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ISLAMIC MEDICAL EDUCATION RESOURCES01

9606-CONCEPTS OF ISLAMIC MEDICAL EDUCATION

Dr Omar Hasan Kasule, Sr. MB ChB, MPH, DrPH (Harvard) Professor, Kulliyah of Medicine, International Islamic University PO Box 70 Jln Sultan PJ 46700 Telephone 60 3 755 3433 fax 60 3 757 7970 (Presented at the 4th Annual General Meeting of the Islamic Medical Association Kuban Kerian, Kelantan 7th June1996)

ABSTRACT

The paper identifies 6 conceptual issues in medical education and presents Islamic approaches to them (a) The purpose of medicine, which defines the system of medical education,  is to maintain or improve the quality of life and not to prevent or postpone death (b) integration of the curriculum, deriving from the the tauhidi  paradigm, implies practice and teaching of medicine as a total holistic approach to the human in the social, psychological, material, & spiritual dimensions and not exclusively dealing with particular diseases or organs (c) The selection of medical students, their training, and evaluation should emphasize that medicine is a human service within the context of Islamic mutual social support, takaful ijtimae (d) The physician must provide leadership as a social activist  who identifies and resolves underlying social causes of ill-health; as a respected opinion leader whose moral values & attitudes are a model for others; and as an advisor on medical, legal, and ethical  issues associated with modern medical technology so that the patients and their families can reach an informed decision (e) The future physician must be prepared to undertake research, a type of ijtihad, to extend the frontiers of medical knowledge, applying available knowledge and improving the quality of life. Time allocated to  basic research methodological tools should be increased at the expense of accumulating biomedical scientific information that is either forgotten or becomes obsolete by the time of graduation (f) The education and development of the physician before, during, and after medical school should inculcate the motivation  to excel in commitment, ikhlas, and care delivery following the model of the early Muslim scientists and physicians. The paper ends by making 2 recommendations: (a) reform of the medical curriculum to be oriented more to methodology than information (b) student involvement in direct health care delivery under an aprenticeship system.

 

KEY WORDS: Medical education, medical training, medical schools, medical curriculum, medical students


1.0 INTRODUCTION

 

1.1 SIX CONCEPTUAL ISSUES IN MEDICAL EDUCATION

This paper discusses 6 conceptual issues in medical education: purpose, integration, service, leadership, research, and motivation. The issues were selected from proceedings of seminars, conferences, reports, and books or articles on medical education at the international level (  ), in Malaysia (    ) , in south-east Asia (  ), the rest of Asia (   ), Europe (    ), America (    ), Australia (  ), and the middle-east  (  ). Journal articles and books on the theory and practice of medical education were used to elaborate the issues raised (     ).

 

The list of 6 issues is selective and not exhaustive. Rapid changes in technology and society give rise to new issues continously in curriculum content, curriculum structure, and methods of teaching (Halcom ). One short paper such as this one can not do justice to all issues and problems.

 

In the present atmosphere of intellectual ferment and search for Islamic answers to societal problems, there is a need to define an Islamic perspective of medical education. This paper therefore addresses a felt and expressed need among Muslim and perhaps non-Muslim medical educators.

 

 

1.2 MUSLIM CIVILIZATION

It may be pertinent at this juncture to pose the question ‘why do we talk about the Islamic concept of medical education today?’. Malaysian history  gives us the answer to this question. There was a thriving Muslim civilization on this peninsula 5 centuries ago. The year 1511 CE marked the start of interrupted and distorted growth of that civilization (  ). Over the past 40 years there has been growing Muslim self-confidence, assetiveness, and a determination to reconnect with their heritage. There is a growing search for an Islamic dimension in all societal endeavours. The establishment of the Islamic Medical Association, holding seminars on Islamic medicine such as this one are all manifestations of the dawn of a new era that seeks to rebuild what had been interrupted for nearly 500 years. The same phenomena of revival and rediscovery of the heritage are occurring in the rest of the Muslim world as an Islamic Civilization Program, al mashru’u al hidhaari al Islami.

 

Islam is a comprehensive guide to all aspects of life for the individual and the community with a fixed and a variable part. The fixed part of the sharia involving aqidat, ibadat, and some of the muamalat was explained in detail by the Qur’an and sunnat. General guidelines were provided for the variable part to give freedom to humans to undertake ijtihad and be able to solve problems as they arise; different solutions being arrived at in each place and each era (Nyazee). This paper is a humble ijtihad on medical education and a contribution to the larger contemporary program of rebuilding Islamic Civilization.

 

It is the nature of Islam to address universal human and not limited or parochial concerns. The theses presented by this paper are relevant even to non-Muslims because they are derived objectively from a universal tauhidi paradigm that is not biased toward any place, any group of people,  or time period.

 

1.3 HISTORY OF MEDICAL EDUCATION IN MALAYSIA

The following background information of the history of medical education in Malaysia is based on written material and not personal experience. The first permanent educational institution of European medicine in Malaysia had an interesting beginning. In 1904 CE leading Chinese and other non-European communities of Singapore submitted a memorandum to the [British] Governor to establish a medical school to train medical men ‘in racial sympathy with the peoples of Malaya’. Funds were raised by the public and the school started in 1905. Schools of dentistry and pharmacy were started in 1929 and 1935 respectively. In 1949 the school became the medical faculty of the University of Malaya. In 1963 a second school was opened in Kuala Lumpur as the Faculty of Medicine of the University of Malaya (UM) while the original school in Singapore became the Faculty of Medicine of the University of Singapore. New medical schools were started at the Universiti Sains Malaysia (USM) and the Universiti Kebangsan Malaysia (UKM) in 1975 and 1981 respectively (Relook 1981, Sixty years, Boedianto et al 1983, Danaraj 1988). The newest school is that of the Universiti Islam Antarbangsa (UIA) that will start operating in Kuantan, Pahang in July 1997 (Dr Tahir-pers comm). It is envisioned that with the current privatization of education, more medical schools will be established by Malaysian entrepreneurs or as branches of foreign schools.

 

The concern to improve medical education to keep up with technological and social change has always been in the forefront. A commission of Enquiry in 1953  recommended increase of physician production to meet manpower needs in the then British-ruled Malaya, Singapore, and Borneo (  ). In both Malaysia and abroad there have always been efforts at reforming the medical curriculum (Danaraj 1988). The University of Malaya held 2 conferences on medical education in 1964 in conjunction with the opening of the medical faculty and in 1969 in conjuction with the opening of the University Hospital (   ). Two workshops on medical education were held at the same university in 1978 (   ). A similar workshop was held in Pinang in conjunction with the opening of the USM medical school in 1981 (  ). Several less formal seminars on medical curricula have been held with the overall concern of defining the system of medical education suitable for Malaysia. Planning of the curriculum for the medical curriculum of the International Islamic University has raised many questions about the Islamic perspective of medical education (Tahir-pers). The present seminar by the Islamic Medical Association of Malaysia is the latest in a series of discussions of Islamic medical education. Many others are sure to follow.

 

1.4 METHODS OF THIS PAPER

The issues or problems of medical education were identified from  personal experience and from available written material. Selection of which issues to discuss was dictated by the need to focus on those considered most important for Malaysia at the moment. Then paper has confined itself to the European medical education system that is taught in Malaysian medical schools. This does not imply inany way non-recognition of other systems of medicine. The Islamic approaches were worked out using two general concepts: the tauhidi paradigm and the general purposes of the law, maqasid al sharia.

 

Medical education consists of pre-medical studies, basic medical education (pre-clinical, clinical, and internship), vocational/specialist training, and continung education (Danaraj 1988). This paper has confined itself to discussion of problems and issues in basic undergraduate medical education.

 

The term ‘European’ has been used instead of the more common ‘western’ to refer to the medical and education systems imported into the Muslim world from Europe and other pats of the world such as America, Australia, and New Zealand where European culture was implanted.

 

2.0 THE ISSUES

 

2.1 THE ISSUE OF DUALITY IN MUSLIM EDUCATION

It is relevant here to put the issues of medical education in the context of the problem of duality in Muslim education in general. Many Muslim authors have written about the problem of duality in education ( IIIT, AHAS, Faruqi, Attas). In most Muslim countries there are two systems of education that run parallel to one another: the traditional Islamic and the imported European and largely secular system. Each system has its own institutions that start from the earliest to the highest levels of education. The educated elites of the ummah are divided along those lines and have little communication, mutual understanding, or co-operation in solving ummatic problems. The above-mentioned duality or dichotomy is reflected n medicine when traditional Muslim hakims practise and teach alongside European-trained physicians. The duality has been responsible for some people being misguided to define ‘Islamic Medicine’ erroneously and confine it to the herbal and other types of traditional medical practice in some Muslim countries. This conceptual confusion was corrected in a paper presented by the present author last year (  ).

 

2.1 ISSUES IN MEDICAL EDUCATION: AN INTERNATIONAL VIEW

The European medical education system is dominant having been adopted or adapted by most countries. This makes the problems of medical education similar in different medical schools in different countries.

 

Dr Fulop, Director of the Division of Health Manpower in the World Health Organization gave what amounts to a laundry list of problems in medical education: isolation of the medical school from the health care system, lack of integration, lack of active student participation, curricula irrelevant to the actual needs of society, curricula not community-oriented, outdated teaching methods, non-experiential learning, and outmoded methods of student evaluation (health needs)

 

The results of the last 4 world conferences on medical education have shown  rapid changes in issues affecting medical education. The first world conference on medical education held in 1953 affirmed that the  western medical model was satisfactory and  multidisciplinary skills were needed for advances in biomedical research (  ).

 

The second world conference on medical education held in 1959 noted new trends and innovations such as cordination of the curriculum in the basic sciences, interdisciplinary approaches, problem-centered education, introduction to clinical experience in the 1st and 2nd years, family and community medicine, learning and not teaching. It also noted that medicine was a humanistic, holistic discipline (   ).

 

The third world conference on medical education held in 1966 observed that medical education was dynamic and was affected by both social change and developments in science. Technological changes necessitate revision of the curriculum. Progress of medical education must also consider socio-cultural aspects (   ).

 

The fourth conference on medical education held in 1972 noted the emphasis of moderm medicine on a technological approach to disease and called for a redefinition of the goals of medical education. It noted that the undergraduate curriculum could not provide detailed specialized knowledge and that it can only produce a person capable of learning. Medical needs and patterns of professional conduct were found to influence medical education. The need to redefine medical curricula continuously and dynamically was underlined (  ).

 

A WHO-sponsored workshop at the University of New South Wales discussed the following issues in medical education: community-based learning, integrated curricula experiences, problem-based learning, behavioral sciences in medicine, early clinical exposure, skills learning, field assignments (Bandara 1987).

 

2.3 MEDICAL EDUCATION ISSUES IN MALAYSIA

The leading issues in medical education in Malaysia have not changed dramatically over the past 30 years. In 1988 an experienced Malaysian medical educator identified the following problems of medical education: overcrowded curriculum, new medical advances that make today’s teachings obsolete, unsatisfactory assessment of students, over-emphasis on hospital medicine, fragmentation, dehumanizing emphasis on technology, curricula irrelevant to local problems, emphasis on quantity and not quality in the quest to satisfy manpower requirements (Danaraj 1988).

 

A conference on medical education held in conjunction with the official opening of the Faculty of Medicine at the university of Malaya in 1965 dealt with health needs of Malaysia as they relate to medical education, identifying objectives of medical education, trends in medical education, organization of medical education, quality vs quantity, and movement of practical training out of the medical school (  ).

 

A workshop at the University of Malaya in 1978 discussed the  sort of doctor needed to be produced to serve the needs of Malaysia, how to decide what to cut out of the curriculum and what to teach, integration/correlation of the curriculum, attitudes and ethics (Cox et al 1978).

 

The Penang workshop of 1981 addressed what should students learn, what teaching technics should be used, evaluation of medical education, curriculum planning, and alternative formulations of the medical curriculum (student vs teacher-centered, problem vs information-centered, integrated vs specialty, uniform vs elective, planned vs apprecenticeship)  (Relook 1981).

 

 2.4 MEDICAL EDUCATION ISSUES IN OTHER COUNTRIES

 

The 1965-68 Royal Commission Commission in UK on medical education (the Todd Commission) was the first comprehensive review of medical education in UK since 1942-44. It made recommendation about the length of the medical course and the need for integration between pre-clinical and clinical courses (    ).

 

The Committee on Medical Schools in Australia in 1973 identified the following problems: lack of innovation, emphasis on medical science and not clinical practice or community care, lack of departments of general practice in medical schools, selection of students based only on academic criteria without considering aptitude or motivation with the result that those ‘academically’ oriented students go into research and not practice (    ) 

 

3.0 PURPOSE

 

3.1 THE PURPOSE OF MEDICINE

Two questions must be posed and answered before proceeding. There is no unanimity of answers to these 2 questions. The first question is: what is the aim of medicine and medical treatment ? The second question is: what is the aim of medical education? What do medical schools try to achieve?. These questions generate further disagreement. On one hand the answer to the second questions depends on the answer to the first question. On the other hand, it could be argued equally logically that in practice medical schools and systems of medical education do not reflect the medical care delivery system.

 

Muslims have several disagreements with some basic paradigms that define the objectives of European  medicine. From the Muslim’s point of view, European medicine suffers from the following deficiencies: (a) it is disease-oriented and not health-oriented (b) it is very arrogant and claiming ability to cure any disease with no recognition of Allah’s involvement (c) It does not have sufficient humility to accept its failures and they are many (d) it sets itself the unrealistic goal of preventing or postponing death regardless of the quality of life that is lived.

 

Since health is the original state and illness is the exception, medicine must be health and not disease oriented. The main responsibility of the physician is to maintain health; cure of disease should be the exception rather than the rule. The ancient Chinese were nearer to our view of medicine and the role of the physician. They paid their physician as long as they were in good health. Payments would be suspended on falling sick. They would resume when the illness was cured.

 

The disease model predominates in European medicine. The disease model involving a biological or physical insult to the tissues is the main causal mechanism recognized and other contributors to the final causal pathway are not emphasized. The bias to the disease model explains European medicine being more curative than preventive.

 

Illness to a Muslim has its positive aspects and can be a blessing (Muslim 4:1363). It can be a reason for expiation of sins (  ). An incident case of illness should not be looked at in isolation. When viewed in a larger context, illness or disease need not always be seen as bad. The Qur’an teaches that a human may like something that is bad for him or may hate something that is good for him (  ). Falling ill may save a person from going where he would be hurt or where he could commit a sin. Pathophysiologically the symptoms of ill-health are useful even if people complain about them. Pain directs us to tissue injury so that corrective measures may be taken before the injury becomes more extensive. Exhaustion and collapsing may be the body’s way of forcing us to take a rest when we are over-stressed or overworked without adequate rest. Much of what manifests as disease are the body’s attempts to return to the natural or normal state.

 

the ultimate cure of illness is from Allah (Qur’an, Muslim 3:1194). The attending physician must realize that his efforts will succeed only if divine will intervenes and should therefore not be to arrogant. He should be aware that his efforts may fail or succeed. Physician arrogance and overuse of biomedical and technological interventions has sometimes led to the excesses of modern medicine in the form of side-effects (short and long-term) or iatrogenic diseases that are on the increase today.

 

Claims of European medicine to have reduced morbidity and mortality can be questioned. Mortality due to infectious diseases like tuberculosis and malaria fell dramatically in developed countries. Some infectious diseases like smallpox have been completely eradicated. However new types of morbidity have appeared. Sexually-transmitted diseases are on the increase. There is a lot of chronic fatigue and stress in industrialized society. Psychiatric morbidity (including depression, suicide, parasuicide, and substance abuse) is on the increase. Fetal wastage has actually increase with the rise in legal and illegal abortions and some forms of contraception..

 

European medicine has had a marginal contribution to the falling mortality and morbidity over the past 2 centuries. Non-medical general improvements in nutrition, environmental sanitation, and personal hygiene have been responsible for the major changes. Mortality from diseases like tuberculosis was fallling many decades before discovery of effective anti-infective agents. The prevalence of debilitating infectious diseases in the third world is more related to their low socio-economic development than to lack of scientific medicine.

 

European medicine has reached or will soon reach a plateau in improving physical health at least in developed countries where infectious diseases that have plagued mankind for millenia are nearly being controlled. Any further improvements in health will not require biomedical interventions but changes in human behavior (nutrition, exercise, stress, psychological balance, substance abuse, violence). The most effective interventions will be non-medical. Changes of human behavior require will-power to choose and stick to healthy lifestyles while avoiding unhealthy ones as well as self-care. The medical profession may have to change its whole orientation to support and enhance the will and ability of the people to take care of maintaining their health (health needs) and lead healthy life-styles.

 

The medical profession will have to know when to stop biomedical intervention and give room to non-medical interventions (health needs). Good results will be obtained only when an equilibrium is established between the two.

 

It is a paradox that medicine will remain busy in the next few decades trying to reverse iatrogenic problems it has caused this decade. Medical exposure to irradiation and steroids 20-30 years ago are responsible for cancers of today. Tonsillectomy, once a popular procedure is now thought to be the cause of Hodgkin’s disease. Oral contraceptives cause coagulation disorders. Other similar examples abound in medicine. Health problems due to environmental pollution will increase in the following decades. It is our contention that an Islamic paradigm emphasizing an integrated and balanced approach would have foreseen and prevented some of these problems.

 

From an Islamic point of view, the aim of medicine is to maintain or improve the quality of remaining life. Medicine does not have as an aim the prevention of death or prolongation of life; the ajal is in the hands of the Almighty( 3:145, 6:60). Life on earth has a fixed and limited span and no one has the power to extend it even for a brief moment (nafy al khullud fi al duniya).

 

Importance of quality of life is recognized by some physicians trained in the European tradition but lacking an integrating tauhidi paradigm, they fail to define this quality in a holistic way. Fliender and Biefang (health needs) felt that reduction of mortality was not the real need of society and not the only goal to be set in training physicians. Islam can provide them with paradigms that enable them to pull everything together.

