Harchan Singh Oration: Scenario of Postgraduate Medical Education in Community Medicine in India

Indian Journal of Community Medicine

http://www.indmedica.com/journals.php?journalid=7&issueid=56&articleid=683&action=article

Harchan Singh Oration: Scenario of Postgraduate Medical Education in Community Medicine in India
Author(s): Sunder Lal*
Vol. 29, No. 2 (2004-04 - 2004-06)

The objectives and goals of Postgraduate medical education in Community Medicine are to produce competent specialists to manage the teaching departments in the Medical colleges, or to manage health services and national health programmes at various levels or to conduct biomedical research in the discipline of community medicine. It is expected that the specialist so trained will be able to manage effectively the health services at Primary Secondary and tertiary level of care and function as effective leader of health teams engaged in health care, research and training. Much will depend upon the nature and content of training imparted to them during postgraduate period as also on the trainers or teachers. Right now the Medical Council of India which is the regulatory body on medical education, provides broad guidelines on postgraduate medical education regulations (2000) and purposely omits detailed curriculum. As per MCI 2000 regulations the major components of Postgraduate Curriculum Constitutes:

1. Theoretical knowledge
2. Practical and clinical skills (Managerial skills)
3. Thesis skills
4. Attitudes including communication skills
5. Training on research methodology.

The major focus of MCI regulations is on staffing pattern, their qualification and facilities and recognition of institutions for P.G. Courses rather than regulating a standard curriculum.¹

The knowledge and skills gained in the field of social sciences, epidemiology, biostatistics and managerial sciences, ultimately should result into capabilities of becoming a good communicator, a young teacher, planner, researcher with analytical skills, a manager, a leader of health teams and above all mobilizes of resources with mindset of thinking epidemiologically and acting socially in varied situations. The emphasis should shift from "teaching to learning". In order to facilitate learning the trainer should have a plan of what needs to be achieved at the end (learning objectives), what content areas need to be selected for this purpose, what method of training is most appropriate and how to judge whether the learning objectives are attained or not (evaluation).

In the first instance, there is no well defined curriculum worked out, if at all it is there, the methods of acquiring the desired competencies are vague or not at all stated. Therefore, the challenge is to work out a written protocol stating the competencies to be acquired and methods to be adopted to acquire such competencies within a time frame. Only a few institutions in the country have adopted a detailed curriculum of PG studies in Community Medicine in the country. I could lay my hands on curriculum of premier institutes of PGI Chandigarh, AIIMS New Delhi, DNB courses, PGDMCH IGNOU and NIHFW, respectively.^2-9 Of late, Universities of Health Sciences have come into existence and hopefully these universities will come out with a detailed uniform curriculum at the national level to be pursued and followed at various levels.

The current situation is that these universities are primarily occupied with conduct of examinations, appointment of examiners for thesis and final university examination apart from awarding degrees. At places Health Sciences Universities have appointed curriculum consultants too, probably to evolve need based, relevant and appropriate curriculum for various disciplines including the discipline of Community Medicine. But so far these curricula have not come out of the shelves.

Prescribing curriculum, its contents and programme of teaching and training is no problem and it appears to be fine on paper and write up but its implementation leaves much to be desired. Since MCI also emphasized ''self directed" learning during the whole course of PG study, the PGs are left to themselves in most situations to learn and acquire need based competencies and skills and knowledge and most of which is based on peer's experience and work culture specific to the situation of that place MCI has left it to each discipline and department to evolve a competency and need based well defined curriculum, made available to trainees at the beginning of the programme to enable them to acquire desirable competencies.

Training Variation - Training Scenario:

The status of PG training in India as imparted by various institutions/universities varies from institution to institution and from state to state, depending upon the strength of faculty positions as also facilities. The course contents, methods of training and experiences gained through postings and methods of evaluation, nomenclature of theory papers and final evaluation varies from university to university. A vast majority of PG education tends to occur in tertiary care hospitals, where super specialists and unusual diseases is the focus of academic attention, whereas M.C.I. regulations explicitly focus on community needs based education. Students are placed in the community to learn social sciences, basic tools of community diagnosis, epidemiology and biostatistics as well as concern for management, community mobilization/organization and participation apart from logistics, supplies and finance mobilization for primary health care.

One of the basic premises of Community Medicine teaching and training is that most of it should occur in the community and of necessity it should be community based and Community biased. Field practice areas in most situations have not been developed and consequently nor its laboratories and accordingly the mindset of PGs develops in that orientation and environments. Since the training contents, methodologies and exposure varies from place to place the competency and skills acquired also vary from product to product. There is no agreed upon principle of minimum or essential skills to be acquired by the PGs in the course of three years training. MD Degree in Community Medicine attracts graduates who have been denied the opportunities or are placed on low merits in entrance test, with some notable exceptions. Therefore it is a challenge for the teachers of Community Medicine or department to train such candidates.

One institution cannot do all the justice for producing a right kind of product. One has to draw other relevant resources of the institute in the first instance or have to develop linkage with the district/state health authorities to create learning situations for PGs. Sometimes one has to develop linkages with other departments in the neighbouring states or national institutes.

Teachers and faculty in Community Medicine must keep their eyes and ear open to know the strengths and weakness of various Public Health Institutions and Medical Colleges in the country. It must be acknowledged that no one institute or Medical College can offer varied learning experiences, so essential to assimilate for training of postgraduate students and to develop faculty and respective department of community health. Networking of teaching, training programmes, research endeavours and facilities available can provide an opportunity to enhance the training programmes.

Recently results of survey of 103 medical institutions as also our observation of 57 medical colleges showed that activities of public health departments/ institutions in India varied substantially. A few of institutions conducted a number of courses including distance education programmes, did publish a lot of research papers, besides organizing national and international conferences and trained many professionals in public health. However distressingly, around 50% of institutions were not very active in terms of above activities.¹⁰

PGs from the department of Community Medicine of various institutions in Delhi were quite often seceonded to Medical College, Rohtak, for extended period of two weeks, in field practice areas to acquire competence in national health programmes in rural settings as also to develop community contact with PRI's. Quite often the PG's from LHMC, AIIMS, NICD, NIHFW were seconded to field practice areas of Medical College, Rohtak to acquire specific competancyrelated to National Health Programmes. Similarly, trainees of NIPCCD, IGNOU and Regional training centres of NIPCCD, were posted to Medical College, Rohtak field practice area to learn aspects of Integrated Child Development Services in rural areas. Similarly, DGHS of India used M.C. Rohtak as a launching pad for developing preventative initiative against common disabilities (Impact India). faculty and students of national institutes of Delhi derived i s such exposure and enriched their training programme. Both Faculty and students of Medical College Patiala, Central Bureau of Health education, Delhi and AIIMS and R.P. Centre of AIIMS had first hand experience of mobile teaching cum service hospitals camps; thus opportunity of C.R. Dass mobile hospital camp was used by neighbouring states quite often.

Postgraduate training in Community Medicine should be far more oriented towards the Community with residents working in direct supervision and in collaboration with one or more interns in the rural areas. He should take responsibility for community in PHC system; this would add on to the credentials of the PG.

Most of the thesis subjects chosen are community based, usually epidemiologic in nature and generally relevant and appropriate to the needs of the community but not necessarily high priority areas. Subjects chosen and studies pursued are focused primarily on the extent and nature of problem, which are too well known by now. Distressingly management areas are altogether left out or seldom attempted. Thesis subjects pursued may not be the local or state level priority and this fits into the convenience of students or teachers. In most situations thesis is the only research work pursued by the departments. Much more needs to be done in this direction as lot of time goes in this pivotal activity (about one year or more). Teachers have to accept this challenge. Ultimately the thesis should lead on the development of competency and skills in research methodology (sampling, epidemiological design, sources of data, interview techniques, primary and secondary data, management of, data, presentation of data report writing and search for references etc).

The struggle starts the day the PG enters the Department of Community Medicine with high hope or some hope and he starts dreaming and most of their) dream to end up with International agencies, nothing bad about it, but what next? After selection to PG Course, a PG struggles to find out the subject of thesis protocol as he has to submit his plan of thesis within one year of beginning of course. Much depends upon the teachers and guides. PGs themselves are at a loss to find out the appropriate subject) topic; therefore teachers have to select a subject for thesis. Teachers with insufficient experience and maturity, of eight years can seldom find an appropriate subject hence the senior teachers must support and take the lead. The subject of thesis should be based on the teachers experience in that area or preliminary work done in that area in the field or at institution. Accepting PG for MD degree is a big responsibility and it must be discharged with utmost commitment and teachers must work hard to accomplish the task. The only research contribution of a teacher happens to be one or two odd papers out of PGs thesis, which leads to self deception and stagnation. Teachers should continuously pursue one or the other research project in the field. Further the subject should be innovative and relevant to needs of community and high priority at state or national level. PG starts searching and gets trapped to internee and gets aliens' references or all foreign references and misses the work done in India altogether and produces an alien protocol not relevant to our situation. Thesis in its final form either becomes a decorative document of library shelf or student's precious possession, it is seldom shared with district, state or other health institution authorities. In essence the results are never fed back to the programme or shared with community whose lives it affects most critically.

Find evaluation of the PG student is in fact an evaluation of teaching and training faculty of that department as also the learning opportunities provided or marshalled by that institute. It is a great event of mutual learning besides faculty development and feed back.

Examination system: System of final evaluation of PGs varies from institution to institution. System of continuous evaluation of student by the department/institution faculty is something of an exception than a rule. Log books in most situations are not maintained by the Postgraduates. In most situations the students are given an episodic family exercise and short cases in the community or in the hospital. Focus of these exercises in most situations are missing or absent, altogether these exercises become an endless process and free for everything and whatever comes to the mind of students.

It is almost a ritual to allocate exercise on statistics and Epidemiology which are highly theoretical and mathematical in nature, far away from real practical situation, and lack application by and large. In some institutions the students are given public health laboratory exercises. Students are grilled during viva voce to test their cognitive domain. Psychomotor and affective domain are seldom evaluated. The experience of over 20 years as Postgraduate examinership reveals that health management exercises, training and communication exercises are almost missing in the final evaluation. It reflects that these are probably not a part of the total curriculum. Performance of students was much better, wherever they were trained in the community and in field practice areas.

It is imperative to carry out PG training in the community to acquire competency in community diagnosis, community needs assessment, health priorities, resource mobilization, training of health teams, work load and work-schedule, evaluation of health programmes etc. Building epidemiological and managerial exercises based on the community based teaching seems to be more rewarding than purely theoretical exercises. Faculty and teachers themselves should take lead in these endeavours to become better guides for students and better teachers of Community Medicine. Continuous follow up of family/families should have positive influence on learning of epidemiologic methods, cohort studies, experimental epidemiology besides descriptive epidemiology.

Learning skills of epidemiology: PGs should always think 'epidemiologically and act socially' in varied situations. There cannot be universal application of a method for learning of basic minimum skills of epidemiology, of necessity these need to be diversified in view of local situation. These skills need to be practiced repeatedly to develop perfection. Skills must be practiced in "live situation" of health care delivery system and Integrated Child Development Services, in urban and rural settings respectively. Onus of developing these situations conducive for learning of skills of epidemiology lies with the teachers of PG." It should be accepted that the real epidemiologists are those who practice the science of epidemiology, in our way of thinking these are grass root workers like, anganwadi workers, traditional birth attendants and health workers and the people themselves. In essence these skills are to be acquired in the community itself. Whole of the epidemiology can be learnt in mastering one programme in the field situation and the living example is National Anti Malaria Control programme.

Following Components of epidemiology can be learnt:

1. Population under surveillance (At risk population),
2. Planning Surveillance operation to cover whole population.
3. Periodicity of visit-beat programme- Spot maps.
4. Calendar of activities - Active Surveillance - Passive surveillance.
5. Monthly and Annual incidence of fever.
6. Annual Parasitic Infection/incidence rate (API)
7. Infant Parasitic rate.
8. Slide Positivity rate.
9. P vivax and P. Falciparum Positivity rate.
10. Mortality rates.
11. Spray operation-coverage-impact.
12. Mosquito density and infection rate.
13. Entomology in Malaria.
14. Intervention Epidemiology - Spray, presumptive and radical treatment, mass radical treatment.
15. Organization of Programme - Laboratory services:
16. Fever outbreak investigations.

