Mission statement and Introduction to the curriculum framework for a new national Myanmar undergraduate medical degree course 2021
“A curriculum should simply be fit for purpose and the context of its place and day”
(Grant, 2018, in Understanding Medical Education: Evidence, Theory, and Practice
edited by Tim Swanwick)
Mission statement
Within the mission statement of the medical university, this outline curriculum is designed to:
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Provide a framework for faculty to map, design and deliver high-quality education of medical students in accordance with the inclusive principles of equality and diversity
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Provide a base for future accreditation at an internationally acceptable standard
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Give autonomy to local universities to adapt the framework to suit local needs
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Stimulate, prepare and support students to take responsibility for their learning process
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Provide the means and the intellectual environment to enhance medical research
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Encourage lifelong learning in line with a dynamic medical world
Graduates, having completed their university studies and one year of supervised practice, will
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Be competent at the standards outlined in the learning outcomes
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Be able to provide patient care that is appropriate, effective and compassionate in dealing with health problems and promotion of health in Myanmar, in the context of acute, continuing and comprehensive needs
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Demonstrate safe practice, high ethical standards and professionalism appropriate to this multicultural society
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Have an appropriate foundation for future career in any branch of medicine
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Be prepared and ready for postgraduate medical education
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Be committed to life-long learning
Development of the curriculum
The framework was requested in 2021 by the pro-democracy movement, for use in the context of change. It looks to the future with an inclusive, federated system of health education and delivery to incorporate many smaller medical universities spread widely across different groups across the country. Currently (Sept 2021) healthcare education is fragmented. Delivery, often from a distance, comes from many sources. Thus the (international) authors sought to prioritise the clinical content first, providing a map to support the organisation of education to partly trained medical students.
The curriculum is based on contemporary learning principles and will continue to evolve in response to advances in medical knowledge and developments in society and IT. The focus is on core knowledge rather than an over-abundance of information, allowing for minor local adaptations to account for different social and cultural conditions and different patterns of disease. In this way students will be exposed to up-to-date, context-sensitive education in accordance with international best practice to support the needs of the people of Myanmar.
Clinical Content
Clinical content was based on that of the newly-designed UK national Medical Licensing Assessment, MLA, for which use the UK General Medical Council generously gave permission. That content was then discussed and prioritised by educationalists in Myanmar, USA, Australia and the UK and adapted accordingly to context.
Standards
Standards are guided by those of the World Federation of Medical Education (WFME) 2020. These represent a global expert consensus on the standards for medical schools and other providers of medical education. They are endorsed by the World Health Organisation, the World Medical Association and IAMRA.
The standards in this document have also been informed by several international bodies, particularly those of the UK General Medical Council. Canada’s CanMEDS, Johns Hopkins university and others in Singapore, Korea and India were also considered.
Learning Outcomes
The educational learning outcomes of this curriculum have been organised into the six domains of the Accreditation Council for Graduate Medical Education Agency – International (ACGME-I) to facilitate future accreditation, as ACGM-I has Recognition Status from WFME. This classification is widely used in SE Asia and beyond.
We choose to define end-stage outcomes but not offer milestones (year-end outcomes). The latter detail the progress of a student and are used for blueprinting of teaching and assessment.
This decision was based on two considerations. Educational delivery is currently fragmented, hence there are no clear gateways between levels. We encourage diverse representation, giving autonomy to the teaching establishments to organise their own delivery as appropriate to their situation.
We have however created some examples of more detailed milestone outcomes, which can be used to support educational establishments if requested.
Teaching
Teaching methods will be determined locally: we suggest, when the situation allows, an integrated approach delivered in varying ways, with less dependence on lectures than previously, and more use of small groups, experiential learning and student directed education. Training for faculty in the use of these modern methods of education is essential and must continue. There are many instructive and interactive educational resources available, some of which will shortly be linked to this curriculum framework.
Assessment
Assessment should also take several forms. Formative assessments should be built into plans for educational delivery. Blueprinted summative exams should take into account the levels of Miller’s educational pyramid, with emphasis on use of knowledge and performance.
For instance: it will take time to lessen the dependence on MCQ exams, but we recommend a move from True/False design to a best-of-five design, with formal standard setting processes. Standardized patient exercises, simulations and clinical exams, supplemented by direct observation in real clinical settings should also all be considered. A clear programme of Quality Assurance should be instituted.
Key References
UK General Medical Council (GMC) Medical Licensing Assessment (MLA) content map (2019)
https://www.gmc-uk.org/education/medical-licensing-assessment/mla-content-map
GMC Outcomes for Graduates (2018) plus supplementary guidance e.g. on procedural skills https://www.gmc-uk.org/education/standards-guidance-and-curricula/standards-and-outcomes/outcomes-for-graduates
GMC Generic Professional Capabilities framework 2017 https://www.gmc-uk.org/education/standards-guidance-and-curricula/standards-and-outcomes/generic-professional-capabilities-framework
GMC Promoting excellence. Standards for medical education and training (2016) https://www.gmc-uk.org/-/media/documents/promoting-excellence-standards-for-medical-education-and-training-0715_pdf-61939165.pdf#page=32
Johns Hopkins Medical University. Genes To society. A curriculum for the Johns Hopkins University School of medicine. https://www.hopkinsmedicine.org/som/curriculum/genes_to_society/mission.html,
Revisiting Millers pyramid in medical education NCBI 2019 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7246123/
Royal College of Physicians and Surgeons of Canada: CanMEDS framework https://www.royalcollege.ca/rcsite/canmeds/canmeds-framework-e
World Federation for Medical Education. Standards for basic medical education 2020 https://wfme.org/download/bme-standards-2020