The following article was sent to me by Sanath on my request. Feedback in the form of "Comments" by viewers (both members of the batch and others who might read it, including those based outside Sri Lanka) would be much appreciated. Those viewers who may not be familiar with the commenting process are kindly requested to follow the instructions provided in a previous post titled "How to post a comment". You may even send in comments to my personal e-mail address:
. I will post them on your behalf.
The teaching consisted mainly of
didactic lectures, practicals and anatomy dissections during the first two
years; clinicals commenced in the third year and the didactic lectures and
practicals continued. There were three end of course evaluations, namely the 2ndMBBS,
3rd MBBS and Final MBBS examinations. There was hardly any
continuous assessment apart from the ‘Anatomy Spots’.
There was only minimal contact
with the community except for a short family visit during the professorial
paediatric appointment. Exposure to psychiatry or psychological medicine was
minimal and it was not evaluated. Evaluation in paediatrics consisted of two
questions in one of the two written papers in medicine and a short clinical
examination. We, the students were of
the view that what was not evaluated need not be studied to pass the
examinations. Therefore our knowledge of paediatrics and psychological medicine
was rather rudimentary. Most questions of written papers were “essay type” and
there were no MCQ papers. (Majority of us answered a MCQ paper for the first
time, when we sat for the ECFMG examination after graduation)
Interim
Period
Paediatrics was the first
discipline to introduce a MCQ paper, at the end of the professorial
appointment. Other disciplines gradually introduced MCQ papers. Paediatrics
became a separate subject at the Final MBBS examination in the 1980’s. Together
with the Department of Community Medicine (called Public Health during our
time) the Department of Paediatrics started a family attachment so as to expand
exposure to the community. However, the traditional curriculum prevailed up to
the 1990’s and students were taught many conditions that were never or hardly
ever seen - for eg. Chaga’s Disease, Sleeping Sickness etc.
NOW
The
build-up
During the 1980s the WHO
recommended reforms in undergraduate medical education. Reorient Medical
Education (ROME) was the theme. In the early 1990’s the Colombo Medical
Faculty, which was one of four medical faculties at that time, decided to
change the medical curriculum in keeping with the country’s needs. Several
workshops were held with representatives of
other medical faculties, Ministry of Health consultants and administrators
, general practitioners, representatives from Professional Colleges, The Sri
Lanka Medical Council, GMOA, senior administrators such as the Vice Chancellor
of the University of Colombo, members of the UGC etc.,
Several members of the academic
staff were provided with opportunities of visiting medical education units
overseas by the WHO awarding short term fellowships. These were to University of New South Wales,
Sydney, Australia, University of Science in KotaBharu, Malaysia, University of
Singapore, University of Dundee, in Scotland and University of Maastricht in
the Netherlands.
After much deliberation a
“new curriculum” was introduced with the A/L 1993/1994 intake of students who
eventually graduated in 2000. This was a major change and very staff intensive
with both (old and new) curriculae running within the faculty during the period
of transition. In later years medical faculties in Peradeniya, Kelaniya, Galle
and Sri Jayawardenapura followed suit and initiated changes in their teaching
programmes.
Structure
of New Curriculum
Several new and some even unique
“streams’ “modules” etcwere introduced. Examples were the Introductory Basic Sciences Stream (IBS),
students being introduced to clinicals
during the first 2 years itself, Applied Sciences Stream (with a modular
structure in the 3rd, 4th
and 5th years) Clinical Stream, Community Stream and Behavioural
Sciences Stream; the last three streams ran through the entire course. Clinical
teaching that was introduced during the first year rapidly expanded during the
next five years. First Contact Care was also another new aspect- and students
were posted to peripheral hospitals and were attached to a General
Practitioner, and a Municipality clinic.
(I functioned as the founder chairman of the Clinical Stream)
Basic and
Applied Sciences Stream
The Applied Sciences Stream
initially consisted of 18 modules, dealing with different systems eg. CVS, GIT,
CNS etc. Later, by joining certain modules it was reduced to about 15. Wherever
possible clinical appointments were made to coincide with the relevant modules.
