MEDICAL COUNCIL OF INDIA
24th August 2007
Minutes of the meeting of the Executive Committee held on 24th August 2007 at 11.00 a.m. in the Council Office at Sector 8, Pocket 14, Dwarka, New Delhi-110 077 where the members of the Adhoc Committee appointed as per the Hon’ble Supreme Court order dated 20.11.2002 were also present.
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Dr. P. C. Kesavankutty Nayar, President (Acting), Former Dean, Govt. Medical College, Trivandrum.
Visit MCI website: http://www.mciindia.org/meetings/EC/2007/ECMN24-8-07.pdf
From page 14 onwards:-
Agenda Item 15. To assess the standards of Medical Education for Indian Students in China-As part of the Indian Delegation as Nominee of Medical Council of India.
Read: The visitation report with regard to his visit to China as part of the Indian Delegation to assess the standards of Medical Education for Indian Students in China.
The members of the Adhoc Committee appointed by the Hon'ble Supreme Court and of the Executive Committee of the Council decided to approve the report submitted by the nominees of the Council as part of the Indian delegation to visit to China which is as under:-
“OBSERVATIONS AFTER VISIT TO CHINA TO – “ASSESS THE STANDARDS OF MEDICAL EDUCATION FOR INDIAN STUDENTS IN CHINA” AS PART OF THE INDIAN DELEGATION AS NOMINEE OF MEDICAL COUNCIL OF INDIA
After visiting of Suzhou University, Jiamusi University, Zhangzhou University, Dalian Medical University, Tianjin Medical University and interaction with the students, staff and the administration of the universities, the following observations can be placed as following –
A) Course content, duration & curriculum:
The duration of is only 4 years plus 1-year internship – a total of five years, which is 6 months less than Indian course. Some universities have said the course is 4½ years plus 1 year internship but no proof of the latter was obtained.
In one university – Tianzin Medical University the course is an integrated course of Chinese and Western medicine.
There appears to be wide variation from university to university regarding the curriculum and subjects taught.
Some subjects like Forensic Medicine, Pharmacology, Social preventive medicine (called public health & hygiene, etc. in China) are either not taught or are very short consisting of 1 semester only (India – 3 semester). Forensic medicine is altogether absent in some universities.
Clinical Psychiatry, Dermatology, ENT as subjects were absent in some universities. In some Orthopedics is part of General surgery; Paediatrics is part of medicine. Pathology course is very inadequate.
The Department of General Medicine appears to be absent as a department in most of the university colleges and hospital. Instead, the component super-specialties like Cardiology, Neurology, Gastroenterology, and Endocrinology are separately present.
They have some additional subjects as cell / Molecular biology, Nuclear medicine, etc. The emphasis is more on experimental physiology, animal experimentation, Chemistry and Biochemistry – which are more like a honours course in Zoology or other subjects in India. Experience and teaching of human physic and clinical based sciences appears to be very less.
Clinical exposure in the course is very less for the students – and it is mostly supervised observations than hands-on teaching and practice on patients.
The structuring of courses are totally different from Indian system – with only 2 divisions of preclinical and clinical, which may be taught in 2 separate colleges of the same university. The first three years of the course are taught in colleges of basic medicine and the clinical part in college of clinical medicine. The duration of clinical medicine is 1 year only.
Chinese and Indian (Foreign) students are two totally separate streams. There is no fixed number for annual admission in both cases.
B) Teaching and teachers:
Teaching is done in English, but teachers proficient in English teaching are very less in number. Moreover, there is much deficiency, compared to Indian requirements, in the total number of teachers in each department.
Many teachers in preclinical and even some in clinical departments are non-medical (non-doctors) teachers. In some universities, all the preclinical and para-clinical teachers (called teachers of basic medicine) are non-doctors but are from a general science stream.
The Student teacher ratio is variable and not fixed. There appears to be no fixed ratio. Indian students in clinicals are divided into groups and put under one supervisor who takes them around the wards and demonstrate patients to them.
Most classes are didactic nature and clinical simulation on the mannequins are done – but how much that is done is doubtful. According to students, exposure is not much. Teaching in experimental medicine – with animal experiments is done here. Most of these classes are taken by non-medical teachers and not by medical doctors.
The laboratories are well equipped, but appear to be used not only for Indian (foreign) but also for Chinese undergraduate students and also for students from other streams as Pharmacy, Dental etc. Since Chinese admissions per annum is 650-2000, the facilities though good, do not seem to be adequate at all for such large number of students.
The students who come here came individually. They were brought by private agents. Most of the students could not make it through the Indian Medical Entrance Examination.
The main problems students face in China is that of language. Though they have mostly picked up rudimentary skills for personal communication, whether that is adequate for interaction with patients is difficult to make out.
The main worry of the students is whether they would be getting registration in India by MCI.
Language skills required by students are HSK level 3 to go into clinical levels. But to pass the licentiate examination required to be able to do practice in China one has to be proficient in Chinese language to the level of HSK 6-11 (the highest). Otherwise, they would not be able to write the examination, which is in Chinese. Most of the students are not sure that they would be able to pass this exam and acquire the basic competence to be able to practice in China. During talks with Chinese Education Ministry officials, they said that they have not yet decided whether such examination can be offered to overseas student in English language. Hostels, meals, recreation are good.
No internal assessment is there in a structured mode.
Semester ending examination, including theory and practicals are usually a mix of MCQs or short questions (20% + 80%).
Evaluation is very lenient. The students who fail upto 3 subjects are allowed to go to the next level.
The examination are all internal. Teachers who teach are the examiners. There is no system of external examiner.
