Against the backdrop of insistent demand for medical education and a rash of scandals involving the Medical Council of India raising serious doubts about the quality of education delivered, EducationWorld commissioned the Delhi-based C fore to rate and rank India’s Top 30 medical colleges 2013. Summiya Yasmeen reports

The two years past have been the worst of times for medical education in India. A rash of scandals in the nation’s 355 medical colleges and the apex-level Medical Council of India (MCI, estb. 1934) have cast a huge shadow over the medical profession, its dubious practices, ethics and commitment to the Hippocratic oath. MCI’s reckless licencing of colleges, green-lighting arbitrary capacity enhancement and approval of sub-standard postgraduate programmes during the past decade has raised serious doubts about the competence and professional capability of the 41,469 medical graduates (MBBS) certified annually. With police and CBI investigations routinely exposing cosy sweetheart deals between medical college promoters and MCI administrators, medical education in India is in deep turmoil.

“There’s no doubt that the spate of corruption scandals has seriously dented the quality of medical education delivered in India. Decades of mismanagement by MCI has resulted in out-dated curriculums, uneven distribution of medical colleges and acute shortage of faculty. The entire regulatory and licencing process needs to be overhauled with MCI playing a facilitative rather than obstructive role to improve standards in medical education. The many conditions, some of which are completely unnecessary for establishing new medical colleges or expanding capacity, must be rationalised to create a transparent approval process. India hosts a lion’s share — 18 percent — of the world’s medical colleges and our doctors enjoy great respect in the West. The government, council, faculty and professionals must come together to cleanse and revive medical education,” says Dr. S. Kumar, president (medical education) of the Gokula Education Foundation which runs M.S. Ramaiah Medical College, Bangalore (estb.1979), with an enrolment of 1,000-plus under-graduate and postgraduate students.

During the infamous ten-year reign (2001-2010) of disgraced chairman Ketan Desai — arrested in 2010 on charges of corruption — MCI licenced and ‘recognised’ 35 new medical colleges, most of them with inadequate infrastructure and faculty. In May 2010, MCI was dissolved by an ordinance signed by former President Pratibha Patil. Subsequently, the Union health ministry constituted a six-member Board of Governors (BoG) with a one-year term under the chairmanship of eminent gastroenterologist Dr. S.K. Sarin.

The BoG’s 12-month term expired in May 2011 and a new four-member board was reconstituted under the chairmanship of Dr. K.K. Talwar, former director of the Post Graduate Institute of Medical Research, Chandigarh. Last month, the Union health ministry reconstituted MCI with seven members enjoying a six-month term, after which elections are to be held within MCI and its “democratic structure’ restored.

Though MCI’s liberal licencing of medical colleges over the past decade has resulted in the number of med schools jumping from 141 in 2000 to 355 currently, the demand-supply gap in medical education is still a yawning chasm. Contemporary India has perhaps the worst doctor-population ratio (1:2,000) worldwide (World Health Organisation’s recommended standard is 1:600) with the ratio particularly adverse in rural India. The huge shortage of qualified medical practitioners has prompted a belated response from the Union government.

In 2006, prime minister Dr. Manmohan Singh announced a major capacity expansion drive in medical education under which six medical colleges-cum-hospitals modelled on AIIMS (All India Institute of Medical Sciences), Delhi, will become operational in Bhopal, Bhubaneswar, Jodhpur, Patna, Raipur and Rishikesh in 2013-14, offering 50 MBBS seats each. Moreover, the country’s 355 medical colleges will be permitted to promote branch campuses in under-served states including Bihar, Jharkhand, Chhattisgarh, West Bengal, Rajasthan, Uttar Pradesh, Madhya Pradesh and north-eastern states.

The demand-supply gap in medical education and the cloud over quality of education dispensed by the great majority of dubiously licenced colleges have sparked intense competition for admission into the country’s too few premier medical colleges. In 2012, over 200,000 Plus Two school-leavers wrote the All India Pre-Medical Test (AIPMT) for a mere 1,900 seats in medical colleges owned by the Central and state governments countrywide. Moreover intense competition for medical qualifications — highly prized by India’s 250-300 million-strong middle class — has driven capitation fees, illegally paid under the table to college managements and/or administrators, sky-high to Rs.1-3 crore.

Against this backdrop of insistent demand for medical education and the MCI-med college corruption nexus exposing the ugly underbelly of India’s medical education system raising serious doubts about the quality of education delivered, EducationWorld commissioned the Delhi-based market research and opinion polls agency C fore (Centre for Forecasting and Research) to rate and rank India’s Top 30 medical colleges 2013.

