Flourishing and perishing waves for non-medical teachers in India

History of flourishing waves

In the 1960s, shortage of medical faculty in the non-clinical subjects of the MBBS course, namely anatomy, physiology, biochemistry, pharmacology and microbiology led to the introduction of non-medical faculty. There was deficiency of 2000 qualified teachers in different medical colleges, so a decision was taken to recruit trained non-medical faculty for teaching and research purposes. The three-year medical MSc postgraduate courses were initiated, following the recommendations in the report of the Health Survey and Planning committee of 1961, chaired by Dr A.L. Mudaliar, Vice Chancellor of the Madras University. Other members in the committee were Sri V.K.B. Pillai, Secretary, Union Ministry of Health, and Dr C.O. Karunakaran, President, Indian Medical Association.²

To begin with, the medical MSc courses were featured by the Indian Medical Council Act, 1956. Until the late 1980s, the Medical Council of India (MCI) accorded permission for medical colleges to start medical MSc courses.

Shortage of 30%–40% of teaching medical faculty has been reported in various medical colleges even till 2010, which affected medical education due to the discrepancy between the number of teaching faculty, and undergraduate and postgraduate students.^3,4 During this period, recruitment of non-medical teachers in the faculty of medicine was promoted and justified, to have adequate teachers in medical colleges.³

Current perishing waves

As per the minimum qualifications for teachers in medical institutions regulations, in the departments of anatomy, physiology, pharmacology and microbiology, non-medical teachers could be appointed to the extent of 30% of the total posts in the department, while in biochemistry department, they may be appointed to the extent of 50%.⁵ These regulations were amended, as per the NMC in 2020, decreasing the percentages to 15% in the departments of anatomy, physiology and biochemistry. Complete elimination in pharmacology and microbiology has upset the paraclinical non-medical teachers. The percentage of 15 implies that as per the norms with a total of 150 students, only 1 non-medical teacher could be appointed (total of five faculty: one professor, one associate professor and three assistant professors), similarly for 250 students also, only one non-medical teacher could be appointed (total of eight faculty: one professor, two associate professors and 5 assistant professors).⁶

Why these amendments?

The NMC has brought reforms in medical education and practice with a vision to produce competent doctors. Teaching the new curriculum of competency-based medical education (CBME) involves early clinical exposure (ECE) and integration from the first year of MBBS, and medical teachers would be better equipped, due to patient exposure during their MBBS. The total time allotted for ECE is 90 hours for the first-year MBBS, of which 30 hours is allotted to each department (18 hours of basic sciences correlation and 12 hours of clinical skills). The 12 hours ECE session needs patient exposure, while other sessions can be paper-based cases, charts, graphs, reports and videos as stated by the NMC guide. Handling the ECE and integration sessions can be done with ease at the departmental level.⁷

At the same time, the NMC makes it mandatory for all medical and non-medical teachers to undergo Curriculum Implementation Support Programme, Revised Basic Medical Education and Attitude, Ethics and Communication training. This provides an opportunity for non-medical teachers to acknowledge the framework of knowledge needed to train the upcoming students and enhance their knowledge.

Statistics

The NMC website has the details of all medical colleges offering MBBS and MD courses along with the list of faculties working in them, but there is no database providing the actual count of non-medical teachers in India. With this motto, the National MSc Medical Teachers’ Association (NMMTA) has started documenting the total number of MSc medical teachers in India. So far, a total of 2131 members have registered. According to the subject-wise statistics provided, there are 31.4% biochemists, 26.4% microbiologists, 20% anatomists, 12.5% physiologists and 9.7% pharmacologists. The NMMTA website provides the complete statistics of the state-wise and sex-wise registered persons with medical MSc courses in India.⁸ However, the actual count of non-medical teachers and students is not accurately reflected as the NMMTA registration is not mandatory.

The unheard voices

An online source documents 3000–4000 students currently pursuing 3-year non-medical postgraduate courses in 35 medical colleges in India, of which only 116 have enrolled on the NMMTA official website.^8,9 The future remains unpredictable and questionable. Many applications, letters, blogs, protests and news are represented repeatedly to the NMC and other regulatory bodies, but upliftment of the non-medical teachers has never gained attention. Although representing a minority in the medical field, the voices are unheard and mostly ignored. In many medical colleges, non-medical faculty are being terminated after the new NMC regulation, even though the guidelines clearly state that these regulations are applicable for medical colleges being established from the academic session 2021–2022 or medical colleges seeking permission in intake capacity from 2020 to 2021. With this scenario, due to reduced job opportunities, the stress to strive in the available medical institutions is amplifying with each passing day. Denial of examinership roles in universities, salary increments, hikes and promotions are a few areas in which the bias is evident. This has hampered their academic progress, and is now witnessing the confused emotions among non-medical teachers.

Career opportunities

With diverse job opportunities for youngsters in India, the non-medical field is experiencing a reverse flow. With microbiology and biochemistry non-medical teachers targeting on laboratories and other scientists’ posts, anatomists and physiologists are left with minimal job opportunities. Dental and allied health sciences, medical coding, research, pharmaco-industries, publishing agencies and instrumentation are other fields to explore for future career prospects, but still, these areas are also available for medical doctors. Moreover, the balance between the output of non-medical teachers per year does not equate with the available job opportunities.

Questions unanswered

Changes in educational policies such as changes in the curriculum, introduction of the National Eligibility cum Entrance Test (NEET) and the introduction of CBME though progressive, are also controversial. They should evolve in a way that it is affordable and acceptable to all sections of society. Similarly, the reduction in non-medical percentage has left many questions unanswered: Why is there no decrease in the number of institutions or universities offering MSc/PhD courses? Why is the number of students enrolling for these courses increasing every year? Why is no regulatory body streamlining these courses? Why are non-medical teachers not given parity with medical teachers in India, while other countries do? What will be the fate of students undergoing non-medical courses at present? What are the ‘true’ issues behind these evolving scenarios?

Training of three-year MD postgraduate and MSc medical postgraduate occurs in the same department using the same resources and facilities. They also undertake journal presentations, seminars, discussions, viva and dissertations, but still, questions arise on the competency of the MSc medical postgraduates in India.

Solutions and the way ahead

If the current situation persists, it may lead to deprived job opportunities for the non-medical faculty. The ratio of 30% of non-medical teachers appointed in various pre- and paraclinical departments as previously decided by the MCI remains justified and prudent. Reducing the percentage to 15 (preclinical) and none (paraclinical) requires reconsideration. Rules and regulations to improve the standards of non-medical teachers, for example making PhD degree mandatory to be promoted or appointed as assistant professor, are acceptable. Reducing the intake of students pursuing these courses in private institutions could be an option. To improve the standard of postgraduate students, a uniform curriculum with framed competencies, teaching learning methods and assessments can happen under the guidance of a common regulatory body for non-medical courses, which could provide us a better way ahead.

Clinical teachers could teach and treat patients; non-clinical teachers should be motivated to continue their teaching. Each has their unique place in medical education and research, which cannot be compared. Healthy collaboration between these two segments is essential to train medical students effectively.