Semester 2 - 5

Semesters 2 - 5 aim to:
• assist the development of the student as an independent learner and critical thinker
• encourage the students to work as members of a team in problem-solving exercises
• further develop the students' understanding of normal structure, function and behaviour
• study abnormal structure, function and behaviour
• integrate the knowledge learnt
• acquire clinical skills necessary to proceed to the next phase of their training i.e. Phase II of the medical programme at the IMU or the PMS
• introduce students to clinical practice (hospital and community-based) in Malaysia

Students learn about principles of community medicine, pharmacology, microbiology, parasitology, immunology as well as various aspects of general pathology in the Foundation II Course before they proceed to the System Courses.

The body-organ Systems Courses at the IMU are structured using an integrated approach incorporating various disciplines of medicine (biochemistry, physiology, anatomy, pathology, microbiology, pharmacology, community medicine, statistics, genetics). Delivery tools include lectures, practical sessions, Clinical Skills Unit (CSU), and hospital visits.

Each system-based course has a study guide that helps to guide the students' learning. The study guide contains a matrix giving the core learning objectives that the students need to meet for a particular systems course. In addition, information on core and recommended textbooks, useful websites, and other suitable learning resources that would help facilitate student learning are given in the study guides.

At the beginning of Semesters 2 and 3, every student will have an elective period each lasting six weeks. Students can opt to take either a nonmedical or a medical-based elective. Medical-based electives are usually undertaken in a Malaysian or overseas hospital or institution. During Semester 4, the students are required to complete a 5-week compulsory rotation posting at one of the designated clinical teaching centres in Malaysia. Electives are aimed at widening students' horizon.

At the end of Semester 4, each student will be offered a choice of Selective courses. Selective courses give a student the opportunity to study a topic in greater depth and encourages wider exposure to other medically related areas. Students are required to undertake two Selective courses on various topics offered by the faculty. The Selectives contribute to the final score for End-of-Semester 5 examinations.

E-Learning
E-learning takes the form of on-line self-assessments as well as on-line submission of AIR (assigned independent reading) topics.

Pastoral Care
Each student is assigned a tutor who distributes in-course results and counsels him/her at that session. The tutors also offers counselling advice when necessary.

Clinical Exposures
During each systems-based course, the students spend part of their time either at the Clinical Skills Unit (CSU) at the IMU, seeing patients in Hospital Kuala Kubu Baru, community clinics and/or visits to Specialist Centres, designated by the University.

The aim of clinical exposure is to ensure that students gain sufficient interviewing and examining skills before they transfer to the clinical course provided by the IMU Clinical School or the Partner Medical Schools. In addition, they will obtain experience in the common presentation of diseases in Malaysian patients, which will be important in their practice of medicine in Malaysia.

In the CSU, students learn how to take a clinical history. This is usually carried out on simulated patients. Students are also shown how to undertake clinical examination relevant to the system being studied. This is done in small groups under the supervision of an IMU clinical lecturer. Students also learn how to perform various basic clinical skills such as taking blood, recording blood pressure and aryngeal intubation.

During their hospital visits, the students are allocated patients whom they will interview and examine. They are expected to clerk patients, write patient notes, consider investigations to assist diagnosis and attempt to reach a diagnosis.

The students then discuss their findings with an IMU or Visiting Lecturer, or a member of the specialist clinical staff at the IMU affliated hospitals. Emphasis is placed on the application of relevant basic medical sciences to the diagnostic process.

The visits to community clinics and general practice attachments give the students experience in the organisation of family medicine, especially in the Malaysian context. They will appreciate the importance of understanding the work, family and home environments when seeing patients. In addition, the students learn the role of public health inspectors in preventive medicine and the importance of health education.

Assessments
Formative & Summative in-course assessments takes place during the Foundation I & II course. There are also in-course assessments for each system course.

At the end of Semesters 2, 3 and 5, there are summative assessments which determine progress through the courses at the IMU. These examinations are externally monitored by examiners from local universities in Malaysia and Singapore as well as examiners from Partner Schools.

