Kerala High Court Reinforces Mandatory Clinical Clerkship for Online-Educated FMGs, Prioritizing Patient Safety

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Published on December 3, 2025

KOCHI — In a significant verdict that underscores the primacy of clinical exposure in medical education, the Kerala High Court has upheld the State Medical Council’s decision to mandate a one-year “Clinical Clerkship” for Foreign Medical Graduates (FMGs) who completed a portion of their MBBS studies online during the COVID-19 pandemic.

The ruling, delivered by a Division Bench comprising Justices Sushrut Arvind Dharmadhikari and P.V. Balakrishnan, overturns a previous Single Judge order that had granted relief to a group of students from Chinese medical universities. The court held that FMGs who failed to “sufficiently compensate” for their online theory classes with an equivalent duration of physical training must undergo this additional clerkship before they are eligible for the standard Compulsory Rotating Medical Internship (CRMI).

The Core Issue: Online Learning vs. Bedside Medicine

The legal battle centers on the 2017-2018 batch of medical students who pursued their education in China. Due to the global lockdowns triggered by the COVID-19 pandemic, many of these students returned to India and continued their coursework online for nearly three years. Upon returning to China post-pandemic, they completed a compensatory period of physical training, which they argued was sufficient to qualify them for registration in India.

However, the Kerala State Medical Council rejected their applications for provisional registration, citing National Medical Commission (NMC) guidelines. The Council argued that the students’ compensatory training was not of “equal duration” to the online period, leaving a critical gap in their practical skills.

Siding with the Medical Council, the Division Bench observed that the sole objective of the clinical clerkship is “to ensure the quality of health care delivery in the country and nothing more.” The judges emphasized that the medical profession deals with precious human lives, and standards cannot be diluted.

Understanding “Clinical Clerkship” vs. Internship

For many readers, the distinction between a “Clinical Clerkship” and the standard internship (CRMI) can be confusing.

CRMI (Internship): A standard 12-month paid training period required for all medical graduates (Indian and foreign) to obtain permanent registration. It involves rotating through various departments with significant responsibility.
Clinical Clerkship: In this context, it acts as a remedial bridge course. It is an additional year of practical training mandated before the internship for students whose primary medical education lacked sufficient hands-on exposure. Crucially, unlike the internship, clerkships often do not carry a stipend, adding to the financial burden of FMGs.

“The court’s interpretation clarifies a grey area in the NMC regulations,” explains Dr. Rajesh Menon, a medical education expert (name changed for illustrative purposes). “The NMC’s concept of ‘sufficient compensation’ is strict—if you studied online for 20 months, you must do 20 months of physical training. If you haven’t, the Clinical Clerkship is the mechanism to ensure you are safe to touch a patient.”

Implications for Foreign Medical Graduates

The ruling has profound implications for thousands of FMGs across India, many of whom are in similar situations after fleeing the pandemic in China or the war in Ukraine.

Extended Timeline: Affected students now face a significantly longer path to practice. A standard 5.5-year timeline could stretch to 7.5 or 8 years (5 years course + 1 year Clerkship + 1 year Internship).
Financial Strain: The additional year of clerkship delays entry into the workforce. While the Kerala High Court recently ruled against charging illegal “internship fees” to FMGs, the lack of a stipend during the clerkship year remains a point of contention.
National Precedent: While this is a state High Court ruling, it relies heavily on NMC public notices, particularly the clarification issued to the Government of Andhra Pradesh in 2024. This suggests that Medical Councils in other states may adopt similarly rigid stances, affecting FMGs nationwide.

Voices from the Ground

The verdict comes as a blow to student associations who have long argued that passing the Foreign Medical Graduate Examination (FMGE)—a rigorous licensure exam—should be sufficient proof of their competency.

“We have passed the same screening test that certifies us to practice,” said a representative from a prominent FMG association, speaking on condition of anonymity. “Asking us to do two years of internship-like duty—one unpaid and one paid—feels like we are being penalized for a global pandemic beyond our control.”

However, the judiciary and the NMC remain firm. The Division Bench noted that online classes, no matter how comprehensive, cannot replicate the complex realities of a hospital ward. “The integrity and safety of the health care delivery system,” the court stated, must take precedence over student convenience.

What This Means for You

For the general public, this ruling acts as a quality assurance mechanism. It ensures that the doctor treating you, regardless of where they earned their degree, has spent a standardized amount of time in actual patient care under supervision.

As the medical education landscape continues to evolve post-pandemic, this judgment serves as a stark reminder: in medicine, there are no shortcuts to experience.

Medical Disclaimer:

This article is for informational purposes only and should not be considered medical advice or legal counsel. Always consult with qualified healthcare professionals or legal experts regarding medical education regulations or health-related decisions. The information presented here is based on current research and expert opinions, which may evolve as new evidence or court orders emerge.