Mulazim Hussain Bukhari  ( University College of Medicine, University of Lahore, Lahore, Pakistan )
Ali Abutiheen  ( Department of Family Medicine, University of Kerbala, Iraq )
Fatema Jawad  ( Editor-in-chief, Journal of Pakistan Medical Association, Karachi, Pakistan. )
Shahzad Anwar  ( Department of Urology, Institute of Medical Sciences, Lahore, Pakistan )
Hassan Nasrullah  ( Department of Internal Medicine, University of Kerbala, Iraq )
Ali Mehdi  ( Department of Orthopedic, University of Edinburgh, UK )
Asad Ali Shah  ( Department of Urology, Institute of Medical Sciences, Lahore, Pakistan )
Tabassum Zehra  ( Department of Educational Development, Aga Khan University, Karachi, Pakistan )
Iffat Batool Syed  ( Department of Dentistry, Sharif Medical & dental College, Lahore, Pakistan )
Ali Ayub  ( Department of Orthodontics, HBS Medical & Dental College, Islamabad, Pakistan )
Musarrat Ul Hasnain  ( Department of Medical Education, Rai Medical College, Sargodha, Pakistan )
Shabih H Zaidi  ( Department of Medical Education, Medics' International virtual university, London, UK. )

The current status of medical education in Iraq requires complete transformation to conform to the latest trends of modern education. Presently it is compromised due to the influence of political factors, finances, weakness or fragility of planning and security. It has to be re-shaped for the future of medical education to produce good and efficient medical professionals. It is necessary to reform and revise the curriculum as accreditation in accordance with international medical universities. The initial requirement is faculty development in areas including but not limited to, curriculum development, teaching and learning improvement, research capacity building, and leadership development. The capacity building of faculty at College of Medicine, University of Kerbala (CMUCK) has been initiated in collaboration with Medics International at a local and the government level. Medics International conducted the current Course on Certificate in Health Professions Education (CHPE) programme in September, 2019 to facilitate the faculty to revise their curriculum and improve their current educational practices. Further steps will be taken to develop the faculty for Masters in Medical Education (MME), PhD, and fellowship programmes. To face the on-going challenges in the medical and health care system, continous efforts are required for faculty education. Medics International has volunteered to begin a series of Webinars through its global faculty to reach out to the Iraqi Board followed by engagement of the Arab Board covering 18 countries.

Key words: Health Professions Education, HPE, College of Medicine, University of Kerbala (CMUCK), Medical Education

 

Introduction

 

¹Iraq, formerly known as Mesopotamia, occupies a major part of the Arabian Peninsula and has a population of approximately 39,507,548. It is situated between the two main rivers Tigris and Euphrates, where the first Prophet was sent. Many Prophets as Noah and others have their burial place in various cities as Najaf Ashraf, Nineveh and Baghdad.^1,2 Kerbala is one of the holy cities in Iraq considered sacred due to the presence of the Shrines of Imam Hussain (AS) and his Brother Hazrat Abbas (AS). Like Maccah, and Madina, millions of pilgrims visit Kerbala, situated about 100 KM from Baghdad, round the year. It is located on the bank of Euphrates on the edge of the desert, with the beautiful greenery of fruit orchards and palm groves. It is one of the most neat, clean and peaceful cities of Iraq. The Concept of Kerbala is based on the eternal Truth (Haq) which could not be destroyed into capitulation, even at the cost of sacrificing lives. A preview of the history of Kerbala starting from Adam (AS) to every succeeding Prophet has proved the greatness and unmatched sacrifice made by Imam Hussain and his companions.^3,4

 

Medical education in Iraq: Past and Present

 

