A Critical Appraisal of the New Competency-Based Medical Undergraduate Curriculum in Biochemistry

Indian Journal of Clinical Biochemistry https://doi.org/10.1007/s12291-022-01088-y REVIEW ARTICLE A Critical Appraisal of the New Competency-Based Medical Undergraduate Curriculum in Biochemistry Sucheta P. Dandekar1 · Farzana Mahdi2 · Thomas V. Chacko3 Received: 25 April 2022 / Accepted: 2 September 2022 © The Author(s), under exclusive licence to Association of Clinical Biochemists of India 2022 Abstract The new competency-based medical education undergraduate curriculum (CBMC) was launched for the 2019 admission batch of MBBS students. The programme is designed to create an “Indian Medical Graduate” (IMG) possessing the requisite knowledge, skills, attitudes, values and responsiveness, so that the graduate may function appropriately and effectively as a physician of first contact with the community while being globally relevant. Given that implementation of this curriculum is still in its infancy across the country, we stand to gain from a unified approach to its implementation. Phase I of the curriculum includes anatomy, physiology, and biochemistry along with professional and personal development modules. Biochemistry enjoys an enviable position in the medical curriculum as it explains the molecular basis of diseases. We present an appraisal of the curriculum in Biochemistry by reviewing the components against Harden’s six themes which are considered when planning or developing a curriculum. Further, five core components of CBME are selected on the basis of three research papers to characterize underlying assumptions of CBME to suggest ways of logical implementation for achieving the competencies expected of the Indian Medical Graduate. The insight gained shall help students to be equipped with competencies which they Sucheta P. Dandekar Farzana Mahdi Thomas V. Chacko 1 Era University, Era’s Lucknow Medical College, Sarfaraz Ganj, Hardoi Road, 226003 Lucknow, Uttar Pradesh, India 2 Era University, Era’s Lucknow Medical College, Sarfaraz Ganj, Hardoi Road, 226003 Lucknow, Uttar Pradesh, India 3 Believers Church Medical College & Hospital, St Thomas Nagar, 689103 Kuttapuzha, Thiruvalla, Kerala, India shall be able to use in their day- to- day work, which shall ultimately help benefit patient care and the society at large. Keywords Competency based medical education · curriculum · biochemistry · undergraduate Indian Medical Graduate Context that Necessitates the Review The “traditional” undergraduate medical curriculum in India had remained discipline-based education, teacher centered, with a focus on knowledge acquisition and single time, summative assessments. The system relied heavily on didactic lectures. Assessments were also largely based on recall of factual information and honing of skills which were becoming redundant, especially in the subject of Biochemistry. Constituted by an act of Parliament, known as the National Medical Commission Act, 2019, the National Medical Commission (NMC), came into force by a gazette notification dated September 24, 2020. The NMC placed “Minimum requirements for annual MBBS admissions regulations, 2020,” in the public domain on October 28, 2020. [1] The main aim of the NMC is to improve access to quality and affordable medical care; ensure the availability of adequate and high-quality medical professionals in all parts of the country.[2]. “Competency Based Undergraduate Curriculum for the Indian Medical Graduate” was launched for the 2019 admission batch of MBBS students. This document highlights the required competencies and the appropriate teaching-learning activities.[3]. Competency-Based Medical Education (CBME) is an outcome-based strategy that integrates knowledge, skills, attitudes, and ethics into observable and measurable competencies.[4] Faculty development was envisaged as a key determinant for the successful implementation of the CBMC. Training of medical teachers through the basic and 13 Indian Journal of Clinical Biochemistry advanced course workshops via the curriculum implementation support program (CISP), contributed to the capacity building of the faculty.[5]. The expertise of local healthcare faculty to guide meaningful standardization and meet the local needs of educational programs should be inculcated. As a guideline, the five core components of CBME should serve to ensure and maintain the fidelity of the original design of outcomesbased education during the implementation of the Biochemistry curriculum, along with the review the new curriculum against Harden’s conceptualization of various components of the curriculum.[6, 7]. The goal of CBME is to produce an Indian Medical Graduate (IMG) who is envisaged as a doctor fulfilling the roles of clinician, leader, communicator, professional and lifelong learner.[3] Biochemistry enjoys an enviable position in the medical curriculum. Biochemistry explains the molecular basis of diseases. A lot of medicine is based on Biochemistry and a total of 250 h of Biochemistry teaching are advocated in the curriculum.[8] How the curriculum of biochemistry shall influence the achievement of the overall goals of the IMG curriculum at national and individual levels remains to be seen. The initial authors of the curriculum of Biochemistry had mostly listed the content and traditional teaching of Biochemistry into outcome competencies. While this is a step forward, one of the advantages of CBME where curricular outcomes are in alignment with job roles and making them “job ready” is not made clear. One of the risks is a lot of cognitive overload and a burden on the students. Hence, we aimed to do this alignment so that essential elements are not missed and at the same time some relatively ‘not directly contributing to job roles’ is got rid of, thereby, reducing the cognitive burden on the students. In the traditional curriculum, this was increasing with no “shedding” of obsolete or unrelated facts. Table 1 showcases the competencies for the goals of IMG and the role of Biochemists to help fulfil them as envisioned by the authors. There are 35 competencies defined for these five roles. The teaching-learning strategies elaborated in the table for Biochemists should be implemented with the spirit in which it is stated, keeping in mind the five roles of the IMG, ensuring that the modules developed have reference to them.[9] It is evident here that the ECE, AETCOM and small group teaching methods shall help instil a foundation for the complete execution of the 5 roles of the IMG. ● *Clarifications regarding the role of biochemists --- at phase 1 biochemists should refrain from expecting the students to diagnose disease, ability to do differential diagnoses or know the normal values of biochemical test 13 parameters. Integration is the need of the hour and the complexities of the disease with inputs from Biochemistry should be pursued at the phase 3 levels. The main role in phase 1 is the introduction of the normal and a clear cut early clinical exposure with n (...truncated)