Continuing Medical Education for Afghan Doctors

Written by admin on November 26th, 2010

Continuing Medical Education (CME) is an important part of a successful medical practice for best patient outcome in any medical setting. CME improves, maintains, and develops professional performance and skills of physicians (Bellos, Bergqvist,?Bockel,?Palombo,?&?Wolfe, 2007). To implement theoretical aspects of medical education into practice after graduation from medical school, doctors need experts’ guidance to deliver quality care as well as add to ones’ own experience. According to the Institute of Medicine (IOM) gap between classroom learning and problem solving skills in clinical settings can result in medical errors (Speicher and Kehrhahn, 2009). Practicing under instruction of experienced mentors in a specialty field provides new doctors with the opportunity to obtain better patient outcome.

Collaboration in training and CME of medical staff in form of exchanging experience has provided positive outcomes in several national and international academic arrangements. Krym, Retezar, & Scott (2009) studied the impact of international partnership in cultivating emergency medicine (EM) practice in northern Romania, which experts from countries with mature EM systems provided support for growth of EM in Romania via transfer of knowledge. Identifying the scope of operation in every organization is an important step to establish education priorities for medical staff. Recognizing the need for different levels of training and knowledge among staff members in the same organization is also an important step before initiating CME (Speicher and Kehrhahn, 2009).

Krym et al., (2009) identified the importance of cultural diplomacy and sensitivity in delivery of international health education. Cultural and lingual differences in international partnership need to be recognized properly before starting an exchange program with a host country. Willingness of local medical directors and staff is essential to overcome language barriers as well as get familiar with the culture. International partnership in education can be built between healthcare organizations in form of direct meetings as well as distance education. Advanced technology such as telecommunication can promote tele-education and mutual growth between individuals and organizations around the globe.

Healthcare Services in Afghanistan

Decades of war in Afghanistan has destroyed country’s infrastructure which in turn healthcare services as well as education and CME for medical professionals have suffered a remarkable seatback. As cited in Jalal (2009) the World Health Organization (WHO) in 2005 reported that continuous war in Afghanistan has caused disparities in equitable distribution of quality healthcare services in the country. Fragmented healthcare system in Afghanistan has further jeopardized accessibility to essential healthcare services for population in need of such services (Jalal).

Access to basic healthcare for individuals in different parts of the globe is the responsibility of local governments. Promoting individuals’ equitable access to basic healthcare requires collaboration among healthcare providers and healthcare professionals. The World Health Organization (WHO, 2009) has recognized healthcare in 21st century as a shared responsibility that involves equitable access to basic healthcare and collaborative defense against transnational threats. Globalization of healthcare via tele-education is a new trend in delivery of healthcare that could standardize training of healthcare professionals worldwide.

?Problems Caused by Lack of CME

?The problem is that there is no sustainable post graduate CME program for Afghan doctors. Doctors who are involved with treating civilian casualties are overwhelmed with the load of patients arriving at hospitals’ emergency rooms at one time during an explosion or similar situations that result in mass casualties. Barriers due to lack of CME for healthcare professionals in Afghanistan affect the diagnostic and therapeutic qualities. Lack of CME can cause difficulties in patient-doctor interaction and proper diagnostic methods. Training of medical doctors requires not only teaching of professional principles of medical treatment based on patients’ need but understanding of cultural and lingual diversity of patients as well (Krym et al., 2009).

1. Problems with standardizing educational systems nationwide and scarce resources of cadres.

Problem with standardizing educational systems nationwide is an important part of disparity in delivery of quality healthcare services in Afghanistan. Lack of adequate cadres inside Afghanistan is the main reason behind this problem. Political turmoil has caused qualified cadres to leave Afghanistan over past several years or some have deceased. Therefore, medical students were deprived of most required information during their school years and graduated with substandard education. Freshly graduated students with substandard education were appointed in clinics to treat patients, while there were no well-trained clinicians to guide them properly. In recent years there have been newly developed medical schools in different provinces which lack qualified cadres and don’t meet educational standards; these substandard medical schools add to the existing healthcare education problems in Afghanistan.

