MCI Restructuring of MBBS Curriculum

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Jan 6, 2011, 9:20:03 AM1/6/11
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Dear Sir

I request your good self to go through the foloowing links below

http://mciindia.org/tools/announcement/UG-medical-education.pdf

http://mciindia.org/tools/announcement/PG-medical-education.pdf

While studying the MBBS restructuring proposal by MCI, one can very
well see that there is a deliberate attempt from the part of MCI to
make the future MBBS course almost equivalent to that of BRHC Course.
Also kindly go through the syllabus of Pharm-D Course conducted by
Rajiv Gandhi University. Please go through the contents of the various
subjects shown in the syllabus. I have quoted some of the relevant
subjects from their syllabus in this mail. Please don’t look at the
name of the subject and conclude. I am sure you will understand the
situation of an MBBS doctor in the future. I once again request you
to, at least, go through the contents of the subjects. Evaluate to
what depth the Pharm-D student will study about the diseases and its
managements. One cannot expect the entire MBBS graduates will get an
opportunity to do Post graduation. So in front of a Pharm-D doctor, an
MBBS doctor will be nothing when the knowledge is compared.
Please don’t support the proposed suggestion by MCI which will
definitely degrade our profession.
In the future the old MBBS of four and half years and the new proposed
MBBS of three and half years will not be having any distinction. They
will be considered as same. Hence if the MCI decides to carry on with
the present proposal, then the name of the proposed MBBS has to be
changed and I suggest to call it as
MBBS (LE) ---LE means Least Edition or Lower Edition
http://mciindia.org/tools/announcement/PG-medical-education.pdf

From the restructuring proposal for PG Courses by MCI which is given
in the above link, every thing seems to be ok except the following
things which I will quote below:


From the proposal of PG restructuring, page No: 4, it is given as
follows:

“Entrance examination for the postgraduate courses: Once approved the
entrance examination can be commenced with phase one for the new batch
of MBBS students being admitted to the course in July 2011. This plan
for the entrance to Post graduation can be mentioned in the brochure
of MBBS. They will take the first professional examination 1 & 2 in
2012 & 2013 and the National Exit Exam step1 examinations in 2015 &
Step 2 at completion of internship. Till such time the batch of MBBS
students admitted in 2011 reach internship the old scheme of
examination for admission to the PG courses would continue.”

In the page No: 8, it is given that


“ENTRANCE TO PG
Steps 1 + 2 scores will be combined



Note: Both the exit exams will be necessary for licensure to practice
independently & MCI
registration.”

It is understood from the proposal that the exit exams at step I (at
the end of IV year MBBS) and step II (after the internship) will be
completed by the MBBS graduate during his MBBS curriculum. That means
the old MBBS graduates cannot be allowed for the admission to PG
course under the new scheme. Presently any MBBS Graduate can attempt
for PG admission at any time and as many number of times as he wants.
An MBBS graduate might have joined or obtained MBBS Degree with that
intention in his mind. But the present proposal will not provide that
freedom to the present MBBS graduates in the future.This is against
the current Medical PG admission regulation 2000,according to which
there is no bar for the age and number of attempts by an MBBS graduate
for PG admission. So my request is to provide a parallel path of
admission to the old MBBS graduates to the PG course. Because, the
entire old MBBS Graduates will not be vanished from the earth on one
fine morning. So please don’t launch them in to the Bay of Bengal with
the new Rocket proposal.



Then my question is:

1. Will the students admitted for MBBS course from the year 2009 get
enough opportunity to attempt for the MD Courses?

2. Will the old MBBS graduates be allowed to admit in the PG Courses
under the new method of entrance to PG course?

3. How many attempts will be allowed for old MBBS graduates for the
admission to PG Courses under the old Scheme?



Also in the page no:4 under the head:

“Program evaluation of the proposed new format course

3. Level IV evaluation (impact) evaluation: After 6-7 Years

a. Evaluate impact of this course on specialist pool, community
health, rural and
urban specialists distribution and other effects on the human health
system”


Everything seems to be ok till the point No: 2, .But the above
sentence shows the lack of confidence of MCI about the results and the
products of the restructured system. That means the specialist doctors
coming out for six to seven years are only the “guinea pigs” for the
MCI to implement new systems in the medical field ! ! !

