Dearth of MBBS seats along with difficulty in getting admissions in medical colleges is forcing aspiring Indian doctors to explore learning opportunities abroad. Thousands of such aspiring doctors have enrolled in foreign universities over the years, spent lakhs of rupees as tuition and accommodation fee, and dedicated 5-6 years pursuing the course. But latest data show this investment is proving to be unproductive for a majority with nearly 84 per cent failing to clear the mandatory test required to practice in India.

Indian laws allow students to pursue MBBS courses from universities abroad. But in order to get a license to practice in India, they are required to qualify the Foreign Medical Graduate Examination (FMGE) conducted by the National Board of Examination (NBE).

Clearing FMGE test is mandatory for all doctors who have earned their MBBS degree from a foreign country. Only those who earn their MBBS and post-graduate degrees from Australia, Canada, New Zealand, the UK and the US are exempted from this test. Besides earning their degrees from these five countries, these students (in case they want to practice in India) also have to be recognised for enrollment as medical practioners in the respective countries.

Replying to written questions in the Lok Sabha on November 29 and December 6 during the Winter Session of Parliament, the Union health ministry accepted that a majority of foreign-educated doctors are finding it hard to qualify the screening test.

Calling out these institutions for poor performance of their students, the government said they "admit Indian students without proper assessment" of the students' academic ability to cope up with medical education, resulting in a situation where many students fail to qualify the screening test.

Data available with the National Board of Examination show that nearly 84 per cent Indians who earned their MBBS degrees from foreign universities in the last seven years (2012-18), failed to clear the mandatory test required to get a practicing license in India.

Between 2012 and 2018, a total of 97,639 Indians who earned their MBBS degrees from foreign universities appeared for Foreign Medical Graduate Examination (FMGE). Of these, only 16,097 were able to clear ita pass percentage of just 16 per cent.

THE WEAK LINK

Among those taking FMGE, most were graduates from Chinese and Russian universities, comprising 51 per cent of the total examinees. However, only a handful among them managed to clear the test.

Of the 32,139 Indian doctors who graduated from Chinese universities and took FMGE between 2012 and 2018, only 4,609 managed to pass it. Similarly, 17,674 MBBS graduates from Russia took FMGE in this period but only 2,606 were able to clear it.

The bottom line thus is: though Indian students spend lakhs in pursuing MBBS course abroad and dedicate 5-6 years, the quality of education in these countries and its disparity with the curriculum in India, is such despite holding MBBS degrees, they are sparingly able to qualify the mandatory test that would make them eligible to treat patients in India.

WHERE INDIANS PREFER TO PURSUE MBBS

National Board of Examination's data for FMGE show Indians earned MBBS degrees from over 60 countries between 2012 and 2018. (Students in Australia, Canada, New Zealand, the UK and the US aren't included in this as they are exempted from FMGE.)

Data of those who took FMGE between 2012 and 2018 show China was the most-favoured destination for pursing MBBS among Indians. It was followed by Russia, Ukraine, Nepal and Kyrgyzstan.

Together, 76,425 Indians graduated with an MBBS degree from these five countries and took FMGE between 2012 and 2018. This was 78.27 per cent of the total FMGE examinees.

But of these, only 11,516 (15 per cent) were able to clear the screening test and get a license to practice in India.

THE MOST AND LEAST SUCCESSFUL

In terms of success rate, MBBS graduates from France, Kenya and Saint Marteen attained a 100 per cent pass percentage, while those from Uganda, Sri Lanka and Czech Republic secured a pass percentage of 80, 75 and 66 per cent, respectively.

These figures, however, don't show the complete picture because the top three countries had just one MMBS graduate each taking the FMGE, while the other three had five or less than five taking the test.

For a holistic and comparative understanding of pass percentages of MBBS graduates from different countries, in this analysis we have picked up only those countries from where at least 50 MBBS graduates took the FMGE between 2012 and 2018.

Based on this analysis, MBBS graduates from Mauritius were the most successful, recording a pass percentage of 55 per cent. The next two most successful MBBS graduates were from the UAE and Pakistan with a pass percentage of 42 and 30 per cent, respectively.

Among countries with at least 50 FMGE examinees, MBBS graduates from Bulgaria were the least successful as only 9.80 per cent of them were able to clear the test. Between 2012 and 2018, 204 Indians who earned their MBBS from Bulgaria took FMGE, but only 20 passed it.

Indians graduating from Romania and Azerbaijan were only marginally more successful than their Bulgarian counterparts. During this period, 336 Indians graduated from Romania took FMGE and 33 of them cleared itwith a pass percentage of 9.82 per cent. The numbers for Azerbaijan, the third least successful country were: 229 examinees; 26 successful; pass percentage 11.35 per cent.

BE CAUTIOUS: WARNS MCI

As a note of caution, the Medical Council of India (MCI) has issued guidelines detailing aspects students should consider before enrolling for an MBBS course abroad. The MCI states that there are a large number of MBBS graduates from foreign countries who are waiting to clear FMGE to obtain license to practice in India.

"The students are advised to exercise due discretion in selecting foreign institutions and countries considering the quality of medical education imparted vis-a-vis the requirements of clearing FMGE," the guidelines state.

The MCI also advises foreign medical institutions to ensure the quality of Indian students who they admit to their courses. It says these institutions "must pay particular attention" to the medium of instruction (preferably English) and ensure students have sufficient clinical exposure.

"The performance of their Indian students in FMGE would reflect on the standard of medical education on the concerned institution and, in cases of continuous poor performance in FMGE, it may lead to withdrawal of permission of MCI for the institution in the interest of Indian students," the MCI guidelines say.

To help those who have already graduated from foreign universities but have repeatedly failed to qualify FMGE, the government has prepared a draft Skill Training Curriculum so that such students can prepare for the exam through self-sustaining MOOCs (Massive Open Online Courses) and Clinical Skill Labs etc.

But the fact that 84 per cent foreign-educated doctors were unable to clear FMGE between 2012 and 2018, not only raises questions on the quality of medical education imparted in these universities, but also opens up the possibility of many of them practicing illegally in India.

The government's monitoring mechanism to identify and trace doctors practicing without license is not robust enough to act as a deterrent.

Besides, in order to address the mounting shortage of qualified doctors, India urgently needs to increase the number of MBBS seats in medical institutes. If achieved, this can help check the trend of Indians going abroad to earn an MBBS degree from foreign universities even though their past graduates have abysmal records of clearing FMGE.

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