BY THE INDEPENDENT | The Uganda Medical and Dental Practitioners Council (UMDPC) is suggesting a national assessment system for medical students as part of the reforms in education. It is of the view that the national assessment will be part of the strategies to enhance the quality of medical education and training.
The Council’s Chairperson, Professor Joel Okullo notes that while there have been advancements such as the adoption of a standardized core curriculum in the East African community, there are still gaps to be filled and one of them should be in the area of assessment.
Prof. Okullo made the proposal at the Amanya Mushega-led Education Policy Review Commission on a Thursday. He and his members expressed fear about potential abuse of autonomy by universities especially instances where institutions may deviate from expected curricula or fail to adequately assess their learners in crucial competencies that were not covered by lecturers due to various factors.
The council is of the view that while anyone institution can train, the examination function should be entrusted to a centralized body, such as the Medical Examinations Board.
Currently, universities operate with autonomy and academic freedom granted by the Universities and Other Tertiary Institutions Act.
The Universities and Other Tertiary Institutions Act provides that each university is responsible for training and assessing its learners. The law further mandates universities to formulate curricula, subject to review and monitoring by relevant bodies like professional councils and the National Council for Higher Education. Universities are required to establish internal quality assurance mechanisms.
Lower-level training institutions for health professionals such as nurses and allied health professionals, undergo assessment by independent national bodies like Uganda Nurse and Midwifery Examination Board and Uganda Allied Health Examinations Board. These bodies no longer conduct end-of-cycle assessments. They assess trainees at the end of each semester for both theoretical and practical competencies.
Dr. Prosperous Nankindu Kavuma, a member of the Commission questioned why the Medical and Dental Practitioners’ Council is suggesting a national assessment for medical practitioners when there have been proposals to eliminate nationalized assessments like Primary Leaving Examination.
Okullo defended his proposal saying there is a need for Uganda to produce uniform doctors regardless of which institution they have come from.
“We cannot run away from examination or assessment as it is called. In fact, in medicine, every patient is an examination and the council like to ensure that the person who is going to handle the patient has the required competencies,” he added.
The council proposes the National University/Institution Examination at various stages. This it said should be conducted early in the semesters, midway through the program, and after the program.
A post-internship assessment was also suggested by the Council. This it said should be conducted by the professional council before an individual is registered and enters the profession. These layers, according to the council, will act as filters, ensuring that only practitioners of the required quality remain in the field.
Meanwhile, Dr. Apollo Epuwatt proposed the creation of an independent audit system tasked with reviewing and, if necessary, revoking the qualifications of trainees from universities upon confirming that they did not attain the required minimum competencies during their training.
As per existing legislation, the university senate is empowered to assess whether an individual meets the required standards of proficiency for the award of any qualification. The Senate also possesses the authority to revoke a qualification if, following a thorough inquiry, queries or issues are identified.
Dr. Epuwatt expressed fear that the increasing presence of universities with commercial interests could impede their senates from recalling degrees.
Professor Okullo suggested the need to redefine the roles of the National Council for Higher Education and professional councils on how they can mutually support each other and when their functions can complement each other.
Okullo cited several incidents when the Council has taken action against some medical training institutions only to be overturned by courts. One such incident was when the Council’s Inspectorate found that students at King Caesar University had not been adequately trained to qualify as medical doctors but its decision was contested in Court.
He highlighted that in the past, when the council advised institutions to halt training for improvements in infrastructure or staff, it was implemented. He cited the closure of dental schools in Makerere University as an example. However, he expressed concern about the King Caesar case, stating that the court ruling set a precedent that needs reevaluation. In the case, court ruled that since the university was accredited by NCHE that was enough.
The council members noted argued that such gaps are denting the trainee from Uganda yet prior to 1976, doctors trained in Uganda held a high level of respect both nationally and internationally. Many graduates from the sole medical school at Mulago were easily registered and licensed to practice in various jurisdictions. However, the situation has changed, especially with the rise of private training institutions.
“Noncompliance to regional and international regulatory requirements which gave reciprocal recognition to the doctors in the region will lead to Ugandan trained doctors and other health professionals being isolated,” their presentation to the commission added.
Okullo also emphasized that the review should guarantee the involvement of professional councils in the higher education and training process, starting from student admissions to the accreditation of training institutions.
He argued that Professional councils possess the expertise and resources necessary to identify crucial issues throughout the process.
This involvement, according to him, would contribute to ensuring the quality of the final output – producing well-trained doctors.
The Council further suggested that there should be a change in the admission criteria for medical students, proposing the introduction of pre-admission interviews and assessments. The Council said that historically admissions have heavily relied on academic performance, with prerequisites such as obtaining principal passes in chemistry and biology.
They further emphasized the necessity for a physical assessment that evaluates a candidate’s fitness for medicine, as well as their attitude and conduct.
“The health professional demands a high degree of intelligence as well as compassion. Academic mediocrity and callousness at heart make a catastrophic, insensitive, and incompetent doctor,” their papers added in part.
Okullo stressed that attitude is critical and should be determined early at admission stage.
In addition to addressing admission concerns, Okullo emphasized the importance of promoting equity to ensure that all regions of the country and diverse backgrounds have the opportunity to produce doctors who can relate to their communities.
“It is commendable that both the government and private individuals are establishing training institutions in various parts of the country. However, it appears that our focus is solely on geographical locations. The training institutions in Kabale and Gulu, for instance, are filled with students from Kampala. Why is this the case? Education should also answer the question of equity,” he submitted.
Among other recommendations the council highlighted the necessity to regulate the influx of students entering training institutions. This regulation aims for better planning, ensuring that the training of doctors is purposeful and aligned with known needs, rather than having many graduates who ultimately face unemployment.