Standard 10 - Program Evaluation & Continual Renewal

Standard 10 – Program Evaluation and Continuous Renewal

(Conforms to Standards 10.1, 10.2, 10.3, 10.4, 10.5, 10.6 & 10.7)

 

General:

Avicenna Medical College in compliance with HEC/PMDC guidelines and the syllabus and instruction issued by University of Health Science works on the subject base curriculum. However, the college has been air marked for the pilot session of 2019-2020 where some college are being assigned the task of running the pilot session on the system based curriculum.

 

Program Objectives

The following are the objectives;

  1. Patient Care: Appropriate histories and performance skillful, comprehensive and accurate patient examinations. To develop appropriate differential diagnosis and patient care management plan. The students select perform and interpret lab test and clinical procedure while taking patient care decision and providing patient care.
  2. Medical Knowledge:  Application of problem solving and critical thinking skills to problem in both the basic and clinical sciences. Demonstration of knowledge on basic sciences and application of these to patient care while involving investigations and analytical approaches.
  3. Practice Based Learning & Improvement: Practice of medicine using evidence based approaches, demonstrating efficiency in retrieval and appraisal of medical literature leading to desired patient care. The will to remain current and apply self-knowledge while treating patients.
  4. Interpersonal & Communication Skills: These are essential for effective communication to the patient and relative and helping patient/relative counseling.
  5. Professionalism: Commitment to carry professional responsibilities ethically while being sensitive to diverse patient population. Having a truestic approach with integrity honesty and patient privacy, knowing weaknesses and limitations and seeking improvement in knowledge and skills. 
  6. Mode of Curriculum: Whether it is the subject based learning or system based learning the object is to provide optimal care to the patient both has individual as well as member of the society. Take in to account risk assessment, illness and making treatment plans while considering public health implications.

 

Program Structure

Subject Based Curriculum

Currently the curriculum being implemented is subject based curriculum. The MBBS curriculum runs over 5 years as follows:

  1. 1st Year: Anatomy, Physiology and Biochemistry
  2. 2nd Year: Anatomy, Physiology, Biochemistry, Islamiyat & Pakistan Studies.
  3. 3rd Year: Pharmacology, Pathology, Forensic Medicine, Behavioral Sciences
  4. 4th Year: Eye, ENT, Community Medicine and Special Pathology
  5. 5th Year: Medicine, Surgery, Gynae, Paeds

 

The first two years are mainly devoted to theoretical instructions with a sprinkle of clinical sciences however, from the 3rd year onwards there is an increase in emphasis on the clinical sciences and this increases goes up many folds in the 4th year where two clinical subjects are studied in detail as they are the part of the prof exam. The 5th year is devoted maily to rotations, clerkship and clinical on-patient training.

 

System Based Curriculum

Avicenna Medical College has been made a part of the pilot session (2019-2020) for the pilot system based learning curriculum. For this reason the college has developed the modules and the study guides for the system based learning which envisages the following:

 

 

Modules

Relevant Common Diseases

1

Blood Module

Blood groups based on antigens expressed on cells

Various types of anemia on the basis of their pathogenesis and morphology

 

2

Cells, tissues, health and disease Module

Abnormal cell divisions

Atrophy and hypertrophy/hyperplasia

Reversible and irreversible cell injury

Agonist, partial agonist and antagonist

Tachyphylaxis

3

Endocrine and Reproduction Module

Development defects of endocrine organs

Ovarian tumors and development of gonads

Abortions

4

GIT, Nutrition and Metabolism Module

Abnormal secretion of acid pepsin

Abnormal absorption of nutrients from gut

Diseases of liver, gall bladder and pancreas

Anginal hernia

Hernia associative with interior abdominal wall

Common infectious diseases

5

Head & Neck special senses Module

Head and neck squamous cell cancers

Motor neuron lesions of cranial nerves

Neurological and conductive deafness

6

Immunity and Infectious Disease Module

Immunity, hypersensitivity and autoimmunity

Normal and abnormal host responses

Active and passive immunity

7

Inflammation and Neoplasia Module

Acute inflammation

Tumors

Granulomas

Bacterial infections

Abnormalities in the development of fetus

8

Multisystem Module-1

Acidosis

Devein thrombosis

Communicable diseases

Typhoid

9

Multisystem Module-2

Benin and malignant tumors

Sarcomas and carcinomas

Lymphoma and leukemia

10

Muscular Skeletal Module

Fractures, repair,

Bone infections

11

Neurosciences Module

 

 

The Traditional Program - Subject Based

Whereas the Committee have taken guidance from the HEC and PM&DC as well as the University of Health Sciences. It has followed the program to be organized for 5 years besides 1 year for the house job. The guiding principles have been

  1. Academic weeks                   36
  2. Professionals                         5
    1. Prof-1                          
    2. Prof-2
    3. Prof-3
    4. Prof-4
    5. Prof-5 Final Prof

Note: each prof is to be held annual basis – yearly.

