Dr. SK Sarin
Chairperson, Board of Governors
Medical Council of India.
Sub: Suggestions and comments on Vision-2015.
1. It gives us immense pleasure in introducing our society (South India Medico-Legal Association) which was established in 2003 with an objective to ensure quality medicolegal work in South India. Ever since then it has been rendering service to its members in attaining highest standards of professionalism and ethical practices in addition to serve the society at large as members of noble profession. Our members are representing the fields of Forensic Medicine, Forensic Science, PHC Doctors, Retired Judges, Lawyers, Senior Police officers and distinguished members of the society.
2. We take privilege in submitting this memorandum with suggestions and comments on the Vision-2015 document after holding due deliberations and also taking into account the views of other branches of medical science and eminent professionals representing legal and investigating agencies.
3. It is pertinent to note here that private medical institutions are permitted by the Government to practice medico-legal tasks such as postmortem examination, issuing medico-legal certificates (examination of injury, drunkenness, both victim & accused of sexual assault, age estimation), expert opinion on skeletal remains examination, weapons of offence and visit to scene of crime etc, thereby proactively assist the investigating agency and serve judiciary in the process of dispensation of justice in larger interest of the society. Our members service has been appreciated by Judiciary and Law enforcing agencies and we deem it as a privilege to render our service not only in the academic field but also in administration of justice. Hence, our submissions are from the perspective of protecting the interest of common man.
5. We are sure that your goodself will consider our submissions based on its merit and we request you to give us an opportunity of personal hearing to clarify some of the concerns raised in the annexed memorandum of submissions.
Journal of South India Medicolegal Association
SUBMISSIONS OF SIMLA
SIMLA (South India Medicolegal Association) welcomes some of the finest proposals made in reforming the UG medical education as envisaged under Vision-2015. However, the society humbly wishes to place on record the following points of concern which call for urgent attention before formulating the same as a policy:
I. Vision 2015 and its inherent flaws:
· Nothing seems to be wrong with the existing UG medical education and the proposed UG medical education is moving away from global standards:
Indian doctors are doing well in-house and abroad because of the time-tested and excellent education in our country. The current duration of the course is still relevant given the kind of ever expanding research in the field of medical science and the growing need to have ‘Basic Doctor’ to provide complete and quality health care to the rural population. We, the faculty members of forensic medicine and the paraclinical subjects (Pathology, Microbiology & Pharmacology) are in favour of retaining the existing course curriculum with 1½ years for phase II MBBS.
In justification to the above claim, when we look at the global scenario, the medical training is typically split into 5 years of schooling, of which the first 3 years are preclinical and the fourth and fifth are clinical, followed by a 1-year apprenticeship on the job [Lancet. 2010;376:1284-5].
Earlier curricular revision has already taken place at National level in 2005 after feedback was collected from all over the country. The vision-2015 is unable to defend its acceptability and practicality with the new proposal, in comparison with the democratically framed proposal.
· The proposed UG medical education leads to poorly trained Basic Doctors:
Some of the developing countries look for Indian doctors as a well trained and well equipped with strong fundamental exposure in almost all branches of medicine. The attempt to introduce change in the period of the course will dilute the importance of critical branches of medical science leading to loss of image not only from foreign visiting patients but also today’s well informed Indian public. This could seriously erode the faith of common man in the medical system. This may result in violation of the Article 21 of the constitution as it is likely to infringe the very right to life as this kind of scenario in all likelihood will lead to rampant rise in medical negligence cases.
· The proposed UG medical education leads to non-identical Basic Doctors:
The attempt to introduce elective subjects will lead to confusion as doctors may be different from each other. Medical education is intended to give all inclusive training to bring out a complete doctor in a student. Every aspect of medical science is important. So, the very concept of introducing elective subjects does not hold good in medical science.
· The proposed UG medical education is inappropriate for the Indian scenario:
Indian scenario which is quite different from other developed countries. As 75% of Indian population resides in rural areas, the time-honoured present concept of the basic doctor with 4½+1 years training is more relevant. Indian setup (especially rural) demands a completely trained doctor.
· Improper method of seeking the feedback on the proposal:
It is pertinent to note here that the very Annexures 1 & 2 [which again forms part of the Vision Document] have neither been made available nor accessible to the stake holders. Under the circumstances, no meaningful purpose would be served seeking the views of the stake holders. Without making full disclosure to enable the stake holders to have their full say, it is not democratic and fair to seek the views in a hurried manner. Hence, the deadline set for taking the feedback should be extended for a reasonable time of one month so that there will be national level debates which would have served the nation’s interest better as members of noble medical profession are accountable and answerable to the entire mankind.
