We need to adopt best standards and practices to ensure provision of universal healthcare-Lt. Gen. S. Imran Majeed

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 AEME Conference 2018 proceedings

We need to adopt best standards and
practices to ensure provision of universal
healthcare-Lt. Gen. S. Imran Majeed

Stay above personal and institutional interests and
look what national needs are - Ara Tekian

Study has shown that patient outcome was much better
in case of 
Non-US medical graduates - John Norcini
 

ISLAMABAD: We have just eight thousand hospital beds in Rawalpindi-Islamabad though we need about thirty six thousand hospital beds. Let us try and learn from military model. At present almost 40% of supervisors and examiners of the College of Physicians & Surgeons of Pakistan for Fellowship exam are from Army. We are now planning to build a Medical City for which details are being worked out. We have accomplished much but a lot more needs to be done. To ensure universal health coverage, we need to adopt best standards and practices. These views were expressed by Lt.Gen. Syed Imran Majeed, Vice Chancellor of National University of Medical Sciences (NUMS). He was speaking at the concluding session of the Association for Excellence in Medical Education (AEME) Conference 2018 held here from March 29-31st 2018. The conference which was hosted by Pakistan Association of Private Medical & Dental Institutions (PAMI) was very well attended by medical educationists from all over the country besides quite a few renowned medical educationists from UK and USA. Theme of the conference was “Linking Patient’s Outcomes to Education and Learning”.


Vice Chancellor of NUMS Lt.Gen. S. Imran Majeed was the Chief Guest in the concluding session
of AEME Conference 2018 held at Islamabad. Picture show him photographed with
Prof. Umer Ali Khan,
Prof. Ghulam Kadir Kazi and Prof. Tariq Sohail.

Gen. Imran Majeed further stated that we must try to understand the plight of people of Pakistan. He then referred to the World Bank Funded report based on a study conducted during 2004-2007 wherein three lac fifty thousand poor as well as rich families of Pakistan were studied. They took stock of the situation when these families faced serious crisis when an event took place. A serious event usually takes place when someone in the family dies or their social class is degraded. This study revealed that almost 60% of these families had one serious event and 54% of these events were related to health. Only 3% of serious events were related to crime, law and order situation. As such when we go for policy making, we must allocate the resources accordingly. He admitted that the present government has increased the allocations for Health by almost 300% but it was also important to find out how this money was being spent. What actually happens is that the allocated funds are not used in time. It is reported that about 60% of the allocated funds are utilized. In all we spend about 1% of our GDP on Health. We need to look into it. Why this happens? Are we advocating the rights of the people of Pakistan through right channels, Lt.Gen. Imran Majeed asked?


Continuing he said that unfortunately tax collection in Pakistan is a serious problem. Over burdened healthcare facilities in the public sector provides ample opportunities to the private health sector to flourish. WHO says that there must be three hospitals beds for one thousand populations. Hence, keeping in view the present population of Pakistan, we need six lac twenty five thousand hospital beds which we do not have, he remarked.

Dr. Ara Tekian Member Executive Committee of AEME speaking at the occasion said that such conference provides an opportunity for networking. He advised the conference participants to share with their colleagues what they listen when they go back. There were many good ideas in the presentations and he hoped that some of it will be published in national and international medical journals. He also advised the audience to stay above personal and institutional interests and look what national needs are? We will move forward and what the organizers are doing will go a long way to improve quality.


Dr. John Norcini President FAIMER from USA in his presentation on National Medical Examinations and Patient Outcome said that at present there was weak to moderate relationship between patient outcome and examination. He referred to the ECFMG examination, Licensing examination as well as the specialty certification. In one of the studies it was studied to see does the ECFMG Exam work? In this study which included six thousand one hundred thirteen doctors it was found out that there was no difference in patient outcome between international medical graduates (IMGs) when compared to US medical graduates (USMG). In fact patient outcome was much better in case of non-US medical graduates. Certification significantly reduced mortality. There was 18% relative reduction in mortality in thoracic surgery based on Board Certification, he added.


Dr. John Norcini President FAIMER from USA presenting Mementoes to Justice Sarmad Jalal Usmani,
Mr. Zahid Hussain and Prof. Ghulam Asghar Channa speakers in the
Plenary Session on Day-2 of the conference.

Prof. Ghulam Kadir Kazi Executive Committee Member of AEME in his brief address said that their seven years struggle has started bearing fruit. Prof. Tariq Sohail President of PAMI suggested to start Licensing Examination at the end of the House Job.

Dr. John Norcini in his vote of thanks stated that we must work on evidence based patient outcome. We must develop effective means as we in United States were spending too much on Healthcare. Dr. Janet Grant from Open University UK said that we must first know the problem which we are trying to solve. If there is no problem, do not try to solve it, she remarked. What is discussed and presented should be looked at critically. Medical Education needs to be standardized but it also needs to be practiced to develop health services, she added.

