Medical Science is evolving day by day and so are challenges faced by medical professional in providing health care services to society. The responsibilities lies with the medical educator to train future medical professional as per changing scenarios. With the same intent, the Graduate Medical Education Regulations (GMER), 2019 was implemented which was the first major revision of the medical curriculum since 1997 and hence changes that were included represent growth in science and thought over two decades. The most crucial advancement is the formulation of global competencies and subject-wise outcomes which define the roles of the “Indian Medical Graduate”. Learning and assessment strategies have been formulated which will allow the learner to achieve these competencies/outcomes.1
As per GMER 2019, the undergraduate medical education program is designed to create an “Indian Medical Graduate” (IMG) possessing requisite knowledge, skills, attitudes, values, and responsiveness, so that she or he may function appropriately and effectively as a physician of first contact of the community while being globally relevant.1 Through GMER 2019, Focus was shifted to Competency-Based Medical Education.
Competency-Based Medical Education (CBME) involves restructuring the medical training and planning of curriculum with a focus on “competencies”2, 3 which focuses mainly on skills and formative assessment.4
Competency-based learning includes designing and implementing a medical education curriculum that focuses on the desired and observable ability in real-life situations. To effectively fulfill the roles of the Indian Medical Graduate, He/She should have obtained the following set of competencies at the time of graduation.1
Clinician, who understands and provides preventive, promotive, curative, palliative, and holistic care with compassion.
Leader and member of the health care team and system.
Communicator with patients, families, colleagues, and community.
Lifelong learner committed to continuous improvement of skills and knowledge.
A professional who is committed to excellence is ethical, responsive, and accountable to patients, the community, and the profession.
Critical thinker who demonstrates problem-solving skills in professional practice.
Researcher who generates and interprets evidence.
Table 1
Reforms in MBBS curriculum & duration: -A comparison
|
Professional |
GMER 2019 1 |
CBME Guidelines 2023 5 |
|
First Professional MBBS |
Foundation Course (1 Month) Duration: -13 Months + 1 Month Foundation Course |
Revised: -Foundation Course -1 Week, Remaining spread over 6 months at the discretion of college Added -Family Adoption Programme (FAP) through Village Outreach. Revised Duration: -12 Months |
|
Second Professional MBBS |
Duration: -12 Months |
Added: -Family Visits for Family Adoption Programme (FAP) Duration: -12 Months (Same). |
|
Third Professional MBBS Part I |
Duration: -13 Months + 2 Months Electives |
Added: -Family Visits for Family Adoption Programme(FAP) Revised Duration: -12 Months including Electives (I Month, 2 Blocks, 15 days each) |
|
Third Professional MBBS Part II |
Duration: -13 Months |
Added: - Oto-Rhinolaryngology, Ophthalmology, Revised Duration: -18 Months. |
|
Yearly Teaching |
240 teaching days with a minimum of eight hours of teaching on each day including one hour as lunch break. |
39 teaching weeks with a minimum of eight hours of teaching on each day including one hour as lunch break. |
|
Clinical Postings |
The clinical postings in the Second Professional shall be 15 hours per week (3 Hours per day from Monday to Friday). Third Professional Part I & Part II shall be 18 hours per week (3 Hours per day from Monday to Saturday) |
39 hours /Week teaching in all Professional. Clinical postings shall be for 3 hours per day, Monday to Friday. There will be 15 hours per week for all clinical postings. |
Table 2
Examination related reforms as per CBME guidelines 20235
|
Guidelines |
As per GMER 20191 |
As p er CBME Guidelines 20235 |
|
Criterion for passing a Subject |
Mandatory 50% marks separately in theory and practical (practical = practical/ clinical + viva) |
A candidate shall obtain 50% marks in aggregate and 60:40 ratio (minimum) or 40:60(minimum) in university conducted examination separately in Theory and in Practical (practical includes: practical/ clinical and viva voce) in order to be declared as passed in that subject.6 |
|
Grace Marks |
The grace marks up to a maximum of five marks may be awarded at the discretion of the University to a learner for clearing the examination as a whole but not for clearing a subject resulting in exemption. |
There shall be no grace marks to be considered for passing in an examination. |
|
Subjects that have two papers |
In subjects that have two papers, the learner must secure at least 40% marks in each of the papers with minimum 50% of marks in aggregate (both papers together) to pass in the said subject. |
In subjects that have two papers, the learner must secure minimum 40% of marks in aggregate (both papers together) to pass in the said subject.6 |
|
Supplementary Examinations |
Supplementary examinations shall not be conducted later than 90 days from the date of declaration of the results of the main examination, |
Supplementary examinations and declaration of results shall be processed within 3-6 weeks from the date of declaration of the results of the main examination for every professional year, |
After the implementation of GMER 2019, the National Medical Commission formulated CBME Guidelines 2023 which have reforms as per the feedback, suggestion, and revision required after the implementation of GMER 2019. CBME guidelines 20236 is implemented across the country from 1st August 2023 since the date of its publication. These CBME guidelines are applicable to every student of every batch admitted to MBBS course since 2019, currently pursuing MBBS course in a Medical College which is under the jurisdiction of NMC.
