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REPORT OF

THE MEDICAL EDUCATION REVIEW COMMITTEE

MINISTRY OF HEALTH AND FAMILY WELFARE


GOVERNMENT OF INDIA
NEW DELHI
1983
CONTENTS

Preface ………………… (iii)


Acknowledgements ………………… (viii)

PART I

Chapter I Introductory …………………………………………………………….……1-3


Chapter 11 Procedures relating to admissions to under-graduate courses………………………...4-6
Chapter III Procedures relating to admissions to the post-graduate course……………………….7-8
Chapter IV Duration of the under-graduate course and Internship………………………………..9-10
Chapter V Duration of the post-graduate courses and thesis……………………………………..11
Chapter VI Review of the Residency Scheme…………………………………………………. 12-13
Chapter VII Measures to bring about overall improvement in the under-graduate and post-graduate
education…………………………………………………………………………… 14-19
Chapter VIII Recommendations in regard to matters not covered by the Committee's terms of
reference……………………………………………………………………………. 20-22
Chapter IX Suggestions regarding the implementation of the Committee's recommendations….23-25
Chapter X Summary of recommendations …………………………………………………….26-29
Annexure I Copy of Ministry of Health & Family Welfare notification constituting the
Committee…………………………………………………………………………...31-32
Annexure II Details of meetings held by the Committee/Sub-Committees………….………………33
Annexure III Copy of Questionnaire issued by the Committee ………………………………… 34-36
Annexure IV Reports of previous Committees referred to by the Committee…………………….37
Annexure V An approach to the implementation of recommendations of the Committee………..38-42

PART II

1. Report of the Medical Education Review Committee—Part II ……………………………….43- 47


2. Report of the Sub-Committee on Medical and Para-Medical Manpower Requirements……... 48-54

APPENDICES
I. Statement indicating details of the organisations addressed to secure information regarding Health
Manpower, with the result thereof……………………………………………………………….55 - 56
II. Statement showing the number of unqualified Private Medical Practitioners as on 1-1-1982
(State-wise/System-wise) ……………………………………………………………………….57
Data in regard to admissions to MBBS course and Output of Graduate Doctors (1980-81)……58 - 64
Statement showing admissions/out-put in the Post-Graduate (Degree and Diploma ) and Post-doctoral
courses in Allopathy (1980-81)………………………………………………………………….65 - 66
V. Available stock (as on 1-1-1982) of Health personnel under the various major National Health
Programmes …………………………………………………………………………………….67
VI. Information regarding manpower data obtained from Central Public Sector Undertakings (as
on 1-1-82) ………………………………………………………………………………………68 - 71
VII. Information regarding Hospitals/Dispensaries etc. maintained by Voluntary Health
Organisations …………………………………………………………………………………..72
VIII. Existing stock of General Practitioners, Specialists, Dentists, Nurses and Pharmacists… 73
XI. Projection of demand of certain categories of Medical and Para-medical Manpower (including
Tables1 to 12)………………………………………………………………………………. 74 - 92
PREFACE

While inaugurating the first meeting of the Medical Education Review Committee Shri B.
Shankaranand, Union Minister of Health and Family Welfare, had urged the Committee to evolve
recommendations on its various terms of reference, ensuring that the same were in tune with the
needs and priorities of the country and easy of speedy, practical implementation. He had urged
the Committee to complete its work as early as possible.

In view of the fact that certain information and analysis was available in the reports of similar
committees established by the Government in the past, the Medical Education Review Committee
did not consider it necessary to undertake visits to institutions in the country or to hold
discussions outside Delhi. Instead, the Committee devised a questionnaire for eliciting the
opinion of identified eminent specialists and teachers, located in various parts of the country. The
Committee also had the benefit of informal discussions with the Chairman, University Grants
Commission. Besides, it had the opportunity of hearing the views of the representatives of the All
India Federation of the Junior Doctors' Associations.

To ensure the maintenance of high standards of medical education it is necessary that existing
teaching institutions strictly adhere to the regulations of the Medical Council of India in regard to
admissions, faculty strength, availability of prescribed infrastructural facilities etc. While the
basic emphasis should be to see that the existing institutions run on the most satisfactory basis,
new medical colleges may be allowed to be established only after very careful examination of
every proposal. Furthermore, a stricter view would require to be taken in regard to the continued
recognition of institutions which have failed to maintain the requisite standards. While the
Committee has evolved various recommendations for bringing about an improvement in the
existing situation, it appears necessary that Government review and urgently bring about suitable
amendments in the Indian Medical Council Act, 1956, to make it effective.

In view of the need to bring about adequate coordination of efforts, on all fronts, as well as to lay
the foundations of a well-considered, uniform approach towards all aspects of medical education
it appears necessary for the Government to consider establishing a central authority to be
responsible for coordination, planning and implementation of various medical and health
education programmes, assessment of health manpower requirements and development
programmes, provision of suitable financial support to medical and health institutions etc. The
Committee has made certain recommendations in this regard and hopes that the Government
would give due consideration to them.

The only term of reference in regard to which the Committee has not so far finalised its
recommendations relates to an assessment of the available stock of medical and para-medical
health personnel and the projection of requirements for the future, keeping various related
considerations in view. This task involves a great deal of time, specially as the basic information
is not readily available. The Committee hopes to submit a further report, on this aspect, shortly,
making such recommendations as may be possible, based on available information.

I trust the Government would consider the recommendations of the Committee on an urgent
basis, so that the much needed reform in the medical education system and related spheres is not
avoidably delayed.

The functioning of the Committee has been most competently handed by its Member-Secretary,
Shri N. N. Vohra, who served it in addition to his heavy charge as a Joint Secretary in the Minis-
try. He had to put in a great deal of hard work and harmonise discussions and varying views on
complicated issues. He has drafted the report of the Committee in very quick time, doing an
excellent job. I would personally like to thank him.

On my own behalf and on behalf of the Committee I would like to place on record our grateful
thanks to Shri B. Shankaranand for his help and guidance and to the Ministry of Health and
Family Welfare for sustained cooperation.

DR. SHANTILAL J. MEHTA,


Chairman September, 1982.
New Delhi.

Medical Education Review Committee*

*
The Committee was established vide Government of India Resolution dated the 8th September, 1981.

(v)
CHAIRMAN
Dr. Shantilal J. Mehta

MEMBERS
Col. R. D. Ayyar
Dr. I. D. Bajaj
Dr. P. N. Chhutlani
Dr. O. P. Gupta
Dr. L. B. M. Joseph
Dr. M. M. Mehta
Prof. V. RamaHngaswami
Dr. Rameshwar Sharma
Dr. Y. P. Rudrappa
Dr. B. N. Sinha
Prof. H. D. Tandon
Dr.K. N. Udupa
Dr. P. N. Ward

MEMBER-SECRETARY
Shri N. N. Vohra

STAFF OF THE COMMITTEE


Shri R. Srinivasan, Research Officer.
Shri J. C. Handa, Private Secretary to Chairman.
Shri A. V. L. Narasinga Rao, Sr. P.A. to Member-Secretary.
Shri Arun Kumar, Research Assistant (till May, 1982).
Shri K. K. Mehta, Research Assistant (from July, 1982),
Shri Sumit Chatterjee, Research Assistant.
Shri M. S. Chawla, Stenographer.
Shri S. C. Chitral, L. D. Clerk.
Shri Jagdish Prashad, Messenger (till July 1982)
Shri Kundan Singh, Messenger (from August 1982).
ACKNOWLEDGEMENTS

The Committee wishes to place on record its grateful thanks to Smt. Madhuri Ben Shah, Chair-
man, University Grants Commission, who kindly agreed to give us the benefit of her valuable
views and experience, in informal discussions.

Our thanks are also due to the eminent scientists and teachers (names given in Annexure HI) who
took the trouble of favouring the Committee with their views, in response to the Questionnaire
sent to them. We would also like to thank the representatives of the All India Federation of the
Junior Doctors' Associations for acquainting the Committee with their views.

Our thanks to various officers in the Ministry of Health and Family Welfare, the National
Medical Library, and the WHO Programme Co-ordinator and Representative in India for
supplying the Committee with publications, information and useful material.

It would not have been possible for me to complete the work of the Committee without the
extremely able and diligent support of Shri R. Srinivasan, Research Officer, and the sustained
hard work of Shri J. C. Handa, P. S. to Chairman, Shri A. V. L. Narasinga Rao, my Sr. P. A. Shri
Sumit Chatterjee and Arun Kumar, Research Assistants, M. S. Chawla, Stenographer and S. C.
Chitral, L. D. C

September, 1982. New Delhi.


N. N. VOHRA, Member-Secy.
CHAPTER I
INTRODUCTORY

The Ministry of Health and Family Welfare, Government of India, set up a Medical Education
Review Committee vide Resolution No. U-12012|28|81-ME (Policy) dated the 8th September,
19812 consisting of the following:—

1.Dr. Shantilal J. Mehta,


(formerly Director, Jaslok Hospital),
Smdhula, N. Garnadia Road,
Bombay-400026. Chairman

2. Dr. M, M. Mehta,
Member of Parliament,
53, North Avenue
New Delhi. Member

3. Dr B. N. Sinha,
President,
Medical Council of India, Kotla.Road,
New Delhi. Member

4. Prof. V. Ramalingaswami,
Director-General,
Indian Council of Medical Research,
New Delhi. Member

5. Dr. I. D. Bajaj,
Director General of Health Services,
New Delhi. Member

6. Prof. H. D. Tandon,
Director,
All India Institute of
Medical Sciences,
New Delhi. Member

7. Dr. L, B. M. Joseph,
Director,
Christian Medical College and
Hospital,
Vellore-632004. Member

8. Dr. O. P. Gupta,
Director of Health, Medical
Services and Medical Education,

2
Annexure
New Civil Hospital,
Ahmedabad-380016. Member

9. Dr. Y. P. Rudrappa,
(former Director of Medical Education and Research, Karnataka),
Chairman, Post Graduate Medical Education Committee,
Medical Council of India
Ravidarshana
121, 10th Main, 6th Cross,
Rajamahal Vilas Extension,
Bangalore-560080. Member

10. Dr. Rameshwar Sharma,


Principal,
S. M. S. Medical College,
Jaipur. Member

11. Dr. P. N. Wahi


(former Director-General, ICMR),
Executive Director
Indian Association for the Advancement
Medical Education, New Delhi. Member

12. Dr. P. N Chuttani


(former Dean. Medical Faculty, Punjab University and former
Director, Post-Graduated Institute of Medical Education and Research),
22, Sector 4
Chandigarh Member

13. Col/R. D. Ayyar


(former Director-General of Health Services Govt of India)
27, Kalakshetra Colony
Madras-600090. Member

Dr. K. N. Udupa
(former Director, Institute of Medical SciencesVaranasi),
Professor Emeritus
Banaras Hindu University.,
Varanasi (U.P.)

15. Shri N.N.Vohra,


Ministry of Health and
Family Welfare
New Delhi Member- Secretary

Secretary, Medical Council of India (Dr U B. Krishnan and latter Dr. P. S. Jain), was co-opted as
a Member of the Committee.

The terms of reference of the Committee are as follows:-

(1) (i) to review the current admission procedures (including entrance tests) and domiciliary
restrictions for admissions to under-graduate and postgraduate courses and to make suitable
recommendations separately, in regard thereto;

(ii) to suggest measures aimed at bringing about overall improvement in the undergraduate and
post-graduate medical education, paying due attention to
(a) institutional goals;
(b) content, relevance and quality of teaching and training and learning settings; and
(c) evaluation systems and standards.

(iii) to recommend the optimum duration of under-graduate and post-graduate cou-ses of study
separately ;

(iv) to examine the existing Internship programme and to recommend its future pattern;

(v) to review the working of the Residency Scheme along with the Housemanship Programme
and to make recommendations regarding a uniform pattern of post-graduate training.

(vi) to examine the current requirement of Thesis or Dissertation as an essential part/ of post-
graduate medical education and to make suitable recommendations in regard thereto; and

(vii) to examine the feasibility of a period of service in the rural areas for medical graduates and
post-graduates.

(2) The Committee will also evolve realistic projections of medical manpower requirements
(MBBS doctors, general specialists and super-specialists) during the Sixth Five Year Plan and
beyond, taking into consideration:

(a) the needs of Government based health care programme;


(b) the requirement of doctors in the private sector;
© the needs arising from bilateral agrees ments, international commitments and Technical
cooperation among developing Countries; and necessity to redress regional imbalances in the
distribution of medical manpower.

(3) The Committee may also consider and make its recommendations in regard to any other
related matter.

The Union Minister for Health and Family Welfare, while inaugurating the first meeting the
Committee, observed that the Committee may also take into consideration the recommendations
of the various Committees set up in the past to consider similar and allied issues and make
concrete recommendations to enable speedy consideration and decisions in regard thereto. He
also emphasised the need on the recommendations being practical and easy of implementation,
keeping all relevant factors in view. He reiterated the need of there being a uniform approach to
medical education in institutions all over the country. The Minister urged the Committee to
complete its work as early as may be possible. However, the report of the Committee relating to
an assessment of medical manpower requirements may come later, as the effort involved in
regard thereto would be time-consuming.

The Committee commenced its work on 5th October 1981, when it held its first meeting. In all,
the Committee held 9 meetings,* till the submission of this part Report.

At its first meeting, the Committee decided to elicit the opinion of selected Deans and Principals
of medical colleges and identified eminent medical scientists on some of the specific issues
arising out of its terms of reference. Accordingly, a Questionnaire**was evolved and sent out to
62 experts all over the country, of whom 41 (i.e. 66.12 percent) responded. The Committee also
invited Dr. (Mrs.) Madhuri Ben Shah, Chairman, University Grants Commission and
representatives of the All India Federation of the Junior Doctors' Associations to hear their views
on various issues before the Committee.

The Committee also undertook a rapid review of the views and recommendations of the
Committee*** appointed in earlier years.

As regards the assessment of medical manpower requirements and projection of future needs, the
Committee appointed a Sub -Committee, consisting of the following to evolve suitable
recommendations:—

1. Dr. O. P. Gupta,
Director of Health, Medical Services and Medical Education,
New Civil Hospital, Ahmedabad (Gujarat)

2. Dr. Rameshwar Sharma,


Principal,
S.M.S. Medical College,
Jaipur.

3. Dr. H. D. Tandon,Director,
All India Institute of Medical Sciences,
New Delhi

4. Dr. K. Ramachandran,
Associate Professor and Head, Biostatistics Unit,
All India Institute of Medical Sciences,
New Delhi.

5. Dr. U. B. Krishnan,
Secretary,
Medical Council of India,
Temple Lane, Kotla Road, New Delhi (uptill 30-4-82).

Dr. P. S. Jain,
Secretary,
Medical Council of India,
Temple Lane, Kotla Road,
New Delhi (from 1-5-82 to date).

6. Shri M. C. Verma
Joint Advisor,
Manpower Unit, Planning Commission, New Delhi

7. Prof. Usha K. Luthra,


Senior Deputy Director General,
Indian Council of Medical Research,
Ansari Nagar, New Delhi.
8. Prof. Gautam Mathur,
Director,
Institute of Applied Manpower Research,
Indraprastha Estate, New Delhi.

9. Dr. P. C. Bhatla,
Dean,
IMA College of General Practitioners,
New Delhi.

10. Shri N. N. Vohra,


Joint Secretary,
Ministry of Health and Family Welfare,
New Delhi. Convenor

1.8 As the assessment of medical and paramedical manpower requirements involved a great deal
of time the Committee decided to submit a part report on its other terms of reference.

1.9 As various Committees established in the past had gone into the requirements of a need based
medical education programme, the Committee did not consider it necessary to present a
voluminous report, reiterating the historical aspects etc. of the existing pattern. To enable speedy
action by the Government, the Committee also decided to make suggestions for the effective
implementation of its recommendations
CHAPTER II
PROCEDURES RELATING TO ADMISSIONS TO THE UNDER GRADUATE COURSE

Eligibility criteria for admissions

2. The Committee is of the view that there is no need for any modification in the Regulations of
the Medical Council of India, which set out the following criteria for adjudging the eligibility of
candidates for admission to the M.B.B.S. course:

“No candidate shall be allowed to be admitted to the Medical Curriculum proper until

(i) he has completed the age of 17 years at the time of admission or will complete the age on or
before 31st December the year of his admission to the 1st M.B.B.S. course.

(ii) he has passed :

(a) The Higher Secondary Examination of the Indian School Certificate Examination which
is equivalent to 10+2 Higher Secondary. Examination after a period of 12 years study the last two
years of study comprising of Physics, Chemistry. Biology and Mathematics or any other elective
subjects with Engish at a level not less than the Core course for English as prescribed by the
National Council for Educational Research and Training after the introduction of the 10+2+3
years educational structure as recommended by the National Committee on Education.

Note—Where the course content is not as prescribed for 10+2 education structure of the National
Committee, the candidates will have to undergo a period of one year pre-professional training
before admission to the medical colleges.

(b) the Inter medical examination in Science of an Indian University Board or other recognised
examining body with Physics, Chemistry and Biology which shall include a practical test in these
subjects.

OR

(c) the pre-professional pre-medical examination with Physics, Chemistry and Biology after
passing either the Higher Secondary School examination, or the pre-university or an equivalent
examination. The Pre-professional pre-medical examination shall include a practical test in these
subjects.

OR

(d) the first year of the three years degree course or a recognised University, including a
practical test in these subjects provided the examination is a "University Examination".

OR:

(e) B. Sc. examination of an Indian University, provided that he has passed the B. Sc examination
with not less than two of the following subjects - Physics, Chemistry, Biology (Botany, Zoology),
and further that he has passed the earlier qualifying examination with the following subjects –
Physics, Chemistry, Biology and English.
OR

(f) any other examination which, in scope and standard is found to be equivalent to the
Intermediate Science examination of an Indian University|Board, taking Physics, Chemistry and
Biology including a practical test in each of these subjects and English.

Note
(a) The pre-medical course may be conducted either at a Medical College or a Science College.
(b) After the 10+2 course is introduced, the integrated courses should be abolished.

Method of Selection

2.1 The Committee considered the existing Regulations of the Medical Council of India in regard
to the selection of students to medical colleges and is of the opinion that a National entrance
Examination, which should be exclusively of an objective type, for admission to the MBBS
course in all the medical colleges in the country would be an ideal arrangement, to put an end to
the varying admission standards. Candidates taking this examination could, offer their
preferences in regard to the institutions they would like to be admitted to, anywhere in the
country. The result of the examinations could be so complied as to set out the inter-se merit of the
candidates while keeping their choices in view. This matching system would ensure admissions
on merit, adjudged on a countrywide basis, and also, provide all round satisfaction. This
would also ensure against the avoidable cost and inconvenience caused to the students in their
having to sit for a number of admission tests, held on various dates, at different stations.
However, as the establishment of the National Entrance Examination would naturally lake some
time in view of the preparatory work involved, the Committee is of the view that for the time
being the phased approach mentioned below may be adopted :—
(a) All admissions to the MBBS course in medical institutions under the control of the
Central Government and the Union Territory Administrations should be through a common
Entrance Examination
(b) Admissions to the MBBS course in all the medical colleges including privately run
institutions, located in a State should be through a common Entrance Examination to be organised
by the State Government in consultation with the University (ies) concerned.

