Vision to promote health professions education in Pakistan

Abstract

About 100 years ago, a series of studies on the education of health professionals (namely, Flexner report 1910¹, Welch-Rose report 1915² and Goldmark report 1923³) pointed out poor quality and standards of education in medicine, public health and nursing. These reports had far reaching effects on the healthcare system and the health professions education system in North America in the next few decades.

One hundred years later, a global independent commission on Education of Health Professionals for the 21^st century highlights healthcare and educational issues;

“Glaring gaps and inequalities in health persist both within and between countries. At the same time fresh challenges in the form of new infections, environmental issues and behavioral risks threaten health security of all. Professional education has not kept pace with these challenges, largely because of fragmented, outdated and static curricula that produce ill-equipped graduatesâ€.⁴

A number of eminent educational scholars have pointed out the challenges being faced by health professionals’ education in the 21^st century.^5-8 These challenges range from curriculum design, learning and teaching, assessment, faculty development to relatively newer issues such as internationalization of health professions education, digitalization, professionalization and social accountability of educational institutes. After a century of rapid progress, consolidation, but more recent ossification, health professionals’ education is poised once again to enter a new epoch of transformation.⁹

One of the major changes in the perspective of health and education planners is increasing importance of health and health professions education as a global subject. According to Harden, ‘Internationalization is fast becoming one of the most important and increasingly complex forces in higher education’.⁵ Some of the factors leading to rapid internationalization of health professions education include: globalization of healthcare delivery; government pressures; improved channels of communication; the development of common vocabulary; outcomes based education and standards and competitiveness and commercialization.⁵ For developing countries such as Pakistan, internationalization means that the Pakistani educational institutes will focus on producing health professionals that are competent to meet the demands of both national and international healthcare markets.

Historical perspective of health professions education in Pakistan

Historically, in Pakistan, the requirements for health workers are affected not only by the development of its health services and teaching institutions but also by the state of its political and economic structure. In 1947, when Pakistan attained the status of an independent country, there was only one fully functioning medical college in Lahore and two partially functioning medical colleges in Dacca and Karachi, to serve a population of about 72 million. By 1960, Nine new medical and dental colleges were established in public sector.¹⁰ By 1980,  this number rose to 16 colleges, with approximately 4000 seats, to serve a population of over 80 million.¹¹ All these colleges were established in the public sector. Agha Khan Medical College secured a distinction as the first medical college established in the private sector in 1983.

Since 1990, Pakistan has seen a surge of medical and dental colleges, established both in the public and private sectors. Today, there are 132 medical and dental colleges in Pakistan, 50 in the public sector and 82 in the private sector, to serve an estimated population of 182 million.^12 

The issues being faced by the health professions education system in the country have been highlighted previously.¹⁰ On a broad spectrum, these problems extend from undergraduate medical education, through postgraduate medical education to continuing professional development. Key issues on this spectrum relate to the quality and credibility of curricula under use, the education and training of faculty and the reliability and validity of assessment methods. The overarching root cause of these issues is the crises in educational leadership, management and regulation at the national level.

Several strategic initiatives have been taken to regulate health professions education in Pakistan. A major step was the establishment of three medical universities in the three provinces to oversee medical education affairs, at the undergraduate and postgraduate levels. The University of Health Sciences Lahore was established in Punjab in 2002, Dow University of Health Sciences established in Sindh in 2003, and Khyber Medical University established in Khyber Pakhtunkhawa in 2007. Out of a total of 132 medical and dental colleges in the country, over 50 percent are affiliated with these three universities.

Health professions education initiatives taken by the Khyber Medical University

Khyber Medical University was established by the government of Khyber Pakhtunkhawa in 2007 to regulate the educational affairs of over 25 of its affiliated health sciences institutes. The leadership of the university realizes the educational challenges being faced by the university to provide quality medical education in the province through its affiliated institutes. Largely, these challenges pertain to educational delivery processes, including modernization of curricula, prevailing use of traditional pedagogical methods, and validity and reliability of the current assessment system. The university realizes that the root cause of most of the educational challenges lies in the following key issues:

• The number of qualified health professions educationists is inadequate in the country, and in the province of Khyber Pakhtunkhwa.
• Until recently, health professions education was not a recognized profession and specialty in Pakistan.
• Medical education departments and related infrastructure do not exist in health sciences colleges.
• There is lack of opportunities for faculty development in health professions education institutes.
• There is little research done on educational issues in the country.

A robust and multi prong health professions education strategy is prepared by the university to address current challenges:

• To send faculty abroad to get education and training in health sciences, including health professions education.
• Initiate a Master in Health Professions Education programme in the university.
• Initiate a teacher training programme to provide basic training to all faculty.
• Advocate the recognition of health professions education as a recognized specialty in the Pakistan Medical and Dental Council Register.
• Provide opportunities to local faculty for conducting research on HPE issues in Pakistan to produce local evidence.
• Develop infrastructure for establishing HPE departments in educational institutes.
• Promote professionalization of health professions education.

For past five years, the University has been actively working on the above mentioned strategic issues. The cornerstone of the University strategy was self-reliance and efficient use of its resources. The Higher Education Commission of Pakistan and The Pakistan Medical and Dental Council fully supported the University to implement its vision of promoting HPE in the province. These five years have been marked by important achievements:

• Graduates have started returning to Pakistan after completing their higher education in health sciences including health professions education from abroad
• Master in HPE was established in July 2011. The programme is running successfully, and recently inducted its fourth batch.
• A basic level teacher training programme (called Certificate in HPE) was launched in 2011. The programme is successfully conducting four sessions per year and has provided training to over 100 teachers so far.
• Institute of Health Professions Education and Research (IHPER) has been established in the university to provide leadership and training, and conduct research in HPE.
• The Pakistan Medical and Dental Council has recognized HPE as a profession and a specialty.
• It is now mandatory for all medical and dental colleges to establish a department of HPE.
• Two successive international conferences on HPE have been conducted by the university in 2013 and 2014. The third conference is planned for March 2015. These conferences have played a major role in raising awareness about HPE in the province.
• The Journal of Advances in Health Professions Education has been launched primarily to promote research at local level and provide opportunities to Pakistani researchers for publishing locally.

The university realizes the challenges in changing the traditional, teacher-centered pedagogical system based on behaviorism, to one that is student and community-centered based on social constructivism. However the university believes that, with clear vision, positive approach and persistent effort, significant changes can be brought to the system in due time. We hope this journal will play a positive role in strengthening the educational research system in Pakistan, by providing opportunities to national and international researchers alike, to address educational issues in a global context.