Presentation at a seminar at the University of Brunei Darussalam on August 28, 2011 by Professor Omar Hasan Kasule Sr. MB ChB (MUK), MPH (Harvard), DrPH (Harvard) Professor of Epidemiology and Bioethics Faculty of Medicine King Fahad Medical City, University of Malaya, and University of Brunei; Chairman of the Institutional Ethics Review Board KFMC, and Head of Knowledge Exchange and International Collaboration FOM at KFMC. EM omarkasule@yahoo.com, WEB: www.omarkasule-ilm.blogspot.com, WEB: www.omarkasule-tib.blogspot.com
ABSTRACT
The paper starts with the thesis of the paper is that higher education has a crisis of duality that has to be addressed even before we think of improving its quality. The crisis can be addressed by an integrated curriculum that fits with the integrative tauhidic paradigm. The curriculum must be delivered using modern teaching methods that also emphasize integration. Quality has an inner dimension that must exist among students, faculty, and administrators. This dimension is motivational and emanates from ihsan (excellence) which alongside Islam and iman is the third greatest fundamental of al diin al islami. The external dimension of quality involving putting in place policies, structures, and infrastructure that will lead to educational quality. Old and premier universities have over time evolved a quality culture and do not need to have a QA department or system. New universities must set up QA system in order to catch up. The paper describes the details of such a system for a new university based on the author’s 15-year experience in South-East Asia.
1.0 RESOLVING THE CRISIS OF DUALITY OF KNOWLEDGE
1.1 The crisis of Dichotomy:
Dichotomy is the most dangerous manifestation of the education crisis because it underlies the low motivation among learners and sometimes among teachers. There is a dichotomy in the education system with competing and contradictory world views: traditional Islamic vs. imported modern; ulum al diin vs ulum al dunia. Dichotomy goes against the integrative tauhidi-based Islamic civilization. Among the consequences of the dichotomy are: division of the ummat’s elite into traditional and modern groups, ‘intellectual schizophrenia’ of the educated elite, and clouding of the vision. The problem of dichotomy lies at the lack of motivation for learning that many teachers at universities are complaining about. The students do not feel that the underlying philosophy and motives of the disciplines they are taught relate to their Islamic and Arab cultural or intellectual heritage. They look at the disciplines as something alien they have to memorize for purposes of passing examinations and getting jobs after that.
1.2 Role of Islamic epistemological reform in resolving the crisis of duality in knowledge
Epistemology is the science of knowledge, ‘ilm al ‘ilm. It a branch of philosophy that studies the origin, nature, methods, and limits of knowledge. The contemporary knowledge crisis can be resolved by a return to Islamic epistemology to ensure an Islamic foundation of knowledge, ta’asil islami li al ma’arifat, which involves presenting the corpus of human knowledge within the Islamic world-view. It is not invention of knew knowledge but giving the various disciplines of knowledge an Islamic conceptual and background. This process will involve (a) a critique of the basic paradigms, assumptions, concepts, and methods of modern disciplines (b) review of existing text-books and teaching materials to identify areas of reform (c) preparing Islamic introductions to each disciplines, muqaddimaat al al islamiyyat li al ‘uluum, to present the basic paradigms and methods from the Islamic world-view similar to Ibn Khaldun’s al muqaddimat which was an Islamic epistemological introduction to the discipline of history (d) research in the discipline under the new paradigms to add to knowledge and thus change from being consumers to become producers of knowledge (e) With accumulation of research publication it should be possible to produce text books that will motivate students to learn because they will reflect their intellectual heritage. (f) Developing applied knowledge in science and technology from basic knowledge will be the last stage of the reform process.
1.3 The needed vision, mission, and objectives of the knowledge and education strategy
The vision of the knowledge strategy is an upright balanced person who understands the Creator, knows his place, his roles, his rights, and his responsibilities in the cosmic order. He participates actively and positively in building society (socially, culturally, and technologically). He understands that development activities must find a just equilibrium between the material and the spiritual, between control of nature and preservation of the environment, and between technology and humanity.
The mission of the knowledge strategy is resolving the duality crisis, creating personal relations between the teacher and the student so that morals are transmitted at the same time as knowledge following the Islamic etiquettes of teaching, adab al mu’allim, and of learning, adab al muta’allim. University education should set itself the objective of producing intellectuals who will promote the integration of knowledge.
