Report of the subcommittee constituted for comparison of modular system of curriculum of king Edward Medical University, Lahore, DOW University, Karachi, ...
Report of the subcommittee constituted for comparison of modular system of curriculum of king Edward Medical University, Lahore, DOW University, Karachi, Aga Khan University, Karachi and John Hopkin’s medical school USA Members Dr. Ahmad Uzair Qureshi Dr. Muhammad Ali Sadiq Dr. Ainul Mumina Need assessment A new modular curriculum is being introduced in King Edward Medical University, Lahore (KEMU). The new modular design of curriculum is mainly structured on the scaffold of curriculum approved by Pakistan Medical and Dental Council, Islamabad (PM&DC). A subcommittee was constituted to compare the structural design of two well established systems with the newly designed KEMU curriculum which is now being implemented till third year MBBS. Methodology Since AKU’s curriculum is designed and implemented according to PM&DC, content and subjects taught were considered to be more comparable between KEMU and AKU. Hence, a module of “neoplasia and inflammation” which are being included in the curriculum of both universities were evaluated on CIPP model. The report and its suggestions are based mainly but not limited to following four articles/ chapters 1. Twelve tips for developing an integrated Curriculum Alam sher malik & rukhsana hussain malik; Medical teacher 2011; 33: 99–104 2. Fogarty R. 1991. How to integrate curricula. Palatine. Illinois: IRI/Skylight Training and Publishing, Inc. 3. Harden RM. 2000. The integration ladder: A tool for curriculum planning and evaluation. Med Educ 34:551–557. 4. Harden RM, Sowden S, Dunn WR. 1984. Some educational strategies in curriculum development: The SPICES model. ASME Medical Education Booklet number 18. Med Educ 18:284–297.
Comparative findings for curriculum for KEMU and AKU “THE CASE OF INFLAMMATION AND NEOPLASIA MODULES”
Year of Study Inflammation and neoplasia modules are taught in 3rd year in KEMU and 1st year in AKU. Duration: Duration of the two modules are comparable i.e. 25 days in KEMU and 28 days in AKU. (Table 1 for details)
TABLE 1 Modes of Information transfer Table 2 shows the modes of information transfer being used by both the programs. KEMU curriculum uses classroom lecturing as the mainstay of MIT, despite the facts that retention of this modality is reported to be around 5%, the class size of KEMU is more than 300. Other Modes of information transfers are clinical rotations, small group discussions and practicals for pathology. AKU on the other hand is using higher levels of educational strategies including synchronization and integration in the form of problem based learning , field visits, focused clinical sessions, interactive sessions and lectures. In the module under review AKU has 19 lectures as compared to 72 lectures in the KEMU curriculum. Maximum number of lectures per day in AKU curriculum is two as compared to 6 consecutive lectures in KEMU curriculum every Saturday. There are no concept of tutorials and problem based learning in KEMU which comprises approx. 20% of time utilized by AKU curriculum. Harden in his article on educational strategies and curricular integration ladder explains the concept of multidisciplinary approaches and integration of concepts by the learners according to their own learning styles. This aim is achieved by reducing the lecturing component by individual subject specialists and propagating techniques and activities where students take main responsibility to explore the real life scenarios. These scenarios or clinical tasks need to be developed by KEMU. The module shows 5 such themes being
taught at AKU for inflammation and infection module in year 1. More than 133 such themes and problem based learning tasks have been developed by Dundee school of medicine as well. Assessments There is no feedback session in the KEMU curriculum reflecting learners and teacher’s perspective for a module which should be introduced and an introductory session for the new module which describes the learning outcomes Assessments are made as formative as well as summative in AKU curriculum and ample study time is being allocated for the students to prepare for the assessments during the last week with very few new topics being included. In KEMU the assessment of one module is adjusted in the middle of new module which disrupts the concept of modular system and learners continue to remain disjoint from the new module until the summative assessment of previous module is completed.
Curriculum designed by Aga Khan includes the time of self study (ss) as devised in the PM&DC curriculum as an integrated part of schedule/ time table. This enables learners to have ample time to prepare for different assignments as well as assessments.
