Experiential Project
Medical school agility during the reform of its curriculum
(Saudi Arabian Case)
Prepared by
Abdulaziz Mosleh Almoutairi
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Table of Contents
Abstract
3
Introduction
3
Reforming Process
5
Assessment of the existing situation
5
Proposed changes
5
Awareness Campaign
5
Preparing To Reform and Get Approval
6
Preparing Curriculum Maps
6
Students’ and Faculty Feedback
7
Challenges
7
Future Outlook
8
Conclusion
9
References
9
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Abstract
Medical educators are trying to close the gap between the needs of medical practice and the rising
expectations of the communities in their countries. The Saudi arabia medical education authorities mandated
all medical schools to change their curricula to comply with revised national academic reference standards,
which changed from outcome-based to competency-based. Monitoring the implementation of this substantial
reform was performed through surveys, field visits and meetings with students, teaching staff and program
directors. In addition to the expected challenges, the COVID-19-associated restrictions presented a
significant further challenge during the implementation of this reform.
Saudi medical schools have been involved in curriculum reform over the past 2 decades. Review of the
existing literature identifies the following as problems with today's curriculum including: Overcrowding of
the curriculum, over presentation of some subjects, presence of relatively non-relevant subjects, dissociation
between basic and clinical sciences, repetition of lectures and exams, need for new subjects of clinical
relevance, predominantly hospital based medical education with minimal community-based practice, as well
as non-optimal use of resources.
Introduction
Medical education serves as the bedrock for cultivating competent healthcare professionals who cater to the
healthcare needs of a nation. However, in many developing countries, the undergraduate medical education
programs face multifaceted challenges that hinder their ability to produce proficient and well-equipped
physicians.
Unfortunately, the traditional structure and content of medical education in numerous developing countries
often lag these advancements, resulting in graduates ill-prepared to meet the dynamic healthcare challenges.
The imperative need for radical reform within these programs has become increasingly evident to address
the existing deficiencies and align medical education with contemporary healthcare demands.
With the start of the millennium came a revolution in undergraduate medical education (UME), which began
with the introduction of a variety of approaches that promote active learning (acquiring and synthesizing
knowledge through student-led activities) to complement the traditional didactic model. However, these
reforms were pedagogical, and the content reform did not expand development of the requisite skill set in
future practitioners of medicine.
By addressing the identified shortcomings and proposing transformative measures, it aims to contribute to
the enhancement of healthcare systems by producing competent, adaptable, and compassionate healthcare
professionals equipped to navigate the complexities of contemporary healthcare landscapes.
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As a result, a worldwide mass movement aimed at producing physicians who can deliver individualized
plans of healthcare occurred.
This requires the implementation of a spiral integrated curriculum that includes both horizontal and vertical
dimensions to link it across time and disciplines. Interventions effective in developed countries may be
ineffective in developing countries, which might result in different social, economic, cultural and
infrastructure factors that affect how the change is implemented as well as the outcome of change.
Medical education has been changing rapidly in Saudi Arabia. Within a decade, the number of medical
colleges increased from 5 medical schools with traditional disciplined-based curricula to 21 medical colleges
with varied curricula ranging from the traditional to more innovative, problem-based, community-oriented
programs.
The private sector has started investing in higher education generally and medical education. Also, other
government sectors that provide advanced health services have started establishing new medical colleges.
The expansion of quantity in medical education has been associated with a drive for greater quality
assurance. Accreditation of higher education institutes began with the establishment of the National
Commission for Academic Assessment and Accreditation in 2005.
This review focuses on documenting developments in Saudi medical education up to 2008 and discussing
the future potential and challenges facing the sector.
The first phase of medical education in Saudi Arabia lasted for over 3 decades. Within this era, the 5 former
medical colleges followed the same 6-year traditional curriculum, which consisted of 3 years of basic and
medical science courses, 3 years of clinical training, followed by a 1-year internship.
The private sector has been invited to contribute and invest in higher education. By 2008, there were 10
new medical colleges that were affiliated with the MOHE, and 3 private medical colleges were licensed. In
addition, the Ministry of Health (MOH) and the National Guard established their own medical collegesKing Fahad Medical City and King Saud bin Abdulaziz University for health Sciences respectively raising
to 21 the number of medical colleges in Saudi Arabia. In 2005, a national accreditation agency for higher
education was established; the National Commission for Academic Assessment and Accreditation
(NCAAA).
This second phase of medical education is witnessing a nationwide movement toward innovation in medical
education programs, with a drive to excellence and recognition by international agencies and institutions.
The educational strategies adopted include a more integrated curriculum, a focus on problem-based
learning and the development of community-oriented and community-based learning.
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Reforming Process
Assessment of the existing situation
There is a high demand by high-school graduates in Saudi Arabia for medical education. So, the expansion
in medical programs across the country has increased the overall intake of students to around 2500 students.
The medical education program is mainly via undergraduate entry and runs for 6 years, followed by a 1-year
internship. KSAUHS has a graduate entry program that runs for 4 years plus the 1-year internship for
holders of a bachelor’s degree in applied or medical sciences.