Avicenna Medical College in conformity with the University guidelines and syllabus has organized the medical education exactly as above.

 

The Integrated Curriculum

This is based on the modular system where each is module is based upon organ systems of the body and the basic and clinical science are taught and learned in the integrated fashion. This involves in organization of the program in modules for the first two years and having an integrated modular system of studies in the 3rd and 4th year while the final year is exclusively devoted to rotations and clerk-ship.

 

Theoretical and Practical Learning:

Approximate allocation of time for theoretical and Practical Learning is based on the ration of contact hours (theory: practice)

  1. Basic Sciences                                   50:50
  2. Clinical Sciences                               30:70
  3. House job (year 6)                            15-20:80

 

Contents & Delivery

The Curriculum Committee has endeavored to provide the outline as well as the details of each subject to be taught in both the subject based as well as the system based criteria. The details of subject based curriculum and the criteria based curriculum are attached as Annexure-A and B.

 

Subject Based Curriculum

A perusal of the subject based curriculum and the details of each subject would show that the contents of the subject  and its delivery as outlined in the curriculum committee are aligned with the competencies and outcomes that have been specified under Standard 2 and expected by the HEC, PM&DC and UHS.

 

System Based Curriculum

The University of Health Sciences has yet to introduce the system based curriculum. Avicenna Medical College had envisioned that in conformity with the international trends and developments the University would at an appropriate time replace the subject base learning with the integrated curriculum learning. For this reason, the college had prepared itself in terms of infrastructure, and has been working on the development of integrated based curriculum.

The University of Health Sciences has in 2019 called upon a few colleges including Avicenna Medical College to be a part of a pilot plan for system based learning as is in vogue internationally. The University of Health Sciences has yet to formulate and finalize the system based learning. However Avicenna Medical College has prepared the outline of the system based learning and attached the same Annexure-B. In this annexure are the details of all the modules for the 5 years including rotation and clerkship. These details can be perused and on perusal it would be found that these are in conformity with the vision and mission of HEC, PM&DC and UHS.

Avicenna Medical College has also prepared study guides for this subject based (integrated curriculum) these study guides are for each module and are attached with the Curriculum Organization in Standard-4 as well as with the Curriculum Management in  Standard 6.

 

Current Curriculum at Avicenna Medical College

  1. The current curriculum being followed and practiced at Avicenna Medical College (till change over to the system based curriculum) is of subject based curriculum, normally known as Traditional based curriculum. Whereas the contents of both the subject based and system based curriculum have been attached with this document. The Curriculum Organization bears full details of the subject based curriculum.
  2. It has been ensured that impart of medical education at Avicenna Medical College is logical and in continuity. The details of the Standard 4 – Curricular Organization bears full details of the syllabus of the University of Health Sciences along with the following details:
    1. Annual planner for each class
    2. Schedule of various tests and examinations
    3. Schedule of annual prof exam
    4. Table of specification to include
      1. Details of each subject and time duration assigned to it
      2. Allocation of periods to each subject
      3. Allocation of time to practicals
      4. Allocation of time to tutorials
      5. Allocation of time to clinical sciences studies
      6. Allocation of responsibilities to the faculty as per rank and status

 

Sequencing of Contents:

The details of Standard 5 – Educational Contents to include the subject based curriculum and the system based curriculum are available in the guidelines and the revised curriculum 2011 issued by HEC and PM&DC. The course content, extent and sequencing of both the subject based curriculum and system based curriculum is achieved as follows:

Subject Based Curriculum (Traditional Curriculum) –

The curriculum may be subject based but in fact the teaching is done in such a way every year that, various subjects are concurrently dealing with the same system. This is done for building of concepts. In fact in practice, the elements of system based curriculum are incorporated in the study of the subject based curriculum.

 

System Based Curriculum – Modular System

Avicenna Medical College is practicing the subject based system. The college has been selected amongst the few colleges that have been chosen to adapt the system based curriculum from the year 2019-2020. The college has therefore developed the framework of the system based curriculum and has prepared study guides which are attached as Annexure-D.

Study Guides

The perusal of the study guides show that there is a logical progress and vertical & horizontal continuity in the study of the systems. The study guides act as guidance for the students as to the sequence in which they have to study each subject and their fine mix and progress for optimum development of concepts and it can also be seen that in the 1st and 2nd year, the emphasis on theory and teaching is done in a modular form while in the 3rd and 4th year there is an optimum mix of studies in clinical sciences and clinical practice while the 5th and the final year is dedicated to rotations and clerkship.

