By: Dr. Om J Lakhani,
MD (Medicine), DNB (Endocrinology), Consultant Endocrinologist
Zydus Hospitals, Ahmedabad
The Medical Council of India in a recent amendment of the teachers eligibility regulations has made it difficult for DNB Pass-outs to become teachers in MCI recognized medical colleges. I had the privilege of pursuing my MD from a reputed MCI recognized government medical college and my DNB in Endocrinology from one of the oldest and best institutes for DNB in India, hence I had a the best of both the worlds and I think I am in a good position to opine on both MD and DNB. My parents have been professors in medical colleges all their lives and I have grown up in a Medical college campus. I know the ins and outs of medical colleges and have seen MCI evolve over the last decade. Here is my take on the controversial MCI amendment.
- TEACHING EXPERIENCE – REALLY ?
One of the main reasons which MCI states for DNB passouts is that those doctors who have pursued DNB from hospitals that are not attached to medical colleges donot have ‘teaching experience’ . Three years of teaching experience as Junior resident is required for post of a senior resident and so on. In my opinion this is total nonsense. I have done my MD from a government medical college and I know for a fact what ‘teaching’ junior residents do. The first and second year residents barely have time to sleep, I don’t think have any interest in teaching of any kind. The third year resident often does take bedside teaching classes for MBBS students and interns, however it all depends on how much time he can spare. All-in-all, in reality, residents doctors hardly do any teaching.
I used to teach medicine for a private PG coaching class after completing my MD. Most of the MBBS students I met hardly even know what residents are supposed to teach. Forget residents, the Assistant professors and other seniors in Medicine also donot have time to teach because of the amount of clinical workload they have. Additionally they have to publish papers for getting promotions and their spare time goes in research and other activities. One or more Assistant professor is shunted around in VIP duties for visiting politicians or running OPDs in Central jails ! What teaching is MCI talking about ?
On the other hand in DNB institute run by a trust hospital, things were so organized that I actually had sometime everyday as a resident not only for teaching my juniors but also for conducting research and publishing papers. I have done more academic work in my three years as DNB resident in Endocrinology than my time as a Junior resident while pursing MD medicine or subsequently as a senior resident and assistant professor. The same is true for almost everyone I know. My message to MCI is get real. If you really want junior and senior residents to teach, then given them time off from their clinical duties. If you can’t do that than please don’t cite the non-existing teaching experience to discriminate MD and DNB passouts.
2. SERIOUS LACK OF QUALIFIED TEACHERS – WHY MAKE IT WORSE ?
India is facing a severe shortage of qualified teachers in the academic field. The existing medical colleges are barely able to fill their vacancies for teaching posts and the new ones fail to get recognition because of lack of qualified teachers. In such a scenario instead of welcoming qualified DNB passouts to become teachers, MCI is making it difficult for them ! There is absolutely no logic in this. If I were the MCI president, I would welcome the DNB passouts with open arms and take steps to make medical teaching more attractive to young MD and DNB passouts rather than making it worse !
3. DNB IS LOT TOUGHER THAN MD/MS
My understanding of NBE and DNB is that it was probably created to act as quality control for post-graduate doctors in India like MRCP in UK and Internal medicine boards in the USA. Infact all MD and MS should be allowed to practice and call themselves postgaduates only if they pass DNB exams. This is the case in most Western counties where doctors are allowed to practice only when they pass their board/RCP exam. Instead the tables have turned and those who have passed their DNB are made to feel inferior ! This is illogical. Everybody knows that DNB exit exam is a lot tougher than MD /MS exit exams. Hence those who have passed DNB have actually gone through a tougher exam than those who have given MD/MS and hence are infact more qualified than MD and MS counterparts.
The DNB candidate does everything which MD/MS candidate does. His or her working hours are the same and he too like MD and MS submits a thesis. However, unlike his MD counterpart, his thesis is not automatically accepted and goes through multiple stages of scrutiny before he is allowed to sit in his exams. I know many MD people who have basically copied and pasted their thesis ! The sad thing is that MCI knows all this and still makes it difficult for DNB people.
4. THE TRAINING IS DNB INSTITUTES IS INFERIOR TO MD/MS- THIS IS A JOKE ?
Some people believe that the training in DNB institutes is inferior to MD/MS. This is a joke. I know many DNB institutes which are far better than any government / private medical colleges. The quality of training depends on the institute and not whether it is affiliated to NBE or the MCI. Infact overall, I think the DNB institutes have a slight edge of the MCI institutes. Additionally the NBE functioning has improved over the last decade and DNB residents have regular appraisals and exams every year. On the other hand, at most places the MD resident just gives one exam at the end of his/her three years training. Why then does one think that DNB training is inferior to MD ? I think this is a wrong notation promoted by some people to prevent DNB doctors to get any limelight in medical practice and teaching institutes.
My guru always used to say, ‘Don’t look for problems, look for solutions’. So here are my suggested solutions to the deadlock.
- If MCI is so concerned about teaching experience of DNB students, why don’t they ask NBE to regularly send their DNB residents to nearby medical colleges to take lectures and help in bedside teaching of MBBS students ? This will solve two problems i) the DNB people will gain teaching experience ii) the MBBS students will be taught something by clinicians which otherwise is non-existent.
- Why have two names for the same qualification- DNB and MD in first place ? The government and MCI should dissolve the terms MD and DNB and instead use a common term for Board speciality and Super-Speciality so that the discrimination ends.
- Allow for regular cross –training. A DNB/MD resident working a private / trust hospital should be made to work for 6 months in a government medical college compulsorily and a DNB/MD resident working in a government institute should be made to work in a private/trust hospital for 6 months compulsorily. This should be a mandatory exchange program so that the doctors are exposed to all types of medical practices in India. All NBE institutes must be affiliated to some government medical college to allow for easy cross exchange of resident doctors and all medical colleges must be affiliated to some private hospital apart from their own hospital for easy exchange of knowledge and expertise.
- Remember the ultimate aim of MCI and NBE is to improve the quality of medical training and practice in India and not to take part in petty politics.
Finally I would like to end by saying that all those in medical practice know that our real enemy in India are unqualified quacks and superstitions prevailing in the society and not whether one is DNB or MD. Then why take part in petty politics instead of doing something which is right for once ? There are some people who are using the ‘divide and rule’ tactics in MD vs DNB to further their own cause, why should we become victims of this ? I think the MD counterparts must help in the agitation which is initiated by DNB doctors for betterment of medical education and practice. A unified voice will help to break these divide and rule policies.
I call for immediate revoke of the controversial MCI amendment to teaching rules for the betterment of medical education in India.
(The Author can be contacted on firstname.lastname@example.org)