Asian Medical Students’ Perspectives on Medical Education Curricula Standards A qualitative research
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Abstract
Introduction: Universal health care, a key aspect of the Sustainable Development Goals, requires effective, safe, and people-centered services ensured through comprehensive medical education. This education involves curriculum development, assessment, and innovation, requiring effective change management. While core knowledge is consistent, curricula vary in diverse global contexts. Hence, this qualitative study combines panelists’ and medical students’ perspectives from Kyrgyzstan, Malaysia, Indonesia, and Macau to compare and contrast medical curricula as well as their ideal version envisioned by students.
Methods: This qualitative study employed a constructivist, phenomenological approach to explore medical students’ perspectives on curricula. Data were gathered from an online event, featuring 48 participants from various countries. The event included a panel discussion and focus group discussions where attendees discussed curriculum design, admissions, learning media, clinical exposure, testing, standardization, and residency programs. Data were analyzed using open coding from transcriptions, with trustworthiness ensured through member checking.
Results: Gaps in medical education curricula were observed globally. Medical students perceived curricula duration, format, and testing methods currently in place to be in accordance with their expectations. Earlier clinical exposure was favorable. Disparities in learning media usage exist, particularly between private and state universities. Financial burdens affect residency decisions universally.
Conclusion: To narrow gaps, international standards should encourage quality improvement, while taking into account the perspectives of medical students.
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© Journal of Asian Medical Students’ Association (JAMSA). Released under a Creative Commons license.
References
Nunes R, Nunes SB, Rego G. Health care as a universal right. Z Gesundh Wiss. 2017;25(1):1-9. doi: 10.1007/s10389-016-0762-3.
Quality of Care WHO Team. Handbook for national quality policy and strategy: a practical approach for developing policy and strategy to improve quality of care. Geneva: World Health Organization; 2018 Apr.
WHO/OECD/World Bank. Delivering quality health services: a global imperative for universal health coverage. Geneva: World Health Organization, Organisation for Economic Co-operation and Development, and The World Bank; 2018.
Taylor DC, Hamdy H. Adult learning theories: Implications for learning and teaching in medical education: AMEE guide no.83 Med Teach. 2013;35:e1561–72. Accessed 2024 May 21.
Gregg A, Turner EL, Scarborough H. Medical education [Internet]. Chicago: Britannica; [updated 2023 Dec 12; cited 2024 May 21]. Available from: https://www.britannica.com/science/medical-education.
Cheng WC, Chen TY, Lee MS. Fill the gap between traditional and new era: The medical educational reform in Taiwan. Ci Ji Yi Xue Za Zhi. 2019 Sep 16;31(4):211-6. doi: 10.4103/tcmj.tcmj_229_18.
Scheele F. The art of medical education. Facts Views Vis Obgyn. 2012;4(4):266-9.
Al Shawwa LA. The establishment and roles of the Medical Education Department in the faculty of Medicine, King Abdul Aziz University, Jeddah Saudi Arabia. Oman Med J. 2012 Jan;27(1):4-9. doi: 10.5001/omj.2012.02.
Tawada K. The importance of medical education on health care. Perspective - Global Journal of Medical, Physical and Health Education. 2022;10(2). doi:10.15651/2449-1802.22.10.047.
Eley DS, Cortes C, Arja S, Villafuerte FR, Khan YH, Grannum J, et al. Perspectives on medical education in an increasingly globalized society: recognizing and embracing our diversity. Med Sci Educ. 2022 Dec 12;33(1):247-54. doi: 10.1007/s40670-022-01705-8.
Wijnen-Meijer M, Burdick W, Alofs L, Burgers C, ten Cate O. Stages and transitions in medical education around the world: clarifying structures and terminology. Med Teach. 2013 Apr;35(4):301-7. doi: 10.3109/0142159X.2012.746449.
Bedoll D, van Zanten M, McKinley D. Global trends in medical education accreditation. Hum Resour Health. 2021;19:70. doi: 10.1186/s12960-021-00588-x.
Accreditation Council for Graduate Medical Education [Internet]. Chicago: ACGME; c2024 [cited 2024 May 21]. Available from: https://www.acgme.org
Harris P, Snell L, Talbot M, Harden RM. Competency-based medical education: implications for undergraduate programs. Med Teach. 2010;32(8):646-50.
