Standard 2 – Outcomes
(Conforms to Standards 2.1, 2.2, 2.3, 2.4, 2.5, 2.6 & 2.1s)
- The Avicenna Medical College established the standards and requirements for the development of the document on Outcomes soon after its inception in 2009. The outcomes sets out what the newly qualified doctors must know and be able to perform at the end of the MBBS program with the ultimate goal of improvement in healthcare of Pakistan.
- It guides the institution on the development of the curriculum, a framework for learning and teaching and assessment plans. It also acts as a guide for the medical students on what they need to learn during their stay in the institution and forms the foundation for their practice and life-long learning.
- The multidisciplinary team involved in formulating the educational outcomes consist of the department of medical education, the basic sciences and clinical faculty, the student body and the administration. This team also takes the responsibility to supervise the implementation of the curricular program and the attainment of the outcomes by the students.
- The recent need to update the Outcome Document in 2019 occurred because of the induction of the National Accreditation Framework for Medical and Dental Schools in Pakistan - 2019 by the PM&DC and in anticipation of the introduction of the Integrated MBBS Curriculum by the University of Health Sciences (UHS) in the session 2020.
Standard 2.1: Outcomes in congruence with the Mission of the Institution and University Vision.
- Avicenna Medical College strives to achieve its Mission to educate and create outstanding healthcare professionals capable of serving the local community and compete at International Forums. The competent authorities have formulated the institutional vision and mission in congruence with the University of Health Sciences (UHS) vision and mission.
- To implement the vision and mission, the institution has created a conducive environment for students to learn, observe and experience Quality Medical Education and Healthcare Delivery. The emphaisis is on ensuring policies and processes for inducing an understanding of the role of doctors in healthcare system of Pakistan. The Health Professional Education we impart forms the foundation for life-long learning, post-graduation and future career choices for our students nationally and internationally.
- The Avicenna Medical College has developed well-defined outcomes for its educational programs (MBBS and BDS) by taking guidance from the National Accreditation Framework for Medical and Dental Schools in Pakistan - 2019 by PM&DC and with collaboration of all the stakeholders. These outcomes are a set of statements, which identifies the expected performance by the students at the end of the program.
- The outcome statements of Avicenna Medical College affirms the expected performances of the graduates at the end of the MBBS program. The students will be able to:
- The newly qualified doctors must make the care of patients their first concern, applying their knowledge and skills in a competent, ethical and professional manner and taking responsibility for their own actions in complex and uncertain situations.
- Demonstrate a thorough consultation of a patient
- Diagnose and manage common, non-critical conditions independently
- Assist in the management of critically ill patients
- Demonstrate clear and efficient written and verbal communication abilities
- Demonstrate professional, ethical and culturally-appropriate behavior
- Advocate health promotion and disease prevention
- Work effectively as a healthcare team member in the Healthcare System of Pakistan
- Demonstrate capabilities of critical thinking, reflection, research and teamwork
- Demonstrate ability for personal and professional development with commitment for life-long learning.
Authority: Pakistan Medical & Dental Council and UHS Guidelines
Standard 2.2: Outcomes incorporate the Knowledge, Skills and Professional Behaviours that the students will demonstrate upon graduation.
- The outcome statements highlight the competencies to be acquired by the medical graduates in Knowledge, Skill and Attitude (KSA) domains of learning, by focusing on the biomedical basic science, the clinical performance, psychosocial aspects, and ethics.
The Outcome statements according to KSA (Knowledge, Skills & Attitute) domains are attached as Annexure A, B, C.
- The educational program designed to achieve the outcomes at the end of the MBBS program currently are based on the Subject or Discipline based curriculum in accordance with the guidelines of the University of Health Sciences (UHS), which takes the Annual Professional Examination at the end of each academic year of the 5 years MBBS program.
- Presently, the UHS is working on the development of an integrated curriculum for the session 2020. Therefore, our institution is also preparing for an educational program for the integrated curriculum and has incorporated new outcomes keeping the rationales of an integrated curriculum in view.
- The Avicenna Medical College has the processes in place for the acquisition of knowledge in the current MBBS program for the subject-based curriculum with the annual examination system of the UHS are as follows and The Outcome statements for the Knowledge domain are attached as Annexure A.
