The situation of medical education in Pakistan is worse than what it was in the United States in 1910. In our country, a student can get admission to a medical college with or without passing the entrance test, after doing A’ levels or Intermediate. In addition, the majority of medical schools are in the private sector, and were established with the sole aim of making profit.
With the exception of the Aga Khan School of Medicine, all medical schools in the public and private sector have part-time faculty members who are far more interested in their private practice than in teaching students. While the Pakistan Medical and Dental Council (PMDC) has established criteria for medical colleges, none of them fulfil it.
The majority of medical schools in private and public sectors do not have 500-bed hospitals attached to them as required by the PMDC, nor do they have the required structured programme for teaching (such as teaching ethics) and training medical students. Medical schools, like all educational institutes in Pakistan have become a business — private medical colleges charge millions of rupees for admission and tuition fees. Public medical schools have followed suit, increasing the number of self-financed seats and charging high admission fees.
Pakistan needs its ‘Flexner Moment’ to completely revamp the structure for training doctors
The PMDC, it seems, has miserably failed in maintaining the standard of education in medical colleges. How did we get here? And is there a way to improve the state of medical education in Pakistan?
It’s time we borrowed a leaf from the US histroy of medical education. In the early 1900s, there were 155 medical schools in the US, not all meeting the standard of the educational training needed. The American Medical Association (AMA) therefore created the Council on Medical Education (CME) in 1904, with the aim to restructure medical education in the US and Canada and sought the help of the Carnegie Foundation. The Foundation hired Abraham Flexner who visited every medical school in the US and prepared a detailed report in 1908.
Flexner was dissatisfied by the standard of teaching and training in medical schools and hospitals. He was highly critical of part-time lecturers and the time wasted in recitation and dissection. After visiting 14 medical schools in Chicago, he described them as a disgrace to the state whose laws permitted their existence.
Flexner recommended reducing the number of medical schools — from 155 to 31, an increase in the prerequisites students needed to enter medical school, training physicians to practice medicine in a scientific manner, appointment of full-time clinical professors who were not involved in private practice, strengthening of the regulation of medical licences and the closure of privately-owned medical schools or their incorporation in universities.
Initially, existing faculty in medical schools vigorously opposed the Flexner Report but soon authorities in the US and Canada began to follow Flexner’s recommendations. This had a positive impact on medical education: a large number of medical schools were closed; it created a single model of medical education in the country and helped to shape one of the great systems of medical education and training in the world.
With the Supreme Court of Pakistan’s recent decision to dissolve the PMDC, I hope, we, too, have reached our Flexner moment. The Supreme Court cited PMDC’s failure to perform its duties as the reason behind its ruling. No one can entirely blame the PMDC for its failures. How can one operate autonomously when owners of medical colleges simply have to make a call to powerful connections or politicians to skirt the rules? Despite the Pakistan Medical Association’s (PMA) long struggle, the government and political parties are not ready to create a medical body, like the PMDC, which can effectively regulate medical education in this country.
Medical schools, like all educational institutes in Pakistan, have become a business: private medical colleges charge millions of rupees for admission and tuition fees. Public medical schools have followed suit, increasing the number of self-financed seats and charging high admission fees.
The Supreme Court took the right action but it’s important to establish a powerful PMDC which can act under the constitution of the country with dedicated council members and honest leadership. Unfortunately, vested-interest groups, with the help of government officials, took advantage of the 18th constitutional amendment and were able to use PMDC for their benefit.
We need to produce good doctors who can act scientifically and professionally in the interest of patients with best ethical considerations. Instead, we are producing young doctors who frequently go on strike to push for their demands at the cost of patients’ lives and health. Instead, we are running medical colleges whose faculty members are more interested in their private practice than to impart education and training. The Supreme Court can act on the following minimum recommendations for immediate improvement in the standard of medical education and regularisation of medical colleges in the country:
We are producing young doctors who frequently go on strike to push for their demands at the cost of patients’ lives and health. We are running medical colleges whose faculty members are more interested in their private practice than to impart education and training.
• Closure of all those medical colleges in the public and private sector which are functional without affiliation with 500-bedded hospitals for teaching and training.
• Abolition of seats on self-finance basis in public sector medical colleges and their inclusion in general meritorious seats.
Appointment of full-time faculty members with restriction on their private practice.
• Appointment of full-time vice chancellors and principals in medical universities and medical colleges who can concentrate on academic activities.
• A centralised policy for tuition fee in private medical colleges and a complete ban on donations and special fee for admission in medical colleges.
• Introduction of minimal criteria for the appointment of faculty in basic medical sciences.
• A national admission policy for all the medical colleges of the country with one national entry test.
• A complete ban on establishment of new medical colleges in the public and private sectors till the formation of an autonomous and independent medical council.
These recommendations run the risk of being vigorously opposed by vested-interest groups in the private sector and provincial political governments who are doing business in the name of medical education. But there is a need to urgently act to regularise undergraduate medical education in Pakistan. The Supreme Court can play a historic role like Abraham Flexner did for the benefit of our coming generations.
The writer is ex-Secretary General Pakistan Medical Association and a former elected member of PMDC
Published in Dawn, EOS, February 11th, 2018