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|Year : 2016 | Volume
| Issue : 3 | Page : 199-201
Combined Bachelor of Medicine & Bachelor of Surgery-Doctor of Medicine (MBBS-MD) course to meet the national health manpower needs
Vice President and Secretary, Moving Academy of Medicine and Biomedicine, Pune, Maharashtra, India
|Date of Web Publication||18-Jul-2016|
M G Deo
Vice President and Secretary, Moving Academy of Medicine and Biomedicine, Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Deo M G. Combined Bachelor of Medicine & Bachelor of Surgery-Doctor of Medicine (MBBS-MD) course to meet the national health manpower needs. J Postgrad Med 2016;62:199-201
|How to cite this URL:|
Deo M G. Combined Bachelor of Medicine & Bachelor of Surgery-Doctor of Medicine (MBBS-MD) course to meet the national health manpower needs. J Postgrad Med [serial online] 2016 [cited 2019 May 19];62:199-201. Available from: http://www.jpgmonline.com/text.asp?2016/62/3/199/184276
The foremost function of medical education is to generate skilled manpower, both generalists and specialists, to meet national needs for health and medical services. Sixty years ago, the major health problems were severe malnutrition and communicable disorders that could be controlled through better nutrition, improved sanitation, a good source of water, and vaccination. Further, causative agents were by and large known and could be effectively treated with appropriate antibiotics. Medical education was tailored to this health scenario. Community medicine, which was earlier taught as an ancillary subject of "Hygiene" became a major teaching discipline. A number of Primary Health Centers (PHCs) that were manned by generalists [Bachelor of Medicine, Bachelor of Surgery (MBBS)], was established to take medicine to the rural people. The health scenario has now changed. Health impact of non-communicable disorders (NCDs), which now account for 60% of mortality, and can no more be ignored.  Their etiologies are ill-defined described more in terms of risk factors. Their control and prevention need services of specialists and super-specialists. The World Health Organization (WHO) recommends a minimum doctor population ratio of 1:1000 for provision of reasonable services. However, the recommendation is on weak scientific footing as it is based on health parameters that are in the domain of paramedics and do not require doctors. Furthermore, for the purpose of computation of the ratio, generalists and specialists have been lumped together.  Today, both rural and urban India urgently need a large number of specialists and super-specialists to deal with the changing health scenario. 
The training of specialists and super-specialists requires several years of quality education. In the present scenario, this may take many decades. To overcome this problem, the author proposes a combined course of MBBS-Doctor of Medicine/Master of Science (MBBS-MD/MS). The duration of the course, in which every medical student is assured of a postgraduate (PG) seat, would be 8 years (16 semesters), the period students take currently just to qualify for the PG admission test. Because rural services would be an integral part of the after MBBS education, at least basic specialist services would be made available to the rural population in the shortest time. In addition, the course will address the compulsory rural posting and perhaps stem the brain drain to the West.
Entry-level educational requirements and admission procedures in vogue for the MBBS course will be followed for the admission to the combined MBBS-MD/MS course that will consist of the following three dovetailed components [Figure 1]:
- The "basic course", named MBBS for historic reasons, will have the curriculum similar to the MD course in the USA with periodic assessment.  The first four semesters are spent in pre- and paraclinical disciplines, simultaneously preparing students for clinical work. The last four semesters would be devoted to rotating "clinical clerkship" that would additionally include rural posting at the PHC/ Community Health Centers (CHC). During the "clerkship", students will be put in charge of few beds and will be made to attend night calls.
- "Foundation Rotatory Residency Program (FRRP)", which is somewhat similar to the "Foundation Course" for newly qualified doctors in the UK,  will consist of two streams of rotatory residency (i) in General Medicine, Pediatrics, and intensive care unit (ICU) and (ii) in General surgery, Obstetrics and Gynecology (OBGYN), and ICU. The duration of the FRRP will be 4 semesters. Additionally, residents will be posted for one semester in the second year in the CHC, where they will hold independent charge and provide specialist services in the respective disciplines to the village folks.
- On completion of the FRRP, students will be admitted to 4 semester Senior Residency programs leading to a MBBS-MD/MS degree in medicine/surgery or one of the related major disciplines. Semester-wise contents of the course are highlighted in [Table 1].
|Figure 1: Summary: Combine MBBS-MD/MS degree program (Diagram not to the scale)FRRP = Foundation rotating residency program|
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PHC is the cornerstone of our rural health system that is geared, even today, for the prevention and control of malnutrition and communicable disorders. In view of the fast changing health scenario, it is necessary that amenities for the control of NCDs are made available to villagers on a priority basis. One approach could be to make CHC that should be preferably located at a tehsil town, as the main hub of rural medical and health services. All residents as well as medical students should be posted at the CHC that should be equipped with modern amenities - ICUs, magnetic resonance imaging (MRI), advance investigative facilities, and well-equipped operation theaters. Every village home has a mobile telephone that would facilitate communication with the CHC. The farthest radial village from a tehsil-town is generally only 13 km. It should be possible to comfortably cover the distance in about 30 min, which is less than the average time taken by an acutely ill patient to reach emergency services in large cities such as Mumbai, Maharashtra, India. Although, details need to be worked out, the proposed restructuring of the rural health services is somewhat on the pattern of Comprehensive Rural Health Service Project at the Ballabgarh tehsil in Haryana, India, established by the All India Institute of Medical Sciences (AIIMS), New Delhi, India 60 years ago. 
| :: References|| |
WHO: Noncommunicable Diseases Country Profiles. p. 91. Available from: .
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Deo MG. Doctor population ratio for India - the reality. Indian J Med Res 2013;137:632-5.
MD Program Curriculum. University of Wisconsin School of Medicine and Public Health. Available from:
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