ACADEMIC EXCELLENCE IN CLINICAL PRACTICE

Shamsh Kassim-Lakha, President, Aga Khan University, giving introductory remarks at Aga Khan Hospital, Nairobi, Kenya.

Introductory Remarks by Dr Shamsh Kassim-Lakha H.I., S.I.
at Aga Khan Hospital,
Nairobi, Kenya.

Bismillah-Ir-Rahman-Ir-Rahim.

Chief Guest Dr Julius Kiyambi, Chairman of the Medical Practitioners and Dentist's Board;
Distinguished Participants;
Ladies and Gentlemen.

It is indeed a great pleasure and privilege for me to deliver the introductory address at this important gathering of distinguished colleagues from the country's physician community, from various government health bodies, our friends from other educational institutions in the region, and the faculty, staff and residents of AKU and our sister institutions, Aga Khan Hospital, Nairobi, and Aga Khan Health Services, Kenya.

I thank you Dr Kiyambi, for your address, I am deeply impressed by what I have heard about your work on academic excellence in clinical practice.

This conference is a most timely initiative, and one that resonates well with the Aga Khan University's broader initiatives in east Africa.  More significantly, it will be an important step in realising our collective shared vision of the region's future with regards to academic excellence in higher education, clinical practice, and medical innovation. I look forward to the discussion and debate that will generate from this conference and the workshop sessions.

In preparing for this address today, and reflecting on the objective of this conference, I have chosen to touch on five factors that contribute, in my view, to creating an enabling environment for academic excellence in clinical practice. They include: innovation, partnership development, research, faculty development and postgraduate and undergraduate education. I see these factors as intertwined, directly impacting and influencing each other, and the broader vision of academic institutions. More importantly in my opinion, these five factors are very relevant to our East African context, and are of the highest priority for the survival and excellence of higher learning institutions in today's world.

Introduction

Let me though begin first by introducing the Aga Khan University. Chartered in 1983, AKU started with a nursing school and medical college in Pakistan.  Twenty years later, this institution founded on the vision of the Chancellor, His Highness the Aga Khan, has grown and flourished, moving well beyond Pakistan to establish campuses on three continents. It now has ten teaching sites spread over Pakistan, Kenya, Tanzania, Uganda, the United Kingdom, Afghanistan, and Syria.

In his address last year at the convocation of the University, his Highness the Aga Khan noted that quote "By terms of its charter, the Aga Khan University is to be an international University, with programs, projects and even institutes and campuses in other countries that have the basic desire capacity and collegial spirit for partnership.when this happens, AKU will be a most exciting innovation: a genuinely international, intercultural University, exchanging students and faculty among campuses that share a common goal of intellectual excellence."

In Pakistan, AKU is already acknowledged as a leading University through its commitment to developing programmes of relevance in the fields of nursing, medical education and school educational development.  Beyond the training of these professionals, the University is also focussing on research and is engaged in national capacity building, and setting new standards of quality and delivery in medicine, nursing as well as primary and secondary education.  Its 500 bed teaching Hospital is engaged in a variety of primary, secondary and tertiary care services, some 75% of the patients at the Hospital come from the middle and low income strata of society, and the care of needy patients is supported by a generous patient welfare programme, whether in the private wing, or the general wards, all patients receive the same quality of care, regardless of their ability to pay. Student admission at all campuses of the University is strictly on academic merit and on a needs blind basis.  Over 40% of our students receive some form of financial assistance.

In Afghanistan and Syria, at the request of the government, the University has been involved in capacity building and technical assistance programmes.  In Afghanistan our School of Nursing has worked closely with the government to develop a relevant, modern curriculum, to graduate the first class of nurses in that country in a decade. In Syria, the University is assisting in developing quality assurance and nursing competence programmes. More recently, it was invited to assist the government in the formulation of a new law, designed to encourage and regulate private initiatives in school education.

