1. EO Olapade-OlaopaDeveloping an UG Medical Curriculum MEPI 2013 Annual Symposium Workshop CBME: Potential for More Effective Training of Healthcare Workers – The Perspective from Africa By E.Oluwabunmi Olapade-Olaopa Esq. MBBS, MD, FRCS, FWACS, FMed. Ed., ACIArb Professor of Surgery, University of Ibadan MEPI CC/ACHEST Medical Faculty

2. EO Olapade-OlaopaDeveloping an UG Medical Curriculum Essential attitudes, skills and knowledge (ASK), required for effective performance of a real-world task or activity. Essential skills that adults (graduates) need to be successful members of families, the community, and the workplace. Competencies reinforce one another from basic to advanced as learning progresses Impact of increasing competencies is synergistic, and the whole is greater than the sum of the parts. What are Competencies

3. EO Olapade-OlaopaDeveloping an UG Medical Curriculum Hierarchical Relationships of Skills Acquisition Competencies Skills, Abilities, and Knowledge Traits and Characteristics Integrative Learning Experiences Learning Experiences Demonstrations ASSESSMENT OF PERFORMANCE ACQUIRED SKILLS, ABILITIES, AND KNOWLEDGE DEVELOPED IN THE LEARNING PROCESS FOUNDATION ASSESSMENT Learner

4. EO Olapade-OlaopaDeveloping an UG Medical Curriculum Assess Stakeholder Needs Community - Local/National - International Student Lecturer Target Instruction and Assessment Select Competencies Evaluate Competency Attainment Developing a CBE Curriculum

5. EO Olapade-OlaopaDeveloping an UG Medical Curriculum Competency-based Education Worldwide Wave – Wither Africa?

6. EO Olapade-Olaopa Developing a CBME Curriculum in an African Medial School The Ibadan Medical School Experience

7. EO Olapade-OlaopaUI Curriculum Sensitization Workshop CMUI MBBS Curriculum Review Four-stage Process – 2001 to 2010 Stage 1 – Preparatory phase (2001 - 2004) –Faculty development –Research – Student / Teacher and posting evaluation –Awareness programs – College Lecture / Workshop Stage 2 – Curriculum Review (2005 - 2007) –MF-Funded Curriculum Review Evaluation of current curriculum Needs assessment of all stakeholders –Development of Curriculum Draft Template Stage 3 – Curriculum Revision (2008 - 2010) –MF-Funded / College Curriculum Committee directed –Development of full 2010 CMUI MBBS Curriculum

8. EO Olapade-OlaopaUI Curriculum Sensitization Workshop University / College philosophy of Instruction –Respond to societal needs and meet global standards –To produce graduates who are worthy in character and learning –To produce confident, compassionate, problem- solving, entrepreneurial physicians with internationally equitable competences who are socially responsive and relevant. –To equip the medical graduate with the core competencies required for modern clinical practice. –To engender self-directed learning CMUI MBBS Curriculum Revision Determination of Competences Domains

9. EO Olapade-OlaopaDeveloping an UG Medical Curriculum WFME Core Competencies Desired of Medical Students

10. EO Olapade-OlaopaDeveloping an UG Medical Curriculum CanMEDS PHYSICIAN COMPETENCY FRAMEWORK PROFESSIONAL COLLABORATORSCHOLAR COMMUNICATOR HEALTH ADVOCATE MANAGER MEDICAL EXPERT

11. EO Olapade-Olaopa The Competent Physician The Physician Patient Care Medical Knowledge Interprofessional Collaboration Personal & Professional Development Systems-based Practice Practice-based Learning & Improvement Professionalism Interpersonal and Communication Skills

12. EO Olapade-OlaopaUI Curriculum Sensitization Workshop CMUI MBBS Curriculum Revision The Education Cycle Needs Assessment Educational Objectives Program Evaluation Learner Assessment Instructional Methods Learners Environment