2.0 INTEGRATED CURRICULUM
2.1 Vertical and horizontal integration: The curriculum is not isolated pieces of information that the student has to put together in his mind. It must ensure that the student gets an ‘integrated’ multi-disciplinary understanding of the world by horizontal integrating among themes and making sure that there is vertical time-phased integration within the same theme. An integrated curriculum is within the integrative paradigm of tauhid.
2.2 Integration of values: Knowledge cannot be acquired in a social and cultural vacuum. The curriculum must be responsive to the underlying Islamic and socio-cultural values of the society.
2.4 Curriculum review
The curriculum should be reviewed on a regular basis. The process of curriculum review should be evolutionary and not revolutionary. Revolutionary changes cause a lot if dislocation and confusion and in the process do not last long. Minor reviews and corrections can be made as needed. Major reviews should not be undertaken every 5 years to give an opportunity to evaluate the performance of the existing curriculum. The review report should consist of: (a) description of the structure of the curriculum (b) description of the implementation of the curriculum (c) internal curriculum review carried out as concurrent informal review, formal faculty review, and questionnaire survey of students and lecturers (d) external curriculum review carried out by accreditation and professional bodies (d) and a summary of the review emphasizing: process measures, outcome measures, strengths, weaknesses, what and how much to change.
3.0 INTEGRATED TEACHING METHODS
3.1 Integration
Modern teaching and learning in medicine have to be integrated. Various disciplines have to be coordinated in the process so that the student gets an overall multi-disciplinary view. This method of teaching and learning is more effective than the traditional method that was compartmentalized by discipline with little reference and coordination with other disciplines.
3.2 Innovation
Rapid changes of knowledge and technology require an innovative approach in which changes are made continuously in response to changes. We cannot be fixated on a certain approach that proved successful in the past because it can quickly become irrelevant. What is needed is local innovation and not importing and implementing any new idea that we hear. That type of blind following, taqliid, is condemned by the Qur’an. Much of what is imported may be irrelevant in view of the local culture and local educational realities.
3.3 Student centered and student-directed learning (SDL)
Education has undergone a tremendous transformation from being teacher-driven to being student-driven and student-centered. The student is no longer a passive receiver of information but an active participant in the search for and internalization knowledge. This has forced a change in the role of the teacher to become a facilitator of the learning process. Practical experience student-centered learning has shown its strengths and weaknesses. The conclusion from weighing the strengths and weaknesses is that the best approach is a judicious balance between teacher-directed and student-directed learning.
3.4 Learning objectives (LOBs)
The term LOB is used to refer to the educational outcomes from a teaching/learning session. LOBs have to be written for each topic in the course outline. Teaching, student feedback, and assessment are based on LOBS. LOBs must be written in a direct, active, and action-oriented manner that is why verbs have to be used for example define, list, relate, analyze etc. An estimate must be made of the contact hours needed to cover each LOB. At the end of the week or whatever other period of time is used, the estimated time is compared with the actual time and the variances are explained.
3.5 Problem-based learning (PBL)
PBL is learning that starts with a problem. As the students search for the solution to the problem they get to learn. PBL is integrated learning spanning several disciplines at a time. It involves discovering and sharing knowledge. The exact method of doing the PBL should respond to local culture and practice. Copying procedures from outside has caused disastrous results. Where the local culture encourages inquisitiveness and questioning PBL can perform very well. Where people are naturally quiet and want to think about what they want to say we need to make relevant modifications. PBL is similar to the method of teaching the Qur’an to the companions of the prophet. The Qur’an was revealed gradually, nuzuul al Qur’an munajjaman. Verses of the Qur’an were revealed when there was a specific problem to be resolved. Thus the learning was tied to a real problem enabling deep understanding and retention of the message. PBL involves encouraging students to look for facts and evidence in solving specific problems. This is in the Qur’anic tradition of relying on evidence as authority, hujjiyat al burhan. PBLhas several advantages: it teaches how to fish instead of providing the fish, it develops long-term search for knowledge, it develop an inquisitive research-oriented mind, it enables integration across disciplines, and it emulates problem-solving in real life. The disadvantages of PBL are: cultural incompatibility, gaps in knowledge, lack of focus and integration, missing linkages
4.0 CONCEPTS AND PRINCIPLES OF QUALITY ASSURANCE []
4.1 Ihsan = quality.
Ihsan is the culture of Islam. Islam sets quality work and excellent performance in all spheres of life as its culture. Quality must permeate all activities. The prophet said that Allah loves ihsan in everything and advised Muslims to perfect every work that they undertake[i].
