REGIONAL GUIDELINES FOR ASSESSMENT AND RECOGNITION OF MEDICAL SCHOOLS INTRODUCTION: The guidelines were developed by Medical Regulatory Boards and Councils following a directive by the 3 rd EAC Sectoral Council of Ministers of Health that directed the incorporation of the EAC Partner States National Commissions and Councils of Higher Education as well as the Inter-University Council of East Africa in the development of EAC regional guidelines for assessment and recognition of medical and dental schools in East Africa. BACKGROUND: The development of Medical schools in East Africa can be traced from the 1920 s when there was one medical school at Makerere, Uganda based on the British model. However, in the face of increased worldwide demand for training of medical doctors, the clamour of establishing both public and private medical schools, and in line with current international trends it is imperative to set basic standards for assessment and recognition of medical schools to ensure quality. The purpose of recognition and quality improvement in medical education is to adjust medical education to changing conditions in the health care delivery system and to prepare doctors for the needs and expectations of society. Recognition and quality improvement are expected to ensure that training is geared to produce doctors able to cope with the explosion in medical and scientific knowledge as well as new technology. The guidelines provide a framework for basic standards in medical education while allowing for innovation. Guidelines do not aim at creating identical programmes. This document is set out in four parts: 1. Part one: Existing medical schools, 2. Part two: Minimum requirements for establishing new medical schools, 3. Part three: Requirements for teaching hospitals. 4. Part four: Responsibilities of the Medical and Dental Regulatory Bodies. PART ONE: EXISTING MEDICAL SCHOOLS All medical schools will be required to have the following: 1. Vision Should be relevant to the training of doctors and should agree with the values of the medical degree awarding institution 1
2. Mission and Objective Must address quality of education with respect to acquisition of professional competence. Areas to be addressed should include: 1.1. Social responsibility and community involvement, 2.2. Relevance of education with respect to service needs, 2.3.Lifelong learning, 2.4. core values including ethics, integrity,respect for human rights, team work spirit 2.5. Graduates prepared to undertake specialist training programs for quality patient care and leadership 3. Governance and Leadership 3.1 The degree granting institution must be registered by a duly recognized government organ responsible for higher education of the country. 3.2 The medical training programme shall have the approval of the National Medical Council/Board, Ministry of Health and relevant organs of the Ministry of Education to train doctors in line with the standards of medical training in the EAC region. 3.3 The programme should be run by a well defined organizational structure outlining the leadership and management structure. 3.4 Appointment of leaders of the medical school must be clearly defined 3.5 Academic Dean who must be at least a senior lecturer with a minimum of 5 years teaching experience. 3.6 Establish Core departments. 3.7 Establish relevant standing committees. 3.8 Define membership of school board. 4. Administration The administrative staff of the medical school must be appropriate to support the implementation of the school s educational programmes and ensure good management of its resources. The management should include a programme of quality assurance and regular review. 5. Academic Autonomy The schools should have the autonomy to design the curriculum and allocate resources using bench marks recommended by relevant regulatory bodies 6. Education programme 6.1. Programme Objectives to include: 6.1.1 Professional values, attitudes, behavior and ethics, 6.1.2 Scientific foundation of medicine, 6.1.3 Communication skills, 6.1.4 Clinical skills, 6.1.5 Population health and health systems, 6.1.6 Information communication technology (ICT), 6.1.7 Critical thinking and research, 6.1.8 Leadership and resource management skills 2
6.2 Educational outcome/roles of the graduate Desired competencies to include: 6.2.1 Management 6.2.2 Clinical practice, 6.2.3 Teaching, 6.2.4 Relationship with professional colleagues, 6.2.5 Interpersonal skills, 6.2.6 Adherence to professional and ethical code of conduct, 6.2.7 Life long learning 6.2.8 Advocacy for human rights and rights to health 6.3. Curriculum The curriculum should address the following: 6.3.1: Students admission 6.3.1 Policy on selection 6.3.2 Admission criteria 6.3.3 Minimum entry requirements 6.3.4 Student number in relation to physical facilities /infrastructure, human and financial resources 6.3.2. Duration There should be a minimum of 5 years but normally not more than 9 years. 6.3.3. Model, structure and instructional methods: 1.5.1 Institutions should state their methods which encourage innovativeness and use of evidence-based training methodologies. 1.5.2 Assessment of students 1.5.3 Medical schools should publish their examination regulations. 6.5.4. Establish assessment systems compatible with the learning/teaching methods. 6.3.4. Core content: All courses shall have objectives Courses to include:- 6.6.1 Basic biomedical sciences 6.6.2 Behavioral and social sciences 6.6.3 Law and medical sciences 6.6.4 Pathological basis of disease 6.6.5 Clinical sciences 6.6.6 Critical thinking and research 6.6.7 Electives 6.6.8 Entrepreneurship 6.6.9 Information Communication Technology 6.6.10 Population health and health systems management. 6.6.11 Optional (Nursing, alternative medicine) 3
