Kerala High Court Upholds Requirement Of Clinical Clerkship For Foreign Medical Grads Who Faced Break In Course During COVID

A Division Bench comprising Justice Sushrut Arvind Dharmadhikari and Justice P V Balakrishnan held that the FMGs, who had completed medical courses in China during the COVID-19 pandemic, had not “sufficiently compensated” the period of online study as required by the National Medical Commission (NMC).

The Appellant approached the division bench in intra-court appeal challenging the decision of Single Judge which held that mandatory clinical clerkship was not necessary for FMGs who had attended compensatory classes abroad.

Respondents 1 to 8 in the present appeal had pursued MBBS courses in Chinese Universities and returned to India during the pandemic, attending a significant portion of their studies online. Although they later travelled back to China and underwent compensatory physical training ranging from four to six months, their full period of online study ranged from 2 years, 9 months to 3 years, 1 month.

They subsequently cleared the Foreign Medical Graduate Examination (FMGE) and applied for provisional registration in Kerala. However, the Kerala State Medical Council declined registration and required them to complete a one-year clinical clerkship, citing NMC guidelines issued in 2023 and 2024.

The FMGs approached the High Court through a writ petition, and a Single Judge had ruled in their favour, holding that clinical clerkship was unnecessary since the students had compensated online classes with physical sessions abroad. The present appeal was filed against this decision.

The division bench examined the NMC public notices dated 07.06.2024 and 19.06.2024 which dealt with the conduct of internship for FMGs. It has also examined the circular dated 09.05.2023 and the clarification issued by NMC on 07.08.2025 with regard to the offline compensation for online study.

In the clarification issued by NMC, it was stated that all students who have 'sufficiently compensated' classes in physical onsite in lieu of online classes and subsequently passed an examination equivalent to MBBS in India shall be eligible for a one-year mandatory internship under the Compulsory Rotating Medical Internship (CRMI) Regulations.

The Court noted that the purpose of issuing these public notices is to ensure that candidates who were unable to attend physical classes during the COVID pandemic and attended classes online, meet the standards required for the courses, to ensure that there is no compromise in the standards of medical education.

The Court observed that as per the clarification, the compensatory classes must be for an equal duration of the course studied by online mode. It further noted that an online period of any duration in one academic year cannot be compensated along with the academics of the next year of offline study, without extension of the study period.

“It is thus clear that in order to 'sufficiently compensate', a FMG who has studied a portion of his course online is required to undergo equivalent in-person training to make up for that duration” Court noted.

The Court further noted that the compensatory studies undergone by the respondents in the present case is not of equal duration of the course studied by them through online mode. It was also noted that the compensatory classes undergone by the respondents were along the academics of the balance years and hence do not fill the criteria specified by NMC.

“We have no hesitation in finding that respondent Nos.1 to 8 have not ''sufficiently compensated'' classes in physical mode, in lieu of the online classes as mandated in Ext.P21.” Court added

The Court further examined whether the State Medical Council was right in imposing a clinical clerkship for a period of one year.

The Court held that the State Medical Council is the statutory authority responsible for evaluating FMG eligibility. It further noted that the guidelines issued by NMC directs the State Medical Council to ensure full compliance with the prescribed curriculum and the circulars issued by NMC.

It has also noted that the public notice dated 07.12.2023 issued by NMC mandated that students who had a break in the final year or in penultimate year of study due to COVID/war and have returned to India and have attended classes through online mode, must undergo a compulsory clinical clerkship for one/ two years.

“In the light of the afore facts, we are of the considered view that the stand taken by the appellant insisting respondent Nos. 1 to 8 to undergo a one-year clinical clerkship cannot be stated as arbitrary, unjustifiable or without any basis.” Court held.

The Court concluded that the State Medical Council acted within its regulatory mandate in insisting on a one-year clinical clerkship before permitting them to commence the Compulsory Rotating Medical Internship (CRMI).

The Bench thus ruled that the earlier judgment was unsustainable in law and contrary to NMC guidelines.

Accordingly, the writ appeal was allowed, and the writ petition was dismissed.

Case Title: Kerala State Medical Councils v Daleel Ahmmed and Ors.

Case No: WA 2321/ 2025

Citation: 2025 LiveLaw (Ker) 790

Counsel for Appellant: Vivek Menon, N Raghuraj (Sr.)

Counsel for Respondents: K S Prenjith Kumar