By Sankalpa Marasinghe –

The phrase ‘double standards’ has been given a new definition by the University Grants Commission (UGC). This feat was achieved by the inconsistency in decision-making with regard to a very important function vested by the University Act in the UGC i.e. the granting of “Degree Awarding Status” to institutions of higher education.

The Institute of Technological Studies and the OASIS Hospital (Pvt) Ltd

In 2008, the above institute applied for “Degree Awarding Status” in order to establish a Medical Faculty which grants the MBBS degree. The application was forwarded to the UGC and at its 768^th Meeting held on 20.11.2008, a subcommittee was appointed to make recommendations on the proposal to the UGC.

The Committee

The committee comprised the following most distinguished academics.

1. Prof. M.T.M. Jiffry, Vice-Chairman, UGC (Chairman)
2. Prof. Rohan Rajapakse, Member, UGC
3. Prof. Sarath Abayakoon, Member, UGC
4. Prof. Janaka de Silva, Member, UGC
5. Prof. Rajitha Wickramasinghe, Dean, Faculty of Medicine, University of Kelaniya
6. Dr. H.H.R. Samarasinghe, President, Sri Lanka Medical Council

Appointment letters were issued on 08.12.2008 and Dr H.H.R. Samarasinghe who was the President of the Sri Lanka Medical Council (SLMC) back then declined to be a member of the subcommittee citing “Conflict of Interest”.

The Recommendations

The committee convened 4 times and subsequently forwarded its recommendations to the UGC. The UGC at its 772^nd Meeting held on 22.01.2009, considered the subcommittee recommendations and made the following decisions.

The Commission having considered the recommendations made by the Committee decided that the application for establishment of a Medical Faculty attached to the Institute of Technological Studies and OASIS Hospital [Pvt] Ltd cannot be approved in the present form and the shortcomings of the application be conveyed to the Director-General, Board of Investment (BOI) of Sri Lanka.

The Commission also decided that the proposed degree programme should conform to the guidelines given in the documents published by the Sri Lanka Medical Council and the Quality Assurance and Accreditation Council.

Shortcomings

It was further decided to convey the following to the Chairman, BOI, and the Chairman of UGC conveyed the same with a letter dated 11.02.2009

(A) The application does not give enough basic details regarding the following areas;

• Whether the course is a traditional or integrated course.
• Facilities available for teaching and learning, specially for clinical and para-clinical training, Library facilities.
• Qualification framework and procedure for assessment.
• Fees structure.
• Quality Assurance guidelines and mechanism.

(B) The submitted names of the lecturers for the course are inadequate.

(C) The proposed degree programme should conform to the guidelines given in the following documents published by the Sri Lanka Medical Council and Quality Assurance and Accreditation Council.

• Document on minimum standards required for medical schools in Sri Lanka (Sri Lanka Medical Council)
• Benchmark statement for Medicine (Quality Assurance and Accreditation Council)

Deficiencies in Clinical Teaching

The Committee appointed to appraise the proposal cited the following as “shortcomings” in the process of reaching their conclusion.

a) The patient spectrum in private hospitals is much narrower than in government teaching hospitals. Hence methods to be adopted to ensure adequate coverage of medical conditions for undergraduate clinical training should be considered.

b) Private hospital patients may not be willing to be used for clinical teaching — i.e. examined by medical students (including internal digital examination of rectum and vagina, training in management of childbirth). The minimum number of such procedures required by a student and the feasibility of achieving this should be considered.

c)  Although there appears to be several medical and surgical units in the document, there are only two Paediatric units and one Obstetrics & Gynaecology unit. One unit in each of these disciplines will have to be reserved for final year training (equivalent to Professorial units in established medical faculties). The others are required for third and fourth year clinical training. If this is the case:

• Where students will have the third and fourth year Obstetrics & Gynaecology and Paediatric clinical training should be specified.
• There are only a few full time specialists in the private sector. It may be difficult for the private sector to find sufficient high quality specialists with academic credentials to cover wards/units in all the specialties required in a fully fledged teaching hospital. Most specialists who work in the private sector are employed in the government sector and are available in the private sector only after 4 pm, and too only in the OPD. Methods to overcome this problem should be considered.

d)      It is suggested that academic posts and qualifications for academic posts conform to those approved by the UGC.

