Denial of examinership: another discriminatory move of the NMC

There are two categories of teachers in India's medical colleges: medical and non-medical. Medical teachers are those with MBBS as the graduate qualification and MD/MS as the postgraduate qualification in a subject specialty. Non-medical teachers are those with B.Sc in life sciences as the graduate qualification and medical M.Sc in non-clinical subject specialty as the postgraduate qualification with or without a Ph.D doctorate. While the non-clinical subjects consisting of Anatomy, Biochemistry, physiology, Pharmacology and Microbiology, which are also considered basic medical sciences, are taught by both medical and non-medical teachers, the clinical subjects such as general medicine, community medicine, forensic medicine, general surgery, orthopedics, obstetrics & gynecology etc are taught exclusively by the medical teachers. This is a general practice in many parts of the world.

Even though the graduate qualifications of both the medical and non-medical teachers are different, the postgraduate qualification is essentially the same. The curriculum and syllabus of MD and medical M.Sc courses in the five non-clinical subjects are similar and students of either course are trained similarly in the one and the same medical college by the same teachers using the same methodology and resources. Medical M.Sc courses follow the same pattern as MD courses with respect to components such as laboratory training, clinical interpretation, seminars, journal clubs, dissertations etc, therefore no qualitative difference exists in the nature of training between the two courses. After successful completion of courses, health universities mostly award postgraduate degrees under the faculty of medicine. Thus, the two classes of postgraduates are similarly placed for teaching roles. It is the knowledge imparted in the subject specialty during the postgraduate course that empowers and enables the teacher to teach that subject, and the knowledge obtained in graduate courses while helpful and supportive, is not essential.

The non-medical teachers in India have been a part of medical education for several decades. Many are working in professorial posts such as Assistant Professor, Associate Professor, and professor in medical colleges. With decades of experience behind them, senior among them also head the department. Some among them have also authored manuals, chapters in textbooks or educative websites. Some have conducted scientific research in their specialty and published scientific papers. Some are also involved in curriculum committees and overseeing the implementation of the syllabus. Despite such long and distinguished service and contribution to medical education, the non-medical teachers now face incessant discrimination imposed by the regulator -the National Medical Commission, which has now barred them from executing their academic role as undergraduate examiners.

The introduction of competency based curriculum in medical education (CBME) is being touted as the reason for this denial. The curriculum has 20% vertical and horizontal integration with other relevant non-clinical and clinical subjects. Since medical M.Sc courses include the compulsory study of Anatomy, Biochemistry, and Physiology irrespective of own subject specialty, the non-medical teachers are competent in integration with the non-clinical subjects. Integration with clinical subjects has always been a part of the medical M.Sc postgraduate course as 'applied aspects', therefore integration is never a hindrance to a non-medical teacher. Besides, all teachers, both medical and non-medical, have undergone mandatory training on the Curriculum Integration Support Program, Basic Course Workshop and AETCOM, thereby equipping all with the necessary knowledge and skills required for teaching the new curriculum. CBME is a repackaged version of the existing knowledge, not a drastically new concept. All the components that were taught earlier will continue to be taught albeit in a slightly different way, but this doesn't call for exclusion of the experienced non-medical teachers from their academic roles of educator and assessor.

Since the introduction of this curriculum, three batches of medical undergraduate students have progressed from non-clinical to clinical specialties. Non-medical teachers have also taught and assessed the students in the new format of curriculum. Barring them now doesn't make any sense. Assessing the student's performance in an exam is an integral component of an educator's academic profession.

Barring non-medical teachers will create the following issues: 1. Artificial shortage of examiners. As many departments already have faculty shortages, conducting both internal and external exams will become difficult and tasking. 2. Involving medical teachers from other colleges whether within the state or outside for every internal and university exam will unnecessarily increase cost as the colleges have to spend on their renumeration and TA/DA costs. 3. Ignoring the senior and experienced teachers will lead to students being assessed by inexperienced junior teachers, which could compromise the standards. 4. Denying the educator the academic role of assessment is a discriminatory and humiliating experience. It will hurt the self-esteem of the faculty and the cordial environment in the department will not be the best.

When the qualifying marks to pass a university exam have been reduced by the NMC to 40%, what difference does it make whether the examiner holds MBBS/MD qualification or medical MSc/PhD? When upholding the quality of medical education is not a priority, rules discriminating against the 'non-medical' teachers stand out as bogus and motivated. Pride and prejudice are the core philosophies of the NMC's undergraduate board in making policies.

 Problems, more problems, and solutions

The so-called non-medical teachers possessing medical M.Sc/Ph.D qualifications who are working in various capacities ranging from Tutors to Professors & HOD are protesting against the unjust norms set by the NMC.

Clarity on the medical M.Sc courses:

The majority of MBBS graduates typically opt for specialization in clinical disciplines, and they consider pursuing postgraduate studies in non-clinical disciplines as a last resort, often after numerous unsuccessful attempts to secure clinical seats. As a result, thousands of postgraduate seats in non-clinical subjects remain vacant each year.

With the establishment of more medical colleges and an increase in MBBS seats within these colleges, the shortage of faculty members has become more pronounced. This shortage is particularly acute in newly established colleges, as well as those situated in remote, hilly, and suburban areas. Due to the scarcity of medically qualified teachers, the education system resorted to appointing non-medical teachers starting in the 1960s. However, historically, the permissible ratio of non-medical teachers was limited to 30% (50% in Biochemistry).

Medical M.Sc courses in the five non-clinical subjects were initially included in Schedule-I of the Indian Medical Council Act. However, as MBBS graduates began to show less interest in these courses and opted for MD programs in the same subjects, the Medical Council of India (MCI) gradually stopped taking interest in these courses. In the late 1980s, MCI stopped granting permission to medical colleges to initiate these courses, and eventually, it completely withdrew its support from them.

At one point, over 100 medical colleges used to offer these courses, but now the number has dwindled to less than 30, including in AIIMS. These courses are primarily conducted within medical colleges, utilizing identical curricula, syllabi, and resources as MD programs. They run concurrently with MD courses, guided by the same teaching methods and faculty. However, regardless of their chosen specialty, all students are required to complete a mandatory one-year study in human anatomy, physiology, and biochemistry, mirroring the curriculum of first-year MBBS students.

All aspects of the M.Sc. course, including university examinations, resemble those of the MD course. Successful candidates are awarded their degrees by the health university under the faculty of medicine. Although there may be differences in the graduate degrees between medical and non-medical teachers, their postgraduate degrees are quite similar. Consequently, aside from clinical practice, both groups of degree holders are well-suited for similar roles and employment opportunities.

It is unfortunate that the regulatory body consistently provides inaccurate information in its affidavit when referring to the medical M.Sc courses. It appears to use misinformation as a political tool to advance its agenda.

Appointment of non-medical teachers:

The practice of appointing non-medical teachers to instruct in non-clinical subjects, which form the foundation of medical sciences, is not exclusive to India. In fact, the percentage of non-medical teachers varies widely in different countries, ranging from 30% to 100%. Only 8-11% of teachers in non-clinical subjects at medical colleges in the United States hold medical qualifications, while the majority are non-medical professionals.

The appointment of non-medical teachers in the non-clinical subjects should be a matter of policy, rather than a temporary measure extended to medical M.Sc postgraduates. The regulations outlined by the World Federation of Medical Education (WFME) emphasize the importance of balanced participation from both medical and non-medical teachers.

