Medical education in Jordan

Medical education in Jordan includes educational activities involved in the education and training of Bachelors of Medicine and Surgery (MBBS) in the Hashemite Kingdom of Jordan, from entry-level training through to continuing education of qualified specialists.

The history of Jordanian medical education and its current status are shown below, as well as an outline of the infrastructure, admission system, curricula and academia of Jordanian medical schools.^[1]

History

Undergraduate medical education in Jordan started in 1972 with the establishment of the first medical school in The University of Jordan (JU). The increasing demand for undergraduate medical studies created a motivation for additional medical schools, and a second medical school was established in Yarmouk University at the northern city of Irbid in 1984; the university then branched out into Jordan University of Science and Technology (JUST) in 1986. A third medical school was founded in 2001 in Mutah University (MU), situated in the southern city of Karak. Finally, in 2006, a fourth medical school was established in the central region of the country at Zarka within the Hashemite University (HU). All of the medical schools, to date, have been established in public universities; there are no existing private medical schools. Graduates from Jordanian medical schools currently play an important role in the development of the country’s healthcare system. Moreover, the Jordanian medical education system is one of the most highly regarded in the Middle East and therefore many students from the region study medicine in Jordan. The country is ranked by the World Bank to be the number one health-care services provider in the region and among the top five in the world.

Name of the Institution	Year of Institution Establishment	Year of Medical School Establishment
University of Jordan (JU)	1962	1972
Jordan University of Science and Technology (JUST)	1986[2]	1984
Mutah University (MU)	1981	2001
Hashemite University (HU)	1995	2006

Undergraduate Medical Education

Admission to medical school

As in most Arab countries, the sole admission criterion in Jordanian medical schools is the achievement of a satisfactory mark in the national exam for high school students, the Tawjihi. This form of admission system is supported by the majority of the society, who sees in it a mean of guaranteeing equal chances of accessing medical education for all. Medical schools’ admissions are further regulated by two different systems:

• The General Competition (applied in 1972);
• The Parallel System (in operation since 1997).

Students with the highest marks in the national high school exams gain admission through the General Competition System. The extremely low percentage of accepted applications, only 6%, is indicative of the high level of competition in order to gain access to the medical schools. Students admitted through this General Competition pathway are rewarded with partially subsidized, inexpensive tuition fees. Currently, 52% of students’ admissions are in this category.

Non-resident international applicants and Jordanian students with lower high school marks can still gain access to medical education by paying more expensive international tuition fees (The Parallel System). The minimum requirement for these students is a high school mark of at least 85%. The Parallel Admission System was established as an answer to the increasingly poor financial situation within the medical schools.

In Jordan, three out of the four medical schools give admission to less than 200 students per year; these numbers resemble those of some universities in industrialized countries such as the USA and Europe; most of the medical schools in Europe give admission to less than 200 students per year (53.4%) (Patricio 1999), while in the USA the average number of admissions per school is of 132 in public universities and 127 in private ones (Barzansky & Etzel 2005). During the academic year of 2006–2007, there were 4095 medical students registered in all Jordanian medical schools, many of them from international countries of 29 different nationalities, all of which credit Jordanian medical education within their own country. The number of female students (35.1%) is slightly lower than in most Western countries.

The Curricula

The 6-year medical education program in Jordanian universities is divided into an initial 3-year pre-clinical stage followed by a period of clinical training lasting a further 3 years. All of the medical schools in the country have adopted semi-integrated curricula, which involve integrated teaching during the pre-clinical stage and traditional teaching during the clinical stage. Even though the overall curricula of Jordanian medical schools are similar to those in European universities (Dusek & Bates 2003), there are modifications and differences between the four schools rendering it difficult for students to change faculty during their studies.

The credibility of the Jordanian medical degrees is confirmed by the success rate of its graduates in the United States Medical Licensing Examination (USMLE) for specialty access to the USA (Unpublished data provided by the FAIMER, 2007). Between 2002 and 2006, 92.52% of the Jordanian graduates presenting to the USMLE step 1 (basic medical sciences) passed the exam on their first attempt and 93.62% the step 2 (clinical sciences).

