By Dr M Asad Nasir Khan
Dr Tahera Ayub always wanted to become MBBS doctor but as luck would have it she became a dentist and then excelled in the field. After doing her BSc in genetics and she got enrolled in MSc and then saw and advert for dental admission at Liaqat College of Medicine & Dentistry. She decided to apply and took the exam and finally got selected in the first batch. So dentistry from an unplanned decision and a sudden change of mind became a career for Dr Tahera Ayub. Today Dr Tahera is a maxilla-facial surgeon, a fellow with a passion for surgery and excels as the administrator at LCMD.
Dental News recently interviewed her and the excerpts of her interview are as follows:-
Tell us about your background, especially what made you choose Dentistry as your profession?
I was born and raised abroad in the early years of my life. I came here when I was in middle school and had to learn Urdu. I belong to a very liberal and supportive family.
Dentistry itself wasn’t a planned decision, I always wanted to become an MBBS doctor, but I left for Hajj after my intermediate, and by the time I came back, the admissions were closed. I, then did my B.Sc in genetics and also got enrolled in M.Sc. During the first year of my M.Sc, I saw advertisements regarding admissions in LCMD while out for shopping. When I came to inquire about it, they told me that they had already taken candidates for the first batch but I can appear in an exam if I want to. I told them that I haven’t been in touch with intermediate course books for a while, but they told me to come and appear and take the test. I spoke to my parents that evening about my wish to pursue this field of education, and my father told me to go for it, if I was sure. I cleared the exam and that I have to pay a certain amount of fees by tomorrow, which I was reluctant to pay and asked what if the college closes in a few months and you run away with my money, as that was the perception those days of fraudulent universities. But they assured me that it won’t happen and later I found out it was Dr. Navid Rashid (Dean) and Dr. Ali Farhan (Vice-Chairman) I was talking so casually to, about it.
So it was an unplanned decision and a sudden change of mind, and the support of my parents for that decision that made me opt for Dentistry.
When you first graduated from dental school, what was your vision for the dental career you wanted to have?
When I first completed my under-grad program, my top priority was to become a consultant. I wanted to opt for a Graduate program in implantology but it wasn’t very common at that time. I even got admissions in Queen Mary University and Manchester University, but since the program was so expensive, I decided to back out from it. I made up my mind to go for FCPS instead, and after two attempts I cleared my part-1 exam. Then came the difficult part, the dilemma that everyone faces, of whether you will get admitted for residency, in what field and under whom, in which hospital. Luckily, our college was recognised and was offering residency in Oral surgery at that time, and my parents were convinced that this is the right option for me. It is very important in a country like Pakistan to ensure for a female practitioner to be able to practice under a male supervisor who has a sound professional credibility, and is sound in his character and conduct. Dr. Navid Rashid was always so kind and humble towards his students since I was in undergrad level, that it became an easy choice.
What prompted you to select your particular specialty and who influenced or guided you?
My parents were the main reason behind my selection of Oral Surgery for my specialisation. They wanted me to become a Maxillofacial surgeon, because the term surgeon itself holds a lot of responsibility, so they were really excited about it. And the second reason for my choice was Dr. Navid Rashid, because we looked up to him since we were in our bachelors, and how he was such a complete mould of an ideal professional and Maxillofacial surgeon.
How do you create a balance between your administrative duties and your clinical commitments? What types of administrative challenges have you faced?
It is very difficult to manage two different domains at the same time. Interestingly another domain I have to manage is academics. So I have to carry these three roles with me and have to make sure that I keep the right balance and act as a role model for my juniors. Being an administrator is a completely different domain than being a clinician or academician. The duties of an administrator are very difficult because, you have to be very strict sometimes and be lenient at the others. You have to think about the betterment of the institution before thinking about the betterment of any other thing. But being an academician as well I have to think about my students as well and for their betterment and their learning process before that of the institute. So it’s very difficult maintaining a balance sometimes. Being an administrator is a thankless job. No matter how hard you try, you can’t keep everyone happy with your decisions because you see things differently from the position you are in. Being an administrator you have to make sure everything, from a small instrument to the infrastructure as a whole, is perfect for your seniors and other practitioners. So it’s hard and there are ups and downs. My main focus is to create a balance between the learning process of my students and at the same time keep the OPDs running in the best possible way to satisfy both the higher management and the faculty at the same time, and that is the biggest challenge I face daily. I feel very blessed for the constant guidance of Dr. Navid Rashid, Dr. Ali Farhan and Dr. Naheed Najmi for helping me in all these issues and in upbringing my career and also my family, who have been very supportive, because managing three roles effects your daily routine so much and your mood can go up and down, but they have always understood my situation and pushed me to do better.
How would you describe the work life to personal life balance? Do you get time for your family?