 

The Islamic Quality of Life Index (IQLI) arises from the tauhidi integrative paradigm and is a comprehensive measure involving social, psychological, physical, spiritual, and environmental parameters. The quality of life is closely related to man’s understanding of the purpose of creation and the mission of humans on earth. Life becomes degraded, hayatan dhankan (  ), in the absence of this understanding. The quality of life is also closely related to lifestyle. A good healthy lifestyle is associated with a higher quality of life. A bad unhealthy lifestyle is associated with a low quality of life. Lifestyle is directly related to the risk of physical and mental illness as well as the response or adjustment to that illness.

 

A healthy lifestyle is characterized by: piety, generosity, charity, chastity, humility, trust, balance, moderation, patience, endurance, honor and dignity, integrity, moral courage, and wisdom.

 

An unhealthy lifestyle is mainly a manifestation of one of the following diseases of the heart: shirk, kufr, takabbur, ujb, hiqd, hasad, ghadhab, ghurur, hypocrisy, miserliness, and suu al dhann. These diseases sooner or later lead to either physical or psychological transgression, dhulm,  against self or others. Most human diseases can be traced to this transgression.

 

Epidemiological studies if interpreted in an objective way provide sufficient data to relate ill-health to lifestyle and to quality of life.

 

3.2 PURPOSE OF MEDICAL EDUCATION

There is no general agreement on the purpose of medical education. A recent BMJ article reviewed the issue indicating that the matter is still on the agenda of medical thinkers (Calman 1994).

 

The following 4 examples illustrate a practical approach to stating the purpose of medical education in a pragmatic way without dealing with the underlying paradigms. (a) The 1953 commission of Enquiry into medical education in the Colony of Singapore, the Federation of Malaya, and the territory of Borneo identified three objectives of medical education: producing enough doctors to serve the needs of society and training some of the graduates as specialists and researchers to resolve medical problems (    ). Such a conclusion is understandable since physician shortage is always a chronic problem (Chien 1982) (b) At the 1965 conference on medical education in Kuala Lumpur, the objectives of medical education were identified as as: diagnosis and treatment, prevention of disease, research and community leadership at (  ).(c) The first Thai National Conference on Medical Education in 1956 defined the goals of a medical school in order of descending priority: teaching, patient care, and research (....). The second Thai National Conference on Medical Education mentioned morality, civility, and medical etiquette as additional objectives of medical education (..) (d) The University of Malaya philosophy states that the objective of the undergraduate program is to produce an undifferentiated doctor who will be capable, with further training, of developing full competence in any branch of medicine (Chien 1982) (e) The UKM philosophy is similar to that of UM with an added rural emphasis (chien 1982).

 

A proper fit is needed between the manpower producer, the medical school, and the manpower consumer, the health care delivery system. The process of medical education must be relevant to the needs of the society since health is a subset of the social system (Bowers 1978). In the ideal state, the type of medical education given should be a reflection of the aim of medical treatment in a particular society. This has however not been true in practice. The western model of medical education has widely been accepted as satisfactory and has been taught without regard to local circumstances. A lot of the tensions experienced in faculties of medicine arises out of this disassociation between the local medical needs and the system of medical education.

 

It is clear that the normal undergraduate curriculum is not sufficient for practice of medicine without further education and training. The best that the undergraduate curriculum can do is to produce an educable basic doctor. It should aim at producing a physician capable of independent thought and should therefore include only those facts that are of enduring relevance (Simpson 1972).

 

The Islamic paradigmatic approach to defining the pupose of medical education can be derived from the the paradigm of tauhid and the general theory of the purposes of the Law,  maqasid al sharia. The majority of scholars concur that the following 5 purposes are protected by the law: (a) religion, diin (b)  life, nafs (c) procreation, nasl (d) intellect, aql (e) wealth, maal.  Medical practice is intimately involved with all 5 of them.

 

Once the puposes of medical intervention are established, the aim of medical education should be to produce physicians who in their practice of medicine will fulfill that purpose or maqsad within a holistic context to ensure harmony and equilibrium.

 

Thus the medical education system should aim at producing a physician who will be health and not disease oriented, who will have the humility to know that he will exert his best and trust in Allah to cure the disease. He will not have the arrogance to feel that he can prevent death but will strive to improve the quality of life for people knowing that the Islamic index of the quality of life is derived from the holistic tauhidi view: physical, spiritual, social, psychological aspects and proper balance between them. The physician should in addition have the following practical and conceptual skills: understanding of the society, epidemiological understanding of health problems, scientific capability, clinical expertise, and leadership (Bowers). These qualities must be in a context of iman, tauhid and fulfillment of the general purposes of the sharia. Moosa (1982) called for an Islamic ambience for medical education when he argued that ‘ the purpose of Islamic Medical Education is to produce men and women imbued with the Islamic spirit, who will serve mankind to improve and maintain the health and welfare of all peoples, undertake research and excell in whatsoever they do’

 

 

4.0 INTEGRATION

 

4.1 FRAGMENTATION

European medicine is characterized by narrow specialization and fragmentation. Physicians know more and more about less and less. The trend toward specialization in medical practice has strongly influenced medical educators to diminish the practical content of the crowded undergraduate program and transfer some of it to post-graduate or vocational training. A new graduate from medical school is therefore unable to treat a patient on his own until he becomes a specialist. Specialty practice however has the great disadvantage of fragmenting patient care among several specialists such that there is no one doctor to care for the whole patient (Danaraj 1988)

 

The fragmentation of medicine is reflected in the balkanization of administration (by department), stages of education (pre-medical, pre-clinical, and clinical) and by discipline or specialty. Separate curricular tracks for research and practice have even been suggested (1965 conf).  In many cases each department teaches independently of others. Specialist physicians find it difficult to teach students who are just being introiduced to medicine (Woodscraft 1995, Simpson 1972).

 

The following attempts have been suggested to overcome the problem of fragmentation: interdepartmental or inter-disciplinary programs, integration of clinical and basic sciences, generalist and not specialist medical practice, vertical integration (linking early with later years in the same discipline), horizontal integration (linkage between different disciplines), teaching by organ systems, and using the problem-centered approach (4th world conf, Lie 1995, Kaufman 1985, Mandin 1995, Dolman 1994, Chang 1995).

 

The concept of integration has been well accepted and propagated but not understood well when it came to practical application (Modern med teach). Attempts at integration are a response to a felt problem and are certainly a step in the right direction however they have not solved all the problems; they even succeeded in creating a few new ones. Unco-ordinated integration has succeeded in producing a hypertrophic curriculum (Simpson 1972, Flexner). There is pressure from each discipline to ‘integrate’ its material into the curriculum (Naylor 1994, davis 1994, Jedrychowski 1993, Durfee 1994, Hope 1994, Kahtan 1994, Wiebers 1994, taylor 1994, Gofin 1995). New disciplines such as genetics, statistics, epidemiology, demography, anthropology, and sociology are at the door claiming their share of the undergraduate curriculum. New disciplines have been created to ‘integrate’ or bridge the gap between pre-clinical and clinical disciplines eg clinical biochemistry, clinical pathology, clinical epidemiology (Burlin 1995). Interdisciplinary teams have been used as a tool of ‘integration’ in community medicine (Freeman 1995). The Experiment at Case western Reserve that started in 1952 had a big impact on many other medical schools in the US and abroad. It was essentially an interdisciplinary approach to teaching. It also did not escape criticism. Training of generalists has become a vogue (Wilson 1994, Sachdeva 1994, Position paper amer board of surgery). No sooner are they trained than they claim recognition for their ‘generalist’ specialty. General practice or family medicine are now accepted in the US and UK as ‘specialties’. Some ideas of integration are at best laughable. The finding that 33% of medical students abused alcohol led to a suggestion to ‘integrate’ teaching about alcohol in the medical curriculum (Varga 1994).

 

If each of these demands and approaches to integration were to be fulfilled, the undergraduate medical curriculum will require a life-time to complete!. There are, however, defenders of a crowded undergraduate curriculum. They argue that students should be exposed to all disciplines to enable them informed choices about their future specialties (Lie 1995). This reminds us of the story of an ’accomplished’ lawyer who knew a bit about every subject including law. The process of continuous additions to and pruning from the curriculum is going on and has been dramatically described as integration, re-integration, and disintegration (Dr  Ellis 1965  ).

 

Fragmentation is a reflection of an underlying European world-view and did not come about in medical education by accident. This world-view started with the renaissance when religion was separated from public life and science. This set in motion centripetal forces that continually separate, fragment and subdivide. The body was separated from the soul. The mind was separated from the body. Science was separated from art in medical practice. Each disease or organ was isolated and was dealt with in isolation. It must however be recognized that specialization has been responsible for much of the progress in scientific medicine because of the concentration of the researcher’s energy on a narrow focused issue.

 

It is not surprising that in a context of increasing fragmentation, the concepts of ‘total health’, ‘total disease’ are not easily accepted. It is not the ‘total human’ who gets sick but his organs or tissues. It is however very surprising that Claude Bernard’s concept of a harmonious ‘milieu interieur’ and the appreciation of the biochemical unity of all life did not motivate practice of ‘total medicine’.

 

Many physicians in the west have recognized that fragmentation is a major problem and have set about attempting to achieve integration in medical treatment and medical education. Some of these attempts were described above. Their limited success is due to lack of a guiding vision. Integration is not just putting two or more disciplines together. It is a fundamental philosophical attitude based on a vision and a guiding paradigm. Only Islam can provide this paradigm.

 

Criticism of the fragmented medical curriculum is actually criticism of the underlying European non-tauhid world-view. The fundamental reason for failure of integration efforts is that the European world-view is atomistic, it is good at analysis and not synthesis. It is incapable of synthesis because it lacks an integrating paradigm like tauhid.

 

4.2 LACK OF BALANCE

 

Lack of equilibrium is a secondary manifestation of lack of integration. A lot of human illness is due to lack of balance and equilibrium; for example excessive intake of some foods leads to disease just as inadequate intake leads to ill-health. The Qur’an calls for observing the equilibrium, al wastiyyat and its violation is associated with many problems. The Qur’an uses several terms to refer to the concept of balance, miizaan (  ). and wastiyyah.  Lack of balance is condenmed as: taraf, israaf.(  ).

 

Ancient Muslim, Indian, Chinese, Greek medical systems understood the concept of equilibrium. Modern European medicine lacks the conept of equilibrium or balance. It is replete with examples of overdoing a good thing beyond the equilibrium point and creating even bigger problems.

 

Some therapies are worse than the disease they are supposed to cure. The quality of life of terminal cancer patients is made worse by chemotherapy and radiotherapy than the original disease perhaps they could have been left to die in dignity. Pesticides were used to eradicate malaria but they led to human disease. The best treatments of yesterday are known causes of malignancies today.

 

The problem of balance like that of integration is acknowledged by some physicians trained in the European tradition.  but there is no solution because of lack of an underlying paradigm. A European symposium called for balance between technological development and social change within an integrated system, education and skill acquisition, general and specialized training, science and behavioral disciplines (Parry). The conference did not however have a comprehensive solution or paradigm.

 

4.3 THE TAUHIDI PARADIGM, INTEGRATION AND BALANCE

Tauhidi is the main paradigm in Islamic civilization that forms a backbone of all intellectual discussion of medical education. Tauhid al rububiyyat motivates the appreciation that there is only one creator and that thee is unity, harmony and useful interconnections among different forms of life amnd the physical environment. Tauhid al uluhiyyat motivates the appreciation that the creator has definite purposes from creation and that human life must fulfill those purposes which implies that there are certain laws that lead to a fulfilling life. Obeying those laws is associated with a healthy high-quality life-style.

 

The tauhidi paradigm implies integration and harmony of matter and soul, body and mind, parts and the whole. The physician should be trained to practice medicine as a total holistic approach to the human in the social, psychological, material, & spiritual dimensions and not an attack on particular diseases or organs.

 

The example of the early Muslim physicians is worth emulating. They were well-rounded in their education and their practice of medicine. They were also integrated in the sense that their medical practice fitted in well with other social activities. Al Qadhi Abd al Razaaq used to teach medicine and mathematics in the mosque in Bukhara until his death. Muwaffaq al Ddiin Abd al Latiif al Baghdadi taught medicine in the Azhar mosque during his stay in Egypt (al Naqiib). Thus the context and the environment in which the teaching was carried out was integrative. It integrated medicine with the mosque and worship.

 

Al Faruqi described tauhid as the source of truth, cosmic and social order. It ensures unity of truth and therefore prevents contradictions between different disciplines of knowledge. Tauhid is a world-wide view that can guide not only medical education but also all endeavors of building a civilization. The Islamic social order is totalistic and Islam is relevant to every aspect of human endeavor (  ).

 

The tauhidi approach to integration is putting medical knowledge, teaching and practice in a larger context to making sure it is in harmony and is well coordinated with other related medical or non-medical phenomena. It is therefore possible to envision a very ‘integrated’ doctor who at the same time is very specialized. Such a doctor will approach the patient as a whole human and not just as organs or tissues.

 

The ideas on integration above are known to some physicians trained in the European tradition as scatered facts that are not joined together by a paradigm. Simpson (1972) described an integrated physician who will go beyond the physicial manifestations of ill health to deal with cognitive, affective, and psyco-somatic issues without a paradigmatic context.

 

5.0 SERVICE

 

5.1 THE SPIRIT OF SERVICE

A Malaysian medical educator did, as far back as 1965, pose a question that is very pertinent even today: ‘Should medicine repair damaged health or try to change the social environmental circumstances that led to ill-health?’( ). The challenge is still before medical educators. Changing the social circumstances requires working on the front-line in rural or poor urban areas. So far medical schools have not been heroes of social medicine although there are projects here and there that are successful and are laudable. In order to medical schools to face the challenge they will have to train medical students in such a way that they internalize the values of social service.

 

The Qur’an calls upon society to look after the weak and less privileged: the widows (Muslim 4:1537), the poor (Muslim 4:1537), the wayfarer (Muslim 4:1537), the orphans. A Muslim must love for others what he loves for himself (Muslim 1;31). The concept of sadaqat includes all good things (Muslim 2:482). Doing good is encouraged (76:5-9, 3;92, 2;188). A distinction is made between the faqir and the maskin (Muslim 2:496).

 

Islam is a very practical religion. It has a culture of action and many of its teachings are action-oriented (al Faruqi). Islam does not only enjoin followers to serve others but has practical measures to ensure this ocucurs. Zakat is an obligatory payment to the poor and the needy (Bukhari: 370., Qur’an 9:60). The obligatory fasting of Ramadhan is training and inspiration for the rich to remenber the poor because they voluntarily taste hunger and fully understand the plight of the deprived. Many breaches of the law are expiated by kaffarat, normally feeding the poor. Thus a medical education or health care delivery system developed within an Islamic society will have no alternative but to be service-oriented.

 

The Islamic paradigm of service requires that the physician should be trained to understand medicine as a social service. The human dimension should dominate over the biomedical one. The selection of medical students, their training, and evaluation should emphasize human service and not material gain for the physician

 

The medical school can not be expected to effectively teach the spirit of serving others. The values and attitudes of self-less service for others are taught by the family and the community and are already well set by the time the student enters medical school. The school can only build on and enhance basic values that students bring with them from their homes and communities. In such circumstances, the medical school will do well to select those students who already have the vocation to serve.

 

5.2 COMMUNITY-BASED EDUCATION

There is an increasing emphasis on community and preventive medicine in many medical schools (mededuc in 80s) as an introduction to service in less privileged areas. Traditionally, the service vocation in medicine called for training the student to serve in a poor or rural area or slums of the big cities (Wise 1994). Involvement of the student in community-based education should be real and not cosmetic or sensational if it will have a major impact on him. The student must actually deliver useful service and should live among the poor for a reasonable amount of time as a fully-fledged professional.

 

The normal prototype of community-based education is setting up a project in  a defined community. For example the department of social and preventive medicine, established at the University of Malaya medical school in 1964, set up its field teaching facility at Kuala Langat in Selangor (Danaraj 1988). The vision of such efforts was to break the traditional mould of the medical school as an ivory tower with no community responsibility and no outreach to the socially deprived groups. It was also expected that social responsibility will be taught to students. Such community facilities sometimes actually deliver services or are just an appendage on on-going services. Sometimes the educational may not agree with service priorities.

 

Medical schools have not been very successful in inculcating the spirit of self-less service in depressed rural or urban areas. There is a reluctance among physicians to serve in rural areas. A study revealed that 83% of UM and 68% of UKM clinical students preferred to practice in urban areas. The respective figures for pre-clinical students were 60% and 45% indicating that idealism goes down the longer students stay in the medical school (Bodianto).

 

The specific goals of community-based education are: (a) understand lifestyles, health behaviors, health beliefs (b) know morbidity and mortality patterns by direct experience (c) acquire problem-solving skills (Bandara). Community-based education is thought to help the student address social needs and responsibility to society (modern med teach).  It is argued that community-based learning will make the student more sensitive to society’s problems. This makes sense since the majority of those who manage to make to medical schools are often from middle-class urban homes and have no contact with the less privileged who live in rural areas or the urban slums.

 

While these approaches are in the right direction, they have a misplaced conceptual basis. Community tends to mean the less privileged and the poor. It is a palliative approach for a student, normally of middle-class urban background, to ‘feel’ the problems of the poor. A few weeks spent  such communities are not enough to change attitudes held by the student’s social class let alone sensitivity. We need evidence that such brief exposure changes the fundamental outlook like producing a zeal in him or her to leave the comforts of an urban middle-class life for serving in rural areas or the urban slums. It is possible that a short period of working in a less privileged environment only enhances the image the students have that community medicine is second class medicine for the less privileged members of society.

