Medical teachers should uphold professional ethics in Research, Publications & Clinical Practice-Arif Siddiqui


 Clinical Proceedings of SAAP-VI and 16th annual conference of PPS

Medical teachers should uphold professional ethics in Research, Publications & Clinical Practice-Arif Siddiqui
SAAP provides unique platform for interaction, sharing of knowledge
and skills among Physiologists-Rita Khadka

By Prof. Samina Malik

LAHORE: Medical Teaches should uphold professional ethics in Research, Publications as well as in clinical practice. Ethical underpinnings of professional activities appropriately cover many faculty activities. Teachers are the greatest assets of any education system. They stand in the interface of transmission of knowledge, skills and values. However, it is not that easy to become an ‘ethical medical teacher’ as there are very few guidelines or rules that are available which may be followed as principles on ethical teaching. This was stated by Prof. Arif Siddiqi, Chairman of the SAAP-VI who has now been nominated as President SAAP 2018-2020. He was speaking at the recently concluded South Asian Association of Physiologists (SAAP) 6th conference held with the annual conference of Pakistan Society of Physiology which was hosted by University of Lahore from December 12-125th 2018.

 Participants of the Preconference Workshop on Digital storytelling photographed along
with the Facilitator, Prof.Arif Siddiqui, Col. M. Alamgir Khan and organizers.

Dr. Rita Khadka from Nepal President SAAP, elaborated on the role of SAAP by declaring it as a unique platform for interaction and sharing of knowledge and skills among national and international scientists/physiologists/educationists and for help in the advancement of physiological research and medical education in the region. She presented her study on cardiovascular & respiratory adjustments in high altitude dwellers in which she expressed that more than 140 Million people in the world live at high altitude. The major indigenous high-altitude populations live on the Andean, Himalayan, Tibetan, and East-African plateau between 3000 m and 4000m, where atmospheric oxygen level is low, therefore, in mountain dwellers, time dependent changes occur in cardiovascular and respiratory adjustments and other physiological changes that make body capable to live and work at high altitude.

Dr. Bishnu Hari Paudel, an eminent Physiologist from B.P. Koirala Institute of Health Sciences, Nepal shared his research study in domain of neurophysiology, on Establishing Electroencephalographic Cognitive Marker N400 as a Diagnostic Tool, in which he was able to obtain statistically significant event related potential amplitudes in students in response to incongruous sentence reading.

Dr. M. Arslan, IMBB from University of Lahore in his plenary lecture highlighted the role of genetics in the current dilemma of obesity. He opined that other than environmental factors and lifestyles, strategic use of advanced technologies for next generation sequencing including GWAS, WGS and WES, shall aid in unravelling the missing heritability of obesity and hence of new molecular pathways affecting energy homeostasis. He also referred to his novel gene discovery of ADCY3 in Pakistani population responsible for obesity, which was recently published in a high impact factor journal, “Nature”.

Dr. M. Aslam, Co-chair SAAP VI, Pro-Vice Chancellor National University of Medical Sciences, Islamabad in his talk, stated that healthcare is considered one of the fundamental rights of every individual. In South Asia, healthcare system is beset by preventable and treatable diseases such as maternal mortality, diabetes and high blood pressure which have shockingly high incidence. To tackle the worsening healthcare conditions, South Asian countries must formulate a platform to outline the role of physiologists in order to enhance the standard of health. Only enhancing the healthcare finance will not help the healthcare system but the policies made on the ground realities can make the required change.

Prof. M. Rauf Patron of University of Lahore presenting a memento to
Dr. Rehana Rehman during the SAAP VI Conference hosted
by University of Lahore last month.

To mitigate the effects of environmental pollution on human reproduction, one of the keynote speakers Dr. Sharaine Fernando, associated with National Coordinating Committee for Research on Human Reproduction in Sri Lanka, discussed the effects of environmental toxicants on selected aspects of reproduction and the possible sources of exposure to toxicants. She elaborated by saying that physiologists in the region should champion environmental justice meaning fair treatment and meaningful involvement of all, in development, implementation and enforcement of laws, regulations and policies related to exposure to toxicants. Other than SAARC representatives, this conference was also honoured by two participants from France.