The presence of teachers with either set of qualifications brings dynamism to teaching, a fact emphasized by the Board of Governors in supersession of MCI when rejecting a demand to exclude non-medical teachers. Non-medical teachers should be an integral part of medical education to prevent a monopoly of one-degree holders, which can lead to stagnation. Both sets of degree holders can complement each other, rather than compete with each other.

It is incorrect to assume that possessing a specific qualification or lacking it has a direct impact on the quality of teaching. Within both sets of qualifications, there are excellent, mediocre, and subpar teachers. The crucial factor determining a teacher's ability to educate effectively is their postgraduate degree, whether it's a medical M.Sc or MD; the undergraduate degree may have minimal influence. Thus, the quality of teaching ultimately depends on the individual's knowledge, skills, and attitude as a teacher. Medical education should draw benefits from both sets of qualifications, and the selection should prioritize the best candidate, regardless of their specific qualification.

MD in non-clinical subjects:

In many developed countries, medical colleges do not provide MD programs in non-clinical subjects. Typically, these subjects are primarily taught by scientists holding Ph.D. degrees, with only a few doctors who have a keen interest in research. MD programs are primarily offered in clinical subjects. In contrast, India has a significant number of non-clinical doctors, who are included in the count of doctors for calculating the doctor-patient ratio. However, these non-clinical doctors do not engage in patient care or contribute directly to healthcare services. Therefore, offering MD degrees in non-clinical subjects in India is irrational. Instead, these programs be replaced with medical M.Sc courses for MBBS graduates, as was the practice in the past.

Monopoly, dominance, and NMC's abuse of position:

Both the MCI and the present NMC are predominantly composed of medical professionals. In contrast, the General Medical Council in the UK maintains an equal representation of both medical and non-medical individuals. Initially, there was a proposal to limit the composition of medical professionals to 60% in the NMC, but this proposal was thwarted by the medical community, ultimately resulting in the dominance or hegemony of doctors in the NMC.

 Despite divisions among doctors regarding clinical and non-clinical specialties, they consistently unite when their interests are at stake. They tend to prioritize their own interests and often restrict or exclude non-medical individuals from various competitive arenas. This behavior can be seen as an abuse of their dominant position. 

When the NMC solicits public feedback, the majority of the responses come from the medical community, which represents a substantial majority. Conversely, the feedback from non-medical individuals constitutes a small minority and can easily be overshadowed. Consequently, it's important to recognize that all feedback received by the NMC tends to be inherently biased.

Over the years, the NMC has systematically eroded the authority of non-medical teachers and has consistently modified regulations to place them at a disadvantage. These changes in norms are inherently discriminatory and are intended to disenfranchise non-medical teachers. This pattern of denials and restrictions can be attributed to the underlying concepts of pride and prejudice within the medical community.

The pride that doctors take in their qualifications often leads to a prejudice against non-doctors, resulting in a general unwillingness or resistance to extend the same rights or dignity to non-doctors as they afford themselves. This sense of self-supremacy, which is seen as a 'superiority complex', prevents them from treating others with the same level of respect and equality. In essence, this is nothing but 'academic apartheid'. When the regulatory body itself practices discrimination at the highest level, it sets a discouraging precedent, encouraging individuals at the college level to perpetuate discriminatory practices.

Discriminations, and denials of opportunities:

Unjust Ph.D. Requirement: There is an unwarranted insistence on requiring a Ph.D. for the Assistant Professor position, despite the absence of such a mandate by the UGC. The demand for a Ph.D. for entry-level demonstrator roles appears to be a deliberate attempt to undermine the value of a Ph.D. and restrict the appointment of non-medical teachers. Equating postgraduate and doctoral qualifications (MSc+PhD) with an undergraduate degree (MBBS) is both belittling and unfair.

Discrimination Against Medical MSc: Despite the equivalent quality of medical MSc and MD courses, medical MSc is unfairly treated and not recognized as a basic qualification. Medical MSc is intentionally excluded as a postgraduate qualification in the NMC's faculty declaration form, despite there being a substantial number of graduates, ranging from 5000-8000.

Exclusion from Faculty Training programs: Non-medical teachers are systematically and unethically being denied/excluded from faculty training programs like the revised basic course workshop, CISP, and AETCOM.

Denial of Examiner Opportunities: Fundamental roles of a teacher to serve as undergraduate examiners are being denied to non-medical teachers despite possessing decades of teaching experience.

Limited Tenure for Tutors/Demonstrators: The tenure for tutor/demonstrator roles has been restricted to a mere 3 years, seemingly designed to discourage non-medical teachers from continuing in these positions.

Rejection of Feedback and Appeals: Feedback and appeals submitted by non-medical teachers or their associations are persistently rejected as if we don’t exist or our issues don’t matter.

Denial of HODship: Senior professors possessing non-medical qualifications are unfairly denied the opportunity to head departments despite seniority and decades of experience.

In essence, non-medical teachers are subjected to a second-class status, characterized by restricted roles, rights, and privileges. 

Political lobbying and the after-effects:

As the MCI transitioned into the NMC, a group of non-clinical medical professionals made concerted efforts to exert pressure on the NMC in order to exclude non-medical teachers from the medical education system. Their previous attempt to influence the MCI had proven unsuccessful. 

The NMC responded by significantly reducing the allowable percentage of non-medical teachers, lowering it from 50% to 15% in Biochemistry and from 30% to 0% in both Pharmacology and Microbiology. While these changes were initially meant to apply to new medical colleges starting from 2020 onwards, they were, in practice, being applied retrospectively to all colleges.

Existing non-medical teachers, particularly tutors and demonstrators, were facing termination of their contracts or non-renewal, citing the new regulations. Even those with four years of teaching experience and M.Sc qualifications were being denied promotions to the Assistant Professor position. Previous guidelines that required a Ph.D. for the Associate Professor and higher positions were being ignored. Instead, a Ph.D. was being demanded for the Assistant Professor position in MSR 2020 guidelines, a requirement not mandated by the UGC. Taking it a step further, NMC has now mandated a Ph.D. as a requirement for the lowest entry-level non-teaching position of tutor in the MSR 2023 guidelines. This change appears to be aimed at discouraging non-medical candidates from entering the field of medical education. Furthermore, the term of employment for tutors was limited to three years, seemingly to prevent them from getting promoted to higher posts.

Individuals in Pharmacology and Microbiology were among the hardest hit by these changes, as they were effectively barred from applying for teaching positions in any other institution. They faced restrictions on transferring to different colleges or relocating to other cities. In essence, they found themselves trapped within the same college and were at the mercy of the college management. These limitations hindered their opportunities for career advancement and their ability to explore new job prospects. Such restrictions appear to contradict the principles enshrined in Articles 19(1)(e) and 16, which uphold the rights of citizens to move freely between states and seek employment anywhere within India.

It's all about jobs for doctors and filling vacant PG seats:

The persistent vacancy rates of 40-50% in postgraduate (PG) seats within non-clinical specialties are expected to perpetuate the shortage of medical teachers in these fields. Additionally, medical colleges are grappling with revenue losses stemming from these unoccupied PG seats. In certain states, private medical colleges have established agreements with the government, obliging them to allocate a specific percentage of PG seats at reduced fees. Consequently, these institutions allocate non-clinical PG seats to the government quota while retaining the more lucrative clinical seats for themselves. 

Given the lack of interest among MBBS graduates in non-clinical seats, medical colleges are compelled to relinquish the clinical seats, which negatively affects their interests. Thus, there is a pressing need to address the vacancies in non-clinical seats. To address these vacancies, efforts have been made to attract MBBS graduates by offering incentives such as freebies, lowering the qualifying percentile to accommodate lower-scoring MBBS students for PG seats, reducing tuition fees, or even providing the seats free of charge.