Keeping a balance between the work life and personal life is very difficult, especially for a working woman, and being an administrator I have to dedicate my days to the institute, sometimes the full length of the day, so weekdays are very hectic and I hardly get time for the family, but I think it’s up to us how we manage our time and take time out after work for the family, because I believe it’s an emotional boost when you get to spend time with your family after a tiring day at work. I always make sure I dedicate my weekends to my parents, spending time with my father over lunch and discussing with him about business related, or personal life issues, and I go out with my mother for shopping. So I try to keep a balance as much as I possibly can between my work and personal life.
What new horizons would you want to explore for yourself and the institution?
I would like to bring a change in the infrastructure of the institute to increase the learning experience of the students by providing them a feasible environment and giving them new equipment and instruments to work with so they know how to apply them in their professional life. The other change I want to bring, is a change in the mindset of the people surrounding us, whether it’s the patients, colleagues or senior faculty that the administration is not always harsh it’s the people around us that make us harsh. We are here to facilitate them and guide them, and not dominate them, and I believe this change is needed. As an academician I want to bring a drastic change in the Oral Surgery curriculum, I want to incorporate research based culture into the institute which is very important. As a clinician I wanted to perform some evidenced based surgeries/treatments so the patients can benefit from them.
Your views about 4 or 5 years BDS and given a chance how would you want to upgrade the education system?Are you in favour of modular system?
The modular system in Pakistan, specially in dentistry has not gained much success. Even the colleges that started following this system for their exams initially, they all came back to the conventional annual system of examination. So for now I do not support this modular based system. I believe we should not follow everything that is happening in the west. They have their own learning environment, cultures and curriculum which is different from ours so we cannot implement everything they do. The governing body ACGME concerned with things like curriculum and examination systems, come to Pakistan every year for conferences related to medical education, and discussions with them have always focused on how it’s important to implement things according to our environment. They emphasize that it’s important to practice things according to your culture and surrounding. We are a developing country so we cannot implement practices done in a developed country. I also don’t support the idea of changing BDS to a five year program, but I believe there are some changes needed in the curriculum which will make it compatible and comparable to a five year program itself.
How has diploma in health education helped you in your career?
I completed my advance diploma in health education from Aga Khan two years ago. It has completely changed my personality and my perspective towards academics, research, curriculum, examination process and the dealing with my students. It is such a complete program overall that I believe all teachers should opt for it. We are surrounded by a perception that the teacher is always right, and whatever the teacher has taught you is the last word, but health education teaches you to listen to your students and to assess them on a continuous assessment basis and their overall personality, not just through the passing marks of an examination. Health education was the change agent in my career and my professional life.
According to you how important is post-graduation and what influenced you to pursue fellowship?
I believe post-graduation studies should be a must for all dentist professionals. Everyone should opt for it. I do not say that it’s a must to go for FCPS, MDS or PhDs. The knowledge in the field of dentistry is huge now and I believe in this time, there are many fields to opt for, for post-graduation studies. A few years ago, you only had an option to opt for operative dentistry, orthodontics, prosthodontics or oral surgery for a masters, but now people are opting for masters in epidemiology and biostatistics, post graduation in basic science subjects, executive MBAs, masters in health education and there are so many diplomas to opt for. I believe in the coming few years, a simple BDS student will not be able to work well in the market and be successful. This is a culture and requirement that has been influenced from the west, that demands that the academician or clinician should have some sort of post graduate education to perform their roles. There are numerous universities offering many different options for dentist to pursue further education in, but people have made a mindset that certain institutes are the only viable options available to them, so the hindrance that is stopping you is your own perception to achieve higher education, you should take knowledge from wherever possibly you can. In the coming years, you will not be able to take a senior position as an academician or faculty member without a diploma or masters in health education, so times are changing.
What were some of the early successes and challenges in your chosen field early-on in your practice?
I didn’t realise how big of a thing it was when I completed my FCPS, until I started going for meetings and discussions outside of my institute, and for my diplomas and courses. That’s when people around me made me feel how it was a big achievement being an FCPS. The basic challenge for a female surgeon is to survive in the field of maxillofacial surgery, because a lot of the female dentist who pursued oral surgery went onto opt for an allied subject such as oral pathology or oral medicine because they could not manage between their family life and professional life. I am not performing a great number of surgeries daily, but I am learning something every day, I realised that surgery won’t bring a lot of money for a female surgeon because it is a male dominated field and they do not give you equal chances to grow. But if you have a good environment and good learning opportunities, and you are confident that you will learn and make your own space then you can surely make a name for yourself in the field. So the initial years ask for a lot of sacrifices but ultimately you make your name.
Where do we stand when it comes to Medical or Dental Research work and publications?
