Why our undergraduate medical curriculum needs to be reformed

Medical education is improving across the world, with updated methodologies that are essential to develop an efficient, community-oriented, sensitive and compassionate doctor. Unfortunately, our medical education system is still falling short of international standards.

Why don't we change the current framework of the medical education system to an integrated competency-based education? If we dig deeper, we will find several serious barriers in the current undergraduate medical curriculum, and the faulty system contributes significantly to the frustration of young and energetic medicos.

The undergraduate medical curriculum is extensive and students are expected to cover several disciplines at the same time. However, the current medical academic curriculum provides knowledge in a limited manner and does not provide students with the opportunity to develop the skills necessary to explore, evaluate and prepare to view the patient's health holistically.

The unexpected growth of a large number of medical colleges in both the public and private sectors, combined with a significant shortage of qualified staff, raises concerns about uniformity in Bangladesh's medical education system, as well as dissatisfaction with the quality and supervision of both public and private medical colleges.

If we examine our medical academic curriculum, we can see that it is primarily based on theoretical rather than practical knowledge. Theoretical studies are much easier to understand when presented in a meaningful and relevant context.

This concept inspired the development of problem-based learning (PBL), which is widely recognised in medical institutions. However, problem-based learning is rarely addressed in the first, second, and third phases of the medical curriculum.

During the first phase, a student learns everything about introductory lessons to medical study and, theoretically, becomes acquainted with theories, definitions, terms and cases.

When students start their clinical ward in the hospital in the second phase, due to lack of exposure to problem-based learning and a lack of expertise in applying theoretical knowledge, students are unable to understand what they need to learn next or further specialise in.

File Photo: Mumit M/TBS

In effect, students struggle to cope when they begin their clinical ward in the hospital in the second phase. Furthermore, because they must complete the syllabus of this phase in order to be cleared for the next professional exam, which underlines a compressed, tight academic schedule, they fail to get enough exposure to the clinical ward.

Additionally, in the Community Medicine course, a student cannot cover all components of a field study relating to community health, such as research methodology, global health, and practical epidemiological knowledge, etc. which are essential for becoming a research-oriented physician. Students usually pay less attention to this subject due to a lack of an integrated course curriculum. 

In the third phase, a student must complete three subjects (Pathology, Microbiology, and Pharmacology) in less than a year within a clinical ward, which is extremely difficult to accomplish as it is. The timeframe set for this objective does not support the fact that it is required for medical students to have a very firm understanding of these subjects.

Due to a demanding academic schedule, the majority of them must rely on guidebooks to complete their curriculum and obtain exam clearance. This creates a significant knowledge gap, which is extremely difficult to bridge during the postgraduate entrance exam preparation period.

Then comes the final phase, the clinical year, which is an accumulation of knowledge pertaining to all the phases in medical college. When we look closely, we can see that there is a distinct lack of knowledge and experience that is supposed to be gathered from the problem-based learning materials by that point in medical education.

All of these factors contribute to a significant gap in basic knowledge, which makes the postgraduate exam that much more difficult and students that much more underqualified.  

Furthermore, in medical schools, training on patient counseling, planned behaviour and hospital administration leadership skills are often put on the back burner and ignored.

The curriculum is poorly planned, and the curriculum materials are out of date and irrelevant. Ineffective instructional strategies, insufficient clinical training, a flawed objective assessment system, a poorly structured internship training program, a lack of teaching staff and resources, and a lack of practical training all make up our current medical curriculum at the undergraduate level of education.

Besides making education and patient exposure a requirement, sessions at the Office of Professional Development (OPD) should also be made mandatory for medical students. Every medical college should implement problem-based learning with integrated teaching methodologies, and our course content, in particular, should be updated and modified on a regular basis to reflect the most recent research and advancements.

Ashrafur Rahaman Mahadi is a final-year MBBS student at Central Medical College in Comilla and an intern at the Public Health Foundation, Bangladesh.

Disclaimer: The views and opinions expressed in this article are those of the authors and do not necessarily reflect the opinions and views of The Business Standard.