|Year : 2014 | Volume
| Issue : 2 | Page : 123-124
Outcome-based undergraduate medical curriculum
Shyam K Parashar
Department of Surgery, College of Medicine, University of Dammam, Dammam, Saudi Arabia
|Date of Web Publication||18-Jul-2014|
Shyam K Parashar
Department of Surgery, College of Medicine, University of Dammam, Dammam
|How to cite this article:|
Parashar SK. Outcome-based undergraduate medical curriculum. Saudi J Med Med Sci 2014;2:123-4
No educational curriculum is static. It should be dynamic and reviewed periodically, until it becomes relevant to the consumers.
Undergraduate medical curriculum has remained static over the years except for minor cosmetic changes. It follows the standard international practice to divide the time and contents of the curriculum, which invariably is that of 5 years. Unfortunately, this does not take into account the needs of the community, which varies from country to country and community to community.
An undergraduate medical curriculum should be capable of producing not only "safe doctors," but "five star doctors" as its final outcome. They should be "care providers, counselors, communicators, community leaders and contributors to overall health and welfare of the community."
In the Kingdom of Saudi Arabia, even the oldest university and its medical college is less than 40 years old; that is, we are at the initial stage of a long academic future in the medical field. It is therefore feasible to try a revolutionary concept that is of a medical undergraduate curriculum, which is outcome based and addresses the aspirations of the graduates as well as needs of the community.
I have been a member of five undergraduate curriculum committees at King Faisal University College of Medicine (Now University of Dammam) since 1981. I have seen the resistance, which any revolutionary change encounters in such committees. With great difficulty, we have been able to introduce basic clinical skills course and Integrated Health Science Course 10 years ago.
The number of Saudi graduates is increasing every year; however, the numbers are not enough to meet all the demands of the community for doctors and other health professionals. It is also natural that most of the medical graduates aspire for higher education and to work in centers with well-established facilities and infra-structure.
A day will come soon, when such opportunities will become highly competitive and most of the graduates will have to satisfy themselves with general and family practice.
An outcome based curriculum should foresee these developments and aim at producing doctors who will ideally be suited to deal with community health problems at the level of general and family practitioners.
Ambitious and eligible candidates can still compete for specialized training positions. This outcome based curriculum should include just the basic community health problems and leave the specialties as part of higher studies.
Our observation is that current medical curriculum is "department" based rather than "need based." Every department, small or big; every specialty and even super-specialties want to have a lion's share or at least a compulsory exposure for students in their field; even though, it may be irrelevant to their actual practice as a "general and family practitioner."
In present curriculum students are exposed to detailed teaching of conditions, which perhaps they will never be able to deal with in their practice.
At the end of this outcome based curriculum, the graduate will be able to:
- Understand that prevention is better than cure; and will be able to assist in organizing community based preventive measures.
- Recognize that practice of medicine is "holistic" and cannot be compartmentalized in physical, psycho-somatic or socio-medical segments.
- Realize that diagnosis and management of maladies require thorough knowledge and understanding of the pathophysiological processes.
- Appreciate the ability to manage "simple maladies" and the need to seek help of "specialists" for "serious" conditions and situations.
- Provide "initial" and first aid management for emergency situations.
- Take all possible "life-saving" measures in "life-threatening" situations.
- Avoid adventures, explorations and experiments with the lives that are entrusted to him. In other words be a "safe doctor."
- Act as a "role model" for the community, a "five star" doctor as explained above and lead by own actions and ethical behavior.
Before planning outcome based medical curriculum, it must be established, by community surveys as to what are the most common medical and health problems in the community.
The following is proposed as part of this new concept of outcome based undergraduate medical curriculum.
- Students should be provided maximum exposure to these conditions in their curriculum.
- Exposure to basic medical sciences should to limited to "applied" aspects only; details are unnecessary and must be omitted.
- Teaching of basic medical sciences is integrated with clinical sciences from the very beginning to make them more relevant and easy to comprehend. Theoretical teaching should be replaced by clinical problem oriented teaching; thus, reducing the didactic class room lectures.
- General medicine and family and community medicine should be the major part of the clinical curriculum.
- Exposure to surgery should be limited to very common conditions, which they may encounter for diagnosis and even fewer, which they may have to tackle surgically. It is unnecessary for general/family practitioners (G.Ps) to know the details of the procedures they may never perform in their practice.
- Teaching of surgical specialties be scrapped and replaced by covering them in emergency medicine course. An exposure of students for just 1 or 2 weeks is meaningless; it is more for the satisfaction of the departments rather than an academic exercise for students.
- Service specialties like anesthesiology and radiology should be integrated as part of regular courses in medicine, surgery etc.; and not as separate courses.
- Diseases of women and children have special significance and must be taught in appropriate proportions.
- "Trauma and emergency medicine" should be taught in detail, initial management of all the traumatic and non-traumatic emergencies; be they neurological, neurosurgical, ophthalmic, orthopedic, urological or psychological, until he is able to seek help from appropriate centers and specialists.
- Frequency of examinations must be reduced. One annual examination covering all the subjects taught during the year should suffice.
- Emphasis should be on meaningful objective continuous assessment based on relevant check list.
- The last examination at the end of final year should be the "Final Certifying Examination," which should cover the subjects and questions relevant for a "safe doctor."
- A supplementary final certifying examination at the end of summer break will reduce the waiting period for the unsuccessful candidates.
On an average, the practice of a general and family practitioner should consist of:
- 20% - preventive and community medicine.
- 20% - general medicine.
- 20% - women and children's diseases.
- 20% - trauma and emergency medicine.
- 10% - surgery, ear, nose and throat and ophthalmology.
- 10% - dermatology and psychiatry.
The clinical curriculum should be proportionately distributed. Teaching should be continuous and integrated, rather than in blocks. Detailed studies for sub-specialty and Super-specialty subjects should be deferred for post graduate level.
In conclusion, majority of medical problems of any community can be addressed by primary and family care physicians. Only a fraction of community health problems require multispecialty five star hospitals and medical facilities.
It is logical and economical to raise the standards of primary and family care facilities to five star levels especially in developing countries, so that more and more medical graduates are attracted toward them.
Wasteful expenditure on time money and facilities on undergraduate medical education can be reduced by adopting an outcome based curriculum.