Admission to medicine program assed to be solely according to high school grades, in which students with
the highest grades were admitted. Later, a written science examination (in English) and interview were
introduced as part of the selection process. In 2002, the National Centre for Assessment in Higher
Education was established. The Centre is responsible for conducting a national standardized aptitude
examination for high-school leavers who wish to apply to universities for medicine. At present, admission
to any medical college in the country is based on high-school grades, the national aptitude test, a summative
examination in science and an interview. Some of the colleges are not using the interview because of lack of
evidence of its objectivity and reliability.
Medical schools are being challenged to admit more students. In view of the considerable attrition rate
among medical students, such an expansion increases the pressure to maintain a high number of quality,
competent graduates.
Proposed changes
The proposed changes in the medical curriculum in Saudi Arabia often revolve around modernizing the
educational system to align with evolving healthcare needs and global standards like (Integration of
technology, Emphasis of clinical skills, adaptation to changing healthcare demands.)
The proposed changes in the medical curriculum in Saudi Arabia often revolve around modernizing the
educational system to align with evolving healthcare needs and global standards like (Integration of
technology, Emphasis of clinical skills, adaptation to changing healthcare demands.)
The reforms also aim to foster a more comprehensive understanding of healthcare that goes beyond clinical
expertise to encompass cultural sensitivity, ethics, and leadership skills.
Awareness Campaign
Promoting awareness of changes in the medical curriculum in Saudi Arabia requires a multi-faceted
approach to reach various stakeholders, including students, educators, healthcare professionals,
policymakers, and the public. By giving Informational Sessions and Workshops, Online Platforms and
Communication, Professional Development Programs, and by establishing Feedback Mechanisms.
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By employing a comprehensive approach that utilizes various communication channels and engages
different stakeholders, an awareness campaign can effectively communicate the importance and benefits of
the proposed changes in the medical curriculum in Saudi Arabia. This would foster understanding,
acceptance, and active participation in the successful implementation of these reforms.
Preparing To Reform and Get Approval
Saudi medical schools have 2 professional functions: medical education and health care. Concerning the
educational role, until 2005, institutes of higher education, including medical colleges, required no
accreditation. In 2005, the Council of Higher Education approved the establishment of the NCAAA, tasked
with ensuring the quality of higher education in the country. It is now mandatory for every institute of
higher education to be accredited by the NCAAA.
The road map of preparing to reform is:
- Conducting a comprehensive assessment of the current medical curriculum. Identify its strengths,
weaknesses, gaps.
- Studying successful models of medical education globally. Benchmark against renowned institutions and
countries known for their innovative medical curriculum.
- Crafting a detailed proposal outlining the proposed reforms. Highlight the objectives, methodology,
expected outcomes, and the resources required for implementation.
- Ensuring that the proposed reforms align with the country's healthcare priorities, such as Vision 2030.
Showcase how the reforms will contribute to addressing healthcare challenges and improving healthcare
delivery.
- Estimating the resources needed for the implementation phase, including financial, technological, and
human resources. Develop a budget and resource allocation plan.
- Presenting the proposal to the appropriate governing bodies or educational authorities for approval.
Highlight the research, stakeholder engagement, and potential impact of the reforms.
Once approved, develop a detailed timeline and strategy for implementation. Assign responsibilities, set
milestones, and monitor progress closely
Preparing Curriculum Maps
The bylaw also defined certain important items that should be emphasized in the curricula which are:
1- Basic Sciences: Anatomy, Physiology, Biochemistry, Microbiology, Pharmacology.
2- Integrated Modules: Introduction to Clinical Medicine, Medical Ethics, Professionalism.
3- Introduction to Healthcare System: Understanding the Saudi healthcare system, policies, and cultural
aspects.
4- Core Clinical Rotations: Internal Medicine, Surgery, Pediatrics, Obstetrics & Gynecology, Psychiatry,
Family Medicine.
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5- Research methodology and research skills to be included in the early years of the program.
6- Leadership and Management Skills: Preparation for leadership roles and understanding healthcare
management.
7- Aligning curriculum components with Vision 2030 objectives, emphasizing innovation, healthcare access,
and quality improvement.
Almost all the schools added early clinical teaching mainly by using clinical skills labs and early experience
with patients in different clinical settings.
This curriculum map provides a structured overview of the various phases, subjects, skills, and experiences
that form the medical education journey in Saudi Arabia. It aims to align educational components with
national healthcare goals, preparing future healthcare professionals to meet the needs of the population and
healthcare system.
Students’ and Faculty Feedback
The first student survey, conducted in 2019, received 9,044 responses. Students reported that the preparatory
period and study guides were beneficial (70%), the interactive teaching methods were interesting (50%), the
teachers spent efforts on their training (50%) and they used the schools’ websites (40%). The second student
survey, conducted in the year 2020, received a total of 18,655 responses. The students’ main responses were
that the learning outcomes were well explained (60%); the websites were useful (60%); they received
training in research and clinical skills (40%); they had courses in communication and ethics (50%); and
electives were applied (40%). Fifty percent of the students were satisfied by small-group teaching, clinical
teaching, and formative and continuous assessment (50%). Additionally, 40% of the students expressed their
satisfaction regarding E-learning and the received feedback.
