Medical Council of India and Joint

Commission of India guidelines on

Hospitals and Medical Colleges

Presented By-
Shweta Saini
Shubhomita Dutta
Mohd Sahil
Amir Alam
 MCI
•The Medical Council of India was
first established in 1934 under the
Indian Medical Council Act, 1933.
The Council was later reconstituted
under the Indian Medical Council,
1956 that replaced the earlier Act.

•The Council grants recognition of

medical qualifications,
gives accreditation to medical
schools, grants registration to
medical practitioners, and
monitors medical practice in India
 FUNCTIONS OF COUNCIL

• Establishment and maintenance of uniform standards for undergraduate medical

education.

• Regulation of postgraduate medical education in medical colleges accredited by it.

(The National Board of Examinations is another statutory body for postgraduate
medical education in India).

• Recognition of medical qualifications granted by University or UGC in medical

institutions in India.

• Recognition of foreign medical qualifications in India.

• Accreditation of medical colleges.

.
• Registration
• Permanent registration
• Provisional registration
• Issue of Good Standing Certificates for doctors going abroad

• Registration of additional qualification

• Recognition / de-recognition of Indian Qualifications / Foreign qualifications.

• Inspection / visitation with a view to maintain proper standard of medical education

in India.

.
• Registration of doctors with recognized medical qualifications. The state medical
councils maintains the register of doctors registered in each state which is then
forward to the Medical council each quarter for updation in the national register.
However, Foreign medical graduates have the option to directly register at the MCI.

• Keeping a directory of all registered doctors (called the Indian Medical Register).

• Making necessary amendments in the regulation related to medical education and

practices.
 REPLACEMENT BY NMC

• On 25 September 2020 MCI was replaced by National Medical Commission

(NMC).

• The NITI Aayog has recommended the replacement of Medical Council of India
(MCI) with National Medical Council (NMC).

• An ordinance to allow a committee run the Medical Council of India (MCI) had
also been re-issued in January 2019. National Medical Commission Bill was re-
introduced in the Monsoon session of Lok Sabha in 2019 on July 22, 2019. The bill
was passed by the Loksabha on 30 July, 2019 and by the Rajyasabha on 1 August,
2019. The National Medical Commission Act, 2019 came into force on August 08,
2019.
• The Supreme Court had allowed the Central Government to replace the medical

council and with the help of five specialized doctors monitor the medical education

system in India, from July 2017.

• The planning commission has recommended the replacement of Medical Council of

India (MCI) with National Medical Commission (NMC). The decision has been

approved by most states and after its approval by the Prime Minister it was to be

proposed as final bill in the parliamentary sessions

• Once the NMC came into being on 25 September 2020, the Medical Council of

India was automatically dissolved and the nearly 63-year-old Indian Medical

Council Act stood abolished.

 FUNCTIONS OFNMC

• Laying down policies for regulating medical institutions and medical professionals.

• Assessing the requirements of human resources and infrastructure in healthcare.

• Ensuring compliance by the State Medical Councils with the regulations made
under the Bill.

• Framing guidelines for determination of fee for up to 50% of the seats in the
private medical institutions.
 NMC BILL

• The 2019 Bill sets up the National Medical Commission (NMC) as an umbrella
regulatory body with certain other bodies under it. The NMC will subsume the
MCI and will regulate medical education and practice in India. Under the Bill,
states will establish their respective State Medical Councils within three
years. These Councils will have a role similar to the NMC, at the state level.