2.1.1 The Committee strongly condemns the charging of capitation fees by some medical colleges
from students seeking admission to the MBBS-PG courses and recommends that the Government
should take the most urgent steps, including legal measures, if necessary; to put an end to this un-
wholesome, practice.

2.1.2 At present the various Higher Secondary Examination Boards|Universities conduct School
Leaving|Higher Secondary| Pre-medical| Intermediate etc. examinations on different dates.
Consequently, the results of these examinations are announced on varying dates, in the context of
its recommendation in para 2.1, the Committee observes that it would be necessary for the
various examining bodies to hold the feeder channel examinations within a re-organised time
schedule so that the results of the various examinations are available before the last date of
application for admission to the National Entrance Examination. Till such time as the
arrangement proposed above- can be secured, the non-declaration of results of any of the feeder-
channel examinations should not stand in the way of the interested students sitting for the
National Entrance Examination. Candidates who qualify in the said examination, may be required
to produce the requisite certificates of their having passed the prescribed basic eligibility exa-
mination, before their results are declared.
2.1:3 As regards the central agency which would hold the National Entrance Examination, the
Committee is of the view that the Government may select a suitable autonomous institution,
existing or to be created, which possesses the requisite expertise.

2.1.4 In so far as the setting of papers for the National Entrance Examination is concerned, the
Committee recommends that while there should be a test in Physics, Chemistry, Biologv and
General Knowledge, the language of the examination should be English as, for many years to
come, the teaching of medicine, at all levels, would continue to be in English.

2.1.5 It was brought to the notice of the Committee that some of the medical institutions which
admit candidates to entrance tests for the MBBS course issue notices, informing the candidates
about their admission to the entrance examination, only a few days before the test. Due to
despatch and postal delays, these notices are in a large number of cases, received by the
candidates either just before the date of the examination or even after the examination has
commenced, thereby depriving candidates who reside at distant places of the opportunity of
competing for admission. The Committee is therefore, of the view that intimation to candidates
about their admission to examination should be sent-to them well in time to enable them to make
timely travel and other arrangements. Further, existing examinations as well as the proposed
National Entrance Examination should be held, every year, on specified dates.

Reservation of seats
2.2 In addition to the prescribed percentage of reservation of seats for SC and ST candidates, the
various States|UTs with medical colleges have been making reservation for a variety of other
categories on an apparently ad hoc basis. In some States the reservations are as high as 68 per
cent of the total number of seats for admission to the undergraduate course.

2.2.1 The Health Survey and Planning Committee 1961 had recommended that except for SC and
ST candidates there should not be any other reservation and that merit should be the only basis
for admissions.

After consideration, the Committee recommends the approach stated below:—


(a) The State Governments may be permitted to fix percentage-wise reservations for SC |ST
candidates as may be prescribed by the Central Government, the same being related to the SC and
ST population in the State;
(b) Any reservation over and above that in (a) above, for other categories of beneficiaries, should
be done only after procuring the prior sanction of the Medical Council of India;
(c) The aggregate of various categories of reservations, including SC|ST, should not exceed 33
per cent of the total number of seats available in each college;

There should be no further relaxation of the existing M.C.I prescription requiring SC|ST
candidates to possess at-least 40 percent marks (against 50 percent for general category
candidates) in English | General Knowledge, Physics, Chemistry and Biology, taken together, at
the entrance examination for admission to the medical course;

There should be no carry forward of reserved seats of any category, from one year to the next. All
seats reserved for SC|ST candidates which remain unfilled may be utilised by admitting eligible
SCI ST candidates from neighbouring States|UTs. If unabsorbed SC|ST candidates from other
States |UTs are not available in the requisite number, the vacant seats should be thrown open to
the general category candidates. The Government of India would have to establish a suitable
mechanism to operate the above recommended approach;
(f) With a view to providing effective protection to the SC | ST candidates, the existing Medical
Council of India prescription regarding the establishment of special coacning facilities should be
enforced most vigorously. Such coaching should be arranged for SCJST candidates who intend to
appear for the entrance examination. Also special counselling arrangements should be made for
the SC|ST students admitted to the MBBS course.

Domiciliary restrictions
2.3 The Committee noted that except in a handful of Central institutions, candidates can seek
admission only to medical colleges located in the State| UT to which they belong. The Medical
Education Committee (1969) and the Medical Education Conference (1970) had recommended
that 5 percent of the total number of seats in every medical college may be reserved for
candidates from otherStates. It was also recommended that such reservation of seats should be on
reciprocal basis. Taking into account all relevant considerations, the Committee recommends that
the final objective should be to ensure that all admissions to the MBBS course should be open to
candidates, on an all India basis, without the imposition of existing domiciliary condition.
However, to begin with, not less than 25 percent of the seats in each institution may be open to
candidates on all-India basis. This would pose no practical problems in view of the Committee's
recommendation, made earlier, to establish the National Entrance Examination. A suitable
percentage of these open seats may be made available to the students from the backward areas in
the States | UTs, particularly those without any medical college. The Government of India may
fix a date, taking various relevant consideration into view by which the alternate to objective of
all seats being open to admission on all India basis would be achieved.

Junior Doctors' Federation's views on reservations

2.4 The representatives of all India Federation of the Junior Doctors' Associations made a
very strong plea before the Committee that economic criteria may be applied to the reservation of
seats for the SC|ST so that the candidates belonging to well-to-do families do not enjoy
protection. Government may like to examine this view. The Committee is not competent to make
any comments, not being fully seized of the implications of the suggestion in other sectors of
functioning.
CHAPTER III
PROCEDURES RELATING TO ADMISSIONS TO THE POST-GRADUATE COURSES

Eligibility criteria for admission


3. The Committee recommends that for admissions to the various post-graduate courses
(Diploma, Degree and post-Doctoral) the candidates should have obtained full registration with
the Medical Council of India after passing the final MBBS examination and should have qualified
in the entrance examination referred to in para 3.1 below.

Method of Selection

3.1 The Committee considered the possibility of holding an all India Entrance Examination for
admissions to the post-graduate courses in the various medical institutions. It is of the firm view
that this would the only viable approach towards the establishment of uniform admission
standards. Such an examination, which may be called the National Entrance Examination for
Post-Graduate Courses, should provide for tests in General Knowledge of Medical subjects
besides a battery of well constructed tests to assess aptitude and competence and to procure a
complete profile of the candidate. The tests should comprise objective type questions. The
Central Government may, keeping all relevant aspects in view, identify the authority|agency,
which may hold this examination. It would be advantageous if the selected agency is an autono-
mous body. The candidates should be selected strictly on the basis of merit, emerging from the
result of the proposed, examination.

3.1.1 The approach set out in para 2.1 would mutatis mutandis; apply in the case of the proposed
National Entrance Examination for admission to the Post-Graduate courses.

Reservation of seats | domiciliary restrictions

3.2 The Committee is of the opinion that there should be no reservations for admissions to the
various post-graduate courses, and merit in the proposed National Entrance Examination should
be the only basis. However, one Member of the Committee was of the considered view that the
constitutional provisions in the matter should also be enforced in the case of admission to Post-
graduate courses. The Committee also recommends that all admissions to the Post-graduate
courses, in any institution, should be open to candidates on an all India basis and there should be
no restriction regarding domicile in the State|UT in which the institution is located.

3.2.1 As regards SC|ST candidates, the Committee is of the view that such of them who have
passed the MBBS examination and gained full registration may be enabled to secure admissions
to higher courses by providing them with special coaching |counselling facilities. Arrangements
for this should be made by the State and U.T. Governments in consultation with the local
university (ies) and the Deans'Principals of the concerned medical institutions. Needless to say,
such special facilities would be required to assist such SC|ST candidates who are not likely to
secure admissions, on merit basis, through the National Entrance Examination.

Rural Service

3.3 The oft-repeated suggestion from various quarters, that compulsory rural service for a pres-
cribed period should be a pre-requisite for admission to post-graduate courses was considered by
the Committee. The overwhelming opinion of the Deans|Principals and other medical scientists
whose views were elicited by the Committee, is that it would not be a practical proposition. The
Committee feels that as the Government may not be in a position to provide employment in the
rural areas to all the medical graduates who aspire to seek higher education it would be
impracticable to impose the condition of compulsory rural service. However, the Committee took
note of the fact that as the graduates who have actually served in the rural areas would have had
no time or opportunity to prepare for and take the proposed Entrance Examination, suitable
weightage, say 10 per cent additional credit in the overall assessment at the Entrance Examination
for Post-graduate Courses should be afforded to the applicants who have served in the rural areas
for atleast two years. The specific additional credit weightage to be afforded to such candidates,
qualifying in the Entrance Examination, may be worked out by the Government through a group
of experts.

3.4 The Committee considered the question of enabling doctors in government service to obtain
post-graduate qualifications, as they may not be able to compete with fresh graduates at the Na-
tional Entrance Examination. The Committee feels that the needs of the situation without be met
if in-service personnel are provided with the opportunity of undergoing training in identified
subject specialities, the duration of each course being related to the training objectives. Doctors
who are thus trained could take NBE|NAMS examinations for securing higher qualifications,
consequent to undergoing periods of practical training at selected centres. However, if any in-
service candidates opt for post-graduate qualification tlirough regular courses, suitable credit, say
5 percent may be awarded to them while computing the results of the National Entrance
Examination.
CHAPTER IV
DURATION OF THE UNDER-GRADUATE COURSE AND INTERNSHIP

Duration of the MBBS Course

4. The Committee reviewed the usefulness of reviving the erstwhile Licentiate Course or intro-
ducing a new short term course in view of the reluctance of the medical graduates to serve in the
rural and backward areas. In tins context the Committee after taking into account the recom-
mendations of the various Committees set up in the past, is of the view that there should be only
the fact whether the doctors are required to serve in the rural or the urban areas, the poor or the
rich, whether they are required for hospital based curative services or for community
oriented, preventive and promotive health care (services. The Shrivastava Committee 3 had
noted that there was no basis for suggesting the re-introduction of the Diploma or
Licentiate Course only for meeting the needs of the rural areas. The, Committee is of the view
that the resolution of the health problems of the country require better and more relevantly
trained doctors rather than less trained ones. It was observed that in view of the large number of
medical graduates being presently produced in the country, the real problem is to enable the
doctors to work in rural areast, urban slums etc., and not to create a fresh stream of semi-qualified
professionals who may also, as recent experiences show, like to settle and work in the urban
developed areas. The Committee is accordingly of the view that there is basis for either1 starting
an intermediate course or reducing the existing duration of the MBBS Course.

4.1 The period of 4-1/2 years for academic study and a one year Internship may continue, as
at present. This period of 4-1/2 years should be divided as under :—
Phase I ... Pre-clinical ... 1-1/2 year
Phase II ... Para--clinical .. 3 years
Phase III. ... Clinical 3 years
The above training schedule is as per the existing regulations of the M.C.I, currently followed by
medical colleges all over the country.

Internship
4.2 The majority response to the Questionnaire /circulated by the Committee is in favour of
continuation of the existing one year Internship after 4-1/2 years of academic learning. The
Committee is of the view that the prescription of one year Internship is an essential feature of the
educational programme which cannot be diluted or tempered with. The Internship period should
have a well structured content. The Committee is of the opinion that rural Internship for atleast a
period of six months is necessary. However, taking note of the fact that the requisite
infrastructural facilities required for the imparting of Internship training on an effective basis
have not yet been provided in the rural training centres by a number of medical colleges it
recommends that six months of the total Internship period should be spent in accredited
districts|taluk hospitals and rural health centres. The responsibility for providing such training
must rest entirely on the medical colleges and the State Governments. The Committee re-
commends that the Rural Training Centres at which the Interns are to be posted should be
managed, in all respects, by the medical colleges. The Medical Council of India should take
effective steps to see that these facilities are provided by the medical colleges and if this is not
done within a reasonable period, to be stipulated by the Central Government |MCI, action should
be taken by the Council to de-recognise the defaulting institutions. The Central Govt should
require the MCI to submit regular reports to the Government regarding the colleges which have
3
Group on medical Education and Support Manpower 1975
so far not taken adequate action to implement the rural Internship programme. It was observed
that the Council has so far not taken any action against the defaulting institutions nor submitted
regular reports in the matter to the Government.

4.2.1 During the period of the six months non-rural Internship, the students should work in the
teaching hospitals, 4 months of which would comprise rotating Internship with a structured
content and 2 months for training in the subject-speciality of the student's choice, as an elective
assignment. During tins period the students should be designated as Junior Housemen and be
responsible for all aspects of patient care, under the effective supervision of senior and
experienced Consultants working in these hospitals. Within the aforesaid approach it would be
necessary to remove the existing condition that candidates seeking admission to a postgraduate
course may do so only in the subject speciality in which they have done Houseman-ship for a
prescribed period. This stipulation is not rational and merely creates a variety of available
problems.

4.2.2 The Committee hopes that, in due course, the Interns would be able to do their full
Internship period outside the college hospital to gain substantial practical experience. At the
conclusion of the Internship period, there should be a formal in-house clinical examination in the
various disciplines to assess the work done and practical experienced gained by the trainees. High
weightage should be afforded to such an evaluation, within the overall performance schedule. The
Committee is of the view that unless a student has cleared this examination, he should not be
entitled to the grant of the Degree. If he fails the Internship period may be extended by such
period as may be necessary, after which he would again be required to take the examination.

The Committee noted with concern that senior faculty members in the medical colleges do not
take the required interest in supervising the work of the Interns during the lattefs rural training.
No matter what changes are recommended to be brought about in the pattern of Internship they
would have little meaning if the Professors|Senior Teachers do not personally instruct (supervise
the students during this crucial period of their training. The Committee strongly recommends that
Professors and senior faculty members in the colleges should be deputed to the PHCs |District
Hospitals|Taluk hospitals etc. to supervise the training of the students during their Internship
period.

The Committee took note of the reported cases relating to the harassment of Interns by the local
unregistered and unqualified medical practitioners operating in the rural areas. The Committee is
of the view that the State Governments|U.T. Administrations should provide suitable security and
such legal protection as necessary to the Interms and young doctors posted in the field.
CHAPTER V
DURATION OF POST GRADUATE COURSES AND THESIS

Duration
5. The Committee reviewed the existing system of admissions to the various post-graduate
courses, as per the provisions in the recommendations of the Medical Council of India, viz., 2
years for post-graduate Degree courses and one year for Diploma courses, both after one year of
House-manship. In view of the recommendation of the Committee that under-graduate students
should be involved, during their Internship, in effective clinical training at the Districtj Taluk
level hospitals and in the designated centres in the rural areas, it is of the further view that after
obtaining the Degree, doctors may become eligible for seeking admission to a post-graduate
course straightway, after full registration with the M.C.I. In other words, there should be no need
for the candidate having to compulsorily go through a period of Housemanship. In this context,
the Committee is of the view that the duration of the post-graduate degree course should be three
years and the duration of the Diploma course should be two years after full registration. The
Committee is of the view that this will provide flexibility for the evolution of relevant training
programmes and provision for suitable training in the related subjects. The number of Resident
seats should be specifically earmarked, department-wise, the number thereof being related to the
employment opportunities and assessed requirements based on actual service loads. The number
of seats, in each post-graduate department should be fixed with the prior approval of the Medical
Council of India. The Council should decide the number of Resident seats, department-wise, with
reference to the assessed medical manpower requirements.

Thesis
5.1 The Committee considered, in some depth, the pros and cons of continuing to have Thesis as
a compulsory requirement for qualifying in the post-graduate examinations. 37 out of the 41
experts who responded to the Questionnaire sent by the Committee are in favour of retaining the
requirement of thesis. The Committee was generally convinced of the value of Thesis in view of
the fact that it contributes to the development of the spirit of the inquiry, besides exposing the
students to the*techniques of research, critical analysis, acquaintance with the latest advances in
medical sciences and the manner of identifying and consulting available literature, preparing
papers for presentation: at Conferences etc. At the same time, the Committee is concerned at the
manner in which the whole system of Thesis is being actually implemented at present and how
much it falls short of the expectations of having it as a compulsory requirement. The Committee
is of the opinion that Thesis should be compulsory for non-clinical subjects while being optional
for clinical subjects. In the latter case, where a student has opted for Thesis, extra credit|
preference should be given in his future career prospects. The effectiveness and success of this
approach could be reviewed at suitable intervals. The M.C.I, should undertake speciality-wise
review in the light of the above recommendation and modify their Regulations accordingly.

5.2 The M.C.I, would also have to ensure that teachers take adequate interest in the identification
of relevant subjects and provide effective guidance to the students in this regard.
CHAPTER VI
REVIEW OF THE RESIDENCY SCHEME

6. The Committee reviewed the working of the Residency Scheme specially keeping in view the
oft-repeated grievances of the Resident doctor’s and the decisions taken from time to time by the
government in regard thereto

6.1 According to the existing M.C.I. Regulations, applicants for post-graduate training should
have obiained full registration and, subsequently lone Housemanship for a period of one year
prior to seeking admission to a post-graduate Degree| diploma Course. The period of training for
MD|MS is three years after full registration, including one year of Housemanship or equivalent
there if and for Diploma courses it is two years after full registration, including one year of
Housemanship. These are the minimum requirements and the universities and medical institutions
are therefore, not prevented from prescribing a longer period of training. The in-service training
requires the trainee to be resident in the campus so that he can be given graded responsibility in
the management and treatment of patient's entrusted to his care. As regards post-doctoral degrees,
the period of training is two years for those who already possess a Post-graduate course. The
M.C.I, have also recommended that the Post-graduate training could be delinked from
Housemanship

6.2 Post-graduate and post-doctoral students, designated as Junior Residents and Senior
Residents, have been agitating, in recent years, for improvements in their working conditions,
remunerations, etc. which vary from State to State. In 1974, the Government of India appointed
Committee under the chairmanship of Shri Kartar Singh, i.e. then Additional Secretary in the
Ministry of Health and Family Welfare, to consider the demands of the "junior doctors", which
includes both junior and senior Resident doctors in the government run hospitals in Delhi. On the
recommendations of the Kartar Singh Committee, certain benefits were extended to the junior
doctors appointed in the Central Government hospitals all over the country. During the last few
years, their service conditions have been improved further. The Committee noted that
Government have extended the following benefits to the resident doctors :-

(i) the break(s) from the date of completion of the senior residency to the date of appointment in
Government service will be condoned for the purpose of granting retirement benefits;
(ii) all inclusive leave is allowed at the rate of 24 days during the first year and 30 days during
the second and third years, to the Junior Residents;
(iii) the residents will not be required to do any laboratory investigations, except those which
the Head of the Department or the residents themselves consider necessary;
(iv) a sum of Rs. 250 is paid to the student for writing Thesis;
(v) all unmarried Junior Residents would be allotted free of charge, one-room accommodation
and married and senior residents would be provided with two-room accommodation. Till this is
done, House Rent Allowance at prevailing Government rates would be granted to the Residents;
(vi) while the Junior Residents receive stipends at varying rates from First to Third year the
Senior Residents are placed in the pay scale of Rs. 650-30-710 plus usual allowances against
tenure-posts for 3 years and are governed by the Central Civil Services (Temporary Service)
Rules, 1965. They are also entitled to P.G. allowance of Rs. 50 per month if they hold a P.G.
Diploma and Rs. 100 per month if they hold a P.G. degree. They are also entitled to NPA @ Rs.
150 per month and (vii) the continuous active duty for Residents should not normally exceed 12
hours at a time; they are also required to be on call duty for periods not exceeding 12 hours at a
time, subject to exigencies of work. They are allowed one weekly holiday, by rotation.

