March 24, 2011

Delay in centralised DNB admissions causes concern

The centralised admission procedure, introduced for the first time for the three year diplomate of the national board (DNB) -- a post-graduate broad specialty course in medicine awarded by the Delhi-based National Board of Examinations (NBE), has left both applicants and hospitals in a state of confusion and anxiety. While opinion stands divided as to whether or not the procedure should be centralised, everyone is unanimous that the execution is inordinately delayed.

Though the marks have long been declared, no one knows what rank they hold yet, and what institute they can expect. Once the merit list is declared, all candidates are expected to make it to New Delhi for the counselling procedure. The confusion in filling up the online forms added to the delay since students were first asked to fill in their final year MBBS marks and subsequently asked to enter previous year's score as well. The applicants have also complained that the list of hospitals compiled for the candidates' perusal is not exhaustive.

The diplomate qualifications, awarded after an applicant has acquired the MBBS degree, have been equated with the post-graduate and post-doctorate degrees awarded by other Indian universities by the Union ministry of health and family welfare. The MD (doctor of medicine) and MS (masters in surgery) on the other hand are degrees awarded by the All India Institute of Medical Sciences.

In a major decision last year, the health ministry has approved the Medical Council of India's ( MCI) proposal to allow doctors with the DNB degree to teach just like those with an MD/MS degree.

The NBE's decision to centralise the admission procedure is aimed at bringing about a greater degree of transparency and fairness. Up to last year, each hospital would put up its own merit list and conduct an interview with the candidate. However, this procedure lacked transparency.

"The centralised admissions will bring about a greater degree of fairness in allocation of seats, and eventually do away with the system of paying donation to the hospital. However, the manner in which the entire process has been carried out so far leaves a lot to be desired. The DNB primary specialty exam was held in December 2010. We got our score in January. But the all-India ranking and date of counselling have not yet been put up. A notice on the website said it would be out on February 14 by 6 pm. But that has not happened. Also, the list of colleges and number of seats they are offering are not exhaustive," said Amit Kamat, an applicant who is looking at specialising in gynaecology.

Another candidate, who wishes to specialise in surgery, said: "Once the ranks are declared on the NBE website, everyone will be required to go to Delhi, rank-wise, for the counselling procedure. We may not get enough time to reach there, as the process is already delayed. Delhi may not be a convenient location for everyone and they could have offered a zone-wise centre."

Madan Hardikar, director of Hardikar hospital, which offers DNB seats for orthopaedics, said that the move to centralise admissions had been opposed at a meeting of various institutes, which had been called by the board.

On the other hand, Mahesh Tulpule, DNB teacher at various hospitals, supported the board's decision. "It will go a long way in bringing transparency in the system. Doctors can look forward to better working conditions as hospitals that ill-treat their staff will eventually fall by the wayside. The argument that applicants will be inconvenienced by having to travel to remote places does not hold good. Even in the entrance exams for the Indian Administrative Service, only the toppers got to choose their cadre. The same holds good with the Indian Military Academy. So why should the same not apply to medicine?"

S P Singh, chief executive officer of the Aditya Birla Memorial Hospital, said that the apprehension and anxiety accompanying this initial exercise were a given. "But, eventually, it will add value to the entire educational system and everyone will benefit. The logistics like a zone-wise assignment/counselling centre will eventually fall into place."

Bipin Batra, executive director of the NBE, said the declaration of the merit list had been delayed because the applicants, despite repeated extensions, had failed to submit their data marks systematically online. "Despite extending the last date to February 4, our office was inundated with faxes to entertain further changes. So, we have extended the date one last time to February 22, after which it should take our system at least 48 hours to compute the final merit list. So the merit list and the counseling dates are likely to be declared simultaneously around February 24. We have received a record 7,000 applications from all over the country," he said.

With regard to the anxiety surrounding the centralised process, he said: "Centralisation is happening for the first time in the case of broad specialty courses. For fellowship programmes, it has been on for the last seven years."

He said that zone wise counseling centres were not possible this time around due to logistical difficulties. "However, it will happen from next year."

Link: Original Article

March 23, 2011

Health and HRD Ministries agree on medical education jurisdiction

The expert group of the Ministry of Health and Family Welfare and the task force of the Ministry of Human Resource Development (HRD) on Tuesday broadly agreed to settle their turf war over the jurisdiction of medical education.

The National Commission for Human Resources in Health (NCHRH) will get to lay down the minimum standards of medical education, while all health-related research will come under the purview of the National Commission for Higher Education and Research (NCHER), promoted by the HRD Ministry.

However, universities will also be free to have more exacting higher standards for which they will deal with the NCHER.

The NCHRH and the NCHER draft Bills — proposed as regulatory bodies — have been pending for the past several months as the two ministries were involved in a tussle over the jurisdiction of medical education.

The Health and Family Welfare Ministry refused to give up medical education for inclusion under the NCHER on the grounds that it was linked to health services, while the NCHER said that since all education was governed by the university system and there were multidisciplinary areas of research, all education should come under one regulator.

The war of words was so intense that the Prime Minister's Office (PMO) had to intervene and ask the ministries to work out a mechanism that would link the two regulatory bodies and complement each other instead of contradicting them.

T.K.A. Nair, Principal Secretary to the PMO, called both sides and asked them to work out some kind of an arrangement. HRD Minister Kapil Sibal and Health and Family Welfare Minister Ghulam Nabi Azad also spoke to sort out the matter amicably.

As per the agreement, the NCHER will lay down guidelines for research to bring in uniformity. All research proposals, including that of health, will be guided and prioritised by the Board for Research Promotion and Innovation, under the NCHER, without prejudice to other funding agencies like the Indian Council of Medical Research, Council for Scientific and Industrial Research, and other institutions.

The Board for Research Promotion and Innovation will also have representatives from other ministries involved in research.

The two Bills will now be amended to accommodate the agreement and then circulated for comments from the other ministries concerned before these are placed in the Cabinet for clearance.

Link: Original Article

March 22, 2011

Changes in MBBS course puts doctors in a dilemma

An eight-member committee of medical experts has recommended several changes in the MBBS course curriculum. The committee has suggested that the Medical Council of India (MCI) restructure the course and the duration of the undergraduate medical programme.

