Supreme Court W.P(C)No. 306 OF 2004 Second Counselling

CASE NO.:

Writ Petition (civil) 306 of 2004



PETITIONER:

Mridul Dhar (Minor) & Anr.



RESPONDENT:

Union of India & Ors.



DATE OF JUDGMENT: 12/01/2005



BENCH:

Y.K. Sabharwal, D.M. Dharmadhikari & Tarun Chatterjee



JUDGMENT:

J U D G M E N T



[With W.P. (C) Nos.308 and 345/2004]



Y.K. Sabharwal, J.



About two decades ago, on June 22, 1984 in Dr. Pradeep Jain &

Ors. v. Union of India & Ors. [(1984) 3 SCC 654], it was directed that

admissions in medical colleges or institutions run by the Union of India or

State Government or a Municipal or other local authorities for MBBS and

BDS courses to the extent of at least 30% shall be granted on the basis of

All India Entrance Examination and 50% in respect of post graduate

courses. The percentage of seats to be allotted on All India basis was

modified in Dr. Dinesh Kumar & Ors. (II) v. Motilal Nehru Medical

College, Allahabad & Ors. [(1985) 3 SCC 22] and in Dr.Dinesh Kumar &

Ors. (II) v. Motilal Nehru Medical College, Allahabad & Ors. [(1986) 3

SCC 727]. For MBBS/BDS courses, the All India Quota was directed to be

15% of the total number of seats and 25% of total number of seats for

post-graduate courses. The percentage of post-graduate courses has

been increased to 50% {Saurabh Chaudri & Ors. v. Union of India &

Ors. [(2003) 11 SCC 146]}. The higher percentage would be operational

from the academic year 2005 {[ Dr.Saurabh Chaudri & Ors. v. Union of

India & Ors. [(2004) 5 SCC 618]}.

The question whether the All India Quota of MBBS/BDS courses

shall be increased from its present 15% is one aspect but the real and

main aspect to be considered is about giving full effect to 15% quota by

including all seats while working out 15% quota and by strictly adhering to

the time schedule by the State colleges and institutions.

The aforesaid aspects come to light when this petition was filed on

10th July, 2004 by two students through their father, as legal guardian, they

being minors, apprehending that they may be deprived of seat in All India

Quota despite having secured fairly high ranking on merits in All India

Entrance Examination taken by about 2,00,000 students. It was, inter alia,

brought to the notice of the Court that various States had not complied with

the time schedule for completion of the admission process and had not

given full information to DGHS besides not taking into consideration many

seats while working out 15% All India Quota. On 29th July, 17

States/Union Territories through their Chief Secretaries and Secretaries of

their Health Department were directed to supply to the Director General

Health Services (DGHS), the requisite information as to the date of the

tests conducted by the States, the dates of first counseling and the dates

of joining of the candidates. This information was of paramount

importance as the second counseling for the allotment of 15% All India

Quota was to commence from 1st August. In absence of the requisite

correct information, meritorious students looking for admission in this

category on the basis of All India Entrance Examination could be seriously

prejudiced. The importance of the time frame has been noticed in brief in

the order dated 2nd August, 2004 which reads as under :

"In Regulations (Graduate Medical Education

(Amendment) Regulations, 2004 published in the

Gazette of India dated 1st March, 2004, a time

schedule for the completion of the admission

procedure for the First MBBS Course has been

provided for (Appendix E). The said time

schedule provides that the second round of

counseling for allotment of seats from waiting list

from All India Entrance Examination shall be filled

by the Central Government by 8th August. It also

provides that first round of counseling/admission

of seats filled up by the state/governments/union

territories/institutions shall be over by 25th of July

of each year. The time gap of two weeks

between the first round of counseling/admission

of seats by the State Governments/Union

Territories and second round of counseling for

allotment of seats from the All India quota seems

to have been provided for so that such of the

students who, in the first instance may have got

admission out of the allocation by the Central

Government, may change over to the seat

allotted by the state government/union territory so

that seats becoming available would be known by

the time the second counseling by the Central

Government is over. It appears that the second

round of counseling for allotment of Central

Government seats have already commenced with

effect from 30th July. It further appears that many

of the State Governments/Union Territories have

not even commenced the first counseling which

was required to be over by 25th of July. We direct

the State Governments/Union Territories to file

affidavits giving details of the dates of counseling

and the reasons for delay. We may note that

ordinarily the 15% seats of the quota under All

India Entrance Examination cannot be permitted

to be made ineffective and many of the seats

therefrom reverted back to the States/Union

Territories. The affidavits shall also be filed by

the Director General of Health Services, Ministry

of Health, Government of India as also by the

Medical Council of India. The petitioners are also

given opportunity to file additional affidavits. The

affidavits shall be filed within four days.

We wish and hope that at least by the next

date of hearing the first counseling by the State

Governments/Union Territories would be

completed."





On 9th August, 2004, it was directed that in whichever State, the first

counseling of the State quota seats in Government Medical Colleges is not

complete, it shall positively be completed by 20th August and latest by 21st

August, 2004, the seats of all India 15% that may become available as a

result of such counseling, shall be intimated to the DGHS, further directing

that all India 15% quota would not revert back to the State quota till further

orders, despite the fact that the second counseling of the all India 15%

quota may have been already over, its last date being 8th August, 2004.

On 31st August, 2004, it was noticed that out of 93 medical colleges

participating and contributing to 15% all India Medical quota, 15 colleges

had not supplied the requisite information and likewise out of 25 dental

colleges, five colleges had not supplied the said information. These

colleges were directed to supply the requisite information on that very day

by 9.00 pm to the DGHS. The requisite information was supplied as

noticed in the order dated 1st September, 2004. Out of 1550 MBBS seats,

122 seats had fallen vacant and out of 144 seats in dental colleges, 38

seats had fallen vacant. As a special case and without it being treated as

a precedent, the court permitted a limited continuation of the second

counseling so as to minimize the hardship to the students but not

permitting the continued second counseling to everyone but limiting it in

the manner stated in the order as under :

"The continued second counseling would be

confined to only those, as per merit, who have not

already been admitted in MBBS Course in any of

the Government Medical College in the country.

If a student has already been admitted there

would be no question of such a student being

permitted counseling again so as to change the

medical college with a view to get admission in

some other medical college. The students who,

as a result of the counseling already held, have

taken admission in Dental Colleges would,

however, be permitted to participate in the

counseling for getting a chance for admission in

the MBBS on their merit position. Further, as a

consequence, certain seats in Dental Colleges

may fall vacant. They would be given as per

merit in the ranking in the All India Quota. We

make it clear that those admitted in MBBS would

not be permitted to change the college. Those

who have taken admission in Dental College

would also not be permitted to change one Dental

College to another Dental College. The

information about continued counseling would be

given to all concerned by publication in electronic

and print media by DGHS. The continued

counseling must be over by 8th September, 2004.

The students must join by 13th September, 2004.

It is necessary to adhere to this schedule so that

the remaining unfilled seats can revert and be

filled by the State and only bare minimum number

of seats may lapse. The States shall also take

timely action so that the seats to a great extent

may not lapse and all the admissions and joining

by students are over by 30th September, 2004.

We make it clear that under no

circumstances, we are inclined to extend the date

beyond 30th September, 2004. The order shall

not be treated as a precedent so as to open

floodgates of litigation in other cases in the

country.

To consider the issue of further directions

for the next academic year, list the matter on 5th

October, 2004."





The aforesaid direction did not undo injustice to all the students

because we permitted only limited counseling but it was necessary to

adopt that course in larger interests of students and medical education as

by reopening the entire counseling, there would have been considerable

amount of delay in commencement of course in various colleges. The

admission process could have gone on till end of the year and that is why

permission was granted for only limited counseling.

Having regard to the utter chaos and confusion mainly on account of

non-adherence of the time schedule, we permitted parties to file

suggestions so that directions could be issued to streamline admissions

from the next year. The suggestions have been filed by the Ministry of

Health, Government of India, Medical Council of India and some individual

parents. We have heard Mr. Mohan Parasaran, learned Additional

Solicitor General, appearing for the Central Government, Mr. Vivek

Tankha, Advocate who placed before us the point of view of students and

medical colleges, Mr. Maninder Singh, Advocate representing Medical

Council of India (MCI), Mr. A.K. Ganguly for West Bengal Government and

Mr.Minocha-in-person.

It is a matter of anguish that despite various decisions of this Court

and laying down of time schedule for completion of admission process, the

time schedule has not been adhered to at various stages by various

authorities resulting in otherwise avoidable discontentment and hardship to

the candidates. The observance of the time schedule is paramount for

effective utilization to All India Quota of medical and dental seats. The

denial of a seat in college of choice on the basis of one's merit position

leads to frustration and results in injustice to the young students. The

admission to a professional course based on merit position is paramount

for the career of a student. The omission and commission in respect of

admissions this year, as is evident from orders aforenoted, adversely

affected the career of meritorious students in their not getting admission in

the college of their choice. Any frustration and feeling of injustice at an

impressionable age at which the students compete in All India Competition

is neither desirable from the point of view of either the young students nor

for country's future. We are concerned with the career of those bright

candidates who compete in a tough all India competition. In this

background, it is necessary to examine the acts of omission and

commission at various levels, the suggestions that have been made and

submissions put forth, to consider the issuance of directions for

streamlining admissions from the next academic year in MBBS/BDS

courses.