Feedback is diverse and dynamic, encompassing both positive reactions and constructive suggestions for
improvement. Gathering and acting upon such feedback is crucial in shaping a curriculum that aligns with
students' educational needs and aspirations.
Challenges
During the implementation of the new medical curriculum, exploring the challenges by questioning the
auditors who met representatives of faculty, students, and leaders of medical schools during the monitoring
visits such as:
1- Many students complained of marked overload in the content of some modules, apparently because some
departments did not make enough effort to tailor the content to the shortened time of their disciplines.
2- Early clinical exposure could not be satisfactorily achieved in some medical schools because of the large
number of students and logistic difficulties in securing the required training places.
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3- In some schools, examinations, especially in the first year, largely addressed recall with a small
percentage of questions devoted to testing higher cognitive levels.
4- The level of horizontal integration was limited to synchronization without actual exchange of material
and educational plans to ensure proper sequencing of educational activities.
5- Lastly, the COVID-19 pandemic presented an extra burden during the implementation.
Addressing these challenges requires a comprehensive approach involving stakeholder engagement,
resource mobilization, continuous evaluation, and a commitment to overcoming resistance through effective
communication and support mechanisms. Flexibility and adaptability throughout the implementation process
are crucial to navigating these challenges successfully.
Future Outlook
The reforms aim to produce well-rounded healthcare professionals equipped with advanced clinical skills,
critical thinking abilities, and a strong foundation in modern healthcare practices, by integrating
international best practices and aligning with global accreditation standards, Saudi Arabian medical
graduates are likely to gain recognition and competitiveness on a global scale.
The emphasis on practical skills, clinical experiences, and interdisciplinary collaboration is expected to
enhance the quality of patient care and healthcare services across the country. Also,the incorporation of
technology, telemedicine, and innovation in medical education will prepare future healthcare professionals
to adapt to and leverage technological advancements in healthcare delivery.
The focus on research methodologies and evidence-based medicine is likely to foster a culture of inquiry and
innovation, contributing to advancements in medical knowledge and practices.
In parallel to the change in instructional methods, all medical schools started implementing reform in tools
of students’ assessment. Specifically, all schools were required to use portfolios for monitoring students’
progress and to provide training in self-evaluation and reflection. Some programs replaced the printed
portfolios first used with an electronic one to facilitate the whole process.
Additionally, the feedback obtained from the faculty and the students after implementation revealed some
strengths such as the relatively large number of faculty who received training and the satisfactory level of
students’ awareness of the learning outcomes. Points that need more emphasis in some schools’ curricula
were the research, clinical skills, and elective modules.
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Conclusion
In conclusion, the imperative for radical reform in the undergraduate medical education programs of
developing countries is undeniable. This comprehensive endeavor necessitates addressing multifaceted
challenges, ranging from curriculum structure to pedagogical methodologies, clinical training, technology
integration, and stakeholder collaboration.
The reforms in Saudi Arabia's medical education curriculum represent a pivotal stride towards aligning
educational objectives with the evolving healthcare landscape. Rooted in the principles of competency-based
learning, interdisciplinary collaboration, and technological integration, these reforms aspire to produce a
cadre of healthcare professionals poised to meet the challenges of modern healthcare.
Reforming undergraduate medical education in developing countries is not merely a process of modification
but an investment in the future of healthcare.
The reforms are strategically aligned with Vision 2030, reinforcing the commitment to a knowledge-based
economy and the advancement of the healthcare sector. By nurturing innovation, addressing specialized
healthcare needs, and fostering leadership capabilities, this reformed curriculum not only elevates the quality
of medical education but also serves as a catalyst for transformative change within the healthcare ecosystem.
References
1- Samarasekera DD, Goh PS, Lee SS, Gwee MCE. Clarion calls for a third wave in medical education to
optimize healthcare in the twenty-first century. Med Teach. 2018; 40:982–5.
https://doi.org/10.1080/0142159X. 2018.1500973.
2- Buja LM. Medical education today: all that glitters is not gold. BMC Med Educ. 2019; 19:110.
https://doi.org/10.1186/s12909-019-1535-9.
3- Bakir I, Abdel -Razig S. The internship year: a potential missed opportunity to expand medical access in
international settings. J Grad Med Educ. 2019;11(4 Suppl):30 –3. https://doi.org/10.4300/JGME-D-1900117. PMID: 31428257; PMCID: PMC6697270.
4- Burnes B. The origins of Lewin’s three-step model of change. J Appl Behav Sci. 2020;56(1):32–59.
https://doi.org/10.1177/0021886319892685.
5- Orla SP. Change management in higher education: an introductory literature review. Perspect Policy Pract
Higher Educ. 2020;24(4):115–120. https://doi.org/10.1080/13603108.2020.1809545.
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