Accreditation standards for medical colleges should be measurable, valid, cost effective, reliable, acceptable to stake holders and implementable-Dr. Gohar Wajid


 ICHPE 2018 by University of Lahore

Accreditation standards for medical colleges
should be measurable, valid, cost effective,
reliable, acceptable to stake holders and
implementable - Dr. Gohar Wajid

Doctors should identify the emotional and mental diseases
they are suffering from and treat them with Prayer
and Ibadat - Prof. Idrees Anwar

Guilds should not take over Pedagogy of
medical education-Prof. Lubna Baig

LAHORE: Pakistan needs to develop accreditation system for medical and dental colleges to improve medical education in the country. However, it is important that these accreditation standards are measurable, valid, reliable, cost effective, acceptable to stake holders and implementable. We cannot implement United States, UK or Canadian standards but we can learn from the principles and look at their standards. This was stated by Dr. Gohar Wajid a noted medical educationists while speaking on “Development of accreditation system for medical colleges in Pakistan” in one of the plenary sessions during the recently held Second International Conference on Health Professions Education organized by University of Lahore from October 14-17th 2018. Giving further details of his prescription for improvement of medical education in Pakistan he suggested that it needs leadership commitment and support, qualified human resource, technical support, involvement of all the stake holders, building on new standards, extensive training of staff, infrastructure capacity building, training of staff at all levels, robust Evaluation and monitoring system besides financial support.

Prof. M. A. Rauf alongwith Prof. Shahid Mahmud Malik presenting a memento to
Dr. Gohar Wajid at the ICHPE Gala Dinner held at the University of Lahore
Campus on October 16th, 2018.

At present the accreditation system in Pakistan lays emphasis on infrastructure alone. Inspectors are not well versed with the concept of accreditation i.e. quality of teaching, how many classes the faculty members are taking. He commended the Pakistan Medical & Dental Council which was doing a good job because the situation could have been even worse, hence we must give them due credit but then hastened to add that there was lot of room for improvement. PM&DC at present does not have enough capacity. We face gender imbalance in the healthcare professionals, there is migration of healthcare workers and geographic misdistribution. Pakistan has more number of doctors than nurses. We need rigorous accreditation system to ensure improvement of medical education. PM&DC Dr. Gohar Wahid opined, has to be fully autonomous, independent away from the government and private medical institutions. We also need to look into how the accreditation system at the PM&DC compares with the accreditation system adopted by the World Fredericton of Medical Education (WFME). Unfortunately some people in Pakistan do not understand the difference between accreditation and inspection, he remarked.

We need to establish Departments of Medical Education in all the medical and dental institutions, strengthen the PM&DC. We should have standard criteria for accreditation; we must take the stake holders into confidence, put monitoring and Evaluation systems in place. We should have quality assurance system. It is heartening to note that a Division of Medial Education is likely to be established in PM&DC, Dr. Gohar Wajid remarked.

Earlier he gave a historical background of medical education in Pakistan starting from 1947 and referred to a paper by Col. M.K. Afridi published in 1962 in Medical Education Journal. It reflected paucity of medical professionals in Pakistan as all the non-Muslim doctors had left after Pakistan became an independent State. Inadequate health coverage of population was the major problem confronted by the authorities in those days. There were only one thousand doctors and 62 of them had graduated in 1947. Almost 90% of our population in those days had no health cover. Total population of the country was thirty million which has now increased to 210 million. Now we have one hundred fifty seven medical and dental colleges, twelve medical universities and forty postgraduate institutions. Some of them have full time and some part time faculty.

Diseases of the Doctors

Prof. Idrees Anwar, Dean Surgery and Allied Health Sciences at Rawalpindi Medical University made a presentation on Diseases of Doctors. This presentation highlighted the various emotional and mental diseases from which a vast majority of the healthcare professionals were suffering. Doctors treat physical diseases of the patients but unknowingly they also suffer from many diseases related to emotions which affect their professionalism, he remarked. These diseases include excessive pride, impatience, injustice, assuredness, worldly greed, spying and backbiting etc. Patients, Prof. Idrees Anwar stated has some expectations from the doctors which include Altruism, ethical behavour, professionalism. There are clear demarcations of boundaries in Islamic Ethics as to what the doctors are supposed to do and what they should not be doing as Muslim doctors.