Currently, the MBBS course is of four and a half year in addition to one-year internship. If the recommendations are accepted, the duration of MBBS course, in the future, will be of four years along with an internship of one year. In addition, a six-month elective course will be introduced at the end.

The committee was formed to address the shortcomings of medical education and to suggest ways to increase the number of medical professionals in the country. The working group has advised the MCI to restructure the entire course by introducing the 4+1+0.5 formula in place of the 4.5+1 year formula.

The last six months will comprise elective subjects which includes bio-informatics, tissue processing, immunology, genetics, sports medicine etc. Students will have to choose from these subjects at the conclusion of their 5-year MBBS course.

Elaborating about these changes, a senior doctor said that the introduction of elective subjects won't be that easy for colleges and students. "All the colleges have to manage faculties for these subjects. Moreover, many subjects are of engineering disciplines," said the doctor.

He added that the committee has suggested other changes as well. They include, introduction of clinical practice from the first year instead of second year. It means that MBBS students will check the patients from the very first year of their studies. "This issue is highly debatable and students may find it difficult too," said another doctor, who is also a professor.

Many doctors feel that it is not necessary to follow the trends of other countries while introducing clinical practice in the very first year. "UK has already done that but it is worth noting that they failed in that," opined a city-based senior doctor.

Link: Original Article

March 21, 2011

Kolkata Declaration calls for publicly provided health care for all

At the ninth Kolkata Group workshop, chaired by Professor Amartya Sen, 45 participants from different walks of life, including social scientists, policy makers and development experts, convened to assess the dimensions of social equity in India, especially as related to poverty, elementary education, and health.

The participants assessed that the benefits of economic growth over the past two decades, while substantial, have not translated into health security for people. Many countries in Asia, including even those with lower per capita income, are tending to outperform India in health and healthcare. India lacks a primary healthcare system that offers effective and affordable protection to all against common illnesses. India's public spending on health – a little over one per cent of GDP – is among the lowest in the world. This has led to an extremely high burden of private out-of-pocket health expenditures, which a huge part of the population cannot afford, and which even fails to guarantee reliable healthcare because of inescapable difficulties of the market for medical attention and care.

Influential policymakers in India seem to be attracted by the idea that private healthcare, properly subsidised, or private health insurance, subsidised by the state, can meet the challenge. However, there are good analytical reasons why this is unlikely to happen because of informational asymmetry (the patient can be easily fooled by profit-seeking providers on what exactly is being provided) and because of the ‘public goods' character of healthcare thanks to the interdependences involved. There are also major decisional problems that lead to the gross neglect of the interests of women and children in family decisions. Nearly every country in the world which has achieved anything like universal health coverage has done it through the public provision of primary healthcare (whether in Europe, Canada, or much of East Asia). The Kolkata Group calls upon India's leaders to recognise the necessity for the state to provide comprehensive quality primary health care for all.

Related to the main focus of the recommendations, the Kolkata Group urges the Government to increase public spending on healthcare to achieve its well-considered pledge of devoting at least 3 per cent of GDP to healthcare. It is particularly important to recognise that there are good reasons for demanding universal entitlements to publicly provided primary healthcare for all. The steady increase in public revenues generated by economic growth can and should be fruitfully committed to this extremely important cause.

In addition to Amartya Sen, the Kolkata Group attendees were Sabina Alkire, Sudhir Anand, Amiya Bagchi, Jasodhara Bagchi, Alaka Basu, Afsan Bhadelia, Countess Albina du Boisrouvray, Sugata Bose, Achin Chakraborty, Lori Calvo, Lincoln Chen, Seema Chishti, Abhijit Chowdhury, Asim Dasgupta, Antara Dev Sen, Nabaneeta Dev Sen, Dilip Ghosh, Joaquin Gonzalez-Aleman, R. Govinda, Shaibal Gupta, Karin Hulshof, Rounaq Jahan, Pratik Kanjilal, Manabi Majumdar, Poonam Muttreja, Rohini Nilekani, P.D. Rai, N. Ram, Mariam Ram, Kumar Rana, Sujatha Rao, Srinath Reddy, Abhijit Sen, Nandana Sen, A.K. Shiva Kumar, Shanta Sinha, Rehman Sobhan, Ramya Subrahmaniam, Madhura Swaminathan, Sharmila Tagore, Sukhadeo Thorat and Sitaram Yechury.

Link: Original Article

March 20, 2011

New medical syllabus to stress practical skills

Medical education in India is all set for a massive overhaul. Medical Council of India (MCI) is close to finalising a brand new curriculum for both undergraduate (UG) and post-graduate (PG) medical education that gives utmost importance to "clinical acumen rather than just theoretical knowledge".

As many as 74 special teams -- each comprising three experts (for example, one for internal medicine, neurology and cancer etc;) are putting finishing touches to vision documents on "how many doctors are presently needed in a particular stream, how many is now available, how to bridge this gap, what kind of content needs to be taught to students and what additional infrastructure is needed". The findings will be incorporated to frame the new medical education curriculum.

Dr S K Sarin, chief of MCI's governing body, told TOI that "we will finalise the curriculum by next week. We plan to present it to Union health minister Ghulam Nabi Azad around March 20, and make it public by end-March."

Around 17 new courses would be started, emphasising that they would be both "niche and also what India needs today".

"The curriculum will also look at the needs of our own people. Clinical competence will be given vital importance as medicine is not just theory. Exposure to disease will be stressed. A basic doctor will have varied skill sets -- from knowing how to treat a snake bite patient to how to save a person who has suffered a heart attack," Dr Sarin added. Officials said the new curriculum would give extra importance to internship done by MBBS students after their four and a half years of rigorous studies.

Professor Ranjit Roychoudhury, member of MCI's governing body, said, "we had invited comments on our draft curriculum which have now come in. We are modifying and finalising the curriculum based on public views."

He added, "The curriculum calls for major changes in the way medicine is taught in India. It will come into effect from the following academic session."

A Union health ministry official said, "We welcome the change. However, the new curriculum has to go through consultation. A meeting with MCI is scheduled next week."

An MCI document confirms how clinical skills are being given utmost importance. It says, "Clinical skills have traditionally been taught in an ad hoc and unstructured manner and some students may graduate without becoming competent in very basic clinical skills. Intensive training in clinical skills right at the beginning of the fifth year will help students become competent in basic and generic clinical skills."

