Saturday, August 28, 2010

Admission to Medical College - Chap 6 from Dr Nadkarni's book

The pattern of selection for entry into medical colleges was supposed to be only by merits. But this principle of admission only on merit was diluted by the political decision of giving reservation for the scheduled cast and scheduled tribe to the extent of 16%. Initially the constitution accepted this special reservation only for 20 years to be replaced later by criterion of pure merits. However, the politicians thought it fit to extend this reservation perpetually. Not only that, on the recommendation of Mandal Commission, another 33% of other backward class were given reservation based on their castes. Constitution prohibited the ratio of reservation not to extend beyond 49%. However, there was a lacuna. The percentage of reservation could be increased even beyond 50% by any state provided such an extended reservation could be approved constitutionally by Central Government. Thus, the states like Tamilnadu increased the percentage of reservation well beyond 49%. The admissions in the respective reserved category however, must be only on merits. However, a minimum of 45% marks had to be obtained in 12th standard examination in physics, chemistry, & biology (P.C.B.) to be eligible for admission. It was reduced further by another 5% for reserved categories. Naturally, the students getting admission under reserved categories scored much lower than in open merit category students, and in the category of scheduled tribes & nomadic tribes students are admitted even today with marks as low as 40%. Immediately after independence, the number of students getting first class i.e. 60% marks was very small and the last student getting admission on merits would have secured as less as 52% marks. The minimum qualifying marks of 45% was justified in those days. Pattern of examination for S.S.C. and H.S.C. changed and students started scoring very high marks. Later, only the marks obtained in P.C.B. only (Physics, Chemistry, Biology) were considered and low scoring subjects like languages and maths were excluded while considering merits, and the percentage sored --- higher. Patterns of examination for S.S.C. and H.S.C. changed further and objective assessment was introduced, so that the students nowadays secure more than 80% in aggregate & above 90% marks in P.C.B. and yet some of them are unable to get admission on merits in the public sector medical colleges. Even then minimum qualifying marks remained at 45% in H.S.C. (i.e. 12 th standard)-that too in P.C.B. only-not the grand total. Full advantage was taken of this lacuna by the private medical colleges. They kept some reservation quota for foreign students, local students, trust students etc. and charged exorbitant additional amount as donation from students seeking admission under such categories, as long as they secured 45% or more marks in P.C.B. at 12th standard. Fortunately the Court’s intervention stopped all such so-called 'quotas' and the court directed the private colleges to admit all students purely on merits. Donations / Capitation fees were prohibited. However, now a new problem propped up. The marks obtained in the very same state as in maharashtra in different zones like Marathwada, Vidarbha, Pune and Mumbai differed a great deal, and comparison became difficult. So this difficulty was overcome by restricting the admission of the students of a particular zone to the medical colleges in the same zone.

But meritorious students from other regions who wanted to enter into the medical colleges of Pune and Mumbai protested and the Courts had to accept their grievances. Court ordered that atleast 25% of the students from other regions must be accepted in the medical colleges anywhere within the state. In addition similar applications were made by the students from other states and again the Supreme Court ordered that an additional minimum of 15 % admission must be reserved on an all India competitive basis. Looking into all these aspects of comparison of merit between different zones in the same state and between students from all states of country, (CET) had to be started in all states. CET was also justifiable because of another reason. The question papers for H.S.C. i.e. 12th standard were set up taking into consideration the average intelligence and capacity of all the students taken together. Passing percentage of H.S.C. is usually 70% or more and kept at that level all the while. Hence, the bright students get 90 to 95 percentage marks without much difficulty with this set of simple questions. Therefore, it was necessary to test the differential merit of these bright students for their selection in professional colleges and a relatively difficult question paper was in order. In addition there are several boards like I.C.S.E., C.B.S.E. which conduct their own 12th standard examination. Thus, taking into consideration all these aspects, CET was perfectly justified. Now the students passing H.S.C. have to appear yet again for Common Entrance Test for Medical or Engineering or any other branches of professional studies. It was presumed that there will be only one common test for one state and may be yet another one by Central Government for an all India selection. But private medical colleges took advantage of this new criterion and decided that they will have a separate CET for private colleges. The University Grant Commission has in addition created another extremely fallacious entity called ‘deemed University’. Originally the principle for considering any institution as 'deemed university' was that the institution has such a high standard far above the standard in the University of the area that they could examine their own students as per their own high standard and confer its own could not degrees. University which in any case had only an average standard could not interfere. But the rules governing deemed University are so fallacious that many new institutions with hardly any standard or reputation could fill in the forms and submit some data as required by the University Grant Commission and could obtain the status of ‘deemed university’. Thus, there are many medical institutions which have obtained the status of deemed university. They can decide the merit criteria and decide the pattern of admissions on their own. The deemed universities conduct their own CETs. Therefore, a student today has to appear for not less than 5 to 6 CETs and run from pillar to post to seek admission in one or the other college, if he wants to enter the medical profession. Needless to say that there have been number of complaints, with solid proofs, about partiality and corruption in these CETs conducted by private medical colleges or by deemed universities. Professional colleagues have authentically mentioned the cash they paid for their ward to secure adequate marks in C.E.T. and get admission. Actually there is no reason why the result of CET conducted by the state and/or CET conducted centrally on an all India basis, should not be acceptable to each and every medical institution, whether it be private medical college or deemed university or for that matter even Armed Forces Medical College.
That would obviate the need of multiple CETs that the students face today. Ordinarily such one common CET would effectively curb the corruption and malpractices practiced by these private bodies.

