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Presentation at the Quality Medical Education Conference held at the Faculty of Medicine King Fahd Medical City Riyadh on 30th March 2010 by Dr Mohammed O Al-Rukban Associate Professor of Family Medicine King Saud University
ABSTRACT
· Quality is a moral value within the individual that manifests externally as exemplary performance. The best contribution that a member of the teaching faculty can make is to be a good role model of quality.
· More specifically the academic faculty's contribution to quality improvement is in 5 ways: (a) adopting the etiquette of the teacher, adab al mu'allim, (b) getting students to adopt the etiquette of the learner, adab al muta'allim, (c) continuous academic and professional self-development, (d) using state of the art curriculum development and delivery benchmarked against the best centers in the world, (e) student motivation, equitable assessment and feedback.
1.0 INTRODUCTION
1.1 Importance of quality in medical education
Medical education nowadays is becoming an art. It has its own regulation, polices and strategies. People moved from the stage of quantity to the stage of quality. The accreditation process, which became a mandatory requirement for all heath profession schools, supports this movement. Quality should not only be the concern of the academic leaders but also the concern of all stakeholders; the student, the faculty, the staff, the patient and the community.
1.2 Roles of faculty in quality medical education
The role of faculty on quality assurance in medical education is great. It starts by recruiting good faculty and passing through professional developmental programs and ending with program evaluation and promotion. This circle will not stop; planning, teaching, assessing, role modeling, mentoring and so on. We will try in this presentation to focus on the expected role of the faculty on quality assurance in medical schools.
2.0 QUALITY (IHSAN) IS THE CULTURE OF ISLAM
2.1 Ihsan (quality) is the one of the 3 fundamentals of the diin
Ihsan is quality and is the highest level of diin. Ihsan was defined in the sunnah as perfection of action[1]. It is quality in worship, work, and in any other human endeavor. It is quality performance driven by the consciousness of Allah’s watchfulness. No activity goes by without being observed by Allah. Each human activity is an act of ‘ibadat and as such should be done with excellence. The quest for quality is a motivation for good performance. The importance of ihsan is shown by its mention in more than 90 times in the Qur’an: as verb in the past tense, as a verb in the present tense, as an imperative, as an adjective, and as a noun.
2.2 Quality Performance
Islam sets quality work and excellent performance in all spheres of life as its culture. Quality must permeate all activities. The prophet said that Allah loves quality in everything and advised Muslims to perfect every work that they undertake.
3.0 THE ETIQUETTE OF THE TEACHER, adab al mu'allim
3.1 Characteristics of the teacher
Teachers should take their task very seriously. The education process, involving giving and receiving knowledge is noble[2]. Teachers should have the humility to know that their knowledge is limited and that they can always learn more. Arrogance because of knowledge is condemned[3].
3.2 The learning process
Teachers must make the learning process interesting and avoid boredom[4]. They should make the atmosphere and circumstances of learning easy for the students[5]. They must be careful in their actions, attitudes, and words at all times because being models and leaders they are seen and are emulated. They must be aware that sometimes they can teach using body language without saying anything[6]. They should be ready to carry out their function at all times and at any opportunity[7].
3.3 Communication with the students
Teachers should have an appropriate emotional expression. They can raise the voice to emphasize an important point[8]. They can show anger or displeasure when a mistake is committed[9]. Asking students questions to ascertain their level of knowledge is part of the teaching process and is not in any way a humiliation for them[10]. Teachers should make sure that the students understand by constant repetition[11]. Teachers should strive to pass on to the students as much knowledge as they can. Hiding knowledge is a cause of moral punishment[12].
4.0 THE ETIQUETTE OF THE STUDENT, adab al muata'allim
4.1 Respect for the teacher
The Islamic etiquette of the relation between the student and the teacher requires that the student respect the teacher. This is respect to knowledge and not the individual. The prophet taught admiration and emulation of the knowledgeable[13].
4.2 The learning process
Students should be quiet and respectfully listen to the teacher all the time[14]. They should cooperage such that one who attends a teaching session will inform the others of what was learned[15]. The student who hears a fact from a colleague who attended the lecture may even understand and benefit more[16]. Students should ask questions to clarify points that they did not understand or which seem to contradict previous knowledge and experience[17]. Taking notes helps understanding and retention of facts[18].
5.0 CONTINUOUS ACADEMIC & PROFESSIONAL SELF-DEVELOPMENT
5.1 Basic qualifications
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.
5.2 Skill training
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. All teachers must upgrade their knowledge and skills by attending conferences or special training courses.
5.3 Research and publication
Academic staff must engage in research to be at the frontiers of knowledge in their chosen discipline. They must be given incentives for good research as well as protected time for research. 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.
