History of Medical Education in Sri Lanka By

History of Medical Education in Sri Lanka By Prof. K. Sivapalan.

Medical Education �It is the process of developing Medical Professionals �It involves the students and teachers who respond to the medical needs of the society �The society keeps changing. As a result, medical needs and awareness of the needs keep changing History of Medical Education 17 October 2021 2

Origin of Medicine � The practice of medicine and teaching of medicine could be traced back to 2500 BC in ancient universities of India. � Different systems developed in different parts of the world. � A common feature probably was the attribute to "Karma" or “committed sin” and hoping to heal through prayer. � Medications were considered as second option or accessory in healing. History of Medical Education 17 October 2021 3

Early Medical Education � Medical professionals were regarded as persons gifted with healing powers. � Teaching was mainly by apprenticeship. The students followed the "Guru" or the Master. � It was a family profession in many instances. When the healer died another member of the family became the healer. � If a system of educating existed, the dominant student became the healer History of Medical Education 17 October 2021 4

Allopathic system �It appears to have originated in the fifth century BC in Greece by Hippocrates. �He introduced observation and reasoning. �This system developed into the Modern Medicine or Western Medicine through organized research and sharing information. History of Medical Education 17 October 2021 5

Medicine in Sri Lanka �The island received Siddha system of medicine from South India, Ayurveda System from North India, Unani system with the arrival of Muslims and Homeopathy and Allopathy with the arrival of Europeans �The Europeans used their system to treat them and their soldiers only. History of Medical Education 17 October 2021 6

Introduction of Allopathic System to Public � The first batch of 5 Missionaries [with some exposure to medicine] arrived in the island in 1816. � The intention of the American Mission Society had been to work in India, but the East India Company forbade such an intrusion at that time. � So they arrived at Point de Galle and traveled to Colombo, and ended at Tellippalai History of Medical Education 17 October 2021 7

Dr. John Scudder, World’s First Medical Missionary, 1819 to 1836 �First dispensary in a thatched hut in Pandaitharippu on 18 th June 1820. �Dr. Scudder left Jaffna for Madras in 1836 and later shifted to Vellore. �Dr. Ida Scudder, Founder and Principal Emeritus of the Vellore Christian Medical College, was a granddaughter of Dr. John Scudder. History of Medical Education 17 October 2021 8

Dr. Samuel Fisk Green: 1847 -1873 � Boston- Madras- Point Pedro � Ignorance and superstition was rife and the common diseases were cholera, small pox, lung infection, an itch - perhaps scabies, fever (malaria), cancer of the mouth and diabetes. � The first Tamil patient was a pundit who taught Tamil to missionaries. � He had fever which did not respond to the treatment of local practitioners and as a last resort they went Dr. Green. He diagnosed the abscess and after operation the patient improved tremendously and Dr. Green became famous. History of Medical Education 17 October 2021 9

Dr. Green’s First Hospital at Manipay History of Medicine in Jaffna 29 -Jun-13 10

Mission Medical College at Manipai - 1848 -1882 � Dr. Green realized the need for increasing the number of medical practitioners. � He started a 3 -year course in Medicine based on the curriculum in American Universities at that time. � The admission criteria could have been after graduation, as in America. � 110 students graduated from this Medical School (only one batch at any time). � The graduates found employment in the newer hospitals being established by the government or as General Practitioners and also in countries like India and Malaya History of Medical Education 17 October 2021 11

Student Welfare and Medium of instruction in the Medical College � The course was free of charge and the students were given a stipend of about 7 shillings per month � The medium of instruction was English initially and changed to Tamil in 1864 and he translated the books into Tamil and authored some in Tamil. � The reason for the change: two views are given in different sources: • To increase the intake to meet the needs for doctors • Since the graduates did not stay to serve the local population, he thought of teaching them in Tamil History of Medical Education 17 October 2021 12

History of Medicine in Jaffna 29 -Jun-13 13

History of Medicine in Jaffna 29 -Jun-13 14

Colombo Medical College During the latter part of the 19 th century, Dr. James Loos who was the Colonial Surgeon for the Northern Province recommended: � “ I recommend the adoption of a plan for medical education in the island itself. This good work is to a certain extent, being carried out among the Tamils by Dr. Green; but I think the benefits of improved medical practice deserves to be extended to other districts of the island other classes of the community (and to protect patients from untrained quacks), and this can be best accomplished by the establishment of a medical school in Colombo. ” � This led to the establishment of Colombo Medical School under British guidance and teachers on the first of June, 1870 with 25 students, 3 year course, fee of 2 pounds per session. � History of Medical Education 17 October 2021 15

End of Manipai Medical College �The government decided to reduce its grant of Rs. 2000 per year for 1883 to 1000 Rs and to stop completely after that. �This resulted in closure of the college �The reason behind this change in policy is not clear History of Medical Education 17 October 2021 16

About Dr. Green � � � Dr. Green, according to one of his letters, had done over 5000 operations, claims to have given the message of Gospel al least to that number of persons. He has confessed that the mission wanted to change natives into Christianized Tamils but ended with Europeanized Hindus. Dr. Green was very happy that native physicians bought his Tamil medical textbooks and some of them sent their sons to study western medicine under him He returned to America due to ill health (? tuberculosis) in 1858, returned to Jaffna in 1862 and worked till 1873. On Dr. Green’s demise in 1884, Dr. Benjamin A Mills stated, “During Green’s time, Jaffna was regarded as the headquarters of western medical science in South-East Asia”. Samuel Green Memorial prize, sponsored by JMA, is awarded to the best student at the convocation. History of Medical Education 17 October 2021 17

