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Medical Council of India

Proposed

UNDER GRADUATE MEDICAL EDUCATION

Undergraduate Education Working Group


2010

1
Final Medical Council Of India
M.C.I. OBJECTIVES FOR UNDERGRADUATE
MEDICAL EDUCATION

Quality Capacity Building Incentives


Improvement (Performance based)

1. Increasing Training - Faculty Incentives


Curriculum Reformation - Financial Grants and
- Restructure &
capacity of doctors
funding
Optimize - Grants and funding
- Vertical & Horizontal Adopting District Increasing Seats
integration hospitals into in existing
- Flexible : expanding Medical Colleges medical colleges
learning opportunities
- Skill development Public Private New Medical
Quality Accreditation Partnerships for
setups
hospitals
GrGrants and funding
-
- Cuboids and Govt. colleges and New Hospitals
- Conical shapes Govt. hospitals & New colleges
 Ideas of rolling and
sliding
- Faculty Development Programme
- Define Career path 2. Medical Teachers
- Inter disciplinary appointments
- Dual /Adjunct Appointments
- Tapping consultant Pool who
have left Govt. service
- Retired Teachers
- Increasing the age of
Superannuation
- New Pool from Young Teachers
from proposed new PG Course

100

80

60 OUTCOMES
East
West
40
North
20

0 2
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
EXPECTED
OUTCOMES

Short Term Middle Term Long Term

Improved and Revised Improved Quality of Improved Health


Curriculum Existing Colleges Parameters

Sufficient Number of Improved Health Care


Detailed Capacity Building Trained Teachers
Plan
Motivating Career Pathways
for Students and Teachers
Faculty Development
Programmes in Place
- Sufficient Number of
Doctors
- Improved Medical
Education
- Improved Doctor: Patient
Ratio
- Equitable Distribution of
Doctors in Urban-Rural
Areas

IMPROVING QUALITY OF MEDICAL CARE


FOR PATIENTS

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Medical Council of India
Curricular reform in Undergraduate Medical Education

INTRODUCTION

The Government of India recognises Health for All as a national goal and expects medical training
to produce capable "Physicians of First Contact" towards meeting this goal. However, the Indian
health care and medical education is facing systems and standards challenges.

The burden of diseases in India is still large. Even though there has been some improvement,
national statistics reveal wide disparities between different states as also rural/urban areas with
regard to access to basic medical services and quality health care. These are attributed to
physician shortage, both generalist and specialist, inequitable distribution of manpower and
resources, and deficiencies in the quality of medical education.

India has the highest number of medical colleges in the world. This unprecedented growth has
occurred in the past two decades in response to increasing health needs of the country. The most
significant challenge for regulatory bodies has been to balance the need for more medical colleges
with the maintenance of quality standards. The globalization of education and health care and
India’s potential as destination for education and quality health care has brought the issue into
sharper focus.

Curricular reform to systematically address the issues and develop strategies to strengthen the
medical education and health care system is a logical next step. There is a need to create systems
and standards that establish and promote state-of-the-art medical education, so that Indian
medical graduates from all institutions are comparable to the best from anywhere in the world.

Additionally, though recent advances in medicine have been understood and adopted by medical
and other health science institutions, the same is not true for new methods and strategies in
medical education. There is an urgent need to build capacity in this area.

To address the above challenges, the Board of Governors, Medical Council of India constituted the
undergraduate and postgraduate working groups in July 2010 to develop a Vision 2015 in
alignment with the following mandate.

1. To evolve a roadmap for the direction of medical education in India in alignment with
national needs..

2. To evolve a broad policy regarding the emphasis, duration and curricular changes that
could be adopted as future strategies to make medical education in India comparable to
global standards.

3. To evolves strategies and futuristic plans so that medical education in India is innovative
and is able prepare undergraduates to be able to perform in the changing scenario of
medical science.

