|Year : 2016 | Volume
| Issue : 11 | Page : 793-795
The mandatory regulations from the Medical Council of India: Facts, opinions and prejudices
S Bala Bhaskar
Department of Anaesthesiology, VIMS, Bellary, Karnataka, India
|Date of Web Publication||9-Nov-2016|
S Bala Bhaskar
Department of Anaesthesiology, VIMS, Bellary, Karnataka
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Bhaskar S B. The mandatory regulations from the Medical Council of India: Facts, opinions and prejudices. Indian J Anaesth 2016;60:793-5
The need to improve the doctor: patient ratio in India as per the world standards led to the Government of India launching various initiatives and encourage the establishment of new medical colleges throughout India, especially in underserved areas. The challenges faced are aplenty and are broadly related to the infrastructure, patient input and teaching facilities in the medical colleges. The apex body of medical education in India, the Medical Council of India (MCI), has strived to improve the quality of teaching in medical colleges. The body also feels that there is serious lack of research and publications in the medical field which needs to be promoted. Publications of 'research' papers in designated quality journals which adhere to broad scientific and ethical guidelines are encouraged. 
The efforts towards meeting the above goals are compounded by lack of availability of qualified and experienced teaching faculty in many institutions.
There are around 9.29 lakh doctors registered in the Indian Medical Register. Assuming around 80% availability of doctors at one time, it is estimated that around 7.4 lakh doctors may be actually available for active service. It gives a doctor: patient ratio of 1:1674 against the WHO norm of 1:1000 (2012).
India's 462 medical colleges admit 63,535 MBBS students and nearly half the numbers of postgraduate students annually.  In addition, there are 450 National Board-accredited institutions imparting training in various broad and superspecialities for the award of postgraduate qualification in broad and superspecialities for postgraduate and postdoctoral examinations in 54 disciplines for the award of the degree of Diplomate of National Board. 
The MCI has set teachers' eligibility criteria for appointment and promotions for undergraduate, postgraduate and superspeciality courses.  The MCI stipulates that along with necessary duration of experience, publications of 'Research papers' in designated types of journals are mandatory for the promotion of faculty from assistant to associate professor (two numbers) and from associate professor to professor (two numbers, four cumulative) in indexed/national journals as the first/second author. ,
Broadly, the policies of the MCI are well appreciated by all stakeholders for its intentions and objectives. Certain reservations, however, have been expressed by medical faculty, especially related to research and publications. The pressure of patient load and lack of system support, both academic and financial, are among the common reasons quoted by faculty for lack of research and publications. These and other considerations were discussed in a common editorial published in numerous Indian biomedical journals in January 2016, including the Indian Journal of Anaesthesia (IJA).  The blanket non-recognition of e-journal publications was the one widely discussed; the emergence of predatory publications is highlighted as the possible reason for the stand of MCI, but the editorial suggests that e-journals listed in reputed indexing agencies should be recognised. The editorial also highlights certain technical flaws in the list of indexing agencies mentioned in the MCI guidelines and suggests that indexing in Medline, PubMed Central, Science Citation Index, Embase/Excerpta Medica, Scopus and IndMed should be recognised. Adding IndMed is a very constructive proposal; IndMed covers about 100 journals in India since 1985.  IndMed can be strengthened in terms of the conditions for indexing and popularising so that genuine Indian publications get indexed and predatory journals will be booted out. Among the types of articles to be recognised, more clarity in terms of 'Original Research Papers' is sought; original research can also include meta-analysis and systematic reviews (which occupy the highest positions in the hierarchy of research publications); some journals may recognize brief communications and reports as original articles. The nomenclature of journals as national or international is also deprecated as there is no real definition of these. The insistence on 'Society Journals' also falls flat as the quality of a journal need not depend on whether it is supported by a society or any other body. What should matter is the indexing in the recommended agencies. The editorial also suggests that insisting on recognising only the first two authors is questionable as senior authors bulldoze themselves into the list as the first or second authors as a matter of right, denying junior researchers their due. Authorship in any order has to be recognised as long as the criteria for authorship are met as per the International Committee of Medical Journal Editors (ICMJE) guidelines.  Of course, the ceiling of number of authors based on the type of article as defined by each journal should also be satisfied alongside that of the ICMJE criteria.
