Postgraduate medical education: The history and development of competency-based training program in Nepal

2021 ◽  
Vol 8 (1) ◽  
pp. 102-112
Author(s):  
Jay Narayan Shah ◽  
Jenifei Shah ◽  
Jesifei Shah ◽  
Ashis Shrestha ◽  
Nabees Man Singh Pradhan
Keyword(s):  
Medical Education ◽  
Healthcare System ◽  
Postgraduate Training ◽  
Core Competencies ◽  
Health Sciences ◽  
Medical Council ◽  
Competency Based Medical Education ◽  
Surgical Workforce ◽  
Competency Based ◽  
Medical Colleges

Nepal is a small, lower-middle-income country; with a population of around 30 million. As per WHO, Nepal has a low doctor-patient ratio (0.7/1000) and even lower specialists (e.g., surgical) workforce (0.003/1000); additionally, data from Nepal Medical Council show the number of postgraduate specialists is 1/3rd of the total registered doctors. The mismatch in the doctor-patient ratio is further aggravated by the overwhelming number of doctors in urban areas; when 80% of the population are in rural Nepal. This inequitable discrepancy in the healthcare system requires: proper training of competent medical graduates, a fair distribution across the country, and effective changes in the healthcare system. Competency-based medical education plays an important role in: standardizing education, training competent doctors, and deploying them where they are needed the most. The Government of Nepal has recently established Medical Education Commission-which plans to oversee the entrance exams; and expand the postgraduate training to be conducted by private hospitals, previously not affiliated with any medical colleges or universities. Historically, Civil Medical School started training compounders and dressers in Nepal in 1934. A big milestone was achieved with the establishment of the Institute of Medicine under Tribhuvan University in 1972, which has continued to train all categories of health manpower needed in the country. In 2006 Nepal Medical Council developed “Regulations for Post-graduate Medical education”. Thereafter, several institutions started providing postgraduate training, for example: the BP Koirala Institute of Health Sciences, Kathmandu University, National Academy of Medical Sciences, and Patan Academy of Health Sciences (PAHS). The PAHS conducts PG programs and post-PG fellowships in line with competency-based medical education. In addition to formative assessments, research thesis, and a publishable article; PAHS requires its trainees to be certified in a pre-set of entrustable professional activities (EPAs) and to master eight Core Competencies domains in: Professionalism, Patient-centered care, Procedural skills, Clinical Reasoning, Communication, Scholarship, Leadership, Community orientation. The number of medical colleges in Nepal has since expanded to 24  (medical 21 and dental colleges 3). Private medical colleges make up about 3/4th of the total medical colleges in Nepal. This makes the inclusion and regulation of more components of the competency-based curriculum in postgraduate training programs, and its monitoring,  somewhat of a challenge.

scholarly journals Competency Based Post Graduate Residency Program at Patan Academy of Health Sciences, Nepal

2021 ◽  
Vol 19 (1) ◽  
pp. 189-195
Author(s):  
Shrijana Shrestha ◽  
Ashis Shrestha ◽  
Jay Narayan Shah ◽  
Rajesh Nath Gongal
Keyword(s):  
Medical Education ◽  
Residency Training ◽  
Residency Program ◽  
Core Competencies ◽  
Health Sciences ◽  
Assessment System ◽  
Competency Based Medical Education ◽  
Post Graduate ◽  
Faculty Readiness ◽  
Competency Based

Competency-based medical education has evolved as an alternative approach in the residency training program. It shows potential to align educational programs with health system priorities through defining the competencies of graduating doctors. Designing and implementing Competency Based Post Graduate (CBPG) training in a resource-limited setting, where most of the trainings are still run in a conventional approach, is a big challenge. Patan Academy of Health Sciences, School of Medicine has taken the competency-based approach in the postgraduate residency training. Defining core competencies and connecting those to teaching methodology and assessment system are important initial steps in implementing the competency-based approach. The institution has implemented Entrustable Professional Activity (EPA), which is a unit of professional practice and helps to measure the trainees’ achievements in the form of milestones. This paper describes the process of piloting and implementing the CBPG program at this school.The school launched the CBPG training in 2018 and so far, three batches of residents have been enrolled in nine different subjects/disciplines. The first batch of trainee, having the PAHS Core competencies and the pre-defined discipline-specific EPAs certified, will be completing their training soon. The program is time and resource consuming. Continuous faculty development, commitment, supportive leadership and faculty readiness to adapt to newer approaches are the key to the program’s successful implementation.Keywords: Competency based medical education; Nepal; patan academy of health sciences; post graduate training; residency program

scholarly journals Students’ feedback on the foundation course in competency based medical education curriculum

