When Ahmed Darwish, Minister of State for Administrative Development, indicated to Al-Masry Al-Youm newspaper on May 27 that he intended to cancel the two-year obligatory residency of Egyptian medical school graduates known "taklif, he set in motion a huge debate within the medical community - one tinged with much criticism and cynicism. It all started with a conversation between the Minister of Health, Hatem Al Gabaly, and Darwish. Al Gabaly discussed the potential for increasing the salaries of resident doctors, which ranges from LE 140 to 200. But Darwish said that this would not be possible under the taklif system, according to Passant Al Kattan, the official spokesperson of the Ministry of State for Administrative Development. We have never and will never issue any decision. Our role is consultative in terms of putting forward the administrative structure, system of promotions and the legal framework of whatever parliament and the government will decide, Al Kattan told The Daily Star Egypt. The very thought of reconsidering the residency program outraged the Doctors Syndicate. We are confident that the taklif is a necessity. Students need to continue training. It is a period that complements graduation, head of the Doctors Syndicate and head of the PA's health committee Hamdy El Sayed told The Daily Star Egypt. Medical school students spend six years studying and one year training (called imtiyaz) at university hospitals, two months in each department before they move on to the taklif. The ministry of health believes that the one year of training is enough. "Had the imtiyaz year not been enough, we would not have licensed graduates of schools of medical schools right after completing it, Abdel Rahman Shahin, the official spokesperson of the ministry of health told The Daily Star Egypt. Graduates need a license to practice medicine in order to start their training and therefore, the ministry has to license them first, elaborated El Sayyed. However, both professors and students reject this argument, skeptical of the idea of entrusting peoples' health to new graduates. The university produces doctors who are qualified to continue training and graduate studies only. they are a raw material that needs to be trained, professor Mohamed Fawzy Montasser, Dean of Ain Shams School of Medicine told The Daily Star Egypt. Dean of Kasr El-Aini Medical School at Cairo University, Professor Mohamed Fawzy Montasser concurs. All students and professors interviewed agreed that receiving two-month training in each department for one year is not enough to qualify a doctor to tamper with people s health, as Rasha Sayed Abd El Salam, a recent Kasr El-Aini graduate now doing her taklif, told The Daily Star Egypt. In addition, equipment and material capabilities to teach medicine to thousands of students are not available. The number of students is larger than the facilities available to train them. Therefore, the product is weak, Head of the Liver Transplant division in Kasr Al-Eini, Professor Adel Hosni said. "During imtiyaz, there are departments were students learn and there are others where students don't, one Ain Shams University student, Shaimaa Yehya, said. Another one from the same school, Nancy Abdeen, said that it all depends on a student's keenness and persistence. Both professors and students agree that undergraduates ability to practice medicine is very limited in school. We do not practice enough to work confidently.. Most of what we learned in school we get from private lessons, said taklif doctor Ahmed Al Shafie from Kasr Al-Eini spending. "Students are not taught primary care during university and so the only time they practice is during their residency, professor of internal medicine in Kasr El-Aini Nagwa Eid, told The Daily Star Egypt. The question of supervision is critical to the taklif issue, with recent graduates working under the supervision of more experienced doctors. But both residents and professors grimace at the quality of training they receive and complain from the financial compensation. Learning depends on whether we are under supervision or not. How much we learn depends on the help we get. But not all places provide us with this opportunity, Kasr El-Aini graduate and resident Rasha Sayed Abdel Salam said. Other students complained that there was too much focus on primary care and simple cases. I gained new knowledge in the first six months, but after that it was more of the same. One year is enough. Plus, I work now under nobody s supervision, said Sara Sami, a post-graduate student about to finish her residency at a medical center in Embaba. In response to a question regarding the level of learning, El Sayyed said that is better than staying in the street. As for the low salaries, he said, Students and parents need to pay some fees for learning. It is a tax that they need to pay. Taklif is still good experience for some graduates. It breaks the barrier between the patient and us.the world outside college is different, Abdel Salam said. Fears from canceling taklif are fuelled by a fear of unemployment. It is a disaster. Taklif was bad, but if cancelled we are going to be worse. We will still look for a job, at least we were training instead of being on the streets, Amira Mohamed, a student in her final year at Ain Shams University. They will be unemployed; where will they go? Ain Shams University Professor of Hematology Inas Asfur wondered. Dr. Mabruka Fathi Abdel Baset, head of a medical unit in Embaba shares the same concern. It is unfair. The taklif offers them a good training opportunity, and they help patients too, she said. Minister Darwish however, argues that taklif is not a job because there is no guarantee that a graduate, after the taklif period ends, is officially employed by the state. If the state aims to employ all medical school graduates, it should draft regulations regarding the number of students admitted depending on our needs, Darwish said at a press conference on June 24. Most professors and students complain from the large numbers of students as a factor reducing the quality of education. Professor Montasser, Dean of Ain Shams University, is working on a reform proposal for the residency system, but he refused to reveal the details to The Daily Star Egypt. This project has to be coupled with a new admission policy according to the needs of the nation and then Arab and African countries. The Thanaweya Amma score [Egyptian high school diploma] should not be the only determinant for joining medical school, he said. Since not all places where students are allocated for their residency provide the necessary supervision and training, there is a need for an alternative system of training before and after graduation, said Professor Farid, dean of Kasr El-Aini. He has started making reforms in the training system, introducing more training during the six-year study period of medical students. We established the Learning Resource Center where students use models to learn, Farid said. As for post-graduate training, the High Council for Universities has authorized a special committee to put forward a five-year training program. The committee is headed by Farid, who declined to reveal any of the details but said that program will kick-off by September. We still have seven years to reform the undergraduate training system before canceling the taklif, he told The Daily Star Egypt. Dean Montasser of Ain Shams has also devised plan to reform the system without totally canceling it. Those who want to cancel the taklif will stand accountable for this decision .. New graduates cannot be trusted with the health of an entire society. They need training, Montasser told The Daily Star Egypt. But the Doctors Syndicate is adamant in its rejection of any alternative to the current residency system. There is no alternative, was syndicate head El Sayyed s last statement to The Daily Star Egypt. The government will try to present a new project again, but whenever they propose an idea, we will reject it.
