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NEW DESTINATION & THREAT FOR MEDICAL EDUCATION
DOCTORS, MADE IN CHINA
By M H AHSAN / Hyderabad
China is the hot new destination for Indian medical students. The lure: low fees and modern facilities at Chinese colleges. But many questions still remain unresolved. HNN does a thorough check-up. If Russia was the destination of choice in the 1980s and 1990s for Indian students who could not make it into medical colleges in India, China has now emerged as the hot favourite. Last year, for instance, nearly 3,000 Indian students took admission in medical colleges in China.
Still in its relatively early years, the trend has already hit a minor roadblock. After complaints from several students who went in the earlier batches about some of the medical universities not having enough professors to teach them in English and about the curriculum, the Chinese government stepped in this year to specify that only 30 medical colleges identified by it can admit foreign students. The medium of instruction will be English in all these colleges.
Of these 30 colleges, only 24 let in foreign students in 2007-08. The total number of seats in these was just about 2,095 for all foreign students, which would include students from Pakistan, Sri Lanka, Bangladesh, Afghanistan, Saudi Arabia, Ghana and Nigeria, though Indians constitute the bulk.
In 2003, the year after the Delhi High Court ordered that students going abroad would need eligibility certificates issued by the Medical Council of India (MCI), 1,595 certificates were issued. Since then the numbers have been climbing steadily, from 2,500 in 2004 to 4,557 in 2006. MCI admits that the bulk of these students is going to China followed by a dwindling number going to Russia.
Russia is not as popular as it once was since it is far more expensive than China, where an MBBS course costs just Rs 5 lakh to Rs 8 lakh. These apart, Mauritius has just one college and there are six or seven in Nepal that take in Indian students. In 2007, only 3,500 certificates were issued, which could be because of the cut in the number of seats in China.
How good is the medical education these students are getting in China? While MCI expresses concern about the quality of education in some Chinese universities, the fact remains that in the Times Higher Education Supplement’s (THES) 2006 listing of top 100 biomedicine universities in the world, three universities from China figure while there is just the IITs from India at 62nd place. Beijing or Peking University is eighth in this list, followed by Tsinghua University at 75th place and Nanjing University at 86th place. Of the top 400 universities listed by THES in 2007, seven are from China and two from India, IIT Bombay and Delhi University. Most of these worldclass universities in China figure in the list of 30 universities that China has opened to foreign students.
MCI secretary Lt. Col Dr ARN Setalvad (retd.) felt that while in India a medical college would be allowed to take in 100-120 students depending on how much capacity their facilities could handle, in China, they would take 200-300 students or more. “Obviously, if you take in more students you can offer education at cheaper rates as overheads come down. But what about the quality of the education,” wonders Dr Setalvad. In the case of colleges in Nepal and Mauritius there are no problems as the medical education in these countries is in English and is the North East too. There is not much rush from Delhi and Punjab, but Uttar Pradesh is fast catching up. Saraswati Online alone has sent about 400 students from UP over the last four years.
“Parents are being taken in by the rosy picture painted by agents of the various Chinese universities. Did any of them bother to find out if they are any good? Did they take the government’s permission before sending their children? If things go wrong they have to bear the brunt of it. We even have students studying medicine in Romania and Tanzania. Who knows what the quality of education there is! Our laws say that as long as they can clear the screening test after completing MBBS they can practise in India,” explains Setelvad, adding that parents misconstrue any warning issued by the MCI as the council’s attempt to help private medical colleges in India.
The hardest hit by Chinese colleges seem be the Indian private medical colleges, some of whom charge Rs 20 lakh per seat. “The medical colleges in China are a blessing for the middle class in India, who cannot afford such a high fee. Many in the government favour private medical colleges. Hence they are trying to run down the medical colleges in China,” says Dr N Laddha of UMCS in Maharashtra, another agency sending students to China.
Now in many universities it ranges between $3,000-4,000. It is expected to increase further next year,” says Kumar. It could also be over $5,000 per year in the best university, Beijing University, which would still amount to just over Rs 10 lakh. Gautam also points out that since the students paid in dollars, with the falling value of dollar, the amount will not increase all that much.
In India, most students hail from Andhra Pradesh, followed by Kerala and Tamil Nadu. There is a big rush from West Bengal, Assam, Jharkhand and modelled after the Indian system.
