The Dilemma with Private Medical Colleges

“Read in the Name of Thy Lord”

(Holy Quran 96: 1)

Note/Warning

The following points do not apply to all private medical colleges. In fact for some they may not apply at all. Most of these points also do not apply to all students studying in these colleges; they probably apply to 10-30 % of the students. They also do not apply to all teachers or examiners. Some private medical colleges are much better than others and probably better than some government medical colleges, in terms of the number of faculty members.

The Admission Criteria

  • Merit is not the criteria most of the time
  • Some of the students may have got very good marks in FSc, but most of them perform miserably in the UHS entry test, thus casting many doubts over their FSc marks.
  • Aptitude, student interest etc is seldom considered
  • Some students admit afterwards that they never intended to become doctors. They were forced, coerced, compelled or requested by their parents to become a doctor.
  • Often students interview is taken as a formality after their admission
  • After all, they are commercial organizations where money matters the most.
  • In fact, in some places the fees is claimed to be inversely proportional to the marks obtained in FSc.

Attendance Problems

  • Students lack of interest continues into graduate studies as many fail to turn up for classes

Problems in Internal Exams: Evaluations, Midterm, Send up etc

  • There is generally unsatisfactory to poor performance in tests, evaluations, term and send up exams throughout the year, especially when a paper with some questions having just a slightly higher cognitive level are given
  • Several students may be trying hard and studying seriously but it is just beyond their caliber.
  • This is also shown sometimes by students performing well in smaller tests, but performing poorly when study material is larger.
  • Some students are not giving enough time to study.
  • Some of them feel overburdened and overstressed by the studious life of a medical student
  • Some students are not serious at all, being swayed away by too many distractions e.g. mobile, facebook etc
  • Some, as mentioned above, were really never interested in becoming doctors anyways

The Admission for University Exams Criteria

  • Nothing said about this the better. Let us just say there may soon come a time when students may be studying MBBS and BDS from home.

Leniency in Paper Setting and Checking

  • This may be from a small class test, to term exam or send up to a prof exam. Paper setters, who themselves may happen to be teaching in such a college, set the paper according to standard of their own students or of the standard of private medical colleges as a whole.
  • This is because, inadvertently they may be thinking in their minds about whether their own students will be able to answer the questions or not
  • Similarly checking of papers may have become much more lenient than was done before.
  • So we may end up getting a send up result of 5 % turned into a 70 % result in the professional exam (this has happened several times).
  • Some teachers check papers so quickly and are concerned with how many ‘bundles’ of papers they get to check so as to show off and/or get the most money possible.
  • In this way proper filtering of students is not done.
  • This is also probably why we are getting university exam results of colleges in 90 % or 95 %, when 20-30 years back 60 or even 70 % was rarely achieved in an era when there were mainly government medical colleges.

The Fraudulent Internal Assessments

  • More often than not, a true factual internal assessment is NOT sent, partly because the internal assessment cannot be changed in the supplementary exams, in some universities

Coerced/Forced/Compelled/Understood Passing in OSPEs & Viva

  • There has been a call by many to do away with the OSPEs as hardly anyone fails in them anyways
  • They only seem to be failing in the theory with some of them getting outstanding marks in the OSPEs while failing miserably in the theory portion.
  • Introduced into the system to avoid examiner bias, they now offer more student bias than was expected.
  • Examiners feel somehow or another, hesitant in failing the students in OSPEs & Viva portion of the exam, in fear that these students may be passing in the theory portion, a fear often inculcated by the high expectations of the owners of the private medical colleges.
  • In some places, it is often understood equally by the students and teachers that they will be passing in Vivas and OSPEs, so that they don’t even come prepared for this portion.
  • The present writer once failed 9 students who deserved to fail in OSPEs/ Viva exam, out of which seven failed in the theory part as well

Incompetent/Non-Dedicated Teaching Staff

Not only is there a problem with the induction of students, there is a problem with the induction of faculty as well.

Unfortunately this is a problem in many colleges with many teachers being hired by private colleges to just fill the gaps in every department so to show to the PMDC.

I have seen professors of Pharmacology not knowing basics e.g. first & zero order kinetics, elimination, many basic concepts of ANS, CVS, CNS & other units of Pharmacology.

A detail has been written on such teachers here:

http://www.drnaumanshad.wordpress.com/2013/11/30/degree-is-degree/

and here:

https://drnaumanshad.wordpress.com/2017/03/18/teaching-the-once-noble-profession/

Most of such incompetent teachers are the ones who try to push students by all means necessary to pass them e.g. by lenient checking, by giving maximum internal assessment marks to everyone irrespective of their performance etc (as if pass/fail is the only aim of medical education)

Teaching Staff Not Given Enough Autonomy

  • Sometimes teaching faculty is not given enough autonomy as to be making the major decisions.

Commercial Business Factor

  • The major reason for all the above points is the commercial factor which, most will openly or secretly admit.

