“You can’t keep me from learning. You can’t keep me from studying.” So says Hunter “Patch Adams” in the eponymous movie which had Robin Williams portraying the real life character of a middle aged medical student. Adams wants to become a doctor to provide compassionate care to patients. Motivated by his own experience while being treated for a mental health disturbance, he wishes to provide healing through love, laughter and tenderness instead of the cold, impersonal, strictly technical approach that became the creed of the white coat wearer.
When this nonconformist is threatened with expulsion from the medical school, he defiantly answers “You treat a disease, you win, you lose. You treat a person, I guarantee you, you’ll win, no matter the outcome.” His victory in the case conveys two messages. No one is too old to learn and practice medicine. Age and experience bring a better understanding of human nature and the social determinants of health that can broaden a student’s learning and enhance the quality of medical care.
An upper age limit for entry to undergraduate medical studies figured recently in Indian courts. The age barrier for appearing in the National Eligibility cum Entrance Test (NEET) for MBBS had been set at 25 years for general category students and at 30 years for those in the SC/ST/OBC categories. This restriction was legally challenged by petitioners who argued that an upper age limit did not exist in the earlier pre-medical tests (PMTs) conducted by state governments. They questioned why an upper age limit was imposed when the NEET subsumed them.
Two arguments were previously advanced by the erstwhile Medical Council of India (MCI) for imposing the age limit. First, younger students were likely to absorb new knowledge faster compared to older ones. The second was that older students would have the ‘unfair’ advantage of more extensive prior learning over the young students just out of school. While older age at entry was portrayed as an impediment to future learning, experiential knowledge was profiled as creating competitive groups of dissimilar backgrounds.
Even as the Supreme Court was examining the case, the National Medical Commission announced removal of the age restriction. Applicable from NEET 2022, there would be no upper age limit, though the lower limit of 17 years remains. Office of Health Minister Mansukh Mandviya tweeted “Good News for the aspirants of NEET-UG! …This decision will immensely benefit aspiring doctors and further help in strengthening medical education in the country.”
This is indeed a welcome development. There are many who may aspire to switch tracks after training in other courses or gaining work experience which is useful for later practice of medicine. A nurse, for example, would have acquired considerable experience of primary care in the community or patient care in a hospital. If such a nurse clears NEET, that experience would be very useful both during medical studies and after qualifying as a doctor.
Some may have financial needs which they meet by working for some years after school, before appearing for the medical entrance examination. Such people are now enabled. The clause that made students of open schools ineligible for NEET has also been removed, making medical education potentially accessible to many more students.
In USA and Canada, medical schools require a person to complete 3-4 years of undergraduate collegiate education before they become eligible for admission to medical schools. That gives the students a level of maturity where they not only absorb the technical content of the education but also appreciate the societal obligations and ethical dimensions of the profession. Often, such prior education not only exposes them to sciences but also to humanities which makes the medical student appreciate the social and psychological dimensions of health and disease. Some American students also acquire a degree in public health before entering a medical school, making them better doctors and researchers.
There is no reason to believe that a person over 25 is too old to learn. Several years ago, a bioengineering faculty member from IIT Delhi, who had earlier obtained engineering, science and PhD degrees from India and USA, joined an MBBS programme in Delhi so that he could gain better understanding of the human body in health and disease. Even in other domains of education, there have been many who have successfully undertaken formal education at older ages and even obtained PhDs.
While returning Indian medical students from Ukraine will mostly be younger than 25, those at an advanced stage of interrupted education may benefit if older. Even if special exemptions enable lateral transfer, they may still need to pass the NEET. The rule change is well timed to help such students. Even in the long run, enabling more mature students to become doctors is likely to enhance the quality of health care by adding life experience and empathy to a technical mix. Will those qualifying as doctors at older ages be more inclined to become general practitioners and family doctors, to fill gaps in primary care? Time will tell.
The author is President, Public Health Foundation of India (PHFI). Views are personal.