This offers extensive ground for learning of descriptive, analytical and experimental or interventional epidemiology provided the PG students assimilate the facts on the ground and in the Community. Likewise RCH programme in field settings offers an opportunity to learn several aspects of epidemiology.'

Similarly Epidemiology of non-communicable diseases can best be practiced in ICDS model. Example is nutritional status of young children and prevention of malnutrition through growth monitoring of young children.13-15 This offers a unique opportunity to learn descriptive, analytical and interventional epidemiology. Cohort studies and case-control studies done by the students themselves offers a wonderful opportunity to learn epidemiology which I call a best opportunity. Class room teaching of epidemiology and computer learning of epidemiology is no substitute to live situation.

Outbreak investigation by students themselves under the guidance of a teacher is yet another opportunity to contain the epidemic and prevent future occurrence and is best example for participatory and active learning of epidemiology. Recently the PGs were involved in investigation of Dengue fever, outbreak of falciparum malaria and hepatitis to learn epidemiology of public health emergencies.

Coverage evaluation surveys should be a routine exercise given to students in urban or rural settings, to both UG and PG students during Intensified Pulse Polio immunization or as a matter for routine immunization coverage in the district. Campaigns like Family health awareness week, goiter surveys, Intensified Pulse Polio Immunization, health melas offer ready made opportunity to learn multiple things including epidemiology, these should be exploited fully.

Epidemiology of interventions like immunization, Vitamin A prophylaxis, IFA therapy and prophylaxis, deworming, therapeutic and supplementary nutrition, safe water, hand washing, school health education, communication for behaviour change for HIV and AIDS and their impact or effect or else coverage, work up by students under appropriate direction can bring in lot of learning of epidemiology.

Two months training course in epidemiology pursued by NICD Delhi, ICMR Institute of epidemiology at Chennai and DPH training at AIIH and PH Calcutta have played distinct roles to prepare field epidemiologists in the country.

Learning Demography and Biostatistics and Health information system: Focus should be on applied demography and biostatistics as it is being used for health programmes and service delivery. Involving students in annual surveys of eligible couples and their updating in urban or rural areas, delineating householder and population, age and sex, composition of population, sex ratio, family size, total fertility rate, birth interval, age of marriage, preferences for contraceptive and contraception use rate, profile of acceptors for different methods, open and closed birth interval; segmentation of clients and according priority to clients for contraception, immunization and antenatal care could be stimulating live exercises in the field, Anganwadi set up or subcentre set up could be used to learn crude birth rate, death rate, pregnancy prevalence, contraceptive prevalence rate, as also causes of death amongst young children. Live book for biostatics and demography is an Anganwadi or sub centre in action.^16-17 According to our rating these are best learning temples for biostatistics and demography. Interaction with people and community on their life styles and pattern of living conditions can further enrich these data. Sampling frame and sampling for coverage evaluation surveys can be best learnt in community setting in the form of project exercise or case studies. Elements of biostatistics can also be picked up from district rapid surveys, facility surveys. NFHS, census data and state and district statistics or statistics of field practice area for better learning of demography, statistics and epidemiology. Unfortunately we are obsessed with class room learning of biostatistics and demography and tend to be data driven than action driven. Programme workers are using their data for action and this is the crux, we have to emphasise and demonstrate how to use data and how to collect data and improve the quality and coverage of services in field situations. Different sources of data collection from the field and their use at local level and sharing of information with community and use of data and information by health managers for decision making needs to be demonstrated to PGs for learning of biostatistics and health information system.^16-17

PGs should be involved in preparation of monthly monitoring reports and participate to some extent in maintenance of records of facility and give feed back to the workers and health managers for effecting improvements in the system besides evaluating the performance of worker or a facility in the system of health care. Recently computer compatible system of health information is in vogue but it has not been adopted universally. Similarly PGs should utilize the opportunity of preparing annual morbidity or monthly morbidity return of a facility to capture the prevalent morbidities of a geographical area and use there of for indenting medicine and prevention of disease to reduce disease burden.

Learning life table method of analysis from growth charts and follow up of pregnant women and young children have undoubtedly served as best tools to learn biostatistics and epidemiology.

Learning of Managerial and Social Sciences Skills: Teaching and learning of management at PG level has been neglected by and large. Teachers are at loss to deal with this subject and they lack confidence and experience. In the first instance the trainers need to be prepared to enhance the learning of management. Though varieties of self directed learning modules are available on management (NIHFW, Agha Khan Foundation, IGNOU and RCH Modules) for different categories of functionaries. There is no guarantee that after reading these modules one acquires the competency or skills of management. Best way to learn skills of management is to practice basic elements of management by doing things themselves in live situations of health care delivery system. Admittedly learning whole of management and appropriate skills may be beyond the reach of many but certain major aspects can be learnt.18-20

We have used the live situations wherein PG becomes part of health care delivery system at the level of Primary Health Centre and CHC. He/she participates in planning of outreach sessions on immunization, beneficiaries sub-centre wise, carries supplies to sub centres, monitors session on immunization, injection safety and prepares reports, ensures follow up of immunized for adverse reactions. Besides this, they participate in social mobilization and maintenance of cold chain system apart from surveillance of diseases (AFP).

Community needs assessment approach: Under RCH, though a paper tiger, has been used as tool - for PGs to learn community diagnosis and "action plan", at the level of sub centre. It is mandatory in our settings for a PG to take responsibility of a sub-centre for two months to pick up the skills by observing job-responsibilities and jobs performed by health workers, preparation of supervisory check list, monitor the performance through monthly reports, participate in continuing education of workers through sector meetings, use of essential drugs in kit A and B, work load and work schedule of health workers, built in mechanism of supervision, community contact and home visits of workers. Once a month, PGs contact the PRI in a predetermined village on fixed dates to get feedback and consultation with elected leaders and to generate additional resources for health sub centre. PGs help organizing women groups (MSS groups), once a month contact with women groups to build their capacities and give them health responsibilities in their neighbourhood (DD., Depots for IFA. contraceptives and chlorine tablets).

Since PGs are part of health care delivery system they are part of all mpnthly meetings held at PHC and CHC to learn the problems faced by workers, managers' responsibilities to solve these problems, supportive supervision, planning with consultation of workers, giving feed back to workers and supervisors and their continuing education as also reviewing their performance. Cash book inventories, total budget on salaries, drugs and other contingencies, indent preparation, stock register of medicines for drug inventories and log book maintenance for vehicle are repetitive exercise done by PGs for presentation to medical interns. Total internship training programme is managed by PG and senior resident in the setting of PHC/CHC. In essence PGs learn about the available manpower, their control and supervision, material resources, planning and organization of services for coverage of total population as also their monitoring and evaluation. It is total participatory learning.

PGs become part of UG training and take responsibilities of training of small batches in family studies, organize demonstrations and prepare settings for training under the supervision and guidance of teacher to impact skill based training to UGs in the Community. Similarly PGs become part of resident Internship training programme in the community setting and follow a well defined competency based curriculum drawn by them for 3 months under the preceptorship of faculty member. Since the PGs are resident with interns and faculty members in the community setting at PHC, the learning is maximum in the areas of community interactions and contacts, health care delivery system and national problems besides continuing education programme of functionaries. Learning methods and educational technologies are practiced in the community with Mahila Swasthya Sangh meetings, school population education programme, PRI, traditional birth attendants, Anganwadi workers, health workers and their supervisor, school teachers and other women groups. In our experience through internship and UG training programme the PGs training has been taken to community settings and it has positive impact on development of right kind of attitudes and value system and leaves an indelible impression on the minds of PGs. Most often the internship training programme is drawn and dovetailed deliberately with the activities of CHC/PHC during a particular month. Having vibrant internship and UGs training programme means creating lot many opportunities and situations for PGs training on sustainable basis. In a way it can be most creative and satisfying experience.

The residents in our situation take the responsibility for a defined community, for the training in management of health team, and perform an important teaching function as well as become role models, giving positive influence to the internship experience. All residents are involved intensively in the management process of primary health care system.

Interaction and involvement of District Programme Officers (Health Services) and District Civil Surgeon/CMO in teaching and training programme provides enrichment of learning of community medicine and enhances the development of faculty of Community Medicine apart from building most relevant PGs' training to learn managerial aspect of health care delivery and national health programmes. The situation of district training teams and regional training centre developed all over the country for integrated skill training under RCH Phase I and basic training/ promotional training for workers and supervisors and specialized skill training, can be effectively utilized for PG's training. Exposure to such situations can be most productive for learning of all aspects of RCH (Maternal and Child Health as also national health programmes). Faculty of medical colleges must utilize this opportunity by building good relationship with local CMO/Civil Surgeon and mutual understanding.

In the first phase, the Professor and HOD of Community Medicine should attend all monthly meetings of Civil Surgeon and help district teams as resource person, and expose all PGs to this stream to learn managerial skills. Such an exposure provides an opportunity to learn the most pressing local health problem, which can be chosen as an area of thesis for PGs or could be taken up as a research project for the department. Faculty of Community Medicine could become part of rapid evaluation team undertaking district programme evaluation. The results of evaluation and thesis subjects should be fed back to the system for effecting improvements in the system.

Responsibility of geographical area in urban slums set up or rural field practice area should rest with the department of Community Medicine for delivery of services of national health programme as also rendering reports to Civil Surgeon or Municipal Corporation on standard format. This step further establishes linkage with health service system and promotes learning in real situations and can lead on to development of field epidemiological unit.^21-26

Developing Positive Attitudes-Motivation-Communication Skills: Motivation and development of positive attitudes comes through role models and it cannot be enthused through sermons. Teachers. Senior residents and Medical officers should become good role models and set high standard for themselves, which is observed by PGs and interns and health teams. Senior residents, PGs and interns are resident in field practice area, in our set up and it gives a positive influence to learning as they lead a corporate life. We all are continuously being judged by people, our health teams, interns and PGs who subsequently talk about us and describe our profile and transmit all these to their fellow colleagues. Teachers leave an indelible impression on the minds of taught. Therefore motivation and developing right attitudes is a challenge to the teacher community, how much they transmit and propagate depends largely on them. Shaping personality of interns and PGs depends on teachers and teachers of Community Medicine have a special role in the institution.

Sustained interaction with community and health workers are the basis of ascertaining their communication needs. Communication needs assessment is seldom undertaken. One needs to organize women groups, PRI groups and communicate with them on regular basis to build mutual trust and platform for communication. Communication material which comes in abundance to PHC has to be used judiciously to communicate the message to targeted groups like MSS, PRI, pregnant and lactating women and adolescent girls and boys in and out of schools. PGs have access to all these materials and should develop the abilities to organize groups along with area health workers and supervisors.21.26 Evaluation of communication material and message is a virgin area altogether, PGs could use this opportunity to learn the technique of evaluation of health education efforts.

Our experience of involving PGs for interpersonal communication skills development has paid rich dividends. Anganwadi workers have proved to be best communicators, their communication skills have been imbibed by the PGs and health workers in the area of safe pregnancy, safe delivery, promotion of breast feeding, feeding of young children, immunization, management of illnesses, contraception and promotion of personal hygiene practices. Communication skills and counselling skills are vital to change behaviour to reduce morbidity and mortality in women and children.

Learning Teaching and Training Skills: While it is essential for teachers in general education to undergo formal training in education, no such Scenario of Postgraduate Medical Education preparatory facilities are available in training in health. Very often teachers acquire skills by chance than choice.

Teacher is a role model for the student community. Teachers training or training of trainers is critical input to develop right kind of trainers/teachers. Medical education cell is a partial answer to the problem. Transmission and propagation of teaching skills to PGs is a pivotal responsibility of the teacher. IAPSM should take the onerous responsibility to train its members as good teachers.

