Institutions should spend on faculty development-Prof.Vishna Devi
Plenary Sessions at 8th ICHPE 2024
LAHORE: Scientific programme of the recently concluded 8th ICHPE organized by University of Lahore included three plenary sessions as well. Prof. Lawrence Sherman was the first speaker in the first plenary session who spoke about” A Global View of CPD: Opportunities to improve to improve the status Quo”. CPD , he stated, means lifelong learning. He then gave details of professional standards of CPD in forty countries including China, Latin America, Middle Ease, and North Africa and pointed out that funding is available in some places. It is also mandatory in some countries but there is opposition from the faculty which is not prepared or trained. Generally there is satisfaction but there are great variations in the system. Often it is not based on learner needs and we do face some challenges.
Some of the invited guest speakers at the just concluded 8th ICHPE organized by University of Lahore on November 6th 2024 photographed with
Prof. Mahwish Arooj and Mr. Uzair Rauf.
Pharma industry supports physicians for CPD and they appreciate it but it has to be need based. We must use right format in right direction with measurable outcome. The whole process is critical. Needs, he said, must be assessed and education is designed to meet needs. Continuous assessment support ongoing refinement. Education outcome are assessed at the end. His advice to his colleagues was that one should always start with end in mind. We must develop educational activities with goals and what the learner should learn. One should use appropriate learning sciences. AI is everywhere and if you do not use it, you are missing something. Prof. Sherman further stated that we must practice together and learn together. He then referred to communication challenges between teams, the expectations of performance of team members, awareness of role of each team member. He also talked about behaviour change, faculty evaluations. Most appropriate teacher must be an educator. He also emphasized the importance of performance impact and quality impact. He concluded his presentation by stating that educational interventions will lead to behaviour change in learning.
Prof. Vishna Devi Nadarajah from Malaysia was the second speaker in this session who discussed “How can the institutions support Health Professions Education to remain relevant: Strategies for Empowerment and Growth. Having served at senior and middle level management, I have some personal experience, she added. At the New Castle University Malaysia, there is institutional support like educational sponsorship, time off, mentoring programmes, access to learning resources besides incentives payments. She also referred to barriers to clinical teaching. Educators face barriers in the organization. There are cultural challenges, assumptions, and problem of IT sources. Early career clinical educators need experience and support.
Institutions, Prof. Vishna Devi opined should spend on faculty development. Produce resources like book chapters by clinical teachers. Setting national priorities is important. She recalled thee was a time that we had just three medical schools but now there are thirty three medical schools in Malaysia. We have education focused universities. Many of the faculty members were trained in Pakistan and India. Pro VC for Education provide opportunities to engage in leadership role. She then talked about considerations for sustainability, annual operating budget. The structure of organization reflects educational development. We need role models in the medical profession who should be Manager, Leader, Scholar, Researcher and professional. She also reminded those present that let us not forget the learner. Do not forget those who support us, she remarked.
During the discussion Prof.Ahsan Sethi from Qatar remarked how much funding the faculty can arrange. Prof. Devi remarked that we need to make investment in the product. It was also pointed out that studies reveal that mandatory CPD was tried by some institutions but it failed. Some medical schools in Malaysia have made it mandatory. One of the participant remarked if pharma industry is not involved in CPD, who will sponsor such activities? Dr. Gohar Wajid stated that CPD is mandatory for over two thousand doctors in UAE. In Pakistan we need regulatory reforms. The regulatory framework is missing here. The technical capacity of PM&D is deficient. We need flexibility in various components of CPD.
Plenary Session-2
Prof. Ken Masters was the first speaker who spoke about Move 37: When you are no longer the smartest person in the Room”. He discussed how we react when AI reads something we think wrong? Alpha Generation, he pointed out is creative. Move -37 is a meaningful move. How you react to diagnosis. Bias, in AI, he opined, is often discussed. We can recover paper from machine, we can examine it. We need to know how AI has made these decisions. Some people talk about AI Bias but we must reflect on our own Bias as well, he remarked.