2019 ◽  
Vol 7 (11) ◽  
pp. 4408 ◽  
Author(s):  
Ajeet Kumar Khilnani ◽  
Jitendra Patel ◽  
Gurudas Khilnani
Keyword(s):  
Medical Education ◽  
Extracurricular Activities ◽  
Fine Arts ◽  
Medical Council ◽  
Competency Based Medical Education ◽  
Medical Graduates ◽  
Community Orientation ◽  
Implementation Program ◽  
Time Table ◽  
Competency Based

The Medical Council of India (MCI) has formulated a new Competency Based Medical Education (CBME) Curriculum for the Indian Medical Graduates with an objective of making medical education outcome based. A one month long Foundation Course (FC) is a hallmark of this CBME which is implemented during the first month of first professional MBBS studies. The objective is to acquaint, allay apprehension and prepare freshers for further studies using andragogical and heutagogical approaches. The MCI also released the guidelines for the medical colleges for uniform conduct of FC across the country. The FC was divided into six modules, i.e. Orientation Module, Skills Module, Community orientation module, Professional Development and Ethics Module (P and E), Enhancement of Language and Computer Skills Module, and Sports and extracurricular activities.1 A total of 175 hours were allotted to these modules. Like every institute, our institute also developed the implementation program and time-table of FC using MCI guidelines and taking into account the available resources.2,3  The FC at our institute was conducted from 1st August 2019 to 31st August 2019 and was meticulously planned and implemented. The effective implementation  required committed efforts of 30 faculty members (12 Professors, 11 Associate Professors and 7 Assistant Professors), two language and one fine arts teacher,  and 4 non-teaching members  (Librarian, IT-personnel, Coach for sports and motivational Guru). The students were trained to write reflections daily in their log - books which are being analysed further. 

scholarly journals Blueprinting for assessment in undergraduate medical physiology curriculum

2021 ◽  
Vol 65 ◽  
pp. 60-65
Author(s):  
Manjinder Kaur ◽  
Naren Kurmi ◽  
Sangita Chauhan ◽  
Anish Singhal ◽  
Suman Sharma ◽  
...  
Keyword(s):  
Medical Education ◽  
Teaching And Learning ◽  
Medical Curriculum ◽  
Education Programme ◽  
Medical Council ◽  
Competency Based Medical Education ◽  
Medical Education Programme ◽  
Competency Based ◽  
Amount Of Knowledge ◽  
Written Questions

Since long, physiology teaching has been monotonous, teacher centric, didactic type and its assessment primarily focussed on the amount of knowledge recalled by means of stereotyped written questions. A blueprint specifies weightage to various mapped topics (also known as competencies) in the syllabus. For this study, IEC approval was obtained. We aimed to prepare a blueprint for assessment in the undergraduate physiology curriculum and thereby test its utility. We found that blueprinting not only establishes a balance between teaching and learning but also improves validity, reliability and acceptability of assessments. Thus, blueprinting of undergraduate medical curriculum can help in actual execution of the Medical Council of India’s Competency-Based Medical Education programme.

scholarly journals Faculty development programs for implementing competency based medical education in India: challenges and opportunities

2021 ◽  
Vol 8 (6) ◽  
pp. 3163
Author(s):  
Manjunatha S. Nagaraja ◽  
Revathi Devi M. L.
Keyword(s):  
Medical Education ◽  
Faculty Development ◽  
Transfer Of Learning ◽  
Faculty Training ◽  
Medical Council ◽  
Development Programs ◽  
Competency Based Medical Education ◽  
Challenges And Opportunities ◽  
Education In India ◽  
Competency Based

India has rolled out competency based medical education which means a thorough overhaul of pedagogical and assessment methods. Several new components are introduced which require focussed faculty training and handholding at times. The erstwhile medical council of India had prepared a meticulous roadmap for this and dedicated faculty development programs were initiated for the smooth and effective transition into CBME. The possible challenges and gaps in faculty development are discussed with available options in this paper. To discharge their duties efficiently, the competencies for the faculty also need to be defined and they should progress from ‘knows’ level to ‘does’ level through longitudinal faculty development programs. The fidelity testing is the key for transfer of learning during FDP for the benefit of the students.

scholarly journals Challenges of implementing competency-based medical education postgraduate training programs: the issue of context

2021 ◽  
Vol 46 (4) ◽  
Author(s):  
Marcio Gomes ◽  
Linda Snell
Keyword(s):  
Medical Education ◽  
Curriculum Development ◽  
Professional Training ◽  
Postgraduate Training ◽  
Local Context ◽  
Dynamic Nature ◽  
Competency Based Medical Education ◽  
Research Curriculum ◽  
Core Components ◽  
Competency Based

