to get provisional registration in India.
6. FMGs must clear the National Exit Test (NExT) to obtain permanent
registration in India. The NExT is a single national examination to be
conducted for both Indian and foreign medical graduates.
4.7 The Committee believes that the FMG Regulations 2021 are a pivotal
framework to maintain and uphold the quality of medical professionals in
India. However, these regulations must adopt a facilitative role rather than
imposing unwarranted obstacles in the registration and internship process for
foreign medical graduates. The NMC should address the inconsistencies in
granting permanent registration to foreign medical graduates across various
States. The Committee recommends the NMC strike a balance between
quality assurance and inclusivity, ensuring that bureaucratic or procedural
impediments do not unduly burden foreign medical graduates who meet the
necessary standards. By acting as facilitators, regulatory authorities can
streamline the registration and internship procedures, enhancing the
integration of foreign medical graduates into the Indian healthcare system.
4.8 Alternatively, the Committee has also taken note of the fact that with
the expansion of the number of medical colleges in India, the reliance on
Foreign Medical Graduates to maintain the doctor to population ratio may
dwindle in the near future. Moreover, the Committee has also come across the
fact that given the high standards of medical education in India, several
FMGs are unable to clear the examination process despite several attempts.
35
Given the future scenario, the Committee recommends that the Government
take a serious view on this issue and come up with some advisories to dissuade
students from pursing medical education abroad.
4.10 In June 2023, the National Medical Commission developed the NMC Exit
Test Regulations 2023 (NEXT Regulations, 2023). The test was to replace the final
MBBS examination, act as a licentiate exam for grant of registration to practice
medicine, and provide a basis for entry to postgraduate courses instead of NEET-
PG. The NExT would be a medical licensing exam that is designed to assess the
competency of medical graduates. However, in July 2023, NMC has videnotice
statedthat "the National Exit Test (NExT) examination is deferred on the advice of
the Ministry till further directions".
4.12 Given the pivotal role the NExT exam is poised to play in medical
education, the Committee recommends the Government exhaustively examine
the implications of implementation. The Committee advocates for meticulous
36
due diligence in addressing the concerns of all relevant stakeholders.
Furthermore, the Committee recommends that the Government allocate
ample time for thorough preparation and provide an early release of the exam
schedule, along with other relevant details regarding the examination. This
will enable the first batch of candidates to prepare adequately and smoothly
transition to the new examination format. Additionally, considering the
diverse background of medical colleges from which the first batch of NExT
aspirants would come, the Committee suggests that the evaluation criteria
should be moderate. It is imperative to ensure that no group of graduates
faces an undue advantage or disadvantage in the examination. Striking a fair
and equitablebalance in the evaluation process will be pivotal in ensuring the
success and fairness of the NExT exam.
4.14 Improving the quality of medical education in India is crucial for producing
well-trained healthcare professionals who can provide high-quality patient care. To
achieve this goal, the Committee feels that a holistic approach to enhance the
quality of medical education has to be taken for India to achieve its targets
concerning the 3A‘s of healthcare - affordability, accessibility, and availability. In
this regard, the Committee would like to mention otherkey aspectsthat need to be
addressed to enhance medical education in India, as listed hereunder:
1. Curriculum Revision:
37
Update the medical curriculum to align with international standards
toinclude the latest advancements in medical science.
2. Faculty Development:
38
Promote interdisciplinary education to foster collaboration between
healthcare professionals, including doctors, nurses, and allied health
professionals.
8. Research and Innovation:
10.Use of Technology:
39
Encourage medical colleges to seek accreditation from reputable
bodies to ensure they meet quality standards.
15.Community Engagement:
Given the fact that most students pursue their medical education in
States in which they are not domiciled, the Committee feels that
UGMEB can design local language learning modules for medical
graduates evincing interest in learning the local language. Such a
move would go a long way in paving the way for establishing
effective communication between the doctor and the patient.
