At the time the Medical College (MC) was established, Pakistan as a sovereign nation had only been in existence for 36 years. The year was 1983, and it was a different era. The healthcare needs of the nation were vast and critical, with limited access to adequate healthcare and a high incidence of disease. An acute shortage of trained medical professionals, inadequate facilities, lack of focus on local realities and contexts and ironically high unemployment for doctors due to a lack of healthcare institutions, plagued the system.
Though many of these issues remain, with some becoming more pronounced due to the boom in population and internal upheavals, the vacuum that the establishment of the Medical College filled cannot be underestimated. It changed the healthcare landscape by holding itself to a higher standard, by leading by example and in time producing medical professionals and researchers of a caliber not seen before in Pakistan. It was the first time a private medical college was formed that functioned very differently from the public universities of the time; with a clear vision, with experts from around the world participating in its development, with emphasis laid on local conditions and needs, and a focus on research and scientific advancement in healthcare.
It is safe to say that the Medical College has far exceeded all expectations set at the time of its founding. Today, in its 39th year of operation it is regarded as one of the top medical colleges globally and ranked #1 in Pakistan by the Pakistan Medical Commission. And what a journey it has been; with many firsts in the field, and every individual associated with AKU during this time contributing to its success.
The Firsts
There have been many firsts when it comes to our fellowship programmes; these are just some examples:
In addition to our fellowships, many departments and programmes at AKU are the first of their kind in the nation.
- Family Medicine was recognised as a discipline and established as a department for the first time in Pakistan; its post-graduate training programme remains the largest in the country.
- Pediatric Neuro Oncology with the only trained paeds neuro-oncologist is a novel programme in Pakistan.
- First in Pakistan to establish Radiology subspecialties such as women imaging, neuroradiology, intervention radiology and pediatric imaging; also the first to introduce latest imaging technology and computed radiography.
- Internal Medicine's residency programme has been training physicians since 1987 and is the largest postgraduate training facility within AKU while its fellowship in Hospital Medicine is the first of its kind in Pakistan.
- Psychiatry as a certifying exam in MBBS is a first despite the fact that it is not a Pakistan Medical Commission requirement.
- First 24/7 primary PCI facility in Pakistan.
Other examples include our multidisciplinary comprehensive palliative care services in Karachi, our bone marrow transplant center and genomics lab. Our comprehensive breast cancer and structural heart disease programmes are highly valued and contribute extensively to the larger narrative on these diseases. The 24/7 rheumatology service is also one of a kind.
A 2007 graduate of the orthodontics residency programme is the first person in Pakistan to achieve the status of “Diplomate American Board of Orthodontics” while the radiology department was the first in the country to introduce computed radiology, tomosynthesis, and interventional procedures such as stereotactic biopsy.
The Department of Educational Development was a pioneer in developing and offering Introductory Short Courses in Health Professions Education nationally. 50 courses training 1094 professionals have been conducted to date.
It is important to note that many of the initiatives launched at the MC have far-reaching effect as other institutions use them to kickstart their own programmes. The anesthesia residency programme was not just the first in the country but one that served as a model on which other national programmes were developed. The pediatric hematology/oncology fellowship programme initiated at AKU led to seven programmes being initiated at various institutes. Thus, what takes place within the walls of AKU definitely doesn’t stay there.
Recognition
Our efforts have been widely recognized on a national and global level by governments, non-governmental organizations and international bodies.
- St Jude’s Global Alliance recognizes us as one of the first 100 institutes globally to join the cause of childhood cancer.
- Our mycobacteriology laboratory has been recognized as a supranational reference lab by the World Health Organization (WHO).
- ACCME has accredited our CME activities conducted by the Department of Continuing and Professional Education; Just in 2021, their work has reached 90,000 participants of which 70% are from outside AKU.
- ACGME-I accreditation for PGME is the first in South Asia, with 5 clinical programmes also recently receiving accreditation.
- All residency and 18 fellowship programmes are accredited with the College of Physicians and Surgeons Pakistan (CPSP).
- WHO collaborating center in Emergency Medicine and Trauma Care and national recognition of Emergency Medicine by the College of Physicians and Surgeons.
The number of prestigious national and international awards that have been conferred upon our faculty and alumni during this time is astounding and too expansive to narrate here.
