OPINIONS

Should there be an ‘Exit Test’ for MBBS graduates?

Saturday, March 22, 2014

by Dr Praveenlal Kuttichira

‘The Hitavada – The People’s Paper’ of March 10 carried an article titled MCI clears ‘Exit Test’ for MBBS pass-outs. The article was written by Mr Vikas Vaidya from Nagpur dated Feb 9. The matter never appeared in the General Council of MCI, but appeared in press. Hence, I also opt for a response in press.

Dr Praveenlal Kuttichira

Dr Praveenlal Kuttichira

The report mentions five decisions of the Academic Council of MCI. (1) After the MBBS course, every graduate has to clear an ‘exit test’ to be eligible for getting registration to practice in India. (2) There will be a reduction of the duration of the course of MBBS by one year – a reduction from 4.5 years to 3.5 years. (3) In the beginning itself, there will be choice for the students to select area of specialisation and learn only those subjects related to it. (4) MCI will develop its own mechanism for accreditation of the medical colleges. (5) The Academic Council will have the powers to formulate any academic courses in Medicine.

At the time of elections, parties and establishments of democracy will withdraw all of its pseudopodia and limit the function only to campaign or conduct of elections. But all these five decisions are so important that it should not creep in unnoticed. There is a need for threadbare discussions before implementation. I am not intending to comment on the powers of Academic Council over and above the statutory council like Medical Council of India. Let the Council decide on that.

As on today, every student has to pass through 23 (21 compulsory and 2 optional) departments in 4.5 years time to get a degree. This will require passing 14 examinations with theory papers (total of 24 papers) and practical or clinics. No single exit examination can be an alternative for this. To replace all the end semester examinations with one exit examination would require a full month at the exit for the conduct of examinations of all subjects. That sort of examination will be unrealistic and cruel. It will not serve the purpose of an examination. One exit examination covering all subjects will be a mere joke. The ‘exit examination’ would be a ‘one more examination’. But will it assess a candidate better?

If it is the exit examination, which is going to make a graduate eligible for registration to practice, what would be the value of the degree awarded by the university? Value less degree will undermine the motivation of students and will deter them from attending regular training programmes of the university. It will keep them away from teachers and the system. The degrees offered by all the Indian universities ranging from All India Institute of Medical Sciences to Datta Meghe Institute would be of scrape value.

A nationwide examination for higher education would be acceptable if it is conducted neat. But that will be only an eligibility test for pursuing PG courses, which require degree as foundation. If variability of standards of university degrees is the problem, MCI has to examine the matter and develop remedial mechanisms after taking the universities into confidence.

The whole issue of BRMS (Bachelor of Rural Medicine and Surgery) arose because of reduction in the period of study. On agreeing to start BRHC (Bachelor of Rural Health Care), the same MCI made it a point that holders of that degree will be a separate group and registration would be in a separate register kept by state medical councils. The very MCI is now reducing the period of its own MBBS course. When it comes to reduction in the duration, the crucial question is which subject is going to have the cut. Usually every expert rigidly sticks on to present duration of training in own subject, but ask for a cut in others’ subjects. If a consensus can be reached and if it is based on any unequivocal evidence, it should be acceptable. When the whole Medical Science is developing at a fast pace, the requirement would be an increase in the duration of course as in other countries. But the matter can be debated.

Option for the students to choose specialisation at the beginning and learn only the subjects related to it is a matter of major concern. Can a student before ‘primary education’ in medical science make a proper choice of specialisation? Only after 10 years of schooling, a student gets chance for a choice for +2. A surgeon ignorant of Gynaecology is not imaginable. A patient on the operating table if seen to have an additional problem related to Uterus cannot be kept waiting on the table for a Gynaecologist to come. At the same time a neurosurgeon ignorant of taking delivery is acceptable. A direct path to super-specialisation can avoid learning unnecessary subjects. But that doctor can serve only in a super-speciality hospital of concerned specialisation. Doctors with qualifications like that will suit only to super-speciality hospitals of metros run by corporates. Can the country afford to have it, especially when we have miles to go before reaching doctor patient ratio according to the WHO norms? A generalist with specialisation is the trend in elsewhere too. Though personally I believe the country is not ripe enough for that, the proposal is worth considering.