Currently there are around 25 medical colleges in Iraq which produce approximately 3000 graduates per annum.⁶ The first medical college in Iraq was the Iraqi Royal Medical College (now Baghdad College of Medicine) founded in 1927 by a group of Iraqi doctors who graduated from international medical schools. Harry Sanderson (a British Physician) was the Dean of Medicine who established the first medical curriculum in coordination with the Royal College of Surgeons (Edinburgh) and set a strategic plan for medical education in Iraq.⁶ In the beginning, the health services in Iraq began to advance from a reliance on traditional medicine towards a modern health care system with health care personnel drawn mainly from neighbouring Arab countries and the subcontinent. Medical schools continued to expand in other cities of Iraq as Mousel, Basra, and Mustansiriya. The medical training and education system reached its peak during the late 1970s and early 1980s. Iraqi medical schools became a destination for scholars from the Middle East and Africa. The quality of medical training was in accordance to international guidelines and it was continually being updated. Iraqi doctors received regular fellowships for postgraduate training in United Kingdom. These efforts improved the health care system making Baghdad Medical City Hospital one of the largest and best-equipped hospitals in the Middle East. Additionally, the first heart center in the Arab world was established in Iraq. It was in 1980s which was considered the Golden Era.⁶ Regretfully came a period of regression both in academic curriculum and teaching technology, for undergraduate and post graduate medical education. Multiple factors were responsible for this decline as wars, sectarian conflicts, and financial sanctions, which had a long lasting effect on medical education and training. Today, the field of medical education and training in Iraq faces multiple challenges resulting from the lack of facilities, financial support,and doctors' emigration due to violence and political unrest.⁷ Health Professionals in Iraq are now looking forward to a significant change utilizing new technology with innovative methodologies in medical education and training, and to revive international communication channels.Iraqi health professionals and academicians are building collaborations with professionals and organizations abroad.⁸ The challenges to medical education in Iraq include lack of vision, outdated curriculum, student selection process not linked to national standards of entry, traditional teaching methods, student assessments, poor quality of educational research, lack of accreditation standards and unavailability of proper facilities. The colleges concentrate more on students' attendance and less on updating the outdated curriculum. There is lack ofan effective regulatory system in Iraq to monitor and improve the quality of medical education and educational practices.³ Similarly, there are no published universal guidelines from the regulatory authorities. In majority of the medical colleges learning is still traditional, and characterized by a teachercentered approach. The new trends and educational theories of teaching and learning are considered obsolete. The modern style of medical education promoting student-centered approach has not yet been introduced in most of the institutions across the nation.^2,9 In 2016, there were 24 medical colleges in Iraq including public and private sector. The first private college was introduced in 2017.¹⁰ Few colleges' started to adopt integrating curriculum which was initiated by Kufa Medical College in 2012 followed by 3 others including Medical College - University of Kerbala (CMUK) in 2013. Some of the institutions, as Kufa College of Medicine and University of Kufahave taken the initiative of changing to a studentcentered integrated curriculum since 2010 in collaboration with international universities like University of Leicesterand Edinburgh. Kerbala Medical University follows the Problem Based Learning (PBL) approach.

 

The vision and mission of current medical education activity

 

The certificate course in Health Professions Education was conducted to enhance collaboration in health professions education between Medics International and College of Medicine, Kerbala University faculty capacity. The activity was conducted to improve capacity of faculty at Kerbala University with an aim to maintain the quality of health care delivered by future doctors to patients.

 

Introduction of the Certificate Course in Health Professional Education

 

The course was held at the College of Medicine, Kerbala from 8th to 14th September 2019. The objective was to develop the faculty in Health Professions Education (HPE) for eventually bringing a change and revive the curriculum of medical education in Iraq based on international standards, practices and guidelines. The faculty of Kerbala Medical University was introduced to the modern methods of student - centered teaching adopting the role of facilitators for effective guidance. Medics International in collaboration with the Government of Iraq and Kerbala Medical University took up this task of conducting a high standard certificate course in HPE, which was attended by faculty members from all over the country. The course comprised of five (05) modules including 1) Curriculum 2) Leadership, Professionalism and Quality assurance 3) Assessment 4) Instructional Strategies and 5) Research Methodology. The broad topics included basics of curriculum development, types of curricula, educational cycle, types and principles of assessment, work place based assessment, developing items, leadership qualities, professionalism, student-centered instructional approaches and engagement strategies, problem based learning and problem solving methods, Skill labs, simulation, structuring webinar methods, Research and its writing etc. The current CHPE programme should assist the CMUCK to revise their curriculum in a manner to face the future challenges in Medical and health care system.