Most teaching and training skills are acquired by imitation of teachers within the department. At the best these skills are acquired by taking responsibility to conduct some tutorials or demonstration for undergraduates. It has been observed that delegation of batches of UGs to PGs is done without briefing or guidance or without preparing the situation for training and consequently the PGs soon become frustrated. In other words PGs are being just told to take a batch or tutorial. How to conduct a group discussion, organization of demonstration, preparation of lesson plan, educational technologies, teaching methods, use of teaching-training aids and evaluation of lesson plan is seldom taught seriously to PGs. Best way to impart training of teaching skills to PGs is to let them attend the UG class when a senior faculty member teaches such a class, as a model of teaching training. Such a step will compel a teacher to come prepared thoroughly. Microteaching is yet another technique which could be exploited in peer groups or small batches to develop teaching and learning skills under the guidance of a supervisor.

Wherever the postgraduate works in direct supervision and collaboration with medical interns and takes responsibility for internship training programme the pride of teaching and training develops to its full potential and provides the postgraduate the valuable experience to become part of his professional credentials when he becomes a teacher for the undergraduate students ²⁷. Gradually involving PGs in teaching, training programmes of multipurpose health workers, integrated skill training programmes, Anganwadi workers and traditional birth attendants, team's training and continuing education activities of health teams at the level of PHC/CHC has paid rich dividends. Teaching and training of grass root functionaries (AWW and TBA and Health guides, women groups) is a bigger challenge than training of undergraduates. Training needs assessment, communication needs assessment and managerial training needs assessment can become core content of developing appropriate activities for skill development and important exercise or stimulus for further action. It may be stated that training responsibility is a neglected area and is left to an individual PG to develop himself/herself by trials and errors and just being told. Active thinking techniques are seldom deployed. Medical education cell/department established in the institutions to fulfill obligatory requirement of MCI is a step in the right direction but these have to work very hard to upgrade the teaching and training technologies and skills of faculty.

Learning skills of research methodology: The PGs should develop an analytical and critical mind. One way and most common method to inculcate this skill is "thesis" for PGs which is must under MCI Regulations. Apart from thesis, the other methods to develop enquiring mind are teaching and training of undergraduates, Project work, rapid evaluation of health programmes, planning and evaluation of programmes as enunciated under acquisition of managerial skills and epidemiological skills. Departmental research projects also can stimulate learning research methodologies. Peer group learning from each other through their respective thesis topics and research methodologies adopted. Operational research and action research activities in the delivery of national health programmes imbibes lot of skills of Health System Research in the areas of improving coverage and quality of services. One neglected area of research is cost containment and cost benefit of intervention or the field of health economics, which is the need of the system. Health system research courses organized by the NIHFW provides useful opportunity to develop research capabilities of young faculty. Community itself provides lot of opportunities for learning of research methodologies.

What I have deliberated/said about PG training scenario in the country is not a road map for all the problems, it is indicative of strengths and weaknesses of various models of PGs training in a vast country like India where diversity prevails, available manpower and facilities are bare minimum with enormous challenges. It is suggested that networking of various models of training, case studies, research endeavours, field practice areas and their facilities, special skills available for learning of epidemiology and biostatistics in the country be done and disseminated widely to enable faculty and teachers of community medicine to facilitate training and teaching of PGs. This is essential in view of the NHP 2002 which envisages progressive increase in the PG seats in the disciplines of "Public Health" and "Family Medicine" to reach the stage of 25% of total seats for these disciplines.²³ Training desist to rely totally on computer based community medicine learning for PG's. Modern technologies should be used but should not substitute community model or live situation. Teachers training in core content of community medicine through training of trainers exercises helped by IAPSM or donor agencies are to be encouraged. IAPSM holds pivotal responsibility in this area and it has demonstrated by organizing successful RCH orientation activities for teachers of 57 medical colleges in the country about two years back. The same endeavour should continue with progressive involvement of IAPSM.

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23. Govt. of India. National Health Policy 2002. MOB and FW Govt. of India, New Delhi.
24. Bulletin on Rural Health Statistics in India March, 2002. Issued by Infrastructure Division, Department of Family Welfare. MOB and FW, Nirman Bhavan, New Delhi.
25. Postgraduate Medical Education in India. Proceedings of the Fifth Annual Conference of IAAME held under the auspices of the University of Delhi-1965. Edited by R Viswanath and AS. Paintal. Published by P.S. Jayasinghe, Asia Publishing House, Bombay.
26. Medical Education in India today an IMA publication. Based on the proceedings of the National Seminars on Medical Education organized by Indian Medical Association at New Delhi, December 7-9, 1990.
27. Organization of Health Services and training of Physicians for Child Health Services. R.S. Arole and Jon Eliot Rohde. A consultant Report to USAID-1983.
28. Health Manpower, Planning, Production and Management. Report of the Expert committee, MOB and FW, New Delhi - 1987.

Ragging is like human rights' abuse, says SC

http://www.hinduonnet.com/thehindu/holnus/002200902112231.htm


New Delhi (PTI): "Ragging in essence is a human rights' abuse," the Supreme Court on Wednesday said making it clear that any student prima facie found guilty of indulging in such an act would invite immediate suspension and institutions' bid to shield the culprits would lead to cuts in grants.

"The act by the seniors is a fist of steel against ice and likewise by doing so, they shatter the ambition, aim and object of freshers and they become aloof in this practical world," the Bench said adding that "ragging in essence is a human rights' abuse".

"Delay in taking action in many cases would frustrate the need for taking urgent action. In such cases if the authorities are prima facie satisfied about errant act of any student, they can...suspend the student from the institution and the hostel and give opportunity to him to have his say," a Bench comprising Justices Arijit Pasayat and M K Sharma said.

The Bench said such a measure was needed as a question was raised regarding giving opportunity to the offender before taking actions like expulsion etc.

It said law has to be set into motion immediately by informing the police about such an incident. "If it comes to the notice of the university or controlling body that any educational institution is trying to shield the errant students, they shall be free to reduce the grants in aid and in serious cases deny grants in aid," the bench said.

“Doctor can’t be held liable for error of judgment ”

http://www.hinduonnet.com/2009/02/19/stories/2009021959251400.htm

Indiscriminate proceedings and decisions are counter-productive: Supreme Court

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If punished, no doctor can practise his vocation with equanimity

It is true that medical profession has to an extent become commercialised

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New Delhi: A doctor cannot straightway be held liable for medical negligence simply because a patient has not favourably responded to treatment or surgery has failed, the Supreme Court has held.

A Bench consisting of Justices Markandey Katju and R.M. Lodha on Tuesday said: “A medical practitioner is not liable to be held negligent simply because things went wrong from a mischance or misadventure or through an error of judgment in choosing one reasonable course of treatment in preference to another. He would be liable only where his conduct fell below the standards of a reasonably compe)tent practitioner in his field.”

The Bench set aside an order passed by the National Consumer Disputes Redress Commission, which held Dr. Martin F. D’Souza of the Nanavati Hospital, Mumbai, guilty of negligence on a complaint from Mohd Ishfaq, who was treated for renal and severe urinary tract infection.

Writing the judgment, Justice Katju said: “While doctors who cause death or agony due to medical negligence should certainly be penalised, it must also be remembered that like all professionals doctors too can make errors of judgment, but if they are punished for this no doctor can practise his vocation with equanimity. Indiscriminate proceedings and decisions against doctors are counter-productive and serve society no good. They inhibit the free exercise of judgment by a professional in a particular situation.”

Therefore, whenever complaints were received against a doctor or hospital, the consumer forum or criminal court, before issuing notice, should first refer the matter to a competent doctor or a committee of doctors, specialising in the field where negligence was attributed. Only after that doctor or committee “reports that there is a prima facie case of medical negligence should notice be issued to the doctor/hospital concerned.”

The Bench said: “This is necessary to avoid harassment to doctors who may not ultimately be found to be negligent. We further warn police officials not to arrest or harass doctors unless the facts clearly come within the parameters laid down by the apex court in Jacob Mathew’s case; otherwise, the policemen will themselves have to face legal action.”

The Bench said: “While this court has no sympathy for doctors who are negligent, it must also be said that frivolous complaints against doctors have increased by leaps and bounds particularly after the medical profession was placed within the purview of the Consumer Protection Act.”

The Bench said: “The courts and consumer fora are not experts in medical science and must not substitute their own views for that of specialists. It is true that the medical profession has to an extent become commercialised and there are many doctors who depart from the Hippocratic oath for their selfish ends of making money. However, the entire medical fraternity cannot be blamed or branded as lacking in integrity or competence just because of some bad apples.”

Sometimes despite the best effort, the treatment of a doctor failed, the Bench said. “For instance, sometimes despite the best effort of a surgeon, the patient dies. That does not mean that the doctor or the surgeon must be held guilty of medical negligence, unless there is some strong evidence to suggest that he is. On the facts of this particular case, we are of the opinion that the appellant [Martin F. D’Souza] was not guilty of medical negligence. Appeal allowed.”

Colleges submit merit lists for PG courses

http://www.hindu.com/2004/03/23/stories/2004032310750300.htm


By Our Staff Reporter

BANGALORE, MARCH 22. Representatives of 13 private medical and 12 private dental colleges in the State on Monday submitted their merit lists for postgraduate courses to the Venkataraman Committee, which is overseeing the entrance test for professional college admissions.

The committee has reportedly indicated that the colleges could go ahead with their admissions after the panel's approval of the merit list. Three more colleges are likely to submit their lists on Tuesday, sources in the Education Department said.

According to the Consortium of Medical, Engineering and Dental Colleges of Karnataka (COMED-K) Chairman, R.L. Jalappa, representatives of the consortium's member colleges on Monday argued before the panel that the postgraduate admissions came under the purview of the Medical Council of India (MCI) regulations of 2000. "We have every right to hold the entrance test as per the regulations," he told The Hindu.

Besides, since there was no decision yet on the fee structure, sharing of government and management quota seats and the seat matrix, COMED-K had decided to postpone the interview dates fixed earlier, he said.

Mr. Jalappa said fresh dates for the admission interviews would be announced soon in the newspapers. A final decision on the entrance test for undergraduate engineering, medical and dental courses would be taken after meeting the Chief Minister, S.M. Krishna, he said. An earlier meeting with Mr. Krishna had to be postponed because of his hectic schedule.

MCI PG Medical Education Regulations, 2000 Notified

http://news.indlaw.com/news2k-1548

October 26, 2000

The Post-Graduate Medical Education Regulations have been revised in tune with the advances taking place in the field of Medical Education and Medical Technology across the world. The Regulations called "Post Graduate Medical Education Regulations, 2000" were notified by the Medical Council of India after getting approval from the Central Government. These Regulations have been revised after a gap of 29 years.

A clause has been added in the new Regulations for allowing non-teaching institutions in Government sector to start PG courses. In the earlier Regulations, the medical colleges recognised for running MBBS courses were only eligible to start the PG courses.

Under the new Regulations, the training period for Super-Speciality courses has been fixed as 3 years after MD/MS. According to old Regulations, it was 2 years after MD/MS. The selection process of Post-Graduate students has also been dileneated. Now, the students can be admitted either on the basis of competitive test conducted by State Governments or other Competent Authority at both State level and Centre level or on the basis of individual performance at MBBS examination. Earlier, the students were selected strictly on the basis of merit judged on the basis of academic record in the Under-Graduate course. Keeping in view the importance of Post-Graduate Medical Education, the Teacher-Student ratio has also been revised. Some of the P.G. courses like Bio-Statistics, Immunology and Allergy, Emergency Medicine etc. were deleted from the earlier regulations as these have already been included in the other related specialities. Some of the courses have been combined into one speciality like Dermatology/STD/Leprosy and Cardio-Thoracic Surgery/Vascular Surgery etc. New specialities like diploma in Marine Medicine and super spcialities like DM Neo-Natology, Neuro-Radiology have been added to list of courses for which PG training can be given.

