Mumbai: Despite the National Medical Commission (NMC) requiring foreign medical graduates without clinical training to undergo a mandatory Compulsory Rotatory Medical Internship (CRMI) for two years instead of one, foreign medical graduates who have already completed the first year are yet to receive details on the new rule.
The students, who have returned from countries such as China, Ukraine, etc, were unable to attend physical lectures owing to restrictions related to the Covid-19 pandemic and the Russia-Ukraine war, due to which NMC mandated them to fulfil the requirement of two years of internship.
Though NMC has defended its policy as a way to make up for the clinical training, during the undergraduate medical course in their respective institutions and as a mechanism to familiarise candidates with the practice of medicine under Indian conditions, FMGs say that there has been a lack of communication from the authorities regarding their second year of internship.
NMC's two year internship rule not positive, according to FMGs
Sunil Singh, a candidate at Ram Manohar Lohia Institute of Medical Sciences, who completed his MBBS from China, and finished his internship in March 2023, is one among many FMG candidates who believe the new rule isn’t going to have a positive impact on their careers.
“If our internship duration was for a year, we would have applied for a permanent licence. But now we are not even aware if we can continue our internships in the same city or our home state,” stated Sunil, who originally hails from Chhattisgarh.
In January 2023, the Supreme Court sought the stand of Centre and NMC on a plea challenging the two-year CRMI rule. The plea hearing, which has now been postponed from March 15 to May 5, focused on the fact that FMGs who had already received their provisional or permanent registration certificates were also added under the new mandate.
“The NMC circular has led to our certificates issued by the state medical council being revoked despite having treated patients for several months,” said Aditya Rana, an FMG who completed his internship at a hospital in Haryana.
The hospitals and medical colleges where candidates could finish their internships were previously listed by state medical councils such as those in Punjab, Haryana, and Maharashtra, but the NMC has now taken on this responsibility. Additionally, NMC had cautioned FMGs in September 2022 not to enrol for CRMI in civil hospitals and stand-alone PG institutions as these institutions lack instructional facilities.
'All work no pay,' claim FMG candidates
Though the two-year internship rule is not going to go away anytime soon, the Centre on March 29 submitted in front of the Supreme Court that FMGs would participate in the first year of internship with zero stipends, while getting paid in the second year as decided by NMC.
“We are asked to pay fees instead of receiving a stipend. The medical colleges are not obliged to pay us a monthly stipend despite working for 10-15 hours every day,” stated Sania Shaikh, an FMG who studied in the Central Asian country of Kyrgyzstan, which has also become increasingly popular among Indian medical students in recent years due to cheaper fees, and NMC-recognised medical institutions.
Back in March 2022, NMC had clarified that FMGs who want to enrol for MBBS internship in India will not be charged any fees for the same, while also being eligible for an equal stipend.
Pulling all stops to avoid two-year internship
Others like Dr. Suhail Ahmed, a returnee from Ukraine, is aiming to take advantage of a course completion certification from their university in the war-hit county which they say will help them restrict their internships to a year.
“The certificate from a Ukrainian university will provide details on how many offline classes the student attended and also prove that he/she took the exams in person rather than online,” stated Ahmed, who is currently following the procedure to obtain his certificate from Ukraine.
Experts weigh in on benefits, negatives of two-year internship
Experts are divided on the new rule as some believe it can help with experience among candidates, and others have cautioned about their mental health in such circumstances.
“The new rules can help candidates have more exposure with their patients and clinical practices, especially considering the circumstances in which they studied in Covid,” said a doctor from JJ Hospital in Mumbai, who didn’t wish to be named.
“In an internship, most candidates are collecting blood samples and other reports. You don’t need two years of internship to perfect that kind of work, so the new rules don't serve any purpose except for affecting the mental health of the candidates,” said Dr. Praveen Tripathi, a Psychiatrist, and a faculty of Psychiatry based in Delhi-NCR, with a popular YouTube channel catering to the medical community.
In April 2022, a division bench headed by Justice Hemant Gupta directed NMC to identify medical colleges where students of 2015-2020 who were unable to undergo their clinical training can complete it. But in December 2022, the top court left it to the centre and NMC to find a solution, while considering comparable petitions from FMGs of the batch 2016–21, and encouraged them to approach the issue from a ‘humanitarian perspective.’
SC's new relief for Ukraine, China, Philippines returnees
In a relief for FMGs from Asian and European countries, the Supreme Court, on March 29, cleared the way for them to attempt the MBBS final examination twice per the existing NMC syllabus and guidelines without being enrolled in any medical college in India.
The Centre submitted a report of an expert committee which said that as a one-time extraordinary measure, penultimate year students should be allowed to take the MBBS final examination, which was modified by the apex court to two attempts.
"However, the committee has emphasised that this option be strictly a one-time option and not become a basis for similar decisions in future and shall be applicable for present matter only in view of directions of the court in the matter," the Centre had said in its recommendation.
The Free Press Journal reached out to Suresh Chandra Sharma, Chairman, NMC, who refused to comment on the matter.
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