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Faculty: The Cornerstone of Health Education

 

Distinguished Lecture
By Shamsh Kassim-Lakha H.I., S.I.

at the
University of Health Sciences, Lahore

Bismillah-Ir-Rahman-Nir-Rahim!

Vice-Chancellor of the University of Health Sciences, Professor Mubbashar Hilal-i-Imtiaz, Sitara-i-Imtiaz,
Honoured Faculty and Staff of the University of Health Sciences, Lahore,
Distinguished Guests,
Ladies and Gentlemen.

Asalaam-o-Alaikum!

It is a pleasure and a privilege for me to be invited to deliver this lecture at your new yet "experienced" University. In some respects yours is an institution with multiple histories - one which faces the challenge of consolidation. I say this particularly because the University of Health Sciences is at its most critical stage now. You have struggled through the birthing pains and focussed, quite rightly, on establishing a base with existing medical education in the province.  The question before us now, I believe, is how to help nurture the University. to help it grow into something more than the whole of merging colleges. more than what is around us. to help it make the impact that is needed in our society.

As you work through this nurturing phase, I am certain that you will receive all sorts of advice on many different aspects of your University. Let me tell you from experience that it is all worth considering!  But you will also hear many doomsday sayers - let's choose to ignore them, for the University is now in place. All sorts of efforts will be needed in all sorts of dimensions. from ensuring a flow of resources to seeking new resources. from setting up the infrastructure to developing linkages with other quality institutions in the country and overseas. from developing appropriate curricula to admitting the right students.

One thing is for sure - your new Institution must not and should not be allowed to continue with business as usual. Otherwise the very purpose of your new University will be lost.  As you sift through this thought - as you find and make your own way - I am sure that you will keep before you the overriding principle of quality. I say this based on my own humble experience at Aga Khan University - or AKU - not all of which I must admit is relevant or applicable to your new Institution. Over the past twenty years at AKU we have worked on the premise that without quality, an institution of higher education is merely a skeleton. it has no flesh and bones. it has no soul.

But how do you ensure quality? I think it is self evident that quality must be sought in the heart of a university. if it is not nested in the very core then it will not filter through to any place else.  And, not surprisingly, we found that across the world - not just in universities but in all top-class institutions - the key determinant of quality are human resources. Specifically, in universities, an indispensable component. an irreducible core, are the faculty. I would like, therefore, to talk today about faculty, the cornerstone of higher education.

Let me say a little bit about where I will be going with this talk. It is generally a good idea to begin at the very beginning. so I would like to touch on the objectives and place of a university in society. I would then like to talk a bit about the place of faculty in this setting. Why do I say that faculty is the cornerstone. the stone on which the entire edifice of higher education is constructed? This will lead naturally into a brief mention of the role of faculty, followed by what a focus on faculty has meant in practical terms for my university, for AKU. In all of this, let me say up front, that there is nothing new in what I am about to say. As in all good tales, what's new is not what I am going to say, what's new is that I will be saying it!

In my assignments as Co-Chairman of the Task Force on Higher Education and then as the Chairman of the Steering Committee on Higher Education, while looking at many universities across the country, I realised that we often take the very existence of universities for granted. 

But should we?

When the founder of our nation, Quaid-e-Azam Mohammad Ali Jinnah said that "our national priorities are education, economy and then defence," there was only one university in the country.  And that, too, was a left-over from a colonial past that we wanted to forget. Why did the Quaid say what he said?  Could it be that he had perceived for Pakistan as early as 1947 what the President of Rice University in Texas, Malcolm Gillis, said in 1999. that "Today, more than ever before in human history, the wealth - or poverty - of nations depends on higher education.  Those with a larger repertoire of skills or a greater capacity for learning can look forward to lifetimes of unprecedented economic fulfilment.  But in the coming decades the poorly educated face little better than the dreary prospects of lives in quiet desperation."

Let me repeat that:  ".the dreary prospects of lives in quiet desperation." What the Quaid said in 1947 was only a trailer, a lead-in, into the reality of the knowledge-based economy. The report of the UNESCO-World Bank Task Force on Higher Education, led by eminent academicians from across the developing and developed worlds, captured this reality in 2000. and then moved beyond it to place an emphasis on higher education.

The reality of our world is, and I quote from the Task Force's report, that, "The world economy is changing as knowledge supplants physical capital as the source of present (and future) wealth.. As knowledge becomes more important, so does higher education.. The quality of knowledge generated within higher education institutions, and its accessibility to the wider economy, is becoming increasingly critical to national competitiveness.. This poses a serious challenge to the developing world.. Quite simply, many developing countries will need to work much harder just to maintain their position, let alone to catch up (p: 12)."

