scholarly journals Medical Education in Nepal and Brain Drain

2017 ◽  
Vol 16 (1) ◽  
pp. 1-2
Author(s):  
Rishi Pokhrel
Keyword(s):  
Medical Education ◽  
Brain Drain ◽  
Career Planning ◽  
Health Workers ◽  
Health Sciences ◽  
Regulatory Body ◽  
Medical Council ◽  
Medical Doctors ◽  
First World ◽  
Medical Colleges

It has been four decades since the beginning of undergraduate medical education in Nepal and more than three decades of postgraduate medical education.1 Currently, Institute of Medicine of Tribhuwan University and Kathmandu University are major institutions providing medical education in Nepal with the help of their affiliated medical colleges. Two other deemed universities, B P Koirala Institute of Health Sciences and Patan Academy of Health Sciences also have major contributions in producing medical doctors in Nepal. National Academy of Medical Sciences (NAMS) provides postgraduate and super specialty training for doctors. Nepal Medical Council is the regulatory body that lays down the guidelines, provides accreditation and supervises to ensure that the regulations are being followed.2 It also conducts licensing examination for medical doctors.Educationalists worldwide vary in their opinions on the aim of education3-8 but Salomon precisely includes almost all of them as “The aim (of education) is to equip the learner with portable chunks of knowledge, skill, and understandings that can serve in other contexts.”9 Adkoli has analyzed migration of health workers in south Asia 10 and found that there was no systematically collected data regarding the extent of migration of healthcare workers and its possible impact on health care in Nepal. Nepal government spends a significant chunk of its financial resources to train doctors but many students who avail this benefit of ‘scholarship’ take part in the migration described in the article. Ironically, many doctors who are currently serving their motherland were either trained overseas or the ones who did study within Nepal but without availing any support from the government. When the first medical school was established in Nepal, the idea was to develop doctors who can prevent, diagnose and treat medical ailments prevalent in Nepal (Community based curriculum) and the career planning was designed in such a way that doctors were inevitably retained in Nepal.  The philosophy of this system was contrary to the definition laid down by Salomon9 but it did benefit the society and the country in the long run11. Things changed gradually over time and currently the doctors produced by oldest and state funded medical colleges of Nepal are ideal for health job markets of first world countries. This suitability coupled with adverse socieo-economic and political factors of our country has led most students who become doctors by state funding opting to serve in first world countries like United States, United Kingdom, Australia and Canada.Brain drain in Health sector is a global phenomenon12, 13, but developing countries like Nepal receive maximum brunt.  Lately, Nepalese medical education sector has been receiving a fair share of attention from all including media. However, it is saddening that this issue of ‘brain drain’ is something that had not gained any attention. Coming back to Adkoli’s work, we don't even have a data on how many doctors we are losing every year?10 There have been certain restrictions and bondages but these sorts of legislations have been seen to work contrarily. What is found to be lacking is the sense of belonging and development of the feeling that ‘I am important to this society and I must work for its betterment’. Most young doctors have a feeling that ‘there is no one taking me seriously anyway and it doesn't really matter weather I stay or Leave’.It is high time policy makers ensure that the medical doctors that we produce from the common men’s hard earned money serve the country. In addition to the legislations in the form of bondage, we should be able to install the feeling of belonging and sense of importance in the hearts and minds of these young doctors. To begin with, it would be a good idea if we start maintaining the database of the medical graduates that were and will be produced from Nepalese medical colleges; taking examples from many colleges from other countries that are doing it currently.14-16 Zimmerman’s study cited earlier provides an interesting insight that medical students with pre-medical education as paramedics were twice as likely to be working in Nepal and 3.5 times as likely to be in rural Nepal, compared with students with a college science background.11 We can also include into the undergraduate medical curriculum the concepts of social ethics, moral values, social justice and the long-term benefits of serving the society and the country that has invested so much for their education.

