Health ministry rankings help you choose a medical school abroad

Gauri Kohli

Those looking to study medicine abroad have their priorities cut out — apart from choosing a reputed institute, they have to factor in tuition fees, cost of living and the city or country they want to go to. To make their search easy, the ministry of health and family welfare has come up with a list of medical institutes they can apply to as degrees from these universities will hold value in India too. The institutes have been ranked on the basis of how students have performed in a screening test, the Foreign Medical Graduate Examination (FMGE) conducted by the National Board of Examinations (NBE). The FMGE is a licensure exam which screens out test-takers who do not have the aptitude for medicine and select those who are capable of boosting the country’s physician workforce with their knowledge and skills.

The list has around 286 institutions from 42 countries, including Russia, Ukraine, China, Nepal, Bangladesh, Pakistan, Philippines, United Arab Emirates and Romania. NBE has ranked institutes on the basis of results of around 35,000 students who cleared their MBBS exams between 2012 and 2014. About 9,690 Indian students passed the screening test during this period with an overall pass percentage of about 27%. The maximum number of graduates, according to the ranking, were from China (11,825) with a pass percentage of 18.9%, followed by Russia (5,950) with a pass percentage of 18.4%, Ukraine (3,520) with a pass percentage of 19.1% and Nepal (3,163) with a pass percentage of 21.2%.

There are 16 colleges and universities from where Indian students have graduated in the NBE screening test with a pass percentage of 100%. Two colleges in China – Chenyang Medical College and College of the Left Side of China have a pass percentage of 100% Indians in the test. Russia’s Kyrgyz Russian Slavic University also has a pass percentage of 100% as has Ukraine’s VN Karazin Kharkiv National Medical University. Nepal’s Nobel Medical College has been ranked number one on the NBE list with a pass percentage of 32%. BP Koirala Institute of Health Sciences is a close second with a pass percentage of 31%.

With increasing competition and fewer MBBS seats in India for lakhs of students who apply, many medical aspirants contemplate pursuing education abroad in countries such as China, Ukraine, Russia and the Philippines. Another reason for choosing these countries over others is the cheaper educational cost when compared to the more expensive countries like the US or UK.

Experts say the health ministry move will help students as well as the Indian medical fraternity. “Generally speaking, a ranking based on objectively structured criteria and defined weightage accruable thereto is definitely useful for a student to make an appropriate choice for seeking admission to a concerned college. An objectively-based categorisation is of definite use to the stakeholders,” says Dr Jayshree Mehta, president, Medical Council of India.

Dr Mehta says that the present scenario would be affected to the extent that the Indian students opting for foreign medical qualifications could make an ‘informed choice’ while selecting an institute. “This would be on the basis of specific quality information handily available to him so that the choice is not blind in nature but is based on subtle relevant information. However, the ranking would turn out to be of consequence and relevance provided it is made in an objective and definitive manner,” she adds.

Dr KK Aggarwal, honorary secretary general, Indian Medical Association, agrees. “We must remember that students make institutions and institutions do not make students. An institution like AIIMS has the best results because the best students go there. Through such a ranking, students can know the pass percentage of these institutions. China and Russia have the cheapest medical fee and that is why most students go there. This kind of ranking helps.”

How did Indians fare in FMGE?

The National Board of Examinations has ranked medical institutes based on the results of around 35,000 students obtaining MBBS degrees from select institutes between 2012 and 2014

–9,690 Indian students passed the screening test during 2012-2014 with an overall pass percentage of about 27%

–11,825 Students from 87 colleges in China appeared for the FMGE from 2012-2014 and 2,239 Indians passed

–5,950 Students from 34 colleges in Russia appeared for the FMGE and 1,094 Indians passed

–3,520 Students from 18 colleges in Ukraine appeared for the FMGE and 671 Indians passed

–3,163 Students from 14 colleges in Nepal appeared for the FMGE between 2012 and 2014.

