Implementation of Competency Based CommunityMedicine Curriculum in Undergraduate MedicalEducation: Time to Think and Act.

A curriculum symbolizes the expression of learning and teaching designs in practice. Harden defines the curriculum as “a sophisticated blend of educational strategies, course content, learning outcomes, educational experiences, assessment, the educational environment and the individual students’ learning style, personal timetable and programme of work”. A well-planned curriculum which is implemented in an effective manner can act as a cost effective intervention to improve the quality of education, produce a skilled human resource, and thereby improve the health status of people residing in the resource poor communities. Recently, Medical Council of India, came out with new Graduate Medical Education Regulations 2018 in order to implement much awaited competency-based curriculum in undergraduate medical education.

Competency based curriculum which is also known as outcome-based curriculum keeps the programme outcomes at the centre and designs competencies, learning objectives, teaching learning methods, assessment and programme evaluation based on them. The entire process is student centric, participatory, feedback driven, collaborative, reflective and evolves as the learner proceeds along the educational process.

Community Medicine, one of the core areas of undergraduate medical education is taught over three years from year one to pre final phase of MBBS. The subject strives to bridge the gap between clinical medicine and public health and creates an Indian Medical Graduate who can efficiently and confidently work as a primary care physician. The new curriculum rolled out by MCI has provided 187 outcomesin Community Medicine spread over 20 different topics. Of these competencies 107 are stand alone and 87 are integrated outcomes to be achieved with other subjects by aligning horizontally and vertically across the years. In order to achieve these learning outcomes a total of 217 hours of teaching and 10 weeks of clinical postings have been allotted across three years. Out of 217 teaching hours, 80 hours are earmarked for lectures, 117 hours for small group teaching sessions like tutorial/seminar/integrated teaching and 20 hours are dedicated for self-directed learning sessions. 

When we peep into MCI list of competencies in Community Medicine, we can realize that most of the competencies are set at the lower level of Blooms taxonomy by using the phrases like to describe, enumerate, define, list etc. Unless the subject level competencies are aligned with the overall programme outcomes and practical applications like health care at individual, family and community level, they are considered to be less effective. Thus, this curriculum should have considered incorporating higher level cognitive and skill-based competencies in the area of Community Medicine in order to bring out a ready to serve primary care physician. Looking at the topic specific competencies there is a lack of clarity with reference few outcomes. For example, competency no. CM 8.1 says, "describe and discuss the epidemiological and control measures including the use of essential laboratory tests at the primary care level for communicable diseases" but will not specify which all communicable diseases are to be included under this competency. Each Institution/ University may perceive this in its own way and teach their students leading to lack of uniformity across the colleges. This non uniformity may be since, MCI has listed only the competencies and allowed the institutions/universities to list their own SLOs. Few competencies look overlapping across different topics, which need a very close attention while framing the learning objectives.

Coming to the acquisition of skills, there are no certifiable skills/competencies allotted to Community Medicine, even though there is a lot of scope to do so. The certifiable skills need not be restricted to the ones taught and assessed at the skills labs. Skills like counselling, anthropometry, preparation of Oral Rehydration Solution, health education at small groups, applying statistical measures/tests, use of computers in data interpretation could have been incorporated.

There is also a need to have a closer attention towards assessment part in the curriculum. GMER 2018 mentions that, there should be one internal assessment at the end of each term of MBBS in subjects which are taught for more than one academic year. As Community Medicine is taught across six terms, we need to conduct six internal assessment examinations. How much weightage must be given for assessment at each term of MBBS and which method of assessment must be adapted? time constraints associated with tests are another important set of questions which need serious attention. One ray of hope is that this curriculum document is a fluid one and will undergo changes over years based on the feedback and experiences shared by us to the medical council.

Now the time has come to go in a more collaborative way by intellectual contributions, mutual hand holding, sharing of best practices across the medical colleges in order to effectively implement of this curriculum. Designing uniform set of learning objectives, planning similar teaching-learning strategies, developing meaningful assessment methods across the medical schools through participatory learning is the more meaningful option ahead.