April 2019, Volume 69, Issue 8

Editorial

The evolution of medical curricula in Iraq

Authors: Saadealdeen Majeed Hasson  ( Department of Internal Medicine, College of Medicine, Mustansiriyah University, and Department of Internal Medicine, Al-Yarmook Teaching Hospital, Baghdad, Iraq )

Although healing practices in ancient Mesopotamia (roughly centered on modern-day Iraq) involved the use of magic, chants, and divination, physicians had an extensive knowledge of diagnosis, a wide list of drug treatments, and carried out basic surgery.1 They were also bound by a well-established, formal code of conduct. From some 5,300 years ago, the cuneiform writing of Sumerian and the following Akkadian, Assyrian, and Babylonian cultures provide exciting snapshots of physicians and their craft. 1 Mesopotamian physicians used around 250 medicinal plants, 120 minerals, and about 200 other substances. Remedies were prescribed for specific diseases: for instance, fish oil and an extract of cedar were thought to treat epilepsy. 1 Hammurabi was the ruler of Babylon. His famous Law Code, written in cuneiform script on a pillar of diorite stone, included several pronouncements on medical care. The quality of the doctor's services was to be clearly defined in the provisions of the Hammurabi Law in Babylon, and it was necessary to adjust the quality of the doctor's training and prepare him for independent medical practice. 1 From around the 8th century, the Muslim lands of the Middle East and western Asia experienced an Islamic “Golden Age.” Spreading out from Baghdad, academic and intellectual pursuits flourished in an atmosphere of tolerance. 1 Islamic teachings strongly encouraged and supported scientific research which led to many advancements and discoveries. In fact, the Qur'an and Hadeeth recognize the pursuit of knowledge as being an act of worship to God. 1 This supportive attitude towards scientific observation and opinion has resulted in numerous scientific achievements and the adoption of a tolerant attitude toward the expression and discussion of scientific observation and opinion. 1 In modern Iraq, the first school of medicine was founded in Baghdad in 1927. It incorporated the latest developments and trend theories of education, which were established in North America around 1910 and then spread to Europe and the rest of the world. The medical School was founded by a number of British and Iraqi doctors. Dr. Harry Sandersen was the founding dean of the college who adopted Edinburgh University medical school curriculum. 2 It was characterized by the teaching methodology used throughout the British Empire and followed the British methods of education based on separate scientific materials and medical disciplines to grant Certificates similar to the medical certificate given out by the College of Medicine in Edinburgh, Scotland. 3 The foundation of the same methodological model, built on separate scientific materials at the time of the establishment of the other colleges in Iraq, continued with the planning and support of teaching staff members of the Faculty of Medicine in Baghdad, and its teaching model adopted until recently in the majority of Iraqi medical schools, since 1959 when the second medical college was established in Mosul. 3 Although the training programme was updated and promoted following the improvement in its training skills but the same principles of the original curriculum had remained as a corner stone model of teaching based on separate sciences. 3 Following the two major summits held in Tehran in 1963, and 1972, were sponsored by WHO, aiming to upgrade medical education and teaching methodology, many local trials were traced to change the teaching curriculum but all were non serious and did not follow formal and systematic steps. 3 We can say that until 2012 there was no systematic change or systematic development of the curriculum, including teaching methods, methods of learning and exams. Apart from the experiment conducted by the Faculty of Medicine, University of Tikrit since its establishment in 1988 and to a certain extent the change in the quarterly curriculum adopted by the Faculty of Medicine in Al-Nahrain University in 1987, all other medical schools have followed the curriculum set by the Ministry of The Higher Education Conference in 1972 called "The Unified Approach of Iraqi Medical Faculties".3The curriculum of existing six colleges at that time namely Baghdad, Mosul, Basra, Salah al-Din (Irbil), Mustansiriyah and its branch in Kufa was the same. This unified curriculum is characterized by a focus on separate subjects, on teaching, which is centered on the teacher and treating the student as a passive recipient. The curriculum focuses on student assessment (exams) on Information and percentages of grades more than the degree of skills, attitudes and behaviours and examinations were away from objectivity and justice.3,4 Presently there are three types of curricula that are currently applied in the twenty-five colleges operating in Iraq. The first curricular approach is based on separate scientific and clinical subjects (the Subject Based Curriculum); the second is the integrated curriculum and the third is the problem-based approach. The first approach is characterized by the adoption of the educational process that totally depends on the teacher through lectures and practical lessons (Teacher-Centred), including clinical training and the examinations are focused on information more than skills and professional behaviour. 3 The other two methods, however, are based on student in active role in the learning process with varying degrees of implementation. The last two approaches use enquiry-learning methods to investigate student’s learning needs. The integrative approach uses inductive methods of reasoning starting from first year of study, while the problem-based approach uses deductive reasoning in the early years of the study and later uses the inductive reasoning in the rest of the years. Although none of these curricula when applied alone seems fully satisfactory, many academic experts in medical education think about the inappropriateness of the method of inductive reasoning in the first years of university study as this approach is known to be used by experts. Hence students, using this approach, need to be already equipped with ample and relevant information which they can learn better in using the deductive reasoning in the first three years of the six-year medical study. 4,5 In conclusion, the situation of medical education in Iraq is complex and determined by many factors, including politics, financial matter, planning, and security situation. However, the ministry of Higher Education and Scientific Research of Iraq implemented a strategic plan to shape the future of medical education in Iraq. Real steps have been taken toward improving the educational system. The curriculum may need to be revised and reformed again by several ways to achieve the best for the student and the patient.


References


1. Steve Parker. Kill or Cure: An Illustrated History of Medicine. DK Publishing. 1st Edition, 2014.

2. Weatherall D. Science and medical education: is it time to revisit Flexner?. Medical education. 2011;45:44-50.

3. Al-Shamsi M. Medical education in Iraq: issues and challenges. Int J Med Educ. 2017;8:88.

4. Amin NM, Khoshnaw MQ. Medical education and training in Iraq. The Lancet. 2003;362(9392):1326.

5. Mosawi AJ. Medical education and the physician workforce of Iraq. J Contin Educ Health Prof. 2008;28:103-5.

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