“Medical Evangelist of the Tamils” Inscription at “Late Green’s Gravestone” History of Medicine in Jaffna 29 -Jun-13 18

More Faculties of Medicine �A second medical faculty was opened in Peradeniya in 1964 � The next two Faculties (3 rd and 4 th)of Medicine were established in Jaffna and Karapitiya in 1978. � More medical faculties came into existence with time in Kelaniya(5 th ), Srijayawardanapura(6 th ), Batticaloa(7 th ), and Anurathapura(8 th ). � The last three were Faculties of Medical Sciences � Two attempts to establish private medical schools in late eighties failed - North Colombo and North Lanka. � Now a faculty in Defense University(9 th ) and a private Faculty at Malabe(10 th ). History of Medical Education 17 October 2021 19

Evolution of Medical Curriculum �The medical schools remained with British curricula until 1950 s. �By then it was realized that the education did not suite the population served. �After that changes began taking place. History of Medical Education 17 October 2021 20

First Medical Education Unit � The first Medical Education Unit in Sri Lanka was established in 1972 in Peradeniya, � with a view to make medical education more appropriate and to train staff in medical teaching, � when Professor Varagunam returned with training in Medical Education. � This made a big impact on the teachers there initially and later in all faculties. History of Medical Education 17 October 2021 21

Jaffna Medical Faculty � Prof. C. Sivagnnaasundram, Prof. Hoover and Prof. S. V. Parameswaran were the founder academic staff. � Prof. Sivagnnaasundram and Prof. Parameswaran were exposed to and inspired by the changing trends in medical education at Peradeniya. � Almost all staff members who joined the Faculty during the early years were influenced by Peradeniya education system as students or as staff. Others were sent there to train in Medical Education History of Medical Education 17 October 2021 22

Curriculum Development at Faculty of Medicine, Jaffna � The Faculty formed a Curriculum Committee sinception which met every month � Professor Sivagnanasundram took a Leading role. Professor Parameswaran also helped. � A workshop was organized for the Faculty and Extended Faculty staff on “Curriculum Development” (sponsored by WHO) in 1983. � The main purpose was to expedite the development of an appropriate curriculum, to document it and to involve hospital consultants in the process. History of Medical Education 17 October 2021 23

Documentation of Curriculum We were the Faculty in the island to possess a documented curriculum by 1985 -86 because of the efforts of Prof. Sivagnanasundram and the cooperation of the Heads of Departments. � The characteristics of the medical graduate had been defined long before the concepts of quality assurance and ‘Benchmark’ came up. � A Subject Benchmark Statement in Medicine was developed by representatives from all faculties of medicine and published by the Committee of Vice Chancellors and Directors in 2004. � History of Medical Education 17 October 2021 24

Curriculum Design � Superficially, Jaffna curriculum appeared to be traditional, subject based. � But it had several modifications to make the course more relevant and meaningful. � For example, physiology incorporated aspects of statistics done by the Department of community medicine and behavioral science done by Department of Psychiatry. � Applied anatomy and applied physiology classes were conducted by consultants from the teaching Hospital. � All examinations had clinicians as external examiners. History of Medical Education 17 October 2021 25

Curriculum Design ctd. � Clinical subjects focused on problem based approach for teaching. � The JMA sessions were made compulsory for final year students and topics related to patients discussed in the JMA were not redone in the ward classes or lectures. � Clinico - Pathological conferences were planned. � AI these progressive approaches had to be abandoned or cut short because of the war situation and dearth of staff. History of Medical Education 17 October 2021 26

Community Based Education � Public Health was a phobia for many in the seventies. “We don’t train doctors to look down the drains”- A professor from Colombo during in-service training (1976). � Prof Sivagnanasundram and Prof Malcom Fernando, at Peradeniya: • introduced community based learning with Hinthagala project area and • introduced the concept of Health Promotion. � Our community based curriculum in Community Medicine, designed by Prof Sivagnanasundram and nurtured by Dr. Sivaraja, is expanding as community and family medicine. History of Medical Education 17 October 2021 27

Student Research �Prof Sivagnanasundram took the initiative to train students in Health System Research through Community Medicine since 1990 as suggested by WHO. �Laboratory Research was introduced by Prof. K Balasubramaniam at pre-clinical level soon after. History of Medical Education 17 October 2021 28

Revision Under QEF of IRQUE � The process commenced in 2007 with workshops for the teachers by MERC of Colombo and the new curriculum came into effect in 2009, with annual revisions � The Faculty decided “Integrated Spiral Curriculum” as the ultimate target and to adopt “SPICES model of teaching”. � SPICES stands for Student centered, Problem based, Integrated, Community based, Electives and Systematic learning activities. History of Medical Education 17 October 2021 29

Major Changes in Curriculum � At the moment we are synchronizing the subjects as first step towards integration. � One major inclusion is the Personnel Professional Development Stream to develop soft skills. � Another area is the subject of Family Medicine to keep with the changing trends in the country. � The scope and objectives for each Clinical Posting has been developed and documented as volume II of the curriculum book. �To be continued……… History of Medical Education 17 October 2021 30

History of Medical Education 17 October 2021 31