2. Lack of advanced technology in laboratories to support medical diagnosis.

Lack of advanced technology in laboratories to support medical diagnosis is also one of the factors that affect accuracy in patient diagnosis. Lack of proper diagnostic tolls in turn negatively affects treatment and patient outcomes. It is also necessary to have well-trained laboratory technicians to perform diagnostic tests on patients’ specimens. To train laboratory technicians properly, it is important to have a certification program for various diagnostic field under supervision of qualified trainers either inside Afghanistan or overseas. The only problem with sending individuals’ overseas for training is that tranees might not return to Afghanistan. A more feasible approach is to have qualified trainers to train technicians inside Afghanistan.?

3. Doctor-patient interaction.

Doctor-patient interaction based on cultural orientation of patients is an important component of CME program for doctors that needs to be addressed by healthcare providers. Cultural sensitivity by healthcare providers can facilitate diagnostic and therapeutic aspects of healthcare services to patients, which in turn could result in positive outcomes by enhancing patient cooperation in the treatment and recovery process. One of the obstacles that doctors are facing in Afghanistan is examining a female patient by male doctor because female patients may not want to speak to a male doctor or expose their bodies for proper physical exam. Although sometimes family members such as patient’s father or brother are present, it is difficult to inquire accurate information about patient’s menstrual cycle, pregnancy, or other specific gynecological problems. Therefore, inexperienced medical doctors need to be properly trained to address patients’ needs appropriately and accordingly.

Comprehensive CME program providers need to be aware of cultural diversity in sub populations in countries and seek solution to existing obstacles in delivery of quality healthcare to these sub-populations. It is important that healthcare providers in Afghanistan evaluate and analyze cultural diversity in Afghan patient populations. The results of such evaluation need to be included in training curriculum for CME program.

Providing a comprehensive CME program for medical doctors could be vary based on the requirements of sub-population in each area and the capacity of each healthcare institution or hospital. For example, a well-equipped major hospital with qualified professional staff could be the center for training new doctors, while the professional staff themselves would participate in international training programs and seminars to enhance their experience. New doctors could rotate for training to these major hospitals for certain amount of time and return to their original clinics after the CME program is completed. The senior doctors from hospitals around the country could also obtain CME in the major hospitals with well-trained professional staff and after completing the program return to their designated centers to educate their medical personnel. Qualified professional staff from major hospitals could also be invited to other hospitals to evaluate the condition of healthcare services in those centers.

To achieve nationwide CME programs in various parts of Afghanistan in efficient amount of time, direct contact of healthcare professionals via tele-education seems another possibility that could facilitate constant contact and communication of healthcare professionals inside Afghanistan or globally. It is essential that participants of global communication regarding healthcare services be aware of cultural diversities in each area.

Conclusion

Problems with standardizing educational systems nationwide, scarce resources of cadres, and lack of advanced technology in laboratories to support medical diagnosis are some factors that cause obstacles in delivery of quality healthcare in Afghanistan. CME is an important part of a successful medical practice for best patient outcome in any medical setting which improves, maintains, and develops professional performance and skills of physicians (Bellos et al., 2007). Doctor-patient interaction is an important aspect of delivery of quality care to patients that needs to be included in a comprehensive CME program for healthcare professionals. Decades of war in Afghanistan has destroyed country’s infrastructure which in turn healthcare services as well as education and CME for medical professionals have suffered a remarkable seatback. Providing a comprehensive CME program for medical doctors could be vary based on the requirements of sub-population in each area and the capacity of each healthcare institution or hospital.

References

Bellos,?J.,?Bergqvist,?D.,?Bockel,?J.,?Palombo,?D.,?&?Wolfe,?J.?(2007). European continuing

medical education in vascular surgery: 5-year results of congresses approved by the Union Europ?enne des M?decins Sp?cialistes Section of Vascular Surgery.?International Angiology,?26(4),?361-6.? Retrieved December 26, 2009, from ProQuest Health and Medical Complete.

Jalal,?Z. (2009).?Emergency medical systems: Prehospital trauma care for landmine and ordnance

blast injuries in Afghanistan.?Ph.D. dissertation, University of Phoenix, United States, Arizona. Retrieved April 17, 2010, from Dissertations & Theses @ University of Phoenix.

Krym,?V.,?Retezar,?R.,?&?Scott,?S.?(2009). International partnerships to foster growth in

emergency medicine in Romania.?CJEM : Journal of the Canadian Association of Emergency Physicians,?11(6),?560-5.? Retrieved December 25, 2009, from ProQuest database.

World health organization (WHO, 2009). About WHO. Retrieved December, 27, 2009, from

http://www.who.int/about/en/

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