Integrated Medical Education Resources: 0910P - CONCEPT PAPER ON ACADEMIC SUPERVISION OF FREE STANDING MEDICAL COLLEGES

Written at the request of the Faculty of Medicine KFMC by Professor Omar Hasan Kasule Sr MB ChB (MUK), MPH (Harvard), DrPH (Harvard)

ABSTRACT

Medical colleges that are not part of a university need affiliation to a university for purposes of quality control. The university senate will approve the curriculum, control academic quality, and either carry out or monitor the assessment process to make sure that students have reached the standards qualifying them for award of its degree. The affiliated college need not follow the same curriculum as the university. Complete documentation of all college academic activities will make the supervision process easier and will improve communication. Both parties must have a common understanding of the quality process.

1.0 INTRODUCTION:

The quality of medical education is a major concern because of its intimate relation with life and health. Universities with well established education quality control systems assure academic quality while statutory accreditation and licensing bodies like the General Medical Council of UK, The Liaison Committee on Medical Education in the US and Canada[1], and the Saudi Council of Medical Specializations assure professional quality. Universities limit the number of students out of concern that they cannot maintain quality while the healthcare systems want to increase the number of medical graduates to provide access to all citizens. The resulting tension between quality and quantity has been solved in various ways some of them very creative. Established market economies like the UK and the US have relied on importing extra medical manpower from developing countries. Developing countries have made each of their universities extend academic quality control to several free standing medical college thus assuring both quality and quantity. This paper presents models from around the world on academic supervision and makes some general conclusions and recommendation at the end.

2.0 REVIEW OF SOME COUNTRY EXPERIENCES

2.1 USA

The Flexner report[2] published in 1910 recommended putting medical colleges under universities to assure quality and standardize medical education. As a result many schools were merged with an overall decrease in the number of medical graduates which has continued to plague the US until today. Today most medical schools in the US are under universities with the Mayo Medical School being an outstanding exception. Started in 1972 it admits only 50 students to assure quality. It is an independent, degree-granting institution not affiliated to any university and accredited by the Higher Learning Commission[3], North Central Association of Colleges and Schools, and the Liaison Committee on Medical Education. US-owned private medical schools have been established in the Caribbean[4]; they admit US students who follow a US curriculum and return to and are licensed to work in the US after passing tough licensing examinations. Graduates from other countries can enter the US after passing the US Medical Licensure Examination[5] set by the Education Commission foreign Medical Graduates[6] that assure their education meets US standards.

2.2 UNITED KINGDOM

The UK generally solves its health manpower problem by importing doctors from its former English-speaking colonies. Its great advantage is that it set up the medical education systems in those countries and continues to influence and nurture them mostly through the University of London. The University of London is therefore a very good model of academic quality supervision for a free-standing medical school in the UK or overseas and we will discuss this unique experience in more detail.

Created in 1835, the University of London was granted powers to examine and grant degrees to students from other institutions. In 1858 the University of London started examining and granting degrees to students in other institutions. Several major British universities started as university colleges affiliated to the University of London and awarding University of London degrees for example the University College Nottingham until 1948, the University College of Southampton until 1952, and the University College of Leicester until 1957.

During the colonial era graduates of medical schools at university colleges affiliated to the University of London in British colonies took the same examinations as those given to students in London and earned University of London medical degrees. Between 1946 and 1970 (when they became independent) university colleges negotiated a special relationship with the University of London covering admission requirements, syllabuses, and examinations. During this time graduates were awarded University of London external degrees examples being the University College of the West Indies until 1961, the University College of Ibadan until 1967, The University College of Rhodesia now Zimbabwe, the Royal College of Nairobi, and the University of East Africa.

At the moment in London itself the University of London is the degree awarding authority to several medical schools: King's College London School of Medicine and Dentistry (KCLMS)[7], St George's Hospital Medical School[8], The United Medical and Dental Schools of Guy's and St Thomas' Hospital, Barts & The London School of Medicine and Dentistry, and the UCL Medical School. These institutions are independent in their administration and funding but are under the University of London supervision because their students get University of London degrees.

