ISSN: 2688-8408
Journal of Biology and Medicine
Research Article       Open Access      Peer-Reviewed

Improving Quality of Education in Extreme Adversities-The case of Libya

Aisha Nasef1,2*, Mohamed A Al-Griw3 and Adel El Taguri4

1Authority of Natural science Research and Technology, Libya
2Scientific Council of Laboratory Medicine/ Medical Specialty council, Libya
3Quality and Performance Evaluation Office University of Tripoli, Tripoli, Libya
4National Center for Accreditation of Health Establishments, Libya
*Corresponding author: Aisha Nasef, Authority of Natural science Research and Technology, Libya, Tel: + 218910419561; E-mail: Nasef@doctor.com
Received: 19 March, 2020 | Accepted: 29 May, 2020 | Published: 30 May, 2020
Keywords: Medical; Education; Universities; Quality assurance; Accreditation; Libya

Cite this as

Nasef A, Al-Griw MA, Taguri AE (2020) Improving Quality of Education in Extreme Adversities-The case of Libya. J Biol Med 4(1): 006-011. DOI: 10.17352/jbm.000020

Introduction

History of medical education in Libya spans over a period of 50 years. Medical education started in faculty of medicine at Benghazi in 1970, and at Tripoli in 1973. Both medical schools performed their main core function and their graduates provided good health services locally and abroad. However, the medical schools did not keep up with the immense changes that medical education experienced over the last two decades with inclusion of research and community services within their main core function [1-3],

Education of professionals must be adapted to practice in order to meet needs and demands of the population and the health systems that serve them. Currently, the role of medical schools needs to be redefined and regulated in a world where specialization is becoming a requirement to practice. Medical schools need to transform their specialist training into a community-oriented education in accordance with World Health Organization (WHO) and World Federation for Medical Education (WFME) recommendation, to reorient medical education to meet current challenges [3-5].

Reflecting the importance of the interface between medical education and the healthcare delivery sector, the WHO/WFME Strategic Partnership was formed in 2004 to improve medical education. In 2005, the partnership published guidelines for accreditation of basic medical education. The WHO/WFME Guidelines recommend the establishment of proper accreditation systems that are effective, independent, transparent and based on medical education-specific criteria [5-7].

An important prerequisite for this development is initiation and use of WFME Global Standards program in 1997 in all six WHO/WFME regions as a basis for quality improvement of medical education [7].

Global Standards for quality Improvement divided the standards into basic standards and quality development standards. Basic standards, which are 106,should be fulfilled by all institutions involved in medical education. Standards for quality development, which are 90, serve as an incentive for development and as a leverage for improvement. Standards are defined in these two levels for each of the different domains (Text box 1).

Current status of medical education in libya

In spite of initial promising level, quality of medical education in Libyan universities progressively declined due to many reasons (Table 1).

Faculty of Medicine in Libyan international medical university was the only medical school getting a provisional institutional and program accreditation on 2017. Of note, Libya is neither included in countries served by agencies with Recognition Status by WFME, nor among countries with application in progress [8].

Consequences of declining teaching level

The decline in the quality of medical education led to exclusion of Libyan medical schools from the annual publications of international rankings, to loss of confidence in Libyan universities, consequent loss of confidence in Libyan doctors, with further decline in medical services.

Benghazi medical schools achieved 33% of basic standards in an assessment performed in 2018, followed by Tripoli medical schools achieved 22%. Other medical schools achieved less than 5 % of basic standards [9].

Most current medical graduates are under-qualified due to sub-standard medical education, with resulting lack of professionalism, absent scientific attitude, weak creativity and inability to play a role in health advocacy. Suboptimal medical education was aggravated by enrolling of large numbers of students despite non-readiness of medical schools. As a result, a lot of Libyans seek treatment in neighboring countries and in Europe with increase of financial costs and economic burden for both patients and government. In addition, patients pay an additional price because of consequent ineffective and/or incomplete management especially for cancer, trauma and rare diseases.

Road map for accreditaion in libya

Road to accreditation composed of two phases. First phase is establishment of a national task force for accreditation prepares for establishment of a national system for accreditation. Second phase is establishment of sound Internal Quality Assurance (IQA) system with clear responsibilities at medical universities (Figure 1).

Phase one is composed of the following steps to be taken in order to establish a national system for accreditation for higher educational institutes (Text Box 2). The Quality Assurance Accreditation of Higher Educational institutes (QAAHEI), currently named National Center for Quality Assurance and Accreditation of Educational and Training Institutes (NCQAAETIs), is the only governmental authorized body accrediting and quality assuring the higher educational institutes in Libya.

