Sibel K ala ça , M .D ., MPH* / Beki K an , Ph.D .** / A yla Ç akın, B .A .***
İlte r G üney, M .D .**** / Nurdan Tözün, M .D .*****
* D e p a rtm e n t o f P u b lic H ealth, S c h o o l o f M e d icin e , M arm ara U n ive rsity, Is ta n b u l, Turkey.
* * C o o rd in a to r-in -C h ie f o f M e d ica l E d u c a tio n , D e p a rtm e n t o f B io p h y s ic s , S c h o o l o f M e d ic in e , M a rm a ra U nive rsity, Is ta n b u l, Turkey.
* * * H ead, R e g is tra rs O ffice , S c h o o l o f M e d icin e , M arm ara U n iv e rs ity , Is ta n b u l, Turkey.
* * * * A s s is ta n t C o o rd in a to r o f Phase I, D e p a rtm e n t o f M e d ic a l B io lo g y, S c h o o l o f M edicine, M a rm a ra U n ive rsity, Is ta n b u l, Turkey.
* * * * * D ean o f th e M e d ic a l S ch o o l, D e p a rtm e n t o f G a s tro e n te ro lo g y , S c h o o l o f M edicine, M a rm a ra U n ive rsity, Is ta n b u l, Turkey.
ABSTRACT
O b je c t iv e : T h e a im o f th is d e s c rip tiv e s tu d y w a s to e v a lu a te th e s tu d e n ts ' p e rc e p tio n s re la tin g to m e d ic a l e d u c a tio n a t M a rm a ra U n iv e rs ity S c h o o l o f M e d ic in e in o rd e r to in c lu d e th e ir o p in io n s a n d r e c o m m e n d a tio n s in fu tu r e c u r r ic u la r a n d m e th o d o lo g ic a l c h a n g e s in m e d ic a l e d u c a tio n .M e t h o d s : D a ta w a s c o lle c te d b y a q u e s tio n n a ire . E ig h ty fo u r re c e n t g ra d u a te s p a rtic ip a te d in th e s tu d y ; th e re s p o n s e ra te w a s 6 0 .4 % . R e s u lt s : T h e g ra d u a te s w e re p le a s e d to be a s k e d th e ir o p in io n s . T h e m a jo rity a g re e d th a t th e re w a s n e e d fo r a " m o d e ra te c h a n g e " in th e e d u c a tio n a l s y s te m o f M a r m a ra U n iv e rs ity S c h o o l o f M e d ic in e . G ra d u a te s w h o re p o rte d " c h a n g e s in th e e d u c a tio n a l s y s te m a re n e c e s s a ry " in d ic a te d th a t n e c e s s a ry c h a n g e s s h o u ld b e d o n e b a s ic a lly in a re a s s u c h a s e d u c a tio n a l m e th o d s , c u rric u lu m , a u d io -v is u a l m a te r ia ls , tr a in in g s k ills a n d a s s e s s m e n t/e v a lu a tio n m e th o d s . C o n c l u s i o n : T h is 'b a s e lin e e v a lu a tio n ' is c o n s id e r e d a s th e in itia l s te p to w a r d s th e im p ro v e m e n t p ro c e s s o f m e d ic a l e d u c a tio n in M a rm a ra U n iv e rs ity S c h o o l o f M e d ic in e , s in c e th e n e c e s s a ry c h a n g e s w e re h ig h lig h te d b y th e re s u lts . T h e s e re s u lts d e m o n s tra te d c o n fo rm ity b e tw e e n th e o p in io n s a n d e x p e c ta tio n s o f s tu d e n ts , a n d th e n e e d s , p r in c ip le s a n d s u g g e s tio n s s ta te d b y th e I n s t it u t io n a l U n d e r g r a d u a t e E d u c a t io n In v e s t ig a t io n . P la n n in g a n d C o o r d in a t io n C o m m it te e . T h e in itia l re s e a rc h p ro v id e d a h o p e fu l p e rs p e c tiv e in o p e n n e s s to a n d c o m p lia n c e w ith th e c h a n g e p ro c e s s at M a rm a ra U n iv e rs ity S c h o o l o f M e d ic in e .
