May 8, 2005

Year after year, substandard medical graduates walk out of our institutions and there’s no stopping this trend.

Medical education is progressively deteriorating in Pakistan. We are not producing medical graduates who are well educated, scientifically oriented, skilled enough to perform their duties and are competent enough to compete with the fresh doctors of other countries. They also lack humanity, respect for patients and the art of communicating with the poor of the country. They are not hardworking and they are also not responsible in their approach. They are only in a hurry to become rich as soon as possible, and at any cost.

But his attitude hasn’t come in a matter of days or weeks. It is has happened slowly, gradually because of the failure of our medical education and training system. Medical institutions became a place of political bribery and corruption. And doctors, who used to have an important role in the community, lost their connection and sadly lost that respect too.

TYPES OF MEDICAL EDUCATION: The government medical colleges are still following a method of teaching that comprises of lectures and clinical teaching, mostly based on tutorials. For the last many years, the government has wanted to implement community based medical education system in selected medical colleges. The system has yet to get off the ground. And anyway, it will be tough, if not impossible to implement this system as our medical colleges are not conducive for this system.

In majority of government medical colleges, the teaching faculty does not teach on a regular basis. Majority of medical students do not come to the classes for traditional lectures or clinical tutorials.

Usually the students come late and the majority of the time, resident medical officers of the ward or postgraduate students teach them. There is no system of accountability, punishment or award for either teachers or students.

In the private sector, the AKUH is strictly following Problem Based Learning (PBL); some of the others (ZMU) has a mix type of system including PBL and traditional method. Most of the others are following the traditional methods. The basic purpose of all private medical colleges is to make money. With this guiding philosophy, the owners are eager to increase the fee, admit students more than the allocation and compromise on the quality of education.

TYPES OF MEDICAL STUDENTS: In public sector medical colleges, we have a majority of students who have been admitted on merit. These are the unfortunate Pakistanis who suffer because they are intelligent and they were born in an unjust system. For example, King Edward Medical College, Lahore or Khyber Medical College, Peshawar will admit the most brilliant students of the province, but the system will stop their intellectual growth. Some of them leave the country and will never come back. Some of them will choose to stay in the system and unfortunately the system will change them for the worse. They will become the part of the system which does not work for the people or patients. Very few of them will be able to survive with intellectual, moral and social integrity.

Recently a wave of self-finance scheme. This was the start of organized corruption in medical colleges. For example, in SMC, students were admitted without having passed their basic exams. Principals of medical colleges made money in collaboration with the Health Department by admitting students who were not qualified to become medical students.

A new chapter of corruption was recently inaugurated when the academic council of Dow University of Health Sciences, shamelessly passed a resolution for the creation of special seats for the sons and daughters of college faculty who failed to get admission on merit.

Majority of the private medical colleges will give admission to any student (even an arts student) if they have their way. The students in these colleges are not violent and do not cause problems because of tight control and cost of medical education.

TYPES OF MEDICAL COLLEGES: We have good medical colleges like King Edward, Nishtar Medical College or Khyber Medical College. And then we have bad medical colleges like Swat or Sukkur Medical College in the government sector. None of the medical college in the government sector are hundred per cent satisfactory as per rules and regulations of PMDC. They lack faculty, resources, laboratories, patients, good hospitals and modern teaching aid with good libraries.

In the private sector, majority of the medical colleges are not up to the standard of the PMDC. They lack good building facilities and equipments. Some of the colleges are operating from bungalows. Majority of the owners of these medical schools are very influential people and have all the resources to continue producing doctors with minimal possible knowledge and skill.

TYPES OF FACULTY: In the government sector, medical colleges have part time medical faculty. Officially designated part time faculty members, usually work quarter time with the exception of very few. Usually faculty members keep good relationship with bureaucrats in the government, political leaders (in power or out of power) and student leaders. A big number of faculty working in government teaching hospitals all over Pakistan usually consume their government time in developing relationships with important people. Majority of the time, either they are busy in keeping their post or trying to throw out someone from his post. Then, they pass students in the exam on the instruction of political leaders and powerful people, issuing wrong medical certificates to political leaders under trial and making themselves available for the services at any time for the powerful and important.

