Personal and institutional medical education venture

The following Editorial appeared in Hadhramout Journal of Medical Sciences, Vol 1, Issue 1, 1-3 (June 2012). The journal (ISSN 2224-1086) is published by Hadhramout University College of Medicine (HUCOM) and the article tells my story as a Founding Dean of the two colleges 1988-2000: Tikrit University College of Medicine (TUCOM) in Iraq and HUCOM in Yemen. This article focuses on HUCOM and I am preparing another article focusing on TUCOM.

From TUCOM to HUCOM: a personal and institutional medical education venture in Iraq and Yemen.

For completely different circumstances, it happened that I was twice assigned, as Founding Dean, to establish from scratch two medical colleges in two different countries. In 1988, I was appointed in Tikrit University, Iraq and in 1997 in Hadhramout University in Yemen.  The philosophy of the two programmes reclines in their abbreviated acronyms: Tikrit University College Of Medicine reads abbreviated as TUCOM pointing to its active orientation towards community in playing an active “To You (we) COM(e)” rather than wait to treat sickness. Hadhramout University College Of Medicine, again reads HUCOM which blankly means in Arabic “bunch of wisdom” i.e. the comprehensive role of the old Islamic profession of Hakims in being scientist, philosopher, care provider and a wise man. Both programmes adapted innovative competency-based educational strategies and clear orientation towards community for first time in the two countries. In the two cases, the founding teams pursued sturdy, painful but pleasurable and enjoyable journeys still reviving till now.

In a June late morning 1997, the Rector of the newly established Hadhramout University of Yemen, Professor Ali Hood Ba-Abbad and his Adviser, Professor Abdulla Ba-Biky, were ending their visits to Iraqi medical colleges scrutinizing medical programmes and seeking recruitment of staff for their medical college in the making. Tikrit college was their last blemish on their way from Mosul back to Baghdad, where the two most old and prestigious medical colleges exist. With only two batches graduated so far from Tikrit, it looked too feeble and meager to seek support from. The delegates were shown around the small group PBL discussions, groups of students discussing their plans for the curricular research projects and observed an OSCE which happened to be taking place at that day. They chatted with students and staff here and there and over lunch they explained their hard journey task around the country and drove away without promises, gains or losses between the two sides. The ministry of higher education was later informed that Hadhramout University decided to adopt an analogous innovative programme and that TUCOM was chosen for support. And, a long story of cooperation between the two colleges followed and still. 

In August 1997, the HUCOM started from scratch. Recruited first 3 faculty staff from local health authority who are still serving in the college: Prof Ali Batarfi (a surgeon, current Dean), Prof Ahmad Bahaj (Internist and Former Vice-Dean for Students Affairs) and Prof Khalid Bashrahil (Pharmacologist and Former Vice-Dean; currently Director General of Academic Evaluation at the Hadhramout University Headquarters). Later other pioneering batch joined comprising Dr Abdullah Al-Yahry (Psychiatrist), Dr Maher Al-Saggaf (Gyn/Obs), Dr Abdul-Hakim Lardhi (Pediatrician), Dr Ahlam Bin Briek and Dr Andulah Bin Ghouth (both Community Medicine, the latter is the DG of Health Services in Hadhramout Governorate). The five are still serving in HUCOM as senior academic staff. The first building (West Mukalla in Fowa) was planned, first batch of students (45 in number) was enrolled with special consideration to enroll students from deprived areas including Socotra Island. The study started in September 1997 sharing the facilities with colleges of Engineering and Business through use of one large lecture hall, one lab and one room for management. The college moved to the its Fowa building in September 1999 and later in May 2006 opened another large campus in East Mukalla (Folok). As a founding dean, I was privileged to be invited to attend the graduation of the first batch of graduates in Oct 2003 and still come to the college on different assignments till present and enjoying old good memories with old colleagues and witness new development on all aspects.

