7 May, 2021

Blog

On Medical Education In Sri Lanka

By Romanie Fernando

Dr. Romanie Fernando

The admission criteria for medical education should be at least 2B and C. At present UGC minimum qualification adopted in 2011 for medicine 2C S. Before 2011 it was 3S.

Implement a merit based admission criteria for state universities (75% merit, 25% marginalised district quota system) or 100% merit. At present 40% merit, 55% district quota, 5% marginalized districts (since 1970, prior to 1970 admission to universities 100% merit)1. For the past 45 years this non merit base admission had caused lead to the problem we face today. This happened nearly 30 years ago and many young lives were lost. Have we learned lessons from the history?

Addition to A/L results an aptitude test, plus added marks for exceptional talents in sports or arts or music or innovation skills should be considered. These aptitude tests should test the Emotional quotient (EQ) and Spiritual quotient (SQ). EQ and SQ are higher order thinking than intelligent quotient (IQ)2.

An independent accreditation council to accredit all universities (public and private) should be established. Every 2 -3 years, compulsory accreditation to be done and standards checked. All state and private higher education (HE) institutions should be accredited and standards maintained. At present many private HE institutes and some state HE institutions do not obtain accreditation from a national or an international accreditation council.

If a non-state medical school is to be established it should be a non-profit making trust. Private- public partnership for non state medical schools with hospitals similar to Sri Jayewardenepura Teaching Hospital (SJTH) will be a feasible option. This will open the door for a majority of Sri Lankan citizens with an affordable health care. Since the inception of SJTH more than 30 years ago there had been no other private-public partnered hospital in the country.

Before establishing a non-state medical school, the medical ordinance should be amended to include the criteria for recognition by SLMC and expected standards of a non-state medical school. This should be similar to any state medical faculty.

National policy for education should be formulated for the primary, secondary and tertiary education.  This should have been done 25 years ago soon after 87-89 students unrest.

Problems I see in Sri Lankan medical education at present:

* Many students with higher marks from Colombo, Kandy and Gampaha unable to obtain medicine due to district quota. Also from above districts dental, Vetenary science Z score is higher than some district’s medical entry cut off.

* Having more than 1000 Foreign qualified graduates unable to pass ERPM. I see two main issues for the failure rate to be so high when the exams and the examiners are in par with Final MBBS.

a) Minimum entry criteria of 2Cs S (2011) before that 3 S given by UGC.

b) Sub-standard overseas universities approved by SLMC without supervision.

* Also within state universities there are many students failing to qualify at exams, who are wasting years in the university. Maximum number of attempts are given at an exam, failing which a student is asked to leave the study course. The facts on failures can be easily obtained from each faculty. The reasons for failure of medical students are mostly the admission criteria, in few cases the language barrier and social or health issues.

* The quality of teaching and assessments have come down in most HE institutions.

* Also the recruitment to university teaching and promotion systems are flawed.

* Not having a mandatory accreditation process for all universities by the UGC.

* The waiting time for admission to medical school after A/L is more than 12 months. Starting internship after final MBBS is more than a year.

* Quality of the end products from the state universities are questionable. Professionalism3 is a virtue, missing in many young doctors today.    

I’m totally for improving standards of teaching, learning and amending the admission criteria for medical entrance to Sri Lankan universities.

Should we promote paid medical education or not? There are many valid arguments for and against this. However working at a university and knowing the short comings and corruption within, I no longer am against non-state medical schools.

Two things are need to be amended on urgent basis: Admission criteria and the formation of an independent accreditation body.

Although entry to medical education in Sri Lanka is been passionately protected by government doctors and state medical students, lateral entry to the medical carrier for foreign graduates through the examination to registration to practice medicine (ERPM).

If the admission criteria amended with an increased cut off and accreditation is strictly adhered by both state and non-state medical education, both can co-exist to produce medical professionals of good standing for our nation.

There is an urgent need for a national policy for education to be formulated. The annual allocation of money, the monitory management, curriculum developments, teacher training, accreditation, etc, should be included in the national policy. National policy should be formulated for at least for two decades and no union or a politician should interfere or change it after passing it to law. A platform for constructive dialog on this national issue is very welcome.

*Dr. Romanie Fernando – MBBS, MD (O&G), University of Colombo, Consultant Obstetrician and Gynacologists, Hema’s Hospital, Thalawathugoda., Former Senior Lecturer, Rajarata University of Sri Lanka. Former Medical officer of Ministry of Health, Sri Lanka.

