Undergraduate pharmacology curriculum at an international medical college in India.

Pharmacology is an important aspect of rational therapeutics. There has been a long-standing need for a change in the undergraduate medical curriculum of pharmacology. A review of literature throws up different approaches to improve the curriculum and to provide more importance to conceptualization and relevance to clinical practice. This article describes the undergraduate pharmacology curriculum which is revised to meet the needs of our unique status as an international medical college in India. We highlight how our curriculum prepares the students for future clinical practice by inculcating higher cognitive skills and soft skills. This article also provides a model for program evaluation and also challenges faced by our department while executing the planned curriculum.

Melaka-Manipal Medical College (MMMC) is in a unique position where we impart basic and para-clinical training at our Indian campus, followed by clinical training in Malaysian campus. Our college is accredited by the Malaysian Medical Council (MMC) and regulated by MMC and Malaysian Qualifications Agency (MQA). The MMC and MQA have their own frameworks for graduate and medical education, respectively, which provide the educational guidelines for standards in undergraduate medical education.[12] MMC guidelines are in line with the World Federation for Medical Education guidelines on international standards in medical education.[1] The guidelines provide a framework that enables medical schools to develop their own goals and objectives.

Based on this framework, our institution has developed a curriculum to inculcate required competencies in medical graduates which enable “them to be safe and competent to practice medicine under the supervision when their career begins” having skills and attitude for lifelong learning as specified by the MMC.[1] In addition, our curriculum is designed to inculcate skills such as critical thinking, problem-solving, teamwork, collaborative learning, self-directed learning (SDL), communication skills, professionalism, research skills, and medical humanities, which are important prerequisites for the current and future medical practitioners.

The students in our institute are from various countries where student-centered training in pharmacology is imparted in different formats, stressing on clinical reasoning, patient-oriented, and organ system approaches. Unlike in Indian medical colleges accredited by the Medical Council of India, at MMMC, pharmacology is taught only for a year in the 2nd year of the course. Along with pharmacology, students study microbiology, pathology, and forensic medicine in the same year. The pharmacology curriculum is delivered in four organ system-based blocks.

Pharmacology teaching at our institute has evolved over the past 20 years from traditional teaching–learning methods such as lecture classes and practical classes using blackboard, slide projector, and PowerPoint to more student-centered activities such as SDL sessions, problem-based learning sessions, and digital and computer-assisted learning while preserving the traditional teaching methods. To keep up with progress in medical practice, we have developed horizontal and vertical integration among the medical subjects. Our curriculum is constantly evolving so as to deliver outcome-based and must-know knowledge and skills to our students and to assess them in relevant aspects with problem-solving and critical thinking exercises.

This article will describe the curriculum, a model for curricular improvement, and also challenges faced by our department while executing the planned curriculum.

Pharmacology Objectives

At MMMC, the goal and major course outcomes in pharmacology in line with the institutional objectives were identified and later, intended learning outcomes for each topic were prepared [Table 1].[3] We started with discussions among faculty and with students (both current and those in the Melaka campus, who had completed their pharmacology training) to identify the lacunae in the pharmacology curriculum. This helped us determine and identify the desired outcomes – What our former students wish we had stressed upon during their second year? Why are these areas needed to be stressed upon? We also contacted our external examiners from Malaysian colleges regarding what they thought about our course and its contents. Based on these and other inputs from practicing clinicians in Malaysia and the accreditation body, our course was modified to provide students a solid grounding in the basic concepts of pharmacology to look beyond the end of the course and to consider lifelong learning needs.

Table 1

Pharmacology course goal and outcomes

Our student learning outcomes include the cognitive, psychomotor, and affective domains of learning as per the Bloom’s cognitive taxonomy and competency levels.[4] Based on the feedback received from the major stakeholder, we identified areas that are commonly encountered by our students in their clinical practice at Malaysia. We used this information to divide our content into “must-know,” “desirable-to-know,” and “nice-to-know” areas to emphasize the importance of various learning outcomes.[5] For example, students who are not competent in “must-know” areas are provided further guidance and counseling in the form of one-to-one faculty interaction to achieve the minimal competency required in pharmacology.

Teaching–learning Activities

Integrated Teaching

To deliver the outcome-based curriculum with thorough grounding in all the pre- and para-clinical subjects, an integrated curriculum delivery was created after brainstorming with all the faculty members and referring to the existing literature.[6] A coordination committee was formed to oversee the implementation of the integrated curriculum. We started initially with sequencing of lectures on similar topics to achieve temporal coordination across the subjects of the same year. Over a period of time, this was modified to include more of vertical integration in curriculum delivery in the form of revisiting topics from previous years and clinical updates through our practicing faculty members. When possible, an additional component in the form of multidisciplinary panel discussions was introduced with members from relevant medical backgrounds to achieve higher level in integration.[7] This process helped us identify areas in which there was a major overlap among the subjects, leading to a further modification in our intended learning outcomes. Currently, this exercise has helped us in reducing repetition of information that has already been discussed in other subjects and creating a more streamlined approach to curriculum delivery through lecture classes, SDL sessions, problem-based learning (PBL), case-based learning (CBL), and practical classes.

Lecture classes

Our lecture classes are in the form of traditional didactic lectures which are vertically integrated by bringing in clinical context in the form of clinical cases that promote critical thinking.

