Debate On Training of Medical Doctors in Papua New Guinea

One of the hot topics debated during the recent medical symposium in Goroka recently was on the training of medical doctors in PNG. The general opinion of recent and senior medical doctors present during one of the discussion session was that the quality of medical training was declining and that there was a need to review how doctors are training at the UPNG SMHS.

There were two major themes:

  1. The urgent to need to review the PBL curriculum and modify it to suit our settings in PNG.
  2. Urgent need for government intervention to improve infrastructure, increase staffing and improve staff salaries at the UPNG School of Medicine.

There were also newspaper reports of this issues as well.

Below is a letter to the editor of Post Courier from Sir Prof. Isi Kevau, Professor of Internal Medicine at UPNG SMHS in response to the one of the newspaper reports.

I was the student leader mentioned in Sir Kevau’s letter below that made the trip to New Castle in 1999.

I was asked to write a report back than (as a third year medical student). My recommendations back in 1999 was:

  • Modify the PBL curriculum to suite PNG setting i.e essentially years 2 & 3 to be solely dedicated to teaching Basic Medical Sciences using the traditional method of teaching.
  • PBL mode of teaching in years 4 & 5.
  • Review how students are selected i.e stick to science foundation as the entry pathway or increase quota of post-graduate students coming in.

This was based on my observation at New Castle that a large proportion of their medical student were first degree holders and I also saw that the PBL curriculum was a resource intensive curriculum (something we do not have a lot of in PNG).

Read below the letter.

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Quality of doctors rising – Prof Sir Isi Kevau
(Post Courier 12/09/14)

I take issue on the front-page article of your paper on Tuesday September 2, bearing the title “standards down” followed by the Editorial the next page; admittedly the Editorial was more positive.

The report was based on accusations made by three of my old students. They alleged that the School of Medicine & Health Sciences (SMHS), UPNG is churning out sub-standard graduates, that there is lack of qualified teaching staff and that the graduates will not be recognised as medical officers in other parts of the world.

I say that these accusations are unwarranted and certainly unprofessional. Further, to discriminate against one’s own siblings in the family of PNG doctors, is a sorry state of affair.

Amazingly, the call was made by doctors who graduated from the same institution when it was then the Faculty of Medicine, UPNG. It is worth mentioning that those senior doctors and the graduates they accuse of being sub-standard in quality have one thing in common — that is, they have been taught by the same academics and clinicians (including the author of this letter) in the same institution under the same rapidly decaying infrastructure.

The difference is the curriculum.

The traditional curriculum used at the Papuan Medical College later Faculty of Medicine, UPNG ran for 39 years (1960 to 1999). I was trained under this curriculum from 1969-1972 as the pioneer MBBS (Bachelor of Medicine, Bachelor of Surgery) student. For the last 14 years (2000 to the present time), the Problem-Based-Learning curriculum is used at the SMHS.

Why and how did we change? By the beginning of 1990s, new methods of learning and teaching were developed in other parts of the world. In 1998, the Faculty of Medicine, UPNG felt it appropriate that a curriculum review was necessary and that newer and innovative methods of learning needed to be explored.

From our searching, we discovered that McMasters University in Canada had developed an innovative curriculum-based on student-centred learning. Later we learnt that, closer to home at the University of Newcastle, NSW medical students were taught under Problem-Based-Learning (PBL) curriculum. The Faculty wanted to explore this path.

In 1999, a group of academics including the author of this letter, student leaders [ this part inserted (Dr Rodney Itaki was the student leader)] and the then Dean, Dr Francis Hombhanje, visited the University of Newcastle to know more about the curriculum and assess its applicability in PNG. The group presented its findings to the Faculty.

Approval was granted to use the new curriculum and with UPNG’s Council’s endorsement at the end of that year, the PBL curriculum was adopted. It was started in January 2000 to 2nd, 3rd and 4th year MBBS (Bachelor of Medicine, Bachelor of Surgery) students.

The first PBL medical graduates, 48 in number, came out in 2004. Since then we have graduated 481 medical doctors with MBBS, 25 clinical specialists with Master of Medicine.

I am very proud to reveal that two of the PBL graduates have completed their doctorate requirements and are about to graduate from Australian universities with PhDs. These are Dr Paul Pumuye, a young academic groomed at the SMHS in molecular biology and Dr Moses Laman who is based at the PNG Institute of Medical Research. Dr Pumuye’s PhD is from La Trobe University, Victoria and that of Dr Laman’s is University of Western Australia. Another two are going to Australia to embark on PhD studies.

During the Goroka Medical Symposium, two senior Australian doctors, Professor Frank Shann and Professor Trevor Duke, both based in Melbourne were very impressed by the quality of PNG medical graduates who presented top-quality papers based on clinical and scientific research they conducted.

I am very proud to be the teacher of PNG doctors who are graduates of both the traditional and the PBL curricula; they have all been very impressive. I say that expressing negative comments about our own medical siblings is counter-productive.

The way forward for all of us is to push the Government of the day to improve the 1960 infrastructure at the School of Medicine and Health Sciences, UPNG, Taurama Campus. Massive scaling-up of infrastructure, laboratory developments and staff numbers must occur immediately so that we can increase our MBBS intake from 60 students in 2nd Year to 100 students.

I am happy to learn that the Government since the 2014 Medical Symposium is taking steps and listening to our grievances. Let us remain united in the direction of increased student intake and more medical graduates from SMHS, UPNG.

Professor Sir Isi H.Kevau. Kt, CBE, MBBS (UPNG), MMed (UPNG), PhD (Syd), FRACP
Professor of Medicine & Former Executive Dean, SMHS, UPNG

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About rodney itaki

I am a medical doctor from Papua New Guinea. My posts focuses on current and emerging health issues in PNG.
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