Updated strategic plan (2012-2017), addressed all drawbacks such as redundancy, repetition of mission as well as an ambiguity and inconsistency with higher institute mission. However, a very big obstacle facing center is being affiliated to Ministry of Education with possibility of conflict of interest and loss of independency and credibility. Secondly, being subjected to continuous changes of bylaws and management staff, absence of clear regulation, job description and specification. Thirdly, it’s currently below standards due to several causes despite being a member of International Network for Quality Assurance Agencies in Higher Education (INQAAHE) and Arab Network for Quality Assurance in Higher Education (ANQAHE) till 2012. Moreover, it’s not recognized by WFME yet.

All the higher educational institutes were requested to adapt and implement the standards of quality assurance and accreditation of the Quality Assurance and Accreditation Guide Lines (General Popular Committee Decree # 430 – 2008). Higher educational institutes have to maintain the minimum requirements for accreditation (Institutional / programs; provisional / final).

Phase two concerning with establishment of sound IQA system at medical schools. This system should have a model QA, responsible for QA, customers charter, continuous monitoring of the implementation of the activity (analysis of previous competences, control of the presence, interim verification, students satisfaction, etc), plan for continuous improvement, attention to customer’s satisfaction, determination of vision, mission and goals of the institute, adequate strategic planning and effective action plans to satisfy the goals. General process of Academic Accreditation are shown in (Text Box 3).

Establishement of internal quality system at medical universities

Quality and innovation of medical education in Libyan medical schools is needed, to identify weak area, to enforce education, to graduate competent care giver medical students, to have an international standards of services to retain public trust, to prevent financial and brain drain. Quality medical education can be established in three steps (Table 2).

Self-study and description through assessment of current status such as; facilities, student’s number/staff number, students (attendance, participation, accomplishments, etc.), teaching staff (self-management, professionalism and ethics, skills, knowledge and commitment), resources and availability of sufficient material for practical teaching, uses of advanced technology in teaching such as (clinical skills laboratories, 3D models, telemedicine conferences, etc), examination method and out-come.

Second component of self-study is bench marking with international faculties for modernization of medical schools, through evaluations and revisions to compete with other similar institutions around the world and to ensure delivery of quality medical education for Libyans and inclusion of Libyan medical schools/universities in the annual publications of international rankings.

Initation of IQA through adoption of recommendation and action plan for changes by finding an alternative approaches. Integrative teaching/learning approaches could help keeping a track between basic and clinical sciences and sequentially link all major components of the teaching/learning process. These approaches permit minimum curriculum that meets agreed-upon learning objectives, thus avoiding unnecessary repetition, saving time money and effort of medical school staff and takes into consideration community needs. Implementation of national quality assurance is composed of institutional and program accreditation process [22,23]. Both institutional and program accreditation scope are listed (Table 3). Accreditation process of both institutional and program are shown in (Text Box 4).

Implementation would start by specifying criteria and standards which have to be met, by an official agency of accreditation body in order to achieve a positive

External assessment. The criteria and standards for accreditation vary widely between different countries and according to the specific field of training (Table 4).

Auditing should involve evaluation of 10 standards, and result should be ≥ 60% for each standard, and overall result should be ≥ 70% (Table 5) [22].

Conclusion

Evidence based medicine, clinical reasoning, self-directed critical thinking and problem solving approach are mandatory in order to acquire better retained and usable knowledge in a clinical context through student-centered teaching, and team interpersonal skills promotion. Adoption of new and high standards methods of teaching such as 3D models [24,25], along with updated responsive teaching materials are mandatory and represent pre-requirements for accredited medical schools

Accreditation, a risk-reduction strategy, is not an aim by itself but it is a tool for self-recognition, continuous improvement of pedagogical skills and a guide to reach out for the standards as a way to achieve academic excellence, which is the real added value of all the operations, we do. 

Therefore, the accreditation and continuous quality improvement in medical education is crucial to adjust medical education to improve the current status of health service system and to prepare qualifying doctors for the needs and expectations of their essential clients, i.e the community they serve.

Accreditation and continuous quality improvement are expected to ensure training in era of information technologies in order to help doctors cope with the explosion in medical and scientific knowledge and technology, and to be lifelong learners.

Stakeholders in National Center for Quality Assurance and Accreditation should work urgently to acquire mandatory state of art performance and excellency of execution.  It would be advisable, for Quality Assurance and Accreditation center to consider a mandate for issuing practice license for all future public and private medical school, to ensure availability of quality requirements since establishment. Then they should consider closing severely underperforming medical schools.