Just in the department of Surgery there are three Tamgha-e-Imtiaz recipients and four who have received the Sitara-e-Imtiaz, while five surgeons are approved as HEC supervisors in surgery. The Department of Education Development (DED) has a Tamgha-e-Imtiaz and lifetime achievement award recipient among their ranks.
Our faculty are consistently invited to be national and international examiners, and over the last few decades have represented AKU, Pakistan and the healthcare community at thousands of conferences and forums across the world. Their contributions have helped with guideline formation at inter-agency organizations, and aided in the development of international standards and processes across the gamut of healthcare topics. They remain critical as mentors and career counsellors.
Education re-imagined
The MBBS programme continues to be a trailblazer for medical education in the country constantly morphing to meet the changing needs of the profession.
It boasts the first completely integrated and blended basic sciences programme, a humanities and social science section and a practice of continuous assessment for clinical sciences. Under the leadership of BBS faculty and the UGME curriculum committee, research is an integral part of the UGME curriculum with a research module being added for year two students. It is also the first university with family medicine and geriatrics as part of the core undergraduate curriculum in MBBS and after sustained advocacy, in 2021, family medicine has been added to the MBBS curriculum throughout Pakistan.
But the Medical College doesn’t just stop there. The MC always strives to be a leader in educational advancement. It is imperative to keep evolving and growing, and the development of two specialized master level degree programmes in public health by the Department of Community Health Sciences (CHS) is a prime example of that commitment.
- The Epidemiology and Biostatistics, and Health Policy and Management programmes have trained over 400 specialists in these specialised areas of public health; these alumni are leading researchers at AKU but are also serving as experts in their fields across Pakistan and internationally.
- The launch of the Mphil in Biological and Biomedical Sciences programme in 2019 further built upon this drive to constantly innovate and educate, while the FHS-PhD programme (fully compliant with HEC guidelines) brought together this vision of research-led education.
- The Master of Health Professions Education continues to develop excellent teachers; innovators and researchers as well as leaders in health education.
- The Associate of Science in Dental Hygiene ASDH, is a two-year degree programme recognised by the Higher Education Commission (HEC) in Pakistan.
These programmes continue to see sustained growth in the number of applications received and our departments have supported the initiation of similar programmes in other institutes. CHS and EM collaborating to support Khyber Medical College with their Epi-Bio programme is one such instance. And we always strive to make our education/training more accessible. One example of this is the Internal Medicine residency programme's flexible tract introduced for women who want to continue practicing medicine while taking care of family obligations.
Maternal and child health is one area where this impact of quality evidence-based research is greatly visible. The work on malnutrition has resulted in AKU:
- performing the last three national nutrition surveys,
- generating evidence to recommend zinc supplementation in the management of diarrheal diseases and
- implementation research to improve breast feeding practices in the country.
Research and advocacy done in the field of maternal and child health has led to:
- improved prenatal care and birthing practices,
- and expanded vaccine coverage (Hib, PCV, Rotavirus, Typhoid etc.) through the national expanded programme for immunisations.
As regional experts in Hypertension, the Department of Cardiology has led two national guidelines with research and physician training on hypertension making significant contributions at the community level. This is a tiny fraction of the research work that has and continues to be generated at the MC; just in the last three years close to two thousand publications have been published and our extramural grant funding stands at $49.2m for the year 2021, taking our total since inception to upwards of $300m. With our new research shared services model, we hope to further grow our research portfolio and realise our Chancellor's vision of being a research-led university.
Our dedicated research incubator, CITRIC is a great move towards advancing scientific discovery. You can read more about the novel centers running in it.
Even the faculty appraisal scoring system has evolved over time to gauge performance on more qualitative and comprehensive parameters such as educational administration and leadership. Extensive efforts have been made for continuous faculty development through DED and the Faculty Office, quality assurance and improving examination systems; our partnership with the world's largest network of exam supervisors UCAN to power up our digital teaching, learning and examinations is just an example. Thus, the goal is not to just produce excellent healthcare professionals but to constantly improve and produce leaders of the highest caliber.
Building capacity
All our work goes hand in hand with training and capacity building. Dissemination of knowledge remains a key guiding principle.
Postgraduate training in Pathology (Chemical, Histopathology, Haematology and Microbiology) for instance, has led to trained professionals currently providing quality diagnostic services nationally and internationally while fellowships in subspecialities like maternal fetal medicine, urogynecology and gynecologic oncology have created pioneers in their fields.
