Professional Documents
Culture Documents
UG Medical Education
UG Medical Education
Proposed
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Final Medical Council Of India
M.C.I. OBJECTIVES FOR UNDERGRADUATE
MEDICAL EDUCATION
100
80
60 OUTCOMES
East
West
40
North
20
0 2
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
EXPECTED
OUTCOMES
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Medical Council of India
Curricular reform in Undergraduate Medical Education
INTRODUCTION
The Government of India recognises Health for All as a national goal and expects medical training
to produce capable "Physicians of First Contact" towards meeting this goal. However, the Indian
health care and medical education is facing systems and standards challenges.
The burden of diseases in India is still large. Even though there has been some improvement,
national statistics reveal wide disparities between different states as also rural/urban areas with
regard to access to basic medical services and quality health care. These are attributed to
physician shortage, both generalist and specialist, inequitable distribution of manpower and
resources, and deficiencies in the quality of medical education.
India has the highest number of medical colleges in the world. This unprecedented growth has
occurred in the past two decades in response to increasing health needs of the country. The most
significant challenge for regulatory bodies has been to balance the need for more medical colleges
with the maintenance of quality standards. The globalization of education and health care and
India’s potential as destination for education and quality health care has brought the issue into
sharper focus.
Curricular reform to systematically address the issues and develop strategies to strengthen the
medical education and health care system is a logical next step. There is a need to create systems
and standards that establish and promote state-of-the-art medical education, so that Indian
medical graduates from all institutions are comparable to the best from anywhere in the world.
Additionally, though recent advances in medicine have been understood and adopted by medical
and other health science institutions, the same is not true for new methods and strategies in
medical education. There is an urgent need to build capacity in this area.
To address the above challenges, the Board of Governors, Medical Council of India constituted the
undergraduate and postgraduate working groups in July 2010 to develop a Vision 2015 in
alignment with the following mandate.
1. To evolve a roadmap for the direction of medical education in India in alignment with
national needs..
2. To evolve a broad policy regarding the emphasis, duration and curricular changes that
could be adopted as future strategies to make medical education in India comparable to
global standards.
3. To evolves strategies and futuristic plans so that medical education in India is innovative
and is able prepare undergraduates to be able to perform in the changing scenario of
medical science.
4. In the light of deteriorating medical education standards in the country, to work on parallel
tracks for immediate solutions and long term improvement in a steady, phased manner.
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MCI Undergraduate Education Working Group 2010
MEMBERS
1. Prof. George Mathew, Principal & Professor in GI Surgery, Christian Medical College, Vellore.
Convenor .
3. Prof. J.M. Kaul, Director, Professor & Head, Department of Anatomy, Maulana Azad Medical
College, Bahadurshah Zafar Marg, New Delhi 110 002.
4. Prof. Sandeep Guleria, Professor, Department of Surgery, All India Institute of Medical
Sciences, Ansari Nagar, New Delhi 110 029.
5. Prof. Sudha Salhan, Professor & Head, Department of Obstetrics & Gynaecology, Vardhman
Mahavir Medical College & Safdarjung Hospital, New Delhi 110 029.
6. Brig. Chander Mohan, SM Former Professor and Head, Dept. of Radiodiagnosis, Army
Hospital (Research and Referral) New Delhi. Senior Consultant and Head, Department of
Interventional Radiology, BLK Memorial Hospital, Pusa Road, New Delhi - 110005.
7. Prof. Payal Bansal, Associate Professor and Incharge, Department of Medical Education &
Technology, MUHS Regional Centre, Pune 411 027.
8. Dr. S.Vasantha Kumar, Vice Principal and Professor and Head, Department of ObGyn,
Kempegowda Institute of Medical Sciences, Banashankari II Stage, Bangalore.
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MEDICAL COUNCIL OF INDIA’S MANDATE FOR MEDICAL EDUCATION
The Board of Governors, Medical Council of India constituted the undergraduate and
postgraduate working groups to develop a Vision 2015 in alignment with the following
mandate.
2. To evolve a broad policy regarding the emphasis, duration and curricular changes that
could be adopted as future strategies to make medical education in India comparable to
global standards.