At the end of five years of undergraduate medical training, MCI says, the students should be able to perform a through and systematic physical examination of any organ-system of the body, performing core clinical skills, demonstrate competency in communicating with patients at ease, request relevant clinical investigations and analyse abnormal findings of an investigation.

MCI document adds, "At the end of the posting, students should be able to perform safely, confidently and effectively procedures like generic skills including perform a venepuncture, setting up an intravenous line, give intravenous injection and obtain a sample of arterial blood and catheterise urinary bladder."

It explains, "under medical skills, the doctor should know how to record an ECG, how to use a nebuliser, interpret and analyse reports of clinical investigations. Under surgical skills, the basic doctor should know how to perform a prostate examination and insert a nasogastric tube. Under emergency skills, the doctors should know how to perform advanced life support procedures, perform basic life support and know how to safely transfer a patient after an accident."

MCI feels undergraduate medical education needs reform. "The MBBS graduate does not feel equipped with adequate skills to take care of the common problems at the secondary and primary level. This is reflected in the low number of graduates who go into practice at the end of their MBBS training," says an MCI note.

It adds, "The past curricular revisions have mostly added to the existing content without undertaking the exercise to remove what is obsolete/outdated. The reforms have to be based on both successes within India, as well as models of medical education that have addressed similar issues in other countries."

Link: Original Article

March 19, 2011

MCI planning entrance to enhance credibility quotient

India is mulling over a proposal to introduce the Indian Medical Graduate degree -- an examination that will be at par with MBBS -- which can be taken by all doctors passing out of medical school as an additional qualification.

Brainchild of Medical Council of India (MCI), it will do away with doubts over the competence of a doctor with an MBBS degree from not so good colleges or universities.

Speaking to TOI, Dr Ranjit Roychoudhury from MCI said, at present an MBBS doctor from All India Institute of Medical Sciences (AIIMS) thinks s/he is better than h/his counterpart from UP or Bihar.

And so, even though the latter holds a valid MBBS degree, the individual is discriminated upon all h/his life.

"Now, a doctor after passing out of medical college can take this examination, which will be of the same standard as the MBBS degree, and prove his mettle. He can then say that even though I got my MBBS from a college in Muzaffarnagar, I also passed the Indian Medical Graduate test, which stamps his credentials," Dr Roychoudhury said.

He added, "The test will, however, be voluntary and will only be for prestige. Those who don't want to appear for the examination can start practicing soon after getting their MBBS degree as usual."

Dr Devi Shetty, another member of MCI's governing body, added that the proposal has been forwarded and is under consideration of the Union health ministry.

"At present, whenever our doctors apply in the United Kingdom for training, British Medical Council asks for a DNB degree. That's because 31 states have hundreds of universities and colleges granting MBBS degree, each having a different standard. So, there is no assurance on quality. DND, on the other hand, is a national standard examination. This new exit examination will give uniformity to all Indian degrees," Dr Shetty added.

MCI had recently informed the Supreme Court of a common exit test after obtaining the MBBS degree from medical colleges. They, however, said it would be mandatory, but seems to have changed that view.

Considering the sensitive nature of the profession -- dealing with life and death -- and keeping in mind varying standards of education in medical colleges, MCI proposed this common exit examination for MBBS pass-outs, solicitor general Gopal Subramaniam had told a bench of Justices R V Raveendran and H L Gokhale.

MCI's recommendation is to standardise the skills of doctors and in line with the decision of Bar Council of India (BCI), making it mandatory for law graduates to clear a test to be able to practice in courts.

Link: Original Article

March 18, 2011

CET for medical courses unlikely from this session

Proposed by the Medical Council of India (MCI), the Common Entrance Test (CET) for undergraduate and post-graduate medical courses may not be started from this session.

Although officials of the Union Health Ministry and the Medical Council of India (MCI) met on Thursday to resolve their differences on the CET, sources said “it will not be feasible to start CET from this year”. Now the ministry and the MCI might file a “joint affidavit in the court saying the process of consultation with the states is still on, so they may not be in a position to start CET this year”.

According to officials in the Health Ministry, many states have announced their medical entrance tests. “We are already in March; there has to be a uniform syllabus if we want to go ahead with the CET,” officials said.

Sources said the matter would again be discussed with the Health Secretary on Monday, but there was little possibility of going ahead with the CET without Tamil Nadu, the state with the maximum number of private medical colleges.

Link: Original Article

March 17, 2011

Healthcare to become costlier

Health treatment, air travel and hotel accommodation are set to become expensive with the widening of the service tax net, though the rate has been kept unchanged. While some viewed it as a step towards introduction of the Goods and Services Tax (GST), industry leaders unanimously gave a thumbs-down to it.

The finance minister said the proposals relating to service tax would end in a revenue gain of Rs 4,000 crore in 2011-12.

“The actual collections of service tax do not reflect the full potential of this sector. While retaining the standard rate of service tax at 10 per cent, I seek to achieve a closer fit between the present service tax regime and its GST successor,” finance minister Pranab Mukherjee said.

The government has sought to levy tax on all services, including diagnostic, offered by a hospital or nursing home that has central air-conditioners and more than 25 beds.

Diagnostic tests as well as services provided by doctors, who are not employees of any kind of clinical set-up, would be charged service tax. Mukherjee said there would be an abatement of 50 per cent so that the actual burden is kept at five per cent of the value of service. All government hospitals would be outside this levy.

“These proposals are extremely significant as well as controversial. I think the idea was to broaden the base in the face of GST. The focus was to tax those services that are in the organised sector,” said Satya Poddar, partner, Ernst & Young.

“This comes at a time when the healthcare sector is already bearing the brunt of an inflationary spiral that has been unrelenting for the past several months. We will be forced to pass on this tax to the patients, something that will certainly cause a lot of heartburn amongst our customers. A service tax only makes the bill dearer and impacts the patient even more adversely,” Pervez Ahmed, CEO and MD, Max Healthcare, said.

Besides, the ambit of service tax was also widened to cover hotel accommodation above Rs 1,000 per day, air-conditioned restaurants serving liquor, and legal services.

“The fact that the finance minister chose to consider healthcare services under the service tax net is going to be extremely retrograde. Besides, as far as including hotel accommodation or restaurants are concerned, they would be litigative because these services are deemed to be sales. The maximum rate proposed under GST is 20 per cent, but what the budget proposed on Monday exceeds 20 per cent limit,” said Atul Gupta, senior director, Deloitte Haskins and Sells.

