Evolution of the Undergraduate Curriculum at the College of Medicine, King Faisal University
1989; King Faisal Specialist Hospital and Research Centre; Volume: 9; Issue: 1 Linguagem: Inglês
10.5144/0256-4947.1989.64
ISSN0975-4466
AutoresM. Hisham Al‐Sibai, Hussein Al-Freihi, Abdelhamid M. Lutfi, Suleiman Al-Mohaya, Qadi Al-Magbool, Mohammed El-Mouzan,
Tópico(s)Problem and Project Based Learning
ResumoSpecial CommunicationEvolution of the Undergraduate Curriculum at the College of Medicine, King Faisal University Mohamad H. Al-Sibai, Facharzt Hussein M. Al-Freihi, MD Abdelhamid M. Lutfi, PhD Suleiman A. Al-Mohaya, MD Qadi Al-Magbool, and Facharzt Mohammed El-MouzanMD Mohamad H. Al-Sibai From the Office of the Dean, Academic Affairs and Clinical Affairs, College of Medicine and Medical Sciences, King Faisal University, Dammam Search for more papers by this author , Hussein M. Al-Freihi Address reprint requests and correspondence to Dr. Al-Freihi: P.O. Box 40006, Al-Khobar 31952, Saudi Arabia. From the Office of the Dean, Academic Affairs and Clinical Affairs, College of Medicine and Medical Sciences, King Faisal University, Dammam Search for more papers by this author , Abdelhamid M. Lutfi From the Office of the Dean, Academic Affairs and Clinical Affairs, College of Medicine and Medical Sciences, King Faisal University, Dammam Search for more papers by this author , Suleiman A. Al-Mohaya From the Office of the Dean, Academic Affairs and Clinical Affairs, College of Medicine and Medical Sciences, King Faisal University, Dammam Search for more papers by this author , Qadi Al-Magbool From the Office of the Dean, Academic Affairs and Clinical Affairs, College of Medicine and Medical Sciences, King Faisal University, Dammam Search for more papers by this author , and Mohammed El-Mouzan From the Office of the Dean, Academic Affairs and Clinical Affairs, College of Medicine and Medical Sciences, King Faisal University, Dammam Search for more papers by this author Published Online::1 Jan 1989https://doi.org/10.5144/0256-4947.1989.64SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutAbstractThe curriculum of the College of Medicine, King Faisal University, Dammam, has been subjected to vigorous and continuous evaluation since the establishment of the College in 1975. As a result, the curriculum was reviewed twice, and appropriate alterations were made. This study highlights the reasons that initiated the reviews, the process by which the information was collected and interpreted and how the findings were acted on.IntroductionThe College of Medicine, King Faisal University, is located on the Gulf shore at the outskirts of the City of Dammam in the Eastern Province of Saudi Arabia. It was established in 1975 to fulfill several goals, including the following objectives:To help the students acquire a code of ethics that relates Islamic values and heritage to their personal behavior and professional practice.To provide its graduates with maximum potential to differentiate into the various types of physicians required to meet present and future health care needs of the Kingdom.To impart a body of knowledge which is basic to the understanding of human structure, development, and function, and the common derangements of the various body systems.To impart those skills that are fundamental to the application of the knowledge to physical, mental, and social problems.To foster attitudes which will enhance the physician's ability to care for people, to work with other professional colleagues, and to achieve personal development and satisfaction.To allow opportunities for the pursuit of academic interests inside and/or outside the requirements of professional education and training.To encourage and to emphasize the importance of the process of self-education.To promote the ability to communicate effectively in both Arabic and English to enable its graduates to participate in translating and assembling a relevant Arabic medical literature.FROM THE FIRST TO SECOND CURRICULUMAt its inception, the curriculum for the College of Medicine, King Faisal University, was planned for 7 years: 4 years of premedical and preclinical sciences, 2 years of clinical training, and 1 year of internship. In the first 4 years, courses were taught over a whole year, i.e., an annual system, with final examinations held at the end of each year. In the remaining 3 years, clinical subjects were taught in rotations. Year 5 was devoted mainly to the four main medical specialties: general surgery, general medicine, obstetrics and gynecology, and pediatrics. With the exception of ophthalmology and otorhinolaryngology, which were assigned 2 weeks each at the end of year 5, the remaining subspecialties, together with primary care medicine, were taken in year 6, which also included 8-week elective periods. Final examinations were held at the end of each clinical rotation in years 5 and 6. The internship period was devoted to the four main specialties, primary care medicine, and 8-week electives. All interns were then required to pass a written examination in clinical medicine in order to graduate.The above 7-year curriculum was not implemented in full: the results of the examinations in premedical subjects for the first two classes of students, with 70% failures in some subjects, called for a review of all aspects of the curriculum. Several committees were assigned this task.RESULTS OF THE FIRST REVIEWA Curriculum Committee interviewed individual staff members and students and held several meetings with department heads. The following is a summary of the findings of this Committee and the changes effected in the curriculum