Qualified Medical Teaching

Contention of AIMDDA- a case of disparity exists between MD and MSc degrees

itself- hence we seek differential treatment of MD and MSc even when holding

same posts. Both degrees are fundamentally different, have no similarity between

them, hence the very notion of giving equal post to different degree holders is

against natural justice, is illegal.

To exemplify a case  at Dharwad court-in case of

appointment to post of associate professor in biochemistry. The opposite lawyer

has argued that both persons are eligible to post of associate professor as per

schedule –I of TEQ regulations MCI of 1998.We could contest this case. Because

of the fundamental difference in degrees does not allow a MSc person to decipher

and report on the various lab tests or appear testimony to honorable courts as

an expert evidence in medical biochemistry or microbiology as the MSc person in

question does not know the fundamentals of Medicine, surgery or Gynecology and

hence cannot claim any sort of equivalent status.Further,on basis of being a

doctor, we are eligible to non practicing allowance, or have a option of

practicing medicine, as per our basic qualification,MBBS.This luxury is denied

to a MSc in Biochemistry or a PhD as he is bereft of appropriate medical

knowledge to diagnose or treat medical diseases. At the same time a MSc is not

trained in pathology or microbiology hence cannot report a sample in

pathological laboratory while a MBBS doctor can report with confidence on the

same sample.

In another case of Parity at Cochin bench of Kerala High court

It has been argued by certain lawyers that MSc persons have been traditionally

been medical teachers in medical colleges hence their continuance as medical

teachers in preclinical/preclinical branches be allowed. In Science, or in

reality of life, just because a unjust practice is in vogue, it does not confer

a immunity against repeal of the unjust practice. One lawyer told that once

medical council has recognized certain qualifications to have been sufficient to

claim a post-e.g. assistant professor post-a MD or an MSc can both apply for the

post is their contention. But it does not however mean that to the council both

qualifications are equal. Though on paper, as per MCI, there is not much for us

to say how we are superior to an MSc, the fact speaks for it self sometimes, and

is itself evidence. A medical man is usually called for forensic evidence not a

master of science in forensic medicine. Ability to teach a subject is different

from ability to give evidence as a truly qualified professional and that fact

distinguishes superiority of an MD from an MSc in any of the medical subjects.

Just because an MSc is a teacher he is allowed to teach. On the face of it we

agree that medical science is not a monopoly of medical MDs or MBBS doctors, but

the fact remains that we are the best persons in our fields as we have been

trained as Doctors. Such a training is absent in MSc PhDs.

Another example –doing a operation to remove a diseased appendix-we can engage a

MBBS doctor, a MS doctor or a MCh doctor to do the same job, which can be done

by a trained nurse or a operation theatre technician itself, if they apply their

minds, but is illegal, as the latter two are not trained in the subject. The

quality of work done by these specialists is also different and hence their

consultation charges vary as noted in reality. The above operation could require

a wound of 12 inches or one inch, and this is the difference in employing a

general doctor or a specialist, as they would employ different techniques (like

laparoscopic surgery and minimize the pain) .Same reasoning can be applied to a

non-doctor teaching basic medical sciences when compared to a medical doctor

teaching basic medical sciences. A non doctor would use non-medical analogy to

teach a applied medical science, while a medical doctor would dig upon his

medical training and expertise to confidently teach applied medical topics.

Government of India, Health ministry or MCI or the Courts of India does not

state that both MSc and MD are equal, at any point. It that further allows space

for thinking that it means both qualifications are unequal. Hence both cannot be

equated, both cannot hold analogous posts.MCI has restricted the MSc

appointments, if one goes through the MCI regulations carefully, MCI has given

the nod for appointing NM people only up to a certain limit. You cannot run a

department with only NM people is the surmise, MCI norms tell openly or else MCI

regulation would have told to appoint only MSc to all the posts in preclinical

or Para clinical departments. And they are being permitted to work only because

of need of people, and there exists some scarcity of semi-qualified skilled

workers in departments and that need is fulfilled on appointing Teaching

assistants from MSc cadre's person can assist teaching ,can be a surmise, not

that they can independently capable of teaching medically relevant Basic Medical

sciences.Msc persons cannot independently run medical departments or head

medical colleges as Medical persons cannot be subservient to nonmedical

graduates of meager medical knowledge, reasoning ,or understanding.

Is Msc Medical Biochemistry etc degree a medically oriented appropriate

postgraduate degree? It is not a relevant degree as training is not in allied

medical subjects.A basic qualification required to do MSc Biochemistry is BSc

Zoology, Botany etc, which are subjects not required in any medical college.

There is no use of such nonclinical background as they don't have the clinical

training or clinical leaning (orientation) required as teachers in Clinical

Biochemistry, Microbiology, and Anatomy etc.

Even though they can hold analogous various teaching posts,they cannot be post

graduate teachers. If you appoint a nonmedical teacher how can you enforce a MCI

regulation which tells that more than 60% of what you teach should be clinical

material? How can a non medical scientist teach clinical medicine? What is the

need of a medical student? Clinical orientation cannot be given by a Nm person.

