We need to create a balance between technology and bedside teaching - Prof. Farhat Abbas


 Plenary Session at AKUH during the AEME 2017 Conference

We need to create a balance between technology
and bedside teaching - Prof. Farhat Abbas

Interprofessional education and Collaborative practice
will strengthen healthcare system

Use of Simulation is not only cost effective but also convenient,
consistent and easier to monitor progress - Prof. Hafeezullah

KARACHI: Prof. Hafeezullah Khan Vice Chancellor of Khyber Medical University was the first speaker in the plenary session held at Aga Khan University during the AEME Conference 2017 on March 4, 2017. The topic of his presentation was Effects of Technology on Teaching and Learning which he said has now progressed from acquisition to participation in learning. There has been lot of advances in information technology. Student’s population is growing and there has been an increase in tuition fee. Patient safety and accountability have become much more important. Today it is the knowledge production era and learning facilitation besides knowledge management.  He also talked about coaching and mentoring.

Continuing Prof. Hafeezullah said that all programmes should be on moodle and simulation should be used for training before the students touch the patients. It is not only cost effective but also convenient, consistent and easier to monitor progress. We at the Khyber Medical University have ensured Wi Fi facility at the campus and in the next phase we wish to become a safe university from smart university. He was of the view that we need to bring learning to the people and not the people to learning.

Sitting on the Dais during the AMEM Conference on Medical Education at AKU from (L to R) are speakers in
the plenary session i.e. Prof. M. Tariq, Ms. Zohra Kurji, Prof. Janet Gant, Prof. Hafeezullah and
Prof. Major Gen. M. Aslam and Prof. Farhat Abbas the chairpersons.

Prof. Janet Grant from UK discussed the Co-construction of teaching and learning. She pointed out that people learn medical education through courses, conferences and reading. No one has first degree to support their postgraduate studies and there is no informed academic way of judging. Modern medical education is lead by the West and the flow of ideas is from West to the East. However, the ground realities, situation is different everywhere and it varies from country to country. At present it is called medical imperialism. It is mostly passive learning and there is reluctance or failure in asking questions to the teachers. Education she emphasized is a social service. She also referred to the changing social values and relationship in the West. It is not based on evidence and is not effective. It is important to find out how other cultures can learn in an objective way, informed and critical way. There is a difference between globalization and internationalization of medical education. Doctors should be equipped with intellectual knowledge and global doctor should be good enough to practice in West. The key to success is by developing understanding. Knowledge can be transmitted from teacher to learner. It is important that each party accepts the concept of co-construction. We now have Certificate, Diploma and Master’s degree in Health Professional Education. One hundred twenty international experts and authors got together and now we have custom built website.  She also remarked that we also discussed the role of medical politicians during this meeting.

Prof. M.Tariq from Aga Khan University talked about Application of cognitive Apprenticeship Model in Clinical learning. He pointed out that upto 1960s, almost 75% of training of doctors used to be at bedside but now consultants are going away from patients and communicate through technology. He further stated that investigations should be based on clinical judgments and inappropriate use of technology should be checked. History taking and physical examination of the patient was very important and professional attitude of the doctors was now a problem. Almost upto 73% diagnosis can be made by taking history and physical examination and in only 25% cases there is a need for technology support. He further stated that certain skills can only be taught on bedside. One should take careful history and if need be do physical examination once again. One of the studies showed that now Ward Rounds were just service oriented. It is quite likely that the patient might mind seeing so many students around but there are patients who like their disease being discussed with the students. Teachers have to be good role models, he added.

Ms. Zohra Kurji Assistant Professor from School of Nursing at Aga Khan University highlighted the importance of Interprofessional education in the curriculum to strengthen healthcare system in developing countries. She pointed out that it was not lack of resources but inappropriate use of resources which was the main problem. There exists poor understanding of each other’s expertise and scope of profile. There is lack of Interprofessional cooperation. According to estimates about seven thousand patients die in Pakistan due to medical errors each year. Collaborative practice will strengthen healthcare system.

She also highlighted the weakness of the leadership and said that we need champions. We need to use available resources and infrastructure. Web designed courses she opined are cost effective. We need to conduct small Interprofessional education courses, have a faculty development programme and more researchers.  She then showed a Video film on palliative care wherein people from different segments, doctors, nurses, paramedics, and technicians were taught and trained in spiritual and psychological care. Interprofessional education, she opined, was the immediate strategy for the developing countries to overcome some of their problems.