6.3 The Committee reviewed the demands submitted by the All India Federation of the Junior
Doctors Associations. After hearing the representatives of the Federation and keeping in view the
fact that the doctors seek, admission to the Residency Programme in order to gain higher quali-
fications, the Committee makes the following recommendations :-

(a) The admissions to the various P.G. Courses (Degree and Diploma) should be directly related
to service loads, manpower requirements of specialists and the clinical facilities available. In this
context, the Committee recommends the demand of Resident Doctors to constitute a National
Health Service, particularly keeping in view the commitment of Government to provide Health
for all by 2000 A.D. Consequently, the number of vacancies of junior|senior Residents in each
subject speciality would require to be related to the assessed manpower requirements.
(b) The leave benefits already agreed to by the Government and referred to in para 6.2(ii) are
adequate, considering the training requirements of Resident doctors.
(c)Labour laws cannot be applied to Resident doctors undergoing training for securing higher
qualifications. They are undergoing in-service training and are not on jobs in which the training
and the service components can be separated. As such there can be no justification for fixing the
limits, on a policy or legal basis of the hours of work required to be put in, per week.
(d) The period of Junior Residency cannot be treated as regular service till such time as the
number of seats in the various post-graduate courses are related to the manpower requirements
and actual employment opportunities. Once this is done there should be no difficulty in treating
the entire period of training for award of service benefits.
(e) The period of service of Senior Residents may be treated as Government service for the
purpose of service benefits like pension, gratuity, etc., provided that the incumbents seek and
secure regular employment in Government. Consequently, the breaks, if any, between the date of
completion of training|securing of post-doctoral degree and the date of entry into Government
service may be condoned as per Government Rules.
(f)There should be no upper age limit for admission to the Senior Residency Programme. In
regard to entry into Government service, the maximum age limit should be raised by suitably
amending the relevant recruitment rules so that doctors with Post-graduate|Post-doctoral degrees
can enter Government service without having to specially seek relaxation of age limits presently
prescribed.
(g) In the case of non-clinical departments since candidates with post-graduate qualifications are
not readily available. Demonstrators |Tutors may be appointed against the posts of Junior
Residents and their services may be continued against regular vacancies, so that the shortage of
staff in these specialities could be suitably met without any further loss of time. Such
Demonstrators|tutors may be allowed to enrol themselves for P.G. qualifications while working in
the departments. After securing P.G. qualifications they may be appointed as Lecturers without
having to go through a fresh process of selection, other things being equal.
(h) The Committee recommends that the Residents should also undertake various laboratory
investigations, as part of their training. In this respect the Committee does not agree with the
Government decision at Para 6.2(iii).

6.4 The Committee is of the opinion that after post-graduation there is no need for the clinical
specialists to put in 3 years of further service as Senior Residents or Registrars, etc., to become
eligible for appointments in Government service. Accordingly, the Committee recommends that
the recruitment rules for appointments to the posts of Lecturers and Assistant Professors should
be suitably amended.
CHAPTER VII
MEASURES TO BRING ABOUT OVERALL IMPROVEMENT IN THE UNDER-
GRADUATE AND POST-GRADUATE EDUCATION

7. One of the terms of reference of the Committee is "to suggest measures aimed at bringing
about overall improvement in the under-graduate and post-graduate medical education, paying
due attention to :—
(a) institutional goals;
(b) content, relevance and quality of teaching and training and learning setting ; and
(c) evaluation systems and standards."

The Committee considered the recommendations of the MCI on under-graduate medical


education, adopted by the Council at its meeting held on 19-3-1981. The Committee also took
note of the recommendations made by the Committees, set up from time to time, to review post-
graduate medical education in regard to the institutional goals, curricular contents, etc. While
broadly agreeing with the approach of these various Committees, the Committee, in the light of
the mandate given to it, wishes to draw attention in this Chapter to some of the essential features
of under-graduate and post-graduate medical education which should act as guidelines to the
formulation of institutional goals, course content, evaluation methods, etc. The Committee further
believes that while institutional goals should be considered separately for under-graduate and
post-graduate medical education; there is considerable commonality between the two in so far as
educational technologies, teaching and learning situations and evaluation systems are concerned.
Indeed, there is a continuity between under-graduate and post-graduate medical education.

Basically, in spite of difference in the process of medical education at under-graduate and post-
graduate levels, the ultimate purpose is to train physicians to fit into different levels of the health
care system and to be able to resolve the health care problems of the community. Viewed from
this angle, it could be said that the ultimate goal of medical education, be it under-graduate or
postgraduate, is that it enables its products to deal, in the most effective manner, with the health
problems of the society.

7.3 In this Chapter, the Committee, in the first instance, separately considers institutional
goals for under-graduate and post-graduate medical education and then goes on to collectively
consider, for both under-graduate and post-graduate education, the other aspects under the term of
reference quoted in Para 7.

Institutional Goals for the Under-graduate Medical Course

7.4 The broad objective of under-graduate medical education is to produce medical graduates
who would have the capability of providing comprehensive health care to both rural and urban
communities. Such care should not only be curative but also include preventive and promotive
aspects of health as well as rehabilitative services in an integrated manner.

7.4.1 In order to be able to do so, the student should have adequate understanding of :—

(a) the structure, functions and development of the human body, including immuno-defence
mechanisms, factors which disturb them and the mechanisms and forms of disorders which may
result therefrom as relevant to the understanding of the clinical manifestations of diseases
commonly prevelent in the community;
(b) methods of first level handling, promptly and efficiently, common, acute emergencies:
(c) techniques of management of health problems including drag therapy, and should also be able
to select the most appropriate form for a given patient, with due consideration to its cost
effectiveness;
(d) legal and ethical implications of medical care;
(e) local patterns of diseases, environmental pollutions, occupational health hazards,
communicable diseases, family welfare programmes, material and child health and nutrition ;
(f) special problems of vulnerable sections of the rural and urban community including the care of
mother and child and
(g) the basis of human behaviour and role of psychological factors both in health and disease.

7.4.2 After successfully going through the prescribed course of learning and training, the young
doctor should be capable of :—
(a) diagnosing common disorders with the help of such diagnostic facilities as are likely to be
available/expected in the average community settings;
(b) performing simple laboratory tests and operative procedures, including surgical methods of
fertility control;providing counselling and appropriate measures of management when drugs and
other medical measures are not necessary;
© providing advice about prevention of disease and promotion of positive health; and
(d) establishing good working relationship with his medical colleagues and members of allied
health professions.

7.4.3 The doctor should recognise the limitations of his knowledge and abilities and seek help
when necessary. He should be an independent learner-with attitudes to self-evaluation and self-
education. This will promote continuing improvement and adaptation to changes in medical
practice, whether these result from the changing needs of the community or from the advances in
the medical sciences.

Institutional goals for Post-graduate Courses


7.5 The Committee feels that the institutional goals for both clinical and non-clinical subjects in
the post-graduate courses are more or less similar. However in view of the variations in the
practice field to which post-graduate doctors are ultimately exposed, the Committee spells out,
seperately, the institutional goals for clinical and non-clinical medical courses.

Clinical Specialities
7.5.1 The educational and training programme leading to the award of the post-graduate degree in
clinical subjects is aimed at imparting knowledge, abilities and skills to enable the trainee to
eventually services a specialist|teacher| research worker in the field of his speciality.

(1) The trainee should possess adequate knowledge pertaining to his speciality in respect of:—
(a) applied structure and functions of the human body and patho-physiological mechanisms
determining the clinical course and evaluation of disease;
(b) important national health programmes and local pattern of commonly prevalent diseases ;
(c )latest modalities of therapy ;
(d) simple methods of statistical analysis of data ; and
(e)developing frontiers of knowledge.

(2) On the successful completion of the learning and training course, the specialist should be able
to :-
(a) manage effectively all clinical problems and handle emergencies independently ;
(b) make a rational plan of investigations and management of a given case ;
© perform common laboratory tests: understand the principles of essential laboratory tests and
clinical procedures and interpret laboratory data for the diagnosis and management of cases ;
(d) know his limitations and those of the facilities available as also when to refer patients that
need more specialised care;
(e) make use of the library to collect the relevant information ; and
(f) identify a research problem, plan a rational scheme for its solution, make a critical analysis of
the data and interpret them in ,the light of the contemporary knowledge.

(3) A post-graduate should be able to plan course of study for the students, defining the
objectives; be capable of participating in didactic and tutorial teaching and be familiar with
educational techniques which make learning efficient and effective.

Non Clinical Specialities


7.5.2 The educational and training programmes leading to the award of the post-graduate degree
in non-clinical subjects are aimed at imparting knowledge, abilities and skills to enable the trainee
to eventually serve as an independent investigator, researcher and/or teacher in his speciality. In
order that he may attain this goal, he should :—
(1) possess current knowledge relating to all fields pertaining to his speciality and be familiar
with the developing frontiers of knowledge ;
(2) be able to identify a research problem pertaining to his speciality, plan .a rational scheme for
its solution and after carrying it out make a critical analysis of the data and interpret it in the light
of contemporary knowledge.
(3) be able to prepare a research protocol, succinctly defining objects of study, lacunae in existing
knowledge and outline rational steps to achieve the objects, providing critical review of existing
knowledge in literature ;
(4) be able to select and apply the most relevant statistical method for analysing research data,
pertaining to a given problem .
(5) be able to make use of the library to collect relevant information ;
(6) be familiar with the principles of the working of different types of equipment essential to his
research work and for teaching students; and
(7) be able to plan a course of study for the students defining the objectives; be able to participate
in didactic, tutorial and laboratory teaching exercises and be familiar with educational techniques
which make learning efficient and effective.

Curriculum of Under-graduate Medical Education

7.6 In translating the institutional goals, enumerated in Para 7.4, into a curriculum, it is essential,
to bear in mind that it has to be a dynamic one. As the problems related to health change with
shifts in the socio-economic and other factors, medical education must also be adapted
continuously to prepare the students to meet the changing needs of the society.

7.6.1 A reference has been made earlier to the recommendations of the MCI in regard to the curri-
culum on under-graduate medical education. The Committee wishes to emphasise the importance
of certain areas, mentioned here under, in the development of the curriculum.

7.6.2 There is mounting criticism that the present under-graduate medical education process does
not pay sufficient attention to practical skills and competence involved in the delivery of primary
health care. The Committee wishes to emphasise that the curriculum should provide opportunities
for an education that is problem-solving and competence-building backed, to the extent needed,
by theoretical knowledge. This cannot be achieved by the efforts of a single faculty member or a
department but must be the total faculty commitment of the entire institution.
7.6.3 The Committee agrees with the recommendations of the MCI that students should be
posted; in a general practice out-patient unit for a period of one month in order to be exposed to
the multidimensional nature of health problems, their origins. With the family and the need for
adopting a comprehensive approach to health problems. In the course of this phase of training, the
students will also develop an appreciation of the need for reference to specialised care facility in
selected cases, thus enabling the students to understand the limitations as well as the strengths of
general practice.

7.6.4 The Committee also agrees with the recommendation of the MCI that the students must be
posted in the accident and emergency sections of the hospital in order to become proficient in
problem diagnosis and treatment of acute cases. This posting would also provide experience of
the legal and social aspects of medical care. It is very important that senior staff should be availa-
ble in this section not only to provide emergency care but to also impart on the spot teaching to
the students.

7.6.5 The Committee wishes to emphasise that when a student is posted in a community health
facility either during the under-graduate course or during, the Internship, the responsibilities for
teaching him in the community setting must be shared by the relevant departments. The
importance of community health can be restored only if the entire faculty demonstrate a basic
commitment to this objective in the education of the student.

7.6.6 There is increasing concern that the curriculum is not sufficiently inter-disciplinary in
nature. The Committee recognises the difficulties of inter disciplinary and integrated teaching. It
is expensive in terms of faculty time but more important than any other factor is the concern of
the faculty to see that an integrated view of health problems is presented to the students in the
most attractive manner. Changes in the curriculum are needed to permit teachers from different
disciplines, when ever such an opportunity arises, to combine together in teaching selected topics.
The Committee envisages that clinical teachers will participate freely in the teaching of basic
sciences drawing attention to the applied aspects of basic medical sciences. Likewise, the
Committee feels that the participation of pre-clinical departments in seminars and didactic
teaching sessions on clinical problems will greatly facilitate inter-departmental teaching. When
all is said and done, integrated teaching succeeds not in the framing of a curriculum but
ultimately when there is a change in the minds and hearts of teachers themselves.

7.6.7 In this connection special attention needs to be paid to areas that are essentially inter-
disciplinary in character. Clinical Pharmacology, Clinical Virology, Clinical Immunology.
Clinical Genetics and Clinical Psychology are examples in this category and efforts must be made
to encourage the establishment of units or departments for this purpose.

Curriculum of post-graduate education

7.7 In addition to the well-defined and age-old post-graduate courses in the groups of clinical and
non-clinical subjects there are post-graduate courses in Preventive and Social
Medicine/Community Health and Health and Hospital Administration, for which a strong need is
being felt and which are also receiving wide recognition and acceptance. In these courses, certain
areas merit special attention. These include demography and population dynamics, study of
social, psychological and other environmental factors, group inter-action and behaviour, social
psychology, health-economics, health statistics, health legislation, environmental sanitation,
principles of epidemiology, public health administration and managerial sciences. In addition to
these, the subjects covered in these courses are problems relating to occupational hazards,
organisation of health services, social security, and the principles and practice of planning,
implementation, monitoring and evaluation of health programmes in general and in special areas
such as health education, nutrition, family planning etc. The basic approach in these courses is
that of developing adequate knowledge to make community diagnosis and management of health
problems with the objective of promoting positive health, preventing disease and disability and to
provide comprehensive medical care. Specialists in these fields are required for various
administrative, research and teaching responsibilities. Separate institutional goals need to be
worked out on the basis of competency required by those holding these positions.

7.7.1 The other area which needs to be gone into is that relating to post-graduate courses in the
field of general practice/family medicine. In the present context, when the country is committed
to the goal of Health for All by the year 2000 through the strategy of primary health care on a
universal basis, it is all the more necessary that a cadre of suitably trained manpower is
developed, which would be capable of delivering comprehensive and integrated health care at the
family level. The Committee strongly recommends that this speciality, which already been
approved by the MCI, should be further developed so that an increasing number of students
pursue higher studies in this area.

7.7.2 In view of the need to enlarge opportunities of training in Public Health and Tropical Medi-
cine, the Committee recommends that atleast six Regional Institutes, on the pattern of the All
India Institute of Hygiene and Public Health and the School of Tropical Medicine, Calcutta, each
imparting integrated training in public health and tropical medicine, should be established in the
country. As avenues and career prospects in these areas are rather limited at present, the
Committee recommends that the Central and the State governments should provide suitable
incentives to attract a progressively growing number of candidates to these disciplines.

Medical Education Units

7.8 In order to effect the changes in the institutional goals and curriculum, teaching methods and
evaluation reforms (to be described later), the Committee believes that it is necessary that each
medical college should have a medical education cell or unit attached to it. To make a beginning
in this direction, it is suggested that such units or cells be developed on a regional basis in
selected institutions where sufficient interest exists among the faculty and the students in bringing
about the much-needed educational reforms. Such units should have a core staff of full-time
personnel who are well-versed in educational sciences, in methods of educational management,
educational technology etc. But they alone cannot bring about the desired changes without the
faculty working in close liaison with them in restructuring the educational process. This
recommendation of the Committee is closely related to another recommendation made elsewhere
in this Chapter dealing with the setting up of National Teacher Training Centres, in different
regions of the country.

Teaching and Learning with special reference to Instructional Technology

7.9 It is well-known that each student has his own style of learning. Therefore, in order to
maximise learning, the teacher has to ensure the appropriate environment for maximum learning
to take place and to adjust his methods and technologies suitably. Having constructed a
curriculum that matches the institutional goals, it is necessary that a teacher should be able to
deploy, in a sound and perceptible manner, the methods and tools of instruction available to him.
He has to select judiciously and use skillfully the available technologies. This implies that the
teacher should be familiar with a range of instructional methods and their potential. These include
didactic lectures, group discussions, laboratory work, clinical work, field work etc. The learning
setting is equally related to the achievement of a specified educational objective.
7.9.1 At the present time, any medical person after acquiring post-graduate qualification can be
appointed as a teacher irrespective of the fact as to whether he possesses the requisite aptitude and
efficiency in teaching. It is widely recognised that the efficiency of an average teacher can be
markedly improved by training him in pedegogic skills and techniques. This is an investment
which the Committee feels should be made in the larger interests of improving the quality and
relevance of medical education in the country. The Committee recommends that a number of
Teacher Training Centres may be established on a regional basis. Six to eight such regional
centres to begin with, would suffice the present needs, the number can be increased as time passes
and adequate momentum is gained.

7.9.2 Of equal importance is the development of instructional materials and media appropriate for
a given learning situation, in our country we have been depending to a large extent upon the
"lecture" as a major instructional medium. While the value of this method is well-known, its
limitations should also be recognised and an attempt should be made to enrich the quality of
teachers by introducing a variety of other his true instructional methods and aids which are now
available. There is, to-day, virtually a revolution in educational technology and some of the
proven methods and aids should be introduced into the medical educational system. Of great
importance in this connection is the use of self-learning devices and self-evaluation techniques.
Simulation methods have also been introduced. Synchronised audio-visual slides, video-tapes and
television are also being effectively deployed in education to-day. The Institute of Pathology of
the ICMR has developed some of these technologies from indigenous sources and has already
supplied educational materials in the medical and health field to a variety of institutions and
organisations. This Institute could play an important part in facilitating the enhanced use of
audio-visual technology in medical education.

7.9.3 The Committee wishes to emphasise that the preparation of teaching and learning materials
involves a great deal of efforts. The examples chosen, if they are derived from local experiences,
will greatly enhance the relevance of teaching. The Regional Teacher Training Centres, recom-
mended earlier, could also be charged with the responsibility of preparing the requisite
introductional materials in collaboration with the audiovisual technology unit/division of the
Institute of Pathology of the ICMR. The services of professional associations and societies and
the National Academy of Medical Sciences and other expert bodies in the country could also be
utilised for their preparation.