- The Syllabus, Curricular Contents and Table of Specifications of the University of Health Sciences (UHS) are taken as guidelines for the acquisition of knowledge, skills and attitudes of biomedical basic sciences, the clinical science subjects and the behavioural and social sciences.
- This is achieved through learning and teaching statergies such as deliverance of lectures, laboratory work, tutorials, Case-Sased Discussions (CBD), Small Group Discussions (SGD), clinical skills sessions, clinical rotation with bedside teaching in ward rounds, outpatient department, clinical case presentations, community field visits, clinic-pathological conferences (CPC) and seminars.
- Students are engaged in self-study with emphasis on reading from the latest editions of the recommended textbooks that are specified for every subject in the syllabus UHS. Every effort is made to refrain the students from making shortcuts by studying praxis notes and guides.
- Emphasis is laid on the provision of learning material and lectures in the e-library and learning resource center, which has a dedicated website of Avicenna Medical College to enable the students to develop concepts and clarify their doubts, if they have not been able to do so in the teaching sessions during college hours. These sites can be approached on http://digital.avicennamch.com/. Details for hearing Resource Center are available in the appropriate Standard.
- The institution has endeavored to link itself with the digital libraries and e-library of the University of Health Science (UHS) and Higher Education Commission (HEC) to enable the students to benefit from the valuable resource material, lectures and knowledge bank at these sites. The links are available with the HEC http://www.digitallibrary.edu.pk/ and learning management system of UHS http://lms.uhs.edu.pk .
- The institution has a host of models, charts, training aids and digital resources available at all basic sciences and clinical sciences departments to enable the students for efficient assimilation and development of concepts of the subject under study. These models, charts and training aids fully meet the requirement specified by the PM&DC and the UHS. Exhaustive lists are with the relevant standards.
- An efficient system for formative and summative assessment of knowledge and a system of regular feedback is in place at our institution. The attainment of knowledge is assessed through written tests and theory papers of early, mid, late-session and send-up examinations consisting of multiple choice questions (MCQs), short essay questions (SEQs) and viva voce. These assessment methods are structured and standardized through a system of quality assurance. Details are attached with the Standard 7 – Assessment.
- The results these assessments reflect upon students’ performance and are used for the feedback, sharing with the parents and maintenance of internal assessment as required by the UHS. For this purpose, the college shares the results of every written assessment and oral examination through a system of SMS with the parents, preferably the father of the student. Parents are kept in the loop on the students’ progress and all reports are sent to the parents after these have been discussed with the students. This is a regular feature handled by the Department of Medical Education.
- The institution follows the regulations for examinations of the UHS in letter and spirit. The students require 80% attendance in all academic sessions and 50% marks in internal assessments and send-up examinations to be eligible for the UHS Professional Examinations.
CLINICAL AND PROFESSIONAL SKILLS:
- The medical students on graduation must demonstrate professional skills in their clinical practice as doctors. These essential skills are attached as Annexure – B.
- The institution lays adequate emphaisis on the acquisition of professional skills by undergraduates medical students. The learning and teaching of the professional skills is carried out throughout the 5-year MBBS program by various educational activities including practicals in biomedical basic sciences, laboratory work, clinical skill classes in clinical skills lab, community field visits, bedside teaching, case presentations in wards and outpatient department (OPD), demonstrations on models and mannequins and simulated patient based case presentations.
- These professional and clinical skills are made an essential part of curriculum for the medical students and are practiced in real time in the Avicenna Teaching Hospital. Certain skills are taught in the skill labs are provided at the following locations:
- College Skill Lab
- Nursing Skill Lab
- Obstetrics and Gynaecology Department Skill Lab
- Obstetrics and Gynaecology procedure rooms
- Surgical and Allied procedure room
- Medical and Allied procedure room
- Paediatrics procedure room
- Ophthalmology procedure room
- Otorhinolaryngology procedure room
- Dermatology Procedure Room
- Community outreach clinics
- Besides these facilities for hands-on skills under the supervision of the clinical specialists, a dedicated team of trained professionals provides knowledge and skill to the students of MBBS Classes, Nursing Students and Students of Allied Health Sciences on the essential skills as attached as Annexure-D.
