Medical studies especially at the undergraduate level (MBBS) are considered to be one of the most demanding, where students follow a hectic study schedule with a single aim to secure passing marks. While same level of effort in any other discipline would secure more than satisfactory grades. I would like to propose my recommendations on restructuring the existing system, so as to reduce unwanted burden on medical students, while improving the standards of training and education of the future doctors.
Before I discuss changes in the existing structure, let’s review the current undergraduate medical education system in Pakistan. The complete undergraduate studies are covered in total of five years, with annual examination system implemented, which is further divided into following four professional examinations.
§ 1st professional, having two years duration, includes basic medical sciences i.e. Anatomy, Physiology, Biochemistry
§ 2nd professional includes Pharmacology, General Pathology, Microbiology, Forensic Medicine
§ 3rd professional includes Special Pathology, Community Medicine, Eye, ENT
§ 4th professional includes Medicine, Surgery, Gynecology & Obstetrics, Pediatrics
In addition, few institutions follow a teaching methodology in which clinical and more practical subjects are started from the initial years. This methodology aims at introducing practical approach from the beginning to improve the understanding of clinical knowledge and concepts. But this is done at the behest of further increase in study load, while the traditional burdens associated with notorious medical education system are still there. The situation is further exacerbated due to inappropriate integration of the subjects and lack of management and planning. Thus, the students are unable to link whatsoever being taught to them with the clinical scenarios.
In my opinion, a semester system can address these issues and should be implemented in the medical undergraduate education system. I strongly believe that implementing such a system can drastically improve the standard of training and education while subsidizing the unwanted burden on students. Following are my recommendations which briefly discuss the overall sketch of such a system.
Presently five years are allocated for the training of medical students at the undergraduate level. It can be divided in to ten semesters, with each semester having six month duration. For the basic medical sciences, first three semesters can be allocated. It will divide the basic medical sciences in to three parts which will ease of the burden and help students to grasp the basic concepts, which will ultimately help them in the future clinical years. Such effects were previously seen when the basic medical sciences was divided in to two parts, which improved the performance and reduced the workload on students. So if divided into three parts, this burden will be further reduced and students will be able to cover basic medical sciences with relative ease. In addition, dividing basic medical sciences into three semesters will reduce the total time allocated from 24 months to 18 months, thus allowing students to move in to the clinical years earlier for which they are usually excited.
Next semester can be utilized to cover the subjects such as forensic medicine and general pathology and provide students with basic knowledge about clinical methods and how to approach the clinical years. These are relatively easy subjects which can be amicable covered in one semester time. In addition they will ease the transition of the students from the years of basic medical sciences to the clinical years.
Next are the clinical years, as per the existing structure, clinical years are divided in such a way that complete pharmacology is taught in third year, complete pathology in fourth year and surgery; medicine in the final year. This approach depicts a subject oriented training methodology, which in my opinion should be a whole body/organ approach. Presently students have to study each system again and again with each of the clinical subjects. This has resulted in lack of clinical and practical approach for the medical undergraduate students thus encouraging cramming. Moreover this has not only amplified unwanted burden on students, but has also resulted in difficult understanding and overlapping of concepts.
My suggestion would be to divide the whole body systems in to six equal units, with one unit covered in one semester. For example, cardiovascular system and respiratory system can be considered as one single unit and pharmacology, pathology, surgery and medicine of corresponding unit can be taught together during the semester. This will not only help students focus on a single unit and help them improve their concepts and understanding, but it will considerably reduce fatigue and burden on students because they won’t be required to learn each system again and again with each subject. In addition, this will also encourage students to have practical approach towards subjects and will generate interest among students which will greatly help them apply their knowledge when they enter into practical life.
Now we are left with six subjects and each of these subjects can be accommodated with ease in the last six semesters. For example, Microbiology in 5th semester, Community medicine in 6th, Eye in 7th, ENT in 8th, Pediatrics in 9th and Gynecology & Obstetrics in 10th semester.
This system might have some flaws which can be addressed through debate, discussion and evolution, but as a medical student, I strongly believe that implementing such a system would greatly help improve the medical undergraduate education and training structure of Pakistan by not only improving the standard and quality of education, but also to reduce the unwanted burden on students.
About the Author: Sairam Ahmed is a medical student at Army Medical College, Rawalpindi, Pakistan. He holds interest in medical research and writing and has been receiving merit scholarship for high grades in his medical college. He can be reached at: [email protected]
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