Tembeling 2.0

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  • Cultivating Planetary Health in Medical Education for a Sustainable Future

    Introduction

    The MBBS programme is designed to produce doctors who are competent, compassionate, and safe. This aim extends beyond technical proficiency to cultivate healthcare professionals who are ethically driven, empathetic, and dedicated to the wellbeing of both their patients and society at large. As the world faces increasingly complex health challenges due to environmental crises, these qualities of compassion and competency must also extend to planetary health. Recognising the profound connections between human and environmental health, doctors today must be prepared to understand and address health issues within a broader ecological context.

    Moreover, the future of healthcare is uncertain, and doctors will confront unknown and unpredictable challenges. Emerging diseases, environmental degradation, and new public health threats will require healthcare professionals who are adaptable, forward-thinking, and equipped to approach health holistically. Integrating planetary health into the MBBS curriculum aligns with these objectives, preparing future doctors to respond to the interwoven challenges of environmental and human health. Through the framework of Education for Sustainable Development (ESD) and recent updates to the Malaysian Qualifications Framework (MQF), medical educators can seamlessly incorporate planetary health principles without increasing total learning time. This paper outlines how these concepts can be embedded within the existing curriculum, equipping the next generation of doctors to safeguard both human health and environmental sustainability in an unpredictable future.

    Understanding Planetary Health, Sustainability, OneHealth, and Nature-Based Solutions

    Planetary health, sustainability (specifically, the Sustainable Development Goals or SDGs), OneHealth, and nature-based solutions (NbS) are interconnected yet distinct approaches within environmental and health frameworks. Here’s a comparison:

    AspectSustainability (SDGs)Planetary HealthOneHealthNature-Based Solutions (NbS)
    ScopeBroad, covering environmental, social, and economic pillars (United Nations, 2015; Raworth, 2017)Focuses on how environmental health affects human wellbeing (Whitmee et al., 2015; Myers & Frumkin, 2020)Specifically targets interactions between human, animal, and environmental health, particularly zoonotic diseases (Rabinowitz et al., 2018)Practical actions that protect, sustainably manage, or restore ecosystems to address societal and health challenges (IUCN, 2023)
    Primary GoalTo balance current needs with preserving resources and stability for future generations (United Nations, 2015)To protect human health by safeguarding natural ecosystems and addressing environmental risks (Whitmee et al., 2015)To address health risks at the intersection of human, animal, and environmental health, especially focusing on zoonosesTo leverage natural systems to enhance resilience and provide ecosystem services that benefit both human and planetary health (IUCN, 2023)
    Focus AreasResource management, waste reduction, social equity, economic stability, and environmental protection (Raworth, 2017)Human health impacts from climate change, pollution, and ecosystem degradation (Prescott & Logan, 2019; Myers & Frumkin, 2020)Zoonotic disease control, ecosystem health, and the interconnectedness of human and animal health (Rabinowitz et al., 2018)Climate change adaptation, ecosystem restoration, green infrastructure, urban green spaces, and sustainable agriculture (World Economic Forum, 2024)
    ApplicationsMultisectoral approach: energy, agriculture, economics, social policy, etc. (United Nations, 2015)Primarily within healthcare and public health, with a focus on preventing environmental impacts on human health (Myers & Frumkin, 2020)Predominantly used in infectious disease control, veterinary science, and environmental healthUsed in urban planning, public health, climate resilience, water management, and more (IUCN, 2023; World Economic Forum, 2024)
    Relationship to HealthIndirect: Sustainable practices support health by maintaining stable resources and healthy environments (Raworth, 2017)Direct: Addresses how environmental degradation leads to immediate and long-term health impacts on populationsDirect: Examines the specific health implications of human-animal-environment interactions, focusing on shared diseasesDirect: NbS provide ecosystem services that enhance air and water quality, reduce disease vectors, and promote mental and physical wellbeing (IUCN, 2023)
    Scope ComparisonBroader scope, incorporating planetary health as a subset (United Nations, 2015)More focused within sustainability, specifically relating to environmental impacts on health (Whitmee et al., 2015)Narrowest scope, focusing specifically on health issues arising from human-animal-environment interactions (Rabinowitz et al., 2018)Targeted approach within planetary health, using ecosystems to deliver sustainable health and environmental outcomes (World Economic Forum, 2024)

    This table clarifies that sustainability is the broadest framework, with planetary health focusing on environmental impacts on human wellbeing. OneHealth and NbS are more specific, with NbS providing actionable solutions that align with both planetary and human health.

    The Role of Nature-Based Solutions in Planetary Health and Medical Education

    Nature-based solutions, supported by frameworks like those from the International Union for Conservation of Nature (IUCN), are integral to planetary health, providing ecosystem services that benefit human wellbeing. Examples include the role of green urban spaces in reducing respiratory diseases, wetlands in water purification, and mangroves in coastal resilience. Pharmaceutical companies are also beginning to invest in NbS, recognising their importance in sourcing medicinal compounds sustainably and supporting biodiversity that mitigates disease spread (World Economic Forum, 2024).

    By incorporating NbS concepts into medical education, future healthcare professionals can better understand how ecosystem health directly impacts human health. This approach allows doctors to recommend preventive strategies that support both individual and community health, aligning with planetary health goals.

    Seamless Integration of Planetary Health and NbS in Medical Education

    Nature-based solutions can be seamlessly integrated into MBBS modules. Here’s a structure for how these topics align with existing curriculum goals:

    1. Physiology and Pathology

    • Embed environmental factors, such as pollution and climate change, in discussions of respiratory and cardiovascular health.

    • Include studies on nanoplastic exposure and its potential inflammatory effects in cardiovascular health modules (Jin et al., 2022).

    • Integrate the effects of urban green spaces on lowering rates of respiratory diseases due to reduced pollution and increased physical activity.

    2. Community Medicine and Public Health

    • Teach how NbS can mitigate vector-borne diseases, such as dengue and malaria, by restoring wetlands and promoting urban green spaces.

    • Discuss the importance of sustainable food systems within nutrition topics, linking agroforestry practices with improved nutrition and reduced pesticide use (World Economic Forum, 2024).

    • Explore mental health benefits of nature exposure, using urban green space initiatives as a case study.

    3. Pharmacology

    • Examine sustainable medicinal sourcing and the role of biodiversity in providing plant-based medicines. Pharmaceutical companies’ investments in biodiversity protection reflect this approach (World Economic Forum, 2024).

    • Discuss antibiotic stewardship to prevent environmental contamination and antimicrobial resistance (Singer et al., 2019).

    4. Clinical Rotations

    • Include case studies that address health impacts of environmental changes, such as heat-related illnesses and waterborne diseases from pollution and ecosystem degradation.

    • Emphasize NbS as community-level solutions in clinical practice, such as recommending exposure to green spaces for stress management and discussing community advocacy for clean water and air.

    Expected Outcomes of Integrating Planetary Health and NbS

    Aligned with the updated MQF and ESD principles, the following are the expected outcomes for medical graduates 4-5 years after completing a curriculum that integrates planetary health and NbS:

    1. Holistic Patient Care with Planetary Health Awareness

    Graduates will deliver patient care that considers environmental factors affecting health, advising patients on lifestyle choices that support both personal and planetary wellbeing.

    2. Advocacy for Sustainable Healthcare

    Graduates will promote sustainable practices in healthcare settings, such as reducing waste, supporting biodiversity, and conserving energy, contributing to planetary health goals.