- The college has developed and hand book of these skills and procedures and every student of the medical college and the nursing college must to have a copy. The students must have a copy of the especially designed logbooks and practical copies for each subject in the respective year of MBBS program. Log Books are maintained and counter-signed.
- The institute organizes through its training programs, evening clinical skill classes for students of the 3rd year, 4th year and final year to help inculcate proficiency in practice of professional skills. Clinical classes are held for 5 days a week for three hours every day in the mornings and in the evenings and attendance at these classes is mandatory. The classes are held under the supervision of the clinical specialists of the respective departments. The students are encouraged to interact with the patient, learn the procedures and develop their skills under strict supervision. The Supervisor to Student Ratio is kept at optimum levels for quality learning.
- The classes of 3rd, 4th and 5th year are provided with clinical handbooks and logbooks where their clinical training is documented and duly signed by the clinical teachers. These clinical logbooks are marked and made a part of the clinical assessments. These are supplemented with ward cards where the students document their cases in each ward and marks of ward tests are recorded.
- The professional skills are tested by multiple assessments methods which include formative and summative assessments. In biomedical basic sciences practical performance examinations, objective structures practical examinations (OSPE) and viva voce are held. In clinical sciences work place based clinical assessments are held these include the bedside ward tests, long cases, short cases, objective structured clinical examinations (OSCE) and viva voce.
- The internal summative assessments are the Oral Examinations of the Session Examinations held at the end of each term such as Early Session Exam (ESE), Mid-Session Exam (MSE), Late Session Exam (LSE) and the Send-ups Exam. These contribute toward the internal assessments sent by the institution to the UHS to be included as 10% marks in the Professional examinations.
- The University (UHS) take the Oral Examinations at the end of the year as a part of the Professional Examinations. These Oral Examinations are held in the institution and conducted by the Internal Examiner ( HOD of the subject) and the External Examiner nominated by the UHS from some other public or private medical college.
- At Avicenna Medical College, great emphasis is laid on professional and personal values and behaviour of the under-graduates medical students. They must demonstrate appropriate attitudes towards the medical profession, the teaching and the non-teaching faculty, the staff, their colleagues, patients and their attendants. The institute aims to educate the medical students to ensure the development of personal and professional values and behaviour, which are becoming of a doctor in clinical practice. The outcomes aim to provide ethical guidance for good medical practice and interpersonal relations and are identified in Annexure – C.
- Efforts are made at Avicenna Medical College to inculcate a sense of pride in the Under-Graduate Medical Students for becoming a doctor and the respect that it carries in the society. The college has its own policy of ethics, which is widely circulated and the medical students are educated, trained and made to follow the medical ethics and professionalism.
- The Pakistan Medical & Dental Council (PM&DC) Code of Ethics duly gazetted by the Ministry of Health wide S.R.O. 80(KE)2011 are followed very strictly and are available in the booklet form and also at the PM&DC website in PDF format at http://www.pmdc.org.pk/LinkClick.aspx?fileticket=v5WmQYMvhz4%3D&tabid=292&mid=845. It is attached as Annexure – E. Various components of the PM&DC policy involving ethics of teaching, patient-physician relationship, standards of professional competence, care and conduct are emphasized. Emphasis is also laid on research, system of punishment and disciplinary action and the adaption of professional attitude in matters related to pharmaceutical industry.
- The institution has worked with all the stakeholders, the faculty, administration and the students in the development of the outcomes on professional and personal behaviour as presented in Annexure – C (as mentioned above).
Standard 2.3: The Outcomes are contextually appropriate for Healthcare Delivery in Pakistan.
- It is emphasized to the undergraduate medical students that their major professional consideration should be the well-being of the patients and their healthcare. For this, they are educated to maintain and demonstrate a high standard of professional conduct. The outcomes of knowledge, skills and professional behaviour domains include the study of the healthcare delivery system of Pakistan as well as community based medical education, through community field visits, and medical camps in the nearby villages.
- The Avicenna Hospital is registered with the Punjab Healthcare Commission (PHC) that has given Minimum Service Delivery Standards (MSDS) to be implemented and these are included to be covered in the MBBS duration by the medical students.
Enforcement of Minimum Service Delivery Standards (MSDS):
- The medical students are educated to abide by to the laws of regulatory authorities for the healthcare establishments regarding the treatment of the patients. The following standards of Punjab Healthcare Commission (PHC) elaborate the Minimum Service Delivery Standards (MSDS) for medical professionals in healthcare establishments.