• The Bill sets up four autonomous boards under the supervision of the NMC. Each
board will consist of a President and four members (of which two members will be
part-time), appointed by the central government (on the recommendation of a
search committee).
• These bodies are :
➢ The Under-Graduate Medical Education Board (UGMEB) and the Post-
Graduate Medical Education Board (PGMEB): These two bodies will be
responsible for formulating standards, curriculum, guidelines for medical education,
and granting recognition to medical qualifications at the under-graduate and post-
graduate levels respectively.
➢ The Medical Assessment and Rating Board: The Board will have the power to
levy monetary penalties on institutions which fail to maintain the minimum
standards as laid down by the UGMEB and the PGMEB. It will also grant
permissions for establishing new medical colleges, starting postgraduate courses,
and increasing the number of seats in a medical college.
➢ The Ethics and Medical Registration Board: This Board will maintain a National
Register of all the licensed medical practitioners in the country, and also regulate
professional and medical conduct. Only those included in the Register will be
allowed to practice as doctors. The Board will also maintain a register of all
licensed community health providers in the country.
• The Bill replaces the MCI with the NMC, whose members will be nominated. The
NMC will consist of 25 members, including:

➢ Director Generals of the Directorate General of Health Services and the Indian
Council of Medical Research.

➢ Director of any of the AIIMS

➢ Five members (part-time) to be elected by the registered medical practitioners

➢ Six members appointed on rotational basis from amongst the nominees of the states
in the Medical Advisory Council.

• Of these 25 members, at least 15 (60%) are medical practitioners. The MCI has
been noted to be non-diverse and consists mostly of doctors who look out for their
own self-interest over public interest.
 NMC GUIDELINE ROR TEACHING HOSPITAL
GENERAL REMARKS
• 1. At the time of submission of application to the Medical Assessment and Rating Board of
the National Medical Commission for intakes up to 150 MBBS students annually, there
shall be available a fully functional hospital for at least 2 years with 300 beds or in North-
East or Hilly States 250 beds, with all necessary infrastructure like OPD, Indoor wards,
OTs, ICUs, Casualty, Labour Room, Laboratories, Blood Bank, CSSD, etc having a
minimum of 60% indoor bed occupancy.
• Space for Clinical Teaching Departments, Teaching faculty and Residents.
Teaching rooms.
• The teaching hospital shall have at least 1 (one) teaching room for each of the Clinical
teaching departments with a capacity to accommodate at least 30 students (as prescribed for
the medical college) for clinical cases discussions/demonstrations. Each such room shall
have audio-visual facilities.
Outpatient Area

• There shall be a minimum daily OPD attendance of 8 patients (old & new) per
student intake annually in the specialties/subjects of undergraduate curriculum.
However, at the time of Letter of Permission the daily OPD attendance should be at
least 4 patients (old & new) per student intake annually.

Indoor Beds
The teaching hospital may provide additional beds in any specialty depending upon the
needs and patient load.

Indoor bed occupancy. Average occupancy of indoor beds shall be a minimum of 75%
per annum. Provided that it shall be minimum of 50% at the time of inception in North
Eastern States and Hill States, notified Tribal Areas, Union Territories.

Operating Theaters

The Operating theaters shall conform to existing norms. The minimum number of
major and minor operating theaters from LOP till recognition for varying annual intake
shall be as indicated in Annexure I-1V appended to this regulation..

Department of Emergency Medicine

• The Department of Emergency Medicine shall be mandatory for all Medical

Colleges with effect from the academic year 2022-2023 onwards:
(i) All Medical Colleges with recognized MBBS Qualification are required to have a
department of Emergency Medicine at the level of recognition as per requirement
stipulated above.

(ii) All Medical Colleges in any stage of renewal including against increase in intake
are required to have department of Emergency Medicine as per the requirement
stipulated above.

• The Department shall have the following facilities:

(i) Casualty area to receive patients and facilities to triage and stabilize them. There
shall be a minimum of 03 trolleys for triage.

(ii) There shall be at least 24 beds/trolleys of which at least 05 will be for green
category (can wait- walk in patients who will need medical care at some point), and 15
for yellow category (Observation – cannot survive without immediate treatment).
• There shall be a minimum 06 bedded intensive care unit in the Emergency
department adjacent to the casualty area.

• There should be minimum 01 Operation theater and 01 plaster room.

• Rooms for the staff on duty

• It is desirable that decontamination and isolation area is also made available.