Speaking about the good qualities of Muslim doctors, Prof. Idrees Anwar said that they should not have excessive pride. What happens that we often do not attend phone calls, do not see patients? They should not suffer from self-grandeur. With seniority the doctors develop these diseases. Graveyards are full of people who once thought them to be indispensable, he remarked. Doctors should not be impatience; do not become angry but we see lack of empathy, apathy and lack of emotions. Empathy decreases as the medical students become doctors. We prefer to treat VIPs which is injustice which we are doing to our patients. We need to be just with all patients. Authoritative attitude makes a person reckless and dangerous. Doctors also suffer from greed for money and positions. It makes doctors unethical, unprofessional, calling names for others was not good, insulting others is not right but if we look around, we all suffer from these diseases. His advice to his professional colleagues was to be Just and Fair, compromising, contented and truthful. We should be ethical, ensure empathy and professionalism. We all need to identify these diseases and then treat them with Prayer and Ibadat which will ensure that we all become ethical in our attitudes and behavour, Prof. Idrees Anwar remarked.

Politics and Pedagogy

Prof. Lubna Baig Pro Vice Chancellor of Jinnah Sindh Medical University spoke about politics and pedagogy and referred to the network of professional associates which direct and rule them. She also talked about interaction of students with teachers, who gets what, when and how and later gave some suggestions to improve the situation. During her presentation she referred to Community Oriented Medical Education (COME), Problem Based Learning (PBL) and the Modular system which have been introduced from time to time. In 2015 the PM&DC stated that integrated curriculum was a must. Now in Pakistan some medical institutions have adopted annual assessment system and some are using modular system. There is lack of continuity in policy and these frequent changes have badly affected the whole system. At present there exists disconnect between the policymakers and the researchers, she remarked.

Continuing Prof. Lubna Baig said that there are some “Guilds” which are functioning. PM&DC wish to inspect the medical universities apart from the Higher Education Commission. These Guilds, she opined, supersede Pedagogy in medical education which is not a good science. Curriculum should be contextual, built on learning theories and integrated. We need to recognize these Guilds which work as pressure groups, talk about these Guilds and make sure that the PM&DC has complete autonomy. Medical Universities, Prof. Lubna Baig opined, must have some autonomy and curriculum should be based on pedagogy principles. Standards should be addressed. These Guilds which work as pressure groups should not enforce anything on the entire country; they can suggest but refrain from dictation. The remedy lies in that Guilds should not take over pedagogy of medical education. PM&DC should develop and have its own standards. Medical educationists in Pakistan should learn from the previous Guilds and refrain from these phenomena. Faculty resources, she stated, are different in different medical colleges particularly in the institutions located in small cities and towns which must be kept in mind, she added.

Assessment in integrated system

Prof. Rehan Khan Chairperson of Scientific Committee of the conference discussed assessment in integrated system. He pointed out that out of over one hundred medical colleges recognized by the PM&DC, only eight to ten were interested in modular system and are also practicing this. Some institutions are following system based system, some integrated system, some single subjects based on modules. Alignment of assessment with PM&DC was a nightmare. He then spoke about programmatic assessment and said that no single assessment methods was good. We need to combine all the assessment methods. Students should not read a particular subject. They must study different subjects to prepare to become good doctors. He then gave details of PROGRESS testing being used at Riphah University Islamabad. He laid emphasis on maintaining knowledge throughout the studies, identifying areas where a student is best and where he or she is weak, areas where they need more studies. After Progress test, we wish to take assessment to the next level, he added.

During the discussion it was pointed out that lot of human resources are wasted in Pakistan in the form of girl medical students who later do not practice and leave the medical profession. Among the doctors who graduate, 70% settle in General Practice and only 30% opt for specialization. There was a need to have a fresh look at postgraduate medical education system for the females. Society expects lot of empathy from the doctors. It is high time that we identify the emotional diseases from which they are suffering and treat them.

Remarks by Chairpersons

Prof. Mughees Baig in his concluding remarks said that lot of under currents does exist in Pakistan. We must be aware of it and try to avoid its negative effects. Maj. Gen.Masood Anwar remarked that we need to look into social, religious, economic factors and take them into consideration along with international law while taking decisions. Prof. Jack Boulet said that he had lot of passion for all the topics which were discussed. Things are changing but these changes should be based on evidence. Assessment has lot of problems. It is desirable that medical schools have some autonomy to do things but they must ensure basic standards.