Looking Ahead

/Looking Ahead

Brief summary of curriculum renewal of MBBS course

The curriculum renewal has been initiated by the Principal, Dr. Anna B. Pulimood, along with her team of Vice Principals – Dr. Solomon Sathishkumar (UG), Dr. Simon Pavamani (PG), and Dr. Judy Ann Joseph (AHS) – with the help of Dr. Anand Zachariah, Professor of Medicine, to examine the whole of the MBBS course towards the college centenary. It is an internal reflection process that attempts to help all the participants of the educational process (teachers, administrators, students and other stakeholders) to examine the CMC MBBS education against the goals of training and based on this analysis,initiate changes in the curriculum and educational process. The curriculum renewal is a participatory process with involvement by teachers in every department and course who are working towards strengthening their own teaching and curriculum.

There are two central ideas of the curriculum renewal: Contextual curriculum and the teacher as a designer, researcher and change agent.

Contextual curriculum

The central idea of the curriculum renewal is that of a ‘contextual curriculum’ that aligns education to the health needs of society and the community context. In doing so we believe that medical education at CMC may work with the CMC hospital services, community programmes and the mission hospitals towards strengthening health care in our country.

In a developing a contextual curriculum there are 4 steps:

  1. Identifying priority health problems
  2. Contextual knowledge
  3. Contextual practice of medicine
  4. Education within contexts in the community.

Teacher as the designer, researcher and change agent

The curriculum renewal envisages the teacher as the change agent for the new curriculum. We are encouraging teachers and the departments to examine their teaching in relation to the goals of training and initiate curriculum projects towards addressing these gaps. The teacher in the new curriculum is envisaged as a researcher in the classroom. The teacher designs action research to answer practical questions that they have in relation to their teaching. They plan, initiate changes, examine what happened and reflect on their experience. In doing so we are using teacher led action research as one of the approaches of the curriculum renewal.

Preparatory phase

In the preparatory phase of the curriculum renewal (January-June 2017) the following have been completed:

  1. Goals of undergraduate training
  2. Competencies for each discipline
  3. Department level discussions of developing plans for the curriculum renewal
  4. Group discussions of special programmes
  5. External advisors visit to CMC
  6. Formulation of a Curriculum renewal report

Goals of undergraduate training

Medical graduates of Christian Medical College, Vellore, should be professionally excellent and socially conscious doctors who will work, in the spirit of Christ, towards improving health and providing healthcare for the people of our country.

They should be:

  1. Professionally excellent and contextually relevant: with competence in primary and secondary medical care, as well as tertiary care, and a commitment to continued scholarship and analytical thinking.
  2. Compassionate, dependable and caring: with special concern for the poor, disadvantaged and marginalised.
  3. Ethically sound: with personal and professional integrity, upholding the highest standards of the profession.
  4. Socially conscious: with a public health perspective and a sound understanding of the social dimensions of health and health care, and responsive to the needs of society
  5. Committed to team work: respecting the diverse roles of team members and providing leadership when required.
  6. Agents of change: making meaningful interventions to address unmet needs and making a difference for good wherever they are.

Activities of the curriculum renewal

The five main sets of activities of the Curriculum renewal:

  1. Departmental plans for the curriculum renewal and plans for strengthening existing educational programmes
  2. Developing and implementing the skills curriculum
  3. Strengthening internal assessment system
  4. Strengthening of secondary hospital training in mission hospitals
  5. Service Learning towards change

A. Department level and special programme plans for the Curriculum renewal

An important part of the curriculum renewal is the department level discussions. Each department has prepared a competency list. We are asking each department to review its teaching against the competency list and goals of training. They are being asked regarding the problems that they face and what changes they would like to make in their teaching. See below table regarding approaches to department teaching from the Curriculum renewal report.

Departmental teaching

Curriculum element Description
Departmental teaching Each department will examine their teaching from the perspective of the new goals of undergraduate medical education’ and the departmental competency lists. They will make detailed plans for addressing the problems and gaps. This may involve:

  • Improved use of classroom teaching time
  • Ensuring learning in small groups through their practical training
  • Developing competence for primary and secondary care
I MBBS Basic sciences Enhancing early clinical exposure

Revising and contextualising basic sciences in later clinical years

II MBBS (Lab sciences) Enhancing the clinical inputs relevant to laboratory science training

Revising and contextualising lab sciences in later clinical years

II MBBS Clinical subjects Strengthening basic skills development

Exposure to common cases

Developing basic procedural skills (e.g., first aid, BCLS)

Involvement in patient care and follow-up of cases

III MBBS Clinical subjects Addressing problems in clerkship in Medicine, Surgery and Paediatrics

Clerkship orientation in Orthopaedics and Gynaecology

Reviewing, revising and contextualising basic and laboratory sciences at the bedside in later clinical years

Community health training Review and strengthening of COP, CHP and internship training
Family Medicine training Enhancing the emphasis of Family medicine training. Clerkship in Family medicine in III MBBS Part 1
Primary and secondary care orientation in training It is suggested that each department should emphasise primary and secondary orientation in their teaching through lectures, clinics and laboratory practicals.
Skills curriculum Faculty and departments will be involved in preparing a list of clinical and procedural skills.

A curriculum should be prepared towards developing these skills in a staged manner through the course.

The skills laboratory should be upgraded with mannequins, required infrastructure and staffing.*

Students should be periodically assessed on these skills according to the stage of the curriculum and given remedial feedback.

They must demonstrate proficiency in these skills and be competent in these before leaving for the service obligation.

Assessment We must augment the university examinations with internal assessments that are relevant to practice. This will involve emphasising the goals of training and departmental competencies in assessment.