as a result.Students' English language proficiency was found to be well below the required standard. Hence, it was decided to devote the whole first semester of year 1 to English language instruction (a total of 450 contact hours). Premedical courses were started in the second semester of year 1, which also contained 270 contact hours of instruction in scientific English.It was also argued that the time assigned to premedical courses was not adequate to cover material that students needed for good understanding of preclinical and clinical subjects. Therefore, the content and time needed for the premedical courses were increased; e.g., physics was assigned a total of 224 contact hours instead of the earlier 96 contact hours, and general biology was raised from 144 hours to 224 hours.The main modification in the curriculum, however, was the change from the annual system to the credit hour/semester system. Under the annual system, all students, despite their varying mental abilities and aptitudes, were expected to learn the same amount of material in the same period of time. As a result, many students' competence suffered. Moreover, when a student failed the final examination in a subject at the end of any of the first 4 years, he/she was permitted to resit the examination before the beginning of the following academic year. If a student failed reexamination, he/she was required to repeat a whole year.Under the credit hour/semester system, each of the premedical and preclinical years is divided into two main semesters (each of 16 weeks' duration) and a summer semester (of 7 or 8 weeks). A credit hour is defined as equivalent to 16 hours of lectures or 16 laboratory sessions, each lasting 2 to 3 contact hours. Several students are supervised by one of the faculty members, who at the beginning of each semester advises his supervisees on the course load he/she should register for, bearing in mind each student's capabilities, course prerequisites, and the scheduling of courses, to avoid timetable conflicts. The upper and lower limits of course loads in each main semester of year 1 were 11 and 9 credit hours, respectively, whereas in a main semester for years 2, 3, and 4, the upper and lower limits were 26 and 15 credit hours, respectively. The maximum credit hour load permissible in summer semester was 8 credit hours.In the clinical clerkships, each week of teaching/ training has been equated to 1 credit hour. Clerkships followed in succession, and hence the semester system was not applicable to years 5 and 6.Under the credit hour system, the student's cumulative grade point average (GPA) must not fall below 1.5 (on a 4-point scale), otherwise he/ she is placed under probation for three semesters. If his/ her GPA does not rise to 1.5 by the end of this probationary period, then he/she becomes liable for dismissal from the college. A GPA of 1.5 is equivalent to 65% marks.The credit hour system therefore requires the students to put a lot of effort into their studies in order to avoid being placed under probation. This is also made possible by the fact that the weaker students can, under the guidance of their academic advisors, register for an appropriate course load, whereas the brighter students are able to register for more credit hours. Thus, each student takes the time that he/she needs to assimilate the subject matter, but in the final analysis all students graduate with comparable competencies. The College bylaws allow a student a maximum period of 9 years (excluding the internship period) to clear all graduation requirements.The objectives of the College were looked into, and each course was restructured to meet these objectives. The following subheadings were used for each course: (1) title; (2) duration, indicating contact hours and credit hours; (3) prerequisites; (4) aims; (5) rationale; (6) objectives; (7) contents; (8) instructional methods; (9) evaluation methods; and (10) references.In premedical and preclinical subjects, students' performance was based on mid-semester tests that carried up to 40% of the total mark, and a final examination at the end of the semester which carried 60% of the total mark. Evaluation in clerkship performance was based on continuous assessment which carried 10% of the total mark, and final examination which consisted of essay (20% to 30%), multiple choice questions (10% to 20%), oral examination (10%), and the clinical component (30% to 50%). In the short clerkships (e.g., 2 weeks), the clinical test carried less weight and the written examination more weight than in clerkships of longer duration.After successful completion of all courses, the student sat for the final certifying examination in two major subjects, medicine and surgery. Those who passed the final certifying examination were considered to have cleared all college requirements for graduation and became eligible for the internship period. The grades obtained in the final certifying examination were not included in the GPA. Then, only after successful completion of the internship was the degree of bachelor of medicine and bachelor of surgery (MB, BS) awarded.The internship period lasted a minimum of 12 months divided as follows: internal medicine (3 months), general surgery (3 months), obstetrics and gynecology (2 months), pediatrics (2 months), and an elective in any of the clinical disciplines (2 months). The internship curriculum was published with clear objectives, and its courses were designed under the same 10 subheadings used for the other undergraduate courses in the first 6 years. During the internship period, the intern is a paid employee, who is assigned