1) Postgraduate medical education in Pakistan faces several challenges including a lack of guidance for career paths, poor working conditions, and minimal training in family medicine. 2) The authors conducted a survey of postgraduate trainees that identified deficiencies and made recommendations for improving competence assessment and diversifying training programs. 3) Recommendations include incorporating international standards of competency, enhancing educational opportunities, and improving collaboration between organizations involved in medical education.

1. How to cite this article: Muhammad Saaiq, Khaleeq-Uz-Zaman. Postgraduate medical education in
Pakistan: challenging issues and the way forward. Ann Pak Inst Med Sci 2008; 4 (3) : 127-8.
Editorial
Postgraduate Medical Education in Muhammad Saaiq*
Khaleeq-Uz-Zaman**
Pakistan: Challenging issues and the * Co-ordinator,
** Director,
Department of Medical Education,
way Forward. PIMS, Islamabad.
Until the end of the last century, medical country. Such research is imperative for identifying
migrants from Pakistan and other developing countries unrecognized deficiencies in our training system. It can
constituted a significant proportion of the medical be employed to construct a real picture of the existing
workforce in the US, UK and many other developed situation and hence used for planning future policies
countries.1 Though this brain drain of doctors posed a regarding residency training.
threat of direct wastage of professionals to the native Challenging opportunities exist for improving
country, it also offered the migrants with opportunities of learning for doctors in training in Pakistan. Certain steps
better medical practice and specialist training. 2 have already been taken in this regard. The contribution
The current situation in the UK and USA is no made by CPSP has been phenomenal in this regard. It
more conducive for Pakistani doctors due to tight has been patronizing not only specialist training but
emigration rules and the changing medical training also paying due attention to the faculty training and
policies.3 The introduction of Modernizing medical development by virtue of its department of medical
career (MMC), Foundation programmes, the New Deal education.8 Pakistan medical and dental council (PMDS)
and the European Working Time Directives (EWTD) in has also been proactive in this regard. In addition to
UK, has further minimized the chances of obtaining a other measures, it has recommended all medical
career post in a desired specialty and majority of training institutions to develop their departments of
specialists end up in non-career grade posts such as medical education in order to improve the standards of
trust doctor, staff grade, and associate specialists or medical education in the country. At PIMS, Islamabad
return to their homeland with a sense of failure. 4-6 the academic council and administration have formally
Given the global scenario of shrinking opportunities, approved the establishment of a department of medical
greater number of doctors are now preferring to education with the following five main objectives:
undertake postgraduate training at home or in countries i- Promotion of medical education
other than the UK and USA. ii- Faculty training and development
Biggs JSG7, an Australian educationist recently iii- Capacity building and grooming of residents
conducted a survey of Pakistani doctors and found iv- Promoting research
certain deficiencies in their postgraduate training. Lack v- Dissemination of community education
of guidance regarding career paths, almost non-
existence of training in family medicine and poor Here are a few Recommendations for
working condition of the hospitals were identified. The improving Postgraduate medical education in our
concept of appraisal and mentoring for trainees was country:
found to be largely missing in their training. Furthermore 1- The objective of competence and its
a sharp contrast was noted between the selection assessment needs to be developed and diversified
criteria, examination system and training structure of the further. We can benefit from the existing body of
programmes offered by the College of physicians and knowledge developed in the developed countries. For
surgeons Pakistan ( CPSP ) and the locally organised instance in the US, the Accreditation council for
degree programmes of MD and MS. graduate medical education (ACGME), Residency
The authors recently conducted a review committee (RRC) and the American board of
comprehensive questionnaire survey of the internal medicine (ABIM) currently endorse six areas of
postgraduate trainees of PIMS, Islamabad about the competency where residents must achieve satisfactory
various training-related-issues. The study findings are performance in order to advance through their training.
interesting and will be published as soon as the data These include medical knowledge, patient care,
analysis completes. Needless to say there is dearth of practice-based learning, systems-based learning,
such research in the area of medical education in our communication and professionalism. 9,10 We also need
Ann. Pak. Inst. Med. Sci. 2008; 4(3): 127-8. 1

2. How to cite this article: Muhammad Saaiq, Khaleeq-Uz-Zaman. Postgraduate medical education in
Pakistan: challenging issues and the way forward. Ann Pak Inst Med Sci 2008; 4 (3) : 127-8.
to incorporate these essential attributes in our 5- Close collaboration and working relationship
training system according to our local circumstances. should be enhanced between various organizations
Institutionalization of such measures in the tertiary care such as CPSP, PMDC, Higher education commission,
hospitals would not only ensure quality training but also Medical universities, Tertiary care teaching hospitals
abolish the sharp contrast seen between the CPSP and Medical colleges of the country. This will ensure
trainees and those pursuing local degree programmes. improved structure of postgraduate medical education,
2- Since residency training relies on learning in better working conditions for the trainees and
the context of providing clinical service to the patient, recognition of their qualification internationally.
there is dire need to redesign the working pattern in
such a way that all the residents have a reasonable
opportunity to participate in the formal educational
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Ann. Pak. Inst. Med. Sci. 2008; 4(3): 127-8. 2