LAHORE: One of the important sessions during the recently held International Conference on Health Professions Education organized by University of Lahore was on “Micro credentialing Course on Academic Leadership and Governance in Health Professionals Education Institutions”. The speakers included Dr. Gohar Wajid from WHO EMRO Cairo and Dr. Salman Rawaf from Imperial College of Medicine London who is also President of International Association of Medical Colleges. This course held on October 31st 2023 was well attended by senior faculty members from various medical institutions of Lahore.
In his presentation Dr. Gohar Wajid pointed out that Emotional Intelligence is the No.1 predictor of leadership skills. Leadership, it is said, is also learnable while IQ is God given. Emotional Intelligence covers areas like self-awareness, self-management, social regulation, relationship management, social awareness. One needs to identify one’s weakness and then manage it.
In the afternoon session Dr. Salman Rawaf discussed strategic planning in Health Service and Academics. Covid19 pandemic, he said, has changed all the strategic planning and increased use of technology has also made lot of difference. Now almost 70% medical graduates are leaving National Health Service in UK. Similarly about 65% doctors are leaving service in Egypt. Now UK has started inviting doctors from everywhere to serve in the country. Many hospitals in UK are facing shortage of doctors. We are faced with serious challenges but we do not have a solution. Almost 80% of what we do in Medicine is based on knowledge and about 50% of papers which are published are fake. Institutions that we trust tell lies which became evident in United States during the Covid19 pandemic. We all talk about Universal Health Coverage. WHO want people to prepare for emergency? WHO has asked for control of smoking but we cannot tackle it. How future looks different from today is called strategic planning. One must define direction of the institution, organization. How we see our institution in the next ten years. One must be aware of the global health challenges, he remarked.
Dr. Salman then referred to disasters, emerging threats and pointed out that in future we will see more and more viral infectious diseases. While the rich can afford to get the best care and achieve everything, we in National Health Service protect social justice. The corporate world lead by America want to have Health Insurance wherein everybody pays health premium but we should not allow this to happen.
Speaking about the health system drivers Dr. Salman referred to population growth, aging population, limited resources, workforce shortage, expanding technology which all call for efficiency. We should be proud of the people working for the elderly. In the 80s it was thought that advances in technology will reduce the healthcare cost and also provide wider access but it did not reduce the cost. He emphasized the importance of priority setting and pointed out that in future technology will be a big shortage. Technology has increased the cost of healthcare growth. People in the planning have to come up with innovative ideas. Just look at Singapore with space limitations, they have gone for high-rise building. Saudi Arabia has introduced virtual hospitals but remember all the planning may not work, he remarked.
Dr. Salman was of the view that long term vision was extremely important. One has to look at the current status, look at the Opportunities and Challenges as well as Threats. Academic leadership must look at health needs assessment. For planning one needs reliable data which is at times not available. Academic leadership must try to meet the needs of the population and identify gaps in meeting those needs. One must have a smart objective which is always based on priority settings. We are servants of National Health Service and we cannot decide the number of students entering medical colleges. Long term vision means that we must opt for medical education which meets the health service needs. He then referred to learning strategy and workforce strategy.
Speaking about the alignment of medical education and training Dr. Salman said, we need value based integrated healthcare system. However, at present many doctors do not have chances to get appropriate training. All students, he said, are our sons and daughters but there are no training opportunities for them. Why we are graduating such a large number of doctors if we do not have proper training facilities for the, he asked? All doctors are regulated by General Medical Council. It is important that the Chief Supervisor, Accreditation System and the Mentors all move in the right direction.
When asked is it the weak public health services in United States which resulted in the highest morbidity and mortality during the Covid19 pandemic despite the fact that it is the richest country in the world, Prof. Salman said, United States has no health system though it has a good public health service. United States, he opined, has the worst health system in the world. Once a plan is developed, one needs to review and revise it from time to time. Priorities and objectives determines a strategic position. National Health Service, Prof. Salman said is run by lay people. They put public, patients and staff at the heart of planning and decisions. His advice to those present was don’t say too many things while planning. Set priorities and opt for doable things, take decisions which are implementable. Reliable data is a must. At present in many countries Births and Deaths are not being registered hence the data available is not at all reliable. Institutions do not know what they are doing. He wondered how the government was allowing it to happen without providing them the data.
Speaking about logical steps in planning Dr. Salman opined that one must know where we are now. Try to understand the drivers and resistors. Data availability was important. We have insufficient resources and use of Artificial Intelligence can be extremely helpful in certain areas. Emphasizing the importance of primary health care, Prof. Salman said that it plays a vital role in any good health system. At present many healthcare professionals who look after the patients are not well trained. Almost 15-30% of GPs in UK face health problems in which they are not properly trained. They are not trained to manage psychosomatic problems faced by the patients. The GPs, need to undergo five years training in family medicine. Morbidity and mortality due to medial errors is a big issue in United States and its prevalence is between 10-18%. It is said that one in three interventions is because of medical errors. Now in many countries annual appraisal of doctors has started. They also need re-certification after every five years and this has been introduced in many countries. WHO defines health as physical, social, mental wellbeing and not just absence of disease? At present we have hospital based care not community based care. Maintenance of health should be preferred but our system is based on treating the diseases, he remarked.