The tools used in the summative assessments include short answer questions, objective-structured practical examinations (OSPE) and objectivestructured clinical examinations (OSCE).

Outcome - Based Education

There is growing evidence (see below) to support the fact that many medical schools worldwide are shifting their education philosophy to outcome-based education:
• In 2000, the General Medical Council (GMC, 2000) in the UK revised recommendations made in "Tomorrow's Doctors: Recommendations on Undergraduate Medical Education" (GMC, 1998) by adding a new major section to this document where the issue of learning outcomes was addressed.
• The Association of American Medical Education (AAMC) has also developed a set of learning outcomes for medical education in its report "Learning Objectives for Medical Student Education: Guidelines for Medical Schools"(Washington, AAMC, 1998).
• The UK Quality Assurance Agency for Higher Education has identified outcome-based learning as a component of the higher education programme which needs to be reviewed in its " UK Quality/Assurance Agency for Higher Education (2000) Handbook for Academic Review".
• The Scottish medical schools, led by the Scottish Deans' Medical Curriculum Group (2000), have produced the "Scottish Doctor-Learning Outcomes", which is used by Scottish medical schools as a foundation in revising their medical curriculum.

Phase II: IMU Clinical School (For students transferring to IMU Clinical School)

The Clinical School curriculum continues the philosophy of the Phase I (Medical Sciences) teaching methodology so that the whole process is seen as a spiral of learning, relearning and experiencing in depth. The spiral builds continuity between the different phases of the curriculum.

As the student progresses to each new phase in the spiral, new information and skills are introduced which are directly linked back to the information and skills from the previous phase. In addition to reinforcing the learning from the early years, the programme for the Clinical School takes into account three recent trends in curriculum development relevant to clinical training.

I. An Adaptive Curriculum
The IMU Clinical Programme follows the principles of adaptive curriculum by allowing students to progress at a rate which commensurates with their mastery of the expected competencies, and to adapt their learning experiences to suit their needs.

II. Outcome-Based Education
The Clinical Programme also adopts the principles of outcome-based education by which the emphasis is in the outcomes expected of the students at the end of each stage of the programme. The "caring doctors"”that IMU wishes to produce drives the design of the curriculum and assessment.

III. Technology-Based Learning
The Clinical Programme uses computer science, communications and information technologies in delivering and administering the education programme as well as in the assessment of students. Students are required to use internet and CD-ROMs as part of their learning strategies.

Teaching and Learning Process
The learning strategy at the IMU is student-centred, rather than teacher-centred. Students are given the responsibility for their own learning and with an emphasis on what students learn rather than what is taught.

Problem-based Learning (PBL) is one of the major learning strategies at the IMU. It forms the basis of much of the learning in early years of the curriculum. However, the principles of PBL will also be applied in the “clinical” years in the form of Task-based Learning (TBL). Here, the clinical tasks undertaken by a doctor, for example the management of a patient with chest pain, becomes the focus for the students’ learning

A series of tasks has been selected to become the focus for the students’ learning during the clinical years. The IMU has developed 113 study guides, each addressing a particular task to assist student learning. The study guides are available online. Task-based learning helps to learn in-depth theory within clinical context.

Students will achieve these aims through a series of coordinated clinical attachments (postings) in Seremban Hospital, Hospital Batu Pahat, health clinics and through the Community and Family Case Study (CFCS) programme.

Study Schedule
The total study time for the IMU Clinical School is five semesters (each semester consists of approximately 26 weeks).

The schedule incorporates the split between Core (77 weeks), Senior Clerkship (20 weeks), Selective (4 weeks) and Elective (4 weeks) subjects. The remaining weeks are assigned to revision, assessment and vacation periods.

Semester 6
This semester begins with an IMU Clinical School orientation programme. During this semester, students will proceed through key departments, such as Internal Medicine, Surgery and Family Medicine for seven weeks each.

Students will acquire proficiency in history-taking and physical examination to identify patients' problems. The clinical rotations have ward rounds, bedside teaching, outpatient clinic teaching/health clinics and task-based learning. Although emphasis is on student-centred learning, there are lectures, interactive tutorials, plenaries and Continuing Medical Education (CME) programmes in the hospital. Students will be required to remain on-call on a rotational basis.

