Kumar Raman
President, Academy of Family Physicians of India, Uttar Pradesh, India.
Chief Editor, Journal of Family Medicine and Primary Care, Ghaziabad, Uttar Pradesh, India.
J Family Med Prim Care. 2019 Feb;8(2):323-325. doi: 10.4103/jfmpc.jfmpc_147_19.
After 21 years, a new MBBS curriculum has been released by the Medical Council of India (MCI), titled "Competency-based UG Curriculum for the Indian Medical Graduates." This curriculum is to be rolled out from August 2019 across India. The curriculum document runs through 890 pages in three volumes. Overall, 2939 competencies have been proposed to be acquired by trainee MBBS doctors. The parliament of India in one of its reports (2016) noted that the medical education system is designed in a way that the concept of family physicians has been ignored. Not to mention a formal introduction as discipline, the new MCI MBBS curriculum does not even mention the words "General Practice" or "Family Medicine" or "Family Physicians" throughout the voluminous document. The curriculum committee has also ignored the recommendations of National Health Policies (NHPs) of 2002 and 2017 of the Government of India (GOI). In practicality, it leaves the MBBS students in the road of no return of specialist and tertiary level hospitalist care. It deliberately deprives thousands of medical graduates an invaluable autonomous career in community setting as practicing family doctors. Simultaneously, this new curriculum drafting exposes a treacherous hierarchical monopoly of hospital based specialists doctors over generalist community based primary care physicians within the healthcare delivery system of India. Keeping out family physicians and general practitioners from the health system means a free flow of patients from community to expensive tertiary care facilities in the absence of any structured referral system. Family medicine and general practice are independent medical disciplines/specialties across world. The curriculum neither meets the national public health aspirations nor the GOI policies on medical education. If implemented, it will be disastrous to the healthcare delivery system and public good in general. The new MBBS curriculum deserves to be outright rejected for the inherent fallacies.
21年后,印度医学委员会(MCI)发布了一门新的医学学士课程,名为“印度医学毕业生基于能力的本科课程”。该课程将于2019年8月在印度全国推行。课程文件共三卷,长达890页。总体而言,提议医学学士实习医生要掌握2939项能力。印度议会在其一份报告(2016年)中指出,医学教育体系的设计方式忽视了家庭医生的概念。新的MCI医学学士课程不仅没有正式引入这一学科,甚至在这份冗长的文件中都未提及“全科医疗”“家庭医学”或“家庭医生”这些词汇。课程委员会还忽视了印度政府2002年和2017年国家卫生政策(NHPs)的建议。实际上,这让医学学士学生走上了专注于专科和三级医院医疗的不归路。它故意剥夺了数千名医学毕业生在社区环境中从事宝贵的自主家庭医生职业的机会。同时,这份新课程草案暴露了在印度医疗服务体系中,以医院为基础的专科医生对以社区为基础的全科初级保健医生存在危险的等级垄断。将家庭医生和全科医生排除在卫生系统之外意味着在没有任何结构化转诊系统的情况下,患者从社区自由流向昂贵的三级医疗设施。家庭医学和全科医疗在全世界都是独立的医学学科/专业。该课程既不符合国家公共卫生期望,也不符合印度政府的医学教育政策。如果实施,对医疗服务体系和公共利益总体上都将是灾难性的。鉴于其内在的谬误,新的医学学士课程应被彻底否决。