 

5.3 PRIMARY HEALTH CARE

Medicine is passing through a period of innovative approaches to health care delivery. One of the most recent of these is the concept of primary health care (PHC) which essentially refers to the first point of contact of a patient with the health care system. PHC can be simple in a rural area or quite sophisticated. It does not have the connotation of second-class medicine. The PHC strategy requires training a physicians who will be able to do the following: respond to health needs and expressed demands of the community; work with the community so as to stimulate healthy life style and self-care; educate the community as well as the co-workers; solve, and stimulate the resolve, of both individual and community health problems; orient their own as well as community efforts to health promotion and to the prevention of diseases, unnecessary sufferings, disability and death; work in, and with, health teams, and if necessary provide leadership to such teams; continue learning lifelong so as to keep their competence up-to-date and even improve it as much as possible (Nooman).

 

We can envisage medical education in the future taking place in primary care settings in both its simple and sophisticated modes.

6.0 LEADERSHIP

6.1 LEADERSHIP IN SOCIETY
A physician is a leader. Islam teaches that everybody is a leader in one way or another ( ). The physician has grave responsibilities for the health and welfare of individuals and their families. This is a trust, amanat, that must be fulfilled (23:8, 70:32, 4:58).

The medical school curriculum and experience should be a lesson in social responsibility and leadership.

The medical school takes the blame for not producing ethical leaders who have the guts to change and improve society.

The physician gets the reward, thawab, for any initiative that leads to introduction of something good in the community (Muslim 4:1405) be it medical or non-medical.

The best physician should be a social activist who goes into society and gives leadership in solving underlying social causes of ill-health

The medical profession must be in the forefront of social change and reform

The physician must play the role of leader in the community (Relook). He can lead when in the community and not the hospital. Inside the four walls of the hospital the physician acts as a technician and not a leader.

The traditional medical school curriculum does not equip the future physician with leadership skills in the form of courses or actual field experience.

6.2 PHYSICIAN AS A MORAL MODEL
The physician is a respected opinion leader because of intimate contact with the patients therefore his or her moral values, attitudes, akhlaq, and thoughts must be a model for others.

Ashour (1982) presented 11 features of an ideal Muslim physician among which were: upright character, devotion to duty, honesty, compassion for the poor and the weak.

Hathout (1982) argued for an integrated approach to produce a Muslim missionary physician who will call others to be morally upright.

Moosa (1982) suggested that 4 requirements must be available to produce a physician imbued with the Islamic spirit: (a) an appropriate environment for the practice of Islam (b) courses on Islamic history, jurisprudence, ethics, Qur’an, and hadith studies (c) teachers imbued with the Islamic spirit who are at the same time experts in their respective fields (d) an atmosphere that will encourage freedom of thought, deductive reasoning, logical thinking, critical analysis, and tafakkur. He concluded that textbooks must be rewritten.

6.3 LEADERSHIP ON MEDICO-LEGAL AND ETHICAL ISSUES
The physician is expected to give leadership to patients on ethical issues that arise out of modern biotechnology. Examples are: forced tube-feeding of the elderly (Hidges 1994), forced treatment (Muslim 4:1201), patients’s wish for death (Bukhari: 936), suicide (Muslim 1:621), birth control, artificial insemination, organ transplantation.

He must be prepared not as a mufti who gives legal rulings but as a professional who understands the medical, legal, and ethical issue involved and can explain them to the patients and their families so that they can form an informed decision.

In order to play this role well, the future physician must have sufficient grounding in Islamic law and other Islamic sciences

6.4 ETHICS
Unfortunately medical curricula do not prepare the future physician to be a leader in ethics. They give information about ethics but cannot make him an ethical person (Hafferty 1994). Ethics can not be taught as an academic discipline. They have to be internalized so that they may inspire and guide.

Teaching ethics in a plural society is not easy (Glick 1994). The initial ethical values of a student are important (Freeman 1994). A course in ethics may add very little (Schorr 1994). Medical school is too late to inculcate ethics. An illustrative example is a survey of obstetrics and gynecology residents in Canada who indicated sources of their ethical decisions as: family views 34.3%, undergraduate teaching 17.1%, religious background 15.4%, views of consultant staff 12.8%, residency training 11.1%, and peer attitudes 9.4%.

7.0 RESEARCH

7.1 WIDE SCOPE OF RESEARCH
The hadith of the prophet that for every disease there is a cure (Muslim 3:1199, Bukh: 938) opens a wide door to research. The Qur’an presents a wide scope of knowledge and calls upon humans to explore the signs of Allah in themselves and the universe around them.

7.2 PARADIGM SHIFT FROM ‘CONSUMPTION’ TO ‘PRODUCTION’ OF KNOWLEDGE

The physician of the future will have to change easily between three inter-related roles: research, teaching, and care delivery. The research called for is not a full-time occupation and will normally be carried out as a multi-disciplinary effort.

The need for a research ability is motivated by the fact that the undergraduate curriculum can not provide all the knowledge that a physician will need. There is thus a need to acquire new knowledge on a continuous basis by reading and research.

Medical graduates are not prepared to be researchers. A committee of the Royal College of Physicians noted that the average medical graduate tends to lack curiosity and initiative, his powers of observation are relatively underdeveloped, his ability to arrange and interpret facts is poor, and he lacks precision in the use of words (Simpson 1972).

The medical curriculum should aim at preparing the student to be a researcher, mujtahid, who will extend the frontiers of medical knowledge. The paradigm shift involved here is to change the student and future physician from a consumer to a producer of knowledge.

The physician must be trained to be a life-long learner. Research is the best way to learn and stay on the frontiers of knowledge because it is learning by doing and being the midwife of new knowledge.

In practical terms, preparation for research means increasing time devoted to subjects on basic research methodological tools and decreasing the amount of biomedical scientific information that is either forgotten or becomes obsolete by the time of graduation.

Student research projects are a good introduction to life-long curiosity in science and discovery

7.3 RESEARCH, MEDICAL CARE, AND TEACHING
A physician actively involved in research will be more dynamic and innovative in caring for his patients. Research combined with patient care fulfils the Prophetic guidance to look for useful knowledge, ilm nafei, because the practitioner does not have the luxury to research into esoteric problems and leave challenges that face him daily in the clinic or hospital.

Applied research is needed to find out how available bio-medical knowledge can be used. Knowledge alone is sometimes not enough for a good health outcome. Physicians who know the dangers of alcohol are sometimes the worst abusers. The most challenging topic for research as far a Muslim physician is concerned is to understand what constitutes quality of life since this is the main aim of medicine

A researcher who is a teacher will always have something new and interesting to share with the students. His teaching will be exciting and students will look forward to it. Research has been proposed as a measure of excellence of a medical school (Roddie)

A question of balance arises. The teacher will have to find the right balance in time allocation between research and teaching. The practicing physician will have to strike the right balance between research and patient care.

8.0 MOTIVATION

8.1 MOTIVATION TO CHOOSE A CAREER IN MEDICINE

What motivates a student to enter medical school, will affect his commitment to practice of good medicine. Medicine is a vocation and success in it requires special aptitude and motivation.

Two processes are going on. Pre-medical school the character of the student and knowledge base are formed by the schools and society. During medical school and after graduation, there are influences from the profession and from colleagues that affect the physician’s motivation. The motivating factors range from the idealistic to the pragmatic material rewards. It is difficult to undertake a valid survey research of the reasons for choosing a medical career. Many students will consciously or unconsciously talk about ultruistic motivation. The real motivators may be prestige, status, family/peer pressure, and expectation of material rewards.

Students are idealistic on entry into medical school. A survey in 1983 of UM and UKM medical students indicated that about half of the students in the first year believed that being a doctor enables them to serve their community. Towards the end of their education, clinical students believed that medical education enabled them to find a job, enjoy easy life and have a high social status (Bodeianto 1983)

8.2 MOTIVATION PRE-MEDICAL SCHOOL
The formal education of a physician starts with the elementary school. In the elementary school a child should learn about morals, Islamic culture, adab and akhlaq, service and feeling for others. Good grounding in the Qur’an and sunnat is needed at this stage. (NAQIIB)

Choice of a medical career fulfils a fadr kifayat. In some cases it may be fard ‘ayn where there is no other physician. Families and communities should encourage children to enter the medical profession where there is a shortage of medical manpower.

The importance of medicine was underlined by Imaam al Shafie when he said: ‘I know of no discipline of knowledge after knowing halal and haram that is more noble than medicine. He also said that Muslims lost one third of all knowledge and left it to the Jews and Chrisitians. He regretted the monopoly of medicine by people of the book.

8.3 MOTIVATION DURING THE MEDICAL SCHOOL
A question should be asked: do we offer a subject called ‘Islamic Medicine’ to orient the students or do we change the whole curriculum so that it reflects Islamic values? The latter choice seems to be the most appropriate.

The student should be taught about the Islamic heritage in methodology and medicine as a motivator for excellence. The achievements of Muslims in the science of fiqh and hadith methodology could motivate excellent research. The model of the earlier physicians is inspiring to the young ones. They were encyclopedic and all-rounded in their knowledge. They would lead prayers in the mosque, go and research on medicine, and may be return to teach Qur’an. The main lesson for the young student is that the ancient Muslim physicians were able to excel while they maintained their Islamic identity. Islam is not incompatible with excellence in science or medicine.

There are several accounts of achievements by early Muslim medicine written by Muslims ( ) and non-Muslims ( ). The Muslims may overstate while the non-Muslims may understate and in-between lies the truth. Early Muslim physicians excelled in several medical fields. The models of Ibn Sina ( ) and Ibn Rushd ( ) are inspiring to the young Muslim physician.

8.4 MOTIVATION AFTER MEDICAL SCHOOL
Material motives can not be completely ignored in the name of idealism. A minimum of comfort is necessary for the practice of virtue.

The physician should be recompensed adequately for his services (Bukhari:472, Bukhari: 495).

Inadequate material rewards often result into frustration or even brain drain. One half of a graduating class in Chang Mai chartered a plane to migrate to better pastures.

Incentives for graduates to work in rural or depressed areas or choose unpopular but necessary specialties lies beyond the control of medical educators. The medical school can however maintain motivation for its graduates by means of continuing medical education programs.

9.0 CONCLUSIONS

9.1 ISLAMIZATION OF SOCIETY
This paper has raised and discussed several issues in medical education. It seems that the medical school by itself has few solutions to most of them. This is because they arise out of fundamental visions of the world and paradigms of life. Any serious solution must start at the level of paradigms. Islam can provide the paradigms that can lead to correct solutions. This however can not be done in the isolation of the medical school. It must involve overall reform of the society so that positive values are imbued in all aspects of its life. An Islamized society will facilitate good teaching and eventually practice of good medicine.

Before establishment of an Islamized society, interim measures to resolve outstanding problems of medical education cam be undertaken. These include review of the admission process, overhaul of the medical curriculum, and an Islamic ambience in for the practice and teaching of medicine.

9.2 SELECTION OF STUDENTS INTO THE MEDICAL SCHOOL
Many of the qualities of leadership needed in a future physician are not identifiable from the academic record. It is risky to admit students without the required personal and ethical qualities in the hope that they will be taught by the medical school. The medical school can not teach all these qualities; they have to be taught by society before entry into medical school. The medical schools will have no choice but to select candidates with acceptable academic and non-academic qualifications, quite a small pool.

Research is needed on whether there is a definable personality profile for those attracted or admitted to medical schools. Anecdotal observations indicate that physicians in several countries and practice settings share some characteristics among which are: bad handwriting, a big ego, mastery and self-control, hard-work and activity. It could be possible to define a new personality profile including some of the good qualities and excluding the bad ones and submitting it to experimental verification over a period of 10-15 years.

The process of selection need to be reviewed to identify those students who have the required qualities. Medical schools will have to draw up criteria, both academic and non-academic, suitable for their community and use them in selecting physicians. The future behavior of the graduates should be used as an evaluation tool of how good the criteria were.

Students admitted , in addition to academic competence, should possess the following qualities: a comprehensive holistic approach based on tauhid, a service vocation, ethical and community leadership, motivation to get knowledge. A heavy weighting may have to be given to the non-academic qualities such that some students may be admitted with lower academic standards if they have the ethical and personality traits neeed in a good physician. The Thai experience of admitting rural students with lower marks seems to be a good model here (recent develop)

Entry into Malaysian medical schools is basically dependent on academic credentials (Boedianto 1983). There is no clear-cut evidence that good grades are related to being a good and successful physician. In Malaysia and other countries intrinsic motivation, personality, attitudes, values are not usually considered (Simpson 1972). In the Malaysian situation, the freedom to select those with the acceptable ethical and moral values is further constrained by the need to redress ethnic imbalances in graduates and the inadequate number of science graduates who qualify for the study of medicine (Danaraj 1988).

9.3 CURRICULUM REFORM
The curriculum of the medical school will have to be reformed along 2 fronts: (a) increase of methodological subjects and decrease of biomedical information and (b) early involvement of students in health care delivery not as bystanders but as actual providers.

What is suggested is a medical curriculum that provides the future physician with basic methodological tools that he can use for life-long learning. Such a curriculum will be limited to the essentials that remain relevant for a long time. It will not be burdened with bio-medical information that is either made obsolete at the time of teaching or soon after by the rapid scientific progress or is forgotten by the student even before graduation and should not have been taught in the first place. Such a curriculum can aptly be referred to as usul al tibb.

The relation between usul al fiqh and fiqh is a very good model for reforimg medical education. Usul al fiqh is amethodological subject that provides tools that can be applied to various situations n order to derive a legal ruling, hukm shari. Fiqh is the law derived by use of usul al fiqh. It is almost impossible for one alim to study all what is available in fiqh and to know the legal ruling in any situation that comes to him. Some of the legal ases that the alim is called upon to decide are novel and have no precedents. He is however not afraid to deal with any case because his training in usul al fiqh gives him methodological tools that can be applied to old and new situations.

It is suggested that the student should spend 30-40% of his time at medical school involved in direct health care delivery. This direct contact will provide the student with practical skills, attitudes, and motivation needed in a physician by an apprenticeship process. The laws of medical practice may have to be revised to accomodate the apprenticeship system. Apprenticeship as a method of medical education needs to be revived. Ancient Muslim medical schools in Egypt, Syria, and Iraq taught most by apprenticeship. Teachers were practicing physicians who did most of their teaching at the bedside (Puschmann 1891).

Another dimension of leadership in medical education is the mentor role of the senior physicians who are supposed to be a model especially in the domain of physician-patient relationship. Besides facts and skills, medical education imparts attitudes and assumptions. These are part of the non-factual learning that students acquire by watching their teachers. Students are wont to follow what their teachers do and not what they say (mededuc & medcare).

For apprenticeship to produce the physician with the desired qualities, the ambience in the hospital or primary health care setting must reflect the Islamic teachings and should be set up in such a way that there are many formal and informal learning opportunities.

A system under control of the medical school should ensure systematic continuing medical education; the exact form and nature of this education can be worked out. Knowledge either becomes obsolete or is irrelevant to the particular circumstances in which the physician is practicing. Whatever useful knowledge the graduate may retain is the real education that he/she got since education can be alternatively defined as ‘what you know minus what you leaned at school’. At the opening of the UM faculty of medicine in 1965, the then dean, Dr Sreenivasan said: ‘ I tell my students thgat 50 percent of what I teach them today in clinical medicine will be proved wrong in 20years time but I do not know which 50 percent it is; if I did I would not teach it to them (mededuc in mal 1965).

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Evalation of continuing education in health professions. Khuwer Nijhoff ; 1985. R845

Eva Coombs ,Robert H. Mastering medicine : Professional Socialization in medical schools . Freepress, USA c1978 R.745

Emmerson ,B.T (Brayan Thoman) Four hats : The roles of a clinical professor of medicine University of Queensland Press.1976. R. 7O8 Emm.

Heath, Trevor .From the centaur through Aesculapius: on learning the skills of the healer. University of QueensLands press 1975. SF 775 Heg

Hurst, J.Wills (John Wills ),1920 Eassy from the heart. Reven Press 1995.W62 Hur 1995.

Laura,R.S ( Ronald S.) / Heanyy,Sandra, Phiolosophical Foundations of Health education. Newyork Routledge, 1990. Education R.737 L377 P.

Mahfooz, Naguib Bey,1982. The history of medical education in Education. Government press Bulan 1935 R823 mah

Medical Education .Blackwell scientific publications. V.10 JAN. 1976 Serial (shelved by title)

Medical Education and primary health care . Croom Helm,1980.W18 Med

Medical Education Blackwell scientific publications. V.10- Jan. 1976 (serial )

Medical education making the grade in cost containment /cordinating editor, Karen E. Lake. W.K. Kellogg foundation, 1986. W 74 Med

Simpson, Michael A. Medical education: a critical approach . Butterworths, 1972 W18 Sim

Wee, Catherine Higher education and and career in medicine . Wenco counselling centre,1990. LB. 1027.5 Y 674.

Wing, Paul. Planning and decision making for medical education: an analyisis of costs and benefits. Office of the Vice president, University of Califonia 1972 R.745 Win

Wing,paul. Costs of medical education . Office of the vice president University of Calofornia,1971. R.745 U 6 Win

Reoreintation of Medical education: part 4: guidelines for developing national plans for action. Geneva World Health Organization 1991 (on order)

University of Sheffield school of medicine United Kingdom. The Asian shefied medical collage a degree of change.Sheffied University of Sheffied 1995. Central LF 766 A 816 M.

John Z.Bowers and Elizabeth F. Purcell . The impact of health services on medical education: A global view . Josiah Macy,Jr.Foundation 1978. W18.Imp.

