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
1st 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
2nd
Medical Student
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
4th 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
4th Year
200 deliveries
General Microbiology
Immunology
Systematic bacteriology
Virology
Parasitology
Mycology
Integrated systems
Microbiology Contribution
5th 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
– 12-15 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
Integrated
curriculum
Structured
Curriculum
Neither
Knowledge
Medical Expert
Lifelong learning
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?
Need real comparative
figures
Two collegues:
One consultant physician
One consultant pediatrician
We do have problems with the new
system
They do not pass USMLE Exams
Literature search
Knowledge
Structured
curriculum
You don’t know what you don’t
know
Learning knowledge
Not the same
Learning how to use
knowledge
Medical Expert skill is a choice not
a talent
Both are needed
Talent gets you in the game but it
can’t make you an expert
Medical Expert skill =
If either zero, it’s all
zero
Performance X Professionalism
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