FIMA Year Book 2009 - Federation of Islamic Medical Associations

FIMAYear Book 2009Federation of Islamic MedicalAssociationsاالتحاد العاملي للجمعيات الطبية اإلسالميةMEDICAL EDUCATION AND PROFESSIONALETHICS: ISLAMIC INSIGHTSالتعليم الطبي واألخالقيات:‏ آفاق إسالميةPublisher:Jordan Society For Islamic Medical SciencesIn collaboration withFederation of Islamic Medical Associations ( FIMA )

FIMAYEAR BOOK 2009Editorial BoardEditor in ChiefProf. Hossam E. FadelProfessor of Obstetrics and GynecologyAugusta, Georia, USAProf. Aly A. Misha’lSenior Consultant in EndocrinologyChief of Medical StaffIslamic HospitalAmman- JordanProf. Abul Fadl Mohsin EbrahimProfessor of Islamic StudiesUniversity of KwaZulu-Natal,Durban, South AfricaProf. Musa bin Mohammad NordinProfessor of PediatricsCyberjaya University College of Medical Sciences(CUCMS)Kuala Lumpur – Malaysia

Publisher:JORDAN SOCIETY FOR ISLAMIC MEDICAL SCIENCES, In collaboration with,and special permission from: FEDERATION OF ISLAMIC MEDICAL ASSOCIA-TIONS (FIMA).Medical Education And Professional Ethics:Islamic Insightsاàd‏©ل»‏º اÑ£d‏«‏ :äÉ«bÓNC’اh á«eÓ°SEG ¥ÉaBGAll rights reserved, No part of this publication may be reproduced, stored in aretrieved system, or transmitted in any means, electronic, mechanical, photocopying,recording or otherwise without the prior permission of the publisher.First Edition:June, 2010ISBN 969-8695-01-XاªŸلáµ ا’‏á«fOQC اTÉ¡dش᫪IôFاO iód ا’‏ójEا´‏ ºbQاáÑൟ اá«æWƒd( 2010/5/1784 )Jordan Society for Islamic Medical SciencesFIMA Year Book 2009: Medical Education And Professional Ethics:Islamic Insights / Jordan Society for Islamic Medical Sciences – Amman:JSIMS, 2010.(174) PDeposit No.: 1784/5/2010.Descriptors:Medical Education And Professional Ethics: Islamic Insights.ا’‏á«dhC hاüàdصæ‏»ف اá°Sô¡Ød äÉfÉ«H اá«æWƒd اáÑൟ IôFاO äóYCGOpinions in the articles are those of their authors. The editorial board does notnecessarily endorse these opinions, nor do these opinions represent the officialposition of FIMA.

Table of contents1. Editorial.2. FIMA: Federation of Islamic Medical Associations: in Brief3. A 13 year experience of integrating Islamic values in the medicalcurriculum in south-east Asia: A model of Islamization of knowledge.Prof. Omar Hasan Kasule.4. Inculcating Islamic input in the curricula of medical sciences atpreclinical yeas (basic medical sciences).Dr. Tayyab Hassan and Prof. Hamdan Noor.5. Problem based learning in medical curricula: An Islamicperspective.Dr. Afshan Khan.6. Teaching medical professionalism: An Islamic approach.Prof. Mohamed Hatta Shaharom.7. Workshop for teaching medical professionalism at the Kulliyah (Faculty)of Medicine at the International Islamic University of Malaysia (IIUM).Dr. Ariff bin Osman.8. The concept of Islamic medical education and bioethics.Dr. Aly A. Misha’l.9. Ethical issues related to medical education in the light of Islamicprinciples.Prof. Mohammad Iqbal Khan, Dr. Rehan Khan and Prof. Masood Anwar10. Muslim contributions to research: Past, Present and Future.Dr. Tayyab Hassan, Dr. Afshan Khan and Prof. Abul Rashid Abdul Rahman.11. Clinicians as effective researchers.Prof. Faroque A. Khan.12. Ethics of clinical research. An Islamic perspective.Prof. Hossam E. Fadel.13. Quality Assurance and accreditation in medical education: An Islamic perspective.Prof. Mohammad Iqbal Khan and Prof. Anis Ahmed.14. Instructiosns to authors.IXXVII129475765738399127137155172FIMA YearBook 2009VII

EditorialDear FIMA membersAssalamu AlaykumBismillah al-Rahman al-RahimPraise be to Allah the Most Merciful, the Most beneficent. May Allah showerHis blessings and peace on His Prophet and Messenger Muhammad (PBUH)I begin by thanking the FIMA Executive Committee for honoring me with theresponsibility to be the Editor-in Chief again for this yearbook. I thank Allahfor giving me this opportunity and enabling me to accomplish this task. Ipray to Allah (SWT) to accept my effort in His way and to reward all whoparticipated in this effort.The term Islamic medicine was introduced few decades ago. Severalconferences have been held to address it, the first of which was The firstInternational Islamic Medical Conference held in Kuwait in 1980. The termhas been understood in several ways including Prophetic medicine (1-3) . Nowit is generally agreed to use the term Islamic medicine to identify medicinethat incorporates the Islamic philosophy of medicine and that it is distinctfrom the term Prophetic medicine. Islamic medicine can only materialize fromprovision of Islamic medical education. Because of the growing interest inthis important topic, the Consortium of Islamic Medical Colleges (CIMCO)proposed Islamic Medical education to be the theme this yearbook. TheExecutive Committee of FIMA approved this proposal and decided tospecifically outline CIMCO activities. Hence the theme of this issue is MedicalEducation and Professional Ethics: Islamic Insights.We at the Editorial Board invited several distinguished FIMA members, someof whom are also members of (CIMCO), to write on the different aspects ofthis topic. The result is a comprehensive collection of articles that I hopeyou will enjoy and motivate all of us to pursue the development of Islamicmedicine, a worthwhile goal.Dr Omar Kasule believes that there is a dichotomy in the current medicalschools’ curriculum. There are two systems; traditional Islamic and importedFIMA YearBook 2009IX

EditorialEuropean systems that is the cause of the intellectual weakness of thestudents / physicians. The solution as he sees it is the integration of thetwo systems in medical education. He discusses his experience in integratingIslamic values in the medical curriculum, a program he called the Islamic Inputin Medical Curriculum (IIMC). He reports the successful implentatation of IIMCin the Kulliyyah (Faculty) of Medicine of the International Islamic University inMalaysia (IIUM) and later on in other universities in Southeast Asia. Dr Kasuleprepared teaching materials, trained the faculty members to teach bothmodern medicine and Shariah principles. Dr Kasule believes that the ethicolegalissues can be resolved by using the tools of MAQASID (purposes) al Shariahand jurisprudence principles. In this paper Dr Kasule gives a comprehensive listof references to all his concepts, works, lectures, essays, presentations, etc….all available on his website.Drs Tayyab Hassan and Hamdan Noor, in their article stress the importance ofthe educational attitude of the students in the pre- clinical years .They arguethat to gain the maximum benefit from education and the proper attitude,divine guidance is essential. While they believe that spirituality has been missingfrom the education system , they describe a trend in Western societies toreintroduce it. In Muslim countries, there should be emphasis on the model ofmedical education that not only binds the sciences together but also includesthe Qur’an and the Sunnah in the medical curriculum. The Qur’an addressesboth physical and spiritual components as related to health. This means thatthe Islamic philosophy of medicine is distinct and needs to be taught in ourmedical schools . They recommend that students learn to obtain spiritualhistory of their patients, study of the Prophet’s Seerah specifically as a rolemodel , learning the Du’a and the beautiful names of Allah (SWT). Also theyneed to be taught complementary and alternative medicine. These measureswill promote the personal and professional development of the students aspious Muslims, life long learners, and competent and kind physicians.Dr Afshan Khan advocates the use of the Problem Based learning (PBL) and SelfDirected Learning (SDL) model of education that not only binds the sciencestogether but will bring relevant Islamic medical ethics and references from thehistory of medicine during the early Islamic period into play. She favors theSPIRAL integration of the medical curriculum with core areas of Islamic MedicalInstruction (IMI)in tandem with the medical subjects. She envisions thatstudents can be asked problems that directly or indirectly address aspects ofIslamic medical ethics and Islamic civilization.PBL packages can be written sothat participants research issues related to Shariah and Fiqh.While it seems that professionalism is part of ethics, Dr Shaharom opines thatit should be treated as a distinct entity. It defines the practice of medicine asFIMA YearBook 2009X

Editoriala moral endeavor that requires a rigorous application of behavioral and ethicalstandards in addition to the scientific training. He defines professionalismto include dedication, respect, compassion, empathy, honesty, altruism,responsibility, integrity, self respect, magnanimity, and accountability.The author believes that most of these characters are embedded in theQur’anic teachings . These principles as well as the Islamic teachings couldbe incorporated in the student- centered approach of learning. Dr Shaharombelieves so strongly in this aspect of Islamic medical education that if thisprogram is instituted in the early college years, students who are unwilling tobe properly educated can be identified. They need to be counseled .If they showno signs of improvement, they should be guided to leave medicine as a career.Dr Osman expands on this concept . He describes its implimentation atthe Kulliyyah of Medicine at IIUM.A specifically designed module in medicalprofessionalism and proper physician etiquette has been organized for thirdyear medical students prior to their first encounter with patients. This moduleteaches four attributes: expertise, ethics, communication, and compassion.It incorporates Islamic values and practice of Islamic culture as the propergreeting(giving salam), and observing good Akhlaq (manners). In addition, todidactic teaching, a workshop is organized which incorporates case studiesthat represent the following themes: appearance and composure, examinationof a patient of the opposite sex, medical confidentiality, verbal consent, refusalof treatment at own risk discharge, breaking bad news, and making Du’a beforeprocedures .Drs Hassan, Khan, and Abdul Rahman discuss “Muslim Contribution toResearch, Past, Present, and Future”. They describe how Islamic teachingsand the environment in which they lived sparked the pursuit of learning andresearch by scientists of the early Islamic period, how the Muslim physiciansand scientists established centers of learning all over the Muslim World, andhow the Arabic language became the language of learning. The authors describethe establishment of libraries, medical schools, and a system of formal medicaleducation primarily through apprenticeships. This Islamic civilization spannedclose to 1000 years. Then they discuss the factors that led to the decline ofIslamic civilization/science. We are now lagging behind other nations in scientificoutput. The authors report that the number of cited publications from sixMuslim countries : Indonesia, Pakistan, Egypt, Iran, Saudi Arabia, and Malaysiato be miniscule compared to the developed countries. Although the output hastripled from 2005 to 2009, the authors state that is not good enough as theoutput has increased during the same period six fold from the Netherland, andnine-fold from Israel. Muslim countries do not provide the proper environmentfor science to flourish. Muslim scientists have to move to the West to pursuetheir academic careers. Many of them excel in their fields and become worldFIMA YearBook 2009XI

Editorialfamous. So it is clear that the talents are there but Muslim countries do nothave the infrastructure to nurture and support the young scientists to makethem productive. The authors then submit a stepwise plan to correct thisglaring deficiency . This should be based on inculcation of research culture inthe medical students and the inculcation of Islamic values that propelled theadvancement in the early Islamic era. The suggested strategy includes, amongmany others, the following :1.establishing endpoints that is respectable research output from Muslimcountries.2. establishing Muslim medical institutions which include SPIRAL integrationof research and Islamic values with medical curricula. Students have to learnresearch as a standard subject not as an option or area of interest.Clearly, such efforts cannot succeed without commitment of the government.This means more financial support, and ensuring the independence of theuniversities. Funding can also be provided by private sources. I can add thatin the Gulf countries there is a movement in that direction. A University ofScience and Technology has been established in 2009 as well as stem cellresearch centers in Jeddah and Riyadh, Saudi Arabia. New modern researchcenters have been established in Qatar, and in United Arab Emirates. Hopefullythis trend will continue and expand in other fields of medicine and to otherArab and Muslim countries. (4-7)As mentioned by Dr Hassan et al it is important to inculcate research culturein the medical curriculum. This should not stop there. Residents in trainingshould be asked to participate in research either basic or clinical. Facultymembers should be required to initiate meaningful research . They should besupported by their medical schools financially and by giving them dedicatedtime for research. Private practitioners can and should perform clinical research.Dr Faroque Khan in his article stresses that . He gives examples of his ownexperience as well as several other clinicians who made important discoveries.All that is needed is scientific curiosity, astute observation, persistence, andI may add hard work.In my article in this issue “ Ethics of Clinical Research: An Islamic Perspective”I reiterate the glorious history of research in the early Islamic period and thatIslam exhorts us to pursue learning and research. Then I draw attention tothe pitfalls that may occur while conducting clinical research i.e. dishonestyin reporting results or abuse of the research subjects. Unfortunately thesestill happen. Ethical principles have been articulated by the World MedicalAssociation in 1964 at a meeting in Helsinki, Finland; the Declaration of Helsinki.FIMA YearBook 2009XII

