Should there be an ‘Exit Test’ for MBBS graduates?

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Should there be an ‘Exit Test’ for MBBS graduates?

Saturday, March 22, 2014

by Dr Praveenlal Kuttichira

‘The Hitavada – The People’s Paper’ of March 10 carried an article titled MCI clears ‘Exit Test’ for MBBS pass-outs. The article was written by Mr Vikas Vaidya from Nagpur dated Feb 9. The matter never appeared in the General Council of MCI, but appeared in press. Hence, I also opt for a response in press.

Dr Praveenlal Kuttichira

Dr Praveenlal Kuttichira

The report mentions five decisions of the Academic Council of MCI. (1) After the MBBS course, every graduate has to clear an ‘exit test’ to be eligible for getting registration to practice in India. (2) There will be a reduction of the duration of the course of MBBS by one year – a reduction from 4.5 years to 3.5 years. (3) In the beginning itself, there will be choice for the students to select area of specialisation and learn only those subjects related to it. (4) MCI will develop its own mechanism for accreditation of the medical colleges. (5) The Academic Council will have the powers to formulate any academic courses in Medicine.

At the time of elections, parties and establishments of democracy will withdraw all of its pseudopodia and limit the function only to campaign or conduct of elections. But all these five decisions are so important that it should not creep in unnoticed. There is a need for threadbare discussions before implementation. I am not intending to comment on the powers of Academic Council over and above the statutory council like Medical Council of India. Let the Council decide on that.

As on today, every student has to pass through 23 (21 compulsory and 2 optional) departments in 4.5 years time to get a degree. This will require passing 14 examinations with theory papers (total of 24 papers) and practical or clinics. No single exit examination can be an alternative for this. To replace all the end semester examinations with one exit examination would require a full month at the exit for the conduct of examinations of all subjects. That sort of examination will be unrealistic and cruel. It will not serve the purpose of an examination. One exit examination covering all subjects will be a mere joke. The ‘exit examination’ would be a ‘one more examination’. But will it assess a candidate better?

If it is the exit examination, which is going to make a graduate eligible for registration to practice, what would be the value of the degree awarded by the university? Value less degree will undermine the motivation of students and will deter them from attending regular training programmes of the university. It will keep them away from teachers and the system. The degrees offered by all the Indian universities ranging from All India Institute of Medical Sciences to Datta Meghe Institute would be of scrape value.

A nationwide examination for higher education would be acceptable if it is conducted neat. But that will be only an eligibility test for pursuing PG courses, which require degree as foundation. If variability of standards of university degrees is the problem, MCI has to examine the matter and develop remedial mechanisms after taking the universities into confidence.

The whole issue of BRMS (Bachelor of Rural Medicine and Surgery) arose because of reduction in the period of study. On agreeing to start BRHC (Bachelor of Rural Health Care), the same MCI made it a point that holders of that degree will be a separate group and registration would be in a separate register kept by state medical councils. The very MCI is now reducing the period of its own MBBS course. When it comes to reduction in the duration, the crucial question is which subject is going to have the cut. Usually every expert rigidly sticks on to present duration of training in own subject, but ask for a cut in others’ subjects. If a consensus can be reached and if it is based on any unequivocal evidence, it should be acceptable. When the whole Medical Science is developing at a fast pace, the requirement would be an increase in the duration of course as in other countries. But the matter can be debated.

Option for the students to choose specialisation at the beginning and learn only the subjects related to it is a matter of major concern. Can a student before ‘primary education’ in medical science make a proper choice of specialisation? Only after 10 years of schooling, a student gets chance for a choice for +2. A surgeon ignorant of Gynaecology is not imaginable. A patient on the operating table if seen to have an additional problem related to Uterus cannot be kept waiting on the table for a Gynaecologist to come. At the same time a neurosurgeon ignorant of taking delivery is acceptable. A direct path to super-specialisation can avoid learning unnecessary subjects. But that doctor can serve only in a super-speciality hospital of concerned specialisation. Doctors with qualifications like that will suit only to super-speciality hospitals of metros run by corporates. Can the country afford to have it, especially when we have miles to go before reaching doctor patient ratio according to the WHO norms? A generalist with specialisation is the trend in elsewhere too. Though personally I believe the country is not ripe enough for that, the proposal is worth considering.

MCI developing its own mechanism of accreditation is a welcome proposal. Shredding away with the present pattern of inspections is long due. Time and again it not only proved its inefficiency, but also corrupted many good doctors. An agency independent of MCI for accrediting the colleges is better than MCI itself doing that job. There should be enough checks and balances to ensure transparency, at the same time making the process as simple as possible. Allowing public scrutiny is to be considered at least at the level of appeals.

It is the responsibility of the Academic Council to make suggestions for starting courses, but that small body should not be deciding on it. Wider discussions are needed for that. In any case it is better that one who suggests is not the one who decides. The one who executes should be yet another. Everything should happen only after all the stakeholders could air their views. Ours is a Democratic country. There is no ‘winner for ever’ in Democracy. Periodical revalidation is a must.

Dr Praveenlal Kuttichira
Professor of Psychiatry and Principal, Govt Medical College, Thrissur
On deputation as Dean (Research), Kerala University of Health Sciences
Member, Medical Council of India
Member, Governing Council, Kerala University of Health Sciences

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