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11 February, 2019 00:00 00 AM

Higher studies in medicine in Bangladesh: Few thoughts

Md. Abdul Jalil ChowdhuryFew thoughts
Higher studies in medicine in Bangladesh: Few thoughts

A radiant change has been observed recently in the general education system of the country. A more creative way of teaching is being practised in schools and colleges and examinations are being held following the same method although there is debate regarding how much this method is helping towards the construction of creative human minds. By now, the western world has progressed impressively in the field of education, even our neighbouring countries too have progressed a lot.

We also have to match our footsteps with them. In comparison to many neighbouring countries, we have a higher index of progress in the health sector. However, we cannot expect to reach the milestone in medical treatment of the people of this country by only establishing medical colleges here and there without building proper infrastructure and without ensuring the appointment of adequate teachers and staff. Let's assume that the existing problems in these medical colleges will be solved in the forth coming years.

Even if it happens, the thing to ponder upon is what will happen to those who will be graduating in these years? Reflecting on this issue while talking about postgraduate education is just to highlight the fact that the way we cannot get high quality finished products from faulty raw materials, similarly if we want to get good specialist doctors in the future, we have to ensure good quality of MBBS/BDS doctors. From the very beginning, the medical colleges were established for producing MBBS doctors.

It is expected that MBBS doctors are eligible for taking care of approximately 80% of the country's patients. On one hand, the newly established medical colleges lack the opportunities required for producing good quality doctors, on the other hand, old medical colleges suffer from the inadequacy of teachers and training materials. Additionally, old medical colleges now run post graduate programmes together with under graduate courses whereas the main responsibility of the teachers of these institutions were to prepare MBBS doctors. Now will they teach MBBS students or post graduate students, provided they already have the additional task of treating patients? As a result, the overall quality of MBBS doctors is deteriorating. No one is being able to rely upon MBBS doctors, hence a need to produce more and more specialist doctors can be observed and this situation has led to the declaration of establishing medical universities in every division. This writing owes its source to this particular context.

 

At present, two institutions are providing post graduate education following their individual autonomous curriculum. One is Bangladesh College of Physicians and Surgeons (BCPS), the other is Bangabandhu Sheikh Mujib Medical University (BSMMU). Father of the Nation Bangabandhu Sheikh Mujibur Rahman felt the necessity of specialist doctors in post independence war-torn Bangladesh and through an ordinance established BCPS in 1972. Since then, BCPS has been setting a unique example in the field of post graduate studies in medicine.

Till now, mostly doctors who have earned their FCPS degree from BCPS are engaged in providing medical treatment and teaching in country's medical colleges, specialized institutions, corporate hospitals, army medical corps and zila upazila sadar hospitals. Even in foreign countries, FCPS doctors are working with a good image. FCPS has now become another term for reliance. BCPS's method of providing education has resemblance to that of the British Royal College.

After passing MBBS, doctors can take practical training in their desired subjects from medical colleges, specialized institutions and zila sadar hospitals while continuing their own professions. However, these institutions have to be acknowledged only through meeting certain standards set forth by BCPS. BCPS monitors all the trainees and trainers according to their own rules. The students have to pass the final examination after being trained in different subjects for different lengths of time. Only after being judged by teams comprised of native and foreign examiners under strict standards through various stages of examinations one is awarded the FCPS degree.

Prior to independence, the Institute of Post-graduate Medicine and Research (IPGMR) located in Shahbag used to provide specialized medical treatment in the country. Doctors who were to sit for the FCPS exams used to take the required training from there. In 1998, with a vision to increase the number of specialist doctors, IPGMR was transformed into Bangabandhu Sheikh Mujib Medical University and post-graduate degrees such as MD, MS, M Phil and Diploma began to be awarded from there.

Moreover, some affiliated colleges and specialized institutions started conducting post-graduate courses in various subjects. This follows that at present two institutions are engaged with postgraduate medical education, one is BCPS and the other one is BSMMU. Two more medical colleges are going to start operating in Rajshahi and Chattogram. This undoubtedly will increase the number of specialist doctors in the country but also gives rise to the question that whether the ongoing practice will ensure specialist doctors of good quality or not?

It is wise to mention here that, after being enrolled in the university or in any of its affiliated colleges in postgraduate studies, one has to undergo deputation in clinical subjects for five  years. As a result, in various situations, doctors are not available one main reason for this is the culture of deputation. On the other hand, one does not need to get admitted to any institution for earning a degree from BCPS.

Doctors can continue in their own profession and take practical training and after a certain period can pay the fees and sit for the final examination, no such kind of deputation is required there. For this training, the students do not have to spend any money and the teachers also do not get any additional financial benefits.

Two institutions are providing the same degree although there is a difference in standard. Therefore, aiming to create good quality specialist doctors, the time has come to build a combined education system for providing postgraduate medical education. If we fail to take the right decision at the right time, then patients will gather a lack of confidence and start going abroad for specialized medical treatment.

A long term project can be designed with the help of a joint initiative by the Ministry of Health, BMDC and BMA. The project can be modified as such that BCPS will provide FCPS degree in general subjects and the universities will provide postgraduate degrees in specialist subjects such as MD, MS etc. A recent remark made by the honourable prime minister applies firmly. She said, universities should be a place for conducting research, their work should not be providing education on general subjects. If this is the case, then prior to becoming specialists, universities are not the ideal place for receiving core training on parent subject. To become a good specialist doctor, one must have profound knowledge and expertise on relevant general subject. The same rule is applicable in developed countries for example to become a cardiologist, one must have expertise in the field of medicine.

As the quality of basic degree or MBBS degree has fallen, and universities should be excused to concentrate on research works, a separate institution can be given the task of providing core training on parent subject and needless to say, BCPS has been performing this task very well. A three step postgraduate medical education system in Bangladesh can be fruitful.

In the first step, one has to complete internship after being done with MBBS, in the second step, one has to take required training to pass FCPS in general subject and the third step will be comprised of interested doctors wanting to become specialist doctors with postgraduate degrees such as MD, MS from universities where they will get the necessary training. From among them, those who want can obtain their PhD by being engaged in further research works in these universities. I hope everyone will agree that this system will open a wide road for creating high quality specialist doctors in the country.

Some might also think that this system would eventually taper the scope of higher education and will decrease the number of specialist doctors in the country along with making BCPS the one and only place from where universities can get students. Only those who do not want to work hard for earning a FCPS degree, those who want to easily earn a postgraduate degree, can think as such. For the comprehensive welfare of the public only the government can take strict measures in this regard.

The question is whether we want quantity or quality? We do not know how many specialist doctors are required in how many departments. Thus time has come for BCPS, BMDC, professionals and specialists affiliated with medical education to consider these facts and take collective actions to create a modern combined postgraduate medical education system before any big mishap takes place in the sector of postgraduate medical studies.

The question may arise that if all the universities provide MD and MS degrees then what will be the role of the medical colleges and specialized institutions? The answer is they will create high quality MBBS doctors and provide the required training prior to FCPS exam. Specialized institutions should be engaged in providing specialized treatments and will provide high quality training on various subjects. Each and every institution should be obliged to perform their designated duties in the best possible way.

 

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Editor : M. Shamsur Rahman

Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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