Radical reform of the undergraduate medical schooling program in a creating nation: the Egyptian expertise | BMC Medical Schooling

To organize and implement the supposed modifications within the medical faculties’ curricula, the next are the actions taken and the outcomes achieved  (Fig. 1):

Evaluation of the prevailing scenario

To evaluate the need and scope of the change, the RUMP carried out a complete context analysis, from October to December 2016, to discover the challenges of the normal program from the stakeholders’ viewpoint. A survey was carried out to discover college students’ opinions in regards to the present scenario of medical schooling and the right way to enhance it (Further file 1). The survey was ready by the RUMP committee members and distributed to all medical faculties’ college students as a hyperlink on Google doc by way of the colleges’ deans and medical scholar of EFMSA (Egypt Federation of Medical College students Associations). The hyperlink was out there for 8 weeks. The information had been saved as excel sheet then reworked to SPSS file. Revising and filtration of information had been performed to protect towards any bias or lacking information. Out of round 50,000 medical college students in Egypt in 2016, 2,154 college students from all educational years (one to 6) participated on this preliminary survey. Evaluation of the survey outcomes confirmed that 66.6% of the scholars had been dissatisfied with the normal manner of instructing by lectures and with the evaluation strategies. Moreover, information recall with out testing of upper ranges of pondering and unfairness had been the principle disadvantages talked about by the scholars. Additionally they reported that they had been required to resort to personal tutoring in a number of topics. Moreover, 70% discovered that their faculties’ web sites weren’t helpful. These information had been introduced to the SCU.

A bunch dialogue was additionally carried out with the tutorial leaders (Deans and Vice Deans of Schooling of medical faculties) in a number of periods carried out throughout the common medical sector committee and attended by representatives of the RUMP committee members to get their suggestions relating to the wanted enhancements within the present medical curriculum. Incorporating newer instructing parts within the under-graduation course particularly introduction of a basis course after admission to arrange a scholar to check medication successfully; facilitation of horizontal and vertical integration between completely different disciplines; advocating early medical publicity proper from the primary 12 months (viz. case situations for classroom dialogue/case-based studying); addition of elective programs and strategies to boost self-directed studying, vital pondering and analysis talents had been the principle responses of the tutorial leaders.

Proposed modifications by RUMP committee

To reply to the evaluation of the prevailing scenario outcomes, a number of conferences had been carried out by RUMP committee in 12 months 2016 the place completely different worldwide medical curricula had been reviewed with a view to agree on the proposed curriculum modifications. The committee reached a consensus to formulate and undertake a competency based mostly medical schooling nationwide framework. The committee additionally really helpful efficient monitoring of the compliance of medical faculties in implementing horizontal and vertical integration, self-directed studying, early medical publicity, extra emphasis on medical apply and implementation of credit score hour/level system.

Consciousness marketing campaign for all medical faculties

To orient the medical faculties in regards to the supposed modifications within the medical program, an consciousness marketing campaign began in December 2016 and led to January 2017. All governmental and personal medical faculties throughout Egypt at the moment had been visited. There have been 28 medical faculties at the moment, the general public faculties constituting the bulk. Every go to was carried out by 2–3 RUMP members. The notice package deal included details about the rationale for the change to competency-based medical schooling (CBME), the relevance to NARS-Medication 2017, the definition, significance, sorts and ranges of integration. Completely different fashions of curricula from UK, Europe and Arab nations had been mentioned as effectively.

The notice package deal was delivered to the stakeholders in every faculty together with college students, latest graduates, educational leaders and college members. Not less than 40% of scholars and 30% of college members attended every consciousness campaigns.

Getting ready the framework for reform and getting greater authorities’ approvals

A collection of conferences and focus group discussions had been made between the coordinator of the RUMP, the pinnacle of the Medical Sector Committee (MSC) and the secretary basic of the Supreme Council of Universities (SCU) and the related ministers within the interval from June to September 2017 to suggest the framework of reform and the required modifications within the legal guidelines and bylaws. The required modifications had been authorised by the Ministries’ Council on the 4^th of October/2017 together with modification of the bylaws clause 154, in order that the interval of undergraduate research for the medical faculty in Egypt might be 5 years competency- based mostly built-in program utilizing a credit score system adopted by two years of internship and a licensing examination earlier than apply. The SCU authorised that the brand new program ought to be carried out by all medical faculties ranging from the tutorial 12 months 2018/2019.