Dr. Farooq Azam Rathore, Prof. Shahid Shamim, Prof. Nazeer Khan and
others sitting on the Dais during one of the scientific sessions at the
AEME Conference on Medical Education held at Karachi recently.

During the discussion, learning and importance of clinical skills, history taking, physical examination was emphasized. One of the participants opined that clinical examination has almost vanished from the West. Since they did not have many patients, they came up with simulation and simulated patients. They have lost contact with the patient. Hence, it is no wonder that most of the doctors who were trained through online courses and Videos, on simulators are now being asked for re-certification by almost all the Boards in United States. Medical Education in the West has lost human contact and we should not copy that. Simulation centers have a limited role. Online CME is most abused in United States and it has its own limitations. It needs long times of residency to become good physicians.

Prof. Hafeezullah Khan said that no one is undermining the importance of clinical skills, patient’s history and physical examination but simulation has a role. Prof.Rukhsana Zuberi said that simulation has an important role in teaching and training and they do not allow any student to touch the patient particularly their genital organs unless they have learnt to examine it on manikins quite a few times.  Students need to learn how to convey bad news to the patient like cancer. Prof. Janet Grant said that we encourage students to critique and question. She further suggested that Interprofessional education should be started at the undergraduate level.

Prof. Farhat Abbas in his concluding remarks said that teaching and learning should be contextual. We need to learn from experts. Educational value of research was missing.  Value of clinical teaching is important. We need to create a balance between technology and bedside teaching. How one should start Interprofessional education is not clear. However, he warned the audience that too much analysis can also lead to paralysis, hence we need to be extremely careful.

Second Session

Prof. Zafarullah Chaudhry President of CPSP was the first speaker in the second session who talked about aligning assessment to outcome. He highlighted the E Log book and monitoring system introduced by CPSP. He pointed out that at present there are two hundred six institutions accredited in Pakistan and fifty nine overseas.  CPSP has 3,126 accredited supervisors in Pakistan and one hundred five overseas. Currently there are 19,047 residents registered with CPSP in Pakistan and one hundred ninety overseas. Monitoring of the supervisors was also important. He also talked about patient management and CPSP Competency Model based on research, service and training. He also talked about integration of all team work, communication skills, technological skills, knowledge and critical thinking besides research  which all lead to patient cure.  CPSP has also introduced Work Based Assessment and in the next phase we wish to introduce Procedure Based Assessment, he remarked.

Prof. Ara Tikean from United States talked about Collaboration for developing a National Examination Bluprint.  He gave details of the Advisory Committee meeting which discussed data gathering and compilation, finalization of the blueprint. Data generation phase was restricted to experts groups. We had small groups of experts and they may be biased. We also discussed the exam format. It was agreed that almost 75% of the questions should be of high importance, 25% of medium importance but no question should be of low importance in the examination.

Prof. Maj.Gen. Mohammad Aslam former VC UHS talked about Aligning Assessment to Outcome. Highlighting the qualities of a doctor he mentioned that they should be skillful, knowledgeable, critical thinker, leader, serve as professional role model, researcher and promoter of community health. We should assess the expected outcome. We need to adopt constructive alignment. He also thanked Dr.Amina Ahmad for her assistance in preparation of his presentation.

Prof. Rukhsana Zuberi from AKUH talked about Fit for Purpose Assessment and pointed out that we must ensure that medical graduates we produce are safe doctors. We must assess their active engagement matching professionalism as outcome tool. We also need to assess their leadership qualities. In fact an overall assessment of all the outcomes was essential.

Prof.  Nighat Huda from Liaquat National Medical College made a presentation on Implementing Assessment for Outcome, Challenges and Opportunities in Pakistan. She first gave a historical background and referred to Shiraz which served as a Center for Medical Education for a long time in this Region. There used to be various workshops on Adult Learning, Task Completion, OSCE, Structured Examination, and Patient Management. She then asked for whom we were now preparing the doctors? Provincial Governments require doctors for rural areas where they are needed but are we producing those doctors she remarked. Even our elite do not trust our Tertiary healthcare facilities and go abroad for their personal treatment. She then referred to the Number of Hours marked for each subject in the MBBS Curriculum on the PM&DC website and said that we need to change our mindset from this number of hours. At present clinical competence is only judged in final year. She was of the view that we need to look at our examination policy critically.