Aims and Objectives of Medical Education

Dr Maung Maung Nyo

Prologue

(Convocation Hall of the University of Rangoon That was first Established

in 1920)

Every medical doctor or physician (in USA) would say that they know what

the aim of the medical education is. It’s to produce doctors to treat patients.

But more educated and intelligent doctors would say that it is more than that

as the doctor has to perform not only treatment of ill patients but also to prevent

the diseases occurring or to prevent the epidemics.

(Rangoon Medical College First Opened in 1923/24 as Part of the

Rangoon University newly Established in 1920)

I heard a minister of health in Burma saying that his government is concerned

with educating the medical students to treat ill patients only in Burma and not to

be able to pass the foreign medical examinations as the previous Burmese doctors

used to do and run away from Burma! I was really disappointed and sad by his

view point, rather his government irresponsible opinion.

(Dr Ba Than, Doyen of Burmese Doctors)

Aims of Medical Education

The aims of medical education programme in any country are drawn not

arbitrarily, but by analyzing the needs of the country at the time of drawing

the curriculum and for future needs. It’s true that the Burma’s medical

curriculum in the 1920s was drawn by the British Burma’s Government

by copying the medical curriculum of the Edinburgh University and by the need

to employ the graduates in the Burma’s health department and hospitals.

(Rangoon General Hospital, RGH)

These graduates could be sent to the British medical schools and universities

for further studies. Hence there was no provision for the postgraduate

medical studies in Burma and no need for considering the political and

social needs of the country.

(General Aung San during Anti-Japanese Resistance 1942-45)

Even then patriotic Burmese doctors like Drs Min Sein, Ba Than, Yin May and

Shwe Zan thought about the future medical education and practice in independent

Burma and they did their part well. The present medical schools and universities

as well as the current medical doctors in Burma and abroad are the fruits of their

labor, directly or indirectly, as they were the fore fathers of medicine in Burma.

(Rangoon University Students Union Building where University Students meet for

Education, Independent Movement etc; Dr Hla Shwe Was once Its President)

The aims of medical education in a country are, briefly speaking,

derived from the following sources:

(1) Health needs of the country or society to serve

(2) Service to the patient

(3) Service to the community or country

(4) Service to the medical profession

(5) Service to the students

(6) Progress of science

(7) Scientific methodology

(8) Philosophy of government

(9) Politics of the country

(10) Others unforeseen factors etc.

Methods to Determine the Aims and Objectives

There are several methods to determine the aims of a medical education in

any country or at any medical institute or university:

(1) Copy from a model university or a medical college like the old Rangoon

Medical College copied it from the University of Edinburgh

(2) Expert opinion by taking the advice of learned medical educators: I once

accompanied Professor Brown of the Ibadan University who advised on the

working of Institute of Medicine 2 in 1965. He has advised the establishment

of Ibadan medical College in Nigeria. My supervisor Professor Bowden advised

on the establishment of the first medical school in Malaysia and Saudi Arabia.

(Professor Kyi Kyi May's Birthday Celebration at IM 1;

Professor Kyi Kyi May, centre, Greeting Dr NOM)

(3) Critical Incident Method: by noting down what a doctor does and tabulating

his activities as the requirements to train a doctor

(4) Task Analysis of all the doctors and listing the tasks as to train the future doctors

(The Lake-Khone, Pyi Road Campus, IM 1, Rangoon)

(5) Epidemiological method: By studying the prevalence of diseases in a community

or country or society where doctors are to be trained: There is no point in teaching

medical students about the diseases no longer present or prevalent in that society e.g.

teaching of multiple sclerosis or tabes dorsalis in Burma. I remember Professor of

Medicine Colonel Tin Ohn asking me to not teach details of the various nerve tracts

to the second M.B. students as they would be forgotten or not relevant in their final

years and practice!

(Branch Medical Faculty of RU in Mandalay 1955, Photo taken in 1965)

(6) Research on future needs of the country or society: Space medicine needed

for doctors to work in the space industry like NASA etc.

(7) Doctrinal or religious needs: During the BSPP government era its

philosophy was taught in the medical schools from the first MB to the Final Part 1

classes as a compulsory subject. In some religious medical schools he relevant

religious texts or practices are taught.

(IM 1 Anatomy Staff, 1985: Sitting L to R: Drs Nilar Shwe, Mary Hmwe, MMN,

Daw Sein Tin, Daw Khin Win)

Relevance of Broad Aims and Objectives

Most Burmese doctors are ingrained with the idea that a doctor’s functions

or duties revolve around a patient and his responsibilities start and end there

once he has served the patient. However, Dr Ba Than and Dr Hla Shwe

showed that it did not end there and a doctor has to take part in the

independence and anti-Japanese Resistance struggles when the country was

oppressed under the colonial rule and the Japanese Fascist Army’s atrocities.