    3. Community Engagement and Environmental Health Advocacy

    Graduates will educate communities on the benefits of NbS, advocating for policies that promote health through clean air, water, and urban greenery.

    4. Ethical Responsibility in Environmental Health

    Graduates will understand their role in promoting ecosystem protection as a foundation for health, supporting efforts to reduce health disparities related to environmental degradation.

    Recommendations

    Integrating planetary health and NbS into the MBBS curriculum, without adding new topics, enriches medical education by promoting a global awareness of health interdependencies. This integration equips doctors to address health in ways that support human and environmental sustainability, making a positive impact on society and the planet.

    Disclaimer

    This article was created with assistance from ChatGPT, an AI language model, to provide an overview of integrating planetary health into medical education. While the content has been reviewed to ensure accuracy and relevance, readers are encouraged to consult additional sources and expert opinions when implementing educational frameworks.

    References

    International Union for Conservation of Nature. (2023). Nature-based solutions. Retrieved from https://iucn.org/our-work/nature-based-solutions

    Jin, H., Ma, T., Sha, X., Liu, Z., & Zhou, Y. (2022). Nanoplastics and cardiovascular diseases: A link from the environment to human health. Environmental Research, 204, 112281. https://doi.org/10.1016/j.envres.2021.112281

    Landrigan, P. J., Fuller, R., Acosta, N. J. R., Adeyi, O., Arnold, R., Basu, N., & Zhong, M. (2018). The Lancet Commission on pollution and health. The Lancet Planetary Health, 2(1), e26-e36. https://doi.org/10.1016/S2542-5196(17)30173-8

    Lim, S. S., Vos, T., Flaxman, A. D., Danaei, G., Shibuya, K., Adair-Rohani, H., & Ezzati, M. (2021). A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: A systematic analysis for the Global Burden of Disease Study 2010. The Lancet, 380(9859), 2224-2260. https://doi.org/10.1016/S0140-6736(12)61766-8

    Myers, S. S., & Frumkin, H. (2020). Planetary health: Protecting nature to protect ourselves. Island Press.

    Prescott, S. L., & Logan, A. C. (2019). Planetary health: From the wellspring of holistic medicine to personal and public health imperative. Explore, 15(2), 98-106. https://doi.org/10.1016/j.explore.2018.11.008

    Prüst, M., Meijer, J., Westerink, R. H., & Brouwer, A. (2020). The plastic brain: Neurotoxicity of micro- and nanoplastics. Environmental Science & Technology, 54(18), 11431-11441. https://doi.org/10.1021/acs.est.0c02350

    Rabinowitz, P. M., Natterson-Horowitz, B., Kahn, L. H., & Kock, R. (2018). One Health and Planetary Health: Perspectives from the U.S. National Institutes of Health. National Institutes of Health.

    Raworth, K. (2017). Doughnut economics: Seven ways to think like a 21st-century economist. Chelsea Green Publishing.

    Singer, A. C., Shaw, H., Rhodes, V., & Hart, A. (2019). Review of antimicrobial resistance in the environment and its relevance to environmental management in the context of planetary health. The Lancet Planetary Health, 3(7), e253-e261. https://doi.org/10.1016/S2542-5196(19)30078-1

    United Nations. (2015). Transforming our world: The 2030 Agenda for Sustainable Development. Sustainable Development Goals (SDGs). Retrieved from https://sdgs.un.org/2030agenda

    Whitmee, S., Haines, A., Beyrer, C., Boltz, F., Capon, A. G., Dias, B. F., & Yach, D. (2015). Safeguarding human health in the Anthropocene epoch: Report of The Rockefeller Foundation–Lancet Commission on planetary health. The Lancet, 386(10007), 1973-2028. https://doi.org/10.1016/S0140-6736(15)60901-1

    World Economic Forum. (2024). How pharma companies are investing in nature to improve human and planetary health. Retrieved from https://www.weforum.org/stories/2024/09/how-pharma-companies-are-investing-in-nature-to-improve-human-and-planetary-health/

  • E-cigarettes as a Harm Reduction Strategy

    Introduction

    Amid growing concerns about long-term health impacts and youth uptake, over 33 countries, including Brazil, India, and Singapore, have instituted complete bans on e-cigarettes and vaping products. These bans underscore health concerns, especially regarding potential harms and unknown long-term effects (Ecigator, 2024; Statista, 2024; Global Issues, 2024). In contrast, around 87 nations regulate vaping through age restrictions, advertising bans, and usage limitations to control accessibility, especially among minors (Global Issues, 2024).

    Some countries, such as the United Kingdom, allow e-cigarettes as part of a harm reduction strategy, permitting regulated access to encourage adult smokers to transition away from traditional cigarettes. Australia has adopted a more conservative approach, requiring a prescription for e-cigarette access to balance harm reduction with health safety (Hawai‘i Public Health Institute, 2024). This global disparity highlights the ongoing debate surrounding vaping’s public health role, weighing its potential as a harm reduction tool against addiction risks and youth appeal. This article evaluates e-cigarettes using four established harm reduction criteria—reduction in harm, proven safety, efficacy, and accessibility—to determine whether they align with harm reduction standards.

    Harm Reduction Criteria

    For a product to qualify as a harm reduction tool, it must meet several key principles: demonstrate a reduction in health risks, provide conclusive evidence of short- and long-term safety, show effectiveness in reducing or eliminating harmful behaviours, and ensure accessibility without unintended consequences. This framework forms the basis for evaluating e-cigarettes as a harm reduction strategy.

    Reduction in Harm

    Harm reduction tools are intended to lower health risks significantly compared to current harmful behaviours. For e-cigarettes, this means offering a lower risk profile than traditional smoking. Public Health England estimates that e-cigarettes are “95% less harmful than smoking” due to the absence of combustion, which is the source of many toxic chemicals in cigarette smoke (McNeill et al., 2015). Studies indicate that e-cigarette vapour contains fewer carcinogens and toxic compounds than cigarette smoke, potentially reducing respiratory and cardiovascular risks (Glantz & Bareham, 2018).

    However, e-cigarette vapour includes harmful substances such as formaldehyde and volatile organic compounds, and regular use has been associated with a 30% increased risk of respiratory issues like asthma and COPD (Bhatta & Glantz, 2020). The reduction in harm is further complicated by limited long-term data, leaving the full health impact uncertain. While e-cigarettes may reduce exposure to certain toxins, their overall health implications remain unclear, meeting this criterion only partially.

    Proven Safety

    Safety is fundamental for any harm reduction strategy, requiring thorough evaluation for short- and long-term impacts to avoid introducing new health risks. Current evidence on e-cigarette safety is limited due to their recent introduction, with most studies focusing on short-term effects. Research has raised concerns about increased cardiovascular and respiratory risks; for example, e-cigarette users have been found to have a 56% higher risk of myocardial infarction than non-users, underscoring cardiovascular safety concerns (Bhatta & Glantz, 2020).

    The history of tobacco emphasises the risks of adopting products without robust safety data. Although tobacco use dates back to 6000 BCE, its addictive and harmful properties were not widely recognised until the 16th century. Cigarettes were marketed as safe until serious health risks were confirmed in the 1950s, nearly a century after their mass production began. E-cigarettes, similarly promoted as safer alternatives without long-term data, risk repeating this historical error. Without comprehensive long-term data, e-cigarettes do not meet the safety criterion.