K ey W ords:
M e d ic a l e d u c a tio n , S tu d e n ts ' p e rc e p tio n s , C h a n g e s in m e d ic a l e d u c a tio nINTRODUCTION
In re s p o n s e to c u rre n t c h a lle n g e s in th is c e n tu ry to re fo rm m e d ic a l e d u c a tio n , a n u m b e r of m e d ic a l s c h o o ls h a v e re p la c e d tra d itio n a l e d u c a tio n a l m e th o d s w ith in n o v a tiv e c u rric u la (1 ). S in c e th e fa m o u s a n d in flu e n tia l F le x n e r re p o rt in 1 9 1 0 , a t le a s t 2 4 o th e r m a jo r re p o rts a d v o c a tin g re fo rm h a v e b e e n is s u e d , a n d th e ySibel Kalaça, et al
a re s trik in g ly s im ila r in th e ir p re s c rip tio n s (2 ,3 ). In n o v a tio n s s u c h a s p ro b le m -b a s e d le a rn in g a n d c o m m u n ity -o rie n te d e d u c a tio n to o k a p rin c ip a l p la c e in n e w m e d ic a l s c h o o ls . T h e n e e d to c h a n g e m e d ic a l e d u c a tio n is h o w e v e r g re a te r in e s ta b lis h e d m e d ic a l s c h o o ls , b u t in n o v a tio n s s e e m m o re d iffic u lt to a c h ie v e th e re , a lth o u g h in s o m e c a s e s a c e rta in m e a s u re o f s u c c e s s h a s b e e n re p o rte d (4). M a rm a ra U n iv e rs ity M e d ic a l S c h o o l is a re la tiv e ly y o u n g m e d ic a l s c h o o l; it is in th e p ro c e s s of c h a n g in g its c u r r ic u lu m a s w e ll a s re v is in g e d u c a tio n a l m e th o d s in th e lig h t o f r e c e n t d e v e lo p m e n ts . S o m e o th e r m e d ic a l fa c u ltie s in T u rk e y h a v e a ls o b e e n d o in g , lik e w is e (5). A s th e firs t p a rt o f th e im p ro v e m e n t p ro c e s s , s e v e ra l s tra te g ie s h a v e b e e n p u t fo rw a rd s in c e th e e n d o f 1 9 9 7 , s u c h a s:
1. p a rtic ip a tio n o f all p a rts , in c lu d in g s tu d e n ts , in re -d e te rm in a tio n o f th e g o a ls of e d u c a tio n , 2. b e in g g u id e d b y th e lo c a l a n d g lo b a l c h a n g e s
a n d im p ro v e m e n ts in m e d ic in e a n d m e d ic a l e d u c a tio n ,
3. d e p e n d in g o n c a r e fu l e x a m in a tio n o f th e c u rre n t s y s te m a n d id e n tific a tio n of th e n e e d s fo r a c h a n g e ; th is p o in t w a s c o n s id e re d a s th e firs t a n d a v e ry im p o rta n t s te p to w a rd s th e im p ro v e m e n t p ro c e s s (2 ,3 ).
4. a n d re b u ild in g o f th e s y s te m s te p b y s te p , s ta rtin g w ith th e c o re c u rric u lu m .
S e v e ra l c o m m itte e s w e re fo rm e d in o rd e r to im p le m e n t th e s e s tra te g ie s . T h is s tu d y h a s b e e n r e g a r d e d a n d c o n d u c te d a s a n im p o r ta n t in s tru m e n t fo r s tu d e n ts ' in v o lv e m e n t in th e re fo rm e ffo rts . T h ro u g h th is s tu d y , th e s tu d e n ts in d ic a te d th a t g iv in g a h ig h p rio rity to th e ir in v o lv e m e n t in re fo rm e ffo rts w a s a p p ro p ria te s in c e th e y w o u ld b e in a b e tte r p o s itio n re g a rd in g th e s c h o o l in r e c o g n iz in g n e w to p ic s ; a n d th e ir e n e rg y , c o m m itm e n t, a n d v is io n c o u ld b e a v e ry im p o rta n t im p e tu s fo r c h a n g e (6 ).