Most MBBS graduates aspire to pursue clinical practice, as non-clinical subjects do not provide opportunities for clinical work. Typically, careers in non-clinical fields are centered around teaching in medical colleges. While there is some competition for teaching positions from M.Sc/Ph.D. candidates, this is a relatively minor factor that discourages MBBS graduates from pursuing PG studies in non-clinical subjects.

Despite the numerous vacancies in PG seats, a significant number of MBBS graduates are currently pursuing MD degrees in non-clinical subjects with the hope of securing faculty positions in medical colleges. The association of non-clinical medicos has actively lobbied the NMC to create provisions that would facilitate job opportunities for these individuals.

As a result, the undergraduate board of the NMC made the decision to significantly reduce and eventually stop the appointment of non-medical teachers. This decision serves a dual purpose: firstly, it aims to encourage the occupancy of MD seats in non-clinical subjects, and secondly, it seeks to create job opportunities for medical postgraduates, albeit at the expense of non-medical candidates.

The primary role of the NMC is to establish policies and guidelines that maintain the quality of medical education, rather than engaging in political strategies to occupy PG seats or secure jobs for doctors. By doing so, the NMC appears to be behaving more like an association of doctors focused on advancing their self-interests, rather than fulfilling its role as a regulator.

Role of ministry in ensuring justice:

While the MCI and NMC primarily are bodies 'of the doctors, by the doctors and for the doctors' furthering the interests exclusively of doctors, the union government is entrusted with the responsibility of safeguarding the welfare of all stakeholders. While the regulatory body tends to be self-centered, the policies of the Ministry of Health and Family Welfare (MoHFW) are grounded in reality and uphold principles of universal justice and equality. The NMC Act empowers the government to supersede the NMC on any matter, including policies. Given the inherent bias of the NMC, it is unlikely to ensure a level playing field for non-medical individuals. Therefore, the ministry's intervention is entirely justified. However, it is shocking that the NMC, after initially submitting an affidavit to the Delhi High Court to comply with the ministry's directives, later reversed its stance and exhibited defiance.

Unjustifiable pretexts - myths vs facts:

The rationale employed by the NMC to disqualify non-medical teachers appears to be weak and unsubstantiated. For individuals who have already covered Anatomy, Physiology, and Biochemistry in the first year of their medical M.Sc. program, integrating these subjects for non-medical teachers should pose no significant challenge. In practice, integration with clinical subjects has been ongoing for many years, albeit under the term "applied aspects," even if it was not formally recognized as "integration." Non-medical educators have successfully implemented these integrations since their introduction a few years ago. It's worth noting that while some non-medical teachers may have been excluded from participating in teacher training programs, many have actively participated in critical training sessions, including the revised Basic Course Workshop (rBCW), Curriculum Integration Support Program (CISP), and Attitude, Ethics, and Communication (AETCOM).

The integration component constitutes only a minor portion, approximately 20%, of the overall syllabus. It's crucial to recognize that the fundamental aspects of health and illness, such as the human body, diseases, and diagnostic and treatment methods, remain constant. A shift in curriculum, therefore, does not alter these core principles. The new curriculum cannot be used as an excuse to disqualify teachers who have been teaching for years/decades or prevent them from the academic role of examiner. Furthermore, the early clinical exposure component comprises just 9 hours in each subject. This relatively minimal requirement can easily be fulfilled by medical teachers, who already make up a significant majority, ranging from 70% to 100%, of the faculty.

Non-medical teachers constitute a small minority, with some colleges lacking any non-medical teachers at all. At most, they can make up to 30% of the total faculty strength. The majority of faculty members in these institutions are medical teachers. Hence, the claims of subpar teaching quality cannot be solely attributed to this minority group of teachers.

Proposal to shift non-medical teachers into research:

The NMC's current proposal plans to relocate non-medical teachers, some of whom have served as Professors for several years or even decades, to research positions, ostensibly to create job openings for doctors. However, this plan is illusory, as there simply aren't enough doctors to fill these positions. Forcibly redirecting an individual's career against their wishes is not only unethical but also inhumane. The process of shifting will not happen as envisaged. While permanent government employees may be accommodated into new positions, privately-run institutions are more likely to terminate the employment of non-medical faculties resulting in job loss of thousands. 

It is to reiterate that medical M.Sc courses are historically meant to create teachers for undergraduate teaching, these are no different from MD courses and the false notion that M.Sc courses are meant for research has to be debunked.

In conclusion, what needs to be done?

1. The presence of non-medical teachers should be an integral part of medical education, and colleges should have the freedom to appoint them on merit up to a limit of 30%.

2. All forms of discrimination against non-medical teachers must be abolished.

3. The NMC Act should be amended to ensure that every board, committee, or sub-committee includes 50% non-doctors to ensure fairness and equity.

4. All discriminatory and contested guidelines in the CBME and MSR 2023 should be amended immediately or withdrawn.

5. In order to strengthen and regulate the standards of medical M.Sc courses, a new body 'National Commission for Scientists in Healthcare and Medical Education' must be framed.

It's all about securing jobs and filling empty PG seats under the guise of prescribing quality

The current landscape of medical education in India has been marked by a series of challenges and controversies, particularly concerning the roles and actions of the National Medical Commission (NMC), the Union Government, and the petitioner association, the National M.Sc Medical Teachers’ Association (NMMTA). These issues have raised concerns about the fairness, transparency, and inclusivity of the system, as well as the balance between medical and non-medical professionals.

Roles of the NMC:

The NMC, as the regulator of medical education, holds significant responsibilities. It is empowered to set standards and guidelines, making it essential for them to engage in discussions and gather feedback from stakeholders while framing these standards. Additionally, the NMC is expected to follow prescribed quorum procedures when framing guidelines or adopting resolutions. Moreover, it should operate under the guidance and policies set by the Union Government and adhere to the norms established by international bodies such as the World Federation of Medical Education. The NMC should ideally maintain a bipartisan, fair, transparent, and inclusive approach in its practices and not let policies be dictated by personal or collective pride or prejudices.

Roles of the Union Government:

The Ministry of Health and Family Welfare (MoHFW) plays a pivotal role in setting the overarching policies for medical education and directs the NMC to follow these policies. The Union Government holds the authority to ask the NMC to amend or withdraw issued guidelines as needed.

Roles of the Petitioner Association (NMMTA):

The NMMTA serves as a vital entity in safeguarding the interests of its members, who are dedicated educators and professionals with non-medical backgrounds. They hold medical M.Sc postgraduate degrees in specialized fields such as Anatomy, Biochemistry, Physiology, Pharmacology, and Microbiology, often accompanied by Ph.D. qualifications. The association can file feedback on guidelines or appeals with the NMC or the MoHFW and seek legal remedies.

Current Issues:

One of the key issues that have emerged is the association of non-clinical medicos lobbying with the Medical Council of India (MCI) and later with the NMC to exclude non-medical teachers from the medical education system. Initially, the MCI proposed to amend the guidelines, reducing the permissible percentage for non-medical teachers to 15%. The Ministry of Health intervened, leading to the proposal's abandonment. However, the association continued to lobby with the NMC, which resulted in alterations to the guidelines.

The NMMTA appealed to the NMC, but their appeal was rejected. Subsequently, they filed a second appeal, leading to the Union Ministry directing the NMC to revert to the previous norms. However, the NMC submitted an affidavit agreeing to comply and later defied the ministry's directives.

