Credit Hours Confusion

ganeshcmeThe Credit Hours Confusion is not only interesting but also reflective of the lackadaisical attitude of the powers that supposedly control medical profession in India. There are several confusions and discrepancies with regard to the required credit hours, award of credit hours, exemptions etc., between various state medical councils.

These confusions began right at the start. The Amal Dutta Committee had recommended a minimum of 30 CME credit hours per five years; but, the national workshop conducted by the MCI in May 1996 and the General Body meeting of the MCI held in Feb 1997 recommended 30 credit hours per year, i.e., 150 credit hours per 5 years.

Five years later, the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, recommended a professional to attend 30 hours of CME every 5 years, but the meeting of the executive committee of MCI held in Sep 2002 stipulated 30 credit hours for 5 years, and then allocated 2 credit hours per 5-6 hours of CME Programme. The regulations of 2002 require only 30 hours of CME per 5 years, but the Scheme of MCI, supposedly to implement the very same Regulations, requires a doctor to attend 90 hours of CME to obtain 30 credit hours (@ 2 Credit hours/6 hours of CME)!

But there is more! According to the MCI Scheme of 2002, each CME programme of two days (5-6 hours daily) shall be eligible for a maximum of four(4) credit hours and if it is only for one day of 5-6 hours, the credit hours shall be two(2). But according to the letter MCI – Academics/2013/30661 dated 29/08/2013, the academic council of MCI recommends 2 credit hours/day/participant for any Conference/CME/Workshop of minimum 8 hours duration/day, for a medical college teacher. Instead of 2 Credit hours/6 hours of CME, the same MCI recommends 2 Credit hours/8 hours of CME, specifically for medical college teachers! Accordingly, a medical college teacher must attend 120 hours of CME per 5 years (@ 2 Credit hours/8 hours of CME, to obtain 30 credit hours), when the Regulations 2002 stipulate only 30 hours!

There is much more: as all the state councils offer 4 credit hours/year automatically to medical college teachers (see Table below), they would be required to attend not 120 hours, but just 40 hours in 5 years to get the remaining 10 credit hours (or better, just give 2 lectures per year in any of the CME Programmes!).

The Karnataka Medical Registration Act amended in 2003 requires a Medical Practitioner to produce certificates for having attended CME Progammes for not less that one hundred hours; it does not mention of credit hours and it does not specify the number of years. But the KMC, acting on the basis of its own resolutions (as per the above mentioned RTI response) stipulates 30 credit hours per five years, that translates into 120 hours of CME (@ 2 Credit hours/8 hours of CME). Mind boggling, to say the least.

The Travancore-Cochin Council of Modern Medicine had tagged renewal of registration every five years, to 30 hours of CME programme in May, 2004. The notice issued by TCMC again on Jan 9, 2015, stated that a physician must participate in professional meetings as part of CME Programmes for at least 30 hours every year!

While some state medical councils have made renewals mandatory with requisite CME credits, some others are seeking renewals without mandatory credit hours and some have started awarding CME credits without any need for renewal. But the reasons for such discrepancies between the states are not clear at all.

The required credit hours are also not uniform across the states. While Karnataka has stipulated maximum 6 credit hours per year (30 for 5 years), Punjab requires 50 credit hours for five years. Although the Gujarat Medical Council Act, 1967 has not made CME Credits mandatory for renewals, the revised CME Guidelines stipulate 30 CME Credit hours per year, i.e., 150 hours for 5 years!

In Gujarat, medical practitioners aged above 60 years are exempted from mandatory CME, in Karnataka the age limit for exemption is 65 years and in Maharashtra it is 70 years, but in Uttar Pradesh (UP) and Madhya Pradesh (MP), no one is exempted!

And worse, the credits awarded for CME and other activities are highly variable across the states.

