Bachelor of Medicine and Bachelor of Surgery

King Ceasor University (KCU) has, as one of its Schools in the College of Medicine, Health and Life Sciences, a School of Medicine (SoM) whose focus is to train health professionals who are conversant with the health problems of the communities they serve; and who have knowledge, skills and above all, the appropriate attitude that will make them sufficiently competent to run health services so as to achieve global health goals. The SoM offers among other programmes, a 5-year programme leading to the award of a Bachelor of Medicine and Bachelor of Surgery (MBChB) degree. This program is designed to produce medical doctors competent to practice in Uganda and beyond.

Rationale of The Programme

Globally and especially in developing countries, there is a mismatch between the number of health profes­sionals and the growing population. In Uganda, statistics show that doctor to patient ratio is 1:24,725 and nurse/midwife- patient ratio 1:11,000. According to the 2011 Human Resources for Health Audit Report, with respect to national level staffing, the proportion of the filled approved positions was found to be 58 per­cent up from 56 percent in 2010. Out of 55,063 approved positions, only 31,797 are filled, leaving 23,321 vacant positions. It has been increasingly recognized that, to reduce the unsustainable increases in health care costs, the patient to doctor ratio, to mitigate for an aging physician population, shortage of primary care providers and achieve high quality health care, there is a need to shift from a medical education and health care delivery system focused on providing curative care to one designed to prevent and manage disease. Therefore, there is a need to train more and more doctors.

The more important question to be answered from a needs assessment regards the type of training such doctors require to make them functionally suitable to face the challenges of the 21^st century. As a result, this revised curriculum is rooted in the convergence of medicine and engineering, computer sciences, quantitative sciences, and technology to teach the human body as an integrated system. This understanding of the human body as an integrated system is critical to the analytical, problem-solving skills needed to be a successful physician-scientist, physician-innovator, or physician-entrepreneur equipped with the knowledge and skills to transform the current health care system.

Programme Mission Statement

The program’s mission is to develop health professionals with leadership, management and communication skills; taking positions of influence through which they will contribute substantially to the health and well-being of the global community. The program aims at ensuring that research priorities are responsive to the felt needs of the community spearheading prioritization of primary healthcare for the majority of the people.

Programme Goals

The overarching goal of MBChB programme at KCU is to produce competent, compassionate, reflective and dedicated health care professionals who:

1. Consider the care and safety of patients, their first concern.
2. Establish and maintain good relationships with patients, their families, attendants and
3. colleagues.
4. Are honest, trustworthy and act with integrity in accordance with the ethical code.
5. Are capable of dealing with common diseases and health problems of the country and are willing to serve the community particularly the rural community; but at the same time have a firm foundation for future training, health service and research at both national and international levels.
6. Are committed to keeping their knowledge and skills up-to-date through continuous professional development all through their professional life.

Programme Objectives

On successful completion of the MBChB program, students will have gained and demonstrated the knowledge, skills and attitudes necessary for them to practice medicine competently. Specifically, they will have acquired and demonstrated:

Knowledge and Understanding of

1. The sciences upon which Medicine depends and the scientific and experimental methods;
2. The structure, function and normal growth and development of the human body and the workings of the mind and their interaction, the factors which may disturb these, and the disorders of structure and function which may result;
3. The range of core problems presenting to doctors, their diagnosis, prevention and treatment;
4. The aetiology, natural history and prognosis of the common mental and physical ailments;
5. Factors influencing variability of disease presentation and patient perceptions of disease;
6. The management of disease, its symptoms and sequelae in hospital and the community;
7. The principles of health promotion, prevention and of curative care, including health education, the relief of suffering and disability, rehabilitation, the maintenance of health in old age, and the care of the dying;
8. Human relationships, both personal and social and the interaction between man and his physical, biological and social environment;
9. The organization and provision of health care in the community and in hospital, the identification of the need for it, and the economic, ethical and practical constraints within which it operates; and
10. The ethical standards and legal responsibilities of the medical profession

Professional skills necessary to:

1. Carry out appropriate clinical procedures, including the ability to:
   • Establish a proper relationship with patients, their relatives and colleagues.
   • Obtain and record a comprehensive patient history.
   • Perform a complete examination and use the findings to assess patient problems and formulate management plans.
   • Deal with common medical emergencies.
   • Counsel and educate patients so that they can make informed choices.
   • Work effectively with the health care team and consult with other colleagues.
   • Initiate proper treatment.
2. Interpret laboratory-derived data effectively in the best interests of patients;
3. Communicate with, and inform others accurately and concisely about disease process, management and prognosis.