J. David Holcomb,Ed.D. Arthur E. Garner, Ed.D.Improving Teaching in medical schools. Charles C Thomas. Publisher Bannerstone. 1973. Wi8 Hoi

Nooman ZM, Schmidt HG, Ezzat E (eds.): Innovation in medical education: an evaluation of its present status. Springer Publishing Company. New York 190

INTRODUCTION
European colonization of Malaysia

Nyazee

Dr Tahir Azhar

Dr Tahir Azhar


ISSUES
IIIT
Abusulayman
al Faruqi
Attas
Kasule Omar


PURPOSE
Disease as a blessing
Disease as expiation of sins
Hate what is goo
ure from Allah
Bad life
Diseases of the heart
khawf
shakk
fisq
fitnat
sakiinat
falaah
Bowers
Moosa
Calman K. The profession of medicine. BMJ. 1994 Oct 29; 309(6962): 1140-1143


INTEGRATION

Woolliscroft JO. Whi will teach? A fundamental challenge to medical education. Acad-Med. 1995 Jan; 70(1):27-29

Lie N. [Traditional and non-traditional curricula. definitions and terminology]. Tidsskr Nor Laegeforen. 1995 Mar 30; 115(9): 1067-1071
al Faruqi, I. Tauhid: Its Implications for Thought and Life.. IIIT 1983

Kaufman A (ed.) Implementing problem-based medical education: lessons for sucessful innovation. Springer Publishing Company. New York 1985

Domans DH, Schmidt HG. What drives the student in problem-based learning? Med-Educ. 1994 Sep; 28(5): 372-380

Chang G, Cook D, Maguire T, Skakun E, Yakimets WW, Warnock GL. Problem-based learning: its role in undergraduate surgical education. Can J Surg. 1995 Feb; 38(1): 13-21

Lie N. The psychiatric semester and recruitment of future psychiatrists. Tidsskr Nor laegeferon. 1995 Jan 30; 115(3): 375-376

Naylor AJ, Creer AE, Woodward-Lopez-G, Dixon S. Lactation management education for physicians. semin-Perinatalo. 1994 Dec; 18(6):525-531

Jedrychowski W, maugeri U. Needs and requirements for undergraduate training in environmental and occupational epidemiology. G-Ital-Lav. 1993 Jan-Jul; 15(1-4): 7-11

Durfee MF, Warren DG, Sdao-Jarvie K. A model for answering the substance abuse educational needs of health professionals: the North carolina Governor’s Institute on Alcohol and Substance Abuse. Alcohol. 1994 Nov-Dec; 11(6):483-487

Kahtan S, Inman C, Haines A, Holland P. teaching disability and rehabilitation to medical students. Steering Group on Medical Education and Disability. Med-Educ. 1994 Sep; 28(5): 386-393

Taylor WC, Moore GT. Health promotion and disease prevention: integration into a medical school curriculum. Med-Edic. 1994 Nox; 28(6): 481-187

Gofin J, Gofin R, Knishkowy B. Evaluation of a community-oriented orimary care workshop for family practice residents in Jerusalem. Fam-Med. 1995 Jan; 27(1): 28-34

Burlina A. The impact of clinical biochemistry on the pre-doctoral medical curriculum: an Italian viewpoint. Clin-Chim-Acta. 1994 Dec 31; 232(1-2): 23-31

Freeman J, cash C, Yonke A, Roe B, Foley R. A longitudinal primary care program in an urban public medical school: three years of experience. Acad-Med. 1995 Jan; 70(1 suppll): S64-8

Wilson M. Pediatric generalist training: graduate medical education at a cross-roads. Curr Opin Pediatr. 1994 Oct; 6(5): 513-518

Sachdeva AK. redesigning the surgical teaching of fourth year medical students to meet the training needs of generalists. J cancer Educ. 1994 Fall; 9(3):148-151

What the future may hold for general surgery. A position paper of the American Board of Surgery. J Amer Colol Surg. 1995 Apr; 180(4):481-484

Varga M, Buris L. Drinking habits of medical students call for better integration of teaching about alcohol into the medical curriculum. Alcohol-Alcohol. 1994 Sep; 29(5): 591-596

al NAQIIB

al FARUQI

William G, Western reserve’s experiemnet in medical education and its outcome. Oxford University Press New York 1980

Report to Congress on the appropriate federal role in assuring access by medical students, residents, and practising physicians to adequate training in nutrition. public-health-Rep. 1994 Nov-Dec; 109(6): 824-826

Mandin H, harasym P, Eagle C, Watanabe M. developing a ‘clinical presentation’ curriculum at the University of calgary. Acad-Med. 1995 Mar; 70(3): 186-193

Wise AL, Hays RB, Adkins PB, Craig ML, Mahiney MD, Sheehan M, Siskind V, Nichols A. Training for rural general practice. Med J Austr. 1994 Sep5; 161(5): 314-318

Zohair M. Nooman,MD Henk G. Schmidt, PhD Esmat S. Ezzat, MD. Innovation in medical Education An Evaluation of its Present status. Springer Publishing Company New York 1990. W18 Inn.


SERVICE

Muslim
Muslim
Muslim
Muslim
Muslim
Qur’an
Muslim
Bukhari
Qur’an

2- مشكلة الفقر وسبل علاجها فى ضوء الاسلام دراسة مقارنة ، عبد الرحمن بن سعد بن عبد الرحمن ال السعود ، مركز العربى للدراسات الامنية والتدريب ، الرياض I HV435A461M 1990

3- تخريج احاديث مشكلة الفقر وكيف عالجها الاسلام ، محمد ناصر الدين الالبانى ، المكتب الاسلامى ، بيروت HC499Q13A32T 1884

4- مشكلة الفقر وكيف عالجها الاسلام ، يوسف اللقرضاوى ، مؤسسة الرسالة ، بيروت iHV435A461M 1990

5- حق الفقراء المسلمين فى ثروات الامة الاسلامية ، للسيد عطية عبد الواحد ، دار النهضة العربية ، القاهرة 1992

6- احكام الزكاة والصدقة محمد عقلة ، مكتبة الرسالة الحديثة ، عمان BP180U67A 1982

7- التكافل الاجتماعى فى الاسلام ، محمد ابو زهرة ، دار الفكر العربى ، القاهرةHW40I8A167I 1987

8- التكافل الاجتماعى فى الشريعة الاسلامية ودوره فى حماية المال والخاص ، محمد بن احمد الصالح ، جامعة الامام محمد بن سعود الاسلامية ، مملكة العربية السعودية ،HD7096174S165 1985

9- التكافل الاجتماعى فى الاسلام ، عبد الله ناصح علوان ، دار السلام ، حلب ، القاهرة BP 173.25U47T 1983

10- الترهيب من اكل مال اليتيم والترغيب فى الاحسان الى الارملة والمسكين واليتيم ، دار الصحابة للتراث ، طنطا ، مصر ، 1993 .

LEADERSHIP

kullukum rai

Amanat

Muslim

Ashour

Hathout

Moosa

Hafferty FW, Franks R. The hidden curriculum, ethics teaching, and the structure of medical education. Acad-Med. 1994 Nov; 69(11): 861-871

Glick SM. The teaching of medical ethics to medical students. J Med Ethics. 1994 Dec; 20(4):239-243

Anonymous. al Ru’uyat al islamiyyat li ba’adh al mumaarasaat al tibiyyat. Al Munadhammat al islamiyyat li al uluum al tibiyyat, Kuwait 1987

Anonymous. Qadhayat tibiyyat mu’asirat fi dhaw’i al sharia al Islamiyyat. vol 1. Dar al basheer. Amman 1995

Ibrahim, Abu Fadl Mohsin: Biomedical Issues, Islamic Perspctives Islamic Medical Association of South Africa, Mobeni 1988) .


Chamberlain JE, Nisker JA. Residents’ attitudes to training in ethics in Canadian obstetrics and gynecology programs. Obstet-Gynecol. 1995 May; 85(5 Pt 1): 783-786

American College of Physicians. The role of the physician and the medical profession in the prevention of international torture and in the treatment of its survivors. Ann Intern Med. 1995 Apr 15; 122(8): 607-613

Wiebers DO, Barron RA, leaning J, Ascione FR. Ethics and animal issues in US medical education. Med-Educ. 1994 Nov; 28(6):517-523


Hope T, Fulford KW. The Oxford Practice Skills Project: teaching ethics, law, and communication skills to clinical medical students. J Med Ethics. 1994 Dec; 20(4): 229-234

Freeman JW, Wilson AL. Virtue and longitudinal ethics education in medical school. S D J Med. 1994 Dec; 47(12):427-430

Hidges MO, Tolle SW. Tibe-feeding decisions in the elderly. Clin Geriatr Med. 1994 Aug; 10(3): 475-488



1- مسآلة تحديد النسل وقاية وعلاجا ، محمد سعيد رمضان البوطى ، مكتبة الفارابى ، دمشق . HQ766.37B984M 1980 .

ARABIC KEY TERMS: IKTI’AB INDA WILADAT AL UNTHA - TAHRIIM QATL AL MAR’ATAT - TAHRIIM QATL AN AWLAD - WA’D - IJHAADH - ISQAAT AL HAML
1- الاجهاض بين الفقه والطب والقانون ، محمد سيف الدين السباعى ، دار الكتب العربية ، بيروت BP 158. 4H5135563I 1977





MEDICAL RESEARCH
Bukhari

Muslim



ISLAMIC HERITAGE IN MEDICINE

ISLAMIC HERITAGE IN MUSLIM: GENERALWRITINGS BY MUSLIMS
Abu Shakuuk, Muhammad. A’alaam al tibb fi al Islam wa al Mardh wa al ‘ilaaj. Muassasat Dar al uluuum. Kuwait 1979

Khan, Muhammad Salim : Islamic medicine ( Routledge & Kegan Paul, London 1986)

Rahman, Fazlur : Health and medicine in the Islamic tradition : Change and Identity (S. Abdul Majeed, Kuala Lumpur 1983).

Ahmad Said : Propheric Medical Sciences ( 15th Ed. Dini Book Depot, Delhi 1987) .

Al Banna Ayda Abd Al Azim : Islamic religion as a basis for a health education program. ( Indiana University, Bloomington Ind. 1979).

Ismail bin Saad : Pengenalan tamudun dalam ilm perubatan ( Dewan Bahasa dan Pustaka, KL 1992).

Taha Ahmad : Kedoktoran Islam ( Dewan Bahasa Dan Pustaka, KL 1992).

Hussein Khalid Bahrisy : Islam dan kesehatan ( Al Ikhlas< Surabaya 1980).

Thaha Ahmadie : Kedoktera dalam Islam 1983

Alatas, Hussein : Biarkan; Sekitar perbahasan ilmiah mengenai derma Cornea- mata dengan Majlis Ugama Islam Singapore (10th August 7th September 1973 -Pustaka National Singapore 1974).Al Khattab Muhammd : Al Aghdiyah Wa al Adwiyah inda mu&#8217;allif al Gharb al Islam; Madkhal wa Nusus ( Dar al Gharb al Islam, Bayrut 1990).

Al Amilia, Jafar Murtada : Al Adab Al Tibbiyah fil al Islam; ma&#8217;a lamhah mujazah an tarikh al tibbi ( Dar al Balaghah, Bayrut 1991).

Ghanem Isan : Islamic medical jurisprudence ( Arthur prbsthain, London 1982)

Al Khattabi Muhammad al Arabi/ Ibn Al Baytar Abd Allah ibn Ahmad 1284 : Al Jami li mufradat al adwiyah: Tanqih mufradat ibn al baytar al Ansab al malaqa min Kitabihi al Jami ( Dar al Gharb al Islam, Bayrut 1990).

Muhammad, Mahmood a Hajj : Al Tibbi inda al Arab wa al Muslimin; Tarikh wa musahamat (Al Dar al Saudiyah Jiddah 1987).

Qatayah Salman : Al Tabib al Arabi ; Ali ibn Radwan, Rais atabba misr (Al munazzam al Arabiyah lil Tarbiyah wa al thaqafah wa al ulum, Idarat al Thaqafah Tunis 1984).

Arif Muhammad Izzat Muhammad : Min kunuz al hawi fi al tibbi wa al tadawi (Maktab al Turath al Islami al qahirah 1992)

Siddiq, Muhammad Zubayr : Studies in Arabic and Persian medical literature ( Calcutta University, 1959).

Ibn Jumay Hibat Allah ibn Zayn : Treatise on Salah ad Din on the revival of the art of medicine ( Kommissions verag F Steiner, Wiesbaden 1983).

Al Sijistan Abd Allah : The Muntakhab Siwan al Hikmah of Abu Sulayman as Sijistan, Arabic text, introduction and indices ( Mouton, The Haque 1979)

Al Khattab Muhammad al Arabi Al Aghdhiyah wa al Adwiyah inda Mu allafi al harb al Islami, Madkhal wa Nusus ( Dar al Gharb al Islami, Bayrut 1990)

Ali ibn Ridwan : Medical medieval Islamic medicine; Ibn Ridwan&#8217;s treatise on the prevention of bodily ills in Egypt ( Unversity of Cal. Press Berkeley 1984)

Khan, Muhammad Salim : Islamic medicine ( Routledge & Kegan Paul, London 1986).

Hathout Hassan : Topics in Islamic medicine ( International Organisation of Islamic Medicine, Kuwait 1984).

Ali ibn Ridwan : Medieval Islamic Medicine , Ibn Ridwan&#8217;s teatise, on the prevention of bodily ills in Egypt ( University of California Press Barkely, Calf. 1984).

Kamal Hassan : Encyclopaedia of Islamic medicine : With a Greco - Roman backgroud (General Egyptian Book Organisation, Cairo 1975).

Ali Mahir abd al Qadir Muhammad Hunayn ibn U‎Ishaq : Al Asri al Dhahabi lil tarjamah (Dar al Nahdah al Arabiyahl, Bayrut 1987).

ISLAMIC HERITAGE IN MEDICINE: GENERAL WRITINGS BY NON MUSLIMS
Dr. Theodor Puschmann Ahistory of Medical Education .Hafner Publishing Company, Inc. New York 1966.

Ullman. M. al Tibb al islami (Arabic translation by Dr Yusuf al Kilani) Ministry of Health Kuwait 1981

Hamarneh, Sami Khalaf : Bibliography on medicine and pharmacy in medieval Islam ( Stuttgart: Wissenschaftlinehe verlasgsellschaft 1964) 204 pages Z 6659 Ham U.M

Graziani Joseph Savatore: Arabic medicine in the eleventh Century as represented in the works of ibn Jazlah ( Karachi: Hamdrad academy 1980) 244pages R143 Gra

Hemarneh, Sami Khalaf 19 : Health sciences in early Islam ( Noor Health Foundation and Zahra Publications, Blanco 1983).

Elgood, Cyril : Safavid medical practice or the practice of medicine, Surgery and Gynaecology in persia between 1500 AD and 1750 AD (Lzac, London 1970).

Meyerhof Max / Johnstone Penelope : Studies in medicval Arabic medicine: Theory and practice (Variorum Reprints, London 1984).

Elgood Cyril : A medical history of persia and the eastern Calighate; The development of Persian and Arabic medical science from the earliest times until the year 1932 AD ( Apa - Philo, Amsterdam 1979).

Browne Edward Granville : Arabian medcine ( Hyperion Press, Westport, Conn. 1983).

Ullmaun Manfred : Islamic medicine ( Routledge & Kegen Paul London 1986)

Ullam Manfred : Islamic medicine ( Edinburgh Unversity Press, Edinburgh 1978).


Molloy Aminah : Attitude to medical ethics among muslim medical practitioners. ( CSIC Pub. Birmingham 1979).
MUSLIM ACHIEVEMENTS
(a) ethics Ibn Sina (b) ophthalmology: Ibn Hytham d. 1040 AD, Hunain Ibn Ishaq, Al Razi, Ibn Sina, Al Zahrawi, Ali Ibn Isa, Ibn al Rushd, Abu al Qasim Ammar) (c) blood circulation: Ibn Nafees
(d) general surgery: Ibn Zuhr, al Shirazi, Ibn Dhahabi (e) wound treatment: Ibn Sina, Al Zahrawi, Ibn Rushd, Al Razi (f) thermal and chemical cauterization, syphilis (Ibn Sina) (g) tumors:(Abdul Malik Ibn Zuhr d. 484 AH (h) anatomy:Ibn Masuwayh, Ibn Abi al Ash&#8217;th, al Majusi, Ibn Habal, Ali Ibn Abbas, Ibn Sina, Ibn al Quffi, Ibn al Nafiis, Ibn Ruhd, Abdul Lateef Baghdadi, Zakariyyah Ibn Muhammad Ibn Muhammad al Cazweeny d. 683 AH).
MUSLIM CONTRIBUTIONS TO OPHTHAMOLOGY
Hunayn ibn Ishaq al Ibad : The book of the ten treatises on the eye ascribed to Hunayn ibn Ishaq; The earliest existing systematic text edited from the only two known manuscripts ( dar al Ma&#8217;arif, Susah, Tunis 1989).

MUSLIM CONTRIBUTIONS TO BLOOD CIRCULATION
Qatayah Salman: Histoire de decouverte de la petite circulation samgine ( ISSESCO Rabit )

MUSLIM CONTRIBUTION TO SURGERY

Al Hadid Sayyid Amrad Al Kulyah wa jirahatuha ( Dar Talas, Dimashq 1992).

MUSLIM CONTRIBUTION TO PHARMACOLOGY
RS.63 Lev U.M Levey Martin : Early Arabic Pharmacology : An introduction based on ancient and medical sources. (Leiden : Brill 1973).

MUSLIM CONTRIBUTION TO PHYSIOLOGY

IBN SINA
Al-Ahwani, Ahmad Fu'ad. Ibn Sina .MISR. Dar al Ma'arif 1958. Central B751 Z7 A 287.

Al-Daffa 'Ali 'Abd Allah .al -Manahi al-ilimiyah 'Indah Ibn Sina. Al-TAIF, Nadi al-
Ta'if al -Adabi,1987 Central B751D1 24 M

Al-Hurr,Muhammad Kamil Ibn Sina : Hayatuh-atharuh 'wa-falsafatuhu BAYRUT Dar al-kutub al- ilmiyyah 1991. Central B651 H966 I.