MATERIALS AND METHODS
T h e 1 9 9 8 -9 9 g ra d u a te s w e re s e le c te d a s th e s tu d y g ro u p . T h e s tu d y w a s h e ld in th e s u m m e r o f 1 9 9 9 b y th e " I n s t it u t io n a l U n d e r g r a d u a t e E d u c a t io n I n v e s t ig a t io n , P la n n in g a n d C o o r d in a t io n C o m m it te e " . A q u e s tio n n a ir e w a s u s e d fo r d a ta c o lle c tio n . W h e n g ra d u a te s a p p lie d to th e re g is tr a r’s o ffic e to re c e iv e th e ir d ip lo m a s , th e y w e re firs t in fo rm e d a b o u t th e a im s o f th e s tu d y a n d th e n g iv e n a q u e s tio n n a ir e c o n c e r n in g b a s ic s o c io d e m o g r a p h ic in fo r m a tio n a n d le v e ls o f s a tis fa c tio n re la tin g to th e ir m e d ic a l e d u c a tio n . G r a d u a te s w e re a ls o a s k e d to e v a lu a te th e q u a lity o f e d u c a tio n o f d iffe r e n t d iv is io n s s u c h a s 'b a s ic ', 'm e d ic a l' a n d 's u r g ic a l' s c ie n c e s . G ra d u a te s c o m p le te d th e q u e s tio n n a ir e u n d e r o b s e rv a tio n . E ig h ty fo u r o f 1 3 9 g r a d u a t e s fille d in th e q u e s tio n n a ire , th e re s p o n s e ra te w a s 6 0 .4 % .
RESULTS
F ifty fiv e p e rc e n t o f th e g ra d u a te s w e re fe m a le . T h e re w a s o n ly o n e m a rrie d s tu d e n t. G r a d u a te s w e re a s k e d to a s s e s s th e ir o w n p e rfo rm a n c e s d u rin g m e d ic a l e d u c a tio n u s in g a 10 p o in t s c a le (1 -m in im u m ; 1 0 -m a x im u m ). T h e y s c o re d fo r e a c h y e a r in th e s c h o o l a n d fo r th e e n tire m e d ic a l e d u c a tio n . T h e m e a n s c o re fo r th e e n tire e d u c a tio n a l p e rio d w a s 7 .5 (S d = 1 ,5 ). T h e s ix th y e a r o f th e m e d ic a l e d u c a tio n g o t th e h ig h e s t s c o re o n th e a v e ra g e (8 .6 7 (S d = 1 ,5 )) w h ils t th e lo w e s t s c o re s w e re g iv e n fo r th e firs t th re e y e a rs (6.71 (S d = 1 ,9 ), 6 .4 8 (S d = 1 ,9 ) a n d 6 .5 0 (S d = 1 ,8 ) re s p e c tiv e ly ) (F ig . 1). A lm o s t h a lf o f th e g r a d u a te s (5 6 .3 % ) re p o rte d th a t th e y h a d h a d "a h a p p y tim e a s s tu d e n t" in m e d ic a l s c h o o l, w h ile 2 5 .4 % o f th e m h a d b e e n "u n h a p p y " . T h e re s t o f th e g ra d u a te s re m a in e d u n d e c id e d . W h e n th e r e a s o n s fo r 'u n h a p p in e s s ' w e re s o lic ita te d b y a n o p e n -e n d e d q u e s tio n , s o m e o f th e g ra d u a te s re p o rte d re a s o n s s u c h a s:• "M e d ic a l e d u c a tio n is v e ry h a rd a n d s tre s s fu l", • "A n x ie ty fo r th e fu tu re ",
• "A v e ry d iffic u lt e x a m in a tio n is w a itin g fo r us a fte r th e g ra d u a tio n " ,
• " P ro b le m s o f th e c u rr e n t h e a lth s y s te m ", • "M e d ic a l e d u c a tio n is o la te d m e fro m s o c ia l
F ig . I Self-Reported Performance Level of Students3 for Each Year and for the Entire Medical Education (Box-plot)b
3 Students were asked to score their own performance (level of success) during medical education using a 10 point scale (1-minumum; 10-maximum).
b Each box represents percentiles of the score distribution. Bold line in each box represents 50th percentile (median value).
