RECOMENDATION OF THE KNOWLEDGE COMMISSION: SAM PITRODA

[Guest guest]

RECOMENDATION OF THE KNOWLEDGE COMMISSION

16th October, 2007

Dear Mr. Prime Minister,

The quality, the quantity, distribution and availability of human resources

for the health

sector in India at present, need to be improved substantially to deliver

care-driven, rural

oriented and equitable health services. Over the years, health related

education and

training has become more urban oriented, doctor-centric and technology-driven.

The

environment of medical education needs to be both nationally sensitive and

globally

competitive. To realize these objectives, our medical education system needs

radical

reforms.

The National Knowledge Commission (NKC) therefore considered it imperative to

carry

out a comprehensive appraisal of the system. For this purpose, we constituted

a Working

Group which included some of the most distinguished members of the medical

profession

in India, chaired by Dr. Sneha Bhargava, former Director, AIIMS. The names of

the

members of the Working Group are listed in the annexure. Based on the inputs

provided

by the Working Group and our consultations with concerned stakeholders, we

recommend the following:

1. Regulation and accreditation

& #56256; & #56451; Regulation: At present, medical education in India is

regulated by the Medical

Council of India (MCI). This system of regulation is neither adequate nor

appropriate to meet the needs of the profession. Therefore, in conformity with

our

recommendations on Higher Education, we propose constitution of a Standing

Committee within the structure of the Independent Regulatory Authority for

Higher Education (IRAHE). The primary function of the Standing Committee will

be to ensure that medical practice and teaching are updated and revised

regularly

and minimum quality standards are maintained. The members of the Standing

Committee would include faculty from recognized universities, practicing

physicians, members of civil society, students and a director from autonomous

institutions representing educators. The Chairman and the members of the

Standing Committee would be accountable to IRAHE. The Standing Committee

would look into manpower planning and development based on disease-profile,

doctor-population ratio and skill-mix ratio.

& #56256; & #56451; Professional Councils: The Indian Medical Council Act should

be amended

such that MCI functions only as a professional association, with powers to

conduct nationwide examinations, and to provide licenses for those who wish to

join the profession. Similar changes are needed for all the other Councils

viz.

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Nursing Council, Pharmacy Council, Dental Council and Rehabilitation

Council.

& #56256; & #56451; Accreditation: IRAHE should be empowered to license suitable

agencies for

accreditation. Accreditation agencies could award different degrees of

accreditation, such as “Full”, “Provisional” or “On Probation” and have the

power

to de-recognize. Institutions would have to ensure transparency in their

admission

processes, able and responsible faculties, a multidisciplinary academic

learning

environment, transparency in assessment of students and close linkages with

regional health care and delivery systems, in order to be accredited.

& #56256; & #56451; Admission: Policies of admission and fee structure of private

colleges have to

be regulated, not only to stop them from becoming sources of political and

financial power but also to arrest falling standards. There should be only one

All India Common Entrance Test for all students who would like to get

admission to Self Financing Medical Colleges. Since the CBSE conducted

examination for the 15 % All India quota in Government Medical Colleges is

taken by a very large number of students, this would appear to be the ideal

examination whose ambit can be expanded. All self-financing Medical

Colleges should announce their fees in their prospectus so that students can

make their choice for admission. Information Technology should be used to

increase transparency and efficiency in the admission, examination,

administration, teaching, content delivery and other related processes.

2. Quality

& #56256; & #56451; Curriculum: All institutions must constitute Curriculum

Committees that plan

curricula and instructional methods, which are regularly updated. The

structure

and composition of the curriculum must describe the content, scope and

sequencing of the courses, including the balance between core and optional

courses. Integration of ICT in the learning process is essential.

Incorporating new

skills like management, disciplines like health economics and frontier areas

like

bioinformatics should be considered.

& #56256; & #56451; Standards test: An independent and standardized National Exit

Examination at

the end of 4 ½ years of study, is essential to conduct a national level

assessment

of skills and knowledge. The National Exit Examination could be conducted

immediately after the University examination, and would also serve as a

postgraduate entrance exam.

& #56256; & #56451; Internship Assessment: The internship year must be assessed

to ensure skill

development. The current practice of students continuing to study in the

internship year without going to clinics needs to be addressed. There must be

compulsory rotation from the teaching hospital to the community and district

hospital during the internship period. Duration of the term in the district

hospital

should be 6 months, in the Community Health Center 3 months and in the

tertiary

care hospital the remaining 3 months. Each intern should be assigned a

“mentor”

at the district hospital and the credits should be based on the assessment by

the

mentor. The entrance to postgraduate programs should be based on a summation

of the pre & post internship examinations.

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& #56256; & #56451; Continuing Education: There is a need to revamp Continuing

Medical

Education (CME) based on distance learning. All professionals should be

required

to undergo a re-certification process every five years, which can be evaluated

by

credits earned through CME. ICT can be used extensively to provide CME at the

convenience of the learner.

3. Faculty Development

& #56256; & #56451; Teaching: Attracting and retaining quality faculty should be

accorded top

priority. Measures such as opportunities to attend international conferences

regularly, sabbaticals, dual appointments, rewarding research, fast-track

promotions, and dissociating remuneration from government pay scales should be

explored. All institutions must clearly lay down exact definitions of what

constitutes conflict of interest for faculty members in public medical

colleges,

who have a private practice in addition to their official duties, and receive

a full

time teacher’s salary. Those who flout these regulations should be penalized.