Scientific misconduct and unethical practices in India have been the unfortunate outcomes of the 'Publish or Perish' situation that many faculties find themselves in. This is inexcusable in any context, but the teaching faculty also expect some understanding of its difficulties and anxiety by the MCI. The MCI can respond positively to the proposals mentioned above and can have a dynamic process of revising the guidelines with evolving circumstances, without compromising or appearing to compromise on integrity and ethics of research and publications and attaining its larger goal of improving the quality of medical teaching and research. There can be stepwise changes in the recommendations in a time-bound fashion. As already mentioned, some types of publications do not meet the criteria of full-fledged scientific investigations and are published as 'Brief Communications'; the MCI can permit one of the four mandatory publications of this type. Case reports can also be another type of recognised publication, with one number being allowed to be permitted out of the four mandatory publications.
The faculty must strive to remove certain prejudices which it associates with and against the MCI. Attributing failure to publish to busy schedule, lack of support staff, lack of facilities, lack of financial support, non-availability of services of biostatistician, etc., are acceptable in the short term; sustaining these reasons for a longer period only implies a lack of academic commitment by the faculty. Questioning the MCI for its stand without a proper and maximal attempt at research and publication is unjustified. The editor feels that much of the so-called constraints can be lessened or cleared at the local level and genuine attempts must be made by the college academic authorities to support the researchers. The teaching fraternity needs to undertake a thorough introspection. Notwithstanding the limitations for conduct and publication of research in Indian scenario, it is also the responsibility of the teaching faculty to imbibe and sustain the spirit of ethical practices of research and publication. The code of conduct for scientific research and publication ethics for authors, reviewers, editors, editorial board members, administrators and members of the scientific committees as per the Committee on Publication Ethics has to be strictly followed. 
| Are Publications Inalienable Tools For Promotions?|| |
It is true that lack of a healthy research environment in majority of institutions in India has led to the current confusion. The situation we face today is also because the faculty of the early years were never trained/inadequately trained in research methodology and publications, excepting in few institutions. Till the time this anomaly is rectified and faculty are adequately trained to conduct scientific research and publish it, the MCI can create and implement/supplement alternate methods of assessment for promotions.
The performance of the faculty can be based on the day-to-day contributions to teaching, intra-institution academic publications, feedback by trainees, use of updated research, statistical tools, etc., all assessments being covered in a structured format which is validated based on experts' opinion (performance-based appraisal system). Currently suggested as an effective method, the scoring system of the Academic Performance Indicators of the University Grants Commission (UGC) is one template which can be modified for the medical faculty appointment and promotions. Three categories of assessment (with subcategories) are defined in the UGC system, with percentage scores allotted to each. The category III gives weightage to research. (category I - teaching-, learning- and evaluation-related activities; category II - co-curricular-, extension- and professional development-related activities and category III - research and academic contributions). 
A special article is published in this issue of IJA on the constraints of publications and the unfortunate fallouts of publish or perish situation. The solutions to reduce the stress on medical faculty and issues related to unethical practices and use of alternate options of assessment are discussed. 
The opinion of the editors of various medical journals overall in India reflects the concerns of the specialists in that field; the goals of MCI are better served by regular and wide consultations between the main stakeholders, the faculty and the MCI.
The onus of restoring the sanity and sanctity of research and publications rests with both the teaching faculty as also the MCI, which has to respond to the justified pleas of the teaching faculty.
| References|| |
Aggarwal R, Gogtay N, Kumar R, Sahni P; Indian Association of Medical Journal Editors. The revised guidelines of the Medical Council of India for academic promotions: Need for a rethink. Indian J Anaesth 2016;60:1-5.
University Grants Commission (Minimum Qualifications for Appointment of Teachers and Other Academic Staff in Universities and Colleges and Measures for the Maintenance of Standards in Higher Education) (2 nd
Amendment), Regulations; 2013. Available from: http://www.ugc.ac.in/pdfnews/8539300_english.pdf
. [Last accessed on 2016 Oct 29].
Dhulkhed VK, Kurdi MS, Dhulkhed PV, Ramaswamy AH. Faculty promotions in medical institutions in India: Can we improve the criteria?. Indian J Anaesth 2016;60:796-800.