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Department of Medical Education should not control the colleges but support what they are doing-Syed Moyn Aly.

Dr. Syed Moyn Aly a noted medical educationist from Jinnah Sindh Medical University Karachi has urged his medical educationist's colleagues not to give the impression as if they are going to take control. Do not show that you are the Boss, take care, do not force but give suggestions. He was making a presentation on 'Working of the Departments of Health Professions Education Becoming Effective' at the recently held Third International Conference of Shalamar Medical and Dental College Lahore on Day-2 of the conference February 2, 2019. This session on Medical Education was chaired by Prof. Farida Munawar alongwith Dr. Syeda Kausar Ali while Dr. Ambreen Khalid was the moderator.

He also disclosed that Departments of Medical Education in Europe were closed down since faculties did not like it. It is important that DME should have a supportive role. DME should help to improve the institution, tell the administration that they can help them, do not take on the examinations but support them. DME should develop internal review, support institutional review and the credit for any improvements have to be shared with others. Department of Medical Education can be effective by building bridges, he remarked.

He pointed out that there are over hundred medical colleges and not all of them have the departments of Health Professional Education. Then some have these departments but then how they are functioning is another thing. Medical Education he stated is an academic department and there is collaboration of faculty in a department.

He then traced the history of the establishment of Department of Medical Education or Medical Education Units in the world in early 70s. WHO recognized a Training Centre of medical education in Shiraz University in Iran which started functioning in 70s? The first Dept.of Medical Education was established in Pakistan in 1970s and CPSP started Dept. of Medical Education in 1979. Its objectives were to create a culture of research, teaching and faculty development, service provision, helping nurturing career of academic staff.

Continuing Dr. Syed Moyn Aly said that Department of Medical Education will be effective if it has the support of administration, culture and politicians. Even if a department is created, how much funding will be provided to it? When we say do it immediately and it should be done, it is not possible. Institutions like PM and DC and HEC have their roles and it will have its effects. In the organizational framework Department of Medical Education is threatening to the faculty and thus faculty will attack the Dept.of DME.

Hence, we need to take care of organizational framework, who calls the shots Department of Medical Education Dr.Syed Moyn Aly opined should not control the college but we need to support what they are doing. If they agree to innovations, we will have resources to do it. We need to have harmony, do not make enemies but work in close harmony with other faculties, he added.

Earlier Dr. Ayesha Summera Abdullah vice Dean at Peshawar Medical College spoke on 'Challenges and Opportunities in Medical Education'. She pointed out that at present medical education in Pakistan was at cross roads and then asked what are we doing about it? We need to revisit its philosophy. There are certain fundamentals which shape its practice. We have a long way to go. There is a moral regression in medical students. Now there is more chances of death and patient being harmed during healthcare. We need to seriously ponder as to what has gone wrong with our medical education. It is the knowledge, skills, aptitudes and competencies which will lead to performance.

We must focus on education philosophy, integrate learning. Currently the gaps between the haves and have not's has increased. There are economic compulsions. Students lack management skills and they are not well equipped to manage challenges ensuring patient safety. We have failed to effectively engage the students to be lifelong learners. On the contrary we opt for quick fix easy to do things. Dr. Ayesha Abdullah reminded the audience that today's teachers are patients of tomorrow.

Hence, the teachers must do something to improve the current state of affairs in our healthcare facilities and medical institutions for their own safety. Healthcare is a team work. We need to practice the method of collaborative teaching. One only achieves when one believes, hence it is time that we re-align our system of evaluation and assessment.

Dr. Ahsan Sethi from Khyber Medical University Peshawar spoke on 'Rethinking Curriculum Integration'. Integration, he opined, is different from institution to institution. His presentation was based on a critique of Harden's principles of Integration Ladder. He laid emphasis on skills, strategy and providing safe places as is the case when one plays the famous game of LUDDO. He also talked about changes in management and proposed integration was also suggested. How different institutions can integrate the curriculum, I am still working on this and hope to come up with some practical suggestions in the near future, he added.

Dr. Saima Chaudhry from University of Health Sciences talked about Internship in Medical Education. She was of the view that when you start trusting the trainees, competency is achieved. In United States, the students are supposed to have over a dozen competencies before they are allowed to join any Residency programme.

During the discussion it was stated that when we trust the trainees to do things independently, it means they have been trained and are competent. Student's intake also matters a lot and it has its effects on quality of training. Risk taking behaviour does not work in medical education. Summing up the discussion Prof. Farida who was chairing the session remarked that we have to come up with solutions to the various problems highlighted by the speakers.

