Flawed medical education in Pakistan | Dr Ghayur Ayub, UK


Flawed medical education in Pakistan

UP until recently the medical education in Pakistan was given high ratings in the West. Not
anymore.Repeated political interference dented those ratings.

Things got worse when the old structure in preclinical and clinical education was not upgraded according to the evolving research-based knowledge. On preclinical side, physiology, biochemistry, and general pathology remain outdated.

On clinical side, the poorly prepared undergraduates are exposed to observe patients in outpatient departments, wards and operation theatres in tertiary care teaching hospitals with no exposure to community. At the end of five years, they appear in final examination of MBBS.

The fresh graduates coming out of such medical colleges perform poorly in western countries because of flaws in medical education in Pakistan.

Because of space shortage, I will highlight only two – one from preclinical and one from clinical side.

1) Preclinical: Recent advancement has revolutionized medical education especially in physiology, biochemistry and pathology. Take for example, cellular metabolism and its effect on health.

The undergraduates are given brief lessons on Kreb cycle without making them understand its importance in metabolism at cellular level and its fallout on diseases.

They are not taught the details of cell respiration, purpose of organelles, function of mitochondria, place of electron chain transport, danger of free radicals, production of ATP, working of nucleus, and performance of DNA. They all play essential role in metabolism.

The teachers do not teach the link between disturbed metabolism with chronic diseases such as diabetes, hypertension, kidney diseases, eye ailments, autoimmune diseases, cardiovascular diseases, heart attacks, strokes etc.

They are not educated on the importance of unhealthy food and how it can cause leaking gut that leads to metabolic syndrome.

How healthy diet improves cardiac health, lowers risk of cancer and keeps mind healthy preventing serious neurological diseases such as parkinsonism and Alzheimer’s.

On nutritional side, they are not taught how leafy green vegetables for carbohydrate, fish and chicken for protein, unsaturated oil for fat, fruit, vitamins, minerals and supplements are important to keep the body healthy.

How disturbed metabolism can produce endogenous toxins that cause inflammation and narrowing of arteries in heart leading to heart attacks or building up amyloid plaques in brain impairing cognitive functions. These are just a few examples on metabolism which is blanketed.

During boring lectures, half of the students keep yawning listening to the teachers who are parroting knowledge from textbooks the students read at home.

There is no research material or attraction in their lectures to stir eager minds and stimulate enthusiasm.

In practical classes, the undergraduates get hold of frogs and pith them mercilessly by banging their heads on the table to trace nerve conduction and muscle twitching on smoked rolling drums. Does it help the students in future professional life? It is an open question.

I can go on counting unnecessary subjects they are taught while ignoring those which really matter on clinical side or in their future professional career.

It is the same story in general pathology where the most important subject of immunology is not taught as it should have been. Anatomy is the only subject which is comprehensively taught.

The demonstrators take pains to teach osteology in detail and let students dissect dead bodies.

2) Clinical: After two years, they move to the clinical side where, for short periods, they are rotated between various specialties in tertiary care hospitals.

They come across patients with diseases which are not common in community.

Those patients had already been through primary and secondary care facilities at basic and rural health centers.

So, the students are deprived of seeing patients with common diseases prevalent in community.

After graduation, when they are posted in rural areas, they fail in their performance as the disease pattern is not what they saw in big hospitals.

To overcome such difficulty, the WHO introduced Community Oriented Medical Education (COME) especially for the developing countries.

The research shows that: 1) COME is relevant to the needs of rural communities and it has created impact on health services delivery in rural areas.

2) Majority students found COME to be useful, meaningful and enjoyable as the exposure help them acquire essential communication and clinical skills relevant to rural practices.

3) The welcoming reception and hospitality by the community members became a motivating factor for the students to go back to the community as doctors practise in rural areas.

4) Such trends remove the objections faced by the government over mal-distribution of doctors in the country.

5) The research shows “learning activity uses the community as a learning environment, in which not only students but also teachers, members of the community and representatives of other sectors are actively engaged throughout the students’ educational experience.”

6) The students are exposed to patients at the primary healthcare facilities who are different from the ones they see in tertiary care hospitals.
This helps them appreciate different categories of patients and learn how to deal with them.

7) The students learn about the preventable diseases prevalent in rural communities and compare them with curative diseases frequently seen in tertiary care hospitals.

8) COME addresses human resource gaps at the community level and in the long run it reduces financial burden on the government.

9). COME plays important role in rural outreach programs with positive impact on health services delivery.

10) COME falls in line with ‘Declaration of Alma-Ata’ (1978) on Primary Health Care identifying its role in promoting ‘Health for All’ strategy by exposing medical students to community so they can understand biological and non-biological determinants of health.

11) COME helps in developing leadership qualities, teamwork skills and management abilities in the students that help them in future practical life.

12) COME exposes the students to the level of poverty in the community and the need to help the poor to get access to quality healthcare. I can go on and on.

The government introduced COME in public and private sector way back in 1998/1999. I am told that except for Agha Khan Medical College, it was not implemented elsewhere.

Let us hope that the government of Imran Khan put the medical education on the track of research-based knowledge and let the fresh graduates regain the high ratings Pakistan, once, was known for. Ameen.
— The writer is contributing columnist, based in London.

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