- MSDS Standard 2.2 Care of Patients
- MSDS Standard 2.3 Management of Medication
- MSDS Standard 2.4 Patient Rights and Education
- MSDS Standard 2.5 Hospital Infection Control
- MSDS Standard 2.10 Information Management System
Minimum Service Delivery Standards PHC – October 2012
Standard 2.4: The Outcomes have been developed in consultation with all the stakeholders
- The educational outcomes are set at Avicenna Medical College through consultation with the all the stake holders. The above outcomes are a result of a perusal of the regulations/instructions of the Ministry of Health, the Pakistan Medical & Dental Council (PM&DC), the University of Health Sciences (UHS). An input was received from the administration, faculty and the students of Avicenna Medical College at time of its inception in 2009-2010, through the meetings of the Curriculum Committee, discussions in the Curriculum Management Committee and final approval by the Academic Council. It was decided that the educational outcomes will be subject to review and revisions every three years by the Program Evaluation Committee and monitored by the Curriculum Management Committee.
- The formulation of the outcomes for medical education incorporates the policy of Pakistan Medical & Dental Council received from time to time and the emphasis made on various aspects of curriculum in terms of clinical skills and knowledge base and appropriate professional behaviour to be inculcated in an undergraduate so as to prepare him/her efficiently enough to do clinical practice as a doctor.
Standard 2.5: The Outcomes are known to all the stakeholders
- The outcomes are communicated through a variety of channels and are known to all the stakeholders. These are inscribed on screens and notice boards in the Medical College, Dental College and the Hospital Buildings, study guides for students and the faculty, the website and in the Standard Operating Procedure (SOPs) manuals of every department of the institution.
Standard 2.6: The Outcomes are reviewed and revised in the light of Program Evaluation Process.
- The Avicenna Medical College, pledges to keep these outcomes up to date with timely revisions to make sure they reflect contemporary medical practice and the guidelines of the PM&DC and the UHS. The educational outcomes are subject to review and revisions on every three years by the Program Evaluation process. Avicenna Medical College has established a Program Evaluation and Review Committee, which carries out constant monitoring of the program and suggests changes in the educational program if required. The Program Evaluation Committee has revised and updated the outcomes twice since the initial formulation in 2009-2010.
- The University of Health Sciences (UHS) revised the curriculum for the 1st and 2nd Prof in 2013, the new syllabus and its requirements were reviewed and discussed by the institutional Curriculum Committee and the stakeholders were taken on board and the educational outcomes were revisited and revised. Recently, the UHS has informed its affiliated institution of the initiation of the Integrated System Based Curriculum for the session 2020 of MBBS. Avicenna Medical College has opted to be among the pilot institutions to adopt it. Therefore, the outcomes were reviewed and updated for the integrated curriculum by the Program Evaluation Committee in consultation with the stakeholders.
Standard 2.1s: The outcomes of the educational program differentiating the Avicenna Medical College from other similar institutions.
- The outcomes for the educational program of MBBS at Avicenna Medical College are formulated through a well thought of process and special importance is given to the outcomes for the medical graduates, which would distinguish our medical graduates among doctors in clinical practice. These include:
- Outcomes for the development of the generic professional capabilities and competencies. The Medical Graduates must demonstrate the ability to build on, develop their knowledge and competencies as they move through the stages of medical profession, and have a smooth transition to postgraduate training in the chosen speciality. These generic capabilities include communication skills, critical appraisal, teamwork, self-direction and reflection.
- The Avicenna Medical College lays emphaisis on Medical Education that responds continually to changes in the current health issues of the population and healthcare systems. The medical graduate must be able to work effectively as a healthcare team member in the Healthcare System of Pakistan.
- The distinguishing outcome includes that the medical graduates in their clinical practice as doctors must keep up with the developments in the technologies used to diagnose, treat and manage illness through evidence-based practices.
- There is inclusion of hidden curriculum at Avicenna Medical College with a strong emphasis on discipline for punctuality, dress code, social interactions among students and faculty.
- The outcomes are regularly revisited and revised in order to assure that our medical education caters for the needs of society and our doctors are tuned to be appropriately responsive to the needs of patients and the public.