CPSP has 211 accredited training institutions for 16,772 registered trainees-Prof.Zafar Ullah Chaudhry

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 Global perspective of postgraduate Medical Education

CPSP has 211 accredited training
institutions for 16,772 registered
trainees - Prof. Zafar Ullah Chaudhry

Royal Colleges in UK have now developed Faculty 
of Medical Leadership and Management-Sir Ian Gilmore

KARACHI: One of the plenary sessions during the Golden Jubilee Conference of College of Physicians and Surgeons Pakistan was devoted to global perspective of postgraduate medical education. The speakers included President of CPSP Prof.Zafar Ullah Chaudhry besides guest speakers from UK, Australia, Canada, South Arica, Kingdom of Saudi Arabia.
Prof. Zafar Ullah Chaudhry was the first speaker who delivered Wajid Ali Burki Memorial lecture on Postgraduate Medical Education Voyage in Pakistan. Earlier a citation for late Gen. Burki was read by Major General Salman Ali. Prof. Zafar Ullah Chaudhry in his presentation stated that at the time of partition there were only two medical colleges in Pakistan i.e. King Edward Medical College and Dow Medical College. Punjab University used to give postgraduate degrees like MD and MS. Later Basic Medical Sciences Institute was established at JPMC Karachi with the collaboration of Indiana University of USA which offered M.Phil and Ph.D degrees in basic medical sciences.

Prof. Zafar Ullah Chaudhry President CPSP and Prof. Mahmud Husain President Bangladesh College
of Physicians and Surgeons presenting mementoes and Hony. Fellowship of CPSP to some of
the distinguished medical personalities from overseas during the Golden Jubilee Conference.

First FRCS Part-I exam was held in Pakistan in 1961. CPSP was established in 1962 and two fellows passed in the first exam held in 1965. Over the years CPSP has progressed a lot and now one hundred eighty four exams are conducted by the CPSP every year. In 1994 prospectus was published with curriculum. He also referred to the Residency programme which has been strengthened and structured now. 

He also gave details of faculty development programme and guidelines prepared for the training of examiners. In the Year 2011, 4,144 postgraduates were inducted. At present we have 211 (159 in Pakistan and 52 overseas) accredited training institutions while the number of registered trainees is 16,772. Giving details of CPSP competency model which is a patient management centered, he mentioned professionalism, advocacy, e log system, monitoring, and quality assurance mechanism. Now we intend to start computer based online exam for FCPS-I. We are aiming at paperless environment. Workshops are also mandatory for trainees as well as the trainers, supervisors, he added. Later he was presented a mementoe by Prof.S.M.Rab one of the Founder Fellows and former President of CPSP.

Prof. Sir Ian Gilmore

Prof.Gilmore from UK was the next speaker who talked about the global challenges of developing leaders and advocates for the future in postgraduate medical education. He began his presentation referring to the speech of Prof. Kh. Saadiq Husain in the inaugural session who had stated that commercialization and corruption virus has infected the medical profession in Pakistan. Doctors moral, Prof.Gilmore stated was all time low. Had we been patient centered and in partnership with the patient, respecting his dignity which comes first, it would not have been so. He also referred to the other duties of healthcare professionals like clinical obligations, research and teaching. External forces, he opined, were influencing which has changed the outlook of this profession. Medical profession is no more in control and now patients come with print out of their disease as they have much more access to knowledge through internet. Now we have almost 50% non-medical members in the General Medical Council. There is lot of uncertainty about role of the doctors, every day there is some scandals about doctors like increased mortality in paediatric cardiac surgery and all this has eroded doctor-patient relationship. There is a set of values, behaviour and relationship that underpins the trust public has in doctors.
Prof. Gilmore than referred to the Royal College of Physicians 2010 report on Future Physicians. In view of tremendous improvements in technology, demography, society’s expectations and economics, quality of care has become much more important. Leadership has assumed an important role which all aims at taking others with you and have strategies to get there and achieve your objectives. He also pointed out that Churchill won the War for Britain. He was a leader of Ware but he could not get elected as the people felt he was not the leader for Health and Economics. Gone are the times for authoritarian approach. Instead now is the time to work together as a team and delegate powers which require that many doctors have to change their authoritarian attitude. RCP has introduced M.Sc in medical leadership. All Royal Colleges have now developed faculty for medical leadership and management. Studies have shown that smoking was as bad as alcoholism. Sponsorship from the Tobacco industry has gone but drink industry was influencing education in schools. The gap between the rich and poor is widening. There is twenty seven years gap between the life expectancy of rich and the poor in UK. Education, housing and where they were born all matters. Alcohol, Sir Ian Gilmore opined, causes more harm in UK than all other practices. Obesity was a problem. Death from heart diseases, direct injury, pollution and food related illnesses, crop failure and water shortages are some of the issues which needs to be looked into, he added.