MCI developing its own mechanism of accreditation is a welcome proposal. Shredding away with the present pattern of inspections is long due. Time and again it not only proved its inefficiency, but also corrupted many good doctors. An agency independent of MCI for accrediting the colleges is better than MCI itself doing that job. There should be enough checks and balances to ensure transparency, at the same time making the process as simple as possible. Allowing public scrutiny is to be considered at least at the level of appeals.

It is the responsibility of the Academic Council to make suggestions for starting courses, but that small body should not be deciding on it. Wider discussions are needed for that. In any case it is better that one who suggests is not the one who decides. The one who executes should be yet another. Everything should happen only after all the stakeholders could air their views. Ours is a Democratic country. There is no ‘winner for ever’ in Democracy. Periodical revalidation is a must.

Dr Praveenlal Kuttichira
Professor of Psychiatry and Principal, Govt Medical College, Thrissur
On deputation as Dean (Research), Kerala University of Health Sciences
Member, Medical Council of India
Member, Governing Council, Kerala University of Health Sciences

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19 Comments »

Comment by dr.vinod kumar b.p
2014-03-22 20:35:07

I strongly agree with the view point of prof. praveen lal sir , one of my well remembered teachers.
all eminent persons in and out the academic council and governing body should think of human beings who approaches a doctors while they are helpless by illness. so the doctors should act as their advocates in this commercialized world of health . any body who seeks reformation must take the opinion of the people who are the users of it and should be in par with the whole world curriculum. I don’t think no body can study the basic subjects and clinical by 3.5yrs, so a reduction of years please……make double sure, don’t spoil the medical field by very quick decisions . every body should have a basic idea regarding the medical subjects because we are dealing with the human beings having vivid picture of presentation. I know a person presented to me with abdominal pain who has undergone a battery of investigations and refereed to psychiatry turned to be a spinal tumor. you have to strengthen the hospital teaching with small modules of teaching aids , conducting many small exams rather than a big final exam( their arise the question of exit exam whether it is needed or not), online tests, making use of the modern advancement of internet. a sound mind only gives good opinion. while remembering the olden days, we are the people who never enjoyed the student life when our peers from other fields of education were compared. so make teaching and exams more human friendly . I can suggest many methods. following each chapter we can conduct exams on line. make a cut of value for pass. every student should get it , you can attempt it for any number of times, but if you pass more and more time the last mark will be comparatively less. you can work up on this ,this is only an example, so that the studying will be more enjoyable. any module if you read repeatedly that will be understood properly. MCI has to accept well conducted online teaching courses also.

MCI should concentrate more on teaching and development of undergraduate level methodologies because it is the base of the whole medical practice so it should be more clinical oriented. since many private colleges are budding all over India, MCI should extend their keen observation to the teaching level in these new institutions.

Let, the much more equipped national board of examination look after the post graduate level teaching and training

I am pleading to all of my colleagues to discuss the matter very seriously.

 
Comment by dr.vinod kumar b.p
2014-03-22 20:55:22

dear all,

the commends I have posted is to stimulate discussion regarding the topic.

this is not to insult anybody.

if any body feel it is useless scraps, just ignore.

I have a re-think after posting whether it is needed or not/ the medical council may feel bad like

that , any way these commends was a very quick one just after reading Praveen lal sir’s writing.

regards,

thank you.

 
Comment by DR SATISH GOYAL
2014-03-23 18:09:47

I fully agree with Dr Praveenlal Kuttichira comments.
It will be great start to have good consultant as required.
MCI should have t6he exams.
I congratulate Dr Praveenlal Kuttichira.

 
Comment by dr c c sahu
2014-03-23 19:38:43

I strongly disagree with the proposal of Exit Test of passing out doctors.Rather more emphasis should be given during the Interneepship,so that they should have more confidence while treating a patient.Thanks.