Reservation benefits state-specific: HC

http://timesofindia.indiatimes.com/Cities/Chennai/Reservation_benefits_state-specific_HC/articleshow/3970062.cms

A migrant can claim reservation benefits under a particular category only if his caste fell within the reserved category in his home

state as well as in the state to which he migrates, the Madras High Court has ruled.

A division bench comprising justice Elipe Dharma Rao and justice S Tamilvanan, passing orders on a writ petition recently, said that even if the name of the caste was one and the same in both the states, the beneficiary could claim benefits only if the caste was declared as OBC or SC/ST in both the states.

"Even if the nomenclature of the caste is the same in both the states, only if the caste to which the beneficiary belongs to in that particular state is declared as SC/ST and the same is declared as SC/ST in the state to which he migrates also, can a person claim the status of SC/ST in the migrated state," the judges observed.

The petitioner R Venu, opposing denial of ST certificate to his son, contended that the community Ganaka, known as Kani or Kaniyan, is a notified OBC community in Kerala. But Kaniyan community is included in the ST list in Tamil Nadu. Noting that place of birth is immaterial for the purpose of determination of caste, he said the place where the parents of the applicant ordinarily reside' should alone be the criterion.

Rejecting the submission, the judges said Venu, who had migrated from Kerala, should make way for the disadvantaged and disabled communities in Tamil Nadu. Pointing out that the Supreme Court ruling on a similar matter passed on distinguishable set of facts, they said the principle applicable for declaration of SC/ST depends on the nature and extent of disadvantages and social hardships suffered by that group in that state, and not on the ground of having ordinary residence or domicile.

SEAT-SHARING FOR PG COURSES MCI unhappy with formula

http://www.deccanherald.com/CONTENT/Dec202007/state2007122042180.asp

By Vijesh Kamath, DH News Service, Bangalore:
The seat sharing pattern for post-graduate medical seats, arrived at between government and private managements earlier this year has come under the scanner of Medical Council of India (MCI)...

The MCI, the highest decision making body on medical education, has taken serious exception to the seat-sharing pattern, citing that it goes against the regulation of the Council.

For admission to post-graduate medical seats for the academic year 2007, the government and 11 medical colleges under the aegis of the Consortium of Medical, Dental and Engineering Colleges in Karnataka (Comed-K), had arrived at a 33:66 seat sharing formula (i.e., 33 per cent filled by government and 66 per cent by private colleges).

In all, 832 PG medical seats were filled by the management, and 277 by the government.


However, the MCI is not happy. Sources say the Council has cited that the pattern is in violation to its ‘Postgraduate Medical Education Regulations- 2000’. The regulations stipulate that in private institutions, 50 per cent of the total seats shall be filled by the government and the remaining 50 per cent by the management of the institution, on the basis of merit.

And that’s not all. The MCI, in a letter dated December 14, had directed principals of the 11 medical colleges to compensate for the “violations” by offering the “excess”16 per cent (which is over and above the 50 per cent seats allotted to the management) to government during admissions for PG courses next year.

In other words, the MCI wants the government to fill 66 per cent seats in private institutions during admissions 2008. These MCI directions come at a time when the government and private managements have agreed that this year’s formula will be applicable for 2008 too.

However, Comed-K representatives argue that the MCI regulations have no relevance now following the Supreme Court judgement in the Islamic Academy case which abolished quota in private unaided colleges.

“Following the Supreme Court order, there is no obligation on us to part with management seats. However, on a request from the government, we decided to share 33 per cent seats,” Comed-K secretary Dr S Kumar said, adding, “Moreover, the memorandum of understanding between the government and Comed-K has been approved by SC.”

Comed-K will hold a meeting next week and dispatching a reply to the MCI to ‘clarify’ the issue, he said.

Doctors’ admission to PG courses quashed

http://www.tribuneindia.com/2003/20031210/ncr1.htm

Doctors’ admission to PG courses quashed
Jatinder Sharma

Rohtak, December 9
The admission of Haryana Civil Medical Services (HCMS) doctors to various post-graduate courses like MD/MS/PG Diplomas in the PT B D Sharma Post-Graduate Institute of Medical Science (PGDMS) for the year 2003 has been quashed by the Punjab and Haryana High Court.

These doctors had failed to qualify in the entrance test conducted by Maharshi Dayanand University since they could not secure 50 per cent marks in the entrance test which was the minimum essential as per the Medical Council of India regulations.

However, the condition was relaxed and those securing up to 30 per cent marks were admitted in August 2003 in a hush-hush manner. The second counselling for their admission was announced only through an advertisement in a Hindi daily giving only 24 hours notice and the counselling was held on a Sunday. No interview letters were sent to the candidates.

The notice given was so short that many qualified candidates could not reach at the time of counselling and interview.

Although many eyebrows were raised, both regarding relaxation in the minimum qualifying marks as well as not giving due notice for second counselling, and strong protest by the open category candidates, the Chairman of the interview board went ahead with counselling and admitted HCMS doctors who had secured up to 30 per cent marks in the entrance test.

As per the regulations of the Medical Council of India, no candidate who scores less than 50 per cent marks (40 per cent in case of SC/ST) in the entrance test can be admitted to any MD/MS/PG Diploma course and these regulations are binding and had been published in the prospectus of Maharshi Dayanand University.

The open category candidates, who had secured more than 50 per cent marks challenged this decision in the High Court which upheld their plea and quashed the admissions of those HCMS doctors who had secured less than 50 per cent marks in the entrance test as being violative of the MCI regulations. The admissions to various courses in the PGIMS, it appears, have been jinxed in this year. In the MBBS/BDS admissions, the candidates with higher merit were left out and those with lower merit admitted.

The Punjab and Haryana High Court ordered a recounselling and admissions to be made in accordance with the merit list. Even the admissions done during recounselling, in pursuance of the High Court orders, have been challenged again in the High Court.

Even in course like B.Sc Nursing, a candidate with higher merit, who was left out, had to knock at the door of the courts.

The candidates of ophthalmic assistant were asked to appear in a written test although as per prospectus, their admission was to be made on the basis of 10 plus 2 merit. When the selected candidates took the matter to the court and pleaded with the highest executive authority of PGIMs as party by name, the administration conceded their plea and cancelled the written test.

Post Graduate Aspirants Group: Karnataka State Junior Doctors' Association (KSJDA)

