NLE will put undue stress on students from backward sections: Panel

The NMC bill proposes that the licentiate exam be made compulsory for any MBBS doctor, including a foreign graduate, to make them eligible to practice medicine in India.

As per the provision of the bill, a person who qualifies the National Licentiate Examination shall be enrolled in the National Register or State Register.

"...the NLE will put undue stress on students, especially those who come from backward sections of the society and states, who cannot afford private guidance or tuitions for NLE and may not be able to crack the multiple choice questions (MCQs)," it observed.

The committee also recommended that the licentiate examination be integrated with the final year MBBS examination and be conducted at the state level.

"The final MBBS examination should be of a common pattern within a particular state, initially due to the logistical constraints, and could be extended across the country as the system streamlines," the committee chaired by MP Ram Gopal Yadav said.

The committee also recommended that the final year MBBS exam be designed in a way that it took into consideration not only cognitive domain but also assessment of skills by having practical problems or case study type of questions as a major component, with a strong tilt towards primary healthcare requirements.

The committee observed that unless the NLE was carefully designed, there was apprehension that a sizeable number of MBBS doctors who had passed their university-level examinations, might be debarred from practice on disqualifying NLE.

This, it said, would not only undermine the sanctity of the examinations conducted by various universities but also put an extra pressure on the system when the country is already facing a shortage of doctors.

"This will create a dichotomy where the university certifies a doctor as fit to practice and the failure to qualify NLE exam renders him unfit to practice," the committee stated in the report.

It added that the implementation problem would be huge and the country would, over a period of time, have a population of mismatched unhappy doctors with nowhere to go.

The committee said the theoretical examination should be a common short-question based exam for all final professional students at a level commensurate with the current final professional theory exam.

"The committee, therefore, recommends that the final year MBBS examination be considered as the licentiate examination," the committee stated.

The bill was referred to the parliamentary standing committee after it witnessed opposition regarding different provisions from the medical fraternity.

It took the views of the Health Ministry and state governments apart from various other stakeholders, including the IMA, MCI, All India Unani Tibbi Congress, All India Ayurvedic Congress, AIIMS Resident Doctors Association, Federation of Resident Doctor's Association (FORDA), India.

Noting that there was no specific data regarding availability of doctors, nurses and para-medical staff among others, the committee recommended that the Ethics and Medical Registration Board keep an Aadhar-linked database of all medical graduates, including their employment status.

It said this would help create an authentic database of the availability of this important human resource and they could be given a choice to opt for rural posting wherever there is a deficit in the country.

The committee also recommended constitution of a medical appellate tribunal, comprising a chairperson who should be a sitting or retired judge of the Supreme Court or a chief justice of a high court, and two other members, to have an appellate jurisdiction over the decisions taken by the commission.

It also recommended that a foreign citizen, enrolled in his country as a medical practitioner in accordance with the law, may be permitted to practice medicine and surgery after qualifying the screening test meant for foreign medical graduates.

However, highly qualified and renowned medical professionals from countries that are accredited by the National Medical Commission may be permitted to obtain temporary registration in India without going through the screening process.

The panel recommended developing competency-based dynamic curriculum for addressing the needs of primary health services, community medicine and family medicine in accordance with provisions of the regulations made under this act.

This was an NMC clause which was being opposed by stakeholders who claimed that it would allow any private medical college to raise its UG/PG seats by itself without syllabus, curriculum, faculty, infrastructure and approval by PG board.