The 1st ASEAN Medical Education Conference (AMEC) To...

The 1st ASEAN Medical Education Conference (AMEC) To Celebrate The Chulalongkorn University Centennial

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ASEAN medical education: past, present and future Tin Tun, Deputy Director General (Academic Affairs) Department of Human Resources for Health, Ministry of Health and Sports, Myanmar Professor, Department of Medical Education, DSMA&MINP Executive Committee Member (Vice President- Elect), SEARAME Introduction

Since inception of the Faculty of Medicine in 1927, the teaching of undergraduate medical education has been based on earlier British medical education models with traditional way of teaching which is a subject / discipline based structure. The Basic Medical Sciences (Anatomy, Physiology and Biochemistry) are taught in the early years and gradually the basis of disease mechanism such as Microbiology and Pathology, the basis of treatment (Pharmacology & Therapeutics) and the basis of prevention (Public Health & Epidemiology) are introduced in the later years. In the final years the clinical disciplines ( Medicine, Surgery, Obstetrics & Gynecology , Paediatrics) are taught but there is little correlation between the subjects introduced in the early years of the Medical school or vice versa. Moreover there is very limited coordination between subjects taught even in the same phase the Medical Curriculum (e.g Anatomy & Physiology; Microbiology & Pathology etc) i.e there are barriers between the subjects as well as between faculty of different departments. The emphasis of this curriculum is more on acquisition of knowledge of basic medical sciences and students do not have much opportunity to learn how these can to be applied in the clinical years and during the internship when they see real patients. Therefore students do not feel worthwhile or meaningful to acquire the knowledge in these subjects, most of which are colossal and difficult to cope and understand.

This traditional approach has been criticised for a number of reasons:

Many existing curricula fail to meet the needs of current and future doctors It creates an artificial divide between the basic and clinical sciences Time is wasted in acquiring knowledge that is subsequently forgotten or found to be

irrelevant (The acquisition and retention of information that has no apparent relevance can be boring and even demoralising for students)

Application of the acquired knowledge can be difficult Too much information (Overload of knowledge which has very little use and

application as doctors. Too little time for Self Directed Learning (SDL) Too many students in crowded rooms with minimal opportunity of having feedback to

the faculty.


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The current undergraduate curriculum has been reviewed and revised several times over the years and the Department of Human Resource for Health (previously known as Directorate of Medical Education) has convened 10 National ME Seminars in the past 5 decades to ensure the quality and good standard of medical training. However as the structure of undergraduate curriculum is based on the traditional format, the revised curriculum is unable to encompass the ever exploding knowledge and technical advances in Medical Science. Current Undergraduate Medical Curriculum

10/30/2016 Current situation of UGME 35

Future Plan (to change into Outcome based, Integrated Curriculum) Tomorrow’s doctors need to be aware of ever changing trends in Medical Science and must be equipped with lifelong learning skills to keep updating themselves with knowledge , skills and professional behavior relevant to the context of their working environment, available resources and social circumstances. Integrated approach in Medical Education will enhance the development of critical thinking and clinical reasoning skills and provide opportunities to apply existing knowledge to clinical scenarios. This allows the use of basic sciences in clinical problem solving and highlight the importance of relationship between basic sciences (and basic principles) and patient presentations. This new approach will also provide students with an opportunity to progress towards deeper understanding, i.e comprehensive learning beyond memorization via active self-