4. In the light of deteriorating medical education standards in the country, to work on parallel
tracks for immediate solutions and long term improvement in a steady, phased manner.
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MCI Undergraduate Education Working Group 2010

MEMBERS

1. Prof. George Mathew, Principal & Professor in GI Surgery, Christian Medical College, Vellore.
Convenor .

2. Prof. Nilima Kshirsagar, Ex-Vice Chancellor, Maharashtra University of Health Sciences,


Mhasrul, Dindori Road, Nashik

3. Prof. J.M. Kaul, Director, Professor & Head, Department of Anatomy, Maulana Azad Medical
College, Bahadurshah Zafar Marg, New Delhi 110 002.

4. Prof. Sandeep Guleria, Professor, Department of Surgery, All India Institute of Medical
Sciences, Ansari Nagar, New Delhi 110 029.

5. Prof. Sudha Salhan, Professor & Head, Department of Obstetrics & Gynaecology, Vardhman
Mahavir Medical College & Safdarjung Hospital, New Delhi 110 029.

6. Brig. Chander Mohan, SM Former Professor and Head, Dept. of Radiodiagnosis, Army
Hospital (Research and Referral) New Delhi. Senior Consultant and Head, Department of
Interventional Radiology, BLK Memorial Hospital, Pusa Road, New Delhi - 110005.

7. Prof. Payal Bansal, Associate Professor and Incharge, Department of Medical Education &
Technology, MUHS Regional Centre, Pune 411 027.

8. Dr. S.Vasantha Kumar, Vice Principal and Professor and Head, Department of ObGyn,
Kempegowda Institute of Medical Sciences, Banashankari II Stage, Bangalore.

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MEDICAL COUNCIL OF INDIA’S MANDATE FOR MEDICAL EDUCATION

The Board of Governors, Medical Council of India constituted the undergraduate and
postgraduate working groups to develop a Vision 2015 in alignment with the following
mandate.

1. To evolve a roadmap for the direction of medical education in India.

2. To evolve a broad policy regarding the emphasis, duration and curricular changes that
could be adopted as future strategies to make medical education in India comparable to
global standards.

3. To evolves strategies and futuristic plans so that medical education in India is innovative
and is able to meet the demands of national needs while preparing undergraduates to be
able to perform in the changing scenario of medical science.

4. In the light of deteriorating medical education standards in the country, to work on parallel
tracks for immediate solutions and long term improvement in a steady, phased manner.

THE UNDERGRADUATE WORKING GROUP MANDATE

 To review present status


 To rationalize and propose reforms

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EXECUTIVE SUMMARY

Summary of Present Status -

1. Need for more doctors :


The current doctor population ratio in India is 1:1700 when compared to a world average
of 1.5: 1000. The committee came to a consensus that targeted doctor population ratio
should be 1: 1000 by 2031. For achieving this target taking into consideration existing
medical colleges in the country, it was felt that the current intake of medical colleges
and the critical mass of doctors should be doubled at least to achieve this target.

2. Improving quality of training: This is proposed as the following measures:-

I. Restructing of MBBS course - 4+1 model of training (4 years course with 6 months
elective+ 1 year internship); 1+1+2+1.

a. Converting conventional education into competency based module to develop the


skill sets of the basic doctor:
b. Early clinical exposure – Clinical teaching from 1st year onwards
c. Integrated Modular Teaching both Vertical & horizontal

INTEGRATION SCHEME

CLINICAL SCIENCES

CLINICAL 80%
20%

PARA CLINICAL 60% 40%

80% 20%
PRE CLINICAL

BASIC SCIENCES

d. Clerkship / Student Doctor Method Of Clinical Training

e. Introduction of Electives - Examples - Bio Informatics, Tissue Processing Computer and


Computer Applications, Ethics & Legal Medicine, Immunology, Genetics, Human Nutrition
etc. Sports Medicine, Lab Sciences, Research Methedology, Ethics, Accident and
Emergencies (A&E), Community Projects, HIV Medicine, Tissue Culture,
PharmacoKinetics/Pharmacodynamics/Pharmacoeconomics, Assisted Reproductive
Technology, Ethics and Medical Education etc.