2.3 MALAYSIA

Malaysia has dealt with the quality/quantity issue in a very bold way. As a professor in Malaysia over a period of 10 years I listened to heated debates between universities and health officials regarding raising the number of medical students. It seems that the government of Malaysia after failing to persuade universities to increase their medical intake in a significant way, decided to offer licenses to private universities that promptly opened medical schools with much facilitation by the government. Some of the universities were foreign. As a result of this policy there are now 10 public medical schools[9] and 11 private medical schools[10].

The Royal Perak Medical College and the Penang Medical College are examples of free standing schools that are a good illustration of affiliation of a medical school to a university. Royal Perak started life as an affiliate of Sheffield University. It became affiliated to University of Malaya before being affiliated to the University of Kuala Lumpur. The Penang Medical College is affiliated to the Royal College of Surgeons of Ireland. Its students do the pre-clinical phase in Ireland and the clinical training in Malaysia. They are then awarded Irish medical degrees.

2.4 INDIA

Medical schools in India may be stand-alone institutions or may be affiliated to universities or other larger institutions. They may be government or privately-owned. We will now review the highest ranked medical schools in India.

A free standing medical college is usually affiliated to a University. The University approves the syllabus, examines the students, and awards the medical degree. The college must also be accredited by the Indian Medical Council.

The highest ranked medical school is the All India Institute of Medicine[11] that is autonomous, established by a special act of parliament, and has a budget of USD100 million a year. Although not a university, it can grant its own medical degrees. The Christian Medical College[12] in Tamil Nadu is an independent organization owned by church organizations. The Armed Forces Medical College[13] belongs to the Indian Ministry of Defence; it as first affiliated to the University of Pune but is now affiliated to Maharashtra University of Health Sciences. It recently applied for university status and was rejected. The Madras Medical College[14] owned by the state government was established in 1835 and was recognized as a medical school in 1850 and was affiliated to Madras University in 1857. It was affiliated to the Tamil Nadu University in 1988. In 2000 for a short time it was accorded university status but this was withdrawn. St John's Medical College belongs to the Catholic Church and affiliated to the Rajiv Ghandi University of Health Sciences. Kastruba Medical College[15] was the first private college in Indian initially affiliated to Mangalore University and became an Independent University in 1993. Maulana Azad Medical College is owned by the Central Government and is affiliated to Delhi University.

2.5 PAKISTAN

Allama Iqbal Medical College was first affiliated to the University of the Punjab, Lahore but as of 2003 it became officially affiliated with University of Health Sciences (UHS), Lahore. The University of Karachi considered a premier university in Pakistan several colleges affiliated to it: such as the Karachi Medical & Dental College and the Jinnah Medical College,

3.0 DOCUMENTATION FOR SUCCESSFUL SUPERVISION AND QUALITY CONTROL

There are variations in the details but the essence is one: to make sure that the curricula, teaching methods, and assessment methods are at the required standards to justify awarding the degree.

The college can have its own curriculum or may adopt the curriculum of the supervising university.

The supervising university must appoint external examiners who will closely monitor the assessment process.

Documentation is a very crucial part of the process because the supervising university sends visitors regularly and they want to review documentation of daily activities at the college.

The following documentation should be readily available for regular review by the supervising university:

Faculty overview

· Faculty prospectus

· Brief history of the Faculty

Growth of students and staff of the Faculty (past 5 years)

· Annual reports (past 5 years)

Faculty governance

Faculty organizational chart
Names and qualifications of top faculty officials
Faculty strategic plan
Faculty quality assurance unit
Functional linkages of the faculty of medicine to other KFMC units

Forms, brochures, and information packages

Administrative forms
Academic forms

Faculty facilities

Physical environment of the Faculty of Medicine
Laboratories completed: size, equipment
Library: area, holdings, seating capacity, online workstations, online data bases and journals subscribed to, hours of opening, and budget, use of library by students (borrowings of books and journals), Library staff: categories and functions
IT and Telecommunication equipment: IT services
Clinical skills laboratory