Self-directed learning activities

SDL sessions require students to involve in directing their own learning through taking initiative and self-assessment. Communicating learning outcomes, questions for self-assessment, and time frame for the completion of task with the student is crucial for the successful completion of the SDL process.

Problem-based learning and case-based learning

In PBL, students acquire new knowledge and soft skills while applying their prior knowledge in the real-life scenarios.[8] The introduction of PBL at MMMC has helped our students to gain knowledge and critical thinking ability along with improving their SDL abilities. The PBL sessions also aid in giving confidence to the students by enhancing their presentation skills and building professionalism and teamwork. The PBL sessions are divided into brainstorming sessions and presentation sessions, based on the “Seven-Jump” method for PBL.[9] Similarly, an integrated CBL has been introduced to promote problem-solving ability and SDL.

Both PBL and CBL modules use virtual clinical scenarios to stimulate student interest in a particular topic. The case is designed in collaboration by faculty of the microbiology, pathology, and pharmacology with inputs from clinicians.

Practical exercises [Table 2] reinforce knowledge outcomes learned through other teaching–learning methods. However, they mainly target outcomes which are difficult to be imparted through other teaching–learning activities.

Table 2

Practical exercises

Student Assessment

To measure student learning outcomes pertaining to various domains, the department has designed its own assessment system based on the assessment model given by our institution.

Students are assessed continuously in class tests and end of block examinations and in the end of course summative examination. Faculty strive to strengthen learning by providing a feedback following each block examination aiding in academic enhancement.[10] A good assessment should be valid, reliable, and feasible.[11] The validity is ensured using the following points:

Blue printing which ensures proportional weightage for learning outcomes from must-know, desirable-to–know, and nice-to-know areas

Discussion at the department level for the clarity, relevance, and difficulty level of the examination questions. The criteria described by Wrigley et al., 2012, form the basis for improving the relevance of questions asked.[12] These criteria include: (1) Questions matching learning outcomes, (2) questions that test knowledge required to function in a practical situation, (3) knowledge that is important for successful practice of medicine, (4) knowledge that is required for handling of high prevalence cases, and (5) knowledge that forms basis for achieving one of the institutional/course objectives

Assessment methods to measure multiple competencies: A proportional weightage is given for questions at the level of recall, comprehension, and those requiring critical thinking and problem-solving skills. Students are assessed in communication skills, presentation skills, active participation, ability to judge, and ability to search for information. The affective domains are also assessed through the ability to take informed consent, show respect for patients, provide clarity, and handle patients sensitively during communication in addition to knowledge in pharmacology [Table 3].

Table 3

A close match between outcomes, teaching-learning methods, and assessment followed by the Department of Pharmacology at Melaka-Manipal Medical College

Evaluation of Pharmacology Curriculum

Feedback from stakeholders is the backbone of curricular development.[13] The MMC also stresses on the need for obtaining feedback during the course.[1] We use multisource feedback from external examiners, students in the preclinical year and clinical years, faculty members of the department, and inputs from practicing clinicians from Malaysia and India to further improve our curriculum [Figure 1].

Figure 1

Model of program evaluation

Discussion

The World Health Organization, in its publication “Teacher’s Guide to good prescribing,” advocates the need for outcome-based learning in pharmacology with a structured program planned well in advance concentrating on practice using disease-centered teaching–learning activities rather than on theory.[14] Teaching pharmacology is a challenging task with most students considering it a dry subject, especially students who are not exposed to clinical applications of the same.[15] With this in mind, the department of pharmacology has devised many different teaching–learning and assessment methods as mentioned in the article.

The implementation of a revised curriculum is not easy.[516] At MMMC, implementation of this revised curriculum is facilitated by our faculty who are exposed to medical education workshops and training within 6 months of joining the department. This provides them with an idea about the various teaching–learning methods and also an orientation to assessment methodologies. Our institute provides incentives to attend various training programs on medical education and the administration helps implement the skills learned at these programs. Our faculty who have completed FAIMER fellowships help us frame modules for effective delivery of the course contents. Another unique facet of MMMC is the absence of departmental boundaries and hierarchical system while working. This promotes interdepartmental collaboration among the faculty, gives a chance for the voice of even the most junior faculty to be heard, and inculcates a system that makes faculty receptive to change.

None of these would work if there was no system to check whether the process was actually useful to the students. This is achieved through a system of continuous constructive feedback during the course and at the end of the teaching year.

As with any initiative, we too face multiple challenges in implementing these methodologies. One major hindrance that we face is that MMMC is not recognized by the Medical Council of India due to the unique structure of our teaching program. This makes it difficult for us to retain faculty for a considerable period of time. The need to pursue research simultaneously with other academic activities creates pressure on the workforce, to balance both, making time an important constraint.

We provide our students with frequent clinical updates by practicing clinicians. The challenge with this system is that students are not assessed on these components and hence tend to neglect these sessions. Further, the continuously growing knowledge in pharmacology and incorporating this knowledge in our curriculum creates a need for continuous pruning of the syllabus. This makes it necessary to align our assessment blueprinting on a regular basis.

The success of any program is based on the feasibility and alignment of the curriculum with the intended goals and objectives. Over the course of the program, we have seen a steady improvement in the positive feedback from our stakeholders. We stress the importance of having a forward thinking and adaptive administration for the streamlining and stability of the curriculum. With this article, we wish to provide an idea that can be utilized by other institutions which are looking to make teaching and learning pharmacology an experience that is interesting, interactive, and enriching for both students and faculty.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.