Department of Radio-diagnosis

1. There shall be facilities for conventional and static and portable X-rays, fluoroscopy,
contrast studies, ultrasonography and computerized tomography.

2. The rooms housing the various diagnostic imaging systems shall be as per the
regulatory provisions of the Atomic Energy Regulatory Board (AERB), Government of
India.

3. The staff of Radio-Diagnosis department shall be covered by Personal Monitoring

System as prescribed by AERB.
Department of Physical Medicine and Rehabilitation (PMR)

There shall be a well equipped department of PMR providing services such as

physiotherapy, occupational therapy, speech therapy, etc.

Department of Radiation-Oncology (Optional)

The department of radiation-oncology should be planned in accordance with the

regulatory requirements and approval of AERB. It would be desirable that this
department be closely connected with the rest of the hospital to facilitate free
interaction of the facilities of various disciplines for multidisciplinary management of
the patients. Prior BARC approval of the radiation therapy rooms/plan along with
complete layout of the entire department is mandatory.

Department of Dentistry

Where there is a Dental College under the same management as of the medical college,
the services of teachers of these may be utilized in the instruction of medical students in
Dentistry and no separate staff in the Medical College shall be necessary.
ART Centre

Every Teaching Hospital should have Anti-Retroviral Treatment (ART) Centre and facility
for management of MDR-TB at the time of IIIrd renewal (admission of 4th Batch of
MBBS students).

Central Laboratories

There shall be well-equipped and updated central laboratories preferably along with
common collection area for all investigations in histopathology, cytopathology,
haematology, immunopathology, microbiology, biochemistry and other specialized work
if any. The central laboratories should be under the administrative control of the
corresponding/related teaching departments of the medical college.

Blood Bank

There shall be a well-equipped air-conditioned Blood Bank capable of providing

component therapy. The Blood bank and Blood transfusion services should conform to the
guidelines of the National AIDS Control Organization and as prescribed in Schedule-F
Part XII-B to the Drugs and Cosmetics Rules, 1945 amended from time to time.
The Blood Transfusion services should be under the administrative control of the teaching
Department of Pathology of the medical college

when there is no separate Department of Transfusion Medicine.

Pharmacy services

There shall be 24-hr pharmacy services to cater to the out-patient, emergency and other
patients attending the teaching hospital.

Laundry and Dietetic services

The teaching hospital shall have provision for Laundry and Dietetic services.

Hospital Waste Management

The Medical Institution must ensure compliance with the Bio-medical Waste (Management
& Handing) Rules, 2019 and as notified from time to time. They shall have a robust
institutional policy on biomedical waste management of human origin, with a well-defined
arrangement for segregation and discarding of biomedical waste. Facilities for hospital
waste management shall be commensurate with the Central/State legislations.
• Minimum Standard Requirements for
Medical College (50/100 Intake Annual
(330/530Beds res. ) )
❑ The medical college or medical institution shall be housed in a unitary campus near its
teaching hospital having room for future expansion.
❑ However the existing medical colleges shall make efforts to have their teaching hospital
within a radius of five kilometer of the campus (For the medical colleges/Institutions
established up to 30.11.2008).
❑ The medical college or medical institution shall be housed in a unitary campus of not
less than 25 acres of land.
❑ However, this may be relaxed in a place especially in urban areas where the population is
more than 25 lakhs, hilly areas, and notified tribal areas where the land shall not be in
more than two pieces and the distance between the two pieces shall not be more than 10
kms.
❑ The hospital, college building including library and hostels for the students, interns,
PGs/Residents and nurses shall be in one piece of land which shall not be less than
10 acres.

❑ Other facilities may be housed in the other piece of land. Proper landscaping should
be done. (For the medical colleges/Institutions established from 01.12.2008 to
12.11.2009).

Minimum Standard Requirements for Medi

-cal College (150 Intake Annual (730 Beds))

❑ The medical college or medical institution shall be housed in a unitary campus near
its teaching hospital having room for future expansion.