 
Comment by DR.PURUSHOTHAMAN
2014-03-23 21:49:41

Strongly agree with the views of Dr.Praveenlal….

Absoute “NO” to cutting short the course duration . Of course there is a need to discuss and revise the teaching methodology …Vertical integration , early clinical exposure etc which were suggested in VISION 2015..
There is no Need for EXIT examination ….
MCI should take firm and sincere steps to assess facilities and teaching of institutions……EXIT exam is not an alternative for that…

 
Comment by dr vt k menon
2014-03-23 22:26:27

when we were students in the eighties we had 3 prof exams at intervals of 18 months. we also had dissections. today the 1st prof exams are held after 1 yr when the student cant get his anatomy right. and now the plan is to cut short the course further making it little longer than a honours degree course. as for the exit test what happened to the much touted neet which was eventually not made compulsory.. medicine involves others lives unlike engineering.

 
Comment by Saikumar G
2014-03-23 23:05:36

The standards of medical education are not same in our country. For example, the interventional procedural experience of MBBS doctors passing out from government medical colleges compared to those from private medical colleges.I have seen MBBS doctors confidently doing venesection, bone marrow aspiration ,lumbar puncture,pleural aspiration etc but now I am doubtful of same skills being exhibited by the MBBS degree holders of newly started private medical colleges.I had seen MBBS doctors unable to do venesection and rushing to get a surgeon for that.Venesection is an emergency life saving procedure.Anybody holding MBBS degree without required proper skills or knowledge is a risk to the unsuspecting patients.Medical Council of India is allegedly controlled by some vested interests and politicians in power.The majority of members are nominated and central government alone can decide and not MCI. Any decision taken by MCI to improve the standard of Medical education in our country is welcome.But one more test to practice after getting the MBBS degree may be too much for those who actually bought MBBS degrees and here also middlemen may surface offering to sell question papers well before the screening test to them.

 
Comment by Prof.Manoj Sharma
2014-03-24 06:38:43

It is a good idea if you want to improve health care and stop white collared quackery by “qualified” white coats.
It should be something like FMG Foreign Graduate entrance examination done for the students who study abroad .Because many of the teaching medical institutions, both in Govt and private set up are no better that the ones in Kiev, Russia, Nepal or China. Yet many institutions in abroad are better than many in India.
I am sure introduction of such an exam will help improve teaching standards in medical colleges and will make students devote themselves to more serious studies and help refrain them from habitual distractions they have in modern times .Parents who spend on them will be more cautious and the politicians or policies that favor induction of substandard stuff in medical care , just in name of social justice, will be forced to think about abolition of at least this method of vote collector social justice.

 
Comment by Dr Jacob John
2014-03-24 08:36:28

Exit exam is a welcome step.

It shouldnot replace the existing examinations semester wise.

Exit exam should be a national level examn covering
all subjects and expected areas of competency.

Those who donot clear this exam, thay should be awarded degrees MBBS just like any other degree ( BA,B.Sc etc) but cannot be regd with the medical council.

This has become necessary since we see a lot of drs without any basic knowledge coming out from many pvt and even govt med colleges.

Acreditation is a welcome step.

Duration of the course shouldnot be cut short.

Specialisation from first MB is a foolish thing.

 
Comment by DR.p.l.nawalkha
2014-03-24 11:11:42

MCI ,as on today. is a politicised forum directly controlled by MOH.Revamping,restructuring,and review of several aspects is a people’s need.First Cleanse the body ,then proceed further.

 
Comment by Burbak
2014-03-26 17:54:00

Medicine in a holistic subject. To teach it in parts, might help in being thorough, but it leads to reduplication of efforts at each Mb. Neither do passouts remember the details of 1st year topics, nor are they required in such great details in clinics.