B. Developing and implementing the skills Curriculum

Planning simulation-based skills teaching alone without assessment is not enough because assessment drives students to take skills learning seriously. Therefore, we need to build simulation-based assessment, into the curriculum both ‘of’ and ‘for’ learning.

When assessing students, we must choose to test the skill sets appropriate to their level, and emphasise those that are most relevant to our local needs. The assessment tools, both those for objective, (e.g., physical examination) and so-called ‘subjective’ domains, (e.g., doctor-patient communication), need to be developed with the support of different teachers.

Formative assessments ‘of’ learning, should be done mainly to provide feedback to the student and allow for targeted remediation. Developing and delivering these assessments is time consuming and labour intensive and will require protected faculty time.

The current equipment and infrastructure are inadequate and we are working towards developing a fully functional skills laboratory. To start with, each of the participating departments in the skills training group have prepared a list of basic skills that can be assessed for UGs at each level (e.g., 1st year, 2nd year). The skills laboratory requirements (e.g., physical space, mannequins, part-task trainers) and staffing are being determined. Most important, thought should be given to how simulation-based instructional activities can be integrated into the curriculum.

Plans for the skills curriculum

The skills group will focus on procedural competency training for a basic doctor who can function at primary and secondary level.

Objectives for this year are:

  1. Develop a procedural skills curriculum for the basic doctor
  2. Set up a functional skills lab
  3. Implement the procedural skills curriculum

C. Strengthening of assessments

Renewal of the curriculum at CMC will demand a much broader look at assessment practices.

Ensure that curricular changes are reflected in the assessment content

Students are driven to study what they are tested on. If the assessments do not match the curriculum, the students will not learn the important material. One of the most efficient ways to move the curricular reform process along is to start modifying the assessments. These assessments do not need to be summative in nature and should foster learning.

Renewing internal assessment

The assessment group has worked on this topic. Internal assessment methods of each of the departments have been compiled. Currently, the internal assessment of the majority of departments is tailored according to the university examination system. The university examination system focuses on essays, short notes, and cases for practical examinations. Higher level conceptual knowledge and practical skills are, in general, not assessed in the examinations. While the CMC curriculum orientates students to practical medicine, students are understandably more interested in meeting the minimum requirements for passing the university examination.

Each department has developed a list of competencies for the basic doctor, comprising the skills and conceptual knowledge necessary for practice. We need to see how these can be prioritised in the internal assessments. If students understand what practical skills are required, and how these are assessed in addition to the university examinations, then the proposed assessment system is likely to work much better. This will demand the development of high-quality clinical assessments, mostly formative in nature, some of which may be based on simulation.

Development of the assessment system must be accompanied by teacher and assessor training, as well as by administrative and supportive systems. The training might include MCQ development, clinical skills development, rater training, quality assurance methods, feedback and debriefing. Some of this has already been started in CMC. The quality assurance processes that should accompany the assessment system will require design and development.

D. Secondary hospital training in mission hospitals as part of the Curriculum renewal

A unique aspect of Christian Medical College education is the linkage to mission hospital network and the use of this network for training. These hospitals form a significant educational resource for CMC, the teachers, the patients and the community programmes. They are part of our training network for the secondary hospital programme. If we harness their potential, support them and involve them in a bigger way, this will have benefits for our training and also strengthen the services in these hospitals. Secondary hospital training in mission hospitals could thereby play a significant role in the curriculum renewal.

Secondary hospitals provide an exposure to the needs in these locations and prepare graduates for their service obligation. Clearly the practice of medicine and the challenges are very different from that at CMC. People who work here are extremely committed, they are clear about what they are doing and have learnt to practice in these circumstances. The SHP programme already exists. So the question is, how to build further on our teaching using the mission hospital network. There are several suggestions that will be taken forward.

The overall changes are to increase the number of hospitals, reduce the number of students going to each hospital and strengthening assessments.

Strengthening SHP 1 (2nd year)

Groups of 6-7 students will be posted to each hospital for 2 weeks. The posting will be planned for greater flexibility so that hospitals can organise it to their strengths. A need based community project on a local health issue will be planned.

Strengthening SHP 2 (3rd year)

The SHP 2 will be planned as a secondary hospital clerkship by posting groups of 4-5 students for 3 weeksto each hospital. They would be involved as a sub-intern in all aspects of clinical work to develop skills in secondary care medicine.

We will be conducting a workshop with secondary hospital faculty towards making these changes.

E. Service learning towards change

This educational project is towards the last goal of MBBS training:

Overall Goal – “Making meaningful interventions to address unmet needs and making a difference for good wherever they are”

The academic curriculum for undergraduate medical students at CMC contains several community oriented and secondary hospital based educational components that serve to sensitise students to medico-social needs and challenges in India. The “service learning towards change project” is planned as yet another link in this educational chain.

The “service learning towards change” is a 6 month long optional educational activity for I clinical year students, aimed at sensitizing undergraduate medical students to medico-social issues in the local community. The activity involves supporting student interventions towards addressing these issues. It involves student groups participating in socially relevant projects such as community education, community service, outreach and advocacy. Each project will be guided by one faculty member.

Current status of the curriculum renewal

Each of the educational initiatives are in various phases of implementation. The implementation will be completed over the academic year 2018-19. The curriculum renewal process has been a bottom up process of encouraging departments and teachers to make changes towards aligning their education towards the goals of training. Various departments have taken the opportunity for the curriculum renewal enthusiastically. We hope that the renewal process will strengthen the institutional capacity to reflect on the educational processes and make ongoing changes towards a relevant and contextual medical education.