Academic committees

Faculty Board Meeting
Faculty Administrative Meeting
Academic program management committee
Board of Examiners
Board of Appeal
Faculty Promotions Committee
Faculty Research Committee
Research Ethical Committee
Faculty Postgraduate Committee
Departmental meetings
Curriculum development
Curriculum revision
Programme evaluation

Administrative committee

Student Admissions Committee
Student Advisory Committee
Facilities Committee
Discipline Committee
IT Committee
Desk Top Publishing Committee
Library Committee

Faculty academic staff

Staff handbook

Full time academic staff per department: Name, qualifications, specialty, and teaching experience
Honorary academic staff per department: Name, qualifications, and specialty
Resume of each academic staff (2 pages maximum in standardized format)

Advertisement of staff vacant positions: Sample advertisement
Advertisement of staff vacant positions: Sample advertisement overseas
Staff selection criteria
Staff promotion criteria
Academic enrichment programs
Continuing medical education
Teacher training
Islamic Orientation Program
Specialty training
Teaching Efficiency Rating

Academic staff activities

Use of faculty time (%) by type of activity by department: teaching, research, clinical service, consultations, administration, community/social service
Teaching load (in hours) for undergraduate students per academic staff by department
Ongoing and completed research projects and the source of funding per academic staff and by department
Consultancy projects by department: name of staff, project, where, and cost
Seminar and conference attendance as well as paper presentation per academic staff by department
Training courses attended per academic staff by department
Membership of professional organizations by department
Community projects undertaken by academic staff by department

Admission process

Description of pre-medical courses for medical students
System of assessment in pre-medical courses
Entry requirements: national and international
Selection criteria
Policy on transfer students
Total applicants and number selected – last 5 years
Projected enrolments in the next 5 years

Characteristics of admitted students

Summary GPS (percentage) score of admitted applicants by year – last 5 years
Nationality, gender and ethnic distribution of admitted applicants – last 5 years
Program book of the last orientation week
Registration & enrolment procedures

Student counseling and advisory system

Student advisory committee
Common student academic problems
Common student social & personal problems
Assessment of the academic counseling system

Student records

Student personal record: items in the record, where and how filed
Student academic record: items in the academic record, updates, filing
Accessibility of student records:
Privacy and confidentiality of student records

Student activities

Student extra curricular activities
Student government

Student discipline

Student disciplinary code
Disciplinary officers
Disciplinary procedures

Faculty research

List of individual research projects
List of group research projects
Collaboration with outside bodies

Faculty consultancies

List of consultancy projects undertaken by the academic staff

The teaching hospital

Administrative arrangements (memorandum of understanding)
Hospital facilities
Hospital staff who help in reaching
Table showing bed capacity, number of MOs, and specialists

Description of academic departments in the faculty

Annual departmental report

Academic activities in the faculty

Seminars at the Faculty of Medicine
Schedule of journal club meetings
Seminars attended by faculty staff Seminars outside
Training programs and attachments
Participation at national conferences
Participation at International conferences

Course descriptions

Use standardized format

Teaching materials

Samples of notes, powerpoint used in classroom

Description of the assessment system

Samples of examination papers and student answer scripts
Itemized examination results by year and course – last 5 years

4.0 QUALITY ASSURANCE IN MEDICAL EDUCATION[16]

4.1 INTRODUCTION

The essence of academic supervision is quality control. It is therefore crucial that the supervising university and the supervised medical college have a common view of the quality process. This section attempts to make a summary

4.1 CONCEPTS AND PRINCIPLES OF QUALITY ASSURANCE

4.1.1 IHSAN = QUALITY

Ihsan is the culture of Islam

Islam sets quality work and excellent performance in all spheres of life as its culture. Quality must permeate all activities. Allah accepts the best of work, taqabbalu ahsan al ‘amal[17] and gives rewards for it, jazau ahsan al ‘amal[18]; The prophet said that Allah loves ihsan in everything and advised Muslims to perfect every work that they undertake including the slaughter of animals[19]. Humans in their earthly life are tested to see who performs the best, Ibtillai al naas ayyuhum ahsan ‘amalan[20].

