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The Indian Medical Education System – Virtues and Vices [Part 1]

Hello peoples of the universe!

We are currently in Chennai after traveling from Hyderabad via Trichy as part of our global health intensive.

Since I last talked to you guys, we’ve visited a number of health care systems. We’ve been to Snehakiran, a holistic care unit for the poor with HIV; Sivananda rehabilitation home, a large health care network for tuberculosis and leprosy; Primary care centers; Apollo Hospitals, and, YRG’s MSM cohort study group.

Our experiences in the above centres have been invaluable, and, have deepened our understanding of health care and wholesome patient care.

We’ve been immersed into most of India’s health care system, which has led to a lot of discussion about the varying health care systems that exist. Throughout our discussions, the topic of medical education came up, particularly when we observed rare cases presented in vivid detail at various conferences in teaching hospitals during our journey.

This brings me to the topic for today’s blog post – The Indian Medical Education System. 

*Disclaimer: Given that this can be a controversial topic, I want you guys to know that the opinions below are entirely my own and are not reflective of anyone else’s opinions, unless otherwise specified. Also, the topic includes some generalizations. 

I’ve had the privilege of visiting and being a part of 3 different medical education systems [India, the UK and the US]. This puts me in a relatively unique position to compare and contrast different health care systems, as well as different medical education systems.

I’d like to discuss a few aspects of our [ETA: The Indian] medical education system. I have decided to divide this into two posts, the first of which will be about my perceived vices of the system.

i) Joining Medical School:

In India, students typically apply to medical school at the age of 17-18, straight out of high school. There are pro’s and cons to this approach. Some people believe that it is too critical a choice to make at this age; others believe that spending the extra 3-4 years in college [like in the US] can place students in a better position to make an independent, informed choice.

In response to the above, it is often stated and felt that parents decide their children’s profession in India. A 2013 paper that surveyed 1st year medical students in India revealed that the majority of medical students felt that parental desire led them to a career in medicine, confirming the above notion. [1]

On the flip end, however, parents typically pay for their children’s undergraduate (and often, their post-graduate) training in India. This is in stark contrast to the US where most students apply for student loans, and therefore, are often in significant debt right after medical school.

It is difficult to find existing evidence to suggest that one approach is better than the other. However, it is clear that parental desire appears to be a key motivator, which, can be more influential when the monetary stakeholder is the same person.

ii) Style of education:

In India, unfortunately, a large component of education is through rote memorisation of commonly asked questions and answers. This is a practice that often stems from school. In my opinion, the education system in India does not encourage students [medical or otherwise] to think critically and independently. It does not make us adept at formulating management plans in real time until post graduate training. Although rote memorisation can be a helpful way to have information readily available, it should be a supplement to active learning. 

I believe that the Indian education system, as a whole, needs to revamp it’s educational strategy. The current system does not provide an incentive to faculty or students to strive to learn to be self-sufficient and tackle management of patients.

There are a number of great faculty at varying institutions that we have seen on our journey and in my medical school, however, in the absence of encouragement to continue to do the same or to do better, they are all very vulnerable to burnout and fatigue.

On the other side of this, our Indian medical education system provides excellent opportunities to learn and practice history and physical examination skills. As we are primarily in resource limited settings, students learn to rely on their skills and limited laboratory testing to plan their management. Further, because of the large volume of patients, illiteracy and delayed presentation, we often see complex and relatively rare cases by way of sheer numbers, which deepens our clinical training and bed-side skills.

I am blessed in that my medical school in India did not discourage our alternative methods of learning, a trait that is relatively uncommon in India.

iii) Post Graduate Training:

Post graduate training [aka residency in the US] is limited by the number of available positions in India.

As of July 2016, the Medical Council of India [MCI] database reported that there are 426 medical schools for undergraduate training [aka medical school in the US], comprising a total of 53,330 seats split between government [209 colleges with 28890 seats] and private [217 colleges with 24,440] institutions.

However, there were only 4581 post graduate training spots available through the nationwide post graduate exam in India per the tentative report of the AIPGME [2]

There is a serious shortage of post-graduate training positions in India. In fact, the number of post-graduate positions that are available throughout the country in 2016 roughly equate the number of undergraduate medical positions available in the old state of Andhra Pradesh in 2014.

In comparison, in the US, there were 18,705 medical student graduates in 2014-2015 [3], and, there were 27,860 residency (or post-graduate training) spots in 2016 [4]

This is a critical problem that limits the ability of medical professionals to pursue advanced degrees in India. As a result of there being limited post-graduate training positions in India, people often spend several years trying to obtain a post-graduate spot in India, or, apply for post-graduate training programs outside of the country. It seems that the government is working towards making existing positions more easily available through providing a common entrance examination for post-graduate training, but, more post-graduate training positions need to be made. As a result of this critical shortage in positions, every year there is an ever growing pool of graduate students applying for the same limited post-graduate positions, and, this will only continue to worsen until more positions are made available.