In Medical Council of India v. Madhu Singh & Ors. [(2002) 7 SCC

258], while making it clear that no admissions can be granted after the

scheduled date, which essentially should be the date for commencement

of the course, MCI was directed to ensure that the examining bodies fix a

time schedule specifying the duration of the course, the date of its

commencement and the last date for admission. It was further directed

that different modalities for admission can be worked out and necessary

steps like holding of examination if prescribed, counseling and the like

have to be completed within the specified time and no variation of the

schedule so far as admissions are concerned shall be allowed. In case of

any deviation by the institution concerned, action as prescribed shall be

taken by MCI.

The Ministry of Health of Family Welfare, Government of India

convened a meeting of the State Health/Medical Education Secretaries

and the Vice-Chancellors of the universities of health sciences and as a

result of discussion issued a directive dated 14th May, 2003 to the

Secretaries of Health and Medical Education in all the States and Union

Territories and to all universities awarding medical/dental degrees laying

down the policy guidelines on admission of students and other allied

matters, inter alia, having regard to the decision in Madhu Singh's case

(supra), laying down the schedule for completion of the various stages of

admission process, commencing of academic session and closure of

admissions in courses of medicine and dentistry to be applicable to all

medical and dental colleges in the country from the academic session

2003-04 onwards. All State Governments, universities, medical and dental

institutions in the country and any other authorities concerned were

directed to strictly abide by the time frame for completion of each of the

stages of admission process indicated in the time schedule. It also

directed that neither any student shall be admitted in any course of

medicine or dentistry after expiry of the last date prescribed for course of

admission in that course nor any university shall register any such

admission sought to be made. The State Governments were directed to

take all necessary steps to prevent deviation from the prescribed schedule.

The directive dated 14th May, 2003 also stipulates the cancellation of

admission granted after the last date of closure of admission and warns

the candidates of the consequences of taking admission after the last date

for closure of admissions. Paragraphs 8.4 and 8.5 of the directive read as

under :

"8.4 In exercise of the powers conferred by the

Hon'ble Supreme Court, the Medical Council of

India or the Dental Council of India may direct

that any student identified as having obtained

admission after the last date for closure of

admission be discharged from the course of

study; or any medical or dental qualification

granted to such a student shall not be a

recognized qualification for the purpose of the

Indian Medical Council Act, 1956 or the Dentist

Act, 1948, as the case may be. The Institution

which grants admission to any student after the

last date prescribed for the same shall also be

liable to face such action as may be prescribed by

MCI or DCI.

8.5 The Time Schedule for completion of the

admission process as in the Annexure shall also

be printed in the Bulletin of Information for the

candidates or the Prospectus for admission to the

concerned course. The candidates shall be

clearly warned of the consequences of taking

admission in any institution after the last date for

closure of admissions."





The time schedule for completion of the admission process for

medical and dental courses is as under :



"Schedule for

Admission

First MBBS/BDS Course

Postgraduate Courses

Super

Speciality

Course



All India

Quota

State

Quota

All India

Quota

State Quota



Conduct of Entrance

Examination:

Month of

May

Month of

May

2nd Sunday

of January

Mid Jan. To

Mid-Feb.

May-June

Declaration of Result of

Qualifying Exam.

/Entrance Exam.

By 5th June

By 15th June

3rd Week of

Feb.

By 28th

February

By 30th June

1st round of counseling/

admission:

20th to 29th

June

To be over

by 17th

July

5th March to

22nd March

To be over

by 25th April

To be over by

25th July

Last date for joining the

allotted College and

Course:

18th July @

29th July

7th April

1st May

31st July

2nd round of counseling

or allotment of seats

from Waiting List:

01st August

to 08th

August

25th to 28th

August

No 2nd

Counseling

No 2nd

Counseling

No 2nd

Counseling

Last date for joining for

candidates allotted

seats in 2nd round of

Counseling or from the

Waiting List:

22nd August

(Seats

vacant after

this date will

be

surrendered

back to the

State/

Colleges)

30th

August

After 7th

April,

vacant

seats will

stand

surrendered

back to the

States/

Colleges

Not

applicable

Not

applicable

Commencement of

academic session:

Between 01st August to

31st August

02nd May

01st August

Last date up to which

students can be

admitted against

vacancies arising due

to any reason :

30th September

31st May

30th

September



NOTE : @ Head of the Colleges should intimate the vacancies existing

after 18th July in respect of the All India Quota of seats to the

DGHS latest by 25th of July."





Reference may also be made to notification dated 25th February,

2004 issued by the Medical Council of India in exercise of the powers

conferred by Section 33 of the Indian Medical Council Act, 1956 (for short,

'the Act') with the approval of the Central Government, making the

"Graduate Medical Education (Amendment) Regulations, 2004, laying

down the time schedule for completion for admission process for first

MBBS course. It is on same lines as the aforequoted time schedule. Time

schedule (Appendix-E) to the regulation reads as under :

"APPENDIX-E

TIME SCHEDULE FOR COMPLETION OF THE ADMISSION PROCESS

FOR FIRST MBBS COURSE



Schedule for Admission Seats filled up by Central Seats filled up by

Govt. through All India The State Govts./

Entrance Examination Institutions



Conduct of Entrance Examination Month of May Month of May

Declaration of Result of Qualifying Exam./

Entrance Exam. By 5th June By 15th June

1st round of counseling/admission : To be over by 30th June To be over by 25th July

Last date for joining the allotted College Within 15th days from the 31st July

And Course : date of allotment of seats

2nd round of counseling for allotment of To be over by 8th August Up to 28th August

seats from Waiting List :





Last date for joining for candidates allotted Within 15 days from the 31st August

Seats in 2nd round of counseling from the date of allotment of seat

Waiting List (Seats vacant after 22nd

August will be surrendered

Back to the States/Colleges)

Commencement of academic session : 1st of August

Last date up to which students can be admitted 30th September"

Against vacancies arising due to any reason :



In various States, the first counseling and admissions in respect of

State quota seats was not over, many States had not even commenced

the process even though second round of counseling for allotment of seats

from waiting list for All India Quota becoming vacant, as a result of

candidates getting admission under State quota, was to commence on 1st

August, to be completed by 8th August. The effect of the aforesaid inaction

and also not sending timely intimation to DGHS is to deprive those who are

high up in the merit list of All India Entrance Examination and waiting to get

admission in such vacated seats which otherwise would revert back to the

State quota. The result is to effectively reduce 15% All India Quota and

increase State quota seats. Directions that were issued to get requisite

information from various States in respect of holding of counseling, and

reporting of vacant seats to DGHS for admissions for 2004-05 have been

earlier noticed. As stated above, despite such directions full and complete

justice could not be meted out to all meritorious students regarding college

of their choice as per their position in the merit list, on account of the time

frame and its all India consequences on admissions and the possible result

of extending the admissions much beyond the schedule date contrary to

the aforesaid statutory regulations and resulting in grant of midstream

admissions. To an extent possible, the seats of All India Quota should not

revert to State Quota. It was brought to our notice that in some cases

deliberately the time schedule is not adhered to so that more number of

seats may revert to State Quota. If that be so, we deprecate the practice

with a fond hope that such a practice would be discontinued failing which

persons responsible therefor will have to face the consequences. The total

impartiality is the need of the time and not the so-called loyalty to the

State.

The academic session commences between 1st August and 31st

August and the last date for joining MBBS/BDS courses is 30th August.

However, students can be admitted against vacancies arising due to any

reason by 30th September. The date 30th September is not for normal

admission but is to give opportunity to grant admissions against stray

vacancies. The adherence to the time schedule by everyone is paramount

for the timely grant of admissions, commencement of academic session

and for closure of the admissions after 30th September each year. In fact,

the timely holding of 10+2 examination and declaration of its results is also

of paramount importance for the entire admission process. If the results of

CBSE or other equivalent examination are not declared well before the

commencement of first round of counseling/admission of All India Quota

seats, i.e., 20th June, it is likely to adversely affect the candidates who may

otherwise be toppers in the All India Entrance Examination. A candidate

may be in the first 200 position, out of about 2,00,000 candidates in the

merit ranking but if the results of his qualifying examination of CBSE or its

equivalent are not available to him or to DGHS responsible for counseling,

the candidate would lose chance to get admission in college of his choice

despite his merit position.

