A national licentiate examination for doctors to practise medicine is a good idea

The National Medical Commission (NMC) Bill, 2017, tabled recently in the Lok Sabha and currently under consideration of the parliamentary standing committee on health, has invited a lot of debate. Among its various clauses, the provision regarding National Licentiate Examination (NLE) has generated particular interest.

The Bill provides that the NMC shall conduct a uniform NLE for students graduating from medical institutions for granting a licence to practise medicine and for enrolment in the register of medical practitioners. Currently, students, after clearing the final year MBBS examination and completing one year of compulsory internship, are eligible for enrolment in the register of medical practitioners, which qualifies them to practise medicine. Critics argue that the failure of MBBS graduates to qualify for the NLE may lead to further shortage of medical practitioners and worsen the already woeful doctor-patient ratio. Besides, it will cause needless harassment to students who will have to qualify in yet another examination to be eligible to practise medicine. Supporters, on the other hand, contend that it will ensure minimum quality standards in MBBS education across India.

In view of the conflicting opinions, a look at certain facts may help clarify the issue. First, the fact that the quality of medical education varies widely across medical colleges is not in dispute. Every now and then, news of ineptitude on the part of poorly trained doctors is reported in media. Besides, the trust deficit between physicians and patients is on the rise. In this situation, it is important to restore public confidence in the competence of medical practitioners by ensuring uniform quality standards. Apprehension among critics that the NLE may result in shortage of doctors is premature since the examination is yet to start.

Second, anecdotal evidence suggests that most medical students aspire for post-graduation (PG) and, therefore, spend considerable time preparing for the PG entrance examination (NEET-PG). The Bill provides that the NLE shall be the basis for admission to post-graduate courses. Therefore, rather than creating an additional burden on medical students, the introduction of the NLE will serve the twin objective of obtaining a licence to practise as well as admission to PG courses.

Third, since NEET-PG assesses students only on theoretical knowledge, acquiring clinical and soft skills during the MBBS course tends to be neglected. A carefully-designed NLE can shift the focus away from just learning theoretical concepts towards a more balanced approach of acquiring clinical knowledge and skills as well.

A well-designed NLE may be a harbinger of significant improvement in the quality of patient care in our country and may also restore public confidence in the medical practitioners.

Amandeep Garg is joint secretary, Cabinet Secretariat

The views expressed are personal