4.1.2 MANAGEMENT TOOLS IN QUALITY ASSURANCE

Principles of quality assurance

Continuous quality improvement (QI) is a management philosophy that is committed to continuous and consistent improvement in quality. It is consistent with the Islamic concept of ihsaan that calls for continuous human improvement. Quality assurance or quality improvement is a type of control.

Quality assurance (QA) is formal and systematic identification, monitoring, and overcoming problems. Quality indicators are statistical indices of work performance that are a bench-mark against which performance can be evaluated. QA review may be concurrent or retrospective. The QA reviewers may be independent clinical auditors from outside or may be part of the institution. The aim of QA review is to ascertain compliance with the given guidelines. If a deviation is found, it is documented as well as its surrounding circumstances. It is discussed at the departmental QA committee. The committee will suggest actions to be taken to alleviate the deficiency and map out an implementation plan. The QA review process is cyclical. Deficiencies found are corrected and the process is repeated.

The concept of quality in university education is more difficult to define than in industry. Unlike the factory, the university has no way of defining its output in a quantitative way. However the inputs and processes of the education process can be described and can be defined. The destiny of the graduates and their achievements can be used as a fairly objective outcome indicator but it occurs too late and we are not sure of what other factors contribute to the student outcome.

Control

Control is assuring that plans are carried out effectively and efficiently. It provides a systematic and methodological approach to ensuring compliance. It enables early detection and correction of mistakes. It may be internal (due to taqwa and thawaab) or external (due to rewards and punishment). It may be pre-action, concurrent, or post implementation. A good control system must be flexible, timely, accurate, cost-effective, understandable, acceptable, and objective. The steps of the control process are (a) setting standards, criteria, or objectives; (b) measurement of actual performance; (c) comparing actual to expected standards; (d) and taking corrective action. Base plans can be changed as a result of control activities. The control program can fail due to resistance, inaccurate information, rigid bureaucracy, negligent management, too rapid changes, and an overstretched organization.

Evaluation

The objectives of evaluation are assessing whether objectives were achieved, assessing efficiency, assessing effectiveness, and learning from experience. Its benefits are: Identification of success and reinforcement, helping the management see areas of weakness and improvement, reassuring workers that they are moving well, reassuring stake-holders, and gaining 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. Evaluation may be process evaluation or outcome evaluation. It may be internal or external. It may be during project implementation or at the end of implementation. The basis for evaluation in the Qur'an and sunnah is the individual accountability as well as the reward and punishment. Data for evaluation can be collected by direct observation, questionnaire, interview, end-product, records review, and performance/knowledge tests. Self-evaluation is very difficult but yet is very important. Only the most mature, most self-confident, and most sincere people are capable of looking at themselves in mirror and deal objectively with their performance, negative or positive. Projects are evaluated on the criteria of keeping the schedule, finishing within budget, meeting all project objectives, and meeting stakeholder expectations.

4.2.0 CONCEPTS AND PRACTICE OF QUALITY IN MEDICALEDUCATION

4.2.1 WHY QUALITY IN MEDICAL EDUCATION

Globalization has led to more competition in all fields of endeavor including medical education. The competitors are global and are no longer confined within national boundaries. Winners of the competition are those with the highest quality in terms of products and services. Governments and medical professional bodies have set up programs for quality assurance these include accreditations requirements and monitoring faculties if medicine with requirements for regular reports. Since in the globalized economy people seek work outside their country of birth, it is very important to ensure that medical qualifications of the mother country are accepted by other countries. This acceptance will occur only if the highest international standards of quality are maintained. Universities and faculties of medicine sometimes cooperate to formulate common quality assurance guidelines. These criteria also provide a framework for benchmarking.

