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Published by gita_12, 2016-02-23 02:56:54

Quality Assurance in Medical Education

Quality Assurance in Medical Education

Quality Assurance in Medical
Education

October 2015

Team CONFORMANCE

1

Moderation by:

2015: Hironmoy, Sanjoy
2014: Gita, Neeti, Rahman
Faculty adviser: Sandeep Dogra
Faculty: Anil, Richa, Bharti, TS Sir

2

Learning objectives for the month:

Participants should be able to :
1-demonstrate an understanding of -

Quality Assurance in Medical Education
Need for QA in Medical education
Accreditation status in India and abroad
2-demonstrate ways to ensure ‘Total Quality
Management in Medical education’ and prepare
checklists for this
3-perform a SWOT analysis of QA in their own
institutes

3

Contents

No Trigger/ Description Page no.

1 Thread 1 Quality Issues in Medical Education due to 5
increase in students capacity 8
19
Thread 2 Discussion on Quality, Quality Assurance and
Quality Assurance in Medical Education
2

Thread 3 Ensuring Quality in Medical Education in Indian
Scenario and ECFMG guidelines
3

Thread 4 Quality of MCI inspections

Trigger 1 NAAC accreditation by UGC
4 Imagine self as inspector to conduct inspection of a 26

Trigger 2& 3 medical college

Common discussion
Trigger 4

5 Thread 5 Process of Internal Quality Assurance 58

Thread 5.1 Quality checks in Internal threads by Team 74
6 Conformance

Certificate of appreciation
Thread 6 Internal Quality Assurance in Medical College

Trigger 1 'Questionnaire or feedback forms' currently used

7 Trigger 2 Draft for sharing report on Quality Assurance & 81

Total Quality Management by groups

Review of drafts to clarify and suggest newer 111
Trigger 3 issues for further improvement of the drafts
8 Thread 7 SWOT analysis

9 Thread 8 Reflections 122

10 Thread 9 Appreciation 124

11 Resources and links 125

4

Thread 1

‘Intake Medical College’ is an eminent medical college in India, run by a private
management; having 100 UG admissions per year. One fine morning the Managing
Director (MD) informed the Dean that the management wishes to increase the
admission capacity from 100 to 200 per year and asked him to prepare the
institute for such increase in seats and requisite MCI inspection.
The Dean summoned two faculty members Dr. Gunwatta and Dr. Bharose (who
were pursuing their FAIMER fellowship) and conveyed this news.
Read the comic strip to find out what happened next……

Task – Please script the continued discussion between the faculty members
regarding quality issues in this situation.

5

On this particular issue, these two FAIMERIANS started discussing… in which Dr.
Vidhrohi joined as a participant.

Dr. Gunwatta and Dr. Bharose in their discussion realized it could not be
conceivable to increase the intake in the present scenario. As there was already
lack of infrastructure, faculty, and laboratory facility. Increase in no of students
would deteriorate the quality and they would not be able to become brilliant
health professionals they would get less patients to see and examine, and MBBS
would just become like a distance education course, increasing the number also
would lead to increase in workload of faculty, and also it would decrease the
personal attention to each student. And so they were of the opinion that the
increase should not be sudden but gradual and the quality should not be
compromised. The infrastructure should well equipped to the increasing need and
there should also be proper training of the faculty, so they were of opinion to get
the review of other members and to talk to the Dean and Convince the Managing
Director.

Dr. Vidhrohi took this issue casually and was not interested in discussing the
quality of medical education rather favour if the management focusing on quantity
of number of students. According to him the orders of MD should be executed (as
the boss is always right) in spite of bad infrastructure, faculty and lab facility. He
felt that an increase in number of students would cause increase in money flow
and also hike in salary, he also felt that what makes a difference if he take a
lecture of 200 students or 100 students. “Only numbers are changing and nothing
else”. He was more eager to become a permanent faculty rather than producing

6

good health professionals. He thought that everything could be managed casually
and a FAIMER fellow should not be so idealistic. For him, basic care was more
important than quality, and he felt that if we were paid by the management we
should work silently as said, and should not oppose every work of management..
The thread was actively participated by Dr.Richa, Dr. Gita, Dr.Sanjoy, Dr. Neeti,
Dr. Hironmoy, Dr.Bharti, Dr. Sandeep, Dr.Anil, Dr. Bharati Mehta, Dr. Abhijit
Datta, Dr. Simer Madaan, Dr. Mohit Joshi, Dr. Hem Rimal, Dr. Kavita Bhatnagar,
Dr. Amir Maroof Khan, Dr. Purnima Barua, Dr. Gagan Bajaj, Dr. Swapnil Paralikar,
Dr.Upreet Dhaliwal, Dr. Juhi Kalra, Dr. Sumanth Kumbargere Nagraj, Dr. Sumanth
Kumbargere Nagraj, Dr. Vanita, Dr. Shuchi

7

Thread 2

We have been talking among ourselves,trying to convince each other that quality is
important. The dialogues between faculty members brought out myriad situations,
possibilities, apprehensions and remedial suggestions - All related to QUALITY.
Please read the comic strip below to find out what happened at Intake Medical
College.....

Task - Please assist Dr. Gunwatta and Dr. Bharose in preparing to discuss with the
MD on these points -
· Why would increased admission of students lead to deficiency in Quality Medical
Education?
· What is Quality in general ?
· What is Quality Assurance in general?
· What do we mean by Quality Assurance in Medical Education ?

8

Please try to explain these terms with some examples (as this will help in
clarifying issues to the MD and improve our understanding about the same too)

Responses

Participants: Amir, Kavita, Juhi, Heetal, Hem, Clarence, Mohit, Bharati, Abijit,
Shuchi, Vijay, Gagan, Sumanth, Gokul, Gita, Anil Sir,Hironmoy and Sanjoy

Why would increased admission of students lead to deficiency in Quality
Medical Education?

In response to above query: Following response were received. Gist of the
discussion is as follows:

• Increased admission of students will lead to compromise in Quality of
Medical student, if the norms set by MCI are not followed.