The question of admitting 15% students on an all India basis could also be resolved suitably. After all, health is a concurrent subject. The central government as well as the state government have a role to play in creating the health care structure. The desire of students from any part of our country to seek admission to any medical college anywhere is also fully justified. But why reserve 15% seats in every college as per the present supreme Court’s order? It would be much simpler for the central government to create 15% of centrally administered medical colleges in all states, and admit all students in these colleges only, on the basis of All India Common Entrance Test. There is no need even to create more colleges. Central Government can take over 15% i.e. one out of seven colleges in all the states and run them through central government funds. In case the municipal corporation as in Mumbai or Pune decide to have medical colleges from its own budget without the assistance of the state government or central government, such institutes definitely have a right to have certain percentage of seats reserved for the students of the city, say about 25% to 33% of the total seats. Similarly if any region / district decides to have a medical college and is willing to support such a college financially, if would be able entitled to have 25% to 33% regional reservation. Instead of reservation based on caste and tribes or religions, the regional reservation as mentioned above would go a long way in creating balanced growth of medical facilities in various parts of the country.

The same principle could be applied even to the different communities. The reservation on the basis of religion, caste and creed is not only strictly against our constitution but it has additionally created a lot of resentment and animosity amongst different castes. The recent examples of Mina Vs. Gujjar in Rajasthan and the agitation for Maratha reservation which is creating apprehension amongst the other backward classes in Maharashtra, are the latest examples. It is ironical that during the period of independence movement, our leaders blamed the British rulers of adopting a policy of 'divide and rule' by creating electorates on the basis of religions. Gandhiji had to fight and use all his power of pursuation to oppose separate reservation for scheduled castes and persuade Dr. Ambedkar against such a move by the British. Pune agreement between them is very famous. Yet it is ironical that our present leaders are increasingly supporting such reservations on the basis of caste and our new politicians are willing to extend them even to Muslims and Christians, thus creating severe resentment and conflicts between various castes and religions. The reservation on the basis of castes has not given any advantage to the poor. On the other hand, only a few privileged people in these various castes are reaping the maximum advantage out of it.

Even in U.S.A. Dr. Martin Luther King Junior and many other protagonists, the uplifters of the blacks in America, did not ask for reservation but instead created opportunity in education and other infrastructure facilities for the blacks and thus brought them up to the level of the whites. Those who have already been benefited by policy of reservation can contribute along with the state or central government or along with N.G.O.s to create educational and other infrastructural facilities including the medical educational and service facilities, with percentage of seats reserved for their own communities (again say 33%). These efforts by community itself to uplift the other members of their own community will not cause any animosity and are likely to benefit the poor much more than the ever expanding reservation system prevalent at present. It may be noted that minority colleges created by minority religions like Christian, Jain, Muslims etc. do have such a facility of reserving the seats for the members of their own religions and they have not caused much resentment in the society. It would be the golden day when the reservations based on castes are totally abolished and replaced by such efforts by various communities and N.G.O.s to uplift the members of backward communities. However, such reservations should not exceed 25% to 33%.