Session on Endocrinology

Prof. Bilal Bin Younis alongwith Dr. Sumera Haque chaired the session devoted to Endocrinology on Day-3 of the conference. Dr. Maria Jamil was the first speaker who spoke about Thyroid diseases and the Heart. She pointed out that it was Celeb Parry who first reported about this association two centuries ago. She then discussed about cardiac contractility, cardiac output, blood pressure and SVR. Most of the patients who suffer from this disorder are female and the changes are reversible. There is a direct effect of thyroid on the heart. It decreases systemic vascular resistance, increase resting heart rate, increase LV contractility, increase blood volume and BP. She also discussed the effects of thyroid hormones on lipid metabolism. The treatment consists of thyroid hormone replacement.

Patients with hyperthyroid complains of chest pain, exercise intolerance, cerebrovascular ischemia, palpitation, peripheral edema and anginal chest pain. The signs and symptoms include AF and chest pain. Digitalis, CCBs are the treatment of choice. Adrenergic blockade are also effective. Beta blockers help in rate control in heart failure. Digitalis can also be used as they are also quite effective. The prevalence of subclinical thyroid diseases increases with age. She also discussed about amiodrone and thyroid function. Although treatment consists of anti thyroid drugs but sometimes surgery is also quite helpful.

Dr. Atif Munir from Fatima Memorial Hospital was the next speaker whose presentation was on Thyrotoxicosis. He discussed in detail the clinical assessment and how to establish etiology. He pointed out that it is important to know the cause only then we will know for how long the patient has to be treated. He discussed the management of a few cases. TSH test is only needed in case of hypothyroid. Establishing etiology is difficult because very few laboratories perform reliable tests. One of the patients he presented was diagnosed to be suffering from Graves' disease. His second patient was fifty two years old female with multinodular goiter.

This was a case of thyrotoxicosis. He laid emphasis on rational use of investigations. The third patient he presented was another female thirty two years of age. On examination she had a diffuse goiter. For management of Graves' disease, beta blockers are used for symptoms control. Anti-thyroid drugs are used in such patient's. He also discussed about the titration of the dose as such patients have to be treated for a period of twelve to eighteen months. Graves' disease may relapse. Radiation iodine and surgery can be used to manage these patients. In case of huge thyroid, it is important to shrink it first before going for surgery. Using low dose of anti-thyroid drugs for long term will not have any adverse consequences. Radioiodine will shrink the tumour by 10-15%. Get the patient in euthyrid position and ensure proper monitoring of the patient.

During management of Grave's disease, make sure that the eyes do not get worse, hence it is essential to involve the ophthalmologist. These patients should be followed jointly by endocrinologist and ophthalmologist. Orbital decompression can be needed in emergency. Use uptake scan and get it done immediately. He re-emphasized the importance of establishing etiology, know what the cause is so that you know how long the patient will need treatment.

Prof. Ali Jawa was the next speaker who highlighted the pitfalls in diagnosis of diabetes mellitus. He emphasized that the FBG in patients should be less than 126, Random blood glucose should be 200mmol and HbA1c less than or equal to 6.5. The patient should be eight to fourteen hours fasting and all these readings are from the laboratory. One should be careful of numerous errors involved in glucometers that is why lab reports should be reliable. Total protein will not increase with blood glucose but it rises with carbohydrates. Diagnosis of diabetes should be made after two sittings when blood glucose should be elevated. OGTT protocols is most often not followed. HbA1c should not necessarily be fasting. Nutritional anaemia needs to be managed.

Thalassemia traits, cost, access to quality labs, POCT availability and cost are some of the other issues. Glycated albumin is not accurate for diagnosis for pre-diabetes. Fructosamine is not routinely preferred as there is not enough data. It can be used after blood loss. Glycomark depends on urine production. Cost and its availability is another pitfall. He then spoke about LADA (late adult onset of diabetes) and MODY which can be picked up early.

These are lean individuals and at the time of diagnosis the age of patient sis usually twenty five years. T1 and T2 characteristics are seen. T1 have family history of diabetes. They will have diabetes in progression. In case of Late Onset Autoimmune Diabetes of Adulthood one does not need insulin for a few years. It is difficult to diagnose. Knowledge about pathogens, diabetes mellitus is changing frequently. LADA is different from Type 2 diabetes, he added.

Dr. Saima Yousuf talked about Charcot osteoarthropathy in Type 2 diabetes persons presenting to specialized diabetic center. During the discussion Prof. Ali Jawa reiterated that diagnosis of diabetes should be lab based. Standard Glucometers can be used for monitoring of diabetes.
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Publication:Pulse International
Date:Mar 15, 2019
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