A check list of standard requirements including inputs, process, outcomes, institutional and program quality, financial cost should be prepared as first step. This should be followed by a review of all medical schools according to these selected criteria. Subsequently, tough but needed decisions are needed to close medical schools with low quality standards in order to ensure efficiency and effectiveness of medical education.   

National Center for Quality Assurance and Accreditation achieved remarkable progress despite all inconvenient circumstances. However, there is still a long way to go. Auditing own performances and outcomes, implementing standards of quality, hiring competent employees, collaboration with international centers and having a national plan to have medical schools with international standards in near future.

  1. Al-Areibi A (2019) Medical education in Libya: Challenges, hopes, and recommendations. Libyan Int Med Univ J 4: 3-9. Link: https://bit.ly/2ZPWor2  
  2. Ambarek MS (2010) The need for Quality Management Systems in Libyan universities. Libyan J Med 5: 10. Link: https://bit.ly/2ZRExA2
  3. Karle H (2008) World Federation for Medical Education Policy on international recognition of medical schools' programme. Ann Acad Med Singapore 37: 1041-1043. Link: https://bit.ly/3dhGiKv
  4. (2012) Health education: theoretical concepts, effective strategies and core competencies: a foundation document to guide capacity development of health educators. World Health Organization, Regional Office for the Eastern Mediterranean. Link: https://bit.ly/3dhMDWq
  5. WFME (2015) Global Standards for Quality Improvement: Basic Medical Education. Link: https://bit.ly/3cdQCll
  6. WHO (2015) Global Strategy on Human Resources for Health. Workforce 2030. Link: https://bit.ly/2TR9O2c 
  7. Karle H (2007) Global Standards and Accreditation in Medical Education: A View from the WFME. Acad Med 81: S43-S48. Link: https://bit.ly/2XFDxMw  
  8. Countries served by agencies with Recognition Status (Map). Wfme. Link: https://bit.ly/2XgLl8u
  9. The Libyan Health System: Study of Medical and Allied Health Education and Training Institutions. Ministry of Health, Health Information and Documentation Center 2018. Link: https://bit.ly/36HznId
  10. Promotion Criteria. University of Toronto. Link: https://bit.ly/2zyBMsF
  11. Frank J, Snell L, Sherbino J. Can MEDS (2015) Physician Competency Framework. Royal College of Physicians and Surgeons of Canada. Link: https://bit.ly/2yPNaQu
  12. Standards. Wfme. Link: https://bit.ly/3gurtX0
  13. Wong BM, Etchells EE, Kuper A, Levinson W, Shojania KG (2010) Teaching quality improvement and patient safety to trainees: A systematic review. Acad Med 85: 1425-1439. Link: https://bit.ly/2ZR3Qly
  14. Alsubaie M (2015) Hidden curriculum as one of current issue of curriculum. J Educ Pract 6: 125-128.  Link: https://bit.ly/2zzV0OD
  15. Schüttpelz-Brauns K, Narciss E, Schneyinck C, Böhme K, Brüstle P, et al. (2016) Twelve tips for successfully implementing logbooks in clinical training. Med Teach 38: 564-569.  Link: https://bit.ly/2MesQeu
  16. Berk RA (2009) Using the 360 degrees multisource feedback model to evaluate teaching and professionalism. Med Teach 31: 1073-1080.  Link: https://bit.ly/2TUkvRo
  17. Service Availability and Readiness Assessment (SARA) Survey 2017. Link: https://bit.ly/2ZNKjCE
  18. Link: https://bit.ly/3cjokpE
  19. Brauer DG, Ferguson KJ (2015) The integrated curriculum in medical education: AMEE guide no. 96. Med Teach 37: 312-322. Link: https://bit.ly/3dt86fj
  20. Link: https://bit.ly/2zJ79ke
  21. Http://.www.who.int/hrh/documents/WFME_report.pdf.
  22. WFME Recognition Programme. Wfme. Link: https://bit.ly/2MaJ08C
  23. The Education System in Libya: Recommendations for Development. Draft Report Submitted by UK NARIC 2012.
  24. Tejo-Otero A, Buj-Corral I, Fenollosa-Artés F (2020) 3D Printing in Medicine for Preoperative Surgical Planning: A Review. Ann Biomed Eng 48: 536-555. Link: https://bit.ly/2XIvIFV
  25. Lim KHA, Loo ZY, Goldie SJ, Adama JW, Mcmenamin PG (2016) Use of 3D printed models in medical education: A randomized control trial comparing 3D prints versus cadaveric materials for learning external cardiac anatomy. Anat Sci Educ 9: 213-221. Link: https://bit.ly/3gxxr9E
© 2020 Nasef A, et al. This is an open-jbmcess article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.