Private medical education takes off in India

Financial barriers and inequity in medical education in India: challenges to training a diverse and representative healthcare workforce

India has been historically challenged by an insufficient and heterogeneously clustered distribution of healthcare infrastructure. While resource-limited healthcare settings, such as major parts of India, require multidisciplinary approaches for improvement, one key approach is the recruitment and training of a healthcare workforce representative of its population. This requires overcoming barriers to equity and representation in Indian medical education that are multi-faceted, historical, and rooted in inequality. However, literature is lacking regarding the financial or economic barriers, and their implications on equity and representation in the Indian allopathic physician workforce, which this review sought to describe. Keyword-based searches were carried out in PubMed, Google Scholar, and Scopus in order to identify relevant literature published till November 2023. This state-of-the-art narrative review describes the existing multi-pronged economic barriers, recent and forthcoming changes deepening these barriers, and how these may limit opportunities for having a diverse workforce. Three sets of major economic barriers exist to becoming a specialized medical practitioner in India - resources required to get selected into an Indian medical school, resources required to pursue medical school, and resources required to get a residency position. The resources in this endeavor have historically included substantial efforts, finances, and privilege, but rising barriers in the medical education system have worsened the state of inequity. Preparation costs for medical school and residency entrance tests have risen steadily, which may be further exacerbated by recent major policy changes regarding licensing and residency selection. Additionally, considerable increases in direct and indirect costs of medical education have recently occurred. Urgent action in these areas may help the Indian population get access to a diverse and representative healthcare workforce and also help alleviate the shortage of primary care physicians in the country. Discussed are the reasons for rural healthcare disparities in India and potential solutions related to medical education.

Indian medical students in public and private sector medical schools: are motivations and career aspirations different? - studies from Madhya Pradesh, India

BACKGROUND

In recent years, there has been a massive growth in the private medical education sector in South Asia. India's large private medical education sector reflects the market driven growth in private medical education. Admission criteria to public medical schools are based on qualifying examination scores, while admission into private institutions is often dependent on relative academic merit, but also very much on the ability of the student to afford the education. This paper from Madhya Pradesh province in India aims to study and compare between first year medical students in public and private sector medical schools (i) motives for choosing a medical education (ii) career aspirations on completion of a medical degree (iii) willingness to work in a rural area in the short and long terms.

METHODS

Cross sectional survey of 792 first year medical students in 5 public and 4 private medical schools in the province.

RESULTS

There were no significant differences in the background characteristics of students in public and private medical schools. Reasons for entering medical education included personal ambition (23%), parental desire (23%), prestigious/secure profession (25%) or a service motive (20%). Most students wished to pursue a specialization (91%) and work in urban areas (64%) of the country. A small proportion (7%) wished to work abroad. There were no differences in motives or career aspirations between students of public or private schools. 40% were willing to work in a rural area for 2 years after graduating; public school students were more willing to do so.

CONCLUSION

There was little difference in background characteristics, motives for entering medicine or career aspirations between medical students in from public and private sector institutions.

Education for health professionals in the emerging market economies: a literature review

CONTEXT

Along with economic growth and social reforms, the emerging market economies (EMEs) are undergoing restructuring of their health care systems. There is now an increased focus on disease prevention and primary care, along with a patient-centred approach to health care delivery. However, these changes need to be complemented by alterations in the health care education system.

METHODS

A review of the published literature, limited to the last 10 years, was conducted to include recent updates on medical and nursing education. This was done by systematically searching appropriate databases using keywords. This review covers only the common issues related to education and training in EMEs.

RESULTS

Issues identified included: the mismatch between the health needs of the population and education curricula; outdated curricula and teaching methods; growing numbers of medical schools; the quality of education, and inadequate career guidance for students to help them make decisions about choosing a health profession as a career and, later, about choosing a field of specialisation.

CONCLUSIONS

The literature provides evidence of innovative approaches adopted in several EMEs, which include: outcome-based education; community-oriented medical education; problem-based learning; initiatives to improve quality, and initiatives to resolve the shortage of skilled educators for medical and nursing schools. The health care systems in EMEs are undergoing changes imposed by economic, political and social transition. Reforms in health systems will need to be complemented by educational reforms. Education systems require to be updated through needs-based comprehensive curriculum design and innovative teaching methods. The challenges imposed by the growth in the number of public and private institutions and the need for a standardised accreditation system for quality assurance demand attention. The profiles of both family medicine and community health care will need to be raised and their status enhanced to attract high-calibre students to these specialties.

Medical education in India

Medical schools in India produce the largest number of doctors than anywhere else in the world (30,408 from 271 medical schools), corresponding to the rapid proliferation of medical colleges in the last two decades, especially within the private sector. The Medical Council of India (MCI), the regulatory body, is required to approve any significant reforms in medical curricula. The accreditation process for medical schools focuses largely on the infrastructure and human resources required and little on the process and quality of education or outcomes. The implementation of the recommendations of MCI regarding recognition or de-recognition of a medical college is governed by the Ministry of Health and Family Welfare, whilst individual universities also have variable sets of regulations for their affiliated medical schools. As a result, there is no uniformity in the standard of medical education across the country.