· Improving rural health care by doubling the production, that too of ‘half-baked’ Basic Doctors:
From a consumer (patient) point of view, an incomplete, ill-equipped, unprofessional and untrained ‘Basic Doctor’ produced under the proposed fast track method might just fulfill the desired doctor-population ratio on papers to substantiate the statistics. Medical service is not a number game, but increasing their availability to the masses. The remedy lies in giving incentives to doctors to work in rural areas by providing proper living and working conditions for doctors in such areas and providing them adequate opportunities for career development.
· The present proposal is contradicting the earlier reports:
It is quite surprising to note that the Vision Document seems to have ignored the valuable suggestions of expert committees. The present proposal is contradicting the earlier authentic and authoritative reports of Mudaliar and Bohr committees, which were constituted by the Government of India to improve medico legal services in India. In 2007, a committee headed by Former Chief Justice of India Mr. Justice M.N. Venkatachalaiah had prepared a draft on “revision of undergraduate medico-legal curriculum”, which emphasized the need for giving more importance to ‘forensic medicine’ in the training of a medical graduate (available at http://medind.nic.in/jal/t08/i1/jalt08i1p37.pdf). How can the Vision Document which intends to bring in reforms lose sight of such an eminent finding? This itself demonstrates that the Vision Document has not even taken into consideration of the recommendations of expert committee which are very much available in public domain. In this context, the present exercise of seeking public views on the Vision Document seems to be a far from sincerity.
II. Forensic Medicine in UG medical curriculum:
· Forensic medicine should be considered as a core and compulsory subject:
Knowledge of Forensic Medicine is important and integral part for a Basic Doctor. Medical and legal duties form the two sides of a coin in the medical profession. Scientific evidence produced by a doctor, helps in increasing the conviction rate. Since majority of crime cases are handled by the Basic doctors (MBBS) in India, they need to have enough knowledge on dealing with medicolegal cases. We are at loss to know as to how come such a high level committee of MCI can lose sight of a stark ground reality? Knowledge of forensic medicine is mandatorily required in the context of the recent amendments of law, it is seen that the examination of victims of grave offences like rape should be done by the nearest registered medical practitioners.
· ‘Forensic Medicine and Toxicology’ Subject should not be split up:
We ridicule the proposal because it suggests that 'Forensic Medicine can be effectively taught during Gynaecology & Obstetrics (rape, assault), Surgery (injuries), and Pharmacology (toxicology)'. If Forensic Medicine will be taught along with other subjects, then it is very unlikely that the students will understand the legal aspects of the subject as a single entity. This is because usually students are exam oriented. Vertical integration of Forensic Medicine with clinical subjects will be useful only if it is included under year 4 (instead of year 2). Following reduction in the duration of pharmacology (12 months from the present 18 months), teaching of toxicology is not possible during pharmacology.
· Knowledge of forensic medicine should be evaluated like any other major core subject:
The teaching hours in forensic medicine should be increased to 200 hours, so that the current curriculum could be revamped stressing upon the chapters like clinical forensic medicine, toxicology (comprising 25-30% of total curriculum) and medical law and ethics which are more relevant to a general medical practitioner.
· Internship and Forensic Medicine:
We suggest that 'Forensic medicine skills should be acquired during internship. This is in addition to the training imparted by during the UG Medical education as suggested above. Until the Indian scenario changes (adequate forensic medicine experts) most of the medico-legal work should be allowed to be done by MBBS doctors, who have been trained about it in the UG curriculum and internship.
· Proposal suggests that 'Legal experts can be called for medico-legal issues':
We ridicule this suggestion simply because forensic medicine experts are best suited for this job. Without a medical knowledge a Legal expert can not teach medicolegal issues related to medical practice.
· Proposal hinders the chances of getting more forensic medicine experts:
If there is no awareness of the forensic subject to basic doctors at UG level, the number of PG admissions in Forensic Medicine will be reduced, which results in less forensic experts in India to handle medicolegal cases effectively in future.
Ø For the foregoing reasons, we humbly submit that the Vision Document in the current form and content is not at all acceptable as it has failed to visualize the far reaching consequences of its own recommendations. Hence, it cannot be called as Vision Document. As visionaries, we are expected to see the wellbeing of next generation and even welfare of the common man in the remotest village of this country. Any hasty attempt to implement this Vision Document will cause more harm than good to the society at large in general and medical profession in particular. It’s time to review the Vision Statement by making it inclusive of each and every aspect of the issue and serve the nation for the generations to come.
Ø We also wish to place on record that this is our preliminary response and we reserve our right to file additional views upon making available the relevant materials as contained in Annexure 2. Further, we request you afford personal hearing to substantiate our stand in this regard.
Ø We hope that your goodself will open the door for national level debate and consider the valid concerns raised hereinabove and do the needful and oblige.
Journal of South India Medicolegal Association