This study focused in particular on what medical educators believe about teaching, learning and assessment in the context of curricular change and brings greater clarity to the influence of the core beliefs held by medical educators. It was demonstrated that quality of teaching methods is fundamental to students’ learning. Based on it, findings showed gaps between the current status in medical school and desired competences of graduated students. Results indicate that teachers’ beliefs directly affect their teaching methods and, then, their teaching and assessment methods affect the learning goals they set for their students.
The findings of this study are significant and show that the participants in this study share a set of core teaching, learning and assessment beliefs that shape their practice as teachers.
Meanwhile, medical educators believed that gaps between theoretical contents and real-world settings cause an ignorance of the core competencies in learning and assessment processes. Another barrier could be in basic courses such as physiopathology, anatomy, biochemistry and clinical courses as checkup which seemed to be in the form of H model. More specifically, in this model students pass all their basic course inside the class without getting any experience in practical courses and then go to the hospital as residents. They seemed to ignore the residents’ expectations that they show their leadership and expert knowledge and be proactive. Thus, following this model causes gaps between what the students learn in class and what they need to know and, especially, do in hospital. Learning in such educational climate is knowledge-based context rather than competency-based.
It also should be mentioned that the first years usually focus on basic sciences while subsequent years deal exclusively with clinical education and skill training. Learning is believed to be a simple accumulation of knowledge. This fundament of basic science is concentrated in a preclinical phase usually lasting four years. Every basic science is presented in an isolated course and there is little or no integration across disciplines (Bergman & de Goeij, 2010).
Medical training is inflexible, overly long, and not learner-centered. Clinical education for both students and residents excessively emphasizes mastery of facts, inpatient clinical experience, teaching by residents, and supervision by clinical faculty who have less and less time to teach, and hospitals with marginal capacity or willingness to support the teaching mission. We observed poor connections between formal knowledge and experiential learning and inadequate attention to patient populations, health care delivery, patient safety, and quality improvement. Learners lack a holistic view of patient experience and poorly understand the broader civic and advocacy roles of physicians. Finally, the pace and commercial nature of health care often impedes the inculcation of fundamental values of the profession (D. M. Irby et al., 2010).
Despite their emphasis on content, medical educators believed that learning opportunity is limited which is the consequences of lecture-dominated curriculum. In this approach, learning processes are mainly the result of direct teaching. In a lecture-dominated curriculum with limited or no clinical experiences, students have few opportunities to observe the professional demeanor or actions of practitioners and thus have no role models to emulate. Later, as more laboratories and clinical experiences are introduced, there is still no formal focus on the development of professional competencies and a professional identity.
The revised medical education curriculum in Iran is expected to improve the quality of instruction and provide opportunities for medical students to enhance their problem-solving, critical thinking and decision-making skills. In this curricular change, it is important that learning experiences provide students with knowledge and competencies that can be used in real-world situations; however, the reform should be continued because there is still a long way to go.
The use of authentic learning, connecting knowledge to real-world issues, problems, and applications, is a powerful learning strategy. The competency-based approach allows learners to practice seven core skills as clinical skills, communication skills, caring of patients, health progression, individual progression, professional commitment and decision making, reasoning and problem solving (Curriculum Committee of MD School, 2015). For integration of the complex skills has been started during the learning process, learners will be more likely to transfer the skills later on in the real setting. In task-centered learning environments, it is real-world problems or tasks that drive learning (Francom, 2016; Van Merriënboer & Kirschner, 2017).
Integration in medical education is important because medical practice itself requires a great deal of integration. Integration refers to the connection of formally structured knowledge of the basic, clinical, and social sciences with clinical experience in a much more balanced manner than is true today (D. Irby, 2011). Integration promotes the blending of the basic sciences with each other as well as with the clinical sciences. The benefits of integration are attributed to presenting information and problems in a way that mimics how they are encountered in the real world, and presenting facts in relevant, meaningful, and connected ways. Integration should be viewed as a strategy of curricular design and development and therefore should be considered at the program, course, and session levels (Ilkiw, 2018).