Movers and Shakers in Medical Education should not be the administrators but those who have knowledge and skills


Interview: Dr. Syeda Kauser Ali MHPE, PhD

Movers and Shakers in Medical Education should
not be the administrators but those who
have knowledge and skills

Only those who are good at interpersonal skills, communication
skills and are not arrogant can succeed in this field

All the Programme Directors are keen and concerned
to ensure quality and standards

By Shaukat Ali Jawaid

KARACHI: At present there are no standards for accrediting Health Professional Education programmes. It is up to the PM&DC inspectors who come and see what is going on. In fact standards are more important for the institutions which are running the MPHE programmes. It is extremely important to have a full time on site faculty of at least two to three people. However, at some institutions running MPHE programmes onsite faculty is not there. Visiting faculty comes and goes with the result that overall development and quality is not assured. Participants who are enrolled in these programmes thus do not get the advice and mentoring is not there.  This was stated by Dr.Syeda Kauser Ali medical educationist and Director of MPHE programe at Aga Khan University Karachi in an exclusive interview with Pulse International recently.

Dr.Syeda Kauser Ali

Most of those who join these MHPE programmes are busy physicians and surgeons. All of them are not so good at self-directed learning. Hence, after sometime they get disillusioned, that is why many of them then decide to leave the programme in between. Most of these are faculty members at various medical institutions. They have to perform their teaching and training duties, look after the patients and then also concentrate on learning. Under these circumstances, how much time they can devote to learning. In the absence of a full time faculty, their problems get multiplied.

Continuing Dr. Syeda Kauser Ali said that in some cases, today you are students of MHPE and the day they qualify, they start teaching passing on the bookish knowledge. We must remember that there is no alternative to experience. You do not know what works and what does not work? This is one of the reasons for those enrolled in these programmes getting disillusioned. We need to find out the reasons as to why some of those who first get enrolled in these progammes left it. It is time that someone looks into this aspect, she remarked.

Explaining her viewpoint further Dr. Syeda Kauser Ali said that the full time faculty should also have at least two to three years’ experience of teaching medical education.  Sometimes we see that team work is not there. We are all very good as individuals. At the CPSP we worked as a team and we were able to do a lot and accomplished a lot because we all used to work as a team. At CPSP we had Dr.Zarrin Siddiqui, Dr. Moyn Aly, Shazia Sadaf, Naghma Naeem, Sajida Samad and me (Syeda Kauser Ali) and we were all working as a team. Single handed one cannot achieve much. Working in a team you utilize the strength of every member of the team.  Someone is good in one area while others have expertise in another area. We never felt threatened from each other. At present we have a good team at Aga Khan University as well. We have three full time faculty members and seven joint faculty members.  Apart from that we also use many other experts from different departments.

You need to have confidence in yourself. If you are confident, others work well, you appreciate that and you are not worried at all. In the field of medical education only those will succeed who are good at interpersonal skills and communication skills and do not have arrogance.  You won’t be able to bring any change if you are arrogant. We will work on all these issues from the platform of Association for Excellence in Medical Education (AEME). Bringing about a positive change in medical education is a highly political agenda but we have to do it and ensure quality and standardization in Health Professional Education programmes. At present apart from AKU, Dow University of Health Sciences at Karachi, University of Health Sciences Lahore, University of Lahore, Khyber Medical University at Peshawar and CPSP are running MHPE programmes. We have excellent cooperation at personal level but what we need is a strong relationship at the institutional level. It is much more important at institutional and international level. As such we need to strengthen the arm of AEME as a national body.

But some people have lot of reservations about AEME. They think it is a “Close Shop”.  It is working with the “same cast” with few extras. Many medical educationists were not invited when it was formed.  It is also alleged that it does not have a transparent working and a democratic set-up.

If there are some issues, they should be looked into and AEME leadership should be receptive to these. I personally feel that these concerns need to be conveyed to the AEME leadership and they should also look into it. As regards standardization of MHPE programmes, all programme directors are concerned and keen to ensure quality and maintain standards. We hope to meet soon to discuss the outcome of MHPE programmes. We need a national body working as an umbrella organization and AEME I feel can serve that purpose. I know Council for Collaboration in Medical Education (CCME) has also started working.

What do you see the future of this specialty of Medical Education?

We now have departments of medical education established at all the medical colleges which number over ninety. They have to work and bring a change. We need to have a national agenda and Vision for a change. We hear a lot about integration of curriculum but no one seems to be fully aware as to what do we mean by integration and what we wish to achieve? Movers and Shakers in Medical Education should not be the administrators but those who have knowledge and skills. I am an optimist and feel that medical education will improve in this country but for that we need qualified people and a standard product. To bring a change takes time. We need to sit together, make a Vision and work together as a team but unfortunately we do not have a Vision so far. I sincerely feel that under AEME we can work together in the field of medical education. We also need to involve nurses and allied health professionals. They are also important members of this team, hence we need to involve all of them and not concentrate on doctors alone. Education is a team work and we need to bring forward everyone involved in healthcare, Dr.Syeda Kauser Ali remarked.

