Medical Education in India Hits Rock Bottom

Medical education in India is facing a severe crisis. The recent NEET controversy highlights the extent of the deteriorating quality of medical education in the country. While much attention has been given to the NEET paper leak and the National Testing Agency's (NTA) mishandling of the examination, another significant issue plagues the system: the government's inaction in promoting non-clinical subjects.

For instance, clinical subjects, which involve direct patient care and interaction, include hands-on training in hospitals and clinics. These encompass disciplines such as medicine, surgery, paediatrics, obstetrics, gynaecology, orthopaedics, ophthalmology, and ENT. In contrast, non-clinical subjects like anatomy, physiology, biochemistry, pathology, and microbiology focus on the foundational sciences and theoretical knowledge essential for medical practice.

In India, clinical subjects consistently attract a large number of students each year, while non-clinical subjects struggle to find takers. The lack of interest in non-clinical disciplines for postgraduate studies has led to many vacant seats, even when some medical colleges offered these positions for free. In response, the government implemented a poorly conceived scheme of zero eligibility criteria. Although some argue this will help fill the seats and encourage students to pursue non-clinical courses, it risks significantly lowering the quality of medical education in the country.

NEET-PG Zero Percentile: A Flawed Move

The Medical Counseling Committee (MCC) recently declared that the eligibility criteria for unfilled postgraduate seats in medical colleges would now be set at "zero percentile across all categories." This drastic move by the Ministry of Health and Family Welfare (MoHFW) aims to address the issue of over 13,000 vacant PG seats in medical institutions nationwide, even after two rounds of counselling. Previously, the NEET-PG cut-off was 50 percent for general applicants, 45 percent for those in the PwD category, and 40 percent for reserved categories. Now, anyone who has taken the NEET-PG, including those with negative scores, can enrol in postgraduate courses. This decision has sparked concerns over the potential decline in the quality of medical education in the country.

Dr. KM Abul Hasan, Chairman of the IMA Junior Doctors Network states that the decision, though flawed, has been able to get the seats filled up: "Every year, there were numerous vacancies, particularly in non-clinical subjects like biochemistry and physiology. There were fewer takers for these seats. It was felt that if you reduce the eligibility criteria, there might be some people who will be willing to do these kinds of postgraduate courses. After reducing the eligibility criteria, the vacancies have become less, and seats are getting filled up.”

Dr Hasan notes that this approach, while addressing the immediate issue of vacant seats, raises questions about the long-term implications for the quality of medical education in India. “It is true that students who are getting negative marks are getting seats easily now. Whoever wrote the NEET exams would get something or the other. The quality will definitely get affected. I do not support zero percentages. The Indian Medical Association also does not support it. The IMA had advocated for a slight relaxation in the eligibility criteria to address the vacancy issue, but the NMC's decision to reduce the criteria to zero percentile is a step too far”. 

It is not just the postgraduate seats in non-clinical subjects that are going vacant; there is also a significant shortage of faculty in these disciplines. Many medical colleges struggle to attract and retain qualified educators in fields such as biochemistry, physiology, and pathology. This faculty shortage further intensifies the problem, as it diminishes the quality of education and training that can be provided to the few students who do choose to pursue these courses. Without experienced faculty to guide and mentor students, the standards of medical education in non-clinical subjects continue to decline, creating a vicious cycle of under-enrollment and under-preparation.

"We have been facing this issue for a very long time. There were also many vacancies in teaching posts in disciplines like physiology, biochemistry, and anatomy. The number of medical colleges has been increasing at a rapid pace, but the number of qualified faculty in these areas is dwindling," Dr Hasan notes. This growing disparity between the expansion of medical colleges and the unavailability of qualified educators further complicates the challenges faced by non-clinical medical education in India.

It is unimaginable that the government, in an attempt to solve one problem, could complicate it even further. By setting the NEET eligibility for postgraduate medical admissions to an unprecedented low, the government has failed to consider the long-term consequences of this decision. This new system, where everyone who takes the exam can be eligible regardless of their score, undermines the merit-based foundation of medical education. If anyone can qualify simply by taking the exam, it raises a fundamental question: why even have the exam in the first place? This approach not only devalues the assessment process but also threatens to degrade the overall quality of medical professionals in the country.

The disparity between clinical and non-clinical subjects in medical education has significantly influenced students' choices. For clinical fields such as paediatrics, medicine, and gynaecology, graduates can establish their own practices, open hospitals, and provide direct patient care, leading to potentially higher earnings and professional independence.

In contrast, graduates with degrees in non-clinical subjects like physiology, biochemistry, and anatomy face a different reality. They cannot establish their own hospitals or private practices, as their fields do not involve direct patient care. Their primary career option is to teach medical students, which limits their earning potential to their salaries as educators. They are unable to supplement their income through consultations or private practice, resulting in generally lower remuneration compared to their clinical counterparts.

Given these constraints, it is understandable why students are reluctant to pursue non-clinical subjects. The lack of financial incentives and professional opportunities in non-clinical fields makes them less attractive, leading to a persistent shortage of interest and enrollment in these critical areas of medical education.

The situation with non-clinical subjects has become so dire that many medical professionals, despite their reservations, support the zero percentile eligibility criteria. Dr. Aviral Mathur, President of the Federation of Resident Doctors Association (FORDA), comments on the lack of interest in non-clinical subjects like anatomy and biochemistry. "There are students who may be interested in these seats but were unable to meet the eligibility criteria in the past. Consequently, they would turn to private colleges, paying exorbitant fees. The zero cut-off was implemented to open the gates to all, as many students couldn't meet the previous cut-off. For instance, Maulana Azad Medical College, one of Delhi's premier institutions, has not seen a single student enrol in anatomy over the past three years. How do you get students to take up these courses then?” Dr. Mathur asks.

Dr. Sahajanand Prasad Singh, former President of the Indian Medical Association, like Dr Mathur, expresses his support for the zero percentile eligibility policy. "So many seats used to be vacant that it was important to fill them. We don't do zero percentile every year, but I support this decision. Once the student gets into a college, he or she can study and improve,” Dr Singh states. 

Reforming India's Medical Education System

Critics argue that the decision to reduce the NEET PG cut-off to zero percentile undermines the integrity of the examination and the healthcare system. Rather than merely filling up vacant seats, the government should address underlying issues such as the high fees in private medical colleges and the need for adequate stipends for all students.

Lowering the NEET PG cut-off to zero percentile shifts the focus from merit to financial means, creating an environment ripe for corruption in private medical institutions. This policy allows seats to be allocated based on students' ability to pay rather than their academic performance. Consequently, private colleges may exploit this situation by charging exorbitant fees, knowing the number of applicants will increase.

To address the lack of interest in non-clinical medical seats, the government should implement a multi-faceted approach. Financial incentives such as scholarships and grants can ease the economic burden on students, making non-clinical courses more appealing. Enhancing career opportunities by creating additional research positions and improving prospects in academia and public health can provide clearer, rewarding career paths. Tackling the faculty shortage through targeted recruitment and training programs will ensure high-quality education and mentorship. Additionally, regulating tuition fees in private colleges to prevent exorbitant charges would make these courses more accessible and equitable, encouraging a broader range of students to consider them.

This year, our medical education system has hit rock bottom, plagued by numerous controversies and allegations. From the NEET paper leaks to the drastic reduction in eligibility criteria, the integrity and quality of medical education have been severely compromised. It is evident that a complete overhaul of the system is necessary to ensure that the future of medical education in India is strong, equitable, and capable of producing highly competent professionals.

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