PRIMUS INTER PARES: CCMAS, CoMUI, And The Possible Realities Of A New Curriculum

Like architectural plans to a house, or assembly lines to a Chinese car factory somewhere in Shenzhen, curricula are the very framework on which the blocks of medical education or any education for that matter are built. While it’s not guaranteed that students will gain the knowledge of or be exposed to everything in their curriculum it’s almost a given that students will hardly get exposed to things not covered by it.

The curricula also determine how much exposure students get to the various subspecialties of medicine, as well as how much time students have to study the intricate details of the various bulky courses making up the MBBS degree. Curricula, although not so obviously, also determine to a large extent how enjoyable or unpleasant the student experience would be during the course of medical school.

The core curriculum minimum academic standards for Nigerian universities or CCMAS for short is a relatively new curriculum which was instituted in 2023 and that came into place officially in the university of Ibadan in 2025 or the current 200 level and the marked differences between it and the current 2010 CoMUI curriculum warrants a deep dive into the similarities and differences between them and the likely realities of students studying under this curriculum.

CoMUI 2010 CURRICULUM VS CCMAS 2023

The CoMUI 2010 curriculum is described as an integrated, system based, person centred, community-oriented competency driven curriculum and was constituted to replace the 1988 composite curriculum. According to the curriculum, the reviews leading up to the Constitution of the curriculum was considered important because of the following reasons: 

1. The CoMUI MBBS curriculum has remained largely unchanged for over 40 years. 
2. The health profile of the community and the profile of its medical manpower needs are changing.
3. The skills required of generalist medical doctors have changed substantially. 
4. Medical education is better understood and methods of medical instruction have changed.
5. There is a need to stem internal and external medical migration as the success of a medical school is evaluated by its impact on the health of its host community. 
6. The University of Ibadan is actualizing its vision of taking ownership of its instruments for student instruction. 
7. The need to maintain CoMUI’s recognition as a world-class medical institution and its primus interpares position amongst Nigerian medical schools.

The 2023 CCMAS curriculum is one that was born out of a generalized review of the previously existent Benchmark minimum academic standards (BMAS) of 14 different disciplines to form the CCMAS of 17 disciplines and was designed with the following broad objectives in mind:

1. Promote the production and development of medical doctors with sound knowledge in physiological, anatomical and biochemical processes in the human body that would lead to the understanding of various diseases.
2. Produce medical doctors who are proficient in clinical clerkship and the use of modern technology for the diagnosis and management of patients.
3. Produce medical doctors capable of understanding diseases and their manifestations using laboratory and pathological skills and knowledge, including the determination of the effect of diseases on the lives of individuals and persons in the community.
4. Train medical doctors with sound knowledge and understanding of causes of diseases at the individual and community levels, and other public health challenges using evidence-based methods.
5. Train medical doctors with an in-depth knowledge of therapeutics and with ability to determine drug actions in their patients.
6. Produce medical doctors with knowledge of ethical principles of the medical profession to attend to diverse ethical situations in the multicultural setting of the Nigerian Nation and other cultures.
7. Produce medical doctors as professionals who are polite, considerate, trustworthy, honest, act with integrity, maintain confidentially, respect patients’ dignity and privacy.
8. Inculcate into the medical doctors and dentists the spirit of teamwork and multi-disciplinary approach to medical practice.
9. Produce medical doctors with sound theoretical knowledge and skills capable of undertaking research in various fields of the medical and dental professions.
10. Produce medical doctors as professionals who recognise the principles of patient-centered care, including self-care, and deal with patients’ healthcare needs in consultation with   them and, where appropriate, their relatives or carers.
11. Produce medical doctors with skills for life-long and self-directed learning.

The Preclinical School Experience

The CoMUI 2010 curriculum prescribes the students cover integrated core basic medical sciences in Anatomy, Physiology and Biochemistry in the 200-level first and second semester as well as multidisciplinary healthcare delivery courses in Human Nutrition, Preventive and Social Medicine, Psychology, Critical Care Medicine and Family Medicine. All of these culminate in the first MBBS examination expected to hold at the end of the first semester of 300 level, prevailing realities in the college however mean that students often write the exams towards the end of 300 level. 

In the CCMAS curriculum however, the first and second semester of 200 level involve courses in Human Anatomy, Human Physiology, Medical Biochemistry, Community Orientation and Psychology as well as multi-disciplinary health care with each semester lasting 25 weeks. The 300-level first semester is expected to last another 26 weeks involving courses in Human Physiology, Medical Biochemistry, Community Service and multi-disciplinary healthcare; this then ends with the first professional examination. The prevailing reality in CoMUI at the moment has shown scant regard for this as the semesters are not 25/26 weeks in length, although it is possible that this gets instituted in the not so distant future.

Pathology And Pharmacology Year 

Referring to Pathology and Pharmacology as basic clinical sciences is a nomenclature that reveals a lot about what those courses are designed to achieve which like the mythological atlas is to bear the very weight of clinical medicine on their shoulders. This is why a very important difference between the 2010 CoMUI MBBS curriculum and the CCMAS curriculum lies in the length of Path and Pharm’s Block 1 and Block 2.

