Recent reports in the media point to the failure of the experiment of introducing a Hindi-instruction-based MBBS degree. A report in NDTV stated that after three years of starting this programme with much fanfare, the less than 20% students from Hindi medium background in medical colleges in Madhya Pradesh are not keen on going the “Hindi” route. With Chhattisgarh, Rajasthan, Bihar, Uttarakhand and Tamil Nadu planning on repeating the unsuccessful experiment and with state governments and the National Medical Commission (NMC) subtly pushing for it, it is imperative to have a thorough relook at the whole bilingual medium of instruction policy in medical education in India.
How It Started
The question “Why can India not have Medical Education in Hindi right now?” first came up in Parliament in August 2018. The then minister of Health and Family Welfare, J.P. Nadda, had replied that due to a lack of resources, the need to update the curriculum and given the international exposure and experience that the English language provides, the Medical Council of India (the erstwhile medical education regulator) had decided not to impart medical education in Hindi. By 2022, thanks to the New Education Policy (NEP), the “MBBS in Hindi” push had gained political momentum, with Madhya Pradesh becoming the first state to walk that path. The NMC while releasing the Competency Based Medical Education Regulations (CBME) in 2024, also gave a further push to the bilingual mode of education as it state that “teaching, learning, and assessment may be carried out using a bilingual mode (Assamese, Bengali, Gujarati, Hindi, Kannada, Malayalam, Marathi, Odia, Punjabi, Tamil, and Telugu) along with English." Today, Madhya Pradesh even offers a 50% reduction in the examination fee if it is taken in Hindi.
However, the misalignment between what the powers that be think about the vernacular language policy and the experiences of MBBS students is only growing stark.
Is There Really A Need?
While it is evident that the government's move in this direction is a bit premature, the concerns of a section of students, which finds learning in English tougher, remain valid. Various studies have shown that foreign language-based medical education negatively affects academic outcomes due to difficulty in comprehending foreign language textbooks.
In a study in a medical college in West Bengal, nearly 70% of students surveyed agreed to the suggestion that medical colleges in India should prioritise offering medical education in vernacular languages to improve the understanding of the subject, with 45% stating that textbooks in vernacular languages must be available. In another study in Uttar Pradesh, the opinion among healthcare professionals was split. A little over half of the respondents believed that MBBS in Hindi would attract more students from Hindi-speaking backgrounds to join the medical field. On the contrary, and aligning with the initial feedback from students in Madhya Pradesh, another study found professionals in two medical colleges in Gujarat and Rajasthan, preferring English over regional language, with pre-clinical students (first and second year of an MBBS degree) showing relatively higher preference for vernacular languages.
These studies go on to establish that a significant number of students who come from non-English-medium schools find it difficult to navigate an English-language-medium MBBS degree.
More And Better Research
However, in a study published in March this year, 274 MBBS students in Maharashtra were classified based on their medium of instruction in higher and higher secondary schooling, and this was compared with their final-year MBBS marks. For the 75% of students who came from non-English medium backgrounds, no difference was observed in their final performance. Such studies in other countries also point to similar findings, thereby putting a question mark over the need to promote vernacular-language medical education.
Even in Madhya Pradesh, there seems to be no data about the exact number of students who have opted for exams in Hindi, how many of them refer to Hindi textbooks, or details of the quality of such textbooks.
Solution Lies Elsewhere
Manouevring MBBS in English does not require producing transliterated textbooks, which anyway do more harm than good to medical education. Nor does it require rolling out Hindi-based MBBS programmes. Surely also, proposals to set up Hindi-medium MBBS colleges is an overkill.
Often, it is the ‘acculturation', the process through which students, especially those from vernacular backgrounds, entering a medical college are stressed with homesickness, culture shock, academic load and thus find it doubly challenging to warm up to a new language as a medium of instruction. It is thus essential that adequate support is provided to such students, especially in the initial years, to help them get more comfortable with English.
The other important language issue, often conflated with the medium of instruction but actually quite different from it, is that an MBBS student must learn - even at a rudimentary level - the local language to effectively interact with patients during their training. For example, that MBBS students face language barriers while studying in a foreign country is well-documented. Be it non-Arabs studying medicine in Saudi Arabia, Malaysians in Egypt, or the large number of International Medical Graduates (IMGs) in the US, language barriers in doctor-patient interaction exist.
In India, just five states - Karnataka, Maharashtra, Tamil Nadu, Uttar Pradesh and Telangana - account for 56% of the total private medical colleges in India. Students from all over the country flock to these states and end up facing language barriers.
One way to surmount this gap is through technology. With Artificial Intelligence being mainstreamed, it must be leveraged to address the concerns of students who find the English language challenging. A slew of LLMs being developed within India have the potential to significantly improve access and equity in higher education for students who come from vernacular backgrounds. These LLMs can, in real time, translate complex medical content in regional Indian languages.
The Real Problem
The Madhya Pradesh experiment is failing because there are gaps. Questions abound about the acceptance of a vernacular language degree, its status in the medical fraternity and research ecosystem and its helpfulness in competitive exams. The solution lies in good old mentoring and creating effective support systems. There needs to be more nuanced identification of the pain points, and these must be addressed in a more tailored fashion, rather than making sweeping changes, such as what the Madhya Pradesh government has done.
(Sambit Dash, PhD, is an Associate Professor of Biochemistry at Manipal University College Malaysia (MUCM) and comments on public policy and health. He tweets @sambit_dash.)
Disclaimer: These are the personal opinions of the author
