In future fully integrated academic, healthcare system will be a norm and not an exception-Prof. Hossam Hamdy


What the Experts Say session at ICME 2019
In future fully integrated academic,
althcare system will be a norm and not
an exception-Prof. Hossam Hamdy
Learning process should be made easy,
interesting and motivating

ISLAMABAD: Prof. Azim Mirzazadeh from Iran was the first speaker in this session during the International Medical Education Conference 2019 organized by Riphah International University from 19-21st October. This session was moderated by Dr. Usman Mahboob. Prof. Azim spoke on Accreditation in health professions education: what, why and how? He pointed out that it was not easy to choose a medical school in Iran. He discussed at length the expertise oriented Evaluation programme and said that they use some external standards for evaluation and opinion of several experts. Accreditation, he further stated, should be external, summative, constructive, and subjective and the criterion should be refined. However, ranking is a bit different. Accreditation is an institutional specialized programme. Similarly accreditation of medical education and healthcare accreditation are different. He also referred to accreditation for research and postgraduate education and felt that maintaining standards in accreditation was very important.

Dr. Mohammad El Eraky from Saudi Arabia discussed medical professionalism in Arabian context. He pointed out that you include patient in decision making but it does not go like this in Arabia as they think themselves as Masters who know what is best. At any sign of uncertainty you will lose the patient. He then referred to altruism, accountability, excellence, honour, dignity, and respect for others. There is a paternalistic model in many countries. He also talked about autonomy of patients and autonomy of physicians, the importance of self accountability, Taqwa and fear of Allah, self motivation and waiting for rewards later on. Medical professionalism, he stated, is culture specific.

Dr. Nadeem Akbar spoke about plagiarism in scientific writing and discussed in detail different types of plagiarism including self plagiarism and how to avoid that. Dr. Brekhna Jamil from Khyber Medical University Peshawar discussed the shift from engaging students to empowering learners. She emphasized the importance of involvement of minds of all who have to learn. There are some behaviour problems in students. Some think they are smarter than the teachers. She also talked about different levels of engagement including ritual engagement. Some want to earn A and B Grades, volunteer to earn points. There are different levels of engagement. Most students can give attention for fifteen minutes. It is important to have active involvement of each learner. How one can engage them better is done through student’s empowerment. She also discussed students centered module to empower students and opined that peer assisted learning should be introduced. For this we will not require more resources as students will be involved in teaching. She concluded her presentation by recommending that students should be empowered and not engaged.

Prof. Hossam Hamdy

In the next session chaired by Dr. Shoaleh Bigdeli along with Prof. Idris Anwar and Dr. Gohar Wajid, Prof. Brownell Anderson discussed aligning curriculum and assessment in health professions education. He discussed at length the changing role of educators and opined that motivation and engagement were essential for learning. It requires focus and attention. It is a multimodal. Feed back and self assessment was important. It is important to find out how many of your faculty members are below average. There are some high performer students. He laid emphasis on how to improve our self assessment. He then referred to low ability for self confidence and overconfidence. Feedback, he stated, is critical in learning. It is the assessment which drives learning. Students respect what you inspect. He then talked about spiral curriculum where in learning is spread over months and years. Competency based learning guide learner activities as well as faculty. The mentor stimulates, promotes, inspires. Progressive feedback has its own advantages.

Prof. Hossam Hamdy from UAE talked about leading organizational cultural change during health professions education reforms. He discussed in detail the need for change in colleges, universities, healthcare system. Medicine, he stated is a social service. He then referred to bureaucratic SOPs, stability, Clans, traditions, loyalty, market targets, and entrepreneurial risk taking innovations. It also covers technology, curriculum design, how to teach, how to assess, relationship between healthcare system and medical education. With the advent of new technology, now patients are better educated. We are seeing evolution of academic healthcare system. We are also seeing more and more public private partnership in health services, fully integrated academic and healthcare system will be a norm and not exception. As regards basic sciences and clinical sciences there is no integration, it is sick but still alive. In the days to come basic medical sciences, clinical sciences, social sciences all will be integrated. Technology has enhanced the educational environment. He was of the view that in future credit hour system will disappear as 19th century system cannot be used in 21st century. Accreditation boards need to reform their standards. We need to facilitate innovations. It is the leaders who produce innovations and bring about changes but manager orders changes. He suggested that one should involve different stake holders to share ownership. Value is quality and one must consider economic viability. We need to promote investment in health professions education. Development of leaders in higher education like Deans, Chairpersons is essential keeping in view the needed qualities. Adaption to change is essential, he remarked.

