Decline in Standard of Medical Education

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 Decline in Standard of
Medical Education

Gradually many vices have crept in the society like dishonesty,
greed, selfishness, callousness, lack of commitment which
has affected Medical profession as well and it is losing respect

Prof. Nasreen Javaid,
Former Professor of Pharmacology,
Fatima Jinnah Medical University, Lahore.

Pakistan  is producing a large number of doctors at a fast pace, however the standard of present day doctors has gone down in all aspects as ability, efficiency, knowledge, human values even though science, technology, research, teaching aids have greatly advanced.

Simply question is why? With the passage of time, there has been deterioration in our society; many vices have gradually creped in as dishonesty, greed, selfishness, callousness, lack of commitment. These have also affected medical profession which though is a noble one, is losing its respect. In past two decades, the teachers relatively speaking were more dedicated with integrity and sense of responsibility. They were strict and maintained a discipline. Students were also hard working and generally produced genuinely good results.

There is a gradual decline in standards of medical education at undergraduate as well as postgraduate level. If we analyze, a number of factors are responsible for this change. With time number of students admitted to medical colleges kept on increasing; also new medical colleges opened and their number increased. Admission policies kept on changing; merit was not the main criterion for admission. Special seats were created as those for northern areas, governor’s seat, army seats, foreign students’ seats. So even with third division in F. Sc., students got admission. There was a great difference between their intellectual caliber and teachers found it difficult to maintain a standard, which came down. The number of students appearing in professional examination increased besides leaking of papers, pressure on examiners, competition between colleges to produce good results no matter how; the standard further dropped.

A major factor is the establishing of private medical colleges and their number is growing like mushrooms. These colleges charge a very high fee so those who can afford and who do not have merit for admission in government medical colleges get admission in them. These colleges offer very lucrative salaries to the staff. Teachers of government medical colleges join these; some take leave, other leave preparatory to retirement, when their abilities are at their peak. Result is the government colleges lose their experienced capable teachers resulting in shortage of staff. Sometimes a demonstrator with hardly any teaching and administrative experience becomes head of department. Consequently, teaching and clinical training suffers badly. In private colleges, the students mostly belong to rich families with low merit and least interest in their studies. Discipline is difficult to maintain as most of teachers have come for a higher salary, they lack dedication. If another private medical college offers more salary, they leave. Courses are unfinished. It may take time to get their replacement. The hospitals attached to these colleges; some do not fulfil the requirements as number of beds, various departments, equipment etc.; some are very far from college premises. The students lose a lot of time attending clinical classes at the hospital. It is not possible for students to go to hospital in evening to study their cases.

Another important factor is large number of students. The batches for clinical and practical training are large ones. Student teacher ratio does not meet the requirement. Student do not get the opportunity to learn and practice clinical methods or perform the practical. Knowledge they gain is mainly theoretical from books, notes etc. Their studies are mainly examination oriented. As there is competition between various colleges, examiners appointed are those who will cooperate and give good results, so standard of students passing out is not up to the mark.

The examination system has also changed with MCQ, short questions. Marks are easily obtained and students are successful with relatively superficial knowledge. Practical OSCE exams are also easy. As the number to be examined in viva is large, students cannot be assessed properly. Very good and mediocre students are the same. This discourages good students and others also do not make more effort; the standard comes down. In past, pass percentage used to be 50-70% or even less. Now it is very high.

As in all other institutions, the approach by parents, relatives etc. is not only to get them through the examination but also to get positions and medals. In some colleges, the children of professors, teachers get position and medals which they may not deserve.

Another very important factor is too many functions are held in college premises and outside as well such as fun fairs, musical programs etc. These are mostly held during academic time. Students miss classes. Then there are trips to places like Murfree, Swat etc. Almost a week is wasted in such trips.

At the end of year when examination is around the corner, students wake up, look around for notes from their class mates which may be difficult to get as at this time, all are studying. Notes, practical copies of good students are often lost. The practical copies are completed hurriedly. They look for short cuts as guesses and leave out portions of the course for choice which is a great risk. The study done in haste leaves them with little opportunity to understand the subject. The objective is just to get through in the examination by whatever means right or wrong. Their knowledge is very superficial and they forget as quickly as they learn; even if they pass they will be of low standard.

In this present time, students have easy access to modern devices and have too many distractions. They have advanced cell phones, tablets, iPad, laptop computers, face book and a large number of TV channels. Students are busy messaging, playing games hearing songs etc. even in class. They hardly concentrate on what is being taught. This not only wastes time but can also affect their moral values and character.

The role of teachers also has a great impact on standard of medical education, who are part of society, and with time, dedication, selflessness, punctuality, discipline etc. is getting less. Reason for joining private medical colleges is monetary gain which they do not hesitate to leave. There is no such thing as loyalty or commitment.

Another important reason is the objective of getting admission into the medical college. A large number are forced by their parents when they have no interest whatsoever. Other want to become doctor to earn money. For girls they want to become doctors just to earn the degree, they may have no intention to practice medicine after qualifying.

There is also a great flaw in admission to medical college. Entry test is not enough. There should be a proper interview by experts of various fields including psychologist and they should try to judge whether student has the ability, interest, temperament, capacity to hard work to go into medicine or not and whether he/she has the aptitude of doing medicine.

The doctors of today have thus declined in many respects as their knowledge, skills, behavior because of which the patients suffer. In hospitals, government and public, even private doctors as well as private practitioners do not give enough time to the patient in taking a proper history, as mostly their training is not adequate; physical examination is hardly done; a number of laboratory and diagnostic tests are ordered, some very expensive. Without arriving at even a provisional diagnosis, a number of medicines are prescribed. The junior doctors follow their consultants, seniors and prescribe expensive drugs which the poor patients cannot afford; very few doctors care to write a proper prescription. Many even do not know how to write one. Often too many drugs are given and the patient sent to a particular pharmacy for drugs of a pharmaceutical firm who has obliged the doctor. This is sheer dishonesty. Private practitioners give a pack of various drugs at a certain price which contain antipyretic, antibiotic, anxiolytic even steroids and give an injection which mainly has a placebo effect as the patients have spent the money they have, they do not usually come back so there is little success of treatment. Inadequate dose and the duration antibiotic is given, promotes drug resistance. There is rising incidence of iatrogenic diseases due to misuse of drugs. There are also adverse effects and drug interactions. Some can be serious or even fatal. All this is due to lack of proper knowledge of drugs.

There has been marked deterioration in character of some doctors. Their behavior with the patients, attendants, subordinates as nurses, ward boys is not satisfactory. They can be arrogant, rude and sometimes abusive. There are frequent incidences of clashes of doctors with patients, attendants. Sometimes, they go to the extent of beating up the doctors or damaging hospitals or property which is very unfortunate. Of course both are at fault. Doctors have a lot of respect in society which has declined with the passage of time.

The doctors coming out are also unaware of the ethics. The malpractices like giving wrong certificates, making the patient spend much more money by sending him to a particular laboratory, prescribing drugs of a certain company that are much more expensive than equally effective drugs with less price. Another malpractice is giving injections unnecessarily; not only patient has to pay more, but exposes the patient to added risk also. Use of contaminated syringes and needles put the patient to risk of hepatitis and other diseases. Surgeons may unnecessarily remove an organ like normal tonsil, uterus or appendix etc.

Thus with decline in standard of today’s doctor, the society suffers. Let us hope efforts will be made to raise the standard of medical education at government level, institutional level and individual level.

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