A RADIANT change has been observed recently in the general education system. A more creative way of teaching is in practice in schools and colleges and examinations are held following the same method although there are debates regarding how much this method helps in 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. 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 people by only establishing medical colleges here and there without building proper infrastructure and without ensuring the appointment of adequate number of teachers and staff.
Let us assume that the existing problems in these medical colleges will be solved in the 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 to produce MBBS doctors. It is expected that MBBS doctors are eligible for taking care of approximately 80 per cent of the country’s patients.
On the one hand, the newly established medical colleges lack the opportunities required to produce 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 courses together with undergraduate courses whereas the main responsibility of the teachers at these institutions are to prepare MBBS doctors. Now will they teach MBBS students or post-graduate students provided that 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 on 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.
At present, two institutions provide post-graduate medical education following their individual curriculums — Bangladesh College of Physicians and Surgeons and Bangabandhu Sheikh Mujib Medical University. The founding president of Bangladesh, Sheikh Mujibur Rahman felt the necessity of specialist doctors in the post-independence, war-torn Bangladesh and, through an ordinance, established the BCPS in 1972. Since then, the 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 degrees from the BCPS are engaged in providing medical treatment and teaching in medical colleges, specialised institutions, corporate hospitals, army medical corps and zila, upazila, and sadar hospitals. Even in foreign countries, FCPS doctors are working with a good image.
The FCPS has now become another term for reliance. The BCPS’s method of providing education has resemblance to that of the British Royal College. After passing the MBBS, doctors can take practical training in their desired subjects from medical colleges, specialised institutions and sadar hospitals while continuing with their own professions. However, these institutions have to be acknowledged only through meeting certain standards set by the BCPS. The BCPS monitors all the trainees and trainers according to its own rules. The students have to pass the final examinations after being trained in different subjects for different lengths of time. Only after being judged by teams composed of local and foreign examiners under strict standards through various stages of examinations, one is awarded the FCPS degree.
In the pre-independence period, the Institute of Post-Graduate Medicine and Research located at Shahbagh used to provide specialised medical treatment. Doctors aspiring to sit for the FCPS examinations used to take the required training here. In 1998, with a vision to increase the number of specialist doctors, the 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. Moreover, some affiliated colleges and specialised institutions started conducting post-graduate courses in various subjects. 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 will also rise to the question that whether the ongoing practice will ensure specialist doctors of good quality?
After being enrolled in the university or in any of its affiliated colleges in post-graduate studies, one has to undergo deputation in clinical subjects for five years. As a result, in various situations, doctors are unavailable. The main reason for their unavailability is the culture of deputation. In addition, one does not need to get admitted to any institution for earning a degree from the BCPS. Doctors can continue with their own profession and take practical training and after a certain period can pay the fees and take the final examinations; no such 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 provide the same degree although there is a difference in standards. Therefore, with an aim to create good-quality specialist doctors, time has come to build a combined education system to provide post-graduate medical education. If we fail to take the right decision at the right time, patients will gather a lack of confidence and start going abroad for specialised medical treatment.
A long-term project can be designed with the help of a joint initiative by the health ministry, the BMDC and the BMA. The project can be modified as such that the BCPS can offer FCPS degree in general subjects and the universities can provide post-graduate degrees in specialist subjects such as MD, MS, etc. 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 the 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 in parent subject and the BCPS performs this task very well.
A three-step post graduate medical education system in Bangladesh can be fruitful. In the first step, one has to complete internship after the MBBS; in the second step, one has to take required training to pass the FCPS in general subject; and the third step will be composed of interested doctors wanting to become specialist doctors with post-graduate degrees such as MD and MS from universities where they will get the necessary training. Among them, those who want can obtain their PhD degree by being engaged in further research works in these universities. This system will open a wide road for creating high-quality specialist doctors. 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 the BCPS the one and only place from where universities can get students.
Only those who do not want to work hard for earning an FCPS degree, those who want to easily earn a post-graduate degree, can think this way. For the comprehensive welfare of the public, 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 the BCPS, the BMDC, professionals and specialists affiliated with medical education to consider these facts and take collective action to create a modern, combined postgraduate medical education system before any big mishap takes place in the sector of post-graduate medical studies.
The question may arise that if all the universities provide MD and MS degrees, what will be the role of the medical colleges and specialised institutions? The answer is that they will create high-quality MBBS doctors and provide the required training before the FCPS examinations. Specialised institutions should be engaged in providing specialised treatments and will provide high-quality training in various subjects. Each and every institution should be obliged to perform the designated duties in the best possible way.