Dr. Sadia Saeed, Research Scientist, Faculty of Medicine, University of Lille, France, highlighting the genetic & molecular mechanisms underlying obesity stated that a high prevalence of obesity associated pathogenic mutations in this population, compared to 3-5% reported in outbred populations. This underscores the importance of comprehensive genetic screening of inbred populations to unravel new genes and signaling pathways modulating energy balance and, thus providing leads to innovative pharmacologic targets for precision medicine in context of obesity pathogenesis.

Dr. Martin Vaxilliare, Research Director, European Genomics Institute of Diabetes, France, discussed the many challenges of an early etiological genetic diagnosis in young-onset diabetic patients, as well as some striking examples of proof-of-concept of genomic medicine enabling to provide the most efficient, less straitening and cost-effective treatment (in place of daily insulin injections) for an improved quality of life.

 Prof. Shahid Malik presenting mementoes to Prof. H. R Ahmad,
Prof. Maj. Gen. M. Aslam and Brig. Saadat Ali Khan
during the SAAP congress hosted by
University of Lahore last month.

Dr. Alamgir Khan, Deputy Director Medical Education, Army Medical College, National University of Medical Sciences, Rawalpindi highlighted the role of self-directed learning by saying that generally, after acquiring postgraduate qualification especially in Basic Medical Sciences, people stop learning and ultimately perish intellectually. The solution is not the condemnation of the stronger forces but self-improvement to the point where our existence becomes indispensable.

Dr. Mohammad Fahim, Vice President Chest Institute, University of Delhi, India, elaborated on how Tadalafil inhibits hypoxia induced pulmonary hypertension and suggested that effect of tadalafil on inflammation was more marked than that of tempol, as tadalafil possesses antioxidant as well as anti-inflammatory action in addition to its vasodilatory property.

Dr. HR Ahmad from Aga Khan University, Karachi in his plenary lecture discussed the life history of atheroma of a coronary artery tree and stated that it shows an exponential curve with three distinct stages of atheroma, plaque and thrombus formation; the clinical manifestations vary according to the stage of atheroma.

Dr. Saadat Ali Khan, from Multan Medical and Dental College, Multan in his plenary talk, declared osmoregulation to possess a mysterious human behaviour. He presented his research study in which 152 males and females from Lodhran City & suburbs were included and a significant difference in serum & urine osmolarity status of dehydrated-state and after-management state was found.

Dr. Muhammad Ashraf, Pro-Rector Institute of Molecular Biology and Biotechnology, University of Lahore, in his plenary talk, highlighted the role of oxidative defence system in stress tolerance by saying that various cellular redox buffers such as tocopherols, ascorbate, carotenoids, glutathione (GSH), flavonoids, osmolyte such as proline and other phenolic compounds serve as non-enzymatic antioxidant defence system. So, a detailed insight into the complex network of ROS as well as antioxidants and their interplay at cellular level should further be elucidated using advanced genomic, metabolomics and proteomic approaches.

Dr. Aamer Qazi from Centre for Research in Molecular Medicine, University of Lahore shared his genome wide association studies (GWAS) which revealed novel colorectal cancer genes expressed by immune cells. According to him, this study hopes to help in diagnosis of cancer and can be used as CRC specific biomarker and to design therapeutic drugs based on these novel molecules.

Dr. Sunil Dhungel, President Neurosciences Society of Nepal and clinical physiologist, presented his study on the role of neuropeptides and steroids in regulation of social behaviour. He stated that in view of the well-known physiological roles of nitric oxide as a vasodilator, in attenuating responsiveness to vasopressors and increasing utero-placental blood flow, an upregulation of the placental and maternal NO regulated by HIF-1 and VEGF system during pregnancy and decrease with preeclampsia is empirically expected.

 Some of the participants to the SAAP VI Conference hosted by
University of Lahore photographed during the conference.

