Standardization of graduate and postgraduate training program and public–private partnership in pathology in government medical colleges of India

Dear Editor,

Competency-based medical education program has brought a paradigm shift in the MBBS training curriculum in India. The broad specialty-wise postgraduate training program is also getting regulated across the country and is predominantly outcome-oriented. Guidelines for competency-based postgraduate training program for MD in Pathology have been released by the National Medical Commission.^[1] The guidelines are broad, comprehensive, and all inclusive. Three months of district residency program in the district health system for PG students is mandatory from 2021 batch onward. The purpose of the new regulations is to standardize undergraduate and postgraduate teaching and bring uniformity throughout the country. The services of teaching, research, and patient care are largely delivered by the federal states run medical colleges in India. Among 672 medical colleges in India, over 391 colleges are offering postgraduate course in Pathology. Nearly 50% of these colleges are in government sector.^[2,3] In addition, many government hospitals are offering DNB Pathology courses, which is equivalent to MD Pathology. The availability of infrastructure for carrying out basic and advanced investigation in the pathology departments of state-run medical colleges and hospitals offering DNB courses is not uniform. The investigations like frozen section, cytocentrifuge or cytospin, liquid-based cytology, immunohistochemistry, immunofluorescence, and high-performance liquid chromatography are not available in most of the medical colleges.^[4]

All these investigations should be available in all the medical colleges offering postgraduate courses. Additional finances should be made available to the medical education department for procurement of expensive equipment and performing of the minimal panel of advanced investigations. Public–private partnership in diagnostic services like radiology, laboratory medicine, and pathology has been a cost-effective and capacity-building measure for the increasing healthcare needs in government medical college hospitals across the country.^[5] Involvement of the private laboratories is the supplementary strategy to augment already cost constrained, overburdened government hospitals. Under the National Health Mission, free diagnostics scheme was launched for accessible, quality, and affordable. Public–private partnership in diagnostics have expanded over the last few years in the states of Arunachal Pradesh, Assam, Delhi, Himachal Pradesh, Jharkhand, Maharashtra, Manipur, Meghalaya, Odisha, Tripura, and Uttarakhand.^[6] However, this initiative has its disadvantages particularly, if implemented in a government teaching institution. Firstly, this agreement between the government and private laboratories does not allow long-term planning, capacity building, to take place in the pathology departments of government medical colleges. Secondly, the teaching material available for the training of postgraduate residents may be limited and inadequate as a significant volume of the patient samples are sent to the outsourced private laboratory. Thirdly, the subject material for thesis purposes of the postgraduate residents and for research activities in an academic institute may be insufficient.

Thus, efforts must be made in improving infrastructure and provide comprehensive services by the pathology departments of state-run medical colleges. It is desirable that pathology departments in government medical colleges and secondary care hospitals should work in a hub and spokes model. The medical colleges should act as the hub and peripheral institutions as a spokes. Public–private partnerships should act in a synergistic model and not as a replacement of investigation specialties in a postgraduate teaching hospital. Accreditation by the regulatory bodies like National Accreditation Board for Testing and Calibration Laboratories (NABL) is a welcome step for improving the reliability of pathology reports.

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