A decade of reform in medical education: Experiences and challenges at Tehran University of Medical Sciences

Abstract

Purpose: In this paper, we present the major curricular reform in MD program of Tehran University of Medical Sciences, the oldest and the largest medical university in Iran, initiated about a decade ago.

Materials and methods: Following a comprehensive program evaluation, many of the basic challenges of the traditional curriculum were revealed, namely, lack of pre-defined competencies for graduates, over-reliance on teacher-centered teaching methods, over-emphasis on knowledge base in student assessments, and focusing solely on biomedical aspects of patient care. In 2010, a vision statement for reform was created and approved by the University Council. The new curriculum was launched in 2011.

Results: The changes included: revising the content of the courses, assimilating horizontal and vertical integration, emphasizing clinical skills, encouraging active involvement in patient management, providing more opportunity for supervised practice, integrating behavioral and psychosocial topics into the curriculum, incorporating interactive teaching methods, assessing students’ higher levels of cognition, and strengthening workplace assessments. To evaluate the changes, data were continuously collected and analyzed from the beginning.

Conclusions: Changing the curriculum of an MD program is a laborious task which should be planned and undertaken carefully and cautiously. It is an endless, yet invaluable and satisfying endeavor toward better future.     

School of Medicine of Federal University of Rio Grande Do Norte: A traditional curriculum with innovative trends in medical education

Abstract

Introduction: The Medical School of the Federal University of Rio Grande do Norte (UFRN) is one of the biggest public medical schools in Northeast Brazil. In the last decade, significant investment in faculty development, innovative learning methodologies and student engagement has been key milestones in educational improvement at this medical school, harnessed to recent political changes that strengthened community-based and emergency education. This study describes how curriculum changes in UFRN Medical School have been responsible for major improvements in medical education locally and which impacts such transformations may have on the educational community.

Methods: A group of students and teachers revised the new curriculum and established the key changes over the past years that have been responsible for the local enhancement of medical education. This information was compared and contrasted to further educational evidences in order to define patterns that can be reproduced in other institutions.

Results: Improvements in faculty development have been fairly observed in the institution, exemplified by the participation of a growing number of faculty members in programs for professional development and also by the creation of a local masters degree in health education. Alongside, strong student engagement in curriculum matters enhanced the teaching-learning process.

Conclusions: Due to a deeper involvement of students and teachers in medical education, it has been possible to implement innovative teaching-learning and assessment strategies over the last ten years and place UFRN Medical School at a privileged position in relation to undergraduate training, educational research and professional development of faculty staff.     

Use of flawed multiple-choice items by the New England Journal of Medicine for continuing medical education

Physicians in the United States are required to complete a minimum number of continuing medical education (CME) credits annually. The goal of CME is to ensure that physicians maintain their knowledge and skills throughout their medical career. The New England Journal of Medicine (NEJM) provides its readers with the opportunity to obtain weekly CME credits. Deviation from established item-writing principles may result in a decrease in validity evidence for tests. This study evaluated the quality of 40 NEJM MCQs using the standard evidence-based principles of effective item writing. Each multiple-choice item reviewed had at least three item flaws, with a mean of 5.1 and a range of 3 to 7. The results of this study demonstrate that the NEJM uses flawed MCQs in its weekly CME program.     

A case study in the globalization of medical education: assisting overseas-born students at the University of Melbourne

Over the past decade there has been a remarkable increase in ethnic diversity among Australian medical students. This phenomenon has been driven by two forces: the disproportionate school-level academic success achieved by first-generation migrant and refugee-origin youth, and the rapid globalization of Australia's tertiary education system, in a context where reduced government funding has accelerated the development of 'academic capitalism' (Slaughter & Leslie, 1997 ). This paper briefly examines each trend, prior to exploring select pedagogical implications of these changes for the University of Melbourne, the destination of choice by 2001 for 30% of all international students electing to study medicine in Australia. Two key questions are addressed: (1) What are the potential problems in delivering Western-style medical education to culturally and linguistically disparate groups?; (2) What model of international student support has been developed by the Faculty of Medicine, Dentistry and Health Sciences at the University of Melbourne? The paper suggests the model may have potential relevance for other universities, in the context of the accelerating globalization of medical education.     

