Bridging the gap: Revolutionising post-graduate medical education in India

India, with more than 1.4 billion, will be the most populous country in the world for the foreseeable future, according to the United Nations population forecast. This massive population presents a major challenge in delivering quality healthcare, with a critical shortage of doctors and health workers in the country, particularly in rural areas. According to a recent report by the Government shared with Parliament, India has achieved a doctor-patient ratio of 1:834, better than the prescribed norm of one doctor for every 1,000 people set by the World Health Organization. However, in most parts of the country, the need for medical professionals is still far outstripped by the supply, and the rural areas suffer the most.
Despite an 82% rise in the number of medical colleges, from 387 in 2014 to 706 in 2023, and a 112% increase in MBBS seats, the gap remains stark. India has made commendable strides in expanding medical education, but the path forward, particularly in post-graduate (PG) medical education, presents unique challenges. The main problem is that many MBBS graduates do not get the opportunity to pursue further specialisation, leading to a significant shortfall of highly trained specialists. This trend has critical implications for healthcare delivery in India, where the need for specialised doctors is growing alarmingly.
Additionally, medical colleges in India are unevenly distributed geographically, so most are established in southern states, which worsens students’ lack of access to quality medical education outside that area. The curriculum focuses less on critical issues such as medical ethics, health economics, and behavioural sciences. Besides, research in medical colleges is often conducted as a formality with little focus on the importance of its value, impact, or any other outcome.
In response, the Government of India, in collaboration with the relevant medical institutes, is initiating many forward-looking reforms aimed at improving PG medical education, expanding seats, and enhancing the quality of education to meet the demands of a growing population.
The growing demand for highly qualified medical professionals has, in turn, led to an increased focus on the quality and quantity of medical education in the country. The Government of India has sanctioned 157 new medical colleges in the form of Centrally Sponsored Schemes (CSS) to upgrade district and referral hospitals, out of which 109 are already functional. The Government has also increased the MBBS and PG seats at all existing medical colleges, which is continuing to record an enormous increase in available slots for medical professionals.
The Government’s move to establish six new AIIMS in underrepresented regions is yet another positive step toward achieving tertiary-level health care and eliminating regional imbalances. Medical institutions’ spatial and geographic distribution still lies at the heart of proportionate healthcare accessibility across the country.
Moreover, Super Specialty Blocks under Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) has sanctioned 75 projects and completed 66. In addition, 22 new AIIMS institutions have been sanctioned with courses in place at 19 locations.
Simulation-based education (SBE) is emerging as an integral part of medical education training. In this regard, institutions such as JSS AHER Skill and Simulation Centre and Sri Ramachandra Institute of Higher Education and Research (SRIHER) are using virtual reality to create an immersive, hands-on experience for students.
The National Medical Commission (NMC) has mandated skills training using simulation in undergraduate education and recommended its use in PG programs. This revolution in medical training allows students to practice in a controlled, realistic environment, reducing the risk of patient harm.
Additionally, the rise of virtual learning and gamification strategies is enhancing student engagement. Curricula now feature interactive technologies to intensify students’ interest, including polling functions, virtual environments, and the flipped classroom model. These digital tools provide students access to global education standards, enhancing their problem-solving and decision-making capabilities.
Building on the international reforms, the Indian Medical Council (now NMC) introduced a new curriculum of Competency-Based Medical Education in 2019. CBME was designed to teach medical content and equip the graduates with crucial skills in ethics, communication, and patient-centred care. Under undergraduate training, the introduction of the AETCOM module, attitudes, ethics, and communication is a huge leap towards humane and ethical medical professionals.
CBME’s focus on performance, rather than mere competence, represents a major paradigm shift. Tools like workplace-based assessments (WPBA) allow medical professionals to be assessed in real-time settings, allowing for more nuanced feedback. This system encourages continuous learning and growth, ensuring that trainees acquire and apply medical knowledge effectively in real-world scenarios.
Recently, the NMC received recognition from the World Federation for Medical Education, making history of medical education in the country. For the first time, graduates of Indian medical education will be able to pursue PG training and practice thereafter in countries like the United States, Canada, Australia, and New Zealand. Most importantly, this accreditation will ensure that all 706 existing medical colleges in India and any new college established over the next decade will have international standards.
Apart from this, some Indian hospitals and universities also collaborated with international institutions to provide PG medical education. Max Healthcare has collaborated with the Joint Royal College of Physicians Training Board of the UK to offer a three-year PG course in medicine. Similarly, Kasturba Medical College and Apollo University have collaborated with institutions abroad and provided opportunities to its students for clinical rotation and internship, which will improve student’s exposure in the world arena.
To address the acute shortage of qualified teaching faculties, the government has recognised the Diplomat of National Board (DNB) qualifications for faculty appointments, which has increased the availability of teaching faculty. The age limit of appointment to a teacher or dean in a medical college has been raised to 70 years so that experienced professionals may continue to contribute to the nation’s medical education.
In parallel, faculty development programs have been introduced, and simulation societies are actively working to educate teaching staff across healthcare disciplines. Technology, such as virtual learning platforms and interactive technologies, has been incorporated to enhance teaching methods.
The future of PG medical education in India lies in incorporating new strategies to address the growing healthcare needs of the population. One such strategy is achieving a balanced inter-specialty distribution of MBBS-to-PG medical education, with a 70:30 ratio between clinical and non-clinical seats. These should be well represented in the health care system to meet clinical and public health demands.
We must encourage the use of technology more intelligently through artificial intelligence, virtual learning, and simulation-based studies to prepare future Indian healthcare providers. International collaborations must also be amplified so that Indian medical professionals get international exposure and learn the best practices worldwide. An emphasis on performance-based assessment rather than merely outcomes-based competence is needed for quality improvement in PG medical education. Tools like workplace-based assessments, clinical encounter cards, and DOPS can give rich feedback to the trainee concerning his real-world competency in practice.
In conclusion, post-graduate medical education is on the right track with enhanced Government support, adoption of innovative educational tools, proper international alignment, and faculty development. These efforts will ensure the supply of skilled professionals to meet the country’s healthcare demands and also place India at the forefront of global medical education. As these solutions take root, the future of healthcare in India looks increasingly promising, bridging the gap between current limitations and future potential.
(Author HS Chhabra is National President, Association of National Board Accredited Institutions. Views expressed are personal.)