Madame - Dr. Jafarey's1 editorial aptly describes the much needed curricular and infrastructural changes in our medical education system. He states that the overall objective of MBBS is to produce a general type physician. We, however, opine that this notion merits reconsideration. It is time to challenge the traditional concept of health care delivery based on general physicians without postgraduate training. The poor community orientation and negligible evidence-based teaching of our curriculum is a well established fact. The practices of recent graduates are no better than those of older graduates.2 To counter these deficiencies, some postgraduate training in family practice must be made mandatory. This will facilitate evidence-based community oriented training with emphasis on research methodologies and self-directed life long learning. Consequently, MBBS would be taken as a program which needs to be built on with some element of proper postgraduate training, irrespective of the specialty chosen. While this is an established practice in many developed countries, the need to improve our primary care services in the face of a rising burden of disease is imminent.

The adoption of this change by Aga Khan University and Ziauddin Medical University in Pakistan is a welcome development. The dynamics and intricacies of this transition need to be carefully worked out by all the stakeholders. Without doubt, this will be no easy task as was envisioned in Edinburgh3 seventeen years ago: "Reform of medical education requires more than agreement; it requires a widespread commitment to action, vigorous leadership, and political will."

Abdul Waheed, Fawad Aslam
Final Year Medical Students,
Aga Khan University Hospital, Karachi.

1. Jaafery NA. The Changing shape of a Medical College. J Pak Med Assoc 2005;55:179-80.
2. Jafar TH, Jessani S, Jafary FH. General practitioners' approach to hypertension in urban Pakistan: disturbing trends in practice. Circulation 2005;111:1278-83.
3. The Edinburgh Declaration [Notes and news]. Lancet 1988;2:464.