To conduct the survey, C fore field staff interviewed faculty and final year students of medical colleges countrywide. “For ranking medical colleges, 217 faculty and 253 final year students of 95 medical colleges were interviewed. Not more than one faculty from each department was interviewed and the ratings respondents gave to their own colleges were not considered. Low-profile colleges not known by a minimum 25 faculty members and 25 students were eliminated from the rankings. Respondents were asked to rate medical colleges on a ten point scale across six parameters including faculty competence, faculty welfare, research and innovation, pedagogic systems, placements and infrastructure and support systems. The ratings under each parameter were totaled to rank the country’s top 30 medical colleges,” says Premchand Palety, the promoter chief executive of C fore (estb.2000) which conducts market research surveys and opinion polls for the Hindustan Times and CNBC TV 18 among other publications, as also for several political parties.

Almost inevitably, the superbly equipped and massively subsidised Central government-promoted All India Institute of Medical Sciences (AIIMS), Delhi has been ranked the country’s # 1 medical college with a total score of 1,169 out of a maximum of 1,450 in the inaugural EducationWorld-C fore India Medical Colleges Rankings 2013. In the second position is Christian Medical College, Vellore followed by Armed Forces Medical College (AFMC), Pune (3), Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry (4), and Kasturba Medical College, Manipal (5).

India’s showpiece medical institution, AIIMS was the brainchild of newly independent India’s first prime minister, Jawaharlal Nehru, and then Union health minister, Dr. Rajkumari Amrit Kaur, and was registered in 1952 with a grant of US $1 million from the government of New Zealand. Subsequently it was formally established as an autonomous institution under the All India Institute of Medical Sciences Act, 1956. Today AIIMS discharges three major roles: it delivers qualitative undergrad and postgraduate education in medicine, nursing and allied health fields at rock-bottom prices; serves as a state-of-the-art referral hospital for affordable medical and surgical care; and conducts advanced research in the health and biological sciences.

Teaching and research at AIIMS are conducted in 50 departments by the institute’s 543-strong faculty supported by 7,702 non-teaching/research personnel. On average, 548 graduate and 894 postgraduate medical practitioners emerge from AIIMS’ portals annually. The institute has also established a reputation in the field of medical research and publishes an estimated 1,200 papers annually. Little wonder AIIMS is ranked #1 on all six parameters of excellence.

“AIIMS was founded on the premise that it should become a role model for all medical education institutions countrywide and the institute has substantially fulfilled this mandate. We attract the brightest students and faculty and our curriculum is dynamic incorporating latest research and contemporary pedagogies. Nevertheless, there is room for improvement. Our objective is to be ranked among the Top 10 medical education institutions worldwide on a par with Stanford, Harvard and MIT. The entire AIIMS faculty is working towards this goal. We need to focus on breakthroughs in medicine, surgery and translate research into practice,” says Dr. Y.K. Gupta, professor and head, department of pharmacology, and designated spokesperson of AIIMS.

Astonishingly, the 75 students selected from the over 100,000 who write the all-India entrance test for admission into India’s leading medical school, are required to pay a fee of a mere Rs.850 per year including tuition, room and board. Even this derisory fee, made possible by a Central government grant of Rs.1,022 crore per year, is payable in two installments. According to a first-of-its-kind study conducted by AIIMS’ department of hospital administration, it costs the institute Rs.1.7 crore to produce an MBBS graduate. In short, the tuition subsidy provided by the institute to every undergraduate student annually totals a massive Rs.31.31 lakh.

Yet the cruel irony of this massive subsidisation of AIIMS students is that 53 percent of the institute’s graduates leave to study abroad and never return. This unchecked brain drain phenomenon is ubiquitous with graduates from private medical colleges in which state governments subsidise the tuition of ‘merit students’ also contributing to the brain drain. According to the Medical Council of India, during the past three years over 3,000 medical graduates have left for foreign shores, and are unlikely to return. Last May, Union health minister Ghulam Nabi Azad made some noises about asking all med graduates bound for the US to sign a bond promising to return after their studies, failing which the government will deny them permission to practice abroad. But this proposal is yet to be implemented.

While the Central government-run AIIMS dominates the EW-C fore all-India as well as parameters rankings, a close second is the private sector Christian Medical College (CMC), Vellore. Founded way back in 1900 by American missionary Dr. Ida Sophia Scudder as a one-bed clinic in Vellore (140 km from Chennai), CMC was an all-women medical college admitting men only in 1947. Even today, of the mere 60 students it admits into its under-graduate MBBS programme annually, 25 are women. CMC offers undergraduate (MBBS), several paramedical and postgraduate programmes to 1,800 students instructed by 673 faculty. Spread over 200 acres, the college campus is self-sufficient featuring classrooms, hi-tech labs, research centres, hostels and a 2,695-bed hospital which caters to 5,500 outpatients, 2,500 inpatients, and performs 75 surgical procedures every day.