EditorialIt has been updated several times, the last of which was in the meeting at Seoul,South Korea in 2008.Guidelines were developed by the Council of InternationalOrganizations for Medical Sciences (CIOMS) in 1982.These have been updatedin 2002. The Islamic Organization of Medical Sciences(IOMS) convened aconference in Cairo, Egypt in 2004 to relate Islamic principles to the CIOMSguidelines. It published “The International Ethical Guidelines for BiomedicalResearch involving Human Subjects: An Islamic Perspective”. Basically, IOMSfound that most of these guidelines are in conformity with Islamic rulings. Inmy article I point out some of the differences. I also stress the importance ofintegrity in clinical research as an amana (trust) that is a basic principle ofIslam. We continue to hear about drug companies falsifying data about thesafety of their products or at least hiding any negative findings. (8) While this isshameful, it will be doubly so if committed by a Muslim scientist or institution.It is sad to see the government of Turkmenistan, a predominantly Muslimcountry, forcing its employees to falsify statistical data presumably to improveits international standing. (9) Muslims who have taqwa (God-consciousness)should be the first to promulgate those ideals as we are given the privilege byAllah to care for His most honored creation, the human race.Many of the multinational drug companies are now conducting researchon new medications or products in developing countries, many of which areMuslim majority countries. CIOMS Guideline 3 directly and Guidelines 10, 12,21 indirectly address this situation. Muslim physicians should monitor theseexternally sponsored research in their own countries .They need to ensure thatthe ethical guidelines are applied and that they are not less stringently appliedthan when applied in the sponsoring organization (s) countries.Dr Aly Misha’l in his article chooses another term for the Islamic input inmedical education i.e. Tarbiyah (moral upbringing). He believes the term derivesits origin from Islamic values which harmonize man’s relationship with hisCreator, fellow humans, and the environment. Tarbiyah is the manifestation ofTawhid, as it integrates matter and soul, body and mind. Dr Misha’l stressesthe fact that science in general and medicine specifically is a form of worship.It is the means that we exercise thinking and contemplation in God’s creationas we are ordered to do in several Qur’anic verses. Medical care provided withthe proper intention to save human lives and alleviate human suffering is alsoa form of worship.Dr Misha’l also addresses the concept of medical bioethics. He defines it asthe application of recognized principles in making decisions about medicalpractice and research. Islamic medical ethics in addition has to depend onlegal codes derived from al-Shariah.FIMA YearBook 2009XIII

EditorialDrs Iqbal Khan, Rehan Khan, and Masood Anwar elaborate on this point. Theyopine that “Islamic ethics is far more superior than Western medical ethics asit protects both the doctor and the patient not only from the sins of worldlystandards but also of divine standards too.”In this conjuncture I will add that the recent biotechnological advances, e.g,the various assisted reproductive technologies including gamete donationand surrogacy, stem cell research, cloning, organ donation, etc. raised majorethical, social, religious and legal issues. Islamic organizations consisting ofIslamic scholars, physicians, scientists have been formed to give the Islamicperspective on these issues. Examples include IOMS, Rabitat al-‘Alam al-Islami,Federation of Islamic Medical Associations (FIMA) and in North America, theethics committee of the Islamic Medical Association of North America (IMANA),a member of FIMA , and many others. The latter published position papersabout Islamic medical ethics, and stem cell research in booklet formats, (10,11)while Islamic scholars issue fatwas (religious decrees).Drs. Iqbal Khan et al also argue that the most significant constituent ofan effective curriculum for Muslim doctors is the integration of behavioralelements based on the truthful understanding of Islamic medical ethicalvalues. They stress the importance of the teacher as a role model for thestudents and the importance of having an Islamic environment in the medicaleducational institution / teaching hospitals. They also stress the importanceof continuing medical education.In another article Dr Iqbal Khan along with Dr Anis Ahmed stress theimportance of quality control in higher education. Measures have to be in placeto assess the quality of the infrastructure, the services, human resources,curricula, instructional strategies, and research quality. It should also assessthe quality of the student selection process , their as well as the alumniperformance. The quality assessment should address the academic counseland faculty development. They equate quality control with the Islamic conceptof Ihsan(excellence). They propose different of quality control models anddescribe benchmarks to be used in the assessment.In this yearbook the different aspects of integrating Islamic values in medicaleducation, research, practice and ethics is presented. It does bring outidealistic ideas but all can be implemented if there is a determined leadership.It behooves all of us to keep these lofty goals in mind and to work hard toimplement them everyone in his or her sphere of responsibility. We ask thatFIMA takes a leading role and to continue its efforts in this regards.I conclude by thanking all the authors who contributed to this issue. I especiallythank Drs Aly Misha’l, Abul Fadl Ebrahim, and Musa Nordin for their valuableFIMA YearBook 2009XIV

Editorialhelp and guidance. I sincerely appreciate the work done by Dr Misha’l’s stafffor copyediting and proofreading of the manuscripts, especially Miss ElhamMohammad Swaid.I pray that Allah (SWT) accept and bless our efforts in His service. May Allah(SWT) guide us to the right path and have mercy on us. Amen.WassalamEditor-in-ChiefHossam E Fadel, M.D., Ph.D., F.A.C.O.GMaternal Fetal Medicine.Clinical Dr, Department of Obstetrics and Gynecology, MedicalCollege of Georgia,Augusta, GA, USAFIMA YearBook 2009XV

EditorialReferences1. Elkadi A. Islamic Medicine in North America. J Islam Med Assoc. 1984;16:8-10. Availablefrom http://jima.imana.org/article/view/5956/16_1_2-32. Nagamia HF. New definition of Islamic medicine. ‘Neo-islamic Medicine”. J Islam MedAssoc. 1996;28:100-1. Available from http://jima.imana.org/article/view/59573. Fadel HE. Editorial: What is Islamic Medicine? How does it relate to ContemporaryMedicine? J Islam Med Assoc. 2008;40:56-8. Available from http://jima.imana.org/article/view/4448/V40N2-56-84. Al- Awady N.”Gulf States Embrace Stem Cell Technologies at Home and Abroad’Nature Reports Stem Cells . Available at http:// dx.doi.org/10.1038/stemcells.2008.21.[Modified 7 April 2008; Accessed 25 Mar2010]5. McKay DM. An international view of the regulation and funding of embryonic stem cellsin Therapeutic Research. Texas Transnational Law Quarterly. 2003;17:149.6. Gottweis. Ethics and Politics of Stem Cell Research, presented at the Qatar Stem CellWorkshop 2009: Saving lives or Crossing Lines. Qatar Foundation Research Division,Weill Cornell Medical College, Doha, Qatar, March 2009.7. Voice of America. “Virgin Mega-Brand Launches Stem Cell Bank in Qatar.” Availableat http://www1.voanews.com/english/news/a-13-2009-03-voa50-68636117.html.[Updated 23 Mar 2009; Accessed 21 Mar 2010]8. Strengthening the credibility of clinical research. Lancet 2010; 375: 1225.9. Médecins Sans Frontières. Turkeminstan’s opaque health system. Amsterdam:Médecins Sans Frontières; 2010. Available from http://www.msf.org/source/countries/asia/turkmenistan/2010/turkmenistan_health_system.pdf. [Accessed 8 May 2010]10. Athar S, Fadel HE, Ahmad WD et al. IMANA Ethics Committee. Medical Ethics:the IMANA Perspective. J Islam Med Assoc. 2005;37:33-42. Available from http://jima.imana.org/article/view/5528. [Last accessed 8 May 2010]11. IMANA Ethics Committee. Stem cell research: the IMANA perspective. Lombard, IL:Islamic Medical Association of North America; n.d. http://imana.org/PDF%20Files/Stem%20Cell%20Position.pdf. [Accessed 8 May 2010]FIMA YearBook 2009XVI

Federation Of Islamic MedicalAssociations (FIMA) in Brief• Established at the outset of the 15th Hijrah century, December 1981, inOrlando, Florida, USA, where senior leading medical figures representing tenIslamic medical organizations, from various parts of the world, convened andlaid down the foundation of the Federation.• Subsequently FIMA was incorporated in the State of Illinois as a non-profitorganization, then acquired the special consultative status with the UnitedNations Economic and Social Council ( ECOSOC ).• Since that time, FIMA membership progressively expanded to include 25full members, 9 associate members, and more than 15 prospective andcollaborating organizations from all over the world.• Most FIMA activities and achievements are based on the endeavors of itsmember Islamic Medical Associations, in constructive mutual cooperation,and harmonious understanding.• These activities include, but are not limited to:1. Cooperation in medical relief work, where and when needed in disaster strickencountries. The last endeavor was the “ Save Vision Campaign”, where more than45,000 cataract and intra-ocular lens surgeries were performed in Darfur-Sudan, Chad, Somalia, Senegal, Nigeria, Burkina Faso, Sri Lanka, Indonesia,Afghanistan and Pakistan by ophthalmology teams volunteering from IMAsfrom several countries.This activity qualified FIMA for a distinguished award from the AmericanCollege of Physicians ( ACP ), designated for outstanding humanitarianachievements.Training of local medical professionals in some of these countries wasinstrumental in continuing and widening of these activities by local talents.In Gaza and other Palestinian Occupied Territories, FIMA has been functionalin establishment of eye facilities, provision of ophthalmology equipments, aswell as training of doctors and other paramedical personnel.Over the past year, two new humanitarian activities were launched in Sudan: Thecleft palate-cleft lip, and the vesico-vaginal fistula projects. Both problems werehighlighted by the IMA of Sudan as locally needed projects in some districts.2. Scientific, professional and ethical jurisprudence related conferences, seminarsand publications.FIMA YearBook 2009 XVII

FIMA3. Establishment of the Consortium of Islamic Medical Colleges (CIMCO), to fostercooperation in improvement of curriculum, training, research, administration,and up-bringing of model medical practitioners.4. Establishment of the Islamic Hospitals Consortium ( IHC ), to pursuecooperation and coordination among medical professionals and hospitaladministrators in areas of experience exchange, improvement of health caredelivery, ethical, administrative and operational activities, to meet the mostadvanced international standards, in the context of Islamic principles.5. Publication of FIMA Year Books, which address biomedical ethical issues thatare needed for medical practitioners, educators as well as Jurists.6. Medical students activities, including conferences, seminars, publications,camps, Umrah and Ziarah programs.7. Collaboration to extend a helping hand to Muslim medical practitioners inunderprivileged countries, to work together and organize professional medicalsocieties.8. CME programs, and establishment of a Council of highly qualified professionalsfor development, improvement and supervision of these activities.9. Establishment of Resource Centers, such as the HIV/AIDS Resource Center,Islamic Biomedical Ethics Resource Center, and in the planning, is the Women’sAffairs Resource Center.10. HIV/AIDS prophylactic, social and therapeutic activities have been underwayin several countries for the past two decades.Islamic medical activities of FIMA have a holistic nature. Leadership,mutual cooperation and innovation are prerequisites for the welfare ofour communities, our Ummah and humanity at large.For Correspondence:qqqqFIMA President: Dr. Parvaiz MalikE-mail: pmalikmd@gmail.comFIMA General Secretary: Dr. Tanveer ZubairiE-mail: tanveer.zubairi@gmail.comFIMA Executive Director: Dr. Aly A. Misha’lE-mail: info@islamic-hospital.org, fimainfo@islamic-hospital.orgYear Book Editor in Chief : Prof Hossam E. FadelE-mail: hefadel@comcast.netFIMA WEBSITE: www.fimaweb.netFIMA YearBook 2009 XVIII

A 13-Year Experience Of Integrating Islamic ValuesIn The Medical Curriculum In South-East Asia:a model of Islamization of knowledge, tajribat al mudkhalat al islamiyyah fi al manahijal tibbiyyah fi junub sharq asia: namudhaj al ta’ asil al islami li al tibbOmar H. Kasule*AbstractThe paper traces the historical development of the Islamic Input in the MedicalCurriculum from its inception in 1995 to date. The Islamic Input in the MedicalCurriculum (IIMC) integrates Islamic values and Law in the teaching andpractice of Medicine. It was successfully implemented over a 13-year period(1997-2010) at the Kulliyah of Medicine of the International Islamic UniversityMalaysia and for varying and shorter periods at other schools of medicine inand outside Malaysia. IIMC achieved Islamization of the curriculum throughintegrating of the teacher (teacher of medicine also teaches Islamic values), theteaching materials (Islamic values and law related to medical knowledge), andassessments (questions on Islam included in the examinations). IIMC has 5objectives:(a) introduction of Islamic paradigms and concepts in medicine, mafahiimIslamiyat fi al Tibb. (b) Strengthening faith, iman, through study of Allah’ssign in the human body. (c) appreciating and understanding the juridical, fiqh,aspects of health and disease, al fiqh al tibbi. (d) Understanding the social issuesin medical practice and research and (e) Professional etiquette, adab al tabiib,from the Islamic perspective. Students who have graduated from the programare now practicing physicians and are involved in a new initiative to establishand run Islamic hospitals that follow Islamic values in their practice.Keywords: Medical curriculum, Islamic medical education, Islam, Islamic Jurisprudence.Professor Dr Omar Hasan Kasule MB ChB (MUK),MPH (Harvard), DrPH (Harvard)Professor of Epidemiology and Islamic MedicineUniversity of Brunei DarussalamVisiting Professor of Epidemiology at University of MalayaProfessor at the Faculty of Medicine King Fahd Medical City RiyadhWebsite: http://omarkasule.tripod.comE-mail: omarkasule@yahoo.comFIMA YearBook 20091

A 13-Year ExperienceIntroductionThe paper traces the author’s journeyin the development of the IslamicInput in the Medical Curriculumand its theory and practice over aperiod of more than two decades. Itdelineates distinct stages: definitionof an Islamic epistemology, definitionof Islamic and prophetic medicine,definition of the philosophy of Islamicmedical education, preparationand implementation of IIMC at theKulliyah of Medicine UIA, training ofIIMC teachers, dissemination of IIMCand its supporting materials (to othermedical schools, medical practitioners,and ulama, using the internet andface-to-face workshops), and furthertheoretical developments on Islamicconcepts (in basic medical sciences,ethics and law, social and preventivemedicine, and personal developmentof the physician). The sequence abovewas correct in essence but there wereoverlaps between stages. The date ofpublication or presentation of conceptsis also not a true indicator of theirgenesis. Many concepts were incubatedin the author’s mind for a long timebefore public presentation. The futurestages envisaged in the sequence areevaluation of the impact of IIMCand extending IIMC to postgraduateeducation. The paper is mainly a recordof history and the same paper titlehas been quoted with dates reflectingchanges in thoughts with passage oftime as ideas fermented and matured.The paper is written in the first personand in the past tense for ease ofhistorical narration.Start In The Early 1980sMy journey towards the Islamic Inputin the Medical Curriculum startedin 1981 when I presented a paper atthe First International Conferenceof Islamic Medicine that was held inKuwait. I made an argument in thatpaper that the practice of modernmedicine must reflect Islamic values (1) .The paper was well received but itwent against the general interest ofthe conference which was historicalMuslim medicine. At the SecondConference of Islamic Medicine alsoheld in Kuwait in 1982, I presented apaper arguing that Islamic medicinemust be reflected in practical medicalaid for the poor and the destitute andI used Africa as a case in point (2) . Irevisited this issue in 1998 (3) but it didnot hold my attention for long. I wasintellectually restless because I was notcomfortable with the idea of Islamicmedicine being seen in a historicalperspective only. I was equally unhappywith Islamic medicine being seen onlyas delivering charity medical services.I sought a distinct Islamic conceptualperspective in medical sciences andmedical practice. The need to reformmedicine using Islamic principles wasstill an intellectual challenge 15 yearslater (4) . This continuing intellectualrestlessness and curiosity led me tothe field of Islamization of knowledgeand the development of an Islamicepistemology.FIMA YearBook 20092

