Post Graduate Medical Education
Medical Council of India
Preamble
An exhaustive review of the existing PG medical education system and the deficiency in the availability of specialists in the country has been done. The available data, within their limitations, suggest that there is a need to rapidly produce a number of specialists in the country not only to fulfill the needs of delivering quality care across the country but also to overcome shortage of faculty in existing and proposed medical colleges in order that the quality of medical education would improve. The aim was also to give adequate opportunities to every graduate student to be able to pursue a postgraduate course, if he so desires and some bold and innovative approaches were required to fulfill these national aspirations.
The proposed framework suggests introduction of a 2 year Master of Medicine (M. Med) program as the first level of specialists with focus on skill development and providing care to community. This may be considered equivalent to Masters/ M Phil programs or existing Diplomas in various clinical specialties. These post-graduate students will be trained mainly to enhance clinical skills rather than get engaged in basic research. The curriculum would be competency based and skill based. The proposed reforms in undergraduate medical education with early clinical exposure and an internship program freed of the stress of simultaneously preparing for PG entrance examinations would ensure that at the entry level the Indian Medical Graduate would be adequately prepared to enjoy and go-through this two year PG training. The quality of the output would therefore be far better than the current outgoing diploma graduates. These PGs would also be able to function as undergraduate teachers at the entry level. Further, progress in the academic stream would require additional training in research and analytical methods. Since the number of options for further training is limited to compared to the number of M Meds, it follows that a large proportion of them would be directed towards providing specialists care to the community. Further, post-graduate specialization will essentially involve a research component and prepare this group of specialists to pursue the academic stream and provide high quality medical education for the next generation of students. After M Med, the students will have an option to pursue one of the five doctorate
streams depending on the aptitude and professional aspirations.
MCI : Vision 2015
Proposed program also institutionalizes the structured fellowship programs for the first time, which are largely unregulated currently. This will ensure that community requirements and advancing medical technology are main streamed on an ongoing basis across disciplines.
After M Med, the graduates will be able to compete for
Doctor of Medicine (MD) or Master of Surgery (MS) other
dual degree programs (MD- PhD; MD- MHA; MD- DM and MDfellowships)
through another competitive examination.
Based on their respective merit and counseling, the students will be able to take up the doctorate programs. The overall philosophy is to have the potential of diversity and to be able to develop a large number of hybrids to generate new breed of accomplished clinicians. The system would also ensure a transparent and open system of career advancement with multiple career opportunities. Quality of training in post-graduation will be maintained through a competency based curriculum, which is implemented and maintained through an elaborate subject specific log book and using clinical training opportunity in accredited regional / offsite non-conventional facilities like district hospitals, industry, private hospitals, private sector laboratories and clinics of family physicians.
The proposed strategy will increase the availability of specialists to provide community care by 33% (Since the course is shortened from three to two years) while sustaining the core requirements of research based post graduates for academic streams and for providing highly specialized sub-specialty care using cutting edge technology. While country gears itself to finalize the proposed strategy, further steps to improve the existing PG program would be simultaneously undertaken. These would address the service needs of the community, the academic needs of medical colleges, foster research and address the development of a large number of subspecialists to take care of the country’s requirement in the 21st century.
Recommendations:
1. Increasing seats of PG diplomas and degrees: Diploma
courses are meant for development of sufficient skills to serve
as secondary care specialist. Increasing the pool of such
specialists would increase the availability of specialized health
care to masses. The increase in degree seats would enhance
the availability of medical teachers in the Govt. as well as
private set-up.
2. Building competency based modules which would add
clinical and analytical skills and enhance the decision power
of the specialists in context of new complexities of the
specialties.
3. Change of Nomenclature and introduction of M.
Med Course : Diplomas courses would continue to be of
two year duration. This would be renamed as Master of
Medicine (M Med) & after successful completion of the
course the candidate would be designated as a Specialist;
such as M. Med (Family Medicine).
4. Career Pathways after M. Med.: After M Med, the
candidate would have multiple career options to improve
the proficiency. This would depend on the interest and
academic performance of the candidate :
I) Degree Course : For comprehensive training in
the same subject, a degree course (MD/MS) is
worthwhile. This would be of one year duration and
would primarily serve to enable the M. Med to
become a faulty/professor in a medical colleges.
II) A two year course on allied subjects like Hospital
Administration, Epidemiology, Bioengineering, Nano
engineering, Molecular biology, Medical Education,
etc. followed by an exit examination would enable
the candidate to earn a dual degree.