“In CMC, our objective is to offer the best possible education experience to produce doctors who combine professional excellence with compassion, particularly for the disadvantaged and marginalised. We are pleased with the top ranking given to CMC in your survey which is confirmation of our efforts to maintain high standards. Our continuous emphasis on excellence in teaching and research, the high-quality medical care offered by our multi-specialty hospital, outreach programmes and the dedication of our faculty are the factors behind our high ranking among India’s top medical colleges,” says Dr. Alfred Daniel, principal of CMC, Vellore.

Likewise Dr. T.S. Ravikumar, director of JIPMER, Puducherry — ranked #4 all-India — attributes its top rating to the institute’s focus on curriculum innovation and high-quality faculty. “We are elated to be in the Top 5, but aspire to be #1. Our committed faculty, bright and talented students selected from a national pool, and excellent campus facilities have contributed to our success. But we have a long way to go. Even the top medical colleges in India do not compare with the best medical schools internationally. We need to develop better evaluation and real-time feedback processes, modernise curriculums and conduct serious research,” says Ravikumar.

Sited on a sprawling 195-acre campus in the Union territory of Puducherry, JIPMER traces its origins to Ecole de Medicine de Pondicherry, established by the French government in 1823. In 1956, the medical school was transferred to the Indian government and in 2008 the Central government designated it as an institute of national importance. Currently the Central government-owned JIPMER offers undergraduate, postgraduate and super speciality medical training in 32 disciplines to 1,082 students. The campus also hosts a 1,500-bed hospital and a nursing college. Every year, 127 students who clear its all-India entrance test are admitted into the undergraduate MBBS programme and pay a paltry tuition fee of Rs.2,000 per year.

Following JIPMER in the EW-C fore India Medical Colleges Rankings 2013 is the Kasturba Medical College (KMC), Manipal. Founded in 1953 by legendary educationist-entrepreneur Dr. T.M.A. Pai (1898-1979), KMC is post-independence India’s first private sector medical college. Sited on a 200-acre campus in the university town of Manipal in the southern state of Karnataka, KMC offers six libraries, hi-tech labs, a 2,032-bed teaching hospital and contemporary hostels to 1,342 undergraduate and 530 postgraduate students. Affiliated with Manipal University, KMC enjoys an enviable international reputation with 25 percent of all medical practitioners in Malaysia graduated by the college. The 250 students are admitted annually into the undergrad MBBS programme through a transparent admission process and pay tuition fees of Rs.5 lakh per year with the college voluntarily providing 28 seats for state government students paying government stipulated tuition fees.

“The Top 10 ranking in your survey is encouraging and simultaneously motivation to improve. It’s the outcome of our constant endeavour to offer quality medical education at affordable cost. The commitment of our faculty, world-class infrastructure and pursuit of excellence distinguishes KMC from other institutions of medical education. In my opinion, KMC is as good as any top medical school internationally in terms of faculty, curriculum, infrastructure and most of all in providing a conducive learning environment for students and facilitating their professional and personal development,” says Dr. Ramdas Pai, chancellor of Manipal University.

Also read: Lifetime Achievement in Education Leadership: Dr. Ramdas Pai

A similar sentiment of satisfaction derived from having done a good job of institutional development is discernible within Grant Medical College (GMC), Mumbai (estb.1845), ranked # 6 (jointly with Maulana Azad Medical College, Delhi) in the all-India league table. “I am delighted that GMC has been ranked among the country’s Top 10 medical colleges and #1 in Maharashtra. I attribute this accolade to our excellent and devoted faculty who provide attention to students individually. India is confronted with a severe shortage of medical practitioners, particularly specialists. Currently our specialist doctor to population ratio is 1:10,000 as against the recommended 1:1,000. We need many more medical colleges to be able to produce the doctors the country needs. But all efforts have to be made to ensure new medical colleges adhere to high academic and infrastructure standards,” says T.P. Lahane, dean of GMC and Sir J.J. Group of Hospitals, Mumbai.

The Maharashtra state government-run GMC is spread across an astonishing 44 acres in the heart of India’s commercial capital and houses classrooms, state-of-the-art labs, research centres, hostels and the 1,352-bed Sir J.J. Hospital. GMC is affiliated with the Maharashtra University of Health Sciences, Nashik, and admits 660 students annually.

Completing the Top 10 league table of the EW-C fore India Medical Colleges Rankings 2013 are St. John’s Medical College, Bangalore (8); Seth G.S. Medical College, Mumbai (9) and Amrita Institute of Medical Sciences and Research Centre, Kochi (10).

To read the all-India league table of India’s Top 30 medical colleges 2013, state league tables and Top 10 rankings according to parameters of excellence visit http://www.educationworld.in/rank-medical/2013.html