In 1904, the American Medical Association created the Council of Medical Education (CME) in collaboration with the government to reform medical education system in the USA and Canada. Abraham Flexner was appointed in 1908 to submit a report regarding the status of medical education in the country. The report, known as the Flexner Report, was published in 1910. As a result of the report, only 31 out of 155 then existing medical schools were allowed to continue in the USA and Canada.
A system was developed for the admission in medical schools with standardisation of premedical education all over America. It was made impossible to open a medical school without the permission of the CME. All teaching hospitals controlled medical schools while non-scientific methods of treating patients were abolished. The licensing of medical doctors was made compulsory and a system of accountability of medical practitioners was established.
Because of the Flexner Report, the medical profession has become the most respectable and highly paid profession in the USA, and has created an extremely advanced and efficient healthcare system in the world.
The newly created council of the PMDC has a delicate task ahead to standardise medical education in the country
The restructuring of the Pakistan Medical and Dental Council (PMDC) indicates that the PMDC has, at last, realised that poor decisions taken in the past have resulted in the total destruction of medical education and training in our country. Presently, the country is producing an enormous number of glorified MBBS quacks. A majority of these half-baked doctors will stay in Pakistan, without any structured training and hence will not be able to pass any respectable and merit-based postgraduate exam. A small minority of self-taught brilliant medical students will leave the country while the majorityof them will never return after completing their postgraduate education and training thereby causing a big loss to this human resource-starved country.
The PMDC is well aware that most of these young medical graduates are neither well-educated, nor is their training up to the mark. They are not aware of their ethical responsibilities towards their patients and profession. We all know that, with the exception of a very few, none of the medical colleges in the country fulfil the minimal criteria set by the PMDC to be declared a medical college. The country doesn’t have 150 professors of anatomy, physiology, biochemistry, pharmacology and for many other important subjects, but we have more than 150 medical and dental colleges providing expensive medical education to medical students. In the absence of trained, skilled and qualified faculty in basic medical sciences, how is it possible to educate young minds for a competitive and advanced medical world?
In the last few decades, vested-interest groups in the public and private sector used and abused the PMDC, doing everything possible to make money at the cost of undergraduate medical education, postgraduate medical training and the suffering patients. Medical colleges and medical universities were established overnight and student body seats increased in the existing medical colleges without facilities and faculty, and these were recognised by the PMDC on special grounds. Many practises in the private and public sector are examples of how to make easy money at any cost and without giving a thought to the end product. No consideration was given to how negatively our medical education and healthcare system would be affected. This is the reason that every day in newspapers, we read stories of doctors’ negligence and blunders, causing the death and suffering of people.
Because of the PMDC’s negligence and the control of vested-interest groups, postgraduate medical education and training suffered enormously as well. It is common to see an army of 20 to 50 young doctors doing house jobs and postgraduate training in a ward of 40-50 patients, without any supervision.
The mushrooming of medical universities has brought a new kind of specialists doing Masters of Science (MS) and Doctor of Medicine (MD) in different branches of medicine and allied sciences. The majority of these programmes are not structured like other postgraduate programmes. In the majority of cases, the same faculty members are supervisors for Fellow of the College of Physicians and Surgeons (FCPS) certifications and involved in training MD and MS candidates. With the exception of a few, most of the supervisors of FCPS, MD, MS and other diplomas are part-time faculty in public and private teaching hospitals. The PMDC has recognised MD and MS as equivalent to FCPS without understanding the basic difference between a diploma and degree.
A small number of institutes have structured training programmes in different fields of medicine for young postgraduate students. Medical ethics is not part of the syllabus and nobody wants to learn it because no examiner will ask any questions about it.
The newly established universities, in the leadership of politically motivated blue-eyed vice chancellors, competed with each other to open new departments in fancy buildings with stylish furniture, without realising that educational institutes need well-paid, qualified, competent and motivated human resource that works oblivious to the clock and calendar.
Led by Dr Ataur Rehman, the Higher Education Commission (HEC) and the provincial governments funded these universities without planning and without long-term and short-term goals. One cannot create educational institutes such as medical universities and medical colleges by executive orders. It needs planning, need-assessment, feasibility and goals. Unfortunately, all these components were missing as the majority of these universities were established after political slogans: if Sindh has a medical university, why not Punjab? If Karachi has two medical universities why not Lahore!
The PMDC has failed in monitoring, regularising and stopping the creation of such institutes. It failed to develop a respectable and merit-based system for the admission of students in medical colleges. The PMDC is least bothered about the postgraduate medical education and training standards in different teaching hospitals in the private and public sector. There is no system for guidance of bodies such as the College of Physicians and Surgeons (CPSP), HEC and medical universities regarding the needs and requirements of the country in relation to the profession and patients.
The newly created council of the PMDC has an opportunity to act in the interest of the patients and for the long-term benefit of the medical profession and the country. It has models such as the Flexner Report to guide them.
Here are few suggestions which may help improve medical education in the country:
• The PMDC should inspect all medical and dental colleges and medical universities in the country with utmost honesty and close those that are not up to the standard.
• There may be a need to merge two or three medical colleges to run them according to rules and regulations.
• Medical universities without proper buildings, the required faculty, a teaching hospital or those with poor reputation should be closed down in the interest of the general public.
• A high-level committee should be able to audit postgraduate diploma and degree awarding institutes and should be able to develop a system for structured training of doctors as per the need of our country.
• A high-powered body must be formed to inspect and regularise hospitals in the private and public sector involved in organ transplant especially those created with political motives or to make money at the cost of patients.
• A strong system of Continuous Medical Education should be organised for family physicians and all specialities to promote scientific medicine in the country.
• A strict and merit-based system of accountability should be established to protect patients from malpractice, incompetency and negligence.
• Lastly, a powerful examination board should be established to conduct transparent examinations for admission in medical colleges and postgraduate training programmes.
It is high time that the PMDC acts in the interest of the people, patients, medical students and the profession. It is shameful to see that, with the exception of Afghanistan, we are the least organised country when it comes to medical education and training in the region.
The writer is ex-Secretary General Pakistan Medical Association
Published in Dawn, EOS, July 21st, 2019