http://www.ourkarnataka.com/pgaspirants/pg_mcilaw.htm

Post Graduate Medical Education Regulations 2000

http://www.mciindia.org/know/rules/rules_pg.htm

MEDICAL COUNCIL OF INDIA SALIENT FEATURES OF POSTGRADUATE MEDICAL EDUCATION REGULATIONS, 2000 SHORT TITLE AND COMMENCEMENT:- These regulations may be called "The Postgraduate Medical Education Regulations 2000. They shall come into force on the date of their publication in the official Gazette. GENERAL CONDITIONS TO BE OBSERVED BY POSTGRADUATE TEACHING INSTITUTIONS: Postgraduate Medical Education in broad specialities shall be of three years duration in the case of degree course and two years in the case of Diploma course after MBBS and in the case of super specialities the duration shall be of three years after MD/MS with the exceptions wherever indicated. Postgraduate curriculum shall be competency based. Learning in postgraduate programme shall be essentially autonomous and self directed. A combination of both formative and summative assessment is vital for the successful completion of the PG programme. A modular approach to the course curriculum is essential for achieving a systematic exposure to the various sub-specialities concerned with a discipline. The training of PG students shall involve learning experience ‘derived from’ or ‘targeted to’ the needs of the community. It shall, therefore, be necessary to expose the students to community based activities. GOALS AND GENERAL OBJECTIVES OF POSTGRADUATE MEDICAL EDUCATION PROGRAMME TO BE OBSERVED BY POSTGRADUATE TEACHING INSTITUTION. 3.1 GOAL The goal of postgraduate medical education shall be to produce competent specialists and/or Medical teachers. who shall recognize the health needs of the community, and carry out professional obligations ethically and in keeping with the objectives of the national health policy who shall have mastered most of the competencies, pertaining to the speciality, that are required to be practiced at the secondary and the tertiary levels of the health care delivery system; who shall be aware of the contemporary advance and developments in the discipline concerned; who shall have acquired a spirit of scientific inquiry and is oriented to the principles of research methodology and epidemiology; and who shall have acquired the basic skills in teaching of the medical and paramedical professionals; 3.2 GENERAL OBJECTIVES OF POST-GRADUATE TRAINING EXPECTED FROM STUDENTS AT THE END OF POST-GRADUATE TRAINING At the end of the postgraduate training in the discipline concerned the student shall be able to; Recognize the importance to the concerned speciality in the context of the health needs of the community and the national priorities in the health section. Practice the speciality concerned ethically and in step with the principles of primary health care. Demonstrate sufficient understanding of the basic sciences relevant to the concerned speciality. Identify social, economic, environmental, biological and emotional determinants of health in a given case, and take them into account while planning therapeutic, rehabilitative, preventive and primitive measure/strategies. Diagnose and manage majority of the conditions in the speciality concerned on the basis of clinical assessment, and appropriately selected and conducted investigations. Plan and advise measures for the prevention and rehabilitation of patients suffering from disease and disability related to the speciality. Demonstrate skills in documentation of individual case details as well as morbidity and mortality rate relevant to the assigned situation. Demonstrate empathy and humane approach towards patients and their families and exhibit interpersonal behaviour in accordance with the societal norms and expectations. Play the assigned role in the implementation of national health programme, effectively and responsibly. Organize and supervise the chosen/assigned health care services demonstrating adequate managerial skills in the clinic/hospital or the field situation. Develop skills as a self-directed learner, recognize continuing education needs; select and use appropriate learning resources. Demonstrate competence in basic concepts of research methodology and epidemiology, and be able to critically analyze relevant published research literature. Develop skills in using educational methods and techniques as applicable to the teaching of medical/nursing students, general physicians and paramedical health workers. Function as an effective leader of a health team engaged in health care, research or training. STATEMENT OF THE COMPETENCIES : Keeping in view the general objectives of postgraduate training, each discipline shall aim at development of specific competencies which shall be defined and spelt out in clear terms. Each department shall produce a statement and bring it to the notice of the trainees in the beginning of the programme so that he or she can direct the efforts towards the attainment of these competencies. COMPONENTS OF THE POSTGRADUATE CURRICULUM : The major components of the Postgraduate curriculum shall be : Theoretical knowledge Practical and clinical skills Thesis skills. Attitudes including communication skills. Training in research methodology. STARTING OF POSTGRADUATE MEDICAL COURSES AND THEIR RECOGNITION. (1) An institution intending to start a Postgraduate Medical Education course or to increase the admission capacity shall obtain permission of the Central Government under Section 10A of the Act. (2) The institution shall apply for recognition of the Postgraduate medical qualification to the Central Government through the affiliating university. NOMENCLATURE OF POSTGRADUATE COURSES. The nomenclature of postgraduate medical courses shall be as provided in the Schedule annexed to these Regulation : Provided that in the case of postgraduate medical degree and diploma courses instituted prior to the commencement of these Regulations with the approval of the Medical Council of India and which have not been included in these regulations, the institutions concerned shall continue such course till the students admitted complete the said courses. GENERAL (1) The institutions recognised by the Medical Council of India for running Postgraduate courses prior to the commencement of the Indian Medical Council (Amendment) Act,1993 and those medical colleges recognised for running Bachelor of Medicine and Bachelor of Surgery (MBBS) course or institutions established by the Central Government for the purpose of imparting postgraduate medical education shall be eligible for starting any postgraduate degree or diploma and higher specialty course. (1A) The Central Government shall exempt any such existing/proposed non-teaching institutions or specialist institution or autonomous body owned and managed by the Central Government/State Government from fulfilling the prescribed provision of having an undergraduate teaching facility, and allow starting Postgraduate medical course. (2) The maximum number of students for a postgraduate medical course, who can be registered in any recognised department, for training for the award of postgraduate degree or diploma by the affiliating university, shall be determined by the facilities available in the department in terms of infrastructure, teaching staff and clinical teaching material. (3) Every student, selected for admission to postgraduate medical course in any of the medical institutions in the country, shall possess recognised MBBS degree or equivalent qualification and should have obtained permanent Registration with the Medical Council of India, or any of the State Medical Councils or should obtain the same within on month from the date of his admission, failing which the admission of the candidate shall be cancelled; Provided that in the case of a foreign national, the Medical Council of India may, on payment of the prescribed fee for registration, grant temporary Registration for the duration of the postgraduate training restricted to the medical college/institution to which he is admitted for the time being exclusively for postgraduate studies; Provided further that temporary registration to such foreign national shall be subject to the condition 5that such person is duly registered as medical practitioner in his own country from which he has obtained his basic medical qualification and that his degree is recognised by the corresponding Medical Council or concerned authority. (4) The students undergoing postgraduate courses shall be exposed to the following :- Basics of statistics to understand and critically evaluate published research paper. Few lectures or other type of exposure to human behavior studies. Basic understanding of pharmaco-economics. Introduction to the non-linear mathematics. SELECTION OF POSTGRADUATE STUDENTS. Students for Postgraduate medical courses shall be selected strictly on the basis of their academic merit. For determining the academic merit, the university/institution may adopt any one of the following procedures both for degree and diploma courses :- On the basis of merit as determined by the competitive test conducted by the State Government or by the competent authority appointed by the State Government or by the university/group of universities in the same state; or On the basis of merit as determined by a centralized competitive test held at the national level; or On the basis of the individual cumulative performance at the first, second and their MBBS examination, if such examination have been passed from the same university; or Combination of (i) and (iii): Provided that wherever entrance test for Postgraduate admission is held by the State Government or a university or any other authorized examining body, the minimum percentage of marks for eligibility for admission to postgraduate medical courses shall be fifty per cent for general category candidates and 40 per cent for the candidate belonging to Scheduled Castes, Scheduled Tribes and Other Backward classes. Provided further that in non-Governmental institutions fifty percent of the total seats shall be filled by the competent authority and the remaining fifty per cent by the management of the institution on the basis of merit. PERIOD OF TRAINING The period of training for the award of various postgraduate degrees or diplomas shall be as follows: (1) Doctor of Medicine (M.D.) / Master of Surgery (M.S.) The period of training for obtaining these degrees shall be three completed years including the period of examination.   Provided that in the case of students having a recognised two year postgraduate diploma course in the same subject, the period of training, including the period of examination, shall be two year. (2) Doctor of Medicine (D.M.) / Master Chirurgiae (M.Ch.) The period of training for obtaining these degrees shall be three completed year (including the examination period) after obtaining M.D./M.S. degrees, or equivalent recognised qualification in the required subject; Provided that where an institution on the date of commencement for these Regulation, is imparting five year training in Neurology and Neuro-Surgery, such institution shall continue to have five year training course. (3) Diplomas The period of training for obtaining a postgraduate Diploma shall be two completed years including the examination period. Migration/transfer of postgraduate student from one medical college or institution to another. Migration/transfer of students undergoing any postgraduate course – degree /diploma shall not be permitted by any university or any authority. EXAMINATIONS The examinations shall be organised on the basis of grading or marking system to evaluate and certify candidate’s level of knowledge, skill and competence at the end of the training and obtaining a minimum of 50% marks in theory as well as practical separately shall be mandatory for passing the whole examination. The examination for M.S., M.D., D.M., M.Ch., shall be held at the end of 3 academic years (six academic terms) and for diploma at the end of 2 academic years (four academic terms). The academic terms shall mean six months training period. For other details please refer to Regulations. EXAMINATIONS The examinations shall be organised on the basis of grading or marking system to evaluate and certify candidate’s level of knowledge, skill and competence at the end of the training and obtaining a minimum of 50% marks in theory as well as practical separately shall be mandatory for passing the whole examination. The examination for M.S., M.D., D.M., M.Ch., shall be held at the end of 3 academic years (six academic terms) and for diploma at the end of 2 academic years (four academic terms). The academic terms shall mean six months training period. For other details please refer to Regulations.  11    Departmental training Facilities:- A department having an independent academic entity of a teaching institution, consisting of one or more units, each having the prescribed minimum strength of faculty, staff and beds shall be recognised for Post Graduate training.  11.1     Staff – Faculty (a)             A clinical department or its unit training candidates for broad or super specialities, shall have a minimum of three full time faculty members belonging to the concerned disciplines of whom one shall be a Professor, one Associate Professor/ Reader/ and one Astt. Professor/ Lecturer, possessing the qualification and experience prescribed by the Medical Council of India; Provided that the second or subsequent additional unit may be headed by an Associate professor.  Of these faculty members only those who possess a total of eight years teaching experience, out of which at least five years teaching experience as Assistant Professor/Lecturer gained after obtaining Post Graduate degree, shall be recognised as Post Graduate teachers.  (b)            In each department, training candidates for super specialities, there shall be a minimum of three faculty members with requisite Post Graduate qualification and experience  - One Professor, One Associate Professor / Reader and one Assistant Professor / Lecturer, with atleast two of them holding the degree of D.M./M.Ch. in the concerned discipline.  Of these faculty members only those who possess eight years teaching experience out of which at least five years teaching experience as Assistant Professor / Lecturer gained after obtaining the higher speciality degree shall be recognised as Post Graduate teachers;              Provided that in the case of super speciality courses which are being newly instituted relaxation of qualification and experience of Post Graduate teachers may be granted by the Medical Council of India for sufficient cause.      (c)        In addition to the faculty staff, the strength of Residents / Registrars / Tutors / Demonstrators, as well as technical and other para medical staff shall be as per the staff strength prescribed for 50 or 100 or 150 students in the “Minimum Requirements for 50/100/150 MBBS Admissions Annually Regulations.’  11.2            Minimum requirements for a Post Graduate institution :  (a)                         An institution conducting both undergraduate and Post Graduate teaching shall satisfy the minimum requirement for undergraduate training as prescribed by the Medical Council of India and shall also fulfil additional requirements for Post Graduate training depending on the type of work being carried out in the department. The extra staff required to be provided in various departments shall be as given in Appendix-I.  (b)                        A Department imparting only Post Graduate training shall:- (i)                           Provide facilities consistent with the all round training including training in basic medical science and other departments related to the subject of training as recommended by the Medical Council of India. (ii)                         have as many autopsies, biopsies and cytopsies as possible for teaching purposes; and (iii)                        make available facilities of ancillary department for coordination of Training.  11.3     Bed Strength in Clinical Departments  A department to be recognised for training of Post Graduate students, shall have not less than 60 (Sixty) beds each of General Medicine, General Surgery, Obstetrics and Gynecology, 30 (thirty) beds each for others incase of M.D/M.S. and diploma and 20 (twenty) beds each in case of D.M./M.Ch  Explaination: - A unit shall consist of 30 beds for MD/MS and 20 beds for DM/M.Ch. respectively. 11.4     Out – patient departments  There shall be adequate space and sufficient number of examination cubicles available in the out – patient Department.  Besides the general outpatient services, Speciality Clinics shall also be available for the training of post-graduate students in the relevant broad and super speciality;  To determine the number of students who may be admitted for training, outpatient attendance, work turnover and ambulatory care also have to be taken into consideration. 11.5            Laboratory Facilities The institution shall have adequate laboratory facilities for the training of the Post Graduate students, and such laboratories shall provide all the investigative facilities required and shall be regularly updated keeping in view the advancement of knowledge and technology and research requirements, and for training of students in non-clinical departments, proper and contemporary laboratory facilities shall be made available. 11.6            Equipment  The department shall have adequate number of all equipments including the latest ones necessary for training and as may be prescribed by the Council for each speciality from time to time.  12.            Number of Post Graduate Students to be admitted.  (1)       The ratio of recognised Post Graduate teacher to number of students to be admitted for the degree and diploma courses shall be 1:1 each for degree and diploma courses in each unit per year, to the extent that in no circumstances more than two students for degree and one for Diploma shall be registered in a unit in one academic year.  (2)       In case the institution is having only Post Graduate diploma courses in any subject then it shall have a unit of 30 beds with three full time teachers.  The ratio of number of students and recognised Post Graduate teachers shall be 1:1 and in no circumstances more than three students can be admitted in a unit per year.  (3)       The requirement of units and beds shall not apply in the case of Post Graduate degree or diploma courses in Basic and para-clinical departments.  The ratio of recognised Post Graduate teacher to students shall, however be maintained at 1:1 both at degree as well as diploma level. (4)       The number of students to be admitted in case of Post Graduate degree (Super speciality) courses shall be one student per year per recognised Post Graduate teacher in a department having a minimum of three faculty members (one Professor, one Associate Professor/Reader & one Asstt. Professor/Lecturer) and twenty beds.  If the number of Post Graduate teachers in the unit is more than one then the number of students may be increased proportionately but not more than two in a unit per year in any circumstances.  For this purpose one student should associate with one Post Graduate teacher:           Provided that no Post Graduate seats left unfilled in an academic year, shall be carried forward to the next or subsequent academic years, being from 1st January to 31st December of any calendar year. 13.    