With an aim to become a comprehensive University, we are establishing our Faculty of Arts and Sciences, on a new 1,100-acre campus on the outskirts of Karachi. The humanities programmes will also play an important and central role in the development of a well-rounded medical and nursing practitioner, aiming for a higher level of understanding of our global context and the value of an interdisciplinary education. Our London-based Institute for the Study of Muslim Civilisations, draws on multiple disciplines to strengthen research and teaching in the heritage of Muslim societies in view of the growing interconnectedness of cultures.

Our plans in East Africa are ambitious, probably the most.  I am pleased to inform you that the Chancellor and the Board of Trustees have decided that AKU will have a permanent presence in the region, offering programmes of quality and distinction, relevant to the needs of the population.  We expect to implement a range of programmes, in our distinct campuses in Kenya, Tanzania and Uganda, and build on the good practices, experience and knowledge gained through our academic programmes in other parts of the world. 

Over the past four years, the University has established an advanced nursing studies programmes in Kenya, Tanzania, and Uganda. In collaboration with the Aga Khan Education Services (AKES) and the Aga Khan Foundation (AKF) in East Africa, AKU's institute for educational development has also been conducting teacher development programmes in all three countries.  Based on this success, at our recent board meetings in Mombasa, approval was granted for the development of a full fledged institute for educational development, based in Dar-es-Salaam, this institute will have significant field sites in Kenya, Uganda and Tanzania.

As many of you are aware, in collaboration with the Aga Khan Health Services, and the Aga Khan Hospitals in Nairobi and Dar-es-Salaam, AKU has this month commenced its post graduate medical education programmes in Nairobi and Dar-es-Salaam. 

I would like to take this opportunity to thank the Ministry of Health and the Kenya Medical Practitioners and Dentist's Board, the Commission of Higher Education, the physician's community and the medical association, and of course our partners, the Aga Khan Health Services, in making this project a reality.  We look forward to your continued encouragement, support and advice as our University grows and develops in the region.

AKU is involved in many new and diverse initiatives, however, it continues to work on the premise that without the pursuit of excellence as a guiding theme, an institution of higher education is like a car without the steering wheel, it can move, but has no clear direction.

Having provided some introductory words on the University, let me now revert to the five factors I believe are critical to creating an enabling environment for academic excellence in clinical practice.

Establishing innovation

I will start with innovation.evident from our vision, and very clear to us through experience, is the fact that for AKU, a University established in the developing world, to become a leading international University, would mean more than just emulating or copying models of academic excellence based in the industrialised world.

To a point, every University can decrease the gap between good and excellent by emulating and copying.but then what.  How do you enhance your position, your reputation and your success?  In this vein, AKU has recognised that only through cutting-edge innovation, creativity, and distinction, building on its own unique strengths and opportunities can any University become a premier higher learning institution capable of adapting to change, and ensuring excellence.

For us innovation, creativity and distinction have stemmed from developing programmes of relevance, quality and impact.  Relevance to the needs of the local population is an undeniable aspect of any University, whether in a developing, or industrialised society.

In aiming for innovation, the principle of quality plays a central role in achieving academic excellence.  We cannot respond to the needs of society, nor have the desired impact unless we focus on the essential demands of quality.

Impact, is another important criterion for AKU and also fuels our creative instinct at the University. It is not just churning out graduates, or writing footnotes in journals, but working towards finding solutions to address the problems of society.seeking always to make those interventions with the help of evidence-based research, that can make a difference in our society.

Let me refer to this in the context of AKU's programmes[1]:

For example the urban health programme in Sindh, Pakistan, has been testing and prototyping health systems in urban and rural settings.  Since 1985 it has implemented primary health programmes designed to improve overall family health, with a particular focus on the health of mothers and children under five. Programmes have expanded to address the root causes of poor health, drawing on an integrated approach that includes income generation, education, clean water supplies and sanitation and community mobilisation.

In the nursing field, AKU has studied the worldwide issue of staff shortages.  In 2003 using the University Hospital as a model, the nursing services division conducted an extensive exercise in all patient care areas to assess and set nurse-patient ratios, based on patient acuity levels, in order to maintain quality care practices.  This has led to the development of comprehensive staffing models.

