Clinical proceedings of the BCPS-CPSP Joint conference held at Dhaka

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Clinical proceedings of the BCPS-CPSP Joint conference held at Dhaka

DHAKA (BANGLADESH): Prof. N. Islam an eminent physician and National Professor of Bangladesh along with Prof. Abdullah Jan Jaffer Senior Vice President of CPSP chaired the first session on October 21st 2008 during the BCPS-CPSP joint conference which was devoted to Theme lectures. Prof. Mahmud Hassan from Bangladesh spoke about current status of postgraduate training in developed countries. He pointed out that in USA almost fifty million people are not insured and Residency training programme is mostly funded by Medicare and medical services. Residency Review Committee which consists of medical professionals looks after the changes which are not the case in developing countries. Residency training consists of thirty six months and there are more conferences on medical ethics and quality improvement. The residents are evaluated every year. Grading in moral and ethical behaviour is also given importance.

The areas of clinical competence assessed include competence in performing various procedures like LP, drawing arterial venous blood; written certification exam is based on critical assessment. Then there is the annual clinical competence evaluation. The problem is that there is no full time supervisor, no external assessment, trainees are too busy, and there is no faculty development programme while research component is not well defined.

In UK they have introduced the Two Foundation Years programme and for specialist training one needs another four to seven years. The trainees get certificate on completion of their training. Now there is a Postgraduate Medical Education Board and there is a demand for quality, ethical and professional service by the patients. The society demands ethical professional doctors. Teaching of preventive medicine is a must.

Prof. Rukhsana Zuberi from Aga Khan University from Pakistan was the next speaker and she talked about achieving optimal training in developing countries. She discussed in detail the goals and objectives in assessment, teaching and training, their sequence and contents. Political instability in these countries and overburdened schools does affect the trainees and the trainers. She also referred to the societal accountability of postgraduate medical education and felt that the institutions must resist pressures and refuse to compromise on quality. There are challenges in governance. Accrediting bodies are seen as policing bodies and they should assume the facilitators role. There is need for faculty development, support from committee members and institutions. Governance of residency programme, need for internal reviews and central coordination was also highlighted.

Speaking about some of the challenges faced she referred to lack of interest among supervisors many of whom do not seem to give emphasis on patient care, medical education and research. Now structured training programme is being introduced in Pakistan by CPSP. We must see how we can make good doctors as superb. She then referred to various learning opportunities and felt that teachers should assume leadership role. Ethics Committees should be constituted in each institution, medical audit should be introduced by holding morbidity and mortality meetings on regular basis. There should be a system in place whereby we can get feed back from the trainees. Department of medical education should help in faculty development besides providing educational support.


Other challenges include variable quality of entrants in the residency training programme, service load, increased number of women in medicine, minimum or no stipend, violence at work place and mistreatment of the trainees. We need to introduce a system of check and balance. Some faculty members, Prof. Rukhsana Zuberi opined, may lack knowledge and skills, no faculty member is there after office hours and there is inadequate supervision.

We need to develop standardized training sites, offer career counseling services and upgrade the libraries. To improve the facilities, we may have to seek assistance of donors and write research grants. She concluded her presentation by stating that where there is a will, there is a way. Some of these problems do not need money. We need to inject fresh blood in the faculty who have enthusiasm, improve learning environment, teach research methodology and control work place violence


Asir Memorial Lecture

Prof. M. A. Majid delivered Asir Memorial lecture and the topic of his presentation was gene surgery in embryo. This, he said, is going to be the trend in the days to come. He recalled the developments in surgery over the years and felt that we must recognize the contribution of our seniors in difficult times. There was a time when bleeding, pain and infection were the main obstacles to surgery. Futuristic surgery, he stated, will aim at prolonging the life. Other topics which he dealt with included non-invasive end luminal surgery, organ saving surgery, genetic surgery in utero, remote surgery, surgery using Xenograft or tissues, implant surgery besides highlighting the importance of potential of telesurgery.



