Sunday, September 25, 2016

Saved by the bill? Reform aims to fix India’s medical education

A fresh breeze is blowing in Delhi’s corridors and it could well turn into a squall. It is whooshing about, not in the ministries but in Niti Aayog, which has recently hired 50 professionals, educated at the world’s best universities. The first institution to experience the welcome showers will be medical colleges as part of an overhaul of the (MCI).
What is fresh, even revolutionary, in this reform is a new regulatory philosophy with a focus on outcomes — what the student is learning. The old thinking was fixated on inputs — student fees, teacher salaries, toilets — and neglected the quality of teaching and learning. If the reform succeeds, we shall have more and better-educated doctors. If this outcome-based approach infects the rest of India’s education, we shall indeed have a better-educated population.

The ills of medical education lie at the doors of a rotten MCI. It is synonymous with corruption and its former head has even spent time in jail. The MCI created an admission system based on illegal capitation fees; froze a teaching curriculum despite advances in medicine; created shortage of quality doctors, and devalued merit and ethics. The proposed bill tries to fix these ills. How well a student performs in a statutory national merit exam will now decide who gets into a college. What students learn will be measured in a common licentiate exit exam that will also decide the college’s ranking and its ability to attract students. Since rankings will be online, students and parents will be able to make an informed choice. Dodgy, poorly rated colleges will be forced to improve standards or face extinction. Passing the exit exam will be mandatory for a licence to practice and will be the entry ticket for post-graduate work.

Based on the world’s best practices, the draft bill does not want the state to micromanage student fees, teacher salaries, curriculum, and size of toilets. Instead, regulators will monitor and publicize how well the college performs in student learning. Once the transparent, merit-based admission system is in place, colleges will be freed from arbitrary controls on fees, salaries, and the expansion of seats. Up to 40% of the seats will be on full scholarship for poor but meritorious students. Freeing teacher salaries should attract ‘big name’ doctors to teaching, at least on a part-time basis. Freeing the curriculum will allow the best colleges to offer innovative courses.

The other problem is the supply of good colleges. Today 11 lakh students are chasing 55,000 seats in medical colleges. India is short by 30 lakh doctors. At the rate we are producing doctors, it will take 50 years to clear the backlog — a terrible, unacceptable sacrifice of two generations.

This unhappy state of affairs is the result of a socialist belief that only the state should provide education. Since the Indian state has never had enough money to do all that the socialists wanted, it has grudgingly accepted the entry of the private sector, but shackled it with the horrific controls of licence-permit-inspector raj. This has discouraged honest individuals from starting colleges but encouraged corrupt politicians to get into the act. Our attachment to state-run colleges is bizarre when private universities abroad are among the best in the world. By removing barriers to entry, the new bill expects a dramatic growth of quality medical colleges, which should, hopefully, solve the problem of the supply of doctors. In the end, I could find only two lacunae in the bill: (1) the lack of provision for village or barefoot doctors and (2) the absence of protection of patients against doctor malpractice.

Passing this new law will not be easy because doctors associated with the MCI are powerful and will fight any attempts to expand doctor supply. They will have the support of ageing socialists who still believe that only government should provide education.

Fortunately, there is rare unanimity in Parliament, judiciary and the executive for a drastic overhaul of MCI. The proposed bill, in fact, follows the spirit of the parliamentary standing committee’s recommendations. The bill itself is available for public consultation. If it succeeds in becoming law, its regulatory philosophy based on outcomes will create a potent precedent for regulating all types of education in India. This is exactly the sort of institutional reform that we had hoped for when Narendra Modi promised to usher in good governance and beat corruption.


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