6.3.5 Linkage with medical practice and the health care systems Students shall be exposed to areas they will be expected to work in upon completion. 6.3.6 Programme management: Establish a Curriculum Committee which shall have authority for planning and implementation of the curriculum. 7. Students welfare There should be a policy on student welfare which should address the following among others: 7.1. Support and counseling 7.2 Social and personal needs which include:- 7.2.1 Academic support 7.2.2.Career guidance 7.2.3 Health problems 7.2.4 Financial matters 7.3 Teacher student relationship 7.4 Student representation at various appropriate levels. 7.5 Rules of conduct should be published. 7.6 Suitable accommodation facilities should be availed 8. Staff Academic, technical and administrative There should be a policy on: 8.1 Recruitment:- 8.1.1 Qualifications 8.1.2 Specialization 8.2 Staff numbers 8.2.1 Basic sciences staff/student ratio of 1:20 8.2.2 Clinical departments staff/student ratio of 1:8-15 8.3 Staff qualification 8.3.1 Non clinical departments 50% should be holders of PhD or M.Med with appropriate mix of medical and non medical staff. 8.3.2 Clinical departments 90% should be holders of M.Med or equivalent 8.4 Part timers - not more than 20% 8.5 Appropriate mix of specialists 8.6 Career development 8.7 Staff management 8.8 Staff welfare: Support and counseling 8.9 Appropriate ratios of staff to students in different disciplines 9. Educational Resources Medical schools should have the following: 4
9.1. Appropriate physical and teaching facilities for the number of staff and students. 9.1.1 Facilities for disabled students 9.1.2 Laboratory space 1-2.5square meters per student 9.1.3 Library space 1-2 square meters per student 9.1.4 Class room space 1-2 square meters per student 9.2 Clinical training resources: 9.2.1 Appropriate Student/inpatient ratios: the ratio of 1:5 9.2.2 Adequate ward and theatre space 9.2.3 Ideally there should be a University teaching hospital. 9.2.4 Identification and development of satellite teaching hospitals approved by the medical regulatory authorities. 9.3 Adequate financial resources. 9.4 Library and information technology services to commensurate with student numbers 9.4.1 Student book ratio of 1:40 9.4.2 Student computer ratio 1:5 9.4.3 Access to internet 9.5 Skills laboratories 9.6 Adequate research facilities. 9.7 Educational exchange programmes for staff and students 9.8 Policy on use of education experts in planning medical education and development of teaching methods. 10. Research, Extension and Development 10.1 There should be a clearly stated research policy that includes:- 10.1.1 Ethical issues 10.1.2 Relevancy to the environment and community 10.1.3 Funding 10.1.4 Dissemination of information: at least 2 publications per department per annum. 10.2At least 5 research projects at any time for the school. 10.3The medical school should have a policy on constructive interactions with the health care and related sectors of society and government including areas of health promotion and disease prevention. 11. Programme Monitoring & Evaluation 11.1 The medical school should have a policy on quality assurance which should address continuous monitoring and evaluation systems. The systems should provide for internal and external mechanisms to address the following areas:- 11.1.1 Staff performance and appraisal 11.1.2 Student performance 11.1.3 Course content 11.1.4 Facilities 5
11.1.5 Organization 11.1.6 Programme evaluation 11.1.7 Involvement of stakeholders 11.2 There must be clearly stipulated mechanisms for regular review and updating of the programme based on the outcome of monitoring and evaluation. PART TWO: MINIMUM REQUIREMENTS FOR ESTABLISHING A MEDICAL SCHOOL Conditions set out in Part One apply with modification in this section. The objective of the adjustment in this section is to enable new schools to start without incurring the cost of the whole school structure before they have students in senior years. New medical schools will be required to have the following before they start: 1. Institutional Setting 1.1 There should be a formal definition of the relationship between the medical school and the degree granting institution. 1.2 Definition of the governance structure of the medical school 1.3 Appointment of the founding dean who should be at the level of a senior lecturer and above 1.4 Job description for the dean 1.5 Appointment of the senior leadership within the dean s staff 1.6 Appointment of administrative leadership for academic units 1.7 Establishment of the standing committees of the medical school 2. Educational Programmes 2.1 A curriculum approved by the Medical Regulatory Authorities. 