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Asian Tribune is published by World Institute For Asian Studies|Powered by WIAS Vol. 12 No. 2038

Students with less cognitive ability likely to make more mistakes than those with greater ability – Prof. Carlo Fonseka

By Manjari Peiris

The purpose of the Sri Lanka Medical Council is protecting health care seekers by ensuring the maintenance of academic and professional standards, discipline and ethical practice by health professionals who are registered with it.

Obtaining approval and registration from the medical council to establish a medical college in that respective country is a universal norm. No medical college in the world is established without the approval of the Medical Council of that country.

An interview was held with the former President, Medical Council, Professor Carlo Fonseka, to discuss on certain issues pertaining to medical education in private medical colleges.

Excerpts are as follows -

Question: Recently quoting Professor Mohan de Silva, the current Chairman of the UGC, you said that medical errors are the third commonest cause of death in the US. You went further and said that doctors have become one of the biggest killers in the modern world after heart attacks and cancers. Is that really true?

Professor Carlo Fonseka: That medical errors occur was well-known for a long time. But it is from Professor Mohan that I picked up the statistic that in the US in 2013, there were over 440,000 deaths due to medical errors. I had already reported to the British Medical Journal in 1996 five errors that had occurred to my personal knowledge during 36 years of medical practice (from 1960-1996).

Question: Why are you focusing on medical errors so much at this point in time?

Professor Carlo Fonseka: For a very good reason which I will presently explain. With the spread of private medical education in the world that is to say medical education which is profit driven, students with low educational attainments are acquiring medical degrees for money in increasing numbers in private medical schools in some parts of the world. In Sri Lanka we have many students going to private medical schools in India, Bangladesh, Nepal, China and Russia who are returning with medical degrees. We have found that many of them have great difficulty in passing the licensing examination called the ERPM, i.e. examination for registration to practice medicine in Sri Lanka.

Question: Why is the relationship between medical errors and medical education?

Professor Carlo Fonseka: Everybody knows that in Sri Lanka the medical profession was the most difficult one to enter because only the highest achieving students were admitted to the limited number of places in the only medical school in the country up to 1962. Only about 100 students in the Biology Stream selected on an all island merit basis were admitted to the medical school. Other things being equal, nobody will deny that students with a higher cognitive ability as measured by their performance at the selection examination are less likely to make mistakes than students with lower cognitive ability. To make matters simple, a student with 3 As in the GCE AL examination has higher cognitive ability - i.e. to say capacity to understand and learn and apply knowledge than a student with only 3 S passes.

Question: But under district quota system that has been in operation in this country for about 40 years is it not true that many students with 3 simple passes (3 Ss) have been selected for medicine and they have not done badly at all?

Professor Carlo Fonseka: That is true. In the State Medical System, students with even 3 Ss have to acquire the 3 Ss at one and the same examination in not more than 3 attempts. After the Z score was introduced they also have to attain a certain minimum level applicable to each district. Also they have to get at least 30 marks in the common general paper. So students who enter the State Medical School with only 3 Ss and they are now becoming very rare. The students selected to the State System are of high quality with improving educational standards even the lowest achievers who are selected for medicine have credit level passes in their 3 subjects. But this is not so in the private medical schools.

Question: What happens in the private medical schools?

Professor Carlo Fonseka: Students with 3 S passes, either in the local AL or in the London AL are admitted to private medical schools. These medical schools also have schemes for admitting students with OLs and who have followed foreign foundation courses. To cut a long story short, private medical schools will admit almost anyone with the ability to pay the big fees they charge. They are only concerned to collect the fees and after keeping them in medical schools long enough for them to make as much money as possible as they can, they will be given a MBBS certificate. They return to Sri Lanka and sit for the ERPM examination many times before they qualify often one subject at a time.

Question: Are you trying to say that such doctors are more likely to make more medical errors than doctors trained in our faculties?

Professor Carlo Fonseka: Of course there are some very good students with foreign qualifications who are quite good but when it comes to medical errors I think no one will deny that students with less cognitive ability are likely to make more mistakes than students with greater cognitive ability. In short, the real concern with private medical education for profits is that students with inferior cognitive ability who are not properly trained will enter the profession. This is what maintaining minimum standards in medical education boils down to in practice and it is the statutory duty of the Sri Lanka Medical Council to maintain minimum standards.

- Asian Tribune -

Professor Carlo Fonseka - Former President, Medical Council
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