MCI silent on medical college inspection fraud

Rema Nagarajan

In the world of private medical colleges and Medical Council of India’s inspection of these colleges, doctors who are assistant professors in one inspection can become resident doctors in the next. Despite this fraud being pointed out to the MCI, no action has been taken so far.

In a letter to MCI Chairman Dr Jayshree Mehta on November 26, 2015, Prof Raj Bahadur, vice chancellor of Baba Farid University of Health Sciences pointed out that three declaration forms of faculty approved by the MCI assessors in Maharishi Markandeshwar Medical College and Hospital, Kumarhatti, in Solan, Himachal Pradesh were found to be faulty. Prof Bahadur, who is a member of the ethics committee of the Punjab Medical Council, said that in a committee meeting, they found that Dr Dinesh Kumar and Dr Barinder Pal Singh who were shown as assistant professors in General Medicine at the medical college during the inspection on May 12, 2014, were shown as senior residents in the inspection on January 1, 2015. Again Dr Kulwant Singh, an assistant professor in General Medicine in the June 2013 inspection, became a senior resident in the 2015 inspection.
In his letter to the MCI, Prof Bahadur sought action. However, the MCI has not responded. There was no response from the MCI president to TOI’s queries on why the MCI assessors had missed such a glaring discrepancy and what MCI intended to do to ensure that such frauds could not be perpetrated in future.
Prof Bahadur in his letter raised questions about why the MCI assessors could not verify that the same candidates in two successive inspections were at a higher or lower designation. “The upper age limit for a senior resident is 35-40 years. These three doctors were 41, 44 and 56 years old. How come this did not alert the assessors? Either the assessors don’t know their job or they are dishonest. The forms are seconded by the head of the department, then by the principal and by the assessors. So every one of them had to be involved. It is a criminal offence of fraud and forging of documents. The MCI ought to have registered a criminal case against the college authorities or even the inspectors if their connivance is shown,” said Dr G S Grewal, PMC president.

“Since these doctors have committed that they have not filled their forms, it is surprising how the assessors have evaluated them on the day of the inspection without verifying whether the declaration form is filled by them or somebody else,” stated Prof Bahadur. He added that only three parties could be responsible for allowing this fraud — the candidate, the assessors or the institution. Interestingly, in the January 2015 inspection report, one of the comments by the assessors was that there was a shortage of about 3% in resident doctors.

The Maharishi Markandeshwar Medical College, which was started in 2013 with permission to take in 150 students, was earlier in the news for its ‘ghost faculty’ or doctors who were shown as full-time faculty and drawing full pay but who were actually working elsewhere and were visiting the college once in a week to 10 days. In this case too, no action has been taken by the MCI yet.

 

PERMANENT CURE FOR MEDICAL SECTORMCI-LL-Size

After the recent directive by Supreme Court the central government has accelerated the move to make a full proof mechanism to keep a vigil on doctors and the medical education. The Health Ministry says it would decide its future course of action after the committee headed by NITI Ayog vice chairman Arvind Panagariya submits its report. However, before this mechanism takes a shape the responsibility of ensuring quality in Medical Education is at Justice Lodha Committee. For the current academic session about 2400 medical seats in 24 colleges are waiting for clearance. According to the Health Ministry sources, the Panagariya committee has met many times on this issue. The three member committee was constituted on the initiate of Prime Minister Narendra Modi. The high-powered committee has Niti Aayog vice-chairman Arvind Panagariya, PM’s additional principal secretary PK Mishra and Niti Aayog chief executive officer Amitabh Kant as members.