Mei A, Gao D, Jiang J, Qiao T, Wang F, Li D. The medical education systems in China and Thailand: A comparative study. Health Sci Rep. 2022 Oct 3;5(6):e826. doi: 10.1002/hsr2.826.
Gilligan C, Loda T, Junne F, Zipfel S, Kelly B, Horton G, et al. Medical identity; perspectives of students from two countries. BMC Med Educ. 2020 Nov 10;20(1):420. doi: 10.1186/s12909-020-02351-7
Gomes LS, Efendi F, Putri NK, Bolivar-Vargas M, Saadeh R, Villarreal PA, et al. The impact of international health worker migration and recruitment on health systems in source countries: Stakeholder perspectives from Colombia, Indonesia, and Jordan. Int J Health Plann Manage. 2024 May;39(3):653-70. doi: 10.1002/hpm.3776.
Jenkins R, Kydd R, Mullen P, Thomson K, Sculley J, Kuper S, et al. International migration of doctors, and its impact on availability of psychiatrists in low and middle income countries. PLoS One. 2010 Feb 4;5(2):e9049. doi: 10.1371/journal.pone.0009049
Yeates N, Pillinger J. International Health Worker Migration and Recruitment. Routledge; 2019.
Tangcharoensathien V, Travis P, Tancarino AS, Sawaengdee K, Chhoedon Y, Hassan S, et al. Managing in- and out-migration of health workforce in selected countries in south east asia region. Int J Health Policy Manag. 2018 Feb 1;7(2):137-43. doi: 10.15171/ijhpm.2017.49.
Eaton J, Baingana F, Abdulaziz M, Obindo T, Skuse D, Jenkins R. The negative impact of global health worker migration, and how it can be addressed. Public Health. 2023 Dec;225:254-7. doi: 10.1016/j.puhe.2023.09.014.
Walton-Roberts M. International migration of health professionals and the marketization and privatization of health education in India: from push-pull to global political economy. Soc Sci Med. 2015 Jan;124:374-82. doi: 10.1016/j.socscimed.2014.10.004.
Kruk ME, Porignon D, Rockers PC, Van Lerberghe W. The contribution of primary care to health and health systems in low- and middle-income countries: a critical review of major primary care initiatives. Soc Sci Med. 2010 Mar;70(6):904-11. doi: 10.1016/j.socscimed.2009.11.025.
Schwill S, Kadmon M, Hahn EG, Kunisch R, Berberat PO, Fehr F, Hennel E. The WFME global standards for quality improvement of postgraduate medical education: Which standards are also applicable in Germany? Recommendations for physicians with a license for postgraduate training and training agents. GMS J Med Educ. 2022 Sep 15;39(4):Doc42. doi: 10.3205/zma001563.
Patrício M, Harden RM. The Bologna Process - A global vision for the future of medical education. Med Teach. 2010;32(4):305-15. doi: 10.3109/01421591003656123. PMID: 20353327.
Thistlethwaite J. Interprofessional education: a review of context, learning and the research agenda. Med Educ. 2012 Jan;46(1):58-70. doi: 10.1111/j.1365-2923.2011.04143.x.
Prideaux D. ABC of learning and teaching in medicine. Curriculum design. BMJ. 2003 Feb 1;326(7383):268-70. doi: 10.1136/bmj.326.7383.268.
Chan LK, Ip MS, Patil NG, Prosser M. Learning needs in a medical curriculum in Hong Kong. Hong Kong Med J. 2011 Jun;17(3):202-7.
Smith KJ, Flaxman C, Farland MZ, Thomas A, Buring SM, Whalen K, et al. Development and validation of a situational judgement test to assess professionalism. Am J Pharm Educ. 2020 Jul;84(7):ajpe7771. doi: 10.5688/ajpe7771.
Ongley PA. Asian medical education. Acad Med. 1989 May;64(5 Suppl):S22-6. doi: 10.1097/00001888-198905000-00028.
Roh H, Lee HJ, Park SB, Yang JH, Kim DJ, Kim SH, Lee SJ, Chae G. Multiple mini-interview in selecting medical students. Korean J Med Educ. 2009 Jun;21(2):103-15. doi: 10.3946/kjme.2009.21.2.103. Epub 2009 Jun 30. PMID: 25813108.
