Systemic Shortcomings in Medical Education System of India: A Review with Radical Solutions

India leads the world in the number of registered medical institutions and produces the largest number of medical doctors in the world. Notwithstanding this, India struggles for the concerns of poor quality of medical education, incompetent medical workforces, and insignificant research contribution to the world which is due to the malfunctioning of Indian regulatory bodies. Many Authors (domestic and foreign) have written extensively on the prevailing deficiencies of the medical education system of India in the last decade but essentially failed in offering effective and realistic solutions for the deficiencies cited by them. The present study undertakes a detailed review of the articles published in the last decade that critically analyses the various aspects of the medical education system of India. The objective of this article is to present the deficiencies in the medical education system in the country supported by statistical facts and figures to provide a framework to enable a better understanding of the complexity of the medical education system in India. This article also attempts to present effective solutions for the same as publicised by the regulatory and governing bodies of medical education and health care system of India thereby providing insight into the future directions in revolutionising it.

Higher education system of India with 51,649 institutions is one of the largest in the world [1]. In terms of enrolment, India with 35.7 million students currently enrolled in universities and colleges stand next to China (41.8 million) [2]. India continues to produce the largest number of doctors and nurses in the world. The overall doctor population ratio stands as 1:1456, which falls behind the WHO recommendation of 1:1000 [3]. The Center for Disease Dynamics, Economics, and Policy, in their report, estimates that the Indian government provided only one government doctor to every 10,189 people creating a deficit of 6,00,000 doctors [4]. According to the Medical Council of India (MCI), medical colleges in India have increased from 20 at the time of independence admitting 1500 students to 542 medical colleges (government-279, private-263) in 2020 admitting around 80,312 undergraduate students annually [5]. The number of undergraduate medical seats has seen a jump of 48%, from 54,348 in 2014-15 to 80,312 in the academic year 2019-20. Postgraduate seats have also increased by 18,704 (65% jump) during the corresponding period. Therefore, close to 47,000 undergraduate doctors in the country annually are denied the opportunity of postgraduation, resulting in low employability and surge in migration overseas [5].

Despite the increased access to higher education, the challenges remain. The Indian regulatory bodies have miserably failed to discharge their responsibility towards the maintenance of standards of medical education and have erected formidable issues like intrastate and interstate inequalities in the establishment of medical institutions and manpower, insufficient funding of government medical institutions, poor quality of medical education, incompetent medical professionals, insignificant research contribution to the world, low employability of medical graduates, etc., [5].

This paper undertakes a review of all the articles published in the last decade that critically analyses the various aspects of the medical education system of India. The objective of the paper was to present the deficiencies in the medical education system in the country supported by statistical facts and figures to provide a framework to enable a better understanding of the complexity of the medical education system in India. This article also attempts to provide effective solutions for the same as publicised by the regulatory bodies of higher education and the health care system of India thereby providing insight into the future directions in revolutionising it.

Authors conducted a review of articles (in English Language) published from 2010 to 2020 utilising an online literature search with PubMed Central, Medline, Scopus, Google Scholar, using the MeSH terms like medical, education, competency-based curriculum, problems/faults/lacunae with MCI, future of medical education, national medical council, globalisation/privatisation/lack of research in Indian medical education, critical analysis of medical education. The inclusion and exclusion criteria for the selection of articles were established. Articles written by both domestic and foreign authors that analysed or critically analysed the medical education system of India regarding the quality, recommended curriculum, lack of funding, lack of good quality research, overseas migration of medical professionals, in India were included. The articles on globalisation, privatisation of medical education, articles on the similar topic, similar review articles on the same topic were excluded. Around 120 published articles were found related to the medical education system of India and the MCI. After applying inclusion and exclusion criteria, 80 articles were shortlisted. Finally, after reading the full text/abstract of the articles, 54 articles were selected that met the criteria for the synthesis of the review and hence was included in the study as presented in [Table/Fig-1] [6-59].

