EDITORIAL: The Predicament of Postgraduate Medical Education in Pakistan

Abstract

In Pakistan, it is dream of most parents to see their children pursuing medical carrier and doing post-graduation. Primary reason for this desire stems from the assumption that specialisation ensures financial freedom and is largely a status symbol. The desire to do post-graduation and path leading to this objective is full of struggle and obstacles. After doing MBBS, students feel less like the start of a career and more like a tough Journey with degree, ambition and investment they still do not have clear path ahead.

Young medical graduates are most of the times not aware of the problems that may come their way in pursuit of their post-graduation. College of physicians and Surgeons Pakistan (CPSP) with more than 80 specialities and sub-specialities is most sought after postgraduate medical education path in Pakistan. Following hindrances are frequently encountered by young doctors.

1. Bottleneck After Doing FCPS Part 1

The most visible problem is sheer volume. Every year, thousands of doctors clear Fellow of the College of Physicians and Surgeons (FCPS) Part 1 examination conducted by the CPSP. Clearing FCPS Part 1 does not guarantee a training slot. Training positions are limited, supervisor-dependent, and concentrated in a handful of accredited hospitals. This problem was highlighted few years back in a report published in leading newspaper of Pakistan. ¹

Core reason for this is supervisor availability. CPSP policy requires that supervisors hold at least the rank of Assistant Professor and should have five years of post-fellowship experience. In some specialties like orthopaedics, one supervisor often ends up overseeing ten to twelve trainees simultaneously, which is not justifiable. ^{2, 3} Supervisors are also not financially compensated for mentorship either, which is one of the strongest incentives to invest properly in trainees. Lack of incentives for supervisors in likely to affect the quality of training being imparted.

2. Quality, Design and Process of Training

There is huge variation in the quality, design and process of training in various specialties across different accredited hospitals and institutes. Some hospitals have built strong training program and monitoring mechanisms to oversee the training. While quite a large number of hospitals. Just see this as an opportunity to have cheap labour to manage indoor and outdoor patient workload.

The exit examination of FCPS has unfortunately high failure rates, higher than comparable exams from the Royal Colleges in the United Kingdom (UK)......................................