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directed learning and consolidate as well as supplement information delivered in other teaching sessions. Moreover, the World Federation of Medical Education (WFME) has announced that all the Medical Schools need to be accredited according to its Global Standards by 2023. Those schools which cannot meet these standards will be removed from the World Directory of Medical Schools and their medical graduates will not be recognized for further training in the international programs. The WFME has clearly stated that in order to be accredited, the curriculum and instructional methods should ensure that students have responsibility (Student Centered) for their learning process and should prepare them for life-long, self-directed learning. The medical school must also teach the principles of scientific method and evidence-based medicine, including analytical and critical thinking, throughout the curriculum. Progress in developing Integrated Medical Curriculum for Undergraduates in Myanmar Being aware of the need to change the present undergraduate medical curriculum, all the Medical Universities under the MOHS have started preparations to develop Outcome based Integrated Curriculum since middle of 2014. Senior faculty from Curriculum Review Committee and Medical Education Units studied how similar curriculum had been drawn in other medical schools including the challenges met and measures used to solve their obstacles. Discussions and workshops with faculty members from other sister Medical Schools (including University of Seoul, School of Medicine, Lee Kong Chian School of Medicine, Singapore and Li KaShing School of Medicine, University of Hong Kong, Imperial college, London) were conducted and site visits to some of these institutions were also done. These educational activities have made the senior faculty aware of the requisites and expectations of developing an entirely new curriculum for the Universities. This issue was also included in the discussions of the Medical Syndicate in the 10th National Medical Education Seminar held in February 2016 and the transformation to this new format was included in the recommendations. In July 2016 the Department of Human Resource for Health with the directive of the Union Minister for Health & Sports formed the Central Committee for Integrated Curriculum development whose function is to plan and develop this new curriculum for all Medical Universities of the country to be ready for implementation by the end of 2017.

The expected program Learning Outcomes of a graduate doctor include: As Scholar and Scientist–To be able to apply basic sciences/ psychological principles, clinical reasoning, critical thinking, decision making, judgment, research and innovation in areas of interest. As Practitioner – to be able acquire clinical skills, empathy, disease prevention and health promotion, information management.


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As Communicator – to be able to speak and communicate with patients, relatives, colleagues, administrative authorities and public in written , verbal, phone and electronically. As Teacher – to be able to reflect, self-direct, lifelong learning and teaching As Manager –to be able to work in a team, collaborate, lead, manage and work to solve family and community health issues. As Professional – to be able to understand moral issues, engage in personal development, work for patient safety, quality assurance, clinical governance, professional ethics and legal issues relating to health.

The Curriculum framework (Foundation

Year)

Year 1

Year 2

Year 3

Year 4

Year 5

1. Biological & Science subjects related to Medicine 2.Foundation for medicine (Principle block)

Integrated Basic

Medical Sciences

with clinical relevance (Block A)

Integrated Basic

Medical Sciences

with clinical relevance (Block B)

Core Clinical Medicine in

practice (Medicine,

Surgery & related

disciplines)

1.Specialities in All Ages of

Medicine

2. Electives

Student internship

programme

(Rotation in four main

Clinical disciplines)

The curriculum consistsof a6 year programand the entry point will be after successful

Clinical management , Medical Ethics and Professionalism

Community and Family Health

Growth and Aging

Research Culture and Skills

Social and Behavioral Science


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After completion of Basic Education High School examination, The first year is the Foundation year where the students will have to learn Biological and Science subjects related to Medicine in the GCE “A” level. There will also be a “Principle Block” where the students will be introduced to Foundation of Medicine. In Year 1 & 2 of the Medical Curriculum the Basic Medical Science subjects will be linked in horizontal fashion and will be taught as system based integrated approach in the context of clinical relevance. Year 1 will be designated as Block A which includes, 1. Cardiovascular module 2. Respiratory module 3. Gastrointestinal, nutrition and hepatobiliary module 4. Hematology and immunology module Year 2 will be designated as Block B which includes 5. Genitourinary and reproductive health module 6. Musculoskeletal and Dermatology module 7.Endocrine module 8. Neurology, Special senses and Mental Health module In Year 3, the Core Clinical Medicine where Principles of Medicine and Surgery will be included together with related disciplines such as Infectious diseases, Dermatology, Anaesthesia, Radiology, Otolaryngology and Ophthalmology. The exposure to real patients in the hospital setting will start from this year. In the Year 4, Specialties related to all ages will be introduced. These include Paediatrics, Obstetrics & Gynecology, Psychiatry, Family Health and Community Medicine, Palliative care, Geriatrics, Emergency Medicine and Critical Care. In this year, Students will be allowed to take Elective period for study outside the Medical School based on their interest or do research during this period. (it will normally be not more than 2 months). In the Year 5, students are expected to learn more clinical skills, communication and decision making as student interns when they rotate in the 4 main Clinical disciplines. This will prepare them to achieve better competencies to acquire desired outcome.


