Madhurima Nundy, Associate Fellow, Institute of Chinese Studies.
The commercialisation of medical education in India has led many students to study medicine abroad especially in China. The Indian medical education is in a state of crisis but there is no sense of urgency to address the serious issues of maldistribution of resources, the unregulated growth of the private sector, dearth of faculty, a lack of uniform admission procedures and dated curricula that needs to undergo a review. The commercialisation of medical education has raised concerns over issues of quality, regulation and increasing corruption in selection and recruitment procedures as has been exposed by the Vyapam scandal leading to the ‘criminalisation of medical education’.
According to the latest data by the Medical Council of India (MCI), there are 412 colleges teaching MBBS with total seats of 52,965. Over 50 per cent (211 out of 412) of these colleges are in the private sector that are mostly registered as Trusts or Societies, the rest are government funded and owned with few that are in partnership with a Society. Most of these private colleges have high capitation fees that could vary from anything between 50 lakhs to 1.5 crores apart from the annual college fees. Despite the large number of seats, demand exceeds the supply. Many of the failures regarding medical education have been attributed to the functioning of the MCI in the recent Standing Committee Report that came out early this year acknowledging that the MCI must undergo a complete overhauling.
Given the highly competitive examination for seats in public medical colleges and high fees in the private, many aspiring students who are unable to make it here, look for other alternatives. These alternatives come in the form of seeking admissions in medical colleges in other countries.
Among the most preferred destination to study medicine abroad, China tops the list followed by Russia, Nepal, Ukraine, Kazakhstan, Kyrgyzstan, and others. There are over 13,000 Indian students in these countries studying medicine. More recently, Philippines is also attracting students from India.
On returning, most of the graduate students from abroad (barring US, UK, Australia, New Zealand, and Canada) have to sit for the Foreign Medical Graduate Exams (FMGE) organised by the National Board of Examinations, a prerequisite to start medical practice in India. In 2014, 12,494 students appeared for the FMGE (medical graduate distribution – 3930 from China; 2519 from Russia; 1600 from Ukraine; 1279 from Nepal; 694 from Kyrgyzstan; 307 from Kazakhstan and 2165 from other countries). The pass percentage was just 13.09 percent.
China opened medical education for foreign students in 2004. There were over 9000 students studying in China in 2010. Streamlining of regulations took number of years. For 2016-17, the MCI lists about 45 Chinese Medical Institutions, which are public institutions, providing 3470 seats to international students. This list has been issued by the Ministry of Education of the PRC. The course is for six years that includes a year of internship. MCI approves only students from these universities to appear for the FMGE. The Indian Embassy provides detailed guidelines to students wishing to study medicine in China. Recruitment of Indian students takes place through ‘agents’ in India who facilitate the process. There are spurious agents too but the guidelines given by the Indian Embassy clearly warn students seeking admission to be careful. There are instances of students being recruited by agents and sent to sub-standard privately run universities that do not meet standards of the Ministry of Education in the PRC.
One of the major reasons that Chinese medical colleges are sought is due to affordability. In 2014, an undergraduate student in China spent on an average 25 lakhs for the complete course. Students also said that unlike Indian private colleges, there were no hidden costs in the form of donations in China. All these colleges teach in English but going by student experiences language becomes an issue during the internship year when they have to interact with Chinese patients. Students feel that there are better equipment, lab facilities and technology in these colleges when compared to the colleges in India. Some have even started returning for post-graduation as seats in India are very limited. The students acknowledge that China was never part of their imagination and they had a lot to learn when they were exposed to a completely new culture and environment. The Indian embassy encourages students to interact more with people from different countries and to absorb as much as they can about China.
The problem seems to arise when they return to India. Analysis of data from 2012-14 shows that students who studied in Bangladesh performed the best in FMGE with a pass percentage of 30.8. China and Russia had the highest number of students and the lowest pass percentage of 18.9. This pass percentage has come down over the years. There is more money spent in coaching centres to clear these exams as very few clear them in the first attempt. Yet, the number of students going to these two countries has not gone down. While the government has streamlined its rules and provides guidelines for students it is clear that many students might not be reaching the recognised colleges issued by the Ministry of Education of the PRC as the number of students going are more than the recognised number of seats approved for international students by the PRC.
There is little information of experience of travel for medical education of Indian students to China and the curriculum and pedagogy for training them. There is an important question that arises of poor recognition of Chinese medical degrees by the MCI. Is it a problem with the skills of the curriculum or is it the many inadequacies of the MCI in restricting the practice of foreign medical graduates who could be potential competitors in the Indian market? The President of the All India Foreign Medical Graduates Association in many of his interviews has accused the MCI of discriminating against graduates from China and Russia. He has argued that the MCI is extremely corrupt and is probably expecting kickbacks for recognition of degrees. He further elaborated that they are seen as competition to graduates who come out of private medical colleges in India who also should be undergoing similar screening examination. Foreign medical graduates claim that the training they receive in China is extremely competent and quality is often better than several private and government medical colleges in India. This is clearly an area which requires in-depth research.