18.Review of retirement age of doctors
4.15 Continuing Medical Education (CME): The Committee feels that there
is a need to introduce regulatory provisions for CME covering the Teachers,
40
practicing Doctors and students pursuing higher medical education. The
Committee is of the view that CME enables healthcare professionals to
maintain, enhance, and update their knowledge, skills, and competencies
throughout their careers. It is a very crucial aspect of professional
development in the medical field which ensures that doctors are aware of the
latest advancements in medicine, technology, and healthcare practices. This
ultimately results in achieving better patient outcomes. The Committee,
therefore, recommends that UGMEB and PGMEB explore the possibility of
including components such as attending workshops, conferences, seminars,
publishing papers in medical journals, etc. for medical students, and as an
incentive measure such students/faculty/medical professionals can earn extra
credits for partaking in them. The Committee hopes that the CME being a
dynamic and evolving process would enable medical practitioners to provide
high-quality care while staying current in the ever-evolving healthcare
landscape.
4.16 The Committee is of the view that improving the quality of medical
education is a long-term endeavor that requires the commitment of governments,
educational institutions, healthcare providers, and regulatory bodies. India is on the
right track to enhance the quality of its medical education system; and by
addressing the critical aspects highlighted in this Report, the country can achieve
the desired outcome of producing highly skilled healthcare professionals.
41
RECOMMENDATIONS/OBSERVATIONS — AT A GLANCE
The Committee has observed that countries across the world have
adopted the Flexner Model changing it suitably whenever required.The
Committee, on scrutiny of various governing authorities for medical
education across the countries mentioned above, has observed that the
National Medical Commission of India meets international professional
standards in medical education. The Committee has further observed that
barring a few countries at the global level, the shortage of doctors at present
or for the future seems to be an all-pervading problem. The developed
countries are able to meet this shortfall by serving as attractive destinations
for medical graduates from developing countries and by easing the process for
the practice of medicine by the International Medical Graduates. In the
context of the standardised tests for medical education, the Committee has
taken note of the fact that behavioural and social sciences are also becoming
part of the testing process of various countries to assess the ethics, integrity,
etc. of the medical aspirants.
(Para 1.16)
(Para 1.17)
(Para 1.18)
The Committee notes that the National Medical Commission (NMC) has
an excellent opportunity to improve the quality of medical education in India.
However, it must address various issues related to modernising medical
education and introduce reforms to bring remarkable improvements in the
overall healthcare system in the country. The NMC can take several essential
and immediate steps to strengthen medical education in India, including
setting and enforcing high standards for medical education, promoting
research in medical education, supporting faculty development, and making
medical education more accessible. The Committee believes that by taking
these steps, the NMC can help to produce a new generation of highly qualified
and competent medical graduates.
(Para 1.21)
43
and continuous learning, ensuring that healthcare practitioners stay up to
date with medical advancements. In this way, quality medicaleducation would
not only secure the present generation‘s healthcare needs but also be an
investment in the future of healthcare.
(Para 1.22)
The Committee notes that the current situation regarding medical seats
both in UG and PG in our country is a critical issue that warrants immediate
attention. With an annual influx of approximately 2 million aspiring medical
students at UG and only 1/20times available seats, the demand far exceeds the
supply, similarly, the number of available seats at PG level is far less than the
demand. The Committee acknowledges the urgency of addressing this
challenge while maintaining the quality of medical education at its highest
standard. To address this issue effectively, several measures can be taken.
First and foremost, there is a need to significantly increase medical seats in
both undergraduate and postgraduate courses. The government's existing
scheme, which focuses on the establishment of new medical colleges attached
to district or referral hospitals, can be instrumental in achieving this goal. By
expanding this initiative, the Government can create more opportunities for
aspiring medical students.
(Para 2.4)
(Para 2.5)
44
Encouraging private investment in medical education is another avenue
to explore. Providing incentives and regulatory support to private institutions
willing to establish medical colleges can not only increase seat availability but
also introduce healthy competition and innovation in medical education. The
Committee also recommends the Ministry leverage technology for distance
learning and organise virtual classrooms that can be a supplementary solution
to address the shortage of seats, allowing a more significant number of
students to access medical education without overburdening physical
infrastructure.