Short Term Outcomes

  • After all the above factors, often teachers are left wondering as to how in the world this or these students ended up here/advanced to this class

Hence it will be no surprise when one sees the following responses in end of the year/send up exams in private medical colleges:

“Atropine and paracetamol undergo zero order kinetics

Zero order kinetics: fraction of drug that reaches systemic circulation in a chemically unchanged form

Drugs undergoing zero order kinetics have a large volume of distribution and have a wide therapeutic index and wide therapeutic window

Reversible Competitive antagonists increase EMax, decrease EC50 and increase potency of an agonist

Pilocarpine, atropine, bethanecol, succcinylcholine, amphetamine, nicotine, cocaine are examples of indirectly acting cholinomimetics

They also include salbutamol, clonidine, atropine, amphetamines……

Succinylcholine buspiron pilocarpine indirectly acting cholinomimetics

Methylxanthines inhibit xanthine oxidase

Methylxanthines inhibit protein synthesis by binding to 30 S

Methylxanthines are prototype among anti-inflammatory agents

Methylxanthines have adrenoreceptor blocking actions

Methylxanthines are given by inhalation, which causes bronchodilation by antigen antibody reaction

Succinylcholine is used for myasthenia gravis

Succinylcholine is used for smoking cessation and muscular diseases

Succinylcholine causes nausea, vomiting and diarrhea; postural hypotension, addiction

Succinylcholine adverse effect: muscle relaxation

Therapeutic uses of Succinylcholine: increases release of histamine, causes vasodilation, decreases blood pressure and reduces mean arterial pressure

Merit of halothane: increases intracranial pressure

Merit of halothane: rate of induction is slow

Colchicine is a local anesthetic

Colchicine is a xanthine oxidase inhibitor

NSAIDS reduce the release of inflammatory mediators from last cells

NSAIDS inhibit formation of COX, decrease formation of TXA2, thus reduce pain

ACE inhibitors increase BP thus relieve CCF

ACE inhibitors inhibit Na/Cl transport, thus useful in CCF

ACE inhibitors help in CCF by decreasing cardiac output

ARBs block release of renin

Acetazolamide inhibits the Na/K ATPase pump

Famotidine and Nizatidine better than Cimetidine because they cross the blood brain barrier more easily

Sulfonylurea is an antibiotic while biguanide is antifungal

Sulfonylureas cause decreased glucose secretion

Sulfonylureas inhibit iodination of tyrosines, used in hyperthyroidism

Biguanide: anti-diabetic drug that increases glucose in system

Biguanides inhibit release of insulin

Allopurinol inhibits HMG Co A reductase

Misoprostol and lastly surgery last option for contraception (confused with abortion!)

Isoniazid is a protein synthesis inhibitor

Halothane demerit: does not enter into brain

Verapamil calcium channel blockers used for CCF

Beta blockers cause dry cough wheezing and edema

Chemotherapy means cancer chemotherapy

Cotrimoxazole is a protein synthesis inhibitor

CCS drugs: Drugs that act on tumor cells when it is in the non-dividing stage

CCNS drugs: Drugs that act on tumor cells when it is in resting stage”

Long Term Outcomes

  • The above points may prove beneficial for a short term, but once these loopholes appear, then students no longer remain under control of faculty or even under the administration.
  • How embarrassing it is for a pharmacology teacher when a professor of medicine tells you that not even one student of final year knows name of a drug used for treatment of chronic heart failure or some other condition
  • There is a gradual decline in standard of medical education and unfortunately not even medical educationists may be able to stop this decline
  • It is saddening/worrying (good for pharmacists) to note that many students and graduates of Pharm D know more pharmacology than graduates of MBBS and BDS
  • This is probably because they have a two year exposure of the subject plus another two years studying clinical pharmacy.
  • Their assessment system is much better than ours, with long essay questions in which one has to give detailed explanatory answers to many questions.
  • The competent among them have often been found more useful as demonstrators in the Pharmacology department than MBBS graduates
  • We all know that Pharmacology is the most important subject for a general practitioner and for the ‘Seven star doctor’.
  • God forbid if such future doctors make blunders in practical life once they go into wards, clinics,hospitals etc
  • Having said all this, there are many students in private medical colleges who are as competent as students of government medical colleges, and often these students from private medical colleges get top positions in UHS examinations.

Remedies

  • Admissions in medical colleges should be based totally or mostly on merit
  • At least 75-80 % marks in FSc and a pass in UHS entry test should be obtained
  • I would personally advise parents, guardians or those who you know not to send their children to medical college if they have less than 75% in FSc and passed in UHS entry test or if they are not willing to become doctors
  • Students’ interviews should be taken before admission to check their aptitude, willingness and general caliber.
  • Students should be compelled to study somehow or other e.g. by holding evening classes
  • Standard challenging papers should be set and minimal leniency shown
  • Factual internal assessments should be sent and separate internal assessments should be sent for supplementary exams
  • OSPEs and Viva are a separate part of the exam. If any student is failing in this portion, he/she should be failed, without any fear of how he/she does in theory portion.
  • More stricter surveillance/check by universities and PMDC of both private and government medical colleges. Some government medical colleges are lacking senior faculty in several departments and students are left mainly to study on their own (but still achieve good results).
  • Pharmacology like most other basic science subjects like Physiology, Biochemistry, Anatomy and Pathology should be taught in two years, to give justice to the subject and for better retaining and understanding by students.
  • Possibly one or two Long Essay Questions be introduced in theory portion of the examination.

Medical Profession

Medical Courses, MBBS & BDS have been ranked as one of the toughest courses for undergraduate as well as postgraduate students. Therefore one who has opted/chosen such a course should observe or demonstrate this fact. They should be seen studying most of the year. They should be doing the most brain storming, asking the most questions besides having an high intellect and be able to work at the highest cognitive levels.

For often it is only the doctor who is between a patient and God…

degree-and-learning

And probably this is the only point or major priority, we as parents, teachers, doctors and all those in administration should be thinking about.

May Allah help and guide us all. Ameen.

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