Like TUCOM, HUCOM adopted upon its establishment the educational strategy of problem–based learning (PBL) and community–oriented medical education with community-based training. Such decision was revolutionary in Iraq 1988 and in Yemen 1997 and still regarded so. At that time, HUCOM was, and still, the only medical school in Yemen to adopt such a programme and now it is the first medical school in Yemen to start real actions towards obtaining accreditation as an important tool for educational development. The beginning was difficult, for lack of expertise and training of staff due to short time given after recruitment, the first batch students spent the first term studying classical subject-based medically oriented courses but immediately that shifted to the planned innovative modular curriculum without any attempt for a U-turn since then. Many colleges in Yemen and the region made sharp U-turns after a few years but Hadhramout College as pertained to its feminine nomenclature in Arabic language took the valuable hint by Margaret Thatcher's famous quotation in 1981: "the lady's not for turning" [1]. 

The College has a well defined mission which was formulated first in 1997 by its principal stakeholders: the founding dean, and one staff member from Tikrit ( Dr Abed Allan as an external expert), the General Director of the Health Services in Hadhramout (Dr Ghaleb Belgaseer) and the Head of Medical syndicate  (Dr  Al-Abed Ba Mousa), the General Director of Ibn Sina Teaching Hospital (Dr Abdulla Bin Ghouth) and the three doctors from Hadhramout health authorities before their recruitment to the college (Dr Ali Batarfi, Dr Ahmed Bahaj and Dr Khalid Basharaheel). The Mission stated as follows: Training and acquiring the graduating doctors with knowledge, skills and attitudes which enable them to deal with the challenges and health changes at the national, regional and international levels [2].

In order to achieve the college mission, HUCOM derived the following general objectives from the general objectives of Hadhramout University as follows:

1. Graduation of morally and behaviorally prepared safe doctors to work efficiently in the field of primary, curative, preventive and rehabilitative health care.

2. Development of comprehensive personality of the graduates through developing acquiring abilities to learn , analyze , drive lessons and ability to solve community health problems utilizing independent scientific thinking and appropriate decision making.

3. Development and improving abilities of doctors through in-service training and continuing education programs as well as postgraduate studies.

4. Activate and direct applied research towards local health problems and utilize the results in the benefit of community.

5. Effective participation of the college through its students, and the academic staff, in providing and development of direct health services aiming at the social development.

6. Maintaining the values and original humane achievements of the Arab and Islamic civilization in the graduate as an incentive to work in building the future and developing a trust in the Arab nation future and enabling graduates to face and overcome the community health problems.

In order for the student to attain the optimal objectives on graduation after spending the six year programme, graduate is required to show acquisition of the described competencies (in nowadays language the optimum competences are called graduate outcomes). As these optimal competencies result from the accumulative acquisition during the 6 years program, therefore the competencies described in a year are scheduled to be based on competencies acquired in preceding years. These competencies compromise 3 elements, integrated with each other during the educational program. However, it is possible to measure, assess and evaluate each by adopting one or more assessment methods, such assessment of competencies could be accomplished during the study (continuous assessment) or during final assessments according to well defined standards which are closely related to the well defined learning objectives so that assessment in general is not focused on knowledge only.

These three elements are:

1- Knowledge; this includes:

1.1: ability to obtain information concepts.

1.2: ability to use and apply knowledge to comprehend human development, function and behaviors on an individual and on a community in case of health and disease and how internal and external factors of the body affect that to enable learners to make the appropriate decision in implementing preventive, curative and rehabilitative management of health needs and problems.

2- Skills, including:

2.1: Analytical evaluation of health information and data.

2.2: Clinical skills

2.3: Self learning skills to identify gaps in self personal performance and to acquire necessary resources to fill gaps and improve performance in care.

2.4: Ability to work within a team including research team.

3: Behavior and Attitude skills, which include:

3.1: attitude towards own self to identify, accept and correct gaps in knowledge, skills and behavior and attitude.

3.2: Attitude towards patients and their families to be able under appropriate supervision to take responsibility of evaluating the needed care towards patients and their families and communicating     in a positive manner.

3.3: Attitude towards team members (supervising and supervised through constructive participation during and outside).

3.4: Attitude towards community participation towards supporting and improving health care level with equity to all community sectors.