Let me now turn to partnership development.  The benefits of partnership development are many, they include the ability to maximise available skills and resources, to increase cooperation at the institutional level, and provide an integrated approach aimed at cutting across specialized sectoral interests.  As an old African saying goes, "It takes more than one person to make a path."

But how can we accomplish this. What strategies can we employ?

In our own limited experience of engaging in partnerships, with such institutions as the universities of Oxford, Toronto and Mcmasters, three principles come to mind. The first is that partnerships mean different things to different people, and thus it is important for institutions to define what they mean by the term "partnership." Second, establishing a partnership policy or framework, assists in building mutual cooperation and collaboration towards creating an enabling environment in which partnerships can flourish. Third, "structured relationships" have also been useful in creating a "win-win" situation for both parties at hand. In other words, this means understanding the expectations and the intended outcomes stemming from a partnership.

For example, in East Africa, of substantial value and benefit has been our partnership with the Aga Khan Hospital, Nairobi.  Built on a common purpose, and based on effective structures, equality between partners, realistic expectations, and mutual benefits. At the Hospital, it has led to improved patient care and higher patient volumes. For AKU it has provided access to teaching sites for the training of clinicians, internship opportunities, and the application of new research techniques, to name a few outcomes.

Similarly, partnerships with higher education institutions, government agencies and associations have all been significant in ensuring AKU's growth and expansion in the region.

Research development

Coming now to research, let us remind ourselves of the age-old adage, "Great universities are distinguished by their contribution to the creation of new knowledge."

Research is increasingly becoming one of the most critical areas on which our academic excellence especially in clinical practice will be based.   I believe that this theme will continue to discern leading institutions from those that merely follow.  

Looking at the scene in East Africa, developing the next generation of leaders who are able to contribute to their communities and to society at large, is indeed one of the biggest challenges we will face as part of the academic community.  With the gamut of social health problems facing us, infectious diseases and especially HIV /Aids clearly threaten the economic and social stability of the region, not to mention of our workforce.

This only reinforces the importance of continued investments in research as the cornerstone for the future prosperity of this nation and the broader region. But as it also suggests, research should be relevant to the local problems. Thus, the thrust of the University's research efforts in the health sciences has been in the areas of infectious diseases, health care delivery systems, and epidemiology of disease. Our current research is concerned not only with the agents of disease, but also the social determinants of illness and disease, such as poverty, gender, violence and injury.  AKU has already established significant capability for biomedical and biosocial research, notably in genetics, cell biology and environmental health.

But conducting research requires researchers, and there we have one of our greatest obstacles.   James Wyngaarden, in 1980, before he became director of the National Institutes of Health, observed, that the clinical researcher was becoming an "endangered species."   Twenty years later, Harold Yarmus, stepping down as the Director of the Nih, said the same thing.[2] This is a call for renewed investment in human capital, and particularly for the people who conduct research.

So what does this all mean for us in the context of academic excellence in clinical practice? Well.if our goal is to ensure the development of research and researchers, it means creating an enabling environment to promote and encourage research, it means investing in the best human minds, and acquiring the best tools and resources to fulfil this goal.  It means, sharing of information, integration of knowledge, enhancing professional development, it means effective mentorship and leadership, and it means innovation and partnerships.

Faculty development

Medical education is, in fact, at the forefront of change in a rapidly changing world.technology is changing..techniques are changing...knowledge of the body and its relationship with the environment is changing and the very concept of medicine is changing, sometimes for the better, and sometimes not.

Equally important, is the concept of education, of pedagogy, which too is rapidly changing. New techniques and knowledge are available to us to make us better teachers, educators and better researchers.and thus it brings me to my next point of faculty development as key to academic excellence especially, in clinical practice.

At AKU we have recognised that faculty development requires planning, appropriate placement, investment, follow-up and further planning.  I think one of the most important things we have learnt as a University is that faculty development cannot be considered a luxury, but rather a necessity, addressed from the outset of an institution's existence and growth.