Getting ready curriculum maps and bylaws by all medical faculties

After getting the upper authorities’ approvals, two paperwork stating a framework for making ready the bylaws and curriculum maps had been ready by the RUMP committee and issued to all faculties from the SCU to observe in making ready their curricular maps and new bylaws. Steady communication occurred between RUMP members and the curriculum committees in every medical faculty throughout its work on bylaws and map to be prepared for the approval of the brand new reform. In April to June 2018, RUMP members revised every medical faculty curriculum map and bylaws in accordance with a pre-set commonplace guidelines to make sure that every program fulfils the up to date NARS-Medication, 2017 necessities and the gadgets acknowledged in a doc issued from SCU in regards to the framework of the bylaws. RUMP members suggestions was given to the colleges and modifications had been performed accordingly. Earlier than the beginning of the tutorial 12 months 2018/2019 the bylaws of all medical faculties had been authorised by the SCU which is the upper authority.

The framework of the brand new bylaws coated all of the factors that ought to be included within the bylaw reminiscent of: details about the Faculty and College, graduate attributes, imaginative and prescient, mission, strategic goals, academic methods, departments and committees, admission course of, the length of research, this system construction, credit score hours or credit score factors information and lots of different necessary directions relating to complaints, withdrawal, switch, and so on. The bylaw additionally outlined sure necessary gadgets that ought to be emphasised within the curricula that are: 1) description of the built-in modules together with varieties of integration and its stage along with the used instructing strategies that may obtain this integration. 2) the presence of a preparatory interval for the scholars to be oriented with the brand new program and the presence of a research information. 3) Self-directed studying and methods of maximizing it. 4) Early medical publicity. 5) Communication and professionalism and different expertise which can be mandated within the NARS competencies. 6) Electives 7) Analysis methodology and analysis expertise to be included within the early years of this system. 8) Together with formative and summative evaluation along with utilizing new goal strategies of scholar evaluation that measures greater cognitive area and sensible {and professional} expertise. 9) implementing high quality assurance measures on this system.

The principle curricula modifications performed by the medical faculties of their new curricula had been introducing completely different ranges of integration in accordance with the colleges’ infrastructures and private competencies, however all had been exceeding stage 5 in accordance with Harden ladder [20]. Trendy instructing and studying strategies had been used, principally interactive and self-directed. Virtually all the colleges added early medical instructing primarily through the use of medical expertise labs and early expertise with sufferers in numerous medical settings. Many of the faculties launched an introductory module, in 12 months one, making ready college students for additional undergraduate research. All faculties added elective module(s). Analysis methodology was launched into all curricula. Evaluation insurance policies witnessed a dramatic change, getting away from information recall and utilizing goal, structured strategies.