Attitudes essential to the practice of medicine, including:

1. Respect for patients and colleagues that encompasses, without prejudice to, diversity of background, opportunity, language, culture and way of life;
2. Respect of patients’ rights, particularly in regard to confidentiality and informed consent;
3. Awareness of the ethical responsibilities involved in patient care;
4. Awareness of the need to ensure provision of the highest possible quality of patient care;
5. Application of evidence and scientific knowledge, to reach conclusions by logical deduction or by experiment, and to critically evaluate methods and standards of medical practice;
6.  Identification of their own strengths and preferences for making appropriate career choices;
7. Appreciation of the limitations of their own knowledge, skills and working environment in appropriate management of the patient and community; and
8. Maintenance of good working relationships with members of the other health care professions.

Roles and Functions of the MBChB Programme

The candidates who graduate from the KCU MBChB programme shall be a;

• Clinician, who understands and provides preventive, promotive, curative, palliative and holistic care with compassion.
  • Leader and member of the health care team and system with capacity to collect, analyze and synthesize health data.
  • Communicator with patients, families, colleagues and community.
  • Lifelong learner committed to continuous improvement of skills and knowledge.
  • Professional, who is committed to excellence, is ethical, responsive and accountable to patients, community, and profession.

General Academic Regulations

Admission Requirements

Five (5) entry points are available for persons wishing to enter the Bachelor of Medicine and Bachelor of Surgery (MBChB) program:

Direct Entry Scheme

In order to be eligible for direct entry into the MBChB prgoramme, a candidate must have;

1. Sat for the Uganda Certificate of Education (UCE) or its equivalent with credit passes in five (5) approved subjects obtained prior to sitting for Uganda Advanced Certificate of Education (UACE) with two passes obtained in one sitting.
2. Sat and passed the UACE or its equivalent with at least two (2) principal passes in Chemistry, Biology and at least one (1) subsidiary pass in either Physics or Mathematics.

Holders of School Certificate Graded in Percentages and Average Points:

In order to be eligible for direct entry into the MBChB program, a candidate whose final high school marks are graded in percentages and average point systems such as in Sudan, The Democratic Republic of Congo (DRC), Rwanda and Burundi must have their grades first equated or standardized before seeking SAIU admission.

Holders of Diploma in Medical Sciences:

In order to be eligible for admission into the MBChB programme, diploma entry candidate must:

1. Possess a good diploma or its equivalent in a health-related field such as Clinical Medicine, Medical Laboratory Technology, Radiography, Public Health, Dental Health, Advanced Nursing, Registered Nursing and Pharmacy Technology.
2. Be registered with the relevant professional council of the home country where applicable.
3. The institution from which such a qualification was obtained must be recognized by SAIU Senate.

Holders of Bachelor Degrees in Sciences:

In order to be eligible for admission into the MBChB degree programme, degree entry candidate must:

1. Possess a Bachelor degree in science disciplines at least at the level of second-class lower division or its equivalent.
2. Have obtained the above qualification from a recognized institution of higher learning in his/her country, which is recognized by SAIU Senate

Transfer from MBChB or equivalent programmes of other Institutions

Any candidate seeking for admission into the MBChB programme, who has been attending a similar programme (MBChB or equivalent) in another Institution of higher learning recognized by NCHE and SAIU senate shall:

1. Start from year one semester one of this programe, if he/she was discontinued from the programme from the institution he/she is transferring from.
2. Be considered for advanced standing admission (admission at a level beyond year one semester one of the programme) by the School of Medicine Board of Studies as the specific case may require, and a recommendation made to senate regarding the level of entry into the programme and the courses he/she has to be exempted, if any.