Mukherjee said a scheme would be introduced for refund of service tax on lines of drawback of duties. This would benefit the country’s exporters to a large extent.

The budgeted estimates for service tax have been pegged at Rs 82,000 crore for 2011-12, compared to the revised estimates of Rs 69,400 crore in 2010-2011.

According to him, the government is panning to create a list of services to bring several untapped sectors under the services tax net that would help the government shape the policy guidelines on GST in a better way.

Link: Original Article

March 16, 2011

MCI too againstequating DNB with MD

While the issue of equating the Diplomate of National Board (DNB) examination with other post-graduate courses in super specialties in medicine by the board of governors of Medical Council of India (MCI), an ad hoc body of the council, has generated a debate on the subject, the autonomous 60-member council too was against any parity between the two.

MCI had debated the issues at length and decided against equating the two. Former academic cell chairman of MCI from city Dr Ved Prakash Mishra told TOI that the general body of MCI had debated the issue at length and decided against equating the two. However, the council had allowed parity of DNB to regular PG qualification only in case the incumbent had one year research associateship to his/her credit along with three years of tutorship in concerned specialty in a recognised medical college," he said. "During PG course students are entitled to teach undergraduate students and this teaching was counted as 'teaching experience'. Such a situation does not exist in non-teaching hospitals," added Dr Mishra.

Former MCI officials tell that the though the government of India had started the National Board of Examination through a parliamentary enactment to meet paucity of avenues for post-graduate education and also avail of infrastructural facilities in non-teaching hospital for academic usage, the primary aim for the said board was to have a national unitary examination for purpose of conformant of DNB in the prescribed super specialties at par with PG degree only in case 'a research associateship' of one year was gained by the student in a recognised medical institution.

However, many senior practicing doctors called up TOI on Thursday expressing views in favour of equating DNB with MD/MS. Dr Rajesh Swarnakar, a senior chest physician, categorically stated that DNB was definitely a superior degree than PG and hence there was no question of equating the two. "The standard is so high that merely 5-15% clear the exam. DNB admissions are centralised and there is no scope for any manipulation. Hence DNB is not equivalent to MD/MS but is much superior," he said. Dr Swarnakar pointed out that the DNB examination had much more recognition abroad as compared to other PG degrees in medicine from India.

Link: Original Article

March 15, 2011

IMA wants govt. to cancel introduction of rural health course, intensifies stir

Continuing its protest against the government's decision to introduce a three-and-a-half-year-long Bachelor of Rural Health Course (BRHC) in the country, the Indian Medical Association has now called upon medical students and young doctors from across the country to join their agitation. The Association has also threatened to intensify its agitation by wearing black bands and going on an hour-long token strike in case the government does not pay heed to their demand of withdrawing the proposed course.

“It is unfortunate that the government has decided to go ahead with its plan to start the BRHC despite strong opposition. We have now called upon young doctors from across the country to be a part of the protest movement to ensure that the government has a chance to listen to the grievances of those who are going to be adversely affected by the introduction of this new course,” said IMA joint secretary Dr. Narendra Saini.

He said it is not just young doctors who would be adversely hit but the course would also affect the health of rural India as the course would “produce half-baked doctors”.

“Next month, doctors across the country will protest by wearing black bands on one day and the next month we will participate in a token strike. This is to drive home the point that doctors are unhappy with the introduction of the course. There is also a general consensus among medical students and young doctors on the ill effects of such a move. These doctors have joined under the banner Young Doctors' Federation to highlight their problems and to ensure that there is sustained pressure on the government to take back the course,” added a senior IMA official.

In a statement, the Association noted that through the introduction of the course, the government will produce “semi-qualified quacks” which will further expose the patients to several problems.

Link: Original Article

March 14, 2011

Delhi docs hog lion's share of Padma awards

Doctors from Delhi seem to have an undue advantage when it comes to receiving the prestigious Padma awards. And, cardiologists and cardiac surgeons make the grade more often in the hallowed list.

An interesting analysis -- "Doctors and the Padma Awards" -- published in National Medical Journal of India on Tuesday lists that 1,166 Padma awards were announced between 2000 and 2010. Of these, 157 (13.4%) were from the field of medicine.

As many as 137 of the awardees were finally evaluated as the rest five were overseas awardees and 15 were from alternative field of medicine like ayurveda, siddha and homoeopathy.

Of the 137 awardees in medicine, 62 (45%) were from Delhi, 18 (13%) from Maharashtra and 17 (12%) from Tamil Nadu. There were less than 10 representatives from other states in the corresponding period.

Incidentally, not a single doctor from large states like West Bengal, Gujarat, Rajasthan, Madhya Pradesh, Punjab and Haryana received any of the Padma awards.

Analysis of the state-wise distribution of the Padma awardees confirmed Delhi's dominance. It showed that among the seven Padma Vibhushan awardees, four (57%) were from Delhi. Among the 25 Padma Bhushans, 16 (64%) were from Delhi and among the 105 Padma Shris, 42 (40%) were from the national Capital.

The analysis -- done by a team, headed by Dr Samiran Nundy, from the department of surgical gastroenterology and liver transplantation of Sir Ganga Ram Hospital -- also revealed the dominance by cardiologists and cardiac surgeons. It showed that 31 out of the 137 awardees (23%) were cardiologists or cardiac surgeons, followed by ophthalmologists 15 (11%) and orthopedic surgeons 14 (10%).

Cardiologists received a greater proportion (43%) of the Padma Vibhushan awards. The other awardees were from Orthopedics (1), Neurology (1) and general medicine (1) discipline. Around 36% of the Padma Bhushans and 18% of the Padma Shris were conferred on cardiac specialists.

"The over representation of Delhi and cardiology in the Padma awards for medicine suggests that their distribution is not entirely fair," the study observed.

It explained, "This data is interesting on many accounts. Nearly half the awards were bestowed on Delhi doctors who were likely to have treated the politicians and bureaucrats who made the decisions. This skewed bias towards Delhi and towards the specialty of cardiology raises some questions about the representative nature of these awards and the selection process."