Postgraduate medical education: The history and development of competency-based training program in Nepal

2021 ◽  
Vol 8 (1) ◽  
pp. 102-112
Author(s):  
Jay Narayan Shah ◽  
Jenifei Shah ◽  
Jesifei Shah ◽  
Ashis Shrestha ◽  
Nabees Man Singh Pradhan
Keyword(s):  
Medical Education ◽  
Healthcare System ◽  
Postgraduate Training ◽  
Core Competencies ◽  
Health Sciences ◽  
Medical Council ◽  
Competency Based Medical Education ◽  
Surgical Workforce ◽  
Competency Based ◽  
Medical Colleges

Nepal is a small, lower-middle-income country; with a population of around 30 million. As per WHO, Nepal has a low doctor-patient ratio (0.7/1000) and even lower specialists (e.g., surgical) workforce (0.003/1000); additionally, data from Nepal Medical Council show the number of postgraduate specialists is 1/3rd of the total registered doctors. The mismatch in the doctor-patient ratio is further aggravated by the overwhelming number of doctors in urban areas; when 80% of the population are in rural Nepal. This inequitable discrepancy in the healthcare system requires: proper training of competent medical graduates, a fair distribution across the country, and effective changes in the healthcare system. Competency-based medical education plays an important role in: standardizing education, training competent doctors, and deploying them where they are needed the most. The Government of Nepal has recently established Medical Education Commission-which plans to oversee the entrance exams; and expand the postgraduate training to be conducted by private hospitals, previously not affiliated with any medical colleges or universities. Historically, Civil Medical School started training compounders and dressers in Nepal in 1934. A big milestone was achieved with the establishment of the Institute of Medicine under Tribhuvan University in 1972, which has continued to train all categories of health manpower needed in the country. In 2006 Nepal Medical Council developed “Regulations for Post-graduate Medical education”. Thereafter, several institutions started providing postgraduate training, for example: the BP Koirala Institute of Health Sciences, Kathmandu University, National Academy of Medical Sciences, and Patan Academy of Health Sciences (PAHS). The PAHS conducts PG programs and post-PG fellowships in line with competency-based medical education. In addition to formative assessments, research thesis, and a publishable article; PAHS requires its trainees to be certified in a pre-set of entrustable professional activities (EPAs) and to master eight Core Competencies domains in: Professionalism, Patient-centered care, Procedural skills, Clinical Reasoning, Communication, Scholarship, Leadership, Community orientation. The number of medical colleges in Nepal has since expanded to 24  (medical 21 and dental colleges 3). Private medical colleges make up about 3/4th of the total medical colleges in Nepal. This makes the inclusion and regulation of more components of the competency-based curriculum in postgraduate training programs, and its monitoring,  somewhat of a challenge.

scholarly journals Continuing the Legacy of Editorial of the First Issue of Journal of Karnali Academy of Health Sciences

2018 ◽  
Vol 1 (2) ◽  
pp. 4
Author(s):  
Binod Aryal
Keyword(s):  
Medical Education ◽  
Trauma Surgery ◽  
Health Sciences ◽  
Academic Program ◽  
Obstetrics And Gynecology ◽  
Medical Council ◽  
Academic Council ◽  
Institutional Review ◽  
Substantial Progress ◽  
Set Up