In both situations (3.1.5 a and b above), each candidate shall produce the following documents before he/she is considered;

1. Original O’ level certificate or its equivalent.
2. Original A’ Level certificate, where applicable.
3. Academic transcripts for the years attended in the Institution he/she is transferring from.
4. A Letter of Good standing from the Institution he/she is transferring from, for those in category

Duration of the Programme

The duration of the Bachelor of Medicine and Bachelor of Surgery (MBChB) degree programme shall extend over a period of not less than five (5) years, unless the School of Medicine Board recommends and the SAIU Senate approves otherwise. Each academic year shall be divided into two (2) semesters. In this curriculum, a semester shall consist of a period of instruction lasting for eighteen (18) weeks and examination of two (2) weeks. Therefore, the duration of the MBChB programme shall be equivalent to ten (10) semesters of biomedical, pathology and clinical courses. At the maximum, the programme shall not extend beyond fourteen (14) uninterrupted semesters i.e. without counting officially approved “dead” semesters.

Mode of Delivery of the Programme

The various courses in the programme will be delivered using a multifaceted approach in which strategies that encourage active learning will be the main ones used.

The strategies will include:

1. Small group tutorials.
2. Overview lectures to provide guidance in scope and depth.
3. Large group discussions between students and discipline experts.
4. Seminars where the area to be discussed cuts across disciplines.
5. Laboratory practicals
6. Clinical demonstrations to emphasize the holistic approach.
7. Clinical clerkships aimed at integrating the art and science of medical practice.
8. Fieldwork particularly important for COBERMS.

During implementation of a given course, some or all of these strategies may be used in a way that will ensure that they complement one another to enhance the students’ learning.

Weighting of Courses

The courses in the programme are weighted using credit units of study (CU). A course shall carry a value of 2 to 10 credit units depending on the nature of content involved. In all cases;

1. One credit unit of study equals 15 contact hours (CH)
2. One lecture hour (LH) equals one contact hour (CH)
3. Two tutorial hours (TH) equal one contact hour
4. Two practical/clinical hours (PH) equal one contact hour

Grading System

The Marks obtained in each course shall be cumulated and averaged into the following letter grades that signify the level of performance in an individual student per unit and on aggregate, the final degree attained.

Percentage Mark	Grade Awarded	Grade Point
80-100	A	5.0
75-79. 9	B+	4.5
70-74	B	4.0
65- 69	C+	3.5
60-64	C	3.0
55-59	D+	2.5
50-54	D	2.0
0-49	F	0

Semester Course Load

Normal Semester Course Load

The minimum number of credit units per semester shall be fifteen (15). The maximum number of credit units per semester shall be twenty-eight (28).

Maximum Semester Course Load

The maximum number of Credit Units per Semester shall be twenty-eight (28) to cater for students who have courses to retake or those who are able to complete the requirements for their respective Academic Awards in less than the stipulated minimum duration.

Pass mark

The pass mark in any part of the examination and in the total (100%) mark for the course shall be 50% provided the clinical part of the exam in the clinical courses has been passed by scoring at least 50% out of the total marks for the component.

Calculation of Grade Point Average (GPA)

The GPA shall be calculated through three steps as shown below.

1. Calculate the course grade point or weighted score of the course achieved by multiplying (Grade Point of the Course) by (Number of Credit Units for the Course)
2. Obtain the Grade Point Total by adding all the Grade Points (or weighted scores) for each Course taken.
3. Obtain the Grade Point Average (GPA) by dividing the (Grade Point Total or total weighted score) by the (Total Number of Credit Units).

The following examples illustrate the computation of GPA.

Course Name	Grades	CU Value	Grade Point
	Grade	GP
Anatomy	A	5.0	3	15.0
Physiology	C	2.5	3	7.5
Biochemistry	B+	4.5	2	9.0
Introduction to Public Health	D	1.0	3	3.0
Embryology & Histology	C-	2.0	2	4.0
Totals			13	38.5
	GPA = 38.5 ¸ 13 = 2.96 for a semester

Cumulative Grade Point Average (CGPA)

The CGPA is the Grade Point Average obtained by a student up to that point, and is obtained as follows: –

1. Multiply the Grade Point of a Course by the Number of Credit Units for the Course to obtain the Course Grade Point achieved or weighted score of the course
2. Add all the Grade Point (or weighted scores) for each Course TAKEN UP TO THAT TIME = Grade Point Total.
3. Divide the Grade Point Total or total weighted score by the Total Number of Credit Units TAKEN UP TO THAT TIME to obtain Cumulative Grade Point Average (CGPA).

Note:  Do not just add the GPA for the first and second semesters and divide by two! This method sometimes gives incorrect results.