• Without parallel increase in infrastructure, trained faculty, staff,
without adequate patients, teaching students in such deficient
environment is bound to lead to compromise in quality of education.

• Increased number of students i.e. 200 would lead to quality compromise
as there are high chances that all the required resources would fall
short to run the programme.

• The MCI or medical council of Nepal have laid down some criteria
regarding the requirement in terms of infrastructures, teaching
faculties, number of hospital beds, bed occupancy, laboratory, IT
back up, skill lab, community hospital, plan to run academic
activities for academic years, etc.

• Hence, it becomes obvious that it's not just the matter of upgrading
one or two areas, rather there will be a need of a robust establishment
with multiple dimensions if an intake is going to be increased by 100

9

students. Dr Gunwata and Dr Bharose should prepare an extensive draft
addressing issues related to above highlighted areas.

• There was also a debate about an ideal number of students we should
have in a class. Even after assuring the availability of appropriately
designed room, audio-visual aids and trained teachers there may be a
chance that quality of education might suffer to some extent. These
issues needs to be carefully put forward while discussing with MD so
that he would be more serious in taking measures in future to assure
quality of medical education.

• Similarly, if the resources are limited and consumers increase
disproportionately, the consumers will receive inadequate resources. As
we say 'small family, happy family' to limit family sizes so that
resources are shared properly between the children

• Likewise, an increase in the number of students without increasing the
resources will lead to poor development of medical students. The
resources which are shared between the medical students are: spaces
like lecture halls, demonstration rooms, hostels, libraries, canteens,
wards, OPDs; teachers, patients and other teaching learning materials.
The more the number of students, there are more chances that certain
students may not be able to receive these learning opportunities due to
shortages of one or the other of these resources.

• Medicine does not lend itself to a distance education model. For
competencies to develop, students must physically, mentally and
emotionally engage in the learning.

• The student-teacher ratio has to be low otherwise it is difficult to
notice which student is in trouble and needs more help or more time.
Students will get neglected unless many more teachers are recruited at
the same time.

10

• Patient load will never be a problem – at least in government hospitals;
however, small group teaching will suffer as there simply will not be
enough rooms available for teachers and students to examine and learn
from patients in a protected environment in small groups.

What is Quality in general ?
The above question was asked to discuss and understand the term ‘quality’ so
that the same can be explained to MD with example. Lots of definition and
interpretation were shared, summary of which is as follows:
Among the discussion, one participant define quality as:
‘Quality’ is a benchmark or landmark of the ‘output’ of any process where
standards are predetermined in accordance to need of the customer. (in
medical education management, the ‘customers’ are the community)

Other participants defined Quality as below-
a. A degree of excellence
b. Conformance to requirements
c. Totality of characteristics which act to satisfy a need
d. Fitness for use
e. Fitness for purpose

f. Freedom from defects
g. Delighting customers
Quality, in the simplest of the terms, means standard. This standard is not
in isolation, but against a criteria fixed by a competent authority in the area
of concern

11

• Quality is the degree to which a commodity meets the requirements of
the customer at the start of its life. (ISO 9000)

• Quality–is characteristic of a function, process, system or object that is
fulfilled when compared with predefined goals or standards.

• Term “quality” is difficult as it is subjective and dynamic. It has
different meaning for different stakeholders. Quality in medical
education is relative term as it is state of reaching required standards
as prescribed by the external agencies. The quality in education can be
multifaceted:

i) Quality as value for money

ii) Quality as deemed fit for research and teaching in educational institutions

iii) Quality as transforming force for fulfilling the vision and mission of an
institution

• According to the dictionary quality is the standard of something as
measured against other things of a similar kind; the degree of
excellence of something. If we are producing a doctor they should have
standard quality of the doctor and they should be comparable to the
quality of any doctor produced in any good standard institution

• Quality can be described as something that is fit for purpose, where
‘fitness for purpose focuses on whether a product or service meets
customers’ needs or the mission of the institute

• While discussing the meaning of ‘quality’, some examples were also cited:

• Aristotle took the example of a knife. An examination of a knife would
reveal that its distinctive quality is to cut, and from this we can
conclude that a good knife would be a knife that cuts well.’ However, as
Zhuangi, a late 3rd to early 4th century BCE Chinese philosopher, reminds

12

us : A good butcher slices his knife once a year, because he slices
flesh. A mediocre butcher changes his knife once a month, because he
hacks at bone.’
• The customers of a medical school and postgraduate education are
medical students and junior doctors, but of course the ultimate
customers of their services are patients. We must then judge the
quality of medical education by its effective translation into patient
care.
• Lets take another example: How will you judge the ‘quality’ of a given
cake?
By ensuring following things:
a. It should be freshly made
b. Should smell good
c. Should be tasty
d. Should have good appearance
e. Should be cost-effective
f. Should be made with sugar free or has optimum sugar, not extra sweet
g. Should have used fresh cream, I don’t like butter cream
h. Icing should be good and optimum, not too much of cream
i. Flavour
j. Fruit cake should have fresh fruits and not preserved ones
Another example of ‘quality’ when we buy a house ?

13

It is quite a personal choice as every one looks for house suitable for them. I
will look for something like----

a. Location-

a. Good locality

b. Distance from workplace,

c. Distance from Army hospital (old age, will need these services more)

d. Distance from army club ( my social life revolves around this quite a
lot)

e. Distance from market,

f. Distance from airport,

g. Distance from railway station,

h. Distance from health services

b. Total area

c. Covered area/built up area, size of bed-rooms, number of bedrooms,
attached bathrooms with latest sanitary fittings, servant room, size of living
room, kitchen-modular

d. Cost (finances)

e. Amenities provided by builder

f. Quality of construction

g. Quality of fittings used (Electric-concealed, sanitary etc)

h. Ambiance of society, Class of people living in the society
i. Availability of Terrace, sit-outs, lawns, private swimming pool etc

Some famous quotes on quality

14

• Quality is not an act. It is a habit." – Aristotle

• "Quality is never an accident; it is always the result of high intention,
sincere effort, intelligent direction and skillful execution; it represents
the wise choice of many alternatives" - William A. Foster

• "Quality is doing the right thing when no one is looking." - Henry Ford

• "Don't find fault, find a remedy." - Henry Ford

• "Quality is everyone's responsibility." - W. Edwards Deming

The next question in the thread was to discuss “What is Quality Assurance in
general?” Following statements were put forward to discuss quality assurance
in general.