Simulation in medical education

Studies in cognitive psychology inform us that the recall of information and its application are best when it is taught and rehearsed in environments similar to workplace. The healthcare professions are heavily task- and performance-based where non-technical skills, decision making and clinical reasoning are important alongside integrity, empathy and compassion. Most of these attributes are difficult to teach and assess in the traditional classrooms. Enhanced patient safety on one hand has to be the ultimate outcome of any medical curriculum while on the other hand, it itself can be potentially compromised in an apprenticeship-based model of medical education. A range of simulation techniques are very well placed to be used alongside clinical placements. These can be employed to enhance learning of healthcare professionals in safe environments, without compromising the patient safety, while maintaining a high degree of realism. This article builds an argument for the use of simulation techniques to enhance patient safety and points the readers to the AMEE Guide No. 50 on simulation, which is written as a practical manual on building a simulation programme in healthcare education.     

Transforming medical education in Kazakhstan: Successful case of internationalization from Karaganda State Medical University

Abstract

Background: Medical education in Kazakhstan has been literally transformed in the past 10 years. Kazakhstan inherited the Soviet-time discipline-based teacher-centered system of education when no decisions could be made independently. The curriculum was mostly governed in a traditional way, with lectures being the core, little use of e-learning tools, and assessment through oral exams and multiple-choice questions. Most of the universities still preserve the subject-based curriculum with elements of integrated learning.

Methods: Being the most active member of International Space Education, Karaganda State Medical University (KSMU) took the initiative to adapt the full integrated curriculum mostly based on problem-based, team-based learning, and use of virtual patient cases. The given approach was chosen because of active involvement of our University in nine Tempus and Erasmus+projects including reforming of Public Health and Nursing curriculum, human resources development, active learning, credit mobility, and move towards autonomy of medical schools.

Results: KSMU became the coordinator of two of these projects, taking its active position in internationalization of medical education. We actively use technology-based medical education, pro-actively adapting deliberate practice in acquiring essential practical skills, for which KSMU was recognized by an ASPIRE-to-Excellence Award in simulation.

Conclusions: Kazakhstan hopes to become the leader in medical education in Central Asia and suggests other Universities in the area to adopt its approach to internationalization of medical education.     

Learning objects in medical education

A learning object (LO) is a grouping of instructional materials structured to meet a specified educational objective. Digital LOs, which can be stored electronically, allow a new approach to instructional activity, making medical education more efficient, and potentially more cost-effective. They are reusable and can incorporate text, graphics, animations, audio, and video to support and enhance learning. A learning object can stand alone or be aggregated with additional objects to create larger forms of educational content meeting multiple educational objectives. Digital learning objects located in online repositories can be accessed by many computers and are easily handled by an array of learning management systems for delivery to learners at any time. Integrating digital learning objects with traditional educational methods in a blended learning approach assists medical educators in meeting the challenges of competing priorities. Multimedia LOs enable learners to tailor their experience to their preferred learning style. Through the use of learning objects, learners' reactions, their acquisition of knowledge, skills and attitudes, and their behavioral changes become readily measurable. Learning objects provide multiple research opportunities, such as their use in adaptive learning, their added value in preclinical versus clinical education, and their impact as part of a blended learning strategy.     

Scientific initiation in medical education

It has been said that scientific initiation propagates the development of logical and critical thinking, instigates a commitment to life-long learning and stimulates the formation of new scientists. This essay describes the personal experience of the scientific initiation process of a medical student and reports on the impacts this extra-curricular activity has had over this student's graduation period.     

Motivation in medical education*

Motivation is a concept which has fascinated researchers for many decades. The field of medical education has become interested in motivation recently, having always assumed that medical students must be motivated because of their commitment to highly specific training, leading to a very specific profession. However, motivation is a major determinant of the quality of learning and success, the lack of which may well explain why teachers sometimes observe medical students who are discouraged, have lost interest or abandon their studies, with a feeling of powerlessness or resignation. After describing the importance of motivation for learning in medicine, this Guide will define the concept of motivation, setting it within the context of a social cognitive approach. In the second part of this Guide, recommendations are made, based upon the so-called “motivational dynamic model”, which provides a multitude of various strategies with positive effects on students’ motivation to learn.     

Standards in medical education in the European Union

Standards in medical education are necessary to enable evaluation of programmes and comparison between institutions. EC Directive 93/16 lays down the standards for both the duration and content of basic medical education in the European Union but the directive is open to wide variations in interpretation. A new approach is needed and the development of common learning outcomes is suggested as a possible solution.