We should have some minimum standards but leave it upto the medical colleges how they achieve them-Prof. Rukhsana Zuberi


Panel Discussion on Current Changes in Medical Education at ICHPE by UOL
We should have some minimum standards
but leave it upto the medical colleges how
they achieve them-Prof. Rukhsana Zuberi
Change should be addressed by all the stake
holders-Prof. Shahid Malik
Change has to come. We have to stop rot learning
& start critical thinking-Prof.Azhar Rashid

LAHORE: One of the important highlights of the scientific programme of the Third International Conference on Health Professions Education (ICHPE) organized by University of Lahore from 4-6th December 2019 was on “Current Changes in Medical Education in Pakistan and its effects”. It was moderated by Prof. Rehan Khan a noted medical educationist. Members of the Experts Panel included Prof.Shahid Malik, Prof. Rukhsana Zuberi, Prof.Azhar Rashid, Dr.Gohar Wajid, Prof.Idrees Anwar, Dr.Ashraf Nizami who represented the PMA and a student Aqsa Shafique.

Prof. Rehan Khan moderating the panel discussion during 3rd ICHPE organized by
University of Lahore on Dec. 6 th, 2019. Panelists sitting on the dais from (L to R)
are Dr. Ashraf Nizami, Prof. Idrees Anwar, Dr. Gohar Wajid, Prof. Rukhsana Zuberi,
Prof. Shahid Mailk, Prof. Azhar Rasheed and Ms. Aqsa.

The first question which the panel discussed was curriculum relevant to the students and what was the right way to move on. It was pointed out that there were gaps in implementation though the PM&DC has started to make some positive changes. Prof.Idrees Anwar remarked that to bring about changes in curriculum was an excellent idea. We will start getting results when we move forward. Once the regulatory body whether it is PM&DC or PMC have adopted some changes, we will get better results.

Prof. Rukhsana Zuberi remarked that standardization is better particularly in basic sciences. All medical colleges should have some minimum standards. There should be some flexibility and we should leave it to the medical colleges how they achieve these standards. Prof. Shahid Malik opined that change is always better. People have produced research and sustained progress. The change must make some sense. Changes in our health services need to be addressed by all stake holders. Ms. Aqsa who represented the students felt that there were some flaws and lack of sensitization. We need to sensitize the students, teachers, government before capacity building and only then these changes should be implemented to have better outcome. She laid emphasis on sensitization, capitation and implementation which should be planned.

Prof. Rehan Khan said that a question is often asked that we are all product of the old system and we have all made excellent progress then why there was a need for a change? Responding to this Prof. Azhar Rashid remarked that change has to come. We have to stop rot learning and start critical thinking. Prof. Shahid Malik pointed out that we cannot live in isolation and we need to respond to the world needs. Our medical graduates have to go abroad hence they need to be better trained. Dr. Gohar Wajid remarked that the Government has to make decision, provide funds and infrastructure while we can provide technical help. Ms. Aqsa said that the world was moving fast, the new generation of students need to change as in the days to come it will be survival of the fittest. Dr. Ashraf Nizami asked whether we are prepared to change ourselves. We have to implement standards which are community based and are accepted globally for which the proposed Pakistan Medical Commission was not the answer. The disciplined based curriculum is only meeting some standards, it will survive if it meets certain standards or we will have to go for integrated curriculum. Dr. Gohar Wajid stated that we need standards and we need curriculum as standards alone is nothing. The whole system needs to change. We need standard guidelines and mechanism through which these standards will be implemented in our institutions. However, we need to look whether these criteria’s are validated. Staff should be trained on those guidelines so that these are implemented. We can also achieve standards with the same curriculum if we define the outcome and competency first to know how we are going to achieve that. We need to define the competency first and we need integrated approach but some cannot be integrated. We need to look at merit of each competency and how one can integrate discipline based curriculum. Prof. Rukhsana Zuberi remarked that we need to find out which competency can be achieved by which system. Ethics, Research Methodology and Communication Skills belong to different disciplines. Dr. Gohar Wajid said let us develop standards and take all the stake holders on board and get their feedback. We must involve all the stake holders. Can we survive following a discipline based curriculum? To achieve excellence we need integration. Some of the institutions do not have the resources for integration, hence how they are going to achieve that, he asked? We should develop curriculum guidelines and then leave it to the institutons how they can achieve that and ensure compliance. Regulatory bodies should have the technical capacity to guide the institutions. Prof.Azhar Rashid said that patient safety is extremely important and measures should be taken to achieve that. Prof. Idrees Anwar laid emphasis on integration as some of the competencies cannot be achieved by one department. Hence to have safe doctors, we need integration.

