Prakash Banjade: The first institution for training health workers started 75 years ago. Further development of teaching/learning institutions, mainly governmental, started from the middle of the 20th Century. The last fifteen years have seen tremendous growth in the number of medical schools in the country.
At the beginning of August 2010, there were eighteen medical schools and all except four were in the private sector. Among government-run schools, the National Academy of Medical Sciences (NAMS) is a postgraduate training institution attached to Bir Hospital, the oldest hospital in Nepal.
The Institute of Medicine (IOM) was the first medical school that started in the late 1970s. IOM admits students from other countries who pay privately to the undergraduate medical (MBBS) course. The other two schools, BP Koirala Institute of Health Sciences (BPKIHS) and Patan Academy of Health Sciences (PAHS) admit students paying partial and full tuition to the MBBS course.
Colleges in Nepal also admit students from India, Sri Lanka, and from developed nations who pay higher tuition fees than Nepalese students. Sri Lanka has only one private medical school and many Sri Lankan self-financing students are enrolled in Nepalese schools.
Considering the high tuition and other fees, working in the government health sector or in rural Nepal does not give an adequate return on investment. The faculty in Nepali medical schools mainly come from Nepal and India, with a few faculty members coming from other countries.
Many faculties are not familiar with the socio-cultural milieu of Nepal and with healthcare delivery in rural areas. The duration of the MBBS course is four and a half years followed by a year of rotating internship which foreign students can do in their home countries.
Medical education and medical schools especially in South Asia have long espoused the principle that one ‘size’ or ‘style’ of medical education fits all. With the rapid advancements occurring in medical knowledge, it might be the time to recognize that no medical student can learn all ‘necessary’ facts and skills.
The knowledge and skills to be taught and learned may be determined by students’ career plans after graduation and where he or she plans to work. In Nepal and in many other countries, self-financing students are supported by their families or educational loans and their primary motive may be to recover the high investment as quickly as possible after graduation.
Many self-financing students have their goals set firmly on examinations like the United States Medical Licensing Examination and postgraduate entrance examinations and/or establishing an urban practice.
Teachers suffer from inadequate knowledge of conditions in rural Nepal and of the government healthcare system. Many have not spent adequate time in rural areas. A similar situation may exist in medical schools in other South Asian countries and other developing nations. The privatization of medical education and admission of scholarship students to these schools has created a student body with diverse educational needs and outlooks.
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