3. To evolves strategies and futuristic plans so that medical education in India is innovative
and is able to meet the demands of national needs while preparing undergraduates to be
able to perform in the changing scenario of medical science.
4. In the light of deteriorating medical education standards in the country, to work on parallel
tracks for immediate solutions and long term improvement in a steady, phased manner.
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EXECUTIVE SUMMARY
I. Restructing of MBBS course - 4+1 model of training (4 years course with 6 months
elective+ 1 year internship); 1+1+2+1.
INTEGRATION SCHEME
CLINICAL SCIENCES
CLINICAL 80%
20%
80% 20%
PRE CLINICAL
BASIC SCIENCES
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f. Introduction of skills development and training - A mandatory & desirable
comprehensive list of skills would be planned and recommended for Bachelor of Medicine
and Bachelor of Surgery (MBBS) Graduate. Certification of skills is necessary before
licensure.
g. Secondary hospital exposure: Each medical college would be linked to the local health
system including CHCs, taluk hospitals and primary health care centres that can be used
as training base for medical students.
i. Flexibility in Curriculum
KEY AGENCIES FOR EXPECTED POLICY CHANGES – MCI, Planning Commission and
Ministry of Health, GOI.
Expected outcomes
Improved need based and well aligned curriculum
Bridging of gap between need and availability of doctors
Well co-ordinated, contemporary education methods
Better student learning
Better health of society
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THE UNDERGRADUATE WORKING GROUP REPORT
The working group set out on its task with the following goal :
To review present status with regard to national health needs vis-à-vis medical education
To rationalize and propose reforms in undergraduate medical education
The reasons for need for reforms in the current MBBS course in India:
The MBBS graduate does not feel equipped with adequate skills and competence to take
care of the common problems at the secondary and primary level. This is reflected in the
low number of graduates who go into practice at the end of their MBBS training and the
lack of manpower in rural areas and in primary health centres and taluk hospitals.
The past curricular revisions have mostly added to the existing content without undertaking
the exercise to remove what is obsolete/outdated. This exercise needs to be taken up in a
detailed and extensive manner and make the curriculum as efficient as possible.
The reforms have to be based on both successes within India, as well as models of
medical education that have addressed similar issues in other countries.( Detailed
proposal for curricular reform given ahead )
An initial in-depth analysis of the current situation of doctor manpower in the country was
done. For this exercise, the committee reviewed existing data from the MCI and the public domain
to arrive at its conclusions.
The current doctor population ratio in India is 1:1700 when compared to a world
average of 1.5: 1000. The committee came to a consensus that
targeted doctor population ratio should be 1: 1000 by 2031.
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The next exercise that the working group undertook was to estimate the need for medical doctors
to achieve this target. The working group looked at the existing number of medical colleges, the
current intake of medical colleges and the critical mass of doctors that will be needed to achieve
this target.
In view of the projected increase in population, it was felt that the existing medical colleges in the
country will be unable to meet this need and therefore current intake of medical colleges and the
critical mass of doctors needs to be doubled at least to achieve this target.
Currently there are 330 medical colleges with an intake of approximately 35,000 and with
the current intake of doctors, the shortfall of doctors by 2031 is estimated at 9.54 lakhs .
MEDIUM TERM SOLUTIONS In 2-3 years: Upgrading existing larger district hospitals and
augmenting their infrastructure to become community medical colleges through private public
partnership or public private partnership.
LONG TERM SOLUTIONS Up to 5 years : Starting new medical colleges and hospitals preferably
in states and underserved areas with doctors and medical colleges. The cost to government
estimates are proposed as Expected Policy Changes.
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TEACHER SHORTAGE:
The next issue that the working group deliberated on was to address the problem of teacher
shortage in medical colleges.
