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Paper presented at the Workshop on the Islamic Input Curriculum at the Kulliyah of Medicine International Islamic University Kuantan on 13th June 2006 by Professor Omar Hasan Kasule, Sr.
ABSTRACT
Evaluation of our activities, muhasabat, is obligatory and has a very strong basis in the Qur’an and sunnah. We undertake evaluation in order to learn from past experiences for better future performance. Process evaluation of IIMC is easier since in involves assessing the processes of planning, scheduling, delivering, and assessing IIMC material. Outcome evaluation is more difficult because it involves assessing changes in knowledge, attitudes, and practice over a long time after graduation. There are many confounding factors that may make the interpretation of such evaluation results. It is suggested that a special workshop be convened to develop an evaluation instrument that can be used on successive cohorts of IIMC graduates. The following are suggested broad areas that can be covered: ethics, etiquette of the physician, fiqh al’ ibaadaat, fiqh al ‘aadaat, ethico-legal controversies, social issues, and personal characteristics. The methods of data collection used can be a combination of the following: direct observation, mail questionnaires, interview, records review, and performance/knowledge tests
1.0 EVALUATION IN THE QUR’AN AND SUNNAH
The basis for evaluation in the Qur'an and sunnah is the individual accountability as well as the reward and punishment. Every action however small will be accounted for.[i] Everyone is personally accountable.[ii] The Qur’an condemned those who claim credit for work they did not do.[iii] Evaluation is necessary for future actions but is too late for taking corrective action in the present project.[iv] The most important evaluation is self evaluation. Evaluation is based on what is seen externally the inside is unknowable.[v] The last actions determine how good job is.[vi] There are several instances of lessons from evaluation in the sunnah. Evaluation can be based on outcome. The debacle at Uhud was due to mistakes by the army.[vii] The main responsibility for the defeat was on the archers.[viii] The debacle at Hunayn was due to overconfidence and failure to take necessary precautions.[ix] The debacle at the bridge in Iraq was due to wrong strategy.[x] There are other situations when evaluation is based on the process and not the outcome for example the Muutah campaign can be evaluated as a successful process but there was no outcome since the enemy fled. The Tabuk campaign is also evaluated as a process because the enemy did not come to the battlefield.
2.0 CHARACTERIZING EVALUATION
2.1 Objectives of Evaluation
Evaluation has three main objectives. The first objective is to ascertain whether the objectives set at the start were achieved. In all human endeavors objectives cannot be achieved 100% because perfection belongs to Allah only; humans try their level best to reach the humanly-achievable accomplishment. The second objective of evaluation is to assess efficiency which is how well were resources used to achieve the objectives. Ann inefficient operation could reach the objective by using more resources than a more efficient operation. Since resources are always limited we have to try to maximize their utilization and thus assure high efficiency. The third objective of evaluation is to assess the effectiveness of the intervention carried out. Some operations may be well executed but in the end there is little long-lasting impact. All the three objectives of evaluation mentioned above contribute to the higher objective of learning from past experience to ensure better future performance.
2.2 Benefits / Uses of Evaluation
An evaluation process has many benefits. It can help identify successful actions and therefore lead to their reinforcement. It helps the workers and managers to identify areas of weakness that therefore require corrective measures aiming at improvement. Evaluation reassures workers and stakeholders that matters are proceeding well. A good evaluation report helps gain the confidence of supporters and donors. If the results of an evaluation process are not used to improve future performance the evaluation has not achieved its purpose
2.3 Types of Evaluation
Evaluation can be classified according to what is being evaluated. Process evaluation assesses the processes or procedures. Outcome evaluation assesses the final result. Evaluation can also be classified according to the person carrying out the evaluation. Internal evaluation is carried out by members of the organization. External evaluation is carried out by persons from outside the organization. Evaluation may be an active process carried out during the life of the project or could be a post-hoc process carried out after the end of the project.
2.4 Limitations of Evaluation
Evaluation is post action. It answers the question whether the objectives of the plan are achieved. Evaluation is too late to be of use to the current project. Its findings are however useful for future projects that are of a similar nature. Evaluation tends to be affected a lot by the activities towards the end of the project. A project that has been performing badly may get a good evaluation when it ends well; all is well that ends well. A project that was performing well throughout its life may get a bad evaluation when it fails towards the end. Evaluation is judgment by what you see. The inner intentions and motivation can never be known. There are a few cases when evaluation is unfair. The outward results may not reflect all the intentions, sincerity, and commitment of the worker. There is little that can be done to alleviate this unfairness because the factors involved cannot measured objectively by humans. Evaluation by others must be accepted as an attempt to help and not criticize or attack.
3.0 EVALUATION OF THE ISLAMIC INPUT CURRICULUM
3.1 Rationale for Evaluation of the Islamic Input
Like any other human activity IIMC has to be evaluated in order to make improvements. IIMC takes a considerable amount of resources in the form of time of lecturers and students. We have to make sure that these resources are well used. Since resources of time are limited we need to make sure that IIMC is a worthwhile project that does not take away valuable time from the rest of the curriculum. Perhaps the most important justifying reason for IIMC evaluation is that it is spreading from UIA to other faculties of medicine. We want to make sure about the quality of the product being exported. So far IIMC has been adopted formally in one way or another in Pakistan, Brunei, and Indonesia. It has however been adopted informally in many more countries and is beginning to have an impact on Muslim medical education. The concepts underlying IIMC are also being adopted in a practical way many hospitals in Malaysia and Indonesia under the aegis of the Islamic Hospital Consortium. We did carry out a questionnaire survey among students in 2003 or 2004 in preparation for accreditation and the results showed general satisfaction with the program and very few and minor suggestions for change.
