Debate: Medical Expert vs. Lifelong learner Eiman Mokaddas MD, FRCPath Professor of Clinical Microbiology Faculty of Medicine Kuwait University

Structured curriculum Medical Expert

Case Medical Student 1 st Clinical Year ( year 5) Phase III

MSD Diabetic Foot Infection

History Clinical Examination Diagnosis

Lab Diagnosis Wound was sent for culture Wound culture result: – Pseudomonas aeruginosa – MRSA

Moderator (Microbiologist) What type of bacteria is Pseudomonas aeruginosa?

Student Pleaaaaaaaaase Dr. Eiman tomorrow don’t ask me this question because I don’t know the answer.

Case (cont.) Treatment of Diabetic foot infection due to Pseudomonas aeruginosa: – Ertapenemn – Ciprofloxacin – Tobramycin

Moderator What is ertapenem?

Student Pleaaaaaaaaaase Dr. Eiman don’t ask me this question tomorrow, I have searched in the internet and got this list

Moderator What group of antibiotics is ciprofloxacin?

Student Pleaaaaaaaaaaase Dr. Eiman don’t ask me this question tomorrow as I don’t know the answer

Moderator Moderator’s Blood pressure: – 200/110 Fortunately no hard stuff in front of the moderator (no Comment)

Case Medical Student 2 nd pre-clinical Year ( year 4) Phase II

Final Exam Oral exam To be upgraded fro B+ to A i.e. Distinction

Examiner Microbiologist What are the causes of pneumonia?

Student Staphylococcus aureus Streptococcus epidermidis Mycoplasma tuberculosis

Moderator What else? Dr. We took respiratory system in year 3 I studied for year 4 systems I forgot the respiratory system Pleaaaaase ask me about GI system

Moderator OK What are the bacterial causes of gastroenteritis?

Student Salmonella Shigella

Moderator Good What type of bacteria is salmonella?

Student Gram-negative bacilli

Moderator Good What media do you use to culture it in the lab?

Student No answer Sorry Dr. Eiman I cannot remember

Moderator Did you hear about MacConkey agar?

Student Yes Yes Yes

Moderator What type of colonies do salmonella produce on MacConkey agar?

Student No Answer I cannot remember Dr.

Case 4 th Year Medical student Old curriculum

Final Exam Oral exam To be upgraded fro A- to A i.e. Distinction

External Examiner from (UK) Microbiologist What are the causes of pneumonia?

Student Viral Bacteria Fungal Protozoa

Student Bacterial – S.pneumoniae – Haemophilus influenzae – Mycoplasma pneumonia – Chlamydia pneumoniae – Chlamydia psitacii – Legionella penumophila Knowledge

External Examiner from (UK) Microbiologist What other infection does S.pneumoniae cause?

Student Bacterial meningitis Otitis media Sinusitis Peritonitis Integration

External Examiner from (UK) Microbiologist How do you culture S.pneumoniae in the lab?

Student On Blood agar Colonies are α hemolytic Optichin sensitive Bile soluble

External Examiner from (UK) Microbiologist How can we prevent pneumococcal meningitis?

Student 23-polysaccharide pneumococcal vaccine Conjugate vaccine: New

What is this called??? Structure-based Lifelong learning

Life long learning Integrated System

Total No. of deliveries as Microbiology & Immunology Contributions A total of 34 lecture A total of 16 seminar (small group teaching) A total of 9 learning topics A total of 2 lab practicals Over 3 years Phase II

Structured Curriculum Old Curriculum

Microbiology Contribution 4 th Year 200 deliveries General Microbiology Immunology Systematic bacteriology Virology Parasitology Mycology Integrated systems

Microbiology Contribution 5 th Year 20 deliveries Clinical Microbiology Course

Problem-based ( integrated system) Most of the medical schools An average per week of: – 3-5 hrs PBL sessions – hrs lectures – 3-5 small group sessions

Problem-based ( integrated system) FOM, Kuwait University An average per week of: – 3-5 hrs PBL sessions – 5-6 hrs lectures – 2-3 small group sessions Rest of the time is self learning

Knowledge Medical Expert Lifelong learning Structured Curriculum Integrated curriculum Neither

Structured curriculum Each subject has an exam If Fail Microbiology Cannot pass the final exam

Integrated (problem-based curriculum) curriculum One Exam Can skip the whole Microbiology The whole Physiology Still can pass the exam

What is the end result? Very weak in managing infectious diseases

What could be the solution Back to structured curriculum??? More control on marking the integrated exam with minimum marks for pass in all disciplines

Any Difference in post graduate performance between the 2 types of curricula?

Two collegues: One consultant physician One consultant pediatrician We do have problems with the new system They do not pass USMLE Exams Need real comparative figures

Literature search

Knowledge You don’t know what you don’t know Structured curriculum

Learning knowledge Learning how to use knowledge Not the same

Medical Expert skill is a choice not a talent Talent gets you in the game but it can’t make you an expert Both are needed

Medical Expert skill = Performance X Professionalism If either zero, it’s all zero

Grades

If I were asked to enumerate ten educational stupidities, the giving of grades would head the list. If I can’t give the student a better reason for studying than a grade on a report card, I aught to lock my desck, go home and stay there. “The wound is mortal” By De Zouche (1945)

Motivation to achieve enjoyment and enthusiasm is vital to excel the medical expert associated with knowledge, rather than making reluctant effort simply to be suscessful when assessed. Ainly, 2006

Conclusion

Medical school is not only about the core science requirements but about the development of the individual as a competent, compassionate and well informed physician upon graduation

Integrating a curriculum is a complex process

Not everything that counts can be counted Albert Einstein

The Brain is: (A work in Progress) Need both Knowledge and creativity In order not to stop

This can be only achieved by Enjoyment

Enjoyment Lifelong learning

Thank you