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f. Introduction of skills development and training - A mandatory & desirable
comprehensive list of skills would be planned and recommended for Bachelor of Medicine
and Bachelor of Surgery (MBBS) Graduate. Certification of skills is necessary before
licensure.

g. Secondary hospital exposure: Each medical college would be linked to the local health
system including CHCs, taluk hospitals and primary health care centres that can be used
as training base for medical students.

h. Contemporary approaches to education such as Skills lab; e-learning; m-learning &


Simulation.

i. Flexibility in Curriculum

j. Setting up of learning facilitation centres and a national strategy for large-scale


faculty development is necessary to be instituted immediately.
Impact
An improved and revised curriculum, capacity building of faculty and increased manpower
can be produced with world standards with the help of necessary infrastructure and faculty
development programmes. The committee also feels that this will result in the improved quality of
the existing colleges, sufficient number of teachers and will create motivating career pathways for
both students and teachers. This should result in an overall improvement in the healthcare of our
country with improved health parameters.

Solutions for manpower shortage (particularly the teaching faculty) -

a. Tapping the consultant pool in government service departments


b. Dual / adjunct appointments
c. Interdisciplinary appointments
d. Faculty development programme
e. Defining career paths
f. Employment of retired teachers
g. Increasing the age of superannuation in specific areas
h. Increasing the pool of young teachers by increasing postgraduate output.

SUGGESTED INTERVENTIONS: This shortage of doctors can be addressed through a three


stage strategy - Short Term Solutions (Immediate), Medium Term Solutions (Lag period of 2-3
years) and Long Term Solutions (Lag period up to 5 years) as given in main document.

KEY AGENCIES FOR EXPECTED POLICY CHANGES – MCI, Planning Commission and
Ministry of Health, GOI.

Expected outcomes
 Improved need based and well aligned curriculum
 Bridging of gap between need and availability of doctors
 Well co-ordinated, contemporary education methods
 Better student learning
 Better health of society
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THE UNDERGRADUATE WORKING GROUP REPORT

The working group set out on its task with the following goal :
 To review present status with regard to national health needs vis-à-vis medical education
 To rationalize and propose reforms in undergraduate medical education

REVIEW OF PRESENT STATUS

Need For Curricular Reforms

The reasons for need for reforms in the current MBBS course in India:

 The MBBS graduate does not feel equipped with adequate skills and competence 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 and the
lack of manpower in rural areas and in primary health centres and taluk hospitals.

 The past curricular revisions have mostly added to the existing content without undertaking
the exercise to remove what is obsolete/outdated. This exercise needs to be taken up in a
detailed and extensive manner and make the curriculum as efficient as possible.

 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.( Detailed
proposal for curricular reform given ahead )

Need For More Doctors

An initial in-depth analysis of the current situation of doctor manpower in the country was
done. For this exercise, the committee reviewed existing data from the MCI and the public domain
to arrive at its conclusions.

The current doctor population ratio in India is 1:1700 when compared to a world
average of 1.5: 1000. The committee came to a consensus that
targeted doctor population ratio should be 1: 1000 by 2031.

Table 1 : Doctor population ratio around the world


Somalia 1:10,000 Singapore 1:714
Pakistan 1:1,923 Japan 1:606
Egypt 1:1,484 Thailand 1:500
China 1: 1,063 UK 1:469
Korea 1:951 USA 1:350
Brazil 1:844 Germany 1:296

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The next exercise that the working group undertook was to estimate the need for medical doctors
to achieve this target. The working group looked at the existing number of medical colleges, the
current intake of medical colleges and the critical mass of doctors that will be needed to achieve
this target.

Table 2 : Predicted Population (India) Over The


Next 3 Decades*
2011 1203711
2021 1380214
2031 1546158
2041 1695051
*At an annual Growth rate 1.4

In view of the projected increase in population, it was felt that the existing medical colleges in the
country will be unable to meet this need and therefore current intake of medical colleges and the
critical mass of doctors needs to be doubled at least to achieve this target.

Currently there are 330 medical colleges with an intake of approximately 35,000 and with
the current intake of doctors, the shortfall of doctors by 2031 is estimated at 9.54 lakhs .

SHORT-TERM SOLUTIONS Immediate – Increasing the intake in existing medical colleges


wherever there is adequate infrastructure of teachers, equipment and clinical load and to augment
infrastructure in relation to clinical load by attaching established medical colleges to district level
hospitals or secondary hospitals run by government agencies.