5.4 Preparing teaching material
Another academic product that must be encouraged is producing teaching materials. Teachers should be encouraged to write up each lecture given. These can be accumulated over the years and can be published as a book.
5.5 Academic conferences
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.
6.0 CURRICULUM DEVELOPMENT and DELIVERY
6.1 Curriculum development
Academic faculty must prepare and document curricula. The curricula should reflect the stated underlying vision and mission of the faculty. They should cover knowledge, skills, and attitudes. They should have horizontal and vertical integration.
6.2 Accreditation of curricula
Curricula 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.
6.3 Curriculum review
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.
6.4 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.
6.5 International standardized examinations
Another approach to benchmarking is registering students to take international medical examinations such as the USMLE and comparable British, Canadian, and Australian examinations.
7.0 STUDENT MOTIVATION, ASSESSMENT AND FEEDBACK.
7.1 Good students
Admitting good students ensures high quality. 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 non-local students 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.
7.1 Motivation: an Islamic perspective
Faculty must encourage students to exert themselves to excel. Motivation starts with commitment to an intention Ikhlaas al niyyat. The reward for work is commensurate with the niyyat. The best of work is consistent and continuous. Motivated students know that studying is ibadat and that Allah observes all they do so they strive for quality. Other sources of motivation are honor, sharaf, generosity, karam, and fulfillment, wafaa
7.2 Methods and techniques of motivation
The academic staff can be motivating leaders in the medical educational process. Motivated and motivated leaders clarify goals, set objectives, consult and respect followers, deal with followers kindly, humanely, and with fairness, have good 2-way communication, and make followers feel secure. Positive reinforcement (appreciation, reward and praise) is a motivator. Negative motivation is due to worries, lack of self-confidence, low self-esteem, low self-worth, negative opinions in the work place, poor study conditions, poor leadership, inequity, injustice, snd negative reinforcement such as reprimanding.
8.0 EARLY MUSLIM PHYSICIANS AS A MOTIVATOR
7.1 Comprehensive excellence
Ancient Muslim physicians were encyclopedic in knowledge, all-rounded, motivated, hardworking, and productive. They excelled in medicine as committed Muslims because Islam is not incompatible with science. Their achievements are a motivator for today’s medical students and physicians.
7.2 Abubakr Al Razi (251-313H), wrote more than 100 books (the most famous being al Hawi al Kabir), investigated diseases (gynecologal, obstetrical, hereditary, eye, small pox, and measles), discovered surgical sutures, used anesthetics, used ammonia to control diarrhea, considered psychological factors in disease treatment, and was director of hospitals in Baghdad and Rayy.
7.3 Ibn Sina (370-428H) wrote many books (the most famous being al Qanuun fi al Tibb), recognized that TB was contagious, accurately described the symptoms of diabetes mellitus, discovered ancylostomiasis, and contributed to science, mathematics, chemistry, and philosophy.
7.4 Al Zahrawi (d. 404H) had interest in surgery, pharmacology, and anatomy. He designed over 200 surgical instruments. His book Kitaab al tasriif, became a standard textbook of surgery. He was an expert in cancer surgery and tooth extraction. Ibn Zuhr (d. 487H), lived in Andalusia and Morocco and authored the book al Taysir translated into Latin and used in Europe .
7.5 Ibn Rushd (d. 595H) was a philosopher and a medical practitioner. His book al Kulliyat translated in Europe . He made the observation that smallpox infected only once.
7.6 Ibn Al Nafees (d. 686H) described blood circulation before William Harvey and authored Sharh tashriih al qanuun in which he explained pulmonary circulation.
8.0 STUDENT ASSESSMENT AND FEEDBACK
8.1 Assessment of students
Student assessment with appropriate feedback should be systematic and continuous. 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.
8.2 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.
7.3 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.
[1] BUKHARI
[2] (MUKHTASAR BUKHARI HADITH #70
[3] (MUKHTASAR BUKHARI HADITH #102
[4] (MUKHTASAR BUKHARI HADITH #62
[5] (MUKHTASAR BUKHARI HADITH #63
[6] (MUKHTASAR BUKHARI HADITH #75
[7] (MUKHTASAR BUKHARI HADITH #74
[8] (MUKHTASAR BUKHARI HADITH #55
[9] (MUKHTASAR BUKHARI HADITH #79
[10] (MUKHTASAR BUKHARI HADITH #56
[11] (MUKHTASAR BUKHARI HADITH #82
[12] ABUDAUD
[13] (MUKHTASAR BUKHARI HADITH #66
[14] (MUKHTASAR BUKHARI HADITH #101
[15] (MUKHTASAR BUKHARI HADITH #78
[16] (MUKHTASAR BUKHARI HADITH #61
[17] (MUKHTASAR BUKHARI HADITH #88
[18] (MUKHTASAR BUKHARI HADITH #93