Objective: To explore the views of academics about the identity of Health Professions Education as a discipline, its fate and sustainability as a profession.
Method: The qualitative exploratory study was conducted from February to July 2021 after approval from the ethics review committee of Islamic International Medical College, Riphah International University, Rawalpindi, Pakistan, and comprised both fulltime and part-time health professions educationists of either gender teaching in different institutions of seven cities of Pakistan; Taxila, Kamrah, Rawalpindi, Peshawar, Lahore, Multan and Karachi. Using Professional Identity theory, data was collected through semi-structured one-on-one interviews which were conducted online. The interviews were transcribed verbatim, coded and thematically analysed.
Result: Of the 14 participants, 7(50%) had qualifications and experience of other specialities as well, while 7(50%) were pure health professions educationists. Overall, 5(35%) subjects were from Rawalpindi, 3(21%) were serving in multiple cities including Peshawer, 2(14%) were from Taxilla and 1(7.5%) each was from Lahore, Karachi, Kamrah and Multan. Accumulated data led to 31 codes with 3 themes and 15 sub-themes. The main themes were identity of health professions education as a discipline, its fate and sustainability.
Conclusion: Health professions education has established its identity as a discipline in Pakistan, with independent, fully functioning departments in medical and dental colleges across the country.
Keywords: Health professions education, Future, Health professions educationists, Profession. (JPMA 73: 264
Submission completion date: 18-01-2022 - Acceptance date: 10-09-2022
The Pakistan Medical and Dental Council (PMDC) remained the main regulatory body for medical and dental education in Pakistan.1 In 2008 the PMDC officially notified to all the undergraduate medical colleges in the country to establish a Department of Health Professions Education (DHPE). As a result of the notification, many medical colleges started opening DHPEs in their setups, but a single faculty member from some other department remained responsible for the duties of Health Professions Education who was responsible to perform his/her duties in the parent department as well.2 In 2020, the PMDC was dissolved and replaced by the Pakistan Medical Commission (PMC).1 The reason for this change was to look into the country’s educational issues and to strengthen the regulations along with the target of ensuring public safety and restoring the medical education inviolability.3,4The future of HPE remained at the crossroads because of its ill-defined career path and the deficiency of structured posts.5 Amid such challenges, the establishment of PMC further increased uncertainties and confusion. As explained in literature, the change in policies of governing bodies in an education system for improving quality impact the discipline’s possible future. As a result of these developments the complexity and uncertainty about the future of the medical education system increases.6
The current study was planned to explore the views of health professions educationists about the identity of HPE as a discipline, as its fate and sustainability as a profession.
Subjects and Methods
The qualitative exploratory7 study was conducted from February to July 2021 after approval from the ethics review committee of Islamic International Medical College (IIMC), Riphah International University, Rawalpindi, Pakistan, and comprised both fulltime and part-time health professions educationists of either gender having a Masters degree in HPE and teaching in different institutions of seven cities of Pakistan; Taxila, Kamrah, Rawalpindi, Peshawar, Lahore, Multan and Karachi.
Professional Identity framework was used for the study.8 Moreover, qualitative exploratory design is commonly used for research in education and social sciences9 and helps improve understanding of how people’s individual experiences give meaning to reality by exploring the perspectives of participants using a constructivist paradigm.9,10
The sample size 0f 14 participants was raised keeping in view the literature available, using convenience purposive sampling technique.10 Data was collected till the point of saturation. The participants were approached through emails, contacts and the LinkedIin app.