    Efficacy

    Harm reduction strategies should be effective in reducing or eliminating harmful behaviour. Some studies suggest that e-cigarettes may assist smokers who struggle with traditional cessation methods. A trial by Hajek et al. (2019) found e-cigarettes to be nearly twice as effective as nicotine replacement therapy (NRT) when combined with behavioural support. Furthermore, widespread e-cigarette use could potentially prevent over 6.6 million premature deaths among American smokers (Levy et al., 2017).

    However, “dual use” — when individuals continue to smoke while using e-cigarettes — raises concerns, as it can increase overall nicotine exposure, potentially offsetting some of the harm reduction benefits. Evidence on long-term cessation is mixed, with some users returning to smoking or maintaining an e-cigarette dependency (Hartmann-Boyce et al., 2016). While e-cigarettes may offer a transitional tool for some smokers, dual use and sustained dependency challenge their efficacy as a full harm reduction strategy, meeting this criterion only partially.

    Accessibility and Acceptability

    A harm reduction tool should be widely accessible and acceptable to those who may benefit from it. E-cigarettes are widely available in numerous countries, accessible through online platforms and retail outlets. Their popularity, particularly among younger users, is often attributed to diverse flavours and appealing designs. In the UK, approximately 3.6 million adults reported using e-cigarettes in 2021, demonstrating significant accessibility and acceptance (ONS, 2021).

    However, the popularity of e-cigarettes among youth raises ethical concerns. In the United States, vaping among high school students surged from 1.5% in 2011 to 27.5% in 2019, driven by flavoured products and youth-oriented marketing (Cullen et al., 2018). This trend complicates the harm reduction goal, as increased nicotine addiction among youth poses a new public health risk. While e-cigarettes meet the accessibility criterion, ethical concerns about youth uptake remain significant.

    Conclusion

    Evaluating e-cigarettes against harm reduction criteria reveals only partial compliance. While e-cigarettes may reduce exposure to certain toxins compared to smoking, they lack conclusive long-term safety data and show mixed efficacy, especially given the potential for dual use. Although they are accessible and popular, especially among youth, this appeal introduces ethical challenges and potential health risks.

    The history of tobacco illustrates the risks of endorsing products without sufficient safety evidence. Healthcare professionals should avoid repeating these mistakes by endorsing e-cigarettes as a harm reduction tool prematurely. High standards of evidence are essential to protect public health and ensure that harm reduction strategies genuinely benefit those in need.

    Disclaimer: This article was drafted with the assistance of ChatGPT for research synthesis and writing. All information included is derived from reputable sources and cited in APA format.

    References

    Bhatta, D. N., & Glantz, S. A. (2020). Electronic cigarette use and myocardial infarction among adults in the US population assessment of tobacco and health. Journal of the American Heart Association, 8(12), e012317. https://doi.org/10.1161/JAHA.119.012317

    Cullen, K. A., Ambrose, B. K., Gentzke, A. S., Apelberg, B. J., Jamal, A., & King, B. A. (2018). Notes from the field: Use of electronic cigarettes and any tobacco product among middle and high school students—United States, 2011–2018. MMWR Morbidity and Mortality Weekly Report, 67(45), 1276–1277. https://doi.org/10.15585/mmwr.mm6745a5

    Ecigator. (2024). Overview of vaping regulations by country. Ecigator. Retrieved from https://www.ecigator.com/vaping-regulations-country/

    Glantz, S. A., & Bareham, D. W. (2018). E-cigarettes: Use, effects on smoking, risks, and policy implications. Annual Review of Public Health, 39, 215–235. https://doi.org/10.1146/annurev-publhealth-040617-013757

    Global Issues. (2024). Ban or restrict? Quandary facing governments as vaping entices teens worldwide. Global Issues. Retrieved from https://www.globalissues.org/

    Hajek, P., Phillips-Waller, A., Przulj, D., Pesola, F., Myers Smith, K., Bisal, N., … & McRobbie, H. J. (2019). A randomised trial of e-cigarettes versus nicotine-replacement therapy. New England Journal of Medicine, 380(7), 629–637. https://doi.org/10.1056/NEJMoa1808779

    Hawai‘i Public Health Institute. (2024). The countries where vaping is illegal, banned or restricted. Hawai‘i Public Health Institute. Retrieved from https://www.hiphi.org/

    Hartmann-Boyce, J., McRobbie, H., Bullen, C., Begh, R., Stead, L. F., & Hajek, P. (2016). Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews, (9). https://doi.org/10.1002/14651858.CD010216.pub3

    Levy, D. T., Borland, R., Lindblom, E. N., Goniewicz, M. L., Meza, R., Holford, T. R., … & Warner, K. E. (2017). Potential deaths averted in the USA by replacing cigarettes with e-cigarettes. Tobacco Control, 27(1), 18–25. https://doi.org/10.1136/tobaccocontrol-2017-053759

    McNeill, A., Brose, L. S., Calder, R., Hitchman, S. C., Hajek, P., & McRobbie, H. (2015). E-cigarettes

  • Recalibrating Careers in Medical Education: A Call for Change in Appraisal and Promotion Systems

    The role of a medical educator or clinical lecturer goes beyond disseminating knowledge; it embodies the spirit of mentorship, guidance, and the holistic development of future healthcare professionals. However, the current landscape in medical education appraisal and promotion systems appears to shift this focus, often prioritising individual achievements over collective institutional goals. This article argues that such systems, heavily influenced by university ranking metrics, could undermine the very essence of education and teamwork within academic institutions.

    The Shift Toward Personal Achievements

    Medical educators once prided themselves on their role as mentors and nurturers of student growth. In the Islamic tradition, this role aligns with the concept of murabbi—a teacher who fosters not just academic knowledge but also spiritual and ethical development. Unfortunately, modern appraisal systems place less emphasis on these nurturing aspects of education. Instead, faculty members are often encouraged to pursue individual accolades, primarily through research publications and citations.

    The increasing focus on research outputs as the primary criterion for academic advancement has led to what many term a “publish or perish” culture, where quantity often supersedes quality in scholarly work. According to research, universities are driven by global ranking systems that primarily focus on research outputs, leading to a shift in faculty priorities from education and mentoring towards securing personal research achievements (Macfarlane, 2011). This change has contributed to the diminishing role of faculty as murabbi—those who mentor with a view to nurturing holistic, well-rounded graduates.

    The Dangers of Ranking Games

    University rankings have gained disproportionate influence in shaping the behaviours and strategies of academic institutions. Metrics such as the number of publications, citation counts, and journal impact factors have become the dominant benchmarks for academic success. A study by Hazelkorn (2015) highlighted the problematic reliance on such rankings, which often fail to account for the teaching mission of universities. The tendency to align institutional goals with these metrics, regardless of context or educational mission, is creating an environment where educators are pressured to focus on individual performance at the expense of broader educational goals.

    This pressure can lead to unintended consequences. For instance, Macfarlane (2011) noted that academic staff are incentivised to prioritise activities that boost their individual research profile, potentially leading to a neglect of their teaching responsibilities. This imbalance risks reducing the overall quality of education and mentorship that students receive.