The reasons behind the NMC's actions are a combination of explicit and implicit factors. Explicitly, the introduction of Competency-Based Medical Education (CBME) with horizontal and vertical integrations, coupled with the perceived availability of sufficient medical teachers, served as reasons for the changes. Implicitly, these actions are seen as an attempt to create job opportunities for medical professionals at the expense of non-medical candidates and to fill the vacant MD seats in non-clinical subjects, which have historically been undersubscribed.

Several thousand non-clinical MD seats in non-clinical subjects remain vacant each year, leading to significant revenue loss for medical colleges. One hypothesis suggests that medical colleges tend to retain pricey clinical seats and offer non-clinical seats to government quotas to fulfill their obligations. However, non-clinical subjects remain unpopular among MBBS graduates, who overwhelmingly prefer clinical practice. Non-clinical subjects are often pursued out of desperation after failing to secure clinical seats, and competition from non-medical candidates adds to the complexity.

Despite the persistent vacancies in PG seats in non-clinical subjects, hundreds of candidates continue to enroll in these courses. As they cannot practice in any clinical specialty, they rely on teaching positions for employment. Consequently, the NMC has taken it upon itself to disqualify non-medical candidates and provide jobs to medical graduates.

The association of non-clinical medicos and the subsequent framing of guidelines by the NMC appear to be primarily motivated by facilitating jobs and filling vacant MD seats, all under the guise of a new curriculum and syllabus. Global norms set by the World Federation of Medical Education (WFME) advocate for a balance between medical and non-medical faculties, yet the NMC seems to be disregarding these norms to favor its own members. The NMC is increasingly resembling an association of doctors, akin to the Indian Medical Association. The original draft of the NMC Act proposed that only 60% of its members would be doctors, but this ratio was changed to grant doctors full control. In contrast, the regulatory body of the United Kingdom includes 50% laypersons, a practice that helps keep a check on doctors' self-interests. It is no secret that doctors may sometimes prioritize their self-interests and attempt to disregard any unethical practice (as discussed in detail in this Times of India article: https://timesofindia.indiatimes.com/blogs/staying-alive/how-docs-have-fought-to-keep-pharma-funding-going/).

The NMC may assert that its decisions align with general feedback received from the public. However, it is essential to note that the medical community, encompassing both clinical and non-clinical professionals, has collectively advocated for the exclusion of non-medical individuals. Given the substantial majority held by medical professionals in this feedback, it is evident that it may be inherently biased. In situations of conflict of interest, doctors tend to prioritize their own interests, indicative of an abuse of the dominant position. 

While the NMC seems to operate as 'of the doctors, by the doctors, and for the doctors,' the Union Government has a broader responsibility to accommodate all stakeholders and protect everyone's interests. Therefore, it is justifiable for the Union Government to direct the NMC to revert to the old guidelines, ensuring a fair and balanced representation of medical and non-medical professionals. It is essential to note that when there is a conflict of interest, doctors often tend to favor themselves. This apparent abuse of dominant position involves changing yardsticks, shifting goalposts, and amending rules to portray one group as eligible and another as ineligible, all to promote self-interests.

In conclusion, the current challenges and controversies surrounding Indian medical education call for a balanced and fair approach that upholds the principles of inclusivity and transparency. The struggle for balance between medical and non-medical professionals is a critical issue that requires careful consideration and a commitment to providing quality education and opportunities for all stakeholders.

Flourishing academic apartheid in Indian medical Academia

In the field of medical education, it is common practice for clinical subjects to be taught exclusively by medical teachers with medical qualifications, while the non-clinical basic medical sciences are taught by both medical and non-medical teachers. As non-clinical doctors are restricted to teaching, they do not contribute to patient healthcare in society. To mitigate this anomaly in many countries, the role of non-clinical teaching is often assigned to non-medical teachers. 

The appointment of non-medical teachers as Heads of Departments (HOD) in medical colleges has been a subject of debate for a long time. However, the allegations that non-medical teachers are not qualified or competent to serve as HODs in medical colleges are baseless and unfounded.

It is important to note that the appointment of non-medical HODs made prior to the notification of TEQ Regulations, 2022, should not be affected in any manner whatsoever. However, this isn't the case as there have been instances where the incumbent HODs with non-medical backgrounds have been removed from their positions and replaced by juniors or someone from the allied departments much to their embarrassment and humiliation.

The Medical Council of India's 1998 Teachers Eligibility and Qualification guidelines state that non-medical individuals may be appointed as HOD in non-clinical departments if there is a shortage of qualified medical teachers available for the position. However, there have been various attempts to change this provision and deny non-medical teachers the opportunity to become HODs.

Despite their different backgrounds, both medical and non-medical teachers perform similar roles in a medical college. The nature of both medical M.Sc and MD degrees are comparable, and both degrees are suitable for academic roles. Therefore, non-medical teachers are not handicapped in any way when it comes to fulfilling academic duties. The role of HOD is to administer the department, which anyone who has worked in the department for at least ten years would be familiar with.

There is no formal training for faculty members on how to become a HOD, and it is not a position that someone is born with the skills to undertake. Instead, individuals learn how to administer a department through interactions with their peers and senior colleagues over several years. As such, anyone who has served as a professor for a significant amount of time is capable of fulfilling the duties of a HOD.

In a department, the highest post is that of a Professor, and HODship is an additional responsibility that a Professor can undertake. If a non-medical person can be appointed as a professor, they cannot be considered unfit for the role of a HOD.

The role of the HOD is not a dictatorial one, and decisions are made in consultation with all members of the department. HODs can seek advice from their peers or superiors when making important decisions, and they can discuss matters with the college dean or management if they are unsure about what course of action to take. The role of HOD is purely administrative, and anyone who holds the position of professor is capable of undertaking it.

Interacting with other non-clinical or clinical departments is not an issue for HODs with non-medical backgrounds. Anyone who is well-versed in their subject area can provide necessary inputs to other departments. While it is true that medical graduates are better equipped to deal with issues related to the health and well-being of patients, the role of a HOD goes beyond that. HODs are responsible for the overall management and administration of the department, including academic programs, research, and collaborations with other departments. A non-medical HOD with experience in management and administration can bring valuable skills to the department.

Non-medical HODs have been working in several medical colleges for many decades without any issues. The success of a HOD comes down to the individual's wisdom, attitude, and behavior, not their background degree. The only underlying issue here is that of prejudice, where doctors who consider themselves superior to non-doctors are unwilling to take orders from a non-medical HOD. This is purely a practice of academic apartheid, and there is no rational basis for denying non-medical teachers the opportunity to become HODs.

The argument that non-medical persons cannot claim parity/equivalence with persons possessing an MD degree is flawed. This is because parity or equivalence is not solely based on qualifications but also on the skills, knowledge, and experience of the individual. A non-medical teacher with relevant experience and expertise can bring a unique perspective to the department and contribute positively to the growth of the institution.

Clinical departments may seek expert opinions from pre-clinical departments for coordination, but it is not necessary that the head of department (HOD) be consulted. Non-medical professors possess similar levels of awareness regarding the latest developments in medicine as their non-clinical medical counterparts. They have also been a part of the department for over a decade, and participate in various meetings, such as journal clubs, CMEs, mortality meetings, and clinicopathological meetings, all of which contribute to their knowledge base. HODs can always consult their peers or colleagues before providing their expert opinions.

