PG medical education: Platform for excellence

The establishment of a National Board to run a programme similar to post graduation is under process. To copy a good system is always correct‚ but we should also look at our infrastructure and capabilities to run those kinds of programmes

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DR BASANT BHATTARAI & DR AJAY RISAL
Medical education is considered to be one of the toughest subjects and excelling in its clinical skills itself is a herculean task. MBBS graduates are capable of having life-saving skills which entitles them to look forward to treating patients and performing deliveries, immunizing babies and also providing comprehensive health care services to the needy community.

Initiation of medical education in our country by the Institute of Medicine (IOM), which is unique for its kind, provided the country with skilled manpower and technical expertise, capable of working at the community and primary care level. At the same pace, BPKIHS of Dharan also initiated its programme which could only partially meet the demand of ever growing need of skilled doctors. In this scenario, Kathmandu University came forward taking a bold initiative, affiliating private medical institutes, providing a growing number of technical expertise capable of working by and large in different parts of the country and offering free seats through the Ministry of Education. We should also not forget the contribution from our neighbouring counties for providing educational opportunities to us (Nepali students). The government sector has also contributed in this regard through NAMS (Bir Hospital) and the recent entrant (Patan Academy of Health Sciences). Now, more than 1000 doctors are being produced every year in this country to meet the demand of the ever-growing population.

These doctors need further training and expertise to become more qualified, updated and professional in their field. Seeking MD or MS confers them to practice as an independent specialist of their wish. In this scenario, IOM and BPKIHS have been providing post-graduate education to doctors, but the seats are limited. Kathmandu University initiated a hybrid system of training their graduates in India and later on started affiliating institutions with capabilities to run post-graduate education. NAMS (Bir Hospital) has also been providing such a kind of programme. Fascinated by MD or MS, each graduate has a dream to pursue a degree of excellence. But, due to the “Demand-Supply mismatch” in our country, many graduates willing for post-graduation are being unable to get seats and are opting for alternative ways.

In this scenario, the establishment of a National Board to run a programme similar to post graduation is under process. To copy a good system is always correct, but we should also look at our infrastructure and capabilities to run those kinds of programmes. To date, none of the private hospitals have full-time doctors in all the specialities. There may be a debate that a consortium of hospitals may be able to run the programme, but those hospitals that have facilities are already running as training centres for foreign institutions and even some are running parallel programmes which is not rational. As many centres are running with limited number of service providers, it’s not trustworthy to have many students under one person at different places. It is good to look into the provisions of other nations too. In India, DNB (Diplomat of National Board) was not independently recognized by MCI till 2009, despite being considered equivalent to MD. Similarly, even after completion of FRCA in UK, the fellow cannot be a consultant until he/she has undergone a comprehensive structured training for seven years.

Although countries like India, Bangladesh, and Pakistan have a dual system of recognition, there is always a tussle between graduates about the superiority of one over the other. For instance, MD degree-holders claim themselves as having an academic degree whereas FCPS fellows declare themselves as being more knowledgeable since they passed tougher exams. Even though the programme is run by the board, the graduates are sent to government academic facilities in Bangladesh for further training, in view of the abundant resources and faculties at government hospitals. In India, there are DNB accredited centres having facilities acceptable for training only for a fixed speciality with the desired number of consultants who are working full time in that institution. The exams are conducted by appointed professors from different parts of the country.

In Nepal, where the hospitals lack essential infrastructure for running a post-graduate programme and are dependent on a foreign country like India for faculties, and even in the government set-up, doctors having enough cases are running to different hospitals for practice. How substantial and valid will this kind of programme be? On the other hand, running these kinds of programme may give temporary benefit as the government is unable to recruit manpower even in the government centres. Academic manpower treating patients will certainly do more good than harm.

Keeping these issues in the background, we need to seek the role of Nepal Medical Council, which is not able to provide any obligatory or statutory warning to any hospitals or institutions so far. In this regard, some of the contestants in Nepal Medical Council election had pledged to start free post-graduate studies in government or district hospitals. Is this a fact or fiction?

source:BHATTARAI,DR BASANT & RISAL,DR AJAY(2013),"PG medical education: Platform for excellence", The Himalayan Times,13 Sep 2013
Dr Bhattarai & Dr Risal are with Dhulikhel Hospital

2013-09-13 | EducateNepal

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