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Medical Education in KhyberPakhtunKhwa (KP, NWFP), Pakistan

Submitted by on August 31, 2012 – 12:04 AM 14 Comments

In Pakistan, entering medicine is considered to be a great honour. This noble profession is one of the most rewarding careers to date . Parents have become highly motivated to do all they can to send their children off to a medical school. So much so that the competition has increased tremendously; thousands of expectant youths give the entry test every year in hopes of attaining a place in their province’s top medical college.

Medical education is what will define you as a doctor; it is the differentiating factor between you and many others in this field. Thus this period of a medical student’s life is the most crucial, and must therefore be given utmost importance. After all, these students will be the doctors of tomorrow, and their education will reflect the system of healthcare that trained them.

 What follows, is an account of  medical education; my experience with it, the problems I faced with it, and how I feel they could be corrected. There may be some who disagree with what I have to say, and some who may be unhappy with it too, but it is the truth.

We’ll start with the beginning of medical education; the admission process. This process depends solely on where a student stands in the merit list; only the people at the top of the list secure a position. Around three hundred students gain admission per year in my college. This includes, people on merit, self-finance, FATA (Federally Administered Tribal Areas), foreign, and disabled seats.

 The selection process is based only on the grades achieved; at present there is no form of determining a person’s aptitude, through questioning or otherwise, to find out whether they have what it takes to be a doctor. There is an interview although it just consists of taking a person’s background information. In my opinion, the admission process needs a slight tweak, it needs to be more selective about the students it takes as right now it seems the administration is more focused on quantity rather than quality.

Next comes the beginning of the medical school year. I remember being very excited; my dream of entering medicine had finally come true.  I was eager for classes to start and to immerse myself in heavy textbooks of anatomy and physiology, but to my consternation, classes weren’t going to be held for the next two weeks as the teachers were busy with the first professional exam. This lack of organization was very surprising.

Once classes actually started, time flew by. Anatomy, physiology, biochemistry, practicals were all new and fascinating.

One little event in my first year really struck me as to how the standards of teaching actually were. I had a problem with understanding the concept of transitional epithelium. I didn’t understand how a fixed lining of the bladder could be ‘transitional’. At the end of class, I went up to the teacher, as any enthusiastic first year would do, and asked him to explain it. He looked slightly surprised at being asked a question. He told me very nicely to read the book. I told him I had. ‘Well then you should look at the atlas. ‘I told him I’d done that too. Rather than answering my very simple question, he just told me I wasn’t reading the book properly and shuffled off awkwardly. To say I was shocked would be an understatement. I had never expected a teacher to shy away from answering a question.

After that I started scrutinizing all the other teachers and how they taught. Most of them just read off the slides they projected. Here the teachers thought they had stepped into the ‘new age’ by using multimedia. What they failed to realise is whether you’re reading off a digital screen or a blackboard, it’s still the same thing. Using multimedia in the best possible manner includes showing pictures and videos, while explaining them; and not reading word for word what has been written.  There were only a few  teachers who actually taught the students properly, they were enthusiastic, didn’t read off the board, and involved the whole class in the subject; considering our class consists of nearly three hundred people, that is no ordinary feat.

Teachers play multiple roles in our education, but what I’ve always found odd is the distant relationship between them and the students. Medical education is supposed to impart confidence to students which includes open discussion with teachers. However in our current situation, most students feel unable to step forward because of lack of confidence and they blame this on the current teaching system. Examination visas have also contributed to this problem.  Students are under the notion that personal likings/disliking of the examiner would affect their viva result; which is not necessarily true. Hence students feel uneasy about being upfront with staff.  I think this issue needs addressing, to restore faith in teachers.

Another aspect of medical education that needs to be looked at is the insane amount of subject matter taught weekly. Six classes of physiology a week, and in each class a different system is taught. Meaning in one week, we were supposed to be learning the cardiovascular system, respiratory system, gastrointestinal system, membrane physiology, endocrine system and hemodynamics. Perhaps if the student’s brains were sponges, they might have been able to keep up however as spongy as our cortical matter may be, it cannot retain everything. As each subject (anatomy, physiology and biochemistry) was taught like this, most students found it impossible to keep up and as a result their interest in the classes plummeted, and only studied in the preparatory leave, and most would be doing the whole course for the very first time!

