Bulletin of the World Health Organization

Continuing medical education in India

Delays in legislation slow the progress of continuing medical education in India

IN FOCUS:
5 February 2004

Indian medical associations say their doctors desperately need continuing medical education (CME) to keep them up to date with the latest drugs, equipment and medical practices but legislation to make this a requirement has made little progress.

The Medical Council of India is campaigning for CME to be made compulsory, as it is in the UK and some US states, for the country’s 615 000 registered doctors and has proposed a draft amendment to a law that would standardize medical practice across the country while making sure it is up to date with the latest developments.

If passed into law, mandatory CME for registered doctors in India could set a precedent for other developing countries but some Indian doctors say their medical associations have failed to lobby hard enough for this and lawmakers have been slow to respond.

“There is resistance to change by [health] professionals who lack the opportunity for undergoing good quality CME, and lack incentives as well as motivation for attending CME programmes,” said Dr P.T. Jayawickramarajah, Coordinator at the WHO’s Regional Office for South-East Asia in New Delhi.

Other doctors in India fear that without CME courses, lack of up-todate knowledge can endanger lives and perpetuate out-moded practices. Umesh Kakrania of SPARSH, a support group for people with HIV/AIDS, said that many Indian doctors were still recommending single or double anti-retrovirals rather than triple combinations which are standard. “Several premature deaths have occurred due to this sad situation,” Kakrania said.

Kakrania said that many doctors, paramedical and nursing staff in India still suffered from the “anti-AIDS phobia” of the past and urgently needed to improve their basic medical education. He said many medical staff still refuse to touch HIV positive patients.

Dr Shekhar Saxena, an Indian physician who works at WHO in Geneva, said that enacting a legislation to make CME mandatory is a necessary but not sufficient requirement for delivering quality knowledge and skills to practicing doctors in India.

"Allocation of substantial funds and professional resources will be needed to really make the system work and it is important that pharmaceutical companies are not allowed to dictate this agenda based on their financial power,” said Saxena.

Despite the lack of legal incentive for doctors to attend regular refresher courses, CME has been catching on in India over the last three years partly due to the efforts of regional medical associations.

Dr Puneet Bedi, a gynaecologist in Delhi, however, believes that doctors’ attitudes will change as more doctors in India realize they must keep up to date with the latest medical practice, but progress is slow. “We are moving extremely slowly in promoting CME,” said Dr B.V. Adkoli of the All India Institute of Medical Sciences in New Delhi.

The Delhi Medical Council, which represents 24 000 doctors in the capital, made it mandatory two years ago for members to complete 100 hours of CME every five years before they can re-register as doctors.

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