Plenary Session

Speaking on Healthcare services and economic progress Mr. Zahid Hussain Senior Editor News Line and a columnist emphasized the importance of providing universal health coverage to the entire population. Expenditures on improving health services reduce poverty. It is essential that everybody has access to quality healthcare. With reduction in poverty level, it offers lot of political benefits as well. Health Service reforms, he said, should reflect standard of living, healthcare, food, clothing and medical care. We need to improve social services. UN General Assembly has resolved that Health is a fundamental right. At present almost 30% of the population is looked after by the private health sector. There is poverty and Lack of healthcare facilities in poor areas. Hence, many of them then go to Hakeems, Homeopaths and faith healers. We have very high infant mortality, under five child mortality and maternal mortality which is higher than many of our neighbouring countries like India, Sri Lanka. We spend just less than 1% of our GDP on health as compared to 10% by Cuba. Healthcare, he opined, must be our first priority, universal healthcare is affordable and possible, he added.


Justice Sarmad Jalal Usmani former Chief Justice of Sindh High Court and former Judge of Supreme Court of Pakistan talked about Forensic Medicine and Criminal Justice. He discussed in detail the practical application of forensic medicine in criminal justice and the problems encountered. Forensic medicine pathology, he stated, deals with cause of death, clinical forensic medicine is related to injury, and forensic serology is relationship between deceased and the victim. Forensic anthropology deals with remains of body, sex, age etc. Now a new sub-specialty has also emerged known as Forensic Psychiatry. Forensic Medicne also deals with postmortem reports and medico legal reports. Inter professional collaboration is needed to establish the cause of death. Doctors, he further stated, lack knowledge as to the type of fire arm used in such incidents. A bullet causes inward wounds and outward wounds when it goes out. Use of Double Barrel Gun is most common is rural areas. During the cases one has to establish whether the injury was caused by pellets or bullet. Distance of the injury is also important to establish the cause. One has to draw the figure of body, show the direction of injury, and show how the injury was caused? Police lack in this knowledge hence most of the criminals get relief. The specialty of forensic medicine is not paying as there is no private practice involved and it does not offer lucrative professional career. There is a Fire Arm Bureau in Karachi which medical students in general and Medico legal Officers must visit. When there are differences in medico legal report, people involved are acquitted.


Some of the participants of the AEME Conference 2018 photographed durning Inaugural session
while National Anthem is being played. Prominent among them are
Dr. Janet Grant, Dr. John Norcini, Dr. Ara Tekian.

Mr. Tariq Hassan Advocate Supreme Court of Pakistan and former Chairman Securities and Exchange Commission of Pakistan talked about Medical Education Reforms and Current Developments. He advocated self regulation and co-regulation of the medical profession. He also advocated an impartial umpire between the PM&DC and the medical profession. Reforms, he said, should cover all healthcare professionals. At present the PM&DC is totally fragmented. There are problems with admission in medical colleges and accreditation of medical institutions. After 18th Amendment Health and Education has become a provincial subject but regulation still remains with the federal government. Some decisions have to be taken by the Council of Common Interests (CCI) which previously was in the concurrent list. He suggested a uniform curriculum by which he later clarified meant ensuring minimum standards, decentralized healthcare system. Continuous Professional Development, he opined, was important. We also need robust standard for accreditation of medical institutions and private medical and dental institutions must get due representation in the PM&DC. He also favoured starting a licensing examination after the completion of House Job.


Prof. Ghulam Asghar Channa Vice Chancellor of SMBBMU Larkana talked about Hospital- A Bridge between the healthcare and Medical Education. He pointed that patients have too much expectations from the doctors. He also referred to the relationship between the medical university and the hospital, lack of integration of services which results in waste of resources and provides poor value for the money. We need a proper referral system linking healthcare facilities at different levels to the teaching, tertiary care facilities. Who will govern the hospitals affiliated with medical universities has to be decided once and for all. Ideally they should be under the administrative control of the medical universities. We need reshaping of the national health services and improve upon the poor health infrastructure. At present we have inadequate staff and there are problems with the supply chain system as well. District Health Authorities needs to be strengthened. Female doctors are facing numerous problems and we need to include behavioural sciences and medical ethics in the curriculum, he remarked.


Participating in the discussion Prof. Rukhsana Zuberi objected to the use of word uniform curriculum. She was of the view that while ensuring minimum standards, medical colleges and medical universities should have autonomy to opt for innovations in the curriculum. Responding to this Mr. Tariq Hassan remarked that to ensure minimum standards, we need some sort of uniformity.

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