Simply put, there we have the role of a university in a developing society such as ours. Universities must be at the forefront of leading our nation into competitiveness and to prevent our citizens from the "prospects of lives in quiet desperation." There are many themes that run through this statement. Perhaps we don't have time to dwell on all of them here. but let me bring out one very pertinent undercurrent in this purpose of a university, that of impact.

The words of Rice University's president or the international Task Force say to me that a university must be aimed at creating an impact in society. not just churning out graduates or writing footnotes in journals but at working at and for the problems of society. seeking always to make those interventions, whether in education or research or service, that can make a difference in our society.  The core business of a university is what can lead our society on the path of development. Not alone, perhaps. But it is probably the single most effective route to capitalising on the opportunities present in the world today and to mitigate the disasters in globalisation.  This national need is played by a university's very reason for existence, that is the generation, dissemination and application of knowledge.

I will come back to these in a little while.  For now, let me bring out another, underlying need. a need that is implicit in the very concept of education. that of stewardship.  If universities are to fulfil their potential for national development, they must recognise their responsibility in society: a responsibility of stewardship. stewardship of future generations. stewardship of society itself.  Let me ask you whether it is possible. whether it is conceivable to think of a university that does not reflect upon society's greatest problems. can a university be a university without grappling with our society's most outstanding dilemmas. without finding new solutions for them?  To me, the answer to this is a flat and resounding, "No!"

Relevance to society is an undeniable aspect of any university, in fact any institution in a developing or even industrialised society.  Over the past twenty years at Aga Khan University, we have strived to keep national priorities and goals at the forefront of our thinking. to invest both human and financial resources where they can be relevant to the needs and concerns of our society.  But we have also re-discovered the time-honoured key of quality. we cannot respond to the needs of society or have an impact unless we focus on the essential demands of quality.

From our inception, guided by our Chancellor and the Trustees of our University, we based ourselves on the premise that an institution that compromises on quality is not an institution worth having.  That is a very strong statement: an institution that compromises on quality is not an institution worth having. In my own limited experience of looking at and working with universities in Pakistan I am more convinced than ever before that the problems with higher education in our country stem more from quality than from quantity. And that quality is not merely a matter of financial resources, although that is a component, but a matter of how you establish your systems of management and governance.

Certainly it is a problem that only 2.6% of our eligible youth are in college or university. but what are those 2.6% doing? Are they creating an impact in society through their research or service?  Are the issues they are working on relevant to our national needs?  Once they graduate, can they compete with the top physicians and engineers and economists in the world? As we move to the next theme of my talk, I will ask you to hold on to some of these concepts:  that higher education must be oriented to quality, relevance and impact if it is to fulfil its potential in society.

So, where is the faculty situated in all of this?  Putting it bluntly, as the Americans say the faculty is where the rubber hits the road. But perhaps the Americans do not realise how powerful a statement that is in Pakistan. We are used to lofty ideals and high-flying plans and policies. we are used to stumbling on the brakes of implementation at almost every turn and on every road.  Especially in higher education, we are used to stumbling at the implementation brakes in this country.  In almost every arena of our society, and especially in higher education, we need to hunt for the key that will unlock these brakes. we need to locate and invest in the resources that will translate our objectives into reality.

As I have said before, the key determinant of quality are human resources, and in universities the faculty are an indispensable component of the capital that a university has. Not just in the core business of the university: that is education, research and service. But also, and more fundamentally, in the stewardship of our future generations and society itself.

When we talk of quality, of impact and of relevance, the university community as a whole must factor these into all its actions and directions. but it is the faculty whose attention to these principles will translate the university's objectives into reality. That is why I talk about faculty being the cornerstone of higher education:  the stone on which the edges of the building rest. Certainly not the only such stone. after all any building must have at least four corners!  But that does not take away from the indispensability of this stone.

So, what are these roles that make faculty indispensable? We know of the very basic functions of all faculty: teaching and research. Once again, though, after working for a while with universities across the country, I feel that perhaps we don't appreciate all that is covered by. that is encompassed by these functions. When we talk about teaching, for example, do we mean just that the teacher must be competent in his or her subject? Do we mean that they should, in addition, have the skills to impart knowledge? Or is there more?