Please look in to this matter and avoid the possible hard ships to the
existing MBBS graduates. Otherwise the rocket model of medical
education will be questioned and may fall in to the Bay of Bengal as
usual in the case of our space research organization…..


I believe that it is the proper time to discuss the future of our
profession as the situations are slowly revealed from the proposal of
MBBS restructuring. While all other braches in the health sector is
trying to grab more and more share in the health sector and there by
trying to establish their importance and positions, we the MBBS
doctors are put in the reverse gear by going down to BRHC course and
now restructuring the MBBS curriculum to an effective duration of 3.5
years.(excluding the duration set for the electives as the electives
are selectable and different students will have different subject as
per their selection. So the duration of the study of electives cannot
be included in the core duration of the course ).Instead of going
strong by introducing more and more subjects and technologies in the
curriculum, MCI is trying to hold us in the elementary level.We cannot
stop other branches of medicines from upgrading and growing,but we can
restructure ourself or reorganize ourself to stand one step ahead of
them. isn't? This will be much more clear from the following
discussions.

I could not attach the detailed syllabus and other details of
Pharm-D course conducted by the Rajiv Gandhi University.I give this
talk here only for a comparison . If go carefully through the
syllabus, one can very well see that the Pharmacy council of India
have covered almost all of the diseases through various subjects and
the corresponding practical via different names and heads. It is not
like that of MBBS curriculum where the sections are categorized as
general medicine, paediatrics, ENT, etc. But here they have concealed
every thing and interpreted in a different way so that one cannot make
out clearly, at first sight; to what extent the student is taught
about general medicine and the clinical aspects. One can realize it
only after going through the syllabus in the attached file. After
carefully going through the syllabus of Pharm-D (from the attached
file) and proposed MBBS curriculum and also the BRHC curriculum one
must judge who the better doctor at the first consulting point is?
There is a deliberate attempt from the part of MCI to make the future
MBBS course almost equivalent to that of BRHC Course. One cannot
expect allthe MBBS graduate will get an opportunity to do Post
graduation.

As all the doctors in India know that in the present days MBBS
curriculum the clinical -non surgical subjects have given more
importance. But clinical with surgical subjects are not given any
emphasis in the current MBBS curriculum. I have suggested the
extension of present MBBS duration from five and half to six and half
years by including subject like the following so that an MBBS graduate
should expertise on surgical procedures, medical imaging technologies,
gene therapy and stem cell therapy, genetic engineering, bio-
engineering etc .Also in the present day’s scenario, they should be
aware of management concepts and legal knowledge.

It is seen from the proposals that there is a deliberate attempt to
degrade and reduce the significance of MBBS and make equivalent to
that of BRHC courses in the future. Hence the authority believes that
there wont be much objections or resistance for the introduction of
BRHC course in the proposed community medical colleges where ever and
when ever the authority or the politicians desires.

From the proposed restructuring of MBBS curriculum the following
defects and modifications suggested.

1. It is seen from the proposal that the total course duration has
reduced from 5.5 years to 5 years. What ever be the modifications,
reducing the course duration will definitely will spoil quality of
MBBS Degree and degrade the reputation of the profession. So it is
suggested that the duration may be increased to 6.5 years by including
more subjects like the following (Otherwise what is the difference
between MBBS and BRHC courses? Out o the five years six months is for
the proposed electives. So effectively there will be only four and
half years duration for the MBBS course including the internship.)