MEDIUM TERM SOLUTIONS In 2-3 years: Upgrading existing larger district hospitals and
augmenting their infrastructure to become community medical colleges through private public
partnership or public private partnership.

LONG TERM SOLUTIONS Up to 5 years : Starting new medical colleges and hospitals preferably
in states and underserved areas with doctors and medical colleges. The cost to government
estimates are proposed as Expected Policy Changes.

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TEACHER SHORTAGE:

The next issue that the working group deliberated on was to address the problem of teacher
shortage in medical colleges.

Table 3 : Additional Requirement of Teaching Faculty

Subject Current Current Projected Total Additional


Need Shortfall Need Need
Anatomy 2000 1000 2000 3000
Physiology 2000 1000 2000 3000
Biochemistry 2000 600 2000 2600
Pharmacology 2000 600 2000 2600
Pathology 2000 600 2000 2600
Microbiology 1600 500 1600 2100
Forensic 2000 1500 2000 3500
Medicine
Community 2400 500 2400 2900
Medicine
Medicine 2000 200 2000 2200
Surgery 2000 200 2000 2200
Obs & Gynae 1600 160 1600 1760
Psychiatry 800 80 800 960
Dermatology 800 80 800 960
Anaesthesia 1600 160 1600 1760
ENT 800 80 800 960
Ophthalmology 80 800 960 800
Orthopaedics 1600 160 1600 1760
Radiology 1000 100 1000 1100

Total 29400 6340 35740

The strategies that were identified and suggested are:

a. Tapping the consultant pool in government service departments


b. Dual / adjunct appointments
c. Interdisciplinary appointments
d. Faculty development programme
e. Defining career paths
f. Employment of retired teachers
g. Increasing the age of superannuation in specific areas
h. Increasing the pool of young teachers by increasing postgraduate output.

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Improving Quality of Training

The next major issue that the working group deliberated on was to improve the quality of training
from what is the current existing model so that the graduates are efficient, competent and
responsive to national and international needs.

The lacunae of the CURRENT MBBS training are:

a. Goal of training is not focused on providing health care to needy and disadvantaged

b. Discipline based curriculum and lack of integration between basic and laboratory science
and clinical medicine

c. Assessment system’s focus on summative assessments at the end of each stage, rote
learning and recall rather than competency

d. Lack of development of clinical competency

e. Majority of clinical training occurs in large teaching hospitals with insufficient practical
training at secondary and primary care level

f. Lack of training in family medicine

g. No mandatory service period at the end of undergraduate training and lack of linkage of
undergraduate to postgraduate training.

Strategies that have been successful in other countries :

a. Selection of students from rural and underserved backgrounds; who are motivated to work
in areas of need

b. Early clinical training from I MBBS with continuity to secondary and primary care

c. Decentralisation of clinical training through clerkship model/student doctor to the


secondary and primary level;

d. Family medicine or Generalist Medical Practice as a core component of the curriculum;

e. Integrated curriculum in starting from the first yearwith- vertical and horizontal integration
between basic, laboratory sciences and clinical medicine;

f. Continuous assessment with specific focus on evaluating skills and competence

g. Partnerships between medical college and other health care facilities in the community

Restructuring and optimizing the current MBBS course.

The process of curricular change necessarily needs to start with the basic foundation of defining
the end product. In this case, the “BASIC DOCTOR” (Annexure I)

The committee recommends the following for consideration for implementation:

A 4+1 model of training (4 years course + 1 year internship); 1+1+2+1

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This strategy is advocated along with other curricular restructuring as follows :

1) Clinical teaching from 1st year onwards

2) Integrated modular teaching both horizontal and vertical

3) Clerkship / student doctor model of clinical postings

4) Secondary hospital exposure

5) Introduction of Professionalism and Ethics

6) Using contemporary approaches to education such as

a. Skills lab
b. e-learning
c. m-learning
d. Simulation

7) Redefine assessment and acquisition of skills

It is important to remove the redundancy in the curriculum and adopt a more integrated approach.
The time thus saved can lead to shorter duration (as given below) as well as time for electives,
professionalism and ethics.

