Newly established medical colleges should fulfill all the criteria like having their own infrastructure, hospital (approval from Ministry of Health and Population, Govt of Nepal), faculty, hostel etc. as per the MEC accreditation standard from the first day of starting the program. Infrastructure developments should be as per the standard norms prevailing in the country.

The Medical College In addition to fulfilling the requirement for the MEC accreditation to run the MBBS program, the medical college must maintain a good environment for imparting quality medical education in Nepal. The medical college must have the required number of departments, sections, together with an adequate number of faculty and staff, both administrative and technical. The head of the college may be designated the Principal/Campus Chief, as per the nomenclature adopted by the respective universities to which the college/campus is affiliated to, and must be a senior faculty of medical/dental background and meet the appointment criteria outlined by the affiliating University. Ideally, all the activities related to the academic program other than community training should be located at the same site. However, for those colleges which have physical infrastructure at geographically separated locations, or have already made arrangement to send students to different hospitals or health institutions for acquiring clinical/ community experiences, care should be taken to ensure that the students are not physically exhausted by commuting. Appropriate accommodation must be arranged for students during teaching- learning activities.

All the medical college should also have a own residential community training center, computer assisted and e-learning/ teaching learning facilities (platforms), skills laboratory and ambulatory teaching learning facilities in clinical departments.

At the start all medical college should have the following requirements fulfilled:

• Minimum 300 bedded functional general hospital which is continuously in operation for three years with approval from Ministry of Health and Population Government of Nepal as teaching hospital.
• Basic science laboratories with adequate facilities.
• Community Training Centre (CTC) with adequate facilities.
• Computer -assisted teaching- learning and e-learning facilities(platforms)
• Well-equipped skill laboratory (minimum content of skill lab is given in Annex
• Simulation based learning facility
• Classrooms for problem-based learning, one for 20 to 25 students.
• Ambulatory teaching learning facilities in each clinical department

Criteria for upgrading of existing MBBS intake for a Medical College:

• All criteria laid down by MEC for allocated seats must be fulfilled.
• Must abide by Rules and regulations of MEC/University and academy
• Well maintained yearly academic calendar.
• All dues/taxes of MEC University/Academy and Nepal government paid on time.
• All infrastructures for upgraded number of seats must be well established as per MEC guidelines on top of provided seats.
• Adequate number of faculties for increment number of seats must be recruited in advance as per MEC guidelines.

For running the MBBS program the following departments are required:

• Human Anatomy
• Physiology
• Biochemistry
• Pathology
• Microbiology
• Pharmacology
• Community Medicine
• Forensic Medicine
• Internal Medicine
• General Surgery
• Obstetrics and Gynecology
• Pediatrics
• Orthopedics
• Ophthalmology
• Otorhinolaryngology-Head and Neck Surgery
• Psychiatry
• Dermatology
• Dental Surgery
• Radiology
• Anesthesiology
• General Practice and Emergency
• Medical Education
• Department of Humanities

Administrative structure

The administrative structure of the Medical College/Campus should comprise the following sections:

1. General and Personnel Administration: All matters related to general and personnel administration of the college/campus should be looked after by this section.
2. Fiscal and Internal Audit Section: The fiscal section should be responsible for the financial planning and management of the medical college/campus. A strong financial commitment must be ensured for the sustainability of the institution. An internal audit section must check and report on the budget, procurement, and store inventory according to the financial rules and regulations pertaining to the colleges/campus.
3. Planning and Evaluation: This section should conduct annual planning, budgeting and annual program evaluation.
4. Academic and Examination: The academic and examination section should look after the academic programs and prepare the academic calendar. An annual/semester academic calendar of operation 38 for all years / semesters must be prepared by the college/school/institute/campus specifying the details of teaching schedules of theory, practical/clinical teaching/learning activities. This section should also ensure that the examinations are held effectively, efficiently and confidentially and the results of the examinations are published in a timely manner and feedback given to individual students.
5. Procurement and Store: All matters related to the procurement and store is carried out by this section.
6. Learning Resources including Audio-visual and Medical Illustration

Library

• A Central library with good ventilation and lighting must provide sufficient space with comfortable sitting arrangements for allowing double the number of admissions of students to sit and study at any given point in time.
• For the core text books recommended by the curriculum there must be at least one book for every ten students in the class. In addition, there must also be adequate numbers of reference books (1 recommended text book for every 30 students) which are to be placed in the reference section and/or departmental libraries or students should have access to e library to text books and reference books. Softcopy of books should be available.
• A good number of national/international medical journals related to all subjects either in paper or in digital form must be available.
• Medical Colleges/Campuses must provide free e-library/e-learning and internet services to the faculty and students. The Central library should remain open preferably 16 hours a day, to provide the opportunity to learn during any hour of the day or night.
• The Central Library must have an adequate number of personnel with relevant skills and expertise to provide library services are provided as mentioned above.

