History and Development of Family Medicine at the Faculty of Medicine, Ragama, University of Kelaniya

The Faculty of Medicine at the University of Kelaniya was established in 1991 following the state take over of the North Colombo Medical College (NCMC) at Ragama. Professor Carlo Fonseka became the founder Dean of this new state Faculty of Medicine, at Ragama.

Family Medicine became established within the university system in Sri Lanka in 1994, when the Faculty of Medicine, University of Kelaniya changed the name of the Department of Community Medicine to a Department of Community and Family Medicine. The change of name was initiated by Dr. Nandani de Silva who qualified with MD Family Medicine in 1989, joined the Faculty as the only lecturer in the Department of Community Medicine in 1993 when medical  students  of  the  Faculty  reached  the  third  year.  Professor  Carlo  Fonseka,  a  strong supporter of Family Medicine together with Dr. Janaka de Silva, Senior Lecturer in Medicine who believed that teaching family medicine to medical students was important having been inspired by the 1993 document “Tomorrow’s Doctors” released by the General Medical Council UK, convinced the Faculty Board that the Department of Community Medicine be changed to a Department of Community and Family Medicine. Approval by the University Senate, Council and UGC followed and Family Medicine became firmly entrenched within the undergraduate curriculum  in  Sri  Lanka.  Dr.  Nandani  de  Silva  was  appointed  Senior  Lecturer  in  Family Medicine and Head of the Department of Community and Family Medicine in August 1994.

The developments that took place in the Department over the years comprised the establishment of  the University  Family Medicine Clinic in 1996  where students had  a two  week  Family Medicine attachment. The Clinic provided a free primary medical care service to the people of the surrounding villages. The clinic also functioned as a Communication Skills Training Laboratory, where students underwent communications skills training through video recording of consultations with patients and through roleplay followed by constructive feedback. This new method of teaching communication skills was presented at the SLMA Sessions in 1997. In addition to paper based medical records, computerized medical records were initiated by Dr. Kumara Mendis who had joined the department. The Family Medicine teaching programme included 12 lectures and three half day visits to GP tutors. At the Third MBBS examination, Family Medicine received 31% of the total marks for Community and Family Medicine. Each year,   students evaluated the Family Medicine programme which was subsequently improved based on the results and feedback from GP tutors.

Two Family Medicine/ GP Teacher Training Workshops were held where 20 GP tutors participated. Expert resource persons at the workshops were, Dr. Nimal  Kasturiarachchi, Director of the Medical Education Unit, University of Peradeniya in 1996 and Professor Richard Hays, Professor of General Practice, James Cook University, Queensland, Australia in 2001.

The first research conducted by the Family Medicine lecturers in the Department of Community and Family Medicine was the ‘One day general practice morbidity survey in Sri Lanka’ which won the first prize award at the Research contest during the World Organization of Family doctors (WONCA) Asia Pacific Regional Conference in Seoul, Korea in 1997 and subsequently published in Family Practice, an International Journal in 1998.

Dr. Nandani de Silva was promoted to Associate Professor in Family Medicine on Merit in 1997. Dr. Janaka Ramanayake joined the academic staff in Family Medicine in 1998. Dr. Kumara Mendis who qualified with the MD in Family Medicine, PGIM and MSc. in Medical Informatics from Netherlands Health Sciences was promoted to Senior Lecturer in 2001.

Since Family Medicine was a new subject and realizing the need for medical students to have an easily readable textbook to understand the principles, concepts and process of family medicine, Nandani de Silva published a book titled ‘Lecture Notes in Family Medicine’ in year 2000. An updated Second Edition was published in 2006 and Third Edition in 2017.

Following a proposal submitted by the Faculty, the UGC granted approval for two separate Cadre Chairs in Community Medicine and Family Medicine. Professor Nandani de Silva was appointed to the first Cadre Chair in Family Medicine in Sri Lanka in December 2000.

Family Medicine in Sri Lanka had an impact internationally when the Faculty of Medicine organized the WHO Scientific Working Group Meeting in 2003 in Colombo, on Development of a Core Curriculum in Family Medicine for South Asia Region attended by delegates from South Asian  countries.  The  workshop  report  outlines the  Core  curriculum  in  Family  Medicine  at undergraduate, postgraduate and continuing professional development levels for South Asian countries.

A new building for the University Family Medicine Clinic was underway in 2005. Dr. Sanjiva Wijesinha,  Senior  Lecturer  in  Family  Medicine,  Monash  University,  Australia  who  was  a visiting Senior Lecturer for a few months helped obtain funds from the Rotary club of Colombo for clinic equipment.

Dr. Janaka Ramanayake,   the first to follow the new MD Family Medicine programme by clinical training and examination at the PGIM qualified with the MD Family Medicine and was promoted to Senior Lecturer in 2005.

The first qualitative research project by the department was on patient expectations from ambulatory care consultations which was followed by a quantitative study on patient satisfaction. This study was published in Medicine Today 2006 and in the Sri Lankan Family Physician. Another study carried out by the department was one on ‘Students’ behavior and attitudes vs academic performance’.

The UGC approved the separation of the joint Department of Community and Family Medicine into two separate departments in 2006. Professor Nandani de Silva was appointed Head of the separate Department of Family Medicine in April 2006. However, she was released in May 2006 as she had been appointed to the post of Vice Chancellor of the Open University of Sri Lanka (OUSL).

Professor Nandani de Silva having completed her tenure of three years as Vice Chancellor of the OUSL returned to the Department of Family Medicine in May 2009. Under the Headship of Dr. Janaka Ramanayake, the Family Medicine programme had been improved with more clinical teaching following increase in the family medicine attachment to four weeks within the new curriculum. Dr. Aruni de Silva had joined the department as a Lecturer and Dr. Leela Rani Jayasinghe, a visiting lecturer for many years continued to be an asset in the University Family Medicine Clinic located in its new building opposite the Faculty.

Senior Professor Nandani de Silva worked in the Department of Family Medicine until she retired in September 2009 and was subsequently conferred the title of Emeritus Professor of Family Medicine, University of Kelaniya.