“The scale of operation in these colleges is beyond what the officials here can imagine. The infrastructure is massive and so they can take more students. They don’t build for just a 100 students like we do here, but for 300-400 students or more,” says Sanjeev Kumar of Saraswati Online, an agency for nine medical universities in China that sends about 700 students to China every year. Students from India studying in colleges echo his views. “You would be amazed if you see the infrastructure here. It is as good if not better than most private medical colleges in India. In terms of training it might not be as good as AIIMS. But it is not fair to compare it with AIIMS, which is the best in our country. Then why not compare AIIMS with the best in China like Beijing University or Shanghai Medical University? ” asks Gautam Singh, a medical student in China.
Five years after Indian students started going to China for medical education, the government is yet to get a grip on how these thousands of students will be integrated into practising in India when they return. In June 2007, the Health Ministry finally sent to China a 14-member team headed by joint secretary K Ramamoorthy, in charge of medical education, to study the kind of education being imparted in these medical colleges.
The team comprising health ministry officials, officials of the National Board of Examinations, deans of various medical colleges and four members of the MCI visited 11 colleges from June 3 to 16. By June 18 the delegation submitted its report. Though the team raised several issues related to the quality of medical education in China, the government is keeping the report a secret rather than sharing it with public. Ramamoorthy could not be contacted despite repeated attempts.
Dr Indrajit Ray, principal of Calcutta Medical College and a member of the delegation, says a major concern is the amount of clinical exposure the students get. “In the second year when students have to take a patient’s history, Indian students do not know enough Chinese to interact with them. Chinese is a difficult language and unlike Russia, where medical students spend the first year just learning the language, here they learn Chinese along with medicine. So their grasp over the language is poor,” he says. They provide the students an interpreter to pass the oral examination, but such a facility will not be available for every student.
The delegation also felt that the screening of students was not stringent as there is no entrance exam, and they just need an eligibility certificate saying they have scored 50% in class XII exams. The delegation is also said to have raised concerns about the proficiency in English of some teachers as many students are said to have complained that their professors could not teach well in English or that their accents were too difficult to understand. “The disease spectrum in the two countries is also different,” says Dr Ray.
The cut in the number of colleges allowed to take in foreign students to just 30 seems to have happened after the Indian team expressed concerns to Chinese health officials about the quality of education in some colleges.
According to a letter dated June 26, 2007 from the first secretary at the Indian embassy in Beijing to MCI, more controls are expected to be exercised by China’s Ministry of Education. “So far, the medical education institutes have been following their own standards for intake of foreign students,” said the letter. The Chinese government has come up with provisional measures for stricter controls on English language medical education imparted to foreign students.
“Students applying for the academic year starting in October could have benefited if the delegation’s findings were revealed,” said a parent of a student in a medical college in China. The ministry does not seem to have shared the report even with the Indian embassy as the embassy letter to the MCI concludes stating: “...grateful if the findings of the ministry of health delegation that visited China in June 2007 are shared with us, with instructions if any to Indian students in China.”
The embassy letter states that MCI ought to ensure that no eligibility certificates are issued for study in institutes other than those in China’s list. However, the MCI certificate merely certifies that the student has passed class 12 with 50% marks in Physics, Chemistry and Biology.
By law, the student can use this certificate to apply for medical education in any college in the world that figures in the WHO directory. And as long as students clear the MCI screening test conducted by the National Examination Board on return to India, they are allowed to register as medical practitioners and treat people in India.
MCI secretary Dr ARN Setelvad says it is not possible for MCI to check where a student will use his eligibility certificate. Then he amends it to say that from the next academic year MCI will specify on the certificate which college the student will attend. Yet he adds, “Our eligibility certificate form has been approved by the high court. We cannot make just any change on it. All these developments happened mid-stream and so we have not decided what is to be done. From the next academic year onwards we will effect the changes.”
The MCI website says that only the specified number of eligibility certificates will be issued for each institute in China. But the council hasn’t figured out how to find out how many students have been taken in by a medical college or how to decide the number of certificates to issue for a specific institute.
Also, to get the MBBS degree, students have to do one-year internship in China. They do not have the option of studying for five years and then doing their internship in India, like students in Russia, Mauritius or Nepal do. MCI hasn’t decided whether students would be able to register as doctors even if they haven’t done their internship in India. “The first batch that went to China has not passed out yet. Hence, the issue of internship has not come up yet and no decision has been taken so far,” says Setelvad. MCI has a list of hospitals in India where MBBS students can do their internship. “The students can come back and do one-year internship in any of these hospitals if the MCI feels the internship in China is not enough. This way they will also get acquainted with the Indian system,” says Sanjeev Kumar of Saraswati Online.
Nothing may bar people from studying medicine in China but the Indian authorities seem to be at sea about handling the thousands of doctors who will soon return to the country.
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