Sri Lanka: A rational approach needed to Solve the SAITM crisis!

The most important point raised against SAITM medical training is the inadequacy of their clinical training component, and perhaps the lack of sufficient qualified staff required for different disciplines. These deficiencies can be addressed in the short term in respect of those who graduated recently, while a long term permanent solution may also be worked out as suggested by some parties.

by R. P. Gunawardane-Feb 24, 2017

( February 24, 2017, Colombo, Sri Lanka Guardian) There have been wide ranging views in all media regarding the degree awarding status of the South Asian Institute of Technology and Medicine (SAITM) in respect of their medical degree program. I consider this an extremely important national issue with regard to the expansion of the higher education sector in Sri Lanka. Therefore, we need to address this issue without any bias, and considering the current realities, global trends in university education, and long term national interests in Sri Lanka.

Sri Lanka Medical Council (SLMC), the University Grants Commission (UGC) and the Ministry of Health are the three most important organizations responsible to settle this issue. It is apparent from recent developments, particularly after the Appeal Court decision, that all interested parties pursue a confrontational approach, rather than trying to move towards settling the issue in the best interests of the students who have gone through the SAITM programme. It is also regrettable to note that some trade unions of respected professions are resorting to trade union action against an order issued by the Court of Appeal.

In any country the independent judiciary is responsible for interpretation of the law and for checks and balances of the executive, and therefore, the decisions of the judiciary should be respected. A good example is coming from the US, where the President, considered to be the most powerful person in the world, had to accept a lower court ruling to suspend his executive order preventing immigration from some selected countries. Thus, such legal disputes could only be settled by legal means alone.

The suggestion by some interested parties for this institution to be taken over by government is counterproductive. It will definitely make matters worse. It is grossly unfair to bring down an important institution built by a dedicated group of Sri Lankans, just because it has some deficiencies. It is much wiser to get the SAITM to correct the deficiencies and conform to the guidelines stipulated by the regulatory bodies. Closing down or government takeover will seriously hamper much needed non-state sector participation in the expansion and diversification of higher education in this country. Instead, such ventures should be encouraged and promoted under a proper regulatory mechanism so that similar issues will not arise in the future. Thus, deficiencies in the SAITM medical degree program should be addressed and remedial measures taken immediately by the SAITM administration in consultation with the SLMC, UGC and the Health Ministry.

It is regrettable to note that SAITM, on its part has continuously disregarded the guidelines issued by the regulatory bodies in their development process. Their gross negligence towards the stipulated guidelines is clearly evident, as reported by Professor Carlo Fonseka. In addition, SAITM authorities have not explained the current status of their degree program to the students at the time of admission. It is rather unfortunate that no action has been taken by the appropriate authorities well in advance to avoid the present situation. Now the first batch of SAITM medical students is already graduated and they are really the victims of the lapses on the part of the SAITM and regulatory bodies. There is evidence to show that the SAITM authorities have made some attempts to use government hospitals for clinical training with no success. It is important to point out that their attempt to use a government hospital for clinical training was stopped by the same group vehemently opposing the provisional registration of SAITM graduates!

The most important point raised against SAITM medical training is the inadequacy of their clinical training component, and perhaps the lack of sufficient qualified staff required for different disciplines. These deficiencies can be addressed in the short term in respect of those who graduated recently, while a long term permanent solution may also be worked out as suggested by some parties.

In the short term, the most urgent issue is to sort out the provisional registration of the first batch of students graduated from SAITM. It is essential that the authorities work out a plan immediately, in the best interest of these students who are really the innocent victims. In this connection, the proposal presented by the Deans of the state medical schools merits serious consideration, although it does not appear to be perfect. They have proposed that these students should be given clinical training in four specified disciplines for a period of one month, in each case in a teaching hospital. However, it is difficult to imagine that this short training program would be sufficient to cover up their deficiency, since the students in state medical schools go through a rigorous clinical program for a period of over 3 years. Yet, it is necessary under the circumstances to implement an acceptable fast-track clinical training program for these affected students by the Ministry of Health, as early as possible with the agreement of the SLMC.

The most serious issue, with regard to private medical schools as well as newly established state medical schools, is the quality of clinical training. Lack of a proper teaching hospital for clinical training at the SAITM is a very valid issue that should be addressed as early as possible for a long term solution. A suggestion to use the Avissawella hospital for clinical training has been raised. This may be a good idea because it does not seriously affect medical students of other faculties. Once an acceptable hospital is selected, the government may establish a state-private sector partnership to develop the selected hospital under the guidance of the Health Ministry. SAITM can upgrade this hospital under the guidance of the Health Ministry to satisfy the needs of clinical training of SAITM students. This will satisfy SLMC requirements and benefit both the government and the SAITM in the long term.

It is extremely important to note that all the requirements and standards stipulated by the SLMC or UGC, or any other relevant regulatory body, should be applicable equally to all state and private sector medical schools. This is the internationally accepted and a fair procedure, which should be acceptable by any court of justice. The SLMC will have to demonstrate that this is the case. If a private medical college operating in Sri Lanka satisfies these conditions, there is no need for their students to sit the ERPM exam for SLMC registration. They should be treated exactly the same way as for students from state medical schools.