Parameter Karnataka Maharashtra Madhya Pradesh Uttar Pradesh Punjab Gujarat Tamil Nadu
CME delegate 2 for 8hrs;
0 for <4hrs
5-6 hrs a day: 2 Foreign faculty: 1/hour;
CME/ Workshop: 1 per 3 hrs;
International level with >10 faculty: 4/full day, 2/half day
2 of 30 mts or 1 of 60 mts by international faculty: 1
CME/ Workshop: 1 per 3 hrs
International level with >10 faculty: 4/full day, 2/half day;
National conference: 6
1 per 2 h; 4/day 1 per 2 h;
4/day; max 12
1 per 3 hr,
2 per day,
1 per hour of foreign faculty
Online NS Allowed up to 20% credits 1 per hour NS As per certificate As per certificate NS
CME Speaker 1 per lecture 1 per lecture Speaker/ chairperson/ moderator: 1 Speaker/ chairperson/ moderator: 1 1/lecture 1/lecture 1/lecture
International CME/Conference Discretionary International Speaker: 8; national speaker: 6 <6 hrs: 2
>6 hrs: 4;
Speaker: 10; Delegate: 4
Speaker: 5
Delegate: 6
Same as CME above Same as CME above;
Int: 3, natl 2
Conference Papers/Posters NS International – 3, national/state 2 International: 6 International:
Paper: 4
Poster+discussion: 3
Poster exhibit: 2
PG Students 4/year of study 4/year of study 4/year of study 4/year of study 10/year of study 4/year of study 4/year of study
Medical teachers 4/year of teaching 2/6 m of teaching 4/year of teaching 4/year of teaching 4/year of PG teaching 4/year of teaching 6/ year of teaching
Director, joint director medical education &
research/ Director, Joint director health services and Deans of medical
None None 4 per year 4 per year NS NS 6 per year
Book 1st Author: 4;
2nd Author: 2
Author/co-author: 4 12 Author/co-author/editor/joint editor: 6 10 16 5
Chapter 1st Author: 2;
2nd Author: 1
Author/co-author: 4 4 Author/ co-author/ editor/ joint editor: 6 10 4 5
Papers in international journals 1st Author: 2;
2nd Author: 1
Original: 8
Case report: 3
Letter: 2
Original: 12
Case report: 8
Letter: 4
Original: 6
Case report: 4
Letter: 2
Author/co-author: 5 Original: 12
Case report: 6
Letter: 3
Author/co-author: 3
Papers in national journals 1st Author: 2;
2nd Author: 1
Original: 6
Case report: 2
Letter: 1
Original: 10
Case report: 6
Letter: 4
Original: 6
Case report: 4
Letter: 2
Author/co-author: 5 Original: 8
Case report: 4
Letter: 2
Author/co-author: 3
Papers in state indexed journals NS NS NS NS NS Original: 4
Case report: 2
Letter: 1
Journal subscription NS NS NS NS 5/year, max 10, for both International and National 5/year, max 10, for both International and National NS

As the Table above clearly shows, a practitioner in Karnataka gets 2 points for attending a CME of 8 hours and gets none for CME of less than 4 hours, but a practitioner in UP gets 1 credit hour per 3 hours of CME and in Gujarat, one per 2 hours of CME. And the confusion within the different directives of the MCI has been already explained above! States like MP, Maharashtra, Punjab and Gujarat allow credits for online CMEs, whereas Karnataka and Tamil Nadu do not. In Karnataka, authoring a text book gets 4 points, whereas in MP it gets 12 and in Gujarat it gets 16 credit hours. A practitioner from Karnataka publishing a paper of any type in either national or international journal gets only 1-2 credit hours, but a practitioner from MP will get 4-12 credit hours for the same activity. Post graduate students of Punjab would get 10 credit hours per year, but in other states, PGs would get only 4 credit hours per year. In Punjab, only PG teachers would get 4 credit hours per year, but elsewhere, all medical teachers would get 4 credit hours per year and in Tamil Nadu, they would get 6 per year. As per the Scheme of MCI 2002, distance education or CME certificate course of one year is eligible for twenty (20) credit hours and similar course of six months for 10 credit hours. Most states have not included this clause in their CME Credit hour allocations.[See]

These guidelines are unduly favourable to the teachers in medical colleges. Almost all the states that have initiated the CME accreditation programme are awarding 4-6 credit hours to teachers of medical colleges and some states are awarding the same to Director and Joint director of medical education, Director and Joint director of health services and Deans of medical colleges. Does this mean that the teachers are automatically updated every year? Do full time, part time, fraction time and on-paper teachers qualify equally for these credit hours? Are the medical practitioners who are not attached to any medical college, but maintaining highest levels of medical knowledge, considered as ignorant and unworthy? Are the practitioners who regularly update themselves by online resources, text books and journals considered as fools? Do the medical councils that regulate evidence based medical practice have any evidence to prove that teachers in medical colleges are more up-to-date than medical practitioners who are not attached to a medical college? Do they also have any basis for awarding the different credit hours for various activities?

The accreditation policies are also different from one medical council to another. While in some states the organizations/institutions that conduct the programmes need to be accredited, every year to once in 5 years, with or without inspections, in some councils like KMC, every CME needs to be inspected before accreditation. While the scheme ratified by the MCI makes no mention of accreditation fees, every council is charging accreditation fees ranging from Rs. 1000 to 5000. It is indeed appalling that the state medical councils are seeking to accredit national level organizations and it is more appalling that these organizations are willingly subjecting themselves to such accreditation and ‘inspections’ of every CME Programme. Also, when MCI is promising funds for such programmes [see], some state medical councils are forcing the organizers to pay the fees for accreditation and also to bear the expenses of the so called inspectors! Such payments to the state councils and their so called inspectors would only add to
the financial burden of the organizers, which in turn would have to be borne by the medical practitioners.

After two reminders on our RTI query, to provide the copy of the resolution, KMC sent a certified copy of the proceedings of the 273rd meeting of the council held on 26th December 2013, wherein it claims to have resolved that the TA/DA would have to be taken care of by the host organization.[See] It follows that any TA/DA paid to any inspector of KMC by any branch of IMA/API etc., or other organizers of CME Programmes/conferences held before 26th Dec 2013 must be immediately reimbursed by the Karnataka Medical Council. All those who have made such payments must claim the reimbursement from KMC.