A 13-Year ExperienceIslamization Of Knowledge: A ProjectOf Epistemological ReformCrisis of knowledge:I spent the period 1982-1994 workingon various projects of Islamizationof Knowledge as a strategy to resolvethe ummatic crisis of knowledge. Idiscussed the crisis in a series of paperseven as recent as 2007 (5, 6) . There wasa dichotomy in the education system:traditional Islamic vs. importedEuropean. There was a dichotomyin the sources of knowledge, ulumal din vs ulum al dunia. Studentscould not deal with the contradictoryworld views presented to them andended up confused. This resulted inthe elite of the ummah having a splitmindneither traditional Muslim norEuropean. This confusion resulted inintellectual weakness with inability toanalyze and solve the problems of theummah. The crisis also explained whyafter many years of sending studentsoverseas to acquire knowledge, theummah was still dependent on othersin the fields of science and technology.Motivation for innovation in scienceand technology cannot occur in thepresence of intellectual confusionabout basic issues like identity. Afteryears of involvement with the issueof the crisis of knowledge, I reacheda working definition of Islamizationof knowledge as well as a practicalstrategy for achieving it. I believed thenas I continue to believe today that theIslamization strategy could effectivelyresolve the crisis of knowledge both inmedicine and other disciplines.The concept of Islamization ofknowledge:Islamization was a process of recastingthe corpus of human knowledge toconform to the basic tenets of ‘aqidat altawhid. The process of Islamization didnot call for re-invention of the wheelof knowledge but called for reform,correction, and re-orientation. It wasevolutionary and not revolutionary. Itwas corrective and reformative. It wasthe first step in the Islamization andreform of the education system (7) asa prelude to Islamization and reformof society (8) . Islamization had to startwith reforming the epistemology andmethodology of each discipline in apro-active, academic, methodological,objective, and practical strategy. Itsvision was objective, universal, andbeneficial knowledge in the context ofa harmonious interaction of humanswith their physical, social, and spiritualenvironment.Immediate goals of the Islamizationstrategy:The Islamization strategy had sixgoals. The first goal was purging fromexisting disciplines of paradigms andconcepts that reflected parochial worldviews in order to achieve universalobjectivity. The second goal wasreconstruction of the paradigms usinguniversal Islamic guidelines. The thirdgoal was re-classifying disciplines toreflect universal tawhidi values. Thefourth goal was reforming researchmethodology to become objective,purposeful, and comprehensive.FIMA YearBook 20093

A 13-Year ExperienceThe fifth goal was generation of newknowledge by research. The sixthstep was inculcating morally correctapplication of knowledge.Dissemination of the Islamizationstrategy:I presented papers clarifying basicepistemological issues from an Islamicperspective such as the nature ofknowledge (9,10) , the history of humanknowledge (11) , the philosophy ofknowledge (12) , the methodology ofknowledge (13) , the Islamic perspectiveof knowledge (14) , and development of ascientific culture (15) . It was clear to mefrom the beginning that Islamizationof medicine was not about contentbecause content changed quickly withon-going research. Islamization had toaddress basic conceptual issues in themethodology of research. I thereforepresented a paper in September 1996in which I explained conceptualproblems in contemporary researchmethodology and an Islamic approachto methodological reform (16) . In thesame direction I presented paperscritiquing the empirical methodologynot in its practical essence butits underlying often unstatedphilosophical assumptions and biasesin data interpretation (17-19) .Islamization of medicine:The decision to focus Islamizationefforts on medicine was not easy becausethe conventional wisdom gave priorityto the social and human sciences. Ihad never been comfortable with thenotion that priority of Islamizationwas in the social sciences on the basisthat had underlying paradigms thatcontradicted tawhid and that they had abigger impact on society. I realized thatthe first assertion was not true sincenatural sciences including medicinewere far from being value-neutral orculture-neutral. I also realized that thesecond assertion was untrue becauseall major social changes had medical orengineering innovations as catalysts. Iwrote a paper on the impact of the oralcontraceptive pill on society and familystarting in 1960 to prove the point. Itherefore started looking at the work ofIslamization of medicine as a model forother disciplines of knowledge (20) .Towards an Islamic epistemology:I devoted attention to the concept ofintegration which was the essence ofepistemological reform since it wouldmarry Islamic values and science.The paradigm of tawhid underlay allintegration efforts (21) . An integratedmedical curriculum had to haveIslamic values embedded (22) in it.Integrated medical practice requiredintegrated medical education (23)because physicians trained in anintegrated curriculum were likelyto practice integrated medicine. AsI progressed further in the evolvingconcept of integrating Islamic valuesin medicine, it became clear to me thatwe would not move forward unless wedeveloped an Islamic epistemology (24)and that more theoretical work onIslamic epistemology needed to beFIMA YearBook 20094

A 13-Year Experiencecarried out. I presented several paperson research priorities in epistemologyand thought (25-28) . The interdisciplinarynature of medicine led me to presentpapers on epistemological issuesin other disciplines (29-32) as well asreform those disciplines within theIslamization paradigm (33-36) . Theseideas were disseminated at severalseminars of non-medical nature outof the realization that Islamization ofmedicine could not be carried out inisolation (37-40) .Definition Of Islamic Medicine1-Muslim vs Islamic medicine:After clarifying Islamization and relatedepistemological issues, I addressed thedefinition of Islamic medicine. This wasneeded to counter strong tendenciestowards regarding the Islamizationof medicine as a return to traditionalMuslim medicine practiced centuriesearlier. My conviction was that wewere dealing with Islamizing scientificmedicine and not doing away with it.In July 1995, I presented a paper at aconference in Kuala Lumpur on myconcept of Islamic medicine (41) . Thepaper continued to generate interesteven 10 years later and was representedat various forums after that, for examplein Indonesia (42) and was publishedat least two times (43-44) . I started byclarifying the semantic confusionbetween the adjectives ‘Islamic’ and‘Muslim’. I explained that ‘Islamic’ refersto values, ideas, guiding principles, andapplication of the Qur’an and ‘Muslim’refers to people who self-identify asMuslims as well as their activities andinstitutions. They may not follow allthe teachings of Islam. Thus Islamicmedicine, the ideal, is not the same asMedicine of Muslim societies, which isthe actual historical or contemporaryexperience of Muslim societies.2- Islamic medicine as concepts andparadigms:I then defined Islamic Medicine asMedicine whose basic paradigms,concepts, values, and proceduresconform to or do not contradict theQur’an and Sunnah. I emphasizedthat Islamic medicine was not relatedto specific medical procedures ortherapeutic agents used at a particularplace or a particular time. Islamicmedicine was universal, all - embracing,flexible, and allowed for growth anddevelopment of various methods ofinvestigating and treating diseaseswithin the frame-work describedabove. I concluded that this definitioncalled for basic transformation ofmedical systems. Islamic medicine thuswould become the result of an Islamiccritique and reformulation of the basicparadigms, research methodology,teaching, and practice of medicine. Thisprocess of conceptual transformation isalso called Islamization of medicine.I revisited the issue of the role ofQur’an and sunnah in medicine inseveral presentations because of itsimportance (45-46) .Definition Of Prophetic MedicineThe next task was to address theFIMA YearBook 20095

A 13-Year Experiencetendency towards confining Islamicmedicine to Prophetic medicineand thus making it unnecessary toIslamize modern scientific medicine.I addressed the issue of Propheticmedicine in several papers in SouthAfrica (47) Malaysia (48) , and Indonesia (49) .The general grain of my argumentswas that Prophetic medicine wasvalid and effective, since propheticpronouncements and practices wererevelation, but that new research wasneeded to characterize efficacy, dosage,indications, and contraindicationsof herbal remedies today becauseof changes in the people, the herbsused, and disease pathology. Languagechanges had also to be taken intoaccount because a word used for aherb or a disease centuries ago maynot have the same meaning today. Ialso argued that Prophetic medicinedid not cover all medical conditionsand diseases since it was limited by itsspatio-temporal context. These effortssucceeded in diverting attention fromIslamization of scientific medicine toconfining understanding of Islamicmedicine to the historical forms ofProphetic medicine. The modern useof concepts from Prophetic medicineafter new research was explored inseveral fields for example in primaryhealth care (50) . After deliberatingProphetic medicine for over 10 yearsI realized that what is defined asProphetic medicine was only a smallportion of hadiths relating to medicine.There were many hadiths of medicalsignificance that were not recognizedby our ancestors because the medicalknowledge available at their time couldnot enable them identify the medicalsignificance of all hadiths. I thereforestarted making a new collection ofhadiths with view to expanding thedefinition of Prophetic medicine (51-52) .Philosophy Of Islamic MedicalEducationThe philosophy of Islamic medicaleducation was presented at a conferenceorganized by the Islamic MedicalAssociation of Malaysia at Khota Bharuin Kelantan in June 1996 in a papertitled ‘Concepts of Islamic medicaleducation’ (53) . The contents of the paperwith improvements were presentedsubsequently at later forums (54-57) . Ipresented 6 problems or issues incontemporary medical educationand explained how an Islamic Inputcurriculum would address them.The 6 conceptual issues were thepurpose of medicine, integration ofthe curriculum, the service vocationin medicine, physician leadershiprole, medical research as ijtihad, andphysician motivation. The purpose ofmedicine, which defines the system ofmedical education, was to maintain orimprove the quality of life and not toprevent or postpone death. Integrationof the curriculum, deriving from thetauhidi paradigm, implied practice andteaching of medicine as a total holisticapproach to the human in the social,psychological, material, & spiritualdimensions and not exclusively dealingwith particular diseases or organs.FIMA YearBook 20096

A 13-Year ExperienceThe selection of medical students,their training, and evaluation shouldemphasize that medicine is a humanservice within the context of Islamicmutual social support, takaful ijtima’i.The physician must provide leadershipas a social activist who identifies andresolves underlying social causes of illhealth;as a respected opinion leaderwhose moral values & attitudes area model for others; and as an advisoron medical, legal, and ethical issuesassociated with modern medicaltechnology so that the patients andtheir families can reach an informeddecision. The future physician mustbe prepared to undertake research, atype of ijtihad, to extend the frontiersof medical knowledge, applyingavailable knowledge and improvingthe quality of life. Time allocated tobasic research methodological toolsshould be increased at the expense ofaccumulating biomedical scientificinformation that is either forgottenor becomes obsolete by the timeof graduation. The education anddevelopment of the physician before,during, and after medical schoolshould inculcate the motivation toexcel in commitment, ikhlas, and caredelivery following the model of theearly Muslim scientists and physicians.Implementation Of The Islamic InputIn The Medical Curriculum (IIMC)1- Preparation of the curriculum:I realized that the process ofIslamization of medicine could onlybe achieved by training future doctors.In October 2005, I joined the newlyformed Kulliyah of Medicine in theInternational Islamic UniversityMalaysia with the determination to putthe views of medicine developed overthe years in the medical curriculum.A draft curriculum was prepared andwas approved by the University Senate.Some lecturers from the faculty ofIslamic studies were not comfortablewith physicians treading on theirterritory and teaching Islam. Toovercome skepticism then prevailing,actual teaching material with Qur’anicand hadith sources was bound in avolume and was presented to the Senate.The basic outline of the curriculumremained the same but changes weremade whenever curriculum reviewswere carried out. The newly foundedFaculty of Medicine at the InternationalIslamic University situated at Kuantanon the East Coast of Malaysia had thedistinction to the best of my knowledgeof being the first faculty in the Muslimworld to formally teach IIMC.2- Start of Implementation:Medicine with embedded Islamicvalues was taught at Kuantan from July1997 to date. Credit for the success ofthe implementation belongs solely toProfessor Tahir Azhar, the foundingdean of the Kulliyah of Medicine,who wholly believed in a new anduntried approach and gave consistentunwavering support over a wholedecade. The implementation was madeeasier by the fact that we were dealingwith a new medical school. We thereforeFIMA YearBook 20097

