[Angel]

Postgraduate medical education
By PROF A K SHARMA
- The Kathmandu Post July 23, 2006


The population of Nepal is increasing very fast, demanding the development of health posts and hospitals in various parts of the country; requiring more and more health manpower (both generalists, specialists and super-specialists) to man these institutions. Besides these institutes, regular health camps need to be held in remote areas of the country.

Over 11 medical colleges in the country and medical institutes in India, Bangladesh, Pakistan, China, Russia and others are helping us to prepare the needed health manpower (graduates). These graduates, after completing their education need to pass the examination conducted by Nepal Medical Council before being appointed by the Ministry of Health or other equivalent agencies for various periods.

Every doctor is determined to specialize or super specialize in one particular subject (public health, clinical health or basic health sciences): so that his/her future career is assured forever. These doctors need to serve in the hospitals for a period of at least two years before qualifying to enter into postgraduate program run by various institutes, presently run by NAMS, TUTH, KU and BPKMH). It is expected that the post-graduates produced by these institutes (MS, MD or equivalent) are able to man the Registrars' posts in various regional and central hospitals. These specialists are knowledgeable, competent and safe in diagnosing and managing the common medical problems. They could refer the patients to super specialists in case they could not manage them. The present-day doctors must share help from the colleagues working in various institutes.

The contents of the post-graduates programs must be very clear. The doctors doing post-graduation should spend one year (of three years) in the departments of basic sciences. At the end of one year s/he should have thorough knowledge of:

1. Anatomy, physiology and basic pathology.

2. There should be a change in the attitude of the candidates of sharing knowledge with the colleagues.'

3. Develop interest in clinical /basic medicine and research.

4. Is able to make sound decision.

5. Is able to prepare and carrying out safe medical or surgical procedures.

6. Is able to tackle medico legal aspects involved in professional practice.

7. Is able to deal with psychiatric problems encountered in the community.

A thorough and comprehensive knowledge of anatomy including embryology is a must to understand the structure of the human body and the congenital or developmental defects encountered.

Similarly, a sound knowledge of human physiology is essential to interpret and treat the abnormalities detected. It is essential to understand the principles of wound healing, principle of bacteriology and pharmacology and the change in the tissues. It is expected that the candidates could interpret the abnormalities detected and suggest measures to prevent and or counteract it.

S/he will spend the next two years (of three years) of the training programs in the clinical departments under the supervision of a senior consultant or super specialist. Besides, attending the regular theory classes and practical demonstration, the candidate will prepare for the thesis on the subject allotted to him/her. To achieve uniformity in the standard, the board must have representatives from teachers working in the various post-graduates institutes and the Nepal Medical Council. S/he will also maintain a logbook of his/her activities. S/he shall conduct Outpatient Dept services, request for needed investigation (interpret the results) to arrive at a definite diagnosis. S/he will also help to perform minor medical or surgical procedure in the OPD. S/he will also help the consultant in performing major medical or surgical procedure and observe closely the progress made by the patients. S/he will also help to mange the complication if observed during the course of his or her recovery.

The candidate will participate in activities of medical education program. S/he will present/join actively the CME program run by the departments. In medical institutes he/she will actively participate to train the medical graduates. He/she will write thesis on one of the commonly encountered problems in the country. The logbook and thesis is reviewed by a group of consultants or super specialists.

Once certified that the candidate could sit for the qualifying examination, the candidate could appear for postgraduate tests conducted by the Board (eg, NAMS, TUTH, KU, BPKIMS etc). The final test for post-graduation could preferably be held in any postgraduate institution (except the place where s/he was trained). On qualifying to become a specialist (MS, MD or equivalent), they could join the medical institutes as Registrar and specialist in the district or regional hospital.

Super specialist or fellowship: Depending upon the performance in the postgraduate examination and the job in the hospital or medical colleges, s/he (if desirable) is allowed to join in services training program for fellowship for four years. They will be required to write a research proposal or thesis on one of the prevalent medical problems in the country besides maintaining a logbook of their performances in the hospitals.

On completing the 4 years training with satisfactory assignment of the thesis and logbook and clinical examination by a group of experts; the candidate is awarded a certificate of completion of specialists training (FNCS) course. The standard of this examination must be same in all the Board (eg NAMS, TUTH, KU, BPKIMS etc) so that the candidate is sellable in all the medical institutes or super specialist hospitals (Bir Hospital, Patan Hospital, TUTH, NMCTH, KMCTH) etc. S/he is declared as Fellow of Nepalese Academy of Medical Sciences or Health Science and recognized as a consultant.

The only way of the standardization of the super specialist could be achieved by forming a national body (under National Academy of Medical Sciences) including of institutions involved in post graduate or super specialist training, spread all over the country. S/he could head the specialist units (Surgeon, Anesthetist, Obst and Gynecologist, Radiologist, Pathologist etc) of the Medical College, Teaching Hospitals, and specialized hospitals. This specialist must share his/her experience with the colleagues working in less developed hospitals.