Prof. Rukhsana Zuberi stated that faculty and students are both important. Politics is there but we need to take all of them on board. We at the Aga Khan University trained one hundred sixty faculty members before we introduced some changes in curriculum. There will be some faculty members who will never change but we should not jeopardize the whole system.

Referring to the proposed National Licensing Examination which the authorities propose to introduce Dr.Ashraf Nizami said that the doctors will remain under pressure. They have to first appear in the entry test, then professional examinations which will be followed by Licensing Examination. In whole they will need to pass three examinations before they can be allowed to practice. How it is going to work, he asked? In the new set up being proposed, it is all based on nominations by one person. The whole system is being planned to be run by a particular group of people. Education environment and faculty is not their concern and it shows that we do not have confidence in our present system being followed by the medical colleges and medical universities. We still do not know what type of Exam it will be? Students will learn which they wish to learn and some of them will be brilliant despite the fact what we are doing to them. We need to give time to the students to prepare for this change, Prof. Rukhsana Zuberi added.

Participating in the discussion Prof. Shoaib asked do we have standards for universities. Some of the medical universities do not have proper curriculum. He was of the view that behaviour changes and changes in management were essential. Prof. Idrees Anwar remarked that our role should be to help people grow and achieve minimum standards. Ms. Aqsa remarked that social responsibility among medical institutons will bring some change. Dr.Ahsan Sethi remarked that can we trust the universities and do they have the capacity to change? We need people to guide the universities. Prof. Rukhsana Zuberi said that we must have minimum standards and there should be no bar to go up but minimum standards must be maintained. It was also pointed out that university should have its own standards and to achieve that faculty will have to be trained. At present students and teachers do not mix up, students are too much pressurized. Prof. Idrees Anwar remarked that the students have to be prepared to face intense pressure. We need to make learning easy and fun. Let us make it simple, use technology to make it easy. Teachers should make it simple and easy but Change is a must. Prof. Shahid Shamim remarked that airline industry is not run by pilots but by professionals.

Concluding Session

The panel discussion was followed by the concluding session of the conference. Giving her impressions of the conference the delegate from Malaysia Prof. Vishna Devi Nadaraja Pro Vice Chancellor International Medical University Kuala Lumpur appreciated the fact that the organizers sticked to the agenda. The speakers were very open and the future of medical education in Pakistan was very promising. She suggested that we should be talking about the healthcare and needs of the community more. Do more scholarly work and share it with the world. Many important issues were highlighted during the conference and it needs to be promoted globally. Dr. Muhammad Saiful Bahri Yousaf also from Malaysia congratulated the speakers for their scholarly presentations. He was of the view that we need to advertise these meetings globally to attract more participants from overseas.

Dr. Ashraf Nizami who was the Guest of Honour in his speech said that we need to look into the philosophy of poverty and address it. Doctors have to be patient centered professionals. Prof. Khalid Masood Gondal Vice Chancellor of King Edward Medical University who was the Chief Guest in his speech said that in the past we use to follow the apprenticeship model which was based on Peeri Mureedi. However, now it has changed to problem based, evidence based and competency based medical education. We do have some challenges. We have streamlined the induction of postgraduates, accreditation of institutions and supervisors. There are some variations in Pakistan and we are going to address those. He also gave details of the eLog system for postgraduates which the CPSP has developed. There are some challenges in assessment. He also disclosed that they intend to start PhD in Medical Education at King Edward Medical University in the days to come. Dr. Mahwish Arooj announced that the next International Conference of Health Professions Education will be organized from 20-22 October in 2020.

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