A 13-Year Experiencecould afford to focus on developingdetailed teaching material for the firstyear only. We prepared more material asstudents moved on to the second, third,fourth, and fifth years.3-Integration:The main motive of IIMC wasintegration to resolve the crisis ofduality or dichotomy manifesting asteaching of Islamic sciences separatefrom that of medical disciplines withdifferent teachers and from differentinstitutions. IIMC resolved the crisisof duality by insisting that Islamicconcepts should be taught by the samepeople who teach medical disciplines.This required specific training ofthose lecturers to be able to handle theIslamic Input. IIMC besides integratingthe teacher and study material,also integrated the examinations.Questions on IIMC were embeddedin all examinations of the Kulliyah.IIMC also achieved integration oftheory with practice with studentsbeing taught in a practical way how apatient can perform acts of ‘ibadat. TheDepartment of Orthopedics was themost successful in this endeavour.4-Joint reading of 2 books:IIMC followed the Islamic paradigm ofreading 2 books: the book of revelation,kitab al wahy, and the book of empiricalscience, kitab al kawn. Both bookscontain signs of Allah, ayatullah, andmust be read together. It is a mistaketo read one of the books and neglectthe other. The solution to the crisis ofduality in the ummah starts from jointreading of the 2 books, al jam‘u baina alqira’atain. Thus medical scientists whoare involved in IIMC read the signs inboth books contemporaneously.5-Two components of IIMC:IIMC had two separate but closelyrelated components: Islamization andlegal medicine. Islamization dealt withputting medicine in an Islamic contextin terms of epistemology, values, andattitudes. Legal medicine deals withissues of application of the Law (fiqh)from a medical perspective.6-Five objectives of IIMC:The 5 main objectives of IIMC were:(a) introduction of Islamic paradigmsand concepts in general as they relateto medicine, mafahiim Islamiyah fi alTibb. (b) Strengthening faith, iman,through study of Allah’s sign in thehuman body (c) appreciating andunderstanding the juridical, fiqh,aspects of health and disease, al fiqhal tibbi. (d) Understanding the socialissues in medical practice and researchand (e) Professional etiquette, adab altabiib, from the Islamic perspective.7-Teaching material of IIMC:All through the past 13 years I workedon the teaching materials for IIMCthat would eventually be publishedas a textbook. I shared the materialswith other medical educators eitherdirectly or through the internet. Thereluctance to print the materials wasdue to the desire to get the full benefitFIMA YearBook 20098

A 13-Year Experienceof feedback from actual teaching ofIIMC and this in hindsight proved avery prudent measure to take becausemany major revisions had to be made.IIMC being an innovative product thatstill needed to be accepted should bepresented in a textbook that has beentried out and improved as much aspossible. At the start the IIMC manualwas titled ‘Muqaddimat al tibb: anIslamic introduction to the study ofmedicine’. In 2006 the title was changedto ‘Muqaddimat al ‘uluum: Islamicintroduction to the study of sciences’after realizing that the manual, like thestudy of medicine, was interdisciplinarycovering basic biological and physicalsciences, health sciences, and socialsciences. A synopsis of the manual isavailable at http://omarkasule.tripod.com). A major revision is envisagedby the end of 2009. The manual is aseries of 18 manuscripts arranged in 5main themes: Theme One: Asasiyyat(Fundamentals) 1: ‘aqidah (creed); 2:usul al shari’ah (foundations of the law);3. ‘ilm and ma’arifah (epistemology);4. khalq (creation / cosmogony); 5.tarikh al umam (world history); 6.tarikh al ummah (Muslim history);7. al tajdid and al islah (renewal andreform); Theme 2: Fiqh Al Ulum AlTibiyyah, (Basic Medical Sciences): 8.‘ilm al hayat (the science of life); 9. jismal insan (the organism: structure andfunction); 10. fiqh al ‘adat (activitiesof daily living); Theme Three: Fiqh AlTibabah (Clinical Sciences): 11. AkhlaqAl Tibb (Ethics Of Medicine); 12. FiqhAl Amradh (Disease Conditions); 13:Fiqh Mustajiddat Al Tibb (ModernMedicine); Theme Four: Fiqh AlJama’ah (The Community): 14. ArkanWa Humum Al Jama’ah (InstitutionsAnd Concerns Of The Community);15. Fiqh Al Mu’amalat (Transactions);Theme Five: Personal Skills: 16. AlTakwin Al Asasi (Basic Formation):17.: Qiyadah(Leadership); 18. Idarah(Management)8-Evaluation of IIMC:After graduating 5 batches of studentswe wanted to make an evaluation of theproducts of the curriculum. A conceptpaper was prepared (58) but the actualdata collection proved elusive untiltoday. A research project was carriedout on ethico-legal knowledge bystudents at UIA (59) and the results willbe published subsequently.9-Implementation of IIMC at thepostgraduate level:After 10 years of teachingundergraduates (1997-2007) a startwas made in exploring Islamizationat the postgraduate level in the fieldof epidemiology. A course was taughtin 2007 successfully with an Islamicepistemological introduction (60) .10-Implementation of IIMC at otherschools of medicineThe start was a year-long course onIIMC for lecturers at the Universityof Malaya in 2002. Then a modifiedform of IIMC was adopted by thenewly founded medical school atthe Islamic University of Science inFIMA YearBook 20099

A 13-Year ExperienceMalaysia starting in 2004. They tookthe matter seriously by appointingthe most experienced IIMC lecturerfrom Kuantan, Associate Professor DrAriff Othman, as their consultant oncurriculum development. In late 2004 alecturer, Dr Sagiran, from the faculty ofmedicine Muhammadiyah Universityin Jogjakarta visited Kuantan and spent1-2 weeks studying the implementationof IIMC. As a result of his visit, InAugust 2005 a week-long trainingworkshop was held at the school ofmedicine of the MuhammadiyahUniversity in Jogjakarta, Indonesia. Iexplained the concepts and methods ofIIMC and provided teaching materials.Implementation of IIMC then startedbut there were difficulties that hadto be ironed out subsequently. Thecurriculum has also had an impact on16 faculties of medicine in Indonesiathat integrated Islamic values in theirmedical curricula and are membersof the FOKI network (Indonesianacronym for Islamic Medical Forum). Iattended meetings of FOKI on a regularbasis and also visited campuses of itsmember faculties. I have presentedIIMC at medical faculties in Nigeria,Bangladesh, and Yaman with goodresponse. Follow up will be neededbefore IIMC can also be adopted inactual teaching.Training Lecturers of The Curriculum1-Lecturer training at KuantanI realized quite early that the curriculumwould not succeed unless there weremedical lecturers trained and confidentin its delivery. At the Kulliyah (College)of Medicine the training process wasvery hands-on. In the first academicyear 1997-1998 I gave all the lectureswhile other lecturers sat in the class.In subsequent years I started assigningspecific lecturers to teach specific topics.I made sure that I gave the lecturers asmuch support as possible in providingteaching material or discussing thesessions before they appeared in frontof the class. I also encouraged themto be innovative and not follow what Ihad provided. They did very well andin the period of 8 years I came to learna lot from their efforts and I transferredthe knowledge acquired to others. Theprocess of empowering the lecturerswas so successful that by the 2004-2005academic years I was just a consultantwith almost all lectures being taughtby others. At the end of that year Imade the decision to leave the Kulliyahof Medicine at Kuantan because mymission was complete and I neededto transfer my efforts elsewhere. Iaccepted the invitation to the chairof Islamic medicine at the Universityof Brunei Darussalam. I howeverreturned from time to time to follow upthe work at Kuantan and taught someclasses to get a feel of how IIMC wasperforming (61-73) .2-Lecturer training at other schoolsof medicineI also turned my attention to trainlecturers at other universities. In thecourse of one academic year 2002-2003 I held workshops for lecturersFIMA YearBook 200910

A 13-Year Experienceat the Faculty of Medicine Universityof Malaya on various topics: theIslamic creed (74) , the Islamic definitionof life and health (75) , fundamentalsof the Islamic Law (76) , medicaljurisprudence (77-78) , and jurisprudencerelating to biotechnology (79-80) . A newseries on bioethics training was plannedfor 2009 (81) . Lecturers were also trainedin Indonesia (82) .Dissemination Of The Curriculum1-Dissemination of IIMC by internet:It was a strategy adopted at thebeginning to make sure that all whatI wrote on IIMC was available. Itherefore, at every opportunity availableto me, wrote up my presentation as afull length paper with references fromthe Qur’an and Sunnah. All lectureson IIMC delivered were also writtenup. A total of 1067 papers and lectureswere published at the Islamic MedicalEducation Resources website (http://omarkasule.tripod.com) in the period1995-2007. The papers have also beenloaded at many websites many ofwhich are unknown to me. In order todisseminate the knowledge on a widerscale I allowed republication of mypapers in several media.2-Book publicationPapers on IIMC have been publishedas books in Bangladesh (83) andIndonesia (84-85) . Other collections are inthe process of being published.3-Lectures, workshops, and conferences:The UIA experience was sharedin papers at many conferencesand seminars in Malaysia (86-88) ,Indonesia (89-90) , and Bangladesh (91-92) .We shared our approach with othermedical educators (93-94) . I presented thenew curriculum to medical audiencesbut also to non-medical audiences (95)because Islamization was a theme forall disciplines of knowledge. I wasalso interested in values that also runthroughout all the sciences (96) . Bythe summer of 2007 I had decidedto embark on a new initiative inYaman of working to help faculties ofmedicine improve their curricula (97) ,teaching (98) , student assessment (99) ,management (100-101) , and quality (102-103) inaddition to adopting the Islamic Inputcurriculum (104) . Towards the end of2007 my thoughts were turning to theidea of starting new medical schoolsthat would use the IIMC de novo. I haddiscussions with people trying to setup such schools in Kuwait and SaudiArabia (105) .It was also clear to me that changewould have to involve all healthprofessionals and not only physicians.I therefore presented papers on thenursing perspective: history of nursingin Islam (106) , challenges to the nursingprofession in the Muslim world (107) ,issues in nursing education (108) ,motivation in the nursing profession (109) ,and professional conduct of a nurse (110) .Towards the end of 2007 I started aseries of workshops on medical ethicsfor nurses (111) .Traditional ulama were an authority inFIMA YearBook 200911

A 13-Year ExperienceMuslim societies and any viable changemust have their approval or at leastneutrality. I started by studying patternsof medical fatwas issues in Brunei (112)and other countries to understandthe mind set of the ulama. It was withthat in mind that I embarked on anexperiment of presenting ethico-legalconcepts that I developed to the ulamastarting with India. I held workshops invarious Indian cities: Hyderabad (113-114) ,Azamghar (115-122) , Lucknow (123-127) , andPatna (128-133) .Further Theoretical Developments InThe Main Themes Of IIMC1-Integrating Islamic values in themedical profession:I talked about the Islamic perspectiveof medicine (134) . I also talked aboutintegrating Islamic values in themedical curriculum (135-138) and medicalpractice (139-140) . The paradigm of tawhidunderlay all integration concepts.2-Islamic concepts relating to basicsciences:The realization that atheistic values weredisseminated in teaching basic medicalsciences prompted me to addressseveral issues relating to basic medicalsciences from an Islamic perspective.Among the issues addressed were:creation of the earth (141) , creation of thehuman (142) , human creation vs humanevolution (143-144) , the biological miracleof human creation (145) . I also addressedissues of treatment modalities in Islamincluding prayer and spirituality andspiritual approaches to treatment (146) .Also addressed were psychologicalaspects such as treatment of anxietyfrom an Islamic perspective (147) . Basicsciences were also addressed such asteaching probability from an Islamicperspective (148) . In 2004 I presenteda paper on the balance betweenoriginality and modernity in medicaljurisprudence (149) . The paper provideda conceptual context for dealing withmatters like understanding spiritualneeds of patients (150) in relation tomodern forms of medical therapy.3-Islamic perspective of ethico-legalissues:The issue of ethics engaged my attentionbecause it would show the immediateutility of the curriculum by teachingshariah-based methods of resolvingpractical problems in medical care.Using the tools of maqasid al Shari’ah,qawai’d al Shari’ah and where availabletexts, from the Qur’an and Sunnah. Iaddressed most of the contemporaryethico-legal issues and provided aconceptual basis for resolving ethicalissues in medical decisions (151) . Iaddressed the issues of changes inmedical jurisprudence that required useof maqasid al Shari’ah in the modernera. I then worked on a major paperin which I formulated a derivation ofmedical ethics from maqasd al Shari’ahand presented it in 2004 at a scientificmeeting of the Federation of IslamicMedical Associations in Amman in July2004 (152) . The paper was subsequentlypublished (153) . It was presented atvarious forums in Malaysia (154-155) ,FIMA YearBook 200912

A 13-Year ExperienceNigeria (156-157) , Indonesia (158) , KualaLumpur (159) , and the UK (160) . Acompanion paper on research ethicsbased on maqasid al Shari’ah waspresented at the same conference (161) .The paper was presented in a modifiedform in Indonesia (162) . A comparativestudy of Islamic and European ethicaltheories and principles reached theconclusion that the Islamic approachwas more robust, more practical, andmore consistent (163) . Several papers onethics from maqasid al Shari’ah werepresented in the UK (164) , Indonesia (165) ,Bangladesh (166) , India (167) , Malaysia (168) ,Kuala Lumpur (169) , Turkey (170) , andYaman (171) . I then addressed specificissues: Progeny (172-173) , AssistedReproduction (174) , Euthanasia (175) ,Contraception (176-177) , HumanResearch (178) , Suicide (179-180) , PublicHealth Research(181), Embalming,Cryopreservation, Autopsy, andResearch on Dead Corpses(182),Protection, Preservation, andPromotion of the Intellect (183) , SexualCrimes (184-185) , Midwifery (186-187) , sawm(188)with Diabetes Mellitus , Healthbenefits of sawm (189-191) .4-The Islamic perspective of publichealth and health services delivery:The following concepts in publichealth and services delivery werediscussed from an Islamic perspective:moderation, balance, and justequilibrium in preventive medicinebased on the Qur’anic concepts ofwasatiyyah, mizan, & itidal (192) , medicalquality improvement (193-194) , medicalservice delivery (195-196) , benchmarkingin Islamic hospital practice(197),medical management (198) , leadershipand management (199) , a critique of thebiomedical model from an Islamicperspective (200) , and contrasting holisticmedicine against practice based onlyon biomedicine (201) .5-Islamic perspectives of physicianetiquette:The following concepts were discussedfrom the Islamic perspective: physicianhuman relations (202) , concept ofphysician etiquette (201) , physicianetiquette with patients and families (203) ,physician etiquette with the dying (205) ,physician etiquette in the health careteam (206) , care for the terminally and thedeath process (207-208).6-Professionalism:I presented the following paperson professionalism: motivated(209)physician , professionalism (210-211) ,being a Muslim doctor (212-213) ,physician leadership (214) , communityinvolvement (215-216) (217), commitment ,spiritual development (218) , training(219), definition of Muslim doctor(220), towards a motivated medicalstudent (221) , leadership attributes andskills (222-223) , and character building (224) .FIMA YearBook 200913

