Intended for healthcare professionals

Letters Broadening access to medicine

Is the extended medical degree programme misguided?

BMJ 2008; 336 doi: (Published 05 June 2008) Cite this as: BMJ 2008;336:1264

Extended/Integrated Pre-Medical Science curriculum --Why do we need it?

Extended/Integrated Pre-Medical Science curriculum --Why do we need it? Prof(Dr) Jogenananda Pramanik.MBBS.MD.Professor & Director of operation(S.E.Asia)St.Martinus University International Admissions,Toronto,Canada.Rajasingham,Director of Asdmissions,Malaysia,Cecilia Chang,Director of Admissions,P.R.China


The twenty first century health care system demands a new breed of medical professionals who are conversant and skilled in designing global health care delivery system in more complex situation than ever before. Those medical professionals are expected to be trained to think strategically about the overall challenges of delivering health care with multidisciplinary operational approach.

Till date medical education system is focusing on preparing clinical or laboratory experts. Time is ripe enough to think out of the box and look for more applied training program in medicine for preparing medical experts who are good managers and can think in global perspective.

During the year 2003,SARS epidemic in China mainland taught us to design an integrated global health care delivery system where medical professionals need to perform the role of manager as well as clinician or laboratory expert. Managerial skills are often important in management of occupational health as well.

Human diseases are not limited by geographical or political boundaries. Economically under-privileged countries with under-served population are the pockets of communicable disease agents. Tuberculosis is re-emerging as dreaded killer disease in developed countries once HIV expands its clutches. . There are several disease conditions, which need general awareness and planning of life processes to prevent them. Diabetes Mellitus, Obesity, Sexually transmitted diseases etc are raising deep concern to health care providers. Knee joint problems often recur in overweight population. Complication of diabetes mellitus are commonly associated with uncontrolled dietary habit and limited exercise. Governmental agencies are worried and seeking professional help to design a long term

Integrated/Intercalated medical education:

A year long pre-medical program is a prime time zone to bridge the gap in thinking process of an aspiring candidate planning to become a physician in 21st century. Multi-faceted knowledge and skills are needed for facing complexity of global health care delivery system. Integrated/Intercalated pre-medical education program may be suitable for widening the sphere of learning process.

At this stage, multiple science subjects may be taught with inclusion of couple of introductory medical subjects in addition to managerial skills as co-curricular activities. Proper motivation to handle simulated complex health care delivery projects may help to inculcate the above motto in the initial stage of professional life.

One of those simulated conditions may be mass casualty condition when dozens of injured patients are brought to a hospital casualty department following a serious street accident or fire accident or bomb blast. One the other hand, a serious threat of epidemic situation needs proper planning and delivery of health care to restrict spread of communicable disease.

A year long Pre-Medical Science course is often considered as waste of precious time in medical course because many students feel that it is a period to relax or enjoy before joining the stressful medical profession.

Some of the serious students feel otherwise. For them it is a period to prepare themselves to cope up with highly competitive life process and get acclimatized gradually.

During this preparatory stage, we always prefer to promote integration of the medical science and general science subjects like medical physics and human physiology, cell biology with human histology, normal psychology with psychiatric conditions. This helps in motivating students to be better prepared to pick up medical subject at ease ( under preparation )

Some of the students have parents or close relatives who are physicians, most of them are already motivated and acclimatized while other students who attend anatomy laboratory as lab-assistant understand anatomy at ease during their regular classes. Some of the students come after working for couple of years as nursing staffs. They analyze clinical conditions with much better aptitudes than others.

We observed that students joining medical schools with working experience as nursing staffs in hospitals exhibits better managerial skills than their colleagues ( unpublished observations). Some of the students join medical schools after completing masters of business administration (MBA) who often excels as hospital administrators.

In this connection, it is needless to mention that pre-med students should be oriented about professional ethics in medical practice. It is imperative that these students need to be educated for legal issues to be careful about. Attending couple of legal proceeding against medical malpractice cases may be fruitful for them. Some of them may be interested in medical jurisprudence practice in later life.

Pre-medical science course may help the aspiring students to take a road test for coping up with stressful life style in medical profession and better prepare for financial burden during training period.

However, higher academic achievements during this period often help them to get scholarships and financial aids for the rest of the career path. Discussion:

Twenty first century physicians need to be trained to consider the strategic, organizational, and structural problems in delivery of health care. They are expected to be astute clinician and effective manager equipped with managerial skills necessary to effectively deliver health care in underdeveloped as well as developed setting and tackle real life problem with expertise.

Although global delivery of health is as diverse as the setting in which care is provided, many real life problems are consistent among region—underdeveloped health care infrastructure, shortages in personnel, health illiteracy, inadequate transportation facilities and breakdown of supply chains.

Programs that train beginners for global health practice need to arm them with the clinical skills that they need to understand the population served and the diseases treated. However, equally critical are the skills to organize and manage the delivery of care with limited resources and in complex setting. In settings where human and physical resources are scare, the careful design of shared infrastructure for health care delivery is essential—that is the outcomes for every dollars spent—is maximized or at least make it cost effective. Concluding remarks:

At the end of the day after a year long Pre-Medical course, we are hopeful to get better prepared candidates for higher studies in the field of medicine with “out of the box” analytical thinking capabilities and leadership skills to tackle the wide range of clinical and managerial dilemmas. References: 1. Is the extended medical degree programme misguided? Charles W Redman:BMJ2008;336:1264-c 2. “Global health: The new world of global health” Cohen John:

Science.2006:311,162-167. 3. Intercalated BSc degrees: Why do students do them? Riaz A,Howell S. The Clinical Teacher 2005:2:72-6. ------------------------------------------------------------

Competing interests: We sincerely acknowledge the moral support and coperation received from Mr Henry Joe Chau,President/CEO of St Martinus University,Curacao,Netherlands Antilles

Competing interests: No competing interests

08 June 2008
Prof(Dr) Jogenananda Pramanik.MBBS.MD
Professor & Director of operation(S.E.Asia)
Rajasingham,Director of Asdmissions,Malaysia,Cecilia Chang,Director of Admissions,P.R.China
St.Martinus University International Admissions,Toronto,Canada.