❑ However the existing medical colleges shall make efforts to have their teaching
hospital within a radius of five kilometer of the campus.
❑ Companies registered under Company Act may also be allowed to open medical
colleges.

❑ Permission shall be withdrawn if the colleges resort to commercialization. *As per

the terms of Notification published on 15.07.2009 in the Gazette of India.

❑ The medical college or medical institution shall be housed in a unitary campus of

not less than 20 acres of land except in metropolitan and A class cities (Ahmedabad,
Hyderabad, Pune, Bangalore and Kanpur).

❑ However, this may be relaxed in a place especially in Urban areas where the
population is more than 25 lakhs (**other than the nine cities mentioned in the
Clause), hilly areas, notified tribal areas, North Eastern States, Hill states and Union
Territories of Andaman & Nicobar Islands, Daman & Diu & Dadra & Nagar Haveli
**and Lakshadweep, where the land shall not be in more than two pieces and the
distance between the two pieces shall not be more than 10 kms.
❑ The hospital, college building including library and hostels for the students,
interns, PGs/Residents and nurses shall be in one piece of land which shall not be
less than 10 acres.

❑ Other facilities may be housed in the other piece of land.

❑ Proper landscaping should be done.

❑ However, in metropolitan cities and “A” class cities (Ahmedabad, Hyderabad, Pune,
Bangalore and Kanpur), the permissible FAR/FSI would be the criterion for allowing
the medical colleges provided that the total built up area required for adequate
infrastructure including medical college, hospital, hostels, residential quarters, and
other infrastructure required as per Minimum Standard requirement Regulations is
made available in an area of not less than 10 acres based upon the permissible
FAR/FSI allowed by the competent authority
 Minimum Standard Requirements for
Medical College (200 Intake Annual

(930 Beds)
The medical college or medical institution shall be housed in a unitary campus of not
less than 25 acres of land except in metropolitan and A class cities (Ahmedabad,
Hyderabad, Pune, Bangalore and Kanpur).

❑ However, this may be relaxed in a place especially in Urban areas where the
population is more than 25 lakhs, hilly areas, notified tribal areas, North Eastern
States, Hill states and Union Territories of Andaman & Nicobar Islands, Daman &
Diu & Dadra & Nagar Haveli, where the land shall not be in more than two pieces
and the distance between the two pieces shall not be more than 10 kms.
❑ The hospital, college building including library and hostels for the students, interns,
PGs/Residents and nurses shall be in one piece of land which shall not be less than
10 acres.

❑ Other facilities may be housed in the other piece of land. Proper landscaping should
be done.
Minimum Standard Requirements for Medical
College (250 Intake Annual-1130 Beds )
❑ The medical college or medical institution shall be housed in a unitary campus of
not less than 25 acres of land. However, this may be relaxed in a place especially in
Urban areas where the population is more than 25 lakhs, hilly areas, and notified
tribal areas where the land shall not be in more than two pieces and the distance
between the two pieces shall not be more than 10 kms. done.

❑ The hospital, college building including library and hostels for the students, interns,
PGs/Residents and nurses shall be in one piece of land which shall not be less than
10 acres.

❑ Other facilities may be housed in the other piece of land. Proper landscaping should
be be done.
NMC VS MCI
 MAIN HIGHLIGHTS
▪ As we mentioned earlier, the NMC bill accounts for the formation of a National
Medical Commission, both at the national and state level, within three years of the
passage of the legislation. The National Medical Commission will have 25
members, appointed by the central government.

▪ Apart from forming a Medical Commission, the bill also has a provision for setting
up a Medical Advisory Council by the Centre. This council will act as a channel
through which the states/Union Territories can convey their views and concerns to the
NMC.

