1.

INTRODUCTION The School of Medical Sciences, Universiti Sains Malaysia was established in 1979. The enrolment of the first batch of 64 medical students started in 1981. The school initially operated in the main campus in Penang. Beginning in 1983, the school moved instages to the new branch campus in Kubang Kerian, Kelantan. By 1990, the whole medical school was based in Kubang Kerian Health Campus. The Health Campus is fully equipped with up-to-date teaching, research and patient care facilities. This is in accordance with the primary aims for its establishment to produce doctors and medical practitioners to meet the nation's needs as well as to upgrade the medical services of the country. In addition to the undergraduate medical (MD) programme, the medical school also offers Masters of Medicine (M.Med), M.Sc and PhD in most of the medical related specialities. The School of Medical Sciences has three main functions, which are :(a) (b) (c) Teaching Patient-care services Research

DOCTOR OF MEDICINE COURSE (MD) In principle, the course is structured according to a multi-disciplinary approach. One of the unique features of the School of Medical Sciences is its integrated organ-system and problem-based curriculum. Emphasis is given to the holistic approach to a patient's medical problems in relation to his/ her family and community. The course aims to produce dedicated medical practitioners who will be able to provide leadership in the health care team at all levels as well as excel in continuing medical education. 1.1 OBJECTIVES/PHILOSOPHY The concept of a competent medical practitioner envisaged by the School of Medical Sciences is a person who upon graduation, having been equipped with a spectrum of medical knowledge, skills and attitudes is able to apply them for problem-solving, be it at an individual or community level. More specifically, the student upon graduation, should be able to:(a) (b) Understand the scientific basis of medicine and its application to patient care. Acquire a satisfactory standard of clinical competence related to the following parameters:(i) (ii) interview a patient and obtain a relevant case history. perform physical examination and basic clinical procedures.

(iii) (iv)

diagnose common diseases and acute emergencies and formulate their solutions, which entails institution of first line management before referral for specialist treatment whenever necessary. acquire satisfactory behavioural and communication skills necessary for establishing rapport with patients and planning their care.

(c)

Understand and appreciate the social and cultural background of the patient and his/her environment in formulating a plan of management including follow-up and long-term management. Understand the broader role and responsibilities of doctors in society and play a leadership role in a health care team and in the community. Utilise the knowledge acquired to pursue continuing medical education.

(d) (e)

1.2

CURRICULUM The Doctor of Medicine programme is a five-year course which is designed to be integrated, problem-based and community oriented. The programme is divided into 3 phases namely : Phase I Phase II 1st year 2nd and 3rd years

Phase III - 4th and 5th years Activities in Phase I, which is the first spiral, are enlarged and reinforced upon in the 2nd phase which comprises the 2nd spiral and so on. This spiral concept enables the school to implement the philosophy of both horizontal and vertical integration of subjects/disciplines. The Medical School in formulating the new curriculum, studied the various problems in established medical faculties parri passu with new developments in medical education. The basic educational strategies adopted by the School of Medical Sciences can be summarised by the acronym 'SPICES'. The SPICES model in this context means that the curriculum has the following features :S P I C E S Student oriented Problem-based Integrated Community oriented Electives Spiral and Systematic

A. PHASE I (YEAR 1) The first year programme is designed to provide a foundation course which includes the study of the normal human being and his/her normal responses to injuries. The study of behavioural sciences and exposure to the clinical environment are also incorporated. The course is implemented based on integrated systems/blocks as indicated below. Teaching is co-ordinated in such a way that related objectives are grouped together in specific blocks.

The systems blocks implemented in Phase I and their duration are as follows:Block Nervous System Musculoskeletal Gastrointestinal Biology Molecul & Pharmacology Haemopoietic and Lymphoid System Endocrine & Metabolism Systems Cardiovascular Respiratory Cell and tissue Urinary System Host and Enviroment Reproductive Nutrition Bioethics and Social Sciences Nursing First Aid B. PHASE II (YEAR 2 AND YEAR 3) Problem-based learning forms a major educational strategy during the 2nd and 3rd years. The problems are structured around blocks consisting of the various organ-systems. Clinical Sciences courses The course in Clinical Sciences involves the integration of a number of subjects taught concurrently by various disciplines. The aim is to integrate the teaching of the undergraduate medical sciences both horizontally and vertically so that the understanding of the disease processes is made efficiently. Duration (weeks) 4 4 3 2 2 2 2 2 2 2 2 1 1 1 1 1

The following are the blocks included in the Phase II programme. Block 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. General Block Respiratory Cardiovascular Gastrointestinal Genitourinary Musculoskeletal Haemopoietic & Lymphoid Endocrine Clinical Bioethical & Communication Skill Nervous System Psychological Medicine Reproductive Communicable Diseases Electives Duration (Weeks) 4 4 4 5 4 4 4 4 2 2 5 4 5 5 4

(The complete objectives are set out in the Objectives Book for Phase II).

Introduction To Clinical Clerkship A series of clinical attachments are carried out in the wards during each teaching block, where closely supervised clerkships are undertaken, designed to introduce students to clinical medicine. C. PHASE III (YEAR 4 AND YEAR 5) During this phase, greater emphasis is placed on the acquisition of skills in clinical work. Clinical work and hospital attachments account for a high percentage of the students time in these two years. Emphasis will be given to problem - solving, and clinical reasoning rather than didactic teaching. Apart from this clinical exposure, the student is also orientated to health care delivery services within the teaching hospital and the network of the supporting hospitals and health centres in the region. The aim is to inculcate a sense of professional responsibility and adaptability so that the student will function effectively when posted later to the various health care centres in the country. The teaching strategy implemented in this phase reflects these approaches:(i) (ii) (iii) Discipline - based Multi-diciplinary integration Problem - based and problem-solving

(iv) (v)

Community-orientated Clinical apprenticeship

To implement the above teaching strategies, Phase III program is divided into: (a) Departmental/ Block Posting (b) Integrated blocks (a) Departmental/ Block Posting The main thrust of Phase III teaching is departmental postings of various clinical disciplines. Some of the disciplines are combined together to ensure a similiar length of posting The students are divided into small groups. These groups rotate through various blocks. The duration of each block is 6 weeks in Year 4 and 5 weeks in Year 5. The duration of each block is as outlined in table 1 and 2. The general objective of each rotational posting/ block is to: (i) allow the student to acquire the competencies appropriate in that discipline both in relation to practice in hospital and in the community. to make him/her appreciate the relevance of the discipline in the overall care of patients.

(ii)

The essence of the block posting will be the apprenticeship model. Learning experiences include: (i) (ii) (iii) (iv) (v) (vi) clerking of patients investigation of patients participation in the treatment of patients in the wards teaching ward rounds attending out-patient clinics or operation theatre attachment to district hospitals, health centers and work in the community (vii) seminars, tutorials and audit sessions (viii) self-study (ix) integrated multi-disciplinary sessions (x) bioethics rounds/discussions (xi) ward work (xii) log books