4.2 Quality in university education
The concept of quality in university education is more difficult to define than in industry. Unlike the factory, the university has no way of defining its output in a quantitative way. However the inputs and processes of the education process can be described and can be defined. The destiny of the graduates and their achievements can be used as a fairly objective outcome indicator but it occurs too late and we are not sure of what other factors contribute to the student outcome.
4.3 Management tools in quality assurance
4.3.1 Continuous quality improvement (QI) is a management philosophy that is committed to continuous and consistent improvement in quality. It is consistent with the Islamic concept of ihsaan that calls for continuous human improvement. The Prophet taught ‘man istawa yawmaahu fahuwa maghboon’ Sunan al Darimi.
4.3.2 Quality assurance (QA) is formal and systematic identification, monitoring, and overcoming problems. The aim of QA review is to ascertain compliance with the given guidelines. If a deviation is found, measures are taken to correct it. The QA review process is cyclical. Deficiencies found are corrected and the process is repeated.
4.3.3 Control is assuring that plans are carried out effectively and efficiently. It provides a systematic and methodological approach to ensuring compliance. It enables early detection and correction of mistakes. It may be internal (due to taqwa and thawaab) or external (due to rewards and punishment).
4.3.4 Evaluation has the objectives of evaluation are assessing whether objectives were achieved, assessing efficiency, assessing effectiveness, and learning from experience. Evaluation may be process evaluation or outcome evaluation.
5.0 QUALITY ASSURANCE SYSTEM
5.1 The role of the QA Unit:
Each University should have a QA unit whose job is to train lecturers and administrators from individual faculties on QA systems. The QA unit should therefore play a supporting role rather than becoming a supreme authority directing QA systems. QA programs succeed most when they are controlled at the faculty or even departmental levels by people with intimate knowledge of what is going on.
5.2 QA system documentation:
The QA system must be documented in detail: QA objectives, methodology of QA implementation, specific quantifiable QA criteria. The QA procedures are published in a QA manual. The manual must include clear quantitative and qualitative QA indicators.
5.3 QA Implementation:
Successful implementation of a QA system requires will from the highest authorities in the university. This is followed by identifying academic and administrative staff who have the motivation to lead the QA process. They are given the necessary training and support. Then QA procedures are formulated as a consensus of several rounds of discussion involving all stakeholders. Budget and time must be made available for the QA process. It is important to maintain motivation all through. Provision must be made for internal and external assessment of the QA system. Assessment reports are discussed to identify ways of improving the QA process. Measures taken to remedy any deficiencies are treated as part of the QA report.
5.4 Monitoring and evaluation: The performance of the QA system must be monitored continuously. QA systems must be audited by both internal and external auditors. Self-assessment by members of the department remains the cornerstone of quality assurance and quality improvement. Scores can be given for each QA indicator so that a total score can be generated. The scoring system is based on existence of documentation for that indicator: 1= very little, 2=little, 3=below average 4=average 5=above average 6=large amount 7=very large amount. The assessment should end with listing of outstanding / unresolved issues as well as recommendation for improvement.
6.0 QA CRITERIA FOR TEACHING AND LEARNING
6.1 Curricula must be fully documented. They should reflect a stated underlying vision and mission of the faculty. They should cover knowledge, skills, and attitudes. They should have horizontal and vertical integration. They should be benchmarked against the best faculties of medicine in the region and internationally. They should also be accredited by the national accreditation authorities to make sure that graduates will be employable.
6.2 Academic staff must be qualified. Appointment and promotion of academic staff should depend only on academic merit and character. Good staff means high quality. The minimum qualification for lecturers is a doctoral degree or its equivalent. All academic staff must undergo training in teaching methodology including writing course descriptions, writing learning objectives, lesson planning, effective use of audio-visual aids, and assessment systems. The teacher to student ratio should vary by department and nature of discipline but must be fixed and documented in the QA manual. The university must have personnel policies that motivate the academic staff to produce their best. A staff handbook should spell out administrative and financial procedures. It should also explain disciplinary measures. All lecturers must upgrade their knowledge and skills by attending conferences or special training courses.