(Para 2.6)
(Para 2.11)
45
the concern area associated with opening a new medical college is the number
of prescribed department-wise and total patient Bed capacity, read along with
the requirement of their 80 per cent average occupancy in the attached
hospital. The Committee would recommendthe Government that such one-
size-fits-all criterion prescribed in the UG-MSR may be revisited to take into
account the geographic imbalances, if any, and formulate region-specific
guidelines/ norms.
(Para 2.12)
(Para 2.13)
(Para 2.14)
46
Evaluation of the existing curriculum and its relevance to healthcare needs,
the need for transformation
47
knowledge and technical skills; it hinges on empathy, compassion, and
effective communication. By instilling these qualities in future healthcare
professionals, we can significantly enhance the overall quality of patient care.
Therefore, the Committee recommends the Government ensure that the
AETCOM module is enforced consistently and effectively to empower medical
students with the essential attributes needed to provide holistic and patient-
centered healthcare. In addition to the implementation of AETCOM, the
Committee recommends the incorporation of these criteria in NEET so that
the aptitude of aspiring medical students can be assessed. Such aptitude tests
at the entrance level go beyond mere knowledge assessment of aspirants, often
obtained through rote learning and mastering MCQ-based exams, and
evaluate the genuine interest and passion of the candidate for the field of
medicine. It will enable the system to identify candidates who have a sincere
calling for the profession and distinguish them from those who may be under
external pressure or legacy expectations. By doing so, we can ensure that
medical work continues to attract individuals who are genuinely committed to
delivering high-quality healthcare.
(Para 2.18)
The Committee was apprised of the fact that some private medical
colleges seemingly fail medical graduates deliberately during mid-semester
exams which results in repetition of the semester, and charging additional fees
for repeating the semester or exam. This practice causes stress on the medical
students, financial and otherwise. The Committee therefore recommends that
UGMEB may develop appropriate feasible modalities for monitoring
assessment, revaluation, etc. without charging any additional fee
(Para 2.20)
48
Research Support and facilities
(Para 2.24)
(Para 2.25)
(Para 2.26)
(Para 2.29)
(Para 2.30)
50
shaping not only the knowledge and skills but also the ethical foundations of
future medical practitioners. The Committee believes that whether it is the
expansion of medical colleges or the implementation of progressive
initiatives like NMC's Competency-Based Medical Education (CBME)
module, the efficacy of these reforms hinges on the availability of a
dedicated, skilled teaching force. The shortage of qualified teachers is a
common thread in both scenarios and addressing this issue is paramount. In
this regard, the Committee has taken note of the findings of NMC for 246
medical colleges. The Committee views that NMC's efforts, like AEBAS-
based attendance CCTVs in colleges, have yet to deliver much as issues like
ghost faculty and zero faculty attendance have only escalated as per the
NMC's assessment. Therefore, the Committee is of the consensus that the
faculty shortage issue in India is twofold: first, there is a genuine shortage of
qualified faculty members, and second, even the available faculty often lacks
the inclination to teach at the college level. To address the issue of ghost
faculty and ensure that the available faculty comes to the college to teach,
the Committee recommends the Government to strictly enforce the
regulations already in place to curb the problem of ghost faculty and zero
attendance. NMC should conduct regular inspections of medical colleges
and take action against colleges that are found to be violating the
regulations.
(Para 3.5)
51
excellence in teaching, research, and clinical work need to be chalked out.
Regular performance evaluations are crucial in identifying and addressing
concerns promptly.
(Para 3.6)
(Para 3.8)
52
transitional period that allows non-MBBS faculty members to continue
teaching these subjects until enough MBBS-qualified educators become
available. This gradual shift will ensure that students continue to receive a
comprehensive education as the transition toward competency-based learning
takes place. Furthermore, it is crucial to emphasize faculty development for
non-MBBS educators, offering them opportunities to enhance their teaching
skills and align their curriculum with evolving standards in medical
education. This will help them remain effective contributors to medical
education. Non-MBBS educators often bring unique perspectives and
expertise to the field. Rather than limiting their involvement, their expertise
can be integrated into the education system through collaborative efforts,
interdisciplinary research, and innovative teaching methodologies.