Computer Assisted Learning Platform:

• Provision of computer assisted teaching learning classes with required facilities and human resources.
• There should be adequate computers for E-learning facility of Students. College should maintain atleast 20-25 computers in smooth running condition in with dedicated e-learning area.
• The institution musts create an academic management office with responsibility for oversight and records of all functional aspects of design, production, presentation and implementation of the course, its elements, students, and staff.

Audio-visual and Medical Illustration Section: An Audio-visual and Medical Illustration Section must be established to provide sufficient numbers of overhead projectors, multimedia, laptop, television and artist facilities for helping teachers to teach effectively and students to learn better. The colleges/campuses are encouraged to continuously adapt to new and innovative technologies for fostering effective teaching /learning activities.

Lecture Rooms: Adequate number of lecture halls with comfortable sitting arrangements together with good ventilation, lighting, acoustic system, cctv coverage and audio-visual aids should be made available for carrying out teaching/learning activities effectively. Tutorial Room for 1:10-15 students.

Examinations Hall: The academic/examination section must ensure that all examinations are held properly by maintaining the examination norms of the respective University. Sitting arrangements may be made in a separate examination hall or in classrooms with adequate invigilation. The examination halls should be mandatorily equipped with cctv for monitoring and record purposes by concerned authorities.

Auditorium: Medical college/campus/school must have an auditorium of at least 250 seating capacity for holding scientific and other activities.

• Students’ Welfare including Hostel and Extra- curricular activities : The students’ Welfare Section should look after the welfare of the students including providing hostels and extracurricular activities. Students’ hostel for both female and male must provide adequate accommodation of adequate standard. (Hostel facility for at least 50% students). Hostels should be on the campus or in close vicinity for maximum use of library and participation in clinical learning activities, including off time hospital exposure for patient care and management.

• Property, Security, Transport and Repair and Maintenance: The safety of the college/campus physical property and students, faculty and staff must be ensured by the property section by providing adequate security. The transport of staff and students is to be organized through the transport section. All matters related to the repair and maintenance of all infrastructures, electrical and sanitary and all others are looked after by the section.
• Research and Publication
• A Medical College/Campus must establish a Research, Ethical and Publication Unit/ section/department and must show evidences of research and publication by the faculty.
• Medical education programs must provide opportunities, encourage, and support student participation in research and other scholarly activities mentored by faculty.
• To facilitate the research activities of the universities and to facilitate statistical part of thesis of the postgraduate residents, employment of a biostatistician is mandatory for every medical college and number of biostatisticians should be determine by number of program and workload.
• IT department with competent human resource
• Waste Management

The Teaching Hospital:

• The teaching hospital of a medical college/ campus/ school should run under a medical director who should be faculty of the medical college.
• In order to widen the clinical and community field experiences, the medical colleges are encouraged to adequately expose their medical students to other hospitals and rural community settings in addition to clinical placements at the institutions’ own teaching hospital. However, the beds of those hospitals other than the own community centers hospitals which are adopted by the colleges will not be counted towards fulfillment of the MEC requirements.
• In the case of those medical colleges/campus/schools/institutions/ either constituent or affiliated to a university, which have already been granted permission by Nepal Government to use government hospitals for running the MBBS program, a memorandum of understanding (MOU) must be signed between the Medical School/Institute/College/Campus and the management of the concerned Government Hospital. Appropriate faculty positions for the Senior Consultants, Consultants and Registrars working in those hospitals should be awarded as per university faculty norms. The commitment of such faculty must be obtained in writing for their involvement in and contribution to the clinical teaching learning activities of the medical students throughout the MBBS program. The MOU and the undertaking signed by the individual faculty members must be produced before MEC to ensure the environment and spirit of collaboration and cooperation between the Medical School/Institute/College and the Government hospitals for academic activities. The academic calendar and other related documentation should be in place.
• The most important aspect of clinical teaching is to identify the learning objectives for different semesters/years by the concerned departments and their strict implementation of those objectives through fixed clinical placements schedules. In addition to acquiring basic insight into the disease manifestation and response to therapy, hands on skill development either on peers, mannequins or real patients under adequate supervision of the faculty/Senior Residents must be the core activity during the clinical rotations. It is also crucial to provide the students with timely feedback on their learning and performance. This will, among other things, provide the students an opportunity to realize their deficiencies and sharpen their clinical skills.
• A fixed time table together with the clinical topics allocated for daily teaching either in wards or OPD must be clearly written in the attendance register of clinical teaching in every department.
• Ambulatory teaching at OPD is to be scheduled in teaching-learning activities as ample common clinical materials are available in the OPD. Hence a separate OPD teaching/demonstration room is required for all departments of the teaching hospitals.