Asi Hasan Ibn Sina :al -rajul wa al-athar.BEYRUT. Dar-al Fikr al-Arab 1990. Central B571 A. 798I

Avicenna,1980-1037/al-Juzajani, Abd al -Wahid ibn, Muhammad,11th century ...The
life of Ibn Sina. ALBONY.State University of Newyork press, 1974. Central B751 F 51 A 957.

Bali, Mirfat' Izzat al Ittijah al-ishraqi fi falsafal Ibn Sina. BAYRUT Dar al jil 1994.Central B751Z 7M 369 J.

Fayyad Sulayman.Ibn Sina: Abu al-Tibb al-bashr AL-QAHIRAH. Mu'assasat al-Ahram, 1992. Central B751 F 286 I

Ghalib, Mustafa Ibn Sina BAYRUT Dar wa -Maktabat al-Hilal 1992 Central B 751 G .411I

Najat,Muhammad Uthuman 1914-al-Idrak al-hassi 'indah Ibn Sina: bahath fi'ilm alm al nafs inda al-Arab. MISR Dar al-Ma'arif 1961.Central B751N 162 I

Saliba ,Jiamil,1902. Min aflantun ila Ibn Sina: Muhadarat fi al- falsafat alArabiyah.BAYRUT Dar al-Andalusi 1983. Central B740S165.



2 of 8
TI: Health promotion and disease prevention: integration into a medical school curriculum.
AU: Taylor-WC; Moore-GT
SO: Med-Educ. 1994 Nov; 28(6): 481-7
LA: ENGLISH
AB: Many authorities have identified deficiencies in the education of medical students in health promotion and disease prevention. This report describes an attempt to address this problem through the longitudinal integration of health promotion and disease prevention into several major courses in the student curriculum at Harvard Medical School. We used adult learning theory to develop the curricular approach, and designed educational experiences to match the professional development of the student at different phases of medical education. Primary, secondary, and tertiary prevention were particularly germane for students in the first, second, and third years, respectively. During clerkships in the third and fourth years, especially those with a focus on ambulatory patients, students built upon earlier experiences to integrate health promotion and disease prevention into clinical practice. By unifying the teaching of disease prevention with several major required courses, we aimed to create an environment in which students could experience their learning about disease prevention in the same manner that we aspired to have them practise it: integrated throughout clinical medicine.
AN: 95166062

TI: A longitudinal primary care program in an urban public medical school: three years of experience.
AU: Freeman-J; Cash-C; Yonke-A; Roe-B; Foley-R
SO: Acad-Med. 1995 Jan; 70(1 Suppl): S64-8
LA: ENGLISH
AB: The experience of the University of Illinois at Chicago's College of Medicine with implementing a pilot generalist program focuses on institutionalization and management. Various features of the program make it an interesting case study: It is inter-disciplinary, comprising pediatricians, general internists, and family practitioners; students join the program in the autumn of their first year; and it is changing from a voluntary to a required, institutionally ingrained course of study. The difficulties and procedures encountered in making room for an interdisciplinary primary care program in a traditional medical school curriculum are discussed.
AN: 95127040

6 of 8
TI: Drinking habits of medical students call for better integration of teaching about alcohol into the medical curriculum.
AU: Varga-M; Buris-L
SO: Alcohol-Alcohol. 1994 Sep; 29(5): 591-6
LA: ENGLISH
AB: A study was conducted with medical students to observe their drinking habits and alcohol misuse. The students completed questionnaires composed of AUDIT and SMAST questions. A significant proportion (33%) of students drank more than the recommended safe limit and screened positive at the AUDIT cut-off score of 11. The high scores of DSM-III criterion questions indicate that problem drinking on college campuses continues to be a significant public health concern. Our opinion is that prevention of alcohol misuse should be started at medical universities. The medical school curriculum must integrate education about alcohol. First the attitude of medical professionals should be changed so that we can achieve results in alcohol misuse prevention in society as a whole.
AN: 95110395

TI: The hidden curriculum, ethics teaching, and the structure of medical education.
AU: Hafferty-FW; Franks-R
SO: Acad-Med. 1994 Nov; 69(11): 861-71
LA: ENGLISH
AB: The authors raise questions regarding the wide-spread calls emanating from lay and medical audiences alike to intensify the formal teaching of ethics within the medical school curriculum. In particular, they challenge a prevailing belief within the culture of medicine that while it may be possible to teach information about ethics (e.g., skills in recognizing the presence of common ethical problems, skills in ethical reasoning, or improved understanding of the language and concepts of ethics), course material or even an entire curriculum can in no way decisively influence a student's personality or ensure ethical conduct. To this end, several issues are explored, including whether medical ethics is best framed as a body of knowledge and skills or as part of one's professional identity. The authors argue that most of the critical determinants of physician identity operate not within the formal curriculum but in a more subtle, less officially recognized "hidden curriculum." The overall process of medical education is presented as a form of moral training of which formal instruction in ethics constitutes only one small piece. Finally, the authors maintain that any attempt to develop a comprehensive ethics curriculum must acknowledge the broader cultural milieu within which that curriculum must function. In conclusion, they offer recommendations on how an ethics curriculum might be more fruitfully structured to become a seamless part of the training process.
AN: 95032461

TI: The impact of clinical biochemistry on the pre-doctoral medical curriculum: an Italian viewpoint.
AU: Burlina-A
SO: Clin-Chim-Acta. 1994 Dec 31; 232(1-2): 23-31
LA: ENGLISH
AB: Clinical biochemistry can be viewed as a subdiscipline of laboratory medicine, but is not confined to the practical aspects of laboratory testing as clinical chemistry is. Since medical studies comprise both theoretical education and practical training, clinical (bio)chemistry must be taught by preceptors experienced in clinical laboratory operations. In Italy, where medical education traditionally has been separated into basic sciences and clinical sciences, clinical biochemistry has been added as a course to bridge between the two phases of the curriculum. However, the broader changes in Italian medical training will create a more cohesive pattern of teaching, and the integration of different material into a 'layer cake' curriculum. In such a structure, clinical (bio)chemistry will be considered a clinical discipline devoted mainly to teaching the use of laboratory tests, while the linkage between basic and clinical sciences falls to general pathology and pathophysiology. Nevertheless, to avoid overlap and lack of propaedeutical coordination, the content of the clinical (bio)chemistry-course must be coordinated with both the basic and the clinical sciences. This viewpoint is also supported by IFCC/IUPAC guidelines on teaching clinical chemistry to medical students.
AN: 95236681

2 of 3
TI: Lactation management education for physicians.
AU: Naylor-AJ; Creer-AE; Woodward-Lopez-G; Dixon-S
SO: Semin-Perinatol. 1994 Dec; 18(6): 525-31
LA: ENGLISH
AB: All health professional groups support breastfeeding as the ideal way to nourish an infant, but numerous surveys have shown that, in general, even perinatal health professionals are not prepared to provide lactation management as part of routine care. Integration of lactation topics into current medical curriculum, whether traditional or problem-based, is the ideal and is possible. Faculty are encouraged to assess the current program for signs of "curriculosclerosis," a prevalent disease characterized by Abrahamson as "hardening of the categories," to look for ways to elasticize the relevant departments, and to integrate lactation management topics at the appropriate place in the larger educational plan. Faculty leadership is crucial. Remedial work, in terms of continuing education, will be necessary for perinatal health professionals until the curriculum model has been in place in preservice and postgraduate programs sufficiently long. Breastfeeding as a primary health care strategy, with its clear health and economic benefits, must be a part of any health care reform and, as such, will be a service expected to be provided by perinatal health professionals.
AN: 95215881

3 of 3
TI: Drinking habits of medical students call for better integration of teaching about alcohol into the medical curriculum.
AU: Varga-M; Buris-L
SO: Alcohol-Alcohol. 1994 Sep; 29(5): 591-6
LA: ENGLISH
AB: A study was conducted with medical students to observe their drinking habits and alcohol misuse. The students completed questionnaires composed of AUDIT and SMAST questions. A significant proportion (33%) of students drank more than the recommended safe limit and screened positive at the AUDIT cut-off score of 11. The high scores of DSM-III criterion questions indicate that problem drinking on college campuses continues to be a significant public health concern. Our opinion is that prevention of alcohol misuse should be started at medical universities. The medical school curriculum must integrate education about alcohol. First the attitude of medical professionals should be changed so that we can achieve results in alcohol misuse prevention in society as a whole.
AN: 95110395

1 of 1
TI TITLE: [Teaching sociology in medical school]
AU AUTHOR(S): Liu-CT
SO SOURCE (BIBLIOGRAPHIC CITATION): Kao-Hsiung-I-Hsueh-Ko-Hsueh-Tsa-Chih. 1994 Nov; 10(11): 600-5
LA LANGUAGE OF ARTICLE: JAPANESE; NON-ENGLISH
AB ABSTRACT: As early as in 1994 medical education was criticised by the Royal College of Physician in London. Nevertheless until 1978 D. C. Maddision was still asking the question: "What's wrong with medical education?", and Abrahamson writing a paper called "Disease of the (medical) curriculum". Since the 1950s social and behavioural sciences have been gradually brought into the curriculum in order to pursue better medical care. In the 1970s critics of medicine went beyond its economical and political aspects, ie. its maldistribution etc., to its cultural side. Not only the efficacy of modern medicine but its moral neutrality and benevolence were called into question. This paper is mainly based on the writer's personal experience of teaching sociology and medical sociology in a medical school in Taiwan. The debate on relevance, the difficulties and problems in teaching and suggestions for the future are covered.
AN MEDLINE ACCESSION NUMBER: 95139122

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TI TITLE: Gender comparisons of young physicians' perceptions of their medical education, professional life, and practice: a follow-up study of Jefferson Medical College graduates.
AU AUTHOR(S): Hojat-M; Gonnella-JS; Xu-G
SO SOURCE (BIBLIOGRAPHIC CITATION): Acad-Med. 1995 Apr; 70(4): 305-12
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: PURPOSE. To obtain information from a group of young physicians and compare men and women on their evaluations of selected areas of the medical school curriculum, their perceptions of issues related to medical practice and professional life, and their specialty choices, professional activities, and research productivity. METHOD. In 1992, a questionnaire was mailed to 1,076 physicians who had graduated from Jefferson Medical College between 1982 and 1986. The responses of men and women were compared using multivariate and univariate analyses of variance, t-tests, chi-square, and median test. RESULTS. Completed questionnaires were returned by 667 graduates (530 men and 137 women). The curriculum areas of interpersonal skills, disease prevention, medical ethics, and economics of health care were rated by both men and women as being the most important in medical training. Conversely, research methodology and statistics received the lowest ratings. Women, in general, valued psychosocial aspects of medical care higher than did men. Among the areas of perceived problems related to practice, lack of leisure time received the highest ratings (as being the greatest problem) and interpersonal interactions received the lowest ratings (as being the least problem) from both men and women. The men were more concerned than the women about the areas of patient chart and documentation, malpractice litigation, physician oversupply, peer review, and interaction with patients. These differences remained when specialties and numbers of hours worked per week were held constant. Generally, the physicians reported satisfaction with their professional lives, but the men tended to be more satisfied than the women about their decisions to become physicians and in their perceptions of medicine as a rewarding career. The proportion of men employed full-time (99.4%) was significantly higher than that for women (84%). Women were more likely to practice general pediatrics, while men were more likely to practice surgery and surgical subspecialties. Full-time--employed women worked fewer hours per week (57) than men (63), and men reported more research productivity than women. CONCLUSION. The implications of the findings of numerous gender differences are discussed regarding the issues of physician workforce, types of care rendered by men and women, and possible changes in the national health care system.
AN MEDLINE ACCESSION NUMBER: 95234118

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TI TITLE: Health promotion and disease prevention: integration into a medical school curriculum.
AU AUTHOR(S): Taylor-WC; Moore-GT
SO SOURCE (BIBLIOGRAPHIC CITATION): Med-Educ. 1994 Nov; 28(6): 481-7
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: Many authorities have identified deficiencies in the education of medical students in health promotion and disease prevention. This report describes an attempt to address this problem through the longitudinal integration of health promotion and disease prevention into several major courses in the student curriculum at Harvard Medical School. We used adult learning theory to develop the curricular approach, and designed educational experiences to match the professional development of the student at different phases of medical education. Primary, secondary, and tertiary prevention were particularly germane for students in the first, second, and third years, respectively. During clerkships in the third and fourth years, especially those with a focus on ambulatory patients, students built upon earlier experiences to integrate health promotion and disease prevention into clinical practice. By unifying the teaching of disease prevention with several major required courses, we aimed to create an environment in which students could experience their learning about disease prevention in the same manner that we aspired to have them practise it: integrated throughout clinical medicine.
AN MEDLINE ACCESSION NUMBER: 95166062

TI TITLE: A longitudinal primary care program in an urban public medical school: three years of experience.
AU AUTHOR(S): Freeman-J; Cash-C; Yonke-A; Roe-B; Foley-R
SO SOURCE (BIBLIOGRAPHIC CITATION): Acad-Med. 1995 Jan; 70(1 Suppl): S64-8
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: The experience of the University of Illinois at Chicago's College of Medicine with implementing a pilot generalist program focuses on institutionalization and management. Various features of the program make it an interesting case study: It is inter-disciplinary, comprising pediatricians, general internists, and family practitioners; students join the program in the autumn of their first year; and it is changing from a voluntary to a required, institutionally ingrained course of study. The difficulties and procedures encountered in making room for an interdisciplinary primary care program in a traditional medical school curriculum are discussed.
AN MEDLINE ACCESSION NUMBER: 95127040

TI TITLE: The hidden curriculum, ethics teaching, and the structure of medical education.
AU AUTHOR(S): Hafferty-FW; Franks-R
SO SOURCE (BIBLIOGRAPHIC CITATION): Acad-Med. 1994 Nov; 69(11): 861-71
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: The authors raise questions regarding the wide-spread calls emanating from lay and medical audiences alike to intensify the formal teaching of ethics within the medical school curriculum. In particular, they challenge a prevailing belief within the culture of medicine that while it may be possible to teach information about ethics (e.g., skills in recognizing the presence of common ethical problems, skills in ethical reasoning, or improved understanding of the language and concepts of ethics), course material or even an entire curriculum can in no way decisively influence a student's personality or ensure ethical conduct. To this end, several issues are explored, including whether medical ethics is best framed as a body of knowledge and skills or as part of one's professional identity. The authors argue that most of the critical determinants of physician identity operate not within the formal curriculum but in a more subtle, less officially recognized "hidden curriculum." The overall process of medical education is presented as a form of moral training of which formal instruction in ethics constitutes only one small piece. Finally, the authors maintain that any attempt to develop a comprehensive ethics curriculum must acknowledge the broader cultural milieu within which that curriculum must function. In conclusion, they offer recommendations on how an ethics curriculum might be more fruitfully structured to become a seamless part of the training process.

TI TITLE: Health promotion and disease prevention: integration into a medical school curriculum.
AU AUTHOR(S): Taylor-WC; Moore-GT
SO SOURCE (BIBLIOGRAPHIC CITATION): Med-Educ. 1994 Nov; 28(6): 481-7
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: Many authorities have identified deficiencies in the education of medical students in health promotion and disease prevention. This report describes an attempt to address this problem through the longitudinal integration of health promotion and disease prevention into several major courses in the student curriculum at Harvard Medical School. We used adult learning theory to develop the curricular approach, and designed educational experiences to match the professional development of the student at different phases of medical education. Primary, secondary, and tertiary prevention were particularly germane for students in the first, second, and third years, respectively. During clerkships in the third and fourth years, especially those with a focus on ambulatory patients, students built upon earlier experiences to integrate health promotion and disease prevention into clinical practice. By unifying the teaching of disease prevention with several major required courses, we aimed to create an environment in which students could experience their learning about disease prevention in the same manner that we aspired to have them practise it: integrated throughout clinical medicine.
AN MEDLINE ACCESSION NUMBER: 95166062

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TI TITLE: The report to Congress on the appropriate federal role in assuring access by medical students, residents, and practicing physicians to adequate training in nutrition.
AU AUTHOR(S): Davis-CH
SO SOURCE (BIBLIOGRAPHIC CITATION): Public-Health-Rep. 1994 Nov-Dec; 109(6): 824-6
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: The Congress has had a long-time concern about the adequacy of nutrition education provided medical students and physicians during their training. Attempts over three decades to address this deficiency have been largely ineffective. Yet, recent changes in the delivery of health care from inpatient to outpatient services require physicians be competent in both applied nutrition and patient counseling. The importance of patient counseling is underscored by the surveys of the National Center for Health Statistics which reveal that overweight for the U.S. population has increased between the early 60s and the late 80s. These findings suggest that the Healthy People 2000 objective of reducing the prevalence of overweight may not be met. Congress evidenced its concern about the nutrition education in the medical curriculum in Section 302 of the National Nutrition Monitoring and Related Research Act of 1990 that required a report on the subject from the Secretary of Health and Human Services. The Division of Medicine in the Health Resources and Services Administration, an agency of the Public Health Service, responded by compiling the report. The report to Congress focuses on two issues--why it has been so difficult to increase the nutrition content of medical school curriculums and, if the Federal Government intervenes, what strategies might be effective.
AN MEDLINE ACCESSION NUMBER: 95098980

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TI TITLE: Needs and requirements for undergraduate and graduate training in environmental and occupational epidemiology.
AU AUTHOR(S): Jedrychowski-W; Maugeri-U
SO SOURCE (BIBLIOGRAPHIC CITATION): G-Ital-Med-Lav. 1993 Jan-Jul; 15(1-4): 7-11
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: Training in modern medicine aims at teaching not only the structure and function of the human organism in health and in disease, but also it aims at revealing the factors responsible for human health. The second field of teaching is based mainly on epidemiology. In undergraduate teaching, the epidemiological training should be introduced as early as possible in the curriculum and possibly divided into two parts, theoretical and practical. With the increasing awareness that the maintenance of health in populations is an ecological problem, there is also a growing need for professional epidemiologists who could assist in recognizing health risks, assessing and developing prevention strategies and in arranging of health services in a responsible way. The objectives of graduate teaching in epidemiology are different from those of undergraduate teaching. The graduate teaching should cover not only professional epidemiologists but also should be addressed to health services administrators, clinicians and graduates from other specialists and paramedical and auxiliary personnel. The needs and requirements for teaching epidemiology in undergraduate and postgraduate levels have been discussed against the background of currently available courses in Europe and local perception of environmental and occupational problems in European countries.
AN MEDLINE ACCESSION NUMBER: 95237482

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TI TITLE: Evaluation of a community-oriented primary care workshop for family practice residents in Jerusalem.
AU AUTHOR(S): Gofin-J; Gofin-R; Knishkowy-B
SO SOURCE (BIBLIOGRAPHIC CITATION): Fam-Med. 1995 Jan; 27(1): 28-34
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: BACKGROUND: A workshop on community-oriented primary care (COPC) has been integrated into Hebrew University's family practice residency program for several years. The participants of the first three workshops did an evaluation to assess subsequent application of the COPC approach. METHODS: The main objectives of the 45-hour workshop are: a) to learn the principles and practice of COPC as illustrated by the Hadassah Community Health Center programs, and b) to learn skills required in the COPC programs' various stages of development. In the workshop, physicians are required to work in groups of 5-6 to carry out the planning of COPC programs, which will be implemented in their practices. A structured questionnaire was sent 2-4 years after workshop completion to each of the 45 physicians who participated in these workshops. RESULTS: Thirty-six of the 45 physicians responded to the questionnaire. Of the 36 respondents, 75% reported that the content of the workshop was relevant to their daily work. Eighty percent of the physicians who were involved in intervention programs reported that participation in the workshop improved their ability to plan community programs. Fifty-five percent of the respondents reported the application of elements learned in the workshop to their current work, mainly in the performance of three COPC functions: definition of the community, identification of health problems, and planning community health interventions. Few (28%) were involved in evaluation measurements. CONCLUSIONS: A COPC workshop characterized by work groups of family physicians, epidemiological analysis of their practices' data, and the planning of a community program in their communities was positively evaluated according to the reported application of COPC functions by family physicians and residents in their daily work.