The Medical Council of India and the National Medical Commission are both dominated by doctors, who often side with their own interests in cases of conflict. As a result, the rules and regulations surrounding non-medical teachers have been continuously altered to put them at a disadvantage. The people running these bodies often have a pathological hatred towards non-medical teachers, which is akin to the discrimination faced by minority populations in other contexts.  The NMC has demonstrated bias against non-medical personnel, resulting in decisions that are often unfavorable to them. Rules have been revised to put non-medical teachers at a disadvantage. Merely because the NMC holds a statutory position does not guarantee that its decisions are always impartial and just. 

Denying non-medical teachers the opportunity to become HOD is purely discriminatory and has no other rational basis. This is purely an Indian thing, as such discriminatory denials are not practiced in the West. There, the faculties with non-medical backgrounds are routinely made heads of the departments. NMC must shed this apartheid and make medical education more inclusive.

The appointment of a HOD is an administrative position and not a practicing profession. Therefore, the qualifications required for appointment to the position should not be limited to medical qualifications. NMC must restrict itself to prescribing a minimum designation of a Professor for the role of a HOD but it must ultimately be left to the college management to select the deserving person for this role.

Finally, the allegation that the scope of judicial review is limited in matters concerning academic/educational policies is not applicable in this case. The appointment of a HOD is an administrative position, and any appointment that does not adhere to the principles of meritocracy and fair play can be challenged in court.

 Open letter to the NMC over  the non-medical teachers

1. When NMC was formed, it was expected that MCI guidelines regarding teachers would be adopted. In fact, the original draft (Minimum Requirements for Annual MBBS admission regulations, 2020) released on 13-10-2020 for public feedback was an adoption of the MCI guidelines in stating, "In the department of Anatomy, Physiology, Pharmacology, and Microbiology, non-medical teachers may be appointed to the extent of 30% of the total number of posts in the department. However, in the department of Biochemistry, non-medical teachers may be appointed to the extent of 50% of the total number of posts in the department."

Making an unceremonious U-turn, the gazetted guidelines stated, "In the department of Anatomy, Physiology, Biochemistry, non-medical teachers may be appointed to the extent of 15%of the total number of posts in the department subject to non-availability of medical teachers". If a change has to be made, the proposed changes should also have been subjected to public feedback, but the NMC did not seek feedback on this. It is difficult to fathom how thousands of feedback were evaluated in just one week's time. We suspect that this move was pre-planned and the process of seeking feedback was a mere formality.

It is unfortunate that many non-clinical doctors, who see scientists as competitors, hold grudge and ill-will against the latter. Despite being in medical education, the scientists, who are labeled as "non-medical teachers" have never been considered as a part and parcel of the system, instead, they were always perceived as outsiders. With no representation in the MCI, the guidelines were always modified to put the scientists in disadvantageous positions. These non-medical teachers suffer a variety of discriminations and harassments at the workplace due to the prejudiced position of the MCI. It is also no secret that some members of the MCI hold personal dislike against the scientists; some of them have continued to hold positions in the NMC. Their personal prejudices have been allowed to influence the policies, which is terribly wrong and unethical.

It has not escaped our observation that in several litigations MCI had always portrayed the scientists as inefficient and unworthy, albeit many observations were factually incorrect. This is because MCI never considered "non-medical" teachers as valuable assets and part of the system.  MCI always seemed eager to denigrate the scientists at the drop of a hat. Time and again, MCI had opposed in various courts the HODship for the non-medical teachers, implicitly implying the deep malice that it holds towards non-medical teachers. This is evident in the minutes of the meeting (held on 01-08-2011) where MCI had acknowledged "post of head of the department headed by non-medical teachers in pre & para-clinical subjects from the premier medical institutes vis-a-vis PGI, Chandigarh & AIIMS, New Delhi". Despite this, MCI was always reluctant to let scientists head the non-clinical departments. Naturally, such an attitude has percolated down and emboldened individuals and associations of non-clinical doctors. There is hardly an instance where the MCI has upheld or supported the non-medical teachers in any litigation. 

2. Succumbing to the demands of one nefarious organization of non-clinical doctors, MCI in 2018 had proposed to halve and halt the appointment of non-medical teachers. A sub-committee was formed to examine the issue, the findings of which were never publicized. Whatever might be the recommendations, the then board of governors in supersession of the MCI had decided against changing the guidelines. 

3. Reference is made to the minutes of the meeting of the Executive Committee held on 06th January 2020 where it was categorically stated "Non-medical faculty will continue in the Department of Anatomy, Physiology, Biochemistry, Microbiology, and Pharmacology. The existing regulation about maximum 30% non-medical teachers in the Department of Anatomy, Physiology, Microbiology & Pharmacology and 50% in the Department of Biochemistry will also remain unchanged."

Why the U-turn now? What are the reasons and circumstances for such a drastic reversal?

4. Reference is also made to MCI's letter No. MCI-7(10)/2019-Legal/(18354)/183596 dated 21-01-2020 written to All India Pre and Para Clinical Medicos Association which contains the following text, "..a complete phasing out of faculty with M.Sc-PhD from the teaching faculty after 3 years in the pre-medical basic sciences (Anatomy, Physiology, and Biochemistry) would create a closed system. It would preclude the intellectual cross-fertilization which generates dynamism in teaching and research that only advances the growth of the subject but intellectually stimulated the mind of the student, who would then be able to think in innovative ways as to how to understand and practice medicine. Also, there is a great thrust from MCI and other bodies involved in higher education to encourage research. Research does not recognize intellectual boundaries. Many of the advances in science have come from basic sciences. hence, there is a need to maintain this flow of ideas and not completely stop the input of faculty who are not medically qualified int eh pre-clinical subjects. We have to be very clear that higher education (and definitely medical education is classified as higher education), should be to encourage the entry of diverse intellectual streams that feed into the medical sciences. India should not be isolated from the trends in the rest of the world including even the developing world, let alone the developed world, by cutting off the basic roots of medical sciences". 

What happened to this wisdom and chivalry? Thrown out? Just to appease a section of non-clinical doctors who are vociferous in their prejudiced demands to oust the scientists? Are these observations not valid or relevant anymore? 

As already admitted by the MCI, the appointment of non-medical teachers is universal, being practiced both in developed and developing nations. In fact, the percentage of scientist teachers is 50-80% in several colleges in western countries. There is no genuine reason to do away in India now.

5. In the same aforementioned letter it is stated: "on average 50% of more seats in the subjects of MD (Anatomy), MD (Physiology), MD (Biochemistry), MD (Pharmacology) and to the extent of 40% in MD (Microbiology) have gone vacant. Thus there continues to be a paucity of Medical Teachers with MD qualifications in these subjects". 

We wonder what has changed in these 9 months? Has the shortage been magically overcome? Are there sufficient medical teachers available now? It may not be a secret that this shortage continues even now. While medical candidates may be available in metros and big cities, those colleges in suburban, remote, or hilly areas have fewer takers as most medical candidates don't prefer such places. At present, such areas are serviced by non-medical teachers.

6. Sir, we respectfully submit that the following statement of the Adhoc Committee appointed by the Hon’ble Supreme, "compromised teaching faculty will result into the degradation of the standards of medical education as the graduates from such institute will be dealing with lives of human beings without getting adequate training from the medical teachers" is unfounded. To some extent, the same could be attributed to situations where all the faculty members were to be non-medical. Anyhow, MCI had put a ceiling of 30-50%, so such a situation would never arise.