Plenary Session-3
Dean of Aga Khan Medical College Prof. Adil Haider was the first speaker in this session. Topic of his presentation was “AI Meets Evidence-Based Guidelines: Transforming Health Education and Simulations”. Landscape of medical education Prof. Adil said is rapidly advancing. During Covid19, there were no class rooms and at the same time Chat GPT came in. Now students, he said, prefer on demand learning. Students wish fast, efficient, flexible learning. AKU students prefer Video tutorials. We have state of the Art simulators and provide hands on training in reliable clinical environment. Future, he opined, is AI driven, simulation learning. AI is changing medical education. Doctors need to work with technical professionals. We need to understand patient’s perspectives, their Hopes and Expectations. He suggested that all medical colleges must provide training in AI. He also disclosed that “Khan Academy” will come to Pakistan soon. We are creating South Asia’s First Manual of Medical Therapeutics. Clinical Guidelines Standard are being developed keeping in view what patients can afford. So far we have completed one hundred fifty Guidelines. How we did it, we took the international guidelines, looked at it and then modified it making appropriate changes. AKU Manual of Clinical Guidelines, he said, will be published soon. It will be related to adult primary care. AKU Alumni has supported this project. We have members of the advisory board from all over Pakistan and a National Advisory Board was constituted which also has members from PM&DC and CPSP. AKU Central Health Board is working in rural areas. Everybody will be able to access these guidelines on mobile App. He hoped it will lead to support study of care, define implementing standard of care in Low Middle Income countries. We are also preparing Manual for postgraduate medical education trainees .He also referred to HAMI Boston AI and said that AI will change healthcare.
Prof. Salman Rawaf (Second from left) responding to questions from the participants during the plenary session at the 8th ICHPE organized by University of Lahore. Also sitting on the stage alongwith him are other panelists
Prof. Olle ten Cate, Prof. Adil Hyder and Dr. Gohar Wajid.
Prof. Olle ten Cate talked about some principles of Entrustable Professional Activities and Entrustment decision making in health professions education. He discussed in detail the competency based education of trainees and education of health professionals. He was of the view that we need to prepare learners for work in healthcare. The competency framework should be acceptable worldwide. There are risks to have it too detailed. EPA he said, require integration of multiple competencies. Competency comes when professional activity is mastered. The growth of competency goes up over time. The five levels of supervision increase trust in trainee authority i.e. be present, practice EPA with direct supervision, practice in indirect supervision, practice EPA unsupervised, and act on supervision for junior teams for EPA. With the growth of competence, there is decrease in supervision. He then referred to an individualized work plan curriculum, psychology of workplace, EPA based assessment, marking one as Supervisor, validity of assessment at workplace, being competent, being trusted. He also discussed the trust concept in EPA based assessment. One should make oneself valuable, accept the risk. Educator must accept that risk. One may ask oneself can I trust the student to attend the patient now. Trust in HPE trainee, trust in his capability, integrity, reliability, humility and willing to ask help and is receptive to feedback were all discussed in detail.. He also talked about self-confident team, safety development and proactive towards work. Work Place based assessment consist of direct brief observation, case based discussion, product evaluation and longitudinal observations.
Dr. Gohar Wajid discussed the Role of PM&DC in steering undergraduate medical curriculum in Paksitan. He discussed the plan in which five rural health centers are affiliated with a medical college supported by the government to promote primary health care. This is the concept of Family Medicine. There are one hundred eighty medical and dental colleges, forty postgraduate medical institutes, thirteen medical universities and about two hundred sixty thousand doctors registered. About sixteen thousand new medical graduates are produced annually. We give emphasis to quantity but not on quality which is my greatest fear. Curriculum guidelines are prepaid by PM&DC. About 65% of medical schools are still using traditional curriculum instead of integrated curriculum. It is proposed that by the end of 2025 all medical schools must implement integrated curriculum. Universities should develop curriculum as per their guidelines. The objective is to produce knowledgeable, skillful seven star doctors. Medical universities have to play some role as to how many hours to be given to different subjects. He also referred to curriculum hypertrophy. We must diagnose the illness and then take decision for appropriate treatment. PM&DC devised curriculum is teacher centered, information oriented, subject and topic based. It is disease focused. Even after changes in curriculum it is hospital based. He opined that we need major curriculum reforms in undergraduate medical education. We need to shift to Well Health Primary Care of community from illness disease hospital based.