Evaluation
7.10 Traditionally, evaluation in medical education is designed to certify competence in the
practice of medicine and can be regarded as a way of protecting the public from sub-standard
practitioners in art and science of medicine. In the educational sense, evaluation has another
dimension, namely, to measure to what extent the objectives of medical education have been
fulfilled and to reveal the deficiencies in the educational process for correction. In addition,
evaluation can help individual teachers and their departments in improving the quality of
education.
7.10.1 In medical education, evaluation can be related to: -

(a) the product (under-graduate and postgraduate students) ;


(b) teaching ; and
(c) the process of evaluation.

Evaluation at times can also be used as a tool to promote learning (formative evaluation).

Product Evaluation
7.10.2 In the existing system of evaluation of the students, there is a significant element of sub-
jectivity while conducting the examinations. Often there are allegations of favouritism,
victimisation, inaccurate assessment which particularly happens while conducting oral and
practical examinations and clinical tests. It is, therefore, essential that the examination should be
made objective as far as possible and the evaluation system should assess all the areas of
knowledge and skills related to the curriculum and institutional goals. Further, it would be
desirable to establish uniform standards of evaluation, in the medical institutions all over the
country. In this context, the Committee recommends, as a long term goal, the establishment of a
central, national level, independent body for conducting the MBBS examination, so as to achieve
not only uniform standards in the ultimate certification of MBBS students but also to monitor the
implementation of institutional goals recommended by the Committee elsewhere and to ensure
that the curricula of medical courses bring to the fore, the national Health, Medical Education and
Health Manpower policies as may be adopted by the Government, from time to time. If this
cannot be achieved immediately, atleast uniformity should be maintained in all the medical
colleges in each State. The structuring and administration of suitable multiple choice questions
(MCQs) can, to some extent, serve the purpose of objective assessment. However, it is
experienced that presently a large number of teachers in our country are not suitably trained in the
discipline of MCQs. It is, therefore, recommended that the Regional Teacher Training Centres,
referred to above, should train the teachers in the techniques of constructing multiple choice
questions. The medical education units proposed for each medical college could also undertake
the responsibility of training the teachers and, later, to conduct item-analysis of the scores
obtained by the students and gradually improve the construction of MCQs. At the national level, a
Central Cell, which should be appropriately linked with the National Board of Examinations
could monitor and oversee the evaluation techniques and establish inter-action with the Regional
Teacher Training Centres and the State level medical education units. Till such time as the
proposed Universities of Health Sciences recommended in Chapter IX, are established, an
identified university, in every State which has more than one university, should be made
responsible to ensure uniformity in the evaluation of all the students in the State. The aforesaid
university could be the one which has been entrusted with the responsibility of conducting the
Pre-medical Test for admissions to all the medical colleges in the State.

7.10.3 The limitations of the MCQ test should, however, be realized and the possibility of com-
bining such tests with short essay type and long essay type questions should be explored and a
judicious balance between them ensured.

7.10.4 The Committee appreciates the relevance of internal assessment as a tool for motivating
the students to learn and for assessing their day-to-day performance, which will contribute to the
achievement of the final goals. However, it is observed that in practice many limitations are
imposed on the system when it is used as a tool for periodic assessments or when it contributes
towards the final assessment of the students. Nevertheless, it is recommended that due weightage
should be given to day-to-day assessment.
7.10.5 There is need for continuous improvement of the evaluation techniques as no single
technique is perfect. Efforts should be made to introduce newer techniques for the assessment of
problem-solving abilities and clinical skills. It is suggested that in the Regulations of the MCI for
professional examinations, the above recommendation should be suitably incorporated.

Evaluation of teaching
7.10.6 The Committee feels that the teaching methods used, the curriculum, the learning
experience provided and the performance of both the staff and the students (under-graduates, and
post graduates) should be kept under constant evaluation in terms of the institutional goals and
the national Health and Medical Education policies. The appropriateness of the teaching methods,
the goals, the effectiveness of the teachers in promoting may be evaluated by inviting students to
provide written comments or by asking them to answer a structured questionnaire. The findings
may be reviewed by the faculty. A well established assessment system shall contribute to
improved teaching. The involvement of students in the evaluation process will engender them,
over time, with greater responsibility.

Process of Evaluation
7.10.7 The validity, objectivity and practicability of implementation of the evaluation process
would vary from situation to situation and from time to time. Therefore, whatever evaluation
system is ultimately introduced, it would be necessary to review and appraise it periodically, to
bring about such modifications therein as appear necessary.
CHAPTER VIII
RECOMMENDATIONS IN REGARD TO MATTERS NOT COVERED BY THE
COMMITTEE'S TERMS OF REFERENCE

8. Though not specifically called upon to do so, the Committee considers it relevant to also offer
its views on certain issues not included in its terms of reference. These are briefly discussed in the
paras following.

Incentives to doctors for service in the rural areas

8.1 The Committee observed that inspite of the various incentives offered to the doctors to serve
in the rural areas, the response, so far has not been very encouraging. There are areas in each
State in which the population is either underserved or almost entirely denied appropriate health
care services. The more mentionable among the reasons usually advanced by doctors for not
accepting opportunities to serve in rural areas are as follows :—

(a) suitable accommodation, educational facilities, civic amenities (transport, drinking water,
electricity etc.) are not available at the rural stations of posting;
(b) essential drugs and basic bio-medical equipments are not provided in the rural health
centres;
(c) the unethical activities of unqualified medical practitioners of the various systems of
medicine, practising in the villages hinder the functioning of the allopathic doctors;
(d) as compared to the opportunities in the rural areas the private medical practitioners can
earn much more in the urban areas;
(e) that they have received hospital based curative training and are not adequately equipped
to practise community medicine; and
(f) medical care is the responsibility of the State Governments, whereas the academic
policies and educational regulations are the concern of the Universities. There is not
enough dialogue between the two. Medical education is not adequately related to the
needs of the health services, specially in the rural areas.

8.1.1 The Committee reviewed the various incentives being provided by the different State
Governments to doctors posted in the rural areas. Some of these are :—
(a) special allowance,
(b) rent free accommodation;
© preference for admissions to post-graduate courses, after rendering rural service;
(d) higher age limit for retirement, for those serving in PHCs etc.

8.1.2 The Committee also noted that some banks grant loans to doctors seeking to set up private
practice in rural|semi urban areas.

8.1.3 To provide further encouragement for service in the rural areas the Committee recommends
that additional incentives, as listed below, may also be provided to doctors:

(a) suitable weightage should be given to those who have served in the rural areas for admission
to the post-graduate courses, as already recommended in Chapter III;
(b) free accommodation, including water and electricity, should be provided to doctors serving in
the PHCs;
© the children of doctors posted in the PHCs. etc, should be enabled to continue their studies,
whether in school or in college, through grant of special allowances to doctors to suitably cover
such expenses;
(d) grant of special rural allowance, not being less than 25 per cent of basic pay;
(e) the service in the rural areas should be given double credit, upto a maximum of 5 years, for
pension purposes as well as for promotions;
(f) soft loans in adequate amounts should be provided by Government to doctors setting up
practice in the rural areas on the same terms as are available to unemployed engineers etc. As in
the latter case, the seed capital should also be provided through the State Financial Corporations
etc.;
(g) the rural dispensaries and hospitals should be provided with minimum essential equipments
and drugs as the lack of basic facilities is one of major factors contributing to the frustration of
the medical personnel appointed at rural stations;
(h) the Committee is of the opinion that doctors who seriously take up and settle down to work in
the rural areas should be adequately assured of security and recognition; and
(i) after serving in a rural area for atleast three years, the incumbents should get urban postings,
if they so desire.

Medical ethics
8.2 The code of Medical Ethics, formulated by the Medical Council of India, was reviewed
by the Committee. The Committee, after going through the various provisions of the Code, is of
the view that it is adequately comprehensive and requires to be enforced strictly. The Committee
accordingly recommends that the Government of India should take effective steps to enable the
MCI to legally enforce the Code.

Continuing Medical Education


8.3 All that is required to be learnt by a doctor cannot possibly be taught in a medical college.
It is in this context that in Chapter VII, the Committee has recommended the need for inculcating
in the students a desire to continue learning, as a life4 long process. As for back as in 1946, the
Bhore Committee observed that "new ideas and new discoveries in medicine come forward with
such bewildering rapidity that it is hardly possible for the busy doctor to keep abreast even of
those advances in knowledge which are necessary for him in the daily carrying on of his
profession". The Mudaliar Committee (1961)5 observed that the efficiency of any medical
service in a country is to be judged from the point of view of efficiency to the general practitioner
and if, therefore, the people are to be served well with upto date methods of diagnosis and
treatment, the responsibility for keeping these practitioners at a level of efficiency is obvious
having due regard to the rapid scientific advances in the faculty of medicine."

8.3.1 The planning and implementation of continuing education programmes should be a


collaborative activity between the medical college (s), the professional associations and the State
Health and Medical Education Departments. Varying approaches will be required for providing
such education to different types of personnel, viz. specialists, general practitioners, teachers,
doctors serving in the vertically organised national programmes, administrators and planners, etc.
The Committee feels that while the Medical and Health Education Commission recommended for
establishment (in Chapter IX) may be the apex body for providing the required directions in
regard to the organisation of these programmes a central coordinating agency for planning,
organising and monitoring such activities should be identified by the Government of India and
entrusted with this crucial responsibility. This agency should establish a small advisory group of
experts, including teachers, representatives of professional associations and councils, health
administrators etc. and draw up, every year, a carefully considered list of courses which require to

4
Health Survey and Development Committee, 1946
5
Health Survey and Planning Committee, 1961
be organised and run at the various medical and health institutions in the country. This group
should also devise procedures to evaluate the various programmes to determine whether the
objectives behind the programmes are being achieved and if not, what correctives are necessary
to be introduced to make them more effective.

8.3.2 The central coordinating agency may arrange continuing medical education programmes
through the various medical colleges, Health and Family Welfare Training Centres run by the
Central Government, the Post-graduate Medical Institutes at New Delhi, Pondicherry and
Chandigarh, the I.C.M.R., professional associations, the Medical Council of India, Indian
Medical Association (College of General Practitioners), the Indian Association for Advancement
of Medical Education, National Academy of Medical Sciences etc.

8.3.3 The Committee observed that so far, continuing medical educational programmes have been
sporadic and arranged by institutions|associations with the help of rather limited educational
material available with them and not on the basis of any well-conceived programme. In the view
of the Committee, a special fund should be created for arranging continuing medical education
programmes all over the country. This fund can be operated by the coordinating agency referred
to in the previous paragraphs. The Government of India, the State Governments, professional
associations, philanthropists and international agencies may also provide funds by way of
grants/donations towards the proposed fund.

8.3.4 The Committee took note of the fact that there have not been frequent visits by teachers
in the medical colleges to the district|taluk or other peripheral hospitals for arranging specific
purpose seminars in regard to specially identified health problems faced by the health
administrators, doctors working in the health service system, also involving the private
practitioners. Thus there is need to encourage peripatetic teams from the medical colleges to visit
surrounding areas to discuss problems and suggest locally viable solutions to problems faced by
the practitioners. In this context, the Committee recommends that continuing medical education
programme should be arranged in the district|taluk level hospitals for the benefit of practising
health professionals. A phased programme should be launched to develop a national information
grid through which each region of the country should be made self-sufficient in providing
information in regard to the latest advancements in the field.

8.3.5 The Committee also recommends the need for strengthening the National Medical Library
and for setting up of libraries in the district hospitals which should contain bibliographic refe-
rences, suitable stocks of audiotapes, sound-slides and programmes instruction materials, self-
learning assessment devices and other aids to independent learning. Government should provide
suitable assistance to the Indian Medical Association to enable it to enlarge the publication of its
Journal and for making it easily available to the medical professionals and students all over the
country. "Swasth Hind" produced in Hindi and English by the Central Health Education Bureau,
can also be improved in content and quality. The Committee feels that such a publication on
health problems relevant to the community should be provided free of charge to all medical
practitioners as is being done in some developed countries. Regular talks, on specially identified
topics, over the radio or T. V., by experts may be arranged for the benefit of medical practitioners
and the public.

8.3.6 Realising the crucial importance of continuing education programmes, the Committee feels
that unless some incentives are provided, the present lack of interest towards such courses by the
medical practitioners will continue. In this context, the Committee recommends that in the case of
government servants, due weightage should be given for promotions, crossing of E.B. etc to those
who have been keeping their medical knowledge upto date by attending such courses. They
should also be paid TA/DA for attending such courses. They should also be paid TA/DA for
attending professional conferences aleast once a year. There should be in-built procedures in the
various health service organisations to depute, periodically, medical and health professionals to
attend continuing educational programmes. Similarly private practitioners may be encouraged
and enabled to participate in professional programmes.

8.3.7 The Committee feels that while such continuing education programmes for various cate-
gories of medical and health professionals should be organised, there is also the need for inter-
professional education programmes, leading to improvements in team approaches, better
appreciation of the role of various categories of health workers in the health care services etc
being undertaken. In the opinion of the Committee, improvements in health care can be achieved
more effectively if the various categories of health personnel are trained to work together, at all
levels of functioning.

Medical Services to be essential services

8.4 The Committee is of the view that hospitals and medical colleges should be declared essential
services outside the purview of the industrial laws. This is necessary to ensure uninterrupted
health care services and the training and teaching of medical students.
CHAPTER IX
IMPLEMENTATION OF RECOMMENDATIONS

9. At its very first meeting the Committee observed that a good number of the existing problems
relating to declining standards of medical education in the country were due to inadequate imple-
mentation of the existing Regulations of the Medical Council of India. It was noted that the pro-
visions of the Indian Medical Council Act 1956, were no longer adequately effective. By way of
example, the Indian Medical Council Act, 1956 does not have the authority to prevent the
establishment of new medical colleges and comes into the picture only when the newly created
institutions seek recognition of the degrees to be awarded by them. It was further observed that
the recommendations of a number of Committees established in the past did not appear to have
been fully implemented. The Committee was accordingly of the view that its recommendations
would have no better value than those of similar bodies established in the past unless the Govern-
ment of India undertook to consider and implement them on a time-bound basis. After taking into
consideration the various problems relating to medical and health education, the Committee
makes the recommendations listed hereunder:-

9.1 At present, under Item 66 of List I of Seventh Schedule to the Constitution, the Union
Government is empowered to take necessary action for coordination and determination of
standards m institutions for higher education or research and scientific and technical education.
Medical Education is however included in List III—Concurrent List—in the Seventh Schedule of
the Constitution. Considering the obtaining state of affairs and growing evidence of the lack of a
coordinated plan of action in all matters relating to under-graduate and post-graduate education,
the Committee is of the considered view that, ideally, the needed education reforms can be
brought about and effectively secured only if "Medical Education", is brought on the Union List
so that the Central Govt. is enabled to evolve and implement fully coordinated plans, to bring
about rapid improvements in the standards of medical education as well as be able to see that the
production of medical and health professionals is largely, if not entirely, in tune with the actual
requirements of the country.

9.2 The maintenance of high standards of medical and health education, production of profes-
sionals of various grades of skill and competence in the required number, educated, trained and
oriented to efficiency tackle the priority health problems of the country is, for obvious reasons,
not a one time affair, but involves a dynamic process of constant monitoring, review, evaluation
and enforcement of remedial action. In this context it would be necessary to constitute an
adequately empowered authority at the Centre. Such a body may be called the Medical and
Health Education Commission, as recommended earlier by the Shrivastav Committee in 1975.*6
Ideally, such a body would require to have a statutory basis.

9.3 The proposed Medical and Health Education Commission should be responsible for drawing
up well-considered plans for health manpower development, in consultation with the Central and
State Governments, existing professional Councils and other concerned agencies. It should also

*Report of the Group on Medical Education and Support Manpower—1975.


be responsible for the drawing up and implementation of continuing educational programmes for
the various categories of medical and health-personnel; securing effective coordination in the
functioning of' the existing /statutory Councils viz. Medical Council of India, Dental Council of
India, Pharmacy Council of India, Indian Nursing Council/etc. to ensure a harmonious approach
and the production of professionals as per assessed manpower requirements. In the initial phase,
the requisite coordination may be achieved through consultation while, in the long run, it may be
necessary to bring about suitable amendments in the related statutes to give overpowering
authority to the Medical and Health Education Commission. Allocation of funds and
disbursement of grants to medical and health institutions would also require to be decided in
consultation with this central authority.

9.4 To begin with the proposed Commission may be a small compact body whose Chairman
should be a leading personality in the field of health administration, education or research. Its
members may include selected representatives of the Central and State Governments, universities
and the office-bearers of the major professional associations. The Presidents of the existing
statutory Councils should be made members of the Commission in their ex-officio capacity. The
Commission should be responsible for the constant monitoring, review and evaluation of all
aspects relating to medical and health education, in the various fields, and should also be charged
with the responsibility of assessing medical and health manpower requirements. In due course, as
the proposed body gets established as a statutory authority, it may enlarge its functions to become
the one Central authority responsible for overseeing and planning all aspects of medical and
health education.

9.5 Presently, the majority of the medical colleges are run by the State Governments or by
private bodies, being affiliated to local universities for the grant of degrees. Only a handful of
medical institutions are directly run and managed by the Central Government. In actual
functioning, the concerned universities have little or no control over the day-to-day functioning of
the medical institutions which do not possess adequate autonomy, so essential to the engendering
of a health and productive academic environment. Furthermore, in the various educational and
training institutions of the modern and the Indian systems of medicine, nurses, pharmacists and
the various other categories of medical and health personnel are trained to function in isolation,
without there being any mechanism for the drawing up of an integrated, common action plan.
Consequently, there is visible variation in the objectives and institutional goals pursued by the
various educational institutions. This is due to the fact that there is no common authority to guide,
assist or direct the various institutions in regard to manpower planning; to advise them about the
number of professionals required annually to support the health services of the country etc. In
order to fill up this serious lacuna and to bring about the vitally needed coordination, it is
essential that the Central Government should establish Universities of Health Sciences to which
all the various medical and health training institutions, falling within the jurisdiction of such
universities, should be affiliated. The establishment of Agricultural Universities, in recent years,
has amply demonstrated the vast benefits which flow from coordinated functioning. However, as
the establishment of state-wise Universities of Health Sciences may take considerable time, it is
recommended that, to begin with, the Central Government may establish one such university on a
trial basis, to cover all the medical and health institutions in a given State or for a region com-
prising a group of contiguous States and Union Territories. On the basis of the experience
gained from the functioning of such a university, the experiment could be extended in due course,
so that medical and health institutions in every State| group of contiguous States|UTs are covered
and controlled by such universities. Besides bringing about the extremely necessary coordination,
the proposed universities could become responsible for launching well-considered initiatives in
the field of Health planning, Health Administration, Health Economics etc., and to ensure that the
concept of the Health Team is indicated in the formative period of training of all medical and
health personnel, of various grades of skill and competence.