3.2 Process Evaluation
Process evaluation of IIMC is far easier than outcome evaluation and can be carried out easily and quickly. The following items can be included in such evaluation:
(a) Lecturers: Motivation of the lecturers to be interested and supportive, training lecturers and full briefing on the curriculum and its implementation, supporting lecturers with reference material, providing lecturers with opportunities to clarify issues that they do not understand,
(b) Students: Are students motivated? Do students understand the objectives of IIMC; do students look at IIMC as an integral part of the medical curriculum? Do the students feel that they benefit from IIMC, do students feel that IIMC gives them something new? Do students realize that IIMC can have positive impact on their future as medical practitioners? What do students feel about the time allocated to IIMC (too much or too little), are the students satisfied with the method of delivery? What is the overall level of student attendance at IIMC sessions? would students attend IIMC sessions if they were not compulsory or examinable? Do students think that the curricular contents are relevant? What content would they like to add? What content would they like to remove?
(c) Scheduling: Is IIMC well scheduled and in advance? Are sessions given at the original time of scheduling or are there changes? Is the burden of IIMC well distributed throughout the 5 years? Is the allocation of teaching broad covering many lecturers?
(d) Examinations: Do the examinations reflect the learning objectives?
3.3 Outcome Evaluation
Outcome evaluation of IIMC is very difficult because it is about long-term impacts with many confounding factors along the way. Success of IIMC is to produce internal change in the knowledge, attitudes, and practice (KAP) of the physician. These changes cannot be measured directly we can only infer them from the observed behavior of the physician. In most cases we cannot observe the physician. If we designate an observer, we will have to deal with the problem of observer-induced behavior in that the physician will behave better in the presence of the observer than in his absence. A physician who is well trained in IIMC with good KAP attributes may behave in contrary ways because of the influence of the hospital environment where he is working.
Although outcome evaluation is beset with so many difficulties, we cannot abandon it. We need to carry it out and exercise caution in the interpretation of the results. We may also need to carry out repeat evaluations every 2-3 years after graduation because the impact of IIMC may not be seen immediately on graduation.
The litmus test of the impact of IIMC is to determine whether there are significant differences between physicians who went through IIMC and those who did not. This will require developing special measuring scales and sophisticated statistical techniques.
I would suggest that a special workshop be held to develop the evaluation instruments for outcome evaluation. The following are suggested general items but they will require a lot of refining:
(a) Ethics: purposes and principles of medicine (ethical theory and principles); regulations of medical procedures, dhawaabit al tatbiib; regulations of research procedures, dhawaabit al bahath; regulations of physician conduct, dhawaabit al tabiib; and regulations about professional misconduct, dhawaabit al inhiraaf al mihani
(b) Etiquette of the physician, adab al tabiib: etiquette with patients and families; etiquette with the dying; etiquette with the health care team; etiquette of research on animals; etiquette of research on humans
(c) Fiqh al’ ibaadaat: taharat; salat, saum, hajj; tilaawat; and jihad
(d) Fiqh al ‘aadaat: menstruation, al haidh; human sexuality, shahwat al jins; pregnancy, al haml; delivery, wadhau al haml; breast-feeding, ridha’a; hygiene, al nadhaafat; foods, at 'imat; drinks, ashribat; activity, nashaat; and sleep and rest, nawm & raahat
(e) Ethico-legal controversies: assisted reproduction, taqniyat al injaab; contraception, mani’u al haml; reproductive cloning, al istinsaakh; abortion, isqaat al haml; artificial life support, ajhizat al in’aash; euthanasia, qatl al rahmat; solid organ transplantation, naql al a’adha; stem cell transplantation, naql al khalaayat; change of fitra, taghyiir al fitrat
(f) Social issues: masjid; ukhuwwat; takaful; shuura; attitude to maal; dawa; enjoining the good and forbidding the bad, amr & nahy; social change, taghyiir ijtima’e; involvement in professional and occupational organizations; and involvement in social welfare and disaster relief organizations
(g) Personal characteristics: continuing Islamic study; motivation; personal behavior; skill development; leadership, and management.
3.4 Methods of collecting data for evaluation:
· Direct observation
· Questionnaire
· Interview
· Records review
· Performance/knowledge tests
NOTES
[i] (Qur'an 99:7-8)
[ii] (Qur'an 53:38-41)
[iii] (Qur'an 3:188)
[iv] (Bukhari 8:285)
[v] (Bukhari 3:491, hadith # 809)
[vi] (Bukhari 8:330-331, hadith # 506)
[vii] (Qur'an 3:140-180)
[viii] (Tabari 7:120)
[ix] Qur'an 9:25-26)
[x] (Tabari 11:188)