If faculty is indeed the cornerstone of our very existence, then what is the best way to invest in them? Let me put forward the three ways we have found that work at AKU.

First and foremost is the availability of financial resources for development.  Support can be sought from sponsors, government agencies, international agencies, but also from the society in which you serve.

Second, I believe we need to ask the tough questions, and it is the responsibility of faculty to be engaged in these: what do we want from our faculty? What competencies do they have, what do they need? How can we make their development a lifelong process that institutions can support?

Third, systems relevant to the University must be developed and put into place, operated and reviewed.   As mentioned earlier, we cannot simply lift training and development models from other contexts, but rather have to work on establishing models suited to our own context and needs.  At AKU, for example, we have established peer reviews, student evaluations, as well as meeting of objectives that are pre-agreed by the faculty member and his or her senior.

Postgraduate and undergraduate medical education

Let me now turn to the fifth and final factor, which i see as critical to achieving the goal of academic excellence in clinical practice. This is the importance of postgraduate and undergraduate medical education.

The AKU postgraduate medical education programme  or PGME as we refer to it in East Africa was established for the purpose of providing high quality education in clinical disciplines to medical graduates through diverse approaches to education. Examples include the development of special study modules to stimulate self-directed learning, problem-based learning as a method of integrating different strands of the curriculum, shorter courses for graduates and the growing concept of life-long learning.  The outcomes in terms of academic excellence include enhancing the quality of clinical practice, and the concept of scholarship in the Hospital environment.  The approach recognises that graduates emerging are not just physicians, or nurses, but also the teachers and leaders of tomorrow, able to develop new models of health care delivery.

Let me take a minute here to talk about the other area of increasing importance, that of undergraduate education.   I was recently reading an article where I came across this famous story (possibly apocryphal), about an opinion survey in which the general public was asked to name the leading law school in the United States. One result of the survey was that Princeton University came out comfortably in the top ten.  The only problem with this is that Princeton University does not have a law school.  But it does have a world renowned undergraduate programme.[3]

More and more, great research institutions are being recognised by the quality of their undergraduate programmes, as the foundation blocks for well rounded students, equipped with intellectual and personal skills, able to survive and succeed in our globalised world of today.

Thus I am pleased to announce here today, it is the wish of the Chancellor, His Highness the Aga Khan, and the Board of Trustees of the University, to broaden the education parameters and introduce an undergraduate medical education programme in East Africa.  Planning has already commenced and depending on the outcome, we hope that this exciting programme may be in place over the next few years.

Ultimately, the role of the University is to develop the enhanced capability of the population, and thereby contribute to the economic and social development of the region.  But the role of the University will be diminished if it is not supported by enlightened public policy.  It is for this reason that AKU intends to remain engaged in policy dialogues with governments in East Africa, as it has done in countries elsewhere.

Bringing it together - conclusion

Before I close, let me say that my address today has touched on five different factors, all of which play a significant role in creating an enabling environment for academic excellence to flourish.  Distinct as they may be, these factors are intertwined and inform each other in a variety of cross cutting ways.  Some are even critical to the growth and development of institutions, but all have a central role to play in the broader pursuit of academic excellence in clinical practice.

I see these factors as providing a foundation which will propel us to a new dimension: creating institutions of value, of intellectual rigour, of change, of cutting edge knowledge and more simply put..of excellence.

As an old Chinese proverb states, "if we do not change our direction we are likely to end up where we are headed."

However, let me also say that there has never been a better time for us to move in the right direction and with dedication, commitment, and inspiration, we can change our direction for the better and for the future.

Distinguished participants, I look forward to our taking on the commitment to change our direction this morning; a change, which through excellence, will enable us to serve our society at large.

Thank you.

[1] Examples extracted from the Progress Report 2004

[2] From Stephen Joel Trachtenberg's Speeches, April 17, 2002 to the Institute of Medicine.

[3] 1998 Annual Address to the Faculty by Steven B. Sample, President, University of Southern California, January 13, 1998.