patient responsibilities under supervision of the resident and the consultants. His/her progress in acquisition of in-depth knowledge, clinical skills, and correct attitudes is continuously monitored using a standardized format. The intern is apprised of his/her performance periodically during the clinical rotation. In case of unsatisfactory assessment in any of these areas the intern will be required to repeat all or part of the period in the discipline concerned.A quality curriculum required for its effective implementation quality students and quality faculty. Two committees, one for student admissions and one for faculty recruitment, were therefore constituted. The two committees worked separately, but both came to a similar conclusion: the quality of some of the enrolled students and some of the faculty members was below average. This finding resulted in the termination of some of the teaching staff and dismissal of a good number of students who were not able to meet set standards. It was also decided that future student admissions would be determined by satisfactory performance on an admission test and an interview. Recruitment of new faculty members was thereafter dependent on the recommendations of the in-house faculty members, a college recruitment committee, and the interviewing committee. At each stage, the qualifications, teaching experience, research activities, previous employing institutions, publications, and academic standing of the applicant were among the characteristics closely considered.An evaluation form for in-house teaching staff was also introduced. The form included 15 items that reflected the instructor's ability to teach, motivate his/her students, interact with them, and direct their learning experiences. Students were asked to grade each item as excellent, very good, good, fair or poor. Based on these 15 items, each student was also asked to give an overall evaluation of the faculty member using one of the five grades and to indicate whether he/she wished to be taught by that particular instructor again.Other peer evaluation forms, assessing faculty or teaching staff members' performance and qualities by departmental colleagues and committee chairmen, were also instituted.These evaluations were conducted under supervision of the college administration, and the results were used in reaching decisions on renewal or termination of contracts, salary increases, and annual increments.The newly adopted curriculum and evaluation system proved to be quite demanding not only on the students but also on the faculty members. Students' performance, as would be expected, greatly improved; the failure rate dropped to 15% to 20%.The revised curriculum was adopted for 5 years before the call for yet another review became necessary.FROM THE SECOND TO THE PRESENT CURRICULUMThe need for a second revision was triggered mainly by the clinical staff and to some extent by the students themselves, for the following reasons:The time assigned to clinical and preclinical subjects was not well balanced; the latter were getting more time at the expense of the former.The subject load in the first 4 years was distributed unevenly, with obvious overcrowding in the 4th year.Pediatrics and obstetrics and gynecology were taught in year 5 and hence were not included in the final certifying examination.The final certifying examination grades were not computed in the cumulative GPA of the students.New courses were needed to keep up with recent trends in medical education.There was a need to eliminate as much as possible unnecessary repetition and duplication which were then existing between some courses.Prerequisites were in many cases unrealistic and obstructive to students' registration for even the minimum required subject load. Some flexibity was required.The first curriculum review was undertaken at a time when the preclinical and premedical faculty outnumbered by far the clinical faculty. This time the numbers of clinical faculty were greater, and there was need to include their local clinical experience in the curriculum.The new curriculum was reexamined in depth by the College Curriculum Committee. They studied several medical school curricula within the Kingdom of Saudi Arabia, the region, and some Western countries as well as reports made by previous curriculum committees and subcommittees in the College.Several subcommittees were constituted to take a closer look at the clinical scene. Each subcommittee consisted of faculty members representing departments that offered closely related courses, e.g., representatives of the physics, physiology, radiology, ophthalmology, and otorhinolaryngology departments looked into the physics courses; or faculty from the chemistry, biochemistry, pharmacology, pathology, microbiology, anesthesiology, and internal medicine departments considered the chemistry, biochemistry, and pharmacology courses, and so on. Each committee was expected to assess the clinical scene to determine the actual health needs of the community and work backwards. Clinicians identified what a practicing physician should be able to do competently at the end of his/her training, and on this basis, the committee determined what should be included in the preclinical and the premedical courses. In particular, each committee was requested to ascertain that contents are relevant to course objectives and that the latter are based on college objectives to eliminate unnecessary repetition and allocate time thus saved to strengthen the curriculum; and to submit plans and suggestions to improve the curriculum. These subcommittees also entertained the help of other subsidiary