Introduction: Competency-based medical education (CBME) is being adopted worldwide. The aim of this paper is to discuss the evolution of CBME and address some perceived challenges in CBME curriculum development and implementation in postgraduate (residency) medical education. Methods: This is an opinion paper based on lived experiences and personal beliefs. The authors have professional training in medical education and are actively involved in CBME research, curriculum development and implementation around the world. Results: The issue of local and system-wide context seems to be of particular importance to individuals, programs, institutions, governing bodies and other stakeholders involved in the development and implementation of CBME programs. CBME has evolved differently at different places, and there are concerns regarding the fidelity of implementation. Stakeholders have been dealing with challenging questions in their CBME journeys, which reflect the varied, complex and dynamic nature of health and education systems. Recently, scholars have established core components of any CBME program. Discussion and conclusions: CBME design should benefit from ground-up strategies that consider the local context. It is essential to approach implementation with a quality improvement lens and pay special attention to the fidelity and integrity of the core CBME components.

scholarly journals An implementation program for Foundation Course in Competency Based Medical Education Curriculum

2019 ◽  
Vol 7 (7) ◽  
pp. 2865
Author(s):  
Ajeet Kumar Khilnani ◽  
Jitendra Patel
Keyword(s):  
Medical Education ◽  
Medical Curriculum ◽  
Medical Council ◽  
Education Curriculum ◽  
Competency Based Medical Education ◽  
Implementation Program ◽  
Competency Based ◽  
Curriculum Making ◽  
Medical Education Curriculum

After a gap of nearly two decades, Medical Council of India (MCI) has revised, rather revamped, the Undergraduate (UG) medical curriculum, making it competency based (CBME) and learner centric.

scholarly journals Key Assumptions Underlying a Competency-Based Approach to Medical Sciences Education, and Their Applicability to Veterinary Medical Education

2021 ◽  
Vol 8 ◽  
Author(s):  
Jared A. Danielson
Keyword(s):  
Medical Education ◽  
Learning Outcomes ◽  
Core Competencies ◽  
Time Frame ◽  
Medical Sciences ◽  
Competency Based Medical Education ◽  
Direct Observations ◽  
Potential Benefits ◽  
Competency Based ◽  
Medical Competence

This perspective explores six key assumptions of a competency-based approach to medical-sciences education, as they relate to veterinary medical education. Those assumptions, derived from characteristics of competency based medical education (CBME) identified by CBME proponents are: (1) There are sufficient shortcomings in the medical competence of graduate veterinarians that solutions are necessary, and changes in the way we teach veterinarians will address those problems. (2) It is feasible to identify generally accepted core competencies in veterinary medical practice. (3) Teaching to defined learning outcomes will produce greater achievement for learners than approaches that do not emphasize clearly defined outcomes. (4) In veterinary medical education, it is possible to articulate the development of competence sequentially in a manner that is relatively consistent across learners, and carefully planning and sequencing learning activities will produce better learning outcomes. (5) Competency-focused instruction, which tailors the pace and progression of instruction to learners, is feasible in veterinary medical education, and will produce better outcomes than instruction that moves all students through an equivalent process in a set time frame. (6) Programmatic Assessment, including numerous direct observations with feedback, will improve learning outcomes, and is feasible in veterinary medical education. While available research does not unequivocally support all six assumptions, overall the potential benefits of adopting a competency-based approach seem promising for veterinary medical education.

scholarly journals Medical Education in Nepal and Brain Drain

2017 ◽  
Vol 16 (1) ◽  
pp. 1-2
Author(s):  
Rishi Pokhrel
Keyword(s):  
Medical Education ◽  
Brain Drain ◽  
Career Planning ◽  
Health Workers ◽  
Health Sciences ◽  
Regulatory Body ◽  
Medical Council ◽  
Medical Doctors ◽  
First World ◽  
Medical Colleges

