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.