Professor Dr MN Marhatta wrote in detail about the 'Milestones of Medical Education in Karnali Academy of Health Sciences' in the first issue of Journal of Karnali Academy of Health Sciences (JKAHS). By the time of this second issue of JKAHS, there has been substantial progress in achieving the goals set and plans put forward by the Academy. Two bachelor programs, i.e., Bachelor in Midwifery Sciences (BMS) and Bachelor in Public Health (BPH) studies are going to start from Mangsir 2075. Certified Anesthesia Assistant (CAA) training course is running smoothly. The Academic Council has prepared and the panel of experts has endorsed the curriculum of Masters in Obstetrics and Gynecology (MD), Masters in Orthopedics and Trauma Surgery (MS), and Masters in Anesthesiology and Critical Care (MD). Masters in General Practice and Emergency Medicine (MDGP) curriculum was prepared in the presence of experts of the various subjects, endorsed by the Academic Council of the Academy and submitted to the Nepal Medical Council (NMC) for approval and accreditation. The NMC has already agreed to take the process forward and has decided to visit KAHS for feasibility study and inspection of its preparation. KAHS is reasonably prepared to start its first Masters academic program. The Academic Council has appointed two professors in MDGP, one each in Obstetrics and Gynecology, Orthopedics, and General surgery, which is an essential and major asset for starting residency programs in the Academy. As per the criteria set by the NMC, the Academic Council has appointed the faculties in the Departments of Psychiatry and Dermatology, and the departments in Basic Medical Sciences including Anatomy, Physiology, Pharmacology, and Microbiology have been established. The class/ lecture rooms are well set up and the faculties of various department are excited and ready to welcome the first batch of MDGP residents in Jumla. There has been huge progress in the field of research and publication as well. The Nepal Health research Council has agreed to permit establishing Institutional Review Committee (IRC) in the Academy, which, we believe, will encourage the faculties and the students to participate in various national as well as locallevel scientific studies and research. There was overwhelming response from the Academy faculties as well as the faculties from various other academic institutes during the call for papers for publication in this journal. The future of Karnali Academy of Health Sciences is looking bright as this Academy was established to provide education and health services to the most marginalized people of the country. This Academy is located in a unique geography which has a huge possibility of becoming a unique institute in the field of medical education. And, this journal will continue to publish cutting-edge research and studies done in this Academy and elsewhere in the country.

Recongnizing India's Doctors: The Institutionalization of Medical Dependency, 1918–39

1979 ◽  
Vol 13 (2) ◽  
pp. 301-326 ◽  
Author(s):  
Roger Jeffery
Keyword(s):  
Public Sector ◽  
General Medical Council ◽  
First World War ◽  
Automatic Recognition ◽  
Medical Council ◽  
World War ◽  
Indian Medical ◽  
The First World War ◽  
First World ◽  
Medical Colleges

In 1975 the British General Medical Council ceased to recognize Indian medical degrees as sufficient qualification for practice as a doctor in Britain. For several years previously the G.M.C. had refused to grant automatic recognition to the degrees of the new Indian medical colleges, and this had soured relationships between the G.M.C. and its Indian counterpart, the Medical Council of India. In retaliation for the British move, the M.C.I. ceased to recognize British medical degrees, and higher qualifications from Britain awarded after 1976 would not be accepted from candidates for promotion in medical colleges and other public sector jobs. This controversy was not as novel as recent commentators have supposed. Indian medical degrees had been refused recognition once before—in 1930—and the issue of G.M.C. recongnition had been at the heart of a dispute between the Indian medical colleges and the British medical authorities which had raged from the end of the First World War to the eve of the Second.

scholarly journals Medical Education in India

2017 ◽  
Vol 53 (04) ◽  
pp. 179-193
Author(s):  
Shridhar Sharma ◽  
Gautam Sharma
Keyword(s):  
Health Care ◽  
Medical Education ◽  
Clinical Skills ◽  
Medical Schools ◽  
Medical Council ◽  
Mortality And Morbidity ◽  
Health Indices ◽  
Education In India ◽  
The Government ◽  
Medical Colleges

ABSTRACTIndia, a country with rich cultural and health care heritage has progressed by leaps and bounds since independence. The health indices have improved and mortality and morbidity have come down significantly. The health care system of India is a mix of public and private sector. In 2017, there are 479 medical colleges in India with admission capacity of over 60,000 at the undergraduate level. The pattern of modern medical education is modeled after the British system and the first few medical schools were established in 19th century. Medical Council of India (MCI), the government-mandated regulatory agency for medical education, was formed in 1934. The Government of India is regularly reviewing the existing medical education policy to give it a new direction so as to make the curriculum relevant and responsive to the national needs. The MCI has also recognized the need to reduce the artificial compartmentalization of the curriculum into preclinical, para-clinical and clinical disciplines. Horizontal and vertical integration is being promoted but not practiced in most medical colleges. Instruction remains teacher-based and not much emphasis has been laid on self-directed learning. There is a paucity of innovative approaches and lack of adapting the recent technology into most medical schools in India. Skills such as related to communication and managerial domains, and professionalism are not imparted in the current curriculum. While the level of knowledge in the medical sciences is highly unsatisfactory, medical graduates are often found to be lacking in the clinical skills. So far, attempts to introduce innovations in medical education have been limited to certain institutions. Also, there is lack of adequate motivation and opportunities for faculty development. It is strongly felt that there is a need to redefine the goals of medical education in India depending upon the needs of the society. MCI has recently attempted designing a need-based curriculum. At present, medical education in India is at a significant juncture with initiatives coming from both external and internal influences, and the political will to attain the goal of health for all, India hopes to be in a better position to prepare physicians for the 21st century.

