ISLAMABAD: The Medical Teachers Association (MTA) has termed the National Licensing Examination (NLE), which has been introduced by the Pakistan Medical Commission (PMC), “eyewash” because it cannot ensure the quality of education in medical and dental colleges.

The association has demanded the restoration of the Pakistan Medical and Dental Council (PMDC), warning that otherwise doctors’ degrees will not be recognised internationally.

Special Assistant to the Prime Minister on National Health Services (NHS) Dr Zafar Mirza has called the NLE the best filter to ensure only competent doctors are allowed to practice in the country.

Earlier this month, President Dr Arif Alvi promulgated an ordinance that dissolved the PMDC and established the PMC. A day later, the NHS ministry sealed the council building and fired its 220 employees.

The PMC has three components: the Medical and Dental Council, the National Medical and Dental Academic Board and the National Medical Authority; the authority will act as the commission’s secretariat.

Under section 21 of the PMC Ordinance 2019, it will be mandatory to pass the NLE to obtain a provisional and full licence to practice in Pakistan. The National Medical Authority will hold the NLE at least twice a year according to a schedule approved by the council and it will be applicable on all students graduating after March next year.

Filters like the NLE have been introduced in other countries, Dr Zafar Mirza says

A member of faculty at a medical college said that although the United States Medical Licensing Examination (USMLE) must be passed before a doctor can obtain a licence to practice in the US, the examination was not introduced and administered abruptly.

According to the examination’s official website, as cited by the faculty member, “the USMLE is not administered immediately after graduation but students actually take the USMLE Step I when they are halfway through medical school, then the Step II closer to the end of medical school and Step III before the end of their internship [house job] year.

“Moreover, the USMLE standard is maintained and ensured by various examination committees composed of medical educators and clinicians from across the US,” he said.

The United Kingdom has yet to begin a medical licensing examination for its own graduates, according to the official website of the General Medical Council (GMC). In June 2015, the GMC announced that all doctors who wish to work in the UK will have to pass the UK Medical Licensing Assessment, which will become applicable to UK medical graduates from 2023-24 onwards.

The faculty member said the UK’s licensing examination will be introduced and undertaken as part of the medical school degree programme and will not be an isolated examination with an unknown format and undeclared outcomes imposed suddenly after graduation, like the NLE.

“In contrast to the US and the UK, under the new ordinance the NLE has been imposed abruptly and without any visible professional preparation, with unknown outcomes, format and mechanisms of examination.

“The NLE will be undertaken by graduates just before the beginning of their internship year. Such a model and mode of introducing licensing examinations has never been practiced in the developed world or any other country in the world,” he claimed.

MTA General Secretary Dr Khurram Sohail Raja said that the decision appeared to be a deception and an eyewash.

“Under the new ordinance, college owners will be under no obligation to keep a minimum mandatory strength of qualified faculty in each discipline as had always been the regulatory requirement in previous laws throughout Pakistan’s history. In a way, they have cleverly shifted the burden on the regulatory body that it itself would be responsible for ensuring the quality of doctors produced by private colleges. Under this arrangement, the regulatory body will guarantee the nation the quality of doctors through a magic NLE examination after graduation,” he said.

A former PMDC registrar said that the government needs to learn from international models to protect people’s fundamental rights to health and safety instead of playing into the hands of influential medical college owners.

“It is no secret that Pakistan is required to comply with the quality standards for medical education for public safety as required by the World Health Organisation, the World Medical Association and the World Federation for Medical Education, which are also against private for-profit medical schools as a matter of their declared policy.

“Under these circumstances, if the situation is not controlled at the level of medical colleges in Pakistan, then Pakistan is under real threat of having its name removed from the World Directory of Medical Schools by the year 2023 and as a consequence, all of Pakistan’s medical graduates will have no recognition of their degrees in the rest of the world,” he said.

Pakistan Medical Association General Secretary Dr Qaisar Sajjad told Dawn the association has rejected the NLE.

“I believe that even the decision makers do not trust the new medical education system that they have made, because of which they have decided to introduce a filter. The NLE would not only put a financial burden on students but it would also increase pressure on them. I suggest the government should improve the quality of education rather than showing mistrust by imposing the NLE,” he said.

Private Medical and Dental Institutions General Secretary Khaqan Waheed Khuwaja refused to comment on the NLE.

Dr Zafar Mirza said filters like the NLE have also been introduced in other countries. He said exams will be held twice a year and only those who clear them will be allowed to practice medicine in the country.

“It will ensure that only competent doctors practice in the country,” he said.

Published in Dawn, October 28th, 2019