Medical Education System Worldwide Survey - 2018

Medical Education System Worldwide Survey Report

September 2018 SCOME International Team 2017/18

Table of Contents Medical Education System Results Map. Link here.

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1. Introduction to the Medical Education System Survey

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2. General results and statistics

4

3. Results in depth

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4. The way forward for next MES Survey

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Medical Education System Results Map. Link here.

1. Introduction to the Medical Education System Survey About the Medical Education System Survey The SCOME International Team 2017/18 created this survey to outline how Medical Education Systems are formulated globally and understand the variations between schools, countries & continents. Our desired outcome was to collect comprehensive information, that includes details of diverse medical curricula in an attempt to detect similarities and differences, repetitive narratives and find new areas of work for SCOME internationally.

Problem Statement SCOME had a lack of data about the medical education systems from around the world. Information that is really useful for the development of the international work of the Committee, as well as a worldwide understanding of different areas of medical education such as the pre-clinical training, clinical training and accreditation process from medical schools was lacking.

Objectives - To collect information on how the various Medical Education Systems are set up across the IFMSA network.* - To provide the collected medical education systems data to IFMSA members and medical students worldwide to understand the global variances in medical education and have evidence-based support for their activities.

- To provide data for relevant externals in order to collaborate on future Medical Education projects.

Considerations and Limitations This medical education system survey was made by the SCOME International Team and was filled voluntarily by medical students from around the world. The results collected and presented in this report are not a representation of the official medical schools’ curricula. This should be taken into consideration when analyzing the data presented here. All answers were tabulated, regardless of the participants’ year of studies or the number of answers from the same country. *This survey is not meant to assess the quality of the educational institutions.

2. General results and statistics We got 371 responses, from 83 countries, covering all the 5 Regions, Africa, the Americas, Asia Pacific, Eastern Mediterranean Region, and Europe.

Countries that participated in the Survey

Type of University

National Unified Medical Curriculum 169 students reported not having a unified curriculum, 135 reported having a unified curriculum, 67 of the responders were unsure of their curriculum structure.

Gender of participants 191 female, 176 male, 1 non-specified.

Year of studies currently attending (when answering the survey)

Duration of Curriculum

Language 86 responders study in a language different from the one spoken in their countries, 274 in the same language, and for 10 students the language of instruction is just one of the languages spoken in the country.

Overall, I am satisfied with the quality of my medical education Average 3.36/5

What is the duration (in years) of your pre-clinical training?

*There is no standalone pre-clinical training.

What is the duration (in years) of your undergraduate clinical training?

*More than 4 years or others

Which types of teaching and learning methodologies do your school use?

Traditional pre-clinical –mainly lectures and tutorials covering science-based modules. Each subject like anatomy, embryology is taught as a separate course.

Integrated – scientific knowledge is taught by the system rather than discipline, eg Renal system, Cardiovascular system etc.

Problem-based learning (PBL) - the emphasis is on peer-to-peer teaching, small group learning and problem-solving.

Case-based learning (CBL) - uses virtual ‘trigger’ cases to prompt learning of a particular area of the curriculum.

Enquiry-based learning (EBL) - learning starts with the posing of questions, problems or scenarios.

Which year offers the first encounter with the patient in a clinical setting?

Access to the Medical career: which of the following postgraduate options are available in your country?

*Post-graduate studies in healthcare-related disciplines (Public Health, Health Economics, Human Resources for Health...) *Residency and Specialization

Internal Medicine Is a mandatory class Is an elective Is integrated into another course (eg a general Internal Medicine course) Is NOT included in the medical curriculum

Internal Medicine - Duration of the course One semester or less 2 semesters 3 semesters or more Is NOT included in the medical curriculum

Internal Medicine - Evaluation Written evaluation Oral Evaluation Practical Skills evaluation Is NOT evaluated Is NOT included in Medical Curriculum

Surgery

Is a mandatory class Is an elective Is integrated into another course (eg a general Internal Medicine course) Is NOT included in the medical curriculum

Surgery - Duration of the course One semester or less 2 semesters 3 semesters or more Is NOT included in the medical curriculum

Surgery - Evaluation Written evaluation Oral Evaluation Practical Skills evaluation Is NOT evaluated Is NOT included in Medical Curriculum

Psychiatry - is it included in your medical curriculum?