Trends and Prospects of the Moroccan Health System

2013 ◽  
pp. 314-336
Author(s):  
Nada Zouag ◽  
Ahmed Driouchi
Keyword(s):  
Health Care ◽  
Medical Education ◽  
Health System ◽  
Brain Drain ◽  
Current Situation ◽  
Medical Doctors ◽  
Collaborative Process ◽  
Growing Population

This chapter looks at the current situation of health deficits and shortages in Morocco with a focus on the role of medical education. The trends and prospects in health care, medical staffing, and medical education are analyzed. The attained results from both trend description and simulations of patterns show major shortages relative to the needs. The existence of these trends appeals for further cooperation in the areas of health care through emphasis on medical education and research. These outcomes appear to be promising for the pursuit of satisfying the needs of a growing population and demand for healthcare. Further cooperation can lead to the acceleration of a mutual win-win collaborative process between Northern and Southern economies with no room for brain drain in the case of medical doctors. This chapter introduces the health system of Morocco to the reader and helps in better perceiving the survey conducted with medical doctors in Morocco and that is analyzed in the following chapter.

scholarly journals Nepal Medical Council: The past and the future

1970 ◽  
Vol 7 (3) ◽  
pp. 196-203
Author(s):  
H Dixit
Keyword(s):  
Medical Education ◽  
Medical Journal ◽  
Key Words ◽  
Medical Council ◽  
The Public ◽  
The Past ◽  
The Future ◽  
Education Medical ◽  
Medical Colleges

The Nepal Medical Council (NMC) has been technically in operation for forty six years though in reality it is much less. The initial years were spent in establishing it. It is only in the last fifteen years or so that there has been much interest in it's functioning. The objective of the NMC is to protect the public and also to oversee the medical education being conducted within the country. A brief account of the NMC from its date of establishment till the present is given here. Key words: NMC; NMA; Medical Education; Medical Colleges. DOI: 10.3126/kumj.v7i3.2723 Kathmandu University Medical Journal (2009) Vol.7, No.3 Issue 27, 196-203

Beyond Brain Drain

2014 ◽  
pp. 777-797
Author(s):  
Ahlam Fakhar
Keyword(s):  
European Union ◽  
Brain Drain ◽  
Knowledge Economy ◽  
Health Workers ◽  
Physical Capital ◽  
Medical Doctors ◽  
The European Union ◽  
Long Run ◽  
The World ◽  
The Relationship

The past decades have witnessed an increase in the pace and a consolidation of immigration of medical doctors and the globalization of the health system. If properly managed, globalization of the health workforce could lead to perceptible gains in health status for all parties involved. In a world economy shaped by strong institutions, globalization could benefit those countries with a strong and human and physical capital. This chapter reviews the importance of immigration and aims at presenting different views on immigration of medical doctors. While the traditional view has been dominated by the rhetoric on “brain-drain,” a new and more promising thread of research has centered on the relatively new concept of “brain-circulation.” Mobility for medical workers and health workers, in general, can be a significant contributor to the formation of scientific and technical human capital, which has been an important driver in economic expansion and social development in many regions of the world. To illustrate the point, the authors use a cooperative framework to elucidate the relationship between immigration of medical doctors and economic development in the long-run using the potential agreement between North Africa and the European Union as an example. The finding could have implications for the capacity of developing countries to turn around and use “circular immigration” as a means to integrate into the emerging knowledge economy.

