That India is a nation of contrasts is also highlighted by the quality of the medical research churned out by its 579 medical institutions. Four medical colleges in India are among the list of top 10 global institutions that published the most research between 2005 and 2014, but close to 60% have published no research at all in a decade, according to a study of peer-reviewed literature. With an average annual research output of 1,100 papers, the All India Institute of Medical Sciences (AIIMS) ranked third in the world but published less than a third of what Massachusetts General Hospital and Mayo Clinic did, with 4,600 and 3,700 papers respectively. What was shocking was that 332 medical institutions in India published no research in a whole decade. Only 25 (4.3%) of top medical institutions published more than 100 papers each year and, between them, accounted for 40.3% of India’s total research output of a little over 100,000 papers in a decade.
Since all the institutions surveyed were recognised by the Medical Council of India (MCI) or the National Board of Examinations, the two bodies that regulate medical education in India, it’s worrying that young doctors are not being encouraged to develop analytical skills and critical thinking that fuel scientific innovation and lead to better outcomes in disease management and surgery. Almost all the 332 medical institutions with not a single publication in a decade were privately-run medical colleges and hospitals. The states with the largest number of private medical colleges did the worst, with more than 90% of the medical colleges in Karnataka and Kerala having no publication at all. The institutions that did best were publicly-funded teaching hospitals, where each doctor treats an overwhelming number of those ailing each day. AIIMS, for example, treats 12,000 patients in its out-patient department every day, far more than what many private medical colleges do.
Research is indicator of an institution’s quality of education and clinical care. India’s research output is poor because medical education has become a business and there is little interest in research, which is not considered profitable. It has no direct effect on income or promotion, which is based on seniority, clinical practice and often influenced by nepotistic considerations. India needs to incentivise research and the MCI’s 2015 guidelines, which require at least four research publications for associate professors and eight for professors, are not enough. To be global players in medical education, institutions need to offer funds and infrastructure to support research that can be applied to the medical and nursing practice.