Medical Education as a specialty came into the limelight only   during the last one decade but you have been involved in it since long. How you got interested in this field and what fascinated you to specialize in Medical Education?

Sometimes you are destined to reach such a destination. I was interested in community health. I wanted to adopt it as a career. I graduated from Dow Medical College in 1984 and soon after completing my house job, joined Aga Khan University and worked with Dr. John Bryant in Community Health Sciences. It was my passion but then I got married and went abroad. When I came back, many of my colleagues had already started their professional career and made progress. It was in 1991 that there was some opening at the College of Physicians & Surgeons Pakistan in the department of medical education. Even at the AKU I was working as a preceptor which was a junior faculty position coordinating between the faculty and the medical students. I used to take the students to the community. At the CPSP after I passed the test, Prof. Fazal Ellahi and Prof. Naeem Jafary interviewed me. Four of us were then selected for a probation period of three months. At the end of three months, I was the only one left as the other three left thinking it was not the field suitable for them. Both Prof.Fazal Ellahi and Prof. Naeem Jafary impressed me a lot. It made lot of difference when I looked back as to how we were taught and how we were assessed. It was in line with my thinking and personality. I thoroughly enjoyed working in the department of medical education. I thought we are now going to get brilliant educated doctors with necessary knowledge and skills. I got interested and form then onward, I never looked back but just continued my professional journey.

I went to the University of Illinois in Chicago, United States for my MHPE on a WHO scholarship through the Ministry of Health for which I was proposed by CPSP. I went in December 1992 and came back in April 1994 after completing my MHPE.  At that time,  Prof. Fazal Ellahi, Prof. Naeem Jafary, Dr. Nighat Huda everybody had left CPSP. I did not know what to do? First I thought not to return back but it was Prof.Fazal Ellahi who was in United States in those days who encouraged me to go back to Pakistan and contribute something. You owe something to your country Pakistan, Prof.Fazal Ellahi reminded me.  And then it was working with Prof.Sultan Farooqui at CPSP that I had my total grooming while working under his leadership. I used to work under his direct supervision.

While at the CPSP, we worked a lot. We introduced MCQs, examination system was streamlined and standardized and we worked for curriculum development. We had teachers training workshops all over the country. Dr.Moyn Aly used to be with us and we started Diploma of College of Physicians and Surgeons (DCPS) in medical education which was later renamed as MCPS. It was the seedling. All other MHPE programmes all over the country started later. We had to struggle a lot to convince Prof. Sultan Farooqui. We had to make a presentation to the Council of CPSP which finally approved this programme.  CPSP was also named as the WHO Collaborating Center for Medical Education hence it provided us lot of opportunities to work with WHO people. I had a full and fruitful life at the CPSP. It was very enjoyable. Under the dynamic leadership of Prof.Sultan Farooqui we used to get due recognition and respect.

Then why did you leave the CPSP?

Having worked for so long at the CPSP, I was getting bore. It was the same routine. Nothing new was happening. I also wanted to do PhD. CPSP would have sent me for PhD but then it would have meant signing yet another Bond and I was not prepared for that.

After leaving CPSP for some time I worked as part time at SIUT as well as Aga Khan University. I had left CPSP in May 2005. Then I thought AKU had a much wider scope so I joined it as a full time in November 2006 in the department of educational development. After a year’s working at AKU I got Faculty Development Award in 2007.  In 2008 I went for my PhD to University of Calgary Alberta and returned back in January 2011 having obtained my PhD. During these yeas I used to work for some time here and for some time in University of Calgary. Working with Prof.Rukhsana Zuberi and Prof. Khursheed was so wonderful. On my return I was immediately promoted as Associate Professor though I had started as a Senior lecturer. It was in the Year 2006 that we had started working on an Advance Diploma in Health Professional Education of which I was the Director. Eventually we started Master’s programme in health professional education (MHPE) in 2011. Dow University of Health Sciences had stated it a year earlier in 2010. It was not easy to convince AKU as they are very concerned about maintaining standards and sustainability of any programme they start. I am now Director of this MHPE programme at AKU.

At the last medical education conference at University of Health Sciences which was held in collaboration with AEME I conducted a workshop on standardization of MHPE.  We discussed many issues. All the programme directors were there.  We also discussed as to what standards are needed and we started working on that. However, we soon came to know that some international standards are being prepared and they were in the pipeline.  Renewed international experts in the field of medical education which included Ara Tekian, John Norcini, and Janet Grant were all involved. We are just waiting for their report. We were told at the UHS medical education conference last month that it will be printed in the next couple of weeks. Once this report is out, we will get together, discuss it and then come up with some standards for our programmes which enjoy national and international recognition, Dr. Syeda Kauser Ali concluded.