Residents must be told about their strength and weaknesses so that they know how they are progressing in their academic journey-Prof.Gominda

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Medical education conference at CPSP-II

Residents must be told about their strength and
weaknesses so that they know how they are
progressing in their academic journey-Prof.Gominda

For the success of the semester system, more administrative
staff and more teachers are needed-Prof. Noshad Shaikh

We need to develop critical thinking in the medical students
which is essence of learning- Prof. Muhammad Aslam

KARACHI: Prof. Zafar Ullah Chaudhry President CPSP made his presentation on “In search of a suitable model of postgraduate medical education in developing countries” at the medical education conference which was part of the CPSP Charter Day Celebrations partly reported in our June 1st 2014 issue. He referred to uncontrolled, ill equipped, under staffed undergraduate medical colleges in the country. He also referred to the poverty, illiteracy and the role played by various institutions like universities and the Higher Education Commission. He then gave details of the system CPSP has developed wherein there is timely induction of postgraduates twice a year. Their training programme is structured and it is strictly monitored and has proper evaluation system. However, there is room for change and improvement, he remarked.

Prof. Gominda Ponnamperuma from Sri Lanka talked about essential ingredients for specialty training. He talked in detail about competency frame work, contents and core of practice, learning opportunities and tools, both in class room and at work place, assessment, and support system following by monitoring and academic counseling. The residents, he opined, must be told about their strength and weaknesses so that they know how they are progressing in their academic journey. You take any programme, the ingredients are almost the same but how you blend them all makes the real difference, he remarked.

Prof. Noshad Shaikh Vice Chancellor of LUMHS gave details of the semester system they are following in undergraduate medical education and highlighted the experiences and challenges they were facing. Every system, he opined, has its own advantages and disadvantages. While we were medical students, five years course used to be completed in seven years. He was of the view that we must have a uniform system either annual system of examination or semester system. AT LUMHS, he said, we have introduced two new courses i.e. information technology and biomedical ethics for the undergraduates. We issue the result the same day; hence it ensures transparency besides eliminating examiner’s bias.

Continuing Prof.Noshad Sheikh said that they conducted a survey and found that 94.3% of the students were satisfied with the semester system. We keep the students busy and they also remain disciplined. Alost 71% of the teachers said that they have to work hard and have less time for research. Faculty is not happy with the semester system. But it has the advantages of more interaction between the teachers and students, no postponement of examinations, academic calendar is followed and five years course is completed in five years. However, for the success of the semester system, we need more administrative staff and more teachers.

Prof. Maj.General Muhammad Aslam Vice Chancellor of University of Health Sciences discussed the aims and objectives of undergraduate medical education which are that we should produce good physicians with professional competencies. The students should be imbibed with professional values and attitudes; they should be compassionate, good human beings with passion. They should know their social responsibilities. We in Pakistan have been suffering from man inflicted injuries like kidnapping, terrorism apart from nature afflicted injuries. We need to develop critical thinking in the medical students which is essence of learning. They should master communication skills, know how their body language verbal and non-verbal affects,. They must be good individuals. We have finest individuals but team work is lacking. We need to inculcate in them the team spirit and professionalism. We tend to compromise in patient care, diagnosis. We should not compromise in teaching and training. We must tell them from the undergraduate days that they must become good professionals. They should be fully conversant with managerial skills, they should know when to listen, when not to listen, speak and when not to speak. Creating a learning environment in our institutions is the major problem. People are hungry and thirsty to learn. Fault lies more with us the teachers and not with the students. We need to blend the tradition with modernity and merge them together, he remarked.

Prof. Mahmood Shaukat along with Prof. Javed Akram and Prof.Maj.Gen. Muhammad Aslam chaired the second session. Prof.Rukhsana Zuberi from AKU was the first speaker. She pointed out the variation in training programmes in various provinces and emphasized the importance of having a standardized postgraduate medical education programme in the country. She also laid emphasis on elective rotations and remarked that attitudes are caught and not taught from the role models. The importance of re-licensing and re-accreditation was also highlighted.

Prof. Khalid Masood Gondal made a presentation on CPSP Residency Programme and gave details of resident’s perspective on electronic monitoring. He first referred to the shortcomings of the log book and then said that the CPSP introduced the e log book from 2011. One of the salient features of this e log book is that entries made once cannot be edited by the postgraduates. We found out that 89% of the supervisors had logged on but only 32% gave feed back whereas 68% did not gave any feedback. Majority of them found it useful. Those who failed to give any feed back were contacted, persuaded as we are monitoring the whole system and those who eventually fail to respond may be removed as supervisors, he remarked.

This was followed by an excellent presentation by Dr. Amina Ahmad from Lahore who discussed how to strengthen the Health Professionals Education. Tracing the history she recalled that it started as a diploma by CPSP in 2004 but later on it was renamed as MCPS and upgraded to M. Phil level. Aga Khan University Karachi started HPE in 2006 and later also started Masters programme in 2012. Dow University of Health Sciences started MHPE in 2010 and now there are over half a dozen programmes run by various institutions in the country and a similar number of places are planning to start this. This proliferation has caused some concerns in the concerned quarters in the world. There are challenges faced by the faculties. There are major concerns about the quality of those programmes and this has been highlighted in various publications. There are discrepancies in programmes. How to strengthen Health Professional Education programme in Pakistan was discussed at a recent meeting where issues of local as well as international accreditation of these programmes also came under discussion. This meeting was attended by programme directors of these courses, faculty members and all other stake holders. The participants agreed on some bench marks and some minimum standards for HPE. What should be taught in these programmes, what mode of instruction to be used and followed which should be in those programmes? Suggestions and recommendations will be formulated and then they will be passed on to the institutions running these programmes. It will also be forwarded to World Federation of Medical Education. It is important that we have some indigenous minimum standards for these Masters programmes. We need to identify target audience, admission requirements, duration of programme and its requirements. It must be at least two years programme. Contents, competencies, faculty all needs to be looked into. Do all the programmes have appropriate faculty, she asked? Dr.Amina Ahmad concluded her presentation by stressing the importance of collaboration between various institutions to strengthen this programme.

