Reform Medical Education to Usher Healthcare Reforms in India

By Dr. Lavanya Pragada, MBBS, MHA

As I transition back to India after studying healthcare management in the US, I’ve been actively working to realign and update myself with the Indian healthcare system. And of the many healthcare reforms that have been happening over the past 10 years, it was shocking to see that medical education remained largely untouched. And no, the National Exit Test (NExT) does not address any of the real issues. 

As a doctor and an aspiring healthcare leader, I firmly believe that the crisis in Indian healthcare goes beyond infrastructure or funding, it's fundamentally rooted in how we educate our doctors. 

The current medical system is outdated and disproportionately focused on rote learning, rather than fostering critical thinking and practical skills. It reflects a growing rigidity and bias, heavily swayed by pharmaceutical and other corporate interests. 

A lot of what is studied in medical colleges rarely translates to skills needed during internship or what’s necessary to be able to give basic treatment. I still remember working so hard during medical college, earning my “Dr” title and feeling utterly useless when I joined as a Medical Officer. While this is accepted as the norm, I choose to question why we are blindly following this ancient institutional approach. When the country is facing a shortage of doctors, it is wise to empower doctors regardless of hierarchy. The imposter syndrome to me, feels like a way to continue the business of medical education through knowledge/skill limitations. 

Medical education in India and globally, is often shaped by systemic biases that favor pharmaceutical and business narratives. Doctors often develop a clinical mindset where medication and surgery are seen as the default solution, and other holistic, non interventional approaches are viewed through a skeptical lens, or worse even labeled quackery. I don’t even want to get started on how underemphasized nutrition is, because of the lack of corporate support. 

Moreover, the curriculum places little focus on essential skills that shape a holistic view of health, like healthcare communication, policy, systems thinking, or the social determinants of health. Future doctors are often unaware of how national policies, budget allocations, insurance schemes, and political priorities shape patient outcomes and access to care. Though these topics may surface in casual discussions, few have

the evidence-based understanding required to engage with them meaningfully. It wasn’t until I pursued a Master’s degree that I began to grasp the broader picture of health. Prior to that, even as a practicing doctor, my understanding of health was unfortunately narrow and, in many ways, harmfully limited. 

All this is aggravated by memorization systems, without which vast amounts of textbooks will leave you failing medical college. This dangerous approach pushes doctors into a culture where critical inquiry and deep observation are stifled and they become immune to ethically questionable practices. Doctors may either dismiss patient concerns outright or unknowingly reinforce industry narratives, further widening the trust gap between the healthcare system and the people it serves. 

In an era where medical knowledge doubles every few years, it feels like the current medical education system in India is minting corporate-driven encyclopedias rather than molding patient-centered doctors. 

Inherited ambitions and glorified misconceptions lead to the making of half-hearted healers. 

A survey by Mindler (2019) revealed that 93% of Indian students are aware of only seven career options, despite there being over 250 viable career paths. This limited awareness often funnels students into traditional fields like medicine, influenced by societal norms and perceived job security. 

Supporting this, a 2018 study titled "Factors Influencing Medical Students in Choosing Medicine as a Career" found that strikingly, 40.4% of students chose medicine not out of personal passion or purpose, but due to pressure or influence from parents and family members. 

Another study titled "Attitude of the First Year Medical Students Towards Medicine as Career: Motivations and Apprehensions of Being a Doctor" (2021), conducted among first-year MBBS students in North India, found that 72% of respondents cited high earning potential as a major motivation for pursuing medicine. However, this belief often clashes with reality. According to various surveys and reports, the average starting salary for a government-employed MBBS doctor in India ranges between ₹50,000 to ₹70,000 per month, and private sector salaries can be even lower for entry-level roles. This is far lower than many “respectable” professions. Moreover, it can often take a decade or more of specialization and practice before doctors begin earning incomes that match their initial expectations and pay off their debts.