Bangladesh College of Physicians and Surgeons organized a special convocation during the Joint Conference to confer Honorary Fellowship of BCPS on some of the Councilors of CPSP. Picture shows President BCPS presenting the Fellowship certificates to the recipients from Pakistan.

Prof. S. M.Rab former President of CPSP delivered the Burki Memorial Lecture and pointed out that we have a glorious past but we should not be content with it. Late General Burki, Prof. Rab said was a visionary. He established our links with the Royal Colleges in UK. He was a fair and just man who ensured parity between the East and West Pakistan. In the recent past there has been a rapid growth in the private health sector and medical profession has been converted into trade for profit. Corrupt practices are on the rise and doctors often indulge in deception. Practice of medicine has become expensive which is beyond the reach of the common man. There is discrimination between the elite and the deprived which has a negative fall out. In Pakistan some people are forced to sell their kidneys because of poverty and doctors do not hesitate to take advantage of their needs. They are all the time in search of short cuts and adopt malpractices. At present seven out of ten medical students are girls and it is high time that the authorities pay attention to this shift. Non-doctor professionals are highly paid as compared to doctors. All the female doctors need is degree and most of them will not practice medicine. We need to do soul searching to find out have we enhanced the image of the medical profession. Muslim rulers built mosques while promotion of health is lacking.

Talking about the future action plan for the medical profession Prof.Rab suggested that we must identify the needs of the society, ensure ethical practice, become self sufficient in drug production, equipment and instruments and develop ambulatory service for the deprived areas. We should extend professional support and organize advocacy and pressure groups to highlight health issues of those who live below the poverty line, equip medical profession with emotion and leadership so that they become dedicated doctors and talented teachers.

Speaking in the session devoted to obstetrics and gynaecology Prof. T. A. Chaudhry from Bangladesh talked about fundamental challenges in women’s health. Pollution, he said, has many facets and environment pollution has adverse effects on health. Shortage of food and water has lead to extensive use of pesticides and fertilizers. There is increased salinity, rapid population growth and urbanization has put Bangladesh on the brink of food shortage. Crop failure will result in food famine. Deforestation, uncontrolled sex, increase in sexually transmitted diseases due to living in close proximity are on the rise. Increase in the number of commercial sex workers, unintended pregnancies, termination of pregnancies which has its own complications, violence against women has also increased. All this leads to psychological changes if the women are not protected. He was of the view that let us reverse this change before it becomes a real disaster.

Prof. Rizwana Chaudhry from Rawalpindi Medical College, Pakistan spoke on cervical intraepithelial neoplasia and HPV vaccination. She pointed out that cervical cancer is the second common female cancer worldwide. Every year five hundred thousand new cases are detected and two hundred fifty thousand deaths are reported annually due to cervical cancer. It is estimated that every two minutes a women dies of cervical cancer which is preventable. CA cervix has a natural history. If diagnosed in early stage, it will have better prognosis. Almost 36% of theses cases if not treated will become invasive in ten to twenty years time. All this is preventable but not yet prevented. UK started a screening programme in 1970 with the result that their mortality due to cancer of the cervix has considerably reduced. Now they have achieved almost 85% coverage. In Pakistan cancer of the cervix is now at Number 4. WHO recommends PAP smear test. It can give 7-27% false positive and 20-25% false negative report. She then discussed the management of abnormal cervical cytology. Treatment options for HPV infection, Prof. Rizwana Chaudhry said, are very limited. It can only be prevented. Vaccine for this is not yet available in Pakistan, even otherwise it is very expensive, hence we have to find the best solution to tackle this problem, she added.