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Teaching Methodology includes

Didactic Lectures, ( not more than 30% of teaching hours) Small group teaching , Practicals, Early Clinical exposure , Case based Learning, Use of Simulation, Independent Study (Self-directed Learning and Directed

Self Learning). Assessment of Students

Future plan and requirements While drawing up of the draft curriculum, other activities which needs to be developed in parallel include: Faculty development and training on Teaching Learning strategies particularly on Problem based Learning (PBL), Case Based Learning (CBL) and Workshops on How to write Learning Outcomes, Contents, Assessment Methods, How to give students Feedback and supervision Acquisition of Appropriate Resources Review and allocation of Human resources to improve Student: Teacher ratio; Administrative and supporting staff. Construction of Physical space especially for small group teaching, Improvement of Library and Telecommunication facilities.


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Acquiring Consultants to support in detail curriculum mapping and training workshops. Conclusion Medical education or medical education system is the “stem of a tree”. Only if the stem is strong and deeply rooted, the branches and leaves of the tree will be healthy, robust and green. The branches and leaves are our products, i.e., doctors or nurses or medical technologists or pharmacists, etc. Medical Education is the biggest investment to any country to make and it is the best investment from long term perspective (Dr Myint Htwe, 4th SEARAME Conference, 2016).


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ASEAN Medical Education: Past, Present and the Future Jamuna Vadivelu Research and Development Medical Education Faculty of Medicine, University of Malaya

The University of Malaya grew from a tradition of service to the society. Its predecessors, the King Edward VII College of Medicine and Raffles College had been established to meet urgent demands, one in medicine and the other in education. The existing Faculty of Medicine was established by University Statute in September 1962. Over the years, the Faculty has also expanded in its teaching activities, training highly qualified medical and allied health personnel at both undergraduate and postgraduate levels in many fields of specialization.

The old MBBS curriculum, also known as the New Integrated Curriculum (NIC) was utilised from 1998 through 2012 in the medical programme. The NIC was structured in three phases where students were taught about the normal human body in Phase I, an abnormal human body in Phase II and do their clinical postings in Phase III. During Phase I and Phase II, the medical students attend discipline-based didactic lectures where essential scientific concepts for basic medicine were introduced. Students are also introduced to problem-based learning sessions and other elective programmes throughout their five years in the medical school. Although the aim of the NIC curriculum was ideal in producing competent doctors, the curriculum which has been running for the past fourteen years appear to have certain weaknesses in the teaching and learning components based on feedback from the medical educators, patients and the society. The faculty in the recent curriculum review decided to bring changes to the medical curriculum to suit the current trend in medical education.

The Faculty of Medicine of the University of Malaya introduced a new MBBS curriculum, named as the University of Malaya Medical Programme (UMMP). Similar to the NIC, the UMMP adopts a five year programme where students are required to go through three stages. However, there are distinct differences in the teaching and learning approach of the UMMP curriculum where students learn in a multidisciplinary environment according to the block system. In addition to the existing basic and clinical sciences, Patient-Doctor sessions, Personal and Professional Development, the students are also involved in more interactive debates and presentations, self-directed learning sessions and clinical days where visits to wards are conducted by the clinicians beginning from first year.

The implementation of medical curriculum which aims to produce safe and competent doctors remains as the utmost concern of the country. With the dynamic intervention of information and technology, the concern on professionalism amongst medical students is an area which has recently appears to be on an alarming state in many medical schools.