Dr. Hamid Javaid Qureshi, Principal Akhter Saeed Medical and Dental College (Lahore) delivered his plenary talk on circulatory readjustments at birth and elaborated the changes taking place at that critical time in a newborn’s life.

Dr. Touqeer Ahmed, Post-doc neuroscientist from National University of Sciences and Technology (Islamabad), in his plenary talk unravelled the mysteries of metal exposure on brain functions by declaring that Aluminium (Al) and copper (Cu) are strongly associated with the cognitive impairment & therefore, we must decrease metal exposure to humans from environment, food and industries.

Dr. Amar K. Chandra, Gen. Secretary SAAP (India) highlighted the goitrogenic/ antithyroidal potential of commonly consumed Indian cyanogenic plant foods and stated that Iodine deficiency does not always cause endemic goitre and Iodine supplementation does not always result in complete eradication of goitre; conversely there are epidemiological and experimental evidences that concomitant exposure to other naturally occurring antithyroid agents magnify the severity of goitre. In such scenario, Indian Cyanogenic plant foods assume much importance.

Dr. Mahwish Arooj from University of Lahore shared her experience regarding formal mentoring programme which was initiated in University College of Medicine & Dentistry in 2014 with 1:12 mentor-mentees ratio. It has proved to be of much help in addressing common issues faced by students. It is enabling them to cope with stressors and to evolve as problem solvers rather than only problem spotters.

Dr. Moghees Baig, Principal University College of Medicine (Lahore) emphasized on the significance of integrated modular curriculum & discussed its advantages and disadvantages. He elaborated that as there is a change in the definition of disease from an anatomical alteration of the organ to its multi-causality and influence on lifestyle, affecting social, cultural and biological parameters, so it’s teaching and learning process also needs to be a multi sprout approach, incorporating socio-humanistic and population health sciences.

Some fruitful recommendations derived from the panel discussion on “Experimental Physiology”, concluded by Dr. Samina Malik (Lahore) stated that as our outcome is not to produce technicians but to develop clinicians, medical teachers and researchers, so our focus should be on interpretation of experimental observations instead of practicing the technique. Furthermore, students should be trained to relate different physiological parameters in routine experiments, e.g., instead of the conventional practical title “Count your own White blood cells”, students can be given the task to “Compare stress levels on DASS scale with Total Leukocyte Count, gender, fever and stressors in the cohort of first year medical students” or instead of “Count your own Red blood cells”, students can be asked to “Compare hemoglobin levels with gender, Body Mass Index, menstrual history, diet and hematinic intake”. Animal experiments are inevitable in Physiology curriculum, especially where patients are not available to understand the pathophysiology, properties of cardiac muscle, gut motility, nerve-muscle preparation and fatigue. Use of power Lab with expertise is important in obtaining research data with publishable graphs. In case of non-availability of Power-Lab, Kymograph may be used to understand mechanisms like muscle fatigue, tetanization etc.

New experiments to be introduced in Endocrinology include interpretation of diabetic profile, thyroid function tests and Adrenal function tests. Also General Physical examination relevant to GIT and examination of gastrointestinal system may be introduced in practical Physiology curriculum along with interpretation of Liver Function Tests. PCR demonstration may also be included as the basis of future research on DNA. Autonomic function tests, EEG, EMG, Resting metabolic rate and mechanical efficiency may be incorporated. Practical on diet-framing for normal and pregnant female can be added in GIT practical curriculum under nutrition physiology. High altitude Physiology research may be incorporated under supervision of relevant research centres in South Asian countries like Nepal.

Dr. Adnan Kanpurwala from Karachi Institute of Medical Sciences, CMH Karachi moderated it after projecting a video-lecture by Dr. Robert Carroll (USA) as a stimulus to generate and orientate discussion.

During the panel discussion that followed, postgraduate Physiology student Dr. Jibran from Akhter Saeed Medical & Dental College (ASMDC) Lahore said it is not about what we teach but how we teach, that is to be focused. Students must be understood at their level. Critical thinking should be promoted as explained by Dr. Samina Malik in her workshop.

