​The Faculty of Medicine and Health Sciences (FMHS) will roll out its renewed MBChB curriculum to first-year students this month – the culmination of a process which began five years ago when Stellenbosch University embarked on a programme of curriculum renewal.

It started off with a university-wide workshop in August 2017 which was attended, among others, by Prof Julia Blitz, then FMHS's Vice-Dean: Learning and Teaching, and current MBChB programme coordinator Dr Derick van Vuuren.

That workshop played a crucial role in the development of the renewed MBChB curriculum. The initial process involved a team-based approach to learning design called Carpe Diem, which was developed by learning innovator Prof Gilly Salmon of the United Kingdom, who facilitated the workshop.

Prof Karin Baatjes, who succeeded Blitz, participated in this process from the beginning. “Some of the important components of this [the Carpe Diem learning design] are encouraging student participation in their learning and a greater emphasis on blended learning," explain Baatjes, Blitz and Van Vuuren in a joint statement.

“We have been guided since then by a selection of principles drawn up at that initial workshop. We have been intentional about having wide input into the curriculum design from across the Faculty (foundational sciences, clinicians and health professions educationalists, as well as students), recent graduates, patient representatives and the Western Cape Department of Health."

An example of the rigorous process of consultation employed by the curriculum renewal project management team was an expo at Stellenbosch University's Tygerberg campus in 2019, where FMHS staff and students engaged with the proposed design of the renewed MBChB curriculum.

There is clearly much pride and satisfaction at the outcome of this inclusive process. “There are not substantial changes in the content of the curriculum," note Baatjes, Blitz and Van Vuuren. “We are still training doctors for internship in South Africa.

“However, there is a change in approach and emphasis. We are focusing on a core clinical curriculum in parallel with the graduate attributes ascribed to by both Stellenbosch University and the Health Professions Council of South Africa (HPCSA).

“In addition to addressing issues pertaining to patient care, we are also assisting students to address issues related to self-care and care within communities, as well as developing an understanding of how to strengthen the healthcare system in which they will be working after graduation."

They add: “We are also optimising the use of learning technologies and distributing training across the full continuum of healthcare facilities. The design uses a spiral curriculum which is aligned with current understandings of the science of learning.

“It is also an integrated curriculum which affords students the opportunity to continuously develop their knowledge and skills across all disciplines. This is encouraged through a strong emphasis on developing the skill of clinical reasoning.

“There is a strong thread of developing research knowledge and skills through the first five years. And we will continue in our endeavours to enable our graduates to converse with patients and healthcare colleagues in English, Afrikaans and isiXhosa."

The sixth year will see another notable change in the renewed curriculum: “The final year of the curriculum will be spent away from our tertiary teaching hospitals. This will be an opportunity for the student, while still under supervision, to participate in authentic learning opportunities as important members of clinical teams in a variety of contexts across the district health system."

Another key change relates to teaching methods. “Students will be expected to take an even greater role in monitoring their own progress and, when needed, adapting their learning to optimise their potential for success," say Baatjes, Blitz and Van Vuuren. “There will be a greater use of learning technologies with access to online learning resources."

Right from the start the FMHS recognised the importance of the curriculum renewal process initiated in May 2017 by Prof Arnold Schoonwinkel, then Stellenbosch University's Vice-Rector: Learning and Teaching. For this reason, it agreed to propose the MBChB curriculum as the first programme to kick off this process and starting working on it soon afterwards.

“All curricula should be renewed on a regular basis so that knowledge and skills respond to new developments, and so that processes can incorporate new knowledge with regards to learning and teaching," state Baatjes, Blitz and Van Vuuren.

“We are striving to strengthen the student experience so that they build lifelong internally driven learning skills; we hope that our graduates will have even more immersive clinical learning opportunities. We also intend our teaching staff to feel more supported in their teaching."

The roll-out of the renewed MBChB curriculum this year is clearly the result of a meticulously planned and well-executed process. “It is not a response to a problem," emphasise Baatjes, Blitz and Van Vuuren. “It is developing on what is already a very good and successful curriculum."

Students contribute to renewal process

Stellenbosch University's medical students were regularly consulted during the process of developing a renewed MBChB curriculum, and their feedback incorporated into the design and implementation of the end-result.

Tygerberg Academic Affairs Council chairperson Jessica Davies, a fifth-year medical student who is also on the Tygerberg Students' Representative Council, is perfectly placed to comment on the renewed curriculum.

“As a student who is almost finished with the previous MBChB curriculum, I am able to compare my experience of that curriculum with the renewed one," she says. “The strengths of the previous curriculum were added to the renewed one, and its limitations helped to pave a new direction for the renewed curriculum."

Davies provides an example of such innovation: “Instead of students being exposed to one organ system at a time and all the preclinical and clinical knowledge related to that organ system, the renewed curriculum is taking things in stages and approaches the preclinical content in its entirety first, before moving forward to the clinical application. This will make the work a lot more palatable for students, and easy to understand and apply in clinical practice."

She adds: “The curriculum is also aimed at ensuring that exposure on the clinical platform starts as soon as possible – which is a massive benefit to students. In addition, more emphasis is placed on research, which is not as explicit in the previous curriculum. This is an important competency to develop to ensure that we produce practitioners who are comfortable operating via evidence-based medicine."

Davies believes the changes will lead to a much better understanding of the physiology and pathophysiology which underpin diseases. “The foundation set by the renewed curriculum will be sound, and will provide students with a much greater and deeper understanding of the human body before learning how to treat it," she explains.

Another important change, in her view, is that the renewed curriculum focuses more on holistic care: “It has a huge focus on health and wellbeing, which is of the utmost importance in healthcare – not only for patients but also for doctors – which is not a key focus in the previous curriculum."

Furthermore, the changes to the MBChB curriculum are not confined to content only; they extend to teaching methods as well. “The teaching methods are geared to be learning-centred, with the use of advanced multimedia technology as aids," says Davies.

“The fundamental approach to learning has completely shifted, and the curriculum is set up in a much more balanced and student-friendly manner. “The renewed curriculum is going to have a much greater student-centred approach."

New curriculum at a glance

The recently completed MBChB curriculum renewal process is the third major overhaul of the programme since it was launched by the Faculty of Medicine and Health Sciences (FMHS) in 1956.

The changes were informed by two key objectives: one, to make the curriculum more pragmatic for students, and, two, to make it more responsive to the health needs of South Africa's population.

The renewal process, which started after a workshop in August 2017, was driven by a FMHS project management team. It finally completed its work last year, and the curriculum was duly accredited by the Health Professions Council of South Africa (HPCSA).

The renewed curriculum will be rolled out this month, starting with this year's intake of first-year students. Those who enrolled in the MBChB programme before 2022 will continue with the current curriculum for the duration of their studies, so there will be an overlap between the current and renewed MBChB programme from 2022 to 2026.

The modules in the renewed curriculum are as follows:

In addition, the Longitudinal Primary Healthcare Exposure and Clinical Curiosity modules will be taught in tandem with all modules.​