4.2.2 SETTING UP A QUALITY ASSURANCE SYSTEM

Each University should have a QA unit whose job is to train lecturers and administrators from individual faculties on QA systems. They should therefore play a supporting role rather than becoming a supreme authority directing QA systems. QA programs succeed most when they are controlled at the faculty or even departmental levels by people with intimate knowledge of what is going on. A big bureaucratic centralized system will create instead of solving quality problems. The QA system must be documented in detail. The details set out QA objectives and the methodology of QA implementation. Specific QA criteria must be formulated for the various activities of the faculty. These must be quantifiable as much as possible.

4.2.3 IMPLEMENTING A QA SYSTEM

Successful implementation of a QA system requires political will from the highest authorities in the university. This is followed by identifying academic and administrative staff who have the motivation to lead the QA process. They are given the necessary training and support. Then QA procedures are formulated as a consensus of several rounds of discussion involving all stakeholders. The procedures are published in a QA manual. The manual must include clear quantitative and qualitative QA indicators. Budget and time must be made available for the QA process. It is important to maintain motivation all through. QA sub-committees are set up at various levels: units, department, faculty, and university. Provision must be made for internal and external assessment of the QA system. Internally every sub-committee has to carry out assessment at its level. Reports of both internal and external assessment are written and are discussed to identify ways of improving the QA process. Measures taken to remedy any deficiencies are treated as part of the QA report. For maximum efficiency these reports should be widely available within the institution because transparency is one of the major factors for the success of the QA process.

4.2.4 EVALUATION OF A QA SYSTEM

The performance of the QA system must be monitored continuously. QA systems must be audited by both internal and external auditors. Self-assessment by members of the department remains the cornerstone of quality assurance and quality improvement. It is the best form of assessment and should be carried out on a continuous basis. Self evaluation is a more detailed process than external evaluation. It involves SWOT analysis. Assessment can also be by internal or external assessors. Scores can be given for each QA indicator so that a total score can be generated. This total score should not be over interpreted as it may not be perfect reflection of total quality. The scoring system is based on existence of documentation for that indicator: 1= very little, 2=little, 3=below average 4=average 5=above average 6=large amount 7=very large amount. The assessment should end with listing of outstanding / unresolved issues as well as recommendation for improvement.

4.3.0 QUALITY ASSURANCE CRITERIA

4.3.1 QA CRITERIA FOR TEACHING AND LEARNING

Curricula must be fully documented. They should reflect a stated underlying vision and mission of the faculty. They should cover knowledge, skills, and attitudes. They should have horizontal and vertical integration. They should be benchmarked against the best faculties of medicine in the region and internationally. They should also be accredited by the national medical licensing authority to make sure that graduates will be registrable and employable in the local hospitals. Recognition of the final qualification by other universities especially overseas is a good indicator of quality. Denial of recognition does not necessarily indicate poor quality because political factors are often invoked. The curricula should be reviewed every 3 years in view of the rapid growth of knowledge and methods of teaching and learning. These reviews should result in refining, redirecting, and restructuring the curriculum. The process of curriculum review should be evolutionary and not revolutionary. Revolutionary changes cause a lot if dislocation and confusion and in the process do not last long.

Academic staff must be qualified. Appointment and promotion of academic staff should depend only on academic merit and character. Good staff means high quality. The minimum qualification for basic medical science lecturers is a doctoral degree. Clinical teachers must have the professional specialist qualification for that discipline. All academic staff must undergo training in teaching methodology including writing course descriptions, writing learning objectives, lesson planning, effective use of audio-visual aids, and assessment systems. The teacher to student ratio should vary by department and nature of discipline but must be fixed and documented in the QA manual. The university must have personnel policies that motivate the academic staff to produce their best. A staff handbook should spell out administrative and financial procedures. It should also explain disciplinary measures. All lecturers must upgrade their knowledge and skills by attending conferences or special training courses.

Assessment of students takes place before admission, during the course, and at the end of the course. It must be systematic and the faculty must have written policies and guidelines for examinations. These should include what to do when students fail or when students cheat in the examinations.

Learning resources must be adequate. Quality starts from the facilities and management. If those are done well only vision and qualified teachers are needed to ensure quality products. These include library books, digital libraries, and internet access.

