New Delhi: Though, thousands of Indians with medical degrees from foreign universities appear for the Foreign Medical Graduate Exam (FMGE) every year, a screening test conducted by the National Board of Examination (NBE) and mandated by the National Medical Commission to qualify for practise in their own country, on an average, less than 20 per cent of them are able to clear it.

In 2019, 25.79 per cent of foreign graduates cleared the FMGE, while the percentage was 14.68 in 2020 and 23.83 in 2021. The figures in years preceding 2019 were even lower, according to NBE (previously Medical Council of India).Foreign medical graduates from countries like Russia, Ukraine, China, the Philippines, Bangladesh and Nepal, among others, are allowed to practise in India only after they have cleared the FMGE. However, MBBS graduates from the US, UK, Australia, Canada and New Zealand do not need to take the exam.

Former Kerala chief secretary Dr Vishwas Mehta, who dealt with medical education during his stint as joint secretary in the Union health ministry, told: I have been to medical colleges in Armenia, Georgia and Russia. There is no entrance test and the fees are reasonable so a lot of people end up there. But there are very strict laws, so students are never allowed to touch a patient, so they often do not know how to put a catheter or injection or even do a delivery.The standards are very different. Also, there is no reciprocal arrangement with these countries for recognising their degrees. Even the US required medical graduates going from India to appear for the USMLE (United States Medical Licensing Examination).

Why FMGE ?
Former NBE executive director Dr Vipin Batra said the idea of a screening exam came up around 1998-99, when what was earlier a diplomatic window — the government would nominate students for PG medical education in the erstwhile USSR and then CIS (Commonwealth of Independent States) countries — gradually became a commercial venture with more and more colleges in the region opening their doors to Indian students.

The demand-supply mismatch in medical education has always been a problem for India. Initially, medical education in the USSR was part of a diplomatic exchange programme when the government would nominate [students]. In 1998, the MCI for the first time passed a resolution derecognising foreign medical graduates, according to Dr. Batra.But that received a setback and the Pokhran nuclear test happened in 1998 and Russia was the only country standing with India through the sanctions. There was a lot of diplomatic pressure against derecognising degrees from a country that stood with India in those times, so finally, in 2001, a middle path was devised. This was the screening test- he said.

However, the test was met with some opposition. Some medical graduates moved the Supreme Court seeking an order to limit the ambit of questions asked to just clinical subjects. The apex court, in its verdict, allowed some relaxations, including removal of the cap on number of attempts allowed. The first FMGE happened in 2004 March and it has been happening for the last 16 years. But new international players came into the picture in the millennium decade and countries like China and Philippines also opened their doors to Indian students. Currently, we send as many students to study medicine in China as to the erstwhile CIS countries. The Philippines has an advantage because it is English-speaking- Dr. Batra added.

Doctors who have experience working with foreign medical graduates, however, claim that even those who clear the screening test are often found wanting in clinical and practical skills. 'There are times we encounter graduates who cannot even put a cannula on a patient', according to a senior doctor from Delhi’s Indraprastha Apollo Hospital. There is a reason that the examination is so tough, and India is not the only country requiring foreign graduates to clear a screening test, say experts.

After failing to clear test?
What do the nearly 80 per cent graduates do after failing to clear this test? While some give up on their dream to pursue medicine and adopt a different career path, others cling to it, especially since there is no cap on the number of attempts for the biannual FMGE.

A 32-year-old from Mumbai, who completed her MBBS (Bachelor of Medicine and Bachelor of Surgery) degree in Russia’s Ryazan oblast around eight years ago, said she could not clear the FMGE despite 10 attempts. She is now pursuing hospital management at an institute in Mumbai. 'I am studying hospital management, but I have not given up on my dream to practise medicine. I appeared for the FMGE yet again this year and am waiting for the results.'

She also claimed that there were errors in the question paper this year and that questions worth 12 marks were wrong, for which students should have been awarded marks. The students have now petitioned the NBE regarding the same. Asked why she chose to pursue medicine from a university in Russia, she said that while she was mulling over where to apply, she was told that the institute is one of the best in that country. 'It’s been many years so I don’t remember the exact fee that I paid, but it was definitely less than what I would have paid in a private medical college in India, so I went for it,' she added.

Asked if the exam had become any easier for her after 10 attempts, she said: 'The syllabus of FMGE is not fixed…they can ask anything and not just from the UG level, but the PG level as well. No matter how much we study, it just seems impossible to crack and not just because it’s tough, but also because there is no transparency about this exam.A candidate cannot apply for revaluation, rechecking, or get the answer sheet…all this makes it more difficult for us.'

Another medical graduate, who completed her MBBS from a university in Shandong, China, four years ago, attempts the FMGE exam every year but has not had success so far. She said she decided not to divert energy into anything else and has been solely focusing on preparing for her next shot at the exam. 'My score has improved every time in the last four attempts. I believe I will be able to clear the exam this time,'added the 27-year-old Noida resident. She also spoke about the lack of a defined syllabus: No books are prescribed to us by NBE, there is no defined syllabus that we can refer to while preparing for the exam. All this makes the exam more difficult for us.

‘Decided to change ...’
However, not everyone is able to retain their interest in the profession after many failed attempts at clearing the exam. A 35-year-old businessman from Jind, Haryana, is one such example. After attempting the FMGE five times following an MBBS degree from a university in the Russian capital Moscow in 2014, he finally gave up the idea of being a doctor three years ago. He now handles his family’s business of manufacturing perfumes.

My father wanted me to be a doctor and sent me to Russia because I could not qualify for a medical seat in India. I tried a lot to clear the screening test and get a licence to practise medicine, but could not succeed. Hence, I decided to give up on it and join my family business instead of wasting more timeþ he told . Some consultants also said that most people are left with no choice but to take up alternative professions after repeated failed attempts at clearing the exam.

Vineet Tiwari, who runs a consultancy in Delhi that helps students choose a medical college and prepare their application, said: These foreign graduates cannot practise in India but they can practise in the country they studied from. Those who have the means and connections, get internships in China, Russia, and then start practising there. This was, however, only possible pre-pandemic.Others who are not able to get such opportunities would either take up an alternative career path or work at a clinic where licensed professionals are not required, in remote areas, villages or small towns.

Neeraj Chaurasiya, another consultant based in Noida, said many graduates keep trying repeatedly to clear the exam. Most people make repeated attempts to clear the exam but those who cannot clear it take up related careers if they have to stay in India. Those who can, go to countries where they can practise medicine, he further said.

-Sources