Community
Stream
In the Community Stream, a family
attachment was made mandatory; two students had to look after a family for
several months and deal with their health and social problems. A research
project was also made mandatory so as to introduce students to basic aspects of
research, as this was considered to be very important for their future career
in any chosen field.
Behavioural
Science Stream
During this stream effective
communication skills, self-development, time management, team work and medical
ethics were emphasized. “breaking bad news”, “caring for a dying patient” and
“reducing conflicts in health care teams” were some of the other important
components.
The final year professorial
appointments were for 2 months each and psychological medicine was also
introduced in to the final year.
Elective
Appointment
An elective appointment was
introduced, which could be spent locally or overseas. One or two students
together could do an elective appointment which may include a research project.
A sub-committee of the Clinical Stream supervised the elective appointment.
Skills
Laboratory
It is a laboratory setting to
allow learners to acquire skills which are embarrassing (eg. vaginal or rectal
examination), painful (eg. catheterization), difficult (eg. suturing of an
episiotomy) IV cannulation, funduscopy, otoscopy etc. These procedures are
practised on models under supervision. Several modules and the Introductory
Clinical Sciences Stream use it for teaching skills.
Methods
of Teaching
Didactic lectures and anatomy
dissection hours were drastically reduced. (Prosected specimens largely
replaced dissections)New methods such as Problem Based Learning (PBL)
Integrated Teaching, Seminars, Small Group Discussions (SGDs), Computer
Assisted Learning. Fixed Learning Modules (FiLMS) are used extensively. There
are many student led assignments. The students are encouraged to do
“self-study,” prepare reports and present these to their colleagues at formal
teaching sessions. These methods, made the students to lose “stage fright” and
develop public speaking skills and become good communicators, early in their
career.
The clinical appointments in the
new curriculum were similar to what we went through except for the addition of
some new sub-specialities and aligning them with the module based teaching of
the 3rd and 4th years. The final year professorial
appointments were for two months each and psychological medicine was also
included.
Methods
of Evaluation
The basic principle was that
whatever that was taught or a sample of it should be evaluated and given a
mark. Continuous assessment was given a prominent place in contrast to “end of
course” evaluation in the old curriculum. MCQs and structured essays are the
hallmarks of written examinations. OSPE (Objectively Structured Practical
Examination) OSCE (Objectively Structured Clinical Examination) are also used
as tools of evaluation.
Psychological Medicine was made a
separate subject for the Final MBBS examination from 1998 onwards. All this
meant a huge exam overload as well as report writing, research projects, etc.
At present .there are over 30 different evaluations adding to student stress.
The Community and Behavioural Sciences Streams also have their final evaluations
at the end of the course, adding to be students work load.
Evaluation
in Paediatrics
During the 2 months appointment
in the final year, a continuous assessment mark of 40% was given in the new
curriculum. Continuous assessment was
made as objective as possible based on their attendance, clinical
presentations, written discussions, work place based interviews and OSCE’s; we
even attempted to assess attitudes through an exhaustive mechanism. The final
paediatric clinical examination was conducted at the end
of the appointment with one long case and two or more short cases (30% of the
final mark is given for it). At the end of the course at the Final MBBS
examination two written papers are held (structured essay and MCQs) and 15% is
given for each paper. In the near future it has been decided to postpone the
paediatric clinical examination and for it to be part of the Final MBBS
examination at the end of the course. This is mainly because a common order of
merit has to be made for all the medical graduates from the different medical
faculties for purposes of employment in the Ministry of Health. Therefore
methods of evaluation have to be somewhat similar in all medical faculties.
As you can see dear colleagues,
over the years, the medical curriculum has been turned “upside down and inside
out”! As I was fully involved in this very tedious process, I am convinced that
it is for the better!
