CPSP should be proud of its accomplishments but must plan to face the challenges ahead


Residency Review Committee could help improve quality of training

CPSP should be proud of its accomplishments
but must plan to face the challenges ahead

It is lucky to have a dedicated team of Techno-Bureaucrats heading
various departments which are the backbone of this great institution

Further strengthening, empowering the Regional Centers, Faculties, Creation
of Young Fellows Forum & offering them Travel Grants to improve their
professional skills, interaction with professional specialty organizations and
due respect to Supervisors will be rewarding and in the national interest

By Shaukat Ali Jawaid

KARACHI: College of Physicians & Surgeons Pakistan should be proud of its accomplishments so far i.e. safeguarding its independence and credibility, holding of all the examinations on schedule and providing an opportunity to the postgraduates of cost effective postgraduate training and examination, interlinking all the Regional Centers with Video conferencing facility, improving the facilities being provided to the postgraduates including easy accessibility, receptive attitude and willing to solve their problems, resolve hardships, providing them opportunities of training overseas at sate of the art healthcare facilities besides post fellowship training opportunities just to mention a few. However, it must be prepared to face the future challenges which they might confront in the days to come.
Last year it organized the Golden Jubilee Celebrations and various academic activities were organized all over the country which culminated with the main Golden Jubilee Conference held at Karachi. It attracted a large number of invited guest speakers from overseas representing various Royal Colleges in UK, Canada, South Africa, and BCPS from Bangladesh besides representatives of postgraduate medical institutions in many other countries including Saudi Arabia and representatives of professional specialty organizations from India. The session on Global perspective of postgraduate medical education was of special significance as many invited speakers shared their experience of running their respective institutions, the problems they had to face and how they resolved it. One does not know whether any one from the CPSP took notes of these pearls of wisdom from these speakers and does they have any plan of implementing some of the suggestions made or it was just a formality of inviting these speakers and listening to them and then forgeting about every thing. One would like to take this opportunity to remind the CPSP authorities of some of the important points made by these invited guest speakers.
Prof. Sir Ian Gilmore in his presentation referred to the address by Prof. Khawaja Saadiq Hussain former President of CPSP wherein he had stated that “commercialization and corruption virus has infected the medical profession in Pakistan. Doctor’s morale is all time low. He also disclosed that it was one of the reasons that now almost 50% of the membership of General Medical Council consists of non-medical members. Every day one hears some scandals involving the doctor’s community and this have all eroded the doctor-patient relationship. There is a set of values, behaviour and relationship that underpins the trust public has for doctors. Tremendous improvements in technology, demography, society’s expectations and economics, quality of care has become much more important. Gone are the days of authoritarian approach, now is the time to wok together as a team and delegate powers which means that many doctors have to change their authoritarian attitude. Gap between the rich and poor is widening which has a direct bearing on life expectancy, death from heart diseases, direct injury, pollution and food related illnesses”.
Now what has the CPSP tried to do to inculcate the spirit of upholding professional ethics among members of the medical profession in general and its Fellows and Members in particular. Its Fellows should be role models in this respect. A lot needs to be done in this respect.
Prof. Michael Holland in his presentation had stated that “Colleges are becoming large and irrelevant for the Fellows; hence the colleges should address this issue and engage with the medical students? His advice to institutions looking after postgraduate medical education was to organize post fellowship training in collaboration with the respective specialty organizations and associations. He had also suggested establishment of Young Fellows Forum and offering them Travel Grants to improve their professional skills. The young fellows should be closely involved with the college otherwise they won’t know about their practices”.
Again all these are very useful suggestions. It is accepted that everything which works overseas and is good for them may not be good for us in Pakistan and we are not supposed to follow them blindly. We must be mindful of the ground realities here, hence it is extremely important that for many reasons, we continue to have a single institution which has done so well so far and all efforts should be made to manage its affairs more efficiently. There is always room for improvement and CPSP administration should welcome constructive criticism and suggestions which help improve functioning of this great institution. However, no visible steps have been taken to establish Forum for Young Fellows and providing them Travel Grants. The CPSP Council members and other officials must pick the young, bright and talented fellows for these Travel Grants which will prove to be their valuable asset in future. To accomplish that, it is important that the CPSP administration is in touch with the young fellows and merit remains the only criteria for provision of these travel grants, rather than any other considerations including trustworthy voters in future elections. There is absolutely no interaction between the CPSP and professional specialty organizations, associations and sooner some positive steps are taken in this direction, better it will be. They should be taken on board in improving the teaching and training facilities in their respective disciplines. A lot remains to be done in this field as well and one hopes the CPSP administration and management is mindful of these important issues.