 

Course Proceedings

 

Day One - 08, September 2019

Prof Hassan Nasrullah, the Dean of College of Medicine, University of Kerbala (CMUK) declared the course open by presenting his welcome address. He gave a brief description of the current status of medical education and professional development in Iraq and considered it a privilege to be a part of the CHPE in collaboration with Medics International. Dean Nasrullah emphasized that there was a need to integrate current modern education the system in Iraq through faculty development. This has taken root all over the world and despite challenges, in some medical institutes of Iraq. Also he said that due to the lack of a uniform structured and integrated medical education curriculum, the faculty is facing difficulties. He hoped that this CHPE program would bring all the major Medical education stakeholders in Iraq on to a common platform along with Medics International (MI) experts to integrate this system for the faculty development program. Speaking on this occasion, Dean of Medics International Virtual University, Professor ShabihZaidi emphasized on having more similar courses to familiarize the faculty and stakeholders in bringing about this change for the better. Prof ShabihZaidi, as the ex-president of Medics International, discussed the role of health professions' education in different regions including Pakistan, Iran and Arab counties along with Europe and the USA. He also thanked the Dean of KCMUK for inviting MI to conduct this educational activity. Dr. Zaidi being the pioneer of educational activities in Iraq through Medics International had initiated this programme in 2016. This year in 2019, was the third comprehensive educational activity of the series.¹¹ The conference programme on the first day mainly included curriculum development from all aspects including Kerns Cycle and Spices Model. There were group and interactive discussions with the facilitators, Professor. Muhammad Shahzad Anwar and Professor Mussarat UL Hasnain.

 

Day Two - 11, September 2019

The second module was on Leadership, Professionalism. Quality Assurance facilitated by Professor. Muhammad Shahzad Anwar, Professor Mussarat UL Hasnain, and Prof. Mulazim Hussain Bukhari. Besides group discussions, there was a video conference with Prof. Ali Mehdi, Prof. Liz Grant and Dr. Mohera directly from Edinburgh University on the subject of Professionalism and Leadership. This was highly appreciated with many questions being raised. Dr. Moira Leng and Zayad Nasrullah monitored the webinar directly. The Chancellor of Qum University of Medical Sciences, Iran, Prof Dr. AbolfazlIranikhah also visited CMUK, especially to honor this session of the video conference through the webinar.

 

Day Three - 12, September 2019

This module included the subject on Instructional strategies facilitated by Dr. Tabassum Zahra, Prof. IffatBatool, Dr. Ali Ayub and Dr. HaiderModhafher. This workshop focused on characteristics of adult learning, strengths and limitations of different modes of instructions, student engagement strategies, small and large group learning, lesson planning using BOPPPS model and clinical teaching. The interactive sessions were well taken by the faculty and were activity-based including role play

 

Day Four - 12, September 2019

The subject for the fourth day was on Assessment in medical education facilitated by Prof. Muhammad Shahzad Anwar. Professor Mussarat UL Hasnain and Dr. Asad Ali Shah.They discussed evaluation, principles of assessment. Checklist. Rating, MCQs, and SEOs development. The lectures were interactive generating excessive discussions.

 

Day Five - 13, September 2019

The topics on the last conference day included types of studies, high-quality research, and its protocol, data analysis on SPSS, writing a research article and reference styles and quoting them. Professor Mulazim Hussain Bukhari and Dr. Fatema Jawad facilitated this session. The participants were involved in answering questions and MCQs. It was an interactive session full of activity.

