Sri Lanka’s medical education sector finds itself in turmoil once again as opposition emerges to the establishment of a Private Medical College (PMC) by the National School of Business Management (NSBM).
Amidst allegations of procedural delays and resource allocation concerns, the NSBM’s failure to submit an application to the Accreditation Unit of the Sri Lanka Medical Council (SLMC) has sparked outrage among stakeholders.
The recent Cabinet decision endorsing the NSBM’s proposal and suggesting the conversion of the Homagama Base Hospital into a teaching facility for the new college has aggravated tensions within the State medical community, pitting proponents of private education against defenders of the public healthcare system.
A short supply?
PMCs emerged against the backdrop of Sri Lanka’s dire shortage of medical professionals, aggravated by the ongoing brain drain.
According to the SLMC, Sri Lanka produced a total of 1,681 doctors and 93 dentists in 2022. As of 19 September 2023, the number of licensed medical practitioners in Sri Lanka included 906 from the University of Ceylon, 5,968 from the University of Colombo, 5,294 from the University of Peradeniya, 3,958 from the University of Kelaniya, 4,105 from the University of Ruhuna, 3,309 from the University of Sri Jayewardenepura, 2,356 from the University of Jaffna, 1,582 from the Rajarata University, 438 from the Eastern University, 582 from the Kotelawala Defence University (KDU), 5,184 from foreign universities, and 383 from the North Colombo Medical College (NCMC).
Currently, Sri Lanka boasts 12 State medical faculties, along with one military medical faculty at the KDU with a fee-paying civilian student intake. The State medical faculties are situated at the University of Colombo, University of Peradeniya, University of Jaffna, University of Ruhuna, University of Kelaniya, University of Sri Jayewardenepura, Eastern University, Rajarata University, Wayamba University, Sabaragamuwa University, University of Moratuwa, and Uva Wellassa University.
The establishment of these faculties dates back to historical milestones, with the Colombo Medical Faculty opening in 1870, followed by Peradeniya in the 1960s, Jaffna in 1978, Ruhuna in 1980, Kelaniya in 1991, and Sri Jayewardenepura in 1993. Subsequent additions include Eastern in 2005, Rajarata in 2006, Wayamba in 2016, Sabaragamuwa in 2019, Moratuwa in 2020, and Uva Wellassa in 2023.
Since 1972, the SLMC has recognised the MBBS degree of nine medical faculties and rejected one application from a medical faculty not established under the Universities Act.
Graduates possessing MBBS degrees from a medical faculty of a Sri Lankan university or foreign university recognised by the SLMC are eligible to register provisionally (foreign graduates after the Examination to Register to Practise Medicine/ERPM) with the council, enabling them to undergo internship training for one year at an SLMC-approved hospital. A doctor with full SLMC registration is permitted to practise as an independent medical practitioner within the country and register in a postgraduate course at the Postgraduate Institute of Medicine affiliated to University of Colombo.
Additionally, there are about three private medical faculties, including the NSBM and Lyceum, in the pipeline.
GMOA ‘not opposed’
Speaking to The Sunday Morning in such a backdrop, Government Medical Officers’ Association (GMOA) Media Spokesman Dr. Chamil Wijesinghe acknowledged the pressing need for more doctors in the country, citing the exacerbation of the scarcity due to the ongoing brain drain.
He emphasised on the urgency of addressing the issue through prompt policy decisions rather than merely opening new medical faculties. “It takes nearly six years to produce a doctor. Therefore, the Government should address the issue immediately.”
While expressing openness to private medical colleges, Dr. Wijesinghe highlighted the importance of maintaining quality in medical education and standards in State medical faculties. “State medical education should not be affected by private medical colleges.”
Regarding the controversy surrounding the Homagama hospital’s allocation to the NSBM, Dr. Wijesinghe highlighted concerns about the impact on existing medical facilities: “If this hospital is given to the NSBM, the Sri Jayewardenepura University will lose a hospital.”
Dr. Wijesinghe also stressed on the importance of conducting feasibility studies to determine the country’s future requirements in relation to doctors and cautioned against overproduction, citing potential drawbacks, while emphasising on the need for expansion of medical education in alignment with national projects.
