Private medical colleges in Punjab faced a whirlwind of changes in 2018. A new ‘Central Induction’ policy was introduced. This policy produced prominent echoes, especially for the group it most affected: the students. It goes without saying that each and every policy, made or altered, heavily affects the training experience of our future doctors.

Before the introduction of the Central Induction policy, private medical schools were not restricted to follow a set admission criteria. Each private medical school had its own requirements and basis for admission. Without the merit and the percentile being standard public information, some of these schools made decisions based on how many ‘donations and gifts’ a student could offer. As a result, the students who had enough merit, but not enough cash, were dropped and forced to either enroll in another college or to choose another profession.

The PMDC (Pakistan Medical and Dental College) took notice of this and proposed a central induction policy which would require all colleges to admit students based on a single merit list. The policy was proposed in 2016.

However, leading private colleges spoke out against this and took a stay order with the courts. In November 2017, the Lahore High Court declared that the private medical colleges were to be allowed to admit students based on their own criteria. In 2018, the Chief Justice of Pakistan, Saqib Nisar, took notice of this issue. Under the directives of the CJP a consensus was reached between the private and public medical colleges. There would be a central induction policy that would ensure that students are admitted on the basis of merit alone. The fee increased as well, fixed at Rs950,000 a year.

The fee had increased for the third time in the last five years. In 2013, the fee for private medical colleges was increased from Rs550,000 to Rs642,000 a year. In 2017, it was further increased to Rs800,000. Only to be increased even further under the new Central Induction Policy. It must be noted that students actually end up paying a lot more than this due a tax system that results in fee increase by seven percent every passing year.

While the policy has good intentions, students see two major problems arise from it: firstly, unjustified increase in the fee; and secondly, the promotion of a system that looks at a merit list that is mostly based on a single component.

The fee increase that accompanied the new policy has left many students still unable to attend private medical school. Aasia, a prospective medical student in Lahore, explains the problem that arises from a fee structure that most people cannot afford.

"Some students with a high merit, who have gotten into private medical colleges under the initial merit lists, cannot secure their seat as the fee has increased," says Aasia and continues that the students have to provide a proof of payment for the next five years. They have to show that they will be able to cover the costs. "Most students do not have that much money in their bank accounts, hence cannot secure the seat despite meeting the merit. The merit lists get delayed as students who have gotten in do not have the capacity to pay the fee and the merit drops in order to incorporate more students with a lesser merit but more money."

A spokesperson of the PMDC points out that private medical colleges ask for a yearly fee increase. "They wanted it to go up to Rs13,00,000 but the courts only allowed them to increase so much". Unlike public medical colleges, private medical colleges are not subsidised by the government. Due to economic reasons such as inflation, the cost of maintaining the colleges increases on a yearly basis. "With the cost increase comes the demand for an increase in income. The government must ensure that the fee is not drastically increased without taking into account the affordability of those paying it,"she adds.

But another student expressed her concern by stating that while the fee has increased, the services and the quality of education offered remains the same throughout the board. This makes the increase in the fee seem pointless and unjustified.

The second problem faced by students is the uniform merit list that excludes major aspects of what an individual has to offer from the admission criteria. The admission requirements of medical school in Pakistan can be concluded in a single formula -- 10 percent (O Level or Matric result) plus 40 percent (A Level or FSC result) and 50 percent for one test called the MDCAT (or MCAT).

The MDCAT is a single day of testing that ends up being equivalent to five years of hard work. The MCAT occurs only once a year, if a student misses this test due to any personal emergency or health problem there is no second chance available.

Standardised testing is an important tool for admission processes all over the world. Medical schools in the UK and USA use similar standardised tests. However, these tests do not represent a 50 percent of the student’s ability. The UKCAT test is not based on a sciences-related curriculum. The format of the test covers questions that assess logical skills such as decision-making, quantitative reasoning or situational judgment. Other components such as A and O Level grades along with reference letters from teachers also form an important part of the admission criteria.

In the US, according to The Princeton Review, "The reality is that your chances of acceptance depend on a lot more than just good MCAT scores. It’s a combination of the following pieces of your med school application: your GPA, your MCAT scores, your undergraduate coursework, letters of recommendation, experience related to the medical field (such as volunteer work or research), extracurricular activities, and your personal statement. Medical schools are looking for a complete package, not just strong scores and a high GPA".

This, quite clearly, is not the case for Pakistan. After the declaration of the Central Induction policy, the PMDC Registrar Dr Waseem Hashmi was reported to have said that "it was a commendable move that a central policy to enroll students will now be in vogue and decisions will not be taken on an individual basis."

Under the new policy, a system is being promoted that completely subtracts any and all individual talent of the student from the admission criteria. This is not common practice all over the world. The MDCAT in Pakistan has become the focal point for medical school admissions.

"The MDCAT is supposed to make all the difference, especially for A Level students. There are academies that enroll 300 students per class and take Rs60,000 from each student. They earn so much, it’s like a mafia that thrives on the importance and weightage given to the exam under our admission system," explains a student in his third year of medical school.

The MDCAT has become even more important under the Central Induction policy as now each and every school is deciding primarily on a single test that takes place once a year. Nobody takes into consideration interviews, letters of recommendation, extra-curricular activities or personal statements.

"I feel that there’s a whole lot of focus on books and minor details and less on practical skills and extra-curricular activities such as experience in the field," says a student. "Many factors need to be taken into consideration for a student applying for medical school. It shouldn’t only be grades because for a doctor, tonnes of other qualities are required such as empathy, confidence, counselling and convincing skills".

Another student explains, "Now that my interaction with the patients has started I realise that I am not equipped to talk to patients, handle the stress that comes with the job and cope with spending the day as a full time doctor. These factors must be considered as part of the admission process".

While the changes injected into Punjab’s medical colleges aim to improve the system by making it just and fair, there needs to be wider change within the system as well. It must be understood that the policies in place at medical schools form the basis of the success or failure of the country’s healthcare system. Hence, the policies must aim to incorporate students with both a diverse financial background and an individualistic, fully equipped, skill set.

The admission policy in place at medical schools promotes an exclusionary system that persists on accepting automated digits on a merit list instead of practically and theoretically equipped individuals.