9.6 The Committee is also of the view that the Central and State Governments would require to
review the existing salary structures of teachers in the medical and health training institutions and
to revise the same with a view to attracting the best available talent. Special incentives would
require-to be afforded to teachers in the basic sciences in which areas there has been continuing
shortage in the recent years.

9.7 The State Governments would require to provide adequate funds to ensure that interns and
doctors posted at the rural health centres are provided with suitable accommodation and other
conveniences to enable them to discharge their responsibilities, effectively and efficiently. Simul-
taneously, it would also be necessary to ensure that primary health centres, rural training centres
etc. are edequately equipped with the necessary machines and equipments and provided with the
requisite supply of drugs.

9.8 The State Governments should take immediate steps to place the rural training centres|pri-
mary health centres attached to medical colleges under the administrative control of the
concerned medical institutions while ensuring that the career prospects of the medical officers
and other staff posted at such centres are not adversely affected by such an arrangement.

9.9 Immediate steps may be taken by the Government of India to bring about suitable
amendments to the Indian Medical Council Act, 1956, specially with a view to ensuring that no
medical institution can be established anywhere in the country without the prior approval of the
Medical Council and the Government of India. Inter-alia, various other amendments in the Act
ibid are also required, to improve its operational effectiveness.

9.10 The Medical Council of India would require to constantly inspect and review the
functioning of medical institutions and take an uncompromising view regarding recognition of
medical degrees, college-wise maintenance of standards of teaching and training and de-
recognition of sub-standard institutions. The Council would also require to gear up its machinery
to possess itself with upto-date information regarding the functioning of each medical college and
to vigorously enforce the registration of doctors, to collect essential manpower data etc. Besides,
the Council should take urgent steps to effectively enforce the Code of Medical Ethics,
formulated by it. Towards this objective, the Central Government should provide such, assistance
as may be necessary to the Council.

9.11 Till such time as the Indian Medical Council Act, 1956, is amended, and the proposed
universities of Health Sciences established, the existing universities may not grant affiliation to
any new medical college unless the Medical Council of India| Government of India have ap-
proved the establishment of the concerned institution.

9.12 Taking note of (i) the existing domiciliary restrictions imposed by the State Governments in
the matter of selections of doctors, teachers etc., and (ii) geographical maldistribution of available
health personnel, the Committee recommends the creation of an All India Health and Medical
Service.

9.13 In order to procure reliable health manpower data to assess current needs as well as to plan
the requirements for 2000 A.D., the Committee recommends that Health Manpower Development
and Research Bureau should be established by all State |U.T. Governments and at the Centre.

9.14 The Committee recommends, for the consideration of Government, the approach set out in
the paper furnished by a Member (Annexure V) in regard to the implementation of the
recommendations.

9.15 Having reviewed the recommendations of Committees established in the past, the Com-
mittee feels that it would necessary for the Central Government to establish a suitably constituted
cell, to process its recommendations on a time-bound basis.

Sd
R. D. AYYAR
I.D. BAJAJ
P. N. CHHUTTANI
O.P. GUPTA
L.B.M. JOSEPH
M. M. MEHTA
V. RAMALINGASWAMI
RAMESHWAR SHARMA
Y. P. RUDRAPPA
B. N.SINHA
H. D. TANDON
K. N. UDUPA
P. N. WAHI
N.N. VOHRA
S. J. MEHTA
CHAPTER X
SUMMARY OF RECOMMENDATIONS

National Entrance Examination for M.B.B.S.

(1) A National Entrance Examination, which should be exclusively of an objective type, for
admission to the MBBS course should be established (Para 2.1).
(2) No institution should be allowed to charge capitation fees from candidates seeking
admission to the MBBS/Post-graduate course (Para 2.1.1).
(3) The concerned examining bodies should hold the feeder channel examinations within a
stipulated time-schedule to ensure that the results of the various examinations are
available before the date of the National Entrance Examination (Para .2.1.2).
(4) The Government may identify a suitable central institution,, preferably an autonomous
body, to conduct the National Entrance Examination (Para 2.1.3).
(5) The Entrance Examination should provide tests, in the English medium, in Physics,
Chemistry, Biology and General Knowledge (Para 2.1.4).
(6) Adequate advance notice of the time-schedules of examinations should be given by the
concerned academic institutions to enable candidates to prepare for the entrance tests and
make timely travel arrangements (Para 2.1.5).

Reservations

(7) Reservation of seats for admissions to the MBBS course, for SC|ST candidates, may be
fixed by the State Governments with reference to the SC|ST population of the State,
within the Government of India's policy directions; for other categories of beneficiaries,
reservation may be made only with the prior sanction of the Medical Council of India
[Para 2.2.1 (a) & (b)].
(8) The aggregate of reservation of all kinds should not exceed 33-1(3% of the total number
of seats available in each college [Para 2.2.1 (C)].
(9) There should be no further relaxation of the minimum qualifying marks of 40% for
SC/ST candidates. Special coaching facilities may be provided for the benefit of such
candidates [Para 2.2.1 (d) and (f)].
(10) There should be no carry forward of reserved seats of any category from one year
to the next and all such seats which remain unfilled should be utilized by admitting
eligible SC/ST candidates from the neighbouring States|Union Territories. Unutilised
seats should be thrown open to general category candidates [Para 2.2.1 (e)].
(11) Domiciliary restrictions for admission to the MBBS course should be
progressively removed. To begin with 25% of the seats in each institution may be open to
the admission of candidates on an all India basis, of which a suitable percentage may be
earmarked for candidates from the backward areas (Para 2.3.).

Admissions to the Postgraduate Medical Courses


(12) A National Entrance Examination should be conducted for admitting candidates
to the various post-graduate courses. The test should be of an objective type (Para 3.1).

Reservations and Domiciliary Restrictions


(13) There should be no reservation of seats for SC|ST candidates, nor any
domiciliary restrictions or pre-conditions of compulsory rural service for admissions to
the postgraduate courses. However, candidates who have done 2 years of rural service
may be given additional credit|weightage, to be determined by Government. Special
coaching|counselling facilities should be provided to SC|ST candidates in-order to enable
them to secure admission to Postgraduate courses. Since doctors in Government service
may not be able to compete with the fresh graduates at the National Entrance
Examination for postgraduate courses, suitable weightage, say upto 5%, may be given to
such candidates, while determining inter-se merit. They may also be enabled to undergo
in-service training in identified specialities and to appear in NAM/NBE examinations to
obtain higher qualifications. (Paras 3.1 to 3.4).

Duration of the Under-graduate Medical Course & Internship


(14) The present duration of the MBBS course should be maintained. There appears
no basis for starting an intermediate medical course or to reduce the existing duration of
the MBBS course (Paras 4 & 4.1).
(15) The period of one year Internship, including six months service in the accredited
district taluk hospitals and rural centres, should not be diluted and the responsibility for
providing such training as well as the requisite infrastructural facilities must rest entirely
with the medical colleges and the respective State Governments. Out of 6 months
Internship in the medical college hospital, 4 months should be for rotating training, with
structured content, and 2 months for training in an elective subject speciality of the stu-
dent's choice. (Para 4.2).
(16) Candidates must pass a formal in-house clinical examination at the conclusion of
Internship, for grant of a Degree (Para 4.2).
(17) Professors and senior faculty members in the colleges should be deputed to
PHCs|Distt. Hospitals etc. to supervise the training of the students during their Internship
period (Para 4.2.3).
(18) The State Government|Union Territory Administrations should take suitable
steps to protect Interns and young doctors posted to rural areas from harassment by local
unqualified practitioners (Para 4.2.4).

Duration of Post-graduate Courses


(19) The minimum duration of the post-graduate degree and diploma courses should
be three years and two years, respectively, after full registration. The existing system of
one year of Housemanship should be abolished (Para 5).
Thesis
(20) In view of fact that the whole systems of thesis writing, as it is being actually
implemented at present, falls short of the expectation of having it as a compulsory
requirement, the Committee recommends that it should be compulsory for non-clinical
subjects and optional for clinical subjects. In the latter case where a student opts for and
successfully completes a thesis, he should be afforded suitable credit|preference in further
ing his career prospects. The success of this approach should be periodically reviewed
(Para 5.1).

Residency Scheme
(21) There is no justification for fixing limits of the hours of work required to be put
in by the Resident Doctors as the training and service components cannot be separated
[Para 6.3(c)].
(22) Resident seats should be determined, department-wise with reference to the
employment opportunities and assessed service loads, manpower requirements of
specialists, and the clinical facilities actually available The number of seats should be
fixed with the prior approval of the M.C.I. [Para 5 & 6.3.(a)].
(23) The period of Junior Residency cannot be treated as regular service till such time
as the number of seats in the various post-graduate courses are related to the
manpower requirements and actual employment opportunities [Para 6.3. (d)].
(24) The period of service of Senior Residents who secure government service may be
counted for pensionary benefits and the breaks, if any, may be condoned. [Para 6.3(e)].
(25) There should be no upper age limit for admissions to the Senior Residency
Programme. The maximum age limit for entry into government service should be raised
by suitably amending the recruitment rules. [Para 6.3.(f)].
(26) In the case of non-clinical departments, Demonstrators| Tutors may also be
appointed against the regular vacancies of Junior Residents and allowed to enrol
themselves for Post-graduate qualifications. After securing Post-graduate qualifications,
they should be eligible for appointment as Lecturers without having to go through a fresh
process of selection, other things being equal [Para 5.3.(g)].
(27) The Committee recommends that the Residents should carry out such laboratory
investigations as part of their training [Para 6.3(h)].
(28) There is not need for the clinical Postgraduates to put in three years of further
service as senior Residents or Registrars, etc. to become eligible for appointments as
Lectures]Assistant Professors (Para 6.4).

Institutional Goals
(29) The Committee recommends the adoption of institutional goals separately for
under-graduate and post-graduate courses, which should project the purpose of medical
education viz. to train physicians to fit into different levels of health care system and to
be able to resolve the health problems of the community (Paras 7.2 and 7.3).
(30) The broad purpose of under-graduate medical education is to train medical
graduates who should be general practitioners and would have the capability of providing
comprehensive health care to both rural and urban communities (Para 7.4).
(31) As regards postgraduate medical education, the Committee recommends the
adoption of institutional goals separately for clinical and non clinical specialities on the
basis of competencies required for the specialists, research workers, teachers, etc. (Paras
7.5.1. & 7.5.2).

Curriculum Reform—Under graduate Course


(32) The curriculum should provide opportunities for an education that is problem
solving and competence building, and should be the total faculty commitment of the
entire medical college (Para 7.6.2.).
(33) The students should be posted in a general practice out-patient department for
about a month in order to be exposed to the multidimensional nature of health problems
as well as to them to understand the limitations and strength of general practice. They
should also be posted in the accident and emergency departments in order to become
proficient in the methods and problems of diagnosis and treatment of acute cases under
he direct supervision of the faculty (Paras 7.6.3 & 7.6.4).
(34) The entire faculty should demonstrate a basis commitment to Community Health
Services. (Para 7.6.5.)
(35) In spite of difficulties in inter-disciplinary and integrated teaching, the
Committee recommends suitable changes in the curriculum to permit teachers from
different disciplines to combine together in teaching selected topics (Para 7.6.6).
(36) In order that a cadre of suitably trained manpower is developed, which would be
capable of delivery of comprehensive and integrated health care at the family level, in the
context of the country's commitment to the goal of Health for All by 2000 A.D., the
Committee strongly recommends that an increasing number of doctors should be
encouraged to seek specialisation in the field of general practice and family medicine
(Para 7.7.1).
(37) At least six Regional Institutes each imparting integrated training in public health
and tropical medicine on the pattern of All India Institute of Hygiene and Public Health
and the School of Tropical Medicine, Calcutta, should be established in the country to
meet the shortage of public health personnel. Suitable incentives should be given to
attract candidates to this discipline (Para 7.7.2).

Medical Education Cells

(38) Every medical college should have a Medical Education Cell|Unit attached to it
in order to effect the changes in institutional goals and curriculum teaching methods,
evaluation reforms etc. To make a beginning in this direction, such cells may be
developed on a regional basis in selected institutions. (Para 7.8).

Instructional technology
(39) In order to improve the quality and relevance of medjcal education in the
country, 6 to 8 Teacher Training Centres should be established on a regional basis to
familiarise the teachers with a range of instructional methods and their potential (Para
7.9.1).

Evaluation
(40) The examinations should be made as objective as possible and the evaluation
system should assess all the areas of knowledge and skills related to the curriculum and
institutional goals. Uniform standard of evaluation all over the country is desirable. In
this context, as a long term goal, the establishment of a national level independent body
for conducting the MBBS examination is recommended. If that be not possible to achieve
immediately, alteast uniformity should be maintained in all the medical colleges in each
State. Regional Teachers Training Centres should also train teachers in the process of
constructing multiple choice questions. The Medical Education cells proposed for each
medical college should also be involved in the process. At the national level, a Central
Cell which should suitably be linked with the National Board of Examinations, could
monitor and oversee the evaluation techniques. Till such time universities of Health
Sciences are established, an identified university in each State should be made
responsible to ensure uniformity in the evaluation of all the students in that State. There is
also a need for continuous improvement of evaluation techniques as no single technique
is perfect (Paras 7.10.2 & 7.10.5).
(41) The Committee recommends that teaching in medical colleges should be kept
under constant evaluation (Para 7.10.6).
(42) There is also the need to appraise the evaluation system periodically (Para
7.10.7).

Incentives for service in rural areas


(43) Additional incentives such as free accommodation, water and electricity,
children's education allowance, special rural allowance, bank loans at differential rates of
interest etc. may be provided to doctors for serving in the rural areas. The rural
dispensaries should also have the basic equipment and supply of essential drugs (Para
8.1.3).
(44) Government should take effective steps to enable the MCI to legally enforce the
Code of Medical Ethics (Para 8.2).

Continuing Medical and Health Education


(45) The Government may identify a Central coordinating agency for planning,
organising and monitoring continuing education programmes all over the country and a
special fund may be created for this purpose (Paras 8.3.1. and 8.3.3).
(46) Continuing medical education programmes should be arranged in the
district|taluk level hospitals for the benefit of practising health professionals. A phased
programme should be launched to develop a national information grid. [Para 8.3.4].
(47) The National Medical Library should be strengthened and libraries set up in the
district hospitals with adequate learning material such as audio-tapes, sound slides, etc.
Health publications such as Journal of the Indian Medical Association, "Swasth Hind"
etc. should be provided free of charge to all medical practitioners. [Para 8.3.5].
(48) Medical Practitioners in Government service should be encouraged to keep their
medical knowledge up-to-date by periodically attending courses on continuing education
programmes etc. Private medical practitioners should also be encouraged and enabled to
participate in professional programmes. [Para 8.3.6.]
(49) There is need for inter-professional education programmes leading to
improvements in team approaches, better appreciation of the role of various categories of
health workers, etc. (Para 8.3.7).

Medical colleges and medical services to be essential services

(50) Medical colleges and hospitals should be declared essential services [Para 8.4].

Medical Education to be brought under Union List of the Seventh Schedule


(51) The needed educational reforms can be brought about and effectively secured
only if Medical Education is brought on the Union List in the Constitution [Para 9.11.]

Appointment of Medical and Health Education Commission


(52) An autonomous, Medical and Health Education Commission should be
established by the Centre and be made responsible for the coordination, planning and
implementation of various medical and health education programmes in all branches of
Health Sciences, planning for the development of health manpower allocation of funds
and disbursement of grants to medical and health institutions etc. [Paras 9.2 & 9.3].

Establishment of Universities of Health Sciences


(53) The Central and State Governments should establish Universities of Health
Sciences in order to bring about coordination between the various educational and
training institutions of the modern and various Indian Systems of Medicine, nurses,
pharmacists, etc, Li the beginning the Central Government may establish one such
University on a trial basis, to cover all the medical and health institutions in a given State
or for a region [Para 9.5]

Review of Salary Structures of teachers


(54) The Central and State Governments should review the existing salary structures
of teachers in the medical and health training institutions and revise the same with a view
to attract the best available talent [Para 9.6].

Maintenance of Standards of Medical Colleges


(55) The Medical Council of India would require to regularly review the functioning
of medical institutions and take an uncompromising view regarding the recognition of
medical degrees, college-wise, maintenance of standards of teaching and training and de-
recognition of institutions which do not maintain the requisite standards[Para 9.10.]
Formation of All India Health and Medical Service
(56) The Committee recommends the constitution of an All India Health and Medical
Service [Para 9.12].

Establishment of Health Manpower Development & Research Cells


(57) The Committee recommends the establishment of Health Manpower
Development and Research Cells in the States and U.Ts. and at the Centre [Para 9.13].
ANNEXURE I

No. U. 12012|28|81-ME(Policy)
GOVERNMENT OF INDIA
MINISTRY OF HEALTH & FAMILY WELFARE
(Department of Health)
New Delhi, the 8th September, 1981

RESOLUTION

There has been large-scale expansion of facilities for medical education in the country at under-
graduate and post-graduate levels during the past three decades. This development has enabled
the country to augment the health services. However, despite this achievement, certain distortions
have crept into the medical education system making it inadequately responsive to the health
needs and priorities of the country. On more than one occasion, the Prime Minister has
emphasised how important it is that the medical education system should be reviewed so that it
harmonises wholly with the over-riding objective of health care besides ensuring that the needs of
the many prevail over those of the few.

2. A review of the present medical education system has become necessary in the context of the
national commitment to attain the goal of "Health for all by the year 2000 A.T). through the uni-
versal provision of Primary Health Care. In this context, the resurgence of some of the tropical
diseases, the predominantly hospital-based rather than community-oriented education, the need
for preparing medical personnel to respond effectively to the health problems in the rural areas,
the imbalance in the proportion of general practitioners to post-graduate and the entire process of
medical education at under-graduate and post-graduate levels, including the goals, instructional
methods and evaluation procedures, necessitate an urgent and careful review.

