A 2012 University of the West Indies’ (UWI) Quality Assurance Report has highlighted lack of proper training for UWI medical undergraduates, as well as faculty teachers not taking a genuine interest in shaping the students’ development. The issue is of interest since the death of Simeon, son of Quelly Ann Cottle and Emil Millington, on March 1, at the Mt Hope Maternity Hospital, led to the suspension of Dr Javed Chinnia.
The internal document compiled by the university’s Quality Assurance Unit outlined a host of problems undergraduate students at the Faculty of Medical Sciences (FOMS) and the Department of Clinical Medical Science (DCMS) face at the hands of consultants and lecturers, while being trained at the Eric Williams Medical Sciences Complex. Some consultants at Mt Hope Maternity Hospital fall within the remit of UWI, while others fall under the regional health authority.
Students left to roam on wards
A copy of the report showed a need for the restructuring of the system as well as a need for adequate clinical training for undergraduate medical students. It spoke about the uneven undergraduate clinical teaching experience across the different sites with much of the teaching conducted by house officers and interns, who themselves were not supervised in their teaching by registrars or consultants.
“While examining clinical facilities they experienced a situation where three undergraduate students were teaching each other, at the bedside, of clinical history, taking a physical examination on an inpatient ward (not in CTU)—in the absence of any physician,” the report stated.
In some instances, students were left to roam on the wards picking up what they could and then presenting themselves for exams, while some did not show up for clinical training when scheduled, the report said. The review team said it received comments from the faculty and students that the training was geared primarily toward passing exams rather than “integrated thinking and clinical problem solving.” “Some faculty members noted that the students were not well equipped to enter internship as a result of this,” the report stated.
Students: Teachers do not have a genuine interest
The report stated the issue of lack of training for young doctors was not new; it had been raised since 2004. It noted a substantial increase in undergraduate student intake without an increase in full- and part-time faculty.
“As a result, the current training capacity is overwhelmed, leading to inadequate clinical teaching and inappropriate intrusion for some patients exposed to undergraduate trainees. There are too many students and not enough teaching faculty, and the organisation of undergraduate training is inadequate and inefficient.”
Also noted in the report was that faculty teachers did not have a genuine interest in shaping the students’ development as doctors and were not willing to teach. Students complained of seeing consultants five minutes once a week. The report said that this problem was not the fault of the DCMS but rather the result of poor planning at higher levels, arising from a lack of strategic planning.
Undergrads refuse to pursue postgraduate training at university
There were also similar issues raised with respect to postgraduate training and matching it to meet the medical needs of the country. The report said (after noting that the Health Ministry said there was an urgent need in many speciality areas such as haematology, oncology, cardiology, among others), there was a lack of accountability of the university to the “physician health human resource needs of the citizens of T&T.” This, it said, made it difficult for postgraduate students to choose which training programme to enter.
Some undergraduates, the report said, refused to choose the university as the place to pursue postgraduate training because of the attitudes and the lack of proper clinical training by the senior medical officers. Many students felt that they were in a hostile learning environment, said the report: “A number of students described their undergraduate experience as so negative from the professional respect perspective that they would not apply for postgraduate training because of that.”
Some of the Quality Assurance Unit recommendations:
• The faculty must develop a strategic plan in line with university directions
• Increase full-time faculty size to more appropriate faculty student ratios
• Create a formally structured departmental clinical teaching unit at each training site
• Educational goals need to be achieved in an environment that is professional, respectful and appropriate for optimising learning outcomes
Sankat: Some issues dealt with, further actions in progress
However, UWI’s principal Clement Sankat in response to questions e-mailed to him, said the university has a long-standing history of continuous quality improvement through internal quality assurance reviews of its units and departments. “These rigorous and extremely detailed processes are led and conducted by the board for undergraduate studies at regular intervals. Teams of experienced professionals are asked to assist the university by providing feedback and recommendations for improvements in its programmes.”
Sankat explained that UWI has a specific mandate to identify its strengths and weaknesses. “As the name implies, internal quality reviews are intended for internal use and, in our professional programmes, help us prepare for periodic external reviews leading to accreditation. The department on which this particular review was done followed the prescribed procedures by developing and submitting an action plan to indicate how the transformation issues identified in the review would be addressed.”
In this instance, Sankat said, the university can report that some issues have already been fully addressed and improvements made, while further actions are in progress to address others. The existence of the report and the department’s highly professional response to it is “evidence that the university’s quality assurance process is functioning as it should,” he said. Sankat said UWI was unrivalled in the region in its use of rigorous quality assurance procedures, and regularly opens itself up to scrutiny by peers and stakeholders.
Tertiary Education Minister Fazal Karim, under whose purview UWI falls, confirmed he received the report, but explained it remains in UWI’s domain for action.