13. EO Olapade-Olaopa Developing an UG Medical Curriculum Challenges to Medical Education and Practice in Nigeria

14. EO Olapade-OlaopaDeveloping an UG Medical Curriculum What competencies for an Ibadan medical student Wisdom Versatility Expertise Excellence Communication Vision Accountability

15. EO Olapade-OlaopaDeveloping an UG Medical Curriculum Competencies Domains Desired of Ibadan Medical Students Expertise Management Skills Critical Thinking Communication Skills Scholarship/ Scientific Foundation Advocacy Professional value/ attitudes Collaboration Skills Person- centered Care

16. EO Olapade-OlaopaUI Curriculum Sensitization Workshop CMUI MBBS Curriculum Revision Determination of Desired Competences - I Tasks I –Identification of learning objectives, outcome indices, assessment and teaching methods for all disciplines –Identification of competences to be acquired in all disciplines with emphasis on skills acquisition i.e. practical/clinically oriented teaching/assessment and small group teaching –Identification of areas of vertical/horizontal integration –Prioritization of competences to be learned i.e. Must know/Must know to pass, Should know/Should know to pass and May know/May know to pass

17. EO Olapade-OlaopaUI Curriculum Sensitization Workshop CMUI MBBS Curriculum Revision Determination of Desired Competences - II Tasks II –Distribution of teaching contact time and classification of teaching activities Skills (Practical/Clinical) = 60% vs knowledge (didactic) = 40% of student learning time Must know, should know and may know – 50%, 30%, 10% of teaching contact time –Development of Departmental Assessment Methods Development of summative and formative assessment methods Determination of distribution and weighting of departmental assessment methods

18. EO Olapade-OlaopaDeveloping an UG Medical CurriculumPublic Presentation, 28 September, 2010 Desired Competencies/Learning Objectives Department of Anatomy LEARNING OBJECTIVES OUTCOME MEASURES/ INDICES ASSESSMENT METHODS TEACHING METHODS 1Possess knowledge of Anatomy sufficient for medical education Demonstration of theoretical and practical knowledge of gross human anatomy MCQs, Long and Short essay questions Practical examination (Steeple chase), and Viva voce (cards). Picture test - Didactic lectures (core basic science) - Tutorial - Practicals demonstration - Slide shows - e-learning materials 2To possess adequate orientation towards application of basic medical science in clinical practice Demonstration of theoretical and practical knowledge of microscopic structures of human tissues and organs using clinical correlates MCQs, Long and Short essay questions Practical examination (Steeple chase), and Viva voce (cards). Picture test - Didactic lectures (applied basic science) - Tutorial - Gross dissections - Slide shows and histological practicals - e-learning materials - Case- based learning 3Competence in basic research methodology Demonstration of basic research methods MCQs, Long and Short essay questions Practical examination (Steeple chase), and Viva voce (cards). Picture test - Didactic lectures - Tutorial - Take home research assignments 4To possess sound knowledge of basic medical science of international standards Demonstration of sound understanding of human developmental process (embryology) gross anatomy, histology and neuroanatomy and basic concept of molecular biology MCQs, Long and Short essay questions Practical examination (Steeple chase), and Viva voce (cards). Picture test - Didactic lectures - Tutorial - Take home research assignments - Gross dissections - Slide shows and histological practicals - e-learning materials

19. EO Olapade-OlaopaDeveloping an UG Medical Curriculum Prioritization Of Desired Competencies For Anatomy For CMUI M.B.,B.S. Learning Objectives Outcome Indices Must know/ Must know to pass 50% Contact Teaching Time Should know/ Should know to pass 30% Contact Teaching Time May know 10% Contact Teaching Time Possess knowledge of anatomy sufficient for medical education Demonstration of theoretical & practical knowledge of grosss and microscopic structures in human anatomy The normal structure (gross & microscopic) of the human body An unders- tanding of the developmental process The surface anatomy of various regions of the body Sexual differences in anatomical structures Anatomical positions of structures in the body Anatomical variants that occur (both normal and abnormal)