Structure and Duration of the Course

4 year course + 1 year internship (which includes 6 months of electives)


The course would be of 4 years duration with one year internship and provision for elective periods
of 6 months before or after internship. Curriculum can be divided into core and non-core with the
non-core part of the curriculum be made elective or applied.

Group A:
Year1- Anatomy, Physiology and Biochemistry;
Year 2- Pathology, Microbiology and Pharmacology

Group B:
Year 4- Medicine, Surgery, Obstetrics and Gyanecology, Paediatrics, Family Medicine and
Community health

Group C :
Year 2- Forensic medicine
Year 3 and 4- ENT and Opthalmology, STD and Dermatology, Orthopaedics, Accident and
Emergency Medicine, Radiology, Anaesthesia, Psychiatry
Elective options- clinical and research electives

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Proposed timeframe in MBBS curriculum structure (to 4 years)

Table 4 : Teaching time for MBBS Curriculum


Semester Weeks No. of hours ( x 40)
First MBBS (1 year) 1 20 800
2 20 800
Second MBBS (1 year) 3 20 800
4 20 800
Third MBBS (2 years) 5 20 800
6 20 800
7 20 800
8 20 800
Total 160 6,400

INTEGRATION SCHEME

CLINICAL SCIENCES

CLINICAL 80%
20%

PARA CLINICAL
60% 88 40%

80% 20%
PRE CLINICAL

BASIC SCIENCES

The innovative curriculum would be structured to facilitate horizontal, vertical integration between
disciplines, the gaps between theory and practice and between hospital based medicine and
community medicine. Basic and laboratory sciences (integrated with their clinical relevance) would
be maximum in first year and will progressively decrease in second and third year as the
curriculum progresses. The essentials of basic and laboratory sciences would be taught in first
year and built on in subsequent years.

MEDICAL ETHICS AND PROFESSIONALISM


Medical professionalism forms the basis of contact between doctors and society and so it is
imperative that professionalism and Ethical issues in practice should be incorporated into medical
curriculum

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Need to review curriculum

Similarly, certain subjects will need extra lectures from first year onwards e.g. approximately 8
radiology lectures can be included in anatomy to teach students cross sectional anatomy of brain,
abdomen , fetal anatomy during embryology teaching etc during first year itself. This practice is
being already being followed by Maulana Azad Medical College, New Delhi . This model can be
adopted by other colleges as well, without changing the number of lecture hours (by integration)

Forensic Medicine can be effectively taught during Gynaecology & Obstetrics (rape, assault),
surgery (injuries), pharmacology (toxicology). Legal experts can be called for medico-legal issues.
Forensic medicine skills can be acquired during internship such as documentation of medico-legal
cases of alcoholism, suicide/homicide, rape, assault and injury cases.

Infection control section in hospital in now an important component and should be included.

Thus, both horizontal and vertical integration will be used for making the curriculum more efficient
and student friendly. Details of this are being worked out by expert committees constituted by MCI
in co-ordination with undergraduate working group. (Annexure II)

EARLY CLINICAL EXPOSURE

Most medical colleges across the world start clinical training in year I with communication,
interviewing skills and basic examination skills through skills laboratories and students practicing
examination on each other. In the several medical colleges the students learnt basic clinical skills
through half a day exposures once a week or once in two weeks with individual doctors at the level
of primary care.

The clinical training would start in first year, with a foundation course, focusing on communication,
basic clinical skills and professionalism. There would be sufficient clinical exposure at the primary
care level integrated with the learning of basic and laboratory sciences. Introduction of case
scenarios for classroom discussion/ case-based learning. It will be done as a co-ordinated effort by
basic science and clinical faculty.

Professionalism and ethics curriculum will be a mandatory part of the curriculum and will be
integrated throughout the MBBS Course.The foundation courses will be taken during the first and
second year and rest of the curriculum will be taught along with the clinical subjects.

CLERKSHIP / STUDENT DOCTOR METHOD OF CLINICAL TRAINING

The need for clinical training through clerkship method


In the first 4 ½ years students learn history and examination and clinical diagnosis. They a learn a
lot of theory related to investigations and management, but are not involved in the process of work,
making decisions and taking responsibility. The focus of MBBS clinical skills development is on the
examination of patients that are “exam cases” for the final examination, eg. Chronic liver disease,
mitral stenosis, paraplegia. These cases and not the common clinical problems that are seen in
general practice at the primary and secondary level. In many medical colleges, students are also
not provided adequate practical involvement in work in internship.