The Pre-Clinical Stage

The courses at this stage are divided into basic sciences, basic medical sciences and university requirement courses (free choice credits lectured in non-medical departments). The integrated system pre-clinical phase requires that the students are assessed at the end of each course by a series of multiple-choice examinations. This integrated system has only been operational for the last 8 years since 2002, and its success has only been partially assessed, (Bani-Hani et al. 2003), and needs to be subject of a more thorough and comprehensive evaluation in the future. Accordingly, the Jordanian Ministry of Higher Education has established a National Committee for standards and accreditation to carry out this quality assessment.

The Clinical Stage

Clerkship rotations start at the beginning of the fourth academic year and continue throughout the final 3 years. During this stage, rotations take place in different clinical units, with mandatory rotations in certain departments. The length of these rotations ranges between 2 and 12 weeks. During these rotations, students work under the supervision of a senior physician, and are responsible for interviewing and examining patients at admission, and following them during hospitalization. Students are expected to learn the techniques of history taking and physical examination. At the end of each rotation, they are assessed by the supervisors, taking into account both behavioral criteria (attendance and relationship with staff and patient) and the quality of their clinical work.

In all Jordanian medical schools, assessments at this stage consist of multiple choice questions (MCQ), patient management problems and oral examination. In addition to the other forms of assessment, objective structured clinical examinations (OSCEs) were introduced at The University of Jordan (JU) IN 2007.

At the end of the 6th year, students are assessed by a comprehensive theoretical assessment of mainly written examinations, and a clinical assessment conducted by committees composed of faculty teaching staff, national external examiners from different Jordanian medical schools, and external examiners from Arab and western universities. The Bachelor of Medicine and Surgery (MBBS) degree is awarded to the students who pass both assessments.

Postgraduate Medical Education

Postgraduate medical education in Jordan is orientated towards the attainment of specialty degrees in all the major clinical specialties and follows a similar system to those in Europe and North America. The quality of these degrees is well recognized, both in the region and internationally, which has a subsequent negative effect of the retention of trained staff within Jordan. Initially, only partial training programs (2–3 years only) were established in 1968 at the Royal Medical Service (Military Health Care System) and some hospitals of the Ministry of Health. This resulted in residents having to be sent abroad to complete their training and obtain their specialty degree from other countries.

In 1982, the Jordan Medical Council (JMC) was created to control the practice of medical specialties in the country, and the first complete residency program was established at the University Hospital of University of Jordan. This was followed by new programs at hospitals of the Ministry of Health, the Royal Medical Services, JUST University Hospital, and more recently, in some private hospitals.

Access to postgraduate medical and surgical training programs is through an entrance examination, performed at specific training centers, accredited by the Jordanian Medical Council (JMC). The training duration varies among the specialties, ranging between 3–6 years, and the trainees are evaluated on a yearly basis. In order to qualify as specialists, the trainees must pass the JMC competency assessment at the end of the program.

At the present time, postgraduate research education, such as a PhD program, is absent in Jordanian medical schools, rendering medical research a rather weak point, even though Jordan has been ranked as having the highest number of researchers in research and development per million people among all the 57 countries members of the Organisation of Islamic Cooperation OIC. In Jordan there are 2,000 researchers per million people, while the average among the members of OIC is 500 researchers per million people.^[3] This means that the number of researchers per population in Jordan, is higher than Italy, Israel and Greece and just close to the number in United kingdom and Ireland.^[4][5]

Notes and references

1. ^ Written permission obtained from Ahmad Faleh Tamimi, MD, PhD, by Yazan Mousa to reproduce information from his article "Medical education in Jordan".
2. ^ Note: Faculty of Medicine was established in Al-Yarmouk University in 1984; the university then branched out into Jordan University of Science and Technology (JUST) in 1986.
3. ^ http://www.nature.com/nature/journal/v444/n7115/full/444026a.html
4. ^ http://www.nationmaster.com/graph/eco_res_in_ram_per_mil_peo-amp-d-per-million-people
5. ^ http://www.jordaninvestment.com/BusinessandInvestment/PeopleDemographicsLabor/ResearchDevelopment/tabid/171/language/en-US/Default.aspx

Original Article: Medical education in Jordan, Medical Teacher Journal 2010; Ahmad Faleh Tamimi, Jordan University, & Faleh Tamimi, McGill University;

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