In the discussion, it was felt to have understanding first the term
“Assurance” and then “Quality Assurance”.

Assurance is a positive declaration on a product or service that it will work
without any problems to maintain the desired level of expectations or
requirements.

“Quality Assurance” can be understood by following ways:

• Quality assurance (QA) is a process of supervision to prevent faults and
defects on a product, “getting things right first time, every time”. To
do that you should have a quality assurance system in place that allows
you to apply the quality standards. The responsibility is seen as being
not on the inspector but in the whole workforce.

• QA includes all the policies, standards, systems and processes in place
to maintain and enhance the quality of medical education and training in
the UK. The GMC carries out systematic activities to assure the public
and patients that medical education and training meets the required

15

standards. This activity is carried out within the principles of better
regulation.

• Quality assurance refers to 'ways to ensure that an optimum level of
quality for the consumers'. To avoid defects in their products and
services. There can be 'internal' and 'external' quality assurance in
order to have an internal understanding to improve the processes and to
also have a transparent and fair quality check mechanisms.

• Quality assurance is an activity/process to ensure best product/service
and focuses on prevention of problems/mistakes/defects.

• Quality Assurance makes sure you are doing the right things, the right
way and Quality assurance need not necessarily assure quality as the
definition of QUALITY varies depending on individual perspectives.

• Quality assurance is way to warrant that predefined standards are met.

• Quality assurance is implied as an accountability to the public and
meeting the requirements of the external standards.

Some participants tried to discuss other terms related to QA and shared
following terminologies

• Total quality management (TQM) incorporates the concept of quality
assurance and goes beyond it. It is about creating a culture where
everyone in the system is in charge of the quality of their own
behaviour, and where the “customer”, (in the terminology coming from
industry and marketing) is the centre and the one who determines the
“quality” of the service given.

• Quality control= Detection

• Quality assurance= Prevention

• Total quality management= Continuous improvement

16

The last question in the thread was to discuss “What do we mean by Quality
Assurance in Medical Education?” Following statements were put forward to
discuss quality assurance in ME.

Quality assurance in Medical Education is the question of-

• Responsibility

• Patient safety

• Responsible use of financial resources

• Scientific progress

It is seen as essential for enhancing and maintaining the quality of teaching
and learning at an institution.

• UK Higher Education, defines quality assurance in education as: the
totality of systems, resources and information devoted to maintaining
and improving the quality and standards of teaching, scholarship and
research, and of students learning experience.

• All the components of medical education should be included in quality
assurance. To achieve the final outcome of a standard quality, each
component/dimension should be of a standard quality. E.g. Curriculum,
student intake process, examination/evaluations, teachers,
infrastructure, academic leadership and others. A systems approach
should be used to study quality assurance in med education.

• To produce "good quality" medical graduates who are able to perform
their roles as medical practitioner in the community. They are given
training so that they acquire basic knowledge, fundamental clinical
skills which is grounded in ethical practice so as they become
independent practitioners. As the scope of knowledge relating to
medicine is growing fast, and many aspects of practice changes

17

rapidly, emphasis during education is to be given on critical judgment
based on evidence and experience rather than on long list of skills and
knowledge.
• So in continuation to the above explanation, quality assurance in medical
education would mean that the education system
does everything to ensure that the students get the best education and
the society gets the best practitioner.
• One participant tried to explain quality assurance in ME through
statistics: According to him, If we consider the ‘Medical Education’ as a
‘system’, then
• ‘Input’= Students, Faculties as well as infrastructure of a medical
college
• ‘process’ = The education, i.e. the teaching-learning process as well as
the evaluation system
• ‘output’ = The medical-graduates well able to serve the community with
pre-determined competency
• So the ’Quality assurance’ in this system = the continuous maintenance
of quality in every aspects of the entire education(medical) system that
is well able to produce the competent medical graduates

18

Thread 3

Great inputs from all! The Dean and faculty of Intake Medical College are happy
to network with all of you.
The Dean has fixed an appointment for Dr. Gunwatta and Dr. Bharose with the
Managing Director of Intake Medical College.
The scene begins as follows:

Task - Please help in answering the question put by the Managing Director.
Q.1. What steps are being taken in India to ensure quality in medical

education?
Q.2 Which ECFMG guidelines is Dr. Bharose worried about?

19

Participants: Shuchi, Bharati, Juhi, Kavita, Upreet, Hem, Abijit, Vijay, Gokul, Clarence, Hetal, Swapnil, Gita, Anil Sir
Hironmoy and Sanjoy

This was an interesting discussion to answer two very relevant questions:

Q.1. What steps are being taken in India to ensure quality in medical
education?

Regarding the above question, first it was discussed about the steps being
taken by MCI and then Government of India through M/O Health and FW and
HRD.

• MCI has put forth “Vision document 2015” with the mission to develop
systems which could continuously assess the needs, aspirations, enhance the
quality& standards of medical education and training in India. With aim to
standardize the output of graduate medical education in the form of an
‘Indian Medical Graduate’; a skilled and motivated basic doctor

• The large gaps in health care accessibility in many parts of the country, the
need for enhanced clinical competency and, limited opportunities for post-
graduate training are of major concerns

• Curricular reforms to systematically address these issues and develop
strategies to strengthen the medical education and health care system are
being planned to be implemented on large scale so that Indian Medical
Graduates match or better the international standard.

MCI has planned to implement and enforce Introduction of many New
Teaching Elements such as:

• Foundation Course
Foundation course will be of 2 months duration after admission to prepare a
student to study Medicine effectively this period aims to orient student to
national health scenarios, medical ethics, health economics, learning skills &
communication, life support, computer learning, sociology & demographics,

20

biohazard safety, environmental issues and community orientation. In
addition, this would include overview in the three core subjects of Anatomy,
Physiology and Biochemistry to be taught in first MBBS.