Accordingly, HUCOM adopted innovative educational strategies and methodologies including:

1- Student Centred Learning

2- Task-Competency-Based Education

3- Community-Orientation

4- Problem-Based Learning with full vertical and horizontal integrated modular courses throughout the 6 years of study.

Graduates of HUCOM reached over 600 so far and have been evaluated in number of studies and proved to have achieved the described outcomes. The most recent comprehensive study indicated that graduates have been evaluated to have accomplished all the described competences and outcomes of the Problem Based Learning strategy which is published in this issue of this journal. [3,4]. Unique curricular longitudinal modules in years 2-5 trains groups of students to plan, implement and present/publish community-based research has contributed in both TUCOM and HUCOM towards achieving number of the outcomes [5]. In the last six years, HUCOM trained more than 20 of its staff in medical education who obtained Masters Degree (Joint Master of Health professions Education-JMHPE from Maastricht and Suez Canal Universities), adopted a new detailed set of graduate outcomes and working hard towards obtaining accreditation before the end of 2012. Two years ago, HUCOM introduced a new innovative clinical presentation curriculum (CPC) in clinical years that was pioneered by Calgary in mid 1990s. It is worth to disclose and divulge a fact that TUCOM in 1989 designed and adopted in 1992, unique modular blocks in fourth year integrating the clinical 4 major disciplines around body regions’ (Abdomen, chest, Head and Neck and Trunk/Limbs) clinical problems/symptoms where students discussed and worked out clinical reasoning towards diagnosis that could be related to one of the major disciplines [6]. In other words, an early version of the CPC that was included in HUCOM’s original plan and actually implemented for only one year when in year 2000-2001, students of the first batch practiced that systematic clerkship in their fourth year. However, the scheme was abandoned in next batches with a little u-turn to discipline-based clinical rotation.

The “Tale of The Two” colleges goes on without a halt; for TUCOM and based on its programme, Harvard Medical School chose it in June 2003 among over 20 medical schools in Iraq to be its 19th global medical school partner and to assign as a national hub for training and upgrading medical education in Iraq [7]. Unfortunately that privilege did not materialize till now for many reasons including security situation prevailed in Iraq since. For HUCOM and again based on its programme and among many academic institutions in Yemen, it received a 2.1M Euro grant from Dutch government (Nuffic) to upgrade its innovative programme to play a role in spreading the 15 year old experiment of innovation at national level. The HUCOM Fourth Medical Conference 2012 devoted this year to medical education in Yemen and the publication of the first issue of this [Hadhramout Journal of Medical Sciences] as the "first of its kind in the governorate" are only a few of the vehicles to achieve that role [8, 9].

References

[1] http://www.youtube.com/watch?v=rQ-M0KEFm9I Accessed on 27/07/2012.

[2] Copy deposited in HUCOM Library. The Educational Plan for Medicine, University of Hadhramout For Science and Technology, College of Medicine and Medical Sciences, Mukalla August 1997. HUCOM Library.

[3] Mahmoud, Asmaa A. (2011), Evaluation of the Problem Based Learning in Hadhramout University College of Medicine. MA Thesis, College of Education, Hadhramout University, Mukalla, 2011.

[4] Elayouty, Hamdy D et al (2012), Perception of Graduate of the PBL Outcomes in Faculty of Medicine, Hadhramout University. Hadhramout Journal of Medical Sciences (HJMS), Volume 1, Number 1: 14-21.

[5] Alsheikh, Ghanim et al. Community-Project: a student-centred curricular course in community-based health promotion research. Abstracts of the International Conference on the Role of the University in Health Research for Development. The Network, Madras, India, February 1995.

[6] Alsheikh, Ghanim and Sherif, Mohamed. Developing a new fully integrated course in TUCOM fourth year clinical study based on complaint rather than discipline. Abstracts of Saddam (renamed Nahrain) College of Medicine Conference on Medical Education, Baghdad 17-18 May 1995.

[7] http://forums.cnet.com/7723-6130_102-28832/tikrit-iraq-univ-to-partner-with-harvard/  Accessed 27/06/2012

[8] https://www.nuffic.nl   Accessed on 27/06/2012.

[9] https://www.hjms.info  Accessed on 27/06/2012.