Persons who are MSc PhD cannot teach autonomic nervous pharmacology.

Further an MD person can only be a MCI member, a medical council inspector, or a

Dean of Medical College, and a NM person cannot perform these roles. Only a

Medical staff can represent the department in the courts, syllabus framing, or

be a examiner for Medical graduates or postgraduates. Only a medical person can

write relevant Medical texts.

Simply asking MSc students to sit with MBBS or BDS students as is with MSc

students of some medical colleges like KMC Mangalore or Manipal does not foster

similarity. In fact it is wrong unless similar content is taught. Emphasis on an

analytical study/estimation is more in MSc syllabi, while emphasis on

diagnostics is more in MBBS or MD syllabus .hence different approach,

methodology, texts for teaching both streams of people is better. We want to ask

some fundamental questions to medical council, health ministry of India

1. Dental Caries,flourosis,anaemia, Jaundice ,diabetes mellitus

,hypertension,asthma,Nephrotic syndrome, protein energy

malnutrition,Obesity,Atherosclerosis,Emphysema,Bronchitis,Appendictis,Tonsilliti\

s,Gonorrhea,Syphilis,Sinusitis,Tuberculosis,Vision defects, Conjunctivitis,

glaucoma, cataract,fever,malaria,tuberculosis,leprosy,myocardial

infarction,coma,Cerebrovascular accidents are some of the very common diseases

in India, How many medical cases of Dental Caries,flourosis,anaemia,Jaundice

,diabetes,hypertension,asthma,Nephrotic syndrome, coma,Cerebrovascular accidents

protein energy malnutrition,

cataract,fever,malaria,tuberculosis,leprosy,myocardial infarction have a average

MSc person seen? Can they tell one diagnostic feature in each? Can they explain

to this honorable court, the disease terms by writing or tell more than 50 words

of relevance in diagnosis- as a test between a average MBBS doctor and an MSc.If

at all they do not know these basic diseases, how are you going to teach a

medical or dental student as per MCI syllabus? Is thinking welfare of medical

students or medical faculty out of purview of MCI?or health ministry? What steps

are proposed?

2. Why cannot MCI recommend colleges to get doctors from other countries for

teaching our medical students? And DCI for dental students? Should courts tell

this administrative matter?

3. Can Msc Persons do casualty duties?How can such nonmedical laymen be allowed

to function as medical teachers?

4. Why autonomous medical colleges are increasing only in private sector?

5. Why can't MCI allow sharing of faculty among government medical colleges? Why

cannot MCI reach a conclusion on the non-necessity of non medical faculty?

6. What is the necessity to increase number of medical college, especially when

we have inadequate number of medical teachers? Is it possible to permit

inadequately trained staff to run these colleges, and will the output reflect

quality abroad?

7. Why cant there be national level single entrance exam for all MBBS seats all

over India, like IIT managed entrance exam to BE? Why is CET being abolished in

many states, is it to help private managements fill seats in professional

courses?

8. Are you going to wind up medical schools after doctor: patient ratio is

reached,as in USA?

9. If at all any MDs or MSc remain unemployed after say 5years, what means of

livelihood awaits them? Are you going to open new colleges to employ

overproduced staff?

10. Is value of MD equal to, less than or more than an MSc. We feel MSc cannot

be equal to MD at any time. The onus is on MSc persons to prove that they are

equivalent to an MBBS or MD, in their subject, by any test by competent

authority being MCI.Do you believe that medical practice will enhance the

quality of medical teaching?

11. Basic qualification for being a teacher in a medical college should be

MBBS.Or will you give MSc persons, a MBBS degree, or confer honorary MBBS or

Honorary registration numbers? There is no registration number at present, leads

to malpractices by our PhD colleagues like appearing for 2 colleges for medical

council inspection in a teaching year etc, as they are not easily controllable

by MCI.There is no NET exam for the MSc persons to enter teaching career in a

medical college.Whilest same candidates have to give the NET exam to gain

teachership or lecturership in degree colleges. Hence to bypass that NET

requirement many MSc enter medical education system, is medical education system

(dental, all health sciences included) so inferior, even to a science or degree

college?

12. In Kerala Public service commission; doctors are discriminated against, when

we compare with MSc persons. There is a written test for all doctors, while MSc

faculty does not have to give a written test, and have to face only an

interview. This is discriminatory.

Some answers are the overriding powers given to health minister, and this

ministry is full of nonmedical persons, and unfortunately for doctors,

non-medical persons decide the future of medical education system in India. Lack

of professional managers is visible proof of health ministry inefficiency;

several adverse comments are published about health care system in India, and

has needed supreme court mediation many times.

Are you going to wind up medical schools after doctor: patient ratio is reached?

This is one point against the so called Doctors: Patient ratio, a mere

statistical figure. This statistic doctor: patient ratio should be implemented

after proper introspection on the brain drain mechanics, lack of training

opportunities, and lack of financial benefits in inflationary society. Are

existing doctors used effectively, the MCI or health ministry does not have any

idea. Nearly 7 doctors in each of 3 departments of Para clinical subjects, and

5subjects of preclinical subjects per medical college i.e. 21 qualified MDs do

not practice medicine they learnt. Effectively 270 x21=540 or more MBBS, MD

doctors are not available specialists, are of no use in treatment of societal

diseases as a physician. Similarly many ICMR doctors are in society and nearly

1000MBBS doctors are in ICMR research projects.