3.1 Medical Council of India:

The Medical Council of India (MCI) was established by ‘Ministry of Health and Family Welfare’ as a statutory body under the provisions of the Indian Medical Council Act (IMC Act), 1933, which was later, replaced by the Indian Medical Council Act (IMC), 1956 and was subsequently amended in 1964, 1993 and 2001 [60]. By its powers, the establishment of a new medical college requires mandatory recognition by MCI, but during the inspection, MCI focuses only on documentation of infrastructure and human resources. There is no inspection of infrastructure proposed for research activities by the institution neither evaluation nor monitoring of student admission procedures, training, teaching-learning strategies, assessment system, student facilities and faculty adequacy, is conducted [61].

There are three important reasons for India’s healthcare woes, the first one is there is inadequacy of physicians (both generalists and specialists), distribution of manpower and resources is not equal and lacuna’s in the quality of medical education as described by Vision 2015 report of MCI [62]. Needless to say, this vision remained a mere vision, even in 2018, without any marked improvement in ground reality.

Ranjit Roy Chaudhury expert committee (2014) recommended structural re-configuration of the MCI and proposed separation between the regulation of medical education from the regulation of medical practice both regulated by MCI [62].

NITI Aayog Committee (2016) raised allegations regarding the composition of MCI and recommended the appointment of regulators through an independent selection process than elections. The committee also recommended the removal of MCI, as the authority for fee regulation of private colleges as it led to corruption and increased capitation fees [62].

Parliamentary Standing Committee on Health (2016) observed that the present focus of the MCI was only on licensing of medical colleges and no emphasis was given to the enforcement of medical ethics in education [62].

Recent corruption allegations against MCI saw its suspension. MCI was reconstituted in 2013, presently governed by the ‘Board of Governors’ followed by the introduction of the National Medical Council (NMC) bill in 2018 [62].

3.2 Growth of higher education in India:

3.2.1 Till 1980:

Before 1980, the higher education was supported by government by setting up universities and colleges and also took over the responsibility of running the institutions set up through the private sector.

3.2.2 From 1980 to 2000:

In the 1980s, economic reforms brought an unprecedented demand for quality higher education from the middle class which grew bigger, younger, and richer which saw a rise in entrepreneurship in the country. During this period, the government sector, established very limited universities and colleges, while a very few were brought within the domain of government funding. Extremely, few institutions were set up by religious and altruistic trusts of repute for charitable purposes, whereas ‘private unaided Institutions’ set up most of the higher education institutions.

3.2.3 From 2000 onwards:

Till the late 1990s, the affiliated colleges saw a rise in number. Advantage of the provision granted in terms of section 3 of the UGC Act, 1956, as urge in the number of ‘deemed to be universities’ was observed from only two in 1958 to twenty-six by the period 2000-2005 [63].

3.2.4 The emergence of a new type of providers:

This period saw the surge in private institutions, and the ‘distance education programs’ gained wider acceptance. The self-financing programs were initiated by the public universities and colleges whereas the foreign institutions started offering programs either by themselves or in partnership with Indian institutions.

MCI was incompetent to deal with this influx without a proportionate increase in material and intellectual resources leading to skyrocketed capitation fees and inter-state and intra-state inequality in the distribution of medical colleges [63].

3.3 Current scenario of medical colleges in India:

Report of Ministry of Statistics and Program Implementation (2011), Unique Identification Authority of India (2019) and Medical Council of India (2020) asseverate that five states: Andhra Pradesh, Karnataka, Maharashtra, Tamil Nadu, and Kerala represent 26% of the population but has 40% of medical seats across India whereas, six states: Uttar Pradesh, Bihar, West Bengal, Madhya Pradesh, Rajasthan and Gujarat representing 51% of the population has only 25% of medical seats [64].

For the academic session 2018-19, the Union Ministry of Health has banned 82 medical colleges- 70 private and 12 government-run from accepting students that meant more than 10,430 seats were blocked citing lack of adequate facilities [65]. In addition to that, for the same academic session, the Union Ministry rejected 68 proposals of new medical colleges (Bihar-4, West Bengal-2) which would have added 9,000 MBBS seats [65].