The Padma Awards were instituted in 1954, and are announced every year on the eve of Republic Day. Padma Shri is awarded for distinguished service, Padma Bhushan for distinguished service of a high order, and Padma Vibhushan for exceptional and distinguished service.

Link: Original Article

March 13, 2011

MCI planning steps to perk up health care sector - Vision 2015

The state of medical services in India might undergo a sea change very soon as the apex body governing these services, Medical Council of India (MCI), has some big changes in mind, especially for the undergraduate medical education.

Broadly speaking the three chief objectives of the council are improving the quality of medical education, capacity building and providing performance-based incentives. With several innovative steps, they are planning to tackle various issues that are weighing down medical care so as to achieve various short term and long term goals that would ultimately give the best available care to the ailing populace of the country.

Improving quality of education: For the improvement of quality of education, the plan is to completely restructure the present format of the MBBS course at the undergraduate level. From a simple 5-year long classroom coaching the format is set to be shortened by six months. After the completion of this period, a student is to take up internship for a year's time.

Additionally, the students would be exposed to clinical cases right from the beginning of their course with an aim to gain more practical knowledge.

In order to make medical education more contemporary, modern technologies like e-learning and m-learning will be introduced. The subjects that are taught will all be grouped into three categories, with several of them like radiology and dermatology being made optional. Also, there would be several electives like bio-informatics, HIV medicine, lab sciences, etc.

Improving skills/capacity building: In order to ensure skill development in the future medicos, there would be a list of necessary skill sets that they need to master in order to get their license. Centers are to be established that would facilitate learning while working.

To build up the professional capacity of doctors under training district hospitals, taluka hospitals and primary health care centers are to be linked with the medical colleges. The seats available in all colleges are to be increased as a short term solution to counter the problems that are bogging the health sector. The medium term solution includes upgrading the existing medical facilities by encouraging public-private partnership in the field of healthcare. Long term solution would be setting up of new medical colleges and hospital.

The intellectual capacity of those teaching in medical colleges are to be improved by conducting faculty development programs, encouraging younger medicos to take up teaching to increase the pool of faculty and making provisions for dual and interdisciplinary appointments. Moreover, the retired teachers and consultant pool in various government departments would also be made use of as teachers. In fact, even the age of superannuation of medical faculty in certain areas is to be increased.

Introducing incentives for teachers: The incentives such as financial rewards and grants would be given out to faculty and the institutions so as to improve their performances and quality of work.

MCI is aiming to achieve a complete transformation of the health care in the country by adopting all these measures.

The main goal that would be achieved through the new improved curriculum and capacity building initiative would be to have sufficient number of doctors so as to have a better doctor-patient ratio.

Improving doctor patient ratio: The doctor-patient ratio in India is as high as 1: 1,722 if only allopathic doctors are taken into consideration. If other doctors are considered as well, the figure becomes 1: 1781. This means that for more than 1,700 patients only one medico is available.

Cuba has a much better count, having one doctor for 170 sick people. The situation is twice as good in our neighbour and the most populous country in the world China where the doctor-patient ratio is 1: 950. Looking at the other BRIC nations, one is awe struck by the fact that one doctor in Brazil can look after 900 patients while in Russia the number is as low as 300. Ideally, the ratio should be a doctor for 500 people.

The MCI identifies this huge disparity and has prepared a mandate to improve the condition, wishing to bring down the ratio to 1: 1000 in another two decades. In their 'Vision 2015', they have listed their aspiration to review the current state of affairs thoroughly to devise reforms for a better future. Their strategy is to develop ways to direct the medical education in the country in a better direction, making it as good as in the developed countries. They also wish to prepare the novice medicos well prepared to face the challenges that come up as the world of medicine keeps evolving every day.

All these steps are expected to ultimately lead to a better system of medical care being made available to the patients in India.

Link: Original Article

Railway ministry to set up medical colleges on public-private partnership basis

The union railway ministry has invited expression of interest (EoI) for setting up as well as running medical colleges on a public-private partnership (PPP) basis on railway land at five locations in the country.

The scheme is open for both Indian as well as global institutions till the end of this month. The medical colleges will come up at Kharagpur, Guwahati, Chennai, Secundarabad, and Lucknow.

According to a railway ministry official, the ministry will provide the land for the purpose. “Railways plans to partner with both Indian as well as overseas institutions for establishing and running medical colleges in railway premises on PPP model. Since the railway land/hospitals are mostly in the heart of the city, it makes a good option for those willing to invest,” the official said.

According to a ministry circular on the subject, “The private partner will have to build operate and maintain the medical college, hostel and other infrastructure required on the railway land. Private partner will have to substantiate the shortfalls as per the Medical Council of India (MCI) norms in the services, including bed.”

Going forward, the railway ministry will commit a 340-bed hospital in Kharagpur, a 317-bed hospital in Guwahati, 500 beds in Chennai, 300 beds in Secunderabad, and 275 beds in Lucknow. But this will come at a price for the private partner. A share of seats will be reserved for wards of railways employees. The circular says, “Seat-sharing for wards of railway employees is an essential pre-requisite.”

Link: Original Article

March 12, 2011

MCI puts curbs on visits by foreign doctors

No foreign national or NRI medical professional will henceforth be permitted to demonstrate procedures/ surgeries in India without prior permission from the Medical Council of India. A warning to this effect has been circulated by MCI to all medical colleges/institutions, state medical councils, all medical associations and hospitals.

Clarifying that prior MCI permission/registration was mandatory, the February 11, 2011 circular, signed by MCI's additional secretary P Prasanna Raj, said suo motu action would be initiated by the MCI against erring medical colleges/institutions.

Aimed at verifying the credentials of foreign/NRI medical professionals participating in continuing medical education (CME) programmes or workshops or post-graduate courses in India, the circular said: ''This is to inform you that all foreign nationals/NRI faculty will have to take prior permission from the MCI in the prescribed form no. MCI-07 available on the website, if he/she demonstrates/conducts any procedure, intervention, surgery, drug therapy, application of any new device or any treatment, on a patient in any CME programmes/workshop/PG course or any other programme, conducted by medical college/ hospitals/ medical association or any other organisation in India.''

The announcement has evoked mixed reactions from the medical fraternity across the country. While some leading doctors agreed on the need to screen the bonafides of visiting medics, many felt that the proposal would needlessly hamper flow of knowhow and research findings into India.