TI TITLE: Developing a "clinical presentation" curriculum at the University of Calgary.
AU AUTHOR(S): Mandin-H; Harasym-P; Eagle-C; Watanabe-M
SO SOURCE (BIBLIOGRAPHIC CITATION): Acad-Med. 1995 Mar; 70(3): 186-93
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: Currently, medical curricula are structured according to disciplines, body systems, or clinical problems. Beginning in 1988, the faculty of the University of Calgary Faculty of Medicine (U of C) carefully evaluated the advantages and disadvantages of each of these models in seeking to revise their school's curriculum. However, all three models fell short of a curricular structure based on current knowledge and principles of adult learning, clinical problem solving, community demands, and curriculum management. By 1991, the U of C had formulated a strategic plan for a revised curriculum structure based on the way patients present to physicians, and implementation of this plan has begun. In creating the new curriculum, 120 clinical presentations (e.g., "loss of consciousness/syncope") were defined and each was assigned to an individual or small group of faculty for development based on faculty expertise and interest. Terminal objectives (i.e., "what to do") were defined for each presentation to describe the appropriate clinical behaviors of a graduating physician. Experts developed schemes that outlined how they differentiated one cause (i.e., disease category) from another. The underlying enabling objectives (i.e., knowledge, skills, and attitudes) for reaching the terminal objectives for each clinical presentation were assigned as departmental responsibilities. A new administrative structure evolved in which there is a partnership between a centralized multidisciplinary curriculum committee and the departments. This new competency-based, clinical presentation curriculum is expected to significantly enhance students' development of clinical problem-solving skills and affirms the premise that prudent, continuous updating is essential for improving the quality of medical education.
AN MEDLINE ACCESSION NUMBER: 95177878

TI TITLE: The social context of women's health: goals and objectives for medical education [see comments]
AU AUTHOR(S): Phillips-S
SO SOURCE (BIBLIOGRAPHIC CITATION): Can-Med-Assoc-J. 1995 Feb 15; 152(4): 507-11
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: The Women's Health Interschool Curriculum Committee of Ontario has developed goals and objectives for medical education based on a definition of women's health that includes emotional, social, cultural, spiritual and physical well-being. The author presents background information on how women have been treated as "other" and sex-role stereotypes have been reinforced by some of the assumptions, terminology and attitudes used in medical practice and research. The objectives address the biologic and social context of women's health, the effect of power differentials (particularly the imbalance in power between physicians and patients), sex-role stereotyping in medical practice and teaching, and the effect of individual physicians' attitudes toward women on the care they provide. These objectives are the first published effort to define what physicians should know about the social context of women's health. The committee encourages readers to debate, discuss and use these objectives.

TI TITLE: What drives the student in problem-based learning?
AU AUTHOR(S): Dolmans-DH; Schmidt-HG
SO SOURCE (BIBLIOGRAPHIC CITATION): Med-Educ. 1994 Sep; 28(5): 372-80
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: In problem-based learning, the development of self-directed learning skills is encouraged through confronting students with (professional) problems. However, several other elements of a problem-based curriculum, such as general teaching objectives, lectures and tutors, may have an impact on students' actual learning activities. The present study focuses on the extent to which various elements of a problem-based curriculum influence students' decisions on what to study. First, interviews were conducted to obtain qualitative data about what actually takes place when students initiate learning activities during self-study. Based on the findings of these interviews, a questionnaire was developed, consisting of statements describing elements of the learning process and their influence on student learning. Elements included in the questionnaire were: the discussion in the tutorial group, content tested, course objectives, lectures, the tutor and reference literature. The students reported that all these elements may have an impact on decisions on what to study. Moreover, first-year students tend to rely more on the literature cited in the references list and content covered in lectures and tests than students in the other three curriculum years. In general, the influence of these elements showed a decrease over the four curriculum years. The influence of the discussion in the tutorial group, on the contrary, tended to increase over the four curriculum years. These findings suggest that students in a problem-based curriculum become more accomplished self-directed learners over the four curriculum years, even although they are provided with many clues which may play a role in their decisions on what to study.
AN MEDLINE ACCESSION NUMBER: 95147736

TI TITLE: Training for rural general practice.
AU AUTHOR(S): Wise-AL; Hays-RB; Adkins-PB; Craig-ML; Mahoney-MD; Sheehan-M; Siskind-V; Nichols-A
SO SOURCE (BIBLIOGRAPHIC CITATION): Med-J-Aust. 1994 Sep 5; 161(5): 314-8
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: OBJECTIVE: To identify requirements for vocational training and continuing education programs in rural general practice. DESIGN: A questionnaire was sent to all 487 rural doctors and 140 metropolitan and 140 provincial city general practitioners (GPs) in Queensland. A sample of medical educators, health professional and consumer representatives and rural doctors was also interviewed. Responses were compared by geographical area, practice characteristics and level of postgraduate training. RESULTS: There are significant differences between rural and urban practice profiles. Rural doctors have to practise a range of clinical skills in an environment with restricted access to health professional support, although the need for advanced training in procedural or other skills depends on the type of rural practice. Rural and urban doctors want more influence in determining continuing medical education (CME) programs. Interactive learning methods were rated as the most effective education methods by both rural and urban GPs. Rural doctors were less likely to consider that they spent enough time on CME. CONCLUSION: Vocational training programs should accommodate various rural career objectives, including those requiring advanced levels of procedural work. There is a significant unmet demand for CME tailored to the needs of individual doctors, both rural and urban, but distance and isolation may make this more critical in rural practice. These issues need to be addressed as training opportunities can contribute to improved retention of the rural medical workforce.

TI TITLE: Pediatric generalist training: graduate medical education at a crossroads.
AU AUTHOR(S): Wilson-M
SO SOURCE (BIBLIOGRAPHIC CITATION): Curr-Opin-Pediatr. 1994 Oct; 6(5): 513-8
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: There is a growing consensus that the United States is training more physicians than it needs or can afford. Public resources are likely be used to bend the graduate medical education enterprise increasingly toward the production of generalist physicians to practice primary care. Pediatrics, with its generalist tradition, can stand tall at this crossroads if it renews its commitment to training high quality generalists and assumes a leadership position as graduate medical education moves from the hospital into the community.
AN MEDLINE ACCESSION NUMBER: 95120072

TI TITLE: Redesigning the surgical teaching of fourth-year medical students to meet the training needs of generalists.
AU AUTHOR(S): Sachdeva-AK
SO SOURCE (BIBLIOGRAPHIC CITATION): J-Cancer-Educ. 1994 Fall; 9(3): 148-51
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: The fourth year of the medical student curriculum remains of questionable educational value at most medical schools. The training needs of generalists include the acquisition of knowledge and skills in broad areas of general surgery and the surgical subspecialties. By appropriately tailoring the educational objectives to the learning needs of individual students and implementing teaching models based on principles of adult education, a special surgical experience may be provided to each fourth-year medical student, building on the previously acquired knowledge and skills. Rotations may be offered in a number of surgical disciplines, with heavy emphasis on teaching in the ambulatory setting. One such model was recently implemented at The Medical College of Pennsylvania. Advantages of this type of program include support of the training of generalists using contemporary teaching strategies and provision of a meaningful educational experience to medical students during the fourth year.

TI TITLE: Attitudes toward and subsequent career choice of family practice: a weak relationship [see comments]
AU AUTHOR(S): Mann-MP
SO SOURCE (BIBLIOGRAPHIC CITATION): Fam-Med. 1994 Sep; 26(8): 504-8
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: BACKGROUND & OBJECTIVES: This study examined longitudinal relationships between attitudes and career choice in family practice from admission to medical school through the end of internship. METHODS: The sample included medical students graduating in 1990 and 1991. Surveys completed at the beginning of each year of medical school, at graduation, and at the end of PGY1 included measures of attitudes toward family practice and stated career choice at the time of each survey. Regression examined the relationship between attitudes and choice; repeated ANOVA measures examined changes over time. RESULTS: Positive attitude scores toward family practice increased over the first 2 years, then declined; women's scores were higher. The proportion of students stating a preference for family practice also increased initially but declined overall; women chose family practice more frequently. Relationships between attitudes and choice were weak over time and neither attitude scores nor change in scores predicted specialty choice. CONCLUSIONS: Although attitudes toward family practice remained positive throughout the 5-year study, student interest in family practice declined during the clinical years. Women maintained stronger interests in family practice than men; the reasons for this are not clear. Attitudes were poor predictors of choice. Care is needed in interpreting cross-sectional studies reporting significant relationships. We need to develop more sensitive attitude measures to improve the predictive validity of attitude measurement scales.
AN MEDLINE ACCESSION NUMBER: 95080522

TI TITLE: [Traditional and non-traditional curricula. Definitions and terminology]
AU AUTHOR(S): Lie-N
SO SOURCE (BIBLIOGRAPHIC CITATION): Tidsskr-Nor-Laegeforen. 1995 Mar 30; 115(9): 1067-71
LA LANGUAGE OF ARTICLE: NORWEGIAN; NON-ENGLISH
AB ABSTRACT: Differences between traditional (conventional) and innovative curricula are described. Technical terms are defined or explained. In traditional tracks, basic and clinical sciences are studied separately. The students meet the first patient after several years. The education is mainly discipline-, teacher-, lecture- and hospital-based. In innovative programmes, basic sciences are taught throughout the study parallel with clinical subjects (vertical integration), and subjects from related disciplines are often taught concurrently (horizontal integration). The students meet patients from the first day at the university, participate from the first week in courses in clinical skills, and, after some months, attend continuity clinics in the community. Teaching is student-directed, problem-based and/or community-oriented, with several electives. Many of the strategies above are also used in traditional curricula. The main difference between traditional and innovative curricula is whether basic and clinical sciences are vertically integrated or not.
AN MEDLINE ACCESSION NUMBER: 95242288

TI TITLE: What the future may hold for general surgery. A position paper of the American Board of Surgery.
SO SOURCE (BIBLIOGRAPHIC CITATION): J-Am-Coll-Surg. 1995 Apr; 180(4): 481-4
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: Developments in the specialty of general surgery have never been more important, nor have the opportunities for general surgeons been more exciting, than at the present. Technologic advances and the expansion of basic knowledge of surgical diseases have contributed to this renaissance of the field. It is of utmost importance that general surgeons seize the opportunity to participate in the education of medical students at all levels in the undergraduate years, seek to improve the surgical clerkships, and strive for the optimal learning environment for surgical residents. Through these means, the best and the brightest students will be attracted to general surgery as a career and will be retained in the practice of general surgery upon completion of residency training. Education of the student preparing for a nonsurgical career in the fundamental concepts underlying surgical therapy must be kept at the forefront of an undergraduate surgical curriculum. Integration and coordination of graduate surgical education in all of the general surgery-based specialties is an important obligation for the future, as knowledge expands in each specialty and the need for more specialty-specific education becomes apparent.
AN MEDLINE ACCESSION NUMBER: 95235862

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TI TITLE: Lactation management education for physicians.
AU AUTHOR(S): Naylor-AJ; Creer-AE; Woodward-Lopez-G; Dixon-S
SO SOURCE (BIBLIOGRAPHIC CITATION): Semin-Perinatol. 1994 Dec; 18(6): 525-31
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: All health professional groups support breastfeeding as the ideal way to nourish an infant, but numerous surveys have shown that, in general, even perinatal health professionals are not prepared to provide lactation management as part of routine care. Integration of lactation topics into current medical curriculum, whether traditional or problem-based, is the ideal and is possible. Faculty are encouraged to assess the current program for signs of "curriculosclerosis," a prevalent disease characterized by Abrahamson as "hardening of the categories," to look for ways to elasticize the relevant departments, and to integrate lactation management topics at the appropriate place in the larger educational plan. Faculty leadership is crucial. Remedial work, in terms of continuing education, will be necessary for perinatal health professionals until the curriculum model has been in place in preservice and postgraduate programs sufficiently long. Breastfeeding as a primary health care strategy, with its clear health and economic benefits, must be a part of any health care reform and, as such, will be a service expected to be provided by perinatal health professionals.
AN MEDLINE ACCESSION NUMBER: 95215881

TI TITLE: The experiential curriculum: an alternate model for anaesthesia education.
AU AUTHOR(S): Tweed-WA; Donen-N
SO SOURCE (BIBLIOGRAPHIC CITATION): Can-J-Anaesth. 1994 Dec; 41(12): 1227-33
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: The shift to direct entry into residency training from medical school for all graduates will offer new challenges for anaesthesia training programmes. In this paper we argue that it also offers us an opportunity to re-evaluate our current approach to anaesthesia education. Emphasis in the residency programmes should be to provide trainees with clinical experiences and stimulation that will develop the required traditional competencies. It should also cultivate competency in clinical decision-making, intuition and judgement. Our purpose is to generate discussion by proposing an alternate curriculum model, the experiential curriculum. The basic premise is that learning is a process and outcome is to a large extent related to what the learner does. The process begins with an experience that provides for observation and reflection. Integration of the thoughts provides the basis for executing either existing or new actions. In the experiential curriculum residency training and learning are enhanced by documenting and critically evaluating the experiences to which the resident is exposed. Included within such a structured programme are the methodologies of problem-based and evidence-based learning. Faculty development will be required to help the resident pursue these skills of self-evaluation and efficient learning. We believe that incorporation of an experiential curriculum into the residency training programme will achieve the goals listed above and allow maturation of the process of lifelong learning. It will also allow greater achievement of the application of new information to one's practice.


TI TITLE: A model for answering the substance abuse educational needs of health professionals: the North Carolina Governor's Institute on Alcohol and Substance Abuse.
AU AUTHOR(S): Durfee-MF; Warren-DG; Sdao-Jarvie-K
SO SOURCE (BIBLIOGRAPHIC CITATION): Alcohol. 1994 Nov-Dec; 11(6): 483-7
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: Physicians can play an increased role in recognizing, intervening, and moderating their patients' misuse of alcohol and other drugs. This article explores the need for educational changes to permit physicians to develop skills in prevention, screening, and office-based treatment. It includes a personal account by one of the authors of his experience in recognizing deficiencies in substance abuse education both in his own medical school training and in today's health science curricula in the United States. It reviews prior initiatives by NIAAA/NIDA to address curriculum needs and describes an innovative collaborative model in North Carolina called the Governor's Institute on Alcohol and Substance Abuse. The Institute was created in 1990 as a nonprofit corporation to promote education, research, and communication among health professionals. Some of the Institute's programs are described, including its curriculum integration project in the state's four medical schools. The article concludes that the time is right to introduce substance abuse concepts into basic and continuing education for all health professionals.


TI TITLE: Health promotion and disease prevention: integration into a medical school curriculum.
AU AUTHOR(S): Taylor-WC; Moore-GT
SO SOURCE (BIBLIOGRAPHIC CITATION): Med-Educ. 1994 Nov; 28(6): 481-7
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: Many authorities have identified deficiencies in the education of medical students in health promotion and disease prevention. This report describes an attempt to address this problem through the longitudinal integration of health promotion and disease prevention into several major courses in the student curriculum at Harvard Medical School. We used adult learning theory to develop the curricular approach, and designed educational experiences to match the professional development of the student at different phases of medical education. Primary, secondary, and tertiary prevention were particularly germane for students in the first, second, and third years, respectively. During clerkships in the third and fourth years, especially those with a focus on ambulatory patients, students built upon earlier experiences to integrate health promotion and disease prevention into clinical practice. By unifying the teaching of disease prevention with several major required courses, we aimed to create an environment in which students could experience their learning about disease prevention in the same manner that we aspired to have them practise it: integrated throughout clinical medicine.