Sources said during a review meeting of the health sector in March this year, Prime Minister Narendra Modi and the Health Ministry discussed the option of even scrapping the country’s apex medical education regulator, which has been shrouded in controversy in recent years. At the meeting it was pointed out that the MCI is one of the major stumbling blocks towards a faster expansion, especially when it comes to ensuring quality education. The development came after the Parliamentary Standing
Committee on health and family welfare too had called for a complete overhaul of the medical council as it has repeatedly failed in its mandate as a regulator of medical education and profession. In its report presented in Parliament last month, the panel has recommended that the Act under which the
council was established be scrapped and a new legislation be brought in Parliament “at the earliest”.
Sources said that at the PM’s meeting, the need for a major focus on increasing the availability of doctors and paramedical staff, especially in the poor per- forming states such as Bihar, Uttar Pradesh, Jharkhand, Chhattisgarh and Odisha, was emphasised. At the same time, the government is acutely aware that drastic action through legislative amendments may not be easy given that the changes have to be ushered in via the legislative route and the government does not enjoy majority in Rajya Sabha. In recent years, the MCI has been involved in a series of controversies.

The parliamentary committee had also pointed to this and had said that it was shocked to find that compromised individuals have been able to make it to the medical council but the ministry of health and family welfare is not empowered to take action. It noted that the MCI president admitted that “corruption was there when there was sanctioning of medical colleges, or increasing or decreasing seats”. It was told that “private medical colleges arrange ghost faculty and patients during inspections by the MCI and no action is taken for the irregularity”. The Committee is also studying the Ranjit Raichaudhary Committee recommendations which has recommended the constitution of National Medical Commission and also four separate Boards under it. Meanwhile the Justice Lodha Committee is also going to start its work.

The NEET, however, is not the end of the road. The more effective antidote to the ills of corruption and the production of poorly trained or fake doctors is the exit examination.

Including in reserved seats, to the ranking obtained in the examination. The 2010 notification for the NEET was implemented only in May 2013, but was set aside by a three-judge bench of the Supreme Court on July 18, 2013. The NEET, however, continued to be held for the all-India seats and those states and private colleges that opted to use this list for their admissions. Sita Naik, former member of the board of governors of MCI and also member of Ranjit Roy Chaudhury Committee, argues that NEET is necessary for many reasons. “One, multiple examinations are often held on overlapping dates; there is rampant malpractice in admissions where merit is of little consequence; and the

‘SC decision on NEET is DISCRIMINATORY’
The RSS associated Shiksha Sanskriti Utthan Nyas termed the Supreme Court decision to conduct National Eligibility cum Entrance Test (NEET) as biased and discriminatory and urged the Prime Minister Narendra Modi to take right measures to protect the interests of the Indian
languages. In a letter addressed to the Prime Minister and also Health Minister JP Nadha, Nyas secretary Atul Kothari said the SC decision to initiate NEET from the year 2016 itself “appears hasty and arbitrary”. “The SC judgement dated April 28, 2016 to conduct NEET phase 1 on May 1, 2016 fails to consider the bias it created against students from regional medium and rural areas. It basically created a bar for students studied in regional language medium by compelling them to appear for entrance examination in either English or Hindi language. Thereby it ousts a large section of students from states like Maharashtra, Gujarat, Tamil Nadu, Andhra Pradesh, Karnataka, Kerala and West Bengal,” the letter said. Shri Kothari said most of the countries across the globe are now providing education in Health and Engineering courses in their mother tongue and it is time that Indian government also initiates the education of these courses in Indian languages.
“The Union Public Service Commission holds the Civil Services Examination in Indian languages, on the same grounds provisions should be made to conduct the NEET examination in Indian languages,” the letter said.

The other kind of discrimination that this decision has created is with respect to syllabus of the examination. The NEET is to be conducted by CBSE based on CBSE Board’s 12th Standard syllabus. “This fails to take into account that there is a huge difference in terms of content in the state and central board’s syllabus. This judgement renders the students from various state boards helpless and un-prepared for the NEET exam. It robs them of an equal opportunity, which the constitution of India
provides them with. Therefore, we request you to take up the issue with the Supreme Court & file a review petition against this judgement so as to provide an equal opportunity to the lakhs of regional medium students across India,” Shri Kothari said in the letter.

abysmally poor standards of knowledge, particularly in science subjects, are largely reflective of the poor standards of the high school education system in the country. Medical profession deals with
human lives and is dependent on the knowledge and basic competencies of the doctor. It is important that standards are not diluted for any reasons. Instead, the focus of governments should be towards
improving the standards of science education in high schools. The NEET will compel governments to focus on high school education,” she opines.