committees. As a result almost every faculty member was involved in the review of the curriculum. The task was formidable and the work involved was overwhelming; but it was done.The Curriculum Committee sought feedback from final year students, interns, and residents; this was obtained through an open-ended, anonymous questionnaire. Each of these candidates was required to give his/her candid, frank, and honest views on the following items:Year(s) with overcrowding of courses.Courses that are not appropriate to the medical curriculum.Courses that are assigned more contact hours than they actually need.Courses that need more time to be covered adequately.Courses that contain similar subject matter resulting in unnecessary repetition.Courses that need to be added to the curriculum.Courses that need to be deleted.In light of the findings of the various subcommittees and their recommendations and after close study of the responses to the open-ended questionnaire by the students, interns, and residents, the Curriculum Committee recommended certain readjustments.RESULTS OF SECOND REVIEWThe Curriculum Committee found that there was need to reduce the time assigned to certain courses: biology, chemistry, physics, and some community medicine courses. Hence, the time previously assigned to premedical and preclinical subjects was reduced by the equivalent of nearly one full semester which was then credited to clinical subjects. The distribution of the course load over the preclinical and premedical semesters became more even, and prerequisites for subject registration were reduced to those absolutely required. Successful completion of all preclinical and premedical courses was emphasized as a necessary prerequisite to the clinical phase.An immunology course was added in year 4. Two new courses were also added to the 5th year: emergency medicine and dentistry (2 weeks each). Exposure of medical students to these two disciplines would give them better insight into the general practice of medicine. Parasitology emerged as an independent course to emphasize its importance in tropical disease.Objectives, contents, and application of each course were revised to ensure their relevance to medical practice. Embryology II was also included as part of the gross anatomy courses for closer correlation.The primary health course previously offered in year 6 was transferred to the internship period. The student would have then cleared all other clinical rotations and would be in a better position to benefit from this course.The new curriculum offers a good spectrum of electives. Each student chooses courses equivalent to 4 credit hours.A bachelor of medical sciences degree was suggested. After successful completion of all premedical and preclinical subjects, a student can pursue 1 year of study in a preclinical subject of his/her choice and then take an examination leading to the said degree.Year 6 was devoted solely to the four major clinical subjects: internal medicine, surgery, pediatrics, and obstetrics and gynecology. The end-of-course examination for each of these was abolished; instead, the four subjects were included separately in the final certifying examination, and the grade attained by students in each subject was computed in the cumulative grade average. Satisfactory continuous assessment has become a prerequisite for sitting the final certifying examination for each course.The curriculum retained its 6-year duration plus 1 year of internship. The latter was modified to include 1 compulsory month of primary health care, leaving 1 month for an elective. The internship periods for the four major subjects remained the same.The total number of credit hours in the new curriculum added up to 228, whereas in the previous one they totaled 254 credit hours. Time saved was to the benefit of each student's private study. Table 1 details the newly developed curriculum.Table 1. Curriculum outline.Table 1. Curriculum outline.DISCUSSIONThe undergraduate medical curriculum is the first stage in the professional education and training of physicians. A graduate of such a curriculum should be able to assume an independent role in the delivery of health care and have the potential to differentiate according to his/her inclinations and the present and future needs of his/her country. The role that physicians assume in health care delivery in a changing society, as the case is clearly exemplified by Saudi Arabia, should determine the training they receive. Curriculum planning is, therefore, an ongoing process which should take into account societal needs, so that education and training can be modified as required. Moreover, the rapid expansion in medical knowledge and its application place a serious responsibility on the physician; such responsibility can only be discharged if the discipline of self-education has been acquired.The process of curriculum evaluation proceeds through a number of stages.1 These stages include identifying the problem, establishing a plan, seeking methodological advice, involving the people concerned, collecting qualitative data, identifying issues, recommending solutions, and reaching and implementing decisions. These were the steps followed in this in-depth review of the curriculum at the College of Medicine and Medical Sciences at King Faisal University.An evaluation of a curriculum may arise for a number of reasons. Over the past few decades, reforms in medical education curricula have been initiated partly as a response to the changing needs of society and partly because of the participation of medical educators in expanded opportunities for educational development.2 