3.3.1 Selection of medical students:

Before 2013, there was no uniformity in the selection of students to medical colleges. A common entrance test at all India level (NEET) was introduced in 2013 to constrain unscrupulous and money-minded businessmen operating in the field of education and to help the deserving students. States like Tamil Nadu, Karnataka, Andhra Pradesh openly objected to the move by citing reasons of large-scale variation in the syllabus and standards of the Central Board of Secondary and State boards [6].

As of 2020, NEET controlling authority faces serious allegations like proxy candidates were caught writing the examination on behalf of other candidates, translation errors in 49 out of the 180 questions in NEET Tamil paper 2018, andstudent protests claiming that four questions were out of syllabus in NEET 2019. Moreover, the NEET examination paper was leaked twice in the last four years [66]. These allegations dented the reputation and authenticity of the ‘Common Entrance Test’-NEET considerably.

3.3.2 Shortage of medical faculty:

Acute shortage of medical faculty in Indian medical institutions is estimated to be currently 40 percent [8,10,27,54,67]. MCI recommendation of the 1:10 teacher-student ratio is not maintained [67]. To address this shortage, in the departments of Anatomy, Physiology, Biochemistry, Pharmacology, and Microbiology, MCI has permitted non-medical teachers for appointment to the extent of 30% of the total number of the posts in the department. In the Department of Biochemistry, non-medical teachers may be appointed to the extent of 50% of the total number of posts in the department. This decision received several criticisms from the medical fraternity as it led to increased unemployment and also deteriorated the quality of medical education. (Clause 2: MCI: Minimum Qualifications, for Teachers in Medical Education Regulations, 1998).

3.3.3 Poor faculty development:

Under the MCI Regulations on Graduate Medical Education, 1997, establishment of Medical Education Units (MEUs) in every medical institution became compulsory, to enable faculty members and residents to enhance their skills in modern education teaching techniques. MCI established Twenty two Regional Centres, since July 2009. But lack of motivation amongst faculty and educational administrators, poor recognition, lack of reward is the impediments in successful faculty development (Faculty Development Program: MCI) [61].

The key determining factor for a good and favorable curricular implementation is the development of faculty. With the introduction of new curriculum, the centre of attention has moved to the Curriculum Implementation Support Program (CISP). The guiding principles and learning plan involved in CBME needs exposure to medical education training, including adult learning principles, framing objectives, aligning objectives and teaching-learning methods to assessments, and various assessment methods. Several medical colleges still have a substantial backlog of faculty deprived of basic medical education training. Conducting CISP training of the faculty, without the minimum basic medical education training, may not provide the desired outcome [7,8,10,31,50,51].

3.3.4 Shortage of clinical material:

Costly and unsubsidised, medical services and insufficiency of medical facilities in medical colleges results in poor patient load with bed occupancy less than 30 percent limiting the learning boundaries of the students. In the last ten years, 21 private medical colleges have been derecognised due to a lack of basic minimum requirements (List of Closed Colleges/Institutions with MBBS courses: MCI).

3.3.5 Flawed assessment pattern:

The existing assessment system evaluates only the cognitive domain with a minimal evaluation of psychomotor and attitude skills. ‘Observed Structured Clinical Examination’ (OSCE) and ‘Observed Structured Practical Examination’ (OSPE) are functional only in premier institutions [7,8,10].

3.3.6 Lack of research activities:

Infrastructure for quality research activity in India is the least. Between 2005 and 2014, over 57% of the medical colleges did not have a single publication and only 25 (4.3%) of the institutions produced research papers that accounted for 40.3% of the country‘s total research output. Since 2015, after the obligatory requirement of publication of papers by MCI for promotion to higher posts, a surge in the number of poor-quality research articles was observed from Indian medical colleges; mostly published in predatory journals or journals indexed in Index Copernicus with a system of pay and publish. From about 53,000 “papers” in 2010, the nearly 8,000 active predatory journals in the world have published a mind-numbing 4,20,000 “articles” in 2014. Over 11,000 fake open access journals were identified. The number of fake journal publishers based in the country has grown several-fold in the last four to five years. Today, as much as 27 percent of fake journal publishers are based in India. India has the dubious distinction of being home to 42 percent of fake single-journal publishers [39]. MCI must lay down specific research related minimum guidelines for institutions so that some responsibility is shared, and meaningful research is carried out [13,14,37,53].