Merge the following subjects and teach them together:

1. Anatomy + Surgery (including Orthopedics) + Ob Gyn + ENT + Eye (only basics used in family practice) + Radiology

2. Physiology + Biochemistry + Pathology

3. Community Medicine + Biostatistics

4. Pharmacology + Medicine + Paediatrics + Clinical Microbiology + Basic Radiotherapy

5. Basic Forensics + Toxicology (more emphasis) + Medical Ethics

Wrap it all up in 3 to 3.5 years. Make internship for 6 months in core subjects + 6 months in elective subject(s). Reduce general surgical internship and give that time to general medicine and Ob Gyn. End community medicine and Radiology internships. Focus on family practice for UGs.

Equalize UG and PG seats and make PG mandatory for licensing like in the west.

 
Comment by Dr Pravina Santwani
2014-03-27 07:32:27

Sir when the students are admitted to medical schools they are just like children/kids. Making one year for basics is too short to start. they should have some practical aspect in curriculum like intramuscular injections /pints etc /dressing of wound or collecting blood. in internships they should have concept of general practice which all MBBS pass out should know.At present all interns are busy for there various types of pg entrance exam. How do they focus on the internships they are posted for and learn those subjects practically? I doubt.

 
Comment by ravi goyal
2014-04-02 18:06:12

very true,every m.b.b.s. doctor should have theortical as well as practical knowledge of day to day procedure. he should be able to treat common things as well as perform basic routine procedure

 
Comment by dr.vinod kumar b.p
2014-04-08 13:13:42

In Short

we actually want practical experience rather than theory test,

I think now the minimum education level is raised to +12 rather than 10 earlier ,like wise everybody

is trying to raise it to diploma level rather than MBBS.

Thank you.

N.B: The response rate is too low when the merit of the subject is concerned.

 
Comment by Joker
2014-05-19 10:02:38

Another exit test? Probably they have MCQ-based “assessment” in mind.

IMAGINE THE AMOUNT OF CASH THE COACHING CLASSES CAN MAKE by introducing this step- You never know who is hand in glove with whom!

The solution should have been to enhance the quality of existing teaching/training practices. Simply playing with permutation-combinations like these are actually enhancing the MCI’s open secret-reputation as a bunch of corrupt, universally despised jokers.

 
Comment by agrwl
2014-07-12 20:24:13

People for betterment of
Foreign Medical Graduates
(COMPLETELY REVISED & UPDATED WITH NEW POINTS)