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In order for the MBBS course to provide sufficient skills development for competent practice, a
frame shift is required in clinical training in the following ways:

a. Focus on common problems seen in outpatient and emergency setting


b. Learning through clerkship method by involvement in process of care as a team member,
in investigation, management and basic procedures
c. Significant part of training to take place at primary and secondary level with compulsory
family medicine training
d. Parts of clinical training should be core requirements and others as elective postings

Description of the clerkship method of clinical training


In the clerkship method students are posted to respective departments as a clerk or sub-intern.
The sub-intern is below the level of intern, and takes partial patient care under responsibility as a
team member. During sub-internship, students have specific objectives of learning in relation to
history, examination, procedural skills, management of common ambulatory and emergency
conditions. Students take care of patients under the supervision of the registrar and consultant
both in the out-patient and in-patient setting and emergency setting. Learning is by practical
involvement in the process of care of patients. Students have lectures, seminars and clinical case
discussions to support practical learning during clerkship.

Annexure III - Model clerkship posting

TRAINING IN SECONDARY HOSPITAL SETTING

Each medical college should be linked to the local health system including CHCs, taluk hospitals
and primary health care centres that can be used as training base for medical students.

NEWER DISCIPLINES AND REVIEW OF INFRASTRUCTURE, EQUIPMENT AND FACULTY


REQUIREMENT

Family medicine or Generalist Practice of Medicine needs to be an essential undergraduate


subject taught by specialists at the level of secondary and primary care. The existing national
initiatives, particularly with respect to Millenium Development Goals and Health Ministry initiatives
like the RCH component of NHRM, including IMNCI and NSSK should be an integral part of this
curriculum.

Need to review requirement of infrastructure, equipment and faculty in some subjects


Keeping in view the advances in all spheres of medicine, there is an inescapable need to review
the requirement of infrastructure, equipment and faculty in most of subjects due to introduction of
newer technology and changed training needs
EXAMPLES –
In case of radiology, the age old dark room technology for processing of X Ray films should be
replaced by digital technology (Computed radiography/ if possible by direct digital technology).
Moreover, the earlier Image intensifier systems for fluoroscopy should be replaced by radio-
fluoroscopy equipment (this will enable long term storage of digitalised data which can be utilised
for both research & training subsequently. Similarly, 60 mA X-Ray machines should be replaced
by 100mA machines and CT scans should be at least 16 slices or higher. This will also necessitate
changes in infrastructure and staff accordingly which will also be required to be amended.
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In Pharmacology, the training will have to be focused to clinical skills e.g. dose calculation
administering the drugs through various routes of administration, optimising the choice of drug and
dose, recognising, managing and preventing adverse reactions. Experimental pharmacology
practical in animals may require to be replaced by modern techniques using videos and
simulations. The techniques relating to drugs and toxin estimations could be set up.

Considerable advances have taken place in laboratory techniques in microbiology. Some


techniques have become redundant and outdated. The undergraduate curriculum should reflect
these changes e.g. molecular diagnostic techniques.

MEDICAL TEACHERS CAPACITY BUILDING IN EDUCATION


This above strategy will not be efficiently implemented without faculty development to familiarize
teachers with this methodology of teaching. Hence, the committee strongly recommends that
Learning Facilitation Centres are set up in many parts of the country for faculty development and
training. Each institution should be encouraged to conduct its own faculty training programme and
the completion of this training must be made mandatory. A national strategy for large scale faculty
development is necessary to be instituted immediately.

Specific Training Programmes will be designed to help faculty and institutions implement
the new curriculum

New programmes will be developed through multi-level system of courses and workshops, basic to
advanced, specific train-the-trainer programmes and workshops on specific topics and for specific
faculty groups. The following courses can be envisioned to begin with:

Level I – 3-day Basic Introductory Course


Level II – 6 month Advanced (Certificate) Course
Level III –1 Year Train-the-trainer (Diploma in ME)
Level IV – 2 Year Masters’ Programme in Health Professions Education
Specialized theme based courses/workshops – 5 to 10 day workshops in Medical Education and a
wide range of CME/CPD Programmes and Workshops.