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ASEAN medical education: past, present and future Medical education journey in Indonesia: the long and winding road Diantha Soemantri Department of Medical Education Faculty of Medicine Universitas Indonesia The history of medical education in Indonesia can be traced back to the era of Dutch colonialism, as early as 1849. For 165 years, medical education has evolved from as simple as a course to train vaccinateur to around 80 medical schools throughout the country. The curriculum has moved from community based, to discipline based and eventually outcome based in 2006, with several changes in the minimum years of study. Many governmental nation-wide projects have been conducted to strengthen the capacity of the human resources, develop the curriculum and improve the learning facilities. Amongst them is the development of a national licensing examination, which has now been transformed to an exit examination for medical students, in the form of MCQ and OSCE since 2013. The regulations for medical education is now stronger than ever with the legalization of Bills of Medical Education in 2014 by the Indonesian House of Representatives. Despite all the efforts made, Indonesia’s medical education is still facing a problem, largely due to significant gaps in the quality and resources availability among medical schools. Some medical schools are not yet in a position to think about the kinds of faculty development program the school should undertake, simply because they are still struggling with the very low number of teaching staff in the school. The future is inevitable, especially with the establishment of ASEAN community, therefore Indonesian medical schools should strive to improve their educational quality and thus, the quality of their graduates. Medical schools, through the curriculum, should aim to equip students with the competency to cope with global requirements, but rooted in local context. Teaching staff in a medical school is also an important stakeholder who need to keep abreast with the advancement of medical education worldwide.


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ASEAN medical education: past, present and future The Changing Landscape of Philippine Medical Education Melinda M. Atienza Department of Pediatrics Faculty of Medicine and Surgery, University of Santo Tomas With the advent of globalization there is the “shift in contemporary international education discourse from education to lifelong learning and from education as transmission of expert knowledge to building learners competences including how to learn”. This is the reality that Higher Education Institutions (HEIs) in the Philippine have to face as they compete in the global and regional area. The Philippine Medical Education has to offer quality medical programs that meet world would class standards and produce graduates with lifelong learning competences. The Asian Economic crisis in 1997 and the world economic crisis has promoted deepening and widening of regional cooperation in ASEAN countries. The ASEAN integration aims to include cooperation among countries for human resource and capacity development and recognition of professional qualification. This of course impact on our educational system as the medical students we produced should be trained not only for the local market but also should be ready for ASEAN markets. Our graduates must be competent not only from our local standards but also from ASEAN standards. To meet this challenge, the Commission on Higher Education (CHED) has issued CHED Memo Order # 46 series 2012 to enhance Quality Assurances (QA) in Philippine Higher Education through the Philippine Qualification Frameworks (PQF) which aligns the Philippine educational system with international qualification framework. This is the K-12 basic education reform where more attention is focused with higher education. This PQF was designed to make our educational system more aligned with the norms of Association of Southeast Asian Nation (ASEAN) Qualification Reference Framework, Seoul Accord for IT, Canherra accord for architecture, Washington accord for engineering. The CHED MO #46, series 2012 also mandate the shift to Outcomes-Based education of all programs. There is a call for transformative education, interprofessional education and social accountability of Medical Schools. From the traditional content based or input based education to the competency based education in our medical education system, we now shifted to an Outcome Based Education (OBE). The CHED programs mandate 10 outcomes for medicine namely: 1. Clinical competence, 2. Communication skills, 3. Leadership and management, 4.Resource management, 5. Interprofessionalism, 6. Health systems management to care, 7. Personal and continuing professional development, 8. Adherence to professional ethical and legal standard,


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9. Nationalism, internationalism, dedication to care, 10. Social accountability. We also have to address that our medical students belong to the so called generation Y or “mellinials” who are perceived to be more “open-minded” more self-expressive, liberal, receptive to new ideas, uses technology in their daily lives and need for instant gratification. Medical education must ready to adjust teaching and learning activities suitable for them. As we embark on this paradigm shift, there are several challenges Philippine medical education have to face. 1. Can our, medical graduates compete with ASEAN graduates in time for ASEAN integration? 2. Do all medical schools in the Philippine deliver quality medical education? 3. Does the competence learned in our medical school match these of ASEAN countries? 4. Are we preparing our medical graduate to be better citizens of our country and the world?

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