An Overview of Medical Education in Pakistan and the Improvements Required
In 1907-8, the American Medical Association’s (AMA) Council on Medical Education approached the Carnegie Foundation for the Advancement of Teaching to compile a report on improvement of Medical Education in the United States.
The report, compiled by Mr. Abraham Flexner, is known as “Medical Education in the United States and Canada” or ‘Flexner Report’. Flexner, in December 1908, began his tour of 155 medical colleges in the United States.
Flexner’s report was published in 1910 and is now regarded as one of the most important exposés in the history of medicine. Known as the Carnegie Foundation’s “Bulletin Number Four,” it was a complete indictment of the American system of producing physicians. Flexner argued that most medical schools weren’t set up to train new doctors, but to give existing physicians a supplemental source of income.
He pointed out that Germany, having far better medical care than America, actually had fewer doctors per citizen. In Flexner’s opinion, there were too many doctors in America and too many medical schools. Most of the medical schools had few, if any, admission standards and not enough equipment. The Flexner report resulted in an overhaul of medical education in United States, Canada and United Kingdom.
Medical Education in Pakistan is provided by more than 50 medical colleges situated across the country. Out of these, 27 are affiliated with the University of Health Sciences (UHS), located in Lahore.
The undergraduate degree for students willing to pursue medical education is ‘Bachelors in Medicine and Surgery’, MBBS. It is a five year course with the first three years focusing on basic medical sciences such as Human Anatomy, Physiology, Biochemistry, General Pathology and Pharmacology. The remaining two years are dedicated to clinical training in the subjects of Medicine, Surgery, Gynaecology, Paediatrics, E.N.T and Ophthalmology.
After completing this five year medical education, graduates are required to complete one year of dedicated clinical training known as ‘House Job’ before they are recognized as Registered Medical Practitioners by the Pakistan Medical and Dental Council (PMDC). The ratio of public sector medical colleges and private sector medical colleges is approximately 50-50, with class sizes varying from 400 students to 100 students in one session.
Medical Education, in general, is different from orthodox education, in terms of technicality and application. Medical Students are supposed to deal with tough situations under pressure and devise ways to ensure the safety of other human beings. In Pakistan, like the rest of our education sector, Medical Education is not a standardized field and a lot of improvements need to be made in this regard. The medical graduates that are being churned out presently, lack the ability to implement the scientific method which is the basis of all sciences. Our system is based on a cramming approach where the students who cram the most invariably score the most. There is little emphasis on concept-building and evidence based learning.
Admittedly, tutorials and EBL (Evidence Based Learning) sessions are conducted at most of medical schools in Pakistan. The deficiency that those sessions and tutorials have is that even the tutors do not understand the concepts of group participation and EBL as they have not been trained in that way. There, in my opinion, lies the biggest flaw in our medical education system. Most of the teachers in medical schools do not possess any qualification for teaching. They are simple graduates of the same system, favouring teaching instead of clinical practice. There needs to be an emphasis on a teaching course or degree before anyone starts teaching students in Medical Colleges.
The other big problem facing medical education in Pakistan is a lack of standardization of examinations. The exams are rarely concept based and despite the introduction of MCQs, there has been no focus on concept-building by teachers during their lecture and internal examinations. The exams themselves are rarely standardized. Only one or two people are involved in setting a paper and there is no independent review of that paper leading to sub standard exams. For some professional exams, the papers are too tough and for some others, they are too easy. There is also the trend that some particular individuals set papers all the time, leading to a benefit for that particular person’s own students.
Just to cite an example, a Professor of Physiology has been setting papers of University of Health Sciences almost since its inception. That Professor uses some of the MCQ pool and most of the SEQ pool in his internal class tests. As a result, his own students and people from other medical colleges who can get their hands on those questions, benefit from that data in the professional exams. In addition, there is little feedback taken by students about the papers leading to episodes of disruption and violence faced particularly by the University of Health Sciences in recent years.
There is a strong need for a change in medical curriculum as well. A paper titled ‘Medical education needs to change in Pakistan’ by Mamoona Nasim published in Journal of Pakistan Medical Association in August 2011 stated, “In a new curriculum, based on findings from cognitive psychology, learners should be stimulated to construct their own knowledge within contexts of problem-solving situations. Students should be taught metacognitive skills and how and when to use them. Knowledge should be taught from different but integrated perspectives and applied in many different situations. Learning should be community oriented, that is, education should focus on the health needs of the community and the groups and individuals within it.”
Another Problem facing medical education in Pakistan is the lack of emphasis on Research. Research is necessary for advancement in any field of knowledge. Due to lack of research credentials, the intellectual level of Pakistani doctors is lagging far behind medical graduates of other countries.
Pakistan today needs its own version of The ‘Flexner Report’. We need to analyze the way our medical colleges are being run and what needs to improve. There has been an upsurge in the number of private medical institutes over the last 10 years.
Students who do not get admission in public sector medical colleges because of low merit, get admission in such institutes. This problem was also prevalent in the United States in the early 1900s. Flexner, though reported that “The curse of medical education is the excessive number of schools. The situation can improve only as weaker and superfluous schools are extinguished” which led to closure of most of such schools. I do not suggest doing the same in Pakistan but at least some steps should be taken to review the quality of education being imparted by private medical colleges who are charging the students millions of rupees in the name of medical education.
In United Kingdom, a report is published every year titled ‘Tomorrow’s Doctors’ by the General Medical Council since 1993, outlining the responsibilities and duties of medical schools, students, doctors and the National Health Service(NHS). In this way, a yearly review is compiled to overlook the improvements required in the health system. This initiative should also be replicated in Pakistan, if we want to increase the productivity of our health system.
About the author: Abdul Majeed is a graduate of the Services Institute of Medical Sciences, Lahore, Pakistan. He is currently working as a House Officer at Services Hospital, Lahore. He has also contributes to blogs/columns for Express Tribune and Dawn Newspapers The Friday Times Newspaper. He can be reached at: [email protected]
About this article: This article is competing for the JPMS International Medical Writing Contest 2012 for the theme: Medical Education
To learn more about the contest and to participate in it, follow this link:http://blogs.jpmsonline.com/writing-contest/
To support the author win this contest, share and like this article at different social media platform using the social icons given in this page. Please note the rules and regulations for this contest for details. Last date for submissions extended to September, 20, 2012.
Join JPMS Medical Blogs Team: If you have any questions about the contest or what to join the JPMS Medical Blogs Team as Editor or Contributor, email us at: [email protected]