6.3 Assessment of students takes place before admission, during the course, and at the end of the course. It must be systematic and the faculty must have written policies and guidelines for examinations. These should include what to do when students fail or when students cheat in the examinations.
6.4 Learning resources must be adequate. Quality starts from the facilities and management. If those are done well only vision and qualified teachers are needed to ensure quality products. These include library books, digital libraries, and internet access.
7.0 QA CRITERIA FOR RESEARCH
7.1 Organization of research: Research committees must exist at the university and faculty levels. The research strategy should be closely linked with the postgraduate strategy because academic staff undertake research by directing and supervising postgraduate students. The faculty should have a strategic plan for research spelling out what is to be achieved in 2, 5, or 10 years. The faculty should find a research niche and work on it in a multi-disciplinary approach. Even if the research undertaken is simple, it can yield useful results if it is focused.
7.2 Funding of research: The research budget should not be less than one percent of the university operational budget. Academic staff must be given incentives for good research. They must be given protected time for research. This requires careful balancing of teaching and research which may be difficult when there is a shortage of teaching staff.
7.3 Research output shall be judged for each individual lecturer as well as for the faculty as a whole. The start should be publication in the local faculty journal with attempts being made to publish in refereed international journals. The faculty should have a research ethics committee. Another academic product that must be encouraged is producing teaching materials. Lecturers should be encouraged to write up each lecture given. These can be accumulated over the years and can be published as a book.
8.0 MEASURES THAT SUPPORT QUALITY PROGRAMS
8.1 Annual Academic Staff Performance appraisal:
Annual evaluation of academic staff ensures quality performance. Any deficiencies detected should then be corrected. It involves the following: (a) Teaching: description of courses taught and a quantitative estimation of the workload (b) Thesis supervision: number of students supervised and level (masters, Phd) (c) Research: list of current and completed research projects with mention of the amount and source of financial support (d) Publications: papers in academic journals, general articles in the non-academic press, monographs / research reports, books (either published or in the process of preparation) (e) Academic appointments: within and outside the university (f) Conferences and seminars attended: title of conference, place, dates, and paper presented. (g) Consultancies: the faculty should have a policy on consultancy specifying how much time a lecturer can spend on consultation and also specifying financial rights. (h) Community activities: The university must have QA criteria for community service. A university cannot be an ivory tower isolated from the community. It must give back to the community by undertaking community service. This should be in the form of programs that have direct benefits for the community. (i) Administrative duties within the faculty
8.2 Student feedback
Students are the most important customers in the educational process. Therefore their satisfaction is very important. We have to listen to them and address their concerns. We can get student feedback from the examinations. It is however also necessary to get their feed-back by use of questionnaires. These questionnaires are more effective if administered regularly usually at the end of each unit or module. Students should be asked to indicate their degree of satisfaction with each individual learning objective. If there are too many objectives we may group them into natural categories and choosing 1-2 objectives from each category for inclusion in the questionnaire. These formal means of getting student feedback are not a substitute for informal means of getting student views on the curriculum. The students may be more honest and forthcoming in informal settings.
8.3 External examiners
Examiners are set and are marked internally. To maintain quality medical educators from other institutions should be involved as external examiners. Their involvement should include comments on the examination questions as well as marking a sample of the answer sheets to make sure that internal marking standards are comparable to external ones.
8.4 Benchmarking
The curricula in the faculty should be compared with curricula in other faculties. This process has now become easier because many universities put their curricula on their websites. The purpose of benchmarking is not to copy or be like everybody. It serves the purpose of indicating whether in general we are ‘moving with the crowd’. If a curriculum differs in major ways from comparable institutions a rational explanation must be found otherwise there is some problem. Another approach to benchmarking is registering students to take international examinations such as GMAT, GRE, MCAT USMLE etc.
