Is this queering the pitch of medical education?

The attention of the world to include the media, newspapers and the ubiquitous social media has been buzzing over the past couple of years focusing on the health of our planet which is in dire straits due to the corona pandemic having reached almost every nook and cranny with frightening speed. As if that weren’t enough, the Russian-Ukrainian war in particular and the flight of Indian medical students from Ukraine to India has been a “déjà vu” for an equal number of medical students in Wuhan, China, following the corona pandemic in 2020. Although many foreign medical institutions including from Poland, Hungary and Romania etc. offered to adapt these beleaguered Indian medical students, the question that deserved to be answered in all its truth is —-Why only Indian medical students have to travel the world to get a basic medical degree? Why not in the country of origin, India? Although reams of paper have been inked in an effort to get to the bottom of the knot of medical education, but it seems like more is adding to the already burgeoning knot of medical education, turning it into a “ Gordian knot” proverbial.

The latest to make the already murky waters murkier in the world of medical education is the ‘Rural Medical Education Bill’ introduced in the ‘Loksabha’ by NCP leader Supriya Sule. With a statement aim to provide the so-called “quality medical education” and to ensure an adequate distribution of health personnel in all rural areas of the country, the bill will have to make a lot of answers in August house of parliament of india . But unfortunately, the way our elected representatives carry out their parliamentary duties, it looks like this bill too will get its assent without too much ceremony. As things stand, it is necessary to take a closer look at the “Rural Medical Education Bill” just introduced in the “Loksabha” with all its connotations for the future footprint of the medical education in the country and judge for ourselves before elected MPs do. in parliament.

The new bill proposes to waive entire medical tuition, boarding and accommodation expenses during the study period for rural medical aspirants, introduce a rural quota for aspiring medical candidates but poor in exchange for compulsory rural service with the appropriate government(s) for a minimum period of six (6) years. Referring to the doctor-to-patient ratio in rural areas as low as 1:25,000, the bill points out that the distribution of healthcare personnel is abjectly skewed in favor of cities/metros where the majority of doctors practice. As a result of the above, there is a drop of 78.9% of surgeons, 69.7% of obstetricians and gynecologists, 78.2% of doctors and 78.9% of pediatricians in rural CHCs / health centers communities according to a 2021 GOI Rural Health Status Report. Is this a new revelation?

The newly introduced bill requires the government to conduct a survey to assess the shortage of medical professionals in rural areas, calculate the number of medical seats required for the rural countryside and designate it as the “rural quota”. Besides the above, the “Rural Medical Education Bill” calls for reservations for SC/ST and OBCs among these aspiring but poor rural medical aspirants. As if that were not enough, the bill provides for the creation of a “National Council for Rural Medical Education” by way of publication of an official journal.

This national council for rural medical education will have one representative from the Ministry of Finance, Health, Family Welfare and Rural Development, one member from each SC/ST and OBC, plus 3 eminent women members and one member from the transgender race in the medical field. The constitution of the council gives the impression of playing for the podium instead of getting seriously involved in the issue. The purpose of the council will be to oversee the selection of candidates under the rural quota, set limits on miscellaneous expenditures by candidates, and take appropriate action against any defaulting candidate.

Although many things are to be debated in the Loksabha by the honorable members when the bill finally comes to the table of the House, I suppose some preliminaries in the form of the following questions should be perfect food for thought to make bring the subject forward…

· The bill is silent on how and what will be the guiding principles for deciding who is a rural student? Have parameters been defined for this?

· How does the bill separate a real, needy rural medical aspirant from an artificial aspirant posing as a rural student?

· Has the bill thought about the origin of the proposed rural medical student quota?

· Will the quota come at the expense of the “general student quota” which has already decreased to ridiculous percentage levels?

· With GR (government regulations) on NEET-UG bookings being 27% for OBCs, 10% for EWS, 15% for SCs and 7.5% for STs, totaling a whopping 59.5%, Supriyasule wants it that country has a preponderance of quota seats, thus giving merit to pass?

· Its refrain in the bill says that these rural medical students will return to their home districts and serve the local rural population they are familiar with after graduation from medical school. Do these rural districts have adequate infrastructure to attract them to a rural medical service?

· Or does the bill propose to establish rural medical colleges close to the hinterlands of India?

· With over 60% of India’s population still residing in rural areas, having pathetic connectivity in terms of roads, rails and electricity, how does the bill propose to handle advanced treatment for patients who escape the medical management of rural doctors?

· With some areas of our country like J&K, NE, Chhattisgarh, Uttrakhand and Jharkhand over 6 days walk from the nearest road start, how does the Rural Medical Education Bill propose to address this last man/patient on such dangerous ground, even though the rural doctors are stationed there?

· The PHCs/CHCs (Primary Health Centers/Community Health Centers) in these areas have proven to be obsolete, with key life-saving drugs either missing or not stocked at all. With the majority of doctors away from their duty stations in these areas, has the bill addressed these concerns when rural doctors are posted under said bill?

· In J&K, NE and some tribal areas in central India, the armed forces, especially the air force, act as “first responders” to any medical emergency developing among people, repeatedly giving an airlift to those critical patients to get them to reach the nearest one. medical institution. Has the proposed rural medical education board done any contingency planning to overcome such a condition?

· Will the proposed National Rural Medical Education Council operate alongside the national testing agency NMC/National, NTA or will it be a subsidiary of NTA?

· How will the powers of the two august agencies support each other even without crossing?

· NTA/National testing agency releases detailed NEET-UG booking criteria under the All India quota (AIQ) scheme. Well, if the proposed National Board of Rural Medical Education takes on the heavy responsibility of setting the rural medical quota, then is that quota separate from that of the NTA?

It should be understood that NEET-UG is directly under the GOI booking guidelines which I have already mentioned above in this article. In each state, 85% of the seats are reserved under the state quota candidates and the NEET-2022 reservation criteria for them are decided by the relevant state government. The DGHS (Dte Gen of Health Services) on behalf of the Medical Counseling Commission (MCC) provides counseling for 15% of the seats available for admission in all government medical/dental colleges. This does not apply to J&K colleges at this time. In accordance with the NEET-2022 reservation guidelines, there is a certain percentage of seats reserved by category in the government medical schools within the 15% / AIQ of which I have already given the breakdown. Does the proposed National Rural Medical Board intend to increase or increase this quota to meet its recruitment needs for needy rural medical aspirants? Adding to the above confusion is the fact that the guidelines for NEET booking criteria for 2022 for seats that are under the state quota will be set by the state council authority based on the previous booking policies.

Since all state governments have their own reservation policies, how and where do these rural quota students fit into the scheme of things as proposed in the new National Rural Medicine Bill that will be debated in the Loksabha? The National Council for Rural Medical Education will operate and formulate its own selection criteria under a rural quota of students to include achieving grades in the NEET-UG entrance exam. It also imposes strict compliance with instructions by rural students. These are some of the gray areas that the Lok sabha needs to discuss in all its sincerity and cut the so-called “Gordian knot” before the country sees more medical students fleeing abroad in desperation to pursue their career in medicine.

(The writer is a retired army officer and can be reached on his email…[email protected])

Helen D. Jessen