Semester 7
During this semester, students will complete 5 weeks of Obstetrics, Orthopaedics, Paediatrics and Psychiatry. At the end of Semester 7, students will have completed all major and intermediate attachments identified in the curriculum. The expected end-of-semester outcome is proficiency in presenting cases and discussing problems. There is a professional examination at the end of this semester.

Semester 8
For this semester, students will undertake 4 weeks of rotation in Family Medicine and 2 weeks each in 4 minor attachments - ENT, Ophthalmology, Dermatology and Clinical Pathology and a second attachment of 2 weeks in Orthopaedics and Psychiatry. Eight weeks in this semester is for Electives and Selectives where students pursue their studies in the areas of interest. Students complete 4 weeks of Selectives (two weeks each in a Medical and Surgical-based attachment) and one Elective lasting 4 weeks. The aim of the Selectives is to provide the student with the opportunity for in-depth study in areas of interest, or to undertake attachments in specialities that are presently unavailable in Hospital Seremban. A four-week Elective enables the student to:

• develop transferable skills relating to independent learning
• gain experience in research
• study a medical subject that would not normally have major input in the curriculum
• study subjects related to medicine which are not represented significantly in the curriculum, e.g. computers in medicine
• experience the practice of medicine in a particular context such as rural communities or ICU

Semester 9
For this semester, students will complete 4 weeks of attachments each in Gynaecology, Surgery, Internal Medicine and Paediatrics, as well as two weeks each of Anaesthesia / Critical Care and Radiology. This will give students time to recapitulate all the major disciplines and build on the foundation set in Semesters 6 & 7. Students will be introduced to detailed aspects of patient management. The final professional examination will be held at the end of Semester 9.

Semester 10
The educational objective governing Semester 10 is to ensure the IMU students, on graduation, will be able to function as competent housemen with the necessary skills, knowledge and appropriate attitudes. This six-month period is known as the "Senior Clerkship".

During this period of medical training, a student is exposed to six of the major clinical disciplines where he/she is expected to learn to function in the role of a shadow houseman. As the basic clinical competency has been assessed in the End-of-Semester 9 examination, this period is utilised for practical, on-the-job training and learning.

In addition to diagnosis and management, training and learning occurs over broader areas of patient care than is usually addressed in a traditional curriculum. This includes an opportunity to follow-up on the progress of patients clerked, counsel patients, prepare patients for operations and procedures, obtain informed consent, break bad news, write discharge summaries and referral letters. Evidence of learning in these areas reflects the learning in the IMU outcomes and is documented in the portfolio the students will develop during this period.

In accordance with the principle of continuing self-directed learning, a portfolio is developed by recording and reflecting on the cases clerked, and the events the student has encountered during postings. The portfolio will form the basis of examination in the exit viva.

The student will rotate through 6 disciplines: Internal Medicine, Surgery, Obstetrics and Gynaecology, Paediatrics Orthopaedics and Psychiatry. The activities during each rotation will include on-the-job activities, on-call activities and academic activities.

The Semester 10 Programme is both structured and supervised. During this period, in every rotation, each student will be attached to a supervisor, a staff member of Hospital Seremban or a faculty member of the IMU.

Assessment of the student in Semester 10 will proceed through 20 weeks at clinical rotations in Internal Medicine, Surgery, Paediatrics, Obstetrics & Gynaecology, Orthopaedics and Psychiatry. The continuum of assessment implies that every rotation is equally important, and assessment is based on the progressive improvement of the student as a trainee houseman as he/she moves from one rotation to another.

At the end of Semester 10, the student will have the cumulative knowledge and skills acquired throughout the undergraduate medical education in the IMU, and be expected to function competently as a houseman with the proper clinical skills and attitude.

Community Family Case Study (CFCS)
The basic philosophy behind this programme is to allow the student to participate in and be with the community. Here, a group of two students has to follow up on a patient with chronic illness or a newborn healthy baby for two years. The family chosen is usually of rural background and students are required to study the biological, physical and environmental factors that can affect the patient's illness or development.

