Is the journey of a medical student on a vicious current being neglected?

Illustration photo of Munjarin Akter

“Give a man a fish and you feed him for a day; teach a man to fish and you feed him for a lifetime.”—Maimonides

Just like Maimonides said as a medical student of Bangladesh, I am agreeing with it fully comparing to the academic curriculum of the Medical Education system in our country. Where the fish is actually the ready-made syllabus feeding us by the authority and making us live in a pond ,then one day without warning they let us dive into the ocean. How so? Let me tell you what we really go through and what we really suffer. Also what we really need or can to overcome those flaws.

The medical profession is the dream job for those who want to devote themselves to saving lives and be good humans. But these dreams are being often shattered for many students to harsh reality by Bangladesh’s undergrad medical curriculum.

In the current medical curriculum when a student is enrolled in a medical college in Bangladesh, he or she has to face a vast subject of the medical undergraduate syllabus. Where basic, pre-clinical, and clinical disciplines along with clinical wards are accomplished within 5 years hectic academic program.

But our existing undergraduate medical academic curriculum provides knowledge in a limited manner and does not provide us with the opportunity to develop the skills necessary to explore, evaluate, and prepare to view the patient’s health holistically.

If we focus on our medical academic curriculum, our medical education system is mainly based on theoretical knowledge rather than problem-based learning. There is some defective planning in the curriculum and curriculum materials are out of date and irrelevant.

Subject imbalance from the beginning:

During the 1st & 2nd phase, we learn about Anatomy teaching us what’s in our body, Physiology teaching us how our body works, and Biochemistry showing the depth of how the body is really working. These are the basement of all subjects, Anatomy is deeply connected to Surgery with its sub-divisions, Physiology is connected with Pathology and Biochemistry is connected with Pharmacology, Community Medicine is connected to Medicine and as well as Microbiology.

But in the mentioned year, when we learn about anatomy, physiology, or biochemistry we learn everything pre-fixed knowledge. We learn what professors give us a lecture or homework, we solely depend on those materials what our teachers said is to be important and study definitions that are favorite to certain professor, books that are written by the professor or favorite of the professor also sometimes favorite ‘words’ that lecturer or professor like to hear. It’s an irony fate that this cycle continues every year of our academic life.

Also same goes for the next academic phases until the final year.

So, practically we know those theories, definitions, terms, cases exist but we never have been lucky to experience it with our eyes.

The disparity in practical knowledge:

During the 1st phase of the academic journey, a medical student finds many names, terms, cases that are related to surgery, medicine, pathology, and other subjects. But they can hardly learn those basics on that instant. They have to wait 1.5 years to learn even about the basics of surgery & medicine from ward classes.

But due to a lack of exposure to problem-based learning and a lack of expertise in applying previous knowledge, we are often unable to understand a case study of a patient with a problem in a third-year clinical period. Also, the academic schedule is so tight that, they don’t get enough exposure to the clinical ward as we have to complete the syllabus of this phase to get the clearance for the next professional exam.

Then let us come to 3rd year where community medicine and forensic medicine stands. However, in the Community Medicine course, a student cannot cover all components of a field study relating to community health, such as research methodology, global health, and practical epidemiological knowledge, etc., which are so important to become a research-oriented physician.

Curriculum mismatch in learning:

We students usually pay less attention to certain subjects due to a lack of an integrated course curriculum. Aside from that portion, there are a majority of topics that are irrelevant to study for a medical student and are irrelevant at that particular time for a medical student.

But if we see Forensic Medicine, Toxicology can be combined with pharmacology, whereas forensic pathology can be combined with pathology. Also, Poisoning cases can be addressed in clinical medicine, and only fatal cases require forensic pathology.

After learning about these two subjects, we go to the next year (4th year) to pathology, microbiology and

pharmacology where we find ourselves in a vicious current of pressure pouring in our minds not being

able to catch up, not able to co-relate the facts, studying again from zero, memorizing the terms we

learned in the first year again and introducing ourselves to more complex terms.

We have to complete our syllabus less than a year within a clinical ward, which is extremely difficult for us where these subjects are necessary for a medical student to have a firm grasp of clinical expertise.

Pathology and pharmacology could have been taught in phase II of the curriculum, as students typically enter the ward with little understanding of these two critical topics for clinical correlation.

Due to a tight academic timetable, the majority of us have to rely on guidebooks to complete the curriculum and to get clearance for the exam. This leaves a huge gap in our knowledge which is difficult to fill during the postgraduate entrance exam.

Then comes the final phase, the clinical year which is combined with all year’s basic knowledge. Everything we learned from the beginning is the main structure to learn further, to understand and evaluate the cases not to mention fourth years subjects play an important role behind it.

A thin barrier between framework & reality:

We hardly get enough exposure to gain knowledge about problem-based learning materials which is related to the theoretical academic programs. Only memorizing textbooks and lectures won't makes us good doctors.

Our undergraduate medical education system is still a long way from achieving international standards since we have no integrated competency-based curriculum but also the existing curriculum is far behind developed countries!

Medical education is improving across the world, with updated methodologies that are essential to developing an efficient community-oriented sensitive compassionate doctor. We need to shift the current framework of the medical education system to integrated competency-based education.

Munjarin Akter

MBBS (4th year), Delta Medical College, Dhaka

Co-Founder, Banglabiotics