Cite this asNasef 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
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 .
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).
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 .
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 .
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 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).
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) .
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.
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