20. EO Olapade-OlaopaDeveloping an UG Medical CurriculumPublic Presentation, 28 September, 2010 ASSESSMENT METHODS SEMESTER/TYPEPOSTING 200 L 1st Semester Integrated Core Basic Science Formativeweekly tests, viva voce for practicals Summativeshort essays, MCQs 200 L 2nd Semester Integrated Core Basic Science Formativeweekly tests, viva voce for practicals Summativeshort essays, MCQs, Term papers 300 L 1st Semester Integrated Applied Basic Sciences Formativerevision tests SummativePart I MBBS Examinations

21. EO Olapade-OlaopaUI Curriculum Sensitization Workshop CMUI MBBS Curriculum 26 Departments/Disciplines Anatomy Physiology Biochemistry Public Health Sciences Human Nutrition Pharmacy (Generic) Histopathology Haematology Dentistry Microbiology and Parasitology Virology Chemical Pathology Pharmacology GOPD/Family Medicine Accident and Emergency Anaesthesia Medicine Surgery Psychiatry Paediatrics Obstetrics and Gynaecology Otorhinolaryngology Ophthalmology Community Medicine Medical Psychology Radiology Radiotherapy

22. EO Olapade-OlaopaUI Curriculum Sensitization Workshop The 2010 CMUI MB,BS Curriculum Novel Characteristics I Homegrown –Needs directed –All stakeholders involved –Socially responsive, relevant and accountable Integrated, system-based, person-centered, community-oriented curriculum, competency- driven model Introduction / Repackaging of courses Early introduction of students to clinical training Prioritized teaching and assessment to ensure the acquisition of desired competences

23. EO Olapade-OlaopaUI Curriculum Sensitization Workshop The 2010 CMUI MB,BS Curriculum Novel Characteristics II Multidisciplinary/Interdisciplinary instruction, learning and assessment –Other healthcare professionals –Non-medical educators/Other faculties –Corporate world / Industry / NGOs Encouragement of self-directed learning/critical thinking and acquisition of competences –Reduction in number/cycles of lectures –Emphasis on tutorials (encompass PBL system) –Student research projects/Term papers Introduction of formative assessments

24. EO Olapade-OlaopaUI Curriculum Sensitization Workshop The 2010 CMUI MB,BS Curriculum Novel Characteristics III Increased contact between teachers and students / Improved mentoring Equivalent instruction at end of every academic year Remediation re-defined –18 semesters maximum (including 100 level) Exit points created for students unable/unwilling to continue program Opportunity for combined degrees Creation of Medical Education Unit

25. EO Olapade-OlaopaUI Curriculum Sensitization Workshop In the end…… ‘With improbable people doing implausible things for imponderable purposes and succeeding by coincidence’ Leo Marks - Between silk and cyanide: A Codemaker’s war 1941-45

26. EO Olapade-Olaopa Science based Problem based Systems based Scientific curriculum University based University based Problem based learning Academic centers Academic centers Competency driven: local-global Competency driven: local-global Health education systems Instructional Institutional 1900 2000+ Three generations of reform David Sewadda – MEPI 2012

27. EO Olapade-Olaopa Reforms for second century........A third generation is now needed. That should be systems based to improve the performance of health systems by adapting core professional competencies to specific context while drawing on global knowledge..... David Sewadda – MEPI 2012

28. EO Olapade-Olaopa Developing a National CBME Curriculum Template Nigeria’s Experience

29. EO Olapade-Olaopa Nigeria’s Undergraduate Medical and Dental Curriculum Template: 2012 Professor E.Oluwabunmi Olapade-Olaopa Coordinator/Technical Advisor On behalf of the National Medical and Dental Curricula Advisory Committee

30. EO Olapade-Olaopa National Medical and Dental Curricula Advisory Committee Federal Ministry of Health National Universities Commission (Fed. Min. Education) Medical and Dental Council of Nigeria Colleges of Medicine and Teaching Hospitals in Nigeria Nigeria Primary Healthcare Development Agency Guild of Medical Directors Assoc. of General Private Medical Practitioners of Nigeria Nigerian Institute of Medical Research Association of Nigerian Physicians in the Americas Medical Association of Nigerians Across Great Britain USAID/HS2020 Project John T and Catherine D MacArthur Foundation