• Integration: Horizontal and Vertical

• Restructuring the Undergraduate medical course

• Curricular reforms to systematically address these issues and develop
strategies to strengthen the medical education and health care system are
needed so that Indian Medical Graduates match or better the international
standards.

• Early Clinical Exposure

• Student Doctor Method of Clinical Training

• Skill Development & Training

• Adoption of Contemporary Education Technologies Skills lab, E-learning,
Simulation.

• Strategy For large Scale Faculty Development

• Competency based learning

• Making mandatory Acquisition of certificate of certain essential skills.

Steps taken by M/O Health and FW, GOI

• To ensure quality medical education in India,

• The Health ministry of India has expressed its intent to hold a common exit
exam after completion of MBBS for both private and Government Medical
Colleges. This will ensure that all graduates have acquired a basic minimum
standard of education. Those clearing this exam will be permitted to
practice or appear for the PG entrance exam

21

• The Health ministry of India is conducting FMGE exam, which was
introduced in 2002, as a qualifying examination prior to permitting the
Indian students holding foreign medical degrees to practice in India or to
appear for PG entrance exam in India.

• The Health ministry of India is also planning to hold a common PG Entrance
exam for Private and Government colleges to ensure Quality of Medical
education in India. The statistics collected from these exams shall be used
for ranking of the Medical colleges across India.

Steps taken by M/O HRD, GOI
In our country, one organization which is looking at quality and going much beyond
quantity is “National Assessment and Accreditation Council (NAAC)”
— It was established in 1994, by the University Grants Commission (UGC), HQ-
Bangalore, M/O HRD
— Assess and accredit higher education institutions in the country.
PROCESS OF ACCREDITATION:
— On-line submission of the Letter of Intent (LOI).
— On-line submission of Institutional Eligibility for Quality Assessment (IEQA)
for applicable institutions.
— Preparation of Self-study Report (SSR), it’s uploading on the institution
website and submission to NAAC.
— Peer team visit to the institution

NAAC for Universities :

Criteria/ Key Aspects /Score

22

I. Curricular Aspects- 150
II. Teaching-Learning and Evaluation -200
III. Research, Consultancy and Extension -250
IV. Infrastructure and Learning Resources 100
V. Student Support and Progression -100
VI. Governance, Leadership and Management -100
VII. Innovations and Best Practices -100

TOTAL 1000

GRADING PARAMETERS FOLLOWED BY
NAAC

Range of institutional Cumulative Letter Grade Performance
Grade Point Average (CGPA) Descriptor

3.01 - 4.00 A Very Good
2.01 - 3.00 (Accredited)

B Good
(Accredited)

23

1.51 - 2.00 C Satisfactory
<= 1.50 (Accredited)

D Unsatisfactory
(Not accredited)

Q.2 Which ECFMG guidelines is Dr. Bharose worried about?
The above question was discussed with reference to quality of medical education
being practiced in an Indian medical school so that a student could be found
eligible to take admission in a foreign medical college with his recognized degree
as per the ECFMG guidelines. If the same is not followed strictly then our college
will not counted in the list ECFMG affiliated World Directory of Medical Schools.
What are the guidelines? What are the essential prerequisite to qualify the
standard of our medical college? These were the basic apprehension posed to Dr.
Bharose.

EDUCATIONAL COMMISSION FOR FOREIGN MEDICAL GRADUATES
ECFMG® guidelines:

International medical students/graduates must submit an application for ECFMG
Certification before they can apply to ECFMG for examination. The Application
for ECFMG Certification consists of questions that require applicants to confirm
their identity, contact information, and graduation from or enrollment in a medical
school that is listed in the World Directory of Medical Schools as meeting
eligibility requirements for its students and graduates to apply to ECFMG for
ECFMG Certification and examination.

24

As part of the application, international medical students/graduates must also
confirm their understanding of the purpose of ECFMG Certification and release
certain legal claims.
To meet the medical education credential requirements for ECFMG Certification,
an IMG must: be a graduate of a medical school listed in the World Directory as
meeting eligibility requirements for its students and graduates to apply to ECFMG
for ECFMG Certification and examination.
If there is no ECFMG note on your medical school’s Sponsor Notes tab, you are
not eligible to apply to ECFMG for ECFMG Certification or examination.

25

Thread 4

Please give your valuable suggestions on -
 What practices need to be changed or added to improve the
'Quality' of MCI inspections ?
 How these practices need to be changed or added ?

Since this is a serious task (to convince MCI to bring about some ‘changes’) , we
will do this in 4 groups outside listserv to have focused discussion among members
of each group without getting distracted by other groups’ discussions!

26

We will be creating 4 groups outside listserv by today afternoon where you will be
requested to share your views and finally submit a compiled report by
13th afternoon (12.00 hrs) in this common thread.
So friends, start your 'silent brainstorming' now before you come out with
innovative and fruitful ideas in your respective groups

Team Quality Promoter
Fellows 2015 – Amir, Gagan, Sumanth, Vanita
Fellows 2014 – Vijay, Krithica, Mohit
Team Quality Manager
Fellows 2015 – Purnima, Juhi, Swapnil
Fellows 2014 – Gokul, Mullai, Clarence, Ruchi
Team Quality Reviewer
Fellows 2015 – Upreet, Sukhinder, Abhijit
Fellows 2014 – Nilima, Peter, Manjinder, Simer
Team Quality Researcher
Fellows 2015 – Shuchi, Kavitha, Bharati, Hem
Fellows 2014 – Hetal, Tapasya, Sabita

27

Responses

Team Quality Researcher
Fellows 2015 – Shuchi, Kavitha, Bharati, Hem
Fellows 2014 – Hetal, Tapasya, Sabita
Roles/ Responsibility:
Leader- Hem-2015
Reporter- Kavita-2015
Email record keeper- Bharati-2015

The national Knowledge commission established by Government of India reported
that the Medical education in India was directionless , unregulated and non
standardised. The NKC Report strongly recommended amendments of Indian
Medical Council Act to make Medical Council of India (MCI) a "truly autonomous
statutory body and not simply as a recommending body to the Central Government
as is the present MCI." Despite the continuing effort of MCI, There are several
factors that need to be reviewed.