While not expressly stated in the curriculum, the prevailing implementational reality of block posting in Pathology and Pharmacology class in CoMUI means that Block 1 lasts a total of four weeks, while Block 2 lasts a total of 8 weeks, ending with a third block posting lasting for four weeks, bringing the entire duration of actual time spent in Pathology and Pharmacology to about 16 weeks (4 months) prior to the second MBBS examination.

The CCMAS curriculum on the other hand schedules a total of 14 weeks for the first block posting in Pathology and Pharmacology, and a total of 16 weeks of posting for the second block, bringing it all to a total of about 30 weeks, nearly doubling the current time being spent. The current Path and Pharm duration can only be described, for a lack of better expression, as extremely impractical and amounts almost to a mockery of the learning process, creating students who are bombarded nay pummelled with stuff in a very short period of time, without the needed space for assimilation and internalization.

One could even argue based on human experiences that it creates students who end up bereft of needed knowledge in the fields of Pathology and Pharmacology, two departments which form the bedrock of clinical medicine. The CCMAS timing changes the very core of that by granting students the needed time in the block postings. A foundational anomaly is being corrected and it would not be an exaggeration to claim that CoMUI students would become better clinicians solely as a result of this change.

CLINICAL EXPOSURE 

Anyone with their ears close to the walls of Ogba would know that a fundamental philosophy upon which CoMUI and many of her lecturers operate is an enduring passion for clinical exposure, referred to in student lingo as “coming to school”. This background philosophy is the sole reason CoMUI has one of the longest clinical posting duration among medical schools in Nigeria.

The expected length of pure clinical postings (not inclusive of path and pharm) in the CCMAS comes to a total of about 128 weeks made up of Community Medicine II for 4 weeks, Medicine and Surgery I for 12 weeks, Community Medicine III for 4 weeks, Medicine and Surgery II for 12 weeks, Obstetrics and Gynaecology and Paediatrics I for 20 weeks, Community Medicine IV for 4 weeks, Obstetrics and Gynaecology and Paediatrics II for 20 weeks, subspecialty postings (Dermatology, ENT, Radiology, Orthopaedics, Anaesthesia, Ophthalmology, and Psychiatry) for 24 weeks, Medicine and Surgery III for 24 weeks.

This is noticeably shorter than the current system in which the length of pure clinical postings comes to about 140 weeks. This includes 12 weeks in Medicine and Surgery I, 8 weeks in Infectious Diseases and Radiology I, 16 weeks in Medicine and Surgery II, 8 weeks in special postings (including ENT, Dentistry, Anaesthesia and Ophthalmology), Community Medicine I for 4 weeks, O/G  and Paediatrics I for 16 weeks, Igbo-Ora Community Medicine posting for 8 weeks, Family Medicine I/Radiology II for 8 weeks, O/G and Paediatrics II for 16 weeks, Special Posting II for 8 weeks, Psychiatry I and Family Medicine II for 8 weeks, External Posting for 4 weeks, Psychiatry II for 4 weeks, Community Medicine for 8 weeks and Medicine/Surgery III for 12 weeks. 

The CCMAS schedule is about 12 weeks shorter than the current one with an attendant reduction in exposure to specialities like Radiology, IDU, Dentistry, Family Medicine, and Psychiatry but with a slightly increased exposure to the core courses of Medicine, Surgery, Obstetrics and Gynaecology as well as Paediatrics. Away from the purely academic angle, this might also mean a slight reduction in the time spent in the clinical arm of the divide by a few months.

THE DISTINCTION CONVERSATION

“What do you mean he had only one distinction despite being the BGS”, this was the genuine reaction of many X users to the immediate past best graduating student of the MBBS program, Dr Joshua Inioluwa John, who was awarded only one distinction despite being the best in a total of 6 courses and having above 70 in five of those.

One reality of COMUI students that stands out absurdly is the pegging of distinction scores at 80 in opposition to the practice in most other medical schools where it is 70 out of 100. This has had many effects, the most noticeable of which is that students realize the impossibility of scoring 80 and decide to score as little as is acceptable. Afterall there is no difference between a person who scored 77 and a person with serious proximity to the proverbial Duncan’s line (50/100).

In the CCMAS curriculum, the prescribed score for a distinction is 70 and if implemented by CoMUI has the capacity to turn around a lot of things. By finally being within reach in most courses, more students would dare to dream of having a distinction and this would result in an improvement in collective academic performance. This would also make it possible for eligible CoMUI students to apply for international opportunities that give preference to students with distinctions such as the Rhodes Scholarship which requires applicants to have a minimum of two distinctions in any of Medicine/Surgery, Pathology, Pharmacology, Obstetrics and Gynaecology, and Paediatrics.

What will Ogba do?

As can be seen throughout this piece, many of the proposed reforms/adjustments are subject to the final decision of the college on how to implement the requirements of the curriculum. It thus remains to be seen, how CoMUI would approach the implementation of CCMAS and its dictates, after all the MAS in CCMAS stands for minimum academic standards.