The formation of a 25-member high-powered committee by the Pakistan government to evaluate and enhance the medical education standard in the country comes at a time when a disturbing incident took place in which several medical students of Pakistan were attacked in Bishkek, Kyrgyzstan. The brutal incident that was unfolded to the students has aroused the indignation of the entire nation and has unveiled the actual issues related to the medical education system in Pakistan.
The parliamentary committee, which has been mandated to prepare the report in the next 10 days, has its work cut out for it. According to the committee’s defined scope, it needs to review a plethora of problems concerning medical education in the country-admission procedures, medical college facilities, quality of faculty, links with industries, and more. These factors make Pakistani students choose medical education abroad.
The fact that the committee is led by none other than the Minister of Finance Ishaq Dar speaks -volumes about the importance and the gravity with which the government has approached the task of identifying and filling the deficits in the capacity and quality of healthcare education. These include the presence of senior ministers and heads of medical teaching institutions in the panel to strengthen the credibility of the act. Nevertheless, the attempt to include such a large amount of work into a small 10-day period can be considered rather challenging and even unfeasible. Evaluating the current situation in healthcare education in the private and public sectors, assessing industry connections, studying the admission policies, and reflecting on the policies and regulations means conducting in-depth research and contemplation.
By doing so, it is possible to gain only very basic and superficial perceptions about the case and make recommendations that, while not amounting to true change, may be far from it. If it is to conduct thorough investigations, it must be provided with sufficient financial, structural, and workforce support and should be at liberty to operate independently.
On the same note, the commitment demonstrated by the government in assembling such a competent committee with a lot of force to address significant challenges in the healthcare education system in the country is commendable. The conclusion and recommendation have the possibility to establish radical changes; however, they can only be seen if the government acts quickly on its recommendations. This, therefore, presents the true measure of the willingness of the government to redress some of the core issues that continue to plague medical education and, by extension, the health sector in the country.
It can, therefore, be argued that change or reform in the face of medical education in Pakistan is very crucial. Currently, the country has a population of over 200 million people and lacks an adequate healthcare workforce, facilities and equipment. The current doctor-patient ratio stands at an abysmal 1:1000 compared to the WHO requirement of 1ml of vaccine per 100ml of water. The shortage of human resources in the system is also evident in the numbers of nursing staff and paramedical workers. Government expenditure on health care remains negligible, contributing to barely 2 to 3 percent of their Gross Domestic Product. The country also has a high incidence of infant mortality and death rates among expectant mothers.
Some of the missing pieces in the system and poor healthcare capacity and quality are a result of a faulty medical training system. Though there has been an exponential growth of new private medical and nursing colleges in the recent past, the problem is the lack of quality control and management focus. A higher number of smaller private colleges has a serious issue regarding the faculty, training facilities and hospital connections. Another area that requires scrutiny is the availability of a large stock of fresh graduates who are inadequately prepared with practical experience or employment.
The process of admission to educational institutions has been a contentious issue in the past regarding the lack of a stringent process as well as the lack of transparency in the process. Several complaints, such as private colleges demanding capitation fees and Competitive exams mainly centering on memorization, have also been made at some point. These issues include the high cost of tuition fees for medical education and the fact that the available placements for medical studies are also limited, forcing most intelligent students to consider studying medicine in other countries. Thus, the committee has core concerns on regulation, policy change and quality enhancement to dive deeper into.
Some of the areas that need the committee’s utmost attention include:
1. Admission into medical colleges should still be based on merit, as it has always been. To make it more comprehensive, it can comprise factors such as GPA, GRE, TOEFL, aptitude, experience in the healthcare sector, recommendation letters, and so on.
2. Today, it is high time that criteria like qualifications and experience required for a professor, trainers, etc., should be reassessed. There is a need to strengthen faculty development programs, exposure to the international curriculum and teaching techniques, etc. For nursing education, this may help to get senior hospital nurses to teaching positions.
3. Infrastructure, such as classrooms, hostels, libraries, skills laboratories, etc., should be assessed, particularly in small SEO private colleges. Likewise, to enhance theoretical understanding and encourage students to gain more practical knowledge, attachments at public hospitals, PHCs, and private clinics can be made compulsory.
4. It also follows the global medical curriculum, which needs to be enhanced and upgraded, especially in relation to the focus on practical training. It is necessary to encourage the practice of the best teaching practices throughout the world, which includes the use of teaching techniques such as interactive teaching methods, simulation laboratories, digital learning devices, etc.
5. One study suggests that there are insufficient interactions between medical graduates and actual patients for them to gain practical diagnosis/treatment skills. Thus, affiliation to hospitals and clinics for internships/residency programs should form the core of course offerings.
6. Similarly, norms and policies for attracting, developing and maintaining faculty talent, infrastructure and training resources should be the basic minimum processes required before a college can be licensed/accredited. License renewal may be periodically implemented to keep standards high.
7. This committee should assess other progressive systems practiced in different nations where the government partly funds seats in private tertiary institutions or provides student loans for deserving candidates. These systems can increase the overall capacity of the supply chain without necessarily weakening it.
The government has formed an investigation committee regarding the reform of medical education is a positive sign. However, it is still naive to expect an overhauling of the existing system anytime soon. The government should see this as just the starting point of an attempt to improve the overall environment of the nation’s economy. Change in policies, regulations, systems, and people’s perspectives towards the delivery of healthcare education will happen through ongoing dialogue and interaction with the key stakeholders, several rounds of feedback and brainstorming sessions, and long-term commitments.
These recommendations must call for change that would be most effective after an empowered medical education governing council that should comprise representatives from universities, the private sector, experts, etc.
The council can facilitate change management-be it in admission, faculty development programs, or college licensing-by creating awareness and gradually bringing about change. It should continuously track progress KPIs for the faculty-student ratio, number of practical training hours, number of internships, examination processes, etc.
More importantly, any change will require a major commitment of funds, and this is the main reason why any organization needs to conduct some level of analysis in order to determine the viability of the proposed change. Besides, the government’s agenda of increasing public health spending to 5 percent of the GDP may provide the needed elbowroom to fund medical education reforms encompassing subsidizing of seats, upgradation of infrastructure and training resources etc. At the same time, political and bureaucratic will is paramount for introducing such out-of-the-box policy initiatives as making practical training mandatory before issuing licenses to graduated doctors.
The problems that have now emerged in medical education can, therefore, be used as a platform to reform the system with structural changes that may revolutionize the healthcare capacity in the country. To what extent the government avails this opportunity can determine whether such incidents as Bishkek could be prevented from being repeated over and over again in Pakistani territory.
The author, a seasoned professional in the field of education (Political Science), holds the esteemed position of Director of ORIC and is an Assistant Professor at the Department of International Relations, MY University, Islamabad.
