How distance Ph.D.s and non-MBBS appointments are undermining India's clinical teaching standards

The Hindu

5 days ago

The slow erosion of India's medical education standards is not occurring through a single cataclysmic policy misstep, but through the quiet normalisation of appointing non‑MBBS distance Ph.D. degree holders to core teaching posts in medical colleges.
For a proportion of previous and recent appointments, such non‑medical appointees reportedly completed their Ph.D. through distance or part‑time modes while simultaneously holding full‑time employment in another institute—a dual track that precludes the sustained, supervised laboratory and pedagogic immersion essential for authentic academic formation.
Regulatory oversight?
These distance or part‑time Ph.D. programmes are outside the regulatory purview of the National Medical Commission (NMC)—the NMC neither designs their curriculum nor directly inspects, audits, or certifies their conduct—meaning the medical education regulator has no effective control or quality oversight over the very doctoral credentials now being used to claim equivalence with clinically trained MBBS postgraduate faculty.
What at first glance looks like an efficient stop‑gap to fill perceived faculty shortages is, on closer scrutiny, a dilution of the clinical, ethical, and integrative foundation on which competent physicians are built.
Undergraduate medical training - the MBBS pathway is a longitudinal, immersion‑based formation: structured exposure to Anatomy, Physiology, Biochemistry, Pathology, Pharmacology, Microbiology, Forensic Medicine, Community Medicine, and a spectrum of clinical rotations — all under a regulated environment that binds the learner and later the practitioner to explicit professional conduct norms, licensure examinations, bedside responsibilities, interdisciplinary team communication, and patient accountability.
Impacts on curriculum delivery
Similarly, post graduate course is also in control of the Competency-based medical education (CBME) programme of the regulatory body, NMC. But a distance‑mode doctoral program and M.Sc. by Non-MBBS teachers pursued parallel to unrelated full‑time employment cannot replicate the crucible of supervised patient contact, procedural stewardship, morbidity–mortality analysis, ethical case discussions, real laboratory quality systems, and iterative assessment that shapes judgment in a medical graduate. When colleges accept individuals without this integrated clinical apprenticeship to teach foundational subjects, the curriculum fractures: facts are transmitted, but the living clinical context and safety net of tacit knowledge are thinned.
Distance Ph.D. pathways—especially when undertaken concurrently with another full‑time institutional job—often emphasize dissertation completion logistics over immersive pedagogy or translational applicability. Medical Students taught under faculty whose own training was not scaffolded by mandatory clinical postings are less likely to receive the nuanced integration: how a biochemical pathway alteration manifests at the bedside, how anatomical variants complicate an emergency procedure, why microbiological resistance patterns alter antibiotic stewardship, how pharmacokinetics aligns with organ dysfunction scoring, or how physiological compensations appear in vital trend curves. The loss is cumulative and only surfaces years later in weaker differential diagnoses, fragmented reasoning on ward rounds, and diminished readiness for unforeseen public health crises.
Knowing subject content Vs Pedagogy
Advocates of widening the faculty pool argue that 'subject content is universal' and that any research doctorate adds scholarly depth. Scholarly depth is valuable; however, a distance or part‑time doctorate earned concurrently with full‑time service elsewhere and unanchored to continuous, verifiable lab supervision or patient‑centered clinical correlation cannot instill the reflexive safety lens essential for teaching future prescribers.
Pedagogy in medical sciences is not solely the transmission of molecular cascades or histological slides; it is the curation of clinically salient emphasis—knowing which deviation matters urgently for patient outcomes and which is academic ornament. That calibration arises from lived participation in multidisciplinary rounds, mortality audits, infection control committees, transfusion reaction reviews, pharmacovigilance reporting, and real‑time management of complications. Without it, teaching risks becoming an abstract enumeration of lists, divorced from risk stratification and pragmatic triage thinking.
Talent drain?
A second risk vector emerges in academic ethics and assessment integrity. Distance/dual‑employment Ph.D. entrants—particularly where oversight of thesis originality, sample authenticity, ethical clearance rigor, time‑on‑task documentation, and statistical methodology is uneven—may unintentionally propagate lax standards among MBBS students observing their evaluators' citation practices or superficial engagement with updated guidelines.
The message a system sends when it elevates distance, simultaneously‑employed credentials over regulated, full‑time, residency‑rooted academic progression is that experiential clinical immersion and competency‑based milestones are negotiable. This disincentivises bright MBBS graduates from pursuing teacher–scholar careers; they witness equivalence (or even preference) granted to those who bypassed the demanding crucible they endured. The talent drain that follows redirects academically gifted clinicians to corporate hospitals or overseas fellowships rather than classrooms where standards appear administratively malleable.
CBME impaired?
Moreover, the 'faculty shortage' justification is frequently unsubstantiated when one audits the actual pool of eligible MBBS postgraduates and junior faculty awaiting timely recruitment or promotion. Bottlenecks typically lie in delayed selection processes, unfilled sanctioned posts, opaque panels, or wage disparities—not in an absolute absence of clinically trained educators.
