Tulip Kanth

April 30, 2022: Considering the realities of pandemic and the Ukraine crisis, the Apex Court has directed the National Medical Commission to frame a scheme within two months to allow Indian MBBS students studying abroad, who have not actually completed clinical training, to undergo clinical training in India in the medical colleges.

The Division Bench of Justice Hemant Gupta and Justice V.Ramasubramanian held, “It shall be open to the appellant to test the candidates in the scheme so framed in the manner within next one month, which it considers appropriate as to satisfy that such students are sufficiently trained to be provisionally registered to complete internship for 12 months.”

The appeals in question were directed against the orders passed by the Madras High Court in the writ petitions filed for quashing the circulars issued by the Tamil Nadu Medical Council and consequential orders of directing first respondent/writ petitioner (students) to undergo two months of Compulsory Rotatory Residential Internship (CRRI), followed by one year of internship before granting permanent registration under the Indian Medical Council Act, 1956 (now repealed by the National Medical Commission Act, 2019).

The brief facts leading to the present appeals were that the student and other similarly situated students after qualifying the eligibility test i.e. as per The Eligibility Requirement for Taking Admission in an Undergraduate Medical Course in a Foreign Medical Institution Regulations, 2002 (Eligibility Regulations) joined medical colleges in the People’s Republic of China, such as Qingdao University Faculty of Medicine (Foreign Institute).

It was the stand of the students that they have undergone nine semesters of their academic course including clinical training on the campus. However, due to the outbreak of COVID-19 pandemic, the clinical training for the subjects of Ophthalmology, Otorhinolaryngology and Nuclear Medicine in the 10th Semester was done online and that they have been granted degree of Bachelor of Medicine & Bachelor of Surgery (MBBS) after qualifying in all the subjects as per the teaching plan till May, 2020 by the Foreign Institute.

According to the student, some of her fellow students have been granted provisional registration by the Tamil Nadu Medical Council but she had been declined such provisional registration which led to filing of writ petitions before the High Court. The argument was that since she has been declared qualified by the Foreign Institute, the only requirement before provisional registration is qualifying in the Screening Test in terms of the Screening Test Regulations, 2002 (Screening Regulations). As she has qualified such a Screening Test, therefore, the condition in the statute read with the Screening Regulations stood satisfied. Hence, the decision of the Medical Council not to grant provisional registration was not justified in law.

According to the Bench, the Eligibility Regulations are to ensure that a student meets the minimum eligibility condition as per the Graduate Medical Education Regulations, 1997, but after completing the curriculum, a candidate has to qualify the Screening Test, provided the entire duration of the course has been completed at the same institute located abroad. 

The question before the Court was whether the degree granted by the Foreign Institute even in respect of clinical training is binding on the appellant and the student has to be provisionally registered.The Bench found that the appellant was not bound to grant provisional registration to the student who had not completed the entire duration of the course from the Foreign Institute including the clinical training.

Taking note of the pandemic, the Bench opined that the pandemic has thrown new challenges to the entire world including the students but granting provisional registration to complete internship to a student who has not undergone clinical training would be compromising with the health of the citizens of any country and the health infrastructure at large.

Observing that the medical course is permitted to be completed abroad to practice in India only on the basis of an endorsement that the completion of such medical course entitles them to practice in the said foreign country, the Bench remarked that the courses are designed in such a way to attract students to undertake admission in the Foreign Institutes so that such students, become eligible to practice medicine in India. 

The Bench said, “The very framework of the Regulations was compromising the interests of the Indian nationals and the health infrastructure in India. However, the malice has been corrected by the 2021 Regulations but such Regulations are not applicable to the students who have taken admission in the Foreign Institutes prior to 18.11.2021.”

On the issue of students completing clinical training through online mode. The Top Court referre to its judgment in Orissa Lift Irrigation Corporation Limited v. Rabi Sankar Patro & Ors. (2018) 1 SCC 468 wherein the degree in the discipline of engineering was being conferred by online method as part of distance education course. This Court held that the practicals form the backbone of such education which is hands-on approach involving actual application of principles taught in theory.

Therefore, without practical training, there cannot be any Doctor who is expected to take care of the citizens of the country. Hence, the decision of the appellant not to grant provisional registration cannot be said to be arbitrary, added the Bench.

According to the Bench, the argument that if a student has a right, then such right can be enforced independent of the order passed by the courts is not tenable. Qualifying in the Screening Regulations is no proof of the clinical experience, if any, gained by the students. The Screening examination is based upon Optical Mark Reader (OMR) answers and has no correlation with any practical training. Thus, the Apex Court did not find that in terms of the Screening Regulations, the students are entitled to the provisional registration.

The Apex Court held that it  would be necessary that the students undergo actual clinical training of such duration and at such institutes which are identified by the appellant and on such terms and conditions, including the charges for imparting such training, as may be notified by the appellant.

Saying that the Courts are not expert in deciding an academic curriculum or the requirement of the clinical training which may be required to be satisfied by the students, the Bench was unable to agree with the High Court that instead of three months of clinical training in China, two months training would be sufficient for provisional registration apart from the 12 months of internship. 

Thus, the Apex Court directed the appellant, “to frame a scheme as a one time measure within two months to allow the student and such similarly situated students who have not actually completed clinical training to undergo clinical training in India in the medical colleges which may be identified by the appellant for a limited duration as may be specified by the appellant, on such charges which the appellant determines.

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