TRAINING PROGRAMME 13.1             The training given with due care to the Post Graduate students in the recognised institutions for the award of various Post Graduate medical degrees / diplomas shall determine the expertise of the specialist and / or medical teachers produced as a result of the educational programme during the period of stay in the institution. 13.2             All candidates joining the Post Graduate training programme shall work as full time residents during the period of training, attending not less than 80% (Eighty percent) of the training during each calendar year, and given full time responsibility, assignments and participation in all facets of the educational process. 13.3             The Post Graduate students of the institutions which are located in various States / Union Territories shall be paid remuneration at par with the remuneration being paid to the Post Graduate students of State Government medical institutions / Central Government Medical Institutions, in the State/Union Territory in which the institution is located.  Similar procedure shall be followed in the matter of grant of leave to Post Graduate students. 13.4        (a)  Every institution undertaking Post Graduate training programme shall set up an Academic cell or a curriculum committee, under the chairmanship of a senior faculty member, which shall work out the details of the training programme in each speciality in consultation with other department faculty staff and also coordinate and monitor the implementation of these training Programmes. (b)     The training programmes shall be updated as and when required.  The structured training programme shall be written up and strictly followed, to enable the examiners to determine the training undergone by the candidates and the Medical Council of India inspectors to assess the same at the time of inspection.  (c)           Post Graduate students shall maintain a record (log) book of the work carried out by them and the training programme undergone during the period of training including details of surgical operations assisted or done independently by M.S./M.Ch. candidates.  (d)       The record books shall be checked and assessed by the faculty members imparting the training.  13.5    During the training for Degree / Diploma to be awarded in clinical disciplines, there shall be proper training in basic medical sciences related to the disciplines concerned; during the training for the degree to be awarded in basic medical sciences, there shall be training in applied aspects of the subject; and there shall be training in allied subjects related to the disciplines concerned.  In all Post Graduate training programmes, both clinical and basic medical sciences, emphasis is to be laid on preventive and social aspects and emergency care facilities for autopsies, biopsies, cytopsies, endoscopic and imaging etc. also be made available for training purposes.  13.6        The Post Graduate students shall be required to participate in the teaching and training programme of undergraduate students and interns. 13.7        Training in Medical Audit, Management, Health Economics, Health Information System, basics of statistics, exposure to human behaviour studies, knowledge of pharmaco – economics and introduction to non- linar mathematics shall be imparted to the Post Graduate students. 13.8    Implementation of the training programmes for the award of various Post Graduate degree and diplomas shall include the following:-  (a)    Doctor of Medical (M.D.) / Master of surgery (M.S.)     (i) Basic Medical Sciences Lectures, Seminars, Journal Clubs, Group Discussions, Participation in laboratory and experimental work, and involvement in research studies in the concerned speciality and exposure to the applied aspects of the subject relevant to clinical specialities.       (ii) Clinical disciplines In service training, with the students being given graded responsibility in the management and treatment of patients entrusted to their care; participation in Seminars, Journal clubs, Group Discussions, Clinical Meetings, Grand rounds, and Clinico - Pathological Conferences; practical training in Diagnosis and medical and Surgical treatment; training in the Basic Medical Sciences, as well as in allied clinical specialitites.  (b) Doctor of Medicine (D.M.) / Magister Chirurgiae (M.Ch.) The training programme shall be on the same pattern as for M.D. / M.S. in clinical disciplines; practical training including advanced Diagnostic, Therapeutic and Laboratory techniques, relevant to the subject of specialisation. For M.Ch. Candidates, there shall be participation in surgical operations. (c)       Diplomas In – service training, with students being given graded clinical responsibility; Lectures, Seminars, Journal Clubs, Group Discussions and participation in clinical and Clinico-Pathological Conferences, practical training to manage independently common problems in the speciality; and training in the Basic Medical Sciences.  14.  EXAMINATIONS The examinations shall be organised on the basis of grading or marking system to evaluate and certify candidates level of knowledge, skill and competence at the end of the training and obtaining a minimum of 50% marks in theory as well as practical separately shall be mandatory for passing the whole examination.  The examination for M.S., M.D, M.Ch shall be held at the end of 3 academic years (six academic terms) and for diploma at the end of 2 academic years (four academic terms).  The academic terms shall mean six months training period.  (1) EXAMINERS (a)          All the Post Graduate Examiners shall be recognised Post Graduate Teachers holding recognised Post Graduate qualifications in the subject concerned.  (b)         For all Post Graduate Examinations, the minimum number of Examiners shall be four, out of which at least two (50%) shall be External Examiners, who shall be invited from other recognised universities from outside the State.  Two sets of internal examiners may be appointed one for M.D./M.S. and one for diploma. (c)          Under exceptional circumstances, examinations may be held with 3 (three) examiners provided two of them are external and Medical Council of India is intimated the justification of such action prior to publication of result for approval.  Under no circumstances, result shall be published in such cases without the approval of Medical Council of India. (d)         In the event of there being more than one centre in one city, the external examiners at all the centres in that city shall be the same.  Where there is more than one centre of examination, the University shall appoint a Supervisor to coordinate the examination on its behalf. (e)          The examining authorities may follow the guidelines regarding appointment of examiners given in Appendix-II.  (2)       Number of candidates The maximum number of candidates to be examined in Clinical / practical and Oral on any day shall not exceed eight for M.D./M.S. degree, eight for diploma and three for D.M./M/Ch examinations.  (3)       Number of examinations The university shall conduct not more than two examinations in a year, for any subject, with an interval of not less than 4 and not more than 6 months between the two examinations.  (4)        Doctor of Medicine (M.D.)/Master of Surgery (M.S.) M.D./M.S. examinations, in any subject shall consist of Thesis, Theory Papers, and clinical/Practical and Oral examinations.  (a)             Thesis Every candidate shall carry out work on an assigned research project under the guidance of a recognised Post Graduate Teacher, the result of which shall be written up and submitted in the form of a Thesis.  Work for writing the Thesis is aimed at contributing to the development of a spirit of enquiry, besides exposing the candidate to the techniques of research, critical analysis, acquaintance with the latest advances in medical science and the manner of identifying and consulting available literature.  Thesis shall be submitted at least six months before the theoretical and clinical / practical examination.  The thesis shall be examined by a minimum of three examiners; one internal and two external examiners, who shall not be the examiners for Theory and Clinical; and on the acceptance of the thesis by two examiners, the candidate shall appear for the final examination. (b)             Theory (i)         There shall be four theory papers. (ii)        Out of these one shall be of Basic Medical Sciences and one shall be of recent advances.  (iii)      The theory examinations shall be held sufficiently earlier than the Clinical and Practical examination, so that the answer books can be assessed and evaluated before the start of the Clinical/Practical and Oral examination.         Provided that after five years from the commencement of these regulations, there shall be one theory paper of ‘multiple choice questions’; unless any institution wants to have such paper earlier.  (c)       Clinical / Practical and Oral (i)            Clinical examination for the subjects in Clinical Sciences shall be conducted to test the knowledge and competence of the candidates for undertaking independent work as a specialist/Teacher, for which candidates shall examine a minimum one long case and two short cases. (ii)          Practical examination for the subjects in Basic Medical Sciences shall be conducted to test the knowledge and competence of the candidates for making valid and relevant observations based on the experimental/Laboratory studies and his ability to perform such studies as are relevant to his subject.  (iii)         The Oral examination shall be thorough and shall aim at assessing the candidate knowledge and competence about the subject, investigative procedures, therapeutic technique and other aspects of the speciality, which form a part of the examination.                      A candidate shall secure not less than 50% marks in each head of passing which shall include (1) Theory, (2) Practical including clinical and viva voce examination.       II.    Doctor of Medicine (D.M.)/Magister of Chirurgiae (M,Ch.)  The examination shall consist of: Theory and Clinical/Practical and Oral.  (a)   Theory There shall be four theory papers, one paper out of these shall be on Basic Medical Sciences, and another paper on Recent Advances. The theory examination will be held sufficiently earlier than the Clinical and Practical examination, so that the answer books can be assessed and evaluated before the start of the clinical/Practical and Oral examination. (b)     Clinical / Practical and Oral Practical examination shall consist of carrying out special investigative techniques for Diagnosis and Therapy. M.Ch candidates shall also be examined in surgical procedures. Oral examination shall be comprehensive to test the candidate’s overall knowledge of the subject. A candidate shall secure not less than 50% marks in each head of passing which shall include (1) Theory (2) Practical including clinical and viva voce examination.   III  Post Graduate Diploma Diploma examination in any subject shall consist of Theory, Clinical and Oral. (a)   Theory There shall be three theory papers. One paper out of these shall be on Basic Medical Sciences. The examination shall be held sufficiently earlier than the clinical examination, so that the answer books can be assessed before the start of the clinical examination.  (b)   Clinical and Oral Clinical examination for the subject in clinical Science shall be conducted to test /aimed at assessing the knowledge and competence of the candidate for undertaking independent work as a Specialist / Teacher for which a candidate shall examine a minimum of one long case and two short cases.  The oral examination shall be thorough and shall aim at assessing the candidate’s knowledge and competence about the subject, investigative procedures, therapeutic technique and other aspects of the speciality, which shall from a part of the examination. The candidate shall secure not less than 50% marks in each head of passing which shall include (1) Theory (2) Practical including clinical and viva voce examinations. APPENDIX-I  POST GRADUATE  EXAMINATION  GUIDELINES ON APPOINTMENT OF POST GRADUATE EXAMINERS  1.                  No person shall be appointed as an examiner in any subject unless he fulfils the minimum requirements for recognition as a Post Graduate teacher as laid down by the Medical Council of India and has teaching experience of 8 (Eight) years as a Lecturer / Asstt. Professor out of which he has not less than 5 (Five) years teaching experience after obtaining Post Graduate degree.  For external examiners, he should have minimum three years experience of examinership for Post Graduate diploma in the concerned subject.  Out of internal examiners, one examiner shall be a professor and Head of Department or Head of Department.  2.                  There shall be at least four examiners in each subject at an examination out of which at least 50% (Fifty percent) shall be external examiners.  The external examiner who fulfils the condition laid down in clause – 1 above shall ordinarily be invited from another recognised university, from outside the State: provided that in exceptional circumstances examinations may be held with 3 (three) examiners if two of them are external and Medical council of India is intimated whit the justification of such examination and the result shall be published in such a case with the approval of Medical council of India.  3.                  An external examiner may be ordinarily been appointed for not more than three years consecutively.  Thereafter he may be reappointed after an interval of two years.  4.                  The internal examiner in a subject shall not accept external examinership for a college from which external examiner is appointed in his subject.  5.                  The same set of examiners shall ordinarily be responsible for the written, practical or part of examination.  6.                  In the event of there being more than one centre in one city, the external examiners at all the centres in the city shall be the same.  7.                  There shall be a Chairman of the Board of paper – setters who shall be an external examiner and shall moderate the question papers.  8.                  Where there is more than one centre of examination, there shall be Co-ordinator appointed by the University who shall supervise and Co-ordinate the examination on behalf of the University with independent authority.  9.                  The Head of the Department of the institution concerned shall ordinarily be one of the internal examiners and second internal examiner shall rotate after every two year. SCHEDULE Specialities / Subjects in which Postgraduate Degree and Diploma can be awarded by the Indian Universities and the eligibility requirements of candidates for registration for the same. M.D. (DOCTOR OF MEDICINE) for which candidates must possess recognised degree of MBBS (or its equivalent recognised degree) Anesthesiology Aviation Medicine Anatomy Biochemistry Biophysics Community Medicine Dermatology, Venerology and Leprosy Family Medicine Forensic Medicine General Medicine Geriatrics Health Administration Hospital Administration Immuno Haematology and Blood Transfusion Medical Genetics Microbiology Nuclear Medicine Pathology Paediatrics Pharmacology Physical Medicine Rehabilitation Physiology Psychiatry Radio-diagnosis Radio-therapy Rheumatology Sports Medicine Tropical Medicine Tuberculosis & Respiratory Medicine or Pulmonary Medicine. M.S. (MASTER OF SURGERY) for which candidates must possess recognised degree of MBBS (or its equivalent recognised degree). Otorhinolaryngology General Surgery Ophthalmology Orthopedics Obstetrics & Gynecology D.M. (DOCTOR OF MEDICINE) for which candidates must possess recognised degree of M.D. (or its equivalent recognised degree) in the subject shown against them.   Sl. No. Area of Specialisation Prior Requirement 1. Cardiology MD (Medicine) MD (Paediatrics) 2. Clinical Hematology MD (Medicine) MD (Pathology) MD (Paediatrics) MD (Biochemistry) 3. Clinical Pharmacology MD (Pharmacology) 4. Endocrinology MD (Medicine) MD (Paediatrics) MD (Biochemistry) 5. Immunology MD (Medicine) MD (Pathology) MD (Microbiology) MD (Paediatrics) MD (Biochemistry) MD (Physiology) 6. Medical Gastroenterology MD (Medicine) MD (Paediatrics) 7. Medical Genetics MD/MS in any subject 8. Medical Oncology MD (Medicine) MS (Radiotherapy) MD (Paediatrics) 9. Neonatology MD (Paediatrics) 10. Nephrology MD (Medicine) MD (Paediatrics) 11. Neurology MD (Medicine) MD (Paediatrics) 12. Neuro-radiology MD (Radio-Diag.) M.Ch. (MASTER OF CHIRURGIE) for which candidates must possess recognised degree of M.S. (or its equivalent recognised degree) in the subjects shown against them. Sl. No. Area of Specialisation Prior Requirement 1. Cardio vascular & Thoracic Surgery MS (Surgery) 2. Urology MS (Surgery) 3. Neuro-Surgery MS (Surgery) 4. Paediatrics Surgery. MS (Surgery) 5. Plastic & Reconstructive Surgery MS (Surgery) 6. Surgical Gastroenterology MS (Surgery) 7. Surgical Oncology MS (Surgery)    MS (ENT)    MS (Orthopaedics) MD (Obst. & Gynae.) 8. Endocrine Surgery MS (General Surgery) 9. Gynecological Oncology MD/MS (Obst. & Gynae) 10. Vascular Surgery MS (Surgery) Ph.D. (DOCTOR OF PHILOSOPHY) Ph.D. Degree may be instituted in all subjects wherever recognised postgraduate qualification in medical subjects are awarded by the concerned Universities subject to fulfillment of the following guidelines : Ph.D. shall be awarded only upon completion of M.D. or M.S. or P.G. Diploma or M.Sc. in medical subjects. The period of training for Ph.D. shall be two years for candidates who possess M.D./M.S/P.G./ diploma in three years for candidates with M.Sc. (medical subjects). For starting Ph.D. course, the institution concerned shall have the following facilities namely :- Adequate facilities for experimental medicine and experimental surgery ; Ancillary Departments, adequately equipped and well staffed as prescribed for Postgraduate departments; Adequate facilities for advanced research work and laboratory investigations in the departments of Biochemistry, Physiology, Microbiology, Histopathology, Radio-diagnosis etc. A guide for the Ph.D. degree shall have not less than fifteen year’s teaching and research experience after obtaining his postgraduate qualification and shall also have not less than ten years postgraduate teaching experience as an faculty member DIPLOMAS for which candidates must possess recognised degree of MBBS (or its equivalent recognised degree). Anesthesiology (D.A.) Clinical Pathology (D.C.P.) Community Medicine (D.C.M.) Dermatology, Venerology and Leprosy (DDVL) Forensic Medicine (D.F.M.) Health Education (D.H.E.) Health Administration (D.H.A.) Immuno-Haematology & Blood Transfusion (D.I.H.B.T.) Marine Medicine (Dip. M.M.) Microbiology (D.Micro) Nutrition (D.N.) Obstetrics & Gynecology (D.G.O.) Occupational Health (D.O.H.) Ophthalmology (D.O.) Orthopedics (D.Ortho.) Oto-Rhino0Laryngology(D.L.O.) Paediatrics( D.C.H.) Physical Medicine & Rehabilitation (D.Phy. Med. & R.) Psychiatry (D.P.M.) Public Health (D.P.H.) Radio-diagnosis (D.M.R.D.) Radio-therapy (D.M.R.T.) Radiological Physics (D.R.P.) Sport Medicine (D.S.M.) Tropical Medicine & Health (D.T.M. & H.) Tuberculosis & Chest Diseases (D.T.C.D.) Virology (D.Vir.) Radiation Medicine (D.R.M.) DIPLOMAS for which candidates must possess recognised postgraduate degree (or its equivalent recognised degree). Neuro-pathology (DNP) (with the prior requirement of M.D. (Pathology)