Assessment and Examination

1. The University examinations and assessments process enables students to demonstrate that they have;
2. Satisfied the conditions for progression from one semester of a course to the following semester, or
3. Attain a standard appropriate to the level of award sought.
4. The mode of Assessments shall employ both formative and summative methods with emphasis on clinical aspects that encourage problem solving skills as far as possible.

Continuous Assessment (Formative)

Continuous assessment shall contribute 40% of the final course marks. It shall take various forms, including:

1. Log of experiences and procedures done (necessary competencies): with essential skills to be acquired for each course;
2. Case reports;
3. Project reports;
4. Regular course examinations: written, practical, clinical (OSCEs, Short and Long cases), and vivas; and
5. Attitudinal assessment. This will be assessed using a number of observable items such as punctuality on duty, attention given to assignments such as preoperative clerking, preparation of patients, availability during working hours and when on call, dealing with colleagues and other staff, the patients and the patients friends and relatives. Such observations will be scored on a five-point scale

End of Semester Examinations (ESE)

• There will be an end of semester or end of course examination in each course as indicated in the curriculum. This will consist of the following;
  • Written: Multiple Choice Questions, Short and Long Essay Questions;
  • Clinical: OSCEs, Clinical Short and Long cases;
  • Practical; and
  • Viva voce.
  • Courses without clinical aspects will be assessed as follows:
  • Written exam                                     40%   
  • Practical (Where applicable)            10%   
  • Viva voce                                            10       
  • Total                                                   60%
• Courses with clinical components will be assessed as follows:
  • Written exam             20%   
  • Clinical exam             30%
  • Viva voce                    10%
  • Total                           60%
  • The final pass mark for all examinations shall be 50% overall in both continuous assessment and final university examination. However, failing the clinical exam will imply failing the course exam overall irrespective of what the total percentage out of 100 (i. e. CATs + ESE) will indicate. If the CATs + ESE produce a total percentage of 60% or higher, the fail will be indicated as FC (Failed clinical).
• Final exams are usually given at the end of all courses. Except in predominantly laboratory /clinical courses, exams may not be given during the last week of classes.
• The General University Examination regulations on registration for examinations, eligibility for examinations, Board of Examiners, conduct of examinations, examination irregularities, procedures for appeals and preservation of scripts shall remain as stipulated in the academic policies of the University.

Design of the Curriculum
The learning experiences are organized into three (3) phases, which spiral into each other with each phase courses being pre-requisite to the next phase courses. Phase I courses are pre-requisite to phase II.
Similarly, all phase II courses are pre-requisite for phase III courses.
Phase One: The Normal structure and Functions (Pre-clinical)
This phase includes courses that deal with the scientific basis of medical practice, especially the basic and applied/clinical sciences, including anatomy, physiology, immunology, microbiology, basic pharmacology
and epidemiology. The students are introduced to the hospital setting and patients during this phase.
Early clinical exposure will assist students to have an early introduction to the patients and the conditions under which they will work and relating it to the biomedical sciences.
At this level, also a number of courses are included, aimed at improving the doctor’s competences in other areas such as bio-statistics, public health and epidemiology, computer applications, behavioral communication skills, ethics and professionalism. This phase extends over a period of two
semesters.
Phase Two: The Abnormal Sand Functions (Pathology)
These include applied aspects of the various biomedical sciences such as general and systemic pathology, clinical microbiology/parasitology and clinical pharmacology and therapeutics. This phase shall extend over a period of two semesters.
Phase Three: Clinical Clerkship
This phase will consist of planned clinical placement rotations to provide core experience in key clinical areas including Internal Medicine, Child Health and Pediatrics, Reproductive Health and Obstetrics and
Gynaecology, Mental Health and Psychiatry, General Surgery and various specialized areas in surgery such as Ear, Nose and Throat (ENT), Anesthesiology and Critical Care Medicine, Radiology and Imaging. Other
areas sometimes regarded as specialties such as Tuberculosis, Leprosy, Dermatology, Sexually Transmitted Infections (STIs) Oncology, Urology, cardiothoracic surgery, paediatric surgery, neural surgery and others are recognized and addressed in their “mother” disciplines such as Internal Medicine and surgery.
These courses are linked to the ethical, social and cultural issues appropriate to different clinical situations with an increased emphasis on medicines management and patient safety. This phase shall extend over a period of six semesters and divided into junior and senior clerkship. There shall be 8 weeks of an elective study period in-between junior and senior clerkship.