ROLE OF MCI ASSESSER
The role of the Assessor in establishing the standards of medical education
cannot be overemphasized. The Council’s decisions regarding establishment of
college, permission for renewals, and recognition or continuation of recognition at
various stages are made based on the report submitted by the assessors. Hence,
the Assessor is the eye of MCI and the assessment report should be such that
the competent authority can clearly take its decision on whether minimum
standard requirements are met or not. You, the Assessor are a medical teacher,
with experience and knowledge regarding the needs and complexities of a medical
teaching institution.
However, the assessment of a college for regulatory purposes is a specific
activity that involves verification that the establishment has the minimum
standard requirements. These refer to the
1. ADEQUACY OF CLINICAL MATERIAL,
2. ADEQUACY OF TEACHING FACULTY &
3. ADEQUACY OF INFRASTRUCTURE.

28

Practices that need Changes How?
to be changed
Adequacy of Should not just check 1. Randomly check case sheets, patient’s signs
Clinical Material total number of and symptoms, investigation reports.
patients in any ward
Quality of patient as per MCI 2. Talk to randomly selected patients to get
care requirement but an idea.
should check if they
are genuine patients 3. Check OT list of any 3-4 random dates,
or not. cross check patients case sheets on that date,
admission and discharge notes, consumables
Should be assessed expenses on those dates, does all information
match?
4. Talk to randomly selected patients about

a. their complaints,

b. why they are admitted,

c. what Rx they are taking,

d. how frequently senior doctors take ward
rounds

e. if para-medical staff available 24 hours

f. general sanitation of wards, toilets

Adequate Teaching Catching ghost g. patient diet

Faculty faculty 1. Maintenance of a national database of
teachers and their institutions

2. Realization of one`s duty and responsibility
among faculty, Deans, owners of private colleges

Adequate Minimum standard 3. Checking bank passbooks of all faculty for
Infrastructure should be ensured entry of monthly salary
1. Photography and video recording

2. Check purchase orders of equipment

29

Academics Quality 1. Check academic calendar,
2. Lesson plan
3. Student log books, journals
4. Student research work
5. Examination pattern, results
6. Internal assessment record,
7. Exit exam after internship
8. Placements of alumni
9. How many students are pursuing fellowships
in premier institutions

Timing of Timing of inspection Solution : Timing can be changed to other half of
inspection: These the year . Whether surprised inspection is useful
days all the medical or not is debatable. So long as there is ample
colleges are worried evidence to support that the faculty has been
about inspection taking class regularly and their leave has been
timing. Almost all sanctioned, they should be counted accordingly in
the inspections are the head count.
held either with
very short notice of 30
24-36 hours or even
without prior notice.
They are usually
held from Nov-
January. This is
generally a time for
the final
professional
examination and
usually the
conferences are
organized during
this period as well.

It is hard for the Solution: The inspectors should develop criteria
faculties to get a to look at the teaching learning process. For
leave sanctioned example They should inspect the following
which abstains documents:
faculties from their
professional 1. The Academic calendar
development.
2. The Rosters of each batch that should be
The other issue is clearly stating theory classes and practical
focus of MCI on classes
infrastructures and
physical 3. The credit hours for theory and practical
environments, head classes must be figured out and see whether they
count of faculties are synchronous with the curriculum requirement.
etc based on which
colleges will be 4. Review of departmental rosters: That should
granted number of have detail information about the name of
students per teacher, topic and duration and methods of
intake. Inspection teaching learning activities.
are more concerned
about quantity and 5. Record of attendance of students in theory
less focussed on and practical class.
quality of medical This will help to verify the faculties and that
education. can be cross checked with the attendance of
faculties.
MCI / NMC( Nepal
Medical Council) Solution:
doesn’t inspect the
academic 1. It is important to see how the academic
department as administration is functioning and their data
such. keeping system.

2. How is the examination cell is like?

31

3. How is the confidentiality maintained ?etc.
this is an indirect indicator of quality
assurance .

The MCI For example, in the In fact, it is possible
recommendations Department of to cater to the laboratory space requirements of
on infrastructure Physiology alone, the 5 departments (Physiology, Biochemistry,
are far in excess MCI mandates four Pharmacology, Microbiology, and Pathology)
of the actual undergraduate with one large central laboratory.
requirement at laboratories, one each
some places and no for amphibian, MCI should include infrastructure and minimum
guidelines for some mammalian, floor space for MEU also as mandatory
others. hematology and requirement.
human experiments – This place can also be used for other
On the other hand, and specifies the conferences, CMEs etc.
there are no floor area for each.
specifications laid This, despite the fact Obsolete equipments should be removed from the
down by MCI on that with a little list and useful ones added.
floor space of juggling, the same
Medical Education laboratory space can
Unit. be utilized for all the
four categories of
MCI regulations on experiments.
essential
equipments are Therefore, majority
seriously flawed. of the colleges just
have a small meeting
room with few plastic
chairs and 203 tables
in the name of MEU
and “Demo” rooms of
pre or paraclinical
departments are
being used for
conducting
workshops.

Many of these
instruments
mentioned in the MCI
booklets are not only

32

unnecessary but even
obsolete, often to the
point of being
unintelligible.
For example, in
ophthalmology,
equipments like Lister
perimeter, Jerome
screen is not only
obsolete but is not
available with the
dealers so from
where will new
medical colleges
procure them.
Pictures of the same
can be used to teach
history of these
equipments.

Surprise versus Surprise checks are So MCI inspections should be surprise but still
planned inspections? being carried out by colleges have their contacts and come to know
the MCI members about surprise inspections also.
after the Supreme Unless people are honest, things won’t improve.
Court issued
directives that the
MCI should not
inform colleges
before inspection.
Prior information has
apparently helped
many colleges manage
staff and patients
and basically clean up
their house.

