Discussion

National Council of Health and

Human Resources

Christian Medical College, Vellore

 Outline of talk

• Regulation and Accreditation

• Models 1 - 4

• Areas for discussion

 Problem
Lack of access to Insufficient doctors
basic health care in needy areas

Medical Council Acts Abstract notion of

professional standards
Not related to provision
of health care
 Social mandate of the Council
to the Republic of India

• Relevant basic MBBS/PG training

• Address disparities in access to health care

- Location of training institutions
- Background of students
- Linkage of training to health care
needs
 COUNCIL

Medical Education Professional Practice

Independent regulation
 Need for Council
covering all health disciplines
Functions:
• Governing body
NCHRH • Ratification of
decisions
• Coordination

Medicine Nursing Dentistry Rehab Allied Pharmacy Public

& PT health health
science

Functions:
Standard setting, accreditation, recognition, examinations
 Regulation for medical education
1. Regulator

2. Setting of standards

3. Accreditation process

4. All levels of education- UG, PG, CME

 1. Regulator of medical education
• Size

• Expertise

• Composition- to include public representation

• Selection process
 2. Define standard setting process for
medical education
• Standard setting process- Basic mandatory
standard
Quality development
standard

• Measures of quality of medical education

(Learning environment, teaching and learning
processes, faculty, assessments)

• Define the competency of a basic doctor

 3. Models of Accreditation

• Principles based model

• Outcome based model

To allow flexibility in curriculum planning

 Processes of Accreditation

• Data gathering- • Standardization

Internal
Peer review • Accountability

• Decision making • Transparency

 Accreditation
Achievement of outcome

• Exit examination

• Regulation of assessment processes

The process of standard setting of
education and accreditation should be
performed by the same body.
 4. Regulation of
all levels of medical education
• Undergraduate
Linked but separate
• Postgraduate bodies

• Practicing physician -
Continuing professional Professional regulator
development
 Postgraduate medical education-
need for expansion
• General specialties particularly family medicine

• Super specialty based on need

- Creation of postgraduate boards

- Accrediting hospitals outside University
for PG training
 Attributes of good regulation and
accreditation

• Social mandate
• Regulator
• Standard setting
• Accreditation
• Address all levels of education
• Public accountability
 Models 1-4
Common features
1. Council overseeing health professions
education
2. Separation of regulation of medical
education and professional practice
3. Standard setting and accreditation
4. Common exit examinations
 Model 1
• Strengths
1. Overall governance structure including all disciplines of
medicine- common legislation
2. Separation of accreditation and professional regulation
within council

• Weaknesses
1. Small council- does not include non-professional members
2. Accreditation processes and standard setting not
adequately specified
3. Too prescriptive in educational requirements
4. Continuing medical education not specified
 Model 2
• Strengths
1. Autonomy of educational institutions
2. Colleges to award their own degrees under the University

• Weaknesses
1. Continuation of existing councils with their problems
2. Separate legislations covering each council leading to
asynchrony
3. Complete separation between education and professional
regulation
4. Does not address the disciplines other than medicine, nursing
and dentistry
 Model 3
• Strengths
1. Emphasis on CME credits
2. Concept of continuous quality improvement of
academic institutions
3. Specialty boards for PG training

• Weaknesses
1. Separation of accreditation from standards setting and
planning of education
2. Central entrance examinations for UG and PG
3. Central regulation of institutions
4. Does not address the disciplines other than medicine,
nursing and dentistry
 Model 4
• Strengths
Emphasis on postgraduate education
Inclusion of non-university hospitals for PG training
Renewal of registration through CME

• Weaknesses
Separation of UG and PG training
Separation of accreditation and professional regulation
not clear
Does not address the disciplines other than medicine,
nursing and dentistry
 SUGGESTED MODEL
Model 1 Governance structure
1. Relative independence of departments under overall
council
2. Each department should have undergraduate,
postgraduate and professional regulation sections
3. The size of council to be 10-12 with one-third public
representation
4. Setting up standard setting process- basic mandatory
and quality development standards
5. Specify accreditation processes based on principles
and outcome to allow flexibility in curriculum planning
 Suggested model
5. PG sections should establish postgraduate
specialty boards
6. Accredit institutions outside Universities for PG
training
7. Expand PG training specially in general specialties
and family medicine to meet national
requirements
8. Recertification through CME credits and appraisal
9. Allow autonomy of well performing educational
institutions
10. Enable colleges to award their own degrees
under the University