Amongst the 54 articles reviewed, Deshwal BS et al., Naik S, Chandramohan P, Jayakrishnan T et al., discussed the issues of irrational increase in medical institutions and admission of medical students, devaluation of merit in admission in private institutions, high capitation fees, questionable validity of premedical test, admission of substandard quality of students with poor motivation, limited academic and research related infrastructure in Indian medical institutions, outdated curriculum and teaching-learning methods and flawed assessment pattern [27,42,50,51].

Chandramohan P advised the regulatory bodies to consult agencies like Indian Institute of Management to formulate a procedure to identify emotionally competent candidates for medical education [50]. To facilitate enough clinical material for teaching purposes, he proposed introduction of student-doctor system where student will be the integral part of treating team and will develop relationship with the patient. He proposed the establishment of a separate ‘Directorate of Rural Health’ to bring healthcare to the rural areas in order to sensitise the students to the healthcare requirements of rural population [50].

Several Authors stated that despite the mandatory implementation of Competency-based curriculum in Indian medical institutions since 2019, its efficient and successful implementation is impossible due to shortage of patients in hospitals, lack of adequate infrastructure to teach students in small groups and conduct multiple assessments, inadequate faculty strength, lack of commitment among managements to bring changes in the existing systemand principally Inertia among faculty and students for change [7,8,10-12,41,48,54,55].

Basheer A states that curriculum envisages interactive teaching-learning methods in the form of small-group learning, problem-based learning, and case-based learning, but it leaves assessment to the discretion of individual universities and institutions Students, in the long run, will soon realise this and finally, the learning became mechanical ie without thinking, shattered and short term, beating the objective of CBME [7]. He added that the curriculum has deficits related to the ambiguity regarding the role in internal assessment and exclusion of the concept of family medicine and family physicians. The curriculum program presents a list of certifiable competencies, but there is no clarity about what happens to a student who fails to get certified in a competency Basheer A (2020) [7] however, did not propose any radical solutions. The present review proposes that the respective universities and institutions should formulate the assessment pattern based on the basic guidelines provided by MCI, by constituting an intra-institutional panel of competent faculties. Institutions will also have to be proactive in completing the basic medical education training of their faculty and residents through trained medical professionals [68].

5. Solutions for the Shortcomings:

The prevailing deficiencies in medical education system are necessarily due to malfunctioning of regulatory bodies aided by flawed educational, healthcare and judiciary policies. Rigorous enactment of regulations of ‘National Medical Commission’ and speedy implementation of ‘Ministerial Policies’ for strengthening and upgradation of medical institutions along with district hospitals and common foundation courses based on medical pluralism. Urgent curtailment is obligatory in the rate of establishment of medical institutions, increase in undergraduate and postgraduate medical seats, increased privatisation and new models of translational collaborations.

We declare that we are free from any personal, or corporate, association(s) which could symbolise a conflict of interest concerning the submitted article. All the authors have respected the ethical principles supporting the research.

[1]. Shamika R, Gupta N, Nagaraj P. Reviving higher education in India. Brookings India. November 2019. Research Paper No. 11:2019;01  [Google Scholar]

[2]. Ministry of Education of the People’s Republic of China (2016). Number of Students in Higher Education Institutions. [Cited 2020 May 19]. Available at: http://en.moe.gov.cn/Reis/Statistics/Edu_stat_2016/2016_en01/201708/t20170822_311603.html  [Google Scholar]

[3]. Samiksha G, The doctor-population ratio in India is 1:1456 against WHO recommendation Economic survey. (Business Edition)Deccan Herald. [Internet] 2020 Jan 31 [cited 2020 May 01] Budget: [about 1p]. Available from: https://www.deccanherald.com/business/budget-2020/the-doctor population-ratio-in-india-is-11456-against-who-recommendation800034Html  [Google Scholar]

[4]. Nagarajan R, The study reveals the poor state of medical research Times of India. [Internet] 2016 April 21. [Cited 2020 May 19] Available from: https://m.timesofindia.com/india/Study-reveals-poor-state-of-medical research/amp_articleshow/51920662.cms  [Google Scholar]

