National Academic Reference Standards (NARS)

Medicine

January 2009

1st Edition
National Authority for Quality Assurance and Accreditation of Education

Table of Contents

Introduction to Medical Education 2

National Academic Reference Standards 8
Glossary 17
References 20

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National Authority for Quality Assurance and Accreditation of Education

Introduction to Medical Education

1. The National Academic Standards have been developed in order

to serve as an external reference for designing and upgrading
the undergraduate educational program of faculties of medicine.
They also represent general expectations about the standards for
the award of Bachelor Degree in Medicine (MBBCh) and
articulate the attributes and capabilities that those possessing
such qualification should be able to demonstrate.

2. The National Academic Reference Standards of the MBBCh

degree include expressions of the professional/employment
related abilities that graduates in medicine would be expected to
have developed during their higher education including
associated practice based experiences.

3. These standards represent the minimum academic quality

requirements which the government regards as appropriate and
reasonable in order to protect the interests of the students, the
reputation of individual faculties, and the community.
4. These standards have been developed by a group of medical
academics representing a wide variety of Egyptian Universities,
Medical Sector Committee of the Supreme Council of
Universities, a representative of the Medical Syndicate, Ministry
of Health and Population, Army Hospitals, private hospitals and
students.
5. The standards are not a curriculum or a syllabus.

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6. The role of NAQAAE is to develop, review and modify the

national academic reference standards when required.

7. The role of the Medical Sector Committee of the Supreme

Council of Universities is to, participate in the development,
dissemination, and facilitate the implementation of the NARS

Role of Faculties of Medicine

8. The role of Faculties is to develop their own standards based on

the relevant external reference points, guarantee the approval of
NAQAAE if their standards are not equal or exceed the
threshold of National Academic Reference Standards and ensure
that their own standards and their program design follow the
regulatory frameworks and bylaws of the Supreme Council of
Universities

9. If any faculty of medicine develops program Intended Learning

Outcomes that are different from the National Academic
Reference Standards, it should be stated in its mission. For
example, it may have a distinctive mission or unusual student
intake, or it might be using alternative external reference points
that are regarded as more relevant to the needs of its graduates
and other stakeholders.

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10. Every faculty of medicine should make available all evidences

they may wish to present under each of the standards and make
this clear in their self-evaluation reports and during external
audit.

11. Every faculty of medicine should ensure that their academic

standards are in compliance with their mission, the faculty
members approve the academic reference standards, and their
students achieve the academic standards and outcomes.

12. Every faculty of medicine should clearly define the program

and course specifications including aims and Intended Learning
Outcomes.

13. Every faculty of medicine should have a plan to implement

successfully the academic reference standards and should have a
means to secure and sustain the use of these standards.

Requirements to achieve NARS

1. Curriculum Management: Every Faculty of Medicine must

establish a system for curriculum management which
inclusively but not exclusively comprise authoritative
committees for curriculum development , implementation,
students assessment and program evaluation

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National Authority for Quality Assurance and Accreditation of Education

2. Curriculum Integration. Traditionally the medical program

was divided into a pre-clinical phase covering the sciences basic
to medicine and the clinical phase covering clinical instruction
with some of the more applied medical sciences. Educational
research has proved that students learn best when basic sciences
are weaved into clinical contexts, and the curriculum is integrated
horizontally and vertically. It is essential that all faculties of
medicine must imply some degree of integration according to
their capabilities

3. Educational Strategies: There are also different approaches to

education across the medical schools. The curricula in most of
the medical schools are predominantly subject based, whereas in
few medical schools is problem based. The NAQAAE & the
Sector Committee confirm that all faculties of medicine must
adopt new educational strategies which enhance students’
participation in the learning process and help the development
of students’ self learning abilities within the next two years. The
Faculty must ensure enough clinical training opportunities and
time for the students throughout their study program which
reflect the variety of health care environments including
hospitals, ambulatory care, primary and family health centers,
general practice, and other available community health care
services. This must also be supported by training in skills
laboratories.

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4. Medical Education Center /Department: In recent years there

has been an increasing professionalism of medical education
with most medical schools now having medical education center
/departments. The NAQAAE and the sector committee request
all faculties of medicine to establish medical education
departments or strengthen their medical education centers.