Workshop on optimizing training

Prof. Khalid Masood Gondal from KEMU Lahore along with Dr. Sirajul Haque from CPSP conducted the workshop on optimizing training. It was chaired by Prof. AKM Mahburbur Rahman from Bangladesh. This was an interactive session wherein the participants actively participated. First of all the problems in training were highlighted which included absence of training programmes, increased number of trainees and too few trainers. Dr. Siraj ul Haq who initiated the debate remarked that we can share knowledge and experience but cannot solve each others problems. One of the participants remarked that the trainees should be considered human beings; they must get proper logistic support. Other issues which were highlighted included proper monitoring of the trainees, proper attitude of trainers and the trainees, financial support to the trainees, some people become teachers just by chance, trainees are not interested in research but they just do it under compulsion, most of the papers are published to complete formalities for promotion. Non practicing full time faculty members may be the answer to some extent but is it feasible and practical. After getting in put from the participants, Dr. Siraj ul Haq remarked that we in Pakistan and Bangladesh have similar problems. Hence we must find out solutions which must emerge from our local environment.

Education, Dr. Siraj stated comprise of knowledge and training skills. There are different domains of learning. Education helps in developing the ability to apply knowledge to various situations so as to make sound judgment. Skills can be equally well applied in variety of situations. Wisdom comes from experience and knowledge. Learning, he said, has three domains i.e. cognitive, psychomotor and affective. Training is different from education. Structured training programmes, Dr. Siraj felt, should have defined entry requirements and a calendar which is a pre requisite. CPSP has now decided that the trainees will be inducted twice a year. There will be adequately accredited trainee posts with funding and training facilities. In the public sector some honorary trainees may be adjusted for the time being but in the private sector, training slots are only recognized if the trainees are fully paid. A supervised training programme leads to highest level of competencies. Assessment and feed back from trainees is helpful. Maintenance of log book, final examination is the fruit of certified training by award of a qualification. Intellectual integrity and professional ethics was also highlighted during the discussion. In structured on the job training, every learning experience is included in the portfolio.

Speaking about the curriculum, Dr. Siraj ul Haq said that it is a set of documents describing all components of a course including aims, outcome, and experiences planned to achieve them and methods of evaluating their accomplishments. Training models, Dr. Sairj ul Haq opined can be divided into apprenticeship models, process based models and competency outcome based models. Competence is defined as ability to handle a complex professional task by integrating relevant cognitive, psychomotor and affective skills. It also takes into account the ability to apply knowledge to various situations and make sound judgments.

Prof. Khalid Masood Gondal Regional Director CPSP Lahore then gave details of the training programme and pointed out that at present one hundred twenty five medical institutions in Pakistan have been accredited by CPSP. We have 1611 supervisors and CPSP offer fellowship after five years working in accredit departments. Teachers have to do compulsory workshops to become supervisors. Currently 9,249 postgraduates are enrolled in various training programmes and the CPSP has so far produced 15,608 specialists. He also highlighted the changes which the CPSP intends to make in the structured residency training programme.

Medical Education

In the session devoted to Medical Education, Dr. Jamshed Akhtar paediatric surgeon from NICH Karachi was the first speaker and he talked about introduction of bioethics as a discipline in medical curriculum. Ethics and morality, he opined, may have different meanings and perceptions in different cultures. Traditional thinking is that science produce standard facts which can be questioned. He also talked about issues like medical ethics and healthcare ethics, assisted suicide, alternative therapy, Pharma physician’s relationship etc. There is a dire need to introduce bioethics in the medical curriculum to tackle all these issues, he added.

Dr. Nilofer Shireen highlighted the importance of practicing bedside teaching while Dr. Reza ul Haque discussed development of a cost effective healthcare in Bangladesh. His presentation laid special emphasis on cost containment and improving patient physician relationship. Dr. Farida Habib from Pakistan discussed the effects of health education on leprosy patients while Dr. Masood Jawaid from DUHS Pakistan highlighted the On-call Emergency Workload of a general surgical team. A number of these calls, he opined, are un-necessary. Prof. Hamid Hassan from Rawalpindi Medical College Pakistan made a presentation on postgraduate surgical training wherein he specially referred to aseptic techniques and gentle handling of the tissues.

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