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Prioritizing Investment in Medical Education

Posted by plosmedicine on 30 Mar 2009 at 23:50 GMT

Author: 'Fawad' 'Aslam'
Position: Doctor
Institution: Lahore, Pakistan
Submitted Date: February 09, 2006
Published Date: February 14, 2006
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

The dire need of reforming medical education in South Asia has been well emphasized in your editorial [1]. It is encouraging to note that efforts are underway to devise strategies to bring about this reformation. However, for such reforms to be effective, it is crucial that the opinions of medical students and young trainee doctors are also taken into account. Students' role should be enhanced from that of mere consumers of medical education [2]. They are important stakeholders and their active participation in policy-making will facilitate more robust solutions to be devised.
The requirement of drastic improvement in health research in South Asia is well established. The need of research in medical education is perhaps even greater. Unfortunately indigenous data pertaining to medical education in the region is limited. Only a small number of studies have attempted to explore the concerns of students and doctors in matters pertaining to, for example, medical decision making and health research [3,4]. The establishment of a research culture is fraught with difficulties but is not impossible [5]. It is my opinion that to bring about reform, both a 'bottom-up' and 'top-down'approach is needed. The former needs ample student exposure to research during medical school. The latter is essentially linked to the availability of funds. No amount of community oriented training, for example, will compensate for the deficiency of properly qualified health professionals in the rural areas. It is only when there is sufficient financial and professional security that the greater purpose of educational reform will stand fulfilled. How this would be achieved when the bulk of budgetary spending pertains to debt-servicing and defense expenditure is hard to envisage.
Alongside medical education parallel investment is sought in health education. This is because it is not only our physicians that are not cognizant of current treatment practices [6]; our patients too have a poor knowledge of common diseases that afflict them [7]. The interaction of better informed patients and properly qualified doctors may result in a significantly improved community health. For our poor nations, the importance of preventive medicine is manifold as it offers the most economical way of combating disease. There is some evidence to suggest that our medical students are not 'prevention' oriented and thus more emphasis must be placed on preventive medicine [8].
It is also hoped that such investment will lead to nationally oriented research activities and not a mere replication of western studies. The study evaluating the significant protective effects of hand washing in children from common childhood diseases is one such example [9]. Another instance is of a study evaluating the effects of garlic on dyslipidemia [10]. Further studies on this line may prove helpful in combating the cardiovascular disease epidemic in Pakistan. Garlic is potentially a much cheaper alternative to statins, the latter being unaffordable for most segments of our society. Similarly on the front of medical education institutions like the Aga Khan University in Pakistan, which is a private sector entity, have started problem-based, community oriented teaching in medical schools. The outcome of these curricular changes remains to be seen. Indeed there is hope for South Asia but for such hope to materialize, the need is of selfless individuals, strong institutions and perhaps above all a more just and realistic distribution of the national financial resources.

1. PLoS Medicine Editors (2005) Improving health by investing in medical education. PLoS Med 2:e424.
2. Awasthi S, Beardmore J, Clark J, Hadridge P, Madani H, et al. (2005) Five futures for academic medicine. PLoS Med 2:e207.
3. Jafarey AM, Farooqui A (2005) Informed consent in the Pakistani milieu: The physician's perspective. J Med Ethics 31:93-96.
4. Aslam F, Qayyum MA, Mahmud H, Qasim R, Haque IU (2004) Attitudes and practices of postgraduate medical trainees to wards research; a snapshot from Faisalabad. J Pak Med Assoc 54:534-536.
5. Aslam F, Shakir M, Qayyum MA (2005) Why medical students are crucial to the future of health research in South Asia. PLoS Med 2:e322.
6. Jafar TH, Jessani S, Jafary FH, Ishaq M, Orkazai R, et al. (2005) General practitioners' approach to hypertension in urban Pakistan. Disturbing trends in practice. Circulation 111:1278-1283.
7. Jafary FH, Aslam F, Mahmud H, Waheed A, Shakir M, et al. (2005) Cardiovascular health knowledge and behavior in patient attendants at four tertiary care hospitals in Pakistan - a cause for concern. BMC Public Health 5:124.
8. Aslam F, Mahmud H, Waheed A (2004) Cardiovascular health-behaviour of medical students in Karachi. J Pak Med Assoc 54:492-495.
9. Luby SP, Agboatwalla M, Feikin DR, Painter J, Billhimer W, et al. (2005) Effect of handwashing on child health: a randomized controlled trial. Lancet 366:225-233.
10. Ashraf R, Aamir K, Shaikh AR, Ahmed T (2005) Effect of garlic on dyslipidemia in patients with type 2 diabetes mellitus. J Ayub Med Coll Abbottabad 17:60-64.

No competing interests declared.