OPINION: Common curriculum: questioning medical education

Thursday March 14 2019

Professor Zulfiqarali Premji

Professor Zulfiqarali Premji 

I am a firm proponent of common exit and licensing examination for medical school graduates in Tanzania. Indeed, I have written in the past on this subject.

The aim of such an examination is to produce high-calibre medics irrespective of the medical school they attend. I can visualise that objective being attained under the transformation project, which involves the MUHAS, CUHAS and KCMC Schools of Medicine. However, it calls for critical analysis.

First: why did it take so long to introduce common exams? Secondly: was the delay caused by lack of project funding?

Much as I support the call that medical colleges should attract research funds and create centres of excellence, I nonetheless oppose the dogma that foreign funding is necessary to establish a structure for a common medical exit and licensing examinations.

One doesn’t need a common curriculum for such an examination. What was needed is for the Tanzania Commission of Universities (TCU) to develop the competencies needed to graduate from any medical school. Each university can take its own path through an appropriately endorsed curriculum to attain the required competencies.

TCU is a regulatory body. Unfortunately, it has never played that role to the hilt. In that regard, I have been advocating revisiting it. Sitting at the same table with curriculum developers – and finally having to endorse their decision(s) – grossly undermines TCU’s regulatory role.

The so-called common curriculum is a competency-based curriculum (CBC) which started at MUHAS sometime in 2012-2013. It is not even a repackaging of the old curriculum; it is a copy-and-paste version with additions here and there of action verbs and semantics.

I’m not against CBC, believing that its purpose is to minimize failure rates... It also breaks the holistic curriculum into blocks so that, once a module is taught and tested, that’s the end of that particular content. In medical education, this breeds mediocrity.

Has MUHAS’ CBC undergone serious evaluation by truly independent institutions?

CUHAS and KCMC should be objective, always ensuring they retain the valuable contents and avoid copy-and-paste CBCs.

Universities are supposed to create new knowledge through exploration, experimentation and similar intellectualism. Our graduates should first and foremost be critical thinkers able to analyze any situation in seeking to solve problems.

Unfortunately, the CBC adopted at MUHAS largely responds to market forces – much to the benefit of mass production.

The main weakness of the CBC is that it works well with some learning environments – and not so well with others. In particular, it focuses on immediate employer needs, and is less focused on imbuing learners with the flexibility needed against an uncertain future.

CBC does not suit subject-areas where it is difficult to prescribe specific competencies, or where new skills and knowledge need to be rapidly accommodated. But, most disconcertingly, it ignores the importance of social learning.

Curriculum is a factor that must be seriously considered when choosing a medical school to enroll at. If I were a student applicant on the interview trail today, I’d pay particular attention to the different curricula among medical schools, asking myself if I’d thrive at such-and-such a school – based on my preferred learning style.

Unfortunately, by creating a common curriculum for the three renowned medical schools in Tanzania, this aspect of choice is lost. Arguably, more than anything else, a curriculum can mean the difference between a positive and a negative medical school experience.

If the curriculum transformation project has collaboration of USA-based universities, then one must question why MUHAS graduates aren’t recognized by those very same universities! NOT that we need their recognition, anyway.

But, apparently, a MUHAS graduate isn’t allowed to practise medicine in California.

I am also a MUHAS graduate and – if I say so myself – am proud I did the term-based curriculum, and current CBC graduates are in no way superior to, or more competent than, me or any other member of my cohort.

In writing this critical piece, I also acknowledge that where there is ready cash to hand, anything can be done – even if it is the dumbest thing to do.

Money can easily give rise to a cult where questioning and rational debate are forbidden – albeit to the detriment of the institutions involved in terms of adverse long-term impact.

This is a cautionary piece from me, as I am aware that the so-called transformation project will continue with the support of others – irrespective of logic and rationale.

Perhaps it is time to choose and plan without bias – always being receptive to constructive, albeit differing, viewpoints.

Zulfiqarali Premji is a retired MUHAS professor. His career spans over 40 years in academia, research and public health.