National Medical Register : Advantages and Challenges – Explained, pointwise

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With the National Medical Commission (NMC) planning to soon switch over to a licentiate test after MBBS, the NMC has released draft guidelines on how the doctors will be registered in order to practice medicine. The NMC put out a set of three draft regulations on the registration of doctors to the National Medical Register. The guidelines aim to bring uniformity to the registration process of medical practitioners in India.

About the three draft guidelines and the National Medical Register

The NMC has released three future-looking draft regulations; (1) License to Practice Medicine, 2022; (2) Registration of Additional Qualifications, 2022; and (3) Temporary Registration of Foreign Medical Practitioner to Practice Medicine in India.

These regulations together stipulate the process of registration of doctors in the National Medical Register.

The guidelines provide a framework for creating a dynamic National Medical Register, with a unique ID assigned to each student who qualifies NEET. The professional qualifications such as post-graduation and super-speciality training will be added to the same ID.

Eligibility for Indian Medical Graduates for getting registration: They have to: (a) Complete their MBBS degree from a recognised college; (b) Finish their mandatory 12-month long internship; and (c) Pass the yet-to-be-implemented licentiate exam called National Exit Test (NExT) for getting their registration.

Eligibility for Foreign medical graduates for getting registration: They have to: (a) Complete their MBBS-equivalent degree from a medical institute “recognised and listed by the NMC” in other countries, (b) Be registerable as a medical practitioner in the said country, (c) Complete a 12-month internship in India and d) pass the same NExT exam.

The draft guidelines also state, “All licenced practitioners are obliged to inform and update their data in the National Register such as Additional Qualifications, Contact Details, and Place of Practice / Employment as soon as changes occur.”

Read more: Structural and practical limitations of Indian medical education system
What is NExT?

The National Exit Test is a proposed examination for granting a license and registration for practising medicine in India. It is similar to the USMLE (the United States Medical Licensing Examination) for those wishing to practice in the US.

The exam will act as a country-wide standardised test for passing MBBS, for granting of the license, as well as a qualification test for post-graduation courses instead of the current NEET-PG that students have to sit for after they have completed their MBBS and a one-year internship.

It will be a theory paper, like MBBS finals or NEET PG test. Instead, It will be held in two parts – one written and one practical exam where the students will be judged on their clinical acumen. Students will have to appear for the first NExT test after completion of MBBS and the second one after completion of the internship.

According to the present draft, till the NExT is introduced, the current processes will continue. The government expects to conduct the NExT from 2024.

Must read: National Entrance cum Eligibility Test(NEET) – Issues and Significance- Explained, pointwise
About the present National Medical Register

At present, all doctors have to register with their respective State Medical Councils, without which they cannot practice medicine. Every state maintains its own medical register, which is then sent to NMC for a consolidated country-wide register.

However, the draft regulation seeks to create a dynamic and regularly updated register.

Read more: What ails medical education in India
What are the advantages of the National Medical Register?

Open registration to foreign doctors: The guidelines open the registration to foreign doctors who want to come to India to study in post-graduation courses, fellowships, clinical research, or voluntary clinical services.

Facilitate the arrival of foreign experts: The guidelines will solve the lacunae of foreign experts being granted “permission” by the Health Ministry.

Instead, the NMC will now grant temporary registration to such doctors that will end with the duration of the programme. The maximum duration of such a temporary registration will be 12 months.

Check errors in registration: The present registration by State Medical Councils usually has to be updated every five years. This leaves a lot of room for duplication of names in different states, and doctors who have retired or died remaining on the register for years.

For instance, A medical graduate in New Delhi has given a NOC for registration in the other state, if he wants to move between the five-year duration. This results in duplication of data.

Read more: Salient provisions of National Medical Bill, 2019

Creates a level playing field for Domestic and Foreign medical students: At present, students who complete their MBBS and pass the final exam of their university are eligible to get their license without any such licentiate test.

On the other hand, foreign medical graduates have to pass the screening test conducted by the National Board of Examinations in Medical Sciences to get themselves registered in India. With this policy, both domestic and foreign medical students have to undergo the same NExT.

Benefits of unique ID: Once a unique ID is created, the portal will be thrown open to all recognised institutes in India who can upload all verified documents of their students to it. This will make the registration process easier, as the state medical councils currently have to get all the documents submitted by those wishing to register from the medical institutes by post before adding the name.

Read more: What the plight of students in Ukraine reveals about medical education in India
What are the challenges associated with the draft guidelines?

Silent on internship: The students who study medicine in foreign has to complete a year-long internship in the country of their study and come back and do another year-long internship in India. The new guidelines do not specify this.

Onus on the doctors: The draft guidelines also put an onus on the doctors to keep updating their registration with details of additional qualifications, change in employment, contact details, or place of work “as soon as the change occurs”.

Promote Coaching Factories: The standardisation with NExT will lead to mushrooming of Coaching institutes to bridge the gap in educational Institutes. This is seen in India with NEET and similar other national tests such as the Joint Entrance Examination and Common Law Admission Test.

Dual exam for practising medicine for Indian students:  There are no professional exams for Engineers, Graduates of Arts and Science to practice their respective jobs after graduation, except in certain scenarios like pursuing higher education or trying any government employment.

At present, MBBS finals have already tested the knowledge of MBBS aspirants. Making NExT mandatory will create a dual exam (MBBS finals and NExT) for practising medicine.

Read more: Medical Education in India and Associated Issues – Explained, pointwise
What should be done?

Make clear guidelines for internship: Before implementing the guidelines, the NMC has to make a clear set of rules for the internship of medical graduates from foreign Universities.

Preparing a list of Foreign Universities: At present, the NMC does not have a list of recognised foreign medical institutes. At present, the NMC have a set of minimum requirements, such as a 54-month-long course or medium of teaching being English, which is an institute follows, their degrees are recognised in India.

But to facilitate the arrival of foreign experts, the NMC must prepare a list of recognised foreign universities.

Implement other reforms essential reforms: With restructured medical licensing systems, the NMC has to focus on other reforms such as ranking medical colleges, and standardizing entry requirements at medical schools across the country are all essential reforms under the NMC.

Address the skewed societal trend: India needs to address the irrational high social value placed on medical and engineering college education across India. This will reduce the hyper-competitiveness and higher failure rate in tests such as NEET, and Joint Entrance Examination.

Read more: Landmark decision taken by Government of India in Medical Education

With a consolidated national register and unique ID, there will be no duplication of data. Further, the data will be updated more frequently, resulting in a comprehensive database of doctors in India, including details on all their education and training in one place. This database can then be shared with state governments or other health programmes, which are looking to hire doctors.

Sources: The Indian Express (Article 1, Article 2)

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