8.5 Student tracer studies:
An identifiable product of an educational system are the students. After graduation they take the knowledge and skills learned to the outside world. Their job performance and character reflect to a certain extent the quality of the education that they received. Thus a faculty of medicine should follow up and trace its graduates to find out how they are performing. The tracing can be by using questionnaires or telephone interviews.
8.6 Exchange of students and staff
Exchange of students and staff with sister faculties for short periods of time 1-2 months can be very helpful. The students can join classes in other faculties and the lecturers can give some lectures. In the process they get to make comparisons with other faculties. They may learn new approaches and methods that can improve their own faculty.
8.7 Recruiting and retaining good students
Admitting good students means high quality. Only the best should be admitted. Besides the academic grades, consideration should be given to character and motivation to study. Experience has shown that diversity improves quality. The proportion of internationals should be at least 10% for good quality. Student counseling services should be provided for all students. There must exist mechanisms for identifying and counseling failing students as early as possible.
8.8 English proficiency:
English has become an international language of scientific and professional communication. The internet information highway is predominantly in English. Therefore quality teaching and quality learning require mastery of the English language. Both academic staff and students must be proficient in English at the highest levels. To achieve this continuing education English language courses must be provided in the faculty for both students and staff. It also may make sense to have an English language unit in the faculty. The unit should focus on using English for medical purposes and not acquiring general competence in English.
9.0 DOCUMENTATION NEEDED FOR QA
9.1 The University: (a) Overview: University prospectus, Brief History of the university, Annual reports over the past 5 years (b) University governance: Registration and legal status, Constitution of the University, Board of trustees, University Officials, University Council/Board of Governors, University Senate, University Organizational Chart, Procedures of Academic Staff Appointment and Promotion, University Research Center/Committee, University Publications Department, University Development Plan, University Integrity/Ethics Committee, University Scholarship and Study Leave procedures, University strategic plan, Quality assurance unit
9.2 The Faculty (a) Faculty overview: Faculty prospectus, Brief history of the Faculty, Growth of students and staff of the Faculty in the past years, Annual reports of the past years (b) Faculty governance: Faculty organizational chart, Names and qualifications of top faculty officials, Linkages with central university bodies, Faculty strategic plan, Faculty quality assurance unit, Functional linkages of the faculty of medicine to other university faculties (c) Forms, brochures, and information packages: Administrative forms, Academic forms (d) Faculty facilities: Physical environment, laboratories and equipment, Library (area, holdings, seating capacity, online workstations, online data bases and journals subscribed to, hours of opening, and budget, use of library by students measured as borrowings of books and journals, Library staff: categories and functions), IT and Telecommunication equipment. (e) Faculty Academic committees: Faculty Board Meeting, Faculty Administrative Meeting, Academic program management committee, Board of Examiners, Board of Appeal, Faculty Promotions Committee, Faculty Research Committee, Research Ethical Committee, Faculty Postgraduate Committee, Departmental meetings, Curriculum development, Curriculum revision, Program evaluation. (f) Faculty Administrative committees: Student Admissions Committee, Student Advisory Committee, Facilities Committee, Security Committee, Purchases/tender committee, Development Committee, Discipline Committee, IT Committee, Desk Top Publishing Committee, Library Committee, Staff Welfare Fund (g) Faculty administrative staff: Appointment and functions of the dean and deputy deans, Appointment and functions of department heads, Administrative staff, Other support staff
9.3 Academic staff (a) Faculty academic staff: Staff handbook, Full time academic staff per department (Name, qualifications, specialty, and teaching experience), Honorary academic staff per department (Name, qualifications, and specialty), Resume of each academic staff (2 pages maximum in standardized format) (b) Recruitment, orientation, training, and promotion of academic staff: Advertisement of staff vacant positions: Sample advertisement in Newspapers, Advertisement of staff vacant positions: Sample advertisement overseas, Staff selection criteria, Staff promotion criteria, Academic enrichment programs, Continuing medical education, Teacher training, Islamic Orientation Program, Specialty training, Teaching Efficiency Rating (c) Terms and conditions of service: Sample Contract for National staff, Sample Contract for International staff, Discipline and termination (Document on staff discipline procedures), Staff attrition by reason (no promotion, better salary offer elsewhere, end of contract, not satisfied, conflict) and year (d) Academic staff salary and benefits: Base renumeration (salary min & max) and other benefits (entertainment, housing, specialist, incentive