• "V e ry lim ite d s o c ia l a c tiv itie s in th e s c h o o l" • " A d a p ta tio n p ro b le m s ", • "T o o m u c h m e m o riz a tio n " , • "P e rs o n a l p ro b le m s ". T h irty e ig h t g r a d u a te s (4 5 .2 % ) re p o rte d th a t th e re w a s s o m e "e s s e n tia l m e d ic a l k n o w le d g e " in th e c u rric u lu m th a t th e y w e re n o t a b le to a c q u ire d u rin g th e m e d ic a l e d u c a tio n . F irs t a id a n d e m e rg e n c y c a re w a s re p o rte d b y 3 9 .0 % o f th e s e s tu d e n ts a s a to p ic , w h ic h w a s n o t ta u g h t s u ffic ie n tly . A lth o u g h s tu d e n ts w e re a s k e d a b o u t th e 'la c k o f k n o w le d g e ' in th is q u e s tio n , th e y re s p o n d e d m o s tly o n th e 'la c k o f e d u c a tio n to g a in c lin ic a l s k ills '.
T h e 'd e fic ie n c y in a c q u irin g c lin ic a l s k ills ’ d u rin g m e d ic a l e d u c a tio n w a s e x a m in e d b y a n o th e r q u e s tio n . T h ir ty fiv e p e rc e n t o f th e g ra d u a te s re p o rte d th a t th e y w e re n o t c o m p e te n t in s o m e c lin ic a l s k ills . F o rty p e rc e n t o f th e g ra d u a te s re p o r te d th e y w e re n o t c o m p e te n t in b a s ic s u r g ic a l in te r v e n t io n s s u c h a s in tr a v e n o u s in je c tio n , s u tu rin g a n d a b s c e s s d ra in a g e . T w e n ty p e rc e n t o f th e m w e re n o t c o m p e te n t in a s s is tin g c h ild -b irth a n d 17 % o f th e m w e re n o t c o m p e te n t in s k ills re la te d to e m e rg e n c y c a re (T a b le I). G ra d u a te s w e re a ls o a s k e d fo r th e re a s o n s fo r th e la c k o f k n o w le d g e a s w e ll a s c lin ic a l s k ills .
T a b l e I. Clinical Skills in Which Students Found Themselves Incompetent
Clinical Skills n %
Basic surgical interventions2 14 40,0
Assisted child-birth 7 20,0
Emergency care skills 6 17,0
Lumbar puncture 3 oo o
Thoracentesis, tracheostomy etc. Invasive interventions 2 6,0
Other0 3 8,0
Total0 35 100,0
a IV injection, abscess drainage, suturing
b 'I've worked hard by myself in order to be competent', 'treatment',
'paediatric examination'
c 'some students have reported more than one skill'
T h is w a s a c lo s e d -e n d e d q u e s tio n a n d in c lu d e d th e s e c h o ic e s : • d u e to p e rs o n a l re a s o n s • d u e to e d u c a tio n a l m e th o d s • d u e to th e c u rric u lu m • d u e to th e p h y s ic a l e n v iro n m e n t • d u e to th e la c k o f n e c e s s a ry to o ls a n d m a te ria ls • d u e to th e p ro fe s s o rs G ra d u a te s w e re a s k e d to m a rk th e s e ite m s a c c o rd in g to th e d e g re e o f im p o rta n c e . It w a s fo u n d th a t th e m a jo rity o f th e s tu d e n ts g a v e th e firs t th re e ra n k s to th e 'e d u c a tio n a l m e th o d s ', to 'p e r s o n a l r e a s o n s ' a n d to 'p r o f e s s o r s'a s th e m a in re a s o n s o f la c k o f k n o w le d g e a n d s k ills . O u t o f 8 4 , o n ly fiv e s tu d e n ts re p o rte d th a t th e y w e re n o t c o m p e te n t in c o m m u n ic a tio n s k ills. S in c e m e d ic a l e d u c a tio n is in E n g lis h a t M a rm a ra U n iv e r s ity S c h o o l o f M e d ic in e ; g r a d u a te s ’ o p in io n s w e re a ls o a s k e d a b o u t th is . S e v e n ty fiv e p e rc e n t o f th e g ra d u a te s re p o rte d th a t 'm e d ic a l e d u c a tio n in E n g lis h ' is v e ry u s e fu l b e c a u s e it o ffe rs a b ig a d v a n ta g e fo r s tu d e n ts in fo llo w in g th e lite ra tu re . T h e re s t o f th e g ra d u a te s w e re n o t v e ry s a tis fie d w ith th e la n g u a g e o f m e d ic a l s c h o o l a n d c o m m e n te d 'th e y w e re h a v in g d iffic u ltie s in b o th u n d e r s ta n d in g a n d c o m m u n ic a tin g w ith p a tie n ts ’ (T a b le II).
