The main objective of medical education should be to provide a cadre of personnel to meet the health needs of the country. In addition, any educational policy in the modern world must take into account social objectives, for example, equity and justice in enrollment and access. That aside, certain fundamental questions need answers too. For example, how many years of training are required for a medical professional? What should be the purpose of a basic medical degree? Is specialization required? If so, how much and how will it be done?
The draft of the New Educational Policy (NEP) talks about equity, inclusion and sustainable development on many points, based on the preamble. However, it is not clear in any way that their recommendations meet these objectives, especially in the field of medical education. For example, on page 300, it is established that the fees in medical schools, both public and private, will be decided by the institutions themselves. However, only a few pages later, he states that the cost of education should be reduced.
At another point, the policy document states that all private institutions must be nonprofit. It seems that the committee that drafted the report hoped that this recommendation, as well as the regulatory apparatus suggested by him, would address the problem of speculation. However, what gives him so much confidence is difficult to understand since current policy is also to consider higher education as a nonprofit company, but it has become a very important engine of the black economy, according to several reports . Although the document states at various points that no student should be deprived of education due to lack of finances, the solution he suggests is scholarships.
The fact that, on the one hand, it seeks to reduce the cost of education and, on the other hand, it is allowed that rates remain unregulated, betrays confusing thinking. With the Bill of the National Medical Commission that regulates tariffs for only 50% of the quotas in medical schools, it seems that the commitment to equity is simply a pious homily.
At various points in the policy document, the need for a flexible education system has been emphasized. A part of this flexibility is in the possibility of multiple entry and exit points. One can understand having a national entrance exam for admission to undergraduate courses. However, it is absolutely clear that having a National Exit Exam for MBBS as the mode of entry to postgraduate courses is neither flexible nor fair. Can a student be expected to take the exit test several times if the initial score is not good enough? Do all medical colleges across the country have the same standard to ensure a level playing field? Sealing the student's destiny once and for all through an exit exam is certainly not fair.
The objectives of autonomy and adaptation to local needs are contradicted by the high level of centralization in medical education by the National Medical Commission. The document considers that the separation of the functions of regulation, financing, accreditation and establishment of standards is absolutely necessary. However, the National Medical Commission has attempted to arrogate many of these functions. In addition, the recommendation that diploma courses should be extended to provide "intermediate specialists" lacks focus. What are these intermediate specialists supposed to do?
Multiple postgraduate courses have been initiated without any clear justification. The MBBS degree has degraded to such an extent that it is simply considered a necessary requirement for the graduate. One of the main drivers of the thirst for a graduate degree is the lack of respectable employment opportunities suitable for an MBBS graduate. The overwhelming privatization of the provision of health services in India has led to the concentration of personnel in those parts where the public has the ability to pay. Having a graduate degree has a multiplier effect on employability, income and respectability for the doctor. How useful it is for society is questionable.
The policy document does not recognize that the main driver of inequity in medical care is the presence of a large, poorly regulated and for-profit sector. Private interests have ensured regulatory capture in the formulation of health policies. It seems that the National Education Policy has not escaped this capture, hence the clear disconnection between repeated exhortations to ensure equity and quality and recommendations that will not achieve any.
Dr. George Thomas is an orthopedic surgeon at St. Isabel Hospital, Chennai.
. (tagsToTranslate) Education (t) Medical education (t) MBBS (t) Health care service (t) Medical (t) Postgraduate (t) Rate regulation (t) Privatization (t) Use (t) Regulatory capture (t) Inequity