Postgraduate Physiology student Dr. Chaman from ASMDC, Lahore expressed that problem is with the teaching methodology. Flip classroom is a good concept. Learning should be learner-focused and interactive. A good teacher makes a non-compliant student into compliant one by motivating and eventually into a critical thinker as emphasized by Dr. Samina Malik in her workshop. Teachers should be entrusted in delivering lectures and their own compliance is also important. Regular teacher training workshops are important. Medical education degree is important and involvement of PM&DC in accomplishment of this training is much needed. Practical time should be increased for long term memory and students should be exposed to patients with anemia, cyanosis, tachycardia etc. by taking them to hospital setting.

Prof. Javed Akram Vice Chancellor University of Health Sciences addressing the 
participants of the SAAP Congress hosted by University of Lahore recently.

Dr. Mehrun Nisa, Professor and head of Physiology from Allama Iqbal Medical College, Lahore raised the point that Problem Based Learning and Case Based Learning are learner-based which must replace the traditional teacher-centered methodology. Integration of physiology in clinical and final year is important. Holistic approach is to be developed.

Dr. M. Tariq, a clinician and medical educationist from AKU, Karachi emphasized that Physiology is the backbone of medicine. Critical thinking should be developed in initial years along with introduction to concept of clinical competencies. Curriculum committees of basic sciences should include clinical people and vice versa, for more collaboration and integration. Cognition load to be reduced.

Dr. Samina Malik Professor and head of Physiology from University College of Medicine and Dentistry, University of Lahore added that medical teachers should not feel threatened from incorporation of clinicians in basic science departments, rather they should equip themselves with updated clinical knowledge.

D. Savi Wimalsekera (newly elected General Secretary SAAP) shared that first two years of curriculum involve Physiology, Anatomy and Biochemistry in nine Medical schools of Sri Lanka followed by vertical integration. In final year, students forget the basic sciences, so integration of basic sciences is needed again. Coaching should be provided to South Asian students with English as 2nd language in order to improve scientific writing.

Dr. Jyotsna Rimal, Professor and head of Oral Medicine & Radiology, College of Dental Surgery, Coordinator, HPE core group, Health Professions Education Department from Nepal informed that at BP Koirala Institute of Health Sciences, during phase 1, along with basic sciences, student go to community to understand social and health issues and conduct door to door surveys which is a wonderful student-based activity. Learning in field also takes place to attend real problems and stages of disease. Different families are assessed periodically on health issues. Such activities should be promoted by cutting down lectures. Faculty development is also important. We don’t need teachers to teach the content. They are needed for the process and assessment of learning. Evidence generation is important. Innovation in teaching must be measured. We are only quantifying grades by testing only recall knowledge. All competencies should be tested in assessment. We only emphasize on theory exam. Thinking and reflection is needed to refine the curriculum.

Dr. Hamayun Ikram, Professor and Dean Basic Sciences, Multan Medical & Dental College, Multan, stressed that five year curriculum plan should be handed over at the time of admission, with defined time for each academic activity. The traditional PMDC syllabus mentions only the topics and lacks the specific Learning Outcomes. It is important to mention as paper is formulated from the specific LOs. Faculty training is important for the curriculum introduction and implementation, leading to quality of product. The product should not decline due to exhaustion of faculty or shortcuts by students. Innovation is needed at that time by PBL, mentorship and integration.

Dr. M. Ayub Prof. and head of Physiology from Muzaffarabad, quoted that Community oriented curriculum (1995) has been partly implemented at AJK medical college, where integrated curriculum is being practiced as per WFME guidelines and a total of two batches have passed out. University of Health Sciences examined the product with 96% and 97.5% result in last two years. Papers are set and checked by external examiners. Students are assessed by six internals and six externals from basic as well as clinical sciences. Six out of nineteen passed FCPS and two passed USMLE. So, it’s not a failure but a success. There are written LOs in module and real life problems (not theoretical) are discussed. Clinical practice is incorporated in summer break with letter for nearest hospital to allow them to work in different departments of hospital. PM&DC does not dictate the mode of delivery / implementation but only prescribe the content. Students are taught in large and small groups in interactive sessions. Students are given Directed Self Learning task to keep them on the track.

