Commercialization of Medicine, increasing privatization of medical education & healthcare is a threat to medical profession-Prof.Rita Sood

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Establish a Medical Staff College to train medical teachers-Majeed Chaudhry

Commercialization of Medicine, increasing privatization
of medical education & healthcare is a threat
to medical profession - Prof. Rita Sood

Doctors cannot work alone; nurses and paramedics are important
members of healthcare team which necessitates
integration-Prof. Mowadat H.Rana

We know our problems and we have the capability of solving
them but will have to come out of academic
inertia-Prof. Majeed Chaudhry

LAHORE: Commercialization of medicine, increasing privatization of healthcare and privatization of medical education is a serious threat to the medical profession. Other issues of serious concern are the role of the pharmaceutical industry in Continuing Professional Development, increasing use of technology which has adversely affected the doctor-patient relationship. We have seen increasing litigations due to poor communication, lack of clear guidelines and inappropriate use of technology. This was stated by Prof. Rita Sood, Prof. of Medicine at All India Institute of Medicine, New Delhi, India. She was delivering Prof. Shujaat Ali Khan Memorial Lecture entitled Teaching and Assessing Professionalism during the plenary session of the 6th International medical Education Conference held at FJMC from February 7-9th 2014.

Prof. Mowadat H. Rana (Centre) chairing the plenary session during the
6th Int. Conference on Medical Education held at FJMC recently.

Continuing Prof. Rita Sood said that now we have large number of medical students and there is no formal curriculum. Ethics teaching is a part of behavioral sciences course. She was of the view that acquiring technical knowledge was good. Psychosocial issues in ethics should be part of medical education and we also need to develop guidelines for teaching and assessing professionalism. Punctuality and commitment only comes through training and experience. We need to bring in humanism in healthcare. We all see patients in the OPD who do doctor shopping. Professionalism Prof.Rita Sood opined is caught and cannot be taught. People have started practicing defensive medicine to be safe. Individuals, departments, institutions, policy makers, institutional review boards, consumers and regulatory bodies all need to have a careful look on these issues. Training and teaching of medical ethics started in USA forty years ago but the problems is still there. She emphasized that let us be what we teach, ensure ethical practice, reflection and respect for the patients, work with others in close collaboration and recognize our social responsibilities. Curriculum should be revised taking into consideration the health needs of the people. We also need to redefine functions in teaching and students leading to policy change.

Continuing Prof. Rita Sood said that students should play the role model of compassion, desire to serve the poor and the community. Giving an example of India of one of the medical schools, she said that during internship all medical students work in rural areas and they live in these areas for three weeks. They have two hundred twenty secondary hospitals and doctors have to do two years mandatory service. She concluded her presentation by stating that we need to have courses in professionalism, make additions to the curriculum based on healthcare needs of the community. Faculty development in medical education is extremely important besides teaching and assessment of professionalism in local context.

 

Prof. Sardar Fakhar Imam Principal FJMC presenting a mementoe to
Kh.Ahmad Hassan at the inaugural session of the Medical Education
Conference held at FJMC recently.

Redefining Integration in Health

Prof. Mowadat H. Rana was the next invited guest speaker who delivered Prof. Nabiha Hassan memorial lecture and the topic of his presentation was Integration redefined in Health. He laid emphasis on providing health professionals education under one roof. Doctors, he said, cannot work alone, nurses and paramedics are important members of the healthcare team. Medical ethics was important for all of these healthcare professionals. At present we have doctor centered education of health professionals, is isolated and divisive. In medical education we are following the infamous cast system which he termed as Health Professionals Cast System. We have the Health Administrators at the top, and then come the professional doctors followed by the doctors and trainees in this pyramid. Nurses, paramedics, technicians and ward boys, Ayaas comes at the last. Nurse, he said, is considered and should be the Mother of the Ward. If we wish to improve our healthcare system, we must integrate.

He then discussed in detail the concept of integration in medical education and referred to the Flexener Report of 1910 in United States. In the post Flexener era the role of hospitals, clinics in learning has changed. It is holistic, well rewarded health professional team approach. He discussed in detail the role of hospitals and clinics in teaching, training, assessment in medical education and how every one performs as a team member. He was of the view that if we provide healthcare through healthcare team, the outcome will be much better. Outcome and competency in Health Professional Education should be based on integration and professionalism. Explaining further he said that if the medical students in the first and second year come to the hospital for one to two hours early in the morning, it will provide a large number of interested, willing and motivated forces which can overcome the shortage of nurses and paramedics in the hospitals. He also advocated sharing learning between public and private sector. We have some medical colleges which are taking medical students but they have no patients while on the other hand, public hospitals have too many patients but lack the staff and other facilities. If we pool our resources medical colleges who have no hospitals will get the patients so essential for teaching and training. Let us ensure PEACE in hospitals in which P stands for Professionalism, E for Equality, A for Accessibility, C for Competence and E for Efficiency, Prof. Mowadat H.Rana remarked.

