We need to make our assessment system more objective, transparent & standardized


Improving Quality of Medical Education in Pakistan
We need to make our assessment system
more objective, transparent & standardized
Better co-ordination between all institutions will help achieve the
ultimate objective of improved healthcare-Prof. Junaid Sarfraz Khan
Medical Universities can form a Council to suggest, implement
changes, audit it and publish the results

From our correspondent

LAHORE: There is no co-ordinated effort to improve quality of medical education in Pakistan. We need to make our assessment system objective, transparent and standardized which will eventually help to achieve the ultimate objective of improved health care. We can improve and standardize our system so that it can be accredited by not only national but international bodies as well and one does not have to sit in the examination for international accreditation. This is my earnest desire which have made me interested in the discipline of medical education. This was stated by Prof. Junaid Sarfraz Khan FRCPS, FRCS, Professor of Medical Education at University of Health Sciences in an exclusive interview with Pulse International recently.

Prof. Junaid Sarfraz Khan

Having spent seven years in medical education, I have a satisfaction that I have done justice to my education and life as I have been able to contribute to improvement of medical education to some extent. I have contributed to assessment and curriculum development. I have tried to contribute by introducing international ideas and concepts and implant them in Pakistan taking all the stake holders onboard. We need to see how the best medical education practices in the world can be rationalized practiced in our own local environment with our own concepts. One of the shortcomings of medical education in Pakistan, Prof. Junaid Sarfraz Khan opined is that we just try to implant ideas from overseas without realizing what are going to be their impact and effect on our students, faculty members and the institutions. Ideas like problem based learning, small group learning practices, simulated patient exercises are good but we have to see what and how they can be practiced in Pakistan. We have no shortage of patients. All the above are good strategies for teaching and learning but our problems and concepts are different from the developed world. We have to be little more compassionate with people. All these good ideas can be incorporated and implemented after modification to suit the local needs after taking care of our cultural values. Only then they can be implemented. At University of Health sciences we have contributed in that concept. How we can implement those practices successfully in Pakistan is a great challenge. We at UHS invite not only the faculty to review the system but the public and peers as well to recommend and advise us how we can bring about some positive constructive changes so that the quality of healthcare delivery is improved.

The department of Medical Education at University of Health Sciences was created in 2003 with forty five staff members. Over the years there has been no increase in this number but when it was established we had just seven medical colleges. This number has now increased to thirty five medical and dental colleges which are affiliated with UHS. If we add the other allied health professional colleges, the number increases to over fifty five. Each year we examine over thirty thousand students. We also conduct entrance test for Government of Punjab for admission to medical and dental colleges. Whatever we have been able to achieve over these years has all been due to team work. I have tried to make the staff understand this that we achieve much more as a team. I have myself worked in various departments and since I have myself done almost everything from punching the data to taking dictation, sealing the question papers, I have earned respect of my staff by working with all of them and we all respect each other. If you order people to do this, it won’t work but if you work with them, they will do it much more efficiently and I have been quite successful in that. Vice Chancellor of the University is a very important member of this team and if you have his support, the team works much better. If the Vice Chancellor upholds merit, successfully handles the bureaucratic and political pressures, it ensures bright future for the institution. He commended the efforts of late Prof. Mahmood Ahmad Chaudhry and former VC Prof. Malik H. Mubbashar in the development of UHS.

When his attention was drawn towards the fact that there have been some protests by medical students against poor pass percentage, Prof. Junaid Sarfraz Khan who is also having additional charge of Controller of Examinations at UHS, said that one of the good things with University of Health Sciences is that it has never buckled under pressure. We always uphold merit and do justice. These were some of the important characteristics of the UHS which made me keep on working here. During my seven years tenure of Controller of Examinations, there have been a few isolated incidents of generalized strike. The decision which we took on the very first day, we stick to that. We will never succumb to pressures. If we have made mistakes, we will accept that and every time the university makes mistakes in examination, we admit it publicly. We make sure that those who suffered are compensated and we also try to learn from those mistakes. If the demands are not just and right, we do not accept that. By doing so we have sent a message to all concerned. We have always tried to accommodate the students when they were right in their protest but un-necessary demands are not accepted. We have a duty to government and the public. If we pass those doctors who are not competent, every case which they will neglect, we will be responsible not only in this world but the world thereafter as well. This has to be understood by all of us. Sometimes we have formed a panel of subject specialists to look at the student’s demands, review our paper, procedure and make their recommendations public. A couple of times the government has also conducted enquiries and found that that there was nothing wrong. Problems related to strikes, he clarified could be multifactorial. It could be related to teaching. We have now too many medical and dental colleges with inadequate faculty. PM&DC and other government agencies have started taking notice of this. The PM&DC rules and regulations need to be implemented in letter and spirit and sooner we realize this, better it will be, he remarked. With limited faculty, medical and dental colleges have their own limitations and they may not be able to teach such a large number of students which may be beyond their capacity.