    The Neglect of Teaching and Real Collaboration

    A career in medicine and medical education is about more than research output. Yet, the current systems undervalue teaching excellence, mentorship, and institutional service. Lecturers may feel demotivated to invest in these areas if they do not contribute directly to promotion prospects. This not only stifles the quality of education but also discourages real collaboration between faculty members. In medical education, where interdisciplinary cooperation and teamwork are essential, such an environment can be detrimental to both faculty cohesion and student outcomes.

    Collaboration is crucial in fostering innovation and holistic educational approaches, particularly in clinical settings where teamwork is a fundamental part of patient care. If academic reward systems are misaligned, these efforts may go unrecognised. In their study, Berthelsen and Hølge-Hazelton (2016) discuss how institutional cultures that prioritise research output over collaborative teaching can lead to a siloed approach within faculties, impeding teamwork and collegiality.

    The Need for Systemic Change

    To address these issues, there must be a recalibration of the appraisal and promotion systems in medical education. Institutions need to re-emphasise the importance of teaching and mentorship, not just as supplementary activities, but as critical components of academic careers. Moreover, universities should develop frameworks that recognise and reward collaborative efforts and interdisciplinary initiatives.

    By valuing the role of a murabbi—the educator who shapes not only the intellect but also the ethical and moral compass of future healthcare professionals—institutions can foster a more holistic and balanced academic environment. According to van Schalkwyk et al. (2015), including student feedback and peer evaluations in promotion criteria can help re-establish the importance of teaching and mentorship in the academic appraisal process.

    Conclusion

    If medical education is to stay true to its purpose, the current focus on individual achievement in appraisal systems must shift towards a more balanced approach that values education, collaboration, and mentorship. Faculty members should be empowered and motivated to contribute to the overall vision of their institutions, embracing their roles as educators and murabbi. Without such systemic changes, teamwork, collaboration, and the essence of medical education risk being eroded, ultimately compromising the quality of healthcare professionals we produce.

    References

    Berthelsen, H., & Hølge-Hazelton, B. (2016). Interdisciplinary collaboration: Barriers and facilitators across disciplines. Nursing Education Today, 40, 32-37. https://doi.org/10.1016/j.nedt.2016.02.007

    Hazelkorn, E. (2015). Rankings and the reshaping of higher education: The battle for world-class excellence. Palgrave Macmillan. https://doi.org/10.1057/9781137446671

    Macfarlane, B. (2011). The morphing of academic practice: Unbundling and the rise of the para-academic. Higher Education Quarterly, 65(1), 59-73. https://doi.org/10.1111/j.1468-2273.2010.00467.x

    van Schalkwyk, S., Hafler, J., Brewer, T., et al. (2015). Fostering communities of practice: A qualitative study of the role of academic institutions in advancing education scholarship. Academic Medicine, 90(6), 802-808. https://doi.org/10.1097/ACM.0000000000000698

  • Adapting Medical Education to Generational Differences: A Call for Systemic Change

    Medical education is transforming significantly due to generational shifts in learners’ expectations, learning styles, and demands. With the rise of Millennials, Generation Z, and the emerging Generation Alpha, traditional approaches in medical training are being challenged. The educational system and teaching methods must evolve to ensure that medical education continues to produce competent physicians who can thrive in a modern healthcare environment. This article explores the impact of generational differences on pre-clinical and clinical medical training, examines the implications for patient-doctor relationships, and discusses whether these changes improve training outcomes.

    Overview of Generations

    Different generations have distinct learning preferences and expectations due to the unique social, cultural, and technological environments in which they were raised. The following table provides a brief overview of the generations relevant to today’s medical students:

    GenerationBirth YearsKey Characteristics in LearningMulti-taskers prefer hands-on and tech-enhanced learning
    Baby Boomers1946-1964Prefer structured, instructor-led learning, value authority and traditionLimited use of digital tools, prefer face-to-face learning
    Generation X1965-1980Independent, self-paced learners, value practical applicationComfortable with gradual tech integration
    Millennials1981-1996Collaborative, favor active learning, expect flexibility and instant feedbackHeavy reliance on technology, prefer blended learning
    Generation Z1997-2012Multi-taskers, prefer hands-on and tech-enhanced learningProficient with digital tools, demand real-time feedback
    Generation Alpha2013 onwardsEmerging trends: immersive, gamified, personalized learningFully integrated into a digital-first world

    With Millennials and Generation Z now making up the bulk of medical students, their learning preferences are driving changes in how medical education is delivered, particularly in the pre-clinical and clinical years of training.

    Pre-Clinical Years: The Changing Face of Classroom-Based Teaching

    The pre-clinical years (Years 1-2) of medical education are typically dominated by classroom-based learning. Historically, this has been characterised by instructor-led lectures, textbooks, and passive learning. However, as Millennials and Generation Z students enter medical school, their learning preferences increasingly diverge from this traditional model.

    A study by Cook et al. (2010) highlighted that modern learners prefer more interactive, student-centred learning environments. Millennials and Generation Z tend to favour active learning techniques such as problem-based learning (PBL) and team-based learning (TBL), where collaboration and real-world application are prioritised over rote memorisation and passive listening. They also expect to learn through technology-enhanced methods, such as digital modules, videos, and interactive simulations (Chen et al., 2017).

    Many students still appreciate structured, face-to-face teaching, particularly in the early stages of medical education. However, they often find long, traditional lectures disengaging and difficult to follow. Studies have shown that incorporating more flexible, blended learning methods can enhance student engagement without sacrificing the benefits of in-person instruction (Ruiz et al., 2006). The use of flipped classrooms, where students access lecture material online and engage in active problem-solving during class, is one such method that has been well-received by Generation Z learners (Chen et al., 2017).

    Clinical Years: Adapting the Apprenticeship Model

    The clinical years (Years 3-5) of medical education rely heavily on the traditional apprenticeship model, where students learn by observing and participating in patient care under the supervision of experienced clinicians. This model, which emphasises hands-on experience, has been the backbone of medical education for centuries. However, generational shifts are impacting the effectiveness and appeal of this approach.

    Millennials and Generation Z students expect more structure, real-time feedback, and integration of technology in their clinical training. A study by Jolly et al. (2019) found that younger generations prefer continuous, structured feedback, often facilitated through digital platforms. This is in contrast to the traditional approach of delayed feedback, which may come at the end of a clinical rotation or after assessments.

    Moreover, workplace-based assessments (WBA), a key element of competency-based training, must evolve to meet these expectations. The use of e-portfolios and mobile assessment platforms allows for real-time feedback and progress tracking, which aligns with the learning preferences of digital-native students (He et al., 2012). Additionally, simulations and virtual reality (VR) tools are becoming increasingly valuable in clinical training, allowing students to practise skills in a controlled environment before working with real patients (Lyon & McLean, 2017).

    Impact on Patient-Doctor Relationships and Training Outcomes

    One of the key concerns about these generational shifts in medical education is whether they affect the quality of patient-doctor relationships and the overall effectiveness of training. Studies evaluating the impact of adopting more flexible, technology-driven approaches have shown promising results. For instance, a systematic review by O’Brien et al. (2020) found that the use of simulation-based learning and real-time feedback tools in clinical training improved students’ communication skills and patient interactions.

    Furthermore, studies have demonstrated that incorporating digital tools into workplace-based learning does not detract from the development of essential clinical skills. On the contrary, it may enhance them by providing students with more opportunities to practise and refine their skills in a safe environment before engaging with patients (Ruiz et al., 2006). This is particularly important for Millennials and Generation Z, who thrive on structured learning and immediate feedback.

