What kind of doctors does Bangladesh need?

When the weaknesses of Bangladesh’s health system are discussed, the most visible problems understandably receive the most attention: overcrowded hospitals, shortages of beds and medicines, inadequate infrastructure, unequal access to care, and the uneven distribution of skilled health professionals.

But there is another issue that cuts across almost all of these problems: how we educate and train the people who deliver healthcare.

A modern hospital cannot compensate for poor clinical judgement. Advanced diagnostic technology cannot replace a doctor who has not learnt to listen carefully to a patient. Investment in healthcare will deliver only partial gains if the professionals working within the system are not equipped to provide safe, ethical and patient-centred care.

The greater attention given to medical education in the FY2026–27 national budget, including support for a competency-based MBBS curriculum by 2030 and modern training centres using existing infrastructure, is therefore encouraging. But allocation is not implementation, and curriculum revision should not be mistaken for reform itself.

The bigger question is: what kind of doctors do we want our medical education system to produce?

If we want doctors who can think critically, practise safely, communicate well, act ethically and continue learning throughout their careers, reform must extend beyond what is written in the curriculum. It must influence how students are taught, supervised and assessed; how teachers are prepared; how institutions are held accountable; and how doctors maintain their competence after graduation.

Clinical reasoning must remain at the centre of medicine
Medical technology has transformed clinical practice. Laboratory testing, imaging, molecular diagnostics and genomic technologies can make diagnosis increasingly precise.

But the fundamentals of good clinical medicine have not changed.

Care still begins with listening to the patient, taking a careful history, performing an appropriate physical examination, considering the likely diagnoses and then using investigations to confirm or revise that clinical judgement.

Technology should strengthen clinical reasoning, not replace it.

When tests are ordered before a sufficiently detailed clinical assessment, investigations can begin to drive decision-making rather than support it. The consequences are not merely educational. Unnecessary investigations increase costs and can place a substantial burden on patients and families, while attention may shift away from the patient’s wider medical, social and financial circumstances.

Students therefore need to learn not simply which investigation to order, but why. What clinical question is the test expected to answer? Will the result change management? Is it appropriate for this patient?

Clinical documentation deserves the same attention. A medical record is not clerical work separate from clinical care; it is part of clinical competence. It should clearly record the diagnosis, treatment plan, changes in medication and the reasoning behind important decisions.

Good documentation supports continuity and multidisciplinary care, enables clinical audit and research, protects patients and clinicians, and provides professional and legal accountability. These habits should be taught and practised from the beginning of clinical education.

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Doctors must be able to explain the nature of an illness, treatment options, expected benefits, possible harms, alternatives and the consequences of declining treatment in language that patients can understand.

Technical skill alone does not make a good doctor
Scientific knowledge and technical competence are essential. But they are not sufficient. A good doctor must also be able to listen, recognise the patient’s psychological and socioeconomic circumstances, communicate respectfully, work effectively with colleagues and make difficult decisions ethically. These abilities should not be left to personality or chance.

Medical ethics and bioethics should be taught alongside patients’ rights, behavioural science, cultural sensitivity, medical humanities and patient-centred care. But classroom teaching alone is not enough. Students need supervised experience in informed consent, confidentiality, difficult conversations and ethical reasoning in clinical settings.

This becomes particularly important when medicine reaches its limits.

Doctors caring for patients with advanced cancer, severe organ failure or critical illness may face situations in which intensive treatment, ventilation or life support is unlikely to provide meaningful benefit. They need the clinical judgement and ethical grounding to recognise potentially burdensome interventions, discuss goals of care honestly and prioritise comfort and dignity when appropriate.

Again, where critical-care resources are limited, clinicians may face difficult choices about their allocation. These decisions require clear and transparent ethical frameworks. Ethical decision-making must therefore be taught, observed and assessed as part of professional formation rather than left for doctors to learn through experience alone.

Communication is a clinical competency
Some of the most consequential failures in healthcare are failures of communication.

A patient may receive the correct diagnosis and treatment but leave without understanding what illness they have, why a medicine has been prescribed, what side effects to watch for or when they should seek further care.Communication is therefore not simply good bedside manner. It is central to diagnosis, patient safety and trust.

Doctors must be able to explain the nature of an illness, treatment options, expected benefits, possible harms, alternatives and the consequences of declining treatment in language that patients can understand.

Informed consent should mean more than obtaining a signature on a form. It should represent a genuine conversation in which the patient is able to understand and participate in decisions about their care.

Training should include breaking bad news, explaining uncertainty and risk, counselling, conducting family meetings and discussing goals of care in cases of serious illness and at the end of life. Written communication matters just as much. Histories, progress notes, discharge summaries, referrals and prescriptions must be clear, complete and accurate.

Healthcare is also increasingly delivered through teams. Doctors must learn to communicate effectively with nurses, pharmacists, physiotherapists, laboratory professionals and other colleagues. Team-based learning and interprofessional education should become part of normal professional training rather than an optional addition.

A modern hospital cannot compensate for poor clinical judgement. Advanced diagnostic technology cannot replace a doctor who has not learnt to listen carefully to a patient. Investment in healthcare will deliver only partial gains if the professionals working within the system are not equipped to provide safe, ethical and patient-centred care.

Learning cannot end at graduation
Reforming undergraduate and postgraduate education is essential, but it will take years for these changes to reach the entire medical workforce.

Bangladesh should therefore introduce periodic renewal of medical registration linked to meaningful continuing medical education and continuing professional development.