ORGANISATIONAL STRUCTURE

Level 1 Centre : EDUCATION UNIT

Number - Every Medical College

Activities/Functions :
 Teachers Training Programmes – Level 1
 Patient Simulation Centre : Level 1
 Skills Training Centre : Level 1
 E-Learning/Digital Learning Resource Centre

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Level 2 Centre : EDUCATION DEPARTMENT

Number - One / state; In larger states, at least – one per 10 medical colleges
Location – Any medical college that fulfills minimum requirement for the centre; Health University
Department

 Teachers Training Programmes – Level 2


 Patient Simulation Centre : Level 2
 Advanced Skills Training Facility :Level 2
 Distance Education : Co-ordinating Centre for Courses, Learning Resource Centre with
Journals, Books and E-Resources as specified

LEVEL 3 Centre : AUTONOMOUS CENTRE with MCI/Central funding

Autonomous Centre under Health Sciences University/ Large/Tertiary Care College


Number - 4 – 5 in country – Region wise

 Faculty Development Activities : Level 3 and Level 4 Programmes


 Skills Training : Level 3 - Trains students, faculty and in-service professionals
 Distance Learning – Testing and Development of Materials. Management of Distance
Education, Learning Resource Centre for multi-institutional use
 Assessment Centre : Standardised Patient Training Centre,. Exam /testing Centre for skills,
including clinical skills
 Education Research Centre : Conducts educational research in collaboration with
Colleges, Universities, National Bodies
 Quality Assurance Unit : Collaborates with Accrediting Body and facilitates Quality
assurance pogrammes in medical colleges

LEVEL 4 Centre : National Centre for Medical Education Research and Training – Apex
Centre
 Guidelines for Regulation of Minimum Standards
 Guidelines for Accreditation
 Maintains Database AND Learning /E Resource Centre
 National Exam Co-ordinating Centre

LEVEL 4 Medical Council of India


1 Centre
M
Health Sciences University Department /
LEVEL 3 – 5 Centres Medical College with Advanced MEU with
full time faculty

Medical College with Advanced


Educational Facilities and Health
LEVEL 2 – 40 Centres Sciences University Departments
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MEDICAL COLLEGES
LEVEL 1 – 400 Centres
Table 5 : Activities at Various Levels of Faculty Development Centres

S.No ACTIVITIES LEVEL 1 LEVEL 2 LEVEL 3 LEVEL 4

1. Teachers Basic Level Advanced Diploma/Masters Orientation


Training 1 Programme Workshops
2 Skills Training Level 1 Level 2 Level 3 Exam Centre
3 Patient Level 1 Level 2 Level 3 Exam Centre
Simulation
Centre
4 E- Learning & Yes Yes Yes Central
Resource Consortium of
Centre Books/Journals/
E-Resources
5 Distance Co- Course and Accreditation
Education ordinating Material
Programmes Centre Development
5. CPD/CME Can do MUST MUST Accreditation
Programmes
BUDGET Establishment 1.5 crore 5 crore X40 20 crore X5 100 Crore X1
X400
TOTAL - 1000 Crores

EXPECTED OUTCOMES:

1. Faculty will apply and use educational principles in their day-to-day teaching and planning
of teaching to make it more student-centered.
2. Faculty will incorporate new teaching-learning methods and improve educational systems
in their own institutions.
3. Faculty will be able to conduct basic workshops in their own institutions
4. Faculty with specialized skills will participate in activities of their affiliated Centre/Unit

ESTABLISHMENT OF SKILLS TRAINING CENTRES

The skills development centres will consist of:


 A simulation laboratory for developing basic clinical, procedural and surgical skills.
 A laparoscopic training facility for acquiring basic skills in laparoscopy
 The facility will be also to open to undergraduate and postgraduate students, interns and
residents, who can come for skills training accompanied by their teachers.
The courses should be tailored to meet the requirement for various levels of competence and
variety of skills.