Going back to what I said about stewardship, I think there is more. we are not just training good professionals, which we must, but we are educating good citizens, with a sound ethical base and strong commitment to the betterment of our country's citizens. In taking care of the future generation, can we afford not to develop their character in the formative years that they spend with us?  The faculty, therefore, must take the lead in ensuring that their students are being educated in as broad-based a manner as is possible and feasible. I think that all teachers in this room would agree with me that we cannot simply neglect the fact that we are here to produce good minds, not just good physicians. that we are here to produce responsible citizens, not just technically proficient professionals. 

And so, as you know all over the world there is an emphasis on all aspects of teaching now, not just on delivering lectures. Increasingly teachers are being asked to devote a significant amount of time to developing their own curriculum or syllabus, to developing their own teaching and learning materials, and to exploring the best ways to impart their knowledge. that is, each lecture that is delivered in the classroom requires at least three times that time in preparation! All these seem very simple to say, but extremely difficult to put into practice in our national environment, where the common trend is just to get by. But if we are to realise our potential as stewards, as leaders in our society, there must be more to it.

Likewise in the function of research. the renewal and generation of knowledge. Is it just the number of publications that we produce in order to rank on an index? Sure that is an important objective. Pakistan has among the world's lowest research and PhD student output. But is it enough?  Or do we believe in the often-heard adage that, "Great universities are distinguished by their contribution to the creation of new knowledge." Are we always sure that our research is aimed at the core problems of our society? That is, relevant to what we need? Once again, it is faculty that will interface between idealistic demands and hard realities. the faculty that will engage with the rest of society to identify our critical problems and explore new ways of tackling them. from how poverty contributes to the burden of infectious disease to the critical relationship between early child development and human potential for achievement and participation. Probably more than any other factor, the faculty will determine whether the university is a positive resource for society to call upon or a drain on the nation's limited bank.

Then again, the faculty have the added burden of not just engaging in research, but also pulling in others to contribute. engaging students in research. collaborating with other faculty for multi-disciplinary research within the university and in other institutions. And in all of this, the faculty have to participate and be encouraged to participate in the university's affairs. they must help to take the university forward.  Not through unbridled anarchy but in a structured way, the faculty must be engaged in the university's affairs and participate in its directions.

Reflecting back on what I have just said, this is a tall order! My purpose here is not to overwhelm you with what you already know, but to serve as a backdrop for what I am about to say.  That is, that without a critical focus on faculty, a university. any university. cannot translate its goals into reality. What does this focus on faculty mean in practical terms?

It means especially at the early stages but - and this must be emphasised - not just now but throughout the life of any university, an ongoing focus on three aspects: faculty recruitment, faculty development and faculty enabling.

Recruitment is, of course, the first critical stage.  Getting the best minds from the very beginning is the key. Again, it is not just at this stage but as a permanent process that faculty recruitment needs to be a focus of attention. There are some general principles that can complement this focus, and that I feel we have tried to ensure at AKU. For a start, we have done our very best not to compromise on a transparent system of appointments and promotions that is based on merit and peer review. Second, we have tried to work around people's priorities to the extent possible. It is not always possible to balance everyone's needs, but it is an important objective in our recruitment or retention approach. we have found that it works better for us to be slightly flexible in determining, for example, whether a faculty member can be appointed full-time or can only work part-time. Third, I think it has helped us to view engagements with faculty, and indeed with staff, in the long-term. Perhaps we didn't start out that way. we were looking to hire full-time staff to fill our immediate needs. But over time, we have discovered that it serves us better to maintain long-term engagements with the best minds, whether as full-time faculty or part-time or even as visiting faculty or volunteers.

The next critical aspect of a focus on faculty, I believe, is attention to faculty development.  This is a neglected aspect in higher education in Pakistan, particularly in the health sector. It is often thought that once a physician becomes a teacher, they just use their notes to deliver their lectures and go off to their practice. Of course we know that education, especially medical education, is not like that anymore, if it ever was.  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. the very concept of medicine is changing: sometimes for the better and sometimes not.

Equally importantly, the concept of education, of pedagogy is rapidly changing too. new techniques and knowledge are available to make us better teachers, better educators, better researchers. As I said before, it does not follow that just because someone is a good physician, or has a PhD or a Fellowship that they also have good teaching abilities.

A focus on faculty, indeed a focus on the very reason for a university's existence, requires us to question this aspect of all faculty members. and to work with them towards improvement.  Most of all, in this day and age, I think that continuing education is now a reality all over the world in all fields. keeping abreast is not just an advantage it is a requirement.  But the more continuing education gains importance in the rest of the world, the more our experience with it in Pakistan disappoints us. There are few cases in the country generally in which faculty development through continuing education feeds back into their professional lives or their teaching or research output.

