Community Based Experience and Services: An Innovative Medical Education of University of Ilorin, Nigeria
As a resolve of the University of Ilorin, Nigeria to produce doctors that are sensitive to the community health needs of majority of our populace the College of Health Sciences, University of Ilorin established the Community Based Experience and Services (COBES) programme as an innovative medical education. The curriculum is Student-centred, Community-based and Problem-solving. During COBES medical students are posted to the communities at the 2nd, 3rd, 5th and 6th year of their training with specific learning objectives tailored at the achievement of the cardinal objectives of the medical college.

Through field assessments by faculty members, community based medical personnel, oral and written presentations of reports and written examinations the students are evaluated.

Some medical schools have remodeled their curricula to accommodate programmes similar to COBES and some of our staff have been resources to other institutions within and outside Nigeria

Background

The College of Health Sciences, University of Ilorin at its inception in 1977, decided to pursue a curriculum which is different in its approach from the older medical schools in Nigeria by the establishment of an innovative medical curriculum with Community Based Experience and Services (COBES) as its fulcrum. It is a programme designed to introduce students to the community at the very earliest phase of their medical education with the view to sensitizing them to the community health needs.

The programme is problem-based learning because it exposes the students to health problems at the rural communities through which the students learn actively. It is student-centred because the students are encouraged and stimulated to be actively involved in their own learning process rather than be passive recipients of information. The students, working with supervisors tried to work out solutions to problems encountered at the community by formulation of hypothesis. Thus it is a problem-solving programme. The curriculum is oriented to studying medicine in the community using the community as a teaching laboratory and learning environment for studying medicine (community-based).

The curriculum thus has three pillars: student centered, community based, and problem solving. The working principle of the COBES programme is to create awareness in students to formulate hypothesis, collect, analyze and interpret data, suggest solutions and to evaluate methods thereby ultimately providing services to the community.

The students start their COBES programme in the 1st eight weeks of the 2nd level academic year. The 2nd level and the 3rd level COBES constitute the pre-clinical programme while 5th level and 6th level postings form the clinical COBES. At each level of the academic year except the 4th level the students spend four weeks each (posting) in the community.

Cardinal objectives of COBES:
(1)    To sensitize the students to community Health needs and enable them to identify themselves with such health needs.
(2)    To assist community health efforts and be able to work in any community regardless of the cultural and socio-economic peculiarities.
(3)    To develop team spirit towards promotion of community health and to develop individual habits to study.
(4)    To encourage students to learn and put into practise basic and applied principles of Epidemiology, statistics and preventive medicine.

Description:
There are four COBES postings, spanning the entire undergraduate medical curriculum. Two of these postings take place in the pre-clinical years at 2nd and 3rd years while the clinical postings take place during the second and third clinical years, i.e. at 5th & 6th undergraduate years, respectively. Each posting year has its “minimum learning objectives”.
Learning objectives of 2nd year posting:
1.    To demonstrate skills in entering a new community with the view to assessing the community health status.
2.    To make a simple map of the Community and carry out its census in order to
      determine the socio-demographic characteristics of the community.
3.    To determine the life pattern of the people and relate its relevance to health.
4.    To identify the existing health facilities in the community and verify their level of utilization.
5.    To identify the social facilities in the Community and determine their relevance to health.
6.    To identify the common health problems in the community and the factors that may be responsible for such problems and to prioritize the identified health problems.
7.    To appreciate man and his environment and how the environment is related to health.
8.    To carry out health education that is relevant to the community’s health needs.
9.    To carry out one or two optional projects relevant to the community.
10.  To present a properly written report and orally present the same to the College.
Learning objectives of the 3rd year COBES are usually based on the World Health Organization (W.H.O) theme for each year in question as unveiled on April 7th at the World Health Day. The objectives thus vary each year.

Objectives of the 5th & 6th years COBES postings generally focus on maternal and child health, malaria and HIV/AIDS because experience has shown that problems relating to maternal and child health and these other health conditions need the most urgent attention in most Nigerian communities.
Evaluation: At each posting, the students are assessed and scored based on laid down criteria during the oral presentation of their report; a written examination at the end of the posting and field assessment by the supervisors who are both College faculty members and senior health workers at the communities of posting.

Results:
Over the years COBES has been able to achieve the following:

  1. Early exposure of the students to health problems (student-centred, problem-solving)
  2. Enhanced the maturity of our students as demonstrated by confidence exhibited at clinical and scientific presentations (student-centred, problem-solving).
  3. Community awareness of health problems through dissemination of yearly WHO themes (community based). Our products are community friendly, work effectively any where: local, state, national and international (community based).
  4. Because of COBES the University of Ilorin College of Health Sciences, Nigeria has been designated a WHO collaborating centre for Innovative Medical Education and Manpower Development in community based medical education and we are also member of the NETWORK (International Network of Community Oriented Institutions for the Health Sciences) based in Maastricht, the Netherlands.
  5. The posting heightened the commitment of the students’ participation in special health programmes e.g. Guinea worm eradication campaign, Mectizan distribution for the prevention of Onchocerciasis, Malaria prevention, Immunization against childhood diseases, HIV/AIDS awareness and control, etc.
  6. Using the COBES programme, the College of Health Sciences, University of Ilorin has been producing doctors who are sensitive to community health needs and capable of working in any community through team spirit and scientific principles in solving community health problems thus contributing to the achievement of the millennium development goals (MDG) in Nigeria

Achievements:
Since the introduction of COBES in 1977, College of Health Sciences, University of Ilorin has rendered assistance to other schools in and outside Nigeria. We have also been accepting foreign students on electives into our COBES programme. Some of our staff have been Ambassadors to other institutions in Africa to assist in establishment of a similar community based experience and services (COBES). So successful is the COBES programme that the University Senate recommended the philosophy and good practice of COBES to other faculties of the University under the Director, Technical and Entrepreneurship Center, TEC.
The programme has enhanced better relationship between the University and the Communities (gown & town). The reports of COBES have influenced government in health and other services provisions to the communities.
Close to four thousand medical graduates of the University of Ilorin passed through COBES, some of whom have helped in establishing a similar programme in their respective areas of calling.
Recommendation to other Universities/Institutions:
Other Institutions are encouraged to imbibe the ideal of COBES and start similar innovative community based medical education programme.