31. EO Olapade-Olaopa Technical Working Groups Determined Desired Objectives Basic/Applied Medical Science Clinical Science Community Medicine Integration Professionalism and Ethics Dentistry –Lead/Members –Coordinator/Technical Advisor

32. EO Olapade-Olaopa National Template of learning objectives for the basic medical/dental sciences Learning ObjectivesOutcome IndicesAssessment MethodsTeaching Methods To produce medical graduates who have sufficient knowledge of basic medical sciences (BMS) for medical education. Demonstration of a grasp of BMS with an understanding of the structures, functions, and biochemical mechanisms of the human body. MCQs SAQs Short and long essays Practical exams (steeplechase) Viva voce Didactic teaching Tutorials Practicals To introduce students to clinical applications of basic medical sciences. Ability to apply the knowledge of structures, functions, and biochemical mechanisms of the human body to clinical scenarios. MCQs Short and long essays Tutorials Case-based learning

33. EO Olapade-Olaopa National Template for desired competences for basic medical/ dental sciences Learning Objectives Outcome IndicesMust KnowShould KnowMay Know To produce medical graduates who have sufficient knowledge of basic medical sciences for medical education. Demonstration of a grasp of basic medical sciences with an understanding of the structures, functions, and biochemical mechanisms of the human body. Normal gross and microscopic structure of the human body Structure, chemistry, and physiology of the cell Developmental processes and basic biochemical processes in the human body Sexual differences in anatomical structures Genetic regulation of cellular metabolism Functional anatomy of the systems and organs in the human body Anatomical variants Gene rearrangement and translocation in disease states

34. EO Olapade-Olaopa National Template for Assessment Methods in Laboratory Medicine for Medicine and Dentistry Semester/TypePosting 300L (1 st Semester)Integrated Block Posting I Formative assessmentIntegrated OSPE, SAQ, portfolio Summative assessmentMCQ, SAQ, portfolio 300L (2 nd Semester)Integrated Block Posting II Formative assessmentCore/integrated SAQ, MCQ, portfolio Summative assessmentCore/integrated, MCQ, SAQ, portfolio 400L (1 st and 2 nd Semesters)Core Lectures/Infectious Diseases Posting Formative assessmentCore/integrated OSCE, SAQ, portfolio Summative assessmentCore/integrated SAQ, portfolio 500L (1 st and 2 nd Semesters)Integrated Revision Block Posting Formative assessmentIntegrated OSPE, SAQ, portfolio Summative assessmentIntegrated long essay, MCQ, SAQ, viva voce, portfolio, practical examination, continuous assessments

35. EO Olapade-Olaopa National Template for Procedures for Nigerian Medical Graduates (Adapted from Procedures List of Committee of Deans of South Africa)

36. EO Olapade-Olaopa PROCEDURE TO BE PERFORMED LEVEL OF COMPETENCE Independent G1 Supervised G2 Elective G3 Excluded G4 Physical Examination Skills Examine all systemsX Fundoscopy, visual fields, visual acuity X Mini-mental state examinationX Rinne and Weber testXX Examination of a lumpX Examination of an ulcerX Examination of external abdominal hernias X Digital rectal examinationX

37. EO Olapade-Olaopa PROCEDURE TO BE PERFORMED LEVEL OF COMPETENCE Independent G1 Supervised G2 Elective G3 Excluded G4 General Skills Take a peripheral venous blood sample X Insert a urinary catheterX Set up intravenous infusionX Take blood culture samplesX Insert a nasogastric tubeX Take a throat swabX Administer injection – IV, IM, SC, intradermal X Perform a lumbar punctureXX Collect a femoral vein blood sampleX Collect a radial artery blood sampleX