[5]. Kaul R, The number of govt medical colleges surpasses private ones Hindustan Times. [Internet] 2020 January 15. [Cited 2020 May 19] Available from: https://www.hindustantimes.com/india-news/number-of-govt-medicacolleges-surpasses-private-ones-data/story yy3shBkdgVcFDM7gplblGL.html  [Google Scholar]

[6]. Walton-Roberts M, IrudayaRajan S, Global Demand for Medical Professionals Drives Indians Abroad Despite Acute Domestic Health-Care Worker Shortages Migration Policy Institute. [Internet] 2020, January 23. [Cited 2020 May 23] Available from: https://www.migrationpolicy.org/ article/global-demand-medical professionals-drives-Indians-abroad  [Google Scholar]

[7]. Basheer A, Competency-based medical education in India: Are we ready? J Curr Res Sci Med 2019 5:01-03.10.4103/jcrsm.jcrsm_18_19  [Google Scholar]  [CrossRef]

[8]. Kulkarni P, Pushpalatha K, Bhat D, Medical education in India: Past, Present, and Future APIK J Int Med 2019 7:69-73.10.4103/AJIM.AJIM_13_19  [Google Scholar]  [CrossRef]

[9]. Bakshi S, Kaljee L, Parke D, A cross-sectional survey on the medical education needs of general practitioners and family medicine: Delhi, Himachal Pradesh, and Tamil Nadu, India J Family Med Prim Care 2019 8(11):3531-37.10.4103/jfmpc.jfmpc_644_1931803647  [Google Scholar]  [CrossRef]  [PubMed]

[10]. Sharma R, Bakshi H, Kumar P, Competency-based undergraduate curriculum: A critical view Indian J Comm Med 2019 44:77-80.  [Google Scholar]

[11]. Kumar R, The tyranny of the Medical Council of India’s new (2019) MBBS curriculum: Abolition of the academic discipline of family physicians and general practitioners from the medical education system of India J Family Med Prim Care 2019 8:323-25.10.4103/jfmpc.jfmpc_147_1930984631  [Google Scholar]  [CrossRef]  [PubMed]

[12]. Jacob KS, Medical Council of India’s new competency-based curriculum for medical graduates: A critical appraisal Indian J Psychol Med 2019 41:203-09.10.4103/IJPSYM.IJPSYM_166_1931142920  [Google Scholar]  [CrossRef]  [PubMed]

[13]. Ghosh K, Ghosh K, Medical Research in Medical College in India: Current Scenario and Ways to Improve it Journal of the Association of Physicians of India 2019 67(4):71-73.  [Google Scholar]

[14]. Kapoor A, Quality Medical Research and Publications in India: Time to Introspect Int J App Basic Med Res 2019 9(2):67-68.10.4103/ijabmr.IJABMR_28_1931041165  [Google Scholar]  [CrossRef]  [PubMed]

[15]. Mondal H, Mondal S, Pressure to Publish: Index copernicus and predatory journals are helping (?) Academicians Indian Dermatol Online J 2019 10(3):332-34.10.4103/idoj.IDOJ_225_1831149587  [Google Scholar]  [CrossRef]  [PubMed]

[16]. Honavar SG, National Medical Commission Bill, 2019- Good intent but unmet expectations Indian J Ophthalmol 2019 67:1259-60.10.4103/ijo.IJO_1324_19  [Google Scholar]  [CrossRef]

[17]. Sachdeva S, Dwivedi N, Medical students’ opinion and perception of the education environment in a medical College of Delhi, India MAMC J Med Sci 2018 4:18-25.10.4103/mamcjms.mamcjms_51_17  [Google Scholar]  [CrossRef]

[18]. Rizwan M, Rosson NJ, Tackett S, Hassoun HT, Globalisation of medical education: Current trends and opportunities for medical students J Medic Educ Training 2018 2:035  [Google Scholar]

[19]. Sethuraman KR, Medical Education in India The Asia Pacific Scholar 2018 3(2):55-57.10.29060/TAPS.2018-3-2/PV1060  [Google Scholar]  [CrossRef]