2. With the proposed as well as the current MBBS curriculum, the
graduate after MBBS will become only a technician. But it is not at
all sufficient in the present day’s scenario. An MBBS graduate must be
aware of management concepts which help him to manage the patients
well and the hospitals and clinics. This will enable the doctor to
deal the patients well and provide them better health care.

3. An MBBS graduate must be aware of the legal aspects regarding his
profession. Hence some legal papers should be included in the MBBS
curriculum. This will provide confidence to the doctor and he will be
aware of his duty and other legal aspects so that possibility of
committing purposeful mistakes can be avoided during the profession.
This will create an atmosphere for better health care.

4. The proposed electives must be avoided as this will create doctors
with different knowledge or awareness at the first consulting points
where there should not be any distinction, which a common patient may
not be aware of. If it is a mandatory item, then can be included as
the common subject and increase the duration of the course by six
months to a total of seven years.

5. The test before licensing to practice must be avoided or it should
be restricted only for MBBS graduates. Or else it indicates that even
after restructuring the MBBS curriculum, MCI is not confident about
the quality of MBBS graduates. Then there is no point in restructuring
the MBBS curriculum???
If it is allowed it is quite clear that those who can pass the license
test will be eligible for the general practice in the future!!! There
by the BRHC people will also be allowed to appear for the license
test…
If a BRHC person is able to pass the license test, then no one can
oppose their GP as a doctor… It is also noted that the proposed
conversion of the district hospital in to a community medical college
is to facilitate the conduction of the BRHC course where ever the
authority desires.
The above points no: 1 and no: 5 have to be read together..,.


Pharm-D :-( Iam not in a position to attach files so that I could not
attach he Pharm-D syllabus file with this mail.So please refer he
syllabus from PCI site.)

Came to know that PCI is having a plan to, gradually, phase out BPharm
Degree in few years, by giving opportunity for existing BPharm
Graduates to attain PharmD by some method, as done in USA earlier.
Keep this fact in mind.

Duration of Course :

Six academic years (Five years study and one year Internship) after
PUC or D.Pharm

Course Content :
o Theory and practical subjects very similar for B.Pharm course
o Internship or residency for one year in multi speciality teaching
hospital
_ Includes postings in speciality hospital units
_ Six months in general medicine department
_ Two months each in three other speciality departm

Certificate of passing Examination :

Being a doctoral degree, a person with PharmD qualification can keep
Dr. as the prefix to his name.

Doctor of Pharmacy
(Pharm.D) Degree will be issued


Duration of the course. –

a) Pharm.D: The duration of the course shall be six academic years
(five years of study and one year of internship or residency) full
time with each academic year spread over a period of not
less than two hundred working days. The period of six years duration
is divided into two phases

Phase I – consisting of First, Second, Third, Fourth and Fifth
academic year.

Phase II – consisting of internship or residency training during sixth
year involving posting in speciality units. It is a phase of training
wherein a student is exposed to actual pharmacy practice or clinical
pharmacy services and acquires skill under supervision so that he or
she may become capable of functioning independently.


Minimum qualification for admission


A pass in any of the following examinations -

(1) 10+2 examination with Physics and Chemistry as compulsory subjects
along with one of the following subjects:
Mathematics or Biology.

(2) A pass in D.Pharm course from an institution approved by the
Pharmacy Council of India under section 12 of the Pharmacy Act.

(3) Any other qualification approved by the Pharmacy Council of India
as equivalent to any of the above examinations.

Provided that a student should complete the age of 17 years on or
before 31st December of the year of admission to the course.


Here are a few portion of the syllabus of Pharm-D course which
directly have the involvement with MBBS curriculum.

Please don’t look at the name of the subject, but see the contents
given in the attached file.


Syllabus of Pharm-D course conducted by Rajiv Gandhi University

One have to go through the syllabus of the below mentioned subjects in
the attached file to understand the truth. I have quoted below only
the relevant subjects for the discussion.