One-on-one open-ended semi-structured interviews were conducted online using the online Zoom platform. The questionnaire was designed based on a systematic literature review.10 Expert validation was done through 5 HPE professionals having experience of >5 years each. The questionnaire was then pilot-tested. The interviews of the participants were recorded after getting consent. The one-on-one interview is an effective tool used in qualitative research and provide indepth knowledge about the perspectives, ideas and opinions of a small number of participants.11
The qualitative data obtained was organised, transcribed verbatim and manually analysed thematically. The interview transcripts were coded line by line. Conflicting and interesting quotations were highlighted and comments regarding them were entered in a Microsoft Word document. Initially, a quite a codes were identified which were reduced after merging. Themes and sub-themes emerged during thematic analysis. Since the researcher was also an HPE professional, therefore throughout the study, another researcher was kept involved to ensure triangulation and bias reduction. The findings were interpreted and comparison was done with what is already known through published literature.10 During the study, reflexivity was written and every component was aligned along with a comprehensive description of every step of the process. Moreover, the position of researchers and participants were also explained to ensure dependability, internal coherence and conformability.
Of the 14 participants, 7(50%) had qualifications and experience of other specialities as well, while 7(50%) were pure health professions educationists. Overall, 5(35%) subjects were from Rawalpindi, 3(21%) were serving in multiple cities including Peshawer, 2(14%) were from Taxilla and 1(7.5%) each was from Lahore, Karachi, Kamrah and Multan. Accumulated data initially led to 71 codes which were then merged into 31. There were 3 themes and 15 subthemes.
The first theme was ‘Identity as a discipline’ which had 6 subthemes (Table 1).
The most common and frequently stressed upon comment was that this discipline is an emerging field that has shown development in the last few years.
“A decade back it was a new and interesting field in Pakistan. It was very well received and got a boom as well. Every university or institute was trying to adopt it” (P7).
The main reason for this development was that the curricular reforms were supposed to be imposed and for this change trained faculty was required.
“PMDC, now PMC, has introduced the concept of curricular reform, a hype for medical education has developed … institutes are searching out educationists to provide support for this initiative” (P3).
Secondly, the role of the regulatory body remained important in the development of identity which was another most frequently discussed subtheme.
“PMDC played a very important role by including it in specialities list and has accepted it as a speciality. The PMDC also defined job structure, career path and postgraduate education in HPE … In Pakistan, medical education is in a rapid transformational stage. Leadership is clear about this change and is in control of it and directing it towards the right direction” (P4).
The second theme was ‘Sustainability as a profession’ which had 5 subthemes (Table 2), and 6(43%) participants explained that it is a sustainable profession because necessary awareness has been created. Stakeholders now know the importance of HPE profession. The complexity regarding duties of HPE professions requires training and dedication. That is why the postgraduate qualifications have started in many universities in the country.
“Having said that, it means that as this awareness has become more widespread and the reason is that the people who are making decisions are among those who have already done masters or courses and have realized its importance. So this will sustain” (P9).
“… (E)ducation has become objective and complex, so it is required that it is taken seriously. With over 100 medical colleges, if they do not take it seriously, they are themselves going to suffer so that is why HPE is going to stay” (P4).
Unclear sustainability or poor sustainability of the profession was also among the comments. The main reasons explained by the participants were the frequently changing, confused or under-developed policies of regulatory bodies.
“… [A]s the authority is in hands of individual universities … non-reputed or underdeveloped institutes will not hire them so it is sustainable only in reputable institutes and will get wiped off from underdeveloped institutes because there are no policies regarding faculty strength, qualifications and promotions in this department” (P13).
“The difference will be that the HEC [Higher Education Commission] criteria are more stringent in Basic Sciences or Medical Education, so they expect that if you would like to be an assistant professor in Medical Education, you should be at least a PhD and not simple Masters” (P9).
Although most of the participants were of the view that the governing bodies are supporting the sustainability of this profession in Pakistan by introducing an integrated competency-based curriculum, making the department mandatory in medical and dental colleges, thereby accepting its importance.
“PMC is promoting competency and integration of curriculum, ensuring its sustainability” (P1).
“… [A]ccording to PMC regulations, HPE is mandatory as a department as well as a profession … already a 6-month certificate course is mandatory for the whole faculty” (P12).