[20]. Misra DP, Wakhlu A, Agarwal V, Letter to the Editor: Individual Researcher and Author Metrics: A Viewpoint from India J Korean Med Sci 2018 33(28):E20210.3346/jkms.2018.33.e20229983695  [Google Scholar]  [CrossRef]  [PubMed]

[21]. Bandewar SV, Aggarwal A, Kumar R, Aggarwal R, Sahni P, Pai SA, Medical Council of India’s amended qualifications for Indian medical teachers: Well intended, yet half-hearted J Anaesthesiology Clin Pharmacol 2018 34(1):01-04.10.46347/JMSH.2018.v04i01.001  [Google Scholar]  [CrossRef]

[22]. Jain MK, Thawani V, Totade S, MCI challenges to manuscript writing and publishing J Rational Pharmacother Res 2018 4(2):06-08.  [Google Scholar]

[23]. Bagcchi S, Indian Government dissolves the Medical Council of India BMJ 2018 363:K 4166Available from: https://europepmc.org/article/med/3028750710.1136/bmj.k416630287507  [Google Scholar]  [CrossRef]  [PubMed]

[24]. Barwal VK, Sharma GA, Medical council of India revised criteria for research publications: A dilemma Indian Paediatrics 2018 55:348-49.  [Google Scholar]

[25]. Jha V, The end of the Medical Council of India. Is the new National Medical Commission justold wine in a new bottle? British Medical Journal 2018 363:K507010.1136/bmj.k507030514701  [Google Scholar]  [CrossRef]  [PubMed]

[26]. Minocha VR, Controversies in medical education: National medical commission (a draft bill for replacing medical Council of India) MAMC J Med Sci 2017 3:03-05.10.4103/2394-7438.201230  [Google Scholar]  [CrossRef]

[27]. Deswal BS, Singhal VK, Problems of Medical Education in India Int J Community Med Public Health 2016 3:1905-09.10.18203/2394-6040.ijcmph20162063  [Google Scholar]  [CrossRef]

[28]. Aggarwal R, Gogtay N, Kumar R, Sahni P, The revised guidelines of the Medical Council of India for academic promotions: Need for are think Indian J Urol 2016 32(1):01-04.10.4103/0970-1591.17311726941486  [Google Scholar]  [CrossRef]  [PubMed]

[29]. Anshu Supe A, Evolution of medical education in India: The impact of colonialism J Postgrad Med 2016 62:255-59.10.4103/0022-3859.19101127763484  [Google Scholar]  [CrossRef]  [PubMed]

[30]. Dhulkhed VK, Kurdi M, Dhulkhed P, Ramaswamy AH, Faculty promotions in medical institutions in India: Can we improve the criteria? Indian J Anaesth 2016 60(11):796-800.10.4103/0019-5049.19365727942051  [Google Scholar]  [CrossRef]  [PubMed]

[31]. Yadav AK, Choudhary S, Faculty perception of medical council of India basic course workshop in medical education technologies as a faculty development programme Int J Basic Clin Pharmacol 2016 5:846-49.10.18203/2319-2003.ijbcp20161532  [Google Scholar]  [CrossRef]

[32]. Bhaskar S, The Mandatory Regulations from the Medical Council of India: Facts, Opinions, and Prejudices Indian J Anaesth 2016 60(11):793-95.10.4103/0019-5049.19365627942050  [Google Scholar]  [CrossRef]  [PubMed]

[33]. Sharma A, Zodpey S, Batra B, India’s Foreign Medical Graduates: An Opportunity to Correct India’s Physician Shortage Educ Health (Abingdon) 2016 29(1):42-46.10.4103/1357-6283.17893226996798  [Google Scholar]  [CrossRef]  [PubMed]

[34]. Sachan D, Health activists join forces in a bid to reform the Medical Council of India BMJ 2016 353:I259710.1136/bmj.i259727154910  [Google Scholar]  [CrossRef]  [PubMed]

[35]. Pandya SK, The functioning of the Medical Council of India analysed by the Parliamentary Standing Committee of Health and Family Welfare Indian J Med Ethics 2016 1(2):68-71.10.20529/IJME.2016.020  [Google Scholar]  [CrossRef]