TI TITLE: Teaching disability and rehabilitation to medical students. Steering Group on Medical Education and Disability.
AU AUTHOR(S): Kahtan-S; Inman-C; Haines-A; Holland-P
SO SOURCE (BIBLIOGRAPHIC CITATION): Med-Educ. 1994 Sep; 28(5): 386-93
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: A survey of UK medical schools was undertaken to determine the teaching that was being offered on disability and rehabilitation. In general, teaching on this topic appeared fragmented and inadequate but a number of interesting innovations were identified. These included: a drama workshop run by a group whose members mainly have learning disabilities at St George's Medical School, student-directed learning at the University of Dundee and structured teaching programmes at the Universities of Leeds and Edinburgh. The General Medical Council Education Committee's 1991 discussion document on the undergraduate curriculum specifically mentions disability as an important topic. A number of schools mentioned that they were in the process of revising their curriculum as a consequence. Recommendations arising from the findings of the survey include integration of disability and rehabilitation into clinical teaching, focus of teaching on those types of disability which are common in the community, greater emphasis on functional assessment in teaching the physical examination, and the wider use of standard assessment instruments, for example for activities of daily living, cognitive impairment and locomotor disability. There is a need for improved communication between medical schools to facilitate the spread of educational activities on this topic.

TI TITLE: Who will teach? A fundamental challenge to medical education.
AU AUTHOR(S): Woolliscroft-JO
SO SOURCE (BIBLIOGRAPHIC CITATION): Acad-Med. 1995 Jan; 70(1): 27-9
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: The level of expertise possessed by medical school faculty members is unprecedented. Unfortunately, faculty members' broad understanding of their domains has atrophied as the specialization they need to compete successfully in the clinical and research arenas has increased. Medical students are novices, needing teachers who possess broad knowledge and experience, who can integrate the specific areas of a subject with overarching themes, and who can teach at the students' level. Clinical subspecialists and researchers on faculties often are ill-equipped to teach medical students. Likewise, busy clinical preceptors may no longer have the latest understanding of pathophysiology. The usual solution of bringing a series of basic science and clinical faculty members to classrooms and seminar rooms often results in disjointed coverage of material. Expanding the values of the university to once again include the scholarship of integration and teaching would provide the best type of faculty.

TI TITLE: [The training of specialists. The case of nephrologists]
AU AUTHOR(S): Vial-S
SO SOURCE (BIBLIOGRAPHIC CITATION): Rev-Med-Chil. 1995 May; 122(5): 572-82
LA LANGUAGE OF ARTICLE: SPANISH; NON-ENGLISH
AB ABSTRACT: Specialists must be trained in properly certified university centers. There are established applicant selection programs and mechanisms and faculties maintain a favorable learning environment. The careful selection of teachers must be based in their personal attributes, their interest and dedication to academic work and their real concern about ethical issues. The center's technological equipment, as a means to favor the action of future specialists, is considered important. Several critical aspects of the training centers that, at the present time threaten post graduate training, are mentioned. The teaching activities of scientific societies and private and public health organisms should concentrate around training centers to reinforce their academic work, favoring their scientific and practicing activities. The interests of faculties and Ministry of Health medical centers should be made compatible for their own benefit. Medical specialties are closely interrelated. Therefore, the boundaries of nephrology should be established to define a training program. A common environment for pediatric and adult nephrology should be created, training centers should be accredited and specialists should be certified using common criteria. Our country has a deficit of nephrologists and scientific societies should encourage cooperative actions between the different training centers.
AN MEDLINE ACCESSION NUMBER: 95241860

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TI TITLE: Residents' attitudes to training in ethics in Canadian obstetrics and gynecology programs.
AU AUTHOR(S): Chamberlain-JE; Nisker-JA
SO SOURCE (BIBLIOGRAPHIC CITATION): Obstet-Gynecol. 1995 May; 85(5 Pt 1): 783-6
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: OBJECTIVE: To determine residents' attitudes toward their current training in ethics, including their preferred learning format, time commitment, and the influences of training and personal background on their views and decision-making process. METHOD: All 203 residents from English-speaking Canadian obstetrics and gynecology programs were mailed an 18-question, numerical-response questionnaire in prestamped return envelopes. One hundred thirty-one residents (64.5%) responded (81 to the first mailing and 50 to the second). RESULTS: The number of hours in the residency program devoted to ethical issues correlated positively with the residents' perception of the residency program in shaping their ethical views (P = .015, r = 0.22). Of the respondents, 44.7% preferred case presentations as their learning format and 30.7% ranked seminars as their first choice. Informal discussions and rounds were less popular, and lectures were considered least appropriate by 69.3%. When asked what most influenced the residents' ethical decision-making process, 34.2% indicated family views, 17.1% undergraduate teaching, 15.4% religious background, 12.8% views of consulting staff, 11.1% residency training, and 9.4% peer attitudes. Sixty-eight percent of residents felt that their training in ethics during their residency program should be increased; this may reflect response bias. A position of conscience conflict during residency training was reported by 28.9% of residents. CONCLUSION: Findings from this survey support the benefit of more discussion of ethical issues during residency programs, particularly with the use of case presentations.
AN MEDLINE ACCESSION NUMBER: 95241015

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TI TITLE: The role of the physician and the medical profession in the prevention of international torture and in the treatment of its survivors. American College of Physicians.
SO SOURCE (BIBLIOGRAPHIC CITATION): Ann-Intern-Med. 1995 Apr 15; 122(8): 607-13
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: The prevention of torture and the treatment of survivors are issues that concern an increasing number of physicians in their daily work. Every day, thousands of men, women, and children are subjected to violence and are forced to flee their homelands. There are more than 18 million refugees in the world and hundreds of thousands of persons seeking asylum, many of them in the United States. Physicians are often the first to interview these victims of abuse. Torture has serious and long-lasting health consequences. Thus, physicians can play a key role in documenting and preventing many forms of abuse and in treating survivors. In some areas, physicians may become the targets of arrest because of their work as clinicians or as influential members of their communities. They may also face disturbing ethical dilemmas as they witness torture or its results. As members of the medical profession, physicians have an obligation to their peers around the world. This report reviews the current state of physicians' involvement in the prevention of international torture and in the treatment of its victims. We propose ways in which physicians can become involved by caring for survivors of torture and by providing expert testimony on behalf of victims who seek asylum. We discuss how the medical profession complements the efforts of individual physicians by providing an infrastructure to support and guide their work. Medical organizations can adopt and disseminate ethical principles that specifically address human rights and their violation. They can coordinate letter-writing networks for human rights, organize or sponsor fact-finding missions, and develop continuing medical education courses on topics such as the identification and treatment of victims of torture. We conclude that physicians can make a difference, both as clinicians and as advocates for the health of the public and the protection of the human rights. The American College of Physicians will continue to advocate for the rights of persons and communities to live in dignity and peace, free of the fear of unjust imprisonment or torture.

TI TITLE: Using electronic mail for a small-group curriculum in ethical and social issues.
AU AUTHOR(S): Coulehan-JL; Williams-PC; Naser-C
SO SOURCE (BIBLIOGRAPHIC CITATION): Acad-Med. 1995 Feb; 70(2): 158-60
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: PURPOSE. To initiate an electronic mail (e-mail) program as a supplement to a medical humanities curriculum focusing on ethical and social issues. METHOD. In 1991-92 an e-mail track (called NET) was established for second-year students participating in Medicine in Contemporary Society, a four-year curriculum in medical humanities at the State University of New York at Stony Brook School of Medicine. In 1991-92 ten students volunteered to form a NET group; in 1992-93 22 students, forming two groups, were randomly selected from a volunteer pool of 76 students (from a class of 100). In both study years, the NET students analyzed and discussed electronically a series of cases posted sequentially through the academic year. Faculty tutors reviewed the students' responses, interacting with the groups and with individual students by e-mail. NET was evaluated in two ways: at the end of the course, the students completed e-mail questionnaires that included quantitative and qualitative assessments; and throughout the course, the tutors assessed the students' participation, quality of case analysis and discussion, and quality of writing. RESULTS. The students' assessments indicated that they considered NET to be more educational than the lectures, "live" group discussions, problem-based learning exercises, and formal papers in the medical humanities curriculum; that they made gains in computer literacy; and that NET enhanced their abilities to think about ethical and social issues. The tutors judged that the students had improved their written self-expression as the course progressed. CONCLUSION. NET adequately accomplished the goals set for it as an adjunct to the small-group sessions and other components of the medical humanities curriculum.

TI TITLE: Ethics and animal issues in US medical education.
AU AUTHOR(S): Wiebers-DO; Barron-RA; Leaning-J; Ascione-FR
SO SOURCE (BIBLIOGRAPHIC CITATION): Med-Educ. 1994 Nov; 28(6): 517-23
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: Increasing public and regulatory agency concern about a variety of animal protection issues that affect the field of medicine have made these issues increasingly relevant to medical school curricula. The purpose of this study was to assess the availability and forms of medical school training relating to ethical, conceptual, and societal concerns in the use of animals within the field of medicine and the perceived need for such training. Questionnaire surveys were mailed to the Deans of the 125 accredited US medical schools, and completed by Deans or their designees within the same medical institution. Questionnaire recipients were informed that results would be compiled in a fashion that did not identify specific individuals or institutions. Survey responses were obtained from 84 medical institutions (67% response). Sixty respondents (71%) indicated that their medical school offered or sponsored some type of activity related to ethical and conceptual concerns in the use of animals in medical research and training. Most schools (43) offered informal discussions/seminars relating to these issues, but nine schools offered full formal courses with up to 15 lectures on these topics. Programme content and perceived need for additional instruction varied greatly amongst respondents. The results suggest a wide diversity amongst US medical schools in the availability and perceived importance of medical school training relating to ethical and conceptual concerns in the uses of animals in medicine. It is proposed that instruction in these areas be pursued with more concerted efforts to address the growing body of knowledge about non-human beings and the ethical implications of such knowledge.

TI TITLE: The teaching of medical ethics to medical students.
AU AUTHOR(S): Glick-SM
SO SOURCE (BIBLIOGRAPHIC CITATION): J-Med-Ethics. 1994 Dec; 20(4): 239-43
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: Teaching medical ethics to medical students in a pluralistic society is a challenging task. Teachers of ethics have obligations not just to teach the subject matter but to help create an academic environment in which well motivated students have reinforcement of their inherent good qualities. Emphasis should be placed on the ethical aspects of daily medical practice and not just on the dramatic dilemmas raised by modern technology. Interdisciplinary teaching should be encouraged and teaching should span the entire duration of medical studies. Attention should be paid particularly to ethical problems faced by the students themselves, preferably at the time when the problems are most on the students' minds. A high level of academic demands, including critical examination of students' progress is recommended. Finally, personal humility on the part of teachers can help set a good example for students to follow.

TI TITLE: The Oxford Practice Skills Project: teaching ethics, law and communication skills to clinical medical students.
AU AUTHOR(S): Hope-T; Fulford-KW
SO SOURCE (BIBLIOGRAPHIC CITATION): J-Med-Ethics. 1994 Dec; 20(4): 229-34
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: We describe the teaching programme in ethics, law and communication skills for clinical medical students which is being developed as part of the Oxford Practice Skills Project. These three elements of practice are approached in an integrated teaching programme which aims to address everyday clinical practice. The role of a central value of patient-centred health care in guiding the teaching is described. Although the final aim of the teaching is to improve actual practice, we have found three 'sub-aims' helpful in the development of the programme. These sub-aims are: increasing students' awareness of ethical issues; enhancing their analytical thinking skills, and teaching specific knowledge.

TI TITLE: Virtue and longitudinal ethics education in medical school.
AU AUTHOR(S): Freeman-JW; Wilson-AL
SO SOURCE (BIBLIOGRAPHIC CITATION): S-D-J-Med. 1994 Dec; 47(12): 427-30
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: This article advances the argument that the inherent virtue/character of the caregiver is an important element in clinical ethical decision making. Virtue should be promoted as an essential component of professional behavior, and specifically emphasized in both medical student education and professional practice.

TI TITLE: The teaching of medical ethics in oncology education.
AU AUTHOR(S): Nelson-WA; O'Donnell-JF
SO SOURCE (BIBLIOGRAPHIC CITATION): J-Cancer-Educ. 1994 Fall; 9(3): 170-3
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: The teaching of medical ethics is an important aspect of oncology education. To prepare future physicians to cope with the many and complex ethical issues in the care of oncology patients, Dartmouth Medical School developed a two-hour medical ethics component in the required second-year course on the principles of oncology. The paper describes the goals and case method for the teaching of ethics.

TI TITLE: [Ideas contributing to the reform of the health sector in Chile]
AU AUTHOR(S): Giaconi-J; Valdivieso-V; Guiraldes-E
SO SOURCE (BIBLIOGRAPHIC CITATION): Rev-Med-Chil. 1994 Mar; 122(3): 346-50
LA LANGUAGE OF ARTICLE: SPANISH; NON-ENGLISH
AB ABSTRACT: General criteria are proposed for the organization of chilean health system. The fundamental ideas emphasize administrative decentralization, an effective and expedite intercommunication between different attention levels and a rationalization of the use of diagnostic procedures and treatments. The "basic health plan" features are outlined. The need for patient and family education and the access to tertiary medicine only through referrals is highlighted. The second part of article proposes changes in Medical Education. The need to reorient undergraduate medical formation towards solving outpatient problems and to extend specialization possibilities to all graduates, including Adult and Children general medicine training programs, is emphasized. The incorporation of basic economical concepts to the curriculum and group work training is considered beneficial. Finally, self-teaching behaviors and resolutive capacities in legal and ethical aspects should be encouraged in students. The potential teaching roles of future health reference, diagnostic and therapeutic centers is insinuated.

TI TITLE: The effect of a class in medical ethics on first-year medical students.
AU AUTHOR(S): Shorr-AF; Hayes-RP; Finnerty-JF
SO SOURCE (BIBLIOGRAPHIC CITATION): Acad-Med. 1994 Dec; 69(12): 998-1000
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: PURPOSE. To assess the effect of a class in medical ethics on first-year medical students. METHOD. A test instrument was developed to measure the attitudes of medical students toward certain ethical questions and to assess their factual knowledge regarding particular legal and ethical issues. The instrument was administered in 1992-93 to 110 first-year students at the University of Virginia School of Medicine before and after the students took a required course in medical ethics. The instrument employed clinical vignettes as well as multiple-choice, true-false, and Likert-scale questions. Its reliability and validity were assessed. RESULTS. The required course in medical ethics had little influence on the students. There was only one significant change (p = .05) in the pattern of responses to any of the clinical vignettes. In a few of the attitude-oriented queries, there were statistically significant changes (p < .05) after the course. Although there were statistically significant changes for only four of the factual-knowledge questions, for all such questions more students identified the correct answers after the class (before the course the range of correct answers was 43% to 99% compared with 64% to 100% after the course). CONCLUSION. The class in medical ethics seemed to have little effect on the first-year students, probably because students arrive at medical school with well-established ethical perspectives.

TI TITLE: [Bases for the teaching of oncology]
AU AUTHOR(S): da-Ascensao-JL
SO SOURCE (BIBLIOGRAPHIC CITATION): Acta-Med-Port. 1994 Sep; 7(9): 493-9
LA LANGUAGE OF ARTICLE: PORTUGUESE; NON-ENGLISH
AB ABSTRACT: We define the parameters for preclinical and postgraduate teaching in oncology coupled with hematology with a view to train competent physicians in these areas as well as to encourage a restructuring of the health system to permit optimal delivery of care to all people. We analyze and define curricular changes in the medical schools to be implemented at a national level with the introduction of an intensive course in hematology-oncology during the clinical clerkships. This course would require a host of appropriate teachers, continued monitoring and a final appropriate written exam. The Oncologic training of the medical student requires an interdisciplinary approach with an emphasis on the personalized approach to the patient with cancer. The postgraduate training should follow minimal guidelines established by the ESMO, EORTC and ABIM with an emphasis on combined training in oncology/hematology, following appropriate training in internal medicine. A need for continued "recycling" of generalists in oncology is felt to be important. Other issues discussed include: methods of teaching and their evaluation; the career pathway for the scientist (docent) in oncology; preventive medicine and finally the need for continuing medical education. An evaluation of the quality of medicine and of ethical and professional conduct while not specifically linked to oncology is considered a vital part of medical care and needs to be placed in perspective.

TI TITLE: The profession of medicine [see comments]
AU AUTHOR(S): Calman-K
SO SOURCE (BIBLIOGRAPHIC CITATION): BMJ. 1994 Oct 29; 309(6962): 1140-3
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: It seems timely to define the purpose of medicine and examine the concept of a profession. This paper does so in the wider context of health, values in society, and the need to involve patients and the public as a whole. The author looks closely at what doctors do and concludes that making the diagnosis is a key element. The consultation is the building block for resource allocation. In addition to the diagnosis it sets out the prognosis and possible treatment and emphasises the importance of communicating these to the patient. Looking at the kind of doctor we need raises such issues as ethical standards, continuing professional development, team working, clinical standards, quality, outcomes, and research and development. Throughout, the role of education is seen as crucial. Leadership and vision are required by senior members of the profession if the opportunities presented are to be developed further.

