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BACKGROUND
PHILOSOPHY and CONCEPTS (5%)
RELIGIOUS BACKGROUND
Islam: The 3 fundamentals (Islam, Iman, & Ihsan), monotheism (Tauhid),
Messengers and messages (risaalat), eschatology (aakhirat), Ithm (sinning), Dhulm (transgression). Pre-determinism:
qadar / taqdiir
Other creeds (milal): The academic
definition of religion. Dogmas with medical implications in other religions.
HISTORICAL BACKGROUND
Civilization: Start of human civilization. Cycle of civilizations
History of medicine: Ancient medicine; Concept of Islamic Medicine. Prophetic Medicine. European
TCM Chinese TCM. Ayurdevic TCM. Unani
TCM. Borneo
TCM. Critique of biomedicine vs holistic medicine
EPISTEMOLOGICAL BACKROUND
Theory Of Knowledge (epistemology):
Knowledge. The duality/dichotomy crisis. The empirical methodology / scientific method. Integration
of knowledge.
BASIC SCIENCES BACKROUND
Creation and afterlife: Creation of the universe. Cosmology. Creation of
the human being. Nature of the human. Superiority of humans. Mission
of humans on earth. Diversity of humans. After-life. The concept of personhood.
Transitions in the status
of life and health: Life. Issues in definition/recognition of life. Death. Health. Disease / illness. Treatment of disease.
The human life cycle (growth
and senescence): Intrauterine
period. Infancy and childhood. Adolescence. Youth. Middle age. Old age. After life
The Biological Miracle: The human organism. Interaction
of the external and internal environments. Functional unity of the organism. Correlation of structure and function by organ
systems
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ETHICO-LEGAL-FIQH
CONCEPTS & PRINCIPLES (15%)
BASICS OF LAWS
Fundamentals of the Law:
Sources of Islamic Law. Sources of European Law. Purposes of the Law: maqasid al shari’at. Principles of the Law: qawa’id al shari’at.
Types of legal rulings. Relation of ethics to law. Islamic perspective of human rights. Secular European perspective of human
rights. The link between human rights and health. Equality before the law. Practical:
visits to Mufti Office and Attorney General’s Chambers
Brunei legal systems: civil and shari’at laws: The Brunei
civil and criminal justice system. Brunei
laws related to health. The Brunei shari’at
legal system. Practicals: Attending a Brunei High Court session & Moot court
THEORIES
AND PRINCIPLES OF MEDICAL ETHICS
Islamic
theory of medical and biomedical ethics: maqasid al shari’at: protection
of morality, life, progeny, intellect, and resources.
Secular
European theories of medical and biomedical ethics:
Deontology vs. teleology. Consequentialism / utilitarianism. Principlism. Kantianism. Virtue theory. Relationship theory.
Casuistry. Communitarian ethics. Libertarianism. Feminist ethics. Narrative ethics. Empirical ethics. Ethical theory based
on social sciences. Deriving ethics from thought experiments. Deliberative ethics based on democratic discussion.
Principles of medical and
biomedical ethics: Islamic ethical principles. Secular
European ethical principles. Relation between Islamic and European ethical principles. Christian bioethics. Buddhist ethics.
Hindu/Jain/Sikh bioethics. Jewish bioethics. East Asian bioethics. International ethical codes. Practical: visit to
Brunei Medical Board offices
ISSUES OF CONSENT
Medical consent for competent patients: Patient
autonomy. Physician autonomy. Competence / ahliyyat: Islamic perspective. Competence
/ capacity: secular perspective. Informed consent. Why is informed consent important?. Scope of consent. Conditions for validity
of consent. Information for informed consent. Capacity to consent. Process of consent / refusal for the competent. Practical:
Visit to the emergency room in the evening.
Medical consent for incompetent
patients: Consent / refusal for the incompetent. Physician assessment of best interests of the patient / best interest standard. Proxy
decisions / substituted judgment standard. Advance statements / directives. Consent by the court. Consent for children. Consent
in emergencies. Practical: consent procedures in surgical and obstetric wards.
PRIVACY, CONFIDENTIALITY
AND DISCLOSURE
Privacy and confidentiality:
Privacy. Confidentiality. Basis/ rationale / justification
of confidentiality.