Capability constructing

In preparation for implementation, a school growth program underneath the title of instructing excellence in medical schooling was carried out by the Egyptian Data Financial institution (EKB) in collaboration with the Medical Navy Academy (Further information 2 and three). All through the years 2017—2020, the EKB organized 48 workshops of 430 h in whole. The workshops had been facilitated by 13 skilled academic leaders from the US of America, United Kingdom, Australia and Canada and had been attended by round 300 individuals. The principle areas of coaching had been excellence in curriculum design, instructing & studying and evaluation. This school growth program began in 2017, earlier than the precise implementation of the brand new curriculum, with eight workshops and continued in 2018, after implementation, with ten workshops, one particular service workshop for deans and one seminar convention. In 2019, 22 workshops and one seminar had been carried out. In 2020, 5 workshops had been performed. In parallel, the EKB additionally offered free entry to digital coaching sources, reminiscent of Incision Academy and Digital Affected person Studying to the medical college students in any respect medical faculties. All medical faculties benefited from EKB companies and 81,086 college students logged in to the Incision Academy portal. The carried out workshops had been thought of a coaching of trainers (TOT) for persevering with coaching of all concerned school in all faculties. Along with this TOT, every medical faculty began its personal school capability constructing with the help of RUMP members. The analysis carried out by EKB for the school growth program in 2019 revealed that the responses of individuals had been as following: 97% acknowledged that the programs met their expectations, 87% affirmed that they’d suggest the programs to their colleagues, 87% stated that they imagine their skilled work will enhance on account of the programs and 88% rated the course chief’s information as above common/excellent. The analysis carried out by the EKB for the 12 months 2021’s programs confirmed that the overall satisfaction fee of the individuals was 96%. The responses had been: we gained invaluable new concepts or insights from the attended workshops (97.5%), we gained sensible information after attending these workshops (95%) and we are going to share what we realized throughout these workshops with our colleagues (98%).

Beginning implementation

The brand new curriculum mannequin implementation began on September 2018, for the primary 12 months college students. This included horizontal and vertical integration of content material, introduction of an orientation module, stronger medical orientation beginning already within the first semester, extra elective elements and built-in examinations. The curriculum included the modular line elements (principally organ/perform modules lasting 3–6 weeks) supplemented with semester-vertical programs. Every medical faculty chosen the coordinators for all modules of the brand new curriculum after an software course of. These coordinators had the duty of selecting an interdisciplinary planning workforce of at the least six members, together with school members from non-clinical in addition to medical topics. These planning groups had been charged with deciding on the content material which might be coated of their module in addition to the suitable studying strategies.

Monitoring (audit) visits

The RUMP members designed a complete, multicomponent and program-wide monitoring system. The framework expects the standard of this system as comprising 4 principal elements: curriculum and sources; employees and instructing; scholar expertise; and administration help. Key rules of the adopted audit included suggestions kind college students and employees, auditing of instructing, studying and assessments strategies. An emphasis on corrective actions following analysis was included (closing the loop), which was undertaken by academics, course coordinators, and directors. An exterior auditing guidelines was ready by the RUMP committee to be stuffed by the assigned auditors. The guidelines included readiness of the bylaws, program specs, course specs, the curriculum matrix, the motion plan, instructing and studying strategies (interactive periods, problem-based studying (PBL), self-directed studying (SDL), simulations, subject visits and sensible/medical coaching), in addition to particulars of the evaluation course of (technique, blueprint, formative evaluation paperwork and summative evaluation instruments).

4 conferences had been held with the auditors who embody the RUMP committee members along with a particular group of college members from completely different universities who’ve {qualifications} and expertise in medical schooling. One assembly was held firstly of the tutorial 12 months 2018/2019 to standardize the auditing course of and focus on the gadgets of the exterior auditing guidelines with the auditors. The opposite conferences had been held earlier than every cycle of monitoring visits. Three in-person monitoring visits had been carried out: two within the first 12 months of implementation (as soon as per semester) and the third one within the first time period of the tutorial 12 months 2020/2021. The third go to occurred throughout the evolving COVID-19 pandemic. Due to the COVID-19 lockdown, auditing within the educational 12 months 2020/2021 was paused. In every auditing go to, two assigned RUMP members visited every faculty. The auditing visits in 2021 had been principally performed on-line.

The stuffed checklists had been included in a remaining report. Usually, the auditors discovered that this system specs had been ready in virtually all the schools by the 2020 audit. Conversely, the alignment matrix between the 2017 NARS-Medication and program supposed studying outcomes (ILOs) had been accomplished in about three-quarters of the schools visited. The reform motion plans that had been formulated by the schools to deal with the feedback of the audit reviewers had been carried out in 71% of colleges within the first audit and 80% within the second spherical of the audit.