What are the roles of medical teachers constituting the rest of 50% in Biochemistry and 70% in other non-clinical disciplines? Why is the fall in standards attributed only to 30-50% of non-medical teachers whereas the remaining medical teachers absolve themselves of all the responsibilities? Why can't they compensate for what the non-medical teachers lack?

7. Since the non-medical teachers are perceived as outsiders and always under constant scrutiny, they tend to perform better than the non-clinical teachers, who tend to take their positions for granted merely for being a natural part of the system. Mere possession of a certain academic qualification or the lack of is not an indication of quality; it ultimately boils down to individual skill and proficiency. There are good and bad teachers with either qualification; hence qualification alone shouldn't be the yardstick.

8. The new curriculum with early clinical exposure along with horizontal and vertical integration is not an impediment to non-medical teachers. It is wrongly held notion that due to no patient exposure, the non-medical teachers are incapable of handling the new curriculum. All faculty members are expected to undergo compulsory workshops on revised basic medical education, competency-based medical education, and AETCOM. It's an altogether different issue that out of prejudice the non-medical teachers in some colleges are deliberately being denied opportunities to undertake these workshops. While not good as medical teachers, the non-medical teachers with due training, exposure and experience will be able to attain the required expertise. Wherever shortcomings are felt, the same can be overcome by involving or seeking the help of medical teachers. Complete exclusion is not necessary.

9. India needs more doctors to provide healthcare; India needs more specialists. In most Western Countries there are no PG courses in non-clinical specialties. Even if there are, they are mostly MSc courses, not MD (or equivalent) courses. Awarding a Doctor of Medicine (MD) degree in non-clinical courses is an oxymoron. India too must stop (or at least minimize) these courses. Let India produce more clinical specialists, let the non-clinical academics be handled by the medical scientists (as practiced in many countries). Let there be a sound policy on how many non-clinical doctors are required and for what purposes. Thousands of doctors who do nothing but teach are an enormous wastage of professional resources in a country that already has a shortage of doctors. NMC must reduce the number of PG seats in non-clinical subjects and increase seats in clinical subjects. Banning the scientists just because non-clinical PG seats in many medical colleges are going vacant is regressive and counter-productive.

We conclude that medical education must get the best of both qualifications; NMC must create a system so that the best teachers get selected; best in terms of knowledge, skill, and attitude, not merely based on academic qualifications. NMC must reinstate the previous MCI norms; in fact, we suggest completely do away with any prescribed ceilings and let the institutions make their own selections.

Open letter to NITI Aayog regarding medical scientists

Open letter to NITI Aayog calling for intervention over policy directions regarding medical scientists

In the 1950s, there were very few teachers in medical colleges to teach the non-clinical subjects of the MBBS curriculum, as most MBBS graduates would pursue postgraduation in the clinical disciplines. To overcome this shortage, the Health Survey and Planning Committee, 1961 (well known as the Mudaliar Committee) under the Ministry of Health and Family Welfare (MoHFW) recommended offering M.Sc courses in the five non-clinical disciplines to the life-science graduates (B.Sc). These courses were conducted by the medical colleges with due recognition by the Medical Council of India (MCI) based on the same curriculum and syllabus as those of MD courses in these disciplines. The degrees are now awarded by the health universities under the 'Faculty of Medicine'. These scientist teachers are known as "non-medical" teachers in order to distinguish them from medical teachers, who possess basic MBBS qualification. At one point, around 100 medical colleges used to run Medical M.Sc postgraduate courses, which has now shrunk to around 35 colleges. It is estimated that around 3-4 thousand students are currently enrolled in these courses. Scientists with Medical M.Sc qualifications, like their counterparts with MD qualifications, have three main career options:
1. as non-clinical teachers in medical/dental colleges,
2. consultants in diagnostic laboratories,
3. scientists in research institutions or industries. 

Having similar educational qualifications and career opportunities, both the degree holders compete for the same jobs. Over the last few years, a section of non-clinical doctors (MBBS graduates with MD in non-clinical subjects) and their associations have lobbied hard with the government to exclude the scientists from the teaching and diagnostic roles. The first axe on the scientists fell in 2014 when the health ministry, through the guidelines under the Clinical Establishment Act, disentitled the entire scientist community from any participation in the diagnostic laboratories despite being granted eligibility by the National Accreditation Board for Testing and Calibration Laboratories (NABL). Both the Directorate General of Health Services (DGHS) and the MCI connived to pressurize the NABL to drop the eligibility of scientists. However, the MoHFW realized its folly and eventually restored the eligibility of scientists as consultants in diagnostic laboratories.

In 2018, again yielding to the lobbying from the community of "non-clinical" doctors, MCI proposed to halve and halt the appointment of "non-medical" teachers in medical colleges. Under the MCI guidelines, there are provisions to appoint scientists up to 30% (50% in Biochemistry) of faculty strength in the five non-clinical disciplines. Following a nation-wide protest by the scientists' community, this proposal was shelved, only to resurface once the National Medical Commission (NMC) replaced the MCI. Under the recent NMC guidelines published through a gazetted notification, the appointment of "non-medical" teachers have been reduced from 30% to 15% in the subjects of Anatomy and Physiology; from 50% to 15% in Biochemistry, and from 30% to 0% in Pharmacology and Microbiology. In a FAQ document released by the NMC, the new guidelines would take effect under three conditions:

1. All new medical colleges that start MBBS admission (2021-22 batch)

2. All old colleges that seek to enhance student admission

3. All new appointments in medical colleges, whether new or old

These guidelines have been like a bolt from the sky that has sounded a death knell to the scientists. These guidelines ensure that thousands of students who are currently pursuing medical M.Sc courses would be deprived of teaching jobs. "Non-medical" teachers who are currently employed in one medical college will have to remain in the same job until they resign, forced to resign or are ultimately fired; once out of a job they have all doors closed everywhere. Being on a sticky wicket, such faculties would be at the mercy of the employers and have to put up with a variety of harassments and give up hopes of any promotions or salary hikes. If a certain institution goes for MBBS seat enhancement, the new rules kick in and the "non-medical" teachers automatically become disqualified or excessive in numbers; which will lead to their sacking. All of these are inhuman scenarios and violation of basic human rights. Scientists, who had pursued these courses never bargained for such an unforeseen situation.

NMC is wrong in its decision for various reasons. Unlike what is projected, there aren't sufficient medical teachers available to fill the void; vacancies are still real. In fact, many MD postgraduate seats in the non-clinical disciplines are going vacant as there are few takers. The prejudiced position of the NMC is arbitrarily depriving the medical students of qualified teachers. Possession of a certain qualification isn't a guarantee of competency and its absence doesn't indicate incompetency. It is a fallacy to assume that the quality of medical education can be improved by purging the scientists. In fact, 21% of teachers (including clinical disciplines) in the US medical colleges are scientists. In the top 10 global medical colleges, scientists account for 70-80% of teachers in the non-clinical disciplines. There are good and poor teachers with either degree. Instead of relying purely on the nomenclature of the academic qualifications, stress must be on the skill and competencies of the teachers. Let the medical education get the best of both; let teachers be selected purely on merit. 

Besides teaching, the "non-medical" teachers are also involved in clinical diagnostic laboratories and research. The "non-medical" teachers are at the forefront of COVID testing in most medical colleges. They are solely or jointly managing these labs in many cases. India's healthcare must not be deprived of quality services that are offered by competent scientists just to please a section of medical professionals. That would be bad policy. Medical education should not be deprived of "non-medical" teachers with Ph.D. qualifications, who can engage in research and guide postgraduates and Ph.D. scholars.  India must utilize the human resource that is available to her. Policies must be made according to the prevalent education system and societal needs. 

