https://imcjms.com/public Ibrahim Medical College Journal of Medical Science https://imcjms.com/public/registration/journal_full_text/188 Wed, 19 Apr 2017 14:56:25 +0000 Throughout the colonial rule of two hundred years, we had no choice other than to accept the westernized medicinal practice. In fact, during this period, Europe and America experienced a revolutionized stage of development in culture, science and industry. And so is the medical science and medical education. The medical schools opted primarily on an apprenticeship model of education.1 The medical education curricula started with the basic medical sciences during the first two preclinical years. The preclinical subjects were anatomy (including histology and embryology), physiology (including biochemistry), pharmacology, pathology, and bacteriology. With the advancement of research and discoveries in the twentieth century, new areas of knowledge were added. Immunology, virology, and genetics were increasingly loaded with enormous input though stayed within the discipline-oriented structure.2 Thus, the old model of ‘basic science education’ faced challenges increasingly with the rapidly generated new information and that necessitated a change in medical education. Many more changes and variations were undertaken to deal with the newly emerged situation for medical education. Finally, the Medical Curriculum Committee at Brown Medical School approved a vision for curriculum transformation that would build upon the competency-based curriculum. The curriculum was found effective and was implemented in 1996, incorporating five essential elements – 1. integrated coursework; 2. patient-centered focus; 3. small group active learning methods, 4. an educational environment that is both humane and conducive to learning, and 5. fuller and more robust integration of new technology. The old model of preclinical basic science (anatomy, physiology, biochemistry) has no chance of developing PBL and no practice of exercising previous knowledge. As a result the students can not decide what more they have to learn. Conversely, in the integrated model, courses supposed to be taught as disciplines like histology, anatomy and physiology are taught as part of the integrated teaching in each block. For example, understanding ischemic heart disease and heart failure, during the circulation and respiratory block, students will learn the anatomy, histology and physiology of the heart and blood vessels including lungs that they would have previously learned in separate courses. Additionally, they will also be introduced to information from other disciplines as appropriate. Another example, learning about staphylococcus as a prototypical Gram-positive bacterium during the infectious disease block cellulitis is described. They learn about the general principles of the inflammatory response at the same time, thus incorporating material that is currently taught in the general pathology course. Principles of pharmacology may also be introduced early as with specific pharmacological agents, with the level of understanding increasing over the two years with repeated exposures. Undoubtedly, our medical education in Bangladesh has failed to produce efficient professionals considering the need of the people and time. The proofs are plenty. Many a people opt to get medical treatment abroad if their financial ability permits to. There are substantial reports that have criticized medical education for emphasizing scientific knowledge over biologic understanding, clinical reasoning, practical skill, and the development of character, compassion, and integrity. More and more frustrations have been expressed in the Dailies almost frequently and regularly. How did this situation arise, and what can be done about it? Obviously, one of the important causes of this adverse outcome is the education model that we are running. We must feel the need to change the hundred years’ old model to IMC. Successful implementation of an integrated curriculum may face serious obstacles. Sufficient time and determination for faculty to meet together to plan the curriculum is the most critical ingredient for success. The departments and faculties are likely to feel pressure to spend time on obtaining research grants and clinical activities. If these constraints on faculty time and allocation can be mitigated, then the likelihood for success is high. Thirdly, assessment of competence and performance of a medical student is another flaw. Competence is not an achievement but rather a habit of lifelong learning.6 Assessment plays an integral role in helping physicians to identify and respond to their own learning needs. Ideally, the assessment of competence (what the student or physician is able to do) should provide insight into actual performance (what he or she does habitually when not observed), as well as the capacity to adapt to change, find and generate new knowledge, and improve overall performance. We have no mechanism to assess competence and performance of medical professionals. To conclude let us review our glorious history of medicine and the apprenticeship and the philanthropic behavior of the physicians of the past. Let us accommodate the new knowledge in medical education curriculum on a scientific basis. Let our medical students be exposed to primary health care in the community and to be actively involved in research on our own health issues. Let us develop mechanism for the assessment of competence and performance. Let ourselves (the teachers) exercise our honesty and integrity in academic performance, research activities and assessment skill so that our medical students develop attributes of medical professionalism – capable of transmitting knowledge, to impart skills and to inculcate the values of the profession.   Professor, Department of Community Medicine   1.   Bonner TN. Becoming a Physician: Medical Education in Britain, France, Germany, and the United States, 1750-1945. Oxford, Oxford University Press, 1995. 3.   McGaghie WC, Miller GE et al. Competency-based curriculum development in medical education: an introduction. Geneva, World Health Organization, 1978. 5.   Fragstein MV, Silverman J, Cushing A, Quilligan S, Salisbury H, Wiskin C.UK consensus statement on the content of communication curricula in undergraduate medical education. Medical Education 2008; 42: 1100-1107. 2026 Ibrahim Medical College. All rights reserved.