    The Jolly et al. (2019) study also found that students who receive frequent, real-time feedback tend to perform better in patient interactions and clinical assessments. The introduction of digital tools like e-portfolios has streamlined the feedback process, allowing for more detailed, competency-based evaluations of students’ performance. These findings suggest that adopting technology-enhanced learning methods in medical education may not only meet the preferences of modern learners but also improve their readiness for clinical practice.

    Challenges in the Transition to Digital Learning

    Despite the potential benefits of integrating technology into medical education, some challenges must be addressed. One significant challenge is the risk of over-reliance on digital tools at the expense of face-to-face patient interactions. Prensky (2001), who coined the term “digital natives,” warned that while digital-native generations are adept at using technology, they may struggle with interpersonal communication if not properly trained in real-world settings.

    Therefore, while technology can enhance learning, it should complement, not replace, hands-on patient care experiences. Medical schools must strike a balance between providing opportunities for digital learning and ensuring that students develop the humanistic qualities necessary for effective patient care, such as empathy, communication, and ethical decision-making (O’Brien et al., 2020).

    Conclusion: The Need for Systemic Change

    The generational shifts in medical education are undeniable, and both the system and educators must evolve to meet the changing needs of learners. The preference for interactive, technology-enhanced learning methods among Millennials and Generation Z requires medical schools to rethink traditional teaching models in both pre-clinical and clinical training. Blended learning, flipped classrooms, and digital tools for real-time feedback are all valuable strategies to enhance student engagement and improve clinical competencies.

    However, the adoption of these methods must be carefully managed to ensure that the development of key patient-doctor relationships and communication skills is not compromised. Studies suggest that, when implemented thoughtfully, these changes can improve training outcomes and better prepare students for the demands of modern clinical practice.

    In conclusion, the future of medical education lies in balancing traditional methods with innovative, technology-driven approaches that cater to the learning preferences of modern students. By embracing this change, educators can ensure that medical education continues to produce skilled, competent, and compassionate physicians.

    References

    Chen, F., Lui, A. M., & Martinelli, S. M. (2017). A systematic review of the effectiveness of flipped classrooms in medical education. Medical Education, 51(6), 585-597.

    Cook, D. A., Levinson, A. J., & Garside, S. (2010). Time and learning efficiency in Internet-based learning: A systematic review. Advances in Health Sciences Education, 15(5), 755-770.

    He, J., Baxter, S. L., Xu, J., Zhou, X., & Zhang, K. (2012). The practical implementation of artificial intelligence technologies in medicine. Nature Medicine, 25(1), 30-36.

    Jolly, B., & Boud, D. (2019). Assessment for learning in the workplace: Workplace-based assessment and feedback in clinical practice. Medical Education, 43(4), 311-317.

    Lyon, P. M., & McLean, M. (2017). How do we handle generational differences in medical education? BMC Medical Education, 17(1), 150.

    O’Brien, B. C., Irby, D. M., & Curry, R. H. (2020). Improving patient-centered care through medical education reform. Journal of Graduate Medical Education, 12(2), 134-141.

    Prensky, M. (2001). Digital natives, digital immigrants. On the Horizon, 9(5), 1-6.

    Ruiz, J. G., Mintzer, M. J., & Leipzig, R. M. (2006). The impact of e-learning in medical education. Academic Medicine, 81(3), 207-212.

  • Incorporating Sejahtera and Planetary Health into Higher Education Curricula: A Path to Sustainable Global Well-being

    The rise of planetary health as an essential framework for addressing the intersecting challenges of human and environmental health has created a need for clarity. However, it is often confused with other important global frameworks, including global health, sustainable development goals (SDGs), Education for Sustainable Development (ESD), environmental health, and One Health. Each of these frameworks carries distinct objectives and approaches. The concept of Sejahtera, deeply embedded in Malaysia’s National Education Philosophy, offers a holistic lens that integrates not only physical and environmental health but also mental, social, and spiritual well-being. By streamlining these overlapping frameworks through Sejahtera, higher education can adopt a more balanced and culturally relevant approach to global well-being. This article explores the need for curriculum reform in higher education to incorporate both planetary health and Sejahtera.

    Origins and Frameworks of Health and Sustainability

    Each framework—whether it is planetary health, global health, or the SDGs—arose at different times in response to specific global challenges. Their individual inception dates and objectives highlight the need to integrate them into a coherent framework for education. This can be achieved by leveraging Sejahtera’s holistic approach.

    Table 1 provides a comparative overview of these frameworks, outlining their origins, year of inception, time frames, and objectives.

    Table 1: Comparison of Planetary Health, Global Health, ESD, One Health, Environmental Health, and SDGs

    FrameworkOrigin of IdeaYear AnnouncedTime FrameObjective
    Environmental HealthRooted in public health practices of the 19th century, focusing on the relationship between environment and health.19th century, formalised mid-20th centuryOngoingTo manage and mitigate environmental risks to reduce the burden of disease and promote healthy living environments (WHO, 2021).
    Global HealthEmerged from public health and international health efforts, particularly during the 20th century, and became well-established post-2000.Mid-20th century but evolved into the modern concept in the 2000s.OngoingTo address health disparities and improve health equity by focusing on global health challenges, with an emphasis on disease prevention and access to healthcare.
    One HealthDeveloped from the veterinary and medical sciences with a focus on human-animal-environment interactions, particularly zoonotic diseases.Early 2000sOngoingTo achieve optimal health for humans, animals, and the environment through a multidisciplinary approach, particularly in the control of zoonotic diseases.
    ESD (Education for Sustainable Development)Introduced by UNESCO to incorporate sustainable development into education systems worldwide.2002Target 2030To foster knowledge, skills, values, and behaviours that promote sustainability across various aspects of society.
    SDGs (Sustainable Development Goals)Evolved from the Millennium Development Goals (MDGs), adopted by the United Nations to address a wide range of global challenges.2015 (UN General Assembly)Target 2030To create a comprehensive framework for sustainable development, addressing poverty, inequality, climate change, and health through 17 interconnected goals.
    Planetary HealthInitiated by the Rockefeller Foundation-Lancet Commission, focusing on the connection between human health and the state of natural ecosystems.2015OngoingTo safeguard human health by preserving the integrity of the Earth’s natural systems, recognising the importance of maintaining ecological balance to support human well-being.

    Sejahtera: Clarifying Overlapping Frameworks

    Sejahtera offers a valuable framework that can help clarify the confusion between these overlapping global health and sustainability frameworks. Malaysia’s National Education Philosophy highlights the importance of fostering holistic well-being, which encompasses not only intellectual development but also emotional, spiritual, and physical balance. The National Education Philosophy emphasizes the creation of balanced individuals who contribute to societal harmony and well-being based on faith, knowledge, and a sense of responsibility (Kementerian Pendidikan Malaysia, 2021).

    This philosophy resonates with planetary health’s emphasis on sustainability and human health, but Sejahtera extends it by adding a spiritual and ethical dimension that is often absent in other global frameworks. By integrating Sejahtera into higher education curricula, universities can foster a more holistic approach that addresses not only the scientific and medical aspects of planetary health but also its cultural and spiritual dimensions.

    Curriculum Reform: Integrating Sejahtera and Planetary Health

    To achieve this integration, universities must shift toward interdisciplinary learning that incorporates the social, spiritual, and cultural dimensions of well-being alongside environmental and health sciences.