Given the poor patient-doctor ratio, India needs more doctors engaged in direct healthcare. Currently, thousands of "non-clinical" doctors are engaged in academics without directly contributing to direct healthcare. In many western countries, there are no postgraduate courses for the doctors in the non-clinical disciplines; in such countries, doctors attend to patients whereas academics and research are mainly handled by scientists. This is a policy that India too must consider.

Finally, it is also to bring to your kind notice that ever since the MCI abandoned the medical M.Sc courses, these courses suffer from variations in curriculum across the universities and haven't been upgraded in a long time. A scientific council to regulate these courses and register the scientists offering professional services in the diagnostic laboratories is warranted. At the same time, given the dwindling job opportunities, the government must put a policy in place regarding the utility of Medical M.Sc courses. By having no representation in the erstwhile MCI and the current NMC, it becomes convenient for the regulatory body dominated by the doctors, to put competing scientists in disadvantageous positions. Our concerns have consistently been ignored both by the Education and Health ministries. The "policy paralysis" regarding the medical M.Sc courses and the biomedical scientists has to end. 

The purpose of this letter is to induce a concern among the top minds of NITI Aayog so as to formulate a futuristic policy taking into account the welfare of this minority community of scientists and their services to the nation.

NMC guidelines for non-medical teachers are bad

The undergraduate curriculum of medical course (MBBS) is broadly divided into early non-clinical and subsequent clinical phases. The non-clinical component is further composed of pre-clinical (Anatomy, Physiology, Biochemistry) subjects taught in the first year and para-clinical subjects (Pharmacology, Microbiology, Pathology, etc) taught in the second year. The non-clinical subjects are basic and foundational whereas the students study the diseases in detail in the clinical subjects (Pediatrics, Ophthalmology, General Medicine, Surgery, Obstetrics & Gynecology, etc). 

The teachers who teach the clinical subjects in all medical colleges are always doctors (MBBS + MS/MD) whereas a minority of the teachers in the non-clinical subjects are scientists (medical M.Sc / Ph.D.), also called "non-medical" teachers. In the 1950s when not many doctors were pursuing postgraduation in non-clinical specialties, a severe shortage of teachers occurred in these specialties. The Health Survey and Planning Committee (Mudaliar Committee) of 1961 recommended opening up of the M.Sc courses in the five non-clinical subjects to non-MBBS science graduates so as to create teachers to teach in medical colleges. The medical M.Sc courses (in Anatomy, Physiology, Biochemistry, Pharmacology & Microbiology) were included in the first schedule of the Indian Medical Council Act. Since the M.Sc courses were pursued by the graduates in life sciences and MD courses in the same subjects were introduced for the medical graduates, MCI quietly withdrew the regulation of M.Sc courses. It also claims that these courses are no longer in the first schedule. At one point in time around 100 medical colleges were running medical M.Sc courses in these five non-clinical subjects, now around 35 medical colleges do. 

Excerpt from the report of Mudaliar Committee

The Teachers Eligibility and Qualifications (TEQ) guidelines of the MCI made a provision to appoint scientist teachers in Anatomy, Physiology, Pharmacology & Microbiology up to 30% of faculty strength, and up to 50% of faculty strength in Biochemistry. There are currently a couple of thousands of non-medical teachers in the various medical colleges across India working in designations ranging from Tutor to Professor & HODs. Similarly, there are plenty of non-medical teachers in centrally administered medical institutions such as AIMMS, PGI, JIPMER, ESI, etc. The appointment of scientists as teachers in the non-clinical specialties is not unique to India; it is practiced almost everywhere. In the top 10 medical colleges of the world, up to 60% of teachers are scientists. In some colleges, some departments are almost entirely composed of scientists. In the US, 21% of teachers in medical colleges are scientists. Although it may seem rational that only doctors should teach MBBS students, it must be borne in mind that non-clinical subjects can be taught effectively by the scientists, who are trained in the same subjects. 

https://journals.physiology.org/doi/full/10.1152/advan.00172.2019

One may still wonder how can a scientist teach medical students even if the subjects are non-clinical. This is because the curriculum and syllabus of medical M.Sc courses are similar in content and quality to the MD courses on the same subjects. Often, both the medical M.Sc and MD courses are conducted in the same medical college by the same faculty using the same curriculum. Both the degrees are offered under the 'faculty of medicine' by the health universities. In addition, the students pursuing medical M.Sc courses have to compulsorily undergo one-year course in Anatomy, Physiology and Biochemistry of the human body (similar to first year MBBS course) so that they are well-versed with the structure and functioning of human body.  Therefore, it can be conveniently concluded that while the underlying graduate degrees are different, the postgraduate degrees are almost similar. 

Medical M.Sc course prospectus

Due to faulty government policies, the number of MBBS UG seats rose in the medical colleges but the number of MD/MS PG seats didn't rise proportionately. There were more doctors but fewer opportunities to take up postgraduation in clinical subjects, hence an increasing number of doctors started pursuing MD in non-clinical subjects. This created competition for the teaching jobs in medical colleges. At the same time, the MCI inexplicably reduced the student-teacher ratio, thereby making the competition for limited jobs even more fierce. 

When the MCI got replaced by the NMC, it published a draft adopting the MCI guidelines regarding the appointment of non-medical teachers. It sought feedback from the stakeholders. Thousands, including non-medical teachers and "non-clinical" medical teachers sent their feedback. In just 7 working days, NMC went through these feedback and decided to reduce the permissible intake of non-medical faculty from 30% to 15% in Anatomy and Physiology, from 50% to 15% in Biochemistry, and from 30% to 0% in Microbiology and Pharmacology. This was the result of incessant lobbying by the community of non-clinical doctors who wanted all the teaching jobs for themselves. In 2018, following a representation from an association of non-clinical doctors MCI had proposed to halve and halt the appointment of non-medical teachers. A sub-committee was formed to examine this issue. The board of governors in supersession of MCI rejected that proposal. Again, following another representation from the same association, the MCI's board of governors  categorically stated in January 2020 that non-medical teachers are required as medical teachers are in short supply. Under pressure from the lobbyists, NMC took a U-turn in October 2020. 

NMC's orginal draft guidelines dated 13/10/2020

25th meeting of BOG held on 6th January 2020

The points that the lobbyists use against the non-medical teachers are the increased availability of medical teachers and the introduction of the new competency based medical curriculum (CBME). While there is no doubt that more numbers of non-clinical doctors are now available for the role of teachers, the vacancies still exist. Many positions are still going vacant for the want of medical teachers, which could have otherwise been filled by the scientist teachers. These conditions force the colleges to deprive the students of teachers rather than appoint scientist teachers. Even to this day, several colleges are managing with non-medical teachers because there is a shortage of medical teachers. For the last few years many PG seats in the non-clinical specialties are going vacant, hence the shortage of medical teachers is likely to continue for several years. 

The CBME involves early clinical exposure and integration (horizontal and vertical) with other non-clinical and clinical subjects right from the first year of the MBBS course. The lobbyists claim that since only the medical teachers have exposure to patients during their own MBBS days, they are better equipped to deal with the new curriculum. While medical teachers can certainly do well, we believe that it is not essential. Only 20% of the syllabus has integrations; there are several chapters that don't need integration at all. All the current teachers, whether medical or non-medical are supposed to undertake Curriculum Implementation Support Programme (CISP), Revised Basic Medical Education as well as Attitude, Ethics & Communication (AETCOM) trainings. In fact, most non-medical teachers have already undertaken these training programs. A non-medical teacher can always seek the help of medical teachers of other specialties to fill the gap. In any case, the 30% limit means only 1-2 non-medical teachers are present in the department whereas the rest (70%) teachers are doctors, who should be able to compensate the shortcomings, if any. 