I realise that I am being very critical in this blog post. However, I feel that I need to be critical in order to garner interest towards bettering out education system. I deeply appreciate my undergraduate training in India and I sincerely believe that I have learned several things that I would have never fully appreciated or learned in other countries. This includes facets of medicine such as cost-conscious patient care, clinical examination skills, and, empathy and humanistic principles in the face of poverty. I will talk about the virtues of medical training in India in my next blog post.

Please feel free to comment on this blog post in the comments section below to discuss the above, or, to discuss other aspects of medical education.

1: Diwan V, Minj C, Chhari N, De Costa A. Indian medical students in public and private sector medical schools: are motivations and career aspirations different? – studies from Madhya Pradesh, India. BMC Med Educ. 2013 Sep 15;13:127. doi: 10.1186/1472-6920-13-127. PubMed PMID: 24034988; PubMed Central PMCID: PMC3851318.

2: AIPGME [URL: http://mcc.nic.in/mccreg/ShowPdf.aspx?Type=50C9E8D5FC98727B4BBC93CF5D64A68DB647F04F&ID=BE057D4CA44C10A0FC1DFCFFD99CCE1490291DC7%5D

3: http://www.aamc.org

4: http://www.nrmp.org


This entry was posted in BMC.

4 comments on “The Indian Medical Education System – Virtues and Vices [Part 1]

  1. Anonymous says:

    Being a medical postgraduate I would like to add my experience from struggling to get a mbbs seat through all India entrance exam till getting a post graduation degree . The most important issue is lack of training in internship after which a graduate can atleast do a govt contractual job while preparing for getting a postgraduate seat as in India the proportion of graduates from both private and government medical colleges seeking for post graduate seats vs the total number of postgraduate seats is too high it’s not easy to get seat just after graduation. In internship we had to do work which has no link with what our profession will seek once we practice and if we protest our seniors would make sure we find difficult in getting internship completion certificate. I think students doing mbbs in govt colleges should to be asked to honestly fill their logbooks and board should know why there is lack of training .Another issue is preparation for postgraduation . In colleges where the graduates are not burdenized to do nonprofessional work are free to get time to read and prepare for post graduation entrance than those who do . Students who after graduation depend financially on their parents either take up foreign course or sit unemployed at home and join coaching for entrance .I have even seen many of my friends who are forced to or themselves prefer to get married to become dependent financially for entrance preparation .At last I would also like to add about our postgraduation entrance test which has questions which are more relevant to what postgraduates read in their theory than what a graduate was taught in a medical college and thats the reason all have to afford to go a coaching institute .Practical based questions which a graduate really needs in real life after graduating really lacks. I after getting frustated that even after so much struggle to get a mbbs seat learnt nothing and was hopeless what to do i followed my friends who were applying for usmle. I noticed that kaplan lectures taught me a lot which i never learnt in my 5 years of graduation. So i decided to save money doing jobs and give exams though my seniors had warned me that it is not possible to do job and save money as it takes lot of time . I did junior resident jobs in many private hospitals to be financially independent and save money for usmle.I cleared steps with score of 235 and 237 but then I needed three letter of recomendations from three pathologists to get observership in a non-profit organization in USA. But then due to financial issues and no support i was hopeless ,depressed and was started on treatment for my mental illness . My family was having lot of worries looking at my hopeless in career life and I lost my father as he had an heart attack fighting with me to convince me take up indian postgraduate seat .I realized that this fight is not worth after i lost my father and decided to quit after wasting 2 years and decided to give Indian exam and joined dnb course in pathology where the training continues to remain the same .I hope soon education system trains students in practical way what there profession seeks when they practice and not just being used by seniors to help out in completing their work . Even postgraduate seats should be prioritize to those who have more of clinical skill knowledge than just the memorized theory from coaching institutes.

    1. yuv90 says:

      I’m sorry you had to endure all of that. It’s unfortunate that this appears to be a consequence of the widening gap between undergraduate and postgraduate seats.

      Your comment gives me a deeper understanding of the individual issues caused by this system wide problem. Hopefully there will eventually be a change to this system.

  2. Parikshit says:

    I agree with much of what you have said in your post. However, from my personal experience I have to disagree that much of undergraduate medical education in India is memorization of commonly asked questions. In my medical college, about half of the class have studied (or at the very least tried to read) the so called stock medical books for each subject (Guyton/Hall for Physiology, Harrison for Medicine,etc) though everyone resorts to memorization before the exams given the format of the university examinations. In contrast, medical students in the US usually use books written for board review along with class notes as core study material, using the standard books as reference.
    Also it would have been great if you talked about the internship in India and your experience during the internship (hopefully you will include it in Part-2)
    Thanks and good luck.

    1. yuv90 says:

      Hi Parikshit,
      I agree that people try to use other books. However, it isn’t enforced by the Indian Medical Education system, and, it isn’t actively encouraged either. There is no real incentive to read those textbooks when it doesn’t seem to change your grade.

      I will try to talk about my internship in the next part. Thanks for the feedback!

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