Kelly ME, Patterson F, O'Flynn S, Mulligan J, Murphy AW. A systematic review of stakeholder views of selection methods for medical schools admission. BMC Med Educ. 2018 Jun 15;18(1):139. doi: 10.1186/s12909-018-1235-x. Erratum in: BMC Med Educ. 2018 Jul 5;18(1):162.
Cheng WC, Chen TY, Lee MS. Fill the gap between traditional and new era: The medical educational reform in Taiwan. Ci Ji Yi Xue Za Zhi. 2019 Sep 16;31(4):211-6. doi: 10.4103/tcmj.tcmj_229_18.
Alselaiti N. Enhancing student engagement and learning outcomes through education technologies in medical education. World Journal of Advanced Research and Reviews. 2023 Sep 30;19(3):1356–67.
Wong ZY, Liem GAD. Student Engagement: current state of the construct, conceptual refinement, and future research directions. Educational Psychology Review. 2022 Mar 6;34(1):107–38.
Xu X, Bos NA, Wu H. The relationship between medical student engagement in the provision of the school's education programme and learning outcomes. Med Teach. 2022 Aug;44(8):900-6. doi: 10.1080/0142159X.2022.2047168.
Bond M, Bedenlier S. Facilitating Student engagement through educational technology: towards a conceptual framework. Journal of Interactive Media in Education. 2019 Sep 10;1(1):1–14.
Sahu PK, Chattu VK, Rewatkar A, Sakhamuri S. Best practices to impart clinical skills during preclinical years of medical curriculum. J Educ Health Promot. 2019 Mar 14;8:57. doi: 10.4103/jehp.jehp_354_18.
Yu JH, Chang HJ, Kim SS, Park JE, Chung WY, Lee SK, et al. Effects of high-fidelity simulation education on medical students' anxiety and confidence. PLoS One. 2021 May 13;16(5):e0251078. doi: 10.1371/journal.pone.0251078.
Omer AA. The Importance of theory to inform practice – theorizing the current trends of clinical teaching: a narrative review. Sudan Journal of Medical Sciences. 2020 Dec 31;15(4):383–98.
Ingale M, Tayade M, Bhamare S. Early clinical exposure: Dynamics, opportunities, and challenges in modern medical education. J Educ Health Promot. 2023;12(1):295.
Tayade MC, Latti RG. Effectiveness of early clinical exposure in medical education: Settings and scientific theories - Review. J Educ Health Promot. 2021 Mar 31;10:117. doi: 10.4103/jehp.jehp_988_20.
Kibble JD. Best practices in summative assessment. Adv Physiol Educ. 2017 Mar 1;41(1):110-9. doi: 10.1152/advan.00116.2016.
Buléon C, Mattatia L, Minehart RD, Rudolph JW, Lois FJ, Guillouet E, et al. Simulation-based summative assessment in healthcare: an overview of key principles for practice. Adv Simul (Lond). 2022 Dec 28;7(1):42. doi: 10.1186/s41077-022-00238-9.
Moghaddam AK, Khankeh HR, Shariati M, Norcini J, Jalili M. Educational impact of assessment on medical students' learning at Tehran University of Medical Sciences: a qualitative study. BMJ Open. 2019 Jul 29;9(7):e031014. doi: 10.1136/bmjopen-2019-031014.
Bauer D, Lahner FM, Huwendiek S, Schmitz FM, Guttormsen S. An overview of and approach to selecting appropriate patient representations in teaching and summative assessment in medical education. Swiss Med Wkly. 2020 Dec 11;150:w20382. doi: 10.4414/smw.2020.20382.
Piedmont S, Robra BP. Theory and practice in medical education--expectations and development of skills experienced by students of human medicine compared with students in other disciplines. GMS Z Med Ausbild. 2015 Feb 11;32(1):Doc8. doi: 10.3205/zma000950.
Sarfraz M, Hussain G, Shahid M, Riaz A, Muavia M, Fahed YS, et al. Medical students' online learning perceptions, online learning readiness, and learning outcomes during COVID-19: the moderating role of teacher's readiness to teach online. Int J Environ Res Public Health. 2022 Mar 16;19(6):3520. doi: 10.3390/ijerph19063520.
Melvin A, Patel RS. Applying educational theory to medical education research. Clin Exp Dermatol. 2022 Dec;47(12):2085-9. doi: 10.1111/ced.15287.