Truthfulness: Patient veracity as a necessity for good clinical care. Physician veracity
between clarification vs confusion. Obligation to tell the truth. Harm of deception vs harm of truthfulness. Information patient
does not need/want to know. Partial disclosure / white / technical lies. Giving bad news. Paternalism in thinking patient
cannot handle the whole truth. Dissonance between the physician’s body language and his words. Truthfulness in uncertainty
about the diagnosis and the prognosis
Disclosure: Disclosure by the patient. Disclosure by the healthcare worker. Conflict
of duties regarding confidentiality and disclosure. Disclosure of family history / genetic information. Generation and handling
of medical records. Disclosure to the mass media. Disclosure by doctors with dual obligations. Physician in court: as a witness.
Practical: visit to hospital medical records department.
RESEARCH
Research policies and procedures: Disparities in allocation of research resources.
Composition of Institutional research committee. Functions of an Institutional research committee / basis for ethical approval.
Types of fraud in research. Avoiding research fraud / malpractice. The pharmaceutical industry Practical: visit to the Ministry of Health research ethics committee.
Animal research: Moral status of animals.
Handling animals before. Purposes of animal research. Purposes and principles of the Law in animal research. Relevance to
humans. Choice of animals for research. Solutions to controversy. Use of great apes. Toxicity testing on live animals. Capture
of wild animals for research. Practical: visit to the animal house.
Human research: History. Phases of clinical trials. Therapeutic vs non-therapeutic
research. Ethical requirement of systematic review before new research. Assessing benefits and harms of clinical research.
Good clinical practice guidelines. Autonomy / informed consent. Consent procedures for different types of research. Freedom
to withdraw. Material inducements. Confidentiality. Research in emergency rooms. Inclusion of women and minorities. Research
on the mentally incompetent. Record based research. Research on cadavers. Research on Children. Research on the elderly. Research
on the mentally incapacitated. Research on prisoners. Research on students and employees. Research on members of uniformed
services, army and police. Research on biological samples, organs, and tissues from living donors. Research on organs and
tissues from dead donors. Research on embryos. Research on fetal tissues. Biomedical
research. Public health research. Health services research. Practical: visit to
a clinical trials operations office
ISSUES
AT THE BEGINNING AND END OF LIFE (5%)
Beginning of life issues:
Prenatal / pre-implantation
gender testing in IVF. Induced abortion. Human reproductive cloning. Practical:
visit IVF / fertility clinic
Stem cell technology: Stem cells
(definition, methods, use in disease therapy, use in research, sources of stem cells and ethical controversies).
Embryo/fetal research: Sources of embryos. Types of research that uses embryos
(contraception, sterilization, reproductive cloning). Ethical guidelines and controversies. Obtaining human eggs for research
(buying, donation).
Genetic technology: Genetic therapy. Genetic banks and patenting issues. Human-animal hybrids.
The Human genome project. Genetic counseling. Genetic testing. Genetic screening. Pre-implantation
diagnosis. Genetic engineering and therapy. Human gene transfer // genetic engineering.
End of life issues: Terminal illness.
Palliative care. Diagnosis of brain death. Initiating / withdrawing artificial life
support. Euthanasia. Physician assisted suicide. Solid organ transplantation. Post-mortem examination. Cadavers for research
and education.
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ETHICO-LEGAL-FIQH
ISSUES IN CLINICAL PRACTICE (20%)
NORMAL PHYSIOLOGICAL CONDITIONS
Issues in normal reproduction: Menstruation. Pre-menstrual tension. Irregular menstruations. Prolonged menstruation. Dysmenorrhea. Menopause. Human
sexuality & sexual behavior. Contraception. Pregnancy. Prenatal screening & diagnosis. Labor. Delivery. Postnatal
care. Breast-feeding. Practical: visits to gynecological and ante-natal clinics.
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Issues in activities of normal living: Physiological secretions and wudhu / salat.
Environmental hygiene. Foods & drinks.
Physical activity. Standing, sitting, walking and running. Sports. Sleep and rest.
MEDICAL PROCEDURES
Diagnostic procedures: History. Physical examination. Radiological examination. Laboratory
tests. Esophagoscopy and colonoscopy. Aggressive investigation of common symptoms. HIV testing. Practical: visit to
outpatient clinic, laboratory and radiology departments.
Therapeutic procedures: Balance of benefit and injury. Prescriptions and administration of
medications. Medication and wudhu. Medication and puasa. Surgical procedures. Pharmacogenetics / pharmacogenomics. Anesthesia. Blood transfusion. Resuscitation.
Cosmetic / reconstructive surgery. Solid organ transplantation. Xenotransplantation.