It has been four decades since the beginning of undergraduate medical education in Nepal and more than three decades of postgraduate medical education.1 Currently, Institute of Medicine of Tribhuwan University and Kathmandu University are major institutions providing medical education in Nepal with the help of their affiliated medical colleges. Two other deemed universities, B P Koirala Institute of Health Sciences and Patan Academy of Health Sciences also have major contributions in producing medical doctors in Nepal. National Academy of Medical Sciences (NAMS) provides postgraduate and super specialty training for doctors. Nepal Medical Council is the regulatory body that lays down the guidelines, provides accreditation and supervises to ensure that the regulations are being followed.2 It also conducts licensing examination for medical doctors.Educationalists worldwide vary in their opinions on the aim of education3-8 but Salomon precisely includes almost all of them as “The aim (of education) is to equip the learner with portable chunks of knowledge, skill, and understandings that can serve in other contexts.”9 Adkoli has analyzed migration of health workers in south Asia 10 and found that there was no systematically collected data regarding the extent of migration of healthcare workers and its possible impact on health care in Nepal. Nepal government spends a significant chunk of its financial resources to train doctors but many students who avail this benefit of ‘scholarship’ take part in the migration described in the article. Ironically, many doctors who are currently serving their motherland were either trained overseas or the ones who did study within Nepal but without availing any support from the government. When the first medical school was established in Nepal, the idea was to develop doctors who can prevent, diagnose and treat medical ailments prevalent in Nepal (Community based curriculum) and the career planning was designed in such a way that doctors were inevitably retained in Nepal.  The philosophy of this system was contrary to the definition laid down by Salomon9 but it did benefit the society and the country in the long run11. Things changed gradually over time and currently the doctors produced by oldest and state funded medical colleges of Nepal are ideal for health job markets of first world countries. This suitability coupled with adverse socieo-economic and political factors of our country has led most students who become doctors by state funding opting to serve in first world countries like United States, United Kingdom, Australia and Canada.Brain drain in Health sector is a global phenomenon12, 13, but developing countries like Nepal receive maximum brunt.  Lately, Nepalese medical education sector has been receiving a fair share of attention from all including media. However, it is saddening that this issue of ‘brain drain’ is something that had not gained any attention. Coming back to Adkoli’s work, we don't even have a data on how many doctors we are losing every year?10 There have been certain restrictions and bondages but these sorts of legislations have been seen to work contrarily. What is found to be lacking is the sense of belonging and development of the feeling that ‘I am important to this society and I must work for its betterment’. Most young doctors have a feeling that ‘there is no one taking me seriously anyway and it doesn't really matter weather I stay or Leave’.It is high time policy makers ensure that the medical doctors that we produce from the common men’s hard earned money serve the country. In addition to the legislations in the form of bondage, we should be able to install the feeling of belonging and sense of importance in the hearts and minds of these young doctors. To begin with, it would be a good idea if we start maintaining the database of the medical graduates that were and will be produced from Nepalese medical colleges; taking examples from many colleges from other countries that are doing it currently.14-16 Zimmerman’s study cited earlier provides an interesting insight that medical students with pre-medical education as paramedics were twice as likely to be working in Nepal and 3.5 times as likely to be in rural Nepal, compared with students with a college science background.11 We can also include into the undergraduate medical curriculum the concepts of social ethics, moral values, social justice and the long-term benefits of serving the society and the country that has invested so much for their education.

scholarly journals Black Ice: ways to get a grip on resident co-production within medical education change

2020 ◽  
Author(s):  
Jeffery D. Dagnone ◽  
Samantha Buttemer ◽  
Jena Hall ◽  
Liora Berger ◽  
Kristen Weersink
Keyword(s):  
Medical Education ◽  
Postgraduate Training ◽  
Postgraduate Medical Education ◽  
Change Leadership ◽  
Successful Implementation ◽  
Competency Based Medical Education ◽  
Education Change ◽  
Competency Based ◽  
Queen's University ◽  
National Approach

The Royal College of Physicians and Surgeons of Canada (RCPSC) is transforming its national approach to postgraduate medical education by transitioning all specialty programs to competency based medical education (CBME) curriculums over a seven-year period. Queen’s University, with special permission from the RCPSC, launched CBME curricula for all incoming residents across its 29 specialty programs in July 2017. Resident engagement, empowerment, and co-production through this transition has been instrumental in successful implementation of CBME at Queen’s University. This article aims to use our own experience at Queen’s in the context of current literature and rooted in change leadership theory, to provide a guide for educators, learners, and institutions on how to leverage the interest and enthusiasm of trainees in the transition to CBME in postgraduate training. The following ten tips provides a model for avoiding the “black ice” type pitfalls that can arise with learner involvement, and ensure a smoother transition for other institutions moving forward with CBME implementation.

scholarly journals Revisiting Integration: A Proposed Framework in the Light of Competency-Based Medical Education in Indian Context

2020 ◽  
Author(s):  
Tripti K Srivastava Waghmare ◽  
Archana Dhok ◽  
Lalitbhushan S Waghmare
Keyword(s):  
Medical Education ◽  
Organisational Structure ◽  
Competency Based Medical Education ◽  
Indian Context ◽  
Competency Based ◽  
Course Outcomes ◽  
Medical Colleges

Various methods of Integration (Temporal co-ordination, Sharing, Nesting and Co-relation) recommended in the revised curriculum of Undergraduate Competency Based Medical Education (CBME) from 2019 academic session onwards is discussed hereby. A brief description of these methods and recommended frameworks for planning such integration sessions are suggested. Medical colleges can plan and place integration of contents across various phases of curriculum on the basis of suggested frameworks, depending on factors like the targeted areas of integration, views and experience of teachers, organisational structure and course outcomes.

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