T h e d a ta a b o u t th e s tu d e n ts ' o p in io n re la te d to th e s o c ia l a c tiv itie s a t s c h o o l is p re s e n te d in
Sibel Kalaça, et al
T a b l e II. Students' Opinions on 'Medical Education in English'
Opinions n %
Positive effects3 63 75,0
Negative effects6 5 6,0
Neither positive nor negative 5 6,0
Must be in Turkish after preparatory year 2 2,4
Inconvenient in clinical practice 2 2,4
No idea 2 2,4
Must be in Turkish, optionally some lectures in English 1 1,2
Unnecessary 1 1,2
Only "bedside" must be in English 1 1,2
No contribution to my college English 1 1,2
Medical education must be in our native language 1 1.2
Total 84 100,0
a Ease in following the literature 13 Difficulty in communication with patients
T a b le III. S e v e n ty p e rc e n t o f th e g ra d u a te s w e re d is s a tis fie d w ith th e s o c ia l a c tiv itie s h e ld a t th e s c h o o l c a m p u s . T h e p ro b le m s w ith b o th q u a lity a n d q u a n tity o f th e s o c ia l a c tiv itie s a t s c h o o l w e re e m p h a s iz e d b y m a n y g ra d u a te s a s a re a s o n fo r b e in g 'u n h a p p y ' d u rin g m e d ic a l e d u c a tio n .
T a b l e III. Students' Opinions About Social Activities
Social Activities n % Completely insufficient 28 34,1 Insufficient 30 36,6 No idea 13 15,6 Sufficient 9 11.0 Other3 2 2,4 Total6 82 100,0
a 'Getting better within this year'
'I had a high school life instead of university' b 2 students did not respond
T h e g ra d u a te s e v a lu a te d th e s tu d e n t-p ro fe s s o r re la tio n s h ip s p e c ific a lly fo r 'o u t o f th e c la s s ro o m c o n ta c ts '; 4 2 % o f th e g ra d u a te s re m a in e d u n d e c id e d ; 14 % o f th e m fo u n d th is 'u n s a tis fa c to ry ' w h ils t 3 5 .4 % o f th e m fo u n d it 's a tis fa c to ry '. G ra d u a te s a ls o s ta te d th a t th e y h a d le s s o p p o r tu n ity to o b ta in c o n ta c t w ith th e p ro fe s s o rs te a c h in g b a s ic s c ie n c e s . U se o f th e lib ra ry is o n e o f th e in d ic a to rs o f th e q u a lity o f m e d ic a l e d u c a tio n . S tu d e n ts w e re a s k e d w h e th e r th e y u s e d th e lib ra ry fo r re a s o n s o th e r th a n 's tu d y in g '. S ix ty e ig h t p e rc e n t o f th e m s ta te d th a t th e y u s e d th e lib ra ry m o s tly fo r re v ie w in g th e lite ra tu re w h ils t 3 1 .7 % o f th e m n e v e r u s e d th e lib ra ry e x c e p t fo r s tu d y in g . G ra d u a te s w e re a s k e d if th e re w a s a n y n e e d fo r m a k in g c h a n g e s in th e e d u c a tio n a l s y s te m of M a rm a ra U n iv e rs ity S c h o o l o f M e d ic in e . O n ly 1 0 % o f th e g ra d u a te s re p o rte d th a t th e re w a s no n e e d fo r a c h a n g e , w h ils t 8 9 .2 % e x p re s s e d th e n e e d fo r ra d ic a l o r m o d e ra te c h a n g e . H o w e v e r, it s h o u ld b e e m p h a s iz e d th a t th e m a jo rity o f th e g ra d u a te s (7 0 .4 % ) a g re e d w ith th e id e a o f th e 'n e c e s s it y o f m o d e r a t e c h a n g e s ' (T a b le IV ).