(Para 3.10)
The Committee notes that faculty development is vital for ensuring that
faculty members have the skills and knowledge they need to teach and train
students effectively. The Committee understands that in our country,
elementary, primary, and secondary school teachers must undergo training in
formal schools or colleges of education to be eligible for appointments and
promotion. Still, there is no such requirement for selecting teachers in medical
colleges in India. Therefore, the Committee recommends the NMC to release
the guidelines on the ―Faculty Development Programme" without any delay.
The policies should be formulated to support the achievement of the goal to
enhance the quality and relevance of education for future healthcare
professionals. These guidelines should encompass critical areas such as
clinical instruction, small group facilitation, large group presentations,
feedback and assessment, personal and organizational growth, leadership, and
scholarly activities. The strategies and formats for faculty development should
exhibit flexibility, ensuring they are tailored to the specific healthcare
requirements of our nation, institution, and learners. Faculty development
programs (FDPs) can encompass a range of activities, including continuing
education, on-the-job training, traditional classroom settings, in-person,
online, or via tele/videoconferences, self-paced learning, mentorship,
53
involvement in communities of practice, or a combination of these
approaches.
(Para 3.14)
(Para 3.15)
(Para 4.4)
(Para 4.5)
54
Foreign Medical Graduates
The Committee believes that the FMG Regulations 2021 are a pivotal
framework to maintain and uphold the quality of medical professionals in
India. However, these regulations must adopt a facilitative role rather than
imposing unwarranted obstacles in the registration and internship process for
foreign medical graduates. The NMC should address the inconsistencies in
granting permanent registration to foreign medical graduates across various
States. The Committee recommends the NMC strike a balance between
quality assurance and inclusivity, ensuring that bureaucratic or procedural
impediments do not unduly burden foreign medical graduates who meet the
necessary standards. By acting as facilitators, regulatory authorities can
streamline the registration and internship procedures, enhancing the
integration of foreign medical graduates into the Indian healthcare system.
(Para 4.7)
Alternatively, the Committee has also taken note of the fact that with
the expansion of the number of medical colleges in India, the reliance on
Foreign Medical Graduates to maintain the doctor to population ratio may
dwindle in the near future. Moreover, the Committee has also come across the
fact that given the high standards of medical education in India, several
FMGs are unable to clear the examination process despite several attempts.
Given the future scenario, the Committee recommends that the Government
take a serious view on this issue and come up with some advisories to dissuade
students from pursing medical education abroad.
(Para 4.8)
55
quality of medical education and training in India and makes the process of
licensure and postgraduate admissions more transparent and fairer. The Act
provides for three years for unrolling of NExT, the Committee has taken note
that NExT is yet to be implemented.
(Para 4.11)
Given the pivotal role the NExT exam is poised to play in medical
education, the Committee recommends the Government exhaustively examine
the implications of implementation. The Committee advocates for meticulous
due diligence in addressing the concerns of all relevant stakeholders.
Furthermore, the Committee recommends that the Government allocate
ample time for thorough preparation and provide an early release of the exam
schedule, along with other relevant details regarding the examination. This
will enable the first batch of candidates to prepare adequately and smoothly
transition to the new examination format. Additionally, considering the
diverse background of medical colleges from which the first batch of NExT
aspirants would come, the Committee suggests that the evaluation criteria
should be moderate. It is imperative to ensure that no group of graduates
faces an undue advantage or disadvantage in the examination. Striking a fair
and equitablebalance in the evaluation process will be pivotal in ensuring the
success and fairness of the NExT exam.
(Para 4.12)
56
(Para 4.13)
(Para 4.15)
*****
57
Annexures
Table-A
Registered Medical Practitioners in India: State-wise
58
59
Table B
State-wise distributionof medical seats(course-wise)
60