    Incorporating Sejahtera and planetary health requires fostering a curriculum that moves beyond a purely scientific understanding of environmental health. For example, medical students could be taught about the impacts of environmental degradation on mental health, while also exploring the spiritual practices that help individuals and communities cope with these challenges. Case-based learning can be employed to engage students in real-world scenarios where they must balance scientific knowledge with ethical and spiritual considerations.

    Sustainability projects on university campuses can also provide hands-on learning opportunities, allowing students to apply planetary health and Sejahtera principles to create green spaces, conserve energy, and promote community resilience. These projects help students understand the practical applications of sustainability while also fostering a sense of responsibility toward the environment and society.

    Streamlining Frameworks for a Coherent Educational Approach

    Given the frequent confusion between planetary health and other frameworks like global health, the SDGs, and One Health, integrating Sejahtera provides a unifying philosophy that clarifies these overlapping areas. Sejahtera’s focus on holistic balance offers a cohesive framework that brings together the strengths of each of these approaches, providing students with a clear and integrated understanding of how they can promote sustainable well-being. By incorporating Sejahtera into higher education curricula, universities can ensure that students are equipped with the knowledge, skills, and values necessary to tackle the world’s most pressing environmental and health challenges.

    Conclusion

    Incorporating Sejahtera and planetary health into higher education curricula offers a transformative opportunity to promote a holistic and integrated approach to global health and sustainability. While planetary health provides the scientific foundation for understanding the relationship between human health and the environment, Sejahtera adds a culturally grounded framework that promotes harmony between humans, nature, and society. This alignment with Malaysia’s National Education Philosophy ensures that future generations are equipped not only to address the environmental and health challenges of our time but also to foster spiritual and ethical well-being in their personal and professional lives.

    Disclaimer: The ideas expressed in this article were generated with assistance from ChatGPT, an AI language model.

    References

    Capon, A. G., & Horton, R. (2019). Planetary health: Safeguarding health in the Anthropocene epoch. The Lancet, 390(10114), 865-870.

    Kementerian Pendidikan Malaysia. (2021). Falsafah Pendidikan Kebangsaan. Available at https://www.moe.gov.my.

    Rockström, J., Steffen, W., Noone, K., Persson, Å., Chapin III, F. S., Lambin, E., … & Foley, J. A. (2009). A safe operating space for humanity. Nature, 461(7263), 472-475.

    Rockefeller Foundation-Lancet Commission. (2015). Safeguarding human health in the Anthropocene epoch: Report of the Rockefeller Foundation–Lancet Commission on planetary health. The Lancet, 386(10007), 1973-2028.

    Whitmee, S., Haines, A., Beyrer, C., Boltz, F., Capon, A. G., Ferreira de Souza Dias, B., … & Rockström, J. (2015). Safeguarding human health in the Anthropocene epoch: Report of The Rockefeller Foundation–Lancet Commission on planetary health. The Lancet, 386(10007), 1973-2028.

    UNESCO. (2014). Education for Sustainable Development: A Roadmap for Implementing the Global Action Programme on ESD. Available at https://unesdoc.unesco.org/ark:/48223/pf0000230514.

  • Are University Rankings Fair? A Reflection on the “Ranking Game”

    University rankings have become a dominant force in shaping perceptions of academic quality, and influencing decisions from students, governments, and funding bodies. Global rankings, such as Times Higher Education (THE), QS World University Rankings, and Academic Ranking of World Universities (ARWU), offer a comparative tool for evaluating universities across a range of criteria. However, growing concerns about the fairness and legitimacy of these ranking systems, particularly in the context of Malaysian higher education, raise important questions. Can we truly apply the same metrics to all institutions? More importantly, do these rankings measure real values and impact relevant to local needs, or are they increasingly manipulated to serve business interests, distorting the true purpose of education?

    The Case of Malaysia: Public vs. Private Universities

    Malaysia’s higher education system includes a mix of public and private universities, each serving different populations and missions. Public institutions like Universiti Malaya (UM), Universiti Kebangsaan Malaysia (UKM), and Universiti Putra Malaysia (UPM) consistently rank among the highest Malaysian universities. In the 2025 QS World University Rankings, Universiti Malaya holds a global position of 65th, the top spot for a Malaysian university (QS, 2025). These institutions cater to diverse socio-economic groups, often focusing on nation-building, research, and community engagement, with missions closely tied to Malaysia’s development needs.

    On the other hand, private universities like Taylor’s University and Monash University Malaysia rank lower on the global scale but perform well in areas like graduate employability and international student satisfaction. Private institutions generally serve a more affluent, often international, student population. Their focus is more on global competitiveness and market-driven education, aiming to meet the demands of the international job market.

    This clear distinction in the missions and populations of Malaysia’s public and private universities illustrates the challenges in applying standardised global ranking criteria across all types of institutions. The public sector’s emphasis on local and national development is difficult to measure through metrics like internationalisation and citation counts, while private universities may excel in areas that align more closely with the global market economy.

    The Problem with Standardised Ranking Metrics

    Global rankings apply the same set of criteria across institutions, which often doesn’t account for the diverse roles universities play. Metrics like research output, international faculty and students, and citations per paper disproportionately favour larger, research-intensive institutions in developed countries. In the Malaysian context, this is problematic for public universities, which are often tasked with local development projects and nation-building goals. Many of these universities excel in health sciences, engineering, and agriculture, focusing on local issues such as public health, infrastructure development, and sustainable agriculture. However, their contributions may not be fully reflected in rankings that prioritise global research visibility.

    Private universities, in contrast, tend to perform well in categories like internationalisation and employability, as these metrics align more closely with their business models. Private institutions in Malaysia frequently form partnerships with industries, focusing on niche programmes that appeal to both local and international students. For these universities, rankings become a tool for marketing and recruitment, serving as a measure of their commercial success rather than their broader educational impact.

    Manipulation of Rankings and Ethical Concerns

    Globally, several cases have demonstrated how universities can manipulate data to improve their rankings. For example, in 2019, Temple University’s Fox School of Business was found guilty of inflating data to improve its position in the U.S. News & World Report rankings. This manipulation included exaggerating student admission statistics and faculty-student ratios (Douglas-Gabriel, 2018). More recently, in 2021, Columbia University was accused of submitting inaccurate data related to class sizes and faculty qualifications, leading to a significant drop in its ranking (Korn, 2022).

    Additionally, dissatisfaction with rankings is not limited to data manipulation scandals. Some institutions, such as Utrecht University, have opted out of global rankings altogether. In 2023, Utrecht withdrew from the Times Higher Education World University Rankings, citing concerns about the ranking system’s emphasis on quantitative metrics and competition, which they felt did not align with their educational values (Science Business, 2023) . Similarly, a UC Berkeley study found that the business practices of some ranking agencies, such as QS, may create conflicts of interest. This study suggested that universities that frequently used QS’s paid services, such as consultancy, experienced a noticeable improvement in their rankings, raising concerns about the integrity of such rankings (CSHE, 2021) .

    Commercialisation of Rankings

    The commercialisation of university rankings has become a growing concern. Ranking organisations, such as QS and Times Higher Education, offer paid consultancy services to help universities improve their scores. Some institutions spend large sums of money on these services to boost their performance in areas like international collaboration, faculty diversity, or research visibility. This practice raises concerns about the objectivity of rankings and whether they reflect true educational quality or merely the financial resources of the institutions (Matthews, 2017).