[36]. Nagral S, Jain A, Nundy S, A radical prescription for the Medical Council of India BMJ 2016 352:I173110.1136/bmj.i173127034460  [Google Scholar]  [CrossRef]  [PubMed]

[37]. Barua MP, Mishra V, Singla M, What is Wrong with the MCI? Indian J Med Ethics 2016 1(4):262-63.10.20529/IJME.2016.07627731299  [Google Scholar]  [CrossRef]  [PubMed]

[38]. Sahai A, Medical Education in India: Introspection, challenges, and reforms- A vision J Anat Soc India 2016 65(2):167-74.10.1016/j.jasi.2017.02.011  [Google Scholar]  [CrossRef]

[39]. Shen C, Bjork B, Predatory’ open access: A Longitudinal Study of article volumes and market characteristics BMC Medicine 2015 13(230):01-15.10.1186/s12916-015-0469-226423063  [Google Scholar]  [CrossRef]  [PubMed]

[40]. Tiwari SS, Reforming the Medical Council of India Indian J Med Ethics 2015 Vol XII(1):5910.20529/IJME.2015.01925716444  [Google Scholar]  [CrossRef]  [PubMed]

[41]. Goswami S, Sahai M, Problems and challenges in medical education in India European Journal of Contemporary Education 2015 11(1):31-37.10.13187/ejced.2015.11.31  [Google Scholar]  [CrossRef]

[42]. Naik S, Medical education in India: Problems and solutions Indian J Rheumatol 2014 9(1):19-22.10.1016/j.injr.2014.01.005  [Google Scholar]  [CrossRef]

[43]. Berger D, Corruption ruins the doctor-patient relationship in India BMJ 2014 348:316910.1136/bmj.g316924812115  [Google Scholar]  [CrossRef]  [PubMed]

[44]. Pandya SK, The Medical Council of India: The need for a total overhaul Indian J Med Ethics 2014 11(2):68-71.10.20529/IJME.2014.02024727616  [Google Scholar]  [CrossRef]  [PubMed]

[45]. Davey S, Davey A, Srivastava A, Sharma P, Privatisation of Medical Education in India: A health system dilemma Int J Med Public Health 2014 4:17-22.10.4103/2230-8598.127116  [Google Scholar]  [CrossRef]

[46]. Solanki A, Kashyap S, Medical education in India: Current Challenges and the way forward Medical teacher 2014 36(12):1027-31.10.3109/0142159X.2014.92757425189276  [Google Scholar]  [CrossRef]  [PubMed]

[47]. Kumar R, Medical Education in India: An Introspection Indian Journal of Public Administration 2017 60(1):146-54.10.1177/0019556120140111  [Google Scholar]  [CrossRef]

[48]. Anand A, Bammidi S, Medical education and training: Implications for India Annals of Neurosciences 2014 21(1):03-04.10.5214/ans.0972.7531.21010225206045  [Google Scholar]  [CrossRef]  [PubMed]

[49]. Chacko TV, Improving the quality of medical education in India: The need to value and recognise academic scholarship J Pharmacol Pharmacother 2013 4(3):171-73.10.4103/0976-500X.11459523960420  [Google Scholar]  [CrossRef]  [PubMed]

[50]. Chandramohan P, Medical education in India at crossroads: Issues and solutions Arch Med Health Sci 2013 1:80-84.10.4103/2321-4848.113588  [Google Scholar]  [CrossRef]

[51]. Jayakrishnan T, Honhar M, Jolly GP, Nelson J, Abraham JT, Medical education in India: Time to make some changes Natl Med J India 2012 25(3):164-67.  [Google Scholar]

[52]. George T, Medical Council of India and the Indian Medical Association: Uneasy relations Indian J Med Ethics. [S.l.] 2016 8(1):2  [Google Scholar]

[53]. Prathap G, Gupta BM, Ranking of Indian medical colleges for their research performance during 1999-2008 Annals of Library and Information Studies 2011 58:203-10.  [Google Scholar]

[54]. Ananthakrishnan N, Medical Education in India: Is it still possible to reverse the downhill trend? The National Medical Journal of India 2010 23(3):156-60.  [Google Scholar]

