An approach to medical curriculum evaluation.

The advent of new trends in medical education makes it necessary for new and established medical schools to evaluate their curricula. The changing needs of society emphasize that this process should be continuous. There are, however, many difficulties which impede the initiation of curriculum evaluation. The College of Medicine and Allied Health Sciences at King Abdulaziz University initiated and carried out a plan for programme evaluation in 1984-85. The pathway selected for this experience was based on existing models which were modified to suit the local needs. The formulation of the plan was guided by general principles aiming at participation, communication, data-gathering from numerous sources and utilization of appropriate resources. The main direction of the evaluation was formative in nature and was carried out internally. The results were analysed and revealed major problems in the existing design and the teaching/learning environment. The recommendations for change were guided by educational criteria concerned with promotion of learning, problem-solving and community orientation. The main emphasis in the presentation of this report is on the process more than the content of curriculum evaluation.

Curriculum development: a strategy for change.

It is generally accepted that educational methods have a lot to offer to the development of teaching and learning in medical colleges. However, it is frequently reiterated that these offerings are theoretical and are either not feasible or have little impact in most settings. This conclusion comes as an inevitable result of frustrations associated with well-meaning attempts to introduce change in the teaching and learning environment. The main purpose of this article is to share with the reader some of the experiences of one medical college in the introduction of change. In this article the decisions and implementation of change in the teaching programme are described. An evaluation of curriculum development was based on the impact or outcome of these strategies. The criteria used in this evaluation were student orientation, problem-solving, integration and community orientation. In the early stages of this experience the main strategy focused on teacher-training, which aimed at 'critical mass development'. A cohesive core group of teachers was formed. Further strategies for the introduction of change were used and modified according to need. Utilization of sources of power and influence was resorted to so as to draw attention to issues and to expedite academic decisions. In many instances group activities utilized emotionally detached 'academic' settings to resolve curriculum issues. Conflicts were mainly dealt with in this setting. The advantages and disadvantages of these strategies for change are discussed.

An approach to the question of relevance of medical physiology courses.

One of the problems of designing basic science courses is to define objectives relevant to the future needs of the graduates. A simple approach is described whereby a series of clinical problems were identified by physiologists and practising physicians. Priority areas were then identified to provide a basis for defining objectives for the medical physiology courses and for the selection of materials and methods. It is argued that the question of relevance, emotional involvement and effective facilitation of learning will be served by the approach described. Finally, the usefulness of this exercise to the selection and orientation of appropriate evaluation tools is discussed.

Age-independent anthropometry: an examination of data from rural Khartoum, Sudan.

The data collected in a mixed cross-sectional longitudinal survey of children in a village in rural Khartoum, Sudan, were analysed in order to identify age-independent anthropometric indices. The mean values of weight/height, weight/height, mid arm circumference, mid arm fat area and triceps skinfold thickness all change little with age over certain parts of the age range. 15% of the boys and 22% of the girls had weights less than 75% of standard weight for age. The ability of age-independent indices to identify these low-weight individuals was investigated in terms of their sensitivity and specificity. Weight/height discriminated best, correctly classifying 85% of the low weight boys and 78% of the normal weight boys in the under-five age group. Weight/height and mid arm circumference were also useful, but triceps skinfold thickness and mid arm fat area did not discriminate usefully. All tests performed better in the under-five age group than in the older age bands.

An assessment of anti-schistosomal treatment on physical work capacity.

Acting as their own controls, village subjects from the Gezira are of the Sudan with relatively high levels of schistosomiasis infection were first tested in an exercise laboratory in Khartoum and the tests were then repeated after a period of about 1 yr during which time the subjects were treated with hycanthone and periodically monitored to ensure that they had remained free of the disease. In the meantime they were also given anti-malarial prophylaxis. Laboratory tests showed a significant improvement in physiological work capacity of up to 20% after treatment compared with untreated controls. An overall improvement in pulmonary function, particularly forced vital capacity, was observed as well as a significant increase in mean haemoglobin concentration by 1.1 g/100 ml of blood in the treated group. Apart from these improvements in physical working capacity, the treated subjects subjectively felt better after the exercise tests, as expressed by the disappearance of fatiguability.

Growth velocity in children in rural Khartoum, Sudan.

The results of a mixed cross-sectional and longitudinal anthropometric survey of Sudanese children up to the age of sixteen years are reported. Weight velocity, height velocity, mid arm circumference velocity, and mid arm muscle circumference velocity, and the age at which 50% of females have reached menarche have been calculated. Growth velocities are lower than for English children and the puberty growth spurts occurs about one year later in Sudanese than in English children

Anthropometric survey of children in rural Khartoum, Sudan.