Published in part – III section -4 of the Gazette of India on 16th March, 2005.  In exercise of the Indian Medical Council Act, 1956 (102 of 1956), the Medical Council of India, with the previous sanction of the Central Government hereby makes the following regulations further to amend the Postgraduate Medical Education Regulations, 2000, namely:-  1.         (i) These regulations may be called the Postgraduate Medical Education (Amendment) Regulations, 2005. (ii) They shall come into force on the date of their publication in the Official Gazette.   2.         In the Postgraduate Medical Education Regulation, 2000 (hereinafter referred to as the principal Regulation). (i) In regulation 11.1 relating to ‘staff – Faculty’, after clause (c), the following clause shall be inserted, namely:- “(d) Consultants of specialists who have the experience of working for a period of not less than 18 years and 10 years in the teaching and other general departments in the institution or hospitals, not attached to any medical college, where with the affiliation from any university, postgraduate teaching is being imparted as contemplated under sub-regulation (1A) of regulation 8, shall respectively be eligible to be equated as Professor and Associate Professor in the department concerned. The requisite department of the said institution or hospitals as Professor and Associate Professor shall respectively be 16 years and 8 years. Consultants or specialists having postgraduate degree qualification, working in such an institution or hospital, who do not have the said period of experience, shall be eligible to be equated as Assistant Professor in the department concerned.”  (ii) In regulation 11.2 relating to ‘Minimum requirement for a post graduate institution’, after clause (b), the following clause shall be inserted, namely:- (c) An institution eligible to start postgraduate course(s) under sub-regulation (1A) of regulation 8 may enter into a comprehensive Memorandum of Understanding with an ongoing recognized medical college, located within a reasonable distance from it as would not disrupt the smooth running of the said course(s), for the purpose of availing the facilities of the basic medical sciences departments of the college concerned; or it shall create the requisite facilities in its own set-up as per the guidelines indicated in Appendix-III. In addition, such an institution shall set up full-fledged departments of Pathology, Biochemistry, Microbiology and Radiology”.   3.         In the principal Regulation, after Appendix-II, the following appendix shall be inserted, namely:-  “Appendix-III [see regulation 11.2(c)]   Criteria to be fulfilled by institutions eligible to start postgraduate course(s) under sub-regulation (1A) of regulation 8, which are required to create their own facilities for setting up departments in basic medical sciences:   A.        The basic subjects identified for the purpose of creation of facilities shall be:             i)       Anatomy             ii)      Physiology             iii)     Pharmacology iv)       Community Medicine with Forensic Medicine being optional.   B.        Staff requirements: (1)The minimum staff required in each of the departments of Anatomy, Physiology, Pharmacology and Community Medicine shall be:             1.            Professor or Associate Professor                   One             2.            Assistant Professor                                    Two Provided that the department of Community Medicine shall also have: a)     Epidemiologist-cum-Lecturer b)     Statistician-cum-Lecturer c)     Health Educator-cum-Lecturer Provided further that the person in charge of a Unit shall not be below the rank of Associate Professor. (2)       The required strength of the teaching personnel shall be in proportion to the number of postgraduate courses started by the institution in a manner that the ultimate upper limit of the requirement shall be on a par with the requirement indicated in the Regulation of the Council titled ‘Minimum Requirements for Establishment of Medical College for Annual Intake Capacity of 50’.   C.              Infrastructural requirements: 1) The infrastructural requirements in terms of lecture theatres and demonstration rooms could be common. 2) The research laboratories shall be well-equipped so that the teachers in the departments concerned shall be able to work on solicited research projects. 3) Department of Anatomy: Apart from the common facilities, there shall be placed for dissection with adequate accommodation, along with an embalming room, cold room and also a museum: Provided that Histology and Research laboratory may be clubbed together. 4) Department of Physiology: There shall be clinical, experimental and animal physiology laboratories along with a museum. 5) Department of Pharmacology: The facilities could be common except for research laboratory, which shall be separate. 6) Department of Community Medicine: There shall be a museum alongwith a well-equipped Rural/Urban Health Centre with necessary staff.”   LT. COL. (DR.) A.R.N. SETALVAD (RETD.), SECY. MEDICAL COUNCIL OF INDIA  NOTIFICATION    New Delhi, the 23rd March, 2006   No.MCI-18(1)/2006-Med./27395. - In exercise of the powers conferred by Section 33 of the Indian Medical Council Act, 1956 (102 of 1956), the Medical Council of India with the previous approval of the Central Government hereby makes the following regulations to amend the Postgraduate Medical Education Regulations, 2000, namely:-   1.         These Regulations may be called the “Postgraduate Medical Education (Amendment) Regulations, 2006”. 2.         In the Postgraduate Medical Education Regulations, 2000 in Regulation 9, after sub-regulation (2), the following sub-regulation shall be inserted: 3.         (i) The Universities and other authorities concerned shall organize admission process in such a way that teaching in postgraduate courses starts by 2nd May and by 1st August for super speciality courses each year. For this purpose, they shall follow the time schedule indicated in Appendix-III.             (ii) There shall be no admission of students in respect of any academic session beyond 31st May for postgraduate courses and 30th September for super speciality courses under any circumstances. They Universities shall not register any student admitted beyond the said date.             (iii) The Medical Council of India may direct, that any student identified as having obtained admission after the last date for closure of admission be discharged from the course of study, or any medical qualification granted to such a student shall not be a recognized qualification for the purpose of the Indian Medical Council Act, 1956.  The institution which grants admission to any student after the last date specified for the same shall also be liable to face such action as may be prescribed by MCI including surrender of seats equivalent to the extent of such admission made from its sanctioned intake capacity for the succeeding academic year.”   LT. COL. (DR.) A.R.N. SETALVAD (RETD.), SECY. [ADVT-III/IV/100/2005-Exty.] Foot Note. – The Principal Regulations namely, “Postgraduate Medical Education Regulations, 2000” was published in Part-III Section 4 of the Gazette of India on 7th October,2000 and amended vide MCI notification dated 16th February,2001, 6thOctober,2001 and 16th March,2005, published in Part-III, Section 4 of the Gazette of India on 3rd March,2001; 6thOctober,2001 and 16th March, 2005 respectively.