President: R K Agrawal,
231, Lalbaug, Morbi-2
Gujarat
Dt.30.06 2014
To,
The health minister,
Ministery of Health & Family Welfare,
Govt of india,
New Delhi
Sub:-Plight of Foreign Medical Graduates & ways to improve supply of competent doctors, while eliminating all types of incompetent ones
R/sir,
Reason for students opting for foreign medical education
Thousands of meritorious youth of mother India, who could not afford Crores of Donation in Pvt. colleges, & could not get meagrely available Govt. seats and still determined to pursue this noble profession, go abroad for economical medical education.
Discrimination being meted out to them by MCI on return
But on return, they are being discriminated in the name of screening test by the MCI, in collusion with NBI. Govt. of India being a mute spectator. A glance at the pass percentage of screening tests (just 15% to 30% with an average of 20%) will reveal the amount of discrimination being meted out by MCI to these graduates. For the last 2 seasons it is expected to be worse, just 10%.
MCI’s argument
I do not buy MCI’s argument that medical education all over the world is not up to Indian standards as justification for such a low pass percentage over such a long period. If their education is indeed so poor, how come they have much better healthcare system than India has ? And if 90% graduates are indeed not worthy, why not ban this worthless education completely? Why waste our youth & financial resources for such a worthless education & spoil life of 90% students by subjecting them to the same test & failing them again & again. They could have been productively used in other fields of life for the benefit of mother india.
Actual reason
However, the fact of the matter is that such discriminatorily low passing percentage is kept deliberately to incite fear psychosis in the minds of students, so that they do not go abroad & ultimately fall pray to Pvt. Colleges to cough up Crores in Donation. As the fear increases, demand for private medical seats increases, & as the demand increases, the donation amount increases.
Justification of this reason
As the actual reason is to incite fear psychosis to frustrate them, MCI do not come up with any plan to give them further training or to give then restricted/ supervised practice licence even in rural areas, which are dependent on Quacks for their healthcare needs.
Adverse impact
Part of donation goes to MCI bosses is no more a secrete. MCI bosses become wealthy, the dens of corruption flourish, but, mother india suffers. Artificial shortage of doctors is created. Rural population falls pray to quacks, thus our National Health parameters decreases, & mother India becomes sick.
Situation of Private Medical Colleges
Scores of Pvt. colleges openly auction their seats in crores, & pass their students from their own Pvt universities by taking crores again. We know how their faculties & facilities are checked by MCI, which exist only on paper. However, the quality of Doctors produced is nowhere checked even on paper. They all are blanketly stamped competent without any scrutiny because corrupt officials get their share of Donation.
Pointed questions to MCI
Has MCI ever checked the standard of these Pvt. Medical College students by subjecting them to such a test?
Is it not possible that MCI is asking for some alien standards from foreign college students, which its own Pvt. College graduates do not possess?
The permanent solution to this problem
In MCI vision 2015 document, the earlier impartial Govt appointed board of MCI directors smelt the foul play of private college controlled board of MCI directors discriminating against foreign graduates to help fill private college seats fill at huge donations & also the competency concerns against private medical college graduates & hence proposed national exit exam applicable both to local as well as foreign graduates with it being mandatory by 2015. As the private college mafia controlled board of MCI directors is now back in control, they have sent a proposal to health ministry somewhere in March –April 2014 for national exit exam, but changed it to be optional for local graduates initially. MCI wants to continue it’s loot for some more years. God knows how long this ‘initially’ will mean.
WE DEMAND THAT THE PROPOSAL OF MCI BE CLEARED IMMEDIATELY IN ITS PRESENT FORM SO THAT A STAGE IS SET FOR NATIONAL EXIT EXAM.
We demand that immediately thereafter it should be made mandatory for all those taking new admissions. Even if it is made mandatory today, it will be effective after 5 years. Doesn’t indian citizens have right to know if these private college graduates are atleast of foreign college graduates standard?
World overview in support of proposed solution
All the developed countries such as UK, USA, Canada, Austrailia, Newzealand and even the least developed countries like Nepal has uniform licentiate exam applicable to both local as well as foreign graduates. However, as the actual reason was to discriminate foreign graduates to the point of frustration to help fill private college seats at huge donation, in india MCI made it applicable to only foreign graduates, branding private college graduates blanketly competent.
Benefit of proposed solution
There will be several benefits to mother india & the only losers will be corrupt officials & Pvt. Medical College mafia, as explained below.
1.There will be no discrimination against anyone as all are subjected to the same test. As the fear psychosis will eliminate, more & more students will go abroad thus increasing supply of competent Doctors which ailing mother india badly needs, without any burden on Govt. resources, & without compromising on standards.
2.Increased supply of quality Doctors will improve the health parameters of ailing mother India. India will be gradually viewed as a healthy country.
3. All incompetent doctors, whether Foreign gradutes or Pvt. college graduates will not be able to get in to the system, thus reducing medical negligence, which will be again beneficial to ailing mother India.
4. Only losers will be corrupt officials & private medical mafia making crores by auctioning their seats, & still giving sub standard education, as demand for their seats will be greatly reduced as students will have the choice of economical education without fear of discrimination.
6.But, the benefit to mother India will be that healthcare will be free of corruption, money power & vested interests, which in turn will reduce the overall cost of healthcare, medical negligence will be reduced, healthcare will be improved, rural population will get increased supply of quality doctors & mother india will no longer be ailing.
7. It will also promote competence in Pvt. Medical Colleges as they will have no choice but to improve their standards.
The proof of validity of above argument
The proof of validity of above argument lies in the fact that the only opposition you will face is from corrupt officials, the Pvt. college mafia & the existing students of such colleges. Opposition from existing students of Pvt. colleges can be overcome by not making these rules applicable to existing students. Those left will be corrupt officials & Pvt. Medical college Mafia, as they will lose the maximum, which they deserve.
Quick Temporary solution
If all these need legislative changes, taking a long time, in the short run we can atleast reduce the discrimination meted out to Foreign Graduates by not subjecting them to some alien standards of test which our own Pvt. Colleges graduates do not possess, by subjecting a representative sample of such Pvt College graduates to this test on experimental basis to find out if the standard expected are indeed those possessed by Pvt. College Graduates. Since, all these Pvt. college graduates are blanketly stamped competent, they all must easily pass this test. Or, else it will prove that blanket stamping of Pvt. college graduates as competent is indeed money driven & not merit driven & foreign graduates are indeed being subjected to some alien standards, which its own system does not possess.
Benefit of temporary solution
This will reduce some discrimination in short run, will increase supply of quality doctors, as fear of subjecting them to some alien standards will be removed & Govt. will also come to know the actual standards of Pvt. College Graduates.
Precaution to be taken
However, to get the real picture all this exercise should be undertaken by an independent body free from the influence of MCI as this will also expose how these Pvt. Colleges were recognised by MCI, which is the main culprit.
Alternate temporary solution of rural posting
Alternatively, those foreign graduates who scores 40% in screening test may be given restricted/ supervised licence to practice in rural areas. For each year of rural service they may be given 5 bonus marks. When this add up to 50% they may be given full licence.
Benefit of alternate temporary solution
Rural population is presently dependent on Quacks for their healthcare needs. These graduates are well trained in modern medicine in the sense that healthcare of many foreign countries is dependent on so trained doctors only. They are deliberately branded incompetent by MCI for illicit financial gains. However, to alienate fear of MCI, it is proposed to give them restricted/ supervised licence.
Thanking you,
Yours sincerely,
(R K Agrawal)
Copy to:
1. Prime Minister of India, sh. Narendra bhai Modi, New Delhi
2. National Board of Examination, New Delhi
3. Medical Council of India, New Delhi