The current MCI Suggestions: MCI must add into their check list
inspection started the following :
inquiring about Provision of skill lab
Medical Education List of modules in the lab

33

Unit and its Review of record of activities in the lab
infrastructures. List of faculties trained in running skill lab
There is missing of
skill lab components Suggestion to add in
in it. With the the check list are:
introduction of Number of community
introduction to facilities
clinical medicine in Structure of those
undergraduate facilities
curriculum further Available services in
necessitates the the facilities
establishment of Review of records of
skill labs in the activities
college. All the
medical students
should learn
resuscitation
technique,
venepuncture,
suturing should be
learnt through skill
lab. In developed
country there exist
a virtual hospital
and departments
where students are
taught about
communication with
patients through
simulated cases.

. Next problem,
MCI doesn't look at
is the provision of
community hospital.
The future doctors
are pared to serve
in the community as
well. Every college
should have
community facility

34

to send their
students for
training. In ,
current system
Medical Council of
Nepal and India
hasn't given much
emphasis upon.

Highly subjective, More authentic Increase in number of inspectors, A team of two
often biased and or three experts.
dictating by MCI
inspector Less time should be Only physical verification with signature can be
The head counting spent on this activity. done at the time of inspection, document
verification can be done as central process at
Faculty evaluation Quality to be later date.
assessed along with Focus group discussion with faculties.
Too quantitative numbers and
experience alone. - Short Presentation of Department by Head /
The initial first To add qualitative Senior faculty and cross questioning and grading
inspection to grant aspect -Comprehensive Feedback from staff and
recognition to the students, especially randomly selected PG
budding medical More stringent students
college esp criterion should be -Weightage for PROCESS
Pvt,,should be more followed on first Govt . should provide some subsidy &grant to
stringent, grant of permission budding pvt colleges with the bargain from their
Often it is seen to start medical side to give certain number of seats to the govt
permission is college. ,in the free category to the meritorious students
granted to colleges in state/national exams.
with building under So that the deficiency in the infrastructure
construction, and ,faculty et could be met.
many other

35

inadequacies, in the
first phase
inspection is done
mainly focused on
1st MBBS subjects,
with leniency
towards subsequent
years department.
inspectors should
see at the very
first visit that
college hospital if
fully functioning and
meets all the norms
on the very first
visit, chord should
not be let loose on
the very first day.
with so much of
laxity on the initial
grant of permission
,how can one expect
that things will be
streamlined in
subsequent
inspection so quickly
over a year or two.
...

36

Team: Quality Manager

Leader: Juhi
Time keeper: Purnima
Record keeper: Swapnil & Hironmoy
Reporter: Hironmoy

If we consider the MCI Inspection as a SYSTEM, then

Input Process Output

1. The faculty Head- 1. The inspection
Count /verification report and its dispatch

1. The inspection 2. Physical verification
guide/module of the TLA (Teaching-
Learning & Assessment)
2. The inspectors methods

Quality management in INPUT

1. MCI can frame a transparent and easy to understand module for guidelines of the
Inspection. (**a plan of such is provided below)

2. MCI can choose computer & net savvy persons, may be from younger brigade (I don’t
think that it is always mandatory to choose the old sixty-crossed Professors always), who are
also accustomed with the present day scenario of Medical education. Names can be proposed
from MEU of the “active” institutes (where MEU is working in true sense), instead of the
Principals.

3. All probable participants will be trained before-hand how to cover inspections…..this may
be done via MEU or via individual e-mail. Even MCI can use “whats-app” group for it.

Quality Management in PROCESS

1. Faculties will be directed to upload/edit personal details using the own login ID-password
well before (e-portfolio), when the inspection is tentative.(which need not to be monitored,
done beforehand of the inspection).

37

2. Only before the inspectors, they will put respective biometry attendance. (again this is
not mandatory to be under observation)

3. Inspectors can well ahead plan their schedule in verification of pre-para departments,
clinics, RTC, UTC and other facilities of the institute (do need a good Team work)

4.. In the saved time-hours they can

a) Take students’ feedback of the TLA process

b) Microteaching sessions of the teaching for any faculty members (chosen
randomly)

c) Utilization of e-class/skill labs (Computer assisted Learning)

d) Record-verification (to get the idea of Teaching-learning & Assessment):

i) Recordings of CCTV in examination hall/ lecture class/ wards, can be
verified. (Randomly chosen clippings can provide a cross-sectional picture).
ii) Internship logbook verification of any randomly chosen logbook
iii) Record of Internal assessment examination of any randomly chosen
department

e) Can meet with the MEU members and college administration persons to solve and
queries and clarifications AND to promote

i) the newer approaches of medical education as well as will promote
the CBME as well as ATCOM modules

ii) Promoting the research activities of the faculties and even the UG
students. (Publications and research aptitude of the institution)

[Problem solving approach, rather than fault finding]

Quality Management in OUTPUT

1. Report to be made in a pre-scheduled proforma, which needed to be shortened (can be
based on a software in MCI website) comparison to present day SA I & SA II forms,

38

Reviving the Gurukul of Medicine MCI
Logo: To thine own self be true Inspector

PART A ’s
Institute's Commitment on comments

1.Facilities Supporti
ve
Teaching Input process Output evidence
Student Teaching Impact on overall
intake methods learning MEU
Criteria for Innovations job placements and Annual
intake Workshops academic report to
Faculty Learning achievements be
intake environment attached
Faculty Discipline Impact on hospital
designations Student services
Faculty centered Visible Impact on
special Experiential society
achievement learning Feedback system
s/awards/ho opportunities intact
nors Assessment
Faculty methods used Meanings derived
competencie from assessments
s

Curriculum
Curriculum last
modified on
Reasons for
modifications
Benefits derived
Lessons learned
Life skills

Working
conditions for
faculty and staff
learning
environment for

39

students Input process Output Supporti
Hospital and ve eviden
patient care Patients ce
Input
Referrals Manageme Patient satisfaction 1.Hospita
nt and feedback l Annual
health Cure rates report to
care Community be
facilities response/benefit attached