We are far behind from the western countries in terms of research. We are hardly doing 10% of what they are doing. The problem is that research culture isn’t incorporated in the minds of the students from the undergraduate level. Only a handful of institutes are practicing and focusing on research. Majority of the students don’t know why research is important and why we need to focus on evidence based learning and how important it is for us to contribute to the local publications, and we are not doing anything to produce a research environment in the country. It’s mostly because the senior faculty does not emphasize on it, and they have become busy in their own professional engagements.
Do you feel that new dentists graduating are practice ready and prepared to face challenges of practice management?
I think they are practice ready to some extent, but not for extensive procedures. In the western country, they do not allow their students to interact with the patients until they have graduated, whereas our students are allowed to work on the patients from the third year of their academic life both independently and under supervision, and hence they get tremendous hands on experience in the last two years of their undergrad program and then in the House job, so I believe they are ready to practice independently in their clinics as well but to some extent, they need to learn more about counselling the patients. We have to teach them more about what’s ethical and what’s unethical, when to stop a procedure and when to refer. We have to teach them the importance of taking a biopsy if they see a lesion, or referring it if they can’t handle a lesion, rather than spreading it or telling a patient that it’s an ulcer and will go away just because they do not want to lose their patient. If we can ask our seniors to come assist us with cases of implants in our clinic to increase the patient flow, why can’t we consult them for diagnosis and biopsies? So these are ethical things that we need to incorporate in our students. We have to teach them that if they have done a procedural mistake, it is okay to do a mistake in your clinical practice, just go back to your literature for guidance. But overall I think they are good enough to work independently.
With dentistry a women dominated discipline now, do you think it is being acknowledged as such or is there a need for more?
I don’t think dentistry is a women dominated profession. There are a lot of girls taking admissions in medical colleges, but what’s important to note is that a very little percentage of that is actually coming into practice. Female dentists mostly after getting married are either opting to quit their profession or take a break, and at the same time, lesser number of male students are enrolling into dentistry as a profession, so that’s why we see a difference in the ratio of professionals in the field.
Do you think that because of less practicing female dentists do patients prefer to get their treatment done from male dentists?
I have only had very rare encounters where a patient wanted a male dentist to do their treatment, otherwise I have never faced that issue. If you are confident while dealing with your patients and are sure about your diagnosis and your treatment plan, the patient will always be comfortable with you and will be satisfied regardless of the fact that you are a male or a female dentist. So it’s down to your personality and how you carry yourself in front of your patients.
How do you think you can contribute for the betterment of the dental profession?
In my own capacity, I think I can contribute more by teaching and training my students to become a good professional dentist, someone who know their work, know when to refer and when to stop a treatment. As a maxillofacial surgeon, I can contribute by inducting more post graduate residents and producing more post graduate. But our responsibility doesn’t end there at producing more dentists. It’s important to provide them with opportunities to work. It’s my responsibility to help the graduating students by counseling them about their options for the future and to help them in getting a job. Even for my post graduate trainees I would like to be there for them to help and guide them. This is something I have learned from Dr. Navid, even if you are not his students anymore, his guidance for you won’t end there. This is the reason why his former trainees still ask for his help and opinion even now. So I think these are the contributions us seniors can give to our profession. I think we can contribute in other ways like researches or by giving time in less developed hospitals or by helping in organizing community trips. I try to do whatever I can in my powers to play my role, staying within my limitations.
As a successful female dentists, what is your advice to female students in dentistry?
To be honest, I do not think that I am a successful dentist. The day I think I am successful, my career will stop to grow. I would say Allhumdulillah I am satisfied, that Allah has blessed me to become a teacher, and to become a clinician to relieve the pain of my patients, and to become an administrator to facilitate and help my juniors and colleagues. So my advice to female dentists would be that there are many options for you to choose from, Sky is the limit in the field of dentistry, so never stop yourself. Even if you are married, try to balance it with your professional life. Dentistry is a very safe field to work for a female if you are confident yourself.
Since students don’t know much about the choices they have, once they graduate from their bachelors, do you think career counseling should be integral in every institution?
Yes, I think it’s very important for every institute to have career counseling sessions. The department of student affairs and medical education should oversee that, to ensure that students know about the possible opportunities they have. I have high hopes that in the near future, such steps will be taken and mentoring of the students will be a high priority.
Beyond the scope of this questionnaire, please feel free to comment on any other aspect of public/private medical education and health care system in our country?
I would just like to add that healthcare is like an ocean and in our country we have not grown as such, not even collected more than a few drops. So we need to acquire more skills and knowledge and we have to implement those skills and knowledge as well to come to a point where we will be recognised at an international level. The role of private and public medical institutes is very important because, the more opportunities you will provide at an undergrad level, the more number of post graduates you will produce in your country. And education is the reason for the recognition of any nation worldwide.