Dr T D Naidu, president of the All India Medical Association and chairman, Chennai-based DD Medical Hospital and DD Hospital, welcomed the proposal and said verification of the bonafide of the foreign medical professionals by MCI would enhance credibility of the profession. ''Some medical institutions flaunt foreign faculty without conducting due diligence on the professional's standing and record in his home country," Naidu said.

He also called upon MCI to step in and play an active role in whetting the memorandum of understanding being signed by Indian medical institutions with foreign entities. "A representative of the MCI shall be part of the expert team finalizing the fine print of such MoU," he said.

While agreeing that prior permission was a must for performing surgeries or live demos on Indian patients, doctors and institute heads said the MCI circular was too restrictive. "What is wrong with foreign nationals or NRIs coming to give lectures or share valuable knowledge about the latest developments in medical field?" said founder-chairman of Frontier Lifeline hospitals, Dr K M Cherian.

"Nothing original in the field of medicine has come out of India. We depend solely on studies by our peers in other countries," he added.

Link: Original Article

Max plans med education institute, may invest up to Rs 1000 cr

Max Healthcare is likely to invest up to Rs 1,000 crore over the next three years to set up a medical education institute at Greater Noida.

"We expect the investment on total infrastructure to be in the range of Rs 700 crore to Rs 1,000 crore. The institute will include a medical college, a nursing college and a college for allied health services," Max Healthcare CEO and Managing Director Pervez Ahmed told PTI.

While the nursing and allied healthcare colleges will become functional this year, it will take nearly three years to start the medical college, he added.

As per the company's plans, the medical college will have 50 seats to start off with, which will eventually go up to 150. The nursing college will have 100 seats and the allied healthcare institution will have 300 seats for various certificate and diploma courses.

The company will fund the project through a combination of debt and equity, Ahmed said.

Apart from the institute at Greater Noida, the company also plans to set up another three nursing colleges over the next three years.

"We have plans to start three nursing colleges at Dehradun, Noida and one in Punjab. For the Dehradun one, we have already identified the location," Ahmed said.

The company will commission four new hospitals this year taking its in-patient bed capacity to 2,000 beds from 800 at present. It expects the total bed strength to go up to 5,000 in the next five years.

"The majority of the addition would be through mergers and acquisitions. There are a few players with whom we are having discussions," Ahmed said, without disclosing details.

Max Healthcare expects its four hospitals at Mohali, Bhatinda, Delhi and Dehradun to become operational this year.

Link: Original Article

March 11, 2011

Medical entrance exam goes biometric to stop imposters

A tiny device, no larger than a TV Remote, will check a rampant Indian examination malpractice —impersonation — in the high-stakes JIPMER (Jawaharlal Institute of Post-graduate Medical Education and Research) entrance exams being held countrywide on Sunday.

The device called AuthenTrac will capture fingerprints and photographs of each of the 15,000 candidates across dozens of exam centres in five cities in real-time, matching it with previously-stored candidate data from the institution. The data will be re-checked at the time of counselling and seat allotment.

The technological innovation will curb exam impersonators, giving the meritorious a fair shot at securing a coveted spot in the 120 post-graduate medical seats at the Puducherry-based JIPMER, one of the top medical schools in India.

AuthenTrac has been developed and is offered as a service by Bangalore-based testing and skills assessment company MeritTrac, which counts Microsoft, Accenture, ICICI Bank and the governments of Gujarat and Orissa amongst its customers. Its AuthenTrac device is pending a patent.

Even though the number of exam imposters caught is low, the potential for masquerading is as much as 15 percent, says Madan Padaki, CEO of MeritTrac. “The current process to nail impersonation is weak because it relies on easily forge-able signatures and photographs which can be smudgy and grainy,” says Padaki, adding, “There is very little chance in this system of the impersonators being caught.”

The new device has huge ramifications in populous India where the demand-supply gap in education and employment is skewed and high-stakes tests have lifelong consequences. Now, technology could help stave off a challenge that India’s institutions have faced for decades.

The potential for masquerading on behalf of candidates is as mind-boggling as the scale of testing itself, says Padaki. Annually, 10 million students take the qualifying exams to win coveted engineering, medical and MBA seats in colleges. Some 20 million applicants take exams to qualify for public sector and bank jobs each year. A further 30 million appear for exams to secure central and state government jobs.

AuthenTrac has already been deployed as a pilot by a leading Indian energy PSU where thousands of candidates took exams for jobs. Padaki says his company will target 5 million candidate authentications in the next three years.

At Sunday’s exam, invigilators will take the hand-held device—equipped with a fingerprint scanner, camera and barcode—to each candidate. They will capture the left and right ring finger prints as well as take a photograph of each candidate. They will match the signature and photo with the candidate’s application data.

The process will be minimally intrusive and take a couple of minutes. The device has time stamps for every authentication action, providing a rich audit trail for later use or for RTI queries, if any. The data is stored in a high-security data center. MeritTrac’s solution costs a few hundred rupees per candidate.

The captured data can be subsequently used to re-authenticate the candidate at the time of interviews, subsequent exams or, as in the case of JIPMER, seat allocation.

Link: Original Article

March 10, 2011

Indian medicine doctors can practise allopathy

The Madurai Bench of the Madras High Court on Friday said the police cannot be allowed to proceed against doctors practising under the Indian Medicine system prescribing allopathic drugs.

In his order on a batch of petitions, Justice K.Chandru said at no point of time a person who is having a valid degree and having registered under an enactment could be directed to be proceeded against by the police by registering a criminal case against him and that too at the instance of an association such as the Indian Medical Association (IMA), which was not even a statutory body. It was a mere association of doctors practising allopathy.

In its petition, the Tamil Nadu Siddha Medical Graduates Association sought to forbear the authorities from interfering with the professional practice of its members and from taking action in the name of anti-quackery action against them, who were practising their profession as per the Central Council of Indian Medicine's rules and the Indian Medical Degrees (Madras Amendment) Act.

Mr.Justice Chandru referred to a State Government order of September 2010 and said it was the statutory order that took out the taboo of such of those Indian Medicine doctors prescribing even allopathy medicine.