Government of India has suggested that for effective implementation

of scheme for allotment of 15% all India seats for medical and dental

colleges, it is imperative that all participating State and Union Territory

Boards of Secondary Education must declare 10+2 result well in advance,

at least one week before start of first round of counseling. This suggestion

was given as West Bengal Secondary Education Board did not declare

10+2 examination result of their candidates before start of first round of

counseling of 15% All India Quota during 2003 and 2004. Due to non-

declaration of result, a couple of candidates qualifying in CBSE merit list

could not appear in the first round of counseling. In this competitive world,

real struggle of students for their career, in almost all the fields, starts after

passing 10+2 examination. The results of this examination is important for

almost all competitions. Therefore, the timely holding of these

examinations and timely declaration of result is of utmost importance, in

particular, by all participating States and Union Territories in All India

Entrance Examination for medical and dental seats. It is imperative that

the CBSE or equivalent results are declared and the mark-sheets are

made available to the candidates not later than five days before the

commencement of first round of counseling. In other words, the mark-

sheet shall be made available to the candidates by 15th June. A candidate

may have to travel long distance to participate in the counseling which

commences at Delhi from 20th June. In response to directions of this Court

suggesting timely holding of 10+2 examination by all States/Union

Territories so that the results thereof are not delayed beyond 10th June, at

least from the year 2005, the only State Government which has put forth

difficulties in so doing is the State of West Bengal.

The West Bengal Council of Higher Secondary Education has stated

that Schedule for 2005 examinations has already been announced on 27th

July, 2004, according to which, the theory examination for higher

secondary conclude on 11th April, 2005 and it takes three months

therefrom to publish the results. As per this schedule, the results would be

declared by 11th July, 2005. It also states that if the dates for board

examination for class XII are advanced, the students will face mental

trauma due to lack of preparation. We are not suggesting the

advancement of the date for the year 2005 for holding board examination

for class XII. By maintaining the dates already fixed, if not the result of all

students, at least the results of those who participate in the All India

Entrance Examination and are in high merit ranking can be declared and

mark-sheets made available to them by 15th June so as to enable them to

participate in the first counseling in All India Quota. Going by the past

figures, the candidates requiring such facility may be only about 100. Only

the candidates in the merit list up to 2500 may need such a facility and

cooperation from the State Authorities. From the year 2006, the State

Government/West Bengal Council of Higher Secondary Education shall

arrange its affairs in such a manner that the examinations are held timely,

results are declared by 10th June and mark sheets made available to the

students by 15th June. The other States/Union Territories would ensure

declaration of result by 10th June and availability of mark sheet to the

students by 15th June from the academic year 2005.

Another connected aspect is declaration of result of qualifying

Examination/Entrance Examination for State quota seats. The State

Governments, as per the time schedule are required to declare the said

results by 15th June of every year. The timely declaration of result will

enable the students to take a decision about participation in All India

counseling or State counseling. The Central Government has rightly

pointed out that due to late declaration of result of State level entrance

examination, candidates and their parents travel from all over the country

to participate in All India Quota Counseling which is conducted in Delhi and

then travel to allotted medical/dental colleges. Later on, if the candidates

get admission in the colleges of their choice in their respective States

through State counseling, they have to travel back to the college allotted

through All India Quota to get their college leaving certificate and other

documents which are deposited with allotted college before joining the

State college. By timely declaration of the results of the State level

entrance examination i.e. by 15th June, which is before the start of All India

Quota counseling, candidates and their parents can be saved from facing

undesirable hardships.

We see no reasons for non-observance of the time schedule which

has been provided after discussion with all the States' functionaries. The

Chief Secretaries and Head of concerned Ministries/Departments in

participating States/Union Territories shall file affidavits before this Court

within four weeks placing on record time table in regard to holding of State

examination and declaration of results thereof on or before 15th June,

2005.

For utilisation of All India Quota to its fullest extent, another vital

stage of admission process is timely reporting to DGHS by Deans or any

other authority whatever be the designation responsible for giving

information as to the joining and/or non-joining of students after first round

of counseling/admission of the State quota seats. The counseling for

allocation of seats of All India Quota is conducted by DGHS at Delhi. The

reporting to be made to DGHS has to be sincere and accurate as wrong

reporting has chain reaction. As per time schedule, the first round of

counseling for State Quota is to be over by 17th July. There is no reason

why this time schedule shall not be adhered to. After this counseling, the

last date for joining the allotted college and course under State Quota is

29th July. The object of the admission and last date of joining college in

State Quota before the start of second round of counseling or allotment of

seat from waiting list in All India Quota clearly is that the correct factual

position as to the availability of the seats ought to be known to the DGHS

before start of second round of counseling. If it is not done, number of

seats would be lost to the merit ranking candidates from All India Entrance

Examination. They, though otherwise entitled, would be deprived of those

seats and to that extent All India 15 per cent quota would stand reduced.

Such seats get reverted to State quota for no fault of the candidates on All

India Quota, thus, reducing the All India Quota and increasing the State

Quota. The Head of the Colleges are required to intimate their vacancies

existing after 18th July in respect of All India Quota seats to the DGHS by

25th July. This gives about a week to the DGHS before it starts second

round of counseling on 1st August. This year (2004) it was found that the

time schedule in this regard by most of the States, was not complied. As

per Appendix-E to the notification dated 25th February, 2004, the first round

of counseling/admission of seats filled up by State Governments/Institution

is to be over by 25th July. For State Quota seats, one week after

completion of first round of counseling to join the allotted college is

sufficient. The date 29th July, mentioned in the time schedule attached to

the directive dated 14th May, 2003 shall be suitably changed and the date

25th July shall be mentioned to make it consistent with the date mentioned

in the notification dated 25th February, 2004. The intimation is required to

be sent to the DGHS well before the commencement of second round of

All India Quota counseling by it. The details about the vacancy position

shall be signed/counter signed by three top functionaries responsible for

admission of State Quota seats.

To an extent possible, all possible facilities shall be afforded to

students and their parents. Due advantage can be taken of advanced I.T.

technology. In respect of counseling of All India Quota seats conducted by

the DGHS at Delhi, with the advancement of IT technology, it should be

feasible to conduct counseling of outstation students by availing the

facilities of video conferencing, It seems that every State capital has the

facility of video conferencing. The use of this facility would save time and

money of not only the candidates and their parents but in the long term, it

may be beneficial to the DGHS as well. Counseling by the video

conferencing can commence from the year 2005, making a beginning from

20th June, 2005. Before issue of directions in this regard, we deem it

proper to direct that this aspect be examined first by the Ministry of Health,

the DGHS and the States/Union Territories officers in consultation with the

officers of National Informatics Centre (NIC) and a report filed thereafter in

this Court. Final directions will be issued on consideration of the report.

We may also note suggestions of Mr. Arun Minocha, father and legal

guardian of one of the students that intake of All India Quota shall be

increased from 15% to 20% and the number of candidates to be placed on

waiting list deserves to be increased from present 70% to 100% so that in

case of availability of seats, the same may not go waste and the

candidates on merit list are in a position to utilize the All India Quota to the

fullest extent. According to him, having regard to the fact that many seats

in medical and dental course, though existing as having been enhanced

many years earlier, were not taken into consideration while working All

India Quota of 15% and the original direction in Dr. Pradeep Jain's case

(supra) was of 30% reduced later to 15% in case of Dr. Dinesh Kumar's

case and Post-graduate seats having been increased from 25% to 50%

and two decades having passed, the All India Quota deserves to be

increased. We have no difficulty in accepting the suggestion regarding

increase of waiting list from 70% to 100%, since its only effect is a little

additional paper work for the DGHS, without any adverse effect on

anybody and possibly the advantage may be to more number of

candidates as per their merit position depending upon the availability of

seats. Regarding the suggestion for the increase of intake from 15% to

20%, we are of the view that it deserves to be first examined by the Central

Government and the DGHS in consultation with States/Union Territories

and report filed in this Court within four months so that the issue can be

examined with reference to admissions to be made for All India Quota from

the academic year 2006-07.

Yet another issue is about not taking into consideration, for

determining All India Quota, those seats which are created under Section

10-A of the Act. In the writ petition, number of seats which were not taken

into consideration have been mentioned. According to MCI, only seats

recognized under Section 11 are taken into consideration and not seats

which are permitted under Section 10-A of the Act. For deciding this issue,

it is necessary to examine the provisions of the Act and the Regulations

issued thereunder. Another connected issue also is regarding the

establishment/renewal granted to medical and dental colleges including

grant of permission to increase intake of the students. There is also the

issue about the allocation of seats in respect of which, the letter granting

permission is issued as per time schedule by the Central Government by

15th July.

Section 10(A) of the Act which was inserted by the Indian Medical

Council (Amendment) Act, 1993 (Act 31 of 1993) with effect from 27th

August, 1992, makes it imperative to seek permission for establishment of

a new medical college, new course of study. In view of this Section, with

effect from 1st June, 1992 prior permission is necessary. Section 10(A),

inter alia, provides that notwithstanding anything contained in the Act or

any other law for the time being in force



(a) no person shall establish a medical college; or

(b) no medical college shall

(i) open a new or higher course of study or

training (including a postgraduate course of

study or training) which would enable a

student of such course or training to qualify

himself for the award of any recognized

medical qualification; or



(ii) increase its admission capacity in any

course of study or training (including a

postgraduate course of study or training),

except with the previous permission of the

Central Government obtained in

accordance with the provisions of this

section.





Section 10-A (2) (a) provides that every person or medical college

shall, for the purpose of obtaining permission under sub-section (1) submit

to the Central Government a scheme in accordance with the provisions of

clause (b) and the Central Government shall refer the scheme to the

Council for its recommendations.