T a b l e IV . Need for Change in Education
Opinions n %
Yes, there is need for a radical change 16 19,8
Yes, there Is need for a moderate change 57 70,4
I am not sure if it is needed 6 7,4
There is no need 2 2,5 Total 81 100,0 G r a d u a te s w h o r e p o r te d 'c h a n g e s in th e e d u c a tio n a l s y s te m a re n e c e s s a ry ’ w e re g iv e n n in e c h o ic e s a b o u t w h a t m ig h t b e d o n e fo r s u c h a c h a n g e . T h e o p in io n s o f th e s tu d e n ts a re s h o w n in T a b le V. M o s t o f th e g r a d u a te s a g re e d
T a b l e V . What Might be Done for Change?
Necessary changes(n=73)* n %
Educational methods which ensure active participation
of the students should be used', 65 89,0
’Innovative methods should be introduced in teaching
clinical skills' 65 89,0
'Audio-visual material which have been used for
the lectures should be redesigned and reproduced' 52 71,2
Training skills of the professors should be improved' 50 68,5
'Theoretical lectures should be reviewed and some of the
topics should be added to the curriculum' 41 56,2
Some of the topics should be considered as electives;
not as a core subject' 41 56,2
Theoretical lectures should be reviewed and some of the
topics should be excluded from the curriculum' 35 47,9
Oral examination system should be changed' 22 30,1
'Written examination system should be changed' 18 24,7
* This question was asked only to students who stated that change was necessary1.
th a t 'e d u c a t io n a l m e t h o d s w h ic h e n s u r e a c tiv e p a r t ic ip a t io n o f th e s t u d e n t s s h o u ld b e u s e d ', 'in n o v a t iv e m e t h o d s s h o u ld b e in t r o d u c e d in t e a c h in g c lin ic a l s k ills ', 'a u d io - v is u a l m a t e r ia l w h ic h h a v e b e e n u s e d f o r th e le c t u r e s s h o u ld b e r e d e s ig n e d a n d r e p r o d u c e d , a n d 'tr a in in g s k ills o f th e p r o f e s s o r s s h o u ld b e im p r o v e d '. G ra d u a te s w e re a ls o a s k e d to e v a lu a te 'b a s ic ', 'm e d ic a l' a n d 's u rg ic a l' s c ie n c e s w ith re s p e c t to th e s u ffic ie n c y o f th e ir th e o re tic a l a n d /o r p ra c tic a l e d u c a tio n . A lth o u g h n o t s h o w n in th is a rtic le , d e ta ile d d a ta d e m o n s tra te d th a t g ra d u a te s h a v e a s h a r e d ju d g e m e n t a b o u t c o m p e te n c y o f e d u c a tio n o f e a c h d e p a r tm e n t in d iffe r e n t d iv is io n s . T h is m a y b e an in d ic a to r a b o u t th e re lia b ility o f th e s tu d e n ts ' e v a lu a tio n .
A t th e e n d o f th e q u e s tio n n a ire g ra d u a te s w e re a s k e d to c o m p a r e th e ir c o m p e te n c y in b o th m e d ic a l k n o w le d g e a n d c lin ia l s k ills w ith th e s tu d e n ts /g r a d u a te s o f o th e r m e d ic a l s c h o o ls in T u rk e y . T h is m a y b e th o u g h t o f a s a p re m a tu re q u e s tio n s in c e th e s tu d e n ts w e re r e c e n t g ra d u a te s a n d h a d n o t h a d a n y e x p e rie n c e in p ra c tic e . H o w e v e r, m e d ic a l s tu d e n ts h a v e m a n y o p p o rtu n itie s to g e t in to c o n ta c t w ith m e d ic a l s tu d e n ts fro m o th e r U n iv e rs itie s . A s a re s u lt, a lm o s t 9 0 % o f th e g ra d u a te s fo u n d th e m s e lv e s 's u c c e s s fu l' o r 'v e ry s u c c e s s fu l’ in k n o w le d g e , p r a c tic a l s k ills a n d a ttitu d e s to w a rd p a tie n t/c o lle a g u e s c o m p a re d w ith o th e r m e d ic a l s c h o o l g ra d u a te s .