Human Resources: Following are the list of sections desirable to run the academic program and hospital services of the medical campus/school/college/institute and teaching hospital.

• Principal/Dean/Campus Chief’s office
• Hospital Directors Office 3. Academic/Examination Section 4. Administration Section/Admission Section
• Fiscal Section
• Public Relation Office
• Transportation Section
• Library
• Centre for Medical Informatics
• Medical Record Unit
• Property Section
• House Keeping Section
• Security Section
• Pantry
• Accommodation/Hostel Section
• Medical Illustration Section
• Bio-Medical Engineering Section
• Planning and Evaluation Section
• Audit Section
• Medical Education Department/Unit
• Community Health Satellite Centre
• Research Unit
• Procurement Section

For the effective management of the academic activities and the clinical services, the management of the academic side and the service side may be looked after by separate administrations of the college/campus/school teaching hospital or may be amalgamated into one, as per the decision of the individual college/campus/institute. Likewise, staff recruitments in different positions shall be as per the needs of individual college/campus/school/institute and the teaching hospital.

Student support services: It should include student representatives, academic and clinical staff, student counsellors, and other support providers on the committee.

• Develop a clear idea of the academic and social characteristics of students, their living and studying circumstances, and their access to technology and other resources.
• Identify the disabilities that students might have and consider making appropriate reasonable adjustments to the course.
• Given the range of academic, personal, and social characteristic of students, identify what support services might be needed.
• Set out the structure, range, and purposes of student support services.
• Design a student support system that is integral to the course process.
• Consider a survey, conducted on a regular basis with students and staff to find out what issues they are facing, what support works well and where the challenges are to ensure that student support is fit for purpose.

Continuous Professional Development Unit: Continuing professional development (CPD) is the way in which registrants continue to learn and develop throughout their careers so they keep their skills and knowledge up to date and are able to practice safely and effectively. CPD involves capacity strengthening after completion of basic medical education and postgraduate training, thereafter extending throughout each health care professional working life. Continuous professional development (CPD) replaces the term “CME” to reflect the wider context in which this phase of medical education takes place and signifies that the responsibility to conduct CPD rests with the profession and individual doctor – WFME 2003.

Motivation for CPD:

• Professional drive to provide optimal care for the patient
• Obligations to honor the societal demands
• Need to preserve job satisfaction and prevent ‘burn out”
• Forms of knowledge required to practice: factual, procedural and intuitive and practical wisdom derived from their combination. All HCWs should mandatorily enroll into CPD system through their respective council. Respective Council should train their members with collaboration with concerned institutions. There should be a mandatory CPD unit in all health care institutions. An initiative should be made in organizing and finalizing the module applicable for various streams of health care with mutual objectives and coordination. Respective council should keep a record of all the CPD activities.

CPD unit should comprise of:

• CPD Coordinator
• CPD Administrative staffs
• Trained Master trainers

Continuing Professional Development (CPD) is a combination of approaches, ideas and techniques that will help to manage own learning and growth. Establishment of such system in an academic institution will implant the basics of learning and continuous education desire throughout the professional life.

Licensing Examination: There is a provision of licensing examination by the respective council after acquiring the academic degree.

