How Indian students from Ukraine can transform medical education

A few weeks ago 20,000 Indian families were glued to their TV 24x7 watching the real-life drama of their children’s plight in war-torn Ukraine. Thanks to GoI’s efforts, most students returned home safe. It is unlikely these students can return to Ukraine to continue their education anytime soon. If returning is not an option, are we going to acknowledge the shattered dreams of 18,000 children from middle-class Indian families? Their parents have virtually mortgaged homes and faced several odds to make these children into doctors and now will Indians look the other way? Contrary to perception most students who went abroad for medical education are not spoilt brats from affluent families. Naveen from Karnataka, who died tragically due to Russian shelling, scored a 97% in PUC and his father is a retired engineer from a private company. All of them cleared the NEET exam with the eligibility to join any Indian medical college. However, the number of seats available in government medical colleges with affordable fees for the open merit category is miniscule. Fees for merit seats in most of the private medical colleges are unaffordable for most Indian families. It is a pipe dream for most middle- and low-income households to make their children into doctors. These are children with fire in their belly who believe they can change the world. How do we accommodate 18,000 Ukrainian students into Indian medical schools? There are 269 private medical colleges in India. So, 200 private medical colleges should be given the choice to absorb 150 Ukraine-returned medical students each. Medical education has two components. First year, termed as pre-clinical, has students learning anatomy, physiology and biochemistry in labs and classrooms, away from patients and hospitals. First year medical students from Ukraine can be easily absorbed into the current batch of running medical colleges. All medical colleges have surplus teachers in pre- and para-clinical areas like pathology, pharmacology, forensic medicine and microbiology, so each teacher generally teaches just four hours a week. They can quite easily teach 150 Indian Ukrainian students. medium nocaption90424701 However, for clinical subjects starting from second year onwards these colleges should affiliate with large busy government hospitals. It is very important for medical students to get involved in the treatment of several patients. Government hospitals, equipped with additional classrooms and passionate teaching faculty, can become ideal places for training medical students. The National Medical Commission should modify existing regulations and allow leading specialist doctors across towns to teach at medical colleges as visiting faculty. This is the way one of us authors was trained in Kasturba Medical College, Mangalore and at government Wenlock Hospital. Teachers at KMC Mangalore were extremely successful doctors who were passionate about teaching. Medical specialists in private practice across the world teach in medical colleges. Unfortunately, India is the only exception, resulting in massive shortage of teachers in medical colleges. How do we create 30,000 additional medical seats only by regulatory changes? Only regulatory changes can bring down the cost of medical education and double the number of seats. According to regulations, to build over 7 lakh square foot for college, hospital and accommodation for the entire student population, staff and family, large centrally air-conditioned auditorium etc in a 20-acre campus will cost about Rs 500 crore. If there’s 140-strong faculty for 100 students, annual salary and maintenance cost will be around Rs 140 crore. With the annual intake of 100-150 medical students per year, cost of medical education can never come down, due to huge infrastructure and working capital requirements. Some of the best medical colleges in Europe and the US have over 300 students. Cambridge medical school in England has 309 seats, In the US, University of Illinois medical school has 331 medical seats, Indiana university medical school has 370 medical seats. Medical colleges in China have over 900 and Cuba has few thousands. Let us be conservative and increase medical seats in existing colleges to 300, by adding additional large government hospitals for practical training of these students. Students chosen for additional 150 seats in private medical colleges should pay about Rs 25 lakh as tuition fee for the five-year course, less than the current fee in Ukraine or China. Students from IIMs pay Rs 25 lakh for two-year management courses. Government medical colleges should continue with low fee structures. This is the time to take pragmatic decisions based on facts and create permanent shifts. In an ideal world, medical education and healthcare should be free. This is impossible however for a country of 1.3 billion producing over 24 million babies a year. We cannot change regulations dramatically. Doubling the number of medical seats in existing colleges will address the shortage of affordable medical seats. Converting large number of government hospitals as vibrant teaching hospitals will take care of middle- and low-income patients. Going forward, new medical colleges should be built by the government, with relaxed regulatory requirements to bring down investment required. Children from low-income families must dream of becoming doctors once again. Extraordinary doctors across the world with magic in their fingers generally come from deprived backgrounds. Devi Shetty is a cardiac surgeon and Chairman and Founder, Narayana Health. Sudhir Krishnaswamy is Vice-Chancellor, National Law School of India University, Bengaluru Illustration by Ajit Ninan