(The First Batch Students of IM2 in 1967)

If all the Burmese doctors had run away to India or abroad during the Japanese

Occupation who would look after the Burmese population in distress?

More courageous and politically mature doctors took part in the political struggles

like Dr Hla Shwe, Dr Tun Maung and Dr Nyan Chit etc.

In the 1960s a first class medical school (The Pahlavi Medical College) was

opened in Iran to train top notched doctors. Only 50 students were admitted

each year. They were taught by highly qualified teachers at world standard.

They were encouraged to sit for ECFMG of the time that they all passed.

But the tragedy was that they did not stay in Iran to serve the country they

were meant for.All the graduates migrated abroad. The Iranian Government had

to close that medical school after 3 or 4 batches as there were no graduates

of that school to work in Iran. Was it lack of foresight by the planners or lack

of patriotism by the medical graduates?

Relevance of Aims and Objectives and the World Standard

Dr Ko Ko, the Regional Director of WHO in New Delhi, once visited IM 1

after 1988 and Professor Dr U Tin Aung Swe was the rector of IM1. I have

been a senior professor at IM 1 since 1985. Dr Ko Ko asked me what to talk

to the staff and students there. I asked him to talk about the world standard

of medicine or high standard in medical education.

(The Preclinical Building for Basic Sciences of IM 1 at Lake-Khone)

He told us that there was no WHO standard for medical degree but that they

followed the practices of the medical councils in the region in recognizing the

degrees and employing the qualified doctors. He said there was no problem

with the Burmese doctors then as Burma’s M.B., B.S. degree was recognized

as good degrees in the region and recognized also by the British GMC

(General Medical Council). Besides, all the Burmese medical teachers were

mostly trained in the UK for their postgraduate education.

(The Dissection Hall at IM 1, Lake-Khone; Now No More Dissection)

Hence many Burmese medicalgraduates were employed by the WHO.

Since 1977 the Burmese medical degreewas no longer recognized fully by GMC.

How many Burmese doctors who graduated after 1977 have been employed

by the WHO or other organizations and Institutions without another recognized

degree or diplomas, memberships and fellowships?

Lecture Theatre, foreground, and Library, back ground, of IM 1 at

Lanmadaw, Rangoon)

And drawing an aim or objective out of touch with reality or demand is also not

profitable or relevant as the medical graduates of the late BSPP era who were

taught the BSPP doctrine have not stayed in Burma and served the people

at large. They ran away if they could. I can cite several such people at hand!

(Staff and Students of Anatomy Department, IM 2, Mingaladon, Rangoon 1972)

However, out of gut feeling or patriotism many Burmese doctors have taken part

in the democracy movement of Burma since 1988. The names of such doctors

are well known to all like Dr Aung Khin Sint, Dr Ohn Maung, Dr Than Nyein,

Dr Zaw Myint Maung, Dr Tint Swe etc.

You Can Not Cut Your Roots Completely

Some expatriate Burmese doctors think that they could cut their connections to

their old country of birth or education by staying away from it, by neglecting

its pathos and pains and by identifying with their adopted countries.

But experience and history have shown that it’s not so.

(World Health House in New Delhi: Drs Nan Ommar and Nyunt Wai)

Dr Hla Myint, an eminent economist, was appointed as the rector of the

Rangoon University during the AFPFL Government. He did only the academic

matters of the university and he remained purposely detached form the students’

feelings and requirements. Friction soon broke out between him and the student

leaders and he told them,” I’m a British citizen and I don’t care what you sayt.

I’ll return to the UK if Burma does not want me.” He then returned after the end

of his contract.

(Burmese Delegates at the WHO Conference/Workshop: Centre Dr NOM)

Then, during the BSPP era his father was seriously ill in Rangoon and he liked

to see him for the last time, came to Bangkok with a view to receiving a visa there.

But U Ne Win did not give the visa and he did not see his father’s dying.

(I’m not supporting U Ne Win’s insensitivity or callousness, but saying how

a man’s root cannot be easily or completely cut.)

(IM1 Graduation or Convocation Ceremony: L to R: Profs Myo Min Aung and

Maung Maung Nyo, PG Nearest to Foreground Dr NOM)

There was one U Than Aung who left Burma at the age of 16 years before Burma’s

independence and worked in London. He married an English nurse and they were

a happy family. I met them quite often. At the age of 65 years, he missed Burma

and for the last time he wished to visit it. He came to Burma in the 1980s with his

wife and he suddenly entered the Donlaba Buddhist Monk in front of his wife

in Rangoon. He went back to UK, lived peacefully in Cornwall and died there

marked as a Burmese. His British name was U Min Lwin.