3. The Government have, therefore, decided to the health problems in the rural areas. The
composition of the Committee is as under .- —
1. Dr. Shantilal M J. Mehta, Chairman
Retd. Director, Jaslok Hospital, Bombay,
2. Dr.I.D. Bajaj, Member
Director General of Health Services, New Delhi.
3. Prof. V. Ramalingaswami, Member
Director General, Indian Council of Medical Research, New Delhi
4. Prof. H.D. Tandon, Member
Director, All India Institute of Medical Sciences, NEW DELHI
5. Dr. L.M.B. Joseph, , Member
Principal, Christian Medical College, Vellore.
6. Dr. M.M. Mehta, Member
Member of Parliament, 53 % North Avenue, New Delhi
7. Dr. O.P. Gupta, Member
Direcor of Medical and Research, Gandhinagar, Gujarat
8. Dr. Y.P. Rudrappa, Member
Director of Medical Education and Research, Bangalore
9. Dr. B. N. Sinha, Member
President, Medical Council of India, Kotla Road, New Delhi.
10. Dr. Rameshwar Sharma, Member
Principal, S.M.S. Medical College, Jaipur.
11. Dr. P.N. Wahi, Member
Executive Director, Indian Association for the Advancement of Medical Education, New Delhi
12. Dr. P.N. Chuttani, Member
22, Sector 4, Chandigarh
13. Col. R.D. Ayyar, Member
139|A, -Kelakshtra Colony, Basant Nagar, Madras
14. Dr. K.N. Uduppa,
Principal, College of Medical Science, Varanasi.
15. Shri N.N. Vohra. Member- Secretary
Joint Secretary, Ministry of Health & Family Welfare, New Delhi

4. The terms of reference of shall be as under :—


(i) to review the current admission procedures (including entrance tests) and domiciliary
restrictions for admissions to under-graduate and post-graduate courses and to make suitable
recommendations separately, in regard thereto;

(ii) to suggest measures aimed at bringing about overall improvement in the under-graduate and
post-graduate medical education, paying due attention to:
(a) institutional goals;
(b) content, relevance and Duality of teaching and training and learning settings; and
(c) evaluation systems and standards;

(iii) to recommend the optimum duration of under-graduate and post-graduate courses of study
separately;

(iv) to examine the existing Internship programme and to recommend its future pattern;

(v) to review the working of the Residency Scheme along with the Housemanship programme
and to make recommendations regarding a uniform pattern of post-graduate training;

(vi) to examine the current requirement of Thesis or Dissertation as an essential part of post-
graduate medical education and to make suitable recommendations in regard thereto; and

(vii) to examine the feasibility of a period of service in the rural areas for medical graduates and
post-graduates.

5. The Committee will also evolve realistic projections of medical manpower requirements
(MBBS doctors, general specialists and super-specialists) during the Sixth Five Year Plan
and beyond, taking into consideration:
(a) the needs of Government based health care programmes;
(b) the requirement of doctors in the private sector;
(c) the needs arising from bi-lateral agreements, international commitments and Technical
Co-operation among Developing Countries; and
(d) necessity to redress regional imbalances in the distribution of medical manpower.

6. The Committee may also consider and make its recommendations in regard to any other related
matter.

7. In formulating its recommendations, the Committee may keep in view the reports made in
recent years by the various Committee and Conferences on Medical Education.

8. The Committee will submit its report within 6 months.


9. The expenditure on TA|DA of official Members will be met from the same source from- which
their pay and allowances are drawn. The expenditure on TA|DA of Non-Official Members will be
met from the Sub-head A.l—Secretariat. A. 1(1)— Department of Health A. 1(1) (3)—Travel Ex-
penses under Major Head '276' in Demand No. 44 Ministry of Health and Family Welfare for the
year 1981-82.
Sd/-
(C.V.S. MANI) Additional Secretary to the Govt, of India.

ORDER

Ordered that a copy of the Resolution be communicated to the persons named in para three of the
above Resolution.

Ordered also that the Resolution be published in the Gazette of India Extraordinary for general
information.
Sd
(C.V.S. MANI)
Additional Secretary to the Govt of India.
ANNEXURE II

Details of Meetings held by the Committee | Subcommittees.

I. Medical Education Review Committee


(1) 5th October, 1981
(2) 7th November, 1981
(3) 19th December, 1981
(4) 11th February, 1982
(5) 15th March, 1982
(6) 29th April, 1982
(7) 26th June, 1982
(8) 31st July, 1982
(9) 3rd September, 1982

II. Sub-Committee for formulating Questionnaire


1. 5th December, 1981.

III. Sub-Committee on Medical and Para-Medical Manpower Assessment.


(1) 1st March, 1982
(2) 3rd April, 1982
(3) 17th July, 1982.

IV. Sub-Committee on curriculum changes, institutional goals etc.


(1) 12th April, 1982.
(2) 31st May, 1982.
(3) 9th July, 1982.
ANNEXURE III

Questionnaire issued by the Medical Education Review Committee

1. Undergraduate Medical Education

The existing provisions of Medical Council of India with regard to the duration of undergraduate
medical education are reproduced below:-

III. Duration of Course:

(1) Every student shall undergo a period of certified study extending over 4-1/2 academic years
from the date of commencement of his study for the subjects comprising the medical curriculum
to the date of completion of examination followed by one year's compulsory rotating internship.

(2) The first 18 months shall be occupied in the study of the Phase I (Pre-clinical subjects) and
introduction to a broader understanding of the perspectives of medical education leading to
delivery of health care and no student shall be permitted to join the Phase 11 (Para-
clinical|clinical) Group of subjects until he has passed in all Phase I (Pre-clinical) subjects for
which he will be permitted not more than four chances (actual examination), provided that four
chances are completed in 3 years.

(3) After passing pre-clinical subjects, 3 years shall be devoted to clinical subjects and para-
clinical subjects concurrently. During the first 18 months of tins period, para-clinical subjects will
be taught with the clinical subjects, collaterally and concurrently".

Kindly go through the above and give us the benefit of your views on the questions listed below.
It is suggested that while filling up the proforma the reflection of the opinions of all the members
of the Faculty be incorporated.

(a) Do you agree that the duration of undergraduate medical education should be 4-l|2 academic
years?
Yes No

(b) If no, what is the duration you consider most appropriate?

(c) Do you agree to the division of 4-112 years of study into 18th months of Phase I for Pre-
clinical studies and 3 years of Phase II for para-clinical and clinical studies as in the Medical
Council of India regulations ?
Yes No

(d) If no, what are your alternative suggestions? Give reasons thereof.
Phase-I Phase-II
i years years
ii years years

Internship
According to the regulations of the Medical Council of India, every candidate will be required
after passing the final MBBS examination, to undergo compulsory rotating internship to the
satisfaction of the University for a period of 12 months so as to be eligible for the award of
MBBS degree and full registration.
(i) Much has been said and written about the utility of the internship programme as administered
at present. Do you agree that one year of compulsory rotating internship as provided in the MCI
regulations is desirable and should continue?

(ii) If "no", what are your alternative suggestions ?


i. ii. iii

(iii) If the answer is "Yes" to the first question, would you agree to provide for a more direct
responsibility of the interns in patient care and towards this end, should the intern be made
responsible for patient care (for a prescribed number of beds) under the supervision of a Registrar
(or his equivalent)?

Yes No

(a) If no, you may state how exactly the intern may be deployed.

(iv) Do you agree that there is need for introducing a structured content in the intern's training
programme? Structured content in the intern's training programme ? (Structured content refers to
both practical aspect and training aspects).

(v) Do you think there should be a formal examination at the end of internship ? If yes, should it
be only in practicals or in both theory and practicals.

(vi) The Medical Council of India recommends posting in community health work at rural health
training centre up-graded primary health centre for a minimum period of six months.

Has this recommendation been implemented in your institution ? If no give the reasons therefore.

(vii) Do senior faculty members regularly visit your rural practice area for training interns as is
prescribed ? If no, give reasons therefore.

Post-graduate Medical Education


The present regulations of the Medical Council of India with regard to the period of post-graduate
training leading to the MD|MS degree are reproduced below :—

"The period of training for MD|MS shall be 3 years after Ml registration including one year of
house job or equivalent thereof and for Diploma courses, 2 years after full registration including
one year of house job. The Council encourages universities or medical institutions to have a
longer period of training as the Council recommendations are for minimum requirement. The
Council, however, emphasises that thorough and intensive training on a planned programme
should be given to the students during all stages of the course etc. etc."

(i) Do you agree with this recommendation.


Yes. No,

(ii) If no, what are your alternative suggestions ?

(iii) Which system is being followed in your institution-Houseman, Registrarship or Residency.


Which system do you prefer ? Give reasons for your preference.
(iv)
(a) Do you think that submitting thesis |dissertation should be essential for post-graduation.
(b) If no, give reasons therefore.
© If yes, what weightage should be given for good thesis |dissertation in over-all evaluation in
post-graduation.
(d) whether in your opinion the thesis| dissertation should be submitted after the formal
examination but before declaration of final result ?

(v) Whether rural medical service should be a prerequisite for admission to post-graduation ? If
yes, what should be the period of rural service ?

List of personalities to whom the questionnaire was addressed.


Deans and Principals:
(1) Osmania Medical College, Hyderabad.
(2) Gauhati Medical College, Gauhati.
(3) Darbhanga Medical College, Darbhanga.
(4) Medical College, Rohtak.
(5) Medical College, Simla.
(6) Government Medical College, Srinagar.
(7) St. Johan's Medical College, Bangalore.
(8) Government Medical College, Mysore.
(9) Medical College, Calicut.
(10) M. G. M. Medical College, Indore.
(11) Grant Medical College, Bombay.
(12) G. S. Medical College, Bombay.
(13) Government Medical College, Aurangabad.
(14) Regional Medical College, Imphal.
(15) Veen Sunder Sai Medical College, Burla, Orissa.
(16) Medical College, Amritsar.
(17) S. P. Medical College, Bikaner.
(18) 18. Thanjavur Medical College, Thanjavur, Tamil Nadu.
(19) S. N. Medical College, Agra.
(20) B.R.D. Medical College, Gorakhpuf.
(21) Institute of Medical Sciences, Varanasi.
(22) K. G. Medical College, Lucknow.
(23) Calcutta National Medical College, 30, Gorachand Road, Calcutta.
(24) North Bengal University Medical College, Sushrut Nagar, Darjeeling.
(25) Lady Hardinge Medical College, New Delhi.
(26) Goa Medical College, Panaji.
(27) Jawaharlal Nehru Institute of Post-graduate Medical Education and Research,
Pondicherry.
(28) Post-graduate Institute of Medical Education and Research, Chandigarh.
(29) M. P. Shah Medical College, Jam Nagar.
(30) M. G. Institute of Medical Sciences, Wardha.
(31) Stanley Medical College, Madras.

Other eminent Medical Educationists & Scientists.


(32) Dr. A. K. Basu, Calcutta.
(33) Dr. B. Rama- Murthy, Madras.
(34) Dr. K. S. Sanjivi, Madras.
(35) Dr. B. K. Anand, New Delhi.
(36) Dr. P. K. Sethi, Jaipur.
(37) Dr. Santokh Singh Anand, Chandigarh.
(38) Dr. Purulkar, Bombay.
(39) Dr. Madhayan Kutty, Trivaidrum.
(40) Dr. J. S. Bajaj, New Delhi. .
(41) Dr. Leela Ram Kumar, Chandigarh.
(42) Dr. R. C. Shah, B. J. Medical College, Ahmedabad.
(43) Dr. P. K. Chetri, Calcutta.
(44) Dr. K. N. Rao, New Delhi.
(45) Dr. A. Venugopal.
(46) Dr. P. Narasimha Rao.
(47) Dr. T. H. Rindani, Jaslok Hospital, Bombay.
(48) Dr. P. N. Mishra, Gandhi Medical College, Hyderabad.
(49) Dr. C. Gopalan, Nutrition Foundation of India, New Delhi.

Members of Medical Education Review Committee.


(50) I. D. Bajaj, D.G.H.S. New Delhi.
(51) Dr. L. B. M. Joseph, Director, Christian Medical College, Vellore.
(52) Dr. H. D. Tandon, Director, A.I.I.M.S., New Delhi.
(53) Prof. V. Ramalingaswami, D. G., I.C.M.R., New Delhi.
(54) Dr. P. N. Chhuttani, Retd. Director, Postgraduate Institute of Medical Education and
Research, Chandigarh.
(55) Dr. Y. P. Rudrappa, Chairman, Postgraduate Medical Education Committee (M.C.I.),
Bangalore.
(56) Dr. O. P. Gupta, Director, Health, Medical Services and Medical Education, Ahmedabad.
(57) Dr. B. N. Sinha, President, Medical Council of India, New Delhi.
(58) Col. R. D. Ayya'r, Retd. D.G.H.S., Madras.
(59) Dr. M. M. Mehta, M. P., New Delhi.
(60) Dr. Rameshwar Sharma, Principal, SMS Medical College, Jaipur.
(61) Dr. K. N. Udupa, Emeritus Professor, Banaras Hindu University. Varanasi.
(62) Dr. P. N. Wahi, Retd. D.G. I.C.M.R.,New Delhi.
ANNEXURE IV

Reports of Previous Committees Referred to by the Medical Education Review Committee

Report of the Health Survey and Development Committee—1946 (Bhore Committee).


Report of the Health Survey and Planning Committee—1961 (A. L. Mudaliar Committee).
Report of the Medical Education Committee—1969.
Report of the Committee to examine the feasibility of introduction of a scheme of resident
service-cum-training in the Hospitals in Delhi—1974 (Shri Kartar Singh Committee).
Report of the Group on Medical Education and Support Manpower—1975 (Dr.Shrivastava
Committee).
ANNEXURE V

An Approach to the Implementation of the Recommendations of the Committee

We have to take an overall view of the medical care in the country in which we will have to fit
the medical education part. After all medical education is not an end in itself. It is only a means to
an end viz., provision of good medical care to all the population.

Viewed in this way the problem can be split into the following parts and our Committee should
concern itself to find the answers:
1. Under-graduate medical education.
2. Post-graduate medical education.
3. Minimising the brain drain i.e., finding useful employment for medical men in India.
4. Fitting item 3 in the provision of medical care.
5. Provision of the Infra-structure for item 4—drugs, and x-ray films and equipment in-
cludes electric and electronic.
6. Standardisation of medical care and training on an All India basis and their super-
vision.
Under-graduate Medical Education:
What are the reasons for modifying the training of doctors in our country? What are our priorities
in medical care?

In my discussion I will emphasise more on the Rural aspect of the requirements because it was to
lack of this in the Rural areas that prompted the formation of the Committee.

I also want to emphasise that our medical education should orient itself essentially towards cura-
tive medicine. If a doctor can do this reasonably well we should be thankful. If you expect him to
look after acute illness, educate the public on health matters &nd supervise water supply, sanita-
tion etc., you are asking for the impossible.

Before we decide on the number of yours a student must spend in under-graduate education and
working out a syllabus, let us take note of the medical needs of the Rural population. This will
give us the direction in shaping the syllabus and the period of education necessary;

1. The most neglected segment of the Rural Community is the pregnant female. There is
little or no provision for safe delivery. Apart from some of the older medical colleges, the training
of male graduate students in midwifery is perfunct. Even the I.M.C. requirement is 10 normal
cases and assistance at least 10 other cases. The training in midwifery in most college hospitals is
imaginery. In one of the Colleges, the male students sit in an adjoining room to the Labour Room
and the Lady Doctor comes and talks to them how the labour was conducted. You will agree that
while midwifery in an institutional set up can be done by Lady Doctors domiciliary midwifery
involving travel at night alone to lonely places has to depend heavily on male doctors and that
without adequate training in midwifery, Rural midwifery will continue to be primitive. I also feel
that it is this lack of adequate training in midwifery that is one of the major causes of the male
doctor staying away from going to rural areas. On the other hand practice in urban set up creates
no such handicap, as midwifery is essentially institutional.

2. Then take the commonest cause of child mortality—acute gastro-enteritic—unless a


doctor is able to put a needle into the child's vein and give the correct quantity and quality of
fluids intravenously the mortality will be heavy. And yet today you cannot find a young graduate,
who has not actually worked for some time in an acute Paediatric ward, able to put a needle into
the veins of a 3 months' old baby let alone in a dehydrated baby. The following is an actual recent
incident only for your information:

In an area where one of the common causes of meningitis is complication of spinal anaesthesia
(iii) a patient of iatrogenie meningitis was transferred to a referral hospital in bad shape. The
sister having failed to insert an intravenous needle (this was an adult patient) asked the attending
doctor— neurologist—to do a cut down. The answer was "Sister, if I could do a cut down I would
have been a neuro-surgeon and not a neurologist."

The recent happening in Kerala where about 50 children with fever, headache and vomiting died
of meningitis without a diagnostic lumber puncture should make us ashamed.

If the child mortality goes unchecked family planning programme will be a fiasco

3. The Rural population is entitled to proper treatment of acute illness in its own area. Therefore,
the graduate should be competent in the diagnosis of all acute conditions and be able to treat
acute medical and paediatric conditions and diagnose surgical conditions.

4. In the Rural set up the doctor will have to depend on himself for all his laboratory examina-
tions and to do a blood transfusion,

If we accept the above premises the skeleton or the frame-work of under-graduate syllabus takes
shape and will include -
1. Excellent familiarity with clinical side room work viz., Blood for total and different cal
count—abnormal WB cells—Hb. Hot. RBCBSR Malarial Parasite—urine reaction—Sp or
Albumin— Sugar, ketone bodies and microscopic examination of deposit—bile salts—urinary
chlorides—Urinary diastase.

C S F Cell count and grams stain and Acidfast pus ordinary, gram stain and Acidfast stain. This
will mean working 6 months in a large clinical side room for 2 hrs daily from 8 to 10 A.M.

2. Four months in midwifery—7. a.m. to 7 p.m. and 7 p.m. to 7 a.m. in two batches, number in
each batch depending on number of admissions.

3. One year acute ward—All acute medical and surgical patients are admitted to a common ward-
— a 3rd year, 4th year and final year students team up and take the history, examine the patient
completely,—that is, even an acute appendicities patient will have his nervous system including
optic funds, Respiratory, Cardiac system etc. fully examined— do the necessary investigation like
urine, blood, C SF after lumber puncture (when necessary) ECG and X-ray. A diagnosis is
established which is confirmed by the Clinical Teacher present in the Ward and the treatment
initiated and continued by the team under the guidance of the Teacher. One year of this training
12 hours daily should make any graduate a good doctor.

4. Matching and grouping of blood and giving at least 20 blood transfusions during the period of
training.

5. Work in the hospital bio-chemistry and Microbiological to familiarise with routine bio-
chemical investigation and know the appropriate culture media in addition to the routine hospital
practical work.
Most of teaching should be clinical and clinico-pathological sessions with hardly any or very little
didactic lecturing.

Pre-Clinical
The separation of medical education into watertight compartments seems to me to be made more
for the convenience of teachers than for good medical education. Take two instances :

The AIIMS has or at least had excellent preclinical teaching. The students were hand-picked And
yet in the 3rd year—the 1st year of clinical studies—when shown a patient with wrist drop and
asked for the nerve which supplied the paralysed muscles, there was no answer. The fault was
certainly not with the students.

Over the last 20 years and more, I have asked under-graduate and post-graduate candidates what
was the quantity of secretion in 24 hours of saliva*, gastric juice, pancreatic juice, bile and succis
Entericus and their composition. I still have not had a satisfactory answer. And still to treat acute
Gastro-enteritis chronic pyloric obstruction and acute intestinal obstruction, the knowledge is
essential.

I want to suggest the study of anatomy be confined to lecture demonstrations on dissected


specimen of that anatomy which a general medical practitioner should know thoroughly. This
should mainly be anatomy applied to medicine and surgery coming under the purview of general
practitioner.