Doctrine of double effect:. The slippery slope. Ordinary vs heroic / extraordinary means /measures in treatment. Acts
of omission vs acts of commission: Islamic vs secular civil law perspective. Use of drugs in sports. HIV treatment. Enhancement
technologies. Psychosurgery, neuro-implantation, and endocrine implantation. Practical: visit to a hospital emergency
room
CONDITIONS OF ILLNESS
Physical Acts Of Worship For The Sick: Toilet hygiene. Wudhu. Tayammum., Ghusl for the sick..
Salat for the sick. Puasa for the sick. Zakat, and hajj. Practical
ibadat pesakit: video, simulated patients, real patients.
Input/output systems: alimentary
and urinary: Upper GIT conditions. Lower
GIT conditions. GIT infection / food poisoning. Appendicitis. Inflammatory bowel disease. Hepatitis. Chronic renal
failure. Urinary incontinence, fistulae, and catheters.. Renal colic.
Transport systems: cardiovascular
& respiratory: Dyspnea
due to cardiovascular causes. Dyspnea due to respiratory causes. Congestive cardiac failure.
Reproductive system: Menopausal disorders. Dysfunctional uterine bleeding.
Pre-natal diagnosis / screening / genetic testing/treatment. Assisted reproduction for infertility.
Locomotion, support, and
connective system: Orthopedic
problems. Limb disorders. Gait disorders. Involuntary movements. Myasthenia gravis. Joint disorders with restricted/painful
movements. Vertebral column pain. Laryngeal, pharyngeal, or oral disease. Drugs to enhance sports performance. Practical: visit to the orthopedic department.
Sensory system: Blindness
and deafness. Olfactory disorders. Taste disorders. Tactile disorders. Temperature disorders. Pain disorders. Hunger and thirst.
Practical: visits to the eye, ENT, and pain clinics.
Neurological disorders: Stroke. Epilepsy. Parkinson disease. Dementias. Brain tumors. Brain /skull trauma. Spinal cord injury.
Multiple sclerosis. Encephalopathy. Aphasia/dysphasia. Vestibular disturbances. Peripheral neuropathies. Practical: visit to neurology clinic.
Psycho-social conditions: Legal impact of loss of competence. Human drives and
the genesis of emotions. Anxiety disorders. Stress. Loss of consciousness. Personality disorders. Psychiatric conditions /psychosis/schizophrenia.
Depression and suicide / para-suicide. Psychogenic sexual disorders. Neurotic
/ anxiety / compulsive-obsessive disorders. Non-therapeutic use of psychoactive drugs. Practical: visit to psychiatry clinic
Endocrine and metabolic disorders: Diabetes
Other conditions: Patho-physiological disturbances: fever, dehydration, infections. Hematological disorders.. Skin disorders: eczema, psoriasis, SLE.
Issues of special groups: Women and maternal conditions. Neonatal and infant
conditions. Congenitally abnormal fetii / infants. Child conditions. Geriatric physical dysfunction. Geriatric psycho-neurological
conditions and dementias. Geriatric psychosocial dysfunction. Disabilities. Mentally retardation. Research on the elderly.
Refugees / displaced |
ETHICO-LEGAL-FIQH
ISSUES IN COMMUNITY PRACTICE (5%)
COMMUNITY HEALTH
The Family: Gender. The family
as a natural social unit. Marriage. Parents and relatives. Children. Child protection.
The Community: Description
of culture. Trans-cultural ethics. Community institutions. Community diagnosis. Life-style. Sexual perversions. Unwanted pregnancy. Addiction and substance
abuse. Poverty. Violence. Child abuse & neglect. Issues of women. Injury
control. Tobacco control.
Community Action: enjoining the good and forbidding the bad, health promotion / education, social change, professional
and occupational organizations, social welfare, disaster relief, refugees,
Civil Transactions: Health-related ethico-legal issues in marital contracts. Divorce &
annulment. Inheritance. Endowments & gifts,
PUBLIC HEALTH
Public health ethics: Public health. Public health
measures in an epidemic without consent. Disease screening and surveillance. Control
of infectious disease. Sexually transmitted disease. HIV. HIV prevention. HIV stigmatization and discrimination. Vaccination
/ immunization. Tobacco control.
Occupational health ethics: Risk assessment
and risk management. Occupational injury and work-related disease. Pre-employment testing. Testing during employment.
Environmental health ethics: Poverty eradication
vs environmental degradation. Risk assessment and risk management.
Health services ethics: Needs vs wants/demands in health care. Commercialism.
Justice. Economic analysis in health. Health policy. Health finance. Health services delivery. Medical tourism. Primary health
care.
Medical humanities: sociological and psychological
theories. Introduction to sociological and psychological methods. Social control.
