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RE-CLINICAL MEDICAL EDUCATION

The text of speech delivered by Professor WISWA WARNAPALA, Minister of Higher Education at the Opening of the Pre-Clinical Building at the Faculty of Medicine, University of Kelaniya at Ragama on 14th February 2008. Any kind of use of the content should be duly acknowledged.

It is indeed a pleasure to be here on the occasion of the opening of the Pre-Clinical Building of the Faculty of Medicine of the University of Kelaniya. This building, as the Vice Chancellor mentioned, represents yet another stage of the expansion of the Faculty of Medicine, and the aim is to increase the annual intake which, at present stands at 160. This building, which we ceremonially opened today, is to house the traditional pre-clinical departments; pre-clinical subjects, I am told, are taught in the first two years in the MBBS course, in addition, a language unit is to be set up to provide the required language skills for the undergraduates so that they can communicate with all types of patients. The entire cost of the project was in the region of Rs.178 million, and it was funded by the Government.

It is therefore relevant and appropriate at this stage to divert the attention of this distinguished academic audience to issues of both Medical and University education in the country. Since the establishment of the fully-fledged independent and autonomous University in 1942, the University system which, initially based on the traditional Oxbridge formula, had undergone a change in the last fifty years. Though the system of University education expanded in response to various popular pressures and issues based on a social demand model of education, there was no comprehensive policy strategy covering the entire higher education policy. Instead of adopting a common policy strategy based on the country's development needs, ad hoc changes were made, resulting in the creation of several imbalances within the system of University education in Sri Lanka.

Medical Education

Though the formal University system began in 1921 with the establishment of the University College, professional medical education began in 1870 with the creation of the Ceylon Medical College, and it remained an institution under the Government Department of Health. It was in the same period that the Law College came into existence as another prestigious professional body. The Ceylon Medical College was able to create a small professional elite, and it was in line with the colonial policy of the period. The Ceylon Medical College, as one of the important institutions of professional education, contributed substantially to the development of University education and its absorption into the University system was such that it dominated Medical education in the country till the establishment of the Second Medical Faculty in 1961. The Ceylon Medical College and subsequently the Faculty of Medicine dominated professional medical education for nearly a century, and this dominance came to be broken with the establishment of new Medical Faculties associated with the Universities which, in other words, meant that it followed the expansion of the Universities. Peradeniya Faculty was established in 1961, Sri Jayawardenepura Faculty in 1993, Kelaniya Faculty in 1995, Jaffna Faculty in 1978, Ruhuna Faculty in 1984, Eastern University Faculty in 2004 and the Rajarata Faculty in 2006.

Today there are eight Medical Faculties, providing medical education to 6025 students. In 2006, we selected 1111 students to the Medical Faculties and the number proposed on the basis of the A/L results of 2007 is 1155. The number of eligible candidates of the relevant subject area stood at 15,718, out of which only 7909 applied and the number selected was 4343. As you know, there is a massive demand for higher educational opportunities in the country and we have taken measures to expand the access; all parents, specially those in the middle class, prefer to provide a medical education to their children and the occupational mobility in the country is integrally associated with this perception. Because of this perception, there is a consistent demand for the expansion of medical education in the country. Certain professional fields have been given University status with a view to diversifying the system of Medical education in the country, and the new Faculty of Allied Health Sciences is the newest example of this kind of diversification. Nursing education is to be given the University status, and initially, the University of Peradeniya and University of Jayawardenepura would undertake to absorb the existing Nurses Training Colleges with a view to providing the nurses with a professional degree and this is certain to enhance the quality of nursing education in the country.