The results of a cross-sectional anthropometric survey of Sudanese children up to the age of thirteen years and six months is reported. Children in whom a quick clinical examination revealed pathology were excluded, as were children who did not have a true birth certificate. Height, weight and mid-arm circumference were measured in all children, head and chest circumference were measured in children up to the age of 5 years and 6 months. Skinfold thickness at biceps, triceps, subscapular and suprailiac sites were measured in children above the age of 30 months. The children were found to be shorter and lighter, and to have less subcutaneous fat than British children. The findings are also compared with those from other African populations. Comparison with a survey performed in the same village seven years earlier reveals that the heights and weights of the children have hardly changed despite a considerable improvement in economic status. The children have a lower weight for height than British and other African populations.

The nutritional status of the Fur people of Jabel Marra.

The nutritional status of the adult Fur people of Jabel Marra of Western Sudan was assessed by means of physical anthropometry, haematologic and serum protein measurements. The results of the anthropometric survey show a high incidence of low weight for height in comparison with caucasean standards. The muscle mass as indicated by the upper arm circumference is also smaller than expected by European standards. The upper arm muscle circumference, however, is only marginally lower than the above standards. Subcutaneous adipose tissue is found to fall within the lower range of normal in comparison to available standards. The results are discussed in the light of findings in other African countries with similar ecology and socio-economic conditions. The haematological and serum proteins results reveal a high incidence of anaemia especially in women. As the R.B.C. count was not done in this work the type of the anaemia cannot be ascertained. The value of cross-sectional nutritional surveys for the establishment of baseline data for future assessment of development is indicated.

Energy expenditure and physiological performance of Sudanese cane cutters.

The thermal and exercise tolerances of 165 Sudanese cane cutters were measured in the laboratory and related to work performance and productivity in the cane fields. The results showed that the amount of cane cut per minute in the field was significantly correlated with changes in body weight (r = +0-53) during the third hour of work, aerobic energy expenditure (r = + 0-43), and cardiac frequency during work. These variables in turn were associated with predicted maximal power output (VO2 max) measured in the laboratory. The average energy expenditure during cane cutting was 1-66 +/- 0-33 1/min-1 (34-9 kJ/min-1) which represents approximately 60% of the workers predicted VO2 max. This rate of energy expenditure was sustained in the cane fields for at least three hours without significant pauses for rest. The sweat losses measured in 32 cane cutters during the two and three hours of work averaged 637 +/- 221 and 770 +/- 282 g/h-1 respectively, while the mean urine temperature immediately on cessation of effort was 37-74 +/- 0-46 degrees C. Despite the additional environmental heat load of the tropics, it would seem that cane cutters performing a self-paced task demanding heavy physical effort, are able to sustain work levels well in excess of those recommended for most European factory workers without obvious signs of fatigue or heat stress.

Physiological performance and work capacity of Sudanese cane cutters with Schistosoma mansoni infection.

Physiological tests of work performance and measurement of field productivity were made in 194 Sudanese cane cutters in order to study the effect of Schistosoma mansoni infection. The cane cutters were selected from two age ranges (16-24 and 25-45 years) and subdivided into three clinical groups: not infected, infected with, and infected without clinical signs of hepatosplenomegaly. Men infected with Schistosoma haemotobium, malaria (blood film), or with hemoglobin levels less than 10 g/100 ml were excluded. There was a statistically significant (P less than 0.002) higher mean hemoglobin concentration in those not infected but the mean difference was less than 1 g/100 ml. Submaximal responses to exercise on a stationary bicycle ergometer, oxygen intake, ventilation, tidal volume, cardiac frequency and estimated maximal aerobic power output calculated both in absolute terms and relative to lean body mass and leg volume were similar in the six groups of cane cutters. No significant differences were found in physique, body composition or in thermoregulatory function tests. The cane cutters were found to have little natural acclimatization to heat in terms of sweating capacity when compared with a group of fully acclimatized Sudanese soldiers. The mean productivity (mean daily weight of cane cut per man) was significantly correlated with the individual's estimated maximum aerobic capacity determined in the laboratory, but not with the degree of S. mansoni infection. The noninfected group was less "efficient" (mean productivity:oxygen intake) during cutting than the infected groups but a larger proportion of the noninfected were in their first season of cutting. There was a positive correlation between the number of seasons' cutting experience and the individual's age, degree of infection and mean productivity. Cane cutters studied in this investigation were a relatively fit, active population from whom the more seriously ill were excluded. These results do not, therefore necessarily reflect the effects of S. mansoni on physiological work capacity and productivity of more static populations in areas of high endemicity.