A magic pill for the problems faced by medical graduates from abroad?

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The plight of thousands of Indian medical students who were forced to flee midway through their course due to conflict in Ukraine and uncertainty about their future has once again reignited the problems facing Foreign Medical Graduates (FMG) in India.

The concerns of FMGs have not changed for nearly two decades. Thousands of these medical graduates returning to India are unable to practice or pursue higher education because they fail to pass the screening test/qualifying examination, required to gain registration to practice. The average pass percentage for the FMG (FMGE) exam has never exceeded 20-25% in all these years.

Misguided

With at least a lakh of FMG – many still trying to clear FMGE, some pursuing other non-medical options, some working away from the eyes of the law – languishing in the country, questions now arise as to why neither the Neither the National Medical Commission (NMC) nor its predecessor, the Medical Council of India, has ever stepped in to redeem this situation.

“Such a waste of human resources should not go unnoticed. If FMGs have consistently failed to authorize FMGE, why do regulators annually allow some 20,000 students to join random medical schools overseas? Isn’t it the NMC’s responsibility to advise students on the pitfalls of pursuing medical education abroad, especially with regard to universities and medical schools whose undergraduate courses might not be on par with those in India,” asks a senior medical professional.

The NMC, which replaced the MCI in September 2020, however chose to wash its hands of the whole issue. MCI has at least provided a list of overseas medical colleges for MBBS or equivalent courses (based on information received from the relevant Indian Embassy/High Commission of India). The NMC, on its website, clearly states that “…the National Medical Commission does not approve any list of foreign medical institutions/universities for MBBS or equivalent courses”.

He advises the general public to seek all the details of the course (the course should be commensurate with MBBS courses in India) on their own from the relevant university/institution.

“The NMC, which guides medical education in the country, cannot absolve itself of any responsibility in the case of students wishing to pursue medical education abroad. How are individual students supposed to check the credentials of an overseas university on their own,” asks KV Babu, Member of Public Health Standing Committee, IMA Headquarters

Barrier to NEET thresholds

Each year, the number of students appearing for NEET (undergraduate) has increased. In the NEET exam 2020, out of the 13.66 lakh students who appeared, 7.71 lakhs qualified. In 2021, up to 15.44 lakh sat for the exam, out of which 8.70 lakh students were declared qualified.

When the number of available MBBS seats in the country is slightly over 90,000 and those who sit for the exam exceed 15 lakh, there is no reason to keep the NEET threshold at the 50th percentile (40th percentile for SC/ST students) and declare as many students as qualified,” experts say. Since May 2018, only people “qualified” in NEET can follow a medical training abroad.

The highest NEET 2021 score was 720 (out of 1,200). The range of scores at the 50th percentile for the unreserved category was 720 to 138. For the reservation category, the lowest threshold to qualify in NEET was 108 points.

“The NMC needs to take a more rational approach to this limit for the NEET qualification in relation to the number of MBBS seats available in the country, because year after year thousands of “NEET qualified” students are left behind. account. Of these, some 20,000 hopefuls will pursue their dreams of careers in medicine at an overseas medical school, which may or may not provide a quality education and still end up in the pool of the unemployable,” said the Dr. Babu.

The president of the NMC did not answer these questions of The Hindu.

The FMGE is a difficult exam but there is no negative grading and students must score 50% to get a passing grade. The exam takes place twice a year and an unlimited number of re-attempts are possible

The Association of Medical Physicians (AMD), an organization of FMGs, has been writing to the Union Department of Health since 2020 that “the archaic practice of applying the percentage-based qualification criterion (for FMG only) challenges logic and fairness”.

This is especially true when all the other qualifying exams in the country – NEET-UG, NEET-PG and Super Specialty, IIT-JEE Advanced (Engineering), IIM-CAT (Management) and NLU-CLAT (Law) – as well as the internationally accepted SAT and GMAT exams are determined using the percentile system, points out Rajesh Rajan, AMD president and interventional cardiologist.

“We have never asked that they dilute the FMGE but we seek the intervention of the NMC and the Union Ministry of Health so that the conduct of the FMGE is fair and transparent. The National Board of Examinations does not publish answers and does not offer the possibility of re-evaluation. If the percentile system were to be applied, students who scored up to 35% would pass the exam,” says Dr. Rajan.

Expensive process

But the NBE prefers to keep the percentage system and fail the FMGs so that for each new attempt these students pay ₹7,200 to the NBE, he alleges.

It also points to the discrimination to which FMGs are victims at every turn. Except for FMGE, the application fee for all other competitions in the country ranges from ₹2,000 to ₹4,200. An FMG who qualifies for an internship has to pay ₹1.2 lakh to the government (Kerala) while the internship fee for a private medical college student is only ₹60,000.

“When the government allowed students to get an MBBS degree abroad, why should they be discriminated against at every turn? These students are going abroad for MBBS not because they are rich, but because they cannot afford the high fees charged by private medical schools,” says Dr. Rajan.

With less than 25% of those pursuing MBBS study abroad successfully passing the FMGE, what happens to those who do not qualify for the FMGE despite repeated attempts is also a matter of concern for the NMC.

Because these MBBS graduates end up as cheap labor for some private sector hospitals, working as “clinical assistants” or practicing clandestinely in some rural hospitals. At least 30,000 FMGs in the country are required to do so, according to the AMD.

Dr Babu has now written to the Union Health Ministry that the NMC, instead of simply issuing a certificate of eligibility to all students wishing to go abroad, should be asked to provide students with details of the best overseas medical schools/universities.

Incidentally, students who complete their MBBS in Bangladesh, Philippines, and Nepal seem to have consistently better FMGE passing percentages. The NMC should therefore assess the performance of FMGE students over the years, determine which are the best colleges/universities for students to opt for and advise students accordingly, it is stressed.

With the NMC planning to introduce the National Exit Examination (NExT) as a single qualifying final exam for MBBS final students as well as FMGs, it would be interesting to see how much of a leveler this would prove .

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