Development of Medical Education in Kathmandu Medical College

2018 ◽  
Vol 6 (3) ◽  
pp. 116-122
Author(s):  
Binita Pradhan ◽  
Jenash Acharya ◽  
Eurek Ranjit ◽  
Meera Bista ◽  
Sanjaya Mani Dixit ◽  
...  
Keyword(s):  
Medical Education ◽  
Teacher Training ◽  
Medical Council ◽  
Education Department ◽  
Medical College ◽  
Medical Education Department ◽  
Medical Colleges

Background: When the Nepal Medical Council Act was enacted in 1964 it was accepted that it would be responsible for the regulation of Medical Education in Nepal. Subsequently followed the establishments of medical colleges of which Kathmandu Medical College is one.Present Status: Kathmandu Medical College started the MBBS program back in 1997 and has since then developed over the years. The development of medical education at Kathmandu Medical College ensued subsequently with the formation of Medical Education Unit Teacher Training Cell on June 2001. First batch of teacher’s training was held on February 2003 and since then the Medical Education Department has remained active. It was in the year 2014 that Medical Education Department was strengthened further and different committees and sub-committees were formed to develop the standard of medical education to new heights.Conclusion: The medical education has developed over the years as has been recorded in this paper. There are shortcomings to be corrected. For medical education to develop further, specific steps need to be carried out in future years to meet the challenges of international accreditation.

scholarly journals Problem Based Learning in Medical Education

2014 ◽  
Vol 10 (4) ◽  
pp. 78-82 ◽  
Author(s):  
DI Mansur ◽  
SR Kayastha ◽  
R Makaju ◽  
M Dongol
Keyword(s):  
Medical Education ◽  
United Kingdom ◽  
Medical School ◽  
Problem Based Learning ◽  
Health Sciences ◽  
Harvard University ◽  
Learning Method ◽  
The United Kingdom ◽  
Great Support ◽  
Medical Colleges

Problem based learning, originally introduced in the Medical School at Mc- Master University in Canada in the late 1960s, and is now being used as a learning method in many medical schools in the United Kingdom and worldwide. Problem based learning have been adapted in many medical colleges of Nepal be used either as the mainstay of an entire curriculum or for the delivery of individual courses. Institution of Medicine, Tribhuvan University in 1980, BP Koirala Institute of Health Sciences at Dharan in 1999, KUSMS with the great support of faculties from Harvard University in 2001, Patan Academy of Health Sciences (PAHS), and lately all the affiliated medical colleges of Kathmandu University have adapted Problem based learning DOI: http://dx.doi.org/10.3126/kumj.v10i4.11002 Kathmandu Univ Med J 2012;10(4):78-82

scholarly journals The impact of colonial-era policies on health workforce regulation in India: lessons for contemporary reform

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Veena Sriram ◽  
Vikash R. Keshri ◽  
Kiran Kumbhar
Keyword(s):  
Medical Education ◽  
Health Workforce ◽  
Health Workers ◽  
Regulatory Policy ◽  
General Medical Council ◽  
Main Body ◽  
Medical Council ◽  
Critical Function ◽  
Middle Income ◽  
The Impact

Abstract Background Regulation is a critical function in the governance of health workforces. In many countries, regulatory councils for health professionals guide the development and implementation of health workforce policy, but struggle to perform their responsibilities, particularly in low- and middle-income countries (LMICs). Few studies have analyzed the influence of colonialism on modern-day regulatory policy for health workforces in LMICs. Drawing on the example of regulatory policy from India, the goals of this paper is to uncover and highlight the colonial legacies of persistent challenges in medical education and practice within the country, and provide lessons for regulatory policy in India and other LMICs. Main body Drawing on peer-reviewed and gray literature, this paper explores the colonial origins of the regulation of medical education and practice in India. We describe three major aspects: (1) Evolution of the structure of the apex regulatory council for doctors—the Medical Council of India (MCI); (2) Reciprocity of medical qualifications between the MCI and the General Medical Council (GMC) in the UK following independence from Britain; (3) Regulatory imbalances between doctors and other cadres, and between biomedicine and Indian systems of medicine. Conclusions Challenges in medical education and professional regulation remain a major obstacle to improve the availability, retention and quality of health workers in India and many other LMICs. We conclude that the colonial origins of regulatory policy in India provide critical insight into contemporary debates regarding reform. From a policy perspective, we need to carefully interrogate why our existing policies are framed in particular ways, and consider whether that framing continues to suit our needs in the twenty-first century.

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