Accreditation drives medical schools to improve quality and faculty development-Ara Tekian


 AEME 2018 Conference Proceedings-II

Accreditation drives medical schools to improve
quality and faculty development - Ara Tekian

Patient safety must be learnt and students
should have role models - Janet Grant

Each medical, dental institution should set up two outreach
clinics in the community and there should be
before registration - Tariq Sohail

ISLAMABAD: Dr. Syed Tariq Sohail President of Pakistan Association of Private Medical & Dental Institutions was the first speaker in the First Plenary Session during the AEME Conference 2018 held here from March 29-31st 2018.  Speaking on Medical Education in Pakistan, Dr. Tariq Sohail said that this story of medical education   was encouraging with lot of pitfalls. At the time of independence in 1947, there were just two medical colleges i.e. King Edward Medical College at Lahore and Dow Medical College in Sindh which started at Hyderabad and was later shifted to Karachi. Fatima Jinnah Medical College for Girls was the first all-female college established at Lahore in 1948. In 50s and 60 six new medical colleges were established and admission was on BSc on priority basis followed by FSc. During 80s two new medical colleges were established followed by twelve colleges in late 90s but after the Year 2000 flood gates were opened and we saw mushroom growth private medical and dental colleges in Pakistan.

Three hundred fifty students used to be admitted to medical and one hundred fifty to dental colleges in public sector while the admission in private medical and dental colleges used to be one hundred and fifty respectively. Now these days over thirteen thousand students are admitted to medical and dental colleges annually of which 7,700 are in private institutions. Private sector, he said, has come a long way in producing doctors and dentists. At present Pakistan is the fourth leading country exporting doctors to the world. We focus on input and not output. We have curriculum deficiencies and no outreach clinic for the community. There is no referral system from BHUs to RHCs nor do the students visit them. There is deficiency of basic science teachers. Medical Ethics is neither taught nor is it the requirement. He suggested that each medical and dental institutions must have at least two outreach clinics in the community. The deficiency of basic science teachers must be met. There is a need to encourage and assist basic science teacher’s programme by the PM&DC. Currently Eye and ENT disciplines are given too much time. He further suggested ensuring standardizing the competency and licensing examination before registration with the PM&DC.

Miss Anis Haroon’s presentation was on Rights to Health.  Health, she stated, was a fundamental right and public health at present was in shambles. We have 50% children who are malnourished, high morbidity and under five mortality. We need to revisit our health policies to see where we have gone wrong. There are inequalities in Health. Health as a fundamental right should be included in the Pakistan constitution. Lawyers and doctors should help us to get it included in the Constitution, she remarked.


Prof.Ara Tekian’s presentation was entitled “Are patient outcome linked to challenges in Accreditation and continuous quality improvement?” Accreditation, he stated, has impact on medical education.  He then gave details of a survey conducted in seventeen medical schools in Canada which participated in this On Site Peer Review system of medical education programmes. Interviews were conducted with the Deans of these medical schools. Thirteen schools finally participated and all of them were accredited. During the survey the researchers looked at the governance, data collection programme, monitoring system, documentation, continued quality assurance, faculty engagement, academic accountability, costs, feelings and moral of the faculty besides credibility of the institutions. The study conclusions were that Accreditation drives medical schools to improve quality and faculty development.


Prof. Janet Grant was the next speaker. She talked about continuing professional development of patient safety: The role of Medical Schools. She was of the view that patient safety must be learnt and students should have good role models. She further stated that role models come from clinical teaching. Medical Schools, she opined, must support the role models and their practices. The fundamental role of medical schools is to support clinical teachers through CPD. They must develop research programmes in areas prone to error. Medical schools should start CPD programmes. They can manage these systems.  They should transfer learning into practice. They must keep CME and CPD as close to practice as possible. Give ownership and control to predictors including identified risk to patients. Learning, Prof. Janet Grant remarked is a process and not an event.  We can start credit for effective learning process. Learnt it and apply what you have learnt. We need to look into what will be learnt, how it will be learnt, learn and use it. Identification of risk is important and methods of learning need assessment. It is important to know risks. Patient safety should be included in the curriculum.


All learning methods are valid. What is needed is to reinforce learning.  Give clinical teachers recognition and it will improve patient safety. It will also help students, faculty as well as the patients.  She laid emphasis on risk based research, link medical school courses to practice, ensure excellent role models and provide national based CPD system.

