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Excellence in Medical Education
الأربعاء 22 ذو الحجة 1441
Wednesday 12th August 2020
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Role of accrediting bodies in promoting/regulating medical education in Pakistan
Khadija Iqbal
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Journal Reference:
Volume 11 - Issue 4     July - August 2019
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Medical education has been under transformations over the past few decades. The old concepts have been replaced with new ideas. Health care system is now targeted towards patient care1. The curriculums are designed to target those outcomes which can help to achieve better diagnosis and management of the patients. The achievements of the patient outcomes is according to certain standards and guidelines which are nationally and internationally acceptable2. Guidelines for the accreditation of basic medical education have been developed by the World Federation for Medical Education (WFME) along with the World Health. These guidelines ensure that the medical schools should deliver curriculum in an appropriate way to achieve those outcomes3.
The accreditation process is not a single step process. Firstly the presence of accreditation body for a particular country is a mandatory requirement. Development of standards to achieve patient based outcomes is the next step. General Medical Council (GMC) , UK, is one such example which grants accreditation to the medical schools when these fulfil certain standards. GMC has published the latest and recommendable guidelines in the form of Tomorrow’s doctor4. The subject based curriculums were replaced with integrated outcomes which were desirable for the undergraduates. The empowerment given to GMC has led to dramatic changes in the curriculum in UK5. Funding was provide to Liverpool and Glasgow universities to move from subject based curriculum to problem based learning6. Annual monitoring by GMC ensures quality assurance in the process of transition of the curriculum. Australia is also following WFME guidelines to set up standards for the medical education7.
In Pakistan PMDC is the official authority for the recognition and accreditation of the medical schools. Since 1962 Regulations have been formulated and revised many times to achieve desired quality education in Pakistan8. The newly laid standards by the PMDC are very elaborate and meeting these standards ensuring the quality medical education is an uphill task. These have been categorized as essential standards and quality standards. These encompass the curriculum as well as assessment plus the logistic facilities provided to the faculty as well as the students for smooth running of the curriculum9.
PMDC is facing many challenges for standardization of medical education in Pakistan. Formulation and powers of executive committee of PMDC are disputable and no one knows the limits to which the PMDC can alter the medical education systems10. The fact that most of our regulation come from the ministry of health and not from PMDC is a disturbing factor11. Most of the regulations need approval from the senate and ministry of health. So the autonomy of this accreditation body is hurt on many occasions. The main challenge for PMDC is that a vast majority of our graduates leave this country and go abroad for the sake of earning and specialization. They have to fulfil certain criteria in order to get certification for entry into US from the Educational Commission for Foreign Medical Graduates (ECFMG)11. ECFMG has announced that, after 2023, all applicants for certification will be required to have graduated from an accredited medical school, have to appear in PLAB in order to get job in UK3.
The increasing number of recognition of private colleges is also putting a question mark on the credibility of PMDC. Government colleges once dominated but now the private colleges have outnumbered them. Although private medical colleges have opened the doors of health care and medical education for the far flung areas in Pakistan but quality of medical education as well as healthcare is not satisfactory. The number of private medical colleges is around hundred while number of Government medical colleges is less than fifty12. In Bangladesh the number of medical colleges in private sector is more than public but India is now combating the situation and increasing seats in public sector. The association of business mind-sets and politics in medical colleges is a hurdle to set uniform standards for quality assurance for all the medical schools in the country13.
The biggest role and responsibility of PMDC is changing the curriculum from traditional to an integrated one. The past few decades have witnessed numerous trends in transforming medical education including the development of educational frameworks, competency-based education and increased demands for compassion and care from the healthcare providers14. When we are talking about change in the curriculum we need to change the inherited traditional discipline based curriculum which has produced thousands of our ancestor doctors. The curriculums need to be modified according to the social needs of the community on a regular basis. The teaching and learning have to be linked with the assessment6. The PMDC has a crucial role in defining the parameters for the evaluation and assessment so as to match the level of our graduate with the international standards. Inclusion of ethics and professionalism, behavioural sciences and research in the curriculum is another emerging challenge for the PMDC7.
The accreditation process is highly recommended to ensure quality standards for medical education. This role is well performed by the PMDC. Facilitation for the provision of SOPs regarding transparent selection procedures, entrance examinations, centrally regulated curricula, self-evaluation and academic audits conducted by the institutions themselves, along with involvement of external examiners for national examinations before licensure are the highlighted things for ensuring quality standards. However for International accreditation WFME is working efficiently to ensure quality standards for medical education around the Globe. The working of WFME is strengthened by strategic partnership with WHO.
The PMDC is a huge body in its own capacity knowing that it is the sole authority for regulating the medical colleges but an insight will show the limitations of this organization4. The government has to empower PMDC more than the existing status but the inclusion of more visionary leadership in this body is required to accomplish the task of accepting the challenge for training Tomorrows Doctor in a conducive environment15.
Iqbal K. Role of accrediting bodies in promoting/regulating medical education in Pakistan. Isra Med J. 2019; 11(4): 206-207.

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