A 13-Year ExperienceReferences1. Omar Hasan Kasule. Some Reflectionson Islam and Medicine. Proceedings ofthe First International Conference onIslamic Medicine, International Medicineorganization, Safat, Kuwait 1981.2. ---Islamic Medicine in Africa: Proceedingsof the Second International Conference onIslamic Medicine, Safat, Kuwait 1982.3. --- The Islamic Medicine Movement InAfrica: Paper Presented At The 18 th AnnualIslamic Medical Association Convention,Capetown, South Africa, 25-27 th April 1998.Source: http://omarkasule.tripod.com.4. ---Reform Of Medicine, Islaah Al Tibb:Outline For Discussion At A WorkshopOn Epistemology Held At DhakkaOn September 1, 2007. Source: http://omarkasule.tripod-04.com.5. ---Crisis of Knowledge: Paper PresentedAt A Medical Education Workshop HeldAt The Faculty Of Medicine University OfScience And Technology Sanaa Yaman 14-27 June 2007. Source: http://omarkasule04.tripod.com.6. ---Crisis Of Knowledge And Education:Presentation for postgraduate students atthe Department of Social and PreventiveMedicine Universiti Malaya on Friday 13 thJuly, 2007. Source: http://omarkasule-04.tripod.com.7. ---Muslim Physician Education:Indonesian Experience And NewChallenges: Paper presented at a 1-dayworkshop on the Muslim PhysicianEducation held at the Yarsi UniversityFaculty of Medicine on 5 th May 2006.Source: http://omarkasule04.tripod.com.8. ---Tajdid & Islaah: Outline Of An AddressTo 3000 Students Of Dar Al Uluum NadwatAl Ulama Lucknow India 0n 16 th May 2007.Source: http://omarkasule-04.tripod.com.9. ---Knowledge in Islam: Nature, Crisis,and Methodology. Lecture at KampungBaru Medical Center on 20 th February 2004.Source: http://omarkasule-03.tripod.com.10. ---Nature Of Knowledge: Presentation forpostgraduate students in the Departmentof Social and Preventive Medicine Facultyof Medicine University of Malaya on 13 thJuly 2007. Source: http://omarkasule-04.tripod.com.11. ---History Of Human Knowledge:Presentation for postgraduate students atthe Department of Social and PreventiveMedicine Universiti Malaya on Friday 13 thJuly, 2007. Source: http://omarkasule-04.tripod.com.12. ---Some Philosophical ConceptsRelevant To Knowledge And Its Sources:Presentation for postgraduate students atthe Department of Social and PreventiveMedicine Universiti Malaya on Friday 13 thJuly, 2007. Source: http://omarkasule04.tripod.com.13. ---Methodology Of Knowledge:Presentation for postgraduate students atthe Department of Social and PreventiveMedicine Universiti Malaya on Friday 13 thJuly, 2007. Source: http://omarkasule-04.tripod.com.14. ---Islamic Perspective of Knowledge:Epistemology, Methodology, andIslamization. Paper at a workshop on‘Methodology and Skills to Develop IslamicInput in the Medical Cuirriculum’ for deansand academic staff of MuhammadiyahUniversity Jogjakarta 5 th and 7 th August2005. Source: http://omarkasule-05.tripod.com.15. ---Towards A Scientific Culture:Presentation for postgraduate students inthe Department of Social and PreventiveMedicine Faculty of Medicine Universityof Malaya on 13 th July 2007. Source: http://omarkasule-04.tripod.com.16. ---The Empirical Scientific Method:An Islamic Reformulation. Paper at theInternational Conference on Values AndAttitudes In Science And Technology KualaLumpur September 1996. Source: http://omarkasule-04.tripod.com.17. ---Strengths And Weaknesses Of TheEpidemiological Methodology: Seminarpresentation at the Kulliyah of Medicine,FIMA YearBook 200914

A 13-Year ExperienceInternational Islamic University, KuantanMalaysia, June 19 th 1999. Source: http://omarkasule-02.tripod.com.18. ---Epidemiologic Methodology InPublic Health: New Frontiers AndChallenges: Paper presented at the 6 thNational Colloquium on Public Healthunder the theme ‘ Paving the Way for aPublic Health Renaissance’ 5-6 th October1999, Department of CommunityHealth, University Kebangsaan Malaysia,Cheras, Kuala Lumpur. Source: http://omarkasule-02.tripod.com.19. ---Issues in Science and Technology: TheIslamic Solution. Paper at the InternationalSeminar on Islam and the Challenges ofScience and Technology in the 21 st Centuryheld at the University of TechnologyMalaysia in Johor Malaysia 7-9 September2003. Source: http://omarkasule-03.tripod.com.20. ---Islamization of Knowledge: Medicineas a Model: Paper presented at a Seminaron The Methodology of Sciences froman Islamic Perspective held at the Facultyof Dar al Uloom and organized jointlyby the Epistemology Institute, theFaculty of Science Cairo University, andthe Department of Philosophy CairoUniversity 23-26 April 2007. Source: http://omarkasule-04.tripod.com.21. ---Tauhidic Paradigm in Medical Practice:Paper read at a dinner for chief executiveofficers of private hospitals, senior statehealth directors, and deans of medicalschools held at the Quality Inn in KualaLumpur on Friday 14 th April 2006. Source:http://omarkasule-04.tripod.com.22. ---Towards integrated medical and healtheducation: An Islamic approach: Keynotepaper at the Second Islamic Medical ScienceWeek, held at Dewan Utama, KampusKesihatan, Universiti Sains Malaysia,Kubang Kerian, Kelantan, Malaysia on 18thAugust 2002. Source: http://omarkasule-03.tripod.com.23. ---Integrated Medical Education: paperpresented at a workshop on the Educationof a Muslim Physician held at the YarsiUniversity Faculty of Medicine Jakarta May5, 2006. Source: http://omarkasule-04.tripod.com.24. ---Towards An Islamic Epistemology. PaperPresented At A Seminar On EpistemologyHeld In Dhakka On 1st September 2007.Source: http://omarkasule.tripod.com.Source: http://omarkasule-04.tripod.com.25. ---Research Priorities on Epistemologyand Thought: Paper presented at aworkshop on epistemology held in Dhakkaon 30-31 st March 2007. Source: http://omarkasule.tripod.com.26. ---Overview of the Epistemology andThought Project: Paper Presented At AWorkshop In Istanbul On 3 rd May 2007.Source: http://omarkasule-04.tripod.com.27. ---Research Priorities On EpistemologyAnd Thought: Paper presented at aconsultative meeting on epistemology andthought held in Jakarta on 4 th August 2007.Source: http://omarkasule-04.tripod.com.28. ---Research Priorities On EpistemologyAnd Thought: Concept paper written fora series of intellectual seminars in SouthEast Asia in the year 2008. Source: http://omarkasule.tripod-05.com.29. ---Epistemology Of Classical IslamicDisciplines: Outline For Discussion AtA Workshop On Epistemology Held AtDhakka On September 1, 2007. Source:http://omarkasule.tripod-04.com.30. ---Epistemology Of Disciplines RelatedTo Finance: Outline For Discussion AtA Workshop On Epistemology Held AtDhakka On September 1, 2007. Source:http://omarkasule-04.tripod.com.31. ---Epistemology Of Disciplines RelatedTo Public Life: Outline For DiscussionAt A Workshop On Epistemology Held AtDhakka On September 1, 2007. Source:http://omarkasule-04.tripod.com.32. ---Epistemology Of Social And HumanSciences: Outline For Discussion At AWorkshop On Epistemology Held AtDhakka On September 1, 2007. Source:http://omarkasule-04.tripod.com.FIMA YearBook 200915

A 13-Year Experience33. ---Reform Of Education, Islah Al Tarbiyat:Outline For Discussion At A WorkshopOn Epistemology Held At Dhakka OnSeptember 1, 2007. Source: http://omarkasule-04.tripod.com.34. ---Reform Of Life Sciences, Islaah Al‘Uluum Al Hayaatiyyat: Outline ForDiscussion At A Workshop On EpistemologyHeld At Dhakka On September 1, 2007.Source: http://omarkasule-04.tripod.com.35. ---Reform Of Physical Sciences: Outline ForDiscussion At A Workshop On EpistemologyHeld At Dhakka On September 1, 2007.Source: http://omarkasule-04.tripod.com.36. ---Reform Of Social Sciences, IslaahAl ‘Uluum Al Ijtima’iyyat: Outline ForDiscussion At A Workshop On EpistemologyHeld At Dhakka On September 1, 2007.Source: http://omarkasule-04.tripod.com.37. ---Islamization of the Curriculum:presentation at the Ta’aruf and IntellectualDiscourse XX programme held at Guoman,Port Dickson , NS 26-31 December 2002.Source: http://omarkasule-03.tripod.com.38. ---Islamization of the Curriculum: Paneldiscussion at the 22 nd Ta’aruf and Discourseprogram held at Corus Paradise Resort,Port Dickson on 18 th October 2003. Source:http://omarkasule-03.tripod.com.39. ---Islamization of the Curriculum: a paneldiscussion at the 25 th Ta’arif and IntellectualDiscourse on 8 th April 2005 held at theCentury Mahkota Hotel Malaka. Source:http://omarkasule-03.tripod.com.40. ---Islamization of Curricula: paperpresented in Kuwait 19-24 December 2005.Source: http://omarkasule-03.tripod.com.41. ---Islamic Medicine: Concept &Misunderstandings. Paper Presented at theInternational Islamic Medicine Conferencein Kuala Lumpur July 09-14,1995. Source:http://omarkasule.tripod.com.42. ---Islamic Medicine, mafhum al tibb alislami: Paper Presented at the AnnualHealth Islamic Conference held at Facultyof Medicine University of Indonesia JlSalemba Raya No 6 Jakarta Pusat held on3-5 February 2006 and organized jointlyby Forum Ukhuwah Lembaga DakwahFacultas Kedoketran se-Indonesia andForum Studi Islam Kedokteran UniversitasIndonesia. Source: http://omarkasule-04.tripod.com.43. --- Concept Of Islamic Medicine Int. MedJ Vol 4 No 1 June 2005. Source: www.e-imj.com.44. --- Islamic Medicine: Concepts andMisunderstandings. Journal of theFederation of Islamic Medical AssociationsVol. 1 No. 1 July 1996, page 33-5645. ---The Approach of the Qur’an andSunnah in Medicine: The Challenge andPractice in the Era of Globalization: IbnSina keynote address at the 4 th UniversitiMalaya Medical Center Conference onMedicine from the Islamic Perspective heldat the Saujana Subang Malaysia on 24 thMarch 2007. Source: http://omarkasule-04.tripod.com.46. ---The Approach of the Qur’an andSunnah in Medicine: Challenges andPractice in the Era of Globalization: Paperat Dhakka on 30 th March 2007. Source:http://omarkasule.tripod.com.47. ----Prophetic Medicine: Between the nass(original sources of Islam) and empiricalexperience. In: Prophetic Medicine, Al TibbAl-Nabawi. Islamic Medical Association ofSouth Africa, Qualbert 200048. ---Prophetic Medicine: Between TheNass And Empirical Experience: Paperpresented in absentia at the 3 rd InternationalSeminar on the ‘Medical Curriculum: TheHolistic Approach’ 19-21 February 1999,at Hospital Universiti Kebangsaan, Cheras,Malaysia jointly sponsored by the IslamicMedical Association of Malaysia (PPIM),Federation of Islamic Medical Associations(FIMA), and the International IslamicUniversity, Malaysia. Source: http://omarkasule.tripod.com.49. ---Prophetic Medicine, tibb nabawi.Paper written for the Scientific and IslamicMedicine Seminar at Diponegro UniversitySemaran Java Tengah Indonesia 8 th October2006. Source: http://omarkasule-04.FIMA YearBook 200916