Utomo PS, Randita AB, Riskiyana R, Kurniawan F, Aras I, Abrori C, et al. Predicting medical graduates' clinical performance using national competency examination results in Indonesia. BMC Med Educ. 2022 Apr 7;22(1):254. doi: 10.1186/s12909-022-03321-x.
Ranjan P, Ranjan R, Kumar M. National exit test: how will one size fit all? Ann Indian Acad Neurol. 2020 Mar-Apr;23(2):145-9. doi: 10.4103/aian.AIAN_478_19.
Ha TM. A commentary on the National Medical Licensing Examination in Vietnam: why, what, who and how. MedEdPublish (2016). 2023 Sep 6;13:30. doi: 10.12688/mep.19654.2
Chen Y, Henning M, Yielder J, Jones R, Wearn A, Weller J. Progress testing in the medical curriculum: students' approaches to learning and perceived stress. BMC Med Educ. 2015 Sep 11;15:147. doi: 10.1186/s12909-015-0426-y.
Dehury RK, Samal J. "Exit exams" for medical graduates: a guarantee of quality? Indian J Med Ethics. 2017 Jul-Sep;2(3):190-3. doi: 10.20529/IJME.2017.037.
Gandomkar R, Mirzazadeh A, Changiz T. Clearing the confusion about post-accreditation monitoring, meta-evaluation and meta-accreditation. BMC Med Educ. 2024 Mar 7;24(1):248. doi: 10.1186/s12909-024-05214-7.
Taber S, Akdemir N, Gorman L, van Zanten M, Frank JR. A "fit for purpose" framework for medical education accreditation system design. BMC Med Educ. 2020 Sep 28;20(Suppl 1):306. doi: 10.1186/s12909-020-02122-4.
van Zanten M, Boulet JR, Shiffer CD. Making the grade: licensing examination performance by medical school accreditation status. BMC Med Educ. 2022 Jan 14;22(1):36. doi: 10.1186/s12909-022-03101-7.
Benbassat J, Baumal R, Cohen R. Quality assurance of undergraduate medical education in Israel by continuous monitoring and prioritization of the accreditation standards. Rambam Maimonides Med J [Internet]. 2022 Jul 31 [cited 2023 May 10];13(3):e0023. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9345766/ doi: 10.5041/RMMJ.10480.
Bhardwaj A, Nagandla K, Ibrahim S. Malaysian Medical License Examination (MMLE): Is This a Way Froward? Education in Medicine Journal. 2017 Dec 29;9(4):63–7.
National Resident Matching Program. NRMP® Publishes Research Brief about Content Evaluation of the Applicant Survey [Internet]. 2023 [cited 2024 May 30]. Available from: https://www.nrmp.org/about/news/2023/07/new-nrmp-publishes-research-brief-about-content-evaluation-of-the-applicant-survey/
Spector AR, Railey KM. Reducing reliance on test scores reduces racial bias in neurology residency recruitment. J Natl Med Assoc. 2019 Oct;111(5):471-4. doi: 10.1016/j.jnma.2019.03.004
Ross D, Schipper S, Westbury C, Banh HL, Loeffler K, Allan GM, et al. Examining critical thinking skills in family medicine residents. Fam Med. 2016 Feb;48(2):121-6.
Lin CC, Semelsberger S, Saeed AA, Weiss J, Navarro RA, Gianakos AL. Perception of debt during resident education-a systematic review. Perm J. 2023 Sep 15;27(3):99-109. doi: 10.7812/TPP/23.025.
Mahendradhata Y, Trisnantoro L, Listyadewi S, Soewondo P, Marthias T, Harimurti P, et al. The Republic of Indonesia health system review. 2017.
Sayampanathan AA, Tan YT, Fong JM, Koh YQ, Ng CL, Mohan N, et al. An update on finances and financial support for medical students in Yong Loo Lin School of Medicine. Singapore Med J. 2017 Apr;58(4):206-11. doi: 10.11622/smedj.2016142.
Pumphrey K. Show Medical Interns the Money. J Grad Med Educ [Internet]. 2020 Apr 1 [cited 2024 Jun 2];12(2):141-2. Available from: https://doi.org/10.4300/jgme-d-19-00749.1
Gianakos A. Residency Training Lacks Financial Education [Internet]. American Academy of Orthopaedic Surgeons - AAOS; 2023 Dec 31 [cited 2024 Jun 2]. Available from: https://www.aaos.org/aaosnow/2024/jan/residency/residency01/.