The third main theme was ‘Fate as a profession’ and had 4 subthemes (Table 3). The most common subtheme was that fate of HPE is dependent on the regulatory bodies and it is the regulatory bodies who must play their role in this regard.
“I think PMC must clearly define its role, the leadership role it has, it is their responsibility to define their scope of work, and define what they want to do and what not to do, and define who is going to perform the functions which are abandoned by them. The community or stakeholders must talk to the PMC to clearly define roles and responsibilities and policies for HPE and how to progress with this profession. HEC doesn’t have the capabilities or faculty or system to deal with medical college affairs, but if PMC is not willing to work on these areas, then PMC decides who will do it and train and help the HEC to perform the functions” (P4).
However, others said international bodies would also work for the sustainable fate of HPE profession, and that institutes will promote this profession because they have realised its importance as well.
“… [E]ven if such regulations from PMC emerge which goes against the HPE it is well realised by the institutes that they need separate departments of HPE for every institute” (P1).
Whosoever has the authority to decide the fate of the profession, HPE is a reality that became evident in most of the transcripts and emerged as a subtheme as well. It has a bright future and will further progress with time.
“I think it is going to go more beyond, of course. I mean it has a good sustainable fate” (P6).
Another subtheme was that fate is uncertain or threatened because of the emergence of PMC in Pakistan.
“But the fate of HPE is inversely affected as it has created uncertainties about it” (P14).
The current study is a unique qualitative study that addressed the uncertainties regarding the future of HPE in Pakistan, providing a platform to stakeholders to gain information and plan according to the changing scenario.
HPE in Pakistan has developed tremendously as a profession over the last many years.5,12 However, while all medical and denta colleges had an HPE department, the same was mostly being run by a single faculty member. No well-defined departments were encouraged in the medical and dental colleges of Pakistan.13
The current study showed that HPE has developed its identity as many institutes have started offering different degree programmes in the discipline. These programmes are well structured (Table 1). These findings were in line with literature.14
The participants had a view that HPE in Pakistan has a good future, fate and is sustainable because initially the PMDC made it compulsory for promotions, and then PMC encouraged it through introducing curricular reforms.15 The reforms demand skilled faculty.16 In different medical and dental colleges of Pakistan, HPE professionals were being hired as skilled faculty.2 Moreover, these professionals train the rest of the faculty to remain up to date with the changing demands of medical education.2 It is important to note that international regulatory bodies like the World Federation for Medical Education (WFME) also encourage positive developments in medical education which are resulting in the sustainability of HPE3 (Tables 2-3).
The current study showed that although the local governing body has been changed in Pakistan, causing confusion, but overall sustainability and future of HPE have not been adversely affected. It is so because HPE has diverse roles to play for quality medical education, and institutes will not take the risk of compromising on the quality of medical and dental education.17
It is evident through literature that the future of HPE is bright and it is going to develop further. It is because of its importance which is realised by the stakeholders, especially the national and international governing bodies and universities.18 In Pakistan, medical education is striving to achieve international standards.3,13 In addition, literature showed that HPE departments are necessary for quality medical and dental education. Moreover, its diverse roles, especially in the domains of curriculum, research and faculty development, promote its sustainability.19
The current sudy has its limitations as more participants representing more geographical locations across the country would have improved the generalisability of the findings. Moreover, there was no representation from the entire Balochistan province.
Despite changes in policies and regulatory bodies, HPE has established its identity and its future is bright as an independent department in medical and dental colleges of Pakistan. However, it is up to the institutes and the regulatory bodies to set the direction of this profession.
Acknowledgement: We are grateful to our teachers, peers and colleagues for helping us out during the research.
Disclaimer: The text is based on a thesis done for the attainment of Masters degree in Health Professions Education.
Conflict of Interest: The first author Dr Syeda Sanaa Fatima is currently affiliated with Department of Medical Education, Pak International Medical College, Peshawar.
Source of Funding: None.
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