E) Nomenclature of the degree :
What is the name of the final degree to be awarded to Indian students is not clear. Some say its MBBS, some MD-Medicine, some diploma, some Bachelor of Medicine.
F) Direction of the course :
The undergraduate medical courses are mostly theoretical, didactic, simulator based and observatory in nature. The concept of producing a competent graduate doctor strong in clinicals in tune with the actual health care needs of the country (India) does not seems to be the goal of the course-curriculum. It appears mostly to be produced a graduate weak in clinicals, community health management, but possibly attuned mostly to the manning of tertiary care system in a global Market era.
a) Preclinical college section: the facilities appear to be quite advanced. But considering the large number of students (both Indian, foreign and Chinese and also students from other stream) the facilities do not appear to be adequate at all. The facilities cannot be adequate for a proper training with a proper curriculum.
b) Clinical section: The clinical hospitals shown to us were tertiary care units, paying (from 150-600 Yuan every day), and also mostly super-specialty level. Nowhere have I seen any bedside clinics conducted in any of the hospitals. The students also say that clinical exposure is quite less. The hospitals do not appear to be the right place for undergraduate training and internship.
There appears to be no clear-cut policy regarding internships. Though the students were told that the course is 4 years with one year of internship. The students are under the impression that they would be able to do this internship in India in Indian hospitals after they return from China after 4 years. The agents who have recruited them have also given the same impression. The students said that they have been given to understand by agents as well as by Chinese authorities that they are to return with an internship completion certificate from India and on production of that, they would be given their degree certificate after which they would appear in the screening test for registration in India.
The Chinese authorities in the universities, which we visited and also the Chinese Education and Health Department officials could not give us a clear answer to the question of doing an internship in China. Nor would they spell out whether the degree awarded is with or without an internship. It appears that no clear cut policy or structured course curriculum for internship have yet been evolved by them.
These appear to be no provision or policy of registration of Indian students after graduation in China. Nobody, including ministry officials could give us a clear picture in this regard. The system for Chinese students is like this. After graduation, they have to undergo 1-2 year practical training in different hospitals where they are sent. This period is called practice period. It is not known whether it is structured like an Indian internship with time distribution in different subjects or not. After this period, they appear in a nationwide centralized licentiate examination. When they pass this, they are registered and can take up employment, practice, do P.G. Studies. For foreign and Indian students there appears to be no system for provisional registration (during the internship) or final registration till date. Moreover, there is the question of language. The licentiate exam is only held in Chinese language and needs very high proficiency to pass it. Indian students generally would not be able to master it. The sum total is that the Indian students would not attain the level of competence (may be barring 1-2 exception) to get registration in the country where they graduate.
Further, as there is no system of provisional registration, their internship training is likely to be just demonstrative without any hands-on-training.
It is clear that Indian students after they pass out from Chinese colleges would not be able to get registration in China. The course is not structured or meant for that. Thus, they would not be employable in China (should Chinese Govt. decide to employ them) also. Their whole teaching and training would thus be incomplete half-baked and practically useless.
J) The Economic underpinnings of the whole operation:
The recruiting agents for Indian students seem to be the advisers of many of the universities. They collect a hefty sum – to the tune of Rs. 1 lakh per students sent to China. The Chinese universities who are collecting money in dollars from students are having a financial windfall utilizing the same infrastructure in little addition. This market-oriented approach is the main driving force behind the entire operation than holistic approach towards education.
Based on the above-recorded observations, the following recommendations need to be made regarding training of Indian students in Chinese Universities and the advisability of its continuation in the future.
Medical undergraduate courses being run in China appear to be of totally different in nature from the Indian undergraduate medical courses. Graduates from China are unlikely to fit in into the Indian Medical System at all. Their learning, course, curriculum everything appears to be inadequate. Therefore, in the National interest this coming of students to China should be discouraged and stopped forthwith.
Continuation of such practice of allowing Indian students to come to China would produce a large number of misfits who are academically not sound to start with in 10+2 level, whose training is more theoretical and totally inadequate and who would burden our country with half-baked doctors once they go from here. Hence, it has to be stopped.
Regarding eligibility to appear for screening test in India – no relaxation should be given to these students, as this would help in the continuation of the problem.
Continuation of the practice of allowing Indian students to come to China would adversely affect the healthy growth of the Indian Medical teaching institution in private sector and also possibly in Govt. sector as well.
Since there are no approved and universally accepted International standard or curriculum or methodology of training in undergraduate medical education, we have to accept the Medical Council of India’s guidelines & curriculum for undergraduate medical education, which is similar to what, is being followed in U.K, as the benchmark. Compared to these standards, standards of U.G. Medical Education imparted to Indian students in China is grossly inadequate from all aspects. It is more like a foundation course for medicine.
Notes on the future of the students who have already come.
(This is purely a personal suggestion)
Presuming that the continuation of the current practice of allowing medical students from India to come to China shall be put to an end by the Government of India, the question of the future students admitted upto 2007 would remain. This may be dealt in the following way to provide them Natural justice.
a) They shall attend special classes in regular Indian medical colleges for 1 year or for such period of time as is required and appear and pass in the clinical subjects in Medicine, Surgery, O&G, Paediatrics, Eye & ENT by payment of fees.
b) Then they shall appear and clear the screening that by the National Board.
c) After that they shall complete the internship programme of India for 1 year. They shall have provisional registration during this period.
d) Then they would have full registration by MCI becoming thus eligible to either pursue higher studies (P.G.) in India or go in for practice.
e) This provision shall also cease from batch to be admitted from 2008.”
In view of above, the members of the Adhoc Committee appointed by the Hon’ble Supreme Court and of the Executive Committee of the Council further decided to send the above report to the Govt. of India for further necessary action in the matter.