5. Elective Courses: Most of the medical schools use a

compulsory core curriculum to all the students. The core
curriculum provides the essential knowledge, understanding,
clinical skills and professional attitudes which are required by
any medical graduate in order that s/he may practice as a house
officer and commence postgraduate training. The elective
courses became one of the essential international standards all
over the world. The NAQAAE and the Sector Committee
support medical schools to include elective studies within their
undergraduate courses. The aim of the elective studies is
stimulation of critical thinking; it should allow students to
acquire research abilities and enhance their skills in collection,
evaluation, synthesis and presentation of evidence. Elective
studies also provide opportunity for study in depth and may
extend beyond the traditional medical disciplines.

6. Student Assessment is an essential component in the

educational process, as it drives learning and allows the
institution to ensure that the students has achieved the desired

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intended learning outcomes to the degree determined by the

academic standards . This NARS emphasizes that the Faculty
should make all the efforts to establish an assessment system
that utilizes a variety of methods and techniques to ensure that
all the curricular outcomes have been adequately met. This
requires the use of objective questions (MCQs, matching etc.) in
addition to modified essay and problem solving and case studies
in written exams. Similarly, the Faculty must ensure that
assessment of clinical and practical skills encompasses tools
that allow the coverage of a wide variety of required
competencies. This should inclusively but not exclusively
include the wider implementation of Objective Structured
practical and Clinical Exams (OSCE/SP), extended direct
observation of students interviewing and examining patients
throughout their clinical clerkships, as well as the assessment of
procedural skills in skills labs. Assessment of attitudes and
ethics though relatively difficult, yet must be sought through the
reflection of the attitudes on the students’ behaviors by extended
direct observation from their teachers. All Faculties must make
necessary arrangements to monitor the assessment process
through students and staff feedback.

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I.National Academic Reference Standards (NARS)

Students should be prepared to approach their medical practice

acquiring sufficient knowledge of the basic and clinical sciences in
an integrated manner, and an understanding of the underlying
principles of scientific method. They must be prepared for lifelong
learning to remain current in their understanding of the scientific
basis of medicine.

On graduation, the graduates must possess all the

competencies that enable them to carry out the duties of the house
officers during the house officer year; after which they must possess
the competencies essential for working as primary health care
providers. Professional skills are acquired during the undergraduate
education, and continue throughout the house officer year.

The medical school must ensure that before graduation the

student will have demonstrated, to the satisfaction of the faculty, the
knowledge and understanding, the intellectual, practical,
professional attitude and behaviors, communication, general and
transferable skills of the following

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1. Attributes of the Graduates of Medical Medicine

The Medical Graduate must:

1.1. Work to maintain normal health, provide primary

health care and deal with common health problems in
the society.
1.2. Be aware of the importance of a good doctor/ patient
relationship, and work to establish and maintain it.
1.3. Follow rules of medical ethics.
1.4. Demonstrate appropriate communication, clinical and
practical skills.
1.5. Show appropriate attitudes and professionalism.
1.6. Be prepared for lifelong learning.
1.7. Be able to engage in post- graduate and research
studies.
1.8. Acquire basic administrative capabilities.

2. Knowledge and Understanding

2.1. Normal Human Body:

a. Normal structure and function of the body (as an intact
organism) and of each of its major systems.
b. Molecular, biochemical, and cellular mechanisms
which are important in maintaining the body
homeostasis.

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c. Main developmental changes in humans and the effect

of growth, development and aging on the individual
and his family.
d. Basics of normal and abnormal human behaviors.
2.2. Altered structure and function of the body and its
major systems that are seen in various diseases and
integrate it in clinical conditions.
2.3. Etiology, pathogenesis, clinical features, diagnoses
and complications of common and life-threatening
illnesses affecting the body and each of its major organ
systems, presenting throughout the age spectrum.
2.4. Principles of management of common and life
threatening illnesses including:
a. Pharmacological and non pharmacological basics of
therapy.
b. Non invasive and invasive intervention.
c. Basic pre- and post operative care.
d. Pain relief and palliative care.

2.5. Population Health and Health Systems:

a. The determinants of health, principles of disease
prevention and early detection of common community
health problems.
b. Principle and organization of National Health Care
System.

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c. Epidemiological principles of demography and

biological variability.
d. Principles of disease surveillance and screening.
e. Communicable disease control and health promotion.
f. Population-based approaches to health care services
and their role in improving medical practice.
2.6. Basics of ethics, medico legal aspects of health
problems, malpractice and common medical errors.
2.7. Basics of health and patient’s safety and safety
procedures during practical and clinical years.
2.8. Principles of clinical audit.