References:

1. https://www.colombotelegraph.com/index.php/university-admission-process-needs-urgent-review-a-proposal/

2. https://www.scribd.com/presentation/12499212/IQ-EQ-SQ-Manifestation-of-Human-Potentialities

3. https://www.ijme.net/archive/1/developing-medical-professionalism-in-future-doctors.pdf

4. http://www.slguardian.org/2017/02/sri-lanka-what-went-wrong-in-saitm/

5. http://srilankamirror.com/features/1829-saitm-beware-of-becoming-a-bite

Print Friendly, PDF & Email

Latest comments

  • 5
    0

    The author makes some good points and recommendations. But I am quite skeptical of any Government of Sri Lanka actually implementing anything meaningful.

  • 7
    1

    The minimum A Level qualifications are interesting. In Britain it is 3As, an assessed personal statement, proof of voluntary social or medical work, psychometric testing, references and up to two interviews.

    • 2
      0

      Those who are unable to enter state medical schools after sitting Sri Lanka ALs have then done London ALs within 6 months and gained entry to Australian Medical schools.

      This shows that it is harder to gain 3 As at our local ALs than in the London. However the London syllabus is probably better at encouraging innovative thinking!

  • 7
    3

    Romanie,
    You have come up with some good suggestions. However, there are some aspects you suggest to implement I guess from the west, which are flawed. With first hand experience in the west on using exceptional talents in sports or arts or music or innovation skills as admission criteria, I would not venture into such yardsticks as good practice. The reasons are two folds; It facilitates academically unfit students to enter medical education. How does one determine some talents are better than other talents and who are the experts on such assessments? Only thing this facilitate is, people of authority and connections to use these loopholes to get admission to their favorites. Secondly, with my experience most these students are academically challenged. As one of my colleagues said playing good piano music by the death bed is not going to bring life back!
    My suggestion is that academic merit should be the sole criteria for selection and if there are two or more candidates with same academic levels you should then venture into exceptional talent assessment.
    I suggest district and other selection quota systems should be totally abolished and over all academic merit should be the only criteria used for admission. We have come a long way since these quota systems have been implemented. It is the gov. responsibility to make sure that every school get the same level of education. If not the best and the brightest students should be transferred to better schools in urban areas. I guess this is already happening.

    • 2
      0

      Eusense,
      “It is the gov. responsibility to make sure that every school get the same level of education. If not the best and the brightest students should be transferred to better schools in urban areas.”
      The govt. cannot possibly provide high standards in every school. It could of course provide low standards, with the means it has. The solution is to charge those who are able to pay (like the hordes who patronize tuition-masters).
      There used to be a Central School network, which provided English medium education to bright students.

      • 6
        0

        Old,
        Gov. had close to 50 years since starting the quota system. They should have done something. At least giving scholarships to bright rural students so that they can attend city schools is a good step. But with that in effect quota system should be abolished.

    • 2
      2

      The basic entry qualification should be A/L marks but national/international level performances or innovations should be added marks. Academic performance only will not select healthy balanced individuals.

      The district quota system was initiated temporary until the remote districts with teacher and laboratory shortages in science streams were improved. However 45 years on has there been an improvement?
      Primary and secondary education should be standardised first. Giving quotas for entry to tertiary education without improving the education in the primary and secondary level has prevented equal opportunity to many.

      The deprivations of equal opportunity to standard education at primary and secondary level of education in this nation is another problem not been highlighted in the media. Teacher shortages in remote areas and excess teachers in the city schools has been kept under the carpet for decades.

      • 7
        0

        romanie,
        Looks like you did not grasp my post. Sri Lanka’s AL is of higher academic level compared to similar exams in western countries. If you speak to any Sri Lankan University science professors in the west this can be confirmed. However, as you suggest the use of “national/international level performances or innovations should be added marks” has limited or minuscule value. In fact this brings bias to the admission policy. How many Sri Lankan parents have the means and capability to fulfill this kind of requirement to be competitive? I have already explained why such admission criteria fails to achieve what is intended and the drop out rates are higher in the west. Also, I have already explained my experience with students who have exceptional talents but poor academic capabilities. How do you intend to select “healthy balanced individuals” out of them? That is the reason I stated that academic achievements should be the primary selection criteria and any other factors should be used only when there is a need to chose one candidate from a pool with similar academic levels.
        I have no comments on the rest of your post. However, I don’t think a poor country like SL has the means to achieve all what you suggest. But scholarship programs for the rural bright students is a positive action. From what I am told most city students do well not because of good teachers and good schools but due to private tutoring classes. You may be more familiar with that.