4.3.2 QA CRITERIA FOR RESEARCH

Research committees must exist at the university and faculty levels. The university must allocate funds for research. The research budget should not be less than one percent of the university operational budget. Academic staff must be given incentives for good research. They must be given time for research. This requires careful balancing of teaching and research which may be difficult when there is a shortage of teaching staff. The research strategy should be closely linked with the postgraduate strategy because academic staff undertake research by directing and supervising postgraduate students.

Research distinguishes a university from a secondary school. It also enhances the academic standards by making the medical teachers producers of knowledge instead of being only consumers of knowledge who just pass it on to the students. Teachers who engage in research have up to date knowledge. The faculty should have a strategic plan for research spelling out what is to be achieved in 2, 5, or 10 years. The faculty should find a research niche and work on it in a multi-disciplinary approach. Even if the research undertaken is simple, it can yield useful results if it is focused.

Research output shall be judged for each individual lecturer as well as for the faculty as a whole. The start should be publication in the local faculty journal with attempts being made to publish in refereed international journals. The faculty should have a research ethics committee. Another academic product that must be encouraged is producing teaching materials. Lecturers should be encouraged to write up each lecture given. These can be accumulated over the years and can be published as a book.

Conference attendance is useful for purposes of presenting research results and getting feedback from other researchers. Just attending a conference without any paper presentation is not very useful.

4.3.3 QA CRITERIA FOR CONSULTANCY

The faculty should have a policy on consultancy specifying how much time a lecturer can spend on consultation and also specifying financial rights.

4.3.4 QA CRITERIA FOR COMMUNITY SERVICE

A university cannot be an ivory tower isolated from the community. It must give back to the community by undertaking community service. This should be in the form of programs that have direct benefits for the community.

4.4.0 GENERAL QUALITY APPROACHES IN MEDICAL EDUCATION

4.4.1 STUDENT FEEDBACK

Students are the most important customers in the educational process. Therefore their satisfaction is very important. We have to listen to them and address their concerns. We can get student feedback from the examinations. It is however also necessary to get their feed-back by use of questionnaires. These questionnaires are more effective if administered regularly usually at the end of each unit or module. Students should be asked to indicate their degree of satisfaction with each individual learning objective. If there are too many objectives we may group them into natural categories and choosing 1-2 objectives from each category for inclusion in the questionnaire. These formal means of getting student feedback are not a substitute for informal means of getting student views on the curriculum. The students may be more honest and forthcoming in informal settings.

4.4.2 EXTERNAL EXAMINERS

Examiners are set and are marked internally. To maintain quality medical educators from other institutions should be involved as external examiners. Their involvement should include comments on the examination questions as well as marking a sample of the answer sheets to make sure that internal marking standards are comparable to external ones.

4.4.3 BENCHMARKING

The curricula in the faculty should be compared with curricula in other faculties. This process has now become easier because many universities put their curricula on their websites. The purpose of benchmarking is not to copy or be like everybody. It serves the purpose of indicating whether in general we are ‘moving with the crowd’. If a curriculum differs in major ways from comparable institutions a rational explanation must be found otherwise there is some problem.

Another approach to benchmarking is registering students to take international medical examinations. The Americans have the MCAT and USMLE examinations. The MCAT examination is taken by pre-medical students. The USMLE I examination is taken by students who have completed the medical sciences curriculum. The USMLE II is taken at the end of clinical training. There are equivalent UK and Australian examinations.

4.4.4 STUDENT TRACER STUDIES

An identifiable product of an educational system are the students. After graduation they take the knowledge and skills learned to the outside world. Their job performance and character reflect to a certain extent the quality of the education that they received. Thus a faculty of medicine should follow up and trace its graduates to find out how they are performing. The tracing can be by using questionnaires or telephone interviews.

4.4.5 EXCHANGE OF STUDENTS AND STAFF

Exchange of students and staff with sister faculties for short periods of time 1-2 months can be very helpful. The students can join classes in other faculties and the lecturers can give some lectures. In the process they get to make comparisons with other faculties. They may learn new approaches and methods that can improve their own faculty.

