Medical education in Nepal: Impact on doctor's image

We are losing our influence as doctors. We are not politicians but professionals. We need to search our souls‚ accept that we have not been perfect and try to find our way back to where we were. We need to win the respect of patients and that will begin only when we go back to ethical practice.

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There was a time when the Nepali doctors were not interested in the Nepal Medical Council (NMC) and its activities. But, that has changed following the arrival of private medical colleges and hospitals, an increase in the number of doctors, the ever-growing demand for higher education in medicine. This has also increased the activities of the Council and its role has become pivotal, so much so that all positions in the Council are becoming more attractive to doctors than just practicing their vocation. This explains why the number of doctors contesting for the NMC positions in the upcoming election has increased. This has also led to forming of panels backed by political parties and publication of election manifestos. The interest in seeking a position there also indicates the power that it brings to the incumbent.

The educational system, however, still fears change and therefore faces the danger of becoming irrelevant soon. The outdated modes of teaching and examinations are still the rule and therefore there has been a continuous deterioration in the standard of medical education and the quality of the graduates.

Medical ethics is now largely limited to only the time when doctors take the Hippocratic Oath. The only progress there is to show about the sector today is the increase in the number of medical colleges. Here too, there is a great disparity in the quality of the colleges, it includes both the good, bad and ugly ones.

With the Medical Council also turning into a party organization, a medical institution recognized by it is no longer a guarantee that it is pursuing its objectives in a satisfactory manner. Students seeking only a degree and not knowledge and skills, teachers who do not teach but attend classes and non-performing institutions are unfortunately not uncommon in both the private and government sectors. In effect, the expansion in numbers has taken place at the cost of quality.

The curriculum for medical education in Nepal is outdated and the teaching approach lacks innovation. Practical training, for example, is considered to be least important as is usually left for learning on the job. The interns also are least interested and prefer to prepare for higher education entrance examinations abroad, mainly in the United States or the United Kingdom.

The most important factor that determines the quality of the students graduating from a medical school is the quality of the teaching staff. Teaching performance of teachers can either excite and encourage or discourage those around him or her paramedics, non-medical staff and certainly the medical students. Proper pay, perks, incentives, additional provisions, opportunity for continued medical education and requisite scientific and departmental infrastructure can bring back the desired work culture and ethics to medical education. But, the situation is just the opposite; there is a large gap between demand and supply of faculty positions. Well-qualified and adequately trained doctors are no longer attracted by the medical institutions, because they are not paid well and are also not provided the basic facilities and infrastructure to work in.

Admissions to post-graduate courses today have become a nightmare for the graduates. The happiest are those who get selected for the MBBS course and most unhappy ones are those who after passing the level have to go through the NMC license examination, and need to search for medical colleges to pursue postgraduate education abroad. This is when they realize what the quality of instruction was at their educational institutions. The public image of doctors, including super-specialists, in Nepal has not been very good. Doctors have lost the traditional admiration and respect from the public. Ethical practice is also deteriorating and patients are rated according to disease, investigations, modality of treatment and referrals.

Nepal has very good doctors and there has been enormous development in medical services. But, the public does not trust the services which is often manifested in vandalism, and controversies that emerge after mortality. Many patients prefer treatment abroad and this includes everyone who can afford the treatment and consultations. Sadly, even political leaders, heads of state agencies and those who can get the State to cover the expenses want to go abroad. Even the president who is a medical professional opted for going to Japan for a check-up. This practice does not bode well for the professional development in the sector.

We have lost our way. We are losing our influence as doctors. And, rather than anything else, our own success and reluctance have contributed to creating this situation. We are not politicians but professionals. Politicians come and go, professionals need to do what they need to because only then they remain professionals. We therefore need to search our souls, accept that we have not been perfect and try to find our way back to where we were. We need to win the respect of our patients and that will begin only when we go back to ethical practice. NMC can provide the leadership for taking us to where we were, or else we will be fighting a battle that we are destined to lose.

source:SHARMA,DR UMESH KUMAR(2013),"Medical education in Nepal: Impact on doctor's image", The Himalayan Times,25 August 2013
Dr Sharma is a consultant radiologist

2013-08-26 | EducateNepal


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