This topic has been discussed in Sri Lanka in various forums. However, the discussions have not focused on the key problems.
a) Inadequate Academic staff
b) Deficiencies in clinical training
c) Danger to the public from persons practising medicine without the required clinical training.
Inadequate Academic Staff
The most important factor for the quality of university education is the presence of qualified academic staff. The percentage of professors in different universities varies from 0 percent to 19.7 percent. The percentages of lectures who are not qualified to lecture and conduct examinations vary from 36 percent to 87.39 percent.
This has resulted in significant differences in the quality of education at different universities. The UGC has not taken any steps to grade the universities.
A significant deficiency is the low percentage of professors in all universities. A short term solution is to increase the retirement age of professors to 70 years. However, the UGC has not implemented this suggestion, although it has been proposed more than five years ago.
How do the private institutes obtain the staff to teach their students? It is obvious from the announcements made from SAITM that they have used the services of the academic staff from Government universities.
Academic staff of state universities are not allowed to teach in private institutes during working hours. If the academic staff members want to do private work during office hours, they have to obtain permission from the Head of Department, Dean and the Vice Chancellor. They also have to pay a part of their earnings to the University. Has this procedure been followed? If not, who gave permission to the UGC and university administration to turn a blind eye to the violation of the University regulations?
A number of academics in the private sector are calling themselves professors. Have these professors obtained the necessary academic qualifications and fulfilled the required criteria as given by the UGC to be promoted to professor grade.
At present to produce a professor, it takes more than fifteen years of training and the Government has to spend more than twenty million rupees to provide facilities for research. However, the Government donates these professors to the private education system free of charge when they reach the age of 65.
Inadequate Clinical Training
The clinical training is the most labour intensive part of medical training. There is no argument that clinical training requires a well equipped and properly staffed teaching hospital. The most important part is the presence of a large patient population. Private hospitals cannot fulfil these criteria. Therefore, private medical schools are unable to provide adequate clinical training. The danger to the public from allowing inadequately trained persons to practice medicine can be seen from the reports of medical error in the USA.
Medical School
In the United States a medical school is an institution with the purpose of educating physicians in the United States in the field of medicine. Admission into medical school may not technically require completion of a previous degree; however, applicants are usually required to complete at least three years of “pre-med” courses at the University level, because in the US, medical degrees are classified as Second entry degrees.
Once enrolled in a medical school the four years progressive study is divided into two roughly equal components: Pre-clinical and clinical (Clerkships consisting of rotations through different wards of a teaching hospital). The degree granted at the conclusion of the next four years of study is Doctor of Medicine (MD) this degree allows the holder to practice medicine after completing an accredited residency programme.
Board Certification
The Physician or surgeon who has completed his or her residency and possibly fellowship training and is in the practice of his or her specialty is known as an attending physician. The physicians then must pass written and oral exams in their specialty in order to become board certified. Each of the 26 medical specialties has different requirements for practitioners to undertake continuing medical education activities.
All board of certification now requires that medical practitioners demonstrate, by examination, continuing mastery of the core knowledge and skills for a chosen specialty. Recertification varies by particular specialty between every seven to ten years.
The United States has the highest paid general practitioners in the world. In 2009 the number of physicians per 10,000 population was 32.
With all these safeguards in training in 2016 the deaths due to medical error in the USA were 251,454. This is the most common cause of death after heart disease and cancer. Medical error can include misdiagnosis or delayed diagnosis, administration of the wrong drug to the wrong patient or in the wrong way and giving multiple drugs that interact negatively.
It must be very clear that allowing improperly trained persons to practice medicine will result in a much bigger disaster than CKDU. I estimate that this will result in at least ten deaths per year from medical error for each of these untrained practitioners.
These medical error deaths are likely to happen in districts like Batticaloa, Mullaitivu, Monaragala, Mannar, Killinochchi and Ampara were these persons are likely to be posted.
The writer is also Past President of the Sri Lanka Association for the Advancement of Science
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