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Improving Quality of Training
The next major issue that the working group deliberated on was to improve the quality of training
from what is the current existing model so that the graduates are efficient, competent and
responsive to national and international needs.
a. Goal of training is not focused on providing health care to needy and disadvantaged
b. Discipline based curriculum and lack of integration between basic and laboratory science
and clinical medicine
c. Assessment system’s focus on summative assessments at the end of each stage, rote
learning and recall rather than competency
e. Majority of clinical training occurs in large teaching hospitals with insufficient practical
training at secondary and primary care level
g. No mandatory service period at the end of undergraduate training and lack of linkage of
undergraduate to postgraduate training.
a. Selection of students from rural and underserved backgrounds; who are motivated to work
in areas of need
b. Early clinical training from I MBBS with continuity to secondary and primary care
e. Integrated curriculum in starting from the first yearwith- vertical and horizontal integration
between basic, laboratory sciences and clinical medicine;
g. Partnerships between medical college and other health care facilities in the community
The process of curricular change necessarily needs to start with the basic foundation of defining
the end product. In this case, the “BASIC DOCTOR” (Annexure I)
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This strategy is advocated along with other curricular restructuring as follows :
a. Skills lab
b. e-learning
c. m-learning
d. Simulation
It is important to remove the redundancy in the curriculum and adopt a more integrated approach.
The time thus saved can lead to shorter duration (as given below) as well as time for electives,
professionalism and ethics.
Group A:
Year1- Anatomy, Physiology and Biochemistry;
Year 2- Pathology, Microbiology and Pharmacology
Group B:
Year 4- Medicine, Surgery, Obstetrics and Gyanecology, Paediatrics, Family Medicine and
Community health
Group C :
Year 2- Forensic medicine
Year 3 and 4- ENT and Opthalmology, STD and Dermatology, Orthopaedics, Accident and
Emergency Medicine, Radiology, Anaesthesia, Psychiatry
Elective options- clinical and research electives
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Proposed timeframe in MBBS curriculum structure (to 4 years)
INTEGRATION SCHEME
CLINICAL SCIENCES
CLINICAL 80%
20%
PARA CLINICAL
60% 88 40%
80% 20%
PRE CLINICAL
BASIC SCIENCES
The innovative curriculum would be structured to facilitate horizontal, vertical integration between
disciplines, the gaps between theory and practice and between hospital based medicine and
community medicine. Basic and laboratory sciences (integrated with their clinical relevance) would
be maximum in first year and will progressively decrease in second and third year as the
curriculum progresses. The essentials of basic and laboratory sciences would be taught in first
year and built on in subsequent years.
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Need to review curriculum
Similarly, certain subjects will need extra lectures from first year onwards e.g. approximately 8
radiology lectures can be included in anatomy to teach students cross sectional anatomy of brain,
abdomen , fetal anatomy during embryology teaching etc during first year itself. This practice is
being already being followed by Maulana Azad Medical College, New Delhi . This model can be
adopted by other colleges as well, without changing the number of lecture hours (by integration)
Forensic Medicine can be effectively taught during Gynaecology & Obstetrics (rape, assault),
surgery (injuries), pharmacology (toxicology). Legal experts can be called for medico-legal issues.
Forensic medicine skills can be acquired during internship such as documentation of medico-legal
cases of alcoholism, suicide/homicide, rape, assault and injury cases.
Infection control section in hospital in now an important component and should be included.
Thus, both horizontal and vertical integration will be used for making the curriculum more efficient
and student friendly. Details of this are being worked out by expert committees constituted by MCI
in co-ordination with undergraduate working group. (Annexure II)
Most medical colleges across the world start clinical training in year I with communication,
interviewing skills and basic examination skills through skills laboratories and students practicing
examination on each other. In the several medical colleges the students learnt basic clinical skills
through half a day exposures once a week or once in two weeks with individual doctors at the level
of primary care.
The clinical training would start in first year, with a foundation course, focusing on communication,
basic clinical skills and professionalism. There would be sufficient clinical exposure at the primary
care level integrated with the learning of basic and laboratory sciences. Introduction of case
scenarios for classroom discussion/ case-based learning. It will be done as a co-ordinated effort by
basic science and clinical faculty.
Professionalism and ethics curriculum will be a mandatory part of the curriculum and will be
integrated throughout the MBBS Course.The foundation courses will be taken during the first and
second year and rest of the curriculum will be taught along with the clinical subjects.
