Competency Based Medical Education for MBBS - NMC issues new course curriculum, details

New Delhi: Issuing a circular, the Undergraduate Medical Education Board of the National Medical Commission has informed about the implementation of new Competency Based Medical Education for Undergraduate Course Curriculum. Salient features of the curriculum which will also focus on Local Language adaptation include a transliteration of Maharshi Charak Shapath, Family Adoption Programme as well as academic calendar and guidelines on supplementary exams.

The decision to implement the new CBME Undergraduate Course Curriculum for the current batch of MBBS students (2021-2022) was taken after detailed discussion and deliberation on the issue in the 6th meeting of the National Medical Commission on March 24, 2022 at New Delhi.

This new Curriculum is being introduced to the new MBBS batch, who took admission in February-March 2022, with the objective of "covering all three domains of learning (Cognitive, Affective & Psychomotor). The new course curriculum introduced in August 2019 enriches the medical student with a sound base and balanced approach to overall aspect with the introduction of foundation course which includes Family Adoption Programme, Yoga, meditation, Local Language adaptation and skills."

NMC in its recent circular mentioned, "All State Governments/UTs, universities and medical colleges/institutes are requested to take immediate necessary steps to implement the new Competency Based Medical Education for Undergraduate Course Curriculum from the current batch of MBBS students i.e. 2021-22, admitted in the month Feb-March 2022."

Guidelines for implementing the new CBME Course Curriculum, Academic Calendar for the MBBS batch, Month-wise schedule of new CBME Course, Curriculum for new Family Adoption Programme, Brief modified transliteration of Maharshi Charak Shapath- all these aspects have been covered in the NMC circular dated March 31, 2022. 

Guidelines for implementation of new CBME Course curriculum for MBBS batch 2021-22 admitted in Feb-March 2022

NMC has mentioned in the circular about the guidelines for the UG CBME 2021 batch, who got admitted only a couple of weeks ago. The guidelines specify that-

• The curriculum of UG CBME 2021 will begin from 14th Feb 2022in all medical colleges across the country. The basic framework and inclusions of CBME will not be disturbed as they are vital components of outcome-based education. It is mainly the redistribution of hours in view of COVID-19 pandemic within the time frame that needs consideration for 2021-22 (admitted in Feb. 2022) batch.
  
• Redistribution with timeline of professional years for 2021-'22 (admitted in Feb. 2022) is provided in slides herewith. Since the duration for 1st professional has been reduced from 14 months to 12months, the period can be adjusted by :

a. Having one week of Foundation Course at the beginning of the academic calendar and then spreading remaining three weeks of Foundation Course In first six months beyond curricular hours

b. Allocating Sports & Extracurricular hours for regular teaching

c. Reducing duration of vacation (1 week in Summer &1 week in Winter, at the discretion of University and college)

d. Final, 1st exams will be for Forensic Medicine, Toxicology and Community Medicine

e. All clinical subjects will be taught as per curriculum parallel and exams will be covered under NEXT.

• Early clinical exposure and Integration retained since they are all teaching- learning methods/strategies for addressing identified competencies.
  
• Self directed learning (SDL): Some SDL hours can be reduced, specifically from Phase-| subjects like Anatomy (there are 40 hours), Physiology (20 hours). Some SOL hours can go beyond office hours if required (as such also students may be required to do certain things for SDL beyond regular hours).
  
• Electives promote academic flexibility and may be offered onsite based on student's need and choice. One month of Electives (Block A & B, 15 days each) can be adjusted for this batch, wherein Block A (pre/para clinical electives) can have electives along with clinical postings and Block 8 (clinical electives) without clinical posting.
  
• Family Adoption Program: Family Adoption Program, which NMC had been planning to introduce for the betterment of the healthcare services in the rural areas, has been included in the new MBBS curriculum.

NMC mentions in the circular, "Family adoption program is recommended as a part of curriculum of Community Medicine and should begin from 1st professional year and remain throughout the curriculum. The orientation towards the same may be a part of foundation course under the theme of 'Field visit to community health centre' (8 hrs) which is already allocated to foundation course in GMER 2019. The family adoption shall include villages not covered under PHC adopted by medical college, and if travel time from college to site is more than 2 hours on week-ends, in such situation, bastis / Jhuggis/ towns or on outskirts of cities may be adopted."