Along with Section 10-A, clause (fa) was also inserted in Section 33

to empower MCI to make regulations to provide for the form of the

scheme, the particulars to be given in such scheme, the manner in which

the scheme is to be preferred and the fee payable with the scheme under

clause (b) of sub-section (2) of Section 10-A.

Section 11(1) of the Act, inter alia, provides that medical

qualifications granted by any University or medical institution in India which

are included in the First Schedule shall be recognised medical

qualifications for the purposes of this Act. Section 11 (2) provides that any

University or medical institution in India which grants a medical

qualification not included in the First Schedule may apply to the Central

Government to have such qualification recognised, and the Central

Government, after consulting Council, may, by notification in the Official

Gazettee, amend the First Schedule so as to include such qualification

therein, and any such notification may also direct that an entry shall be

made in the last column of the First Schedule against such medical

qualification declaring that it shall be a recognized medical qualification

only when granted after a specified date.



In exercise of the powers conferred by Section 10-A read with

Section 33 of the Act, the MCI made the establishment of new medical

colleges, opening of higher courses of study and increase of admission

capacity in Medical College Regulation, 1993. The Regulations, inter alia,

provided as a qualifying criteria that the eligible organization shall abide by

Indian Medical Council Act, 1956 as modified from time to time and the

regulations framed thereunder and shall qualify to apply for permission to

establish new medical colleges only if the conditions therein are fulfilled.

One of the conditions is that Essential Certificate regarding the desirability

and feasibility of having the proposed medical college at the proposed

location has been obtained and that the adequate clinical material is

available as per Medical Council of India requirements has been obtained

by the applicant from the respective State Government or the Union

Territory Administration. It also provides that the applicant owns and

manages a hospital of not less than 300 beds with necessary

infrastructural facilities and capable of being developed into a teaching

institution as prescribed by the Medical Council of India, in the vicinity of

proposed medical college. The MCI has also made the Establishment of

Medical College Regulations, 1999 in exercise of powers conferred by

Section 10-A and Section 33 of the Act, inter alia, prescribing the form of

Essentiality Certificate as a qualifying criteria to make application for

permission to establish a medical college. These Regulations stipulate

that Essentiality Certificate in Form-2 regarding No objection of the State

Government/Union Territory Administration for the establishment of the

proposed medical college at the proposed site and availability of adequate

clinical material as per the council regulations, have been obtained by the

person from the concerned State Government/Union Territory

Administration. The Form of Essentiality Certificate requires a Certificate

from the Competent Authority to the following effect :



"It is certified that:-

(a) The applicant owns and manages a 300

bedded hospital which was established in





(b) it is desirable to establish a medical college

in the public interest.



(c) Establishment of a medical college at

. by (the name of

Society/Trust) is feasible.



(d) Adequate clinical material as per the

Medical Council of India norms is available.



It is further certified that in case the

applicant fails to create infrastructure for the

medical college as per MCI norms and fresh

admissions are stopped by the Central

Government, the State Government shall take

over the responsibility of the students already

admitted in the College with the permission of the

Central Government."



The time schedule for the receipt of applications for establishment of

new medical colleges and processing of the applications by Central

Government and the Medical Council of India is fixed under the schedule

to 1999 Regulations. The said schedule is as under:-



"SCHEDULE FOR RECEIPT OF APPLICATIONS FOR

ESTABLISHMENT OF NEW MEDICAL COLLEGES AND

PROCESSING OF THE APPLICATIONS BY THE CENTRAL

GOVERNMENT AND THE MEDICAL COUNCIL OF INDIA





Stage of Processing

Last date

1.

Receipt of applications by the Central Govt.

From 1st August to

31st August (both

days inclusive) of

any year

2.

Receipt of applications by the MCI from Central

Govt.

30th September

3.

Recommendations of Medical Council of India to

Central Government for issue of Letter of Intent

31st December

4.

Issue of Letter of Intent by the Central Government

31st January

5.

Receipt of reply from the applicant by the Central

Government requesting for Letter of Permission

28th February

6.

Receipt of Letter from Central Government by the

Medical Council of India for consideration for issue

of Letter of Permission

15th March

7.

Recommendations of Medical Council of India to

Central Government for issue of Letter of

Permission

15th June

8.

Issue of Letter of Permission by the Central

Government

15th July



Note: (1) The information given by the applicant in Part-I of

the application for setting up a medical college

that is information regarding organization, basic

infrastructural facilities, managerial and financial

capabilities of the applicant shall be scrutinized by

the Medical Council of India through an inspection

and thereafter the Council may recommend issue

of Letter of intent by the Central Government.

(2) Renewal of permission shall not be granted to a

medical college if the above schedule for opening

a medical college is not adhered to and

admissions shall not be made without prior

approval of the Central Government."



According to Regulation 8 (3) of 1999 Regulations, the permission to

establish a medical college and admit students may be granted initially for

a period of one year and may be renewed on yearly basis subject to

verification of the achievements of annual targets. It shall be the

responsibility of the person to apply to the Medical Council of India for

purpose of renewal six months prior to the expiry of the initial permission.

This process of renewal of permission will continue till such time the

establishment of the medical college and expansion of the hospital

facilities are completed and a formal recognition of the medical college is

granted. Further admissions shall not be made at any stage unless the

requirements of the Council are fulfilled. The Central Government may at

any stage convey the deficiencies to the applicant and provide him an

opportunity and time to rectify the deficiencies.

It cannot be doubted that proper facilities and infrastructure including

teaching faculty and Doctors is absolutely necessary and so also the

adherence to time schedule for imparting teaching of highest standards

thereby making available to the community best possible medical

practitioners. It cannot be said that such facilities are not insisted upon for

Section 10-A seats. No instance has been brought to our notice where

Section 10-A seat in a Government college has not been recognized under

Section 11. The All India Quota seats are applicable only to Government

colleges. In many colleges, full-fledged seats for all intent and purposes in

so far as medical education is concerned, whether in a new medical

college or increase intake in an existing college, are continuing as 10-A

seats. Prima facie, we see no reason why such seats shall not be taken

into consideration for calculating 15% share of All India Quota. The 15%

quota seats get substantially reduced by not taking into account Section

10-A seats. We direct the Central Government, DGHS and MCI to

examine this aspect in detail and submit a report, on consideration whereof

we would finally decide the matter regarding inclusion of Section 10-A

seats for working out 15% All India Quota.

The time schedule for post-graduate and superspeciality course

admissions may also be noted as under :

"TIME SCHEDULE FOR POSTGRADUATE AND

SUPERSPECIALITY COURSES ADMISSIONS



Schedule for admission

Postgraduate Courses

Super-speciality

Courses



All India Quota

State Quota



Conduct of entrance

examination

2nd Sunday of

January

Mid-Jan

Mid-Feb.

May-

June

Declaration of result of

qualifying exam.

3rd week of Feb.

By 28th

February.

By 30th June

1st round of

counseling/

admissions

5th March to 22nd

March.

To be over by

25th April.

To be over by

25th July

Last date for joining

the allotted college

and course

7th April.

1st May.

31st July.

2nd round of

counseling or

allotment of seats from

waiting list.

No 2nd counseling

No 2nd

counseling

No 2nd

counseling

Last date for joining for

candidates allotted

seats in 2nd round of

counseling or from the

waiting list.

After 7th April

vacant seats will

stand surrendered

back to the

states/colleges

Not applicable

Not applicable

Commencement of

academic session

2nd May

1st August

Last date up to which

students can be

admitted against

vacancies arising due

to any reason

31st May.

30th September"





Having regard to the professional courses into consideration, it

deserves to be emphasized that all concerned including Governments,

State and Central both, MCI/DCI, colleges, new or old, students, Boards,

universities, examining authorities etc. are required to strictly adhere to

time schedule wherever provided for; there should not be mid-stream

admission; admission should not be in excess of sanctioned intake

capacity or in excess of quota of any one, whether Stare or Management.

The carrying forward of any unfilled seats of one academic year to next

academic year is also not permissible

Before we come to matter of issue of directions, some other small

aspects may also be considered. All seats under All India Quota deserve

to be fully disclosed and published by a date to be specified by the DGHS

so that at a glance, if required, it may be possible to verify whether the said

quota has been correctly worked out or not. The States shall file

compliance report in regard to admission with the DGHS about annual

admissions indicating adherence to the schedule and the seats taken into

consideration for working out All India Quota and giving details of other

seats. The compliance report shall give details of filling up of seats with

names of students admitted and dates of admission. It shall be signed by

the Principal/Director or Head of the medical institution by whatever name

called and by Vice-Chancellor. The recalcitrant States, particularly officers

personally will have to face consequences.