3. Practical and Clinical Skills

Graduate should acquire the following practical as well as Clinical

skills and competencies during the undergraduate years

3.1. Demonstrate basic sciences practical skills relevant to

future practice.
3.2. Take and record a structured, patient centered history.
3.3. Perform full physical examination of patients with acute
and chronic clinical conditions appropriate to the age,
gender, acute and chronic clinical conditions while
being culturally sensitive.
3.4. Assess the mental state of the patient
3.5. Record patients ' data appropriately.

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3.6.
Formulate a management plan for common diseases and
acute emergencies.
3.7. Write safe prescriptions of different types of drugs
based on patient's weight, age and health condition
3.8. Provide first aid measures for injured and critically ill
patients.
Procedures and technical skills acquired under appropriate
supervision during undergraduate and house officer training:

3.9. Perform venepuncture and collect blood samples.

3.10. Insert a cannula into peripheral veins.
3.11. Give intramuscular, subcutaneous, intradermal and
intravenous injections.
3.12. Perform suturing of superficial wounds.
3.13. Demonstrate competency in cardiopulmonary resuscitation
and basic life-support.
3.14. Administer compulsory childhood vaccines.
3.15. Perform and interpret basic bedside laboratory tests.
3.16. Perform and interpret ECG.
3.17. Administer basic oxygen therapy.
3.18. Perform and interpret basic respiratory function tests.
3.19. Use a nebulizer for administration of inhalation therapy.
3.20. Insert a nasogastric tube.
3.21. Perform bladder catheterization.
3.22. Perform procedure of normal labor.
3.23. Adopt suitable measures for infection control.

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4. Professional Attitude and Behavioral Skills:

Graduates should be able to:

4.1. Adopt an empathic and holistic approach to the patients and

their problems.
4.2. Respect patients’ rights and involve them and /or their
caretakers in management decisions.
4.3. Understand and respect the different cultural beliefs and
values in the community they serve.
4.4. Recognize the important role played by other health care
professions in patients’ management.
4.5. Be aware of and understand the national code of ethics issued
by the Egyptian Medical Syndicate.
4.6. Counsel patients and families suffering from different
conditions.
4.7. Recognize one’s own limitations of knowledge and skills and
refer patients to appropriate health facility at the appropriate
stage.

House Officers should be able, under appropriate supervision,

to:

4.8. Ensure confidentiality and privacy of patients’ information.

4.9. Treat all patients equally, and avoid stigmatizing any
category regardless of believes, culture, and behaviors.
4.10. Demonstrate respect and work cooperatively with other
health care professions for effective patient management.
4.11. Be willing to share in all types of inter-professional activities
including collaborative and shared learning

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4.12. Ensure the cost effectiveness of health care management.

4.13. Notify/report about any physical or mental conditions related
to himself, colleagues or any other person that might
jeopardize

5. Communication skills:
5.1. Communicate clearly, sensitively and effectively with
patients and their relatives, and colleagues from a variety of
health and social care professions.
5.2. Communicate effectively with individuals regardless of their
social, cultural, ethnic backgrounds, or their disabilities.
5.3. Cope with situations where communication is difficult
including breaking bad news.
5.4. Show compassion to the patients and their relatives in
situations of stress and grief.
5.5. Honor and respect patients and their relatives, superiors,
colleagues and any other member of the health profession.

6. Intellectual Skills:
6.1. Integrate basic biomedical science with clinical care
6.2. Reason deductively in solving clinical problems:
a. Recognize, define and prioritize problems.
b. Interpret, analyze, and evaluate information
objectively, recognizing its limitations.
6.3. Use personal judgment for analytical and critical problem
solving and seek out information.

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6.4. Integrate the results of history, physical and laboratory test

findings into a meaningful diagnostic formulation.
6.5. Construct appropriate management strategies for patients
with common diseases, both acute and chronic, including
medical, psychiatric, and surgical conditions.
6.6. Design an initial course of management for stabilization of
patients with serious illnesses.
6.7. Classify factors that place individuals at risk for disease or
injury, to determine strategies for appropriate response.
6.8. Retrieve, analyze, and evaluate relevant and current data
from literature, using information technologies and library
resources, in order to help solve a clinical problem based on
evidence (EBM).
6.9. Recognize and cope with uncertainty that is unavoidable in
the practice of medicine by accepting and reacting to
uncertain situation through proper counseling ,consultation
and referral
6.10. Involvement into research and scientific methods through:
a. Formulation of research questions that is pertinent to
medicine.
b. Recognition of the importance of precision in
collecting, analyzing and interpreting medical data.