Also Read: No Proposal for replacing Hippocratic Oath with Charak Shapath: MoS Health

• Recommendation of Charak Shapath: The controversial "Maharshi Charak Shapath" has also been recommended in the new CBME curriculum. Although the circular does not mention anything about replacing the existing Hippocratic Oath, NMC states in the circular, "Modified 'Maharshi CharakShapath' is recommended when a candidate is introduced to medical education."

Apart from recommending the Charak Shapath, NMC has also included a brief transliteration of the oath. The trasliteration of Maharshi Charak Shapath is as follows-

• Yoga Training during Foundation Course: The new CBME curriculum for MBBS also advocates for initiation of Yoga training during the foundation course - 1 hour, preferably in the morning in orientation week.

The circular states, "Yoga practices shall be for maximum 1 hour every day during the period of 10 days beginning from 12th June every year to be culminated on International Yoga day, i.e. 21st June, to be celebrated in all medical schools across the country. These may be practiced by all batches of MBBS. Yoga module will be made available to all  colleges by UGMEB- NMC. However colleges may adopt their own modules. Yoga unit may be inducted under PMR department or any other department of all colleges at their discretion."

• Assessment: Regarding Assessment, the new curriculum mentions that, "A robust continuous formative and internal assessment is required to ensure competencies and thereby a competent medical graduate. if required, we can have two internal assessments and the third internal assessment can be calculated from various unitary and continuous tests taken throughout the year."
• Supplementary Examinations: As per the NMC circular, the Supplementary exam shall be conducted between 4 to 6 weeks from the date of declaration of results of regular university examinations. The result of Supplementary examinations will also be declared within 10 days from the date of completion of examinations.

However, NMC has clearly mentioned in the notice that "There shall be no supplementary/ repeater batch. For students who fail in their university examination."

The guidelines state, 

"- Students who pass in 1* MBBS supplementary examination shall be offered special classes and ward postings to cover up the syllabus, so that he/she copes up with subjects. Subsequently (after passing in supplementary examination) the student shall continue with his/her regular batch. Attendance of special classes/ postings for such students shall be counted. Students who fail to pass in supplementary examination, shall be joining the subsequent junior batch.

- Students who pass in 2nd MBBS supplementary examination shall be offered special classes and ward postings to cover up the syllabus, so that he/ she copes up with subjects. The student shall not join classes of the Final MBBS till he/ she is given a chance of passing in first supplementary examination. He/ she shall continue with his regular batch after passing in supplementary examination of 2nd MBBS.

Attendance of special classes/ postings be counted. Students who fail to pass in supplementary examination of 2nd MBBS may be allowed to continue with his/ her regular batch. However the student shall have to pass 2nd MBBS before taking up Final MBBS examination, as per the existing guidelines."

• Regarding the upcoming National Exit Test (NEXT), the guidelines issued by NMC mentioned, "Details and guidelines on NEXT examination shall be notified by NMC."

Academic Calendar for MBBS Batch (2021-22) admitted in Feb-Mar 2022

Month Wise Schedule for New CBME Course for MBBS Batch 2021-22 Joined in Feb-Mar 2022

CURRICULUM FOR FAMILY ADOPTION PROGRAMME

NMC has discussed in detail regarding the features of the newly introduced Family Adoption Program. The top medical body has mentioned in the circular about the need of the program, the aim and objectives, targets that students need to achieve and other details. Besides, the circular also includes a proto-type log book that students need to maintain for Family Adoption.

Need of the Program:

In India, around 65.5 % of population resides in rural settings (as per 2020 statistics) whereas availability of health care facilities and services are skewed towards urban set ups. Though adequate healthcare supplies exist in the community, it is the access to healthcare to a rural citizen that is a major concern. Issues like health illiteracy, ignorance about communicable and non communicable diseases, means to reach health care facility, services, take time off from their daily wages work and workforce shortages are some of the barriers that limits timely and quality health related awareness and care leading to a scenario of 'Scarcity in abundance'. Hence there is a need to take measures to make healthcare more accessible to the rural and needy population and impart community based and community oriented training to budding healthcare professionals.

Aim:

Family adoption program aims to provide an experiential learning opportunity to Indian Medical graduates towards community based health care and thereby enhance equity in health.

Objectives of the Program:

During the Medical UG training program, the learner should be able to :

1. Orient the learner towards primary health care

2. Create health related awareness within the community

3. Function as a first point of contact for any health issues within the community

4. Act as a conduit between the population and relevant health care facility

5. Generate and analyse related data for improving health outcomes and Evidence based clinical practices.

Specifics of the Program:

Family adoption program is recommended as a part of curriculum of Community Medicine and should begin from 1st professional year with competencies being spread in ascending manner for entire MBBS training program. The orientation towards the same may be a part of Foundation course under the theme of 'Field visit to community health centre' (8 hrs) which is already allocated to foundation course as per GMER 2019.