Admissions are now based on marks obtained in the C.E.T. provided the student gets a minimum of 45% in P.C.B. in his 12th standard examination. One adverse effect of this system is that the students totally or near–totally ignore their 12th standard examination and remain satisfied with obtaining the minimum of 45% marks in P.C.B. in that examination. It is also illogical that languages and mathematics are totally ignored. Obviously this omission was done as demanded by the parents who have now developed a habit of complaining of ‘stress’ or ‘tension’ for their wards. Language is a means of communication and those who cannot communicate well can never become good medical professionals. Similarly the modern advances in the medical knowledge have made it more a science, less an art and the students have to be mathematically precise in their clinical practice after they graduate and start practising. Modern equipments are now mathematically derived and the student who does not have a mathematical attitude is likely to fail in treating properly, the complexities in cardiac, renal and such other diseases. Besides, examination is a test to know how much the students have absorbed out of what is taught to them. Therefore, if languages and mathematics are taught, his ability to absorb these subjects also must be a part of examination to decide his merits compared to the others. Therefore, marks obtained in languages and mathematics must also be considered while deciding the merit at 12th std. and CET must include questions in these subjects too.
To keep the minimum qualifying marks at 45% in the present days is ridiculous. This is one of the reasons why undeserving students are able to manipulate and get admission in private medical colleges or under reservation category as long as they can obtain more than 45% marks in PCB in the 12th standard. It is tragic that many of these students are not able to complete the course at all and I have seen many parents suffering huge financial loss-despite their poverty-in trying to make their-ward a doctor and getting frustrated after 7 to 8 long years. Such a tragedy among scheduled tribes and such a corruption among the among influential and wealthy parents in CETs would be avoided, if the minimum qualifying marks are made 55% in aggregate and 70% in physics, Chemistry and Biology. As at present, the minimum percentage could be 5% less for all catagories having reserved seats. So, the minimum would be come 55% in aggregate and 70% in P.C.B. It could be safely presumed that candidates getting less than these percentages are not safe to be entrusted the task of caring for the sick.

Also merit need not be decided only on the basis of CET. Merit can be best decided by taking into consideration
a) the performance in 10th standard;
b) the performance in the 12th standard and
c) the performance in the common Entrance Test
If all the three examinations were taken into consideration, a chance freak lower performance by a particular student in CET would affect him less, as his average performance would prove to be better. Similarly the corruption is likely to reduce, as it is not so easy to use the corrupt methods in all the three examinations.The comparision of 10th and 12th standard marks could be done on percentile basis. Properly re-calculated percentile basis removes most discrepancies. It is the best method universally adopted by developed nations.

In short, having considered the present pattern of selection of students for medical education from the 12th standard, I would suggest the following important steps.
(1) Admission should be purely on merits. The merit is decided based on CET examination, provided the candidate gets a minimum 55% marks in 12th standard overall, and/or 70% in P.C.B. The merits need not be decided only by the performance in CET. It would be better to consider the performance of the students at various levels from his 10th standard to 12th standard. At least overall marks in 12th standard, corrected by percentile
method should be considered to 50% extent & CET would make up the other 50%
(2) The omission of certain subjects like languages and mathematics while considering the candidate for medical admission is faulty. The performance in all the subjects must be considered and therefore these subjects ought to be part of the CET also, if overall marks of 12th standard are not to be taken into account.
(3) The minimum qualifying percentage of marks for eligibility to enter the (medical) professional colleges must be raised from the present 45% in PCB to a minimum of 70% in PCB or 55% marks overall. (5% less for all 'reserved' catagories.)
(4) Despite some criticism and adverse publicity, I still believe that S.S.C., H.S.C. and CET or equivalent examination conducted by different Government Boards are still the most impartial examinations conducted in the state. Hence, there
should not be multiple CETs. Only one common entrance test conducted by the boards appointed by the government is not only sufficient but be made absolutely compulsory for all colleges whether government, private or colleges of the deemed university. Central government would be the only other body to conduct their CET on an all India basis. As stated above, if the central government takes over 15% of the colleges from all the states and itself administers them, these students will get
admitted to the Central Government Medical Colleges. Thus, admission to the rest of the colleges in the state will not be hampered, delayed or interfered with because of the so called 'central quota' as is happening today.
(5) Reservation on the basis of caste should be totally abolished. However, regions or communities willing to conduct their own medical colleges with their own expenses should
certainly be allowed to reserve some percentage of seats but not more than 33% to the students of their regions or the students of their particular community. In short, reservation should be based on region or community, provided the region or community takes the responsibility of running their own medical colleges and hospitals.

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