Prof. Anil Madaree who represented College of Medicine from South Africa in his presentation disclosed that in Cuba 97% of doctors specialize in Family Medicine, hence it is not at all surprising that despite the fact that Cuba is not a very rich and developed country but even then they have the best primary health care set up. We need to promote the discipline of Family Medicine further and make it more attractive so that more and more doctors adopt it as a career. There was a time that medical students from Saudi Arabia used to come to Pakistan and go to many other countries for medical studies but now the situation has changed a lot. At present according to Prof. Abdul Aziz Alsaigh from King Saud University, there are thirty two medical schools in Kingdom of Saudi Arabia and there is great demand for postgraduates. In the days to come they will also become self sufficient in specialists and may not remain dependent on overseas specialists. At present Pakistani specialists with FCPS degrees are now offered handsome remuneration thanks to the efforts made by the CPSP. Not only that the CPSP administration has also acquired facilities for training of Pakistani postgraduates in state of the art healthcare facilities in Saudi Arabia after they have done their FCPS Part-I. The situation may not remain the same in the coming years, hence we need to impress upon our governments to improve, upgrade and expand the healthcare infrastructure within the country providing more and more training opportunities within the country. CPSP needs to utilize all its contact and resources to impress upon the Government of Pakistan to give Health and Education priority it deserves. Government too can benefit from the expertise and facilities of CPSP and formulate plans whereby more and more postgraduates are accommodated in training institutions.
Addressing the cardiology faculty members at the NICVD last year, the CPSP President Prof. Zafar Ullah Chaudhry had remarked that “Faculties are the Eyes and Ears of CPSP” but in case some hearing impairment takes place or eyesight is weak or cataract develop at some stage, they wont be able to do justice to their duties and responsibilities. Hence, it is essential to see that these Faculties are alive, functioning and doing the job which is their duty. One often hears the voices that some Faculties are non-functioning or have not met for long time; there are people who are sitting in these faculties for decades who may not be in touch with the ground realities. Hence, perhaps the time has come that the CPSP management takes a careful look at the composition of these Faculties. Induct fresh blood, revamp them and strengthen them to ensure that they are able to discharge their duties and come up to the expectations. They should guide the postgraduates, revise and update their respective curriculum, give their input on evaluation, how best it can be improved. The pass percentage in FCPS examinaitons has improved a bit which is a healthy sign. According to reports the number of average attempts for FCPS in major disciplines has reduced from 7.5 about six seven years ago to 3.8. Similarly for non-major subjects the average attempts have reduced from five or six to just two while for IMM the average attempts are said to be 1.2 which is all quite impressive. This needs to be further reduced because any training system which has a very high failure rate is not good. It has many and serious implications as well. The College should not feel happy that the repeaters ensure them more money which they can use for further development, improvement of the college but it also has the side effect of frustration and depression afflicting the postgraduates who keep on appearing in the exam again and again without any success. Above all it also changes their personality affecting their attitude towards students and patients alike.
Another development which the CPSP must take into account is the fact that now many medical universities have started various postgraduate degree programmes. Hence in the days to come there could be many postgraduates who may be tempted to go for these University degrees and diplomas instead opting for FCPS and MCPS or other diplomas offered by CPSP. As such the number of postgraduates sitting in the CPSP exam may start declining in the years to come. All these issues need to be considered giving it a serious thought and efforts made to improve the quality of training programme which will then improve the pass percentage as well. Establishment of Residency Review Committees as suggested in the recent conference of Pakistan Cardiothoracic Surgeons can also help improve the quality of training. Trainers and Supervisors play a vital role in this regard, hence they need to be recognized and given due respect by the CPSP. They can be offered free Workshops and other incentives. Though it is an honour to be a Trainer and Supervisor but other incentives may also work.
CPSP also has representation in various Committees formed by the Government where effort should be made to nominate people who are competent and able to contribute something and have interest in that particular subject. It is not essential to accommodate all the “councilors” here and there and keep them all happy but if no one among the council has time, interest or capability to contribute in any particular subject, the CPSP administration should not hesitate to look beyond the Council among its Fellows to make these nominations which should be purely on merit based on their competence and ability. If their representatives do something good, it will bring laurels to the CPSP. This is yet another area which needs improvement.
Further strengthening and empowering the Regional Centers, Faculties will go a long way in improving the functioning and image of the CPSP as an institution. At present CPSP remains the only institution in the medical field which enjoys international recognition and it has earned the Trust of medical educationists in many countries overseas. It is also fortunate to have a dedicated and devoted team of Techno-bureaucrats who are heading its various sections which are the back bone of CPSP. These people who most of the time are working behind the scene, needs to be commended and appreciated because what ever the CPSP has been able to achieve and accomplish so are, it is because of them. Their services must be recognized.