Fighting Flaws in the Current Medical Education System: A Student’s Perspective
As someone, who entered the field of medical education bright-eyed and full of interest in first year, I have since lost much of my enthusiasm and drive over the course of two years. One could argue that this is simply because the weight and burden of the studies has over whelmed me or that every student faces this issue but it “gets better in the clinical years”. This has so far not proven to the case for me, as I continue to be disillusioned with the education system.
Why the cynicism? I have many quarrels with the current system of medical education. I will try to approach them in a systematic manner and hopefully provide some insight to teachers and professors about the students view. I have tried to broadly classify the problems in to three categories.
Student evaluation: The current system absolutely insists on shoving test after test and information down our collective throats until we either suffocate on it or regurgitate the information only to forget it afterwards. You see the problem is that in our years we are continually tested on our subjects but these tests count for very little in the long run.
Yes we all know about “internal assessments” but 30+ tests in a year which carry a total weight of 10 marks? It seems ridiculous to put so much effort into passing these tests with good marks for that paltry amount. In the end the most important part of the system is the Professional exam, which if you don’t pass, will cause quite a lot of harm to your career.
The problem is that this puts a lot of unnecessary pressure on students to pass every test throughout the year only to face the immense pressure of the Professional exam. Ideally the tests throughout the year should count towards at least 25% of the final exam, but this is not so. If the internal tests counted for more percentage then you would see students working harder throughout the year instead of just buckling down in the last 2 months.
Exposure and opportunities: Students in various medical colleges are very rarely exposed to the reality of the medical field. Coming from a family of doctors, I was fairly well aware of what the studies and the field entailed. What shocked me was how little everyone else knew about medical education.
Many people came from various backgrounds (A-levels/FSc, upper middle/lower middle class), but apart from a few, most of them were under the impression that after completing five years of education they would simply become doctors. What is more shocking is that even after 3 years they still have the same impression.
The problem is that they are ignorant on two fronts. Firstly, medical education never stops. You continue learning until you have completely finished you career in medicine. You must also look for every possible way to learn more. The course books are not enough. Sadly most teachers tend to reduce exposure rather than enhance it.
Secondly the world of medicine is very fast paced. International medical universities and colleges are always looking for new ways to expose their students to better opportunities. Whether it’s research or conferences or summits or internships, international medical students always seem to be a step ahead. In contrast our colleges and universities curb any attempt by the students to gain greater exposure to the medical world.
For example, most colleges do not allow students time for electives abroad (some do, but I will refrain from taking names). Students are supposed to find their own way and go for electives on their own time. If they happen to find a great elective in a prestigious university then either he/she has to be lucky enough to go during the Ramzan break or risk losing the ever important “attendance”.
Wrong candidates: Another issue colleges seem to face is the admittance of the wrong type of students. We are not talking about foreign seats or “bought” seats. We are talking about the individual student. The problem is that many students get into both private and public medical colleges but more than half of them don’t go for medical education because they “want” to but because their parents have pressured them into going or they go because of the “brand-name” factor.
Only later do they realize they are not happy in this field or that they are not cut out for medical education. By then it is too late to turn back. Interviews are the best possible method of assessing whether a student has the capability and motivation to become a good doctor. Students applying to medical universities are not only tested on their knowledge but also interviewed to see if they have the “right stuff” in most countries.
Very few universities apply that method here. We admit students based on quantitative marks and tend to forget that a student is more than simply the numbers on a page. It is heartening to see that many professors and teachers are taking medical education courses in universities abroad and trying to apply that knowledge here.
Unfortunately simply attending courses is a very poor way to gauge and correct the system simply because you are ignoring the other half of the system i.e. the students themselves. To paraphrase one of our own professors: A classroom is made of two components, the teacher and the students. You cannot have a functioning class if one alienates the other. Student- teacher conferences with frank and open discussions about the problems faced by both faculty and students would go a long way in addressing these issues.
In conclusion; the problems with the medical education system in Pakistan are manifold and it is difficult to address them all in one article. Trying to classify them into three categories has been a feat unto itself, and at a later date I hope to discuss their subcategories even further and in more detail. I will agree that there are many teachers and professors that are doing their utmost to correct the system but we have a long way to go before we start coming to the standard that the international medical community requires of us.
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