Practice makes perfect

A brain drain and a shortage of places offering medical courses has led to the UAE and other Gulf States becoming dangerously understaffed for doctors, especially specialists. Many who train go on to leave the region once they complete their studies and the problem is ongoing thanks to a hat-trick of education, recruitment and staff retention. In 2015, the UAE had just 1.5 doctors for every 1,000 people, according to B.R Shetty, the CEO of NMC Healthcare. One of the best ways to fix this issue is to train more homegrown doctors and the Gulf Medical University is trying to do just that. Founded by Indian businessman Thumbay Moideen in 1998, the school offers programmes in medicine, dentistry, nursing, anaesthesia, medical imaging and more. Spread over 25 acres, the university sees around 1,300 graduates emerge from its lecture halls every year, with another 900 graduating under its Continuing Medical Health Education course.

The university also encompasses a wider network of private clinics, hospitals and pharmacies operating under the auspices of the Thumbay Group. With the appointment of Professor Hossam Hamdy as its chancellor in January 2017, the university signalled to the world its ambition to play a transformative role in the evolution of medical training across the Middle East.

As the founder of several medical colleges in the region, it’s a landscape that Hamdy knows all too well. “I’ve always been wearing two hats, between my clinical practice and medical education,” says the former professor of surgery.

It was a journey that began after he had returned to Egypt in 1978, having completed his surgical training in the UK and the US. The dean of Suez Canal University approached him with an offer, asking Hamdy whether he “would join [the dean] to start a new medical school different from all the medical schools in Egypt”.

At the time, almost all medical students in the Middle East were taught according to subject-based learning methods, a form that risked turning them into “passive receivers of the information,” says Hamdy. “There was no link between the basic sciences and their application in clinical practice or research.” At what would eventually become the faculty of medicine at Suez Canal University in Ismailia, Hamdy and his colleagues saw the benefits of an alternative approach – problem-based learning, also known as PBL.

The model, pioneered at McMaster Medical University in 1969, would see pupils independently analyse specific clinical scenarios and share what they had learned with their fellow students in a group setting. The goal is not necessarily to solve the problem being discussed, but rather improve attitudes among the class towards teamwork as well as their own resourcefulness.

To gain a better understanding of PBL in practice, Hamdy travelled to the Netherlands, Canada and the US to visit the first medical schools experimenting with the method. The young surgeon returned the following year with a much better idea of how to adapt PBL for students at the new college in Ismailia.

“Instead of designing curricula based on subject, we started moving into competency-based types of curricula, which is [about] what the graduate is able to do rather than how much they know,” says Hamdy.

He and his colleagues were the first to introduce PBL to the Middle East, long before many Western universities even considered integrating it in to their curriculum. “We started before Harvard,” he adds, in a tone that implies that he’s had to remind people of this fact more than once. “But, of course, Harvard is Harvard.”

Changed practices

Today, PBL is an essential component of medical courses across the world. Yet, as clinical education has grown in size and complexity, Hamdy has become convinced that existing teaching methods, once new, have now begun to show their age. Rapid changes in research methods and the way clinical information is shared, coupled with a long list of recent scientific breakthroughs, is shaping what and how medical students are learning on a yearly basis.

“In the past ten or 15 years, many changes have come in the practice of medicine that have [influenced] the curriculum structure and content,” Hamdy explains, citing advances in genetics, molecular medicine, public health and the wider realm of clinical epidemiology. Helping students in the Gulf keep pace with these changes has often seen them fly off to hospitals beyond the region to pursue research in niche areas, before returning to pursue further clinical practice in their home nations. Hamdy sees this phenomenon – fostered by exchange programmes set up by GMU and its counterparts in the region – as a vital complement to the work being done by local schools.

“In my opinion, the undergraduate curriculum is, in many places [in the region], good and strong,” he says. However, he adds, “exposure to another system is very important. It’s very enriching and I would definitely encourage spending periods training, getting super-specialisation as a fellow or doing a residency outside of the region.”

The US, Canada and Australia are all logical destinations for GMU’s students, says Hamdy, not least because most of the courses available at the university are taught in English. The Anglosphere is also a ready source of innovative research that is funded and overseen by established institutions across Europe and North America. “Only good things come out of that,” says Hamdy, in reference to these exchange programmes. “I totally encourage it and it makes a lot of difference, not only in the student accruing technical expertise but also culture-wise. They experience the outside world, and different systems of practice, different ethical and professional behaviours.” GMU also regularly receives exchange students from Europe and east Asia, tapping into what Hamdy describes as a strong network of collaborating institutes. When pupils on either side of the equation return, they often do so with their names on a publication, excellent references and a wide network of clinical acquaintances on tap.

High technology

While exchange programmes can, and frequently do, result in a steady stream of knowledge and expertise back to the Gulf, this must be accompanied by a keen eye towards the quality of training at home. The region currently faces an acute shortage of doctors, and it has become incumbent on medical colleges up and down the Middle East to adapt their training courses to new technological realities.

“A lot of changes in content have come up in the past 20 years,” says Hamdy. “You can have the best lecture from anywhere; you can get it on the wire.” While the availability of electronic resources has markedly increased in this period, the professor still believes that nothing is quite as effective as learning through doing. Although technology cannot fully replace the benefits of working one-on- one with the patient, Hamdy has collaborated with the Swiss firm LifeLike to develop a new simulator for students that almost measures up to the real thing. Dubbed ‘Virtual Patient Learning’, the program uses artificial intelligence to create a scenario wherein the student attempts to diagnose a hypothetical patient.

“The software [contains] all the different possibilities and options that a student can ask a patient, which develops and improves clinical reasoning, decision-making and communication skills,” explains Hamdy. The company claims to have trained over 35,000 doctors and students using the simulator with an overall satisfaction rate of 92%.

“The degree of authenticity is quite high,” says Hamdy, although he acknowledges that it can’t replace training with real patients in the clinic or the hospital. In many ways, it’s a natural successor to the PBL methods that he helped introduced to the halls of Suez Canal University in 1978. While Virtual Patient Learning is not a substitute for time spent with real patients, it nevertheless updates the concept for the 21st century. “At least it is a step towards maximum simulation and it is being implemented now at Qatar University, here at the Gulf Medical University, and in Beirut Arab University,” Hamdy says.

Hamdy and his colleagues are also working hard to develop a department for health economics, policy and management at GMU. It’s a logical move, considering the growing importance of healthcare in the wider regional economy, compared with more entrenched sectors like energy. “I am creating a business programme that is focused on health as an industry,” Hamdy says. “And that’s new; there is no other university [like that] here.”

This new course would bring GMU in line with universities pursuing similar initiatives in the UK, Norway and Germany. It’s just another example of a programme in keeping with Hamdy’s transformative vision for medical training in the Middle East, a vision that has not had its sense of idealism dim since his days as a surgeon, newly returned to Egypt in 1978.