2.Infrastructure Reasons for collaboration Results of
- collaboration

Current Status

Future Plans Of
Expansion
3. IPE and IP Collaboration
Areas covered

4. Publications And Impact Future Innovations
Resea factor Implicatio
rch n
studen
ts
Facult
y

Other Measures taken by the
staff Medical college
4. students
Measures taken for all round development of students
Activities

Sports
Humanities
Literary and cultural activities

40

Participation in inter-college fests, debates,
competitions
Clubs and activity
Student welfare activities
Life skills taught

5.Community services
Details

6.Faculty
Strength at time of inspection Above 75% of expected -Yes/No
Faculty on leave -Names and designation.
Reason for leave
Proof attached -Yes/No
Was he/she on leave on previous inspection- Yes/No,
Reason for leave on previous inspection

Electronic confirmation of data for self updated by faculty-Yes/No

7.Yearly achievements of the medical college Supportive evidence-
Problems faced Annual report to be
attached

Solutions sought

8.Job Placements of the medical college from Alumni data bank

9.Institute 's own ranking
For Grade 1= Basic
For Grade 2=National standards
For Grade 3=International standards

PART B
To be filled by the Medical college
Areas where the Medical college need assistance from the MCI in terms of any of the

above.

PART C
Inspector's report on the System

41

Input Process output
Next inspection due on
PART D
To be filled by the MCI Inspector

Present Grade
For Grade 1= Basic
For Grade 2=National standards
For Grade 3=International standards

Previous Grade
For Grade 1= Basic
For Grade 2=National standards
For Grade 3=International standards
How to upgrade- Suggestions

PART E

Signature Inspector Signature of Dean
Help promised on following issues /Principal
1. Issues to be
2.. complied or
Working conditions corrected by next
Administrative support inspection
Technological advancements

2. Reports can be made by the inspector himself in short summary and can be dispatched
using internet. (so in whole inspection process it will be PAPERLESS)

3. All formalities will be finalized within 6 pm, as in almost all inspection, usually it crosses 10
pm to finalise the report.(Time-bound)

42

Team Quality Reviewer

Team members :

Fellows 2015 – Upreet (Leader), Sukhinder (Record keeper of mails),
Abhijit (Reporter) .

Fellows 2014 – Nilima, Peter, Manjinder, Simer.

Issues Present Practices Required changes – why/ how
Number of Three
Members in members for UGinspec More inspectors per visit to be deputed, so that the
the tion and one sole sheer paperwork doesn't overwhelm them and the
Inspection / member exercise doesn't get diluted due to exhaustion.
Assessment for PG inspection Invariably have a person with locomotor disability on
Team with its the inspection team who can determine if the
composition. No system of training institution is accessible to students, teachers, staff
prevails and patients with disabilities.
Training of
the Train the inspectors prior to the exercise on how to
Inspectors to conduct themselves with politeness, respect, and
improve their compassion even if the institution is flawed and is
quality. going to get a bad report... ie training in how to
behave professionally and not rudely.

Quality of Inspectors is important. The training
procedure may be helpful to ensure the quality of
assessors /inspectors.

Quality of Inspectors also can be assessed by
MCI by taking structured feedback from visited
colleges, where five or more random teachers/
staff/students can give their feedback (on attitude,
behaviour, communication, knowledge etc.of
Inspectors)which can be submitted to MCI along with
the inspection report.

Blueprint of Many a times Blueprint of division of job responsibilities should
different inspecting team be prepared by the inspectors prior to arrival to
job members meet each the college to be visited.
responsibilitie other for the first
s amongst the time only in the college

43

members of to be visited and that The State Medical Councils (SMC) should be given
the inspecting too on the day of authority to assess routinely and advise on the day
team inspection only. There to day activities of Medical colleges under their
is no regular system jurisdiction.SMCs in turn will report monthly/
Decentralizati of making a prior quarterly to the MCI on their routine observations.
on & blueprint of their job Once there is delegation of supervisory power to the
Delegation of responsibilities during SMCs, the State Medical Councils will be more active
Power to inspection, resulting in and devoted to their duties and responsibilities
the State delay in starting the for the improvement of medical colleges and quality of
Medical inspection and chaos medical education as a whole. The MCI will review
Councils during inspection. the reports of SMCs quarterly/ half
yearly andadvise the SMCs regarding further
State Medical Councils actions, if any, to be taken. If this system is followed
arenot empowered to the SMCs will also feel about their importance and
take part in enhanced status, which would stimulate them to
inspection/ assessment remain more responsible and more vigilant on medical
of medical colleges colleges including the overall system of teaching and
assessments followed in the colleges under their
jurisdiction. Based on the analysis of the reports
of SMCs , theMCI may make visits to a particular
medical college or number of medical colleges under
a particular SMC and while taking some actions based
on the findings of these visits, the MCI should take
the opinion of SMCs on the pertinent issues.

Another view is that, one SMC may take the
responsibility of assessing/ inspecting colleges of
another neighboring state.

44

Minimum Defective list of During the training the Inspectors/ Assessors should
Requirements minimum requirements be made thoroughly aware on the minimum
and the - not well defined for requirements.
Check List many items and some The minimum requirements list should be made more
obsolete items still elaborate and specific based on the necessity of
Collecting persist in the list. those items in present days
feedback perspectives.
from Moreover, Inspectors/
stakeholders Assessors are many a The list should be reviewed and the items
with times not well which arenot required by the departments in the
suggestions conversantwith the present days and have become obsolete(but still
minimum requirements, occupying an important place in MCI list) must be
Time taken resulting in adverse/ deleted.
for head negative comments in
count and the reports. Feedback must be taken from students, patients
Inclusion/ No system of and staff of the colleges regarding their
Exclusion of collecting satisfaction on TL, assessments and the health care
recently feedbacks from services provided.
recruited/ various stakeholders Management / CEO / Directors must be made
transferred like students, patients aware on the suggestions given by stakeholders
teachers. and staff during feedback.
Periodic assessments (in stead of a single inspection)
A huge time is may prove to be more useful to assess the quality of
taken for head count TL and assessment methods followed in a particular
of different college.
categories of teachers Time can be minimized by adopting following systems
with physical :
verification of all
supportive documents - Biometric verification of documents by
given by teachers using faculty smart cards to be issued by MCI.
alongwith declaration - Sending the declaration forms alongwith
forms. all supportive documents to MCI well ahead
of the visit for verification well before the
inspection.
Recently recruited / transferred teachers should
not be considered for head count.

