The State of Postgraduate Medical Education in Nepal
The National Academy of Medical Sciences (NAMS) was established in 1982 with a singular mission: to train medical specialists for Nepal. For four decades, it has largely fulfilled that mission. Yet today, Nepal faces a paradox: we train more doctors than ever, but the geographic distribution of specialists remains profoundly unequal.
In Kathmandu Valley, there are more cardiologists per capita than in many European cities. In Karnali Province, an entire region the size of Switzerland, there are fewer than 20 specialists across all disciplines.
The “Expanded NAMS” Vision
When I assumed the position of Rector in June 2023, I did so with a clear mandate and personal conviction: NAMS must expand beyond its Bir Hospital campus to become a truly national institution.
The Expanded NAMS concept involves three core pillars:
Pillar 1: Provincial Campuses
Establishing functional NAMS campuses in each of Nepal’s seven provinces—beginning with Karnali and Sudurpashchim, which have the greatest specialist shortages. These would not be satellite offices but fully functioning teaching hospitals with residency programs, faculty, and research capabilities.
The Dhulikhel MBBS programme—which NAMS began developing in 2024—represents the first concrete step in this direction.
Pillar 2: Standardized, Competency-Based Curricula
Nepal’s postgraduate medical education currently suffers from significant inconsistency between institutions. A MD (Internal Medicine) graduate from NAMS, Tribhuvan University Teaching Hospital, and a private medical college may have markedly different competency levels despite the same degree.
We are working with the Medical Education Commission to develop standardized, competency-based curricula across all disciplines—with objective structured clinical examinations (OSCEs), simulation-based training, and regular external review.
Pillar 3: Faculty Development and Retention
The greatest constraint on NAMS’s expansion is not infrastructure or funding—it is faculty. Nepal’s academic medicine suffers from a severe shortage of qualified specialist teachers. Many of our best graduates leave for clinical practice (better pay) or emigrate (much better pay and conditions).
Addressing this requires a dedicated academic medicine career track with competitive salaries, protected research time, and genuine career progression.
Research: Embedding a Culture of Inquiry
Nepal produces few internationally recognized medical researchers. This is not for lack of talent—it is for lack of structure, funding, mentorship, and time. At NAMS, we are committed to:
- Establishing an institutional review board with streamlined, transparent processes
- Creating seed grant mechanisms for young researchers
- Partnering with international institutions—including the Royal College of Physicians of Edinburgh—for joint research programs
- Mandating that all MD/MS programs require submission of at least one publishable research paper
The RCPE Partnership: An International Model
As Regional Adviser for Nepal at the Royal College of Physicians of Edinburgh, I am working to bring RCPE’s Fellowship and Membership examination (MRCP) more fully into Nepal’s postgraduate training ecosystem. This internationally recognized qualification provides Nepali physicians with a benchmark of excellence and opens doors globally while retaining their expertise within our health system.
Challenges Ahead
The Expanded NAMS vision is ambitious—and it faces real obstacles. Political instability affects long-term planning. Funding from government remains unpredictable. Private medical colleges resist standardization efforts that might expose quality gaps. And the brain drain continues.
None of these challenges are insurmountable. But they require sustained political will, institutional commitment, and above all, a shared belief that investing in medical education today is the most consequential thing Nepal can do for the health of its future citizens.
