Ironies of Medical Education: Fatal Flaws!
On a typical hot and humid afternoon in Karachi, Ahmed Sher, a resident of Mirpurkhas, waits for his turn to see a doctor, along with hundreds of other patients and their families in the compound of Civil Hospital, Karachi. This is his third trip to Karachi in the last eight months to seek treatment for his two-year-old daughter who has chronic pain in her stomach. Despite the medication the doctors have prescribed, she has not had any relief.
“The treatment is not working but I have no choice other than to come here,” he says.
Sher’s troubles are a manifestation of one of Pakistan’s healthcare system’s most basic problems. Many doctors can’t help the public with basic health issues. In fact, it was reported recently in Dawn that the WHO’s regional director, Dr. Hussein A Gezairy, at a workshop on public health said, “The impact of medical education can be gauged from health indicators such as infant mortality and maternal mortality rates. It is therefore important to produce doctors who have skills and abilities to promote public health.”
He also called for the replacement of the three-decade-old medical curriculum in Pakistan with one that takes into account the country’s changing health needs. The medical profession is considered to be the noblest of all professions because it deals directly with the lives of patients. Doctors earn high respect from the society because of the noble work they are associated with. Considering the sensitive nature of the profession, where even minor mistakes can have serious repercussions, it is highly imperative that the standard of medical education should be strictly regulated and regularly updated.
In a developing nation such as Pakistan, medical services play a very important role in the well-being of their citizens and indirectly play a very important part in the economic and overall development of the nation. The development of good medical services in the country is almost entirely dependent upon the medical education imparted in the various medical colleges of the country. Also, for the effective implementation of the various National Health Programs started by the Government of Pakistan, and research work in the field of medicine, medical colleges and teaching hospitals play a very vital role.
To begin with, the first issue which draws attention is selection of students in the medical college. The selection of students in most of the colleges is based on the score obtained in the objective type exam (containing multiple choice questions on subjects of Physics, Chemistry and Biology) which are more based on the factual information rather than communication skills and humanistic attitude which are the basic foundations for the doctors.
The quality of medical education in Pakistan is also marred by the issue of capitation fee in the private sector medical colleges. It allows for admission of non-meritorious students into the medical college run by private sectors, by charging a heavy fee from them under the management quota and non-resident Pakistan quota. It greatly hampers the quality of input into the medical colleges and impairs the quality of medical services in the later period.
The allocation of fixed percent of seats in the Government medical colleges to students belonging to a certain caste in society also raises a similar type of problem. Concerns have been raised over it that it helps jeopardizing the quality of output from the medical school.
Considering the seriousness of damage that can be caused by the slightest of mistake by the medical personnel, we believe that the quality of medical service cannot be compromised at any level. So, this issue has to be seriously looked into to seek out some remedial measures to maintain a high standard of medical education in Pakistan.
We believe that the curriculum of medical education in Pakistan needs to be revised a bit. Medical Colleges in Pakistan divides under-graduation course of MBBS into five year of study and one year of compulsory rotating clinical internship training, with the study period being divided into First two years of pre-clinical courses (Anatomy, Physiology and Biochemistry), Third year of Para-clinical courses (Pathology, Pharmacology, Microbiology and Forensic Medicine) and two years of clinical courses: Part I having ENT, Ophthalmology, Community Medicine and Part II having Medicine, Surgery, Pediatrics and Gynecology and Obstetrics.
No stress is laid on subjects like Medical Ethics and Behavioral Sciences. The students fail to learn the basic principles of medical ethics and are unable to deliver the due respect to the patients. Students overlook the general courtesies needed and it is not uncommon to see a group of students during their clinical postings in out-patient departments or in-patient wards, trying to simultaneously interrogate, palpate or auscultate the patient causing a lot of discomfort to him. The patients are approached in an insensitive manner.
Sometimes to make the matter worse, the clinical manuals are kept open on the patients’ beds aiding them to visualize the distressing pictures, thus adding to the anxiety and fear of the patient. The students thence fail to develop a compassionate doctor-patient relationship. We believe simple courtesies such as shaking hands, introducing themselves, providing a patient hearing can help doctors/students in establishing a good rapport with the patient and foster a healthy relationship. Explaining the disease pathogenesis and the treatment protocols to the patient in simplified language can also help to relieve the anxiety of patient.
A compassionate view by the doctor certainly improves the quality of the medical service and this can be ensured by efficient teaching of the medical ethics to the medical students. A little more caution by the students and adequate guidance by the teachers can help them develop good skills. It will also help to reduce the quantity of increasing medico-legal suits filed against physicians in long term.
After spending five years in a medical college and one year in house job, a medical student remains confused when he or she sees the mammoth medical problems of Pakistan in the health scheme and health policies. Many have resorted to leaving the country. Policymakers and senior professionals of the medical community seem least concerned about the new crop of doctors entering the field. There seems to be no harmony in the demand for medical practitioners in the country and the supply of trained medical staff.
This chaotic condition leads to a growing rot which is the sole responsibility of policymakers who have been ignoring the realities of the deteriorating health situation of the country. The deterioration of medical education in the country is the result of a mushroom growth of medical and dental colleges, both in public and in private sector, without any proper infrastructure. Most of the medical and dental colleges, recognized by the PMDC in the recent past, lack proper teaching faculty — properly equipped laboratories for basic subjects and teaching hospitals with full occupancy — to provide enough clinical material for students. No doctors can be trained in such medical colleges as they are just producing quacks who pose risks to the health of the suffering humanity.
The government should immediately appoint a committee, headed by a former senior member of the Pakistan Medical and Dental Council, to review the recognition extended to medical and dental colleges during last 10 years and suggest ways and means to improve their condition. Those which are not up to the mark should be closed immediately.
At present, medical experts and policymakers need to revisit curriculum and training that revolves around imported issues. Medical curriculum should also reconsider teaching tools, teachers` skills, and the methods of assessment which must be standardized in the medical colleges. Pakistan’s medical education is at a crossroads with medical curriculum issue, the lack of faculty and research, and inadequate infrastructure – it is one that if solved can lay the foundation for a sea-change. Meanwhile, it is the people of the country who suffer as cases of neglect and negligence rise and government inaction continues.
The pyramidal cadre of doctors in the country means that those on the upper level are accessible only to people who have the financial resources to reach them. The less fortunate have no choice but to go to any doctor they can afford.
Ahmed Sher has returned to his village with new medicines and little money left. He did finally get his turn but, only time will tell if this time the doctors were able to diagnose Sher’s daughter’s illness correctly and give her the treatment to end her drawn-out suffering.
About the Author: Saman Iffat is a 3rd Year M.B.B.S student in Sir Syed College of Medical Sciences. She can be reached at firstname.lastname@example.org
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