e)      A significant part of the bedside teaching is done by Senior Registrars and Registrars (postgraduate trainees of the PGIM, Colombo, preparing for MD and MS degrees and Board Certification as specialists) in state teaching hospitals as consultants cannot be expected to be available around the clock: Such grades of full time “consultants-in-training” do not seem available in the private hospital. Details of such positions should be given serious consideration.

f)        Private hospitals usually do not receive the number of acutely ill patients seen in a casualty ward in a state hospital. Private hospitals also lack fully fledged set ups for accident and emergency care. The facilities indicated in the document seem inadequate. Consideration should be given to admission of adequate numbers of acutely ill patients and provision of adequate infrastructure for clinical training.

g)      The teaching of Community Medicine is field based. In a setting where primary health care is exclusively delivered by the state sector, the manner in which this subject is to be taught should be detailed.

h)      Forensic Medicine is a specialty that is almost exclusively under the purview of the government, sector. How such services will be accessed for clinical training should be considered and outlined.

Consistency and persistence

A revised proposal was submitted by the Institute of Technological Studies and the OASIS Hospital (Pvt) Ltd and a subsequent panel which comprised the following distinguished members denied the requested “Degree Awarding Status” on 2^nd September 2010, yet again.

1. Prof. Rohan Rajapakse         Vice Chairman UGC
2. Prof. H. Abeywardana          Member of UGC
3. Prof. Janaka de Silva             Member of UGC
4. Prof. Lalitha Mendis              President SLMC
5. Prof. Rajitha De Silva             Dean Faculty of Medicine, University of Kelaniya

It is pertinent to note that the Institute of Technological Studies and the OASIS Hospital (Pvt) Ltd had the OASIS Hospital which was a fully functional private hospital at the time of applying for the “Degree Awarding Status” and it had not just an OPD with less than 15 patients per day but many disciplines including Surgical, Medical, Gynaecology and Paediatric wards. But it is evident that the high-profile academics of the committees appointed by the UGC were of the opinion that even such an institute is inadequate for an accepted undergraduate training for an MBBS degree.

A different Fortune

However, another institute which was established at or around the same time period had a “different turn of fortune”. Yet another BOI approved project, the South Asian Institute of Technology and Management (SAITM) which also incorporated the word “Technology” (strangely) applied for a Medical Faculty with “Degree Awarding Status” to grant MBBS degrees. The fortunes of SAITM were such that it was granted “Degree Awarding Status” in 2011 by Gazette notification. This was of course way before the institute even started an OPD service in April 2013 which the institute called the “Teaching Hospital”. Unlike the unfortunate OASIS hospital which did not recruit students before it was given recognition, the second institute had already recruited four batches by the time it was granted “Degree Awarding Status”. The four batches, however, were not included in the Gazette notification as the law cannot be applied retrospectively.

Many are wondering what made the very UGC which denied the OASIS hospital in 2009 and 2010 “Degree Awarding Status” was so “convinced” to grant the same to SAITM. Questions are being asked how the latter had fulfilled the same requirements raised by the two expert panels with regard to facilities and training. It is pertinent to know how an institute which still does not have a functioning hospital, can provide the correct “clinical mix” of patients for 10 batches of medical students?

How has the said institute overcome the “obstacles” cited by the two subcommittees with regard to patients and compliance in private sector?

It was revealed at a recent submission to the Supreme Court (SC/FR/512) the actual permanent teaching staff of SAITM comprises many non-medical professionals (A/L teachers, paramedics etc.) and many of the doctors were either MBBS or MD (Russian) qualified doctors. Even some senior lecturers were without post-graduate qualifications. What happened to the suggestion (d) of the subcommittee which specified that “It is suggested that academic posts and qualifications for academic posts conform to those approved by the UGC.”?

Questions to answer

Were there any new “strategies” proposed to be employed by SAITM to avert the obstacle of providing clinical teachers without the services of Post Graduate trainees such as Registrars and Senior Registrars?

What were the proposals to overcome inadequacy of teaching in Forensic Medicine and Community Medicine?

In the face of the Health Ministry’s stern decision NOT to allow government hospitals to be used by a private business venture to profit and the GMOA very clearly and rightfully objecting to the use of state hospitals jeopardizing the teaching of state university students, it is unlikely that the said shortcomings are fulfilled by this institute.

The only possible answer would be that the wisdom of those who “recommend” such institutes to be granted “Degree Awarding Status” would have been much, much higher than those who made the former.

*Dr Sankalpa Marasinghe; Medical Officer, Castle Street Hospital For Women