Another closely related issue is the layout of the classes. In the first two years the three basic subjects mentioned above are taught. In third year, pharmacology, general pathology and forensics are taught, and in fourth year, special pathology and all the clinical subjects. Now this may seem like a good class structure, however by third year the basic subjects are long forgotten and studying pathology and pharmacology isn’t nearly as effective as it should be.

In my opinion, there should be a maximum of two different systems taught weekly until they are completed. In this manner, the students would actually be able to keep up, pay attention and reap full benefit out of the classes. If I may be so bold as to go a step further and say that the same system should be taught in all subjects at the same time, so the students can correlate and thoroughly understand the workings of the human body.

Another issue that affects the quality of education is the number of people in the class. Three hundred is far too much for one teacher. Studying medicine needs to be more interactive. It needs to have discussions and debates, and not just sitting for hours on end in the classroom. Quite a few medical schools have started using the system of PBL (problem based learning), which has proven to be quite effective; unfortunately my college which is KPK’s finest hasn’t. I’m sure that once this problem is resolved; there will be a dramatic improvement in results.

In the pursuit of becoming good doctors, students need to pass the professional exams which consist of a written paper, a viva, and a practical exam. For this, practice is needed in all three. At present there are two stages per subject a year, maybe a practical test but no practice vivas. They may have started now for the juniors; which is definitely a step in the right direction, however for us, the seniors, there has been no change. I remember being absolutely terrified during my first year vivas and naturally it affected my performance. Had I been prepared, known what to expect I know I would have done much better; and I’m sure I speak for most of my class when I say this.

So far I have talked about medical education in the basic years, but as students know, the clinical years are the most exciting! In our university, clinical wards start in third year. The class is divided into twenty two batches, each batch containing around fifteen students and they spend ten days in each ward.  In third year two hours are spent in hospital, in fourth year three hours, and in final year four hours per day. While the afternoons are spent at the hospital, the mornings are spent in the lecture theatre. Having clinical classes in the lecture hall is not the best way to learn medicine. As I have mentioned earlier, it needs to be learnt in an interactive manner, and a professor of medicine is hardly going to be able to impart his knowledge efficiently to three hundred students. Besides, clinical classes should be taught in hospital settings so students can have hands on experience. Not only would the students be getting information but they’d also have the chance of applying it there and then.

Hospital rounds are when students learn what it’s truly like to be a doctor. That is where they learn bedside manner, how to take a proper history and how to examine patients. This time is absolutely crucial in a medical student’s life. Every student needs individual attention to be able to harness and cultivate their skills under their professor’s supervision; however as there are so many students in one batch it is hard for the teacher to pay adequate attention to everyone.  These clinical skills are essential, without them a doctor’s proficiency is markedly reduced. To prevent this, I would suggest that the batch should be split up into smaller groups and attached to a senior doctor.

One of the most important aspects of our medical education which I can’t stress enough upon is the examination system. In Pakistan MBBS is a five year course hence students should be passing out five years after admission. However in KPK, it takes six years! This is because of the exam schedule, which has not changed one bit since its inception in 1954.This is unacceptable especially in the year 2012. Our system is in desperate need of change for it to be even considered in the same league as other established medical institutes of the world. Not only do the exams need to be held on time, the subjects tested should be changed too.

Last but not the least, well rounded medical education should have an array of extracurricular activities, which I’m proud to say my university does. It has a very strong literary section, composed of the sub divisions of English, Pushto, Urdu, debate, drama, and photography. We also have a very active Social Welfare Society in association with the Red Crescent, which is responsible for many community outreach projects, changing lives. There are also a variety of events that take place throughout the academic year thanks to the combined efforts of the energetic students and teachers.

To conclude, the current system of medical education in KPK is out-dated. There is a dire need for change in most of its aspects. It needs to be brought up to international standards, so that medical graduates of KPK are at par with the rest of the world.

About the author: Arham Malik Iqbal is a medical student at The Khyber Medical College, KP, Pakistan. She is the senior editor of the English division of the literary section at her college and is currently serving as the associate director of the Health and Education Department of the Social Welfare Society, Pakistan. She 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

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  • Syeda Umama

    speechless..great job !outstanding ..