Highlighting the Government’s responsibility to safeguard free education, Dr. Wijesinghe raised concerns about ongoing issues faced by Government universities. He highlighted uncertainties regarding the Uva Wellassa Medical Faculty and ongoing accreditation processes for several State medical faculties such as Wayamba, Sabaragamuwa, Moratuwa, and Uva Wellassa.
High standards
Local medical education commenced in 1870 and celebrated its 150th year in 2020. The predecessor of the SLMC, the Ceylon Medical Council (CMC) was established in 1927 replacing the Ceylon Medical College Council (CMCC). The CMCC recognised the holders of the MBBS degree as medical practitioners and registered them to practise medicine and surgery in the country.
Following the establishment of the University of Ceylon by the University Ordinance of 1942, the Bachelor of Medicine and Bachelor of Surgery (MBBS) degree awarded by it was recognised for registration by the CMC. The name CMC was changed to SLMC in 1972.
In the recent past, the accreditation process, requirements, indicators, standards, and documentation have changed with the introduction of more technical and professional aspects. The practice of medicine and expectations of stakeholders too have changed. Accordingly, the SLMC established the Accreditation Unit (AU) in 2019. Prior to 2019, the accreditation of medical schools was done by the SLMC itself.
The AU operates as an independent body within the SLMC, comprising a head and five members. It appoints qualified reviewers with experience in accreditation from the University Grants Commission to assess MBBS courses across all medical faculties in Sri Lanka. To ensure quality, the AU has developed regulations, application forms, and guidelines aligned with the gazetted Minimum Standards of Medical Education Regulations – 2021.
It oversees both academic and professional aspects during the accreditation process, which may result in accreditation or non-accreditation for medical schools. In case of non-accreditation, the AU provides a remedial period for corrective actions. Currently, the AU is focused on obtaining recognition from the World Federation for Medical Education (WFME), which will enable graduates from accredited medical faculties to pursue postgraduate courses overseas and seek employment in select countries.
The standards for accrediting a medical school as defined by the AU encompass transparent entry criteria and rigorous programme evaluation guidelines. These standards, outlined in Section A, stipulate the minimum qualifications for admission, including Sri Lankan GCE Advanced Level (A/L) or equivalent London A/L qualifications in Biology, Chemistry, and Physics.
Meanwhile, Section H emphasises on the importance of establishing robust quality assurance systems within medical schools, facilitating regular feedback mechanisms for students and staff and undergoing comprehensive programme evaluations at least once every 10 years.
Furthermore, the standards require schools to analyse the performance of students and graduates in alignment with the institution’s educational objectives and assessments, ensuring continuous improvement and adherence to quality standards throughout the medical education process.
‘No interference’
When The Sunday Morning contacted SLMC Registrar Dr. Hemantha Herath on the accreditation process of PMCs, he said: “The process is handled by the Accreditation Unit of the SLMC, which is semi-independent. Once the applications are made, the AU will handle them and independently give its final evaluation with its recommendations.”
Dr. Herath added: “At present, I’m not in a position to comment on the applications. It is a very lengthy process. I know private universities have submitted their proposals and different schools are at different stages. The process is progressing and it is very difficult to say which is at what stage.
“We don’t get directly involved with the AU; we want to maintain the independence of the accreditation process as the AU is an independent organisation accredited by the WFME. Once it is recommended to the council, we will proceed from there.”
He noted that the SLMC’s role was to regulate the quality of the practitioners and their conduct to ensure the safety of patients, pointing out that the council was not involved with numbers and distribution: “When people bring these things in, we evaluate them and facilitate the internship process. We will monitor their professional conduct; the number and how to increase it is beyond SLMC’s scope.”
As for the examination process and quality of graduates, he said: “The world over, the practice is to make them sit for the local final examination. This is the only way to filter. Every time we hold exams, there are people who fail and pass. It is something that happens in a routine fashion. There is no significant increase or decrease in the quality of the graduates.”
Meanwhile, when contacted by The Sunday Morning, University Grants Commission (UGC) Chairman Prof. Sampath Amaratunge said that the NSBM may have already submitted its request to the Education Ministry to recognise its degree programme as a UGC-approved one.
However, he was unable to confirm the reception of any request from the NSBM to the UGC.
Elaborating on the importance of opening up more opportunities for local and foreign students, he said that the entire higher education sector should be expanded to permit higher education opportunities for more students.