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Editorial
The Indian Practitioner d Vol.75 No.6 June 2022
6
The New Medical Education Curriculum in India:
A Great Initiative with Scope for Further Enhancement
Dr Varsha Narayanan
1
Abstract
Medical education in India that includes MBBS and specialty post-graduation programmes are intense, thorough and well
acclaimed. The new medical education curriculum introduced by the National Medical Commission in 2019 is all set to be
uniformly implemented. It is a welcome move in the direction of competencies-based assessment, as well as enhancing soft
skills and integrated learning. It is also important for medical students to learn other aspects and skills that are highly impor-
tant in shaping their career, practice, and life after their education is completed. These include business, nance and admin-
istrative skills and knowledge, medicolegal aspects, interacting with and tackling different kinds of patients, understanding
the scope and benets of general practice, family medicine and holistic healthcare, making informed career choices, and self-
care that involves coping skills, building resilience, managing stress, and maintaining one’s own physical and mental health.
Keywords: MBBS, NMC, new medical education curriculum, CBME, holistic
1
Consultant Family Medicine and Holistic Health, Dr Varsha’s Health Solutions, Andheri (West), Mumbai, India.
Email: info@drvarsha.com; www.drvarsha.com
Introduction
The MBBS curriculum in India is highly acclaimed
and recognized for the thorough knowledge and
clinical experience that it imparts.[1] It is a well-
structured curriculum covering clinical and non-clini-
cal subjects, complete with laboratory work, as well as
active patient care in the hospital. There are rotational
postings in almost all specialties with varied exposure
to outpatient care, ward rounds, emergency and casu-
alty, as well as major/minor surgery. The curriculum
also gives exposure to public health and rural health-
care. Most students nishing MBBS take up postgrad-
uation in a specialty, the curriculum of which is again
thorough and hospital centric with the postgraduates
being the backbone of the patient management and
day to day running of the particular specialty depart-
ment.
Competencies-Based Medical Education
Curriculum
In 2019, the National Medical Commission intro-
duced the new MBBS curriculum with a competencies-
based medical education (CBME) syllabus.[1] The aim
of CBME is to build physicians having capability to
cope with the continuously evolving health-care needs
to provide more comprehensive and multidimensional
patient care.[2] It has structured formative assessment,
periodic internal assessment, and end-of-phase sum-
mative assessment, along with eective and appropri-
ate feedback also built-in. The curriculum starts with
a one-month initial foundation course for orientation
with the MBBS curriculum, Indian healthcare system,
medical ethics, local language, and time management.
For each competency, the learning domains (knowl-
edge, skill, aitude, and communication) are iden-
tied, and the expected level of achievement in that
subject is identied as - knows (K), knows how (KH),
shows how (SH), and performs (P).[3] ‘P’ indicates in-
dependent performance without supervision. The out-
come is a core (Y - must achieve) or a non-core (N -
desirable) outcome. Each medical institute is also ex-
pected to design sub-competencies to enable the broad
outcome to be divided into smaller objectives called
The Indian Practitioner d Vol.75 No.6 June 2022
Editorial
7
Specic Learning Objectives to be achieved at the end
the teaching sessions. The broad competencies cov-
er important aspects of the subjects according to the
NMC, and are thus part of the core competencies.
There is an option for desirable competencies which
an institute can individually add in the undergradu-
ate curriculum.
There is an introduction to aitude, ethics and com-
munication (AETCOM module) to improve the func-
tioning of medical students as physicians at the com-
munity level. There has also been horizontal and ver-
tical integration of the curriculum across subjects and
years, with additional sessions of self-directed learn-
ing (SDL), elective postings, and the clinical postings
starting from the rst year itself. The advantages of in-
tegrated teaching over traditional lectures include re-
duced fragmentation and repetition, simultaneous ap-
plication of knowledge to clinical practice, rationaliza-
tion of teaching resources, and inter-department col-
laboration.
Other features of CBME include student-doctor
method of clinical training, in which the student func-
tions as a team working with and following up pa-
tients longitudinally, and taking part in patient care
from admission activities, hospitalization, writing and
maintenance of the records and participating, observ-
ing and assisting in procedures in a supervised and
graded manner.
Unfortunately, the 2 years of the pandemic that fol-
lowed derailed the eective implementation of this
curriculum. However, in 2022, the new curriculum is
set to be uniformly implemented with the objective
of covering cognitive, aective, and psychomotor do-
mains of learning, withadded features like yoga, and a
family adoption programme.[4] It is yet to be seen how
this new medical curriculum pans out in the time to
come, in terms of consistent implementation across
our country’s medical institutions, training and orient-
ing the faculty, and creating more tools for practical
and simulated case based learning.
Further Scope and Suggestions
A person nishing medical education then enters
the real world of establishing a clinical practice or nd-
ing jobs. Unlike peers in other streams of education,
there is no campus placement or career guidance, and
one is completely at sea and on one’s own. It is then
that one realizes the importance of several aspects that
are an integral part of the medical profession, practice
and professional journey, but are not yet formally part
of the medical education curriculum.