Recently recruited/
transferred teachers

45

Assessment are also Quality and functional status of
of the quality considered for head availableequipments/ items and the availability of
of available count. latest editions of the books in the libraries must be
equipments/ Most of the time only checked during inspection.
books etc. the number of items
are considered and not Although head count of students will be very much
Head count the quality or the time consuming, inspectors should check the
of students functional status of students’ attendance registersand physically cross
those items or the check on a random manner on the day of inspection.
status of
book-edition.
No system of head
count of
students prevails.

Accounntabilit Only the The State MCs may issue warning letters to
y of Dean/Principal and the Management/ CEO/Director of Private/ Govt.
Management/ faculties are held colleges, based on the SMCs’ findings on periodical
CEO/Director liable by the MCI or assessment and on review/ compliance visits on
the actions taken thereto. In this way the Management/
Govt./Management. CEO/ Directors may be made more accountable.

46

Team Quality Promoter
Fellows 2015 – Amir, Gagan, Sumanth, Vanita
Fellows 2014 – Vijay, Krithica, Mohit

The Red indicates the problem/deficiency and Green indicates the probable solution
Equality and Transparency:

· For the same deficiencies, one college is given a go ahead and another college is not.
· One is this practice, which needs to be changed.
· There creeping in corruption due to this.
· The inspection process should be transparent and fair.

MCI guidelines should be Comprehendible:

· The rules are not laid down in simple and easy to use formats so that each and every
teacher and administrator can understand.
· So many things are left to interpretations.
Ex- A professor gets an invitation to be an assessor and s/he gets the forms to be filled
etc. and s/he is ready to assess a medical college. Doesn't it sound absurd?

Decentralization:

· There are no criteria to choose the assessors for the inspections.
· We see biases in the selection of assessors also.

47

· Involve state medical councils in these inspection processes for better coordination
and supervision.

· Need some decentralization of MCI.

.
Ex- On fair ground, some leniency can be given to Chhattisgarh colleges etc., especially if
falling in tribal areas or purely rural, where it’s obvious that there could be deficiency in
staffing and infrastructure.

But when it comes for colleges which are based in cities, metro and there is no obvious
reason for deficiency then-DAL ME KALA HAI. Making it mandatory for a medical college
in Delhi to have a residential rural hospital is not possible. Similarly a college in a remote
rural area: how can it have an urban health center? Either gives permission to only those
colleges which are not in the heart of metropolitan cities or in remote rural areas.

Logical Promotion criteria:

· Promotion criteria are very vague.

· Not expected from a body like MCI. Or should I say, expected? Anything before coming
out in public domain should be internally validated and externally piloted.

Go beyond papers and head count:

· MCI inspection is now solely dependent on MCI inspectors and the papers shown to
them.

· Different medical colleges have different employers which are associated with
limitations.

· The MCI has its own notion of 'ideal' or 'pragmatic' but the ground rules are entirely
different.

· Have a compulsory closed door meeting with the students of the college. None of the
teachers or support staff should be allowed inside.

· Have Interaction of MCI inspectors with parents should be mandatory.
48

· Have Random faculty 'one to one' interview should be conducted. Many a times faculty
members can open up and give the actual facts.

· Inspectors should be chosen on their credibility and not on their seniority or
influence.

· Any inspectors who are doubted as ghost faculty should not be sent for inspections.

· A minimum of Research papers should be generated annually and mandatory for
recognition.

Attitude of the Inspectors:

· Pay a Surprise Visit to the Medical College if possible. Or If it's mandatory to
announce the MCI inspection dates for various reasons then prefer to give a short notice of a
day or two. The real picture would be revealed only then.

· Use a pen and paper to jot down things that are noticeable. Both innovative and
deficiencies. Just going round talking to people as they come across, then some points cud be
missed.

· Take live feedback from students and staff in pre, para depts. and also
from patients from clinical side.

· Be very careful about waste disposal system in the Medical College. Much bio
hazardous materials go straight to drains without treatment. That is ecologically dangerous.

· Never manipulate any point inspection report to petty gains!!

Categorize the Inspecting visits

· There should be two types of visits: one facilitatory and one for inspection.

What happens is the doubts of the administrators/faculty members/ other staff/ students
are not clear regarding the MCI regulations.

· Once there is a two way interaction, things are sorted out before hand, and then
matters will be easily sorted out.

49

· So in these facilitatory visits, there would be problem solving attempts within the
framework of the MCI guidelines.

Be well versed as an inspector:

· The MCI inspector should have sound knowledge of all the rules and regulations that
govern MCI recognized Medical Colleges.

· IMC Rules 1957 are quite in number & undergone several Amendments till date.

· This is because any discord reported especially in private Medical College &It is often
challenged in the court of law.

· There are cases, of a similar objection raised that has spoilt the calm in a senior doctors
life at New Delhi. He has to face the legal consequences for no fault of his., maligning his
career forever.

· There was a drive to make data base of faculties of all medical colleges and cross
check it during inspections so as to curb this menace. This if followed rigorously, at least this
problem can be avoided.

· If surprise visit cannot be planned then at least inspectors should make a point to take a
360 degree feedback to ensure if facilities are uniform throughout the year.

· Inspectors must talk to teaching non teaching staff, patients, students and if possible to
parents of the students.

· Although student feedback appears to be a good idea but their opinion might be biased
and they would not like to talk against the administration/ resources as their career is on
stake.

Aap Hamari madar kare aur hum aapki karenge

· Inspectors share a synergistic relation with each other.

· They mask the deficits and expect same to be reciprocated during their institute
inspection.

50


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