TI TITLE: Tube-feeding decisions in the elderly.
AU AUTHOR(S): Hodges-MO; Tolle-SW
SO SOURCE (BIBLIOGRAPHIC CITATION): Clin-Geriatr-Med. 1994 Aug; 10(3): 475-88
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: Tube-feeding decisions in the elderly can be most challenging. We begin our decision making with the premise that artificial nutrition is a medical therapy and therefore that its prescription is based on a calculation of net benefits over burdens for the patient to whom it is given. When the burdens of this therapy outweigh the benefits of prolonged life, tube feeding may be ethically withheld or withdrawn. For the cognitively impaired and in the absence of known patient preferences, the ratio of benefits to burdens may best be figured after a time trial of therapy. If restraints are needed to keep the tube in place, or if significant medical complications ensue, the burdens of the therapy have outweighed its potential benefits, and the therapy may be ethically withdrawn. State statutes and institutional policies are often confusing and at times in conflict with the ethical choice made by families and health care providers for their loved ones and patients. The options--starting a court battle (Cruzan7), moving the patient to a different state (Busalacchi), or committing civil disobedience--are not best for the welfare of the patient, family, or health care team. We well recognize that what is legal is not always what is ethical. Ethics should lead the law as we consider how to use new health care technologies wisely. We hope that the state legislatures will work to minimize future conflicts by acknowledging that (1) artificial nutrition is a life-sustaining therapy that should not have special status distinct from other life-sustaining therapies and (2) artificial nutrition and hydration are medical therapies that can and should be ethically withdrawn or withheld when their burdens outweigh their benefits.

TI TITLE: Developing an ethics curriculum for a family practice residency.
AU AUTHOR(S): Levitt-C; Freedman-B; Kaczorowski-J; Adler-P; Wilson-R
SO SOURCE (BIBLIOGRAPHIC CITATION): Acad-Med. 1994 Nov; 69(11): 907-14
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: PURPOSE. To develop a curriculum in ethics in family practice by studying which ethical issues physicians believe to be important based on frequency of encounter, difficulty in managing the problem, and helpfulness of discussion; to examine whether there are any important differences between faculty and residents and between genders; and to determine the preferred format(s) for teaching these issues. METHOD. Between November 1991 and June 1992 a total of 475 questionnaires were mailed to all the family practice residents (first- and second-year), graduates in their first two years of practice, and the physician faculty of the Department of Family Medicine at the McGill University Faculty of Medicine. Overall, 319 usable questionnaires were returned, for a final response rate of 67%. The questionnaire asked respondents to evaluate 14 ethical dilemmas in order to determine the importance of teaching specific ethical issues as well as to determine the preferred format for teaching. Chi-square tests, analyses of variance, and Student's t-tests were used to test the significance of differences in responses. RESULTS. No consistent pattern of interrelationship was found among frequency of encounter and difficulty and helpfulness of discussion for most items. Overall, there was little difference in how faculty and residents, men and women, perceived the importance of these ethical issues. Women reported encountering ethical issues less frequently than men [F (14,285) = 1.82, p < .04], while at the same time finding them somewhat more difficult and more deserving of discussion. Small-group, case-oriented discussion appears to have been the favored teaching format regardless of the ethical dilemma. CONCLUSION. It is difficult to narrow down the content to be included in a curriculum in ethics in family practice. Frequency of encounter, difficulty in management, and helpfulness of discussion can all be argued to be important factors for consideration; they should all be considered separately or in combination for each teaching situation if time restrictions force a choice between topics.

TI TITLE: The ethics of learning and teaching medicine.
AU AUTHOR(S): Reiser-SJ
SO SOURCE (BIBLIOGRAPHIC CITATION): Acad-Med. 1994 Nov; 69(11): 872-6
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: During the second half of the twentieth century, medicine turned its attention to the ethics of practice. A large and important literature has developed that clarifies the problems generated in the treatment of illness. The same focused attention now should be given to ethical issues and relationships connected with teaching and learning in medicine and to elaborating an ethics of education. Pedagogic relationships anticipate professional relationships. The associations that medical students form with teachers, patients, school, and each other, and the values that shape them have a great influence in determining the sort of physicians students will be. This article examines ethical principles and their application to the relationships and pedagogic problems encountered in studying and teaching medicine. It shows how the introduction of ethics into these areas can not only help students and teachers but also enhance the standing of teaching itself.

TI TITLE: The hidden curriculum, ethics teaching, and the structure of medical education.
AU AUTHOR(S): Hafferty-FW; Franks-R
SO SOURCE (BIBLIOGRAPHIC CITATION): Acad-Med. 1994 Nov; 69(11): 861-71
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: The authors raise questions regarding the wide-spread calls emanating from lay and medical audiences alike to intensify the formal teaching of ethics within the medical school curriculum. In particular, they challenge a prevailing belief within the culture of medicine that while it may be possible to teach information about ethics (e.g., skills in recognizing the presence of common ethical problems, skills in ethical reasoning, or improved understanding of the language and concepts of ethics), course material or even an entire curriculum can in no way decisively influence a student's personality or ensure ethical conduct. To this end, several issues are explored, including whether medical ethics is best framed as a body of knowledge and skills or as part of one's professional identity. The authors argue that most of the critical determinants of physician identity operate not within the formal curriculum but in a more subtle, less officially recognized "hidden curriculum." The overall process of medical education is presented as a form of moral training of which formal instruction in ethics constitutes only one small piece. Finally, the authors maintain that any attempt to develop a comprehensive ethics curriculum must acknowledge the broader cultural milieu within which that curriculum must function. In conclusion, they offer recommendations on how an ethics curriculum might be more fruitfully structured to become a seamless part of the training process.

TI TITLE: Problem-based learning: its role in undergraduate surgical education [see comments]
AU AUTHOR(S): Chang-G; Cook-D; Maguire-T; Skakun-E; Yakimets-WW; Warnock-GL
SO SOURCE (BIBLIOGRAPHIC CITATION): Can-J-Surg. 1995 Feb; 38(1): 13-21
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: OBJECTIVE: To familiarize the surgeon with problem-based learning (PBL) and to discuss the current and future role of PBL in undergraduate surgical education. DATA SOURCES: Two meta-analyses comparing the outcome of a PBL curriculum with a traditional curriculum and other studies in the English-language literature. STUDY SELECTION: Data on the effectiveness of PBL can best be assessed by a meta-analysis in which the conclusions of many studies are reviewed and combined to provide a more comprehensive picture. The studies chosen represent those from the only two recent meta-analyses of the problem that have appeared in reputable journals. DATA EXTRACTION: Results reported are those obtained using appropriate techniques and published in reputable journals. Information relevant to the major issues in undergraduate surgical training was selected for inclusion. DATA SYNTHESIS: PBL depends on self-directed learning, triggered by a clinical problem. The students meet in small groups led by a facilitator and discuss carefully designed clinical cases. At the conclusion, the students will have encountered all the information necessary to solve the case and, in so doing, will have gained knowledge that in a conventional curriculum would usually have been disseminated by lecture. There were only small differences between graduates from the two types of curricula. Those from a PBL curriculum had comparable examination results to those from a traditional curriculum on both basic science and clinically based examinations but were happier with their educational experiences. CONCLUSIONS: Centres that have adopted a PBL approach have found improved student motivation and enjoyment, but there has been no convincing evidence of improved learning. An intelligent combination of both traditional and PBL approaches will likely provide the most effective training for undergraduate surgical clerks.

TI TITLE: Peer tutoring and student outcomes in a problem-based course.
AU AUTHOR(S): Sobral-DT
SO SOURCE (BIBLIOGRAPHIC CITATION): Med-Educ. 1994 Jul; 28(4): 284-9
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: Does peer-tutoring affect students' educational outcomes in problem-based learning? Students' characteristics and outcomes were compared along 14 successive classes of a problem-based learning course in the University of Brasilia medical programme. In the first stage of this time series, 26 teacher-tutored groups were formed; in the second stage, 50 groups had both teacher- and peer-tutoring. Both groups had equivalent characteristics in stages one and two as regards membership size and composition (students' learning style, self-confidence and motivation to learn). Results showed that scores for problem-solving tests and self-evaluation of skills were not significantly different between first and second stage groups. However, scores of meaningfulness of course experience and group work usefulness were significantly higher in the peer-tutoring stage. Significant positive correlations were found between scores of meaningfulness of course experience and both self-evaluation and group work usefulness but not between the first measure and group size or motivation to learn. The findings suggest that peer-tutoring can facilitate group work without sustained loss of cognitive achievement in long range conditions of problem-based learning experience.

TI TITLE: [The psychiatric semester and recruitment of future psychiatrists]
AU AUTHOR(S): Lie-N
SO SOURCE (BIBLIOGRAPHIC CITATION): Tidsskr-Nor-Laegeforen. 1995 Jan 30; 115(3): 375-6
LA LANGUAGE OF ARTICLE: NORWEGIAN; NON-ENGLISH
AB ABSTRACT: Before and after the psychiatric course, students from three successive year classes received a questionnaire. Of 102 subjects, 75% responded before and 82% after the course to the question: "Would you like to be a psychiatrist? (1 = definitely not--8 = very much). 11% chose one of the alternatives 6-8 before the course, and 24% after. No differences were noted between the three classes prior to the course. After the course, the students were asked to rate the total profit of the course on a 8-point scale from 1 (no gain) to 8 (very much gain). The class with the highest mean for total profit also had the highest mean for motivation for becoming a psychiatrist. The class with the lowest mean for profit had the lowest mean for psychiatry. Among the former, 38% selected one of the alternatives 6-8 regarding preference for psychiatry. Among the latter the corresponding frequency was 16%. Every class consisted of two groups. In the group with most gain from the course (6-8 on the scale), 48% would like to become a psychiatrist (6-8 on the scale). In the group with the lowest profit, the frequency was 6%.
AN MEDLINE ACCESSION NUMBER: 95159129

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TI TITLE: What drives the student in problem-based learning?
AU AUTHOR(S): Dolmans-DH; Schmidt-HG
SO SOURCE (BIBLIOGRAPHIC CITATION): Med-Educ. 1994 Sep; 28(5): 372-80
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: In problem-based learning, the development of self-directed learning skills is encouraged through confronting students with (professional) problems. However, several other elements of a problem-based curriculum, such as general teaching objectives, lectures and tutors, may have an impact on students' actual learning activities. The present study focuses on the extent to which various elements of a problem-based curriculum influence students' decisions on what to study. First, interviews were conducted to obtain qualitative data about what actually takes place when students initiate learning activities during self-study. Based on the findings of these interviews, a questionnaire was developed, consisting of statements describing elements of the learning process and their influence on student learning. Elements included in the questionnaire were: the discussion in the tutorial group, content tested, course objectives, lectures, the tutor and reference literature. The students reported that all these elements may have an impact on decisions on what to study. Moreover, first-year students tend to rely more on the literature cited in the references list and content covered in lectures and tests than students in the other three curriculum years. In general, the influence of these elements showed a decrease over the four curriculum years. The influence of the discussion in the tutorial group, on the contrary, tended to increase over the four curriculum years. These findings suggest that students in a problem-based curriculum become more accomplished self-directed learners over the four curriculum years, even although they are provided with many clues which may play a role in their decisions on what to study.

TI TITLE: Why students choose a primary care or nonprimary care career. The Specialty Choice Study Group [see comments]
AU AUTHOR(S): Fincher-RM; Lewis-LA; Jackson-TW
SO SOURCE (BIBLIOGRAPHIC CITATION): Am-J-Med. 1994 Nov; 97(5): 410-7
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: PURPOSE: To analyze the factors influencing students to choose residency training in primary care (internal medicine, family medicine, and pediatrics) or nonprimary care specialties and study the combined effect of reported responses on their choice. MATERIALS AND METHODS: A 12-item questionnaire using a 7-point Likert scale was mailed to the 1,164 graduating seniors from 9 medical schools in 1991. Responses ranged from 1, very negative influence, to 7, very positive influence. Four indicated no influence. The overall response rate was 69%. Univariate analysis of factors associated with specialty choice was done with the Mantel-Haenzsel chi-square test. Odds ratios were calculated for each significant variable without controlling for other variables. Factors found to have univariate significance were then tested for combined significance with logistic regression analysis. The regression was performed on a randomly chosen training sample, and validated on a test sample. RESULTS: Forty-five percent of respondents chose an internship and planned residency training in a primary care specialty. Factors that remained positively associated with choosing a primary care specialty when controlling for other factors were desire to provide comprehensive care, to keep options open, and to undertake ambulatory care. Desire for monetary reward was negatively associated with choice of a primary care specialty. CONCLUSIONS: Positive educational experiences in the ambulatory setting should be enhanced, and disparity in remuneration among disciplines reduced.

TI TITLE: Specialists/primary care professionals: striking a balance.
AU AUTHOR(S): Kohler-PO
SO SOURCE (BIBLIOGRAPHIC CITATION): Inquiry. 1994 Fall; 31(3): 289-95
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: Even before the recent movement toward managed care, there was mounting evidence of excessive numbers of many medical and surgical specialists. Generalist physicians are now in short supply, as are nonphysician providers. The ideal correction for the current problems of specialty surplus and total physician excess would be based on economics or the marketplace. However, a rapid correction is unlikely in a voluntary system. A national commission has been suggested by several bodies. This commission could make recommendations for the total number of training positions and, subsequently, the subspecialty trainees needed. Implementation of the recommendations could be through large multistate regional consortia.

TI TITLE: The Medical Council of Canada's key features project: a more valid written examination of clinical decision-making skills [see comments]
AU AUTHOR(S): Page-G; Bordage-G
SO SOURCE (BIBLIOGRAPHIC CITATION): Acad-Med. 1995 Feb; 70(2): 104-10
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: In 1986 the Medical Council of Canada (MCC) commissioned a six-year research and development project to create a new, more valid written examination of clinical decision-making skills for the Canadian Qualifying Examination in Medicine. At that time, the qualifying examination consisted of three booklets of multiple-choice questions and one booklet of patient management problems administered over a two-day period. All graduates of Canadian and foreign medical schools must pass this examination before practicing medicine anywhere in Canada except Quebec. The project was undertaken because (1) numerous studies do not support the use of patient management problems (PMPs) to assess clinical decision-making skills, and (2) research results on the characteristics of clinical decision-making skills offered guidance to develop new approaches to their assessment. In particular, research suggested that these skills are specific to the case or problem encountered and are contingent on the effective manipulation of a few elements of the problem that are crucial to its successful resolution--the problem's key features. The problems developed by this project focused only on the assessment of these key features. The project was implemented in three overlapping phases over a six-year period, 1986-1992, each containing a development component followed by a pilot test through which the research studies were carried out. The pilot tests were conducted by presenting sets of new key feature problems to classes of graduating students in medical schools across Canada.(ABSTRACT TRUNCATED AT 250 WORDS)
AN MEDLINE ACCESSION NUMBER: 95169170

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TI TITLE: The social context of women's health: goals and objectives for medical education [see comments]
AU AUTHOR(S): Phillips-S
SO SOURCE (BIBLIOGRAPHIC CITATION): Can-Med-Assoc-J. 1995 Feb 15; 152(4): 507-11
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: The Women's Health Interschool Curriculum Committee of Ontario has developed goals and objectives for medical education based on a definition of women's health that includes emotional, social, cultural, spiritual and physical well-being. The author presents background information on how women have been treated as "other" and sex-role stereotypes have been reinforced by some of the assumptions, terminology and attitudes used in medical practice and research. The objectives address the biologic and social context of women's health, the effect of power differentials (particularly the imbalance in power between physicians and patients), sex-role stereotyping in medical practice and teaching, and the effect of individual physicians' attitudes toward women on the care they provide. These objectives are the first published effort to define what physicians should know about the social context of women's health. The committee encourages readers to debate, discuss and use these objectives.
AN MEDLINE ACCESSION NUMBER: 95162995


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TI TITLE: Nursing care of the childbearing Muslim family.
AU AUTHOR(S): Hutchinson-MK; Baqi-Aziz-M
SO SOURCE (BIBLIOGRAPHIC CITATION): J-Obstet-Gynecol-Neonatal-Nurs. 1994 Nov-Dec; 23(9): 767-71
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: It is estimated that 2 to 3 million Muslims live in the United States. This article describes the Islamic beliefs and practices nurses must be aware of to understand the spiritual needs of childbearing Muslim families. Strategies are suggested for developing a plan of care to meet the needs of childbearing Muslim families during the prenatal, intrapartal, and postpartal periods.
AN MEDLINE ACCESSION NUMBER: 95156155

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TI TITLE: The effects of stereotyping on impression formation: cross-cultural perspectives on viewing religious persons.
AU AUTHOR(S): Chia-EK; Jih-CS
SO SOURCE (BIBLIOGRAPHIC CITATION): J-Psychol. 1994 Sep; 128(5): 559-65
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: We examined the effects of stereotyping on impression formation when encountering people dressed to represent a religious faith. We used stimulus photographs of eight male and female models dressed casually and a second photograph of one male and one female model in religious attire that was placed beside the control photos of models dressed causally. From each set of photographs, subjects selected a photo of the person with whom they would associate the various positive personality traits suggested by our stimulus questions. Subjects were students from a U.S. Catholic school, a U.S. public school, and a Malaysian Muslim school. All the subjects attributed more of the positive traits to photos of the models who were religiously attired than to photos of those who were casually dressed, but subjects from U.S. schools attributed more of the positive traits to the photos of religiously dressed models than did the subjects from the Malaysian school.
AN MEDLINE ACCESSION NUMBER: 95074761

TI TITLE: Gilbert's syndrome and Ramadan: exacerbation of unconjugated hyperbilirubinemia by religious fasting.
AU AUTHOR(S): Ashraf-W; van-Someren-N; Quigley-EM; Saboor-SA; Farrow-LJ
SO SOURCE (BIBLIOGRAPHIC CITATION): J-Clin-Gastroenterol. 1994 Sep; 19(2): 122-4
LA LANGUAGE OF ARTICLE: ENGLISH
AB ABSTRACT: Gilbert's syndrome is a benign, often familial condition characterized by recurrent but asymptomatic jaundice. We report two cases of recurrent jaundice due to unconjugated hyperbilirubinemia in Muslim subjects during the fast of Ramadan. As the diagnosis of Gilbert's syndrome was not suspected, both patients were extensively investigated before the relationship to fasting was recognized and the correct diagnosis made. We conclude that the possible exacerbation of Gilbert's by fasting should be borne in mind in the evaluation of Muslim patients with jaundice.

© Professor Omar Hasan Kasule Sr. June 1996