▪ One of the biggest changes which the NMC Bill will bring about is the
▪ introduction of “bridge courses.” It is a known fact that in India, several rural
areas lack adequate staff or facilities at the local health centres. To ‘bridge’ this
gap, the government proposes that dentists, AYUSH and

▪ homoeopathic practitioners, paramedical students and others, be allowed to take a

six-month crash course in practical medicine. On completion, the trained students
could be allocated the post of the doctor at these healthcare facilities.
 CHANGES IN THE BILL
• Members- While MCI had 100+ members, NMC will only have 25 members in
the committee.
• Re-nomination- MCI members could be re-nominated or re-elected. But NMC
members nominated by the central government Cannot be renominated.
• Decision- In MCI fifteen of 100+ members were enough to make a meeting and its
decisions valid while for NMC, it will be 13 out of 25.
• Tenure- The MCI tenure was five years, while the NMC tenure will be four years.
MCI had to meet at least once a year while the commission has to meet every
quarter.
• Appointment- Nearly 70% of the 100-plus member MCI were elected members.
But a majority of the representatives of the NMC would be nominated by the
central government.
• Assets- Unlike MCI, the members of NMC will have to declare their assets at the
time of assuming office and when they leave. They will also have to submit a
conflict of interest declaration.
• No jurisdiction over AIIMS- Like MCI, NMC also will have no jurisdiction over
the
various AIIMS, JIMPER or PGI in almost all matters.
▪ The newly constituted National Medical Commission has removed the provision of
requirement of minimum five acres of land for setting up a medical college and its
affiliated teaching hospitals while making skills laboratories mandatory.

▪ The requirement for the number of beds in a medical college hospital has been
reduced from 530 to 430 for a 100-seat college, and from 930 to 830 for a 200-seat
college, according to the new regulations notified.
▪ In tier 1 and tier 2 cities, hilly and north-east states and notified tribal areas,
the campus could also be on two plots of land – one housing the teaching
hospital and the other the medical college with hostels for students and
interns, the notification stated.
▪ If the campus is housed in more than one plot of land, the distance between
each one of these plots should be less than 10 km or less than that of 30
minutes travelling time.
▪ “Provided that where the government district hospital is being considered for use as
the teaching hospital of a medical college, all constituents of the district hospital,
even if they are on two plots of land, will be considered as the affiliated teaching
hospital, provided that the main district hospital has at least 300 beds or in Hilly
and North-East states has 250 beds,” it said.
▪ According to the new regulations, every medical institution shall have a skills
laboratory where students can practice and improve skills pre-specified in the
curriculum.
▪ The skills laboratory shall have a total area of at least 600 sq m for intake up to 150
MBBS students annually and 800 sq m for intakes of 200 and 250 MBBS students
annually, and should have trainers or mannequins required to achieve skills outlined
in the competency based undergraduate curriculum document, the regulations
added.
 CONCERNS FOR DOCTORS

▪ The bill authorises the government to allow non-medical degree holders to

practice medicine as community health providers. This provision has been
vehemently opposed by the Indian Medical Association. According to the IMA,
this will legalise quacks in the country. The IMA claims that this will allow
anyone with limited exposure to modern medicine in the country to prescribe
medicines.

▪ The doctors and the doctor bodies also raise concerns on the mode of electing the
representatives in NMC. At present, 70% of representatives in MCI are elected
members. But when it comes to NMC, only 20% of the members would be the
elected representatives. Also, there was an allegation that the non-elected members
will be government officials or those nominated by the government, giving the
bureaucrats full control on the functioning of NMC.
• Doctors have also concerns regarding NEXT, the single national-level exit exam to
issue licenses for doctors. They claim that giving too much weightage for a single
exam can harm the career of medical aspirants.
• The doctors across the country also have counter-
argument on the decision of the commission to “frame guidelines for determination
of fees and all other charges in respect of fifty per cent of seats in private medical
institutions and deemed to be universities”. They say that it increases the number of
seats for which private institutes will have the discretion to determine fees. At
present, in such institutes, state governments decide fees for 85 per cent of the
seats.
JOINT COMMISSION INTERNATIONAL
ACCREDITATION(JCIA)
 ACCREDITATION
• Accreditation is a process in which an entity, separate & distinct from the health
care organization ,usually non governmental assesses the healthcare organization to
determine if it meets a set of requirements (standards) designed to improve the
safety and quality of care .
• Accreditation is usually voluntary.
• It has gained world wide attention as an effective quality evaluation and
management tool.