Whenever they attend meetings of the academic council, most of the time, the agenda deals about their problems (salary, increment, promotion, personal assistant, vacation, office air conditioner) and they pass resolution to support whoever is in power. This is the reason the faculty members have failed to bring about any significant change in the curriculum, methods of teaching, training and examination in the medical colleges of Pakistan.

It is heart breaking to note that in last many years the faculty in the public institutions were not able to present themselves as role model to young doctors. The clinical teaching is the responsibility of the junior staff (RMO, Senior Registrar and assistant professors). They are paid less and usually the system does not acknowledge them. In fact they are the ones who are victimized for one or another reason.

In the private sector, with the exception of the AKUH, all medical colleges have part time medical faculty on the clinical side. The part time faculty members in majority of the private medical colleges perform better than their counter parts in the public sector because they have to work at least part time and are not involved in public relation activities at the cost of teaching and patients. Some private colleges are in extremely bad situation but are surviving because of their connections.

From the time it came into being, the Aga Khan Medical College has had full-time faculty members and a system of accountability. It is interesting to note that there is a continuous progressive change in their method of teaching, training and examination system, despite the childish restrictions and compulsory outdated curriculum from PMDC.

It was only possible because the faculty has the time to think, discuss, implement, monitor, analyze the system on continuous basis. They were also able to bring changes according to changing world without fear of the unknown which is a common fear in government institutes. The system promoted the development of the institute instead of individuals. People in the country know about Aga Khan Hospital and Medical School and go there for treatment and training, despite its higher cost and expenses. There is more to learn from this experience.

HOW TO BRING ABOUT THE CHANGE? It will be a different and an uphill task to bring change in the present system of medical education without political will of politicians and people who are managing the country. Politicians have no idea about the present situation neither have they any interest in these types of “minor” issues. The people who are managing the country are under control of vested interest groups. This group in all provinces of Pakistan are very active for using the resources for personnel interest at the cost of patients, people and students.

Hoping for change in the near future is like hoping for too much or a miracle. It is the duty of all the professional societies and stakeholders to continue debating the real issues of health and medical education. We must realize, the sooner the better, that we just cannot continue with the present pathetic system of medical education and training for the majority of the people in this country. Following initial steps are required to address this issue in Pakistan:

We need a totally independent, autonomous and powerful PMDC comprising of professionals who can work without any fear and not for personnel profit. The government should not interfere in the running of the PMDC, and PMDC should be allowed to exercise its power to bring revolutionary changes in our medical education system.

* The PMDC should be reorganized and should have democratically elected members; it should run the council for the betterment of people and profession.

* The five-year MBBS course should be extended to six years. Subjects like Medical Ethics, Comparative Religion, History of Medicine, some introduction of Philosophy and Social Sciences should be included in the curriculum.

* More emphasis should be given to biochemistry, genetics, immunology and community medicine. Students should be encouraged to do bachelors in different subjects included in the curriculum, during their stay at medical college.

* All teaching posts should be full time posts with adequate salary. The colleges in public and private sector should be full-time institutes. Majority of the medical colleges in government sector close at 1pm and faculty members engage themselves heavily in private practice. This system should be abolished immediately.

• All political parties should develop a consensus regarding the proper teaching, training and examination of their student activists at medical institutes. Violence should be stopped at any cost.

• All medical colleges should bring changes in the methods of teaching as per requirement of their people and province.

• The PMDC should start a National Licensing Exam for all fresh graduates before registering them as doctors and allowing them to treat patients.

• A method of continuous medical education should be introduced for junior and senior doctors.

It is time to do something about the miserable situation of medical education and training in Pakistan. There is a need to address these issues on emergency basis.

The young medical students of Pakistan deserve best and we need to produce excellent doctors for our patients and people. The system should not work for the benefit of vested interest groups. In the last 57 years, this system had not solved any problem of our people. For how long can people in power just negate the rights of those who deserve them most? If the government will continue the same policies it will only show that change of colour, does not mean a change in mind and right thinking in right direction.

Please Visit our Sponsor (Ads open in separate window)