Limitations

Since the system consists of 15 Universities, there is this view that every University should establish a Faculty of Medicine, and this is primarily because of the fact that a large number of our students go abroad, seeking a medical qualification. Here in this context that I would like to refer to two categories; there are established Medical Colleges which have been recognized by the Sri Lanka Medical Council and the second category includes schools which are sub-standard and they have not been recognized by the Sri Lanka Medical Council. The Sri Lanka Medical Council has raised a number of pertinent issues relating to medical education in the country and the Ministry of Higher Education, taking into consideration its concerns, does not wish to establish Medical Faculties in the other Universities in the near future before the existing faculties are upgraded with the required facilities, especially their basic infrastructure. Though there is a need to accommodate the increasing number of Advanced Level qualified students, the functioning Faculties of Medicine, in my view, cannot expand the intake without compromising the standards of patient care and the doctor-patient relationship. 
For Medical sciences to be taught efficiently, well equipped laboratory facilities are necessary and they cannot be provided within a few months. The Medical Faculty at the University of Rajarata, though it took a batch of 180 students, is still not properly equipped and there is a shortage of teachers. No good teachers can be attracted to a place like Rajarata; these difficulties which any institution is likely to face in the initial phase but they need to be overcome in order to provide the students with better system of education, and this is of special importance to professional medical education. The Sri Lanka Medical Council, as the organization engaged in the maintenance of professional standards, has informed the Ministry of Higher Education that appropriate measures are necessary to protect the public from unqualified, poorly qualified and inadequately trained professionals in the field of medical education. We are conscious of such observations and I, therefore, can assure this audience that we do not intend to establish new Universities as well as new Faculties of Medicine in the near future but in terms of policy, we have recognized the need for expansion of medical education in the country. In planning our policy in respect of Medical education, we proposed to consult both the Ministry of Health and the Sri Lanka Medical Council on matters pertaining to the establishment of a new Faculty of Medicine. In my view, this kind of consultation and relationship would help to overcome some of the problems and issues relating to the running of the Faculties.

Postgraduate Studies

It has been the policy of the Ministry of Higher Education to provide opportunities for the expansion of the post-graduate studies in all disciplines; in my view, post- graduate sector was neglected in the past as the policy makers always emphasized the need for expansion of under-graduate studies. The dearth of teaching personnel in the Medical Faculties could be tackled by expanding the number of courses in the Post-Graduate Institute of Medicine. A proper programme of expansion could address the dearth of specialists in pre-clinical and para-clinical subjects; more post-graduate students are necessary in such areas as Anatomy, Physiology, Bio-Chemistry and Pharmacology to meet the demand of Universities. It is true that the post-graduate institutions are not properly monitored and they are not properly funded, and the Ministry, through the University Grants Commission, proposes to supervise the post-graduate institutions in order to see that they become active partners in the development process. Yet another problem associated with the medical profession is the number of students going on scholarships to different countries.

Since there is an ever - increasing demand for medical education, certain countries offer scholarships, and it through this method they attract students as private students. The Ministry of Higher Education would award a scholarship only after ascertaining whether the particular institution has been recognized by the Sri Lanka Medical Council and the Ministry proposes to establish some kind of a mechanism with the assistance of the UGC to verify the credentials of the institutions which provide medical education. This kind of control, though difficult a system to be adopted in the given global context, would help us to maintain standards and obtain professionals of accepted quality. As far as this matter is concerned, I tend to agree with the views expressed by the Sri Lanka Medical Council.

It is here in this context that I need to advert your attention to the main goals in the sphere of Higher Education. Today the country is expected to give priority to accelerate growth, reduce poverty, achieve Millennium Development Goals and create a highly skilled workforce. In the context of the global economy, based primarily on the knowledge economy, higher literacy rates are not enough; take for instance, Karnataka State in India, its literacy rate is 54.5 percent but it remains one of the developed states in India. What I am trying to drive at is that higher education is an indispensable tool for achieving national goals. We need to move in the direction of a knowledge economy so that the country can build an educated workforce which will help all citizens to uplift their economic status. In order to achieve this, Sri Lanka, at this time, needs a development-oriented Higher Education Policy through which we can up-grade the quality and relevance of education offered by the Universities of Sri Lanka. One has to acknowledge the fact that it is through Higher Education that goals of social equity and economic and social development could be achieved in any country as higher education's primary role is to develop the intellectual and skills capabilities of our society. Such capabilities are necessary to address and resolve the range of problems and challenges faced by the Sri Lankan society. Higher Education must also play a central role in meeting the realities of international competition under the new conditions of globalization, and it is in this context that we need to devise a comprehensive policy on Higher Education with the sole purpose of enhancing the quality and relevance of higher education, and it is only on the basis of change that the country can convert the Sri Lankan Universities into centres of learning and active partners of development in the country. It is on this basis that we can build a new development framework that can support knowledge-driven economic growth, and it, in addition, requires an expanded and inclusive higher education system which can reach larger segments of the population. We intend to formulate a new Higher Education Policy on the basis of such vital considerations relevant and useful in the given context, both local and international.

I thank you for giving me an opportunity to share some of my views with this distinguished academic audience.