The extent of people today who really want to be doctors and understand the depth of responsibilities and extent of possibilities is low. The lack of purpose and harsh reality often derail young doctors towards long term dissatisfaction. Their primary motivation shifts from healing to earning, from serving to surviving. I myself have been a victim of 

this system of disillusion that continues to haunt brilliant young minds. 

Medical Colleges - Worlds of Learning and Healing. Sorry, I meant - Playgrounds for bullies, politicians and predators- are slowly destroying healthcare. 

Welcome to the secret world of doctors - Shh don’t tell anyone else, I might be ragged for life. My Head of department might fail me. Or worse.. 

When hierarchy turns into exploitation, power turns into privilege, gender becomes a liability, and threats lurk around every corner, how many “red-stained white coats” really focus on their passion or purpose? How many “victims” are really interested in patient care and healthcare reform? If harm begins within the system, how can healthcare stand resilient against threats from outside? 

When you combine biased education, unmotivated students, and a systematically abusive environment, you don't get doctors, you get traumatized individuals with medical degrees. 

Doctors need to lead Change in Healthcare, because they understand it better than anyone else. 

Despite the many limitations of the current medical system, doctors remain the ones with the expertise and lived experience to truly understand what needs to change. 

However, meaningful change can only be driven by doctors who are highly motivated, intellectually curious, ethically grounded, and professionally courageous. These are the doctors who can see through misinformation and resist being swayed by corporate or political agendas. They are emotionally resilient. And most importantly, they are not content with surviving the system, they are compelled to change it. 

But for such doctors to emerge and lead, the transformation must begin at the root: our medical education system. If we want doctors who can challenge outdated systems and lead healthcare into a new era, we must empower them from the start. 

Healthcare cannot be reformed from the outside in. It must be rebuilt from the inside out and it starts by rethinking how we educate the very people we trust to care for our lives. 

Call to Action: Let’s Rebuild Medical Education that’s - intentional, relevant, holistic and safe.

● National career guidance system: Introduce aspirants to the realities of medicine and other abundant career options through a national career guidance system that students take before they finish school. 

● Reimagining selection criteria: Selection criteria must be able to filter candidates based on passion and purpose. Take a page from other successful countries and organizations through holistic profile matching and interviews. 

● Curriculum and Assessment Reform: Medical Education must be geared towards being more holistic with emphasis on preventive medicine, communication skills and infused with critical thinking modules and exposure to policy, systems thinking and relevant research. Curriculum must be intentionally strengthened to allow graduating doctors to be able to practice according to limitations but confidently. 

● Assessment: Relying solely on the shift to MCQs to assess competency will not bring about the necessary change in how we evaluate medical professionals. A more holistic approach is required, one that tests not only clinical knowledge but also communication, research, and problem-solving skills. What’s crucial here is to enrich the educational system with faculty who are equipped to foster, develop and assess these skills. Without investing in educators who can guide students through these multifaceted dimensions of competency, the curriculum changes will not be enough. 

● Safety Solutions and Culture Shifts: This is definitely a long process, I hope not too long. But we must strive patiently to facilitate culture shifts in medical colleges. To me, this starts from top to bottom. We must be able to promote this among medical education leaders, administration and then faculty. Then only can this trickle down to students and legacy thereafter. We must also ensure the safety of all medical professionals with zero tolerance for abuse. Investments must be made to have sustainable systems for monitoring, reporting and swift justice. I honestly do not have concrete solutions for this. Only hope and determination. 

As I write this piece, I recognize that my analysis may have limited impact, and my proposed solutions may not seem comprehensive. But here's what I've learned through my own journey: change doesn't require perfection; it requires courage to begin. Every doctor who questions the status quo - they are all part of a movement that's quietly growing. 

My message is simple yet vital: Empower doctors, and they will empower healthcare. Transform medical education, and healthcare transformation will follow.

References:

1. Mindler (2019). “Indian Career Aspirations: Seven Career Options Dominate.”

2. Factors Influencing Medical Students in Choosing Medicine as a Career. (2018).

3. Attitude of the First Year Medical Students Towards Medicine as a Career: Motivations and Apprehensions of Being a Doctor. (2021).