Graduate Medical Education Regulations 2023: A Community Medicine Perspective

Dear Editor,

The new Graduate Medical Education Regulations (GMER) was released by the National Medical Commission and was brought into effect from August 1, 2023. The new GMER-2023 has evolved from the key principles of Regulations on Graduate Medical Education, 1997 and GMER, 2019, and adapted them in the current context of advancement in medical education, emerging diseases, changing sociodemographic and economic scenarios, and advancement in science and technology while meeting the expectations of the stakeholders and aligning with the global trends.^1,2

In the GMER-2023, several revisions have been made, which include the reduction of the duration of I Professional MBBS to 12 months, including the foundation course, and the reduction of the III Professional year (Part-1) to 11 + 1 month including electives, and increased the teaching hours for Community Medicine. Other changes include the incorporation of teaching hours for the family adoption program (FAP) within the schedule, and the duration of classroom teaching hours has been reduced to accommodate experiential learning through FAP^2,3 [Table 1].

The departments have been allotted specific competencies under AETCOM across the phases. The AETCOM competencies 3.5A – “Identify, discuss, and defend medico-legal, socio-cultural, professional, and ethical issues as they pertain to the physician-patient relationship (including fiduciary duty) and Identify” and 3.5B – “discuss physician’s role and responsibility to society and the community that she/he serves” are allocated for community medicine.²

More importantly, the duration of the clinical postings is reduced to 4 weeks in the III Professional year from 6 weeks. The total duration of interactive lecture sessions increased from 80 h to 90 h from I MBBS to III MBBS Part I. However, the cumulative small group discussions/learning (SGL) duration has been reduced from 117 h to 90 h from I MBBS to III MBBS Part I and no SGL for Phase II. Self-directed learning (SDL) duration has been modified in such a way that there is no SDL in Phase I, no change in hours (10 h) in Phase II, and duration increased from 5 h to 20 h in Phase III-part I under SDL. Specific modules are allocated for AETCOM (Attitude Ethics and Communication) in Community Medicine^1,2,4 [Table 1].

According to GMER, 2023, to declare a candidate as pass in Community Medicine, the learner must secure a minimum of 50% marks in aggregate in Community Medicine Paper I and II together to pass the subject. Further, the candidate shall obtain 50% marks in the university examination separately in theory and in practical (practical includes practical/clinical and viva voce) to be declared as passed in that subject. In GMER 2019, the learner must secure at least 40% marks in each of the papers (Community Medicine Paper I and II) with a minimum of 50% of marks in aggregate (both papers together) to pass the examination. Even though the eligibility for writing the university examinations is the same (Minimum 40% separately for theory and practical and 50% cumulative in internal assessment (IA) for eligibility in Summative examination), certain modifications in the internal assessment criteria between GMER, 2019 and GMER, 2023 are made with some mark translation of SDL, home assignments, and attendance in the current regulations [Tables 2 and 3].^1,2,5

To summarize, GMER 2023 has emphasized the family adoption program more, allocated more teaching hours in Phase III, especially in lectures, than SGL, and given detailed directions for internal assessment mark allocation compared to GMER 2019 recommendations.