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Opinion: Exit test if done right can do wonder for raising the standard of medical education in India

I have long argued for a common robust exit test to raise the standards of undergraduate medical education in the country and hence the draft bill suggesting government’s desire to move ahead in this direction is welcome news. The move will have several positive offshoots.

Dr Kamal Mahawar
Dr Kamal Mahawar

Firstly, it will ensure that medical colleges enrol only those students who can stand the rigour of medical education and this will bring an end to the culture where people with money could pretty much buy a medical career. It will also end the somewhat erroneous perception in the minds of some that substandard candidates enter medical profession from the reserved category and then go on to become full-fledged doctors without necessarily having the ability to absorb the teachings. Because no medical college would like a large number of its students failing this test and hence not be able to practise, the move will indirectly improve the entry requirements into the profession.

Secondly, and even more importantly, it will lead to an improvement and standardisation in the quality of medical education across the country. Currently, the quality of the medical education can be very variable and the exit bar has been set somewhat low and arbitrary. The exit examination, provided it is robust, can hence work as a tool to elevate the standards of medical education across the country. For example, if we want our colleges to ensure that medical students learn about methods of research and ethics, well all we then need to do is give the colleges adequate warning and include these topics in the test!

Thirdly, by standardising the quality of the output, the move will help in restoring the confidence of the public in the medical profession.

However, to be truly effective, the test will have to be carefully constructed. It will have to include aspects of medicine relevant to the general public in the country and truly ensure that those who pass it are fit to work as independent doctors because that is what they will be currently doing. Let us not forget here that we are unique in allowing our fresh pass out doctors to practise independently; elsewhere in the world they would be required to undergo further training in their chosen area for a period ranging from 5-10 years before obtaining independent credentials. We further need to recognise that even those who wish to work as general practitioners (GPs) need to be supervised and mentored for a period of time before they can realistically treat patients independently.

Since this test will also be used for the entry to postgraduate medical courses, perhaps I could point out here that we need a dramatic expansion in places for postgraduate training (can be achieved by creating places for GP training) and a significant increase in the remuneration of postgraduate medical trainees across the country. Trainees, and also the trainers, who choose to work in rural areas should also perhaps be incentivised by even higher remunerations to encourage them to work there.

The current suggestion in the Bill to reserve up to 50% of PG seats for those medical graduates who have served in rural areas is hence unwelcome. We cannot force our doctors to work in inadequate rural government facilities at current levels of remuneration. It will only force more doctors to emigrate or take up other professions upon qualification. Doctors as such undergo prolonged periods of education and further training. We need to enable our junior doctors by streamlining things and ensuring adequate remuneration at par with say an IT graduate and not further alienate them by forcing them to deal with the inadequacies of the government. It is the responsibility of the government to invest in rural healthcare and attract doctors to work there by building world-class facilities and paying them attractive wages over and above what one can expect to earn in big cities, and none of this will be possible with our current levels of healthcare funding.

Following his graduation from Calcutta Medical College and post graduation from Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Dr Kamal Mahawar is now a Consultant General and Bariatric Surgeon with Sunderland Royal Hospital in the United Kingdom. He is also an Associate Clinical Lecturer with Newcastle University and editor of renowned scientific journals. His recent book ‘The Ethical Doctor’ published by Harper Collins India examines some of the serious issues affecting Indian healthcare.

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