Study guides are available in the Standards 4 – Curriculum Organization and are also attached Annexure-D to this document.

 

Curricular Map

This pictorial, vertical and horizontal presentation of the course content and extent shows the sequence in which various systems are to be covered. 

 

Allied Subjects

The HEC and PM&DC curriculum lays emphasis on a number of traits expected from a graduate. These traits include Communication skills and ethics besides teaching the under graduate allied subjects and procedures. The allied subjects are covered along with the following subjects as shown in the Subject Based Learning curriculum:

 

Main Subjects

Allied Subjects

Anatomy

Cell & Genetics, Growth and Development, Nutrition

 

Physiology

Cell & Genetics, Growth and Development, Nutrition

 

Biochemistry

Cell & Genetics, Growth and Development, Nutrition

 

Pharmacology

Drugs and drug abuse

Pathology

Inflammations and Infectious Diseases

Forensic Medicine & Toxicology

Community based treatment, Medico-legal matters, Crime

Community Medicine

Organizations of Health Department, Family Medicine, Information Technology, Research

Medicine

Family Medicine, Communication skills, Patient safety

Surgery

Infectious diseases and infection control, Communication skills, Patient safety

Gynae & Obstetrics

Family Medicine,  Patient safety

Ophthalmology

Community based treatment

ENT

Community based treatment, Patient safety

Paediatrics

Community Paediatrics, Family Medicine, Patient safety

Behavioral Sciences

Professionalism, Medical & Islamic Ethics, Phsychiatry, Communication Skills

Islamiyat & Pak Studies

 

 

The allied subjects, along with the subjects in the System Based Learning are covered in its inherent design as specified in the system based curriculum guidelines issued by the HEC and PM&DC as 5.21.2 the essence of which is:

  1. Clinical methods are interspersed with other modules and/or rotations and clerkships, as necessary.
  2. Sessions on Islamiyat and Pakistan Studies are included in Years 1 and 2.
  3. Clinical skills, nutrition, medical ethics, professionalism, communication skills. Radiology, behavioral sciences and evidence-based practice are re-enforced in all clinical rotations/clerkship.

 

Practical Learning on Patient – (Planned Contact with Patients)

  1. The curriculum by HEC and PM&DC and its compliance with the University of Health Sciences has appropriate allocation for time for Theoretical and Practical learning and is based on the ratio of contact hours as follows (theory : practical)
    1. Basic Sciences                       50 theory : 50 practical
    2. Clinical Sciences                   30 theory : 70 practical
  2. Besides this the curriculum of UHS as adapted by Avicenna Medical College incorporates greater emphasis on patient contact learning and the clinical classes where students have “own patient learning” start from the 3rd year and there is a visible increase in the 4th year, whereas the 5th year is mostly clinical rotations and clerkship.
  3. Avicenna Medical College has implemented the “on-patient training” to its entirety for the 3rd year, 4th year and 5th year classes. Salient features are:
    1. 3rd year – The yearly planner spelled out all the details of the clinical classes. The class is divided into 6 batches and these rotate throughout the year for 6 different subjects of medicine, medicine sub-specialty, surgery, surgery sub-specialty, eye and ENT. For the 3rd year these are restricted to history taking and examination and the entire study is supervised. The details of 3rd year clinical classes involving on-patient training are attached as Annexure-F.
    2. 4th Year – As in the case of 3rd year, the class of 4th year is divided into 6 batches to be rotated for on-patient training in the departments of Medicine, Surgery, Gynae, Paeds, Eye and ENT. The details of 4th year rotation in clinical classes and their progression is attached as Annexure-G. However with Eye and ENT being the major subjects, the curriculum caters for additional classes for Eye and ENT alone as the students are to appear for their annual prof exam on Eye and ENT in the 4th prof (4th Year).
    3. Final Year – At Avicenna Medical College, the 5th and the Final year is mostly “on-patient training” and the curriculum caters for a total planning of the clinical classes and their assessment. The class is divided into 6 batches and besides major rotations in the following:
      1. Medicine
      2. Surgery
      3. Gynae
      4. Peads
      5. The above are covered in rotations of 6 weeks as follows:
        1. Rotation 1:
          1. Neurology
          2. Pulmonology
          3. Nephrology and acid based disorders
          4. Rheumatology
          5. Psychiatry
        2. Rotation 2:
          1. Cardivascular systems
          2. Endocrinology & Metabolic diseases
          3. Haematology & Oncology
          4. Dermatology, GIT and Liver
        3. Rotation 3:
          1. Skin, Head and Neck endocrines
          2. Breast, Cardiothorasic and vascular
          3. Abdominal surgery
          4. Abdominal surgery
          5. Genito-urinary systems
        4. Rotation 4:
          1. Basic principles of medicine
          2. Basic principles, investigations and diagnosis
          3. Peri-operative care
          4. Trauma
          5. Elective orthopaedics extremity trauma
        5. Rotation 5:
          1. Obstetrics
          2. Obstetrics
          3. Obstetrics
          4. Gynae
          5. Gynae
        6. Rotation 6:
          1. History taking and examination
          2. Pelvic Inflammatory Disease, scrubbing, gloving, gowning, painting and dripping of patients, system of sterilization and disinfection
          3. Miscarriage / GTD (molar pregnancy), suction and evacuation, ectopic pregnancy and laparoscopy