III) A three year research path would lead to the
MD/Ph.D degree on satisfactory completion of the
requirements.
IV) A three year course which would lead to the DM/
MCh degree in sub-specialties. This step would
reduce the duration of acquistion of super-specialist
degree by one year from the current system.
5. Fellowship programs: A two year course in skill oriented
allied areas (listed elsewhere) such as minimally invasive
surgery, dialysis and management of chronic renal failure
etc. which would give them a fellowship in the concerned
field in addition to the basic specialist’s degree.
It is proposed that the PG fellowships would be formalized
and taken under the purview of the MCI. Fellowships may
be administered by Universities but must be under the
domain of a central regulatory agency; i.e. MCI for
acceptability and accountability across the country.
● As new opportunities arise, one year fellowship
program may be offered post DM in allied areas.
● Provision would be made for a lateral entry in to DM/
fellowship courses after appearing for a subject
specific entrance exam.
6. Need based Assessment & Distribution of Diplomas
and PG Courses:
Need based assessments for starting of postgraduate
programs would depend on the needs of the country.
While existing PG courses are being relooked at by the
respective specialty boards, new courses would be
encouraged based on need of the community / public, need
of the subject in view of technological advances, there would
be sufficient content over and above the existing courses &
trained graduate would have adequate career opportunities.
The need based assessment to be done on the reliable
data on morbidity pattern and also existing numbers of
specialists of various categories.
The PG working group felt the need to consider starting
new diploma courses in several areas where an acute
shortage of specialists was felt, such as Pre-clinical subjects
like Anatomy, Physiology, Emergency medicine, Family
medicine, Laboratory medicine (including elements of
Pathology, Bio-chemistry and Microbiology), etc.
The new colleges & new courses would be initiated in
underserved areas keeping in mind equitable distribution of
medical facilities across the country subject to availability
of facilities and expertise.
7. Curriculum Reforms:
● The main focus of the reforms in the course curriculum
would include adequate clinical exposure in the PG
courses in clinical specialities so as to compare with
the patient care practices of high quality and
standards, matching international norms.
● Core Curriculum would contain Ethics,
Professionalism, Modern teaching-learning
technology & Good clinical practice/ Good
laboratory practices, Research methodology &
Biostatistics, Communication skills, Computer
applications, Safe medical care & Medico legal issues
as salient elements.
● Hybrid curriculum for PG courses: This
curriculum allows for different curricular models to
be practiced for different parts of the course i.e. part
of the curriculum may be subject based, part may be
problem based etc. In addition, there can be a core
content and provision for electives.
● Regular revision of curriculum at periodic intervals
depending on newer developments in the field.
● Uniform Duration and Training of courses: The
duration of training would be uniform; Diplomas
(M. Med) – two years, Degrees – One year after M.
Med, Fellowships –two years after M. Med, DM /
MCH – three years M.Med & Post DM fellowships –
two years.
● A log book would carry a record of all activities of
the candidate during the period of training duly
attested by the teachers, it would be subject specific
& would specify skills to be acquired and indicate the
minimum number of procedures etc to be conducted.
It would be the responsibility of the respective boards
to prepare a subject based log book based on the
competency model.
● There would be extra departmental rotations for
at least six months in degree courses in allied
disciplines for increasing breadth of training. Off
site training upto six months would be recommended
during th M. Med course, this would be superwised
8. Training & Assessment:
● Extensive faculty development Training: Prior
to implementation of curriculum teachers would be
given extensive training on competency based
curriculum and associated student assessment.
● Continuous formal structured assessment with
regular feedback is proposed for the post graduation.
National common entrance examination is proposed
for the entry & selection to post graduate and
superspecialities courses.
● Training: As recommended for the broad specialties
including a subject specific logbook. In addition there
would be a doctoral committee in every institute which
is responsible for the training of DM / MCh students.
This will constantly monitor the training of these
students. In addition to what is recommended for
the broad specialties, the candidate would have two
publishable papers based on his work during the DM/
MCh course which would be certified as such by the
doctoral committee after internal review. There will
be minimum six months rotation in allied specialties.
● Skill center: Establishment of skill labs would be
mandatory. These would be of help to several
disciplines to improve the quality of their training.
Funds may have to be allotted from a central source
to existing colleges for establishment of skill labs.