 

Closing Session

 

The five-day interactive course ended with the closing session with an impressive speech by the Dean of CMUK, Professor Hassan Nasrullah, Mulazim Hussain Bukhari, Professor Ali Abutaheen and President of Medics International (MI), Dr. HumaNaqvi. The hosts delivered a vote of thanks and presented gifts to the entire teaching faculty. The participants evaluated the workshops sessions and provided very encouraging remarks. Prof Shahzad Anwar presented the assessment record of the five days workshops.

 

Conclusion

 

This first-ever course on CHPE will help in the faculty development of CMUK in health professions' education. This will further lead to future planning to develop the faculty for master (MME), doctoral(Ph.D.), and fellowship programmes in health professions education. The current CHPE programme conducted by Medics International will help the KCMUC faculty to revisit their curriculum, enhance their educational practices according to newer trends in order to be able to face future challenges in the medical and health care system

 

Recommendations for future challenges of MEDICAL EDUCATION in Iraq

 

There are many challenges faced by the section of medical education in Iraq. The rising global demand for good health practitioners in general and physicians, in particular, is a major requirement worldwide. The numbers of medical colleges in Iraq is increasing placing tremendous pressure on the government to provide an effective infrastructure and a highly qualified faculty, well trained in health professions' education. The requirement for more academic medical institutions needs careful planning, keeping in view that the education and training of teachers is a priority. In the present situation, medical education in Iraq is in a crucial phase. It needs gross changes with systematic planning that considers all potential challenges. These should be recognized and addressed. The current phase of reform and expansion must be coupled with accreditation and quality assurance procedures in order to ensure that each endeavor meets internationally acknowledged goals and standards.

 

Acknowledgment

 

We are highly indebted to Prof. Liz Grant, Dr Ali Mehdi, Dr Moira Leng of Edinburgh University and Zayad Nasrullah for the video conference on the subject of Professionalism and Leadership. We are also grateful to the Chancellor of Qum University of Medical Sciences Iran, Prof Dr. AbolfazlIranikhah for attending this course. He traveled a long way to encourage this academic activity on Health Professions in Education. We are thankful to Ms. Esraa Zaman Sahib of CMUK for her tireless and excellent commitment for an excellent IT system available on all the five days of the course.

 

References

 

1. Worldometer. The Irqa Population, URL:https://www.worldometers. info/world-population/iraq-population/. Cited 21.9.2019

2. Medical education in Iraq: issues and challenges. Shamsi M, Int J med Edu. 2017;8:88-90 ?

3. Qur'an, 57:22, Bihar, vol. 2 p. 34- 35, NawasikhutTawarikh, vol. 6, p.470-471.

4. The Historical City of Karbala. URL; https://www.imamreza.net/old/ eng/imamreza.php?id=5087. Cited 25.9.2019

5. Historical View. University of Baghdad, College of Medicine URL: http://www.en.uobaghdad.edu.iq; cited 20 September 2019.

6. Barnett-Vanes A, Hassounah S, Shawki M, Ismail OA, Fung C, Kedia T, et.al.Impact of conflict on medical education: a cross-sectional survey of students and institutions in Iraq. BMJ Open. 2016; 6:e010460.

7 Webster P. Medical faculties decimated by violence in Iraq. CMAJ. 2009;18:576-8.

8 Kassebaum DG. Change in medical education: the courage and will to be different.Acad Med. 1989;64: 446-7.

9 Shamsi M. Medical education in Iraq: issues and challenges. International journal of medical education. 2017 8, 88-90.

10 World Directory of Medical Schools Search. Search.wdoms.org. 2017 URL: https://search.wdoms.org. [cited 20 September, 2019

11 Zaidi SH, Abutiheen A. Medical Education in Iraq: The cradle of Civilisation. Pak J Med Sci. 2019;35:868-872.