Increase the number of MD seats, in the same way you are increasing MBBS seats.

There is an over saturation of MBBS undergraduates, and under saturation of MD

seats in Indian system, a anomaly. Why are private colleges starting MSc courses

instead start MD courses in private med colleges, as MBBS persons like

professional advancements.MCI should relax its eloquent criteria system for PG,

and help more MBBS persons gain MD.Very few MD seats available, and half of the

PG seats are diplomas, and many of these are not recognized by the medical

council.First, medical council correct this anomaly for especially preclinical,

and Increase retirement age of MDs to 70 years

4. Who is going to orient (see MBBS syllabus)

Deficiency in multiple areas, inability to answer questions posed by clinicians

is a common complaint as MSc persons have not been trained in clinical sciences.

Not even a single day you have seen a case-do you know what is enlargement of

liver? Have you seem human liver live? Taking theory classes, taking practicals

are not the only thing a basic medical sciences doctor does. We see that their

medical basics are poor, quality of teaching poorly medically oriented,

deficient in medical applied areas. We do not think they can implement

integrated medical teaching.

Integrated medical teaching or learning or EBM or data interpretation or

interact with clinicians is not possible by any MSc teacher independent of MBBS

faculty.

MSc physiologists as inappropriate teachers, unqualified mute spectators -MSc

Physiology degree holders don't even know how to do a proper general physical

examination in a normal person or a diseased person hence cannot teach the same

to budding doctors. Many MSc persons cannot perform the clinical examination of

respiratory, cardiovascular, gastrointestinal, Central nervous system or any

other system in the human body. Many HODs testify that many MSc cannot perform

this examination and hence cannot teach this important topic to their students.

They have an inferiority complex of inability to teach-clinical systemic

examinations above-and hence many do not come to these practicals at all. How

can they claim equivalence when they lack skills to perform above? Any MBBS

doctor, why even a First MBBS passed student, or even a nursing student, even of

worst medical expertise can do such an simple medical basic examination, which

is impossible by very well qualified, and PhD holding MScs?Such persons ,how can

they teach relevant physiology to their wards? Many HODs testify that MSc

persons are disinterested in learning or teaching systemic physiology, or

examination. They do not know how to do Blood counts or measure Jugular venous

pressure required to diagnose heart failure. They do not know how to take blood

from artery or veins, an easy job for a MBBS doctor. They are effectively

colossal failures in Physiology. Nearly 20-50 hours of practicals per year of

160hours they can't teach effectively per year. Similarly in biochemistry they

cannot handle Liver function test or other organ function test theory, or

discuss normal values, give idea about public health aspects of human nutrition,

which we doctors can give succinctly.MSc lack even more so in Anatomy and

Microbiology, hence they prove themselves as useless to medical education

systems. The fact is they have acquired a partial medical knowledge insufficient

to call these half baked persons as medical teachers.

Diplomate national board DNB postgraduates though equal to MDs,were considered

inferior to MD,was not considered equal by MCI,but rank inferior persons like

MSc are allowed into the medical education system, is a glaring anomaly.

Further, enough MD persons are available, and we need not appoint more MSc

persons, in any teaching post in any medical or dental colleges, private or

government or deemed university colleges. MSc person can be appointed as a last

case, and not preferentially, and should be appointed inn any department if and

only if a suitable MD candidate cannot be found.

Nonsuitability of MSc persons-Non experience in clinical applications arises

from their limited syllabus. Further lack of medical/clinical application is a

inherent defect of a MSc course, and hence this course cannot be considered a

full, complete, or perfect course as compared with perfection personified MD

course. Because they are not doctors, they have never interacted with doctors,

the MSc person cannot take a proper history or do clinical exam of any patient

in case of emergency. Further a point to note is they have not been taught

during their course how to interact with the patients, and elicit signs and

symptoms and correlate pathobiochemical/microbiological findings. While as a

technician, a MSc person may be able to do certain steps of a biochemical

reaction sequence, they cannot show overall knowledge in examination of

reproductive physiology or biochemistry. Relevant clinical experience is

missing, lacking in all MSc persons-medical MSc or nonmedical MSc.

We want to know is there any nonmedical member in the MCI or its registry, if

not why, do we invite nonmedical into MCI now? If the MSc do not have bachelor's

degree in medicine, surely they are unfit to teach in medical colleges.

Parties-

1. Director of Medical education, Ananda Rao Circle, Bangalore 560001.Karnataka

2. Secretary, Medical Education, Govt of Karnataka, Secretariat, Bangalore

3. Vice-Chancellor Rajiv Gandhi University of Health Sciences, Jayanagar 4th T

Block, Jayanagar, Bangalore.560040

4. Director, NIMHANS, Hosur Road, Bangalore.

5.Karnataka Medical Council, Double Road,opp Basavangudi Head Post

office,Basavangudi,Bangalore.