    In Malaysia, this is particularly relevant for private universities that use rankings as a marketing tool to attract international students. By improving their ranking performance, these institutions can justify higher tuition fees and appeal to a more global audience. However, this focus on ranking performance may come at the expense of local educational needs, raising questions about whether rankings are being used to inflate perceptions of quality rather than to reflect the true impact of the institution.

    The Impact on Local Needs

    One of the most significant issues with global university rankings is whether they measure the real impact of universities on their local communities. Public universities in Malaysia play a critical role in nation-building, producing graduates who contribute to vital sectors such as healthcare, engineering, and education. Their research often focuses on local issues, such as improving healthcare access in rural areas or developing sustainable agricultural practices. However, these contributions may be overlooked by global rankings that prioritise international visibility over local impact.

    Private universities, while playing an important role in providing specialised, market-driven education, tend to focus more on the commercial aspects of higher education, which can lead to misalignment with local needs. As Malaysia continues to balance public service with market demands, the pressure to perform well in global rankings may distort institutional priorities, particularly when these rankings favour global recognition over regional contributions.

    Conclusion

    University rankings are a useful tool for evaluating institutions, but they must be used cautiously. The standardised approach to ranking public and private universities in Malaysia often fails to capture the full scope of their missions and societal roles. While public universities focus on local development and nation-building, private universities tend to pursue market-driven goals. Rankings that prioritise global visibility over local impact risk distorting the educational landscape, rewarding institutions that are skilled at navigating the ranking system rather than those that provide real value to their communities.

    As educators and policymakers, it is essential to ensure that rankings do not become the sole measure of success. Instead, we must develop more inclusive metrics that reflect the true contributions universities make, both globally and locally, to ensure a fairer and more comprehensive understanding of educational quality.

    References

    Douglas-Gabriel, D. (2018, July 9). Temple University’s business school dean forced out amid scandal over fake U.S. News rankings data. The Washington Post. https://www.washingtonpost.com/education/2018/07/09/temple-universitys-business-school-dean-forced-out-amid-scandal-over-fake-us-news-rankings-data/

    Korn, M. (2022, September 12). Columbia University drops to No. 18 in U.S. News rankings after cheating scandal. The Wall Street Journal. https://www.wsj.com/articles/columbia-university-drops-to-no-18-in-u-s-news-rankings-after-cheating-scandal-11662934553

    Matthews, D. (2017, March 2). World university rankings are ‘open to manipulation’. Times Higher Education. https://www.timeshighereducation.com/news/world-university-rankings-are-open-manipulation

    QS World University Rankings (2025). Available at https://www.topuniversities.com/university-rankings

    Science Business. (2023, October 12). Utrecht University withdraws from global ranking as debate on quantitative metrics grows. Science Business. https://sciencebusiness.net

    Center for Studies in Higher Education (CSHE). (2021). Berkeley study: major university rankings may be biased. UC Berkeley. https://cshe.berkeley.edu/news/berkeley-study-major-university-rankings-may-be-biased

    Disclaimer: This document was created with the assistance of AI technology

  • HONOR Magic V3 and Magic Pen

    HONOR Magic V3 and Magic Pen

    I recently purchased the HONOR Magic V3 alongside the Magic Pen, with hopes of enhancing my productivity, especially for document signing and note-taking. The Magic V3 is a strong performer with a great display, but there are a few areas where it hasn’t quite met my expectations.

    Document Signing and Stamping Experience
    A key reason for opting for the Magic V3 was the ability to sign documents directly on the phone, something I’ve found challenging. My workflow requires me to sign multiple documents, and ideally, I would like each document to have a unique, handwritten signature. This process has proven to be tricky, as I haven’t been able to find a suitable app on Android (or even iOS) that allows for this level of flexibility. Signing directly on the Magic V3 with the Magic Pen lacks the fluidity I was hoping for.

    Additionally, I often need to stamp documents using a digital name stamp. This adds another layer of complexity to the process, as finding software that allows me to sign and stamp documents easily, all in one go, has been difficult. Whether I’m using Android or iOS, no app so far has met both of these requirements. A solution that combines these features—unique signatures for each document and the ability to apply a digital stamp—would be a game changer.

    Note-taking Experience
    The handwriting experience on the Magic V3, particularly with Evernote, was also a bit of a letdown. It feels less responsive compared to Apple Notes on the iPad. I’ve since switched to Microsoft OneNote, which offers better syncing capabilities across devices, allowing me to streamline my workflow. Migrating my notes from Evernote and Apple Notes to OneNote has helped to create a more cohesive system for managing my notes.

    Android Auto vs. Apple CarPlay
    In terms of integration with my car, I noticed that Android Auto feels less polished compared to Apple CarPlay. I’ve experienced issues like erratic volume control while using Android Auto, which interrupts the experience, making me miss the smoother interface of CarPlay.

    Final Thoughts
    The HONOR Magic V3 is an impressive device in many ways, but for users like myself who need a seamless process for signing and stamping documents, it falls short. The Magic Pen is functional but doesn’t offer the precision or flexibility needed for these tasks. Finding a robust app that allows me to sign each document with a unique signature and apply a digital stamp remains a challenge on both Android and iOS. Despite these limitations, the device itself performs well, and I’ll continue searching for better software solutions to suit my needs.

  • Integrating Islamic Epistemology into Medicine

    Epistemology, derived from the Greek words episteme (knowledge) and logos (study or discourse), refers to the branch of philosophy that examines knowledge’s nature, origins, and scope. It explores fundamental questions about acquiring, validating, and applying knowledge. In the Islamic tradition, epistemology extends beyond the material and empirical realms, incorporating naqli (revealed) knowledge from divine sources and aqli (rational) knowledge from human reasoning. This integration forms the foundation of Islamic applied epistemology, a framework that seeks to harmonise these dimensions to guide education and societal development.

    Professor Emeritus Datuk Dr. Osman Bakar, a renowned scholar of Islamic philosophy and the seventh Rector of the International Islamic University Malaysia (IIUM), has extensively contributed to this field. With a doctorate in Islamic philosophy from Temple University, Philadelphia, USA, and decades of academic leadership, Prof. Osman has shaped contemporary discourse on Islamic thought and education. He previously held the Al-Ghazali Chair of Epistemology and Civilizational Studies at the International Institute of Islamic Thought and Civilization (ISTAC), IIUM. Recognised as one of the world’s 500 most influential Muslims in 2009, Prof. Osman is widely respected for his work in integrating Islamic principles with modern challenges.

    In his essay “Defining the Core Identity of a 21st-Century Islamic University,” featured in The Muslim 500 (2025 edition), Prof. Osman articulates a transformative vision for Islamic universities centred on institutional values, epistemological teachings, and ethics. This article explores how these principles can be applied to medical education—specifically MBBS and clinical specialist training—and to foster a nurturing environment for lecturers in the Kulliyyah of Medicine. By embedding these principles, Islamic applied epistemology can bridge the gaps left by modern secular medicine, ensuring a holistic approach that addresses spiritual, ethical, and professional dimensions.

    Institutional Values in Medical Training

    Institutional values are the foundation of any educational system, guiding its governance, leadership, and broader mission. In medical training, Islamic principles offer a clear framework for cultivating unity, purpose, and holistic development.