Can we think ahead, say five or ten years from now, to a time when such continuing education is actually a requirement for certification in any professional field. or even as a medical teacher?  This is the practice in some other countries, where even nurses are required to continually upgrade their skills to learn of the latest developments in their profession and in teaching practices and to renew their certifications.

At a university-wide level, the basic issue is probably a definition of faculty development.  Is it an ad-hoc business of sending someone on a training? At AKU we recognised that this approach does not help us. although it is not easy, we felt that faculty development requires planning, appropriate placement, investment, follow-up and further planning. We learnt from the value placed on faculty development elsewhere in the world. it is not a luxury to address when we have the time or feel more "established". but must be addressed from day one.

If faculty is indeed the cornerstone of our very existence, then what is the best way to invest in them so that the university's objectives are met? I can put forward here the three ways we have found that work at AKU.

First and foremost, financial resources must be earmarked.Let me assure you, this is quite a challenge even in well-endowed universities across the globe.  Support must not only be sought from sponsors or founders of the University - in your case the Government - but also from the very society which we are expected to serve. Indeed it is the quality, relevance and impact of our performance that will earn us the respect and material support of philanthropists in our society. These are the same qualities external funding agencies look for before rendering support.

Second, we need to ask tough questions, and it is the responsibility of faculty to be engaged in these:  what do we want from our faculty? What skills do they have and what do they need? How can we monitor and ensure their performance? How do we make their development a lifelong process that the institution can support? How can their time at the institution be a fulfilling one?  What sorts of interaction do faculty need with external scientists, educators, clinicians?

Third, systems relevant to the university must be developed and put in place, operated and reviewed. We cannot simply lift training and development models from other countries where the context is very different. we have to establish models suited to our own context and needs.  Likewise with faculty evaluation models, which are inextricably linked to faculty development approaches. we need to ensure that we invest only in those faculty who deserve it, but also that we can monitor the results of that investment. At AKU we have evolved some home-grown systems, learning from best practice across the world, that focus on transparency. For example, these are based on peer reviews, student evaluations, as well as meeting of objectives that were pre-agreed by the faculty member and his or her senior. 

Finally, let me turn to the third aspect of a focus on faculty: enabling faculty to perform. This is perhaps where the least concentration and thought has been invested in Pakistan. In my examination of looking at higher education institutions across the country, both in the public and private sectors, I found that the fundamental issue is that of management and governance systems in universities. This has a major, almost determining impact on the performance of faculty and hence the quality of education. Especially in light of focus on faculty recruitment, once you have the best minds, how will you retain them? 

It is not just a matter of financial compensation but also providing the environment to meet their goals. This environment can, perhaps, be provided in some very direct ways, for example through the provision of adequate facilities, infrastructure, computers and learning resources, support staff, performance-based incentives, and so on.

One very direct way is to focus on compensation policies: the current practice of clinical faculty means that they earn most of their living outside the university which, in turn, means little research, less concentration on teaching and less participation in helping to take the university forward. I know that this is a difficult issue, and there are many parameters and boundaries that we need to be aware of and work around. But in doing so, I feel, we should be mindful that the key is time. I would say that it is not possible to have even a college, let alone a university, without enabling faculty to spend time with students, in research, in thinking of and helping to take society forward, and in taking the university itself forward.

More indirect but no less effective ways of providing an enabling environment are to ensure that management systems are transparent and have built-in accountability. and that they create a participatory environment that encourages faculty engagement with the goals and objectives of the university. This can be provided by, for example, strong, transparent, completely internal decision-making forums without allowing the university to be held hostage to party politics or anarchy.

With these three focuses on recruiting, developing and enabling faculty I feel that a university, any university, has the basic ingredient to mix together into a useful, productive outcome for society. These factors could be particularly relevant to your new University as you consolidate and strengthen the quality of your own programmes.  It is so simple once stated, that it almost seems axiomatic:  we need to put people first. by doing so, we can not only build the best possible institution but also the best possible country. 

As physicians and as educators our entire existence is founded on the belief that the preservation of life and development of human resources are the keys to national development. I ask whether there is any better way to fulfil our mission than by focussing on these very human resources.

Before I close, let me say that I believe that we are at an interesting stage in the history of our country. We have many opportunities and many traps ahead of us. In this time of national need it is for us, the universities, to lead a process of development by aligning ourselves with national priorities and goals. And in this process the faculty have a central and indispensable role to play.  There is a challenge ahead of us. posed some decades ago by H G Wells, who said that "Human history becomes more and more a race between education and catastrophe?". Are we ready to take his challenge and win the race?

Thank you!


 

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