Medical Curricular reforms

Changing needs of the society, advances in scientific knowledge, and innovations in the educational field necessitate constant changes in medical school curricula. Dedicated efforts of effective change agents can bring about successful curricular change. Those who direct curricular change initiatives at medical schools need to consider the factors that promote or inhibit the change process. A series of reports published in Academic Medicine under the banner - “A Snapshot of Medical Students’ Education at the Beginning of the 21st Century: Reports from 130 Schools” - outlines the current thinking, the curricular reforms that have been initiated, and the
future direction that medical education is likely to take in 130 of the 141 accredited medical schools in the US and Canada. Importantly, these changes have occurred without a major influx of money or additional resources and have been due to a dedicated group of faculty and administrators responsive to societal needs. The innovations pertain to curriculum management and governance structure; establishment and role of offices of education; budgetary support for educational programs; creating a culture that A few of the curricular change initiatives deserve detailed mention here. Several US medical schools introduced early community-based training models for longitudinal clinical experiences. The outcomes of these curricular changes indicated that community experiences contribute positively to students’ education, critical thinking, and problem-solving skills. The students value early clinical experiences and make important achievements in clinical skills and knowledge development. However, logistical challenges exist in conducting these courses. Development and administration of the medical school curriculum by an interdepartmental faculty committee,comprising members from clinical as well as basic science departments, rather than individual departments may help achieve integration between departments. This would enable the participation of clinicians in basic science instruction of medical students. The existing basic science departmental administrative structure may continue, but the curriculum need no longer be the responsibility of the individual basic science departments. Several medical schools have also attempted innovations in the teaching of basic sciences to integrate basic and clinical science content and to promote active student learning.5 Introduction of problem-based learning (PBL) has been one of the most dramatic changes. Medical Education in India remains steeped in the traditional paradigm with a few efforts by several “forward-looking” schools seeking alternatives. Many stakeholders, including students, graduates, faculty,medical educators and members of the community, have criticized traditional Medical Education. Particularly problematic has been: compartmentalization among departments; lack of integration of course material among departments; absence of inter-departmental coordination leading to poor coordination between the material taught in basic science courses and clinical sciences; and ongoing adherence to traditional didactic pedagogic methods of instruction where significant alternatives abound. These are important issues.
The National Health Policy (1983) of theGovernment of India provided direction to restructuring the curriculum. Undergraduate medical education was to aim at training a Primary Care Physician capable of providing essential health care services to the rural population - one who is capable of diagnosing and treating common ailments of the community. In 1986, a consortium of Indian medical schools was formed. The consortium adopted an Inquiry Driven Strategy for Innovation in Medical Education and addressed the key issues of evolving a revised curriculum, defining the departmental objectives, classifying the course content as ‘Must Know’ and ‘Desirable to Know’, formulating Educational Objectives, and compiling a list of essential skills required for a Competent Primary Care Physician. The Medical Council of India (MCI)organized a National Workshop in 1992 for debating a Need Based Curriculum for Undergraduate Medical Education. The year 1997 is a major landmark in the history of Medical Education in India. The Government of India, on the recommendation of the MCI, promulgated the “Regulations on Graduate Medical Education” through a gazette notification. The MCI guidelines stipulate that undergraduate medical education should be oriented towards health and community as opposed to disease and hospital. It recognizes ‘Health for all’ as a national goal and health right of all citizens. The graduate must develop humanistic qualities in discharging professional obligations and be able to function as leader of the health team in urban and rural settings He must be competent to diagnose and manage common ailments and must be familiar with National Health Programmes and receive adequate training in maternal and child health care, management and control of communicable and non-communicable diseases, sanitation and water supply, and health education of the community. Students’ training must aim at inculcating
scientific temper, logical and scientific reasoning, clarity of expression, and ability to gather and analyze information. Methods aimed at fostering self-directed learning and lifelong learning must be part of the teachinglearning process with greater emphasis on learning in small groups and didactic lectures should not exceed a third of the hours allocated to a subject. In a major restructuring, Phase I of the undergraduate medical course was reduced to one year. It requires integration among traditional subject areas using problem based learning approach and calls for horizontal integration among these subjects. Teaching of basic science subjects should be
clinically oriented and the student should receive additional learning experiences in these subjects during clinical years to ensure vertical integration. Student assessment should be by objective methods and student activities documented in logbooks and used for providing formative feedback.