The State of Medical Education and Training in Pakistan

While the world has moved ahead in leaps and bounds in terms of advancement in medical education, Pakistan has actually moved backwards and institutionalized mediocrity in every aspect of this noble profession, opines Dr Sohail Rao, a medical professional par excellence.

n 1910, the Flexner Report started the revolution in medical education and training in the United States and Canada. Published by the Carnegie Foundation, this comprehensive report concluded that the education offered by the 155 medical schools surveyed at that time was substandard and recommended major changes, which included (among others) emphasis on a process for student selection, duration of the curriculum and closure of “proprietary” schools. 

Since then, medical education and training has undergone seismic changes catapulted by the mapping of human genome – the largest collaborative biological project that was completed in 2003. Genetic mapping has given birth to a new era of medicine dominated by “personalized” care and “population” health. It is generally believed that with the advent of artificial intelligence combined with digital revolution and advancements in medical informatics, the field of medicine of tomorrow will be radically different from what we practice today and totally unrecognizable of what we have practiced in the years past. 

Having graduated from Dow Medical College in 1983, and with over three decades of experience in various senior leadership positions in Tier I universities, medical colleges and health systems in the United States, I returned to Pakistan last year with the explicit purpose of learning more about what advances have been made in education and training of future workforce in health sciences. My focus was to evaluate undergraduate and postgraduate education and training programs particularly in medicine in the country. 

I must admit that I was overtly disappointed to note that instead of embracing rapidly evolving innovations in medical education, research and clinical care, Pakistan has unfortunately regressed and has institutionalized mediocrity in every aspect of this noble profession. I have summarized my observations into distinct challenges with proposed solutions that are iterated below. Before I proceed, I must state that this narrative is not an attempt to malign any person or institution in Pakistan but an expression of a sincere Pakistani who wishes to see nothing but a thriving homeland with an outstanding health care network. Additionally, while my focus in this manuscript is limited to education and training in medicine, observations similar to those noted below are also widespread in other disciplines such as pharmacy, nursing, healthcare administration, public health, etc.

Challenge I:

Pakistan Higher Education Commission (HEC), Pakistan Medical & Dental Council (PMDC) and College of Physicians & Surgeons of Pakistan (CPSP) have made no material change in the curriculum of undergraduate & post-graduate programs in the last 3-4 decades. This is despite of the fact that during the same period these curricula have undergone radical innovations in North America and other western countries. Our curriculum still relies on:

      • Lectures rather than Problem-based learning
      • Memorization rather than acquisition of knowledge
      • Organ-specific teaching rather than System-based approach
      • Discipline-specific teaching and training with minimal interdisciplinary interactions
      • Minimal use of technology
      • Nominal focus on evidence-based, patient-centered clinical care and creating life-long learners

Proposed Solution:

      • Invite external reviewers from United States to modernize the curriculum
      • Create an External Advisory Board of experienced educators from North America and United Kingdom to advise and educate HEC, PMDC and CPSP of the rapidly evolving innovations in teaching and learning in various disciplines of health sciences

Challenge II

  • HEC, PMDC and CPSP must promote innovation in medical and dental education 

Proposed Solution:

  • Give medical and dental schools reasonable freedom to adopt new methods of teaching and training and to innovate with the aim towards creating a life-long learner
  • Allow medical and dental schools to modify the structure of various departments and disciplines to best support innovative curriculum
  • Many medical schools in North America have disbanded discipline-specific departments in favor of creating interdisciplinary schools/programs

Challenge III

  • Both HEC and PMDC take an inordinate amount of time to review and approve paperwork creating unwarranted delays in approval/accreditation of programs with downstream adverse impact on the students as well as the institution

Proposed Solution:

  •  HEC and PMDC must streamline their review and approval process with defined turn-around time and close monitoring of time-to-approval with accountability and transparency

Challenge IV

  • HEC equates FCPS to be equivalent to an MPhil

Proposed Solution:

  • FCPS must to equated to a doctoral degree

Challenge V

  • HEC does not have adequate number of highly knowledgeable personnel in the area of health sciences education & training

Proposed Solution:

  • HEC must eliminate this deficiency by hiring relevant personnel with optimal experience & expertise

 

Challenge VI

  • Unlike a common practice in medical schools in North America, PMDC does not allow instruction in basic sciences to medical students to be delivered by PhD faculty who do not concurrently possess a medical degree (such as MBBS)
  • This has created difficulty for basic science departments to recruit faculty with attended consequence of less than desirable teaching and a burgeoning dearth of faculty.

Proposed Solution:

  • Allow PhD faculty who do not possess a medical degree to teach courses in basic sciences to medical students

 

HEC, PMDC, CPSP and all regulatory authorities have to evolve and accept the fact that education and training programs in health sciences in Pakistan need massive transformation to meet the burgeoning healthcare needs and the use of tools (such as, artificial intelligence, genetics, personalized medicine, etc.) to address the same. These innovations must become a regular part of the curricula in health sciences along with education and training in areas such as behavioral sciences, leadership, communication and similar skills that when delivered together creates a healthcare provider that is most suited to serve the community.

About the Author

Dr Sohail Rao is a seasoned medical professional with over three decades of experience in various academic and non-academic leadership positions in healthcare systems around the globe. He is the President & CEO of DHR Health Institute for Research & Development, DHR Health System, Texas, USA and Executive Vice President for Research and Development at DHR Health System, Texas.