& #56256; & #56451; Research: With a view to encouraging research in medicine, a

Mentored

Medical Student Research Program should be set up as a catalyst to introduce

medical students to a potential career in patient-oriented/ community-oriented

research including interdisciplinary research. Two points of entry into PhD

programs should be considered: one after MBBS and another after MD depending

on the student’s interest. The government should facilitate setting up of

research

centers in medical colleges. Validating Indian Systems of Medicine using

biosciences

tools should form an integral component of the research effort.

& #56256; & #56451; Training: Five Regional Centers for teacher training/ faculty

development

should be set up so that teachers from the outlying regions can be sent to

these

centers periodically for up-gradation of their teaching skills.

4. Post graduate education

& #56256; & #56451; General Physicians: The medical profession needs to be

structured like a

pyramid with the base made up of general physicians. At present there is

little if

any space for such doctors in post graduate courses. Therefore, we suggest

that

adequate representation should be given to general physicians while carrying

out

expansion of post graduate seats such that fifty percent seats are reserved

for

general physicians. New streams for post graduation should be looked at based

on

needs.

& #56256; & #56451; Admissions: Admission to post graduate courses should be done

on the basis of

credits received in the National Exit Examination and pre and post internship

clinically oriented exams after internship. There is a need to reserve post

graduate

seats (upto 20% of total available seats) for graduates who have worked in

rural

areas for at least 3 years.

5. Regional balance

& #56256; & #56451; Location priorities: The number of medical colleges in

relation to population in

some states is much higher than in other states. The Central Government should

aid new colleges in these states to address this regional disparity. For

instance,

north eastern states require urgent attention in this context. The Central

4

Government can develop a list of priority sites for establishing new colleges

where the impact of new clinical facilities would benefit the surrounding

rural

population.

& #56256; & #56451; Role models: Further at least one institution should be

identified in each State

that can serve as a center of excellence and role model for the other

institutions of

the state. These institutions should have state-of-the-art infrastructural

equipment

such as research laboratories, teacher training facilities, and libraries, as

well a

talented faculty of adequate strength to act as a common resource and also to

serve as a benchmark of excellence.

Medical education cannot be standalone. It requires support in the form of

trained

nurses, pharmacists, paramedic workers. It must all also serve the essential

purpose of

delivering health care to the people. Therefore, we also set out some

recommendations

on education for supporting services and public health.

6. Education for Support Services

& #56256; & #56451; Nursing: We need to create additional capacity for training

nursing staff. In

addition, every district hospital should have attached to it a nursing school,

which

offers diploma in nursing specifically to operate primary health centers as

nurse

practitioners. A career growth pathway should be ensured for nurses after a

specific period of primary health care service. For graduate nurses in city

hospitals, specialized courses for family nurse practitioners, nurse

anesthetists and

in areas of tertiary care are recommended.

& #56256; & #56451; Pharmacy: Pharmacy education should be popularized and the

number of seats

for pharmacy education should be increased substantially. Gradual phasing out

of

untrained pharmacists should be considered.

& #56256; & #56451; Paramedics: The role of Paramedic workers should be expanded.

A

Paramedical Council needs to be immediately established, which would prepare

training programs for multi skill and specialty technicians and oversee their

delivery and quality. Paramedics, such as compounders, dressers, and

laboratory

technicians can also perform public health functions, such as health

education,

providing immunization, and first aid. Such a health worker could be trained

through vocational training at the higher secondary level followed by a one

year

diploma. Career paths should be built into their service in order to retain

them

because international demand is high.

7. Public Health

& #56256; & #56451; Education: A three tiered structure consisting of a 1 year

diploma course, a 3

year B.Sc course and a 3 year Masters course may be introduced. These programs

can be attached to departments of Community Medicine in all medical colleges

for providing hands on training. All universities, all district hospitals and

the

Public Health Foundation of India can run them.

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& #56256; & #56451; ASHA: The role of Accredited Social Health Activists (ASHA)

needs to be reconceptualized

within this framework, and ASHA must be viewed as an

accessible and effective health worker. The training period of the ASHA needs

to

be lengthened from its current duration. Steps should be taken to review the

system of remuneration and improve the working conditions of the ASHA

workers.

NKC believes that traditional systems of medicine have a great potential in

addressing the

need of health services in the country especially in the rural areas.

Recommendations on

education in traditional medicine systems will be sent in a separate letter.

We urge you to initiate action on our recommendations to ensure broad based

reforms in

medical education with a view to delivering quality manpower to provide

substantially

improved healthcare services to the common man, urban or rural. This is

essential to

continue our economic growth and improved quality of life.

We look forward to being involved in consultations for the speedy

implementation of these

recommendations.

Thank you and warm personal regards,

Sam Pitroda,

Chairman, National Knowledge Commission

Copy to:

1. Dr Montek Singh Ahluwalia, Deputy Chairman, Planning Commission

2. Sh. Arjun Singh, Minister for Human Resources Development

3. Dr. A. Ramadoss, Minister for Health and Family Welfare

Ashok Sinha

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