The details of 5th year on-patient training are attached as Annexure-H.

 

The Academic Council

Pakistan Medical & Dental Council accreditation standards in Regulations of 2012 vide clause 21 demands the existence of Academic Council with the primary task to determine Institutional Academic Policies, Curricular delivery techniques with the responsibility to determine and provide scenarios and appropriate patient access with clear learning objectives in each discipline. Academic Council shall function as a supervisory and oversight body. (Authority – The gazette of Pakistan of 26th January, 2012 Page 9)

 

Study Boards and Curriculum

Study boards and Curriculum Committee are required to be formed by the institution to ensure that there are mechanisms for direct Faculty involvement in decisions related to educational programs its delivery and evaluation. (Authority – The Gazette of Pakistan 26th January 2012 – Clause 22)

 

Effective Teaching

Effective teaching requires knowledge of the discipline and an understanding of curriculum design and development, evaluation, and methods of instruction. Faculty members involved in teaching, course planning and curricular evaluation shall possess or acquire expertise in teaching methods, curriculum development, program evaluation and student evaluation. Such expertise may be supplied by a department of medical and dental education or by Faculty or staff members with backgrounds in educational science. Faculty involved in the development and implementation of a course shall be able to design the learning activities and corresponding evaluation methods (student and program) in a manner consistent with the institution’s stated educational objectives and sound educational principles. Community physicians aiding the Faculty shall serve as role models for students and provide insight into contemporary practical methods of providing patient care. Faculty members shall have a commitment to continuing scholarly productivity characteristic of an institution of learning. To ensure adherence to the standards of the PM&DC, the following amongst shall be parameters namely:

  1. Documented participation of the Faculty in professional development activities related specifically to teaching and evaluation
  2. Evidence that Faculty members’ knowledge of their discipline is current.

(Authority – The Gazette of Pakistan 26th January 2012 – Clause 29)

 

Program Evaluation Committee

Avicenna Medical College has formulated a program evaluation and review committee which carries out constant monitoring of the program and suggests changes if any in any of the categories as under:

  1. Changes in the conduct of instructions of any subject.
  2. Changes in allocation of hours.
  3. Changes in time duration.
  4. Changes in mode of instructions – theory, practical, tutorial and on-patient training
  5. Changes in program in terms of location or postponements 
  6. Holding of special study classes for the development of concepts where required.

 

Organization of Program Evaluation Committee

Academic decisions at Avicenna Medical College are taken by Academic Council. The Academic Council also monitors and oversees the functions of the Curriculum Committee, Assessment Committee as well as the Program Evaluation and Review Committee. This Committee works on a two tire function and consists of the following:

  1. Prof. Dr. Rehana Shahid                  HOD Anatomy
  2. Prof. Dr. Binyamin Ahmed             HOD Physiology
  3. Prof. Dr. Zubair Ahmed                  HOD Biochemistry
  4. Prof. Dr. Rubina Hafeez                  HOD Pathology
  5. Prof. Dr. Najma Naz                                   HOD Pharmacology
  6. Prof. Dr. Zainab Perveen                 HOD Forensic Medicine
  7. Prof. Dr. Rana M Akhtar Khan       HOD Community Medicine
  8. Prof. Dr. Luqman Ahmed                HOD Medicine
  9. Prof. Dr. Mehmood Alam                HOD Surgery
  10. Prof. Dr. Nuzhat Parveen Khwaja HOD Obs & Gynae
  11. Prof. Dr. Mariam Waheed               HOD Paediatrics
  12. Prof. Dr. M. Ayub Khan                  HOD ENT
  13. Prof. Dr. Khalid Mehmood              HOD Ophthalmology
  14. Assistant Prof. Dr. Fatima Aslam    HOD Behavioral Sciences / Psychiatry
  15. Student Members

The class representatives from all classes (three from each class) attend the program evaluation and review sessions for the items that pertains to their class. The list of CRs is as follows:

  1. 1st Year: Laibah Zakariya, Asim Dildar
  2. 2nd Year: Uswah, Abdullah Altaf
  3. 3rd Year: Ali, Fatima
  4. 4th Year: Fatima Zahid, Salman Masood
  5. 5th Year: Sameer, Ayesha

 

Every HOD has an appropriate assistant who helps and does the main monitoring, receives and processes all review requests for consideration by the program evaluation committee.