PROFESSIONALISM (15%)
Professional physician etiquette
/ conduct with patients: Physician competence, responsibility,
and accountability. Patient etiquette, duties, obligations, and responsibilities. Doctor-patient relationship. Dealing with violent / abusive / uncooperative patients.
Fidelity obligations. The disabled patient.
Professional etiquette with
the terminally ill/dying: palliative care. The terminally ill / dying. Death. Burial. Bereavement.
Collegial relations / etiquette
in a health team: principles of successful group work.
General and special group dynamics. Student-teacher relation. Mutual respect and cooperation.
Conflict resolution. Whistle blowing on unethical behavior. Cooperation with traditional healers.
Professional misconduct:
Abuse of privileges. Private misconduct derogatory to
the profession. Financial misconduct. Un-ethical business practices. Felonies. Dealing with the pharmaceutical industry. Conflict
of financial interests. Licensing and registration. Promises of wonder cures.
Malpractice & negligence. Definition of negligence/malpractice. Ingredients of a negligence suite.
Avoiding negligence suits. Bolam principle as modified by Bolitho. Patient complaint
/ grievance system as a tool to prevent malpractice.
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PERSONAL
DEVELOPMENT (5%)
INDIVIDUAL DEVELOPMENT
Success as a medical student: Etiquette of the student and the teacher. Time management. Study techniques
and strategies. Speed reading. Group study and teamwork. Motivation. Management of student stress. Conflict resolution. Cheating
and plagiarism. The nature of medical education. Physician rights. Physician responsibility.
Towards developing a scientific culture: Understanding. Thinking. Description.
Analysis. Objectivity. Rationality. Prudence. Respecting the other opinion.
Character and behavior: Character, habits, and
behavior. Positive personality traits.
Self Development and personality
enhancement: Self improvement. Intellectual development. Social development. Skill development. Professional development. Personal beliefs and conscience
in health care decisions: respecting conscientious objection.
SKILL DEVELOPMENT
Communication: Concepts and theory of communication.
Communication in small groups. Purposes and types of written communication. Characteristics of good writing. Special characteristics
of medical/technical writing. Publishing a paper. Ethics of medical publishing.
Problems in writing. Public speaking. Dealing effectively with the mass media.
Negotiation skills: Nature and purpose of win-win negotiation. Negotiation strategies.
Negotiation tactics. Management of a negotiation session. Difficult negotiations.
Leadership Skills: Basic characteristics of effective
leadership. Personal Attributes of leaders. Conceptual leadership skills. Technical leadership skills. Human skills of leaders.
Diseases of leaders. Diseases of followers. Model leaders in medicine;
Organizational management: Strategy,
planning, and implantation. Control and evaluation. Quality assurance/quality improvement. Decision-making. Problem-solving.
Crisis management. Basics of organizational management. Basics of organizational financial management. Health information
management systems.
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RESEARCH
SKILLS (25%)
Mathematical and conceptual foundations:. Introduction to Epidemiology. Introduction to biostatistics. Probability theory in science. Variables and distributions. The scientific method and hypothetico-deductive inference. Epidemiological
studies. Critical reading of scientific literature
Descriptive statistics: Understanding computers, databases. Use of SPSS.
Review of data grouping, data tabulation, and data diagrams, Descriptive statistics for numerical variables. Descriptive statistics
for categorical variables.
Inferential statistics: Comparison of parametric with non-parametric analysis.
Inferential statistics. Inferential statistics. Numerical / continuous statistical analysis. Categorical / discrete statistical
analysis. Linear correlation. Linear regression. Logistic regression. Multiple regression. Basics of survival analysis.
Descriptive & inferential statistics applications: Data presentation.
Writing a research report Critical appraisal of clinical research. Review mathematical and conceptual foundations.
Quantitative disease measures: Measures of incidence.
Prevalence. Rates & proportions. Measures of excess disease occurrence. Diagnostic tests. Screening tests.
Parameters of screening tests. Time series
analysis. Vital statistics and demographic methods.
Study design and analysis: Sample selection.
Sample size. Sources of data. Questionnaire data collection. Data management. Data analysis: summarizing and inference. Cross
sectional study. Ecological study. Case control study. Follow-up / cohort study. Community randomized study. Clinical trial.
Health surveys. Meta-analysis. Causal inference.
Study interpretation: Measures of association:
t test; F test; chi square. Measures of effect: risk ratio and odds ratio. The Odds ratio. Sources of bias & treatment
of bias: selection bias, misclassification bias, confounding bias. Interaction and effect modification. Validity and precision.
Critical reading of epidemiological studies |