Humanistic Environment: Humanistic environment is of utmost need to facilitate enabling teaching learning environment. A humanistic pedagogy inculcates respect, tolerance, understanding, and concern for others and is fostered by mentoring, advising and small group interaction. A medical college environment should be characterized by respectful professional relationships between and among faculty and students that establishes a context for the development of interpersonal skills necessary for learning, for patient care, and for making meaningful contributions to the profession.

Technical Support: The institution should ensure that students have appropriate technology and access, and provides orientation to technology and ongoing technical support for students.

• Ensure that all students have technical access to the course (computer, mobile telephone, and Wi-Fi). Where this is not so, the institution develops a policy and provides practical support.
• Provide an introduction to using the technology and navigating technology-based course elements.
• Provide guidance on access to e-library services.
• Plan how students can record and track their study, and the resources they have accessed.
• Map available platforms for characteristics such as: accessibility, cost, organisational requirements, one way communication, two-way communication, asynchronous, synchronous, one-to-one, and one-to-many communication.
• Determine the reliability of connectivity and offer a back-up plan in the case of failure.
• Provide a named contact or accessible helpdesk from whom technical advice can be obtained.
• Intranet facilities for students and faculties.

Assuring Teacher’s Skills : Teachers should be prepared and supported to provide the distance learning. Teachers should be trained and supported in:

• The process and principles of distributed and distance learning,
• educational design,
• writing and producing course elements,
• assessment,
• using information technology, media, and methods for DDL including social media,
• communication style at a distance, including conveying personal presence,
• teaching in small groups, large groups and individually both at a distance and faceto[1]face,
• providing feedback in a variety of ways, using different methods and media,
• supporting students,
• problem-solving with students and colleagues,
• working in teams and implementation,
• identifying and helping students in difficulties,
• working with the course management office,
• Trained for monitoring and evaluation

Assuring Teacher’s Time

Teachers need to have sufficient time in their job plan to undertake the development and presentation of distributed and distance learning without threatening their research and other academic and clinical duties.

• Undertake a study of the time required of teachers to develop and then implement DDL elements and processes. Time required will be different for each stage.
• Organize each teacher’s job plan to ensure that there is sufficient time for both DDL and other academic, research, and clinical duties during course development and course presentation.

Application of Technology
Technology enables medical education programs to improve patient care, and to revolutionize all aspects of the curriculum, from didactic courses to clinical instruction. Contemporary medical education programs regularly assess their use of technology and explore new applications of technological advances to enhance student learning and to assist faculty as facilitators of learning and designers of learning environments. Use of technology must include systems and processes to safeguard the quality of patient care and ensure the integrity of student performance. Technology has the potential to reduce expenses for teaching and learning and help to alleviate increasing demands on faculty and student time. Use of technology in medical education programs can support learning in different ways, including self-directed, distance and asynchronous learning.

Collaboration with other Health Care Professionals:  Access to health care and changing demographics is driving a new vision of the health care workforce. Medical curricula can change to develop a new type of graduates, providing opportunities early in their educational experiences to engage allied colleagues and other health care professionals. Patient care by all team members will emphasize evidence-based practice, quality improvement approaches, the application of technology and emerging information, and outcomes assessment. Medical education programs are designed to seek and take advantage of opportunities to educate medical school graduates who will assume new roles in safeguarding, promoting, and caring the health care needs of the public.

Related organizations

• Nepal Nursing Council (NNC)
• Nepal Medical Council (NMC)
• Nepal Health Professional Council (NHPC)
• Nepal Pharmacy Council
• Nepal Ayurvedic Medical Council (NAMC)

Related readings

• Medical Education Commission (MEC)
• Medical Education Commission (MEC) Eligibility Certificate
• Syllabus for Undergraduate Common Entrance Examination 2020
• List of Registered Postgraduate Medical (Health Professionals) Programs in Nepal
• Medical Education Commission Syllabus for Postgraduate Entrance Examination (2020)
• Syllabus for Postgraduate Integrated Entrance Examination
• Syllabus for Bachelor in Public Health (BPH) Common Entrance Examination
• Syllabus for MBBS/BDS/BSc Nursing/BASLP/B Perfusion Technology Common Entrance Examination
• Syllabus for Bachelor in Nursing Science (BNS) Common Entrance Examination
• Syllabus for BAMS/BSc MLT/BSc MIT/BPT/B Pharm/B Optometry Common Entrance Examination