The Program Evaluation Committee maintains and oversight of the conduct of the Curriculum being a Committee composed of HODs and their assistants as well as the student CRs of each class, the role of the program evaluation committee is the affect the expression and delivery of the curriculum in every aspect.

The Program Evaluation Committee is responsible for the regular evaluation of the curriculum as put up by their assistants and the CRs of every class.

 

Evaluation Approach

Standards

The curriculum evaluation by the Program Evaluation Committee is guided by the standards as communicated by the HEC and PM&DC. The following:

  1. Utility: The evaluation will serve the information needs of the intended users.
  2. Feasibility: The evaluation will be realistic, prudent, diplomatic and frugal
  3. Propriety: The evaluation will be conducted legally, ethically and with due regard to those in the evaluation as well as those affected by its results.
  4. Accuracy: The evaluation will convey technically adequate information about the features that determine worth or merit.

 

Rationale

The faculty of the college engages in curriculum revision and program evaluation activities to ensure that the medical education program quality is maintained and enhanced and that the medical students achieve all medical education program objectives and participate in required clinical experience and setting. For this, the Program Evaluation Committee encompasses in its membership, the HOD, the Junior Faculty as well as the students’ participation. The outcome is achieved throughout the program till its completion by the participation of the instructors and the students.

 

Technique

The evaluation of the curriculum uses a blended approach of the utilization technique and context, input, process and product technique. Both these aspects are implemented in the process of evaluation and mean:

  1. Utilization Technique: In this case the content of the curriculum program is governed by the Academic Council and is in conformance with the UHS guidelines. The Program Evaluation Committee has the authority to make recommendations and changes to the conduct of curriculum within the limitation imposed by the University of Health Sciences. Also the HODs use the evaluation data to make decisions in the process and implementation in the teaching of their respective subjects. The departments use evaluation data as a guide in formulating educational priorities. Thus, these actors represent the intended uses of evaluation. This model provides guidance to establish an evaluation process that focuses on the end use of the data being collected, analyzed and presented. It also helps to prioritize the data in its usefulness for the intended users.
  2. The Context Input Process and Product Technique: This scheme can be briefly explained as evaluation process of delineating, obtaining, providing and applying descriptive and judgmental information about the merit and worth of some object’s goals, design, implementation and outcomes to guide improvement decisions, provide accountability reports, inform institutionalization/dissemination decisions, and improve understanding of the involved phenomenon.

 

Standard Operating Procedure – Program Evaluation Committee

Avicenna Medical College has devised Standard Operating Procedure for the Program Evaluation Committee. 

 

Goals to Implement

The Program Evaluation Committee has a goal to gather information to provide timely and accurate feedback on the performance of the curriculum to support decision making at the program review. This also achieves the evaluation of the Curriculum and adherence to fresh curriculums / criteria which is a key requirement of accreditation. The Faculty of Avicenna Medical College engages in Curriculum revision through program evaluation activities to ensure that the medical education program quality is maintained and enhanced and that medical students achieve all the medical education and curricular standards and objectives and participate in required clinical experiences and setting.

 

Data Sources

 The following data sources are available for consideration by the Program Evaluation Committee:

  1. Program Evaluation Feedback Form – this is to be filled on occurrence but definitely well before the Program Evaluation Committee meets by all the departments and HODs. 
  2. Class Discipline & Conduct Form – this is to be filled up by all members of the Faculty as their comments on every lecture or instructional event. 
  3. The Student Change Request Form – this is to be filled up whenever any student feels that he/she can contribute towards any change in the program. Such forms are routed through the Class Representative. 
  4. Faculty Change Request Form – this form is initiated by any member of the Faculty who wants any change in the program or any repetition in the program or wants additional emphasis and thus the allocation of time to a particular subject. 
  5. Review Request Form – this form is available to all students who may feel aggrieved about their result and request for examination of his papers along with the key as answers to the questions. Such a request is sanctioned at the point and time and collected by the directorate of medical education for perusal by the Program Evaluation Committee at its next meeting.