Medical Student Who Has Not Undergone Clinical Training Of Foreign MBBS Course Can't Be Granted Provisional Registration By NMC : Supreme Court

The Supreme Court has held that the National Medical Commission is not bound to grant provisional registration to a student who has not undergone clinical training in physical form a part of the medical course in a foreign medical institute.

The Court observed that a medical student who has not undergone clinical training cannot be granted provisional registration to complete internship.

"Without practical training, there cannot be any Doctor who is expected to take care of the citizens of the country", the bench comprising Justices Hemant Gupta and V. Ramasubramanian observed.

In this case, the medical students had undergone nine semesters of their academic course including clinical training in medical colleges in China. 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. The Tamil Nadu Medical Council declined provisional registration to some of such students which made them approach the Madras High Court. The High Court allowed their writ petitions.

The National Medical Commission approached the Supreme Court against the High Court verdict.

Before the Apex Court, the contention raised by the National Medical Commission was that the clinical training cannot be imparted through online mode as it is the actual training involving diagnosis and interactions with the patients and there cannot be any online clinical training which will satisfy the requisite condition of the Screening Regulations. The respondents on the other hand contended that acquiring primary medical qualification from the Foreign Medical Institute was acceptable for grant of registration. 

The court noted that the students have admittedly not completed clinical training which was part of the curriculum in the tenth semester. The court noted that the question that arises in this case is 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.

"We find that the Commission is not bound to grant provisional registration to the student who has not completed the entire duration of the course from the Foreign Institute including the clinical training", the court said.

No doubt, 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, the court added

The court also observed that the very framework of the Undergraduate Medical Course in a Foreign Medical Institution Regulations, 2002  was compromising the interests of the Indian nationals and the health infrastructure in India.

The students had taken admission in medical colleges outside India for the reason that they could not get admission in the medical colleges in India. China alone has a number of Institutes offering medical courses conducted in English language. The Act and the Screening Regulations are framed in such a way that the course completed by the students is treated to be valid in India provided that the medical qualification is recognised for enrolment of the medical practitioner in that country. Obviously, none of the Indian students are going to practice medicine in the foreign country, therefore, the grant of degree to the Indian students has no corresponding obligation that such students actually practice medicine in that country. In other words, 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 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 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

Regarding the students' claim that they have completed clinical training through online mode, the court noted that in Orissa Lift Irrigation Corporation Limited v. Rabi Sankar Patro & Ors.  wherein the degree in the discipline of engineering was being conferred by online method as part of distance education course, it was observed that the practicals form the backbone of such education which is hands-on approach involving actual application of principles taught in theory. 

"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.", the court  observed.

The court also added that the 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. We do not find that in terms of the Screening Regulations, the students are entitled to the provisional registration.", it said.

The bench also disapproved the view taken by 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. 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, it added.

At the same time, the Court issued certain directions to alleviate the pandemic-related problems faced by students with foreign medical degrees.

"..the fact remains that the students were permitted to undergo medical course abroad and that they have completed their curriculum according to the certificate granted by such Foreign Institute. Therefore, such national resource cannot be permitted to be wasted which will affect the life of young students, who had taken admission in the foreign Institutes as part of their career prospects. Therefore, the services of the students should be used to augment health infrastructure in the country. Thus, it would be necessary that the students undergo actual clinical training of such duration and at such institutes which are identified by the appellant(NMC)and on such terms and conditions, including the charges for imparting such training, as may be notified by the appellant(NMC)"

The court directed the NMC :

i) 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. 

ii) 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

Case details

National Medical Commission vs Pooja Thandu Naresh | 2022 LiveLaw (SC) 426 | CA 2950-2951 OF 2022 | 29 April 2022

Coram: Justices Hemant Gupta and V. Ramasubramanian

Counsel: Sr. Adv Vikas Singh for appellant, Sr. Adv S. Nagamuthu for respondent

Headnotes

Screening Test Regulations, 2002 - 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 - The decision of the National Medical Commission not to grant provisional registration cannot be said to be arbitrary - Qualifying in the Screening Regulations is no proof of the clinical experience, if any, gained by the students. (Para 16-21)

Eligibility Requirement for Taking Admission in an Undergraduate Medical Course in a Foreign Medical Institution Regulations, 2002 - National Medical Commission is not bound to grant provisional registration to the student who has not completed the entire duration of the course from the Foreign Institute including the clinical training. (Para 15)