It was suggested by Mr.Tankha that MCI/DCI and also colleges shall

be made answerable to a high-powered Committee which may be directed

to be constituted for not following a fair and transparent procedure in its

duties and obligation including carrying out inspections and sending

reports by MCI/DCI to the Central Government on the basis whereof the

requisite recognition is granted and to also look into other medical

admissions related matters and matters relating to establishment of

medical colleges and increase of intake etc. Various petitions are pending

in this Court where grievance have been made in regard to inspections

carried out by MCI/DCI and other aspects pointed out by learned senior

counsel. The suggestion made about constituting a body like Ombudsman

to which above authorities may be answerable deserves to be examined in

depth by Ministry of Health and a report submitted to this Court.



Having regard to the aforesaid, we issue the following directions:-





1. All participating States and Union Territories, Board of Secondary

Education shall declare 10 + 2 result by 10th June of every year and

make available the marksheet to the students by 15th June.

The aforesaid condition would not apply to West Bengal for the year

2005. As already noticed, the West Bengal would make available to

the concerned students the marksheets by 15th June, 2005

Heads of Boards would be personally liable to ensure compliance.

2. The time table mentioned in Notification dated 25th February, 2004

shall be strictly adhered to by all concerned including States and

Union Territories and results of State Medical/Dental Entrance

Examination shall be declared before 15th of June.

3. The States/Union Territories shall complete the admission process

of first round of State Level Medical/Dental College admission by

25th July i.e. a week before start of second round counseling or

allotment of seats under All India Quota. The correct vacancy

position shall be intimated by the Chief Secretary to the DGHS by

26th July. It shall be verified by the Head of the Institution/or Head of

the Medical Institution/Health Department in the State.

4. It shall be the responsibility of all concerned including Chief

Secretaries of each State/Union Territories and/or Health

Secretaries to ensure compliance of the directions of this Court and

requisite time schedule as laid down in the Regulations and non-

compliance would make them liable for requisite penal

consequences.

5. All seats in All India Quota must be fully disclosed giving details of

the date of recognition/renewal to DGHS before a date to be notified

by DGHS and the same shall be duly published.

6. By 31st October, the State through Chief Secretaries/Health

Secretaries shall file a report in regard to admissions with the DGHS

giving details about the adherence to a time schedule and admission

granted as per the prescribed quota. The recalcitrant States,

particularly officers personally will have to face consequences for

violation.

7. The DGHS shall file by 31st January, 2005 report in regard to

feasibility of conducting counseling through the process of video

conferencing.

8. The DGHS shall file report within three months on the aspect of

Section 10-A seats being subjected to 15 per cent All India Quota

and about the increase of the quota from 15 per cent to 20 per cent.

9. The DGHS shall also file a report within three months on the aspect

of constitution of high-power Committee/Ombudsman.

10. The seats allotted upto 15th July, shall also be subjected to

respective State Quotas.

11. If any private medical college in a given academic year for any

reason grants admission in its management quota in excess of its

prescribed quota, the management quota for the next academic year

shall stand reduced so as to set off the effect of excess admission in

the management quota in the previous academic year.

12. The time schedule for grant of admission to postgraduate courses

shall also be adhered to.

13. For granting admission, the merit determined by competitive

examination shall not be tinkered with by making a provision like

grant of marks by mode of interview or any other mode.

14. time schedule for establishment of new college or to increase intake

in existing college, shall be adhered to strictly by all concerned.

15. Time schedule provided in Regulations shall be strictly adhered to by

all concerned failing which defaulting party would be liable to be

personally proceeded with.

16. Copy of the judgment shall be sent to Chief Secretaries of all

States/Union Territories for compliance.

List the case in 3rd week of February, 2005.

10 A 1 vs Contract Medical Consultants

The Tamil Nadu State and Subordinate Services Rules
They shall come into force on the 1st January 1955.

Appointed to a service
(1) A person is said to be “appointed to a service” when in accordance with these rules or in accordance with the rules applicable at the time, as the case may be, he discharges, for the first time the duties of a post borne on the cadre of such service or commences the probation. Instruction or training prescribed from members thereof.
*(Explanation - The appointment of a person holding a post borne on the cadre of one service to hold additional charge of a higher post in the same service or a post borne on the cadre of another service or to discharge the current duties thereof does not amount to appointment to the latter service;)

• Rule 10 : Temporary Appointment
• 10 a (i) 1
• 10 a (i) 2
• 10 a (ii)
• 10 a (iii)
• 10 a (iv)
• 10 a (v) a
• 10 a (v) b
• 10 a (v) bb
• 10 a (v) c
• 10 a (v) d
• 10 b
• Rule 11. Appointment by agreements

10.Temporary appointment:
10 a(i) (1) where it is necessary in the public interest owing to an emergency which has arisen to fill immediately a vacancy in a post borne on the cadre of a service, class or category and there would be undue delay in making such appointment in accordance with these rules and the Special Rules, the appointing authority may temporarily appoint a person, who possesses the qualifications prescribed for the post otherwise that the accordance with the said rules.
*(Added Vide G.O.Ms.No.21, P&AR (S) Dept., 23-1-96 w.e.f.23-1-96)
*(Provided that no appointment by direct recruitment under this clause shall be made of any person other than the one sponsored by the Tamil Nadu Public Service Commission from its regular or serve list of successful candidates to any of the posts with in the purview of the Tamil Nadu Public Service Commission.)
*(Added Vide G.O.Ms.No.21, P&AR (S) Dept., 23-1-96 w.e.f.23-1-96)
(Provided further that the reserve list of successful candidates shall be in force until the regular list of successful candidates is drawn up subsequently; and that candidates shall be allotted from such reserve list for the vacancies in the place of those who have not jointed duty.)
Provided also that appointment by direct recruitment under this clause (1) in respect of posts within the purview of Tamil Nadu Public Service Commission shall be made, only where new posts with new qualifications are created temporarily and where the Tamil Nadu Public Service Commission does not have a regular or reserve list of successful candidates for sponsoring.
*Added in G.O.Ms.No.856, P & AR (Per.P) dt.28-8-86 w.e.f.28-8-86
Substituted in G.O.ms.No108, P & AR (Per.S) dt. 27-3-91, w.e.f.16-6-90
10a (i) (2) Omitted Vide G.O.Ms.No.21, P & AR (S) Dept., 23-1-96 w.e.f.23-1-96)
10a (ii) Where it is necessary to fill a short vacancy in a post borne on the cadre of service, class or category and the appointment of the person who is entitled to such appointment under these rules and the Special Rules, would involve excessive expenditure on traveling allowance or exceptional administrative inconvenience, the appointing authority may appoint any other person who possess the qualifications, if any prescribed for the said service, class or category.
10a (iii) A person appointed under clause (i) shall be replaced as soon as possible by a member of a service or an approved candidate qualified to hold the post under the rules, and in any case, he shall not be continued for a period of more than one year from the date of his temporary appointment;
*(Substituted vide G.O.Ms.No.21, P &AR (S) Dept., 23-1-96 w.e.f.23-1-96)
10a (iv) where it is necessary to appoint an officer against whom an enquiry into allegations of corruption or misconduct is pending, the appointing authority may appoint him temporarily, pending enquiry into the charges aginst him. The competent authoiry shall have discretion to make regular appointment in suitable cases.
10a (v)a Person appointed under clause (i), (ii) or (iv) shall not be regarded as a probationer in such service, class or category or be entitled by reason only of such appointment to any preferential claim to future appointment to such service, class or category. The services of a person appointed under clause (i), (ii) or (iv) shall be liable to be terminated by the appointing authority at any time without notice and without any reason, being assigned.
10a (v) b and 10 a (v) bb: Omitted.
(Vide G.O.Ms.No21, P&AR (S) Dept., dt.23-1-96 w.e.f. 23-1-96)
10a (v) c A person appointed to any part-time post created in lieu of a whole time post borne on the cadre of a service, class or category shall not be regarded as a probationer in such service nor shall be entitled by reason only of such appointment to any preferential claim to future appointment to such service. class or category.
10a (v) d Notwithstanding anything contained in these rules, if and when a temporary post is created as addition to the cadre of any service, class or category and the holder thereof is required by the State Government to possess any special qualifications, knowledge or experience, any person who possess such qualifications, knowledge or experience and is considered to be best the fitted to discharge the duties of such post may, irrespective of other considerations, be appointed to that post by the appointing authority, but the person so appointed shall not, by reason only of such appointment, be regarded as a probationer in such appointment, be regarded as probationer in such service, class or category nor shall he acquired hereby any tial right to future appointment to such service, class or category.

* (10 A. Recruitment to posts, which are outside the purview of the Tamil Nadu Public Service Commission.— (a) Where the posts are outside the purview of the tamil Nadu Public Service Commission, recruitment shall be made only by calling for names of eligible candidates from the Employment Exchange. In respect of specialised posts for which candidates are not a vailable with the Employment Exchange, the appointing authority shall get a certificate of a non-availability from the Employment Exchange, and call for applications from eligible candidates by advertising the posts in prominent daily newspapers giving the number of vacancies and indicating the qualifications, etc.)
(Provided that this sub-rule shall not apply in the case of appointments of dependants of Government Servants who die in harness, or the Government servants who retire from service on medical invalidation before obtaining the age of fifty years.)

