The Programme: In 2011, the first cohort of students undertaking the franchised MBBS graduate entry programme at St George’s University of London (SGUL) started at the University of Nicosia in Cyprus. According to Cyprus legislation, franchised programmes should deliver identical outcomes to that of the original programme.

 PBL is the key learning strategy used in years 1 and 2. The programme uses long cases with tutor notes reaching up to 30 pages per case. The case is progressively released in three tutorials. The PBL cases were designed for a UK-based curriculum so delivery to a much more international cohort was potentially challenging. Further, it was not permitted by Cypriot law to make any significant changes to the PBL cases. 

 The students: Our students come from 21 different countries around the world making our program quite diverse.

 Aim

To determine whether the PBL cases were transferable to an international cohort.

Methodology

 Reviewing the cases

1. The year leads in Cyprus and the UK set up Module teams in Cyprus to examine the cases.

2.The Module teams examined all the cases under the guidance of their London colleagues.

3. The Module teams highlighted areas that might need adaptation. Those areas fell under the following categories:

a.      nuances of the English language

b.      UK-specific cultural issues

c.      differences in medical care and support services

4.      Supplementary information was put together and provided to students where necessary.

 Other factors considered

1.      Running cases simultaneously in two countries in different timezones.

2.      Finding appropriate tutors.

 The evaluation of the cases indicated that 19 out of the 35 cases needed some additional information in order to adapt the case to an international cohort (fig. 1A). The evaluation of the cases indicated that 19 out of the 35 cases needed some additional information in order to adapt the case to an international cohort (fig. 1A). The evaluation of the cases indicated that 19 out of the 35 cases needed some additional information in order to adapt the case to an international cohort (fig. 1A). The evaluation of the cases indicated that 19 out of the 35 cases needed some additional information in order to adapt the case to an international cohort (fig. 1A).

The evaluation of the cases highlighted differences relating to (a) nuances of the English language (b) UK-specific cultural issues, and importantly (c) differences in medical care and support services (fig. 1B).

As indicated by figure 1B the majority of the differences related to differences in medical care and support services.

Looking at the differences in medical care and support services in Cyprus and the UK it was noted that those fall under three major categories (a) GP and specialists, (b) other services available and (c) prevalence of illness (Fig. 2).

A selection of those is shown in table 1 below.

Table 1: Differences in medical care and support services identified through PBL cases. 

 Prevalence of Illness

·    In general prevalence statistics are different in the UK and Cyprus and whenever applicable this is pointed out to the students.

 ·   Lack of prevalence data on Hepatitis, TB or HLA associations.

Other factors considered

Running cases simultaneously in two countries in different timezones

Cyprus has a two hour difference from the UK so that meant that:

1.  PBL started in Cyprus at 09:00 (CY time) and then two hours later 11:00 (CY time, 09:00 UK time) the UK cohort started the case.

2.  Each PBL tutorial runs for three hours so the Cyprus cohort was still in PBL when their UK counterparts started the case.

3.   PBLs in Year 2 run on different days in the UK and in Cyprus.

4.   In most years there are differences in holidays e.g. Easter, Cataclysmos Day. The PBLs therefore have to run on different days or even different weeks.

5.   There has been some leakage of PBLs across countries.

Finding appropriate tutors

All key persons in the course were trained for PBL. That included physicians, basic scientists, social scientists and clinical psychologists. All tutors have been regularly monitored, peer reviewed and given formal written and verbal feedback by experienced PBL tutors.

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Assessment of the two cohorts

An indicator of whether curriculum delivery was successful is student assessment. Both cohorts took the same exams at the same time and the results indicated that there were only small differences in the performance of the UK cohort as compared to the Cyprus cohort.  Detailed results categorized by theme are shown in Tables 2 and 3.

Table 2: Yearly average assessment results for the UK and CY cohorts for the academic year 2011-12 (Abbreviations: Basic Clinical Sciences (BCS), Personal and Professional Development (PPD), Community and Population Health (CPH), Patient and Doctor (PD)).

Table 3: Yearly average assessment results for the UK and CY cohorts for the academic year 2012-13