A 13-Year Experiencetripod.com.50. ---Guidance On Prophetic Medicine,Tibb Nabawi, For A Primary Health CarePractitioner: Presentation to Master ofPrimary Health Care Class at the Institute ofMedicine Universiti Brunei Darussalam onJuly 6, 2006. Source: http://omarkasule-04.tripod.com.51. ---Towards a Broader Definitionof Prophetic Medicine Based onContemporary Bio-Medical Research,Nahwa I’itibaar Awsa’u Li Mafhuum Al TibbAl Nabawi I’itimaadan ‘Ala Al IktishaafaatAl Tibiyyat Al Mu’aasirat: research paper.Source: http://omarkasule.tripod.com.52. ---Teaching An Expanded DefinitionOf Prophetic Medicine Based OnContemporary Medical Knowledge:Paper presented at Musolla Al ZahrawiUniversiti Antarabangsa Kuantan Malaysiaon 2 nd November 2007. Source: http://omarkasule-04.tripod.com.53. ---Concepts Of Islamic Medical Education.Paper at 4th Annual General Meeting OfThe Islamic Medical Association KubanKerian, Kelantan 7th June 1996. Source:http://omarkasule.tripod.com.54. ---Issues in Medical Education. Paper atHospital Universiti Malaysia Cheras on 18 thJuly 2003. Source: http://omarkasule-03.tripod.com.55. ---Concepts of Medical Education andPractices: Islamic Perspective. Paper atthe Mesra Ibadat program organized byHospital Universiti Sians Malaysia KubangKerian on February 21, 2005 at RenaissanceHotel Kota Bharu Kelantan. Source: http://omarkasule-03.tripod.com.56. ---Islamic Medical Education: Purpose,Integration, And Balance: Paper presentedat the Islamic Medical Education Workshopheld in conjunction with the 3 rd Federationof Islamic Medical Associations (FIMA)Scientific Convention held in JogjakartaIndonesia on 21 st July 2006. Source: http://omarkasule-04.tripod.com.57. ---Leading In Medical Education AndPractice As Social Engineering: TheOral Contraceptive Pill And The SexualRevolution: Paper presented at the 8 thAnnual Conference of the Islamic MedicalAssociation of Malaysia held at KotaBaru on July 1-3 2006. Source: http://omarkasule-04.tripod.com.58. ---Methodology Of Evaluating The IslamicInput Curriculum: Paper presented at theWorkshop on the Islamic Input Curriculumat the Kulliyah of Medicine InternationalIslamic University Kuantan on 13 th June2006. Source: http://omarkasule-04.tripod.com.59. ---Assessing Ethico-Legal Knowledgeand Attitudes of Medical Students:Opinion written for a research projectat UIA February 2007. Source: http://omarkasule-04.tripod.com.60. ---Teaching Postgraduate Epidemiologywith an Islamic EpistemologicalIntroduction: Presented at theEpidemiology Unit University of Malayaon 9 th March 2007. Source: http://omarkasule-04.tripod.com.61. ---Physician Etiquette: Presentation to 3 rdyear medical students at the Kulliyah ofMedicine International Islamic University,Kuantan, Malaysia on 13 th June 2006.Source: http://omarkasule-04.tripod.com.62. ---Fiqh Tibbi: Ethico-Legal Guidelines ForStudents In Clinical Training: Presentationfor students of the Health Sciences CampusUIA Kuantan on 14 th July 2007. Source:http://omarkasule04.tripod.com.63. ---Medical Ethics: Theory & Principles:Presentation at the Kulliyah of MedicineUIA Kuantan on Saturday 20 th July 2007.Source: http://omarkasule-04.tripod.com.64. ---Medical Privacy and Confidentiality:Presentation to 3 rd year medical studentsat the Kulliyah of Medicine InternationalIslamic University, Kuantan, Malaysia on 14 thJuly 2007. Source: http://omarkasule-04.tripod.com.65. ---Principles Of The Law, qawaid al fiqh:Presentation for year 3 medical studentsat the Kulliyah of Medicine UIA Kuantanon Saturday 20 th July 2007. Source: http://FIMA YearBook 200917

A 13-Year Experienceomarkasule-04.tripod.com.66. ---Professional Misconduct: Presentationfor year 3 medical students at the Kulliyahof Medicine UIA Kuantan on 20 th July 2007.Source: http://omarkasule-04.tripod.com.67. ---Purposes Of The Law, maqasid alshari’at: Presentation for Year 3 medicalstudents at the Kulliyah of Medicine UIAKuantan on Saturday 20 th July 2007. Source:http://omarkasule-04.tripod.com.68. ---Regulations Of Physician Conduct,dhawaabit al tabiib: Presentation for year 3medical students at the Kulliyah of MedicineUIA Kuantan on Saturday 20 th July 2007.Source: http://omarkasule-04.tripod.com.69. ---Regulations On Medical And SurgicalTreatment: Presentation for Year 3 medicalstudents at the Kulliyah of Medicine UIAKuantan on Saturday 20 th July 2007. Source:http://omarkasule-04.tripod.com.70. ---Research: Theory, Practice, And Policy:Presentationfor year 3 medical studentsat the Kulliyah of Medicine UIA Kuantanon Saturday 20 th July 2007. Source: http://omarkasule-04.tripod.com.71. ---Sources Of The Law, masadir al shariat:Presentationfor Year 3 medical studentsat the Kulliyah of Medicine UIA Kuantanon Saturday 20 th July 2007. Source: http://omarkasule-04.tripod.com.72. ---The Law: An Over-View: Presentationfor Year 3 students Kulliyah of MedicineUIA Kuantan on Saturday 20 th July 2007.Source: http://omarkasule-04.tripod.com.73. ---Tauhidic Paradigm In Medical Practice:Presentation to medical students by DrOmar Hasan Kasule Sr. at Surau al ZahrawiKulliyah of Medicine UIA Kuantan onFriday 13 th July 2007. Source: http://omarkasule-04.tripod.com.74. ---The creed. Paper presented at a seminarfor academic staff of the Faculty of Medicine,Universiti Malaya on 29 th June 2002. Source:http://omarkasule-03.tripod.com.75. ---Life and Health. Paper presented at aseminar for academic staff of the Faculty ofMedicine, Universiti Malaya on 26 th January2002. Source: http://omarkasule-03.tripod.com.76. --- Fundamentals of the Law. Paperpresented at a seminar for academic staffof the Faculty of Medicine, UniversitiMalaya on 23 rd March 2002. Source: http://omarkasule-03.tripod.com.77. --- Medical jurisprudence I. Paper presentedat a seminar for academic staff of the Facultyof Medicine, Universiti Malaya on 29 th June2002. Source: http://omarkasule-03.tripod.com.78. ---Medical jurisprudence II. Paper presentedat a seminar for academic staff of the Facultyof Medicine, Universiti Malaya on 29 th June2002. Source: http://omarkasule-03.tripod.com.79. ---Biotech jurisprudence II: Paper presentedat a seminar for academic staff of the Facultyof Medicine, Universiti Malaya on 27 th July2002. Source: http://omarkasule-03.tripod.com.80. ---Biotech jurisprudence I: Paper presentedat seminar for academic staff of the Facultyof Medicine, Universiti Malaya on 24 thAugust 2002. Source: http://omarkasule-03.tripod.com.81. ---Outline of a Course on Bio-Ethics froman Islamic Perspective for Academic Staffat The Faculty of Medicine University ofMalaya: Paper presented at the Departmentof Social and Preventive Medicine UniversityMalaya on 09 th March 2007. Source: http://omarkasule-04.tripod.com.82. ---Training Lecturers Of The IslamicInput Into The Medical Curriculum:Presented at the Faculties of MedicineUniversitas Muhammadiyah Yogjakartaand Indonesia Islamic University Yogjakartaon Friday 3 rd August 2007. Source: http://omarkasule-04.tripod.com.83. ---Ethics in Medical Education and Practices.August 2007. ISBN 9164-70103-DDDD-D.Published by BIIT No 50 Road No 16Dhanmondi Dhaka-1209. Cover design byNazrul Islam Badal. Printed by ChowkashPrinters Ltd 131 DIT Extension RoadFakirapool Dhaka-1000 (196 pages).84. --- Towards Islamic Medicine (AugustFIMA YearBook 200918

A 13-Year Experience2007) lecture notes edited by Dr. H Sagiranand M Badul Ghoni Published by theIslamic Medicine Forum of Indonesia andPrinted by Grafina Design and Printing JlSulawesi no 7c Ourwosari Ring Road UtaraYogyakarta 55284 Indonesia. (208 pages).85. ---Chapter 2 in Evolution Toward betterUmmah Through Islamic IntegratedMedical Curriculum (IIMC) edited bySagiran, Edwyn Saleh, Supriyatiningsih,Nurul Qomariyah, Dirwan Suryo Soularto.Published by the Center for IslamicMedicine Faculty of Medicine UniversityMuhammadiyah Jalan Lingkar BaratTamantirto Kasihan Bantul YogyakartaIndonesia MUY August 2005. Printed byPercetakan CV AQSHA Jalan Bibis No78 Kembaran Tamantirto kasihan bantulYogyakarta 55183.86. ---Islamization And Integration OfKnowledge In The Kulliyah Of Medicine,IIUM. Paper presented at TIDE program,IIUM Gombak Campus on 3 rd April 2003.Source: http://omarkasule-03.tripod.com.87. ---The Islamic Input Curriculum (IIC) AtThe Kulliyah Of Medicine. Presented atthe 24 th Ta’aruf And Intellectual Discourseheld at Admiral Marina & Leisure Club,Port Dickson, NS on 5 th June 2004. Source:http://omarkasule-03.tripod.com.88. --- Overview Of The Islamic Input InThe Medical Curriculum (IIMC) At TheKulliyah Of Medicine In The 2004/2005Academic Year: Paper presented at theWorkshop on the Islamic Input Curriculumat the Kulliyah of Medicine, UIA Kuantanon 13 th June 2006. Source: http://omarkasule-04.tripod.com.89. --- Islamization Of The Curriculum: TheIslamic Input In The Medical Curriculum(IIMC) At The Kulliyah Of Medicine:Paper Presented the Annual Health IslamicConference held at Faculty of MedicineUniversity of Indonesia Jl Salemba Raya No6 Jakarta Pusat held on 3-5 February 2006and organized jointly by Forum UkhuwahLembaga Dakwah Facultas Kedoketranse-Indonesia and Forum Studi IslamKedokteran Universitas Indonesia. Source:http://omarkasule-04.tripod.com.90. --- Medical Education: An IslamicPerspective: Paper Presented At AWorkshop On Islamic Medical EducationOrganized By The Indonesian IslamicMedical Education Convention At TheFaculty Of Medicine Makassar Indonesia25-27 May 2007. Source: http://omarkasule-04.tripod.com.91. --- Islamization of the Curriculum: TheIslamic Input in the Medical Curriculum(IIMC) at the Kulliyah of Medicine: Paperpresented at the Ibn Sina Medical CollegeDhakka Bangladesh on 31 st March 2007.Source: http://omarkasule-04.tripod.com.92. --- The Islamic Input In The MedicalCurriculum (IIMC): Outline of apresentation at a Workshop on the IslamicInput in the Medical Curriculum heldat the Bangladesh Institute of AdvancedManagament Dhakka on 31 st August 2007.Source: http://omarkasule-04.tripod.com.93. --- The Teaching of Bio-ethics at UIA.Paper presented at a workshop on ‘Teachingof Bio-ethics and Communication Skills inMedical Education- A Malaysian Model’organized by the School of Medical Sciences,Universiti Sains Malaysia, Kuban Kerian,Kelantan 26-27 th May 1999. Source: http://omarkasule-02.tripod.com.94. ---The Teaching of Communication Skillsat UIA. Paper presented at a workshop on‘Teaching of Bio-ethics and CommunicationSkills in Medical Education- A MalaysianModel’ organized by the School of MedicalSciences, Universiti Sains Malaysia, KubanKerian, Kelantan 26-27 th May 1999. Source:http://omarkasule-02.tripod.com.95. --- Islamization of Knowledge: Medicineas a Model.. Abstract in Proceedings of the12 th International Conference on IslamicPhilosophy: Science Cirricula from theIslamic Perspective. Conference jointlyorganized on 7-9 Rabi Akhir 1428H and24-26 April 2007 at Cairo University by theFaculty of Science Cairo University, Facultyof Dar al Uluum Cairo University, and theFIMA YearBook 200919

A 13-Year ExperienceEpistemology Studies Institute of Cairo.Source: http://omarkasule-04.tripod.com.96. ---Values And Attitudes In Science AndTechnology. Paper presented at TheMalaysian Institutions Program Seminaron Islamization of Knowledge UniversitiTeknologi Malaysia, Johor Bahru January4-5, 1997. Source: http://omarkasule.tripod.com.97. ---Check List for Reviewing anUndergraduate Medical Curriculum:Presented At A Medical EducationWorkshop Held At The Faculty Of MedicineUniversity Of Science And TechnologySanaa Yaman 14-27 June 2007. Source:http://omarkasule-04.tripod.com.98. ---Teaching And Learning Methods InAn Integrated Undergraduate MedicalCurriculum: Paper Presented At A MedicalEducation Workshop Held At The FacultyOf Medicine University Of Science AndTechnology Sanaa, Yaman 14-27 June 2007.Source: http://omarkasule-04.tripod.com.99. ---Assessment Methods for IntegratedUndergraduate Medical Education:Paper Presented At A Medical EducationWorkshop Held At The Faculty Of MedicineUniversity Of Science And TechnologySanaa Yaman 14-27 June 2007. Source:http://omarkasule-04.tripod.com.100. ---Annual Report of Academic StaffActivities: Presented At A MedicalEducation Workshop Held At The FacultyOf Medicine University Of Science AndTechnology Sanaa Yaman 14-27 June 2007.Source: http://omarkasule-04.tripod.com.101. ---Contents of an Undergraduate MedicineProgram Handbook: Paper Presented At AMedical Education Workshop Held At TheFaculty Of Medicine University Of ScienceAnd Technology Sanaa, Yaman 14-27June 2007. Source: http://omarkasule-04.tripod.com.102. ---Quality Assurance in MedicalEducation: Paper Presented At A MedicalEducation Workshop Held At The FacultyOf Medicine University Of Science AndTechnology Sanaa Yaman 14-27 June 2007.Source: http://omarkasule-04.tripod.com.103. ---Documentation Needed for anAccreditation/Evaluation Visit of anUndergraduate Medical Curriculum:Paper Presented At A Medical EducationWorkshop Held At The Faculty Of MedicineUniversity Of Science And TechnologySanaa Yaman 14-27 June 2007. Source:http://omarkasule-04.tripod.com.104. ---Mapping an Integrated UndergraduateMedical Education Curriculum: PaperPresented At A Medical EducationWorkshop Held At The Faculty Of MedicineUniversity Of Science And TechnologySanaa Yaman 14-27 June 2007. Source:http://omarkasule-04.tripod.com.105. ---Some Preliminary Ideas ‘ThinkingAloud’ About The New Medical School As:concept paper submitted to the steeringcommittee on 19 th December 2007. Source:http://omarkasule-04.tripod.com.106. ---Historical Roots Of The NursingProfession In Islam: Paper Presented AtThe 3 rd International Nursing Conference“Empowerment And Health: An AgendaFor Nurses In The 21 st Century” Held InBrunei Dar As Salam 1st-4 th November1998. Source: http://omarkasule.tripod.com.107. ---The Nursing Profession In The MuslimWorld: Prospects & Challenges In The21st Century: Paper Presented At The3 rd International Nursing Conference“Empowerment And Health: An AgendaFor Nurses In The 21 st Century” Held InBrunei Dar As Salam 1-4 November 1998.Source: http://omarkasule.tripod.com.108. --- Issues in Nursing and MedicalEducation. Abstract in Proceedings of the6 th International Nursing Conference heldin Brunei Darussalam 10-13 th October page30 2004. Source: http://omarkasule-03.tripod.com.109. --- Motivation in The Nursing Profession:An Islamic Perspective: Paper presented atthe 4 th International Nursing Conferenceheld in Brunei 19-22 November 2000.Source: http://omarkasule-02.tripod.com.FIMA YearBook 200920