First Year

1.1 HUMAN ANATOMY & PHYSIOLOGY

1.3 MEDICINAL BIOCHEMISTRY
BIOLOGY :

Second year

2.1 PATHOPHYSIOLOGY

2.2 PHARMACEUTICAL MICROBIOLOGY

2.4 PHARMACOLOGY – I

2.5 COMMUNITY PHARMACY( very important)

1. Scope: In the changing scenario of pharmacy practice in India,
Community Pharmacists are expected to offer various pharmaceutical
care services. In order to meet this demand, students will be learning
various skills such as dispensing of drugs, responding to minor
ailments by providing suitable safemedication, patient counselling,
health screening services for improved patient care in the community
set up.


2.6 PHARMACOTHERAPEUTICS – I

1. Scope of the Subject: This course is designed to impart knowledge
and skills necessary for contribution
to quality use of medicines. Chapters dealt cover briefly
pathophysiology and mostly therapeutics of various diseases. This will
enable the student to understand the pathophysiology of common
diseases and their management.

Third year

3.1 PHARMACOLOGY – II

3.3 PHARMACOTHERAPEUTICS – II
1. Scope of the Subject: This course is designed to impart knowledge
and skills necessary for contribution to quality use of medicines.
Chapters dealt cover briefly pathophysiology and mostly therapeutics
of various diseases. This will enable the student to understand the
pathophysiology of common diseases and their management.

3.4 PHARMACEUTICAL JURISPRUDENCE

1. Scope of the Subject:) This course exposes the student to several
important legislations related to the profession of pharmacy in India.
The Drugs and Cosmetics Act, along with its amendments are the core of
this course. Other acts, which are covered, include the Pharmacy Act,
dangerous drugs, medicinal and toilet preparation Act etc. Besides
this the new drug policy, professional ethics, DPCO, patent and design
Act will be discussed.

Fourth year

4.1 PHARMACOTHERAPEUTICS – III

1. Scope : This course is designed to impart knowledge and skills
necessary for contribution to quality use of medicines. Chapters dealt
cover briefly pathophysiology and mostly therapeutics of various
diseases. This will enable the student to understand the
pathophysiology of common diseases and their management.

4.2 HOSPITAL PHARMACY

1.Scope: In the changing scenario of pharmacy practice in India, for
successful practice of Hospital Pharmacy, the students are required to
learn various skills like drug distribution, drug dispensing,
manufacturing of parenteral preparations, drug information, patient
counselling, and therapeutic drug monitoring for improved patient
care.

4.3 CLINICAL PHARMACY

1. Objectives of the Subject :
Upon completion of the subject student shall be able to (Know, do,
appreciate) –

a. monitor drug therapy of patient through medication chart review and
clinical review;

b. obtain medication history interview and counsel the patients;

c. identify and resolve drug related problems;

d. detect, assess and monitor adverse drug reaction;
e. interpret selected laboratory results (as monitoring parameters in
therapeutics) of specific disease states; and

f. retrieve, analyse, interpret and formulate drug or medicine
information.

4.6 CLINICAL TOXICOLOGY

Sixth Year:

Internship or residency training including postings in speciality
units. Student should independently provide the clinical pharmacy
services to the allotted wards.
(i) Six months in General Medicine department, and
(ii) Two months each in three other speciality departments


Internship._ (1) Internship is a phase of training wherein a student
is expected to conduct actual practice of pharmacy and health care and
acquires skills under the supervision so that he or she may become
capable of functioning independently.