LEVEL 1 – Basic Surgical Skills, Basic Life Support Skills, Procedural Skills, Normal Labour
Management and Conduct of Delivery. These should be a compulsory part of clinical training of all
undergraduates.
Level 1 training facility is mandatory for all medical colleges.
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LEVEL 2 – Advanced Life Support and Refresher Level 1 Courses, Basic Laparoscopic Skills
Course, Neonatal and Paediatric Resuscitation Skills.

Level 2 skills training centres are desired in each medical college; however if there are financial
constraints, these could be conducted in collaboration with regional centres.

LEVEL 3 – These will be available for multi-institutional use. Course will include
Microsurgical Skills Courses, Advanced Laparoacopic Skills Courses and Human Patient
Simulators for Anaesthesia, Pharmacology, Physiology and other physiology competencies.

Level 3 is to be offered only in regional skill training centres and above.

Interns should have a mandatory Level I Certification before they get their Licensure degree

A detailed document regarding the training programmes, minimum activities, infrastructure and
equipment requirement at each level, minimum faculty and staff with budget is attached as
Annexure IV

RESEARCH METHODOLOGY
There should be a workshop on learning the nuances of research in terms of principles, collection,
organization and analysis of data to prepare a budding faculty member for guiding the
thesis/research work in their subsequent work profile. The minimum duration of the exposure to
these techniques should be at least 3 days.
A mandatory course on epidemiology for at least 2 days should also be incorporated into the
capacity building.

IMPARTING COMPUTER SKILLS


These would include power point presentations, hosting a web page , excel sheet maintenance
and a basic training in SPSS software.
The above courses/workshops on Research methodology and computer skills will need to be
organized by the individual institutes themselves.

LIBRARY AND DISTANCE LEARNING CENTRE

In all centres, this facility will be utilized by teachers who attend course and programmes ar these
centres. It will be equipped with books, journals, a variety of electronic resources including
interactive multimedia and self assessment packages for students. The advanced centre facility
will also be made available to instiutions affiliated to the University at nominal rates.

KEY AGENCIES FOR EXPECTED POLICY CHANGES – MCI, Planning Commission and
Ministry of Health, GOI.

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EXPECTED POLICY CHANGES

Table 6 : Role of Policy Makers

Medical Council Planning Commission Government


of of
India India
1. Redefine teaching 1. Budgetary requirements, 1. Coordination with
staff cadre and upgradation of infrastructure of hospitals and colleges.
eligibility existing colleges 300 Crore

2. Remove unitary 2. Upgrading existing districts 2. Recurring budegets


complex requirements hospital – for salaries and other
30 x 100 = 3000 Crore expenses for existing
colleges = 1330 Crore

3. Revise minimum 3. Build new colleges – 3. District Colleges =


requirement of faculty, 70 x 100 = 7000 Crore 1050 Crore (10.5 x 100)
bed, equipment and
infrastructure

4. Curricular Reforms 4. Learning facilitation centres 4. New Colleges = 3500


Level 1 Colleges = 600 Crore Crore (70 x 50)
Level 2 =200 Crore
Level 3 = 100 Crore
Level 4 = 100 Crore

5. Learning facilitation
centers = 1000 Crore

POST MBBS EDUCATION AND SUPPORT

One of the factors in the reluctance of fresh graduates to serve in secondary or primary hospitals
is professional isolation and lack of educational support. There should be options for distance
education towards a Fellowship or Diploma in areas like Diabetic care, HIV medicine, Geriatric
Medicine, Hospital infection control, Hospital management etc. so that the graduates will continue
their learning and enhances their skills in areas beyond what is available in their regular
curriculum.

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CONCLUDING REMARKS

Thus the working group is of the opinion with an improved


and revised curriculum and detailed capacity building of
faculty, increased manpower can be produced which is
equal to world standards, provided the necessary
infrastructure and faculty development programmes are put
in place.

The group also feels that this will result in the improved
quality of the existing colleges, sufficient number of
teachers and will create motivating career pathways for
both students and teachers.

This should result in better alignment of medical education


with health needs and an overall improvement in the
healthcare of our country with improved health parameters.

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