We need to rationalize the number of students in each medical and dental college. At the same time we also need to take appropriate measures to stop the brain drain of faculty members. We need to come up with some strategies to ensure that faculty members stay in Pakistan particularly the basic science teachers. They need to be looked after so that they keep on working here in Pakistan rather than going abroad for better prospects.

Certificate Course in Medical Teaching and Training

Continuing Prof. Junaid Sarfraz Khan said that after consolidating our gains and accomplishments, we are trying to bring a change in all operations. We are trying to decentralize workshops in teachers training programmes in various medical and dental colleges all over the province. Instead of inviting them here, we go there and teach, train them which is also cost effective.

We have already started training the faculty in teaching. We have started a Certificate course in medical teaching and training programme. In this we were helped by University of Liverpool UK. We are running this course with the help, assistance and cooperation of Higher Education Commission (HEC) and Government of Pakistan. We wish to select trainees in this programme at national level to go and conduct these courses all over the country. It is mostly the basic training in how to teach health professionals. At present it is free due to funding provided by HEC and GOP. If at some stage we feel financial constraints, we will charge nominal fee so that we can cover the travel expenditures of the visiting faculty.

MHPE programmes in Pakistan

We have also introduced Masters in Health Professionals Education (MHPE) programme which is of two and a half years duration. It is an online programme of international standard. Those enrolled in this programme have to submit an assignment every week and review the assignment of other students. They are also required to write a Thesis of up to forty thousand words and defend it before they are given this degree.
Responding to a question that now various institutions in Pakistan are running such courses, is there any co-ordination among them to ensure standards, Prof. Junaid Sarfraz Khan said that we wish that all these institution should come together. They can have their own programmes but we constitute a joint committee to standardize this programme. We had some response. We wish that we can have a consortium of supervisors. Aga Khan University contributed to our programme. Professionals of all segments coming together will improve the standards. Unfortunately some institutions have not agreed. I feel that the entire country should be able to benefit from their expertise. Through some meaningful collaboration we can bring together ideas and enrich this programme. Working with self concepts and bickering, we won’t be able to achieve much. We need to have a world class collaboration programme with representatives from various institutions. We at UHS have a dynamic Vice Chancellor who is a great team player and people listen to him. We wish to standardize and modernized UHS culture in undergraduate and postgraduate fields. People have been teaching with their own concepts for generations. We need to develop indigenous curriculum keeping in view our needs and requirements. For this we have to involve our own people rather than look at foreign experts. Training will take few years, changes may be slow but we will change and it will last for many years.