The CPSCP approved fellowship trainings in Paediatrics have created a substantial pool of specialists who are excelling in a wide array of hospitals and academic centers. With over 1900 highly trained residents and fellows, the level of impact is substantial not just in terms of number of trained professionals but also the quality of healthcare offered to patients.
The collaboration with AKHSP for training its physicians since 1994 built critical capacity within the larger AKU network. It also increased access to quality primary care by opening off-campus AKUH sites in Karachi which over time have resulted in 30+ clinics for AKUH in nine cities across Pakistan.
The annual conferences organized by the Department of Surgery, Emergency Medicine and Oncology to name just a few, bring together experts from around the world for knowledge sharing; such initiatives are critical for advancement and growth.
This process of building capacity isn’t limited to students or trainees; extensive work with the public sector has led to a vast improvement in their capacity.
- The strengthening of public sector laboratories and National Institute of Health in Islamabad has greatly improved capacity for detection of antimicrobial resistance, with the laboratory network providing access to accurate and timely results even in remote areas.
- Establishment of reference level services for fungal diagnostics
- Our specialized workshops over the years impacting areas of primary prevention, ECG and rhythm disorders are a great example of external capacity building.
- The establishment of MRCGP International exams in South Asia in 2004 is an example of cross-regional impact with the exam continuing to enhance training and provide accreditation to general physicians across five countries (Pakistan, India, Sri Lanka, Nepal and Bangladesh).
- The Department of Medicine along with almost all other departments serve as supervisors and examiners for specialist national exams.
- Fellowships in child psychiatry and many certificate courses in psychiatry, child and adolescent psychiatry and psychology build much needed capacity in under-represented yet critical fields like mental health.
In addition to building the medical college’s own institutional leadership, the faculty continue to serve on innumerable external forums and societies. The list is impressive, exhaustive and all en-compassing; one example would be the Asia Pacific Heart Rhythm Society that has great representation from our cardiology faculty.
And the contribution of our faculty and residents in the COVID-19 pandemic has been invaluable. From our experts informing national policy, spreading critical awareness and building capacity to executing a tele-icu project and conducting in-depth research, the scope and impact of the contribution cannot be underestimated.
Improving Lives
Our vision is to go beyond traditional medical education and introduce services that improve the lives of the communities in which we serve. Some examples of innovation in traditional models of healthcare:
- mobile mammogram bus services,
- lactation consultation programmes,
- ECD parenting education clinics,
- multi-modality imaging and cardiac MRI centers,
- state-of-the-art Anatomy Surgery learning studio
- patient-centered care models,
- simulation-based education, and
- research incubation centers.
And this constant effort to improve and innovate is instilled in our own teams and departments; just in the last ten years Emergency Medicine has added extended triage services to shorten wait times, established separate cardiac emergency services, used technology to strengthen clinical monitoring and operational performance, with Cardiology pioneering simulation based training workshops in general cardiology, electrophysiology, intervention and imaging.
Looking Ahead
As we move into the next phase of our growth, we aim to amplify our impact and growth, and continue to improve the quality of life of the communities in which we serve. A few exciting developments to look forward to are:
The addition of two new departments to our family; the Department of Opthalmology and the Department of Allied Health.
Two new CITRIC centers; Center for Bioinformatics and Center for Oncological Research in Surgery.
New Masters of Public Health, Health Data Analytics and Clinical Nutrition to be launched soon.
We continue to build on a solid foundation of fund-raising and stewardship, and aim to enhance student scholarships in a bid to encourage further diversity in our student body. Upwards of 15 million usd in financial assistance have been disbursed to local and foreign students since the MC began, and we will continue to make quality education accessible to those who qualify on merit and need.
Our alumni have been exceptional partners on this journey; through class gifts, individual donations, endowments, sharing their expertise, being a part of our faculty/leadership and being excellent ambassadors of the Medical College across the globe. We are extremely proud of our alumni and will continue to engage with them.
It is a great legacy of excellence that we take into the future, and as we move towards more integrated health models and developing into a true Academic Medical Center, we step into a new phase of progress, learning and commitment to our vision.
On behalf of the Dean of the Medical College, we extend our gratitude to the countless brilliant individuals who have illuminated the halls of the Medical College from conception to inception till today.