Pathology Course in MBBS Curriculum

*Rahman MZ

 *Dr. Mohammad Zillur Rahman, Professor and Head, Department of Pathology, Chattogram Medical College, Chattogram. drzillur@gmail.com

Medical Education in Bangladesh is run by a curriculum introduced by the regulatory authority Bangladesh Medical and Dental Council (BM&DC). Now we are continuing our MBBS curriculum 2012. This new curriculum was introduced and published by BM&DC, which was funded and supported by WHO. A national body was appointed to formulate this curriculum. But the beginning of medical education was not that much structured as we are getting now a days.

After liberation in 1971, MBBS course had been running as it was in the then Pakistan period. At that time, Pathology was taught for 3 years. In 3rd year and 4th year, general Pathology, hematology and clinical pathology were included and ended with 3rd Professional examination. Systemic pathology was called as Special Pathology and was taught in 5th year course. It was also a full paper examination in final professional examination.

It was first in December 1982, when Professor M A Mannan, the then President of Bangladesh Medical and Dental Council, offered a 12 page curriculum for MBBS students. Prof Mannan was a Professor of Neurology at IPGM&R. The President of BM&DC was his additional post. At the introduction of the curriculum, he wrote “the quality of medical education in the country requires to be supervised and constantly monitored by BM&DC to ensure adequate standard and appropriateness of such education in meeting the health needs of the population to be served for achieving the national goal of health for all by 2000 A.D.” The curriculum was made through sub-committees at all medical colleges by the experienced teachers. It was also mentioned that the need based and country oriented curriculum have been suggested.

But, in this curriculum, the course of Pathology was shrunken and adopted within two years instead of previous three years course. On the other hand, at that time Pathology and Microbiology was included in one subject. Though the course was of two years, students actually couldn’t give priority to Pathology because of upcoming forensic medicine and Pharmacology examination in 2nd professional examination. That means most of the students though attending the pathology classes for avoiding non collegiate status, usually didn’t go through pathology books.

Later, in 1988, the curriculum was revised. This time, Professor M A Wahab, led the committee through Center for medical education. A complete book volume of 167 pages were published. This time the curriculum was more structured but the courses content of Pathology remains as before. But in 1988 curriculum, item card was introduced and made mandatory to complete each and every items of the card, followed by a card completion examination. This had somewhat improved the situation.

 In 2002 curriculum, a revolutionary decision was taken. 2nd professional examination after completing 3rd year has been merged with 4th year completion. This time, pathology was separated from microbiology. Thus reducing one professional examination, students had to study all five subjects; i.e. Pathology, Microbiology, Pharmacology, Forensic Medicine and community medicine. So, here the students became more regular in Pathology learning in comparison to the era of previous curriculum. As Microbiology became separate examining subject, total 5 subjects were included in 2nd professional examination. Though the course was modified into 3 phases, the phase-2 was kept two years long, which was adequate for Pathology learning. On the other hand, the examination schedule was reprogrammed 6 monthly instead of previous 4 monthly schedule. This made the students comfortable to attend all the classes and to study all five subjects equally for two years. But the problem the students faced was the examination phobia of appearing in 5 subjects at a time. Not only that, there was a remarkable reduction in rate of passing the examination too.

To consider these problems, BM&DC again formulated sub-committees to rearrange the curriculum. These committees finally formulated a curriculum known as 2012 curriculum. This new curriculum again turned to 4 professional examination system.  But, this time, forensic medicine and community medicine are placed in 2nd phase. Pathology, Microbiology and Pharmacology are kept in 3rd phase. Moreover, in this one year course time for pathology, Microbiology and pharmacology, students get only 6 to 8 months time, due to different kinds of vacations and preparatory leaves. So, ultimately, the 3 years course of Pathology converted to 1 year course, that should be taught within 6 to 8 months time. This is very alarming that students are getting 2 to 3 months time per subject in the classes.

Pathology plays the pivotal role in learning medicine. Inadequate knowledge in Pathology cannot make a good clinician. Moreover, Pathology should be read in both 2nd and 3rd phases. A group of the pathologist professionals involved in teaching pathology think that pathology should be taught in undergraduate level as Term-1 with general pathology in 3rd year and term-2 with systemic pathology in the 4th year. The professional examination should be held at the end of the 4th year.

It is a matter of concern that medical graduates who goes abroad for higher education requires academic transcript from Bangladesh.The total working hours of pathology in our country, in comparison to different countries in SAARC , is lower than others. For this reason, equal distribution of pathology study hours with foreign curriculum are required.

On the other-hand, in previous curriculum of postgraduate medical education, pathology was taught in Part-1 and genetics in part-2 of the course. Now a days, residency program is adopted and these topics are no more included as a separate subject. So, there is no scope to fill in the gaps of knowledge regarding pathology which is needed as a must to become a better clinicians. That is why, this is very important to learn pathology with proper care in undergraduate course as a backbone of medical science.

So, it can be proposed that general pathology and hematopathology to be included in 2nd phase and Pathology paper-1 examination in 2nd professional examination, followed by systemic pathology including clinical and chemical pathology and forensic pathology in 3rd phase; as well as Pathology paper-2 examination in the 3rd professional examination. It will be of great improvement in the learning process as general pathology knowledge is very essential to learn forensic medicine and community medicine, which are taught in 2nd phase.

MBBS is the basic course for a medical graduate. If adequate knowledge, skill and attitude is not developed through this course and curriculum, medical graduates will fail to diagnose and manage patients efficiently as well as their weak base of pathology knowledge will make them facing difficulties in postgraduate course also. So, the curriculum 2012 needs an urgent review and pathology should get proper attention in the upcoming curriculum.