New Doctors in Egypt Aren’t Ready to Treat Emergencies, Experts Say

CAIRO—Graduates of Egypt’s public medical schools lack basic medical skills for dealing with emergencies when they start work, due to outdated academic curricula and teaching methods, medical experts say. A number of newly graduated doctors confirmed that they face difficulty in dealing with emergencies.

“Once, I was not able to interpret the X-rays of a patient who was injured in a car accident,” said Khaled, a doctor at a public hospital in Assiut, in southern Egypt, who asked not to reveal his surname. He said he felt embarrassed and later afraid, especially when another older physician looked at the X-ray and discovered a brain hemorrhage and was able to save the patient’s life.

Khaled is one of the 7,000 students who graduate annually from Egypt’s medical schools without sufficient practical training in some basic medical skills needed to qualify them to deal with emergencies and accidents, putting the lives of patients and sometimes the physicians themselves at risk.

“It seems obvious to me that recent graduates’ skills are very weak,” said Khaled Menaisi, director of a private hospital in Alexandria. “They are not able to deal with many emergency cases such as drowning, burns and heart attacks due to the shortcomings of the curricula and colleges in teaching these subjects.”

Training on  how to deal with such cases should take place before graduation and before obtaining the certificate, Menaisi said.

“Some emergencies take place in the streets and public spaces,” he said. “A doctor should learn how to deal with them on his own without the presence of a specialized doctor, for any delay in such cases may lead to death.”

Old Curricula

Hussein Khaled, chair of the Medical Sector Committee at the Supreme Council of Universities and a former minister of higher education, says that Egypt’s medical education system started in 1911 but the six-year format it established for training doctors was not updated until 2018. (See a related article, “Egypt Prescribes Changes for Doctors in Training.”)

In turn, Tarek El-Khouly, a professor of cardiology at Cairo University’s Kasralainy Faculty of Medicine and an expert on cardiopulmonary resuscitation,  or CPR, confirms that medical faculties’ curricula at Egypt’s universities do not include any CPR training. “There is a rudimentary training in the stage of medical residency,” he said, “but it does not qualify them to deal with patients on the ground.”

Cardiopulmonary resuscitation can save the lives of 30 percent of people who experience sudden cardiac arrest, according to El-Khouly. He stressed that the chance of saving a patient’s life increases by 10 percent for every minute of earlier intervention.

El-Khouly noted that the statistics of the World Health Organization indicate that cardiovascular diseases are the cause of an estimated 32 percent of all deaths around the world.

In Egypt, however, The prevalence of cardiovascular disease is five times the global average, at a rate of 500 people out of every 100,000, according to Dr. Sameh Shaheen, president of the Egyptian Society of Cardiology.

Hussein Khaled believes that the new education system at Egypt’s medical schools, adopted in 2018, that is compatible with the approved international system, will address much of the study-practice gap. He explained that the implementation of the new system required a major change in curricula.

“Students of the old system must have their diplomas accredited if they want to practice their profession abroad,” he said. (See a related article, “Hiccups in Adopting a New Way of Teaching Medicine.”)

A Bigger, Hidden Problem

However, many think the problem is not with the curricula.

“Theoretical study at Egypt’s medical schools is very strong and covers all the points and details a doctor needs,” said Mona Mina, a former deputy secretary-general of the Egyptian Medical Syndicate, the main professional association for doctors in Egypt. “Yet there is a problem in the amount of practical training students get. It is not enough and needs to be developed, whether in the number of hours or the capabilities available for its application.”

Mohamed El-Sherif, an assistant professor of diagnostic radiology at Sohag University’s Faculty of Medicine, agrees with Mina about the negative impact of lack of practical training while teaching medicine in Egypt. However, he also stresses that the established curricula do not cover all subjects.

“In radiology, for example, we only learn superficial things, such as chest X-rays,” he said, “As for the details of magnetic resonance imaging (MRI) and CT scans, I only learned about them during my master’s study and during my work at the university. So far, I do not know much within my specialty, even though I obtained a master’s degree and the first part of a doctorate.”

El-Sherif explained that students of radiology do not learn to properly interpret X-ray films, as shapes of bleeding vary in their appearance in X-rays according to the hemorrhage’s site. A doctor needs to know the bleeding’s shape in ultrasonography and how it appears in X-rays, as well as the shapes of other conditions, such as water in the lung, he said, because not knowing them reduces the patient’s survival chances. If a patient has a stroke and it is detected and treated early, the patient’s chances of survival are great. However, any delay exposes the patient to complications that could end in death.

“The part of emergency intervention any family doctor or general practitioner should know, I didn’t study it and I don’t know anything about it,” El-Sherif said. “I don’t know how to deal with brain hemorrhages or strokes,” he added. “We didn’t learn anything about all these things while studying, we only encountered them while working.”

El-Sherif pointed out that emergency medicine is a newly developed department at Sohag University’s Faculty of Medicine, although it has been taught in Cairo University’s medical school for nearly 30 years.

In turn, Mohammed Ahmed Badri, a sixth-year medical student and head of the Medical Student Union at Assiut University, believes that the most difficult thing for new graduates is learning how to deal with patients, because of the scarcity of hands-on training with patients during the study years.

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“The majority of medical graduates cannot deal with most emergency situations … due to lack of experience,” he said.

This is a serious concern because emergency situations can lead to permanent disability or death, he said. “For example, fracture patients should only be dealt with by specialized doctors, because any wrong movement of the fracture site might cause wrong healing of the fractures. If this happens, the bone must be broken again to restore proper healing. Repairing malunion is very difficult, and its success rate is not high.”

Alaa Ismail, a professor of general surgery at Ain Shams University and former head of the National Hepatology and Tropical Medicine Research Institute, refuses to blame universities. Studying medicine takes place through stages, and each stage has its own rules, he says.

“Students graduate as general practitioners, which means that they know the basics and essentials, and they must specialize later in a specific subject to become familiar with all its aspects,” Ismail said. He added that college graduates are not supposed to work in hospitals without supervision.

“Cardiopulmonary resuscitation needs an intensive-care-unit doctor, an anesthetist, or a cardiologist, and no graduate can do it,” he added. “All medical college graduates must spend two months training in the emergency room to interact with patients and receive the necessary practical training.”