Reforms in MBBS Curriculum & Duration as per CBME Guidelines 2023:6
The entire MBBS course is divided into 4 professional (across 4.5 years) and 1 year compulsory rotating medical internship, duration of 4 professional (across 4.5 years) was revised in CBME regulation 2023, now first professional MBBS, second professional MBBS & third professional MBBS part are for 12 months each, and third professional MBBS Part II is for 18 months. The foundation course which was earlier for 1 month was revised and now the Foundation course is for l week and the remaining spread over 6 months at the discretion of the college. Family adoption programme is introduced from first professional MBBS which is mandatory from MBBS batch admitted in the year 2023-24, and duration of electives is reduced to 1 month from 2 months as mentioned in Table 1.
Examination related Reforms as per CBME guidelines 20235
There was no change in Internal assessment criteria and attendance criteria for eligibility to appear for the examinations in that subject and is the same i.e Internal assessment criteria is 50% combined in theory and practical (not less than 40% in each) and there shall be a minimum of 75% attendance in theory and 80%o in practical /clinical for eligibility to appear for the examinations in that subject. There are many Examination related reforms as per CBME Guidelines 2023 which are mentioned in Table 2.
Theory and Practical Examination Reforms as per CBME Guidelines 20236
As per CBME Guidelines 2023 Theory examination and Practical Examination Guidelines are same for First Professional & Second Professional as it was in GMER 2019, Major reforms is in Third Professional Part-1 where only Forensic Medicine & Toxicology (1 Paper) & Community Medicine (2 Papers) examination will be held. Third Professional Part II / National Exit Test (NExT) will be as per NExT regulations.6 Final Professional examination shall be at the end of 17th & 18th month of Final professional training, in the subjects of General Medicine, General Surgery, Ophthalmology, Otorhinolaryngology, Obstetrics & Gynaecology, and Pediatrics, and allied subjects. Although CBME Guidelines 2023 are implemented from 1st Aug 2023 onwards, however, instruction regarding from which MBBS batch, NExT regulations will be fully implemented is still awaited.
Reforms in Eligibility of Examiners for University Examination
Four years of total teaching experience as an Assistant Professor after obtaining a postgraduate degree following MBBS, in the subject in a college affiliated with a recognized medical college (by UGMEB of NMC).
Only MBBS faculty with the required qualifications mentioned in the guidelines shall be eligible to be appointed as examiners for the UG examination at all stages, i.e., both internal examination and final university examinations.
Any faculty who is not from the college where the students are to be examined shall be treated as external, even if he is from the same university.
However, if possible, examiners from outside the university and preferably from outside the state may be appointed as external examiners. This shall widen the horizons of students and examiners and students across the whole country shall be evaluated more equitably.
This editorial is an attempt to help medical educators understand reforms as implemented in CBME Guidelines 20235 as compared to GMER 2019.1 NMC have devised the whole Medical Curriculum to develop a competent Indian Medical Graduate. Dedicated and devoted efforts are required by medical faculty for successful implementation of CBME as per reforms directed in CBME Guidelines 2023.
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