Islamabad

Friday, January 22, 2010

Our correspondent

Time to revisit education, training of healthcare

professionals.
The education and training of healthcare professionals needs a serious revisit. Behavioural
sciences must be included in the curriculum and a programme on human resource development
should be developed for people involved in patient care.

This proposal was floated by Professor Mushtaq A. Khan, child specialist and ex-dean and
executive director of the Pakistan Institute of Medical Sciences (PIMS), while chairing a seminar
on ‘Medical Education for Healthcare Professionals.’

Organised by the Department of Medical Education of PIMS, the seminar was based on the
theme ‘Be a self-learner and hence become a lifelong learner’ and represented the first occasion
where an educational activity was attended by all categories of healthcare providers ranging from
students, qualified senior and junior nurses and paramedics to junior doctors and specialists.

Professor Mushtaq was of the opinion that the doctor-patient relationship cannot flourish without
appropriate exercise of communication skills when dealing with ordinary people and layman.
Lack of proper documentation and casual record keeping are other factors that affect patient care,
leading to lack of continuity of care, he stated.

Dr. Mushtaq particularly called for prioritisation of documentation and communication skills in
all training programmes for healthcare professionals. “Not documented means not done. Free and
frequent communication in simple language satisfies a patient and hence minimises chances of
complaints being lodged against doctors. Proper documentation protects doctors in case of a
complaint. So communication and documentation not only promote a healthy doctor-patient
relationship but also save the former from unnecessary stress and finger-pointing by the public,”
he stated.

Professor Dr. Tanweer Khaliq, general surgeon at PIMS, shared the step-by-step approach for
imparting surgical skills, where a trainee is taken from a less complicated to more complex tasks,
progressively learning more and more difficult procedures till he becomes an independent expert.

Dr. Muhammad Saaiq from the Department of plastic surgery focused on the value of evidence-
generation by virtue of research and the resultant authenticity of the evidence so produced. He

1
called for high-quality evidence being generated by experimental and quasi-experimental local
studies in the indigenous environment. “Research produced by local scientists in local
circumstances and with the involvement of local people is always more useful. However,
‘search’ is important before ‘research’ to prevent reinvention of the wheel,” he stated.

Dr. Mohsin Mahmood from the World Bank referred to the objectives of health professionals’
education. These objectives need to be SMART i.e., Specific, Measurable, Attainable,
Reproducible and Time-based. “The lack of clean and crisp objectives creates confusion instead
of clarity in the mind of the learner,” he pointed out.

Dr. Samina Mohsin highlighted the basics of evaluation and emphasised that evaluation must be
done more often during the training period and that competency certification must not entirely be
left to the final evaluation. Brigadier Mawadat Rana talked about cognitive philosophy and
explained how a trainee learns better when he gets emotionally involved and starts enjoying
learning new concepts.

Professor Umar Ali Khan, Associate Dean of Ripha Academy of Research and Education made
an excellent presentation on scholarship. He defined scholarship as original research done by an
individual scholar, peer reviewed and disseminated. “Such scholarship is useful only when it has
clear goals, is executed with adequate preparation, brings out significant results, is presented in
the effective way and its critique is done dispassionately,” he mentioned. He also stressed the
need for rewarding excellent teaching and scholarship if an institution or society wishes to fulfil
its mission.

The lectures were followed by an interesting presentation by Professor Jehangir Akhtar, dean of
Al-Shifa Trust Eye Hospital and dean of the Faculty of Medicine at the Quaid-e-Azam
University. He beautifully described the change in emphasis in training programmes. Previously,
more emphasis was placed on the moral and ethical training of students. With the advent of
‘information technology,’ more attention is being paid to minutest and sometimes irrelevant
details. “This magnification of details has led to compromise of the holistic approach to patient
care. Where specialisation has helped to achieve higher academic standards, it has taken the
physicians’ attention away from the patient as a whole,” he rightly pointed out.

The socio-economic stress of modern times has led to a trust deficit between both doctors as well
as patients. This has resulted in deterioration of the doctor-patient relationship which, at times,
appears to have a businessman-and-client status. Professor Jehangir advised professionals to
improve their attitude with patients.

Professor Khaleeq-uz-Zaman talked about systems approach in medical education. He pointed

out that most of the supervisors in health professionals’ education are not trained in the subject.
Education needs to be learner-oriented, rather than teacher- and programme-centred, and the
objective should be to ascertain whether or not the learner has achieved certain competencies.
Once the objectives are clear, instructional strategies can be individualised and evaluation can be
done to ensure that the objectives are achieved. “This will inculcate self-learning and hence
enable a qualified doctor to become a life-long learner through continuing medical education and
professional development,” he said.

2
Dr. Khaleeq called for establishment of departments of medical education in all medical
institutions. “These departments should be manned by qualified educationists and must have a
well thought-out educational programme and curriculum so that health professionals are trained
in a well-organised manner. The results of such a programme will be obvious in the shape of
gradual improvement of the standards of professionals and hence patient care.

The presentations were followed by a lively discussion. Every participant received a certificate
of CME (Continuous Medical Education) certificate equal to three credit hours. The participants
proposed holding of similar programmes on a regular basis.