Similarly in teaching physiology the emphasis should not be knowing bare facts but on applied
physiology.

The further teaching of both applied anatomy and physiology should be conducted in ch'mcal
classes where the anatomist, phvsioloeist pathologist, micro-biologist, bio-chemist and clinician
will collaborate.

From the above, as a frame-work, an undergraduate curricula can be constructed after consul-
tations with the various departments.

It will be noted that I have made no mention of pharmacology. I feel applied therapeutics should
be taught in the wards by clinicians and clinical pharmacologist and not in the college
laboratories. The new drugs come on the scene with alarming rapidity, replacing the older ones so
that in 5 years time very few of the older ones remain in use. The time spent on lecture and
demonstration on animal experimental pharmacology could well be replaced
by clinical pharmacologyin-the ward on human patients.

Jurisprudence should not form part of the syllabus. Doctors taking a Government job can be given
a course on appointment.

It must be made compulsory, that every student possesses along with stethoscope, a tendon
hammer, a torch and an opthalmoscope. Students be encouraged to examine the funds of all
patients whom they examine. They should be familiar with funds appearance of hypertensive and
diabetic retinitis and papillocdeme of intracranial hypertension.

I feel all graduates should know how to lake intra-ocular tension because glaucoma is far more
common than people imagine. I remember years ago my opthalmic colleague at Safdarjung
insisted on all cases of headache coming to the Emergency Ward being examined by an
Ophthalmologist. The result was detecting an average of seven patients of acute glaucoma a
week. So if we really mean to prevent blindness one should include ability to measurement of
intra-ocular tension in the undergraduate syllabus.

One of the major changes that will have to be effected is transferring the Bio-Chemistry and
Micro-biology Departments from the College to the hospital buildings where they will function
on a 24-hour basis like clinical Departments.

As for pathology only general pathology need be taught in the Department. Pathology as related
to diseases should be done along with clinical medicine and in the autopsy room.

There should be an earnest attempt to introduce the Bombay Coroners Act throughout the country
so that autopsies are done routinely. With autopsy we will be a major, medical power in the
world; otherwise we will continue to be what we are.

As for histopathology even when specialists differ in their interpretation it will be ridiculous to
examine the under-graduates in histopathology.

Post-Graduate Medical Education (Clinical Subjects):


Again the object is to train a graduate doctor to be good practical specialist; For this a continuous
period of 3 years practical and clinical training is essential. It is presumed that the institution has
adequate clinical material, has a good library, the laboratory and radiological facilities are above
reproach end adequate and additional facilities like dialysis, nuclear medicine investigation are all
available. In addition there should be teacher clinicians who should be prepared to spend
considerable periods of time with the post-graduates in the wards.

My idea is that a teaching unit should consist of 2 teachers, say a professor and Associate or
Assistant Professor each being in independent clinical charge of 30 beds but collaborating in
teaching and also giving consultant cover in the absence of the other. The Post-graduate in his 1st
year is posted as Junior Registrar to the Associate Professor's beds. In the 2nd Year he passes his
Postgraduate examination. The 3rd Year is spent as Senior Registrar to the whole unit working
under both the teachers. As there will be no Assistant Professor or Lecturer, the clinical and
operative experience obtained during the 3-year period under two different teachers will be
adequate for proper training.

At the end of the 3rd year training he should be able to practise as a Specialist independently.
There is no necessity for a thesis or any other substitute for thesis. The training is essentially cli-
nical and practical and there is no time to waste on writing a- thesis, which, in most cases, is not
worth the paper on which it is written.

I do not think any syllabus need be laid down. The clinical teachers should have the responsibility
of training their charge to become a competent practising specialist. The methods may be left to
them.

By finding useful and gainful employment for doctors brain drain can be minimised and medical
care provided to all people. As soon as a doctor graduates, he is offered the following facilities
for group practice in a rural area:

1. For a group of four doctors funds for building a Poly-clinic building with residential
accommodation for the doctors will be arranged with a bank at a low rate of interest.
2. Funds for buying the equipment necessary for a general practice—also should be arranged. The
information regarding cost and source are also given.

It is estimated that for a population of 1,00,000, there will be an amiual consultation of 4.00,000.
This with domiciliary midwifery and treatment of illness should guarantee a very satisfactory
financial income.

For providing hospital medical care and employment for the post-graduate, it is recommended
that all P.H.Cs be converted into 60 bedded hospital capable of expansion into 100 beds at a
future date. Each hospital should have a Physician. Surgeon, Anaesthetist and an Obstetrician, a
100 MA X-Ray Unit and adequate Bio-chemistry and Microbiology Laboratory support for
diagnosis of all acute illness.

The four general practitioners can also be employed on a part-time basis to help the hospital
doctors so that their medical knowledge is kept reasonably up-to-date.

The hospital will also have residential accommodation for the Doctors and other para medical
personnel who are not local people. For a 60 bedded hospital the average annual intake would be
more than 3,000 admissions and this should keep the 2 Specialists busy and with a wide variety of
patients for their professional interest would be kept up.

Para Medical Personnel


The one way to-improve radically the standard of medical care would be to upgrade the standard
of professional knowledge of the para-medical personnel like Radiographer, Laboratory Techni-
cians. The ideal solution would be to have the syllabus of hospital laboratory technicians and
Radiographer course of U.K. adopted as a standard one. J he hospital and Radiology units m for
training should be accreditated. This laboratory and Radiological support for the Rural hospitals
would be a beneficial factor in improving the quality of clinical work.

No health care can survive without adequate supply of drugs of quality. The quantity of course
would be enormous.

Drugs are—
1. 100-150 Essential Drugs.—(WHO has delineated them, with modifications to suit our
country's requirement, the list can be accepted as our Essential Drug List.) The Kerala
Government constituted a Kerala Drug and Pharmaceutical Limited Company to produce or
formulate and supply all Essential Medical Items to the 200 and odd medical institutions of that
State. This was to be on no-loss-no-profit basis and when this was done they could supply drugs
at l/3rd the cost at which they were buying in bulk supplies. The items included I.V. Fluid like
glucose, glucose saline etc. in addition to the Essential Drugs.

It should be possible for all States to start 2, 3 or more such factories depending on the size of the
State and make possible, availability of all Essential Drugs and I.V. Fluid for all their State
Medical Institutions down to Rural Hospitals at considerably cheaper rates than at present. The
availability of medicines at hospitals is a grant morale booster for the population and doctors.

2. Other Drugs.—To obtain these at cheaper rates than at present, I suggest that the Centre,
Railways, Defence and all States and Public Sector Undertakings declare their requirements for
the succeeding year and a Committee consumed by the Centre enter into a running rate contract
with pharmaceutical firm whose products have been certified by the Drug Controller as of
required standard and purity.
Once this is done the individual Units will, on the basis of the original demand, get on 1st January
2 months' supply and on the 1st of the succeeding months one month's supply. This will ensure
staggering of production by firms, saving of medical storage space in hospitals and of course
pilferage which is bound to happen when large quantities of medicines are stored. Further, this
will avoid maintenance of an utterly useless and wasteful medical stores department and deposits,
(except in the Defence Services where supplies have to be stored and kept in readiness against
emergencies),

The responsibility of the Centre would be to ensure regular supplies of high quality drugs and the
States to ensure a- prompt payment on receipt of the supplies.

3. Equipment, Surgical, Medical, Electrical and Electronic.—The responsibility for the ready
availability of a standard pattern of all necessary equipment as laid down by an Expert Panel
appointed by Government, should be that of the Central government in collaboration with the
States. If import of equipment is necessary this should be of a common pattern and arrangements
for repair and spare parts should be full proof.

4. Hospitals.—The first requirement for teaching clinical medicine is adequate


clinical material—not too much or too little. Today for the considerably increased annual intake
of medical students the inpatient material is insufficient and the out-patient one too much for
orderly teaching. Our object can be achieved by converting all Government hospitals including
District Hospitals into Associate Teaching Hospitals. Apart from providing an almost
clinical material for practical teaching, the upgrading in equipment, laboratory facilities and staff
and buildings which will accompany the upgrading will benefit the district and Rural population
thus achieving the double object of improving medical care and medical education. I further
suggest that all teaching hospitals be supplied with standard equipment- Laboratories—
Radiological, Electrical, Electronic, hospital furniture, Operating Theatre, nuclear medicine, etc.
on a formula adopted from the one use in Defence Medical Supply. The provision of all necessary
equipment, drugs, X-ray Film etc. on a standard basis will go a long way in removing the gross
disparities in the quality of medical care and medical education in the country.

5. Standardisation of Medical Education— It seems to be only a matter of time before we have


medical degrees in the different regional languages losing what little communication we have
between the different medical centres. Before this happens, I think the Centre should step in and
take over temporarily" say for 10-15 years the responsibility for medical education. The hospitals
in the State are mainly State-owned but I do not see any great difficulty in the Centre coming to a
mutual understanding with the States on the use of hospitals for Medical Education in public
interest.

The responsibility should function through a Central Medical University with Regional Bran-
ches—North, South, East, West and Central. This seems |o be the only method to improve the
quality of, medical education on all India basis, while the Central University will have 1/5th
representation from each Region. Each Regional Branch will be administered in a similar way i.e.
l/5th representation for each Region, e.g., South Region will be administered by a Group
consisting of 1/5th from North, l/5th from South, l/5th from East, l/5th from West and l/5th from
Central Region. This will eliminate pressure from local groups, the bane of Medical Education in
many States.

6. Rural Health Board—To ensure quick results in the upgrading of P H C to 60 bedded hospitals,
a Rural Health Board will have to be constituted. They will ascertain priorities in location arrange
for building and equipment and staff and monitor progress. If all the 5.500 P H Cs can be
converted into 60 bedded hospitals within a space of 10 years, we would have achieved
something which the planners of 1st Plan would never have thought possible.

If the principles enunciated above are accepted, details can be worked out in a short time.

If my views find general acceptance, it should be possible to draft the syllabi for under and post
medical graduates modern in concept, content in depth, practical in implementation and above all
beneficial to the vast Rural Population, as well as Urban people.

Sd/

Col. R. D. Ayyar.

Report of the Medical Education Review Committee

Part II
Medical Education Review Committee*

CHAIRMAN
Dr. Shantilal. J. Mehta

MEMBERS
(1) Col. R. D. Ayyar
(2) Dr. I D. Bajaj
(3) Dr. P. N. Chhuttani
(4) Dr. O. P. Gupta
(5) Dr. L. B. M. Joseph
(6) Dr. M. M. Mehta
(7) Prof. V. Ramalingaswami
(8) Dr. Rameshwar Sharma
(9) Dr. Y. P. Rudrappa
(10) Dr. B. N. Sinha
(11) Prof. H. D. Tandon
(12) Dr. K. N. Udupa
(13) Dr. P. N. Wahi

MEMBER-SECRETARY
Shri N. N. Vohra
(from inception uptill 4th October, 1982) Shri P. P. Chauhan (from 8th November, 1982)

The committee was established Vide Government of India Resolution dated the 8th September,
1981. It commenced functioning on 5th October, 1981, and submitted its Report (Part I) on 12th
October, 1982. The final meeting of the Committee was held on the 10th December, 1982.

STAFF OF THE COMMITTEE


Shri R. Srinivasan—Research Officer
Shri J. C. Hand a—Private Secretary to Chairman.
Shri A. V. L. Narasihga Rao—Sr. P.A. to Member-Secretary
Shri K. K. Mehta—Research Assistant
Shri H. L, Dhamija—Research Assistant
Shri M. S. Chavvla—Stenographer
Shri Pritpal Singh—L.D.C.
Shri Kundan Singh—Messenger
REPORT OF THE MEDICAL EDUCATION REVIEW COMMITTEE
PART II

1. The Medical Education Review Committee submitted to the Government, on 12th


October,1982, the first part of its Report on all its terms of reference except the one relating to
medical manpower assessment. It had earlier been agreed that the Committee would separately
submit, in Part II of the report, its recommendations on the below stated term of reference :—

"This Committee will also evolve realistic projections of medical manpower requirements
(MBBS doctors, general specialists and super-specialists) during the Sixth Five Year Plan and
beyond taking into consideration :

(a) the need of Government based health care programmes ;


(b) the requirements of doctors in private sector ;
© the need arising from bilateral agreements, international commitments and Technical
Cooperation among Developing countries; and
(d) Necessity to redress regional imbalances in the distribution of medical man
power."

2. At its meeting held on 19th December, 1981 the Committee appointed a Sub-Committee
to examine the issues contained in the term of reference quoted in para 1. The Committee felt that
manpower assessment should not be restricted merely to "doctors but should also take into
account the various categories of para-medical personnel. The Sub-Committee was accordingly
assigned the task. The Sub-Committee's report was circulated to all members of the Committee
on 25th October, 1982. In the interest of speedy fmalisation of Part II of the Report, the Members
of the Committee were requested to send their comments on the Report of the Sub-Committee.
Such comments as were received have been taken into account while finalising the Report. After
due consideration the Committee agrees with the recommendation of the Sub-Committee, as
contained in the later's report in the pages following.

3. The Committee observes that due to dearth of relevant statistical data, it is not possible to
evolve reliable assessment of the existing stock of medical and health personnel and,
consequently, to make any recommendations regarding an in crease decrease in the existing scale
of production of functionaries of various categories.

3.1 The Committee hopes that Government would give very early thought to the
recommendations contained in the Sub-Committee's report.

4. The Committee wishes to place on record its appreciation of the services rendered by Shri
N. N. Vohra, formerly Joint Secretary in the Ministry of Health and Family Welfare, who
functioned as the Convenor of the Sub-Committee and assisted in preparing its draft Report even
after relinquishing office as Member-Secretary of the Committee. The Committee also would like
to place on record its grateful thanks to the Members of the Sub-Committee for the very keen
interest evinced by them.

Sd/-
R. D. AYYAR
I. D. BAJAJ
P. N. CHHUTTANI
O. P. GUPTA
L.B. M. JOSEPH
M.M. MEHTA
V. RAMALINGASWAMI
RAMESHWAR SHARMA
Y. P. RUDRAPPA
B. N. SINHA
H. D. TANDON
K. N. UDUPA
P. N. WAHI
P. P. CHAUHAN
S. J. MEHTA
REPORT OF THE SUB COMMITTEE ON
MEDICAL AND PARA-MEDICAL MANPOWER REQUIREMENTS

1. At its meeting held on 19th December, 1981 the Medical Education Review Committee
appointed a Sub-Committee to examine the issues contained in para 3 of the Committee's terms of
reference, viz :—

"This Committee will also evolve realistic projections of medical manpower requirements
(MBBS doctors, general specialists and super-specialists) during the Sixth Five Year Plan and
beyond taking into consideration :.-—
(a) the need of Government based health care programmes ;
(b) the requirements of doctors in private sector;
© the need arising from bilateral agreements, international commitments and Technical
Cooperation among Developing countries : and
(d) necessity to redress regional imbalances in the distribution of medical manpower".

The Sub-Committee was asked to submit an early report to the committee.


1.1 The Sub-Committee consisted of : —
1. Dr. P. C. Bhatla,
Dean, IMA College of General Practitioners, New Delhi.
2. Prof. Gautam Mathur, Director,
(Shri A. K. Dasgupta, Adviser— Alternate Member). Institute of Applied Manpower
Research. Indraprastha Estate, New Delhi.
3. Dr. O. P. Gupta,
Director of Health, Medical Services and Medical Education, New Civil Hospital,
Ahmedabad.
4. Dr. P. S. Jain, Secretary,
Medical Council of India, New Delhi.
5. Prof. Usha K. Luthra,
Senior Deputy Director General, Indian Council of Medical Research, New Delhi.
6. Shri K. Ramachandran,
Associate Professor and Head, Biostatistics Division, All India Institute of Medical
Sciences, New Delhi.
7. Dr. Rameshwar Sharma,
Principal, S.M.S. Medical College,
Jaipur.
8. Dr. H. D. Tandon,
Director, All India Institute of Medical Sciences,
New Delhi.
9. Shri M. C. Verma,
Joint Adviser; Manpower Unit, Planning Commission, New Delhi.
10. Shri N. N. Vohra, Convenor
Joint Secretary,
Ministry of Health and Family Welfare, New Delhi.

Procedure adopted
1.2 The Sub-Committee held three meetings (on 1st March, 1982, 3rd April, 1982 and 17th July,
1982) to consider the issues referred to it.

2. At its first meeting, the Sub-Committee decided to collect all available information regarding
admissions|output of the graduate|post-graduate courses for the years 1980 and 1981 is well as
about the existing stock of medical and paramedical, personnel, all over the country. Accordingly
communications were addressed to the various concerned quarters, governmental and non-
governmental, seeking the requisite information in regard to the various categories of health
personnel. The statement at Appendix I indicates the details of the organisations addressed and
the results achieved.

2.1 The responses received from the various organisations which were addressed have been
unsatisfactory, despite repeated reminders. Consequently, the Sub-Committee could not meet as
often as originally envisaged, to complete the task assigned to it.

Analysis of the obtaining situation

3. The Sub-Committee is dismayed at the patent inadequacy of the readily available information
in regard to the eixsting stock of health personnel in the country. It is also to be observed that the
assessments of health manpower requirements, undertaken so far are rather sketchy, being based
on incomplete data. Even these projections have not been up-dated and are, as today, of Limited
worth.

3.1 The Institute of Applied Manpower Research, New Delhi (IAMR) had undertaken in 1966,
1970, 1971, 1977 and 1979 health manpower studies relating to different categories of health
personnel. As no special facilities exist in the IAMR for continuing such work on a sustained
basis it has not been able to up-date its researches to continually evolve the kind of projections
which are so vital to appropriate decision making regarding health manpower developments}.

3.2 The Ministry of Health and Family Welfare and the Institute for Research in Medical Sta-
tistics, New Delhi (an establishment of the ICMR) are also not possessed of the requisite
infrastructure for undertaking health manpower studies.

3.3 The Planning Commission has been engaging itself in health manpower analysis at the time of
formulation of sucessive Five Year Plans. For want of to-date information regarding available
stocks of health manpower the Commission's projections regard to future requirements have, per-
force, been built upon rather broad-based assumptions.

3.4 The Sub-Committee has been disheartened to note that the various statutory bodies respon-
sible for the primary registration of medical professional—Medical Council of India, Central
Councils for the various Indigenous Systems of Medicine and Homoepathy, Dental Council,
Pharmacy Council etc.—have not been able to keep their registers up-to-date. The information
available with these bodies represents one time registration of the practitioners. Since there is no
system of renewal of registration a good number of those registered may have since ceased to be
in practice, migrated from the country, expired etc. Consequently, persons listed on the Central
Registers are not those actually engaged in practice in the various States |UTs.

