From colonial heritage to modern issues: The development of medical education in India

INTRODUCTION India, one of the world’s oldest civilizations, boasts a rich cultural and healthcare legacy. Medical education in the country has evolved significantly from ancient traditional healing systems to a comprehensive and modern framework of medical training. Deeply rooted in age-old knowledge and influenced by colonial rule and post-independence reforms, India’s medical education system has continually adapted to meet the nation’s diverse healthcare demands. The historical interactions between India and its colonial rulers offer valuable perspectives on how these cross-cultural exchanges influenced the region’s development of medicine and medical education. BRIEF HISTORY OF INDIAN SYSTEMS OF MEDICINE The history of medical education in India dates back to the Vedic period, when Ayurveda, the indigenous system of medicine, was systematically taught. The Charaka Samhita and Sushruta Samhita, composed around 600 B.C., were foundational texts covering diagnosis, surgery, and pharmacology principles. Medical knowledge was transmitted orally or through gurukuls, where students learned under the guidance of experienced physicians. The Siddha system of medicine, similar to Ayurveda, is more prevalent in southern India and focuses on herbal preparations. Unani medicine originated in Greece and was introduced to India by Muslim rulers. It is still practiced in certain parts of northern India.[1] AYUSH SYSTEMS OF MEDICINE Ayush is a short form of various systems of Indian medicine that has been followed in India for quite some time. It includes Ayurveda, Yoga, Unani, Siddha, and Homeopathy. India continues to uphold its indigenous medical systems alongside modern medicine. Currently, India has 3,100 Ayurveda hospitals, 300 Homeopathy hospitals, 200 Siddha hospitals, and 250 Unani hospitals. The government has promoted these systems through the Ministry of Ayush, ensuring their integration into mainstream healthcare. BRIEF HISTORY OF THE INTRODUCTION OF THE WESTERN SYSTEM OF MEDICINE IN INDIA Western medicine was first introduced in India by the Portuguese in the 16th century, followed by the East India Company in the 1600s, which brought medical officers to care for British troops and personnel. By 1775, hospital boards comprising “Surgeon Generals” and “Physician Generals” were established. The foundation of the Native Medical Institution in Calcutta in 1822 marked the beginning of formal Western medical education in India. This was further advanced with the establishment of Calcutta Medical College in 1835, which replaced traditional medical teachings with a European-style curriculum. Similar institutions emerged in other regions, including Grant Medical College in Bombay (1845) and Madras Medical College (1835). In recent years, India has experienced remarkable growth in medical education. A decade ago, there were approximately 381 medical colleges in the country; today, that number has exceeded 700. Correspondingly, the number of MBBS seats has more than doubled—from 50,000 to over 1,07,000—while MD/MS seats have surged from around 25,000 to over 65,000. This expansion underscores India’s commitment to enhancing its healthcare infrastructure and doctor-patient ratio. ROLE OF MEDICAL COLLEGES DURING THE COVID-19 PANDEMIC The COVID-19 pandemic underscored the importance of medical colleges in India’s healthcare system. These institutions were pivotal in testing, treatment, and vaccination efforts. They were converted into COVID hospitals, quarantine centers, and testing laboratories, helping manage the crisis. Medical students and faculty members worked on the front lines, providing critical care and participating in vaccination drives. The pandemic also accelerated digital transformation in medical education, with online classes, virtual simulations, and telemedicine becoming integral to medical training. NATIONAL ELIGIBILITY CUM ENTRANCE TEST (NEET) A major reform in medical education was the introduction of the National Eligibility cum Entrance Test (NEET) as the sole entrance examination for medical colleges in India. NEET was implemented to replace multiple state-level and private medical college entrance exams, ensuring transparency, uniformity, and merit-based admissions. Key aspects of NEET A single, centralized entrance test for all medical aspirants in India, ensuring fairness in selection. Removal of capitation fees and streamlining of admission procedures in private medical colleges. Bringing medical education under one regulatory framework reduces discrepancies between states. Heightened competition resulted in the admission of more well-prepared students into medical colleges. Apprehensions regarding the NEET examination Although NEET has simplified the admission process, it has also sparked concerns about the rise of coaching culture, increased student stress, and limited accessibility for candidates from rural areas. The southern state of Tamil Nadu has even approached the courts to challenge NEET as a single centralized entrance exam for medical courses. Despite these issues, NEET represents a major move toward the standardization of medical education in India. IMPLEMENTATION OF COMPETENCY-BASED MEDICAL EDUCATION To improve the quality of medical education, the National Medical Commission (NMC) introduced the Competency-Based Medical Education (CBME) program for undergraduate students.[2] Key features of CBME include: Early clinical exposure to enhance practical learning. Integration of ethics, communication skills, and professionalism into the curriculum. Competency-based assessments rather than just theoretical exams. Emphasis on research and problem-solving. The blending of modern and traditional medicine to provide holistic care. This shift marks a move towards producing well-rounded, patient-centric doctors. Medical education in India is at a critical juncture. The rapid expansion of institutions and seats, the standardization brought by NEET, and the integration of traditional and modern medicine signify a promising future. The response to COVID-19 has showcased the resilience of medical colleges, while the adoption of CBME ensures a more competent generation of doctors. However, addressing faculty shortages, ensuring quality control, and bridging infrastructure gaps are essential. As India progresses, it must balance expanding capacity and maintaining high standards to ensure its medical education system aligns with global benchmarks and effectively serves the country’s diverse healthcare demands.[3] In conclusion, the authors believe that the current Indian medical education system can compete with the finest globally. The doctors it produces possess the knowledge, skills, empathy, and resilience required to work tirelessly, making them among the best in the world. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.