Our medical colleges must impart education in line with the requirements of modern times
THERE is a shortage of doctors all across the world. The medical profession has a certain charm for the younger generation and their families, making medical education in Pakistan very popular. It is believed that the most talented students are given admission to our medical colleges. But the woeful condition of our health delivery system is also well known. Surely, a fair share of responsibility for poor health care in the country should be accepted by our doctors who are supposed to be the cream of their generation when they set out to acquire training. But it has to be conceded that these days, doctors’ approach to their profession is not up to scratch.
The question that needs to be asked regarding such doctors is: Does something go wrong during their stay in medical colleges? A lot is spoken or written on the state of medical education during conferences, commissions and reforms. May be a comparison of our medical colleges with those in some English speaking countries — the ESC (the UK, the US, Australia, India) — will elucidate the causes of our poor performance in this field.
In this respect, one thing that instantly springs to mind is the teachers at our colleges. Most lectures that our teachers deliver to students are didactic in nature. Sometimes spoon-feeding is also resorted to. Whereas in the ESC the teachers teach in an interactive way. Their training is evidence-based, and hands-on training is often encouraged.
In Pakistan, consultants take little responsibility for the condition of general patients in need of attention on an emergency basis. Such patients are looked after by resident doctors. Whereas in the developed countries, there is a greater involvement in routine patient care of consultants, who head caring teams of which medical students are members.
The examination system in our colleges is almost the same since half-a-century. In other parts of the world, it’s innovative and changed to suit modern methodologies.
Very little research work is done by professors and associate professors in Pakistan. Whereas in other parts of the world it is routinely undertaken by about half of senior faculty members at any given time.
Now we try and further look into the matter.
Reasons for Pakistani colleges’ poor performance
1 Well-known ones:
a. Colleges are unable to update and sustain modernization
b. Shortage of staff — poor teacher-student ratio
c. Unavailability of qualified teachers
d. Poor salary of teachers, which forces them to undertake private practice
2 Other causes i. Very little time:
The working hours on a daily basis are 8am to 2 1/2pm. Work starts late (the better known you are the later you come). Most seniors have to attend many meetings, some have protocol duties and all have personal work in places outside the college premises. The junior staff has to pick up children from schools. Everyone feels hungry at 1pm, so they leave.
Documentation and paper work is minimal and poor. Research is put side. There is hardly time for thinking, planing and executing any change.
If we look at medical colleges in the ESC, we will find they all work from 8am to 5pm.
ii. Large student intake:
About 225 to 300 students are admitted yearly to public medical colleges and somewhat less in the private ones. In comparison, the yearly intake in the English speaking countries ranges between 50 and 10, the average number being 70. Although the staff and unit requirements have been increased by the PMDC, the efforts and facilities to properly coordinate teaching, training, monitoring and evaluating of such large numbers are inadequate. Individual attention and small group teaching remain a dream. As a result, deductive lectures, clinical demonstrations and infrequent evaluations become practised strategies of teaching in our colleges.
iii. Private practices of teachers:
Since private practice income can help make a person’s ends meet, everyone in institutions relies on it. There is virtually no restriction on it from the employers. All residents and senior medical students choose their role models from among those with big private practices.
In all medical colleges in the ESC, practices are either totally disallowed (even in India) or restricted to a limit which is a satisfactory compromise between academic activities, research work and personal income. In Pakistan, the efforts for introducing institutional practice are made so half-heartedly that it can never be established.
iv. Teaching programmes:
These are drawn and implemented very loosely. Detailed dates, topic of lectures and demonstrations or clinical training are not made for the year in advance.
Similarly, departmental evaluations and feedback are not standardized. Most students rely on end-of-year self study. These inadequate teaching activities are also the result of a large number of students and limited working time with faculty members.
v. Lack of integration of medical college departments:
Departments have been established as stand-alone units. Each has its own laboratories, staff and equipments. Modern trends of physically integrated departments with multi-disciplinary laboratories have been adopted by a couple of colleges only. The physical segregation of departments also strengthens the mental barrier in the way of integrated teaching of these subjects.
vi. Research:
Research work in medical colleges is nominal. Assistant and associate professors have devised ingenious ways of fulfilling PMDC requirements for research publications. There are of course other constraints like the lack of intellectually stimulating atmosphere, suitable role models, required facilities, the lack of time and the need to invest time in private practice.
RECOMMENDATIONS
This review is by no means complete. In the light of deficiencies and their causes discussed above, the following recommendations come to mind.
1. Institutional working time:
It should be from 8am to 5pm, five days a week. Appropriate cafeteria facilities should be provided to all categories of staff. Work places, libraries, offices etc., should be air-conditioned. Efforts should be made to pick and drop children of staff members from their schools. All business enterprises (local and foreign) in Pakistan work full day. Only government departments work half-a-day in the morning.
2. Number of student intake:
This should be reduced to about 100. Present students intake could be divided with staff members into at least two groups and transferred to new locations in different districts. The standard of teaching, training and patient care will rise in new hospitals where half of the colleges should be shifted.
3. Restricted private practice:
Institutional private practices should be introduced with full preparation and practices should be done during college time. After serving for some years as assistant or associate professors, doctors who find academic medicine not attractive enough, should be encouraged to leave. Pakistan is now producing enough post-graduate qualified specialists. There is hardly a specialist who is indispensable (only the decision-makers at the top have been convinced by them that they are).
4. Planned teaching and evaluation: Every discipline and class should work out a year’s plans before the new session begins. The planner should give the topic of the lecture with brief description, the name of the teacher, date, day, time and place for the whole year. Dates and methods of evaluation should be pre-determined. These should carefully be prepared by the department. Such programmes should be given to each student before the commencement of classes.
5. Integration of subjects and modernization of teaching:
This requires considerable thought and effort. With the training, orientation and involvement of the faculty, teaching should be made student-centred. This is not impossible if undertaken in stages with full involvement of the faculty. The methodology of teaching needs to be modernized with every teacher receiving adequate training and assistance from educationists who should be hired by colleges.
6. Promotion of research:
The constraints that hamper good research in our medical institutions have been briefly discussed. We need to replace them with promotional measures.
THERE is a shortage of doctors all across the world. The medical profession has a certain charm for the younger generation and their families, making medical education in Pakistan very popular. It is believed that the most talented students are given admission to our medical colleges. But the woeful condition of our health delivery system is also well known. Surely, a fair share of responsibility for poor health care in the country should be accepted by our doctors who are supposed to be the cream of their generation when they set out to acquire training. But it has to be conceded that these days, doctors’ approach to their profession is not up to scratch.