        • 0
          1

          Eusense,

          you say ‘a poor country like SL has the means to achieve all what you suggest.’

          We say poor when it comes to education reforms but when the ministers vehicles are in par with rich country.

          The admission criteria additions are open to dialog but the basic entry criteria should be higher at least 2B C or 3Bs

  • 4
    0

    Dr. Fernando

    Kudos to you for honestly analyzing the issue, rather than trying to make political mileage from it. I agree with your recommendations – merit should be the main criterion for entrance. I for one, got 2Bs and 2Cs (when botany and zoology were separate subjects), but yet did not make it to medical school; even though another of my classmates with the same grades got in. Incidentally his mother was high up in the state administrative service. Wonder whether that had an effect ? Also the fact that I was from Colombo and attended Royal College must have also had a negative impact.

    Anyway, the issue of medical college entrance and the final licensing exams should be standardized and applied universally. Anyone getting a free tertiary education, should be required to work within Sri Lanka for a minimum number of years upon graduation.

  • 2
    0

    Romanie Fernando in: “On Medical Education In Sri Lanka” points out the deficiencies in Lankan Higher Education in general and in particular Medical Education. This started with the GoSL introduced “standardization” for political reasons. This has had some positives but political interference in tertiary education has become the norm now. SAITM was warned of the risk of involved with recognition but they hoped to overcome business risks with political connections.
    GMOA, SLMC and 8 medical faculty staff are concerned about “standards”. SAITM may create elitists. (Remember the lawyer who scored 98% in a paper but who failed to show brilliance since.)
    Foreign universities have this fee paying students – almost always rich overseas. Is there a fee paying student in Lankan system?

  • 2
    0

    The district quota system should be abolished.And agree with all contents therein.The sleeping Minister of Higher Education must getup from slumber and act immediately.

  • 2
    0

    It is high time that we do away with the concessions given to those disadvantaged schools/ districts, but not over night. We first need to bring all the schools to the same level in terms of teachers, labs, etc. The idea of establishing central schools in 1956 did pave the way for this. It is possible to further explore that idea. Also, it is high time that we overhaul the entire system not to divide students into various streams after OL. Let them study more than three subjects/ courses: major and minor. Drop unnecessary portions from all major subjects/ courses. Architecture is one of the first (if not the first) to have an aptitude test for the entrants and international accreditation for their degree. Now we also have a national accreditation. We also added spatial cognition tests to our aptitude test, which many parents/ students had misidentified as a drawing test. Why not all the Medical faculties go through an accreditation process? Do SLMC visit those foreign universities in India, B’desh, Nepal, Russia, etc.? Or does SLMC visit the national universities at all?
    Also, do not forget that most of us study in our mother tongue, and immediately change to English in many of these educational programs. Students as well teachers struggle as a result. Need to address this too.

  • 1
    1

    Government should NOT standardize admission criteria for medical colleges (or any college for that matter). It should be left to the respective schools to decide what the admission criteria should be depending on their program.

    Schools may admit students based on O/L, A/L or even Bachelors/Masters programs and may offer multiple courses spanning 6 years to 3 years depending on the student population admitted to each program.

    Once a person obtains a bachelor’s degree his performance at A/L or other entrance exam is irrelevant.

    For anyone outside the school, what is important is not the standard of the student going into the program but the standard of the medical professional graduating from the program. To ensure the latter we need licensing exams and a scheme where the license has to be renewed periodically.

    There should be one licensing exam that all doctors must sit to practice in Sri Lanka regardless of where they get their medical degree: state medical schools, private medical schools or foreign medical schools.

    Even without private medical colleges based on GMOA’s own pronouncements in the past we have so many bogus medical professionals in the country. Hence we need strict mechanisms to ensure only license medical professionals are allowed to practice.

    Our education system needs to be more open not more closed and should provide multiple opportunities for people to pursue any carrier they want whenever the life presents itself with opportunity which may not be when they are in their 20s for everyone. It should be more forgiving not unforgiving and penalizing.

    The more the government tries to standardize the system the more rigid and restrictive it becomes. Hence instead of standardizing the system it should standardize the professional to ensure quality of healthcare delivery.

    Constant refusal by the medical professionals in the country who are predominantly from state medical schools to make the system more open only indicate their fear of competition. Why fear competition if you are competent?

