Well, Back in My Day… CBME- Chaos Based Medical Education

CBME- Chaos Based Medical Education

By Avantika Jain, Final year medical student, Goa Medical College, Batch of 2019

It was the 1st of August, 2018, when I stepped into that building for the first time. The place that changed my life- Medical College. They say, if you spend enough time at a particular place, you become a part of it … and it becomes a part of you.

The Batch of 2019 was special. Famous, even. But not because we were great at studying or sports or research. It was because we were the first batch privileged enough to experience the new…. curriculum. The curriculum that was changed after 21 long years, much to the delight of our professors.

It was the Year of CBME, or as they proudly called it, ‘Competency Based Medical Education’. This curriculum was mainly aimed at producing altruistic, communicative and competent medical professionals. It was also the advent of the ‘AETCOM module’ which was aimed at streamlining attitudes, ethics and communicative capabilities of medical students.

I can imagine that the curriculum was formulated to address the most pressing concerns of the medical fraternity -at heart, but the plan of implementation was quite contrary to the very virtues it aimed to dispense. It was like a human experiment, but I don’t remember our consent ever being taken. It was not just a booklet with a new set of instructions, like when you take a pack of cards and switch from blackjack to black queen. Same cards, but a slightly different game. That’s what you’d expect. But no, the cards were now blocks, the instruction manual was half torn, rules changed as you progressed in the game, and even the dealers barely knew where to start. But you have to fit it in the same old card box.

That is CBME in a nutshell, or at least how it felt.

It all started with a month-long Foundation Course to orient us for the next 5 years. This was a sound decision, if we didn’t have to write a feedback report about ‘what happened?’ and ‘what next?’ every other hour. (Truly felt like a reporter). A feedback report, that could easily have been done over an email or google form. But we were the Guinea pigs under observation… we had to write our own case report, right?

When we started classes, everything seemed normal, until it wasn’t.

“ This is as new for us as it is for you ” – it’s astonishing how every professor sought this very dialogue. Even though most of our teachers expressed sympathy and pity, sometimes it was also anger – adapting to the newly thrust changes in a very short period of time. Almost as if we students were the ones who drafted the proposal.

The logic behind the curriculum was this- since some topics were way more common and important than others, students should only learn those topics , and perfect them. This should enable them to make ‘competent physicians’. Practically, a sensible decision, no?

But honestly, it was more like – if you wanted to learn the alphabet, and you were only taught the vowels, since it’s the most important part. How would you understand the alphabet without all the letters?

Though this is a crude example of the complex syllabus, unfortunately this is what it turned out to be.

Is it worth focusing on ‘must know information’, if in the end, it compromises a good foundation?

Another factor that really gripped the necks (and wallets) of medical students were Logbooks. A gift from our friends overseas, originally a logbook serves as a portfolio, and is supposed to provide incentives to reflect and learn better. Ironically, the effect was quite the opposite, because now not only did we have to fill a subject-wise notebook with all kinds of unnecessary information, we also had to get it signed after every clinical posting/lecture/short class. Fun. \

Another brainwave under CBME was the ‘Self Directed Learning Experience’ – which was neither self, nor directed, and the learning in question was debatable. The ‘Early clinical exposure’ was too early, and the ‘Small Group Discussions’ weren’t small at all.

All over… I think it was formulated with pure intentions. But gravely lacked clarity, reasonability and just the sheer understanding of the available resources and infrastructure in a medical college of India. But hey, these were just ….teething troubles which would streamline over time. No biggie. And then came Covid. It went mostly south from there. Between Covid and CBME, I think our batch has (almost) seen it all.

We were just getting used to it when the Centre assumed it was our responsibility to prove the success of the new curriculum by rewarding us with the (wait for it) totally New Format post graduate entrance-cum-final exam – NEXT 2023. Instead of the biggest exam of our lives being 2 years away, now we had just 10 months to prepare for it. So yes, we have everything going for us right now. But hey, at least they told us in advance right?

Maybe… I’m just a medical student filled with the stress and angst of med school. But even in the midst of all the chaos, Medical College is the place I’ve made the most amazing memories. If you spend enough time at a place, you become a part of it.. and it becomes a part of you. And I can’t wait to see what my final year has in store for me.

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