Assessments
are
done
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separate
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in
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last
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with atleast one day off for preparation for the test from the module ( termed as self study )
Both curricula match in terms of number of hours and distribution of time for different activities. Minor changed need to be made in the ratio of taught:practical sessions which are slightly different for basic versus, pre-clinical and clinical subjects i.e. 50:50, 40:60 and 30:70 respectively
Higher level of integration should be achieved
Indicators for planning. Organization and implementation of modular KEMU
Indicators 1. Availability Trained staff curriculum development
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Remarks suggestions of Qualified medical educationists are not involved with the specialists in Faculty members with formal qualification in medical in any phase of the ICD education must be included in the process to improve the standard of the program. This will improve the quality standards of KEMU program at every level from conceptualization, planning, designing, organizing, implementation and evaluation. Scope of Integration The new integrated schedule is being implemented without any clear The committee must also decide the phasing and road map to decide level of integration and phasing of integration. timelines when to step up or step down the ladder. There is evident discrepancy between the resources available and set The committee must also recommend an evaluation goals and objectives. committee to collect feedback from all stakeholders, submit the same for evaluation and submit 6 monthly or end of module evaluation reports to committees. Level of integration After detailed evaluation it is clear that the current modular design is at The committee must decide the level of integration step 5 out of 11 (Awareness/ sharing) of Harden’s integration ladder. based on Harden’s ladder of integration to atleast 6-8. This step means that the concept of block system exists and topics taught are still bounded into subject specialists. However, one specialty is aware of what is being taught by other subject specialists simultaneously. Another requirement for this level is sharing to lecture handouts for each lecture to every teacher teaching the module Vertical and This particular step is being addressed adequately. And Horizontal as Standalone / block subjects not integrated fully with the Horizontal well as vertical integration is being introduced at all levels. module should be allowed to teach on one particular day integration However, disagreement may exist in the contents of lectures being per week. delivered to first year students in KEMU Establishment of Qualified medical educationists need to identify competencies and Each module should have its own Module Integration MIC and working learning outcomes based on their discussion with subject specialists. Committee (MIC) which may be led by the module group These qualified medical educationist must have their major input based coordinator (MC). on their knowledge of medical education to develop educational The Faculty Integration Committee (FIC) should be led concepts based on theories of adult learning, should be student by a senior academician preferably by one who also centered and devise modes of information transfer inline with aims and holds a key post such as deputy dean academics. objectives. The implementation can be in phases. The medical educationists should For a pre-clerkship module, apart from representatives develop mind maps and storyboards before embarking upon a final draft of all the basic medical science disciplines (e.g. of modular curriculum Anatomy, Physiology, Biochemistry, Microbiology,
Parasitology, Pathology and Pharmacology) the team should include a medical educationist and at least one relevant clinical teacher as a member. For a clerkship module, the majority of the members would be clinicians with adequate representation of the relevant basic medical science teachers. Each team should choose their secretary and scribe and specify their roles. 6. Responsibilities of Following task should be assigned to each FIC Faculty integration 1. Learning outcomes working group 2. . Contents & Relationship of contents to the learning outcomes and themes 3. . Sequencing of topics 4. . Teaching/learning methods for each topic 5. . Contents of each topic and their relation to the learning outcomes 6. . Assessment methods 7. Learning outcome Learning outcomes are generalized Learning outcomes need to be more specific designs 8. Creating themes No theme are identified Themes need to be identified e.g. in endocrine module “diabetes mellitus” can be chosen as a theme. Anatomy will teach the anatomy of pancreas, physiology will describe the functions 9. Designing a Is available Needs regular revisions and update of lecture comprehensive time presenters and contents table 10. Reliance on More than 70 lectures in span of 20 days to a class of 328 attendees is Modern techniques including interactive sessions, PBL conservative not fruitful and should be brought down to 15-20% of the whole teaching and workshops and symposia should be introduced to lectures reduce the percentage of time used by lecturing 11. Assessment method Formative assessment is missing Needs to be introduced Summative assessment is done on one day in next module There is no evaluation of psychomotor and affect domains 12. 360o feedback Needs to be introduced
13. Evaluation revision
and There is no standard operating protocols set for this aspect of the new A standard protocol should be implemented to deal with system the Content, Input, Process and Product sections of the new system on periodical basis. 14. Fixed days for sports No day/ time is fixed for Days may be fixed & extra-curricular activities 15. Development Milestones should be set to gradually reduce the number milestones of lectures and increase new teaching methodologies to compete best medical institutions in the world