The family adoption shall preferably include villages not covered under PHCs adopted by medical college. If transit time from college to site in more then 2 hours, then bastis / jhuggis/ towns on outskirts of cities may be considered for family adoption. Medical students may be divided into teams and cach tear may be allocated visita, with 5 families per student. These fumilice may be introduced during their first visit; however, the model may be flexible depending upon the number of students and svailable famities for sdoption. The entire team should work under a mentor teacher for entire pert of the training program.

Other considerations:

Every college may arrange one diagnostic medical camp in the village wherein identification of: anemia, malnutrition in children, hypertension, diabetes mellitus, ischemic heart diseases, kidney diseases, any other local problems may be addressed.

If required, patients shall be admitted in the hospital for acute illness under care of student, charges may be waived off or provide concession or govt. schemes.

For chronic illness, students shall be involved.

Subsidized treatment charges may be provided under govt. schemes or welfare schemes.

Camps may be arranged by Dean and Community Medicine P.S.M. department with active involvement of Associate/ Asst. Professors, social worker and supporting staff, Local population may be involved with village Ieaders.

Visit by students be made to the visit as mentioned in table below. Annual follow up diagnostic camp can be continued by the PSM department. As a step towards environment consciousness, students may be encouraged for tree plantation/medicinal plants around beginning of monsoons, in the environs of the families adopted. This could be also included in the environs of the hostels/ residence of students wherever possible.

At the end of the programme, students may be envisioned to become leaders for the community.

TARGETS TO BE ACHIEVED BY STUDENTS:

First Professional Year:

-Learning communication skills and inspire confidence amongst families

-Understand the dynamics of rural set-up of that region

- Screening programs and education about ongoing government sponsored health related programs

- Learn to analyse the data collected from their families

-Identify diseases/ ill-health/ malnutrition of allotted families and try to improve the standards

2nd Professional Year

- inspire active participation of community through families allotted

- Continue active involvement to become the first doctor /reference point of the family by continued active interaction

- Start compiling the outcome targets achieved

3rd Professional Year

- Analysis of their involvement and impact on existing socio-politico-economic dynamics in addition to improvement in health conditions

- Final visit in the last months in advance to examination schedule, to have last round of active interaction with families

- prepare a report to be submitted to department addressing:

1) Improvement in General Health

2) Immunization

3) Sanitation

4) De-addiction

5) Improvement in anemia, tuberculosis control

6) Sanitation process

7) Any other issues

8) Role of the student in supporting family during illness/ medical emergency

9) Social responsibility in the form of environment protection programme in form of plantation drive (medical plants/ tree), cleanliness and sanitation drives with the initiative of the medical student.

NMC has also mentioned in a table regarding the year-wise progress that the students are expected to make, competency that the students will achieve, suggested teaching and learning methods, suggestive assessment methods, and the required hours of teaching.

Speaking to Medical Dialogues, Dr Rohan Krishnan, President, FAIMA Doctors Association said, "This is just a new dish from the old recipe. There is nothing new in the inner structure of the curriculum . There are some changes academically wherein forensic medicine which was earlier taught in second Professional MBBS, will now be taught at third year and exams will be taken in third year MBBS & field visits and community medicine which was taught in third year will now start from first year itself. But overall there seems to be lack of innovation and modernisation in the curriculum."

"I am shocked to see that even after Pandemic there is no extra time or practical skiils allocations in virology, microbiology or handling of a Pandemic. The hippocratic oath is been replaced by Maharashi Charak Sapath and some more hours been dedicated to Ayurvedic studies. This also indicates that medical colleges may now also have to hire Ayurvedic teachers. As Per NEXT Exam, since its introduction ot has been a mystery as when will it start . Now it's clear that it will be applicable from this batch which means it will take four more years for it to commence. So overall, I believe that it is just an attempt to create a mirage but in reality this has nothing innovative, but infact lack of research based , experience based teaching curriculum," he added.

To view the official notice click on the following link:

https://medicaldialogues.in/pdf_upload/implementation-1-173331.pdf

Also Read: Coming Soon: NMC plans on Introducing Family Adoption Programme in MBBS Curriculum