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In order for the MBBS course to provide sufficient skills development for competent practice, a
frame shift is required in clinical training in the following ways:
Each medical college should be linked to the local health system including CHCs, taluk hospitals
and primary health care centres that can be used as training base for medical students.
Specific Training Programmes will be designed to help faculty and institutions implement
the new curriculum
New programmes will be developed through multi-level system of courses and workshops, basic to
advanced, specific train-the-trainer programmes and workshops on specific topics and for specific
faculty groups. The following courses can be envisioned to begin with:
ORGANISATIONAL STRUCTURE
Activities/Functions :
Teachers Training Programmes – Level 1
Patient Simulation Centre : Level 1
Skills Training Centre : Level 1
E-Learning/Digital Learning Resource Centre
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Level 2 Centre : EDUCATION DEPARTMENT
Number - One / state; In larger states, at least – one per 10 medical colleges
Location – Any medical college that fulfills minimum requirement for the centre; Health University
Department
LEVEL 4 Centre : National Centre for Medical Education Research and Training – Apex
Centre
Guidelines for Regulation of Minimum Standards
Guidelines for Accreditation
Maintains Database AND Learning /E Resource Centre
National Exam Co-ordinating Centre
MEDICAL COLLEGES
LEVEL 1 – 400 Centres
Table 5 : Activities at Various Levels of Faculty Development Centres
EXPECTED OUTCOMES:
1. Faculty will apply and use educational principles in their day-to-day teaching and planning
of teaching to make it more student-centered.
2. Faculty will incorporate new teaching-learning methods and improve educational systems
in their own institutions.
3. Faculty will be able to conduct basic workshops in their own institutions
4. Faculty with specialized skills will participate in activities of their affiliated Centre/Unit
LEVEL 1 – Basic Surgical Skills, Basic Life Support Skills, Procedural Skills, Normal Labour
Management and Conduct of Delivery. These should be a compulsory part of clinical training of all
undergraduates.
Level 1 training facility is mandatory for all medical colleges.
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LEVEL 2 – Advanced Life Support and Refresher Level 1 Courses, Basic Laparoscopic Skills
Course, Neonatal and Paediatric Resuscitation Skills.
Level 2 skills training centres are desired in each medical college; however if there are financial
constraints, these could be conducted in collaboration with regional centres.
LEVEL 3 – These will be available for multi-institutional use. Course will include
Microsurgical Skills Courses, Advanced Laparoacopic Skills Courses and Human Patient
Simulators for Anaesthesia, Pharmacology, Physiology and other physiology competencies.
Interns should have a mandatory Level I Certification before they get their Licensure degree
A detailed document regarding the training programmes, minimum activities, infrastructure and
equipment requirement at each level, minimum faculty and staff with budget is attached as
Annexure IV
RESEARCH METHODOLOGY
There should be a workshop on learning the nuances of research in terms of principles, collection,
organization and analysis of data to prepare a budding faculty member for guiding the
thesis/research work in their subsequent work profile. The minimum duration of the exposure to
these techniques should be at least 3 days.
A mandatory course on epidemiology for at least 2 days should also be incorporated into the
capacity building.
In all centres, this facility will be utilized by teachers who attend course and programmes ar these
centres. It will be equipped with books, journals, a variety of electronic resources including
interactive multimedia and self assessment packages for students. The advanced centre facility
will also be made available to instiutions affiliated to the University at nominal rates.
KEY AGENCIES FOR EXPECTED POLICY CHANGES – MCI, Planning Commission and
Ministry of Health, GOI.
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EXPECTED POLICY CHANGES
5. Learning facilitation
centers = 1000 Crore
One of the factors in the reluctance of fresh graduates to serve in secondary or primary hospitals
is professional isolation and lack of educational support. There should be options for distance
education towards a Fellowship or Diploma in areas like Diabetic care, HIV medicine, Geriatric
Medicine, Hospital infection control, Hospital management etc. so that the graduates will continue
their learning and enhances their skills in areas beyond what is available in their regular
curriculum.
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CONCLUDING REMARKS
The group also feels that this will result in the improved
quality of the existing colleges, sufficient number of
teachers and will create motivating career pathways for
both students and teachers.
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