10 (b) The candidates to be appointed shall be selected on the basis of merit by the appointing authority, or by an officer designated by the appointing authority or by a Committe of Officers not exceeding three duly constituted by the appointing authority, subject to the rule of reservation of posts wherever applicable after subjecting the candidates to an oral interview and, if necessary, a short written test which can be evaluated in a short time.
* Inserted in G.O.Ms.No.605, P & AR (Per.S) dt. 3-6-80, w.e.f.3-6-80
Added in G.O.Ms.No.354, P & AR, dt.20-06-89, w.e.f.3-6-80

11. Appointment by agreements. –
11 (1) When in the opinion of State Government Special provisions inconsistent with any of these rules or of any other rules made under the proviso to article 309 of the Constitution of India or continuing by ARticle 313 of that Constitution (hereinafter referred to in this rule as the said rules) are required in respect of conditions of service, pay and allowances, pension, discipline and conduct with reference to any particular post, or any of them, it shall be open to the State Government to make an appointment to such post otherwise than in accordance with these rules or the said rules and to provide by agreement with the person so appointed for any of the matters in respect of which in the opinion of the State Government special provisions are required to be made and to the extent to which such provisions are made in the agreement, nothing in these rules or the said rules shall apply to any person so appointed in respect of any matter for which provision is made in the agreement:
Provided that in every agreement, made in exercise of the powers conferred by this rule it shall further be provided that in respect of any matter in respect of which no provision has been made in the agreement the provisions of these rules or of the said rules shall apply.
11 (2) A person appointed under sub-rule (1) shall not be regarded as a member of the service in which the post to which he is appointed is included and shall not be entitled by reason only of such appointment to any preferential claim to any other appointment in that or any other service.

www.targetpg.com www.nellaimedicos.com www.mcqsonline.com www.doctorbruno.com www.penandscale.com

Contract Medical Consultants and Contract Pharmacists

As per G.O No 81 H& FW Dept, dated 13.04.2005, para 4.iii

Such persons (Pharmacists) appointed on consolidated pay shall be brought into regular time scale of pay on completion of two years

As per G.O No 197, H& FW Dept, dated 07.06.2004, Annexure IV paras 4, 5 and 6 where doctors are appointed on Contract Basis

1. The Appointee shall not be entitled for any preferential claim whatsoever for regular appointment in Government service at a future date.

2. The Appointee shall not be entitled to any probationary or other rights.

3. The services of the Appointee are liable to be terminated at any time during the contract period without any notice.

This clearly shows that the present contract medical consultants have practically NO chance of being regularised

See here for more details
http://targetpg.blogspot.com/2005/03/10-1-vs-contract-medical-consultants.html
http://medicolegal.blogspot.com/2005/06/contract-medical-consultants-and.html

Options for Clinical Training

if you just want to know the practical aspect, there are lot of good certificate courses available. I will list 3 such things. These courses are not MCI recognized, but u get a degree and u can handle any case after taking it.Further if you take up PLAB, these courses will help you get a job in UK as most courses are approved by british universities. I know it for a fact because my friends have done it and have gone abroad.

a) Diploma in Emergency Medicine/ Diploma in family medicine :
These are 6 month courses offered by the Appollo group of hospitals. For more details log on to http://www.medvarsity.com/vmu1.2/dmr/dmrdata/courses/accident/home.htm . Well they give you a degree and confidence to handle any emergencies. I know this because some of my friends have done it and are happy. Further you need to study for the 1st 4 months at home and then work for the next 2 months in their hospital.

b) PG in bioinformatics:
For more details visit http://www.bioinformaticscentre.org/page/academic_program/bio_prospectus.asp

c) Ramchandra university offers a diploma in family medicine too .
You can get more details at www.medindia.com

Well as I told earlier these are not MCI recognized, but they give you a chance to work in a good hospital and learn all the tricks of emergency medicine as well as OPD . I feel that's more than enough for a private practice. You can also take up DNB www.natboard.nic.in and then work in a good hospital.

Contributed by Dr.Ashwin (http://www.edoctor.mcqsonline.com/ )

Going Abroad

If you want to go abroad there are 5 options for us doctors:

a) USMLE:

Well this is the best option . But getting a visa is very tough but NOT IMPOSSIBLE. Here are the short cuts-

• Avoid going to Madras & Bombay US Embassies, they are very strict here and once they see that u r a doc then they reject ur visa application rt away. (South Indians have to go to MAdras, but if you wait uptill midweek then you will see that all appintments will be full and they will refer u to delhi)
• Delhi & Calcutta are the best options. If you go there u will have an 80% chance of getting a visa.
• Never apply for an interview on the 1st 3 days of the week, but apply on the last 3 days.
• Never tell the embassy people that you have relatives staying in US. ( many believe that a relative in US can sponser their visa's but thats all crap)
• During the interview tell them that u have plans to work in australia or middle east. Don't ever tell them that u want to stay back in US, or that u want to come back here (as MLE/residency is not valid here).
• Keep this all to yourself. No point in telling everyone Then U will have no advantage.
• These are unwritten rules, but even if u follow it to the core, there r chances of ur visa application getting rejected, but my friends how followed it got visa'a100%

b) PLAB:

• PLAB without MRCP is like doing an extended internship. True for Indian standards, one earns more, but you end up spending a lot for food and accomadations there.
• Further once u start working then u find it hard to study for MRCP.
• After 8 years max, they will boot you out of UK and you will be MBBS in India, without any job or experience ( the only thing Plabees do in UK is the paper work- if any of ur friends have told you that they are treating patients, then its crap)
• A better alternative is taking MRCP-1 in INDIA and then taking up PLAB . MRCP-1 exams costs 30000 bucks while IELTS costs 8000 bucks.
• KAPLAIN Bangalore has started an MRCP trainig course for 6 months / its costs 20000 bucks. It makes sense to take the course.
• Don't take the MAHE -MRCP degree, its IRISH and has no value abroad.

c) Australia and NewZealand:

• Working in NZ is the best option. They pay you 1 lakh US dollars to start with ( yearly offcourse) and there are only 276 doctors in NZ to date ( hard to believe but true).
• But one has to have an US or UK degree to work here and also they will have to pass their qualifying exams. ( theory & practs)

d) Middle east:

• Good to make money and come back. Better if u have some additional degrees.

e) Mauritius :

• They pay 40000 bucks (indian) per month for a duty doctor.

So there are lot of other ways to go abroad . If you need anything more on this please use google, as I dont know a thing more on it

Contributed by Dr.Ashwin (www.edoctor.mcqsonline.com )

AIPG 2005 Psychiatry Wernicke encephalopathy

QUESTION.
A 45-year-male with a history of alcohol dependence presents with confusion nystagmus and ataxia. Examination reveals 6th cranial nerve weakness. He is most likely to be suffering from:
1. Korsakoff's psychosis.
2. Wernicke encephalopathy.
3. De Clerambault syndrome.
4. Delirium tremens.
Answer
2. Wernicke encephalopathy.
Reference
A Short Textbook of Psychiatry by Ahuja 4 ed Page 36
Quality
Reader
Status
Repeat (from the same question paper !!!)
QTDF
Ahuja
Discussion
Wernicke's disease is a common and preventable disorder due to a deficiency of thiamine. Alcoholics account for most cases, but patients with malnutrition due to hyperemesis, starvation, renal dialysis, cancer, or AIDS are also at risk. The characteristic clinical triad is that of ophthalmoplegia, ataxia, and global confusion. However, only one-third of patients with acute Wernicke's disease present with the classic clinical triad. Most patients are profoundly disoriented, indifferent, and inattentive, although rarely they have an agitated delirium related to ethanol withdrawal. If the disease is not treated, stupor, coma, and death may ensue. Ocular motor abnormalities include horizontal nystagmus on lateral gaze, lateral rectus palsy (usually bilateral), conjugate gaze palsies, and rarely ptosis. Gait ataxia probably results from a combination of polyneuropathy, cerebellar involvement, and vestibular paresis. The pupils are usually spared, but they may become miotic with advanced disease
Explanation
1. Korsakoff's psychosis (Korsakoff's syndrome) presents as profound and persistent anterograde amnesia (inability to learn new material) and a milder retrograde amnesia. Additional symptoms can include impairment in visuospatial, abstract, and conceptual reasoning but with a normal intelligence quotient (IQ). Some patients demonstrate an acute onset of Korsakoff's syndrome in association with the neurologic stigmata seen with Wernicke's syndrome (e.g., sixth nerve palsy and ataxia), whereas others have a more gradual onset..
2. Ataxia, Nystagmus and lateral rectus weakness point towards Wernicke’s encephalopathy
3. In erotomania, the subject, usually a single woman, believes that an exalted person is in love with her. The supposed lover is usually inaccessible, as he is already married, or famous as an entertainer or public figure. According to De Clerambault, the infatuated woman believes that it is the supposed lover who first fell in love with her, and that he is more in love than she. She derives satisfaction and pride from this belief. She is convinced that the supposed lover cannot be a happy or complete person without her.
4. Delirium Tremens (DT) is the most severe alcohol withdrawal syndrome and it occurs when the patient has abstained from alcohol.
Comments
Read the relevant chapters on Alcoholic and other Addictive substances with special emphasis on the Toxicity as well as Withdrawal Symptoms
Tips
Questions like these which are straight and easy are nowadays very rare. Though this is a simple question, I have to warn you that if you come across a “simple looking” question in AIIMS and All India Question Paper, please read it a couple of times more. The chances are that there is a “trap” there