    Medical schools can adopt a tawhidic approach to governance rooted in the Islamic principle of divine unity. Inspired by Ibn Khaldun’s “moderate size” theory, institutions must manage growth carefully to maintain governance quality and personalised education. Leadership models should emphasise collaboration, inclusivity, and mutual respect, creating an environment where students, faculty, and staff thrive collectively.

    Graduates from these programmes must embody technical skills, ethical values, and compassion. Islamic principles frame leadership in healthcare as a sacred trust, requiring sincerity (ikhlas) and accountability to Allah. This perspective fosters a sense of responsibility in graduates to serve humanity while maintaining their spiritual integrity.

    Epistemological Teachings in Medical Education

    Islamic applied epistemology integrates naqli and aqli knowledge, offering a holistic and balanced framework for education. Prof. Osman Bakar identifies seven key functions of Islamic epistemology, all of which have direct applications to medical education:

    Philosophy and Curriculum Design:

    Medical education can integrate Islamic perspectives on health, illness, and healing alongside biomedical sciences. MBBS programmes could include modules on spirituality in medicine, the contributions of Islamic scholars to healthcare, and ethical practices rooted in Islamic law. Specialist training can incorporate discussions on maqasid al-shariah (objectives of Islamic law) in clinical decision-making.

    Epistemologies of Disciplines:

    Faculties can define the foundations of medical disciplines while incorporating Islamic teachings. For instance, courses in clinical ethics can address Islamic jurisprudence (fiqh), while public health modules can explore community well-being through an Islamic lens.

    Tawhidic Vision for Academic Programmes:

    Academic programmes aligned with tawhidic principles integrate physical, emotional, and spiritual dimensions in patient care. This vision ensures rational and efficient academic governance while addressing patients’ holistic needs.

    Balanced Curriculum Between Fard ‘Ayn and Fard Kifayah Knowledge:

    Programmes should balance fard ‘ayn knowledge, such as spirituality and moral decision-making, with fard kifayah knowledge, including clinical skills, diagnostics, and research.

    Balanced Curriculum Between Perennial and Ephemeral Knowledge:

    Curricula should blend timeless Islamic principles of justice, compassion, and humility with cutting-edge advancements in modern medicine, such as AI-driven diagnostics and genomics.

    Serving as a Source of Intellectual Values:

    Islamic epistemology instils intellectual virtues like truthfulness, rationality, and objectivity in students and faculty. This culture encourages ethical inquiry and prioritises societal benefits in medical research.

    Serving as a Source of Research Values:

    Islamic principles guide the development of ethical research practices, ensuring outcomes align with the needs of society. For example, emerging technologies like precision medicine or AI can be evaluated within an Islamic ethical framework.

    Ethical Responsibilities in Medical Education

    Ethics is central to Islamic applied epistemology, shaping how knowledge is created, disseminated, and applied. These ethical principles address three key areas in medical education:

     Ethics in Knowledge Creation and Dissemination:

    Educational and research activities must adhere to Islamic ethical principles, including beneficence, non-maleficence, and justice. Community service projects integrated into training reinforce these principles, helping students internalise their ethical responsibilities.

    Source of Professional Ethics:

    Professional ethics should be a cornerstone of training. Students and lecturers must embody compassion, integrity, and accountability, ensuring ethical principles guide clinical practice and research.

    Value of Ethical Knowledge:

    Modern curricula often sideline ethics in favour of technical training. Reflective practice sessions and case-based discussions can equip students to navigate ethical dilemmas with moral clarity, ensuring that their decisions align with both Islamic values and clinical standards.

    Nurturing Lecturers in the Kulliyyah of Medicine

    A successful transformation of medical education requires an environment that nurtures lecturers intellectually and spiritually. Opportunities for advanced studies in Islamic epistemology, bioethics, and integrative health approaches can deepen their expertise. Collaborative research projects between lecturers and Islamic scholars can explore topics like public health, mental health, and environmental health from an Islamic perspective.

    Leadership training rooted in tawhidic principles equips lecturers to mentor students effectively, fostering a culture of collaboration and mutual support (ta’awun). This reduces competitiveness and aligns the institutional environment with Islamic teachings, creating a faculty dedicated to holistic education.

    Why Modern Medicine Falls Short

    While secular medicine has achieved remarkable technological progress, it often fails to address the holistic framework offered by Islamic applied epistemology. Secular frameworks emphasise materialism over holism, focusing on physical health while neglecting emotional, spiritual, and social dimensions. This fragmented approach can lead to inadequate patient care.

    Moreover, secular medical systems lack divine accountability, prioritising professional obligations to institutions or legal systems over the Creator. Ethical considerations are frequently treated as secondary to technical expertise, while market-driven approaches reduce healthcare to a transactional relationship. Islamic applied epistemology provides an alternative, emphasising equity, compassion, and accessibility as essential elements of healthcare.

    A Path Forward

    Integrating Islamic applied epistemology into medical education offers a holistic framework that aligns technical advancement with ethical and spiritual integrity. By embedding these principles into MBBS and specialist training, healthcare professionals can be nurtured who excel in both competency and compassion. Additionally, fostering a supportive environment for lecturers ensures the sustainability of this transformative model.

    This framework aligns naturally with the Kulliyyah of Medicine’s focus on competence and compassion. However, it calls for a deeper spiritual integration. Competence and compassion, as practised today, align with modern healthcare’s technical and ethical demands. Yet, to fully embody Islamic applied epistemology, these principles must be redefined: competence should prioritise physical wellness, spiritual well-being, and closeness to the Creator, while compassion should reflect a practitioner’s connection to the Creator, expressed through care for patients and those around them.

    Medicine, guided by Islamic applied epistemology, becomes more than a profession—it becomes a sacred endeavour that alleviates suffering, promotes justice, and brings humanity closer to Allah. This approach offers a path forward for healthcare that truly serves humanity.

    Disclaimer: This article was created with the assistance of ChatGPT. While it reflects the author’s thoughts, readers are encouraged to engage critically and consult referenced works for deeper insights.

    Reference: Osman Bakar (2025). “Defining the Core Identity of a 21st-Century Islamic University,” The Muslim 500.

  • About tembeling 2.0

    Welcome to Tembeling 2.0, a platform where thought-sharing reaches new heights with the advent of AI.

    I am Jamalludin Ab Rahman.

    Currently, I am the Dean of the Kulliyyah of Medicine at the International Islamic University Malaysia (IIUM), Chair of the Council of Deans of Public University Medical Faculties, and President of the Persatuan Pakar Perubatan Kesihatan Awam Malaysia (PPPKAM). My work spans public health, medical education, and leadership in shaping Malaysia’s healthcare future.

    “Tembeling” holds personal significance, named after the remote area in central Pahang where I served as a medical officer in Jerantut from 1996 to 1998. It was there that I developed a deep love for public health and nature. This blog, originally a space for showcasing my photography and outdoor adventures, has since evolved into a platform for sharing insights on public health, medical education, and technology.

    With expertise in research methodology and statistical analysis, I have made this a significant part of my practice throughout my academic career. Beyond work, I am passionate about ultra-distance cycling, mountain hiking, and capturing nature through photography—interests that shaped the original tembeling.com.

    Through Tembeling 2.0, I explore the ethical and productive use of AI, while reflecting on my work in healthcare leadership, medical education, and research. Join me as I navigate the intersections of health, nature, AI, and education, pushing thought-sharing into new dimensions.