APPENDIX-III  TIME SCHEDULE FOR COMPLETION OF ADMISSION PROCESS FOR POSTGRADUATE MEDICAL COURSES  Schedule for admission Postgraduate Courses Super-Speciality Courses All India Quota State Quota Conduct of entrance examination 2nd Sunday of January Mid-January to End January May-June Declaration of result of qualifying examination/ entrance examination 2nd week of February By 14th Feb. By 15th June 1st round of counseling/ admissions 1st March to 15thMarch To be over by 10thApril To be over by 10th July Last date for joining the allotted college and course 31st March @@ 17th April 17th July 2nd round of counseling for allotment of seats from waiting list By 7th April By 24th April By 24th July Last date for joining for candidates allotted seats in 2ndround of counseling. 14th April 30th April 31st July Commencement of academic session 2nd May 2nd May 1st August Last date upto which students can be admitted against vacancies arising due to any reason from the waiting list 31st May 31st May 30th September  NOTE:- @@ Head of the Colleges should intimate the vacancies existing after the last date for joining the course by the candidate concerned in respect of the All India Quota of seats to the DGHS within seven days and latest by 6th April for postgraduate courses and 23rd July for super-speciality courses.

MEDICAL COUNCIL OF INDIA  AMMENDMENT NOTIFICATION New Delhi, the 20th October, 2008 No. MCI.18(1)/2008-Med./29544. - In exercise of the powers conferred by Section 33 of the Indian Medical Council Act, 1956(102 of 1956), the Medical Council of India with the previous approval of the Central Government hereby makes the following regulations to further amend the “Postgraduate Medical Education Regulations, 2000”, namely:-  1.         These Regulations may be called the “Postgraduate Medical Education (Amendment) Regulations, 2008”.  2.         In the “Postgraduate Medical Education Regulations, 2000”, the following additions / modifications / deletions / substitutions, shall be as indicated therein:-    3.        (i)            In Clause 2(i) after the sentence “duration shall be of three years after MD/MS”, the words “with the exception wherever indicated” shall be deleted.              (ii)             In Clause 2(v) the words “various sub-specialties concerned with a discipline” shall be substituted by “various areas concerned with the discipline”.            4.         In Clause 5 the words “Thesis skills” shall be substituted by “Writing Thesis/Research articles” and the words “Training in research methodology”shall be substituted by “Training in Research Methodology, Medical Ethics and Medicolegal aspects”  5.   (i)  In Clause 8(3) the sentence “Every student, selected for admission to a Post Graduate medical course in any of the medical institutions in the country shall possess recognized MBBS degree or equivalent qualification and should have obtained permanent registration with the Medical Council of India, or any of the State Medical Councils or should obtain the same within one month from the date of his admission, failing which the admission of the candidate shall be cancelled;”shall be substituted by “Every student, selected for admission to a Post Graduate medical course in any of the medical institutions on acquiring MBBS Degree or an equivalent qualification thereto shall have obtained permanent registration with the Medical Council of India, or any of the State Medical Council(s) or shall obtain the same within a period of one month from the date of his/her admission, failing which his/her admission shall stand cancelled;”  (ii)            In para –2 of Clause 8(3) the sentence “training restricted to the medical college/institution to which he is admitted for the time being exclusively for Post Graduate studies” shall be substituted by “course limited to the Medical College/Institution to which he/she is admitted for the time being exclusively for pursuing the Post Graduate studies”  (iii)            In para –3 of Clause 8(3) the sentence “as medical practitioner in his own country from which he has obtained his basic medical qualification and that his degree is recognized by the corresponding medical council or concerned authority” shall be substituted by “with appropriate registering authority in his own country wherefrom he has obtained his Basic Medical qualification, and is duly recognized by the corresponding Medical Council or concerned authority”  (iv)            In Clause 8(4) (b) “Few lectures or other type of exposure to human behaviour studies” shall be substituted by ‘Exposure to Human Behaviour studies’               (v)            Clause 8(4) – sub clause (c) & (d) shall be deleted.  6                (i)         In Clause 10(1) the word “having” shall be substituted by ‘possessing’  (ii)                In Clause 10(2) the sentence “The period of training for obtaining these degrees shall be three completed years (including the examination period) after obtaining M.D. / M.S. degrees, or equivalent recognised qualification in the required subject:” shall be substituted by “The period of training for obtaining these Degrees shall be three completed years including the examination period.”  (iii)              In Clause 10 (iii) the paragraph “Migration/transfer of Post Graduate students from one medical college or institution to another. Migration/transfer of students undergoing any Post Graduate course-degree/diploma shall not be permitted by any university or any author” shall be substituted by: “MIGRATION Under no circumstance, Migration/transfer of student undergoing any Post Graduate Degree/ Diploma / Super Specialty course shall be permitted by any University/ Authority”  7      (i)             In Clause 11 the para “A department having an independent academic entity of a teaching institution, consisting of one or more units, each having the prescribed minimum strength of faculty, staff and beds shall be recognised for Post Graduate training” shall be substituted by “A department having an independent academic identity in a teaching institution, comprising of one or more units, having prescribed strength of faculty, staff and teaching beds shall be recognised for Post Graduate training.”  (ii)                Clause 11.1  shall be substituted by the following:   “11.1   Staff – Faculty (a) A clinical department or its unit training candidates for Broad or Super Specialities, shall have a minimum of three full time faculty members belonging to the concerned disciplines of whom one shall be a Professor, one Associate Professor/ Reader and one Astt. Professor/ Lecturer, possessing requisite qualification and teaching experience prescribed by the Medical Council of India.  Provided that the second or subsequent unit may be headed by an Associate Professor alongwith two Assistant Professors/Lecturers.    Of these faculty members only those who possess a total of eight years teaching experience, of which at least five years teaching experience is as Assistant Professor gained after obtaining Post Graduate Degree, shall be recognised as Post Graduate teachers.  (b)  In a Department, training candidates for Super Speciality, there shall be a minimum of three faculty members with requisite Post Graduate qualification and experience, one shall be Professor, One Associate Professor / Reader and one Assistant Professor / Lecturer.           Provided that the second or subsequent unit may be headed by an Associate Professor along with two Assistant     Professor s /Lecturers.  Of these only those faculty members who possess eight years teaching experience of which at least five years teaching experience is asAssistant Professor or above gained after obtaining the Post Graduate degree shall be recognised as Post Graduate teachers :        Provided that in the case of super speciality courses which are newly instituted,  relaxation of qualification and experience for recognition as Post Graduate teachers, may be granted by the Medical Council of India for sufficient cause.”  (iii)              Clause 11.2 (a) shall be substituted by the following:  “(a) An institution conducting both Undergraduate and Post Graduate teaching shall fulfill the prescribed minimum requirements for undergraduate training and also additional requirements for Post Graduate training depending on the type of work being carried out in the Department. The additional staff required to be provided in following Departments shall be as under :-  1)      Department of Pathology  i)Associate Professor/Reader    -1, ii) Assistant Professor/Lecturer - 1 iii) Tutor/Demonstrator - 1                         2)  Department of Radio-diagnosis i) Associate Professor/Reader    -1, ii) Assistant Professor/Lecturer - 1 iii) Tutor/Demonstrator - 1                         3)  Department of Anaesthesiology                         i)  Associate Professor/Reader    -1, ii) Assistant Professor/Lecturer - 1 iii) Tutor/Demonstrator – 1” (iv)              Appendix I shall be deleted.  (v)               Clause 11.3  shall be substituted by the following:  “11.3 Bed Strength in Clinical Departments  A Department to be recognised for training of Post Graduate students, shall have at least 60 (Sixty) beds each of General Medicine, General Surgery, Obstetrics and Gynecology and 30 (thirty) beds each for others specialties for Degree and Diploma courses, and 20 (twenty) beds each in case of Super Specialty courses.   Explanation: - A unit shall consist of not less than 30 and more than 40 beds for Degree/Diploma courses and not less than 20 and more than 30 beds for Super Specialty courses respectively.”              (vi)             Clause 11.6 shall be substituted by the following:                          “11.6             Equipment The department shall have adequate number of all such equipments including the latest ones necessary for training and as may be prescribed by the Council for each speciality from time to time.”  8       (i)            Clause 13.2  shall be substituted by the following:  “All the candidates joining the  Post Graduate training programme shall work as ‘Full Time Residents’ during the period of training and shall attend not less than 80% (Eighty percent) of the imparted training during each academic year including assignments, assessed full time responsibilities and participation in all facets of the educational process.”  (ii)                Clause 13.3  shall be substituted by the following:  “The Post Graduate students undergoing Post Graduate Degree/Diploma/Super-Specialty course shall be paid stipend on par with the stipend being paid to the Post Graduate students of State Government Medical Institutions / Central Government Medical Institutions, in the State/Union Territory where the institution is located.  Similarly, the matter of grant of leave to Post Graduate students shall be regulated as per the respective State Government rules.” (iii)              Clause 13.4 (d) shall be substituted by the following:  "The Record (Log) Books shall be checked and assessed periodically by the faculty members imparting the training.”  (iv)              Clause 13.5 shall be substituted by the following:  “During the training for award of Degree / Superspecialty/Diploma in clinical disciplines, there shall be proper training in Basic medical sciences related to the disciplines concerned; so also in the applied aspects of the subject; and allied subjects related to the disciplines concerned.  In the Post Graduate training programmes including both Clinical and Basic medical sciences, emphasis has to be laid on Preventive and Social aspects.  Emergency care, facilities for Autopsies, Biopsies, Cytopsies, Endoscopy and Imaging etc. shall also be made available for training purposes.”  (v)               Clause 13.8 shall be substituted by the following:  “Implementation of the training programmes for the award of various Post Graduate Degree and Diplomas shall include the following:-  (a)     Doctor of Medical (M.D.) / Master of surgery   (M.S.) (i)                   Basic Medical Sciences – The teaching and training of the students shall be through Lectures, Seminars, Journal Clubs, Group Discussions, Participation in laboratory and experimental work, and involvement in Research Studies in the concerned speciality and exposure to the ‘Applied aspects’ of the subject relevant to clinical specialities.  (ii)               Clinical disciplines The teaching and training of the students shall include graded responsibility in the management and treatment of patients entrusted to their care; participation in Seminars, Journal Clubs, Group Discussions, Clinical Meetings, Grand Rounds, and Clinico-Pathological Conferences; practical training in Diagnosis and Medical and Surgical treatment; training in the Basic Medical Sciences, as well as in allied clinical specialitites.  (b) Doctor of Medicine (D.M.) / Magister Chirurgiae (M.Ch.) The training programme shall be on the same pattern as for M.D. / M.S. in clinical disciplines; with practical training including advanced Diagnostic, Therapeutic and Laboratory techniques, relevant to the subject of specialization.  Postgraduate Degree/Diploma/Superspecialty Residents in Surgical Specialties shall participate in Surgical operations as well.      (c) Diplomas The teaching and training of the students shall include graded clinical responsibility; Lectures, Seminars, Journal Clubs, Group Discussions and participation in Clinical and Clinico-Pathological Conferences, practical training to manage independently common problems in the specialty; and training in the Basic Medical Sciences”  9.      (i)            Clause 14 shall be substituted by the following:                “EXAMINATIONS The examinations shall be organised on the basis of ‘Grading’ or ‘Marking system’ to evaluate and to certify candidate's level of knowledge, skill and competence at the end of the training.  Obtaining a minimum of 50%  marks in ‘Theory’ as well as ‘Practical’ separately shall be mandatory for passing examination as a whole.  The examination for M.D./ MS, D.M., M.Ch shall be held at the end of 3rd academic year  and for Diploma at the end of 2nd academic year.  An academic term shall mean six month's training period.”  (ii)                Clause 14.1 (d) shall be deleted.  (iii)              Clause 14(4) (a) the sentence in second para “Thesis shall be submitted at least six months before the theoretical and clinical / practical examination” shall be substituted by “Thesis shall be submitted at least six months before the Theory and Clinical / Practical examination”  Further, para 3 of clause 14(4)(a) shall be substituted by “The thesis shall be examined by a minimum of three examiners; one internal and two external examiners, who shall not be the examiners for Theory and Clinical examination. A candidate shall be allowed to appear for the Theory and Practical/Clinical examination only after the acceptance of the Thesis by the examiners.”  (iv)              Clause 14(4) (b) (ii), the words “Basic Medical Sciences” shall be substituted by ‘Basic Medical Sciences’.  Further, in clause 14(4)(b) (iii) the words “sufficiently earlier than” shall be substituted by “well in advance before”, the word “start”shall be substituted by “commencement”   Further last para of clause 14(4) (b) i.e. “Provided that after five years from the commencement of these regulations, there shall be one theory paper of ‘multiple choice questions’; unless any institution wants to have such paper earlier.” shall be deleted  (v)               In Clause 14 (II), the sentence “The examination shall consist of: Theory and Clinical/Practical and Oral” shall be substituted by “The Examination consists of: (i) Theory and (ii) Clinical/Practical and Oral”  In clause 14 (II) (a) para under heading ‘Theory’ shall be substituted by the following: “There shall be four theory papers, one paper out of these shall be on ‘Basic Medical Sciences’, and another paper on ‘Recent Advances’. The theory examination shall be held in advance before the Clinical and Practical examination, so that the answer books can be assessed and evaluated before the commencement of the clinical/Practical and Oral examination.”  In clause 14(II) (b) the word “shall” shall be substituted by “may”, the word “comprehensive” shall be substituted by “‘comprehensive’ enough” and the sentence “clinical viva voce examination” shall be substituted by “Clinical and Viva Voce examination”  (vi)              Clause 14(III) under heading Post Graduate Diploma, the sentence “Theory, Clinical and Oral” shall be substituted by “Theory, Practical / Clinical and Oral”  Further, in Clause 14(III)(a) the para under heading “Theory” shall be substituted by the following”  “There shall be three ‘Theory’ papers, one paper out of these shall be on 'Basic Medical Sciences'. The theory of examination will be held well in advance before the Clinical examination, so that the answer books can be assessed before the commencement of the Practical / Clinical and Viva-Voce examination.”  10        (i)         In Appendix (II), point no. 1, under the heading “GUIDELINES ON APPOINTMENT OF POSTGRADUATE EXAMINERS” shall be substituted by the following:  ‘No person shall be appointed as an internal  examiner in any subject unless he/she has three years  experience as recognized PG teacher  in the concerned subject.  For external examiners, he/she should have minimum six years of experience  as recognized PG teacher in the concerned subject.’  (ii)                In Appendix (II), last sentence of para 2 i.e. “and the result shall be published in such a case with the approval of Medical council of India” shall be substituted by “The result in such a case shall be published with the approval of Medical Council of India”  (iii)              In Appendix (II), Para 3 shall be substituted by the following:  “An examiner shall ordinarily be appointed for not more than two consecutive terms”  (iv)              In Appendix (II), Para 5 and 6 shall be deleted.  (v)               In Appendix (II), Para 8, shall be substituted by the following:  “Where there is more than one centre of examination, there shall be Co-ordinator/Convenor/Chairman who shall be the Seniormost internal Examiner, appointed by the University & shall supervise and Co-ordinate the examination on behalf of the University with independent authority”  (vi)              In Appendix (II), Para 9 shall be deleted.  Foot Note :     The Principal Regulations namely, “Postgraduate Medical Education Regulations, 2000” were published in Part – III, Section (4) of the Gazette of India on the 7th October, 2000, and amended vide MCI notification dated 03.03.2001, 06.10.2001, 16.03.2005 & 23.03.2006.     [Lt. Col.(Retd.) Dr. A.R.N. Setalvad] Secretary Medical Council of India