Prof. Aamer Zaman Khan from FJMC Lahore discussed the assessment of important non-academic attributes. Physician, he said, has to be a healer and professional. Qualities of a good physician are very well emphasized and documented by various bodies. The importance of self regulation was also emphasized. They should be supportive of institutional policies and they should be more receptive to a change. We need to have a proper linkage between primary, secondary and tertiary care institutions. We need to improve and upgrade our Tehsil and District Headquarters Hospitals. PM&DC, it was pointed out is a registering body but not an accreditation body.

The next session was chaired by Maj. Gen. Waqar along with Prof. Gominda. Prof. Mowadat Rana was the first speaker who talked about Reflection in learning. Medical educationists, he said, are the people who reflect. Prophet Muhammad (PBUH) Prof. Mowadat Rana said used to spend lot of time in Ghare-e-Hira busy in reflections. We learn by observing, by doing, learn by our mistakes, by trials and errors. We also learn from experience. We learn with bigger picture in mind. Reflection, Prof. Mowadat Rana opined was in fact learning. It is important that one must reflect, plan and think, act and then observe how change has taken place or happened. Reflection is equal to thinking brain plus emotional brain. He was of the view that it was the reflection which was the missing link in adult medical education in Pakistan.

Prof. Rakshanda Rehman from Lahore was the next speaker who opined that inter professional education should be a high priority for higher education institutions. IPE and ICP will strengthen health care system. IPE will reduce complication, hospital stay length, treatment cost, mortality and medical errors. Speaking about the challenges she talked about legislation and regulation, competition from within universities, disciplined based culture, logistical challenges, ineffective communication, isolation and competition between team members. As regards opportunities, we have common platform for higher education institution, existing pattern of curriculum development, MHPE for inter professional faculty development, research, use of existing institutions and information technology facilities.

Prof. Aqeel Safdar talked about team based learning. He quoted Ms Janet from UK who while speaking at the medical education conference at UHS Lahore two months ago had remarked that medical education concepts are not eternally enduring. Team based learning requires minimal needs of multiple faculty rooms, students must come prepared to sessions. It should be instruction directed learner centered. It is important that one ensures that individual and team are both accountable. He then talked about orientation, advice, assignments, individual readings, assurance test and instructor clarifications. Team Based Learning, he opined, was for us and one can visit the website teambasedlearning.org for further details.

Prof. Muhammad Tayyab from AIMC Lahore talked about faculty development- workshop to workplace. He discussed in detail the educational skills and leadership skills. Skills, he said, have scholarly activities. It leads to personal development. One needs to learn skills in designing and implementation of development plans. Speaking about principles of faculty development, he said, one can think about one’s lecture. One always gets an inner feedback. It is based on caring, Trust and collaboration. He also referred to principles of adult learning and mentioned about peer review and acceptance. Who will use curriculum? There are some challenges and one often sees resistance to change. Orientation meetings include workshops and seminars. One must ensure regular faculty meetings, have observations and feedback. There is no need for policing. It is essential that we have a vibrant medical education department in every institution. He also briefly talked about the fight between the Higher Education Commission and PM&DC on certain issues.

Prof. Umar Ali Khan Pro VC Isra University from Islamabad made a presentation on developing leadership for comprehensive healthcare. Team leaders, he said, are those who create more leaders and not followers. He referred to the presentation of Prof. Mowadat Rana who had mentioned about the Ghare-e-Hira where Prophet Muhammad (PBUH) used to spend lot of time to reflect, what, how and why all this was happening. Competencies, he said, was equal to knowledge, understanding and practice. For effective healthcare leadership we need health resources, healthcare informatics. He concluded his presentation by showing a video based on Turtle and Rabbit story where each one of them wins the game once but when they decided to work together, both of them win. Thus moral of the story was that working in a team was beneficial for all of us.

Panel Discussion

Prof. Gominda, Prof. Javed Akram, Prof. Muhammad Aslam, Prof. Hamid Mahmood Butt and Dr. Faisal Sultan were the panelists in the panel discussion that followed. During the discussion it was pointed out that when the medical students get admission all wish to serve the humanity but what happens that during their five years stay at the medical college, they lose all competencies. One often hears the phrase of pre clinical years to cynical years. Prof.Javed Akram felt that young doctors are drifting away and our social economic values have changed. Prof. Aslam disclosed that in Indian Punjab, universities have introduced human values in higher educational institutions. Students have their electives in rural areas. They go where they feel comfortable and complete a research project. It also improves the healthcare set up in rural areas. They organize medical camps. Prof. Hamid Mahmood Butt said that now we have more private medical colleges than public sector medical colleges. Number of students have increased manifold. Faculty has thinned out. The concept of self learning has vanished. We must create a learning environment. Doctors have to be respectful to the patients. They should be able to work in a team and work for conflict resolution for which communication skills are extremely important. Dr. Faisal Sultan opined that empathy was the highest demand in medical profession. I at SKMT run an infectious disease clinic; we do get some postgraduates for training. We are lucky as we are providing the same facilities to our students. We have a vertical and horizontal division in the country. No one is groomed to serve in the private sector after they complete their five years in medical colleges, he added.

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