The New Innovative Medical Education Initiative

1. Launching at Ambo University The New Innovative Medical Education Initiative Dr. YoditAbraham (Col) Consultant Internist ,MBA Federal Ministry of Health Ambo Feb 4, 2012

2. Vision • No one should get sick when we can Prevent i • No one should die when we can cure ! Our vision is For All Ethiopians to enjoy highest possible standard of health care.

3. Vision To take this vision to the remotest parts of Ethiopia to the villages beyond the villages • W e need to saw the seeds here and now! • If not now when if not us who ! • We cannot harvest what we have what we have not sawn ! • let us plough the land, eradicate the weed, water the soil and plant the best seeds now!

4. 1. NIMEI for scaling up and transformation

5. 1.1LEADERSHIP OF THE NIMEI • NIMEI is a Government Initiative • Leadership : joint FMOH and FMOE • Under the focus of the of Medical and Health Sciences and Curriculum council . • Curriculum development: was by taskforce from FMOH, Tulane University ,FMOE,5 Universities,WHO and Jhpiego. • Currently has wide base partner’s involvement on the implementation.

6. 1.2The NIMEI for scaling up and transformation The Need : to fill the demand and supply gap • The inherent gap : in number of Physicians in the Health care in absolute terms and distribution • The countries development pace and induced needs • Economic ,Social and basic infrastructure growth and induced needs for services from the health sector

7. 1.3The Need: to fill the demand and supply gap cont… Doctor to Population ratio: 1 physician per 36,158 people 43% working in Addis Ababa.

8. 1.4 The Need: to fill the demand and supply gap cont. The shortage of physicians is attributed to a combination of factors: • Limited number of medical schools, • Limited capacity of enrolling students of MS, • Shortage of medical educators and faculty, • Internal displacement and Brain-drain

9. 1.5The NIMEI for scaling up and transformation The predicted Doctor to Population ratio in 5-8 years time : >1 physician per 10,000 people

10. 1.6 Initiative for Scaling up and transformation • New Innovative Medical Education Initiative (NIMEI): • A new medical education system has already been developed • Enrollees graduates with BSc degree in Health and natural sciences • 10 Universities and 3 hospital based medical schools established

11. 1.6 Initiative for Scaling up and transformation A new medical education system • A New Competency Based Curriculum • Faculty Development system • Student recruitment and selection and graduation system • IT support system of the education • Educational environment and recourses standards • System of continuous monitoring and evaluation

12. 1.7 The NIMEI for scaling up and transformation Goal: To educate medical doctors quantitatively sufficient and professionally competent to provide quality health care services to meet the demand of the Nation . To educate the 21st century medical doctors of Ethiopia.

13. 1.8 Goal of NIMEI for “ Six star doctors” To produce medical doctors of the 21st century for Ethiopia who will be “six star doctors” equipped with a comprehensive knowledge to functions as : Care Provider Decision -maker Team leaders Researchers Teachers in the health sector Social mobilizer

14. 2. The NIME Curriculum and its development process

15. 4.1 2.1 Establishment of Taskforce • In 2009 Taskforce was established with members form : • The Federal Ministry of Education, • The Federal Ministry of Health/Tulane University , • Addis Ababa University, Jimma University, Mekele University, Hawassa University ,Gondar University • WHO and JHPEIGO

16. NIMEI Curriculum Development Taskforce

17. 2.2 Trends in Medical Education Global trends in medical education • Changes and reforms even in the developed countries • Direction & strategies for in "The Edinburgh Declaration” • Social accountability of medical education

18. 2.3SHIFTS IN THE BASIC/CLINICAL SCIENCE DISTRIBUTION Basic Sciences Basic Sciences Basic Sciences Clinical Sciences hospital -based Hospital -based Clinical Sciences hospital -based Clinical Sciences Community based

19. 2.4. NIME Curriculum :Roadmap to the development of the 2009- 2010 Study the current situation National Surveys conducted Stakeholders Opinion Survey Competency Assessment Survey Ethiopian Experience • Desk review • Ethiopian situation • Global trends of medical Education • Advantages • Anticipated challenges • Stakeholders opinion survey • Competency assessment survey of General Practitioners • University presidents • Deans • Hospital Directors • Practising Physicians • Professional association leaders • 700 doctors and health professionals in 72 hospitals participated • Self report GPs with in 5yrs of service on their medical Education • National medical Curriculum • Jimma University • : CBE • Defence college of HS : HO to MD • St. Paul Millennium • college :

20. National Area Experts work shop National Medical & Health science Council 2.5Roadmap to the development of NIMEcurriculum cont … Curriculum Development Benchmarking International Experiences NIME Curriculum • -Visit of 12 universities • Canada • Netherlands • South Africa • Sudan • Egypt • - Review of Several other curricula Globally • Approach • -Six step approach • Based on the • -Competency assessment result • -Stakeholder opinion survey result • -Benchmark result • -International experts consultation • -Desk review • Competency Based • Hybrid • Integrated • Inquiry driven methods • Modular • Universities • Professional Association • Partner organizations • Private hospitals and colleges • 21 Universities • 5 regional Health bureaus • Private collages and hospitals • Partner organization • and other stakeholders

21. 2.6.Ethiopian Experience The following medical curricula were reviewed: • Addis Ababa University medical faculty • Jimma University • Defense college of health sciences • St. Paul's millennium medical school

