Journal of Medical Sciences and Health

A Few Steps Forward And A Few Steps Backward

The 2017 Amendment[1] is noteworthy for it states that to be eligible for assessment, a paper must be published in “indexed” journals. This appears to be a step in the right direction because indexing indicates that a journal meets certain standards and quality within a specialty, specific to a particular index. However, in this amendment, the MCI has not specified any particular index(es). Thus, possibly the list of indexes previously specified in its 2015 order will continue to apply. Let us look at this issue more closely. Accepting only the MEDLINE-indexed journals would exclude some research invaluable allied fields such as medical humanities, basic sciences, and social sciences as applied to medicine. Thus, the inclusion of other indexes may be useful for recognizing these diverse- related disciplines beyond the pure health sciences, although with due diligence. For example, some indexes have little credibility as they are known to include pseudojournals (also known as “predatory journals”) in their listings. Hence, it is important that MCI specifies only those indexes which are reputed to have quality journals. The 2015 MCI list of eligible indexes has been faulted on this score.[5] Aggarwal et al.[5] had suggested the following list of acceptable databases: Medline, PubMed Central, Science Citation Index, Embase/Excerpta Medica, Scopus, and IndMED. The latest amendment missed out on an opportunity to revise the list of eligible indexes.
The amendment does not specify whether or not papers published in “e-only” indexed journals are acceptable for assessment. Here too, possibly the stipulation in the 2015 order, that e-journals, are not included, will continue to apply. Currently, many e-only journals (e.g. PLos group, BioMed Central, etc.) are comparable in quality to, and at times even better than, those published as hard copy. Their inclusion would allow a much wider range of journals for the faculty to choose from for publishing their work.
Unfortunately, as with Regulations, 1998,[2] the 2017 Amendment[1] also limits the credit for authorship to only some of those listed on the author byline. Unlike the first version in which those listed as the first and the second authors was eligible, the amendment gives the credit for a paper to only the first author and the corresponding author. As critiqued earlier, this approach inhibits collaborative research and could be counterproductive by undermining the advancement of knowledge. Some of the best research today is multidisciplinary and multiauthor.

Problems Untouched

The MCI regulations, even after the recent amendment,[1] are problematic in other aspects too. These lay down two criteria to assess a candidate’s eligibility for a particular position: Duration of service and number of research publications. One would expect the parameters assessed during appointment and promotion to be aligned with the responsibilities of teachers in medical colleges, with a strong convergence, suggesting appropriateness and sufficiency of the criteria. In clinical or paraclinical departments, medical teachers have three primary activities; providing clinical or laboratory/imaging service, teaching, and doing research; which vary for different specialties. However, in most medical colleges, irrespective of specialty, the research activity forms a small part of the total work of a medical teacher. Hence, any assessment of only research output without an assessment of the other two domains does not appear to be reasonable. What about the other two activities? Provision of clinical or laboratory services and teaching is integral to the core work of a medical faculty member. The assessment, if any, of these domains, is only by the years of service put in. This appears unfair. The MCI regulations should address the issue of assessing medical faculty in all the three activity domains. Undue focus on research and not on the other two domains might prove to be detrimental both to the training of medical students and to clinical work.
Failure of the faculty to do research is a well- documented problem in Indian medical colleges. It has been argued[6] that this is due to commercialization of medical education in the country. However, we believe that this phenomenon is multifactorial. One major reason may be a lack of interest and training to do research on the part of the teachers or of lack of infrastructure to facilitate research on the part of the institutions. Furthermore, good research requires financial resources - and most of the institutions, whether funded publicly - or privately have no or little funds dedicated to this activity. These factors may need to be corrected first before we can expect research to be an important criterion for assessing eligibility for appointment and promotion of medical teachers.
Lack of adequate funding too discourages the MCI’s approach. India has nearly 450 medical colleges. Let us assume that each college has around 100 teachers and that each of the nearly 45,000 teachers needs to publish a research paper every 3 years. This translates to around 15,000 research papers a year. In addition, around20,000studentsjoinamedicalpostgraduate course every year in the country, and each of them has to write a thesis. Let us assume the “most optimum” case scenario - that each thesis results in a paper with a student and his teacher - guide as the two eligible authors. Even with this unlikely scenario, we would require to generate at least 20,000 new research ideas every year - a formidable task. For these research works to be novel and publishable, a large proportion of these ideas would need funding - which is currently not available.
Another important consideration is whether there are sufficient peer-reviewed, “indexed” journals to publish this large body of work. The requirement to publish by teachers in Indian medical colleges and universities has seen a proliferation of “predatory journals” in India.[7-9] We are not arguing that research may be altogether abolished as a criterion for eligibility and assessment of medical faculty. It is known that good research institutions globally and in India are sought after by students and patients alike, as these are considered better centers for learning and providing a better quality of care. However, whether the quality of teaching and patient care can necessarily be improved by mandating research of whatever quality remains uncertain.
Thus, it is not reasonable to make an assessment for promotion of a medical teacher solely on the basis of research activity - that too by counting the number of publications.

The Way Forward