AIPG 2005 Psychiatry Delirium Tremens

QUESTION.
A 40-year-old male, with history of daily alcohol consumption for the last 7 years, is brought to the hospital emergency room with acute onset of seeing snakes all around him in the room, not recognizing family members, violent behavior and tremulousness for having missed the alcohol drink since 2 days, Examination reveals increased blood pressure, tremors, increased psychomotor activity, fearful affect, hallucinatory behavior, disorientation, impaired judgment and insight.
He is most likely to be suffering from:
1. Alcoholic hallucinosis.
2. Delirium tremens.
3. Wernicke encephalopathy.
4. Korsakoff's psychosis.
Answer
2. Delirium tremens.
Reference
A Short Textbook of Psychiatry by Ahuja 4 ed Page No 36
Quality
Reader
Status
New
QTDF
Ahuja
Discussion
Delirium Tremens (DT) is the most severe alcohol withdrawal syndrome. It occurs usually within 2-4 days of complete or significant abstinence from heavy alcohol drinking in 5 % of the patients, as compared to acute tremulousness which occurs in 34 % of the patients. The course is short with recovery occurring within 3 - 7 days. This is an acute organic brain syndrome with the characteristic features of
a) Clouding of consciousness with disorientation in time and place
b) Poor attention span and distractibility
c) Visual and Auditory hallucinations and illusion which are often vivid and frightening. Tactile hallucinations of insects crawling over body may occur
d) Marked autonomic disturbance with tachycardia, fever, sweating, hypertension and pupillary dilation.
e) Psychomotor agitation and ataxia
f) Insomnia, with a reversal of sleep - wake pattern.
g) Dehydration with electrolyte imbalance
Explanation
1. Alcoholic hallucinosis when the patient has consumed alcohol.
2. Delirium tremens is classically seen when a patient who has history of consuming alcohol habitually has missed his drink for 2 to 4 days.
3. Wernicke encephalopathy is an effect of Drinking alcohol.
4. Korsakoff's psychosis is an effect of Drinking alcohol
Comments
This question is easier to answer as choices 1,3,4 are concerned with Alcoholic Intoxication
Tips
This question and the next one given here forms an example of the “theme couple” that you so often see in All India and AIIMS question

AIPG 2005 Ortho Fat Embolism

Question
A 30-year-old man had road traffic accident and sustained fracture of femur. Two days later he developed sudden breathlessness. The most probable cause can be:
1. Pneumonia
2. Congestive heart failure.
3. Bronchial asthma.
4. Fat Embolism.
Answer
4. fat Emboolism.
Reference
Harrison 15th Edition Chapter 369
Sabistorn 15th Edition Chapter 18
Quality
Reader
Status
Repeat
QTDF
All Books
Discussion
Fat emboli probably originate from the bone marrow and enter the circulation through torn venules at the fracture site. Although direct occlusion of small blood vessels in the lungs, brain, and skin by fat droplets may cause ischemic injury, the pathogenesis of the syndrome probably involves generation of toxic free fatty acids by lipase in the lungs or platelet aggregation around the fat droplets, with release of vasoactive mediators such as serotonin.
The classic triad of the fat embolism syndrome consists of respiratory insufficiency, neurologic signs, and a petechial rash, although many patients exhibit only one or two of these features. Respiratory insufficiency is associated with dyspnea, inspiratory crepitations, and hypoxemia. Neurologic disturbance ranges from mild confusion to severe impairment of consciousness, which may be accompanied by focal neurologic signs. The petechial rash characteristically occurs in the distribution of the carotid and subclavian arteries, affecting skin, mucous membranes, and conjunctiva. Pyrexia, tachycardia, retinopathy, and oliguria due to renal embolization are additional features.
Laboratory investigations may reveal fat droplets in the blood, urine, or sputum; increased serum lipase and free fatty acid levels; decreased serum albumin and calcium levels; and decreased platelet count. However, none of these tests is specific for fat embolism syndrome, and a combination of clinical and laboratory features is required to establish the diagnosis.
No specific treatment is of proven benefit after fat embolism. Heparin, low-molecular-weight dextran, aprotonin, and alcohol have all been suggested on theoretic grounds, but they may add more risks than benefits. There is anecdotal evidence that high-dose steroids, which stabilize membranes and reduce the inflammatory response, may limit the pulmonary injury. Early immobilization of fractures is a logical preventive measure, and internal fixation may be the most effective method. Measures directed at the early identification and correction of hypoxia and avoidance of hypercarbia, which may exacerbate the neurologic injury, are currently the mainstays of treatment.
Explanation
Self Explanatory
Comments
No specific treatment is of proven benefit after fat embolism. Heparin, low-molecular-weight dextran, aprotonin, and alcohol have all been suggested on theoretic grounds, but they may add more risks than benefits. There is anecdotal evidence that high-dose steroids, which stabilize membranes and reduce the inflammatory response, may limit the pulmonary injury. Early immobilization of fractures is a logical preventive measure, and internal fixation may be the most effective method. Measures directed at the early identification and correction of hypoxia and avoidance of hypercarbia, which may exacerbate the neurologic injury, are currently the mainstays of treatment.
Oxford Text book of Surgery says “that treatment with high-dose corticosteroids may reduce platelet aggregation. Other agents such as aspirin and heparin carry a significant risk of haemorrhage and are not recommended.”
Tips
Few more points : Several days after the bone fractures occur, restlessness, delirium or drowsiness progressing to coma in severe cases, seizures, generalized brain edema, and hypoxia develop. About half the patients have retinal and punctate conjunctival hemorrhages or fat that is visible in retinal vessels. A petechial rash (prominent in the anterior axillary folds and supraclavicular fossae), diffuse interstitial infiltrates on the chest x-ray, fat in the urine, and/or renal failure occur in some patients. Severe reduction in arterial oxygen content is common from widespread lung injury (ARDS). Cerebral fat embolism causes a cerebral purpura, mainly in the white matter, due to capillary occlusion by fat globules. There is evidence that patients in whom this complication is recognized and treated early have a better prognosis. Massive doses of glucocorticoids and administration of positive-pressure ventilation with high end-expiratory pressures have been claimed to be useful

Question
A 30-year-old man had road traffic accident and sustained fracture of femur. Two days later he developed sudden breathlessness. The most probable cause can be:
1. Pneumonia
2. Congestive heart failure.
3. Bronchial asthma.
4. Fat Embolism.
Answer
4. fat Emboolism.
Reference
Harrison 15th Edition Chapter 369
Sabistorn 15th Edition Chapter 18
Quality
Reader
Status
Repeat
QTDF
All Books
Discussion
Fat emboli probably originate from the bone marrow and enter the circulation through torn venules at the fracture site. Although direct occlusion of small blood vessels in the lungs, brain, and skin by fat droplets may cause ischemic injury, the pathogenesis of the syndrome probably involves generation of toxic free fatty acids by lipase in the lungs or platelet aggregation around the fat droplets, with release of vasoactive mediators such as serotonin.
The classic triad of the fat embolism syndrome consists of respiratory insufficiency, neurologic signs, and a petechial rash, although many patients exhibit only one or two of these features. Respiratory insufficiency is associated with dyspnea, inspiratory crepitations, and hypoxemia. Neurologic disturbance ranges from mild confusion to severe impairment of consciousness, which may be accompanied by focal neurologic signs. The petechial rash characteristically occurs in the distribution of the carotid and subclavian arteries, affecting skin, mucous membranes, and conjunctiva. Pyrexia, tachycardia, retinopathy, and oliguria due to renal embolization are additional features.
Laboratory investigations may reveal fat droplets in the blood, urine, or sputum; increased serum lipase and free fatty acid levels; decreased serum albumin and calcium levels; and decreased platelet count. However, none of these tests is specific for fat embolism syndrome, and a combination of clinical and laboratory features is required to establish the diagnosis.
No specific treatment is of proven benefit after fat embolism. Heparin, low-molecular-weight dextran, aprotonin, and alcohol have all been suggested on theoretic grounds, but they may add more risks than benefits. There is anecdotal evidence that high-dose steroids, which stabilize membranes and reduce the inflammatory response, may limit the pulmonary injury. Early immobilization of fractures is a logical preventive measure, and internal fixation may be the most effective method. Measures directed at the early identification and correction of hypoxia and avoidance of hypercarbia, which may exacerbate the neurologic injury, are currently the mainstays of treatment.
Explanation
Self Explanatory
Comments
No specific treatment is of proven benefit after fat embolism. Heparin, low-molecular-weight dextran, aprotonin, and alcohol have all been suggested on theoretic grounds, but they may add more risks than benefits. There is anecdotal evidence that high-dose steroids, which stabilize membranes and reduce the inflammatory response, may limit the pulmonary injury. Early immobilization of fractures is a logical preventive measure, and internal fixation may be the most effective method. Measures directed at the early identification and correction of hypoxia and avoidance of hypercarbia, which may exacerbate the neurologic injury, are currently the mainstays of treatment.
Oxford Text book of Surgery says “that treatment with high-dose corticosteroids may reduce platelet aggregation. Other agents such as aspirin and heparin carry a significant risk of haemorrhage and are not recommended.”
Tips
Few more points : Several days after the bone fractures occur, restlessness, delirium or drowsiness progressing to coma in severe cases, seizures, generalized brain edema, and hypoxia develop. About half the patients have retinal and punctate conjunctival hemorrhages or fat that is visible in retinal vessels. A petechial rash (prominent in the anterior axillary folds and supraclavicular fossae), diffuse interstitial infiltrates on the chest x-ray, fat in the urine, and/or renal failure occur in some patients. Severe reduction in arterial oxygen content is common from widespread lung injury (ARDS). Cerebral fat embolism causes a cerebral purpura, mainly in the white matter, due to capillary occlusion by fat globules. There is evidence that patients in whom this complication is recognized and treated early have a better prognosis. Massive doses of glucocorticoids and administration of positive-pressure ventilation with high end-expiratory pressures have been claimed to be useful

Have you registered your educational qualification ???