● Log Book: Maintenance of log book, which would
be day to account of the activities of an educational
in which the candidates participate. This would be
duly attested by the teacher and available for
inspection in the summative examination.
9. Entry criteria for postgraduate courses: In the
suggested pattern of entrance examination, the candidate
would have ranking based on NEET-PG conducted initially
at the exit of Final MBBS examination and for licentiate skill
based examination at the completion of internship. With
new proposed changes, candidate would be free to
concentrate on skill development during internship. MBBS
students would be eligible for appearing for PG seats via a
common PG entrance examination which would be inclusive
of PG seats in the All India quota and in the state where
they have done the MBBS.
10. Rural Service: In addition there may be a additional weight
age (5% or more) if the candidate has put in two years of
rural service.
11. Exit criteria: The curriculum is largely competency based;
the exit criteria would also focus on assessment of acquisition
of competencies and therefore would be criterion referenced.
12. Structure/composition of postgraduate unit:
Minimum requirements of beds, infrastructure and
equipment for each specialty are revised by the respective
specialty boards. This needs to be revised for specialties
which are now largely outpatient based such as
ophthalmology and dermatology etc. and they may not
require a large component of inpatient beds. The minimum
structure requirements of different specialties would
therefore be need based and not uniform across the
specialties.
13. Licensing of Institutions imparting post-graduate
medical education: Licensing process would also include
assessment of associated institutions, laboratories and health
facilities where students will be sent for offsite training.
Medical Council of India would continue to be the primary
licensing agency. Accreditation would be encouraged as a
quality improvement process.
14. Accreditation & ranking of institute imparting PG
Medical Education: It would be encouraged as a quality
improvement process, transparent, explicit and objective
bench marks will have to be developed for accreditation for
the institutions and shall be subject specific. Accreditation
would essentially incorporate both the infrastructure (along
with manpower) as well as the processes of imparting the
PG
15. Increasing Faculty Pool: Efforts would be made for
increasing the faculty pool and several innovative
approaches would need to be explored. All newly
recruited teachers would mandatorily undergo a course in
modern Teaching - learning technology in approved centers
for further promotion within a specified time. Teachers retiring
from the Govt institutions can continue on contract basis
up to the age of 70 years till the crisis is tided over.
16. Promoting Research for faculty promotion:
● All newly recruited teachers would mandatorily
undergo a course in research methodology within a
specified time.
● Research activity must be made mandatory in the
academic stream by linking it to promotions. The
institutional and departmental environments would
actively encourage research activities.
● Existing criteria of the MCI as regarding number of
publications for promotions would be enforced for
the teaching cadre.
● Medical college teachers would be encouraged to
pursue PhD degrees. Postgraduates with PhD degrees
would be given preference to join the faculty. A weight
age of three years would be give as teaching
experience for these PhD holders.
● Facilitate research by mandatory creation of research
cell in every medical college that will provide
assistance in financial and administrative
management of research projects.
● Medical colleges would create a corpus of intra-mural
funds that provide seed money to encourage young
teachers and research workers to initiate and then
seek funding from regular funding agencies.
● MCI and ICMR would work jointly to initiate research
mentorship programs for young medical teachers.
● MCI would interact with other National and
International Research organizations in promoting
funding of research in medical colleges. These funds
may be disbursed through the MCI based on specific
proposals received from Medical colleges after due
vetting by a nominated peer group committee.
17. Continuing Professional Development (CPD): The
process is to improve the performance of the doctor in his
practice and thus improve the care that patients receive.
The MCI guidelines regarding accreditation of organizations
for conduct of CMEs and the individual requirements are
already in place. There is a need to ensure implementation
of these guidelines and the use of foolproof methods to
ensure participation in CME activities on a regular basis.
Innovative models to ensure wider coverage and effective
implementation of the guidelines are recommended. There
is a need to encourage self learning using the distance
learning modality using online courses. MCI also needs to
develop an electronic resources library that can be made
available to all physicians at a reasonable cost.
Seventy percent of curricular content may be standard across
the country and remaining 30% allowed to emphasize regional
considerations and leave place for innovations.
The curricula for various courses need to be revised at
periodic intervals not exceeding 5 years depending on newer
developments in the field.
The details of the syllabus of individual subjects, would be
worked out by the respective specialty boards.
Educational institutions would be encouraged to conduct
experimental modules on innovative tracks and disseminate the
results of these to the rest of the country.
