Some ten odd years ago in a meeting of the ‘Academic Council’ of King Edward Medical University (KEMU), once known as King Edward Medical College (KEMC), ‘improvements’ were discussed that occurred after we became a university. Out of curiosity during this discussion, I asked the professor of pharmacology whether his department was still teaching medical students how to dispense powdered medicines in folded paper (purias). An art almost as exquisite as origami.
I was stunned when he said yes. I still remember that that was a skill I was forced to acquire fifty years ago as a student in KEMC but it was sadly a skill I never had a chance to demonstrate to my colleagues in the United States over more than the three decades that I trained and then worked there.
Having returned to Pakistan a couple of years earlier after having been involved in teaching of medical students, physicians in training, nurses, and different levels of ancillary medical staff while in the US, I was surprised beyond belief about what was still being taught to medical students in supposedly the best medical college in the Punjab and arguably in all of Pakistan. And more importantly what was not being taught.
As a professor of cardiac surgery, a non-examination subject I had little ability to influence the curriculum in any ‘core’ subject. Core subjects are anatomy, physiology, pharmacology, pathology, medicine, surgery, ophthalmology, ENT, obstetrics, and gynaecology.
Interestingly, an MBBS degree still states that the recipient of that degree is authorised to practice medicine, surgery and obstetrics. Of course he/she is not capable of doing any such thing but that is a discussion for another time.
The present curriculum with few changes was basically designed almost a hundred years ago during the Raj with the idea that the graduates of medical institutions like KEMC would go out and practice medicine in the community as my eldest uncle did in the nineteen thirties and my father a bit more than a decade later. However, a graduate today needs to learn a lot more but the present curriculum is totally inadequate.
Here it is important to mention that the KEMU Act of the Punjab Assembly that created KEMU in 2005 mandates a curriculum development committee in KEMU. During my seven years as professor and chairman of a teaching department in KEMU, I never saw this committee in action.
After the folded paper incident and after realising that I really had no ability to influence curriculum development in KEMU, I did what I could. I went back to my friends and former colleagues in the US that were a part of the King Edward Medical College Alumni Association of North America (KEMCAANA).
I managed to convince the office bearers of KEMCAANA that they absolutely had to have a meeting about curriculum development in KEMU to try and improve the situation. Fortunately, many of the members of KEMCAANA had arrived at a similar conclusion after visiting KEMC over the last many years.
So we had a one-day meeting on the issue of curriculum development in KEMU in 2008 where important matters were discussed and brilliant presentations presented along with a great tea interval. And that, as happens in much of Pakistan, was it. I stayed on in my position in KEMU for a few more years after that and saw that little change happened.
As a head of a department in Mayo Hospital, I was allowed to hire a number of house surgeons every year. For some reason my comparatively small department of cardiac surgery became one of the more popular departments for house jobs among recent graduates with the highest merit. Not being given to a belief in my brilliance as a teacher and my excessive personal charisma I did try and figure out the reason for the popularity of my department for house jobs.
The tip off was that of the roughly two dozen house surgeons in my department at any given time, only three or four turned up every day on a planned ‘rotation’. Clearly then it was neither my teaching ability nor my charisma that brought them to my department. Most of the people who came to my department were trying to prepare for the exams that would allow them to go to the US for further training.
Since my department did not have an emergency call so there were few night calls. Therefore, the house surgeons working in my department had more time to study for their ‘steps’ (US exams). And since I was US trained and qualified as well as a Fellow of the American College of Surgeons (FACS) and a Fellow of the American College of Cardiology (FACC), my recommendations evidently carried more weight in applications for clerkships as well as residencies in the US.
The important point that I want to make here is that some of the best students from KEMU who wanted to go to the US for further training would essentially take a year off to do house jobs in my department while they studied for the US exams. That of course presumes that what they were being taught as MBBS students in KEMU was entirely inadequate for taking examinations that most US medical students have already taken before they finish medical school.
This in no way suggests that our medical students are inferior to US medical students. An important point worth making here is that most of the recent graduates from KEMC/KEMU that make it to the US do quite well during training as well as when they go into medical practice.
What it does mean is that our medical students are not being taught all that they could be due to the limited established curriculum. Limited curriculum is in my opinion a result of the limited ability of our teachers to teach and not limited by the ability of our students to learn.
If we expect that most of the medical graduates in Pakistan will end up diagnosing common problems and up pushing anti-malarial and anti-diarrhoeal pills then why bother teach them about the intricacies of the genetic basis of disease.
During my time on the faculty of KEMU, I pushed the idea that KEMU in collaboration with KEMCAANA should develop a visiting professor programme. US trained alumni visit KEMU and Pakistan for a few weeks every summer and have teaching programmes that prepare students for US exams. Of course the local faculty thought of this idea as an insult to their breadth and depth of knowledge.
Therein lies the problem of higher education in general as well as in medical institutions. Most of those that hold senior faculty positions in our teaching institutions are unwilling to accept that they are really not qualified to teach the latest developments in their fields of ‘expertise’ since sadly they themselves have not kept up with them.
Rumour has it that a professor of medicine at KEMU was asked a few years ago about his choice for the best textbook of medicine. His response was, “I don’t read medical text books. I am the best medical text book myself.” That sums up the problem.
The author served as
professor and chairman, department of cardiac
surgery, King Edward Medical University