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Doctors need both a qualification and a licence to practise
View(s):As many voices of reason came out strongly this week from Colombo to bring about an end to the SAITM issue, there arose a firm echo from the Peradeniya Medical Faculty.
Prof. Rasnayaka M. Mudiyanse
“A great majority of us believe that SAITM should be shut down,” said the President of the Peradeniya Faculty of Medicine Teachers’ Association, Prof. Rasnayaka M. Mudiyanse.
He is categorical that the selection process of students for SAITM’s medical programme is not right. Usually, the ‘gold standard’ is performance at the Advanced Level (AL), where the most competent are selected to undergo the MBBS curriculum. The criterion of three AL passes for university admission even though laid down by the UGC does not apply for medicine.
When asked why, his answer is very clear – it is because the SAITM students who have low marks at the AL will be competing for limited internships in the state hospitals along with the cream of the AL students who have achieved a very high Z-score to enter state medical faculties. Is this fair, he queried.
Prof. Mudiyanse reiterates that medicine is “different” to any other profession. Once doctors pass out of medical school and get registration from the SLMC, they deal with human lives. This is why the quality of training in medical school matters and carries much weight. It is not just a matter of being “trained” to pass the Final MBBS, face vivas and spew out case histories.
All students in the state medical faculties get a thorough training in hospital wards, interacting with patients, while it also matters how many night rosters they have done, he says, explaining that they spend a long time talking to patients, examining the patients, looking at investigations, putting forward a diagnosis and a management strategy and presenting the findings to a teacher. “Our students do it repeatedly, over and over again.”
The argument that SAITM students have had one-to-one teaching from Consultants does not hold any water, for then they would just be given a scenario, along with a story and they would be coached how to answer multiple choice questions (MCQs) and other questions and how to face a viva. With that, they can pass an examination and this is called ‘didactic teaching’ or teacher-centred teaching, he said, as opposed to experiential learning or learner-centred learning.
He stressed that the process of teacher-centred teaching is good to pass examinations but not to become a doctor, because in medicine there is a need to inculcate attitudes and bring about behavioural changes. This comes about by spending long hours in wards and feeling what it is like to be there, facing difficulties and problems in the wards and overcoming them.
“The time a lecturer spends with a student is not what matters but how much time a student spends in the ward. This is why medicine is different to piloting an aircraft, engineering, accountancy, law or any other profession,” he points out.
Contrasting the jobs of a pilot and a doctor, Prof. Mudiyanse states that even though pilots are responsible for lives, they train with machines, but potential doctors train with human beings, talking to them and understanding what the matter could be. He cites the example of a mother who brings in a child, with a complaint that the child is not eating. The doctor will have to get the case history to find out whether the child is not eating because of meningitis, a lung issue or dengue. Such abilities are gained by the experience of being with patients, which SAITM students have not been exposed to.
The excuse that SAITM students have learned the art of doctoring on dummies is not valid, he says. In state medical faculties, in the First and Second Years, the students use dummies and simulations to grasp the basics of Anatomy, Physiology and Biochemistry. But when they reach the Third, Fourth and Fifth Years, they have to interact with patients. “This experience can’t be matched with what you get from dummies.”
Therefore, the clinical training of the SAITM students is “inadequate”. Even if the Neville Fernando Hospital is improved, it is unlikely that it will have an adequate number of patients in the near future. Even if the SAITM students improve, according to the law and order situation in the country, they have not got acceptance from the SLMC, a fundamental and essential requirement for medical graduates who have to secure both a qualification and a licence to practise.
“The qualification should be from the UGC and the licence to practice from the SLMC and both should happen simultaneously. Just because someone has acquired an MBBS, that person by right cannot enter a hospital and treat patients unless that person has SLMC registration. Therefore, SAITM should not resume its curriculum,” said Prof. Mudiyanse.
The Medical Faculty Teachers’ Associations Federation understands that SAITM is a multi-degree awarding private institution. SAITM can continue to award degrees in other fields but is not fit to award the MBBS. “It is not good enough and it has shown no capacity or credibility in conferring an MBBS. Therefore, the MBBS programme should be terminated,” he said in no uncertain terms.
He added that they, however, as teachers and parents understand the plight of more than 1,000 students already at SAITM. Their human rights should be respected. They have lost a lot of money. So the Health and Higher Education Ministries need to carry out a training programme for these students so that they are able to secure a qualification which makes them fit to work in the state hospitals.
Prof. Mudiyanse said: “What is happening though is that the government and the Health Ministry are making use of the agitation about the human rights of the SAITM students to establish private medical education. SAITM has wronged these students and as a business establishment cheated their ‘customers’ by not telling them that SAITM does not have SLMC recognition. SAITM has acted for money and this is not the right thing to do.”
Elaborating, he says that the intention of the parents of SAITM students was to teach their children to become doctors, but not to experiment with a new business venture or support the expansion of the government’s privatisation policy. They have become guinea-pigs and victims in this process. It is time for them to join with others to come out of this mess.
Building the Neville Fernando Hospital, according to him, would have been a very profitable business venture as it could have generated enough income by the provision of patient-care while creating a much-needed clinical experience for their students. However, it has not materialised. The public has chosen and trusted the government hospital system. The ‘donation’ of this hospital to the government can be considered a wise escape decision because the cost of maintenance would be unbearable to a single businessman. However, the extent of appreciations extended by the government is too much and has been recognised by public as a deception.
Prof. Mudiyanse adds: “The way that SAITM, the Health Ministry and the government have handled the issue so far is unfair. Nobody has listened to the state medical faculty students nor considered what they are saying. This, in turn, has resulted in an escalation of the situation. Not heeding the students’ voice is primitive and the unfair criticism, suppression and aggression demonstrated by authorities are not acceptable. The students, the Government Medical Officers’ Association (GMOA) and the university teachers are being told one thing by the government which then does something else. This is why the government has lost credibility. There is a need to turn a new page in this fiasco and do what is right.”