Health Professions Education in IRAQ

[align=left] بسم الله الرحمن الرحيم
السلام عليكم ورحمة الله وبركاته
This article was published in Annals of Iraqi Science 2008;Vol 1; Issue 1
Leading article

Health Professions Education In IRAQ
Abdulghani M. Alsamarai MD, MGUM, Ph D, FRCP
Mohammed S. Abdullah, MRCP; Jamal A. Latif, CABS; Alla H. Alwan, CABS
College of Medicine (Alsamarai) College of Dentist (Abdullah), Departments of Surgery (Latif), and Pediatrics (Alwan), Tikrit University College of Medicine, Tikrit, Iraq.

Requirements of patients care and selection of physicians on comparison of their efficacy, risen the need for improvement and implementation of changes in medical education. Changing paradigms of patient care requires a new approach to the education of health professionals for the improvement of care. These approach include vertically integrated undergraduate curricula, interprofessional learning, Redesigned residency programs, the development of exemplary clinical settings where optimal patient care and education take place in a professional career, and the creation of an academic base to facilitate theses goals.1
Regional and National Councils for Health Professions Learning Colleges [R/NCHPLC] and a National Accreditation Board for Graduate Medical Education [NABGME] need to be established. This board in collaboration with Regional and National Health Professions Learning Schools work to implement school wide curricula. This project to focus on interprofessional learning, vertically integrated improvement curricula, exemplary learning sites, faculty development, and student initiated quality improvement and organizational infrastructure.
In Iraq, there are 18 medical colleges, 17 of them run a tradition – based learning and only one is with innovative medical education curriculum that is Tikrit University College of Medicine (TUCOM).
Medical education and practice of medicine are a hybrids that involving both conceptional and working knowledge2. Over the previous years that follow establishment of medical colleges in Iraq, medical students in their preclinical years have been expected to acquire enormous amounts of conceptional biomedical knowledge, primary through lectures and readings, supplemented by seminars and laboratory experiments, and driven by written examination. The students try to understand and solve clinical problems in terms of that basic concept. However, during their clerkships ( 4th,5th and 6th years of their learning course) and residencies they switch to experiential learning as they begin to solve patients real problems, an approach that differs fundamentally from that what they acquired during their preclinical years. TUCOM adopted an innovative learning curriculum, incorporated problem based learning, community oriented, community based, student centered and competence oriented medical education. During the period from the date of establishment of TUCOM (1989) to date the college mission and faculty, member activities do perform effect to induce changes in other Iraqi college curricula and learning process. However, these changes are limited, because of notorious resistance to change.
The traditional medical education in Iraqi colleges, no longer is sufficient for medical students and residence to know that certain generalized biomedical principles and facts are true, they are not expected to know how to apply that knowledge to individual patient and groups of patients in ever more sophisticated ways. Thus there is a need for shift from a medical education curriculum focused mainly on structure and process to one concerned mainly with the development and measurement of competent performance that is, the ability to act, to deliver care.
Medicine is an extremely high performance profession. As to date, medical education included only a fragmented of experiential learning cycle: minimal classroom exposure to in adequate biological and clinical concepts, without linkage to actual case understanding and management, with little connection to cases to meaningful conceptional knowledge. Despite the introduction of clerkship into the formal structure of medical education, followed by residency and Iraqi board fellowship training, the primary focus of medical educators has been and remains , on cognition- helping leaders understand the biomedical concepts that are medicine unique intellectual asset- rather than on competence- the working knowledge that determine the quality and consistency of performance.
A number of innovative educational initiatives designed to develop competence in individual patient care have now taken root and are begin to spread, but still limited. These include problem based learning, practice of evidence based medicine, and the development and use of clinical guidelines. Unfortunately, even specialist neglects the use of clinical guidelines and most of them practice medicine under the influence of patients demand or as a trade. Some faculty members of the traditional medical education colleges in Iraq do believe that there is a need for changes in their curricula and learning process, but they do not implement this approach of education to their learning programs.
How the innovative changes performed in medical education in Iraq?
We think the change can be achieved by building Health Professional Learning Communities. The guide to action for creating professional learning communities start with the definition of six core elements as Richard Dufore address: a focus on learning; a collaborative culture with a focus on learning for all, collective inquiry into best practice; an action orientation (learning by doing); a commitment to continuous improvement; and a focus on results.
The first and obvious implication of pursuing the implementation of deep professional learning is for leaders to declare the aim is changing the learning culture of the colleges. There is also a need to distinguish between structure and culture, noting that college cultural change is the more important change and more difficult to achieve. Secondly, colleges should interact with each other to promote intra – college collaboration as educators show to others what they are doing and learn from others. Thirdly, encompass two – way interaction and mutual influence across the two levels of college and community. A bigger change take place when both colleges and community leaders found themselves engaged in changing of the system. Sophisticated practice based, performance oriented learning programmes will therefore be increasingly needed if medicine is to continue meeting one of its most fundamental professional obligations, unceasing movement toward new levels of performance3.
1. www.ihi.org/ IHI/Topics/ HealthProfessionsEducation -
2. Davidoff F. Focus on performance: The 21 st century revolution in medical education. Men's Sana Monographs. The Men's Sana Foundation, India, December. 2007.
3. Bataldien PB, Davidoof F. What is quality improvement and how can it transform care? Qual Saf Health Care 2007; 16: 2-3.