Issues and Challenges in Medical Education

Prof. Majeed Chaudhry Principal of Lahore Medical and Dental College delivered Prof.Rose K. Madan memorial lecture and the topic of his presentation was issues and challenges in medical education. Medical Education in Pakistan, he said, leaves much to be desired. Maladies are in abundance and it was about time that we do some passionate analysis and medical intelligentsia plays an advisory role to guide the regulatory authorities to take some concrete steps which should result in some positive change. The problem, he opined, starts with the intake of the students.

Continuing Prof. Majeed Chaudhry said that we have irrelevant premedical curriculum. Entry test is a good screening tool but with non-uniform standards. We need unified curriculum. Maths has lot of application in telemedicine, radiology, oncology, pharmacology and so is the case with statistics. English is the scientific language but it poses lot of problems with many students. It might make a strong case for bringing back BSc as a pre-requisite for admission which is practiced in United States. In UK, it is optional to do BSc after initial two years in medical school. Selection of medical students, he said, is the key importance to medical education. The quality of students being admitted will determine the quality of the doctors. Obtaining FSc or A level degree does not tell us anything about the most desirable attributes of a doctor which should be human empathy, technical competence, wisdom and experience. Number of girl students is on the rise because they are better students and reasons for this change are manifold. We need to know the exact number of students leaving the profession. It cost lot of money to the parents and the State to train these doctors. Some students are forced to enter medical school against their wishes. We have mushrooming of sub-standard medical colleges which has added fuel to the fire. One wonders how some of these colleges are allowed to function. Some of them have no infrastructure available. The differentiation between public and private medical colleges should be done away with ensuring uniform standards are applicable.
Continuing Prof. Majeed Chaudhry said that there is need for student support services so that depression can be identified and treated in good time. Counseling service is not available in some of the institution but it is important that the institution heads are aware of these problems. The importance of conducive learning environment cannot be over emphasized. The education we impart is not developing their mind as they are loaded with plethora of factual knowledge. Teaching and learning is not students centered though a few institutions have made some cosmetic changes. Exposure to clinical teaching is deplorably deficient as there are no skills training in many institutions. Curriculum needs to be standardized. COME concept was misconstrued in Pakistan with the result that at present there is very little community exposure of our undergraduates and they are poor at communication skills. Some institutions have no faculty, others have deficient faculty and some have untrained faculty. Faculty development is extremely important but the greatest difficulty in life is to make knowledge effective, to convert it into practical wisdom. As Sir William Osler said, no one can teach successfully who is not at the same time a student. No formal mentorship relationship exists in our institutions despite the fact that monitoring is essential to create new leaders and new kind of leadership.
He then referred to teacher centered education, misuse of audiovisual aids and said that we seldom try to understand the students, stake holders are not taken on board. In fact we are teaching specialist’s medicine but not community diseases. Despite the fact that majority of the doctors are gong to become family physicians, family medicine is not at all taught in our medical colleges. This specialty needs to be developed in our institutions. Constructive feedback from the teacher gives the leaner an insight into his/her actins and their consequences and it also plays a critical role for the leaner, the teacher and the education programme. Speaking about the issues related to governance, Prof. Majeed Chaudhry said that autonomy to the institutions was a step in the right direction but true autonomy was never given. At present there is insecurity among the doctors, faculty members. Contract appointments policy has adversely affected medical education and it has also lead to brain drain. International market is attracting our faculties. Poor service structure, bureaucratic tangles has lead to departure of so many qualified professionals besides discouraging expatriates returning to homeland.

The authorities have failed to regulate with the result that we have substandard medical colleges in both public as well as private sector. There is differential application of rules, number of students admitted far exceed the available facilities. There is not enough space in lecture halls, OPDs and laboratory. Incumbent consultants feel threatened due to establishment of new medical colleges at DHQ Hospitals who in return resort to unsettling measures and at times some of them are threatened. Some are involved in legal battles because of so called patient negligence. Then comes the Bossy attitude of the hospital administration about which less said the better. New medical colleges have poor infrastructure, no faculty or part time faculty. Forcible transfer of some faculty members for six months will not solve the problem and it is also violation of PM&DC regulation as regards registration of faculty. In the field of research, we have fake papers, ghost writers, ready made synopsis and Thesis, arm-chair researchers with fake studies and involvement in plagiarism. One wonders how some of the institutions could achieve 100% result with no faculty which says a lot about the poor assessment system.
Prof. Majeed Chaudhry suggested that we should form a Commission to look into these issues and its recommendations should be binding on regulatory authority and health departments. We know our problems and we have the capability of solving them but will have to come out of academic inertia. We need curriculum which is relevant to the needs of the population, consult all stake holders, initiate faculty development programmes and establish a Medical Staff College to train medical teachers, Prof. Majeed Chaudhry remarked.