Teacher shortage, poor infrastructure undermine medical education quality

Nilphamari Medical College is yet to have a permanent campus and a medical college hospital although classes started in 2019. 

The medical college has only one lecturer each for the subjects of forensic medicine and pharmacology and no associate professor or professor for that subject. Three contractual technicians from Rangpur Medical College go to Nilphamari two-three days a week to run the lab of the medical college.

A student of Nilphamari Medical College told The Business Standard that they were told teachers for the subject would join after Eid and the classes will start.

"As the hospital does not have a medical college, we may have to complete our internship from the 250-bed Sadar hospital. Since the Sadar hospital does not provide all types of treatment, we will have a learning deficit," the student said.

Not only the Nilphamari Medical College, several government medical colleges including Jashore, Cox's Bazar and Noakhali medical colleges do not have hospitals.

Besides, most medical colleges do not have standard labs while there are many vacant teacher posts. According to the Directorate General of Medical Education, 49.7% posts for assistant professors are vacant in government medical colleges.

Of the 1997 posts, 723 posts are vacant for basic subjects in the government medical colleges. Of these, 132 out of 204 approved posts for professors are vacant.

For the post of assistant professors 156 out of 352 positions are vacant and 94 of 251 associate professor posts are vacant. Besides, 16 out of 48 posts of curators, 324 out of 1,135 posts of lecturers and one of seven medical officer posts are currently vacant.

There are 108 medical colleges in Bangladesh, of them 38 public and 70 private medical colleges. Half of all medical colleges are in the Dhaka Division.

According to a study, 68.4% eminent citizens think that the quality of medical education in Bangladesh is up to the mark. They think if we can't produce good physicians, it will not be possible to provide quality health care no matter how good the infrastructure is.

To identify and solve existing problems in Bangladesh's medical education, scientific recommendations were taken through a policy dialogue with 60 individuals including eminent doctors, politicians and journalists from 11 March to 2 July, 2021.

Former health minister Dr AFM RuhulHaque, in collaboration with the non-government organisation Eminence Associates for Social Development, conducted the study last year and published the report on 20 March 2022.

The study found that there is a shortage of teachers in all medical colleges and 46.7% of the participants felt the system of recruitment and promotion of teachers should be restructured.

Some 81% of the participants were in favour of streamlining health education to bring the quality of health care to the doorsteps of common people.

The research recommended splitting health education into four categories - clinical health education, health management education, disease prevention education and medical teacher health education.

Medical education is not up to date

Medical college teachers said, the existing medical education is not based on current epidemiological transition and pattern of diseases.

"Our medical education is curative, not preventive. Now non-communicable diseases are increasing, as a result of which people's out-of-pocket expenditure has increased by 67%. But non-communicable disease prevention is not taught in our curriculum," Dr Rizwanul Karim, associate professor, Community Medicine, Rajshahi Medical College told The Business Standard.

"There is a shortage of teachers and other manpower while the teachers we have are not connected with modern curriculum. Also, there is a lack of modern labs.  We are basically producing less skilled doctors as they are not getting quality practical education," he said.

DrRizwanul Karim recommended that seats in existing big medical colleges should be increased instead of creating new medical colleges.

M Iqbal Arslan, former dean of the Faculty of Basic Science and Paraclinical Science at Bangabandhu Sheikh Mujib Medical University told TBS, "We are not producing enough teachers as compared to the rate at which medical colleges are being established. Students at most of the new government and private medical colleges do not get patients and therefore they are lacking the practical education. The quality of education is also not up to the mark."

36% teacher posts are vacant

According to the Directorate General of Medical Education data, currently 36% of teaching posts in public medical college hospitals are vacant in basic subjects like anatomy, physiology, biochemistry, pharmacology, community medicine, microbiology, forensic medicine and virology in medical colleges.

Professor DrRabiul Islam, principal, Nilphamari Medical College told The Business Standard, the shortage of basic subject teachers has reduced a little.

Civil society in Jashore demands medical college hospital

Even after 11 years since the establishment of Jashore Medical College, it does not have a hospital. Locals have been calling for a 500-bed hospital with the medical college since last October.

Zillur Rahman Vitu, member secretary, Jashore Medical College Hospital Implementation Committee told TBS, "Our medical college students are only learning from books but they are not learning practically by seeing patients, because critical diseases are not treated in sadar hospital."

Zillur Rahman said they formed the Medical College Hospital Implementation Committee with the prominent citizens of the district. This committee has been organising various programs including human chain, road blockade, memorandum to the Prime Minister and mass signature campaign for their demand.

More crisis in private medical colleges

It is mandatory for a 50-bed private medical college to have a 250-bed modern hospital. However, many private medical colleges do not have hospitals that meet these prerequisites. Other than the shortage of teachers, they also lack modern teaching equipment.

A few medical colleges are still admitting students and continuing their activities by filing a writ with the High Court after their registration were cancelled due to non-compliance of Bangladesh Medical and Dental Council policy. However, now they are facing complications regarding the internships of their students.

Meanwhile, newly passed doctors of CARE Medical College 2015-2016 session are protesting demanding internship migration.

DrAkmAmirulMorshed, additional director general of Directorate General of Medical Education told TBS, there are questions about the quality of our medical education.

He added that  information about the quality of colleges and where they lack will be soon uploaded to the website of the Directorate General of Medical Education so that guardians of students can make an informed decision.

Out of 70 private medical colleges, 58 colleges have provided information on their teacher shortage status to the directorate while the remaining 12 have not provided the information asked by the directorate.   

There are 4,626 teachers including 890 professors, 895 associate professors, 799 assistant professors, 73 curators and 1,968 lecturers in 58 private colleges, which need at least 9,000 teachers.

What the authorities are doing to improve the education quality

DrAkmAmirulMorshed said quality teachers are needed to ensure quality medical education.

"We are providing training for teachers. Besides, medical infrastructure is now being developed. The medical curriculum has been revised and a new curriculum will be launched soon," he said.

"The teacher crisis has intensified due to no promotion for a long time. There will be a meeting on the matter next week. Hope the promotion issue will be resolved soon and teacher shortage will be reduced," he added.