*Yes, as an elective course *Yes, as a mandatory course

Psychiatry - what is the duration of the course [Theoretical Classes]?

Is internship mandatory in your medical curriculum?

Do you receive any salary for your internship?

Are hospital shifts mandatory or optional in your medical curriculum?

Usually how many hours is your shift at the hospital?

Is your medical school accredited?

Is your medical school accredited by a national or an international body?

3. Results in depth a. General Report: The survey had 371 responses covering medical schools from the 5 regions affiliated to IFMSA, on different scales of regional representation: Americas 36.9%, Europe 32.9%, EMR 10%, Africa 8,5% and Asia Pacific 11,7%.

72,2% of the medical schools represented by our survey belong to the public sector, versus 27.2% to the private sector, with some exceptions of one medical university that is owned by a religious institution. When it comes to the curricula, not all the countries have a unified national curriculum, of which only 36.4% do have a national standardized medical curriculum, versus 45.6% who don’t. As for the duration of the curriculum, most of the medical schools (65%) have a 6 year medical education program, compared to 15.1% of medical schools who follow a 7 years program and 10,5% whose curriculum does not exceed 5 years.

74.5% of Medical Schools use the same language of instruction as the language of communication with patients. Thus, we should not underestimate the usage of each native language, even though English is predominant as a teaching language according to the results of our Survey. b. Pre-clinical Training: Duration: more than half of medical schools have a 3 year program of pre-clinical training for medical students (52%), versus 35% of medical schools who have a 2 year program. A minority of medical schools follow a 4 year program (2.4%). However, we shouldn’t neglect some medical schools who do not have an independent pre-clinical training, as the Problem-Based Learning approach integrates the learning objectives of both preclinical and clinical trainings.

Subjects: the topics that are most represented within the curricula are: Anatomy (99.7%), Physiology (98.7%), Biochemistry (96.8%), Histology (95.7%), Embryology (92.5%), Microbiology (92.5%) and Pharmacology (90.3%). he least represented subjects reported are: Physics (39.9%) and Behavioural Science (41.5%).

Teaching and Learning Methodologies: traditional teaching dominates the teaching methodologies (77.1%). To some extent, other teaching methodologies are also used within the curricula such as Integrated Systems Course (36.7%), Problem Based Learning (33.4%), Case-Based Learning (23.2%) and Enquiry Based Learning (10.8%). c. Clinical Training: Duration: more than half of medical schools have a 3 year program of clinical practice for medical students (57.1%), versus 27% of medical schools who have a 2 years program. Only 7.8% of medical schools have a 4 years program of clinical training. In addition to that, we should mention that some medical schools have an integrated

medical education system that doesn’t make of its clinical training independent of the preclinical training. Consequently, 42% of medical students get their first clinical encounter during their 3rd year, versus 17.3% of medical students whose first encounter with a patient starts later at the 4th year. However, a considerable number of medical schools provide medical students with an early clinical exposure during 2nd year (17%), or even during the first year of medical school (19.9%) Internal Medicine: - Subjects: most of the subjects are mandatory, whether as independent subjects (64.7%), or integrated into another course (31.5%). Only 2.4% of the courses were electives, as well as 1.3% of the courses were stated as not included in the curriculum. When it comes to subjects’ exposure, most of them are taught during one semester (76.3%), versus some subjects that are taught during more than one semester: 10.8% are taught during 2 semesters, and 8.6% during 3 semesters or more.

- Evaluation methods: medical schools use a variety of evaluations methods regarding the learning objectives of each subject. Written evaluation of only 31%, oral evaluation only 5.1%, practical skills evaluation only 3.8%. In many cases a combination of evaluation methods is used for each subject, such: Written, Practical and Oral Evaluations 29.1% Written and Oral Evaluations 10%, Written and Practical Evaluation 14.3%. We shouldn’t omit that some subjects are not evaluated as they are electives.