  • Arham

    thankyou :)

  • faryal methot

    AWESOME:)

  • http://www.facebook.com/Bhainstronic Malik M Alam

    great article mate..one of a kind…i certainly agree with the author when it comes to the admissions..
    but the author should have thrown the light on the standards of private medical colleges..their “BUSINESS” certainly is booming!!
    all in all good article ..cheers (:

    • http://www.facebook.com/arham.iqbal Arham Iqbal

      Thanks Malik. :)

  • Abid Jameel

    A well thought of article, Arham. We have been pointing out these problems to the Government and to the administration of medical colleges (including KMC), but unfortunately, the will to improve is simply not there. Those who are in position of responsibility in undergraduate medical education have no knowledge of how to improve medical education but they consider themselves above all! This has led to the downfall of medical education in Pakistan, specially in public sector medical colleges.
    One way to improve the current situation is to make training in medical education (at least teaching and learning methodolgies) mandatory for all faculty members. Selecting the proper candidate is another area on which I am working but it seems that it will be ages before we can improve on the current selection criteria.
    Well done for writing this artcile highlighting the deficiencies of our medical education system. Keep going!
    Prof. Abid Jameel,
    Director Medical Education,
    PGMI, HMC,
    Peshawar

    • http://www.facebook.com/arham.iqbal Arham Iqbal

      Thankyou for your kind words professor. And, yes I absolutely agree with you on how our teachers should take courses; just because one knows their subject doesnt mean one can teach it properly. I hope our system changes soon and perhaps these courses might be the start of it. :)

      • Dr.Malick

        isnt it the responsibility of KMU to arrange for the courses and/or make sure that all the teachers get the courses ?
        if its not KMU then who should be responsible? students to make sure that their teachers are uptodate on all the courses ?
        are these teachers specially the clinical faculty accountable and answerable for their poor quality of teaching to any one in this world except God ?
        who will make sure that they perform their duty of teaching the students properly? is there a system to evaluate our teachers ? or the VC, Director education and Principal need CM’s permission for that ?
        Has any one ever asked any of the clinical Professor sahb that why is he not always giving the students time they deserve?

    • Dr.Malick

      Good to have Director of Medical education PGMI, KMU here, some one who should atleast be partly responsible for this faulty system and should definitely be in a position to bring a change to the clinical part of our education system, because the ones responsible to teach the medical students are none other than the faculty of PGMI, KMU. unfortunately, all i see here is putting blame on others not otherwise specified (unfortunately even the director of medical education KMU doesnt know the names of authorities responsible with in the KMU), and is trying to get away with his promise of working on the selection of candidates that too he failed to improve so far in his years and years of service in PGMI and admits that he still wont be able to make ab improvement unless he probably retires.( its a known fact how fair is the selection process, as we know and have worked with those selected by KMU). if VC, Principal, Director medical education cant perform their basic duty of improving the quality of education then do we really need them? do they really deserve to be called the VC, principal and director medical education? unfortunately we terribly fail to deliver even a bit but still we want to stay seated on the same chair that we dont deserve. why we want to stay seated on that chair despite being a failure?
      unfortunately our system wont change unless we get real teachers in KMU who will sincerely work for teaching the students and make sincere efforts towards changing this archaic system that i am sure they easily can if they want to, as you probably dont need chief minister’s permission for a change to your teaching methodology in KMU. our system wont change unless all the doctors and administrators in KMU are replaced with teachers.

  • http://www.facebook.com/tahirayaz89 TaAhir AayAz

    great effort…:)

  • j

    exactly my thoughts. its so dumb how they hoard all the students together like sheep. no individual attention AT ALL i say.

  • the Mahsood

    What she has written are her personal opinions but with great
    apology, she ought to change its Title from (Medical
    Education in KhyberPakhtunKhwa KP, NWFP, Pakistan) to (“Demerits/Suggestions
    for improvement” of Medical
    Education in Khyber PakhtunKhwa KP, NWFP, Pakistan).

    • md

      Trust me, this isn’t just demerits, this is all there is to medical education in kpk. She didn’t leave anything out, if that’s what you implying.

  • Dr.Malick

    good that you could identify atleast some of the basic faults in our medical education system, though i am not sure how fruitful this of your effort could turn out to be, but trust me our education system needs more extensive radical reforms than you have mentioned, though i agree with some of your suggestions specially the one for decreasing the number of clinical medical students in a batch.
    i am a kmcite myself and currently working as a medical resident in U.S in a university hospital with its own medical school and now i know how archaic our medical education system at KMC is, but unfortunately i cant go into details at the moment and will discuss at some other time. good effort and keep going.