The following are the expected role of a pharmacist in the future
health sector which given by IPA:

Some of the roles of PharmD (community) pharmacists are as follows:

1. Patient medication history interview

2. Medication order review

3. Patient counseling regarding safe and rational use of drug

4. Adverse drug reaction monitoring

5. Drug interaction monitoring

6. Therapeutic drug monitoring

7. Participating in ward rounds

8. Providing drug information at the drug information and poison
information centre.
.
Career options available to PharmD Graduates:


v Community Pharmacy
v Hospital Pharmacy
v Pharmaceutical Industry
v Pharmacy Education
v Bio-medical research
v Geriatric Pharmacy
v Governmental Agencies
v Home Healthcare
(Possibility of General Practice in Modern Medicines also considered)

Proposed MBBS curriculum by MCI

Structure and Duration of the Course

The committee recommends the following for consideration for
implementation:
A 4+1 model of training (4 years course + 1 year internship); 1+1+2+1

4 year course + 1 year internship (which includes 6 months of
electives) Effectively the course duration will be three and half
years(excluding the duration for electives which is as good as BRHC
course duration)
The course would be of 4 years duration with one year internship and
provision for elective periods of 6 months before or after internship.
Curriculum can be divided into core and non-core with the non-core
part of the curriculum be made elective or applied.


Minimum qualification for admission:

Class XII with Physics, Chemistry and Biology as subjects with 50 %
marks for Biology alone and an aggregate of 50% for all the subjects.


Subject covered

Group A:

Year1-
Anatomy,
Physiology and Biochemistry;

Year 2-
Pathology,
Microbiology and Pharmacology

Group B:

Year 4-
Medicine,
Surgery
Obstetrics and Gyanecology,
Paediatrics,
Family Medicine and Community health

Group C :

Year 2-
Forensic medicine

Year 3 and 4-

ENT and Opthalmology,
STD and Dermatology,
Orthopaedics,
Accident and Emergency Medicine,
Radiology,
Anaesthesia,
Psychiatry
Elective options- clinical and research electives

Even after passing the restructured MBBS one should undergo the
following:

Certification of skills is necessary before licensure.


Career options available to MBBS Graduates:

What should I write here????

Now here we have to see the scope of the pharmacist and must compare
it with that of the MBBS doctor:

BRHC Course

Structure and Duration of the Course

The course would be offer in three-and-half-year (approximately same
as proposed MBBS Course—When Electives kept away) and will not have
any specialization.
(To show the difference between MBBS and BRHC Course the electives are
introduced in the MBBS restructuring proposal)

Minimum qualification for admission:

Class XII with Physics, Chemistry and Biology as subjects.

Weightage will be given to those who have studied in village schools.

Subject covered

The course will be broken up into
Anatomy,
Physiology and Biochemistry,
Pathology and Microbiology,
Pharmacology,
Forensic medicine,
Medicine and allied disciplines,
Paediatrics,
Surgical an allied disciplines,
Orthopaedics,
Obstetrics and Gynaecology
community medicine.

Career options available to BRHC Graduates:

Spoil the medical profession ! !

“The key points listed in the draft will be the skeleton for the
implementation of this course. Only a few changes are expected in the
final framework.”


Now you decide who is the better
doctor?



Also the following points may be noted:
The current doctor population ratio in India and in some of the other
countries are given by the MBBS restructuring proposal and is given
below:

The current doctor population ratio in India is 1:1700 when compared
to a world average of 1.5: 1000. The committee came to a consensus
that targeted doctor population ratio should be 1: 1000 by 2031.




Table 1 : Doctor population ratio around the world
Somalia 1:10,000 Singapore 1:714
Pakistan 1:1,923 Japan 1:606
Egypt 1:1,484 Thailand 1:500
China 1: 1,063 UK 1:469
Korea 1:951 USA 1:350
Brazil 1:844 Germany 1:296


But it is not clearly specified whether the number of doctors in other
braches of medicines like Ayush, Homeo,Sidha etc are counted while
preparing this table ! ! If not, it is a disgrace to those doctors
working in other braches of medicines as it means that only the
modern medicine doctors are capable of serving the patients
effectively.....

If one compare other countries and blindly adopt the systems and
statistics there, then the other branches of medicines like
Ayush,Homeo, Sidha etc. must be banned in India as these branches of
medicines are not allowed in most of these countries ....Why can’t we
adopt that set up too???

Regards

Vtharavath
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