Plenary Session-II

Prof. Maj.Gen. M.Aslam Pro Vice Chancellor of National University of Medical Sciences was the first speaker in the second plenary session. He discussed linking patient outcomes to duration and Training: Why it is necessary? He highlighted the importance of assessment derived learning. Quality healthcare, he said, must be safe, effective, patient centered, timely. He also talked about education and training, learning objectives, curriculum, learning strategies, assessment and Evaluation, learning outcome and pointed out that they complement each other.


Prof. Mohammad Umar former VC of RMU speaking about patient safety said that best practices lead to optimal patient outcome. He pointed out that over one million patients die due to medical errors worldwide annually.  It is the most common cause of death. Infections were another major cause of deaths. Surgical procedures, medical care, medication, diagnosis are the other causes of deaths. Majority of medical errors are due to surgical procedures. In fact what we have been doing all these years was harming the patients. Continuing Prof. Umar said that to err is human but patient safety is a serious public health problem. He also referred to difficulties in recognizing errors, Lack of information system, shortage of clinical professors and culture of patient safety was lacking. We need to develop this culture. Culture, he further opined, is learnt. We need a system change to create a culture of safety. He highlighted the importance of patient engagement, implementing changes, education and training campaign besides research. Hand washing reduces the infections. We need to prevent hepatitis, ensure safe surgery to ensure patient safety. He then gave details of the manuals, Standard Operating Procedures which they have developed for every advanced procedure. There are guidelines for doctors, nurses, patients, consultants on sterilization. We have established a Skills Lab, simulation lab, provided facilities for patient education at the Liver Diseases Centre established at Holy Family Hospital Rawalpindi. We need to lead, support our staff and promote error reporting system.

Dr. Tariq Sohail President of Pakistan Association of Private Medical Institutions presenting a
memento to Lt. Gen. Ismat Majeed Vice Chancellor of NUMS at the concluding
session of AEME Conference 2018.

Prof. Rukhsana Zuberi talked about Stone Age to the Era of Artificial Intelligence. She was of the view that we need to make teaching and training informative and enjoyable. She also highlighted the role of great Muslim Physicians. WFME/FAIMER has come up with competencies for competence. We have done nothing in pre medical stage. Artificial Intelligence, she stated, will transform the future of medicine. Competences help in identification of risks. We have been following outdated medical education system.  Time has come that medical education should be provided at many locations by new healthcare teams. Patient safety should be on the forefront. Simulation has its own importance, she added.

Prof.Tariq Rafi Vice Chancellor of Jinnah Sindh Medical University talked about Global standards of medical education and PM&DC.  He was of the view that we have to tailor our curriculum relevant to our needs.  We cannot cut and paste, implement what is being used in the West. We have to find indigenous solutions. Let us get accredited with WFME. Core competencies should be designed for recognition by PM&DC and HEC and it is essential that we meet global standards. PM&DC needs to be accredited by the WFME. We need to streamline medical schools, evaluation and accreditation is needed to ensure minimum quality standards are being maintained to safeguard the interests of the patients. He suggested that PM&DC should delegate some authority to medical universities and they can improve their affiliated medical schools. For this the PM&DC needs to transfer authority to medical universities to control medical schools. Behavioral sciences and medical ethics need to be included in the curriculum. It is the curriculum which matters and not the system. One can use any system. He also suggested online registration within three months. PAMI, he suggested must ensure minimum standards in their institutions. During the discussion it was stated that artificial intelligence is now a fact. We need medical graduates who can use it judiciously.

Prof. A. Majeed Chaudhry in another session talked about Demise of Clinical Acumen which was affecting the quality of health care. He discussed at length the unethical practices, in adequate training, vanishing of good role models, there is no holistic approach. Private practice, he opined, was a scourge, and starting practice in surgical infancy has its own repercussions. In the past students were different and the teachers were also different. He suggested regular feedback from the students about the faculty. Parents believe that they have paid for everything and now the medical schools have to produce doctors. He also criticized the high pass percentage in medical schools which has become a routine.

Dr. Junaid Lakhani gave highlights of his study about student’s perception of the learning environment in a private dental college in Karachi. He pointed out that students felt that the faculty was well prepared and learning environment was good. Social life at the campus was comfortable. He suggested promoting learning environment at the colleges. Their study limitation was that it was conducted at just one institution and its finding cannot be generalized.