Medical education in India has emerged as one of the largest of its kind in the world with over 660 medical colleges producing over 100,000 MBBS doctors every year. The quantitative expansion of medical education in the country took place largely in the first two decades of the new millennium. The other streams of medical education such as homeopathy, ayurveda and other systems also underwent an expansion in the same period. In a country such as India, still facing a 40 percent shortage of qualified physicians, the quantitative expansion of medical education infrastructure has been rightly hailed as a remarkable development. The quantitative expansion is however not matched by quality standards as well as development of systems and practices that could be considered on par with global standards. The following areas needed the attention of policymakers and other stakeholders in the healthcare sector in the country. 

A: Uneven growth of medical colleges: The number of medical colleges has increased many fold.  The majority of the growth is attributable to new private medical colleges.  However, no uniformity is maintained regarding quality, infrastructure intake of students, and fees. There is also regional disparity. Earlier, in Bihar and UP, there was one medical college for every 11.5 million people. In contrast, there is one medical college for every 1.5 million people in Kerala and Karnataka. With a population of 900,000, Pondicherry has 8 medical schools. The Union Government’s plan to build one medical college in every district of the country may resolve such regional imbalances. 

B: Standards for accreditation: Although NMC accreditation is required, the requested data emphasizes physical and human resource documentation (head counting and biometrics) rather than measures of the effectiveness of medical education and outcomes.


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C: Student selection for medical school: The efficacy of student selection strategies for private medical colleges is in doubt, and it is clear that they devalue merit in admissions, particularly at such institutions because of rising capitation fees. Students are admitted to their desired medical college in public sector medical colleges based on their NEET- UG score.

D: Lack of medical educators: A 30–40% shortage of medical educators exists. As the number of colleges is increasing day by day, the pool of educators is remaining nearly the same. Shuffling and deputation from existing colleges to newer ones are creating a genre of ghost faculty.

E: Bad internship management: The internship program, which is meant to help them enhance their skills, is mostly focused on coaching and preparation for PG admission exams or is burdened with patients at government hospitals without seniors guiding them.

F: Poor faculty development program: There aren't many internal faculty development initiatives; instead, regional medical education units are relied upon. The majority of medical college professors lack training in contemporary teaching and learning techniques. NMC has made Basic Workshop in Medical Education Teaching compulsory for all faculty members; it comes with a hefty fee to be paid, thus de-motivates faculty members to enroll in it.

G: Innovations in education and research contributions are almost nonexistent: Though research is a priority for promotion, however, interest in it is lacking. In many colleges, the minimum criteria are met for promotion and the research is majorly biased or depends on fabricated or fictitious data.

H: Lack of clinical resources: Medical students are deprived of continual and ongoing availability of patients for exams and acquiring skills since treatment in the majority of private medical colleges is expensive and not funded. There is little motivation for medical colleges to choose these due to the exorbitant cost of setting up a good clinical lab and other types of equipment.


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I: Quality of life of medical students: Medical students after clearing their NEET UG, fall into an ocean of robust curriculum. Classes start at 8 am and end at 4 pm, sometimes with evening clinical rounds. The majority skip their morning breakfasts and oftentimes take a hurried afternoon meal from the canteens standing in a queue. The physical and mental health of future caregivers is not given importance, and attendance in classes is leading to burnout.

J: Suicide amongst medical students: The Hindu cited one study which found that between 2010 and 2019 there were 358 documented suicide fatalities among medical students (125), residents (105), and doctors (128). In addition, 1,166 students left medical schools, and there were numerous pleas for help from both students and parents. Suicide deaths were mostly concentrated in South India except Kerala. According to a recent NMC's response to a Right to Information (RTI) request, 64 MBBS and 55 postgraduate medicos committed suicide in the previous five years. Medical students have an unacceptably high rate of suicidal thoughts. Researchers have identified a number of risk factors or predictors for suicidal ideation, including academic stress, prior maltreatment, stress brought on by family expectations, and strained relationships with friends and classmates.

Suggested Measures: Medical colleges should be started based on population. Small-group learning should be implemented so that every medical student can be attended to by the educator. Continuous medical education should be prioritized to brush up on skills and knowledge at regular intervals. Problem-based learning approaches should be engraved. Assessment at regular intervals should be done to improve the quality of education for students as well as educators. To improve the quality of life of medical students and reduce burnout; sports, co-curricular activities, breaks, healthy and nutritious food, and counseling when needed should be focused on.

The National Medical Commission (NMC) implementing a more organized methodology (Competency Based Medical Education) including components such as communication skills, attitude, empathy, compassion, professionalism, humanities, and others is a welcome sign.  Such measures are the first step towards making medical graduates in the country professionally efficient and personally compassionate.