Prof. Junaid Sarfraz Khan was of the view that there is lack of planning, implementation and monitoring in medical education. Whereas there are bodies at highest level like PM&DC and HEC, we can form a Council of Medical Universities with representatives of various universities which can be called as University Syndicate. It should discuss national issues in medical education; make recommendations to Government of Pakistan and HEC. After bringing changes, it should be asked to monitor the change. Once this council is established, its recommendations should be implemented; its work should be audited and published. All this is doable. With blessings of Government of Pakistan, representation from these universities at the highest level, its voice would be heard everywhere and at the highest level, he added.
When asked to describe his academic and professional journey from Allama Iqbal Medical College in 1997 to University of Health Sciences Lahore, Prof.Junaid Sarfraz Khan said that I graduated from AIMC in 1997. At that time Jinnah Hospital had just been commissioned and it was fascinating to see this newly developed healthcare facility coming up. It was very educational how various services were being established. At that time there were no paid house jobs for our class as no paid posts had been created at Jinnah Hospital as such. Hence, I joined Medical Unit-I to do honorary house job the very next day when the Final Professional Exam result was announced. I did six months house job in medicine and six months in surgery and during that training period I also cleared my FCPS-I hence I was immediately appointed as Medical Officer. All my colleagues started six months late hence I was senior to all of them. This also provided me an opportunity to learn about their sensitivities. Eminent medical personalities like Prof.Mahmood Ali Malik and Prof.Ashraf Khan Niazi guided me as regards development of professional skills and leadership.
I did my FCPS-II in 2002. During my training I got opportunities to work not only at Jinnah Hospital but also at Services Hospital with Prof. Shamim Khan and at Mayo Hospital as well as I had to do some rotation in cardiothoracic surgery. In the meantime I had also applied for FRCS, went to UK and earned my FRCS from the Royal College of Surgeons Glasgow the same year. I soon got a job of House Office and later as Registrar in Epson General Hospital in Surrey. It was a tertiary care hospital and the experience was not so good. Hence I joined St. Bartholomew’s Hospital in London. I also worked at Royal Hospital London for one and a half year and at Royal Free Hospital in UK which are all very famous healthcare facilities and training institutions. At these hospitals I had the privilege to work with consultants with different ethnic background, they were from South Africa, India, Jordan, Egypt, UK and it was nice to go along with all of them and work with people with different religious background i.e. Jews, Hindus, Muslims, Christians and all this taught me how to tolerate ethnicity and religion and how to work with people with different background and achieve the larger objective.
While I was working at Royal Free Hospital in London, my father who was in Pakistan fell sick and had cardiac problem. Being the only son I was very much depressed. I tried to take him with me to UK but he refused, hence I decided to return to Pakistan suddenly without any planning. It was in August 2006 that I returned to Pakistan.
During my training in UK I had developed interest in breast cancer reconstruction surgery. It attracted me because it was a very clean specialty and it also appealed to my aesthetic sense. Patients suffering from breast cancer usually remain neglected in Pakistan. They come to the physician when the disease is at a very advance stage and not much can be done and it is difficult to save them. Breast cancer services is a team work involving not only the surgeons but breast cancer nurses, physiotherapists, pathologists, oncologists besides prosthetic implant management. Hence it is a multidisciplinary team. It appealed to my professional sense. If the disease is diagnosed at an early stage, it can be managed well and with appropriate management, the patient’s quality of life improves and they enjoy their life. I have never seen such a multidisciplinary team work in Pakistan. My consultants taught me a lot about breast cancer reconstruction. In Pakistan there are no comprehensive breast cancer care services and it is not difficult to establish this if people in authority can be convinced. At present people in each unit i.e. Heads of Departments they work in isolation and no one can do anything at his/her own unless the Head of the Department is on board.
Prof. Junaid Sarfraz Khan further disclosed that while in London I had also got a diploma in Medial Education from university of Dundee. When I returned to Pakistan the post of Assistant Professor of Medical Education was advertised by University of Health Sciences. I dropped my application with CV. After interview I was selected and started working at UHS in November 2006. When the post of Controller of Examinations at UHS became vacant I was asked by the administration if I will be interested. I agreed and assumed the charge of acting controller of examinations as well from January 2007. My tenure ended in May 2012 and I still continue to work as controller of examination till new one is appointed. I was appointed as Prof. of Medical Education in October 2011.
Having been trained as breast reconstruction surgeon, how you ended up as a medical educationist and what was your first love, was my next question. Replying to this Prof. Junaid Sarfraz Khan said that in fact breast care was my first love. I leant and enjoyed it. Every single case of breast cancer is a challenge and their satisfactory management gave me lot of pleasure. Each breast cancer patient management has to be different and individualized which is a great challenge and it was all very wonderful experience. On return to Pakistan I also did a Master’s course in educational leadership and management from University of Management and Technology Lahore in 2009. In the same year UHS started a PhD programme in medical education and I got myself enrolled in this as well. An eminent medical educationist Jennet Striven from University of Liverpool UK is my supervisor. I have completed my Thesis and it has also been approved. I hope to get the PhD after completing the remaining formalities in the coming couple of months.
When asked since now you have got too much involved in medical education hence what happened to your first love, Prof.Junaid Sarfraz Khan stated that I still wish at some stage I will be able to develop breast care services. Just remember we did not have any emergency service but then suddenly we had this 1122 Rescue Service. It has made an impact and brought us from stone age to the modern era in emergency services. We have a huge burden of breast cancer and breast diseases in Pakistan which remain neglected. How can we neglect our women who constitute almost over 50% of our population? Breast cancer is one of the leading cancers in women. At present we have no organized screening services, no specialized units for breast cancer care. It is not difficult to establish these. With mammography and appropriate therapy, the disease progress can be stopped. I believe a lot more can be achieved in breast diseases in women by spending much less that what the authorities are spending on hepatobiliary surgery and transplants, he concluded.

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