No provisional registration for foreign medical graduates without clinical training in India: Supreme Court

The Supreme Court on Friday held that medical students who studied abroad cannot be granted provisional registration to practice in India without undergoing practical clinical training [The National Medical Commision v. Pooja Thandu Naresh and ors]..A Bench of Justices Hemant Gupta and V Ramasubramanian held that the decision of the National Medical Commission to not grant provisional registration to such students without clinical training was not arbitrary."...without practical training, there cannot be any Doctor who is expected to take care of the citizens of the country," the judgment stated..However, the Court noted that students who have completed their curriculum according to the certificate granted by the concerned foreign institutes are "national resources" who should be utilised to augment the national health infrastructure."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," the judgment stated..Therefore, the top court held that such students must undergo clinical training for the duration and at institutions which are identified by the National Medical Commission (NMC)..The judgment was passed in an appeal moved by the NMC against the decision of the Madras High Court which allowed the respondent-students who joined MBBS courses in medical colleges in the People's Republic of China, to be provisionally registered and undergo internship.The students claimed that they had completed nine semesters of their course, including the clinical course on campus during the ninth semester. However, due to the outbreak of the COVID-19 pandemic, the clinical training for the subjects of Ophthalmology, Otorhinolaryngology and Nuclear Medicine in the 10th Semester was done online. Subsequently, they were given their MBBS degrees by the foreign institute. The respondent students claimed that they are qualified doctors who had cleared the Indian Screening Test. Despite this, the NMC declined to grant them provisional registration. However, they admitted that they had not undergone practical and clinical training in the physical form, but had undergone the course through online mode for the entire duration. This satisfied the requirement under Regulation 4(3) of the Screening Regulations, it was contended..NMC contended that in terms of the Regulations, a student has to study the medical course in the same institute located abroad for the “entire duration”. Moreover, it was argued that clinical training cannot be imparted through online mode, as it involves diagnosis and physical interactions with patients. .The Supreme Court held that the NMC is not bound to grant provisional registration to the respondent as she has not completed the required clinical training. Qualifying under the Screening Regulations is not proof to showcase clinical experience, the Court said. "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," the top court observed..Even considering the pandemic situation which forced students to return to India before completing their clinical training abroad, the Court held that they cannot be granted registration without practical training."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 Bench held..However, Senior Advocate Vikas Singh, appearing on behalf of the NMC, submitted that in light of the Ukraine crisis and the pandemic, there are many students who are suffering and, therefore, their interest must be safeguarded without compromising on the quality of education. Taking note of the submission, the Bench passed the following directions to the NMC while disposing the appeal: Frame a scheme within two months for Indian medical students studying in foreign countries who are not able to complete their clinical training outside India due to inadvertent circumstances, so that the quality of medical education is not compromised. Training must be undergone in Indian medical colleges which must be identified by the NMC. The duration and the cost shall also be determined by the NMC which shall be borne by the students. 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. .Senior Advocate S Nagamuthu appeared for the respondents. .[Read Judgment]