Development of medical curriculum

Heart To Heart

By Dr. Muhammad Hafizullah

“Khyber Medical University in a very short span of time has done a tremendous job in the so for neglected field of medical education,” said Prof. Dr Mukhtiar Ahmad, Member Operation & Planning (O&P) HEC and acting Executive Director, Higher Education Commission, Islamabad during his inaugural speech.

The workshop was inaugurated by him on 18th August.

He said, "Khyber Medical University while adopting a reforms agenda in the medical education will play a role model in whole region". He assured that in the process of reformation in curriculum and evaluation HEC will extend all possible support to Khyber Medical University.

A curriculum is certainly a lot more than just a syllabus or a statement of content. A curriculum is about what should happen in a teaching programme - about the intentions of the teacher and about the way they make it happen.

The word 'Curriculum' has its origins in the running tracks and chariot courses of ancient Greece and derives from a Latin word 'currere' meaning to run. 

A curriculum is therefore everything that happens in relation to an educational programme. This includes its intentions, outcomes and processes. It is a statement of the intended aims and objectives, content, experiences, outcomes and processes of an educational programme including a description of the training structure and a description of expected methods of learning.  

Curriculum planning has to follow Hardens' well described ten steps. This starts with identifying the needs, determining the expected student learning outcomes, deciding on the course of content, organising the course and deciding on education strategies to be adopted and teaching methods to be used. This is followed by assessment of students' progress, communication about the curriculum, development of educational environment and management of the curriculum.  

Khyber Medical University conducted a two-day workshop on "Curriculum Development" at Higher Education Commission's Hall at Islamabad on August 18 & 19.

The workshop was arranged and conducted with the cooperation of HEC, Islamabad. The aims and objectives of the workshop were the development of modules of undergraduate medical curriculum. This was the third in series of steps towards development of new evidence-based integrated undergraduate medical curriculum.

Earlier principals of all public medical colleges were taken on a 'Journey of Search and Research' to visit the leading institutions of the country.

The aim was to update them on the latest trends in curriculum, mode of instruction and evaluation in undergraduate medical education and systems currently in practice in AKU, Ziauddin University and Shifa College of Medicine.

After a series of meetings with heads of departments and head of institutions a roadmap was drawn for indigenous development of curriculum.

A two-day workshop was held in CPSP hall at Hayatabad Medical Complex, on Problem-Based learning and development of Curriculum conducted by Shifa International and Rawalpindi Medical College.

Having decided on the need for new curriculum, level of integration being 7-8 and mode of instruction being small group format and problem-based learning, public and some private medical colleges were asked to develop modules according to the new guidelines. 

The Department of Medical Education, Aga Khan University Karachi was requested to collaborate and send focal persons and experts on curriculum development for the workshop. This workshop after introduction offered the participants hands on experience of module development.

The facilitators from Aga Khan University Karachi were Dr Sheilla Pinjani, Dr Syed Abdus Saeed and Dr Naveed Yousuf.

The workshop participants included senior faculty from all the public and private sector medical colleges of NWFP.

This workshop enabled the participants to derive the core contents, develop a module in line with curricular outcomes including teaching and learning strategies, assessment, timeline and evaluation.

They were able to sequence the modules in a two year programme. Nineteen senior faculty members from both the public and private sector medical colleges across the NWFP participated in the workshop.

The current undergraduate medical education leaves a lot to be desired. More than fifty years old curriculum is being taught mostly in large format.

The evaluation system is old and based on annual assessments.  Efforts are underway to change undergraduate curriculum, that is dynamic, relevant, comprehensive and evidence and outcome based. It should accommodate healthy extracurricular, literary and cultural activities.

The mode of instruction has to change from large format-based teaching-based to problem-based learning.

We have to shift to an objective and continuous system of evaluation from the antiqued annual long essay format. We need to encourage the health education continuum - under and postgraduate medical education, continuous medical education and continuous professional development with opportunities and commitment for lifelong learning.

Why switch from a "traditional" curriculum? In a traditional curriculum it is assumed that students should first master the basic sciences of Anatomy, Physiology and Biochemistry and then the applied sciences: Pathology, Microbiology, Pharmacology, Forensic Medicine and Community Medicine and THEN move on to a study of clinical Medicine.

The main criticism is that students may not see the RELEVANCE of what is taught to their future career as doctors. Once they have passed the examinations in the basic sciences, students tend to forget or ignore what they have learned (as we continue to experience).

Rationale for "integration". Students should start thinking like a doctor from the day they enter medical school.

In a vertically integrated curriculum, students are introduced to clinical medicine alongside the basic sciences in the early years.

The students continue to look at the basic sciences as applied to clinical medicine in the later years. In a horizontally integrated curriculum, interdisciplinary margins are "productively" blurred to enable acquisition of knowledge/skills and attitudes in a relevant, inter-related, logical sequence and facilitation of learning in a collaborative, team-based, inter-dependant model.

In a SPIRAL curriculum, there is iterative revisiting of topics throughout the course at numerous levels of difficulty. New learning is related to previous learning. The competence of students increases with each visit to a topic.

Why is there a need for integrated learning? Medical practice begins with learning from the scientific literature and ends with learning to care for patients.

Every healthcare practitioner has to be able to apply the relevant knowledge, skills and professional attitudes in order to resolve each individual's health or disease concerns. All practitioners must develop the ability to reconstruct their understanding of healthcare problems based on their experience and be able to adapt their understanding in the presence of a new problem.

This process of developing flexible, changing and adaptable knowledge can be described as integrated learning. This is to promote culture of critical thinking, problem solving, team-based learning, interdisciplinary collaboration/relevance, Pooling together learning resources and infrastructure, reduce curricular overload and redundancy and very importantly integrate assessment and evaluation

In the concluding session, chief guest president of PM&DC Prof Dr Syed Sibtul Hasnain lauded the achievements made by Khyber Medical University so for and said that adaptation of uniformity in curriculum and the evaluation system will  help in bringing medical education on par.

He said that initiative towards change in the curriculum of medical education is the need of the day and it is an effective step in right direction.

He also assured that PM&DC will continue its support and facilitation in reforms process. Earlier, Prof Dr Abdul Majeed Chaudhry, Principal Fatima Jinnah Medical College and Chairman of PMDC appointed Curriculum Committee, addressed the participants and answered their queries.

VC Khyber Medical University Prof Dr Muhammad Hafizullah thanked the participants, specially the faculty of Aga Khan University Karachi for conducting the workshop in a befitting way and achieving the desired goals.

He presented souvenirs to the chief guests and workshop facilitators. The chief guest distributed certificates among the participants.

The importance of taking all curriculum stakeholders i.e. Faculty, Students, University, local and regional health care authorities (PM&DC, HEC, WHO) and the community, was emphasised while designing and planning the curriculum, in an orchestrated way.