(The Late Percy and Betty Paddon with H.E. U Maung Maung Gyi of Burma)

In London, I was invited to many British homes and the English or Britons were

very friendly to me. But when I asked them why I did not see the Burmese turned

British citizens invited to their homes, they said they wanted international friendship

and not with the expatriates. It was so in Michigan and New England, USA.

(The Nargis Victims Waiting for Donations or Disbursement of Aid Materials)

It’s my limited experience, of course. But in times of crisis in a country

like the Nargis in Burma, the people of an adopted country will ask the

citizens of that country what you would do for your country. It’s shameful if

you neglect your mother country then!

(Institute now University of Medicine Mandalay)

I always like and admire a person who does not hide his identity. I still remember

Dr Nyan Myint teasing Ajit Das that he was a Kala and he should not talk about

patriotism for the Burmese during their student days at IMM. Ajit replied that he

was an Indian by race but a Burmese by birth and citizenship and he had every

right as Nyan Myint to talk and act like a Burmese. We applauded him. Ajit and

Nyan Myint were both close friends and they qualified from the IMM.

Dr Ajit Das is now dead.

(Dr Nan Ommar Taking Master of Science Degree Scroll from

Rector Professor Dr Hla Myint, IM 1, December 1985)

What the Burmese Medical Curriculum Should Aim for?

It’s therefore clear that our Burmese medical curriculum should aim for training

our future doctors to be equipped with the following:

(1) Up-to-date medical knowledge and skills

(2) Capability for problem solving and self reliance

(3) Capability for further study and life long learning

(4) Dedication to medical practice and profession

(5) Compassion and sympathy to patients

(6) Humanism and human rights

(7) Siding with righteousness and right cause

(8) Educating and leading the patients and population for higher causes

(9) Respects for old teachers, Alma mater and medical ethics etc.

Types of Aim and Objective

(The Emblem of the University of Rangoon 1920-1964;

Its motto is that there is no True Friend like Knowledge or Education)

The composite or total aim of the medical education is to transform a bright,

intelligent and inquisitive learner in medicine to become a complete medical

professional serving the patient and community with maximum efficiency,

dedication and sensibility abiding by the requirements of the state or society

he/she serves and the ethical standards laid down by the responsible authorities.

The secondary aims are to train him medically, socially, ethically and politically

if the need be.

Broadly the objectives are as follows:

(1) Institutional Objectives: Broad, all inclusive at the educational level

(2) Intermediate Objectives: At specified levels and areas like group activities

for students or patients to have their blood pressure or blood sugar levels

checked and recorded

(3) Specific Instructional Objectives: That is at the departmental or subject-wise l

ike how to learn anatomy of a muscle, a region or physiology of muscle contraction.

Objectives are usually or conventionally written from the view point of the learner.

Thus it is stated as ‘ the learner should be able to take a medical history or

to perform a clinical examination effectively in the allotted hours.

Characteristics of a Specific Instructional Objective

(1) Relevant: An objective should reflect the need of the society and learner

(2) Unequivocal: An objective should be stated in clear and unequivocal term

for the learner or student

(3) Feasible: An objective must be feasible to carry out

(4) Observable: It must be stated in behavioral terms like writing, taking history

or teasting a nerve function.

(5) Measurable: An objective must be stated with means for measurement of

its performance; it must not be an abstract idea like thinking, understanding etc.

(6) Valid; An objective must be valid or true what it intends to do like measuring

blood pressure in medicine not making a table for dinner for medical students.

Conclusion

(A Burmese American Doctor serving the Nargis Victims in Burma)

A medical doctor is more than a person trained in medical practice. He must be

sensitive to the needs of a society or its people in social, economic, political or

human rights aspects. He is not a robot or a callous person oblivious of the

surrounding or the people’s suffering and wishes, but he is the one identifiable

with them treating or encouraging or leading them as the need be at times

critical moment in his society or root.

Dr Maung Maung Nyo

21.05.2009 (original)

References

1. McGuire, Christine (1974). An Overview of Applied Research in

Medical Education Problems. WHO Report, Alexandria, March 1974.

2. Maung Maung Nyo (1978). A Proposed New Medical Curriculum

for Burma. Burma Medical Journal, Volume 24, Nos 1 to 4, Page 3 to 8.

3. Maung Maung Nyo at el (1981). Workshop On Medical Education

Handbook. Institute of Medicine 2, Rangoon, Burma.

4. Maung Maung Nyo (2009). Personal Experiences.