Prof. Michael Holland

Lifelong learning for Surgeons in Australia was the topic of Prof. Michael Holland’s presentation. He discussed in detail the seven ages of a surgeon and referred to pre-vocational RACS training, post fellowship training, Young Fellows, active surgical training followed by retirement. He laid emphasis on professionalism and relevance of training. Society grants the surgeons some privileges’ and also expects that they will regularize themselves. Colleges are becoming large and irrelevant for the Fellows Colleges should address this issue and engage with the medical students. He also talked about quality of training workshops which are pathways to becoming a surgeon. Appropriate selection, training and assessment and competencies should be the aim of a surgical training programme. Vocational training, training in skills was also important. His advice to the institutions looking after postgraduate medical education was to organize post fellowship training in collaboration with respective specialty associations and organizations.
Continuing Prof. Michael Holland said that they have set up an Academy of Surgical Educators which promotes excellence in surgical training ad this also serves as a resource for surgical educators. We have established a Young Fellows Forum and Young Fellows are offered travel grants to improve their professional skills. The Young Fellows are closely involved with the college otherwise how you will know about your practices. Three years cycle for Continuous Professional Development is now being changed to one year in 2013. Active learning with the peers is encouraged and promoted. We have senior surgeons groups and have also started publishing a Surgical News letter. Regular training courses and assessment is organized. We help them in preparing their retirement plans as it is the social responsibility to the Fellows which is critical for the College, he remarked.

Prof. John Barry Kortbeck

Canadian perspective of postgraduate medical education was discussed by Prof.John Barry Kortbeck. He pointed out that we must be clear what we expect from a surgeon and what he or she is supposed to do. At times it appears that the Royal Colleges have moved away from their role. He then gave details of CANMeds. A physician is supposed to be a medical expert, manager, health advocate, as scholar life long committed to learning and a processional. He also referred to Doctors as a role model as communicator and gave a road map for learning objectives. The objectives, he opined, should be specific, concrete and measurable.
Prof. John Barry Kortbeck then spoke about Competency Based Medical Education (CBME) and emphasized on societal needs, De-emphasis on time based curriculum. Direct observation, he stated, is central to assessment. He also referred to active learning which should be relevant and there should be variety in teaching methods during follow up. Objective of all surgical programmes is that Foundation residents must be evaluated at the end of second year of postgraduate training programme. He concluded his presentation by stating that a doctor is supposed to be a medical expert, communicator, collaborator, scholar, manager, health advocate and above all professional.

Prof. Anil Madaree

Prof. Anil Madaree from College of Medicine South Africa gave details of postgraduate medical education in South Africa. He pointed out that they have many colleges and each college has two seats in the Senate which represent their respective colleges in this central body. We have three standing committees while Audit and Risk Committee has been added recently. In Cuba, Prof Anil Madaree said, 97% of doctors specialize in Family Medicine after two years. We impart training at universities and at Satellite units all over the country. All doctors must do community service for a period of two years. There are four to eight examiners for each candidate and they are all paid. We are autonomous and hold national examination.
However, at times true assessment of practical skills is not possible during exams. Exams are technique dependent. Some candidates who may not be so good can pass while others who are quite good may not pass. These are some of the strengths and weaknesses of the exam.

Prof. Abdul Aziz Alsaigh

Prof.Abdul Aziz Alsaigh from King Saud University presented a comprehensive account of postgraduate medical education in Kingdom of Saudi Arabia. He stated that it was in 1983 that the first postgraduate programme started at King Faisal University. It was followed by initiation of similar training programmes at King Saud University in 1984 and at King Abdul Aziz University in 1985.In 1995; Saudi Commission on Health Specialties (SCHS) was constituted. It is a scientific body with corporate entity. It started in 1992 with fifteen members. Now it has fifteen branches. Postgraduate training programme is going on in accredited hospitals and successful candidates are awarded Specialty Certificates.
SCHS, Prof. Abdul Aziz said, is involved in general as well as specialty accreditation of hospitals. It has a 7-12 Board Members who have a four years term. It’s renewable only once which means that one person can serve on the Board for a maximum of eight years. We have a central committee, training and accreditation committee, regional supervisory committee and examination committee. We have sixty three training programmes in 2011. The number of training programmes increased manifold after 2005. So far 4,235 doctors have graduated from these postgraduate training programmes and at present we have 4,800 trainees. We have introduced e log books. Computer based exam was started in 2009 and now most of the exams are computer based tests. Postgraduate medical education in KSA is evidence based and attempting to produce high quality specialists. We lay due emphasis on communication skills, evidence based medicine and research ethics. Recently we have also started a Journal of Health Specialties (www.thejhs.org). At present there are 32 medical schools in Saudi Arabia and there is an increased demand for postgraduates. We maintain quality. In view of the rapid increase in medical services, we are facing problems in providing specialist cover and faculty for postgraduate medical education programmes and these issues are being addressed on priority basis. More recently we have started a training programme in Bahrain and our overall performance of the last eighteen years was quite satisfactory, Prof. Abdul Aziz concluded.

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