The student should be aware of the family's cultural practices and their use of complementary medicine by the family. They should also identify the community and healthcare resources available to the family. The work undertaken by the students is compiled in a report. Regular presentations, nurses’ reports, patients’ feedback and a viva constitute the assessment of the programme.

Assessment
The assessment methods include both in-course evaluations and End-of-Semester examinations. The in-course assessment will consist of clinical examination, MCQ (Multiple Choice Questions), problem-solving questions and evaluation of the student's portfolio, which includes case write-ups, research projects and log books.

The End-of-Semester assessment includes SAQ (Short Answer Questions) and MEQ (Modified Essay Questions) to assess the theory component. Practical skills will be assessed in the OSPE (Objective Structured Practical Examination) and clinical skills will be assessed in the OSCE (Objective Structured Clinical Examination). The in-course assessment makes a substantial contribution to the marks received in the End-of-Semester examination.

Students' attitudes as well as their skills in the long-term follow-up of patients in relation to the family and community context of healthcare are assessed throughout the clinical programme. Assessment in Semester 10 will be mainly in the form of on-the-job continuous assessment of knowledge, skills and attitude. The level of achievement in the eight specified outcomes will be assessed throughout the programme, helping to achieve the final goal of creating a “CARING DOCTOR”.

Students Achievements
The research projects undertaken by the students have provided them with the opportunity to present and publish papers both at local and international levels.

MBBS (IMU)
The MBBS (IMU) is recognised by the Malaysian Medical Council (MMC) and accredited by the National Accreditation Board (Lembaga Akreditasi Negara or LAN) of Malaysia. The IMU MBBS medical programme is also recognised by the Sri Lankan Medical Council and the degree is listed in the World Health Organisation (WHO) directory of medical schools.

Phase II (Semester 6 - 10)
(Applicable to IMU Clinical School only)

Foundation I Course (16 weeks):
• Cells & Molecules
• Human Biology
• Behavioural Sciences
• Genetics & Statistics

Foundation II Course (8 weeks):
• General Pathology
• Microbiology
• Immunology
• Parasitology
• Pharmacology
• Community Medicine/Clinical Skills

Clinical rotations in:
• Medicine (7 weeks)
• Surgery (7 weeks)
• Family Medicine (7 weeks)

Foundation II Course (4 weeks):
• General Pathology
• Microbiology
• Immunology
• Parasitology
• Pharmacology
• Community Medicine/Clinical Skills
• Elective I (6 weeks)
• Rotations (5 weeks)
• Cardiovascular System (5 weeks)
• Assessment 1

Clinical rotations in:
• Obstetrics & Gynaecology (5 weeks)
• Orthopaedics (5 weeks)
• Paediatrics (5 weeks)
• Psychiatry (5 weeks)
• End of Semester Examination

• Respiratory System (4 weeks)
• Haematology System (4 weeks)
• Gastrointestinal System (6 weeks)
• Rotations (5 weeks)
• Elective 2 (6 weeks)
• Assessment 2

Specialised postings (16 weeks):
• ENT
• Dermatology
• Emergency Medicine
• Ophthalmology (2 weeks each)
• Selectives & Electives (8 weeks)

Second rotation of major postings:
• Family Medicine (4 weeks)
• Orthopaedics (2 weeks)
• Psychiatry (2 weeks)

• Endocrine and Reproductive System (8 weeks)
• Renal System (4 weeks)
• Selective (3 weeks)
• Rotations (5 weeks)

Clinical rotations in:
• Internal Medicine (4 weeks)
• Paediatrics (4 weeks)
• Surgery (4 weeks)
• Obstetrics & Gynaecology (4 weeks)
• Anaesthesiology (2 weeks)
• Radiology (2 weeks)
• End of Semester Examination  

• Musculoskeletal System I (5 weeks)
• Nervous System (6 weeks)
• Health Issues (4 weeks)
• Assessment 3

Senior Clerkship (20 weeks):
• Internal Medicine (5 weeks)
• Surgery (5 weeks)
• Paediatrics (5 weeks)
• Obstetrics & Gynaecology (5 weeks)