2.2 Definition of overall objectives for the educational programme 2.3 Working plan for the curriculum as a whole, consistent with the educational objectives 2.4 A general plan for the whole course and detailed layout for the first two years of study 2.5 Written standards and procedures for the admission, evaluation, advancement, and graduation of students and for disciplinary action, including appeal mechanisms to ensure due process 2.6 Specification of the types of teaching and student evaluation methods best suited for the achievement of educational objectives 2.7 Design of a system for curriculum management and review 2.8 Design of a system for educational programme evaluation, including the designation of outcome measures to indicate the achievement of overall educational objectives 3. Medical Students 3.1 Clearly defined admissions policies and selection criteria 3.2 Ensure essential student services in the areas of academic orientation, support and counseling, financial aid, health services, and personal counseling (in a student handbook/manual) 6
3.3 Standards of conduct for the teacher-learner relationship 4. Teaching staff 4.1. Written policies and procedures for faculty appointment, promotion, tenure and code of conduct 4.2. Hiring of adequate teaching staff (ideally two full time academic staff) in the core areas to provide the first two years of instruction for the medical education programme and other faculty as needed for the implementation of institutional plans 4.3. A recruitment plan and timetable for hiring faculty to deliver the subsequent years of the educational program 5. Educational Resources 5.1 Budgets and supporting financial resources for the first five years of operation 5.2 Classroom space and supporting educational infrastructure for the first two years of instruction 5.3 Plans for providing classroom space and any supporting educational infrastructure for the subsequent years of study 5.4 Library and information technology services appropriate to the needs of the school for education, research, and patient care 5.5 Identification of clinical teaching sites accredited by a medical regulatory body. PART THREE: GUIDELINES FOR TEACHING HOSPITALS Teaching hospitals are key components in the training of doctors. It is desirable for such institutions to attain certain minimum requirements including: 1. Facilities 1.1 Medical wards 1.2 Surgical wards 1.3 Pediatric wards 1.4 Obstetrics and Gynecology 1.5 Emergency and Critical care medicine departments 1.6 Clinical support departments 2. Specialties 2.1 Medicine 2.2 Surgery 2.3 Pediatrics and child health 2.4 Obstetrics and Gynaecology 2.5 Pathology and Laboratory medicine 2.6 Radiology 2.7 Mental health 2.8 Emergency and Critical care medicine 2.9 Public Health (community medicine) 2.10 ENT, Dental, Eye, Orthopedics, Anesthesiology, Dermatology among others. 7
3. Relationship between Medical Schools and Hospitals 3.1 University hospital is ideal and is highly recommended 3.2 Non-university hospital (including satellite hospitals). 3.2.1 There should be clearly stipulated memorandum of understanding defining the following among others: 3.2.1.1 Total number of staff required for both service and teaching functions. 3.2.1.2 Distribution of staff between university and hospital 3.2.1.3 The role of staff in the medical school/hospital in areas of teaching and patient care 3.2.1.4 Student- patient ratio 3.2.1.5 Resources sharing 3.2.1.6 Quality assurance of services rendered. 3.2.1.7 Relationship between the departments of the hospital and the university. 3.2.1.8 Suitable accommodation facilities for students PART FOUR: RESPONSIBILITIES OF REGULATORY AUTHORITIES. The following should be executed as part of the implementation and evaluation process by the Medical and Dental Regulatory Bodies: 1. Approve all programmes and any modifications of the same. 2. Be responsible for evaluation in conjunction with appropriate organs of the Ministries of health and education in the region. 3. Form a regional medical and dental regulatory body. 4. Make statutory provision for recognition in the East African Community. 5. Prepare and carry out assessment and recognition of the medical programmes 6. Evaluate the implementation of recognition process annually 8
References: 1. World Federation for Medical Education: WFME Global Standards for Quality Improvement, 2003. 2. General Medical Council. Tomorrows Doctors Recommendation on undergraduate Medical Education. The Education Committee of the General Medical Council, London 1993. 3. Global Minimum essential requirement in Medical Education. Core Committee, Institute for International Medical Education. Copy 1999 2006. 4. Recognition guidelines for New and Developing Medical Schools. Caribbean Recognition Authority for Education in Medicine and other Health Professions CAAM HP 2.1 2004. 5. Core curriculum in Psychiatry for Medical Students. World Psychiatric Association. World Federation for Medical Education. WHO 2005. 6. Recognition of medical education institutions. Report of a technical meeting Schaeffergarden, Copenhagen, Denmark, 4 6 October 2004. 9