MEDICAL EDUCATION: WHICH WAY FORWARD?*
Arab and Muslim physicians, such as Ibn Sina, Al-Farabi, Ibn Al-Nafis and Ibn Al-Haitham, besides being physicians were astrologers, philosophers or Muslim scholars. In the nineteenth century apart from Grey’s Anatomy, medical students in Europe had to study the Bible and Shakespeare.
In those days, the doctor was a family physician who invested his time in a close relationship with his patients and the community. But things changed, especially after the Second World War. When medical education started to become more specialized, the emphasis shifted more to the affected organ rather than the person as a whole. Doctors became more hospital-based and less involved in the community. Medical education was characterized by lectures and didactic teaching. Teachers lectured to their students and expected them to reproduce what they had learned in these lectures in examinations.
Pioneered by universities such as Case Western Reserve in USA, McMaster in Canada, Mastricht in Holland and Newcastle in Australia, the content and methods of medical education in industrial countries began to change in the fifties. Innovative medical education which emphasized the educational needs of the students, the use of dialogues and discussions instead of lectures came into being. It also emphasized exposure to the community besides hospital training. The innovative approach stresses integration in medical education: care of the whole person rather than the individual organs.
At the beginning of the 1980's, the World Health Organization (WHO) initiated the slogan: 'Health for all and responsibility of all'. It called for relating medical education to the needs of the community. It stated that health was not just the absence of disease but a state of complete physical, mental, social and spiritual well-being. According to 'WHO' the aim of medical education is to train members of the health team to have deep concern and commitment for prevention.
These new developments and concepts in the content and methods of medical education were welcomed and fostered in Europe by the establishment of a network of community-oriented medical schools. These schools needed innovative teaching methods and expanded the role of medical education to incorporate the needs of the community. Mastricht University in Holland became the headquarters for this network. In three decades, this network has extended to 180 medical schools in 80 countries. These universities are more concerned with health services and medical research.
With the rapid advances in technology and the dissemination of information, the Internet had become a rich source of scientific knowledge and an effective means of communication between students and teachers. The portable laptop is seen daily in medical schools. Skill laboratories have been developed making it possible for students to be trained on clinical and pre-clinical skills by means of the computer and polythene polymer models.
Until recently, it was thought that 'distance learning;’ was applicable in every field except medicine. The International University of Health Sciences, in the Caribbean, challenged this and started the first medical school with students based outside its boundaries. Its students are scattered all over the US and beyond. Students study under supervision using learning materials reaching them through the Internet. Laboratory and clinical training is done in hospitals nearby through special arrangements with those hospitals and their faculty. The university is committed to maintaining the same standards as obtained in other conventional medical schools and graduates of this university have the same job opportunities as those from other schools.
What about the future? One may ask. It is expected that the innovative approach in medical education would prosper to produce physicians and health professionals who would become agents of change in their communities. The next few years will bring in more of these developments in content and methods of medical education. It is hoped that there would be some integration of medical education, health services and the community.
It is expected that clinical and preclinical departments would train medical students in preventive and promotive aspects of their specialties to produce graduates who would integrate prevention with cure, and have a perception of the patient as a whole human being of body and soul. It is hoped that there would be an emphasis on the training of an integrated health team in which there are no barriers between medical departments nor between medical colleges and the community. It must be emphasized that health is the responsibility of all; not only that of the health institutions: whose aim should be the promotion of health rather than the cure of disease. The initiative is to be taken by people to help themselves and their communities.
Innovative medical education will progress. More and more medical schools will take up the challenge. This would increase students' capabilities of self-learning, communication skills and prepare them for life-long learning.
The scope of 'cooperative education' would expand beyond collaboration between colleges to partnership between medical education institutions, health services and the community. The result would be reflected in the redefined educational objectives, and re-orienting curricula. On-the-job training would be another feature. The utilization of information technology to improve basic and continuing medical education would increase. Students would be more positive and self-reliant in obtaining and using knowledge and in communicating with their colleagues and teachers. Medical education would be more accessible, not be limited to college or hospital. Students would be able to work and study at the same time. The role of the teacher in the classroom would change for the teacher would be a facilitator who prepares students for self-learning rather than one who presents information didactically. The classroom with its computer and other communication technology would enhance learning.
There are of course, limitations to progress. Modernization should not be our only goal. We should occasionally pause to as what our aims are. Though modernization is desirable, we should not lose sight of our ethical values and heritage. Ultimately our goal should be to promote health, enable and empower people to take responsibility for their own health.
Zohair A. Sebai
Professor of Family & Community Medicine
& Member of the ‘Shura Council’