We have 8 (Colombo, Peradeniya, Kelaniya, SJP, Ruhuna, Jaffna, Rajarata and Eastern) state medical schools in the university system coming under the purview of the UGC. In addition, another medical school was also opened recently at the Kotalawala Defence Academy (KDA) outside the purview of the UGC. State medical schools coming under the UGC are well regulated through the UGC itself and its Standing Committees, but it is not the same for KDA which is functioning under the Ministry of Defence. In these circumstances, it is hard to believe that the KDA maintains the same standard of training as in other state medical schools. It is in this context, most observers question the rejection of SAITM while the same SLMC has accepted the KDA Medical School, in addition to the newly established and poorly equipped state medical schools such as Rajarata and Eastern universities.

The general public expects regulatory bodies such as SLMC to be completely impartial and independent in dealing with these matters of national importance. If there are any plans to amend the Medical Act/ Ordinance, it is also important to consider broad basing the composition of the SLMC, to include some non-medical professionals, so that SLMC is not dominated by a particular interest group. Similar medical councils in most developed countries have wide representation including professionals from other disciplines and prominent civil society members.

Since KDA Medical School has come up for discussion, it is necessary to examine its setting up by the Defence Ministry. It is also a state medical school, although it does not come under the UGC. In the state sector, new medical schools are established based on the need, after a careful study of the infrastructure needs for teaching, clinical work, library and availability of teaching staff in different academic and clinical disciplines, among many other factors. This is usually done by the UGC through its Standing Committee on Medical and Dental Sciences. Apparently the UGC has not been consulted officially and this procedure has not been followed. In such a scenario it is hard to imagine how standards can be maintained or monitored in the absence of any expertise in the defence establishment.

In addition, there are other pertinent questions. How many doctors are needed to the defence establishment per year? Why not train the few doctors needed by the Army, Navy and Air Force in the existing medical schools in Colombo, Peradeniya, Ruhuna, or any other faculty, by spending a fraction of the colossal amount used for the establishment of a separate medical school? This is extremely important because the existing medical schools are already under funded and they need extra funding to improve their facilities.

In a previous article (Island, December 9, 2016) the author highlighted the importance of establishing an independent Accreditation and Quality Assurance Council (AQAC), applicable to all state and private sector university level institutions in Sri Lanka. The role of such an institution in this particular case is accreditation (a form of licensing) and quality assurance of the degree programs, in collaboration with the relevant professional body in each discipline, such as SLMC in the case of Medicine. In the absence of such an authority (AQAC), this function has to be performed by the UGC along with the SLMC.

In the accreditation process for medical schools, due consideration must be given specifically to minimum criteria (A/L requirements) for admission, availability of infrastructure facilities for teaching, laboratory work and library, plan for clinical teaching/ teaching hospital, quality of academic/ clinical staff and availability of scholarships/ loan schemes for needy students.

While this specific issue regarding non-state sector medical schools is being discussed, some interested parties are bringing a general issue against the establishment of private universities in Sri Lanka. They claim that it is against the free education policy in this country. Thus, it has become more of a political issue. It is surprising that no one is bothered about private sector participation in the education, health care and in many other sectors in this country. It must be realized that the state and private sector institutions can coexist and compete without harming the free education policy, as it happens now in the education sector.

Almost all Montessori preschools are run by the private sector. There are many private sector primary/ secondary schools operating throughout the island while we practice free education to all. Some of these private schools are of extremely high standard. There are many non-state sector universities and other degree awarding institutes operating in the country for many years. High quality private hospitals operate side by side with state hospitals providing valuable service, while we practice free health care to all. Government doctors are free to practice in private hospitals, although some tend to abuse this freedom. Similarly, private sector organizations operate in competition with the state sector in the transport, insurance, banking, media, fuel, energy, trade and in many other fields, giving people enough choice and thus benefitting the customers. Then, why this fuss about private universities and private medical schools as long as they comply with common rules stipulated by the regulatory bodies?

It is important to note that the top and highly rated medical schools in the world are all private, but non-profit institutions. Examples are Harvard, Stanford, Johns Hopkins medical schools in USA. Their admission is based purely on merit worldwide, and financial aid is mostly need-based. Private medical schools are operating in parallel with state medical schools in our neighboring countries such as India, Nepal, Bangladesh and Pakistan. Our students go to these countries and others like China, Malaysia, Cuba and East European countries to study medicine. When they return, they sit the ERPM exam and start practicing in Sri Lanka. We know very little about the quality of their medical education, for that matter SLMC has not sent teams to inspect these medical schools. Yet, they are allowed to practice medicine in Sri Lanka. Then, why this double standard approach to SAITM, when they are ready to fulfil requirements stipulated by the regulating authorities? Thus, all parties should assist and cooperate with SAITM in their effort to overcome deficiencies and upgrade facilities for clinical training.

We have seen over the years in this country that the state monopoly on university education has hindered expansion, diversification and innovation in the higher education sector. It is also evident that the state alone is not in a position to provide sufficient opportunities to satisfy the current and future demand for university education. Broad-basing the providers of tertiary education also introduces an element of competition to the system, which is expected to improve quality, provide more variety and reduce cost of training.Thus, it is time for us to promote and facilitate private sector participation to establish universities in all disciplines including medicine, with the implementation of national accreditation and a monitoring mechanism in association with professional and regulatory bodies, which includes SLMC in the field of Medicine.

(The author is a Professor Emeritus, University of Peradeniya, formerly Secretary, Ministry of Education and Higher Education, and Chairman, National Education Commission, Sri Lanka)