DISCUSSION
T h is 'b a s e lin e e v a lu a tio n ' is c o n s id e re d a s th e in itia l s te p to w a rd s th e im p ro v e m e n t p ro c e s s o f m e d ic a l e d u c a tio n a t M a rm a ra U n iv e rs ity S c h o o l o f M e d ic in e , s in c e th e n e c e s s a ry c h a n g e s w e re h ig h lig h te d b y th e re s u lts . T h e m a jo rity o f th e 1 9 9 9 g ra d u a te s s ta te d th a t th e re is n e e d fo r m o d e r a te c h a n g e . T h e y h a v e in d ic a te d th a t n e c e s s a ry c h a n g e s s h o u ld b e d o n e b a s ic a lly in a re a s s u c h a s e d u c a t io n a l m e th o d s , c u r r ic u lu m , a u d io - v is u a l m a t e r ia ls , t r a in in g s k ills a n d a s s e s s m e n t / e v a lu a t io n m e th o d s . T h e s e re s u lts d e m o n s tra te d c o n fo rm ity b e tw e e n th e c ritic a l a n d e x p e c ta tio n s o f s tu d e n ts a n d th e n e e d s , p rin c ip le s a n d s u g g e s tio n s s ta te d b y th e I n s t i t u t i o n a l U n d e r g r a d u a t e E d u c a t io n I n v e s t ig a t io n , P la n n in g a n d C o o r d in a t io n C o m m itte e . S u b -c o m m itte e s s tu d y in g th e a re a s w h e re im p r o v e m e n ts w e re e x p e c te d h a v e a lre a d y b e e n e s ta b lis h e d . E d u c a tio n a l re fo rm m o v e m e n ts h a v e b e e n in itia te d in m a n y m e d ic a l s c h o o ls in T u rk e y w ith d iffe re n t p e rs p e c tiv e s a n d e x p e rie n c e s . S e v e ra l s tu d ie s h a v e b e e n c o n d u c te d in o rd e r to e v a lu a te c u rre n t m e d ic a l e d u c a tio n a ls o in th o s e m e d ic a l fa c u ltie s . T h e re s u lts o f th e s e s tu d ie s h a v e s h o w n m a n y s im ila ritie s w ith o u r s tu d y , y e t s o m e im p o rta n t d iffe re n c e s e x is t.A c c o rd in g to th e re s u lts o f a s tu d y w h ic h w a s c o n d u c te d in E g e U n iv e rs ity M e d ic a l S c h o o l s tu d e n ts w e re v e ry d is s a tis fie d w ith th e s o c ia l a c tiv itie s h e ld a t s c h o o l, a s w e re o u r s tu d e n ts (7). In a n o th e r s tu d y , 8 7 .7 % o f th e s ix th y e a r m e d ic a l s c h o o l s tu d e n ts s ta te d th a t th e y d id n o t p a rtic ip a te in s o c ia l a c tiv itie s d u e to la c k of le is u re tim e (8). T h e s a m e s tu d y s h o w e d th a t 1 5 .8 % o f s tu d e n ts n e v e r u s e d th e lib ra ry , w h ils t 6 5 .4 % u s e d it o n ly fo r s tu d y in g (p r e p a ra tio n fo r e x a m in a tio n s ). In o u r s tu d y , th e ra te o f u s in g th e lib ra ry fo r re a s o n s o th e r th a n s tu d y in g w a s m a rk e d ly h ig h e r. S tu d e n t-p ro fe s s o r re la tio n s h ip fo r th e 'o u t of c la s s ro o m c o n ta c ts ' w a s e v a lu a te d b y 9 4 .2 % of th e s tu d e n ts a s 'u n s a tis fa c to r y ' in U lu d a g U n iv e r s ity M e d ic a l S c h o o l( 8 ) , w h ile 'u n s a tis fa c to r y re la tio n s h ip ' w a s re p o rte d b y 1 4 .6 % o f th e s tu d e n ts in o u r m e d ic a l s c h o o l. In th e s a m e s tu d y a t U lu d a g U n iv e rs ity , 7 9 .2 % of th e s tu d e n ts re p o rte d th a t th e y d id n o t fe e l th e m s e lv e s c o m p e te n t in c lin ic a l s k ills a n d 8 1 .3 % o f th e m in e s s e n tia l m e d ic a l k n o w le d g e . E ig h ty s e v e n p e rc e n t o f th e s tu d e n ts re p o rte d th a t it w a s v e ry im p o rta n t a n d n e c e s s a ry to k n o w a t le a s t o n e fo r e ig n la n g u a g e fo r a b e tte r m e d ic a l e d u c a tio n ; a n d o n ly 2 0 % o f th e m re p o rte d th e y w e re c o m p e te n t in o n e fo re ig n la n g u a g e . A lm o s t 1 0 0 % o f th e s tu d e n ts a t M a rm a ra U n iv e rs ity S c h o o l o f M e d ic in e a re c o m p e te n t in m e d ic a l E n g lis h .