    Furthermore everyone graduating from state universities especially medical professionals since dentistry/medicine costs more per student compared to other programs would do well to remember that their education is paid for by all citizens of the country most of whom were NOT fortunate enough to enter state universities.

    • 3
      1

      no name,
      The gov. will never allow respective schools to decide what the admission criteria should be. The UGC has played a major role in trying to legitimize a non-accredited medical school (SAITM). Look what is happening now with the SLMC, the governing medical body which issues medical registration. The gov.and the legal system is forcing them to register un/under qualified medical students. Even if the medical schools are allowed to decide what the admission criteria should be, it will be the SLMC that will finally decide on registration. The importance here is accreditation from the SLMC. Look what happens with the American system. A bachelors is required to enter medical school. Do every bachelors degree holder get admission? Here, the best with GPAs of 4 or close to 4 who have scored high on pre-med subjects and highest MCAT scores are accepted. So whether ALs or Bachelors or any other exam the competition is extreme. For the above reasons I don’t agree with your statement “For anyone outside the school, what is important is not the standard of the student going into the program but the standard of the medical professional graduating from the program. “. However, there should be periodic continuing medical education and training of all medical graduates to keep them updated with the latest in medical field.

  • 6
    0

    It was brave of the writer to expound concepts that are at odds with her “trade” union and the established medical mafia that seem to dictate national policy. It is vitally important to test aptitude in emotional quotient which demonstrates the ability to feel empathy with the suffering patients.

    Sports and Arts, aesthetics and music are excellent additional criteria to establish maturity and intelligence that cramming for ALs do not establish. It is clear that many relatively young Sri Lankan doctors who practice do not possess mature humanitarian or ethical notions that are critically important in medicine.

    A foreign accrediting body would be ideal. This would leave out the tribal jealousies and petty politics of local assessors that has brought a very bad name to a once noble profession. Proficiency in AL subjects will not determine the mettle of a graduate. It is merely a bar that helps to screen out less competent candidates at that level. A holistic and apolitical approach is long overdue.

  • 2
    0

    RF.
    Agree that there should be a minimum exam based criteria for admission to medical schools; but this should not be the only criterion. Scoring very high marks at an exam does not make you a good practicing doctor whish should be the ultimate goal. An aptitude evaluation by way of testing and interview should be an added requirement for all admissions to medical schools.
    There is no perfect solution as such especially for a country with limited resources and rampant political interference; and to boot extraordinary and blatant political clout with little empathy for patients like the present GMOA.

  • 1
    0

    Eusense’
    no name is spot on.
    What the government does in SL does not necessarily make sense as this is not really a model which should be emulated by others.
    SATIM is too political and a “trade union issue” -not a patient orientated issue.

  • 1
    1

    Good article indeed. In UK you need 4 Straight A’s to get entry into Veterinary College yet we have doctor’s with 2Cs and a S pass?

    AL “S” or “C” S should not be a criteria for any University Entrance at all.
    Cream should go to Universities not the Crusts?

    • 2
      1

      London A/L and Sri lankan A/L not the same. It is harder to gain 3 As at our local ALs than in the London.

      • 1
        2

        RF.
        Silly comparison. Typically Sri Lankan.
        Everything in Sri Lanka is the best in the world.

        • 3
          0

          I’m not telling its the best but the exam is difficult to score an A see the results as a whole.

  • 1
    1

    RF.
    Correction!
    Silly; Sri Lankan “talk”.
    Comparing apples and oranges.

  • 2
    1

    These are very good suggestions of Dr. Romanie Fernando : “Private- public partnership for non state medical schools with hospitals similar to Sri Jayewardenepura Teaching Hospital (SJTH) will be a feasible option.”**********Better still, will it be, if the private-public partnership is with the STATE Medical Schools (rather than non-state medical schools).***************Each students will be assessed on family income and wealth, and scholarships and 1%-100% public-funding will be awarded accordingly.

  • 0
    0

    I think it is time that Sri Lanka patients too follow the UK ones as in this link.

    https://www.medicalprotection.org/uk/practice-matters-issue-7/digital-dilemmas—patients-recording-consultations
    At the entrance to the consultation room there are notices to say “switch of your phone”! However recording the conversation will help in following the correct instructions especially those given during the short exposure in the consultation room.

Leave A Comment

Comments should not exceed 200 words. Embedding external links and writing in capital letters are discouraged. Commenting is automatically disabled after 7 days and approval may take up to 24 hours. Please read our Comments Policy for further details. Your email address will not be published.