allowance) for various academic ranks by department, Retirement Benefit Fund, Non-monetary staff benefits: eg reduced tuition for children and spouses, medical benefits (e) Academic staff activities: Use of faculty time (%) by type of activity by department: teaching, research, clinical service, consultations, administration, community/social service; Teaching load (in hours) for undergraduate and post graduate students per academic staff by department; Ongoing and completed research projects and the source of funding per academic staff and by department; Consultancy projects by department: name of staff, project, where, and cost; Seminar and conference attendance as well as paper presentation per academic staff by department; Training courses attended per academic staff by department; Membership of professional organizations by department; Community projects undertaken by academic staff by department
9.4 Student admissions and projected enrolments (a) Admissions and graduates: Admitted students by year and nationality, Graduating students by year and nationality, Study of attrition and causes (b) Admission process: Description of pre-university courses, System of assessment in pre-university courses, Entry requirements, Selection criteria, Policy on transfer students, Total applicants and number selected in the past year, Projected enrolments in the next 5 years (c) Characteristics of admitted students: Summary GPAs (percentage) score of admitted applicants by year, Nationality, gender and ethnic distribution of admitted applicants, Program book of the last orientation week, Registration & enrolment procedures, Student oath, bayi’at
9.5 Student services and activities: (a) Counseling and advisory system: Student advisory committee, Common student academic problems, Common student social & personal problems, Assessment of the academic counseling system (b) Medical services: Schedule of the student clinic, Student clinic consultations last year, Hospitalization: medical benefits available, Student insurance (c) Hostels: Hostel administrative personnel, Room space and equipment, Shower and washing facilities, Electrical equipment in rooms, Canteen operations, Amenities, Car parking, Shops, Sports/exercise: gymnasium, tennis court, basketball court, football field, swimming pool
(d) Student records: Student personal record (items in the record, where and how filed), Student academic record (items in the academic record, updates, filing), Accessibility of student records, Privacy and confidentiality of student records (e) Student activities: Student extra curricular activities, Student government (f) Student discipline: Student disciplinary code, Disciplinary officers, Disciplinary procedures (g) Student financial situation: Self sponsored students, Students on scholarship, Students on loans.
9.6 Academics: (a) Course descriptions: Use standardized format (b) Teaching materials: Samples of notes, powerpoint used in classroom (c) Description of the assessment system: Samples of examination papers and student answer scripts, Itemized examination results by year and course 2002-2007
10.0 DILEMMAS OF QUALITY
10.1 Expansion vs. consolidation: a new university is faced with the dilemma of expanding by admitting more students or offering more programs (that bring in more financial resources) but does not have enough facilities, enough academic staff, or enough institutional experience. The university fears failures or bad reputation at this early stage because it has no record of success to mitigate short-comings. An innovative university cannot avoid expansion because new ideas need implementation.
10.2 General education vs. skill training: The new university has to find the right balance between a general and liberal education program and programs that impart skills needed in the job market.
10.3 Research vs. teaching: Research distinguishes a university from a secondary school. It also enhances the academic standards by making the medical teachers producers of knowledge instead of being only consumers of knowledge who just pass it on to the students. Teachers who engage in research have up to date knowledge.
10.5 Teaching vs service: the university must find a balance in its academic staff commitments between teaching and university administration as well as a balance between the class room and the community.
10.6 Internal stakeholders vs. external stakeholders: the university must balance the academic quality demands of internal stake holders and the quantity demands of external stakeholders who expect the university to produce manpower and products to support the national economy.
10.7 Postgraduate vs. undergraduate: the balance between postgraduate and undergraduate numbers is delicate and is affected by many factors. The undergraduate pool must be large enough to generate enough quality candidates for postgraduate studies. Postgraduate students help in undergraduate teaching as tutors. Postgraduate are the backbone of research because they do the laboratory and field work for the professors.
7.9 Corporate president vs. academic president: The university as an institution had been transformed beyond recognition. In the past it was purely academic and required an academic head because all its funding was provided by government. It is now more of a corporation with business activities, investments, and lobbying for funds from the public and the government. The new type of university requires a leader with more corporate qualifications. The danger is that academic leadership will be lost in the process.
NOTE