T h e A s s o c ia tio n o f A m e ric a n M e d ic a l C o lle g e s g iv e s in fo rm a tio n a b o u t th e k in d s o f c h a n g e s a lre a d y o c c u rrin g . In th e p re c lin ic a l c u rric u lu m , s c h o o ls h a v e in tro d u c e d a w id e ra n g e of n e w
Sibel Kalaça, et al
c o u rs e s a n d to p ic s ; a n d th e re is m o re a tte n tio n o n p ro fe s s io n a lis m a n d v a lu e s . S c h o o ls a re m a k in g fu n d a m e n ta l c h a n g e s in th e d e s ig n a n d c o n d u c t o f th e c u rric u lu m , p rim a rily b y a d o p tin g m o re in te g ra te d (n o n -d e p a rtm e n ta l) a p p ro a c h e s to c o u rs e d e s ig n a n d m a n a g e m e n t. A ls o , fa c u ltie s a re p a y in g m o re a tte n tio n to th e ro le o f re s id e n ts a s p ro fe s s o rs a n d ro le m o d e ls (9 ).
It w a s s ta te d th a t to d a y 's p ro b le m s , h o w e v e r fo rm id a b le th e y m a y b e , a re n o t a s p ro fo u n d a s th o s e fa c e d b y m e d ic a l e d u c a to rs a c e n tu ry a g o - a n d th a t th e re is tim e a n d o p p o rtu n ity fo r v is io n a rie s a n d le a d e rs to a c t. T h is m a y b e tru e , b u t o n ly if th e y c a n p ro p e rly d ia g n o s e th e p re s e n t p ro b le m s o f m e d ic a l e d u c a tio n , a m p ly u n d e rs ta n d th e ir ro o ts , id e n tify e ffe c tiv e m e a n s to re m e d y th e m , a n d g a lv a n iz e m e d ic a l e d u c a to rs to m a k e th e s y s te m ic , in s titu tio n a l c h a n g e s , lo c a lly a n d n a tio n a lly , th a t a re c a lle d fo r(2 ).
A m e d ic a l s c h o o l s h o u ld b e a c tiv e in v a rio u s re a lm s . U n d e r g r a d u a te tr a in in g s h o u ld b e s itu a te d in th e c o n te x t o f m e d ic a l tra in in g a s a w h o le , w h ic h d o e s n o t s to p w ith g ra d u a tio n (IO ).
C h a n g e in m e d ic a l e d u c a tio n is m o re lik e ly to be m a in ta in e d a s a c h a ra c te ris tic o f e d u c a tio n th a n s ta b ility . "W e c a n lo o k a ro u n d " s u g g e s ts P ritc h e tt a n d P o u n d (1 9 9 7 ) a n d s e e " m a n y w o u ld b e re fu g e e s fro m c h a n g e , p e o p le lo o k in g fo r e a rly re lie f fro m a ll th e s tre s s . Y e t th e re is no p la c e to ru n . N o b a c k d o o r. N o e s c a p e ro u te fro m re a lity ". E v e ry o n e , to a g re a te r o r le s s e r e x te n t w ill be in v o lv e d in e d u c a tio n a l c h a n g e . P ro fe s s o r s , tr a in e r s , c u r r ic u lu m d e s ig n e r s , a s s e s s o r s , re s o u rc e d e v e lo p e r s a n d s tu d e n ts w ill n o t be a b le to e s c a p e fro m it. H o w s h o u ld w e re s p o n d ? W e s h o u ld m a k e “ c h a n g e ” o u r p a r tn e r n o t riv a l (3).
W ith its y o u n g e r fa c u lty , s m a lle r n u m b e r of s tu d e n ts , p r o g r e s s iv e b a c k g r o u n d , a n d o p e n n e s s to a n d c o m p lia n c e w ith th e c h a n g e
p ro c e s s o b s e rv e d d u rin g th e in itia l s te p s of tra n s itio n p e rio d , M a rm a ra U n iv e rs ity S c h o o l of M e d ic in e p r o m is e s a h o p e fu l e d u c a tio n a l p e rs p e c tiv e fo r th e fu tu re .
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