3.5 The Sub-Committee noted that there are a very large number of semi-
qualified|unqualified practitioners of various systems of medicine who are not registered with any
governmental agency. The information supplied by the Private Medical Practitioners' Association
of India and the All India Private Medical Practitioners' Association, who were approached in the
matter, may be seen in the statement at Appendix II. Prima facie, the information is incomplete in
regard to distribution as per the various systems of medicine, State}UT wise dispersal, percentage
break-up as per levels of education and professional training (if any) of the practitioners etc.
4. Through persistent efforts, the Sub-Committee has been able, by tapping all possible
sources, to collect data in regard to the admissions|output in regard to graduate, post-graduate
(diploma and degree) and post-doctoral courses. This may be seen in the statement at Appendices
III and IV. The information is incomplete, as a good number of institutions failed to respond to
the communications from the Sub-Committee or furnished only partial information.

4.1 A number of new medical colleges have been established in the recent past. It is not known
whether these institutions shall, in due course, be able to secure the recognition of the Medical
Council of India. If they manage to do so, their future product shall also require to be duly taken
into account, for computing the net annual out-turn of graduates, post-graduates etc.

5. Besides addressing the medical colleges, Professional Councils, State Governments etc.,
the Sub-Committee considered it necessary to secure in formation regarding the manpower
requirements for the implementation of the major national health programmes e.g. those relating
to Malaria, TB, Blindness, Leprosy, Family Planning etc. Besides, it was also considered
worthwhile to address the larger public sector employers e.g. the Ministries of Railways,
Defence, Labour, Posts and Telegraphs and ascertain their existing stock of personnel and
requirements for the future. The information which became available uptill 30th September, 1982
in regard to major health programmes may be seen in the statement at Appendix V. It is
incomplete and, consequently, not amenable to any meaningful analysis.

5.1 The response from the Central public sector undertakings, reflected in the statement at
Appendix VI has been comparatively more satisfying. However, this information is not complete
and requires further refinement.

5.2 Efforts were also made to evolve as reliable a picture as possible regarding the requirements
of the private sector. In this connection, the Federation of the Indian Chambers of Commerce and
Industry was addressed. The Federation was very helpful and assisted in the supply of
information in regard to 33 Companies, which is contained in the Statement at Appendix V.

5.3 At the Sub-Committee’s request, the Voluntary Health Association of India supplied useful
information in regard to the personnel employed in private hospitals and clinics, which is
contained in the statement at Appendix VII.

5.4 The State Governments and Union Territory Administrations were addressed to elicit
information regarding the available stock of manpower comprising self-employed practitioners.
Their response has been inadequate. Consequently, the data which has become available is of
restricted value. The Indian Medical Association have also not been in a position to supply
information regarding the existing stock of private registered practitioners
(generalists and specialists).

6. The various concerned Departments of the Government of India—Ministry of External Affairs,


Foreign Assignment Section of the Ministry of Home Affairs, Department of Science and Tech-
nology (Indians Abroad Register) etc.—were addressed to gather together reliable information in
regard to the number of medical personnel who have been leaving the country, in recent years, to
secure higher qualification, specialised training or for employment. Full information in this regard
has not become available from any quarter.

Non-availability of norms

7. In the process of its deliberations, the Sub- Committee noted that as regards the
assessment of manpower requirements for the future there do not exist, at present, any nationally
accepted norms in regard to :
- population : doctor ;
- population : dentist ;
- doctor : nurses ;
- population : specialist (speciality-wise)
- population : super-specialist (super-speciality-wise) ;
- doctor : pharmacist ;
- doctor : para-medics (various categories) ;
- population : hospital-beds ;
- doctor: hospital-beds ; etc.

7.1 It is obvious that projections regarding the requirements of manpower of various


categories|grades of skill cannot be undertaken without establishing the crucial ratios referred to
in para 7. Consequently, it is not possible to work out the number of educational and training
institutions required, all over the country, to "produce the number of health personnel, of various
grades of skill, required for meeting the present and future health care needs of the country.

8. As regards the development of the health infrastructure to achieve the goal of Health for All by
the year 2000 A.D., the Sub-Committee observed that a Working Group established by the Mini-
stry of Health and Family Welfare, to evolve Sixth Plan proposals for the Health sector, had
worked out the basis|norms for the establishment of Sub-centres, subsidiary Health Centres,
Primary Health Centres, Community Health Centres etc. covering the period uptill 2000 A. D. On
the basis of the approach established by the Working Group the number of the various categories
of health personnel was also worked out. Subsequently, taking into view the recommendations of
this Working Group, the Planning Commission have laid down physical targets for infrastructural
development during the VI Plan and also given a broad indication of the required pace of such
growth till 2000 A.D.

8.1 In the aforestated context it is to be further observed that while the VI Plan document
provides the parameters for the development of the governmental health services infrastructure,
from the sub-centres upto the Community Health Centre level, nationally accepted norms in
regard to the establishment of dispensaries, hospitals, centres for specialised treatment etc. arc not
available. Furthermore, in so far as health manpower planning is concerned, a State-wise picture
regarding the percentage of the population envisaged to be served through the governmental
sendees has still to be evolved. Unless such ratios, worked out on a well considered, practical,
basis are available, it is not possible to undertake manpower assessment on a centralised basis.

8.2 The Sub-Committee also observed that in moving towards a complete assessment of available
health manpower in the country due notice would naturally have to be taken of the very large
number of practitioners of the various Indigenous Systems of Medicine and Homoeopathy
whether they are registered or unregistered, qualified or unqualified. The existence of such
practitioners as well as of those of the modern system of medicine who are unqualified yet active
in practice is a fact of life and cannot, therefore; be ignored.

8.3 Once the requisite information regarding the available stock of health personnel is available,
on a reliable basis, it would be possible to evolve projections regarding present and future
manpower requirements. The working out of requirements for the future would naturally have to
take into consideration the erosion of the existing stock on account of superannuations,
migrations, change in vocation etc. Standard ratios for each of these factors would therefore
require to be worked out.
Recommendations

9. Keeping in view the discussions in paras 3—8 above, the Sub-Committee makes the
recommendations set out in paras below, for the consideration of the Medical Education Review
Committee.

National Health Manpower Policy


9.1 A relevant National Health Manpower Policy can be evolved only within the parameters of
the National Medical and Health Education Policy. Needless to say, the latter Policy can flow
only from the National Health Policy. The Ministry of Health and Family Welfare have only
recently finalised the National Health Policy. It, therefore, appears necessary that further work on
the National Health Manpower Policy should commence only after the National Medical and
Health Education Policy has been finalised, clearly bringing out the kind of medical and health
personnel, of identified categories, required to be produced, for meeting the present and future
health care needs of the country.

9.2 The National Health Manpower Policy would naturally need to take into account and evolve a
fully integrated view regarding the utilisation of practitioners of all systems of medicine and not
merely those of the Allopathic system.

National Medical Manpower Census

9.3 While it would take some time for the National Medical and Health Education Policy to
be finalised it is necessary to initiate action, on a time bound basis, to arrive at a reliable
assessment of the available stock of health manpower, encompassing health functionaries of all
kinds, belonging to the various systems of medicine, actually active in practice. Considering the
vastness of the country and the coverage of the presently available registration systems, the Sub-
Committee is of the considered view that the objective can be achieved only through a nation-
wide Medical Manpower Census, to be conducted during a fixed period (say a week) after
organizing effective publicity throughout the country. It may be necessary to publicise that those
who are not registered during the Census Operations would not be eligible to practise and may
have to face legal consequences, as may be prescribed. The proposed Census would enable the
States to identify the exact numbers of qualified practitioners, of the various systems of medicine,
against whose functioning there has been mounting criticism in the recent past. The Indian
Council of Medical Research (Institute for Research in Medical Statistics), National Sample
Survey Organisation, Institute of Applied Manpower Research and Planning Commission may be
consulted in finalising the list of items in respect of which information requires to be collected as
well as for evolving parameters of the proposed Census

Manpower assessment during interim period

9.4 As the proposed Medical Manpower Census would naturally take some time to be organised,
if it is decided to hold it, it is felt that the following measures may be taken on an immediate
basis:
(i) The Ministry of Health and Family Welfare may address ail State Governments and Union
Territory Administrations to undertake a reliable district-wise assessment of available health
manpower of various categories and systems of medicine. Perhaps the Planning Commission can
be persuaded to address the State/ UTs in the matter. It is unavoidably essential that at the time of
preparation of every Five Year Plan, the States and Union Territories should furnish a reliable
assessment of the stock of medical and para-medical manpower as it stands at the close of the on-
going plan, requirements upto the close of the succeeding Plan (annually) and projections for the
next succeeding Plan. In this context the States and UTs must specifically state their objectives
and the nature of help they would require from the Centre.

Furthermore, those responsible for the implementation of the various national health Programmes
should intimate the stock and projections in regard to technical personnel required in respect of
such programmes. It is felt that if the States/ UTs accept this obligation and undertake to
discharge it on an organised basis it should be possible for them to collect and compile the
requisite information within 3 months. The format for eliciting the necessary information may be
evolved with the assistance of the I AMR, New Delhi and finalised in consultation with the
NSSO/Planning Commission, To ensure speedy results, the Ministry of Health and Family
Welfare may have the reporting forms printed on a centralised basis. In case financial problems
arise perhaps available extra-budgetary sources could be utilised for the purpose.

Up-to-date Registration of Health Personnel


(ii) The Ministry of Health and Family Welfare may issue a suitable directive to the Central
Councils of the various systems of Medicine, Dentistry, Pharmacy, Nursing etc. to advertise and
call upon all qualified personnel to register/renew their registration with the concerned Councils
within 4/5 weeks. Towards this end, each of the various Councils may make available, on request,
self-addressed reply cards on a well-considered format, listing the items in respect of which
information is sought. Inter-alia, the information to be collected must include the qualifications of
the practitioner, when and from where obtained; age; sex; whether practising as a
generalist/specialist/ super-specialist; whether self-employed or working for State/Central
Government or public sector organisation, local bodies, private organisation etc; whether
functioning in urban|rural areas; etc., etc.

(iii) In the efforts as at (i) and (ii) above, the cooperation and assistance of the Indian Medical
Association, various specialists' Associations, similar bodies of the various other systems of
medicine and the Voluntary - Health Association may also be solicited.

(iv) The Ministry of Health and Family Welfare may hold consultations with the various
Associations of Private Practitioners and persuade them to launch special drives to enlist and
prepare to-date registers of all unqualified practitioners (it is assumed that the qualified
candidates would get registered with the concerned Central Councils), indicating their age, sex,
levels of education and training, whether practising in the urban/rural areas etc. If necessary,
suitable financial support may be made available to identified bodies/agencies to secure the
desired results.

Categories of health personnel to be assessed


10. While the proposed National Medical Manpower Census may enlist and prepare to-date in-
ventories of health personnel of all kinds, engaged in active practice, the short-run assessments
proposed in para 9.4 may cover :—
(i) General practitioners (of all systems of medicine) ;
(ii) Specialists (-do-);
(iii) Supper-specialists (-do-);
(iv) Dental Surgeons (at various levels of functioning) ;
(v) Nursing personnel (including ANMs, LHVs, Midwives, and Public Health Nurses);
(vi) Pharmacists;
(vii) Laboratory Technicians ;
(viii) Physip-therapists|Occupational Therapists ;
(ix) X-Ray Technicians ;
(x) Ophthalmic Assistant|Technicians.

Fixation of ratios/ norms for health personnel to population etc.

11. It is hoped that the Ministry of Health and Family Welfare would consider and take
early decisions regarding the recommendations contained in. para 9 above. Side by side with
action on various fronts, to assets the existing stock of health manpower, it would be extremely
necessary for the various Central Councils and each of the Specialist's Associations to urgently
get involved in exercises to establish uniformly accepted service norms; (doctor—population,
dentist-population, etc. ratios referred to in para 7) on the basis of which present and future
requirements of health manpower could be worked out. It may be observed that the basis of
these norms must necessarily flow from the health care approach engrained in the National Health
Policy. It is relevant to reiterate that those norms must be realistic and pragmatic, keeping in
view the socio-economic conditions of the country, and not be related to exotic western models
of health care. These norms would naturally be variable for the urban and rural areas. Along
with the norms, there is need for evolving an agreed view regarding the average period of active
work to be expected of practitioners at various levels of functioning, to determine a viable
attrition rate. In this context, the Ministry of Health and Family Welfare may consider organising
a meeting of experts, involving representatives of the various Central Councils and Specialists
Associations of physicians, surgeons, gynaecologists, paeditrictions ophthalmologists etc. etc.
The Institute for Research in Medical Statistics (ICMR), NIHFW and the Institute of Applied
Manpower Research can be use fully involved in this exercise. It may be pointed out that
without formulating some form of normative projections of future requirements of specialists. It
would be difficult to relate the admissions to-the various, prost-graduate courses to assessed
requirements of specialists, as recommended by the Committee in its Report (Part I).

Migration of personnel
12. The National Medical Manpower Policy, to be evolved, must necessarily take into
account the migration of physicians, nurses etc. in recent years whether under governmental
exchanges or otherwise—and provide, in the overall assessment of requirements, for a given
percentage of health personnel, of various categories and grades, to leave the country, every year,
for service, higher education and training etc. abroad. Centralised systems and procedures would
require to be evolved, in consultation with the various concerned Ministries and agencies, to
maintain to-date, accurate records of all such out-flows. Such information is not available at
present, from any quarter. Continuous assessment of health manpower

13. Whatever be the approach adopted by the Ministry of Health and Family Welfare in pro-
ceeding to arrive at a reliable assessment of the existing stock of health personnel it would be
most essential to organise a mechanism to continuously collect, monitor and analyse health man-
power date. In this context, perhaps the ideal arrangement would be to ensure the establishment
of Health Manpower Bureau in every State and Union Territory, linked with a Central Health
Manpower Bureau. If this approach is accepted, the constitution and style of functioning of the
proposed Bureaux could be finalised in consultation with the IAMR, NSSO and the Planning
Commission. The expenditures on account of the establishmentjfunctioning of the proposed net-
work could perhaps be met under a new Centrally Sponsored Plan Scheme or from the extra-
budgetary resources of the Ministry of Health and Family Welfare.

Survey by National Sample Survey Organisation


13.1 It is understood that the National Sample Survey Organisation have agreed, in their projected
work plan, to undertake a survey of Vital Health Statistics. This Survey is likely to be conducted
during January—June, 1984. Keeping in view the larger perspectives it would be useful for the
Ministry of Health and Family Welfare to hold a meeting with the representatives of the IAMR,
NSSO and the Planning Commission to consider and decide whether it would be possible to
include Health Manpower even on a limited basis, as one of the items of the proposed Survey. In
any case, it would be beneficial to evolve, in consultation with the aforementioned bodies, a fully
integrated and harmonious view regarding immediate and future action in the matter. Needless to
say, after arriving at a reliable assessment of the existing stock of medical and health manpower,
it would be necessary to evolve projections for future requirements, keeping all relevant factors in
view.

14. Whatever the decision of the Ministry of Health and Family Welfare in regard to the re-
commendations of the Medical Education Review Committee (based on the report of the Sub-
Committee), it appears essential that the efforts made by the Committee's Secreariat are carried
forward and the date collected by it is further worked upon and refined. This can be done by
creating a small Manpower Planning Cell in the Medical Education Division of the Ministry. In
the alternative, the responsibility can be entrusted to the Director, Central Bureau of Health
Intelligence of the Institute for Research in Medical Statistics, New Delhi (an establishment of the
Indian Council of Medical Research). It would be necessary for the entire records of the Sub-
Committee dealing with collection of manpower data to be transferred to the authority designated
to handle this rather important item of work.

Demand projections in respect of medical and certain para-medical manpower


requirements
15. The information collected by the Sub-Committee in regard to certain categories of health per-
sonnel, the obtaining training capacities, employment situations etc. has been put together in the
statement at Appendix VIII. This as well as all other available information was passed on to the
Institute for Research in Medical Statistics (ICMR), New Delhi, for projecting the requirements
of medical manpower in the period uptil 2000 A.D. The IRMS have made certain projections
relating only to personnel of the modem systems of medicine, viz. doctors, dentists, nurses and
pharmacists. In computing existing stocks and assessing future needs the IRMS projections have
not taken into account—(i) the practitioners (registered/unregistered) of the Indigenous Systems
of Medicine and Homoeopathy, and (ii) the unregistered practitioners of the modern system.

15.1 Without entering upon any debate on the relative merits of the various systems of medicine
it must need be emphasised that in any exercise in medical manpower planning it would appear
unavoidable to take into account all those who are actually rendering medical and health care
services to the peopled Also, in terms of planning of services for future and computing manpower
requirements a definite view would require to be evolved regarding the nature and extent of
burden to be borne by the various systems of medicine. Also, as regards requirements of
technicians, para-medical personnel etc. it would be necessary to assess their need alongside the
exercises to project the demand for doctors and specialists. Such a conjoint view is necessary to
ensure that manpower planning adequately takes into view the Health Team approach. It is,
therefore, imperative that Government should arrive at a clear view in regard to these issues.

16. The efforts made by the IRMS may be seen in their report at Appendix IX, specially the
Tables 1—12. On the basis of given assumptions, projections have been made in regard to future
increases (until 000 A.D.) in the existing stocks of doctors deists. Nurses and pharmacists
further, on the basis of assumed ratios regarding the targetted scale / coverage of health services
in the period uptill 2000 A.D. projections have been made regarding the requirements of the
aforesaid categories of personnel, adjusting for given attrition rates. Finally, relating the projected
requirements to the corresponding stocks, a picture of the likely surplus /deficit of manpower has
also been arrived at, category-wise for given points of time. As stated in Appendix IX, Ihe
projections are based on secondary data for want of the essential statistics.

16.1 It does not appear necessary to make any critical comments on the projections contained in
Tables 4 (A & B), 5—12, of the IRMS Report (Appendix IX). While, obviously, a meaningful
effort at medical manpower planning can be undertaken only after resolving the issues referred to
in paras 7, 8, 9 and 12 it would be worthwhile for the various Central Councils and Specialists
Associations to examine the implications of the IRMS projections, specially to arrive at a view
regarding the assumptions involved therein. The Ministry of Health and family Welfare may also
like to consider early further action in the matter, in consultation with the I.C.M.R. and the
Planning Commission.

17. In view of the discussions in the paras foregoing it would be appreciated that the Sub-Com-
mittee is not in a position to make any concrete recommendations regarding the changes required
to be brought about in the existing scale of production of personnel of various categories, to meet
the manpower requirements in the future.

17.1 Grateful thanks of the Sub-Committee are due to Shri M.C. Verma, Joint Adviser, Man-
power Unit, Planning Commission and to Dr. Usha K. Luthra, Senior Deputy Director General,
Indian Council of Medical Research, for their help and assistance. The statistical projections
would not have been possible but for the prompt help and assistance of the Institute of Research
in Medical Statistics. Our thanks to Dr. A. D. Taskar, Director, Institute of Research in Medical
Statistics, Dr. N. N. Singh, Senior Research Officer and Miss Shibani Bhattacharjee.