There was a misconception about doctors who were qualified under the Indian Medicine and having valid degree as well as registration under the statutory council being dealt with by the police solely at the instance of the IMA and treating them as criminals. “If allowed, it would certainly bring disrepute to them in the eye of public and will make it appear that the system of Indian Medicine comprises only quacks or non-professionals.” The merits and demerits of each system had to be scientifically established.

Ultimately, it was for the people to opt for a particular system of medicine. The court's legal interpretation ultimately guided to deal with complaints of malpractices. “But, certainly, the police cannot be allowed to take an initiative in such matters.”

Quoting a Supreme Court order, the Judge said no blanket permission could be issued to the police to arrest the so-called quacks identified by the IMA. If the IMA as a guild association of allopathic medical practitioners was aggrieved by any misconduct committed by other medical professionals governed by other systems of medicine, it could complain to their professional bodies under which those professionals were registered and could find remedies. Only in case where it was able to establish that there were persons masquerading as doctors, then the question of pressing into service the Anti-Quackery Act would come into play.

Link: Original Article

March 09, 2011

Arogyasri Insurance patients turn guinea pigs

The poor literacy level of Arogyasri beneficiaries has given a lucrative but worrisome spin to healthcare business in the state- city hospitals are now hardselling their patient numbers to bag clinical trial projects from international pharma firms.

Whether big or small, public or private, most hospitals in the state now have a dedicated clinical research unit to carry out trials. Doctors note there is a surge in the number of companies headed to the state and also the number of trials being carried out, "because there are a lot of guinea pigs here''.

Being tested on people are drugs for diabetes, cancer apart from drugs for cardiac, gastro and liver conditions. Certain drugs for hormonal problems as well as rheumatic disorders are also being tested currently in city hospitals. The trials are on even in district hospitals, both private and public and doctors involved in clinical trials agree that most of their volunteers are 'uneducated and poor'.

There is reliable information on poor patients even being 'supplied' to hospitals under Arogyasri for the trials. "Getting a signature on the consent form is not difficult. If it takes a year to get 10 patients to volunteer for a trial in the US, here the same number can be arranged in no time,'' said a researcher.

Dr M Prakasamma of Academy of Nursing Studies who has been a member of various ethical committees on medical research in the past says there are huge concerns on patient awareness on what is being tried on them. And that the clinical trial business is big is evident from the fact that now institutes for training manpower to carry out trials have sprung up to meet the growing demand for personnel in these research units.

Industry sources note that most clinical trials are taking place in government hospitals, because "recruiting volunteers'' is easy. However, private hospitals over the last couple of years have emerged as competitors with the state health insurance scheme giving them the much-needed numbers to bag trials. "If earlier we could recruit one patient from 10, we now have larger base and can recruit 10 from 100,'' said a senior industry source dabbling in clinical trials.

Link: Original Article

March 08, 2011

Training medical specialists, virtually

E-teaching can help solve the numerous challenges associated with medical training in India, especially in the super specialty area, writes Dr Sunita Maheshwari

One downside of a busy medical practice is that doctors no longer have time to teach and pass on their experience to the next generation. This is leading to a dearth of trainers, especially in the super speciality arena. The problems in the field of super speciality training in India are several and include the following:

*Limited number of trainers, i.e. super specialists interested in teaching

*Even for those interested, the amount of energy and time needed for clinical work makes content creation/class delivery a challenge

*Variable quality - different institutions have different protocols/approaches to patient care leading to a lack of standard content taught across the country

The greatest gift of the west to the world has been its Universities and training institutions. I was a recipient of that incredible training at Yale University and returned to India a decade ago and trained several batches of paediatric cardiologists at the hospital I worked.

However, I was aware that the same level of knowledge transmission was not necessarily available throughout the country. How can one expand the frontiers of super speciality training in India? Now, with technology and bandwidth being a non issue in India, using technology to effectively take one teacher’s class to multiple students across the country can be one way of obviating the issue of medical and health care training in India.

The use of e-learning in training for medical students and super specialists has been attempted via teaching websites, blogs, Wikipedia and the creation and distribution of DVDs/CDs. However these are non-interactive i.e. there is no direct interaction between the student and teacher and thus, although available, they have not always had the desired impact. Some group discussion sites for specific medical specialities have garnered interest as they are interactive, although the interaction is chat-group based.

Video conferencing has been one method to offer live sessions. The pan-Africa tele-education network is one such successful example. The advantages of this are that the sessions are live and question and answer sessions are a part of it. The disadvantage is that the teacher and students need to be physically situated in the conference rooms where the point-to-point satellite connection has been done.

An ideal e-teaching platform needs to allow student-teacher interaction and be accessible from a laptop with a data card. Such a platform must:

*Be easy to use as many doctors are technologically challenged

*Work on easily available and inexpensive bandwidth

*Be web-based so that the teacher and student can log in from anywhere, anytime.

*Have the ability to demonstrate a power point presentation as well as a drawing board

*Be recordable so classes can be replayed

*Be interactive so Q and A (question and answer) sessions complete the class
Since May 2010, I have been running a not-for-profit trust called Heart Strings, a People4People initiative, partnered with Cisco Systems to pilot live interactive e-teaching in pediatric cardiology. The Cisco Remote Education Center platform is completely internet-based with no special equipment or software required. It enables highly interactive, online classroom learning with live audio, video, white board and presentations. Instructors need only a computer with the internet, webcam and an optional digital notepad. Remote class rooms / students need a computer with the internet, webcam, microphone, speakers and an optional projector. Instructors can easily create content, and manage and schedule courses.

From May 2010 to December 2010, at the time of writing this report, 60 simultaneous e-classes in pediatric cardiology have been conducted, using this technology. The classes were conducted for postgraduates in Bangalore, Kolkota, Chennai, Delhi, Bhopal, Mumbai and Nigeria.

Link: Original Article

March 07, 2011

Health Ministry for driving licence to indicate desire to donate organ

If the Union Health Ministry has its way, driver’s licences will indicate if the holder wants to donate organs after death.
In an ambitious plan to decrease the gap between the demand and supply of organs, the government is considering earmarking a designated space, indicating “donor”, on the driving licence.

The idea, officials say, will soon be communicated to the Ministry of Road Transport and Highways.

The ministry has got a sample driving licence from the US so that the same design and matter could be replicated here.

“At least, the intention of a dying person will be known to doctors, who can thereafter convince the family,” said a senior ministry official.