1. Business, Finance and Administration – It is sur-
prising that medical students are not given any ori-
entation of nancial management, business skills,
and administration during their MBBS or post-
graduation, given that a large number of them will
be seing up practice or medical centers on dier-
ent scales.[5] Understanding the logistics of start-
ing practice, managing sta, budgeting and loans,
structuring nances and investments, and dealing
with dierent agencies like the municipality, resi-
dential societies, waste management agencies, so-
cio-cultural organizations, and procuring required
paper work and licenses, should be a very impor-
tant part of the medical curriculum especially in the
nal year.
2. Medico-legal Aspects and Insurance – There
should be some orientation and understanding
given to medical students about medicolegal as-
pects of medical practice.[6] These include indem-
nity and professional insurance, what constitutes
negligence, precautions to take while treating pa-
tients, documentation, procedural notes, prescrip-
tion writing, patient records, patient counselling,
consent and clarity in description and explanations
provided, telemedicine and digital health regula-
tions, and above all one’s own rights and the legal
resources available.
3. Patient Handling and Interaction – While ethics,
language and communication has been emphasized
in the new medical curriculum, it is also important
to have practical sessions on handling dicult pa-
tients or relatives, how to disclose a grim prognosis,
disability or death, how to explain diagnosis in sim-
plied terms, how to express empathy and under-
standing while maintaining rmness and profes-
sionalism, and above all how to safeguard against
and deal with verbal or physical violence.[7] It is in-
teresting that there are multiple case presentation
sessions by students to the professors, however
there is almost never a presentation (mock/ simu-
lated/real) by the student to a patient explaining the
patient’s condition, diagnosis, treatment planned,
and course/outcomes expected.
4. Orientation to Family Practice and Holistic Care
– The pandemic has driven home the importance
of the family physician and holistic management,
as being the need of the hour for strengthening the
healthcare foundation of India.[8] However, there
are no family medicine departments in medical col-
leges, and there is lile exposure to holistic man-
agement that includes nutrition and diet regulation,
Editorial
The Indian Practitioner d Vol.75 No.6 June 2022
8
lifestyle and physical activity assessment, stress
and sleep management, and addressing psycholog-
ical aspects in physical health conditions. The intro-
duction of aspects like family adoption and yoga in
the new medical curriculum is a welcome move. It
is pertinent to consolidate family medicine and ho-
listic health in the form of a subject with dedicated
faculty, so that it encourages more students to take
up general and family practice, instead of all stu-
dents trying to squeeze into postgraduate specialty
seats. This can help build a broad and strong base of
the Indian healthcare system.
5. Career Counseling and Self-Care – The Indian
medical education curriculum is grueling, packed
and extremely demanding physically and mental-
ly. It often takes away one’s youth, hobbies, and en-
joyable years, and still leaves one without any def-
inite career opening on a plaer at the end of it, as
opposed to other non-medical courses like business
administration, nance, engineering, etc. The post-
education professional practice road is only more
demanding and harder, often eating into social,
family and personal spaces. A dedicated depart-
ment for student counselling is a desperate need in
medical institutions. Here students should be pro-
vided with psychological counseling when the go-
ing gets tough, and also taught to deal with them-
selves when failures of treatment and procedures
happen, or when a treatment decision does not go
as expected, and when there are complications and
death.[9] Students must be taught and counselled
that their own physical-mental health and well-
ness is as important, and that they should guard
themselves against burnouts, saturation, frustra-
tion, breakdowns and exploitation. Often medical
students grab post graduate specialty seats based
on prestige or subject interest. There is never any
pre-selection discussion, counseling or interview to
understand suitability or unrealistic expectations.
Career counselling can not only help students se-
lect appropriate specialties in an informed way, but
also understand other options like health adminis-
tration, public health, medical/pharmaceutical re-
search, as well as healthcare innovations and entre-
preneurial opportunities.[10]
Conclusion
The Indian medical curriculum has the global ad-
vantage of highly trained faculty, huge and robust pa-
tient pool, and a wholesome learning experience across
socio-cultural and economic diversity. However, given
the intensity of the medical curriculum itself, and the
life thereafter of medical professional practice, empow-
ering medical students with skills apart from medical
subject knowledge itself is very important. The new
medical curriculum set to be implemented across the
country is one positive move in this direction. Further
eorts in this direction like including business, nance,
administrative and medicolegal aspects, patient inter-
action and handling, orientation to general and family
practice as well as holistic healthcare, and improving
informed career choices and self-care, can greatly en-
hance condence, coping skills and success of medical
students and future doctors.
References
1. Jacob KS. Medical Council of India’s New Competency-Based
Curriculum for Medical Graduates: A Critical Appraisal.
Indian Journal of Psychological Medicine. 2019;41(3):203-209.
2. Mial N, Medhi B. New undergraduate medical education
curriculum. Indian J Pharmacol. 2022:54:73-6
3. Sulania A, Goel SK, Singh SV. The New 2019 Medical
Curriculum in India; In Light of the Integration of Medical
Curriculum. 2019;18(4):251-259.
4. India Today - indiatoday.in [Internet]: NMC issues circu-
lar on competency based medical education for UG med-
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2022]. Available from hps://www.indiatoday.in/edu-
cation-today/news/story/nmc-issues-circular-on-com-
petency-based-medical-education-for-ug-medical-stu-
dents-1932076-2022-03-31
5. Grewal K, Sweeney MJ. An Innovative Approach to
Educating Medical Students About Personal Finance.
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9. Gold JA, Johnson B, Leydon G, Rohrbaugh RM, Wilkins KM.
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