The PM&DC and CPSP Power Politics – Reflections of A Medical Educationist WARNING: Long Article. You may put it on your facebook page, link, or publish it as long as the author is acknowledged. Your views are also solicited on the topic. Yesterday I read a discussion from frantic trainee medical officers (TMO)/PG residents of Postgraduate Medical Institute, Peshawar regarding the accreditation of their teaching hospitals by PM&DC. I also received “inbox” messages through face book from worried TMOs regarding the issue and whether their training is recognized by PMDC or not? Despite being abroad and on an intensive training course in Medical Oncology at MD Anderson Cancer Center, Texas, I felt that I could not be aloof from the issue. So here I am. I woke at 4 am (Texas time) and first thing that came to my mind was the message from TMO – is the advertisement by PMDC true? Is my training recognized? Rather than try unsuccessfully to go back to sleep again I decided to make myself a nice mug of coffee at 4 am and write a few sentences on this very issue – a tug of war between two giants. A war that is crippling the health system of the country and causing unnecessary anxiety among the future generation of specialists of Pakistan (and the world). Coming to issue of accreditation of all programs and institutions/hospitals with PM&DC, I agree with PMDC that every degree/diploma issued by any Degree Awarding Institution (DAI) must be first accredited with PMDC. The degree or diploma is to be printed in the Third Schedule of PMDC to be acceptable for registration by PMDC. No problems here as the regulations are very specific and clear. For this purpose PMDC visits the institution and the departments and after a thorough inspection gives approval (or otherwise) to that institution. But the question is: has PMDC lived up to its role? Has it ensured that all the institutions are accredited? The answer unfortunately is another big “no”. PMDC has granted FCPS to thousands of specialists over the past few decades who completed their training from the very institutions that now it calls unrecognized. Where did Prof. Humayun Khan, Prof. Mumtaz Marwat, Prof. Iqbal Begum, Prof. Amjad Taqweem, Dr. Shiraz Jamal, Dr. Shahid Ayub and many others complete their training? Did they not do it in LRH, KTH and HMC? If these institutions were not recognized, why did PMDC register their diplomas and why are they working as specialists? Why did PMDC never bother to write to these institutions to get themselves registered or accredited with PMDC over the past so many decades? PMDC can not absolve itself from this blunder. By registering the diplomas from these institutions and never asking inspection of these units/institutions, PMDC implicitly accepted their accreditation. Moreover, according to PMDC, FCPS and MD/MS are equal. PGMI LRH and HMC are recognized by PMDC for Diploma, M Phil, MD and MS training in various specialties as shown in the Third Schedule of PMDC (Page 77 – 80 of the Third Schedule of PMDC). So how can an institution be recognized for MD/MS by PMDC not be recognized for FCPS if PMDC consider both as equal? Doesn’t make sense, does it? So what went wrong? Why this sudden attack of “accreditation” by PMDC? Ladies and gentlemen, it is all power game. What CPSP was and is doing is wrong. CPSP had started its own “role” of accrediting units for FCPS without any respect for PMDC rules and regulations. In order to gain power (or should I say votes?), it started recognizing centers for FCPS that were not even recognized by PMDC for undergraduate training! Yes, that is true. TMOs working in Mardan and D I Khan etc can vouch for this. My head bowed in shame when TMOs form Mardan resigned from PGMI and joined private hospitals for training because the training according to them was non-existent at these units that were recognized by CPSP. Same must be the story at other places. How can CPSP play with the careers of hundreds of aspirants for future specialization by recognizing such substandard training programs? So, CPSP overstepped its authority that resulted in substandard training and PMDC had to step in to ensure minimum standards of training. But why so late? Because it has now realized that CPSP is taking over the role of PMDC! This is exactly what we were asking the Government of KP as role for PGMI – to ensure a minimum standard of training in KP irrespective of PMDC or CPSP approval and to cancel accreditation of any supervisor or unit not ensuring minimum training. Why should we look at other institutions to take care of our TMOs? PGMI role can be widened to ensure proper training standards all over the province so that TMOs should not resign in disgust when sent to training programs that are below standard. Unfortunately, there is a lobby that is against PGMI in KP because PGMI has been challenging their role in recognizing substandard training programs which has affected many TMOs. The current Government unfortunately is listening to the very lobby that has resulted in the above mentioned chaos of recognizing substandard institutions. TMOs must be aware of this fact and must not accept any decision undermining the role of PGMI to make a few doctors turned politicians happy. Although the step by PMDC is a step in the right direction however in my opinion placing an advertisement in newspapers was totally unnecessary and has only resulted in unrest and anxiety among PGs and public. While training in medical education at FAIMER, Philadelphia, we were told that USA will accredit all the medical institutions of all countries. Graduates from accredited institutions only can take USA exams for International Medical Graduates (IMG) from 2023 onwards. But they have given a time of 20 years for this so that institutions can prepare themselves and ECFMG has enough time to visit all institutions. This is what PMDC should have done. It should have written a private letter to all these institutions to get accredited with PMDC and given them a time frame to do this. This will need a long time taking into account the efficiency of PMDC. PGMI wrote to PMDC in 2009, with all documents attached for accreditation of new diplomas and MD/MS programs – so far no response from PMDC despite repeated reminders to inspect these new programs so that they can be started for the benefit of doctors and patients. With this level of efficiency at PMDC may be ten years will be required to inspect and accredit all the programs. My recommendation to PMDC is to give ample time for all institutions to get accredited. As a first step, to hurry up things, inspect the institution as a whole and accredit all the programs in the institution that is compliant with PMDC rules and regulations. In the next step (may be 5 years from now) each and every program may then be visited for individual recognition. Till then, all trainees/PGs working in these institutions must be registered for training. My recommendation to institutions is to apply for recognition/accreditation of their degree/diploma programs immediately and also to ask for registration of current PGs on compassionate basis till the process of accreditation is completed. In future, any program that is to be started in any institution must first be inspected by PMDC and then by others before training is to be commenced. It is 5:30 am so I have to get ready and hit the breakfast before the training course starts at 7:30 am (by the way it is accredited by AMA for 49 credit hours of CME!!!). Advice to TMOs/PGs: stay safe, study hard, take care of your patients and enjoy your training – this too shall pass. PGMI-LRH, KTH, HMC and ATH are strong enough to pass any test by anyone at anytime! PS: Get yourself registered with PMDC as PG trainee (forms available at PGMI and at PMDC website). Prof. Abid Jameel; Associate Dean, PGMI, Peshawar.
Posted on: Tue, 09 Sep 2014 12:02:58 +0000