Besides teaching, the non-medical teachers in the department of Biochemistry and Microbiology also take part in clinical diagnostic laboratory, train MD students, and participate in research activities. In the present COVID pandemic, non-medical teachers have been in the forefront of establishing and running the COVID testing laboratories. Scientists should be an integral component in both medical teaching and diagnostics, as is practiced in many parts of the world. Instead of supporting the scientists, upgrading them, or utilizing them better, the NMC has gone for their exclusion. This certainly is a flawed move. 

Through its FAQ document, NMC has clarified that the new guidelines would be applicable only to the new colleges that would admit students into the 2021-22 batch. The new guidelines would also apply to those medical colleges that would seek enhancement in students' admission. Also, any new appointment into the medical college, whether old or new, will have to follow the new guidelines. This effectively means that a non-medical teacher would be forced to stay put in the same college until retirement, and all possibilities to seek new employment in any college, whether new or old, would be denied. Also, the colleges that opt for seat enhancements will be forced to terminate existing employees in order to fulfill the new guidelines. This will mean that hundreds of teachers would lose jobs. Also, the students who are pursuing medical M.Sc courses hoping to join medical colleges as teachers will have their doors closed by the time they complete their education. It is to be noted here that many medical colleges clearly state in their course prospectus that students can get teaching jobs in medical colleges. These students would be cheated of their chances to earn a livelihood. Having pursued medical M.Sc courses, there are limited avenues of employments outside the medical colleges. In many Western countries, there are no PG courses for doctors in the non-clinical specialties; these areas are mostly serviced by the scientists. In a country that has skewed patient-doctor ratio, more doctors are required to provide direct healthcare, something which our government must seriously consider. 

In every way, the scientists stand to lose, therefore they are protesting it. The entire community of non-medical teachers and students pursuing these courses are alarmed, anxious, and tensed. The scientists' community feel that since NMC is populated and dominated by the doctors, this body would always take the side of doctors whenever there is a conflict of interest. Although NMC is an independent body, the scientists feel that the ministry should step in as it is expected to impartially safeguard the interests of all the stakeholders. For far too long the ministry has pandered to the doctors' community and neglected all others involved in healthcare and medical education. It is time for the government to stand up to the scientists' community and restore their due place. The scientists' community has demanded that the previous MCI norms on the appointment of non-medical teachers be restored. 

The NMC's new guidelines for non-medical teachers are bad for various reasons.

1. It is assumed that only those with MBBS/MD are good teachers and all scientists are bad. This is a myth. There are good and bad teachers with either qualification. In fact, many scientists are excellent teachers. These guidelines will deprive medical students of potentially good scientists teachers.

2. It is assumed that since scientists lack clinical exposure (both theoretically & practically), they will not be able to do justice to the new competency-based curriculum (CBME), which has horizontal and vertical integrations with clinical subjects right from the first year. All teachers, whether medical or non-medical, have undergone the mandatory MCI-monitored curriculum implementation support programme for the implementation of CBME. The integration component is only 20%. It should not be assumed that an undergraduate student in the first or year will start practicing from the third year onwards. The first two phases of MBBS are para-clinical; they get to learn about all the ailments in the clinical subjects anyway. It is wrong to assume that the quality of medical education would not be met due to the presence of one or two scientist teachers. 70-100% of teachers in the non-clinical subjects are anyway doctors. They can always compensate for what a scientist teacher lacks. The NMC must invest some efforts to train the scientist teacher. The scientist teacher can always consult the clinical teacher for inputs, learn, and teach. After all, the scientist has studied the same thing that the medical teacher has learned in the MD curriculum. Basic medical education is undeniably useful, but the teachers from either background teach mainly on the basis of their postgraduate curriculum.

3. It is assumed that the new guidelines would apply only to the new colleges that will establish from 21-22 onwards. Our prior experience tells us there is a strong tendency among the medical colleges (especially private) to apply them as and when they wish. There are already reports of scientist teachers being sacked or asked to leave, even in instances where these rules don't apply. The exclusion of scientist teachers in the rules will give opportunity and armament to the employers to harass the existing scientist teachers and compel them to leave. Once out of job, the new rules will make it impossible to get another job in any new/old medical college.

4. It is assumed that the newly established colleges will get medical faculties. The shortage of medical teachers (including in non-clinical subjects) are very much real even now. In several instances, the positions are going vacant despite several rounds of placement advertisements and interviews. This is more so in rural, remote, under-developed or hilly areas, where most doctors don't want to go. The students will be deprived of teachers in such colleges. Currently, in these scenarios, the scientist teachers are carrying the most burden.

5. It is assumed that by selectively applying new rules to the new colleges, the quality of medical education will improve by ousting all scientist teachers. The new CBME curriculum will be applicable to all the medical colleges, both old and new. In fact, the number of students admitting to the MBBS course will be much higher in the current 542 medical colleges. The existing scientist teachers will continue in the established colleges for another decade or two until all the scientists are eventually flushed out of the system. The benefit of limiting scientists in the new colleges is negligible.

6. It is assumed that the currently employed scientist teachers will be unaffected by the new regulations. The current scientist teachers will be forced to stay in the same job because no medical college, new or old, will hire them anymore. They will be forced to work without promotion or pay hikes. The job insecurity will persist forever and their entire career will be spent on fearing termination. They could be exploited to any extent.

7. It is assumed that currently employed teachers in medical colleges under various stages of recognition will be unaffected by the new rules. As and when these colleges seek to increase their student admission, the new rules would apply. In such a scenario the current scientist teachers will be perceived as a liability. Therefore, those medical colleges that are eying to increase student admission in the foreseeable future will not regularize the current scientist teachers, resulting in their termination. 

8. Since the medical M.Sc courses were offered to the science graduate since the 1960s merely to create teachers in the non-clinical subjects, around 35 medical colleges continue to admit students for these courses. A career as a teacher in medical colleges is the prime reason why students opt for these courses. Currently, 3000-4000 students are pursuing the three-year courses. Their chances of employment are now completely wiped out. Similarly, hundreds of scientists are pursuing Ph.D. hoping for promotion or placements. Their career too would be over before it begins.

9. It is assumed that the medical teachers will be able to handle academics (teaching & practical demonstrations) and diagnostic laboratories all by themselves. In many colleges they are, but in many other colleges, it is the scientists who are jointly or mostly doing this. Not only these, but scientists are also contributing to the growth of scientific knowledge through research and publications. The contributions of the scientists must not be belittled. The fact the medical teachers are forced to undertake a course in Research Methodology, whereas the Ph.D. scientists have already gone through it in their Ph.D. curriculum. Such scientist teachers are better suited to be PG research guides.

10. It is assumed that by purging the scientists from medical teaching, the standards of education can be raised. This is similar to Hitler holding the Jews responsible for Germany's miseries and consequently purging them- "the final solution". The fact that premier central institutions such as AIIMS, JIPMER, PGI, etc continue to employ scientist teachers without any bias, is indicative that scientists are an integral part of medical education. The same is the practice in developed countries; 21% of teachers in US medical colleges are scientists. It is the golden rule in surgery that every attempt to save the body part must be undertaken before taking the easy but radical measure of amputation. Here, the NMC has gone straight for the amputation.