 
Comment by dr rskesh kesarwani
2015-04-18 21:42:17

I am strongly agree with Mr r k agarwal. Exit exam. will same for indian and foreign trained doctors and it will mandatory for both.

 
Comment by Seshadri R
2015-06-08 12:28:01

I observe that lot of comments from various medical bodies in favour of scrapping the exit exam for MBBS, citing various reasons. But the same organisation do not understand that there is screening test being conducted for Foreign Medical Graduates. The reason cited by the bodies are very well applicable to FMGE and why this bodies are not fighting with MVI for scrapping of screening test. The FMG is mainly consist of students from Russia and China. The medical colleges are run by State in those countries and have better facilities than most of the Indian Universities. If medical bodies are really interested in the Indian health Care system they should also raise their protest in favour of FMG’s also.

But not raising any protest these bodies are discriminating the FMG.

 
Comment by Ajith
2018-07-28 16:49:23

Dr Praveen Lal,USA requires it’s medical graduates to sit for the usmle exam.These are students who got into medical school only by merit.For students who passed MBBS in India honestly do not need to fear the exit test.The fear is from.50%who bought their degree and have the fear this test may not be for sale. In some states students can pass MBBS by paying per practicals and board exam.
MCI since it’s inception.has been about money in.the tune of not millions but billions.
It is the corrupt elements which causes fear mongering among students about this exam.
In reality honest students will find it easier than their semester exams.
Also,students who studied in WHO approved colleges outside India are kept out of the system for reasons we all can see every well.It doesn’t matter to then that some Indian colleges are hundred times worse
The mafia doesn’t want the Indian student to come back and just be a doctor by bypassing their system of almost 80 lakh for an MBBS seat.These students should be able to take reasonable exit exams and practise considering the doctor shortage in India.
I can understand the politicians and mafia part but the average practising medical college professors are the one who should raise their voice but they fail to understand the issues beyond their immediate concern.It could be because most of them have children and grandchildren studying in the capitation fee colleges. So this country will always be this way,seems like.
Not seeing the bigger picture.

 
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