Surgery: - Subjects: 83% of the subjects are mandatory, of which only 11% are integrated in another course. Only 2.7% of the courses were electives, as well as 2.7% of the courses were stated as not included in the curriculum. When it comes to subjects’ exposure, most of them are taught during one semester (56.1%), versus some subjects are taught during more than one semester:22.4% are taught during 2 semesters, and 18.1% during 3 semesters or more.

- Evaluation methods: medical schools use a variety of evaluations methods regarding the learning objectives of each subject. Written evaluation only 25.6%, oral evaluation only 6.2%, practical skills evaluation only 5.1%. In many cases a combination of evaluation methods is used for each subject, such: Written, Practical and Oral Evaluations 30.5% Written and Oral Evaluations 12.4%, Written and Practical Evaluation 14.3%. We shouldn’t omit that some subjects are not evaluated as they are electives.

Psychiatry: - 93.5% of medical schools stated that Psychiatry was a mandatory topic, versus 3% of medical schools having Psychiatry as an elective course. Only 3.5% of medical schools stated that psychiatry isn’t part of their curricula.

- Medical students exposure to Psychiatry Education:

-

Theoretical classes: 52.8% of medicals schools’ psychiatry course duration exceeds 30 days. 27.2% of medical schools have stated that psychiatry course duration is comprised between 16 and 30 days, meanwhile, only 16.7% of medical schools stated that their psychiatry course duration doesn’t exceed 15 days Practical classes: 32.1% of medicals schools’ psychiatry course duration exceeds 30 days. 28.8% of medical schools have stated that psychiatry course duration is comprised between 16 and 30 days, meanwhile, only 29.9% of medical schools stated that their psychiatry course duration doesn’t exceed 15 days.

Within psychiatry education, medical schools use a variety of evaluation methods: Multiple Choice Exams 67.7%, Written Theoretical Exams 51.5%, Oral Theoretical Exams 34%. As well as Clinical Interviews are used as an evaluation method, whether with a real patient in 28.3% or with a simulated patient 15.3%.

d. Internships: - 86.8% of medical schools stated that the internship is a mandatory part of their curricula. As for the rest, it is not mandatory either because it’s not part of their educational goals, or it is instead part of the medical licensing process after graduation.

- 44.7% of medical schools stated that the internship duration is limited to 1 year, versus 30.5% whose internship duration is 2 years. Only 8.1% have a 3 years internship program.

- In 45.3% medical schools, students get paid for their internship. Meanwhile, 47.7% of medical students don’t get paid.

- 75.2% of medical students stated that it is mandatory to complete hospital shifts, which is 66.7% cases it doesn’t exceed 12h, in 19.8% it is 24h long, and in 13.4% cases it can go 36h long and more. Consequently, medical students are mandated to complete at least 5 shifts per month in 45% of cases.

- 53.1% of medical schools allow medical students to complete internships abroad. Meanwhile, it is not possible for at least 33.7%, whether because the system doesn’t allow it, or it is limited to a specific exchange program such as Erasmus. e. Post-graduate opportunities: When it comes to postgraduate opportunities, General Practice is pursued in 77.6% of medical schools, Residency in 92.7% of medical schools, Research in 69% and other healthcare related studies are also available in 64.2% cases.

4. The way forward for next MES Survey As explained on the first page of this report, there is a number of limitations and considerations of the data collected that can be improved in future Surveys.

The main point to consider for the future is that a validation process for the data should be implemented in order to provide accuracy in the collected information and that comes as close as possible to reality.

If the Survey is repeated, other medical education questions related to IFMSA areas of work can be implemented. For example, the IFMSA programs topics, the IFMSA Global Priorities, etc.

A dynamic spreadsheet with the results could be created, so data can be sorted by the question, by the region, by the country or even, by the medical school. It should respect privacy policy, and the validation process mentioned before.

The information from this report can be used for the work of our NMOs, advocacy activities, projects, etc. But the limitations of the current data should be taken into consideration.