22. 2.7.Competency assessment survey

23. 2.7Competency assessment survey Clear needs for Changes and improvement • Gaps in skills in emergency surgical and life saving clinical skills • Missing and redundant courses were identified • Improving quality of care and teaching the hospitals • Evaluation of students should be objective following several methods and progressively

24. 2.8.STAKEHOLDERS OPINION SURVEY The survey included four categories • Universities : Presidents/AVP/Medical/Health science faculty Deans (16) • Hospitals :Chief Executive Officers , Directors and Deputy Directors of hospitals affiliated hospitals(28) , • Professional association :Leaders (6) • Physicians: GPs and specialists ( 44)

25. 2.9.Benchmarking • Canada: Mac masters &Northern Ontario Universities • South Africa: Walter –SisuluUniversities and Nelson Mandela University • Sudan: Khartoum university , AHFAD, Academy for Medical Studies and Jezira university. • Netherlands : Maastricht University • Egypt : University Cairo aSuez canal University

26. 3. The CURRICULUM DEVELOPMENT STEPS Step 1 : Problem identification &needs ass Step 2 : Identifying competencies Step 3: Objective of the curriculum Step4 : Educational strategies Step5 :Resources standard Development Step 6: Implementation plan & M/E of the program

27. 3.1 NIME CURRICULUM PRINCIPLES and STRATEGIES The NIME curriculum is a Competency Base with the following principles and strategies Early community and clinical contact Community orientation in medical education (COME) Integration of the different sciences and unity between education & practice Self-directed learning Problem-based learning (PBL) ICT supported Continuing professional development (CPD)

28. 3.2 Competencies expected the graduate The NIME Curriculum identifies seven domains of core competencies expected from a graduate: • Professional Values, Attitudes, Behavior and Ethics • Scientific foundation of Medicine • Communication skills • Clinical skills, • Population Health and Health Systems • Management of Information • Critical thinking and research, Practice-Based Improvement

29. 3.3. Curriculum components The major arms of the curriculum • Biomedical and Clinical Sciences • Professional competency development (PCD) • Social and population sciences (SPH)

30. 3.4 Structure and components cont Five major components: • Introduction to Medicine • Integrated System Based module • Clerkship • Internship • Social and population health(SPH) • PCD integrated with all

31. Curriculum Framework

32. 3.5. Curriculum Duration Total : 4 and 1/2 years including 1 year Internship • Year 1 45 weeks • Year 2 48 weeks • Year 3 Clerk ship I 48 weeks • Year 4 Clerkship II 53 Weeks • Internship 48 weeks

33. 3.6.Conceptual differences in NIME Curriculum • Competency based curriculum • Incorporated new educational strategies • Competency, learning objective, methodologies and assessment linked • Integrating Biomedical ,Professional competency development ,social and population health sciences with in their disciplines and with each other • Modular delivery

34. 3.7 Conceptual differences cont… • Emphasis on : • Essential clinical and professional skills • Emergency live saving surgical and obstetrics skills • Ethiopian health problems, Infectious diseases& rural health introduced

35. Area Expert Workshop For NIMEI 2011

36. Medical & Health Sciences Council Meeting for NIME I2011

37. 3. NIMEI Implementation

38. 3.Institutional arrangement of Medical schools • Designed to take place under • FMOE : Universities under the Education sector • FMOH : Regional Hospitals and Health Sciences Collages under the Health sector transforming them in to medical schools

39. 3.1 Implementing medical schools • Ambo University • Axum University • Debre-Birhan University • Dilla University • Debre-Markos University • DireDawa university • Made-Walabu University • Wolega University • WolaytaSoddo University • Wollo University 10 University based Medical schools

40. 3.2 Implementing medical schools cont.. • Adama Hospital • Yekatit 12 Hospital • Yirgalem Hospital 3 Hospital based Medical schools

41. 3.3.Phasesof Implementation • Phase One- Preparation • Phase Two- Implementation • Phase Three -Out put evaluation

42. 3.4 Phase one - Preparation • Activities under taken • Budget allocation and mobilization of resources, • Introduced of Curriculum to all stake holders, • Familiarization training on the NIME Curriculum, • Faculty development training for 110 teachers form the implementing schools has been completed .

43. 3.5Phase one - Preparation cont.. • Faculty pool, • Sites preparation , • Material resources, • Student entrance exam , selection and recruitment process • Web page development http://info.moe.gov.et

44. 3.6 Phases :Two and Three Phase two : • Strengthening of systems: educational, managerial and other relevant systems • System development for continuous evaluation • Continuous capacity building • Expansion of program Phase three : • Output evaluation

45. 4. Faculty Development

46. 4.1 Faculty Development • Faculty pool development in the medical schools. • Recruit the existing faculty in the MS • Involve inter professional group of professionals • Encourage Private public partnership • Involve the retired but not tired • Ethiopian Diaspora • Expats and friends of Ethiopia • Volunteers

47. 4.Faculty Development cont… • Faculty development through training • To shape the minds and hearts of the future Ethiopian. • Equip medical educators with adequate knowledge, skill and attitude to teacher and facilitate student learning Phase 1: Initial training on the curriculum, teaching skills and other professional relevant areas. Phase 2: Medical Education at MSC level.

48. Faculty Development training 110 teachers July –Aug 2011Adama

49. 5.Recruitment ,Admission and Graduation

50. 5.Recruitment ,Admission and Graduation • Recruitment and Admission process • Graduate of Natural and Health sciences • Criteria based and credential check • Preparation for National Entrance examination • National Entrance examination(Joint) • Interview • Graduation • National Exit examination before graduation • Preparation for national Entrance examination