BENEFITS OF ACCREDITATION
• Improve public trust
• Provide a safe and efficient work environment
• Negotiate with sources of payment
• Listen to patients & their families, respect their rights & involve them in the care
process as partners
• Create a culture that is open to learning
• Establish collaborative leadership & continuous leadership.
 INTRODUCTION TO JCI

• Joint Commission International (JCI) was founded in the late 1990s to survey
hospitals outside of the United States.
• JCI, which is also not-for- profit, currently accredits facilities in Asia, Europe, the
Middle East, and South America.
• A count of JCI-accredited hospitals worldwide (as listed on the JCI website till
2015) shows 820 hospitals in 47 & above countries.
• 21 hospitals in India
 JCIA GLOBAL PRESENCE

JCI Team:
❑ World headquarter in North America
❑ Regional offices in Asia-Pacific, Europe, and the Middle East.
❑ More than 200 international consultants and accreditation surveyors.

WHAT IS JCI? HOW IS IT GOOD FOR US?

• JCI stands for JOINT COMMISION INTERNATIONAL.
• It is US based, not for profit accreditation body, which sets & addresses standards
for the healthcare providers level of performance in key functional areas, such as
patient rights, patient treatment & infection control.
• JCI’S mission is to improve the quality of healthcare in the international
community by providing worldwide accreditation services.
• JCIA is an initiative designed to respond to a growing around the world for
standards- based evaluation in healthcare.
 HOW WILL IT HELP US?
• JCI standards would lead us to improved patient care, safety & path of continuous
quality improvement.
• This would strengthen patient ,third party and insurer confidence and would
provide us a competitive edge.
• JCI accreditation is the gold standard for quality as it reflects the provision of
patient care & patient safety.

JCI ACCREDITS 8 TYPES OF

HEALTHCARE PROGRAMS:
1. Hospitals
2. Academic medical care hospitals
3. Ambulatory care facilities
4. Clinical laboratories
5. Home care facilities
6. Long term care facilities
7. Medical transport organization
8. Primary care centers.
 JCI SURVEY METHODOLOGY

• Typical survey team consists of a physician, nurse , and administrator.

• Surveyors evaluate various units within an organization and meet to discuss their
findings
• Surveys conduct a complete system analysis on integration and coordination of care
processes.

ACCREDITATION SURVEYS
• Interviews with staff & patients & other verbal information.
• On-site observation of patient care process by surveyors
• Policies, procedures, clinical practice guidelines, and other documents provided by
the organization.
JCI ACCREDITATION PROCESS
TIMELINE
 SCORING THE SURVEY RESULTS
• Each standard must have a scoring of at least 5
• Each chapter must have a score of at least 8
• All standards must together average for at least 9
• All measurable elements are averaged to obtain the core for the standards..

SCORING SURVEY RESULTS

• Each measurable element (ME) is scored.
➢ Met (10)
➢ Partially Met (5)
➢ Not Met (0)

• All standards are averaged to obtain the score of the chapter

• All Chapters are averaged to Obtain the overall score.
 IPSG ( INTERNATIONAL PATIENT
SAFETY GOALS)
GOAL 1
• Identify patients correctly
GOAL 2
• Improve effective communication
GOAL 3
Improve the safety of high alert medications
a. IV potassium chloride = or > 2meq concentration
b. Sodium chloride >0.9%
c. Magnesium sulphate =or >50% concentration
d. Potassium phosphate = or > 3mmol/ml concentration
GOAL 4
• Ensure correct site , correct procedure & correct patient surgery
GOAL 5
• Reduce the risk of healthcare associated infection
GOAL 6
• Reduce the risk of patient harm resulting from falls
THANK YOU