Algeria (Le Souk) Argentina (IFMSAArgentina) Armenia (AMSP) Aruba (IFMSA-Aruba) Australia (AMSA) Austria (AMSA) Azerbaijan (AzerMDS) Bangladesh (BMSS) Belgium (BeMSA) Bolivia (IFMSA-Bolivia) Bosnia & Herzegovina (BoHeMSA) Bosnia & Herzegovina – Republic of Srpska (SaMSIC) Brazil (DENEM) Brazil (IFMSA-Brazil) Bulgaria (AMSB) Burkina Faso (AEM) Burundi (ABEM) Cameroon (CAMSA) Canada (CFMS) Canada – Québec (IFMSA-Québec) Catalonia - Spain (AECS) Chile (IFMSA-Chile) China (IFMSA-China) China – Hong Kong (AMSAHK) Colombia (ASCEMCOL) Costa Rica (ACEM) Croatia (CroMSIC) Cyprus (CyMSA) Czech Republic (IFMSACZ) Democratic Republic of the Congo (MSA-DRC) Denmark (IMCC) Dominican Republic (ODEM) Ecuador (AEMPPI) Egypt (IFMSA-Egypt)

El Salvador (IFMSA-El Salvador) Estonia (EstMSA) Ethiopia (EMSA) Finland (FiMSIC) France (ANEMF) Gambia (UniGaMSA) Georgia (GMSA) Germany (bvmd) Ghana (FGMSA) Greece (HelMSIC) Grenada (IFMSAGrenada) Guatemala (IFMSAGuatemala) Guinea (AEM) Guyana (GuMSA) Haiti (AHEM) Honduras (IFMSAHonduras) Hungary (HuMSIRC) Iceland (IMSA) India (MSAI) Indonesia (CIMSA-ISMKI) Iran (IMSA) Iraq (IFMSA-Iraq) Iraq – Kurdistan (IFMSAKurdistan) Ireland (AMSI) Israel (FIMS) Italy (SISM) Jamaica (JAMSA) Japan (IFMSA-Japan) Jordan (IFMSA-Jo) Kazakhstan (KazMSA) Kenya (MSAKE) Korea (KMSA) Kosovo - Serbia (KOMS) Kuwait (KuMSA) Latvia (LaMSA) Lebanon (LeMSIC) Lesotho (LEMSA)

Libya (LMSA) Lithuania (LiMSA) Luxembourg (ALEM) Malawi (UMMSA) Malaysia (SMMAMS) Mali (APS) Malta (MMSA) Mexico (AMMEF-Mexico) Montenegro (MoMSIC) Morocco (IFMSAMorocco) Nepal (NMSS) The Netherlands (IFMSA NL) Nicaragua (IFMSANicaragua) Nigeria (NiMSA) Norway (NMSA) Oman (MedSCo) Pakistan (IFMSA-Pakistan) Palestine (IFMSA-Palestine) Panama (IFMSA-Panama) Paraguay (IFMSAParaguay) Peru (IFMSA-Peru) Peru (APEMH) Philippines (AMSAPhilippines) Poland (IFMSA-Poland) Portugal (ANEM) Qatar (QMSA) Republic of Moldova (ASRM) Romania (FASMR) Russian Federation (HCCM) Russian Federation – Republic of Tatarstan (TaMSA) Rwanda (MEDSAR) Saint Lucia (IFMSA-Saint Lucia) Senegal (FNESS)

www.ifmsa.org

medical students worldwide

Serbia (IFMSA-Serbia) Sierra Leone (SLEMSA) Singapore (AMSASingapore) Slovakia (SloMSA) Slovenia (SloMSIC) South Africa (SAMSA) Spain (IFMSA-Spain) Sudan (MedSIN) Sweden (IFMSA-Sweden) Switzerland (swimsa) Syrian Arab Republic (SMSA) Taiwan - China (FMS) Tajikistan (TJMSA) Thailand (IFMSA-Thailand) The Former Yugoslav Republic of Macedonia (MMSA) Tanzania (TaMSA) Togo (AEMP) Trinidad and Tobago (TTMSA) Tunisia (Associa-Med) Turkey (TurkMSIC) Turkey – Northern Cyprus (MSANC) Uganda (FUMSA) Ukraine (UMSA) United Arab Emirates (EMSS) United Kingdom of Great Britain and Northern Ireland (SfGH) United States of America (AMSA-USA) Uruguay (IFMSA-URU) Uzbekistan (Phenomenon) Venezuela (FEVESOCEM) Yemen (NAMS) Zambia (ZaMSA) Zimbabwe (ZIMSA)