Substituting structurally expedient distance/dual‑employment Ph.D. holders masks governance failures instead of correcting them. Long term, this misallocation impairs implementation of Competency‑Based Medical Education (CBME), which demands scenario‑based learning, early clinical exposure, skills lab mentorship, simulation debriefs, and Workplace Based Assessments—activities requiring mentors with authentic clinical anchoring and physical presence.
Policy Inconsistency with CBME Implementation: Notably, in its recent gazette notifications preceding Teachers Eligibility Qualifications (TEQ) 2025, the NMC itself had reduced the permissible percentage of non‑MBBS faculty—first in Pharmacology and Microbiology, and then further in Anatomy, Physiology, and Biochemistry—explicitly citing the roll‑out of CBME and the consequent need for clinically anchored teaching. If CBME's very premise is integrated, bedside‑linked learning, what policy logic now justifies reinstating higher quotas for non‑MBBS appointees in TEQ‑2025? The reversal appears not to be evidence‑driven but expediency‑driven, undermining the pedagogic rationale NMC advanced barely a year earlier.
Questioning the Rationale for re‑inclusion: When the regulator had already acknowledged that MBBS‑trained faculty are essential for CBME's success—and when postgraduate (MD/MS) doctors in these subjects are increasingly available—why reopen the door for Non-MBBS M.Sc, distance/part‑time Ph.D. holders outside NMC oversight? This about‑turn demands transparent disclosure of: (a) the data sets reviewed, (b) stakeholder consultations conducted, and (c) the projected impact on CBME outcomes that purportedly justify this shift.
Call for Evidence and Transparency: TEQ‑2025 should therefore be compelled to publish a comparative impact assessment: What measurable deficits arose from the reduced non‑MBBS percentages that necessitated their resurgence? Absent such data, the move appears to legitimize administrative shortcuts rather than solve genuine faculty gaps. If quality was the stated reason to decrease non‑MBBS representation earlier, quality cannot simultaneously be the reason to increase it now.
Research culture also suffers. Foundational departments steward antimicrobial stewardship, pharmacogenomics, molecular pathology validation, high‑throughput clinical biochemistry quality assurance, public health surveillance analytics, and emerging biomarker translation. Faculty whose doctorates were accumulated in distance modes while employed full time elsewhere may generate publication counts, but translational relevance, patient safety nuance, and interdisciplinary collaboration depth often lag, shrinking institutional capacity to contribute meaningfully to national health priorities (antimicrobial resistance containment, rational drug use, outbreak analytics, non‑communicable disease biomarker validation).
Regulatory complacency over equivalence invites proliferation of marginal institutes offering distance doctoral products to meet 'demand,' inflating a supply of paper‑qualified yet clinically unseasoned aspirants and accelerating a downward feedback loop. The absence of NMC oversight over these distance Ph.D. courses further compounds the risk: no centralized standards for laboratory infrastructure, ethical review rigor, or supervisor–student ratios are enforced, allowing uneven quality to masquerade as equivalent scholarship.
Medical Students—the most vulnerable stakeholders—may initially remain unaware. Pass percentages can stay superficially stable if examinations overemphasize recall. Yet internship supervisors will perceive weaker synthesis skills; postgraduate entrance outcomes may reveal deteriorating performance in integrated reasoning segments; patient safety indicators may subtly decline. By the time alarms are undeniable, affected cohorts cannot retroactively receive authentic mentorship. Preventive action is therefore imperative now.
Who ensures quality?
Policy and governance imperatives: Reaffirm that core preclinical and paraclinical teaching posts must be held by MBBS graduates with requisite postgraduate degrees and documented full‑time academic engagement; disallow acceptance of distance/part‑time Ph.D.s pursued concurrently with other full‑time employment as equivalently qualifying for these posts—especially noting that such courses are presently outside NMC regulation and control; mandate transparent, third‑party audited logs of laboratory presence, ethical approvals, raw data provenance, and supervisor sign‑offs for any doctoral work considered in faculty selection;
It should also be required that every faculty member's doctoral credentials are screened and vetted by the NMC or its designated authority—recognising that to date there has been no systematic screening of non‑MBBS appointees who completed distance Ph.D.s while employed full time in Indian medical colleges; realign promotion criteria toward educational innovation, validated clinical–research integration, mentorship hours, and ethical scholarship instead of mere credential accumulation; and accelerate timely recruitment of clinically grounded educators through streamlined selection panels, competitive retention packages, and structured pedagogical upskilling.
Medical education is a national trust. Diluting its human resource standards by normalising distance, dual‑employment Ph.D. credentials for core teaching posts—credentials produced in courses that the NMC does not directly regulate—risks manufacturing future practitioners less prepared for complex, resource‑constrained, ethically intricate healthcare realities. India's demographic scale, epidemiological dual burden, and aspirational global health leadership demand the opposite: uncompromising reinforcement of clinically rooted academic excellence. Reversing this quiet slide—especially the pattern where most non‑medical entrants secured distance doctorates alongside full‑time external jobs beyond NMC oversight—protects both the competence and the conscience of tomorrow's healers.
If CBME demanded fewer non‑MBBS teachers yesterday, how does the same CBME demand more of them today—without any new evidence on learning outcomes?
(Dr. Anoop Singh Gurjar is the General Secretary, All India Pre and Para Clinical Medicos Association (AIPCMA) and a member of Rajasthan Medical Council)