Worrying Signs For India As More Than 50% Medical Colleges Produce Zero Research

In a country that produces 50,000 doctors every year, a recent medical conference in the national capital revealed shocking statistics - over the last 10 years,332 out of the 576 medical teaching institutions have failed to produce even a single research paper.

President of the Association of Diplomate of National Board (DNB) of Doctors, Dr. Jateen Ukrani raises concern for the medical science community. ¡°Research is supposed to be the foundation stone of medical teaching and training.If our colleges are not producing enough research, how do we as doctors keep up to being efficient?¡±

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The medical education system in India is one of the largest in the world,60 per cent of the colleges of which lie in the private sector. While the number of medical colleges in India has grown exponentially, there is still almost no published research work from many institutions where hundreds of postgraduate students write a thesis for their exams.

World Bank¡¯s HNP (Health,Nutrition and Population) statistics show that one third of these doctors leave India every year for residency training and/or practice abroad, with around 1,500 medical graduates emigrating to the United States each year to enter residency training. The quality of Indian medical education and of the physicians it produces therefore, has implications for the United States and the entire world.

With 5 doctors per 1,000 people, compared with 23 per 1,000 in the US, the Indian doctors are over burdened with patients.

"The patient to doctor ratio is highly imbalanced and we are almost always overburdened. Furthermore,we as medical students are not promoted or even encouraged to pursue research,¡± shares Archita Singh, student of a government medical college.

Why is research,so integral to medical education?

Medical education and medical research are non separable components of health care. In their article for the Walawalkar International Medical Journal 2017, called ¡®Current Status of Medical Research in India- Where are we?¡¯, Dr.Basavraj Nagoba and Milind Davane discuss this issue.

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¡°Health research is of paramount importance as it provides knowledge regarding the health status, diseases relevant to our soil, changing pattern of disease prevalence, treatment strategy to be adopted and the impact of various health programs initiated by Government,¡± states the article.

To be a global provider and not just another secondary research consumer, the need-based clinically oriented research useful to patients in particular and general public at large is crucial to sustain quality and hence, is a must.

Why is there a lack of research in India?

Dr. Anand Rai, in 2013, had exposed a massive cheating ring involving medical school entrance exams in the central Indian state of Madhya Pradesh wherein despite lacking sufficient research papers, students were selected to work as full time professionals. According to a probe by Reuters, recruiting companies,even today, routinely provide medical colleges with doctors to pose as full-time faculty to pass government inspections.

¡°The next generation of doctors is being taught to cheat and deceive before they even enter the classroom,¡± Dr. Rai had told The Telegraph.

Thus, very few students actually take up a medical career essentially out of a sense of scientific inquiry but do so, to provide solely for their financial aspirations.

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¡°I know of almost 252 private medical colleges that have never produced research since their existence,¡± said Dr. Pawan Kapoor, Founder of NABH. Dr. Kapoor, in an attempt to explain this behavioural pattern, said that since these institutes are solely running after money, they find it impossible to focus on research.

As per the data analysis report of Index Medicus, India¡¯s share was only 0.714% to the world research portal in medical sciences.

According to Dr Ukrani, there are two basic reasons as to why Indian medical colleges produce less research,¡± Medical curriculum does not lay proper emphasis on research. Only at a PG level, thesis is mandatory, but still many institutes don¡¯t train their post graduates in systemic research. Secondly, half of the medical colleges in India are private medical colleges. Many a times at these places, infrastructure and patient load is insufficient to learn the art of medicine, so research takes a backseat.¡±

At another level, however, the low output of research papers is a serious issue because it is a harbinger of something much bigger, with implications for healthcare delivery.

Evidence-based medicine is a new buzz world of modern medicine. Medical colleges are expected to be the forerunners in this endeavor. But, presently, medical colleges in India contribute very less to their present capacity. Lack of training and lack of appreciation are the major hindrances. They need to be corrected to the root cause to guide the medical practice in the country and further the evidence-based medicine which is a need of hour.

What can be done to stimulate research in India?

Experts think that we need to focus on research as a mandatory part of the curriculum and organize research oriented workshops.

¡°We need to get appropriate funding from the government to conduct research in the medical colleges.Until there are set incentives for doing research wherein students are given some sort of financial or non-financial benefits for publishing papers or for presenting papers,research in India can just not flourish,¡± says Dr. Kapoor.

Although this aspiration may be unique to India, in many countries where a nationalised health system means fixed salaries, students aspiring for big money typically don¡¯t enter the medical field for the payout.In some countries including the US, there is significant space and recognition for research and teaching activity as an alternative to private practice.

Of the two parallel post graduate medical education systems, the one under National Board of Examination(NBE) focuses on research more than the one under Medical Council of India(MCI). All DNB post graduates undergo thesis workshops wherein they are taught systemic research and thesis is mandatory without which candidates¡¯ results are not declared. It has one of the most stringent criteria for research. On the other hand, MCI does have thesis mandatory for MD/MS but there is no training on how to go about it and that in turn produces futile researches.

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Dr. Avinash Supe,professor and head, Department of Surgical Gastroenterology, SGS Medical College, Mumbai; director, School of Training and Evaluation, Maharashtra University of Health Sciences, states in his research paper titled ¡¯Challenges and Issues in medical Education in India¡¯, that constraints created by the detailed national regulations from the MCI make the much needed reform of medical education-difficult.

It is essential for the government--the policy makers-- to really understand research and employ them to make policies. Busting the myth for students pursuing research from the beginning of their careers, Dr. Kapoor says,¡± The reason why we don¡¯t have enough research is that our aspiring doctors don¡¯t know how to do it! The policy makers think including research at an early stage will be a waste of time and ought to be introduced later but that only scares the students away.¡±

This mentality in turn, promotes non-exposure to students and it is due to the non-mandatory nature of research, that it is,ultimately, not given due importance.

Present status in the world of medical science?

India¡¯s share in global literature in indexed medical journals,as observed by Index Medicus, has significantly declined in the recent years from 0.9% to 0.5% which is much lesser than China,Thailand and Philipinnes.

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As per the ICMR report (2016), only four medical colleges among the nation¡¯s top 10 global institutes have publications in peer- reviewed journals-namely - AIIMS, New Delhi, PGI, Chandigarh, CMC, Vellore and SGIMS, Lucknow.

The results of this review concluded that the India has the best and yet the worst medical education in the world.

To remain globally competitive, quality research is a must. To enhance the quality of research, experts stress on the need to rethink the whole medical education system of our country and adopt reforms that will encourage the idea of research amongst young aspirants.

The writer is a New Delhi based freelance contributor.