The NEET, however, is not the end of the road. The more effective antidote to the ills of corruption and the production of poorly trained or fake doctors is the exit examination. Based on an MCI recommendation, in 2010, a ministerial decision was taken to conduct a common national exit examination. This was to ensure that a doctor, irrespective of the institution trained in, had the basic
skills and competencies as per laid down standards. Further, this test was to be made mandatory for those desirous of getting the MCI license to practice
anywhere in the country or go abroad.

Those not willing to take the test were, in the interim, to be left to practice only in their states. The time has come to revive the proposal. The wide variation in standards, for instance, between a graduate from the AIIMS or Christian Medical College, Vellore, and an Azamgarh medical college is
unacceptable. A common exit exam will compel “bogus” medical colleges to provide quality training or face the prospect of being rejected by prospective students. The MCI is an anachronism and its reform has been long-drawn and tortuous. The Health Ministry overlooked the recommendations made by several expert committees to arrest declining standards and the massive corruption that had crept into the system. In 2010, pushed by the PMO, a draft bill revamping the MCI and replacing it with the
National Commission for Human Resources for Health (NCHRH) was tabled in the Rajya Sabha. In
October 2012, this was returned to the Ministry with three concerns to be examined: One, the autonomy of states and potential violation of federal principles; two, excessive bureaucratisation and centralisation; and three, faulty selection procedure of regulators, providing scope for abuse.

The Ministry lapsed into inaction and as per a PIL, a fraudulently elected MCI was restored in November 2013. In 2014, at the instance of Dr Harsh Vardhan, the then Minister of Health, the Ranjit
Roy Chaudhury Committee was constituted. The Committee submitted its report in September
2014, reiterating in large measure the recommendations of the NCHRH Bill. But no action was taken. It is to the credit of the parliamentary standing committee (PSC) that it took suo moto cognizance of the Roy Chaudhury Committee Report and tabled its findings in Parliament on March 8, 2016. The PSC report indicted the MCI providing adequate justification to set it aside. Instead, a three-person committee has been constituted to recommend policy options for revamping the MCI. Many of us were dismayed at the missed opportunity and felt anxious that the “invincible” influence of certain individuals who dominate the MCI does not once again thwart the reform process. The health sector in India has failed to develop to its full potential on account of the corrupt and incompetent MCI. The MCI has done nothing regarding reforms of curriculum, quality assurance, ethical practice, rational treatment, and humane patient care. By overhauling this institution with mappropriate expertise as required to govern this sector, India can expect a great leap forward on health outcomes. Demands by parliamentarians to defer implementation by a year and claims that NEET undermines the special status of J&K needn’t be encouraged. A national eligibility and entrance test is a good step that will
improve the quality of medical education.

3-MEMBER COMMITTEE TO OVERSEE MCI FUNCTIONING
The Supreme Court in May constituted a three-member committee comprising of Justice
RM Lodha (former Chief Justice of India), Dr Shiv Kumar Sarin (former Chairman of the Medical Council of India) and Vinod Rai (former Comptroller and Auditor General of India) to oversee the
functioning of the MCI till the Parliament enacts a new law replacing rhe Medical Councilm Act, 1956 governing the regulator. The court directed the Centre to issue a notification constituting the panel, giving them a free hand to even override decisions taken by the MCI. “The said Committee will have the authority to oversee all statutory functions under the MCI Act. All policy decisions of the MCI will require approval of the Oversight Committee. The Committee will be free to issue remedial
directions,” said a five-judge mConstitution Bench of Justices AR Dave, AK Sikri, RK Agrawal,
Adarsh K Goel and R Banumathi