He suggested that we need to have community health needs based curriculum. It should be family based practice, take care of local disease epidemiology and add digital technology. Reforms need to be introduced at two levels i.e strategic reforms and operational reforms. We also need to go for faculty development. The curriculum should be competency based, community based. He also talked about the role of stakeholders in the process of transformation. His conclusions were that curriculum has to be community based, competency based and Interprofessional education based. The report has been sent to the President of PM&DC.
Prof. Salman Rawaf from UK was the last speaker in this session who discussed preparing medical students for leadership role in healthcare. He was of the view that a good doctor should be a good researcher. He pointed out that we are witnessing rapid advances in medical technology and it has influence on public expectations of health solutions. He also referred to socioeconomic developments, the demographic changes, evolving disease burden, emerging diseases. This is the world of medicine today, he remarked.
He then revealed that at present there are one lac twenty four thousand vacancies of secondary care in UK. About 70% of doctors leave in second year of foundation. Training is very rigid. We need to be careful of stupid bureaucratic hindrances. We must see how students look at us. We must look at the disease burden, diseases of the elderly hence what type of doctors do we need who should take care of the people, they must have knowledge and skill. Are we selecting the right students for medical schools, he asked? During selection we only look at academics and science subjects only. We need to look at aptitude test, interest in sports, music, art, writing, research by the students. Secondary schools are the best places to select best students. We are selecting students who come from affluent class rich families. He warned, let us be careful. We need to bring students from different social ethnic background, monetary aspect may not be strong with them. Leadership is important in healthcare. WHO says that almost 40% of the health resources are wasted as they cannot be spent adequately? Drugs form 36% cost of treatment. It has definite impact on patient outcome and employee’s satisfaction. Most of the doctors are not good Managers unless they get training in Hospital Management.
Speaking about the importance of leadership in medical education, Dr. Salman said they should have vision and planning, good at communication and decision making, coordination, collaboration, have resilience and adaptability. Soft skills, he further stated, are extremely important. He laid emphasis on mentoring and training, we need to identify and nurture the potential leaders. Provide opportunities for growth and develop future leaders. He was very critical of bureaucracy in medical education and remarked that the smartest people are found in primary care. They are the richest people in United States.
Panel Discussion
This was followed by a panel discussion on Medical School for the future healthcare system. The panelists included Prof. Usman Mahboob, Prof. Lubna Baig Ansari, Prof. Muhammad Tariq and Ms Celine Tabche. Prof. Tariq highlighted the importance of EPA based competencies in medical education. The physicians must be able to perform. He also talked about the array of abilities which all physicians must have. Patients must trust doctors and we also must trust each other, he remarked. After training I have trust in my team, junior and senior resident that they will look after my patient. EPA and competencies, he stated, are different. EPA will enhance competencies and improve patient care.
Prof. Lubna Baig Ansari highlighted the Gender disparity in health and leadership. The system is not fair to all genders whether male or female. More women get into medicine but then give up and do not practice medicine due to various reasons. Look at the structure of PM&DC and CPSP. At present more than 70% students are girls in medical schools. It was after seven to eight years that I could select my career. In our society male get better quality of care. In rural communities they also get better care and better education and in academic leadership as well. In 2022 there were very few women in leadership role in academic cadre.
Dr. Usman Mahboob referred to data privacy and security concerns related to Artificial Intelligence. There are many ethical issues as well. Education of Ethics Committees, full disclosure about institutes, policies on use of AI tools, systems by faculty and students were all discussed. It was felt that we need to adopt new technology but consider its modality and legality.
Ms. Celine Tabche from Imperial College talked about Global Health Competency. Their institution, she said, is a WHO Collaborating Center for Public Health. WHO is giving too much importance to public health and it has focus on twelve main public health issues. During the discussion it was stated that competency is ability of physician to diagnose and treat patient. The two terms, EPA and Competencies are overlapping.