A 13-Year Experience110. --- The Nurse’s Professional Conduct FromAn Islamic Perspective: Paper presented atthe 4 th International Nursing Conferenceheld in Brunei 19-22 November 2000.Source: http://omarkasule-02.tripod.com.111. ---Medical Ethics: workshop for nursesat Kuala Belait General Hospital on21 November 2007. Source: http://omarkasule.tripod.com.112. ---Patterns and Trends of Religious Edicts(Fatwa Mufti Kerajaan & Irsyad Hukum)on Medical Matters in Brunei Darussalam1962-2005: Paper presented at the 2 ndAcademic Session Institute of MedicineUniversity Brunei Darussalam 11-12 March2007. Source: http://omarkasule-04.tripod.com.113. --- Jurisprudence Of Disease Conditions,fiqh al amraadh: Paper presented at aworkshop on Ijtihad Maqasidi organizedby the Fiqh Academy of India at Hyderabad03-04 February 2007. Source: http://omarkasule-04.tripod.com.114. ---The Legal and Ethical Basis of MedicalPractice: Paper presented at a Workshop onUse of Ijtihad Maqasidi for ContemporaryEthico-Legal Problems in Medicineorganized by the Fiqh Academy of India atHyderabad 03-04 February 2007. Source:http://omarkasule-04.tripod.com.115. ---Contemporary-Ethico-Legal IssuesFrom an Islamic Legal Perspective: Expertopinion presented to the 16 th Session of theFiqh Academy of India held at Jamia Islamiadarul Uloom Muhazzabpur Azamghar nearVaranasi India on April 01-02, 2007. Source:http://omarkasule-04.tripod.com.116. ---Ethico-Legal Issues Relating ToArtificial Life Support: Expert opinionpresented to the 16 th Session of the FiqhAcademy of India held at Jamia Islamiadarul Uloom Muhazzabpur Azamghar nearVaranasi India on 01-02 April 2007. Source:http://omarkasule-04.tripod.com.117. ---Ethico-Legal Aspects Of EuthanasiaAnd Physician Assisted Suicide: Expertopinion presented to the 16 th Session of theFiqh Academy of India held at Jamia IslamiaDarul Uloom Muhazzabpur Azamghar nearVaranasi India on 01-02 April 2007. Source:http://omarkasule-04.tripod.com.118. ---Islamic Legal Guidelines on PolioVaccination in India: Expert opinionpresented to the 16 th Session of the FiqhAcademy of India held at Jamia Islamiadarul Uloom Muhazzabpur Azamghar nearVaranasi India on 01-02 April 2007. Source:http://omarkasule-04.tripod.com.119. ---Response to Questions on Brain Deathfrom the Fiqh Academy of India: Expertopinion presented to the 16 th Session of theFiqh Academy of India held at Jamia Islamiadarul Uloom Muhazzabpur Azamghar nearVaranasi India on 01-02 April 2007. Source:http://omarkasule-04.tripod.com.120. ---Response to Questions on Euthanasiafrom the Fiqh Academy of India: Expertopinion presented to the 16 th Session of theFiqh Academy of India held at Jamia Islamiadarul Uloom Muhazzabpur Azamghar nearVaranasi India on 01-02 April 2007. Source:http://omarkasule-04.tripod.com.121. ---Towards a Legal Definition of Death:Expert opinion presented to the 16 th Sessionof the Fiqh Academy of India held atJamia Islamia darul Uloom MuhazzabpurAzamghar near Varanasi India on 01-02April 2007. Source: http://omarkasule-04.tripod.com.122. ---Ethico-Legal Aspects Of EuthanasiaAnd Physician Assisted Suicide: Expertopinion presented to the 16 th Session of theFiqh Academy of India held at Jamia IslamiaDarul Uloom Muhazzabpur Azamghar nearVaranasi India on 01 st April 2007. Source:http://omarkasule-04.tripod.com.123. ---Derivation Of Professional MedicalEthics From Maqasid Al Shari’at AndQawa’id Al Shari”At, Istinbaat MabadiAkhlaaqiyyaat Al Mihnat Al TibbiyyatMin Maqasid Al Shari’at Wa Qawa’id AlFiqh: Paper Presented At A ConferenceOf Muslim Jurists Held At Lucknow 15-17May 2007. Source: http://omarkasule-04.tripod.com.124. ---Impact of Medical Technology onFIMA YearBook 200921

A 13-Year ExperiencePublic Morality: The Oral ContraceptivePill as an Example, Athar Al Taqniyat AlTibbiyyat ‘Ala Al Akhlaaq Al Mujtama’e0705-Paper Presented At The ConferenceOf Muslim Jurists Held At Lucknow UttarPradesh 15-17 May 2007. Source: http://omarkasule-04.tripod.com.125. ---Application of Maqasid al Shari’at andQawa’id al Fiqh to Issues of Embalming,Cryoprservation, Autopsy, and Researchon Dead Corpses, Maqasid Wa Qawa’id AlShari’at Fi Qadhaayat Tata’akllaqu Bi JuthatAl Mayyit: Paper Presented At A ConferenceOf Muslim Jurists Held At Lucknow 15-17May 2007. Source: http://omarkasule-04.tripod.com.126. ---Derivation Of Legal Rulings On InVitro Fertilization From The PurposesOf The Law (istinbaat ahkaam al talqiih alistina’e al khariji min maqasid al shari’at):Presented at the Training Workshop forJudges and Jurists held at Patna Bihar Indiaon 7-8 July 2007 at the Higher Institute forTraining Judges and Jurists a division ofthe Law Directorate for the States of Bihar,Orissa, and Jarkhand . Source: http://omarkasule-04.tripod.com.127. ---Derivation Of Legal Rulings On InVitro Fertilization From The PurposesOf The Law (istinbaat ahkaam al talqiih alistina’e al khariji min maqasid al shari’at):Presented at the Training Workshop forJudges and Jurists held at Patna Bihar Indiaon 7-8 July 2007 at the Higher Institute forTraining Judges and Jurists a division ofthe Law Directorate for the States of Bihar,Orissa, and Jarkhand. Source: http://omarkasule-04.tripod.com.128. ---Contemporary-Ethico-Legal IssuesFrom An Islamic Legal Perspective:Presented at the Training Workshop forJudges and Jurists held at Patna Bihar Indiaon 7-8 July 2007 at the Higher Institute forTraining Judges and Jurists a division ofthe Law Directorate for the States of Bihar,Orissa, and Jarkhand. Source: http://omarkasule-04.tripod.com.129. ---Contraception: The Islamic Perspective:Presented at the Training Workshop forJudges and Jurists held at Patna Bihar Indiaon 7-8 July 2007 at the Higher Institute forTraining Judges and Jurists a division ofthe Law Directorate for the States of Bihar,Orissa, and Jarkhand. Source: http://omarkasule-04.tripod.com.130. ---Ethico-Legal Issues Relating ToArtificial Life Support: Presented at theTraining Workshop for Judges and Juristsheld at Patna Bihar India on 7-8 July 2007at the Higher Institute for Training Judgesand Jurists a division of the Law Directoratefor the States of Bihar, Orissa, and Jarkhand.Source: http://omarkasule-04.tripod.com.131. ---Preservation Of Progeny: A MedicalPerspective (maqsad hifdh al nasl: almandhuur al tibbi): Presented at theTraining Workshop for Judges and Juristsheld at Patna Bihar India on 7-8 July 2007at the Higher Institute for Training Judgesand Jurists a division of the Law Directoratefor the States of Bihar, Orissa, and Jarkhand.Source: http://omarkasule-04.tripod.com.132. ---Social And Religious DimensionsOf ‘Unwanted Pregnancy’: An IslamicPerspective: Presented at the TrainingWorkshop for Judges and Jurists held atPatna Bihar India on 7-8 July 2007 at theHigher Institute for Training Judges andJurists a division of the Law Directorate forthe States of Bihar, Orissa, and Jarkhand.Source: http://omarkasule-04.tripod.com.133. ---Towards A Legal Definition Of Death:Presented at the Training Workshop forJudges and Jurists held at Patna Bihar Indiaon 7-8 July 2007 at the Higher Institute forTraining Judges and Jurists a division ofthe Law Directorate for the States of Bihar,Orissa, and Jarkhand. Source: http://omarkasule-04.tripod.com.134. --- Islamic Perspective in Medicine.Paper presented at an Ibadah camp heldat Indera Mahkota on 4 th February 2001.Source: http://omarkasule-03.tripod.com.135. ---Integrating Islamic Values In TheMedical Curriculum: Paper presentedat the Regional Conference on MedicalFIMA YearBook 200922

A 13-Year ExperienceManagement from an Islamic Perspectiveorganized by the University of MalayaMedical Center 18 th -20 th September 2000at the Summit Hotel, Subang Jaya, Selangor,Malaysia. Source: http://omarkasule-02.tripod.com.136. ---Integrating Islamic Values Into theMedical Curriculum – the UIA Experience:Presentation at a Retreat on Islamic Values inMedicine organized by the Medical Centerof the University of Malaya on 30 th June2001 at Awana Resort, Genting Highlands,Pahang. Source: http://omarkasule-03.tripod.com.137. ---Integration Of The Islamic Input InThe Medical Curriculum: Paper presentedat a Workshop on the Integration of IslamicInput in the Medical Curriculum held at theFaculty of Medicine Yarsi University JakartaIndonesia on 2 nd June 2006. Source: http://omarkasule-04.tripod.com.138. ---Integration of Islamic Values in theMedical Curriculum: Paper presented atBayero University Faculty of Medicine KanoNigeria on 17 th September 2006. Source:http://omarkasule-04.tripod.com.139. ---Islamic Values: the Lost Jewel: Paperpresented at a seminar on Islamic Practicein Hospital Administration organizedby the Islamic Hospital ConsortiumMalaysia at Hospital Universiti KebangsaanMalaysia on 15 th April 2006. Source: http://omarkasule-04.tripod.com.140. --- Islamic Values: the Missing Jewel inthe Medical Profession: Paper presented atworkshops on medical ethics and Islamicmedical education at campuses in England06-31 December 2006. Source: http://omarkasule-04.tripod.com.141. --- Creation of the earth: Paper presented ata seminar organized by Saba Islamic Mediaat Kuala Lumpur on 8 th September 2002.Source: http://omarkasule-03.tripod.com.142. --- Creation of the human: Paper presentedat a seminar organized by Saba IslamicMedia at Shah Alam on 11 th October 2002.Source: http://omarkasule-03.tripod.com.143. --- Human creation vs theory of evolution:Paper presented at a seminar organizedby Saba Islamic Media at Kota Kinabaluon 20 th October 2002. Source: http://omarkasule-03.tripod.com.144. --- Human creation vs theory of evolution:Paper presented at a seminar organizedby Saba Islamic Media at Kuching on 19 thOctober 2002. Source: http://omarkasule-03.tripod.com.145. --- The biological miracle of humancreation: Paper presented at a seminar onthe Signs of the Creator organized by SabaIslamic Media at Hyatt Regency in Kuantanon 21 st September 2002. Source: http://omarkasule-03.tripod.com.146. ---Prayers And Spirituality In Health.Presentation at the Faculty of Pharmacy,IIUM on 26 th June 2003. Source: http://omarkasule-03.tripod.com.147. ---Cognitive And Spiritual Approches InPatient-Centered Counseling For Anxiety:Presentation For The Class Of Msc PrimaryHealth Care On July 13 th , 2006. Source:http://omarkasule-04.tripod.com.148. --- Islamic Perspectives In The TeachingOf Probability To Medical Students: PaperPresented at the 5 th National Conference onMedical Sciences, 4-5 May 1999 organizedby the School of Medicine, Universiti SainsMalaysia, Kota Bharu, Kelantan, Malaysia.Source: http://omarkasule-02.tripod.com.149. --- Understanding Spiritual Needs OfPatients. Lecture For 1 st Year NursingStudents At Indera Mahkota CampusOn 24 th June 2004`. Source: http://omarkasule-03.tripod.com.150. ---Medical Jurisprudence betweenOriginality and Modernity. Paper preparedfor the 6 th Scientific Meeting of the IslamicMedical Association of Malaysia held atPenang 28-29 th May 2004. Source: http://omarkasule-03.tripod.com151. --- The Conceptual Basis For ResolvingEthical Controversies In MedicalDecisions. Paper presented at a seminaron medical ethics at the National HeartInstitute, Kuala Lumpur on 30 th April 2004.Source: http://omarkasule-03.tripod.com.FIMA YearBook 200923

