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he alignment of intended learning outcomes of postgraduate medical courses/ programmes with clinical outcomes is crucial for development of competencies for healthcare professionals. Put simply, what medical students learn in their training must directly connect to providing better patient care. In order to fully understand the process, lets familiarise ourselves with some basic concepts relating to postgraduate medical training programmes and trainers.
Generally, main components of a medical curriculum include: objectives, teaching methods, and assessment. A written curriculum provides the framework; the taught curriculum includes lectures, group work and discussions; workshops are also an integral part of the training. In order to deliver a written curriculum effectively, it is important that all three elements are delivered appropriately and the curriculum is reviewed regularly based on student’s performance and feedback.
The key competencies a clinician requires include communication skills, psychomotor skills (physical movements and coordination), decision-making and problem-solving. Psychomotor skills include the ability to perform clinical examination and various procedures. These are assessed as directly observed procedural skills (DOPS). This is a form of workplace-based assessment (WPBA). Another type of WPBA is a case-based discussion. This allows the trainee to improve application of theoretical knowledge in a clinical setting. A number of competencies can be assessed using this method.
Various methods of assessments are available in medical education. One objective form of assessment is multiple choice questions (MCQs). A well-constructed MCQ can verify a candidate’s recall, analysis and interpretation of the given information. A high quality MCQ focuses on a single concept and has ‘plausible’ incorrect options. Development of high quality MCQs can be challenging and requires faculty training.
Clinical assessments can be done through objective structured clinical examinations (OSCE). These have observed and unobserved stations or task-oriented assessment of clinical skills (TOACs) at interactive or static stations. It is noteworthy that TOACs are an initiative of the College of Physicians and Surgeons, Pakistan. The interaction between the candidate and examiner in TOACs allows for in-depth and extensive evaluation. These methods allow assessment of competencies through clinical scenarios with simulated or real patients and examiners. Development of challenging clinical scenarios by faculty requires training. Recent research shows that peer-assisted learning can boost students’ confidence in clinical practice and improve learning in both hands-on skills and knowledge areas, particularly relevant for institutions facing faculty shortages.
When medical schools align their teaching with real-world healthcare needs, students become better doctors and patients receive higher-quality care.
There is a need also for the faculty’s professional development. Students’ evaluation can be more effective with regular training programmes to enhance understanding of evaluation methods.
Medical educators’ skills and knowledge can be enhanced through structured programmes like medical faculty development and train-the-trainer courses. Such programmes focus on teaching methodologies, learning techniques and creating engaging learning environment and developing administrative and leadership skills for the faculty. These courses offer support to junior faculty through facilitation and mentoring, which in turn helps them train the future generation of doctors.
Structured training involves: eligibility criteria to enter in the programme, learning objectives as per an approved curriculum, feedback to trainees, midway assessment and exit exams leading to a qualification. Training sites (hospitals, healthcare facilities) approved for structured postgraduate medical training with qualified supervisors overseeing the training programme help in on-the-job training of residents.
Medical education outcomes and clinical data may exist in unconnected databases. This can make connecting learner outcomes with patient outcomes difficult. This disconnect means that medical schools often don’t know if their graduates provide the best patient care.
There is a need to standardise assessments to ensure fairness and achieve better outcomes – fewer errors in managing patients. There is evidence that graduates from programmes with better training methods encounter fewer complications in their clinical practice. The ultimate goal is improved patient safety.
Teachers at a medical institution are not only responsible for improving the learning outcomes for their student but also for their own professional development. A well-equipped faculty is aware of the latest teaching approaches and skills. It is actively involved in research projects, too. When medical schools align their teaching with real-world healthcare needs, students become better doctors and patients receive higher-quality care.
The writers wish to thank Associate Professor Paediatrics, UCHS, Dr Wajiha Rizwan, for providing invaluable information for this article.
Dr Hina Jawaid is an associate professor in family medicine at Health Services Academy, Islamabad.
Dr Tehzeeb Zulfiqar is a research fellow at Australian National University, Canberra.