Dr. Paudel from Nepal added that delivery of content is more important to engage the mind of student. Primary need is to be creative in the class in setting a learning environment and engaging in role play. Students’ learning during the lecture must be focused upon. Body language enhances imagination and understanding. If our South Asian students were eligible to practice in our country at the time of graduation, but not passing in first attempt in international exams, we need to evaluate our curriculum. Dr. Alamgir Khan from AMC, Rawalpindi added that despite grades, students may not be satisfied, so we need to build the capacity as teachers.

Dr. Rita Khadka from Nepal suggested that when students cannot see physically, what they study in Physiology, it becomes irrelevant and does not convey the real understanding. Students are not being coached to practice MCQs. They study from online Q-bank instead. Patients are not shown along with the courses, so students lose interest. From day one, bed-side exposure is important.

Dr. Humera Wyne, from Central Park Medical College, Lahore concluded that there is disconnect between clinical and pre-clinical years. Didactic lectures, still provide cognitive domain. OSPE covers psychomotor and affective domain. Basic Physiology knowledge needs to be applied to clinical sessions to be a good physician / medical teacher. Consensus was on early exposure to patients. It will have better acceptance by students. Proper allocation of man power and time is needed. Primary to tertiary healthcare to be included. All sciences must be integrated in early years. It involves faculty development by seminars, small group discussions and analysis, student evaluation and teaching videos etc. Discussing and sharing experience which connect teaching and research is very much needed.

There were 47 oral papers presented on 8 scientific themes (in 3 parallel sessions) and 75 poster presentations (distributed over 3 consecutive days) that were selected by double-blind review (out of more than 150 submitted abstracts) conducted by Scientific Committee under the chairperson Dr. Rehana Rehman, Vice Chair Research and Graduate Sciences, Aga Khan University. Presentations were evaluated and winners were announced. Best oral paper was awarded for each theme and the winners included Dr. L S Kaththiriarachchi from University of Sri Jayewardenepura, Nugegoda, Sri Lanka (MSK / Special Senses, Renal & Other), Dr. Ambreen Tauseef from CMH Lahore Medical College & Institute of Dentistry (Cardio-respiratory), Dr. Qanita Mahmud from University College of Medicine & Dentistry, University of Lahore (Curriculum Development), Dr. Fareena Bilwani from Aga Khan Medical University (Cell Biology / Genetics), Dr. Syeda Sadia Fatima from Aga Khan Medical University (Endocrine / reproduction), Dr. Hamid Habib from Khyber Medical University, Peshawar (Neurosciences), Maheen Qutab from Al-Aleem Medical College, Lahore (Teaching & Learning and Research) and Dr. Kevin Joseph Jerome Borges from Zia-ud-Din University, Karachi (Gastrointestinal and Renal).

Different sets of posters were displayed on three days and best poster of the day was awarded to three winners: Dr. Huma Bugti (University of Karachi), Dr. Shazo Sana (Fatima Jinnah Medical University, Lahore) and Dr. Shafaq Javed (University of Karachi). All the abstracts of oral and poster presentations were published in the abstract book as well as on the conference website:

Dr. Javed Akram Vice Chancellor, University of Health Sciences was the chief guest for the closing ceremony. He too commended the efforts of organizers for arranging a successful event. Some other distinguished guests included Dr. Saqib Nasir (Pakistan Science Foundation) & Dr. Salma Kundi President, Pakistan Medical Association.

The conference concluded by prize distribution and vote of thanks from the Organizing Secretary SAAP VI, Dr. Samina Malik. She commended the whole-hearted participation of physiologists and clinicians from PPS, SAAP and beyond to promote Physiology teaching and research. Pakistan, she stated, needs to collaborate with other SAARC countries to meet health challenges faced by South Asia. A lot of improvement in the field of research & health education is required to explore the emerging trends and to face the new challenges, she added.