The principle is straightforward: remaining registered to practise medicine should demonstrate that a doctor continues to maintain professional competence, not simply that a fee has been paid or that their name remains on a register.

But such a system must not become another exercise in collecting certificates.

Attendance at seminars and conferences can contribute to professional development, but attendance alone is a weak measure of learning. Continuing professional development should also recognise practice-based activities such as clinical audit, mortality review, case discussion, patient feedback, teaching, research and quality-improvement work.

The objective is not to accumulate hours but to improve performance.

Implementation can be phased and designed so that doctors working in different settings have realistic opportunities to participate. Ultimately, however, continuing professional development should become a requirement for all practising doctors.

Doctors must learn to judge evidence, not simply follow it
International evidence and clinical guidelines are indispensable, but evidence generated in different health systems may need careful interpretation before being applied in Bangladesh.

Medical institutions should also create an environment in which students and teachers can ask questions, debate evidence, challenge assumptions constructively and change practice when better evidence emerges. The ability to ask, “What is the evidence, how reliable is it, and does it apply here?” should be regarded as part of clinical competence.

Medicine must look beyond cure
Medical education also needs a broader understanding of what good healthcare means. A doctor’s responsibility does not begin only after disease develops, nor does it end when a cure is no longer possible. Rehabilitation deserves similar attention. For someone affected by a stroke, serious injury, chronic illness or disability, successful care may mean regaining independence and returning to family, work and community life.

And when curative treatment is no longer possible, care must not stop. Patients with cancer, advanced organ failure, neurodegenerative disease and other life-limiting conditions need relief from pain and other symptoms, as well as psychological, social and, where appropriate, spiritual support.

Prevention, treatment, rehabilitation and palliative care should therefore be understood as connected parts of patient-centred medicine. Clinical placements, community-based learning and interprofessional education can help students understand this continuum of care.

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Bangladesh does not simply need a revised MBBS curriculum. It needs a coherent programme of medical education and professional development.

Competency-based education requires competent teachers
Changing what students are expected to learn will accomplish little if teachers are not supported to teach and assess differently.

Competency-based medical education depends on teachers who can observe students in practice, provide useful feedback, supervise clinical work, assess performance fairly and model the professional behaviour expected of future doctors.

Bangladesh therefore needs a long-term strategy for recruiting, developing and retaining medical educators. A national digital network could allow experienced faculty to conduct lectures, clinical case discussions, journal clubs and conferences across multiple colleges.

But distance and hybrid learning cannot substitute for supervised bedside teaching.

Clinical judgement develops at the bedside: by watching experienced clinicians, being questioned about one’s reasoning, making decisions under supervision and receiving thoughtful feedback. No technology or online lecture can fully reproduce the experience of an experienced clinician observing how a student takes a history, examines a patient, develops a clinical assessment and explains their reasoning.

Institutional standards must have consequences
Educational reform will also fail if institutions themselves are not held to meaningful standards. Medical, nursing and other health-professional institutions should undergo regular, independent accreditation against transparent and published standards covering faculty, teaching hospitals, laboratories, libraries, clinical exposure and student support.

Institutions that fall short should receive a clearly defined and time-bound opportunity to improve. But accreditation cannot be credible if repeated failure carries no consequences. Where deficiencies persist, responses should escalate in stages—from suspension of admissions to suspension of recognition and, where necessary, withdrawal of accreditation.

Regulation without credible consequences will not protect students or patients. The purpose of accreditation is not punishment. It is to ensure that institutions entrusted with educating future health professionals are capable of doing so safely and effectively.

Medical education is sometimes treated primarily as an academic concern. It is much more than that. It is a public responsibility. Every weakness in medical training eventually reaches a patient. Equally, every improvement in the knowledge, judgement, ethics, communication and humanity of a doctor has the potential to improve someone’s care.

The real outcome of medical education is patient care
Bangladesh does not simply need a revised MBBS curriculum. It needs a coherent programme of medical education and professional development.

Curriculum reform, faculty development, competency-based assessment, communication training, research capacity, continuing professional development, registration renewal and institutional accreditation need to operate as parts of the same system.

This will require political commitment from the government, effective leadership from regulators, accountability from educational institutions, and active participation from teachers, students and professional bodies.

But amid discussions about curricula, accreditation and regulatory systems, the purpose of reform should remain clear.

Ultimately, the success of medical education reform will be seen in the care doctors provide to patients. Can they listen carefully before ordering an investigation? Can they take a thorough history, examine the patient and explain their clinical reasoning? Can they recognise when a test or treatment is unnecessary? Can they communicate uncertainty and difficult information honestly? Can they take account of a patient’s social and financial circumstances? Can they work respectfully with other health professionals? Can they critically evaluate evidence and change their practice when better evidence emerges? And will they continue learning long after their final examination?

Medical education is sometimes treated primarily as an academic concern. It is much more than that. It is a public responsibility. Every weakness in medical training eventually reaches a patient. Equally, every improvement in the knowledge, judgement, ethics, communication and humanity of a doctor has the potential to improve someone’s care.

If Bangladesh is serious about building a safer, more effective and more humane health system, reforming medical education cannot remain at the margins of the health reform agenda.

It must be one of its foundations.

Manzur Morshed, FCPS, MRCP, is a former Professor of Clinical Haematology at Bangladesh Medical University, former Physician at the Haematology and BMT Unit of KFSHRC in Riyadh, Saudi Arabia, and Chairman of the Bangladesh Thalassemia Foundation.

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