Emergency, Respiratory Dept 'Not Needed' in Med Schools? Experts Raise Questions

NMC has excluded Emergency and Respiratory Medicine from its list of required departments to run a medical college.

Image used for representation.

(Photo: Chetan Bhakuni/FIT)

The National Medical Commission has excluded Emergency and Respiratory Medicine from its list of "required departments" to run a medical college/institution.

In its latest notification released earlier in August, the government body mandated 21 departments that every medical college needs to have to run undergraduate MBBS classes.

NMC's notification released in August 2023.

NMC’s previous notification, released in 2020, had mandated 23 departments, including Respiratory and Emergency departments with Radiation Oncology being an optional department.

FIT reached out to experts to understand how this could impact public healthcare in India.

What Does This Exclusion Mean?

Dr Charu Sadhwani, Junior Resident, Department of Respiratory Medicine at Lucknow’s Era Medical College & Hospital, explains that from now on, respiratory and emergency medicine won’t be taught as individual subjects to MBBS students as part of their undergraduate curriculum. 

She says,

“It also means that separate clinics won’t be run for these papers.”

Dr Imron Subhan, Senior Consultant and Head, Emergency Medicine, at Hyderabad’s Apollo Hospitals, concurs.

He says that for undergraduate students, about two weeks of their course are set aside for casualty/emergency training which happens in these departments. With the new notification, students won’t have access to this.

Dr Jeetendra Sharma, Chief of Critical Care & Medical Quality at Gurugram's Artemis Hospital, also points out that these are departments where “hands-on experience and practical skills” are of utmost importance.

He adds that there’s only so much you can learn in theory when it comes to emergency medicine. 

NMC's notification released in 2020.

NMC's notification released in 2020.

But, There's Also No Clarity

However, Dr Anant Bhan, a public health expert, puts across a cautionary note:

These departments have not been done away with. They will probably be covered under the General Medicine unit for undergraduate students, and hospitals would have these departments for regular functioning, he maintains. 

The 2023 notification by the NMC mentions that hospitals need to have an Intenstive Respiratory Care unit.

Dr Rajesh Sharma, Former Joint Director, Department of Health, Government of Chhattisgarh, agrees with Dr Bhan. He says that specific emergency treatments are anyway taught under each subject. “As far as respiratory diseases are concerned, they are taught in Medicine and ENT.”

But the other doctors fear that "hands-on training will take a hit."

All hospitals need to have a casualty, emergency department, the 2023 notification reiterates.

Why Is This a Cause of Concern?

Dr Subhan says that it seems like “lessons have not been learnt from COVID-19.”

Dr Sharma agrees. He tells FIT:

“In unprecedented situations like COVID, when doctors from all specialisations are rolled into emergency care, how will the future batches of students be able to help when they don’t even know anything about emergency medicine or respiratory medicine?”

Dr Sadhwani has the same concerns. She goes on to add that when respiratory medicine won’t be a separate dedicated paper anymore, that might lead to a lack of interest for students in the subject.

She fears that in the longer run this might mean fewer students opting to specialise in it, fewer seats at the postgraduate level, and then fewer doctors of respiratory medicine in the country.

“In such a scenario, India might lag behind in advancements in the respiratory medicine field down the line.”

Dr Charu Sadhwani

What Next?

This notification comes at an important point because just three years ago, when the pandemic hit, emergency and respiratory medicine were the two departments that saw an overwhelming amount of cases.

It’s also important because India has set 2025 as the target year to eliminate tuberculosis, which is five years ahead of the global goal. The Global TB Report in 2022 had highlighted that India accounts for 28 percent of all TB cases in the world. 

In such a scenario, doctors fear that medical students not being taught intensively about respiratory diseases might be concerning.

“NMC should sit down with all stakeholders to formulate better policies. Emergency care is important for doctors from all domains. Deletion of the emergency medicine department from the mandatory list of departments for medical colleges is a negative step for the growth of emergency medicine specialty in India.”

Dr Imron Subhan, Senior Consultant and Head, Emergency Medicine

In fact, Dr Sharma feels that the absence of both these departments is something to be gravely concerned about for students.

"A medical college that doesn’t have an emergency department is a grossly inadequate medical facility."

Dr Jeetendra Sharma

Did The NMC Notify Any Other Changes to Medical Colleges?

• Seats capped at 150 for undergraduate medical students in each batch.

• Medical colleges can have two different campuses (for departments or hostels) that are within a 30-minute distance from each other.

• Yoga department has been recommended.

• Biometric-based attendance system will be made available to all staff members.