7. General and Transferable Skills:

7.1. Be prepared for the lifelong learning needs of the medical

profession.
7.2. Use information and communication technology effectively
in the field of medical practice.

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7.3. Retrieve, manage, and manipulate information by all means,

including electronic means.
7.4. Present information clearly in written, electronic and oral
forms.
7.5. Communicate ideas and arguments effectively.
7.6. Work effectively within a team.
7.7. Analyze and use numerical data including the use of simple
statistical methods).

House Officers should be able to:

7.8. Use Evidence Based Medicine in management decisions.

7.9. Effectively manage time and resources and set priorities.
7.10. Work efficiently within the health care team and as an
effective team leader.
7.11. Solve problems related to patients, work management, and
among colleagues.
7.12. Cope with a changing work environment.
7.13. Apply safety and infection control measures during practice.
7.14. Evaluate their work and that of others using constructive
feedback.

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National Authority for Quality Assurance and Accreditation of Education

II. Glossary

1. Institution
A University, faculty or higher institute providing education
programs leading to a first university degree or a higher
degree (Master's or Doctorate).

2. Graduate Attributes
Competencies expected from the graduate based on the
acquired knowledge and skills gained upon completion of a
particular program.

3. National Academic Reference Standards (NARS)

Reference points designed by NAQAAE to outline / describe

the expected minimum knowledge and skills necessary to
fulfill the requirements of a program of study.

4. Academic Standards

Reference points defined by an institution comprising the

collective knowledge and skills to be gained by the graduates
of a particular program. The academic standards should
surpass the NARS, and be approved by NAQAAE.

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5. Subject Benchmark Statements

Guideline statements that detail what can be expected of a

graduate in terms of the learning outcomes to satisfy the
standards set for the program. They enable the outcomes to be
compared, reviewed and evaluated against agreed upon
standards.

6. The Program

A set of educational courses and activities designed by the

institution to determine the systematic learning progress. The
program also imparts the intended competencies required for
the award of an academic degree.

7. Intended Learning Outcomes (ILOs)

Subject-specific knowledge, understanding and skills

intended by the institution to be gained by the learners
completing a particular educational activity. The ILOs
emphasize what is expected that learners will be able to do as
a result of a learning activity.

8. Knowledge and Understanding

Knowledge is the intended information to be gained from an

educational activity including facts, terms, theories and basic
concepts. Understanding involves comprehending and

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grasping the meaning or the underlying explanation of

scientific objects.

9. Intellectual Skills

Learning and cognitive capabilities that involve critical

thinking and creativity. These include application, analysis,
synthesis and evaluation of information.

10. Professional and Practical Skills

Application of specialized knowledge, training and

proficiency in a subject or field to attain successful career
development and personal advancement.

11. General and Transferable Skills

Skills that are not subject-specific and commonly needed in

education, employment, life-long learning and self
development. These skills include communication, team
work, numeracy, independent learning, interpersonal
relationship, and problem solving... etc.

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III. References

 General Medical Council. Tomorrow’s doctors,

Recommendations on undergraduate medical education.
London,UK2003.
http://www.gmcuk.org/Education/Undergraduate/Tomdoc.Pdf
 General Medical Council. Guidelines on good medical
practice. London, UK 2006.
http://www.gmcuk.org/guidance/good_medical_practice/inde
x.asp
 Association of American Medical Colleges. Learning
Objectives for Medical Student Education, Guidelines for
medical schools, Medical School Objectives’ Project,
Washington DC, USA1998.
http://www.aamc.org/meded/msop/msop1.pdf
 Quality Assurance Agency of Higher Education. Subject
Benchmark Statement, UK.
http://www.qaa.ac.uk/academicinfrastructure/benchmark/hon
ours/medicine. pdf
 Liaison Committee on Medical Education. Function and
structure of a Medical School; http:/www.lcme.org
 World Federation of Medical Education. Basic Medical
Education WFME Global Standards for Quality
Improvement. Copenhagen, Denmark 2003.
http://www.wfme.org/

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