In addition, an evaluation may ensue when a course experiences problems or difficulties; e.g., examination results may be poorer than expected, students may be exhibiting signs of unrest; changes in staffing levels occur or staff may not be available for teaching, or faculty involved feel unsettled about the course or consider that everything is not well.1 Sometimes curricular changes may be dictated by personal interests of faculty members who insist that their specialty receive favored treatment.3The changes introduced into our college curriculum were in no way dictated by personal interests of faculty or favoritism to any particular specialty, nor did students' protests or pressure skew the evaluation or distort the findings. However, any curriculum plan which disregards the nature of learning and of the learners is bound to be ineffective.4 The clinical faculty have used local experience to determine what the graduate of this college should be able to do competently at the end of 7 years of training.5The curriculum at the College of Medicine, King Faisal University, includes several unique features. The merits of the credit hour system were referred to previously. Other features include the special emphasis placed on community-based learning. This is achieved through learning activities in rural communities, community-oriented projects (e.g., health education nutrition, and child care), and training in health centers and rural hospitals. This does not mean that our college has adopted the fully fledged community-oriented education.6Some integration is achieved through courses such as behavioral sciences, neurosciences, laboratory medicine, and also in clinicopathological conferences during the clinical years, where topics are discussed with full participation of preclinical and clinical faculty. Of course, during the preclinical teaching, relevance of subject matter to clinical practice is highlighted.A number of medical schools adopted a fully integrated curriculum. This model was first introduced by the Case Western Reserve University Medical School, Cleveland, Ohio, in 1952. In the United Kingdom, the University of Newcastle-upon-Tyne did so in 1962, followed by the University of Southampton Medical School. By 1974, the integrated curriculum had been introduced in 25 schools in the United States and in four in Canada.7 In 1969, a more innovative problem-based learning was started at McMaster Medical School in Canada.8 Since then several schools followed: Maastricht in the Netherlands, Xochimi in Mexico, Newcastle in Australia, and in 1979, Gezira in Sudan.9 Only long-term follow-up studies will determine whether these schools are achieving their objectives.Subsequent to the establishment of the problem-based learning approach, several community-oriented schools were established in the eastern Mediterranean region: at the Gulf University, Bahrain; University of Suez Canal, Egypt; Aga Khan Medical College, Karachi; and the University of Sanaa, Yemen. The College of Medicine at King Faisal University will follow-up and consider the experiences of these schools when another review of the curriculum is undertaken.CONCLUSIONSCurriculum review should follow a sequence of logical steps based on accepted educational principles, drawing on the experience of the local faculty and community health needs. With this concept in mind, the curriculum of the College of Medicine at King Faisal University, Dammam, has been reviewed twice and appropriate Improvements introduced. The process is a continuous one, and future reviews will be conducted along similar lines, with special consideration to the experiences of schools adopting the problem-solving, community-oriented approach.ARTICLE REFERENCES:1. Coles CR, Grants JG. "Curriculum evaluation in medical health-care education" . Med Ed. 1985; 19: 405–22. Google Scholar2. Miller GE. Educating medical teachers. Cambridge, MA: Harvard University Press, 1980. Google Scholar3. Eichna LW. "Medical school education, 1975-1979: a student's perspective" . N Engl J Med. 1980; 303 (13): 727–34. Google Scholar4. Taba H. Curriculum development: theory and practice. New York: Harcourt, Brace & World, 1962: 76. Google Scholar5. Bandaranayake RC. "How to plan a medical curriculum" . Med Teacher. 1985; 7 (1): 7–13. Google Scholar6. Hamad B. A three-year-old school on the blue Nile: community-oriented teaching and learning in Sudan. Faculty of Medicine, University of Gezira, Wad Medani, 1982. Google Scholar7. Regional Committee for the Eastern Mediterranean, Health manpower development in countries of the Eastern Mediterranean Region, World Health Organization, EM/RC33/11, July1986. Google Scholar8. Walsh WJ. The McMaster Programme of medical education, Hamilton, Ontario, Canada. In: Personnel for health care. Geneva: World Health Organization, 1978: 69. Google Scholar9. Hamad B. "Problem-based education in Gezira, Sudan" . Med Ed. 1985; 19: 357–63. Google Scholar Previous article Next article FiguresReferencesRelatedDetailsCited byIbrahim E, Al-Idrissi H, Al-Freihi H and Al-Gindan Y (2019) Evaluation of Students' Performance and Examination Procedures in Final Certifying Examinations in Internal Medicine (1982-1988), Annals of Saudi Medicine , 11:3, (325-330), Online publication date: 1-May-1991. Volume 9, Issue 1January 1989 Metrics History Accepted25 April 1988Published online1 January 1989 ACKNOWLEDGMENTWe wish to acknowledge the contribution of all faculty members without which such curriculum evaluations would be meaningless.InformationCopyright © 1989, Annals of Saudi MedicinePDF download
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