Реформа медицинского образования в Индии сталкивается с кризисом из-за нехватки кадров и перегруженности больниц

Divyansh Kumar | Posted September 02, 2026 09:00 AM When India rolled out the Competency-Based Medical Education (CBME) curriculum in 2019, it promised dismantling teacher-centric rote memorisation and replacing it with demonstrable bedside skills, early clinical exposure, ethics through the Attitude, Ethics, and Communication (AETCOM) module, and workplace-based assessments for medical students. However, at across more than 820 medical colleges having over 1.15 lakh MBBS seats, there is massive gap in implementation of innovative curriculum largely due to overwhelming documentation, faculty shortage, infrastructure limitations, and overcrowded hospitals. The rapid expansion of MBBS seats has intensified disparities in training quality, raising concerns that standards are falling behind scale. At a recent medical education forum, Dr Abhijat Sheth, chairman, National Medical Commission (NMC), said, “As we expand medical seats, our greatest responsibility is to ensure that expansion doesn’t compromise quality, which we are feeling now because the quality is trailing amid rapid expansion. We cannot create a two-tier medical education system where students in some institutions have access to excellent faculty, rich medical material, simulation facilities, and research opportunities while students elsewhere receive significantly fewer opportunities.” Pointing out that regulatory audits have historically failed to gauge real learning, an NMC official, on condition of anonymity, says, “Implementation of CBME curriculum should be one of the metrics when the NMC checks the infrastructure of medical colleges focusing on quality of buildings, faculty and equipment. Accreditation should increasingly examine whether students are achieving prescribed competencies, whether assessments actually measure competence, whether faculty are continuously developing and whether institutions are protecting patient safety and teaching professionalism.” Faculty Bandwidth While the framework expects teachers to serve as mentors and clinical evaluators, medical educators on the ground face crushing patient loads, bureaucratic paperwork, and rigid university systems. Highlighting the structural roadblocks faced by educators, Dr Ritika Sud, professor of Medicine, Lady Hardinge Medical College (LHMC), New Delhi, says, “Faculty readiness is one of the most important and challenging tasks. Gaps in infrastructure, documentation burdens, and conventional university examination practices continue to complicate the transition. The traditional paper logbooks have become quite unmanageable. Assessment has become more cumbersome for the educators as well as for the students who continue to be assessed through conventional examination methods rather than being evaluated in line with the CBME framework.” Dr Sud notes that aligning institutional assessment with competency training remains an uphill task. “Under CBME, examiners need to assess is higher-order learning and implementation of what has been taught. Earlier, teaching, learning, and assessment were never aligned with each other. Furthermore, in clinical postings, students usually run around just for signatures of the teachers until the very end of the academic term, while in CBME the assessment is an ongoing process.” Overcrowded Wards For students, the disconnect between ideal guidelines and understaffed hospital wards frequently reduces hands-on training to clerical checklist compliance. Dr Chaitra BA, president, Medical Students Association of India (MSAI), says, “Not everything mentioned in the curriculum is taught as there is a significant gap between the NMC curriculum and what happens in a hospital. A competency can be very well put together on paper and still become a checklist for exams. If the faculty is overburdened, if the hospital is understaffed, or if patient numbers are enormous and administrative work consumes everyone's time, even the best-designed curriculum struggles to survive.” Dr Chaitra adds, “The sheer volume of compliance creates student burnout without adding educational value. When logbooks, assessments, and endless documentation rather than tools for learning, they risk feeling administrative rather than educational. We are adding workload without equivalent educational value.” There is a misalignment between bedside training and high-stakes entrance exams, which further widens the gap in CBME implementation. Explaining why students are driven away from clinical postings, Dr Chaitra says, “NEET PG continues to assess students largely through MCQ-based questions that are not fully aligned with the CBME approach, which emphasises clinical skills and application-based learning. As a result, students have to devote significant time to coaching and preparation for an examination that determines their next step in medical education. They are therefore not choosing coaching classes over hospital wards because they do not value clinical learning, but because the assessment system rewards a different set of skills. When time is limited, students understandably prioritise the resources that prepare them for NEET PG over bedside learning.”