During the discussion it was pointed out that we need to contain the existing contents to allow the students to get on with latest developments. Core knowledge is very important for any profession and medicine is no exception. We also need to look into the fact that was the time in Pakistan right to change? For outcomes we need to follow a strategy, pathways to achieve that outcome. We must learn from our failures for which it is important that we share our experiences. It was also suggested that younger faculty should be given leadership role while seniors can be managers and administrators. We should made learning process easy, interesting and motivating. Gen. Salman Ali asked are we going to change our text books for integration and how we are going to help the students? Dr. Gohar Wajid remarked that doctors should be responsive to the needs of the community. We have to follow certain principles and needs of the community should be kept in mind. We also need to look into as to what is the best way to achieve that outcome efficiently and cost effectively. Sustainable development growth is essential for universal health coverage.

Prof. Brownell Anderson

In the next session Dr. Masood Jawaid spoke about Are we preparing our Health Professions Educators to teach the generation Z while Mr. Shaukat Ali Jawaid in his presentation highlighted how to get published in an Impact Factor Journal wherein he gave some useful tips to the authors. Dr. Shagufta Feroze discussed the importance of life style medicine and highlighted the importance of training undergraduate medical students in this area. Dr. Ahsan Sethi discussed the common reasons for failure to fail the students which was an eye opener as to what goes on in our educational institutions. He discussed in detail the principles of assessment. He further stated that community puts some trust in us hence we should desist from producing false positive. He also referred to safety measures adopted and practiced in aviation industry and nuclear power which are safe. He also mentioned preventable fatalities. Image of the institutions, he said, was also at stake if the students fail. Those students who will be unsuccessful are known early on. They should be given proper feedback and there must be some process of appeal against failing. Today failing a student is very difficult as there is more focus on giving good results. We have seen both private medical colleges and public sector medical colleges giving more marks. There is a need for training in the process of assessment, Dr. Ahsan Sethi remarked.

Dr. Irfan Shukr referred to the challenges in teaching and learning of professionals in health professional’s education. He discussed at length the importance of upholding professional ethics, academic integrity, honesty, respect for confidentiality, public health and patient safety. We have seen academic dishonesty worldwide. He also referred to the consequences of academic dishonesty. How honestly we the teachers assess our students is a great challenge, he added.

In the session devoted to patient safety which was chaired by Prof. Mohammad Iqbal Khan, Dr. Iftikharuddin talked about applying Focus PDCA which stands for Plan, Do, Check and Act on medial internship programme and discussed in detail the improvement of processes, methods, strategies, organize clarify, understand and select during house jobs and residency. He suggested starting internship in patient safety. Competency based curriculum is essential and quality in medical education was as important as in any other higher education programme. Dr. Sadiq Fatima spoke on Patient Safety- Need or Luxury and referred to the lack of incident reporting in Pakistan. Medical Errors need to be documented and tackled. There should be no blame culture and organizations have to be responsible to ensure patient safety. Dr. Matiur Rehman discussed the importance of hand hygiene and satisfaction of patients. He further stated that we need more resources to ensure patient safety. He also highlighted the importance of professional ethics, clinical skills, communication skills and development of curriculum for patient safety. He also gave details of patient safety curriculum developed by Riphah University which includes ensuring correct medications, ensuring correct site, correct procedure, correct patient surgery, hand washing to reduce infections. He was of the view that we must produce safe healthcare professionals. We have also included simulation based learning, mentoring and coaching in our curriculum. So far we have organized over two hundred fifty courses and offer Diploma in Healthcare Quality and Patient safety.

Lt. Gen. Khawar Rehman Surgeon General Pakistan Army was the chief guest in the concluding session. Giving his impressions about the conference Dr. Hamdi from UAE said that this was one of the best conferences on medical education he had attended. The quality of presentations and the knowledge which has been shared with the participants was excellent. The scientific programme covered many important issues in medical education and it is hoped that the future will change faster. Dr. Gohar Wajid highlighted the importance of such conferences on learning and improvement of healthcare systems in Pakistan. Now establishment of Dept. of Medical Education has become essential in every medical college and medical education has been recognized as an important specialty. Maj. Gen. Masood Anwar Chairman of the Organizing Committee announced that Riphah International University will organize the next conference in Indonesia from April 1-4, in 2021. The chief guest in his concluding remarks said that Riphah has taken a lead and was giving much more importance to medical education which was a welcome step. He also congratulated the university management and administration for holding a successful conference which attracted such a large number of participants from all over the country and overseas.

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