College students’ and college suggestions after implementation

To evaluate the scholars’ and college’s factors of view after implementation, questionnaires, designed by RUMP committee, was distributed to all medical faculties by way of a survey monkey software. The primary scholar survey (Further file 4), carried out in 2019, obtained 9,044 responses. College students reported that the preparatory interval and research guides had been helpful (70%), the interactive instructing strategies had been fascinating (50%), the academics spent efforts on their coaching (50%) and so they used the colleges’ web sites (40%). The second scholar survey (Further file 5), carried out within the 12 months 2020, obtained a complete of 18,655 responses. The scholars’ principal responses had been that the training outcomes had been effectively defined (60%); the web sites had been helpful (60%); they obtained coaching in analysis and medical expertise (40%); that they had programs in communication and ethics (50%); and electives had been utilized (40%). Fifty % of the scholars had been glad by small-group instructing, medical instructing and formative and steady evaluation (50%). Moreover, 40% of the scholars expressed their satisfaction relating to E-learning and the obtained suggestions.

Concerning suggestions of the school members, their implementation survey (Further file 6) elicited 1,911 responses. About 95% acknowledged {that a} workforce exists for implementation of the built-in medical program of their colleges. Half of the respondents indicated their involvement within the implementation of this system. About 70% of the respondents obtained coaching both by way of the EKB or of their school in regards to the idea of integration, its design and implementation. Solely 60% obtained on-line coaching for instructing and evaluation and 70% of the respondents acknowledged that their college students obtained instructing in small teams.

Dealing with the pandemic

So as to handle the instructing and studying actions throughout the COVID-19 pandemic, all the schools adopted a blended studying method of on-line and on-campus actions. Within the auditing visits, auditors seen that many of the colleges used the Microsoft Groups platform in addition to the EKB sources. The utilized EKB sources included the Incision Academy and Digital Affected person Studying. Though free entry to the EKB studying administration system was offered, some colleges carried out the open-source studying platform MOODLE (Moodle Pty Ltd, West Perth, WA, Australia) and continued to make the most of its choices throughout the pandemic.

Conversely, variable approaches occurred for the evaluation course of throughout the pandemic. Most colleges used on-line formative assessments to inspire the scholars studying. Concerning remaining written assessments, some colleges used on-line assessments, whereas different colleges requested that college students submit evaluate articles that had been uploaded on-line. Contemplating the sensible expertise, they had been assessed by goal structured sensible examination (OSPE) on campus with the applying of all COVID-19 prophylactic procedures.

Challenges of implementation reported by auditors

Throughout the implementation of the brand new medical curriculum, RUMP explored the challenges by questioning the auditors who met representatives of college, college students and leaders of medical faculties throughout the monitoring visits. Their solutions might be summarized within the following factors:

• Skepticism and resistance had been discovered from some school members who felt that such younger college students can be unable to undertake self-directed studying. School members of sure disciplines expressed considerations that the brand new scoring system within the built-in curriculum, which assigned scores to studying outcomes quite than disciplines, would encourage some college students to disregard topics that contributed a small share in some modules. As a result of the built-in modules adopted a standard sequence, some school members argued that this order was essentially the most appropriate one for his or her disciplines. Some believed that shifting the scholars into the modular system wouldn’t present a superb base of the required information in all disciplines. Others noticed that the built-in system required that instructors should change the best way of instructing, which that they had been adopting for a very long time. Collaboration with colleagues from different departments would even be wanted to plan courses. In different phrases, they’d be required to make an additional effort that they used to do within the authentic curriculum.

• Many college students complained of marked overload within the content material of some modules, apparently as a result of some departments didn’t do sufficient effort to tailor the content material to the shortened time of their disciplines.

• Early medical publicity couldn’t be satisfactorily achieved in some medical faculties due to the big variety of college students and logistic difficulties in securing the required coaching locations.

• Some RUMP reviewers reported that in some medical faculties, the extent of horizontal integration was restricted to synchronization with out precise alternate of fabric and academic plans to make sure correct sequencing of academic actions.

• In some faculties, examinations, particularly within the first 12 months, largely addressed recall with a small proportion of questions dedicated to testing greater cognitive ranges.

• Lastly, the COVID-19 pandemic introduced an additional burden throughout the implementation.