April 03, 2009

Health Ministry, MCI 2006 standoff over DNB

THE UNION Ministry of Health and Family Welfare has said its Diplomate of National Board degrees will be treated on a par with the MD/MS and DM/M.Ch degrees awarded by Indian medical institutions for the purpose of all appointments including teaching posts in medical institutions.
In particular, the June 1 order to the Health Secretaries of all States and Union Territories removes the earlier requirement of one year and two years of teaching experience for the appointment of DNB degree holders to posts in broad specialities and super-specialities respectively. This implies that the DNB degrees in broad specialities will be completely equivalent to the MD/MS degree. And, the DNB degree in super-specialities will be equivalent to the DM/M.Ch degree. In fact, the DNB degrees, awarded by the Ministry's National Board of Examinations (NBE), are the ones that are recognised globally.

The current directive assumes significance in the context of the proposed expansion of infrastructure, student and faculty strengths in medical institutions as part of the implementation of the announced policy of 27 per cent for Other Backward Classes (OBCs) in Central institutions of higher education. Nine existing national medical institutions directly under the Centre's control and the six institutions proposed to be set up in various parts of the country on the lines of the All-India Institute of Medical Sciences (AIIMS) in New Delhi will be covered by this reservation policy.

The NBE was established in 1975 with the aim of elevating standards of post-graduate medical examinations and ensuring uniformity across the country. The NBE became an independent autonomous body under the MoHFW in 1982. The Board has a system of accreditation of hospitals and institutions having adequate trained manpower and infrastructure for training students towards post-graduate and post-doctoral degrees of the Board. Currently, there are 415 such accredited hospitals/institutions across the country.

Entry to the DNB programme is through a very stringent qualifying Central Entrance Test and an institutional-level speciality-specific aptitude evaluation. Qualifying for the degree is through an extremely rigorous evaluation both in theory and clinical knowledge in which the pass percentage is only about 30-35 per cent.

Medical experts say that, by enabling the large number of NBE-qualified post-graduate medical students to enter the country's mainstream health care system, this move would help offset to a great extent the shortage of teachers in medical institutions that could arise as a result of the envisaged expansion. In fact, this shortage is in some sense artificial because the guidelines of the Medical Council of India (MCI) rendered a whole cadre of qualified doctors ineligible for teaching posts.

Decision welcomed

"It is a welcome decision," said M.S. Valiathan, the well-known cardiac specialist from the Chitra Tirunal Institute of Medical Sciences and Technology and at present the National Research Professor at the Manipal Academy of Higher Education. "I could never understand MCI's contention on this issue. In fact, many medical colleges awarding MD or M.Ch degrees today have no credibility. The DNB examination standards are, on the other hand, very high. It is a national examination with no issues such as home ground advantage." Prof. Valiathan, however, added a caveat to his remarks. The NBE's accreditation and certification procedure for DNB training centres needs to be improved further, he said.

At present, every year, there are about 25,000 medical graduates of whom 9,000 obtain MCI-approved post-graduate degrees and about 3,000 qualify with DNB degrees, according to K.M. Shyamprasad, the NBE vice-president. "But," he says, "employment opportunities in medical institutions are significantly limited for DNB degree holders because of the MCI guidelines. There is also scope for at least doubling the number and also institute national programmes in areas where there is shortage of faculty. But the MCI directives prevent many institutions from offering their facilities for training DNB students. The proposed infrastructure expansion will also result in increased capacity of institutions to train DNB students."

These MCI guidelines are formulated by the Post-graduate Medical Education Committee (the PG Committee) constituted under Section 20 of the Indian Medical Council Act, 1956. It was on the basis of the recommendation made by the PG Committee in 1993 that the Government stipulated in October 1994 that for teaching appointments in broad specialities, a DNB degree holder was required to have at least one year's experience as tutor/registrar/demonstrator, or an equivalent post, in a recognised undergraduate medical college. Similarly, for teaching posts in super specialities, a DNB awardee was required to undergo two years' training in a recognised medical college with recognised post-graduate degree course in the concerned speciality.

While the Act only mandates the MCI to prescribe under-graduate courses and degrees, as well as approve the corresponding institutions offering them, it has only advisory and recommendatory powers as regards post-graduate courses and degrees. However, according to the NBE, the MCI had in recent years begun to impose guidelines for post-graduate education as well. These guidelines, as formulated by the PG Committee, rendered a whole cadre of DNB-qualified post-graduate medical students ineligible for teaching posts in medical institutions. This assumed authority, the NBE contends, goes beyond the provisions of the Indian Medical Council Act.

According to Dr. Shyamprasad, the requirement of additional experience was reasonable earlier because DNB students did not do any dissertation for their degrees. "But now since DNB students also have to do dissertations, there is no rationale any longer for insisting on additional teaching experience. Moreover, all over the world the paradigm of medical education has advanced and today it is integrated with clinical science," he points out.

But the MCI has continued to maintain its earlier stand. In 2003, the MCI enumerated specific reasons why it could not accept the equivalence of DNB degrees with MD/MS and DM/M.Ch degrees. However, both the Government and the NBE find no merit in the MCI's arguments and have rejected them.

In August 2004, and again in September 2005, the MoHFW notified that institutions conducting MCI-approved post-graduate courses were also permitted to run DNB courses. However, in November 2005, the MCI unilaterally instructed all medical institutions to refrain from this practice without seeking the Government's consent as required.

It is pertinent that the MCI did not attend a meeting on post-graduate medical education convened by the Health Ministry last week at which the issue of DNB degrees was discussed. According to MCI Secretary Lt. Col. (Dr.) A.R.N. Sethalwad, "the meeting had no legal validity because an executive order cannot override the decision of a committee constituted under an act of Parliament."

But the Government is keen to resolve this standoff between the Ministry and the MCI at the earliest. A Bill is pending with the Parliamentary Standing Committee on Health that would enable suitable amendments to the Act and bring about changes in the MCI's functioning.

Link: Original Article

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