4.4.6 FACULTY BOARD

The faculty board meeting monthly should play an important role in quality assurance by reviewing reports of ongoing academic activities, reviewing examination questions, and reviewing minutes of monthly departmental meetings.

4.4.7 PERFORMAMNCE APPRAISALS

Academic staff should have annual performance appraisals of their work. Any deficiencies detected should then be corrected.

4.4.8 GOOD STUDENTS

Admitting good students means high quality. Only the best should be admitted. Besides the academic grades, consideration should be given to character and motivation to study medicine. Experience has shown that diversity improves quality. The proportion of internationals should be at least 10% for good quality. Student counseling services should be provided for all students. There must exist mechanisms for identifying and counseling failing students as early as possible.

4.4.9 ENGLISH PROFICIENCY

English has become an international language of scientific and professional communication. The internet information highway is predominantly in English. Therefore quality teaching and quality learning require mastery of the English language. Both academic staff and students must be proficient in English at the highest levels. To achieve this continuing education English language courses must be provided in the faculty for both students and staff. It also may make sense to have an English language unit in the faculty. The unit should focus on using English for medical purposes and not acquiring general competence in English.

NOTES

[1] http://en.wikipedia.org/wiki/Liaison_Committee_on_Medical_Education

[2] http://en.wikipedia.org/wiki/Flexner_report

[3] Higher Learning Commission 30 N. LaSalle Street, Suite 2400
Chicago, IL 60602-2504 (800) 621-7440; (312) 263-0456; Fax: (312) 263-7462

[4] http://en.wikipedia.org/wiki/Caribbean_Medical_Schools

[5] http://en.wikipedia.org/wiki/United_States_Medical_Licensing_Examination

[6] http://en.wikipedia.org/wiki/ECFMG

[7] http://en.wikipedia.org/wiki/King%27s_College_London

[8] http://en.wikipedia.org/wiki/St_George%27s,_University_of_London

[9] The public schools are: 1. University of Malaya, Faculty of Medicine; 2. Universiti Kebangsaan Malaysia Faculty of Medicine; 3. Universiti Sains Malaysia, School of Medical Sciences; 4. Universiti Putra Malaysia, Faculty of Medicine and Health Sciences; 5. Universiti Malaysia Sabah, School of Medicine; 6. Universiti Malaysia Sarawak, Faculty of Medicine and Health Sciences; 7. International Islamic University Malaysia, Kulliyyah of Medicine; 8. Universiti Teknologi MARA, Faculty of Medicine; 9. Universiti Sains Islam Malaysia, Faculty of Medicine & Health Sciences; and 10. Universiti Darul Iman,Faculty of Medicine.

[10] The private schools are: 1. UCSI University, Faculty of Medical Sciences - School of Medicine; 2. Monash University Malaysia, School of Medicine and Health Sciences, 3. International Medical University, Faculty of Medicine; 4. AIMST University, Faculty of Medicine and Health Sciences; 5. Management and Science University, Faculty of Medicine; 6. Cyberjaya University College of Medical Sciences, Faculty of Medicine; 7. Royal College of Medicine Perak, School of Medicine; 8. Melaka Manipal Medical College, School of Medicine; 9. Penang Medical College, School of Medicine; 10. MAHSA University College, Faculty Of Medicine; 11. Newcastle University Medicine Malaysia ( NuMED)

[11] http://en.wikipedia.org/wiki/All_India_Institute_of_Medical_Sciences

[12] http://en.wikipedia.org/wiki/Christian_Medical_College

[13] http://en.wikipedia.org/wiki/Armed_Forces_Medical_College,_Pune

[14] http://en.wikipedia.org/wiki/Madras_Medical_College

[15] http://en.wikipedia.org/wiki/Kasturba_Medical_College

[16] Paper presented at a Medical Education Workshop held at the Faculty of Medicine University of Science and Technology Sanaa Yaman 14-27 June 2007

[17] 6:16

[18] 29:7, 39:35

[19] inna al llaaha yuhibbu al ihsaan fi kulli shay…idha dhabahtum fa ahsinu al dhabhat..

[20] 11:7