Making the final year MBBS examination also the designated licentiate examination is fraught with a host of complications. Making the final year MBBS examination also the designated licentiate examination is fraught with a host of complications.

IN HIS address at the AIIMS convocation Tuesday, Health Minister J P Nadda had defended MCI reforms — read the National Medical Commission Bill currently with the standing committee on health. One committee meeting in, the health ministry is already exploring the option of whether the proposed licentiate examination for doctors can be replaced with the final year MBBS examination, as demanded by the medical fraternity.

The first meeting of the standing committee happened on January 12 and ministry officials are back to the drawing board looking at how to make the final year examination fulfil all the various roles that the proposed exit exam would have played. Apart from qualifying doctors for licensing, it was also to have functioned as a screening test for foreign medical graduates and as a common entrance test for postgraduate programmes.

Making the final year MBBS examination also the designated licentiate examination is fraught with a host of complications, not least of which is the fact that the MBBS final year examination tests students in only four subjects. An examination that tests the suitability of a doctor to see patients, say ministry sources, cannot be that restrictive.

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It would also mean, for all practical purposes, that the final year entrance examination — that would have to be conducted by the proposed National Medical Commission instead of individual medical colleges as it currently happens — would essentially become as decisive as the class-XII examination is in deciding a student’s choice of course and college, robbing doctors of multiple attempts at the PG entrance test in order to get a specialty of their choice.

The introduction of a licentiate exam, after passing MBBS, which would make doctors eligible to practice medicine in the country, is among several thorny proposals in the NMC Bill that was introduced in the Lok Sabha during the recent winter session and immediately sent to the standing committee. “The Commission shall conduct a uniform National Licentiate Examination for students graduating from the medical institutions which are governed by the provisions of this Act for granting licence to practice medicine as medical practitioners and for enrolment in the State Register or the National Register, as the case may be,” says the bill.

Medical students in Bhubaneswar protest the proposed NMC Bill during a nationwide strike on January 2. Medical students in Bhubaneswar protest the proposed NMC Bill during a nationwide strike on January 2.

Wiser from the experience of the common medical entrance test, NEET, which got mired in a web of court cases, delaying its implementation by several years, the ministry is wary of a similar tangle over the provision of a separate licentiate examination – the way NEET is conducted without interference of the academic calendars of any states/schools/boards. “We are looking at 480 colleges, reconciling the academic schedules, payment of fees etc of all of them. If even one student goes to court, the entire process could come to a halt. That is a serious concern. Also, making the MBBS final exam double up as the licentiate examination would mean that the Foreign Medical Graduates Examination (FMGE) would have to continue as a separate entity. That then leaves us open to the present criticism of FMGE being a tougher test that results in lower pass rates,” a government source said.

On the other contentious provision – a bridge course that would allow AYUSH doctors to practise modern medicine – the government is hopeful of convincing the standing committee that the provision in reality is so stringent that it may never actually happen. Every member of the 25-member NMC, which includes five elected members and directors of AIIMS, JIPMER, PGIMER etc, has a veto on this issue. A bridge course can in reality happen only if the NMC decides on it unanimously.

The bill says: “The joint sitting [of the National Medical Commission, the Central Council of Homoeopathy and the Central Council of Indian Medicine] referred to in sub-section (1) may, by an affirmative vote of all members present and voting, decide on approving specific bridge course that may be introduced for the practitioners of Homoeopathy and of Indian systems of Medicine to enable them to prescribe such modern medicines at such level as may be prescribed.”

Ministry sources say opposition to the provision had actually taken the government by some surprise; while it was being drafted, there were concerns that the criticism may actually be that the bill is biased against Indian systems of medicine rather than in their favour.

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