[55]. Kumar MD, Gupta S, Medical Education Present Scenario & Future 2010 12(3):154-56.  [Google Scholar]

[56]. Venkatraman A, Nagpal SJS, Patel J, Systems of medical education in India and abroad: A comparison The National Medical Journal of India 2010 23(1):43-45.  [Google Scholar]

[57]. Sood R, Adkoli BV, Medical education in india- Problems and prospects J Indian Acad Clin Med 2000 1(3):210-12.  [Google Scholar]

[58]. Chatterjee P, Trouble at the Medical Council of India The Lancet. World Report 2010 375(9727):167910.1016/S0140-6736(10)60720-9  [Google Scholar]  [CrossRef]

[59]. Thomas G, Varghese J, Gifts to doctors, scientific information, and the credibility gap in the Medical Council of India Indian Journal of Medical Ethics 2010 7(2):68-69.10.20529/IJME.2010.027  [Google Scholar]  [CrossRef]

[60]. Medical Council of India. Official website: About MCI: Introduction. [Internet] [cited 2020 May 21]. Available from: http://www.mciindia.org/  [Google Scholar]

[61]. Medical Council of India. Official website: Establishment of Medical College Regulations, 1999: Amendment: July 2018. [Cited 2020 May 21]. Available from: http://www.mciindia.org/  [Google Scholar]

[62]. Sethu Krishnan M. The Problems of Medical Education in India- Should the Medical Council of India (MCI) be Scrapped? Clearias.com. Current affairs notes. 2018. April 19. [Cited 2020 May 21]: Available from: https://www.clearias.com/medical-council-of-india-mci/  [Google Scholar]

[63]. Aggarwal P. Higher Education in India: The Need for Change. Indian Council for Research on International Economic Relations. Working Paper no. 2006;180:01-182  [Google Scholar]

[64]. Statistic Times. List of Indian states by population. Statistics Times.com. 2020. May 13 [cited 2020 May 24]. Available from: http://statisticstimes.com/demographics/population-of-indian-states.php  [Google Scholar]

[65]. Staff FP, Health ministry bans 86 medical colleges from accepting fresh batch of students; plan to open 68 new colleges also shelved First Post 2018. June 05. [Cited 2020 May 24] Available from: https://www.firstpost.com/india/health-ministry-bans-86-medical-colleges-from-accepting-fresh-batch-of-students-plan-to-open-68-new-colleges-also-shelved-4496741.html  [Google Scholar]

[66]. Mustafa F, NEET is not student-friendly, merit-promoting The Hindu. [Internet] 16th May 2020 [Cited 2020. May 21]. Available from: https://www.thehindu.com/opinion/lead/neet-is-not-student-friendly-merit-promoting/article31596368.ece  [Google Scholar]

[67]. Ananth Krishnan N, Acute shortage of teachers in medical colleges: Existing problems and possible solutions Natl Med J India 2007 20:25-29.  [Google Scholar]

[68]. Government of India. National education policy, 2019. Ministry of Human Rei and Development. Faculty. P16.4: P.298-299. [Internet]. [Cited June 04, 2020]. Available from: https://mhrd.gov.in/sites/upload_files/mhrd/files/Draft_NEP_2019_EN_Revised.pdf  [Google Scholar]

[69]. National Medical Commission Act. 2019. The Gazette of India. Government of India [Internet]. [Cited on June 06, 2020]. Available from: http://egazette.nic.in/WriteReadData/2019/210357.pdf  [Google Scholar]

[70]. Government of India. Ministry of Health and Family Welfare. Medical education policy and Medical education. 2018-19: Chapter 14. Section 14.5: Schemes for Medical Education. Page: 232-233. [Internet] [cited June 04, 2020]. Available from: https://main.mohfw.gov.in/sites/default/files/14 Chapter 237-239AN2018-19.pdf  [Google Scholar]

[71]. Government of India. National education policy, 2019. Ministry of Human Rei and Development. [Internet]. Healthcare Education. P16.8: Page 304-306. [Cited June 04, 2020]. Available from: https://mhrd.gov.in/sites/upload_files/mhrd/files/Draft_NEP_2019_EN_Revised.pdf  [Google Scholar]