In a bid to streamline organ donation, the government also proposes to allow swap donation, tissue donation and expand the definition of near relatives to include grandparents and grandchildren in the Transplantation of Human Organs (Amendment) Bill 2009, which is likely to see light of the day soon.

With the amendments ready, the ministry proposes to table the final draft of the Bill, which may be called “Transplantation of Human Organs and Tissues Act” (THOTA), during the budget session.

The amendments were recommended by the Standing Committee on Health and Family Welfare last year. Tissue donation will include heart valves, bones transplantation, cornea, skin and vessels.

Once passed by Parliament, a pair of donor and recipient who are near relatives but whose organs do not medically match for transplantation will now be permitted to “swap organs” with another pair of such persons.

However, the approval of an authorisation committee that will be constituted by the state governments and Union Territories will be required. The composition of the committee will be prescribed by the Centre .

The Health Ministry accepted about 43-odd recommendations of the Standing Committee to widen the scope of organ donation.

After the Cabinet passes it, the proposed Bill will be sent to the Law Ministry and then tabled in Parliament during the Budget Session.

Earlier, near-relatives included spouse, son, mother, daughter, father, brother, sister. Now, it adds grandparents and grandchildren.

The Bill enhances the penalty for unauthorised removal of human organs and for receiving or making payment for human organs up to 10 years of imprisonment and Rs. 25 lakh fine.

In case the donor or recipient is a foreign national, prior approval of the authorisation committee will be mandatory.

“In case the recipient is a foreigner and the donor is Indian, donation will be allowed only if they are relatives,” said a senior official in the ministry.

The government is also considering “required request” for patients dying in the intensive care unit (ICU). “If the patient is brain dead, the incharge of the ICU can give the option of donation to the family,” added the official.
Link: Original Article

Vasan Healthcare to invest Rs 300 cr to open 45 hospitals

Eye care specialist Vasan Healthcare today said it will open 45 hospitals in India by the end of March 2012 at an estimated cost of Rs 300 crore.

"Vasan Healthcare will open 45 single super speciality eye care hospitals pan-India by the end of next financial year. Out of these 25 hospitals will come up in the next four months," Vasan Healthcare Chairman and Managing Director A M Arun told reporters here.

When asked how much the company will invest for setting up the new hospitals, he said: "We will be spending around Rs 300 crore."

The company will open 28 eye care hospitals with four in Delhi, five in Kolkata, four in Mumbai and in Surat, Ahmedabad, Baroda, Rajkot, Nagpur, Pune, Kolhapur, Nashik, Amritsar, Jalandhar, Ludhiana, Chandigarh, Indore, Bhopal and Bhubaneshwar.

At present the company has 80 eye care hospitals across India. The firm will also plans to open hospitals in Colombo and Dubai by April 2011, it added.

On the model for its operations, Arun said: "All our hospitals will be fully owned, fully operated by us as we do not believe in franchises or in joint ventures."

"We are confident of creating success with our pan-India operations and providing world class super speciality eye care services in other parts of the country," he added.

The company also aims to open 15 dental hospitals to take the total number of dental hospitals to 30 by end of 2011. A closely held entity, the company has not made public is financials.

Link: Original Article

March 06, 2011

If govt gives nod, rural students can become doctor after class 10

If the union health ministry accepts the recommendations made by a national-level committee of medical experts, students from rural areas can study medicine after class X — and become healthcare professionals in three years flat.

The recommendations have been made by the ‘Curricular Reform Committee for Undergraduate Medical Education’ to the health ministry.

According to a senior doctor who has been asked to give his opinions on the recommendations, there are chances that the central government will introduce a separate medical course for rural students.

The course will produce doctors exclusively for rural areas because of dearth of doctors as city-based doctors don’t want to work in those areas.

“The government is seriously thinking to introduce a three-year medical course for rural students,” said the doctor. According to him, the name of the course will be ‘Bachelor of Rural Health Care’ (BRHC), and it can be done after class X instead of class XII.

“Though the proposal is still under consideration, it is the only practical solution to improve the healthcare scenario in rural areas,” he said.

The proposed roadmap has been submitted to the health ministry by a group of medical experts from all over India. According to the plan, the students have to either sign a 10-year bond or make a lifetime commitment to work in rural areas.

The students have to produce a bona fide certificate stating their ‘rural’ status to get admission.

According to the doctor, this move will ultimately help the patients of rural areas. “City-based doctors cannot understand the local dialect of rural patients, so some times the symptoms are not conveyed properly to the doctors,” said the doctor.

As far as starting this course in remote areas is concerned, the committee has proposed to open new medical colleges in under-served areas till 2015.

The committee has also proposed to start ‘Community Medical Colleges’ as well as extending the facilities of the existing district hospitals. “To start such course, these infrastructural changes will be important,” he said.

However, other doctors involved in medical education have protested the move to introduce BRHC. “We have been protesting this new course, because there cannot be a parallel course with MBBS. This will only deteriorate the medical education,” opined a senior doctor.

Link: Original Article

Bank of New York Mellon picks stake in Apollo Hospitals

Two funds of asset management and security services company Bank of New York Mellon has picked 3.6% stake in Apollo Hospitals for Rs 204.75 crore (USD 44 million). Apollo Hospitals is India’s largest healthcare services firm and is backed by buyout giant Apax Partners and Malaysian sovereign wealth fund Khazanah besides International Finance Corporation.

Bulk of the shares were purchased from an entity Olivia Holdings DR AC, which could mean the transaction related to the company’s depository receipts.
Part of the shares were acquired by BNY Mellon Asian Equity Fund, which targets investments in Asia excluding Japan. The over two decades old fund had total net assets of USD 835 million as of November 2010, 5.8% of which was invested in India. Among its other investments in India include Coal India.

Apollo Hospitals is in the process of raising over Rs 1,000 crore through a qualified institutional placement (QIP) and warrant issue to the promoters. It plans to raise Rs 900 through a mix of equity and non convertible debentures with warrants through a QIP besides Rs 154.8 crore through issue of warrants to the promoter Prathap Reddy at Rs 472.46 per warrant.
As of December 31, the promoters already held 3.08 million warrants that are convertible by end 2011. These warrants were issued at a price of Rs 385.8. Apollo scrip was trading at Rs 461.95 at mid-day on NSE.

Link: Original Article



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