For those in tamil nadu, looking for new jobs or better jobs, here is a portal for you

http://www.employment.tn.gov.in/default.htm

Seems to be a very brilliant idea

Results of Kerala PG medical entrance test published

From http://www.hinduonnet.com/2005/03/12/stories/2005031209940400.htm

The provisional rank list of candidates under the General and Service categories, who have qualified in the entrance examination for admission to the various post-graduate Medical (Degree/Diploma) courses for the year 2005, have been published. Mary Suma L (Roll No. 50334), of Vimala Mandiram, Eravipuram, Kollam, has emerged topper in the examination.

The entrance examination was conducted by the Commissioner for Entrance Examinations (CEE) in Thiruvananthapuram, Ernakulam and Kozhikode on February 27. The results of 63 candidates have been withheld and the candidature of 55 others withdrawn for various reasons.

According to an official release issued here today by the CEE, two questions in Paper-I have been deleted from the valuation. The marks for the remaining questions are out of a maximum mark of 450, for this paper. The rank list is available for reference at the office of the CEE and the Director of Public Relations, besides on the website cee-kerala.org. It will also be available in all the District Information Centres from March 15. Candidates desirous of obtaining the details of their marks and rank in the entrance examination may apply to the CEE on or before April 10.

What do you do when you hear a bell ring?

CLASSICAL CONDITIONING
What do you do when you hear a bell ring?
A teacher told this story on himself. When most teachers hear a bell one of the first things they do is walk out into the hallway to be a monitor. Right? Just keep a watchful on the students. Well this guy had acquired such a habit that when he was at home and the doorbell rang he'd walk into a nearby hallway and "monitor" his family. For him it was simply such a strong habit that he'd produce the right behavior (going into the hall to monitor) at the wrong place (his own home).

In this post we will look at Classical Conditioning, perhaps the oldest model of change there is. It has several interesting applications to the classroom, ones you may not have thought about it. Let's look at the components of this model.

COMPONENTS OF CLASSICAL CONDITIONING
The easiest place to start is with a little example. Consider a hungry dog who sees a bowl of food. Something like this might happen:

Food ---> Salivation
The dog is hungry, the dog sees the food, the dog salivates. This is a natural sequence of events, an unconscious, uncontrolled, and unlearned relationship. See the food, then salivate.

Now, because we are humans who have an insatiable curiosity, we experiment. When we present the food to the hungry dog (and before the dog salivates), we ring a bell. Thus,

Bell
with
Food ---> Salivation
We repeat this action (food and bell given simultaneously) at several meals. Every time the dog sees the food, the dog also hears the bell. Ding-dong, Alpo.
Now, because we are humans who like to play tricks on our pets, we do another experiment. We ring the bell (Ding-dong), but we don't show any food. What does the dog do? Right,


Bell ---> Salivate
The bell elicits the same response the sight of the food gets. Over repeated trials, the dog has learned to associate the bell with the food and now the bell has the power to produce the same response as the food. (And, of course, after you've tricked your dog into drooling and acting even more stupidly than usual, you must give it a special treat.)

This is the essence of Classical Conditioning. It really is that simple. You start with two things that are already connected with each other (food and salivation). Then you add a third thing (bell) for several trials. Eventually, this third thing may become so strongly associated that it has the power to produce the old behavior.

Now, where do we get the term, "Conditioning" from all this? Let me draw up the diagrams with the official terminology.

Food ---------------------> Salivation
Unconditioned Stimulus ---> Unconditioned Response

"Unconditioned" simply means that the stimulus and the response are naturally connected. They just came that way, hard wired together like a horse and carriage and love and marriage as the song goes. "Unconditioned" means that this connection was already present before we got there and started messing around with the dog or the child or the spouse.
"Stimulus" simply means the thing that starts it while "response" means the thing that ends it. A stimulus elicits and a response is elicited. (This is circular reasoning, true, but hang in there.) Another diagram,


Conditioning Stimulus
Bell
with
Food -----------------------> Salivation
Unconditioned Stimulus------> Unconditioned Response
We already know that "Unconditioned" means unlearned, untaught, preexisting, already-present-before-we-got-there. "Conditioning" just means the opposite. It means that we are trying to associate, connect, bond, link something new with the old relationship. And we want this new thing to elicit (rather than be elicited) so it will be a stimulus and not a response. Finally, after many trials we hope for,

Bell ---------------------> Salivation
Conditioned Stimulus ---> Conditioned Response
Let's review these concepts.

Unconditioned Stimulus: a thing that can already elicit a response.
Unconditioned Response: a thing that is already elicited by a stimulus.
Unconditioned Relationship: an existing stimulus-response connection.
Conditioning Stimulus: a new stimulus we deliver the same time we give the old stimulus.
Conditioned Relationship: the new stimulus-response relationship we created by associating a new stimulus with an old response.
There are two key parts. First, we start with an existing relationship, Unconditioned Stimulus ---> Unconditioned Response. Second, we pair a new thing (Conditioning Stimulus) with the existing relationship, until the new thing has the power to elicit the old response.

A LITTLE HISTORY AND A COMPARISON
The example we used here is from the first studies on classical conditioning as described by Ivan Pavlov, the famous Russian physiologist. Pavlov discovered these important relationships around the turn of the century in his work with dogs (really). He created the first learning theory which precedes the learning theory most teachers know quite well, reinforcement theory. We will look at reinforcement theory in a separate chapter, but for now I do want to make a point.
The point is this: Classical conditioning says nothing about rewards and punishments which are key terms in reinforcement theory. Consider our basic example,


Conditioning Stimulus
BELL
with
Food ---------------------> Salivation
Unconditioned Stimulus ---> Unconditioned Response
There is nothing in here about rewards or punishments, no terminology like that, not even an implication like that. Classical conditioning is built on creating relationships by association over trials. Some people confuse Classical Conditioning with Reinforcement Theory. To keep them separated just look for the presence of rewards and punishments.

EVERYDAY CLASSICAL CONDITIONING
This type of influence is extremely common. If you have pets and you feed them with canned food, what happens when you hit the can opener? Sure, the animals come running even if you are opening a can of green beans. They have associated the sound of the opener with their food.
Classical conditioning works with people, too. Go to K-Mart and watch what happens when the blue light turns on. Cost conscious shoppers will make a beeline to that table because they associate a good sale with the blue light. (And, the research proves that people are more likely to buy the sale item under the blue light even if the item isn't a good value.)

And classical conditioning works with advertising. For example, many beer ads promeniently feature attractive young women wearing bikinis. The young women (Unconditioned Stimulus) naturally elicit a favorable, mildly aroused feeling (Unconditioned Response) in most men. The beer is simply associated with this effect. The same thing applies with the jingles and music that accompany many advertisements.

Perhaps the strongest application of classical conditioning involves emotion. Common experience and careful research both confirm that human emotion conditions very rapidly and easily. Particularly when the emotion is intensely felt or negative in direction, it will condition quickly.

For example, when I was in college I was robbed at gun point by a young man who gave me The Choice ("Your money or your life.") It was an unexpected and frightening experience. This event occurred just about dusk and for a long time thereafter, I often experienced moments of dread in the late afternoons particularly when I was just walking around the city. Even though I was quite safe, the lengthening shadows of the day were so strongly associated with the fear I experienced in the robbery, that I could not but help feel the emotion all over.

Clearly, classical conditioning is a pervasive form of influence in our world. This is true because it is a natural feature of all humans and it is relatively simple and easy to accomplish.


REFERENCES AND RECOMMENDED READINGS
Hill, W. (1985). Learning: A survey of psychological interpretations. (4th. Ed.). New York: Harper and Row.
Petty, R., & Cacioppo, J. (1981). Attitudes and persuasion: Classic and contemporary approaches. Dubuque, IA: William C. Brown.

http://www.as.wvu.edu/~sbb/comm221/primer.htm

Other links

http://www.wagntrain.com/OC/