38. EO Olapade-Olaopa PROCEDURE TO BE PERFORMED LEVEL OF COMPETENCE Independent G1 Supervised G2 Elective G3 Excluded G4 Surgical Skills Incise and drain an abscessX Perform needle aspiration biopsy of any area X Fine needle aspiration biopsy of breast lump X Perform proctoscopy X Excise lumps / bumps, e.g. sebaceous cyst X Perform cryotherapy /cauterization X Debride wounds or burns X Incise and drain perianal haematoma X Apply compression dressing to venous ulcer X Perform appendectomy X Perform rigid sigmoidoscopy XX

39. EO Olapade-Olaopa GRAPHIC REPRESENTATION OF THE 2012 NATIONAL TEMPLATE FOR INTEGRATED MEDICAL AND DENTAL CURRICULUM Session POSTINGS AND EXAMINATIONS 200L Integrated (Horizontal) Core Basic Science (Includes Introduction Professionalism & Ethics and Multi-disciplinary Healthcare Delivery) 300L Integrated Laboratory Medicine I and Integrated (Vertical) Clinical Application of Basic Sciences MBBS /BDS Part I Exam Integrated (Horizontal) Introductory Medicine and Surgery and Integrated Laboratory Medicine II 400L Integrated (Modified Vertical) System-Based Lectures Clinical Postings (Rotations) 500L Clinical Postings (Rotations) Block Posting Revision MBBS /BDS Part II Exam Clinical Postings (Rotations) MBBS /BDS Part III Exam 600LClinical Postings (Rotations) MBBS /BDS Part IV Exam

40. EO Olapade-OlaopaDeveloping an UG Medical CurriculumPublic Presentation, 28 September, 2010 GRAPHIC REPRESENTATION OF 2010 CMUI INTEGRATED CURRICULUM Beginning of Sessions WEEKS 246810121416182022242628303234363840424446485052 200LGIP Integrated Core Basic Science I Mid-Sem Vacation Integrated Core Basic Science I Medicine as a Profession End of Sem Vacation Integrated Core Basic Science II Mid-Sem Vacation Integrated Core Basic Science II Multi- disciplinary Healthcare Delivery End of Session Vacation 300L Block Posting I (Include Integrated System-based Lectures) Revision Core Basic Science Self Study Rev MBBS Part I Exam Vacation Clinical Introductory Posting (Include Integrated Lectures) Block Posting II Vacation Clinical Application of Basic Science Integrated Introductory Medicine I and Surgery I 400L BreakIntegrated System-Based LecturesBreakIntegrated System-Based LecturesBreakIntegrated System-Based LecturesBreak Radiology IJunior PaediatricsMedicine IISurgery IIJunior OBGYNSpecial Posting I & II Infectious Diseases Posting Community Health I 500L Vacation Block Posting Rev MBBS Part II Exam Psychiatry ISenior PaediatricsSenior OBGYN Family Medicine 1 Community Medicine Revision OBGYN & Paed Rev MBBS Part III Exam 600L Vacation Psychiatry II Elective Posting I Family Medicine II Special Posting IIRadiology II Vacation Community Health II Medicine III & Surgery IIIRev MBBS Part IV Exam

41. EO Olapade-Olaopa The Product The National MBBS/BDS CBME Template First of its kind in Nigeria It prioritizes teaching and assessment to ensure the acquisition of appropriate competences for medical and dental graduates of our country. It reflects the synergy of the cooperation of multiple stakeholders It reflects the current and future health-care needs of our nation whilst meeting global standards. Each school can develop it into the full curriculum it wishes Adopting this curriculum will require change management. Implementation will require regular and repeated training. Can be adapted for post graduate training

42. EO Olapade-Olaopa Competency-based Education Worldwide Wave – Wither Africa? CBME taking root in several countries Educational model being applied to continuum of medical education Also being applied to development of curriculum for other health professionals courses Makes development of multidisciplinary healthcare programs easier Developing an UG Medical Curriculum

43. EO Olapade-Olaopa My Students Enjoying CBME Developing an UG Medical Curriculum