A 13-Year Experience152. --- Derivation of Medical Ethics fromMaqasid al Shari’at. Paper prepared forthe International Scientific Conventionjointly organized by the Jordan Society forIslamic Medical Studies, The Jordan MedicalAssociation, and the Federation of IslamicMedical Associations at Amman, Jordan 15-17 July 2004. Source: http://omarkasule-03.tripod.com.153. --- Medical Ethics From Maqasid AlShari’at. Int. Med J. Vol. 3 No. 2 Dec 2004154. --- The Application of Maqasid al Shari’atin Medical Practice: Paper presented at aworkshop for physicians held at KampungBaru Medical Center in Kuala Lumpuron 2 nd September 2006. Source: http://omarkasule-04.tripod.com.155. --- Islamic Medical Ethics with SpecialReference to Maqasid Al Shari’at: Paperpresented at Kampung Baru Medical CenterKuala Lumpur on Saturday 13 th January2007. Source: http://omarkasule-04.tripod.com.156. ---- Medical Ethics from Maqasid alShari’at: Presented to a seminar held atBayero University Faculty of Medicine KanoNigeria on 17 th September 2006. Source:http://omarkasule-04.tripod.com157. --- Medical Ethics from Maqasid alShari’at: Presented to a seminar at AhmaduBello University Faculty of Medicine ZariaNigeria on 17 th September 2006. Source:http://omarkasule-04.tripod.com.158. --- Ethico-Legal Aspects Of ClinicalPractice According To Islamic Law[Kedokteran Klinik / Terapan MenurutSyari’at Islam]: Presented at a seminar onthe implementation of Islamic values inmedical faculty curricula held at the Facultyof Medicine and Health Sciences SyarifHidayatullah Islamic University Jakarta16-18 November 2007. Source: http://omarkasule-04.tripod.com.159. ---Theory and Practice of Medical Ethics:Paper presented at Training Program forPhysicians at Wisma Mawar Kampung BaruMedical Center on 28 th September 2002.Source: http://omarkasule-03.tripod.com.160. ---. Medical Ethics from Maqasid AlShari’at: Paper presented at workshopson medical ethics at campuses in England09-31 December 2006. Source: http://omarkasule-04.tripod.com161. ---The Ethics and Etiquette of HumanResearch. Paper prepared for theInternational Scientific Convention jointlyorganized by the Jordan Society for IslamicMedical Studies, The Jordan MedicalAssociation, and the Federation of IslamicMedical Associations at Amman, Jordan 15-17 July 2004. Source: http://omarkasule-03.tripod.com.162. --- Biomedical Research Ethics AccordingTo Islamic Law [Etika Penelitian BiomedikMenurut Syari’at Islam]: Presented at aseminar on the implementation of Islamicvalues in medical faculty curricula held atthe Faculty of Medicine and Health SciencesSyarif Hidayatullah Islamic UniversityJakarta 16-18 November 2007. Source:http://omarkasule-04.tripod.com.163. ---Philosophy Of Medical Ethics: AComparative Study Of Islamic AndEuropean Perspectives: Presented At AWorkshop On The Implementation OfIslamic Values In Medical Education InIndonesia Held At The Faculty Of MedicineIslamic University Malang Indonesia On8 th -9 th September 2007. Source: http://omarkasule-04.tripod.com.164. ---Contemporary-Ethico-Legal IssuesFrom An Islamic Legal Perspective:Paper presented at workshops on medicalethics at various campuses in England09-31 December 2006. Source: http://omarkasule-04.tripod.com.165. ---. Application Of Islamic ValuesIn Clinical Teaching: Presented At AWorkshop On The Implementation OfIslamic Values In Medical Education InIndonesia Held At The Faculty Of MedicineIslamic University Malang Indonesia On8 th -9 th September 2007. Source: http://omarkasule-04.tripod.com.166. --- Contemporary-Ethico-Legal IssuesFrom an Islamic Legal Perspective:FIMA YearBook 200924

A 13-Year ExperiencePaper presented at a workshop on ethicsfor physicians held at the BangladeshInstitute of Advanced Management DhakaBangladesh on 30 st March 2007. Source:http://omarkasule-04.tripod.com.167. --- Contemporary-Ethico-Legal IssuesFrom An Islamic Legal Perspective: Paperpresented at a Workshop on Use of IjtihadMaqasidi for Contemporary Ethico-LegalProblems in Medicine organized by theFiqh Academy of India at Hyderabad03-04 February 2007. Source: http://omarkasule-04.tripod.com.168. --- Response To Ethico-Legal Questions:Written for a student workshop on ethicsheld at the Kulliyah of Medicine UIAKuantan on 6 th January 2008. Source: http://omarkasule-05.tripod.com169. ---. Jurisprudence of biotechnology (fiqhal taqniyat al hayawiyat): Paper presentedat Kampung Baru Medical Center WismaMawar, Kuala Lumpur, on 26 th October2002. Source: http://omarkasule-03.tripod.com170. ----Contemporary-Ethico-Legal IssuesFrom An Islamic Legal Perspective. Paperpresented at a seminar for Turkish Physiciansat Topkapi Eresin Hotel Conference RoomIstanbul on Friday 22nd December 2006 at20.00hrs. Source: http://omarkasule-04.tripod.com.171. ---Contemporary-Ethico-Legal Issuesfrom an Islamic Legal Perspective:Paper Presented At A Medical EducationWorkshop Held At The Faculty Of MedicineUniversity Of Science And TechnologySanaa Yaman 14-27 June 2007. Source:http://omarkasule-04.tripod.com.172. ---Preservation of Progeny: A MedicalPerspective (maqsad hifdh al nasl: almandhuur al tibbi). Paper presented at anInternational Seminar “Geneology andPreservation of the Progeny – IslamicPerspective” jointly organized by the Institutefor Islamic Understanding Malaysia and theUniversiti Institut Teknologi Malaysia atShah Alam on 27-28 th April 2004. Source:http://omarkasule-03.tripod.com.173. --- A Medical Perspective on Preservationof the Progeny’ chapter 5 in: Shaikh MohdSaifuddeen and Shaikh Mohd Salleh (eds.):Geneology and Preservation of the Progeny:an Islamic Perspective. MPH GroupPublishing Sdn Bhd Kuala Lumpur 2006ISBN983-42884-4-1.174. --- Assisted Reproduction: An IslamicPerspective. Paper presented at the 6 thInternational Nursing Conference held inBrunei Darussalam 10-13 th October 2004.Source: http://omarkasule-03.tripod.com.175. ---Rulings on Euthanasia from thePerspective of Purposes of the Law(Maqasid Al Shari’at) and Principles ofThe Law (Qawa’id Al Shari’at). Chapterin the 2005 Year Book of the Federation ofIslamic Medical Associations.176. ---Contraception: an Islamic Perspective.Paper accepted for the 3 rd Safe MotherhoodCongress organized at Crown PrincessHotel Kuala Lumpur 25 th -27 th February 2005by the Malaysian Association for Maternaland Neonatal Health. Source: http://omarkasule-03.tripod.com.177. ---. Contraception: the Islamic Perspective.Int. Med J Vol. 4 No. 1 June 2005. Source:www.e-imj.com.178. --- Ethics and Etiquette Of HumanResearch. Int. Med J. Vol. 3 No. 2 Dec 2004.Source: www.e-imj.com.179. --- Prevention Of Suicide: An IslamicPerspective. Paper Presented At The 4 thKuala Lumpur Mental Health Conference2004 Held Under The Theme ‘Mental HealthOf The Nation – The Way Forward’ On6-8 th September 2004 At Prince Hotel KualaLumpur. Source: http://omarkasule-03.tripod.com.180. --- Prevention of Suicide: An IslamicPerspective. Int. Med J. Vol. 3 No. 2 Dec2004181. ---Ethical Issues in Public HealthResearch. Paper presented at the 11 thNational Public Health Colloqium held on21-22 September 2004 at The Summit HotelSubang and organized by the Department ofCommunity Medicine National UniversityFIMA YearBook 200925

A 13-Year Experienceof Malaysia, the Malaysian Public HealthSpecialist Association, and the College ofPublic Health Medicine of the NationalAcademy of Medicine, Malaysia. Source:http://omarkasule-03.tripod.com.182. ---An Islamic Ethico-Legal Perspective onEmbalming, Cryopreservation, Autopsy,and Research on Dead Corpses: Paperpresented at the 8 th Annual Conference ofthe Islamic Medical Association of Malaysiaheld at Kota Baru on July 1-3, 2006. Source:http://omarkasule-04.tripod.com.183. ---Protection, Preservation, andPromotion of the Intellect, Hifdh Al‘Aql: Paper presented at a Symposium onProtection of the ‘Aql held at the Kulliyah ofMedicine International Islamic UniversityKuantan. Source: http://omarkasule.tripod.com184. ---Sexual Crimes: Islamic Perspective.Paper presented at the 8 th Family MedicineScientific Meeting organized by theMalaysian Family Medicine SpecialistAssociation at the Swiss Garden HotelKuantan 7 th – 10 th July 2004. Source: http://omarkasule-03.tripod.com.185. --- Sexual Crimes: Islamic Perspective.Int. Med J. Vol. 3 No. 2 Dec 2004. Source;www.e-imj.com186. --- Ethical and Legal Issues in Midwifery:An Islamic Perspective’: Proceedings ofthe Fifth International Nursing ConferenceBrunei Darussalam 2002 pages 219-220.187. ---‘Ethical and Legal Issues inMidwifery: An Islamic Perspective’: Paperpresented at the 5 th International NursingConference ‘Nursing and Midwifery-Making a Difference’ Brunei Darussalam28 th -31 st October 2002. Source: http://omarkasule-03.tripod.com.188. ---Puasa with Diabetes Mellitus: Paperpresented at a Diabetes Care Group Meetingheld at the Multi-purpose Hall Block B, SuriSeri Begawan Hospital Kuala Belait Bruneion Tuesday 12 th September 2006. Source:http://omarkasule-04.tripod.com189. ---Health benefits of saum: Paper presentedat the Second Universiti Malaya MedicalCenter Conference on Medicine from theIslamic Perspective held at Sheraton Subangon 11-13 October 2002. Source: http://omarkasule-03.tripod.com.190. --- Health benefits of saum: Tadhkirat at theKulliyah of Medicine, International IslamicUniversity, Kuantan on 9 th November 2002.Source: http://omarkasule-03.tripod.com.191. --- Saum: Benefits And Medical Aspects.Lecture Given At The University Of BruneiDarussalam On 14 th October 2004. Source:http://omarkasule-03.tripod.com.192. ---Moderation, Balance, and JustEquilibrium in Preventive Medicine. In:Abu Bakar Abdul Majeed (ed.): PerubatanPencegah Menurut Islam. IKIM, KualaLumpur, Malaysia, 1999. Source: http://omarkasule-02.tripod.com.193. --- Medical Quality Improvement: IslamicPrinciples and Approaches. Presentationat a meeting of The Islamic MedicalAssociation Of Malaysia October 1996Kuala Lumpur Source: http://omarkasule.tripod.com..194. ---Quality Assurance Practice In HealthCare. Paper presented at a seminar onQuality Assurance held at the Ministry ofHealth Headquarters in Kuala Lumpur on14 th June 1997. Source: http://omarkasule.tripod.com195. --- Current Medical Service: an IslamicPerspective. In: Abu Bakar Yang andAbu Bakar Abd. Majeed (eds.): Konsep& Operasi Perubatan Islam.IKIM, KualaLumpur, Malaysia 1999.196. ---Current Medical Services: IslamicPerspective. Paper presented at theSeminar on Islamic Medicine: Concept andOperation held at the Institute of IslamicUnderstanding (IKIM) Kuala Lumpur 17-18 June 1997. Source: http://omarkasule.tripod.com.197. ---Benchmarking In Islamic HospitalPractice: Paper presented at the IslamicHospital Management Workshop heldin conjunction with the 3 rd Federationof Islamic Medical Associations (FIMA)Scientific Convention held in JogjakartaFIMA YearBook 200926

A 13-Year ExperienceIndonesia on 21 st July 2006. Source: http://omarkasule-04.tripod.com.198. --- Medical management: Islamicperspectives: Paper presented at theHospital Tengku Azfan, Kuantan on26 th September 2002. Source: http://omarkasule-03.tripod.com.199. ---Leadership and Management by TheBook. Paper written for the Workshop on‘Is our Current Hospital Practice IslamicEnough: Ideals and Realities’ organized bythe Islamic Hospital Consortium of Malaysiaat El Azhar Camp, Morib, Selangor 2 nd - 4 thJuly 2004. Source: http://omarkasule-03.tripod.com.200. --- A Critique of the Biomedical Modelfrom an Islamic Perspective. Int. Med. J.Vol. 3 No. 2. December 2003. Republishedin the Federation of Islamic MedicalAssociations Year Book 2003.201. --- Holistic vs Biomedicine: Paperpresented at Training Program forPhysicians at Kuala Lumpur InternationalHotel 24 th August 2002. Source: http://omarkasule-03.tripod.com202. --- Physician Ethics: Etiquette of HumanRelations. Paper presented at UKM Facultyof Medicine on 3 rd July 1997. Source: http://omarkasule.tripod.com.203. --- Introduction to Physician Etiquette:Paper presented at Kampung Baru MedicalCenter Wisma Mawar 28 th December 2002.Source: http://omarkasule-03.tripod.com204. ---- Physician Etiquette with Patients andFamilies: Paper presented at the PediatricInstitute of Hospital Kuala Lumpuron 17 th January 2003. Source: http://omarkasule-03.tripod.com.205. ---- Physician Etiquette with the Dying:Paper presented at the Pediatric Institute,Hospital Kuala Lumpur 21 st February 2003.Source: http://omarkasule-03.tripod.com.206. ---- Physician Etiquette in the Health CareTeam: Paper presented at Kampung BaruMedical Center on 28 th March 2003. Source:http://omarkasule03.tripod.com.207. ---- Care For The Terminally-Ill: TheIslamic Perspective: Presented at the 2 ndNational Palliative Care Conference 24-27 March 1999 Penang, Malaysia. Source:http://omarkasule-02.tripod.com.208. ---Islamic Perspective On The DeathProcess In Terminal Cancer Patients:Poster at the Palliative Care Session of the4 th International Conference of the AsianClinical Oncology Society held in Bali,Indonesia 4-7 August 1999. Source: http://omarkasule-02.tripod.com.209. --- Motivation of Doctors. Paper atKampung Baru Medical Center on 20 th June2003. Source: http://omarkasule-03.tripod.com.210. ---Professionalism in Medical Practice:Paper Presented at the Annual HealthIslamic Conference held at Faculty ofMedicine University of Indonesia JlSalemba Raya No 6 Jakarta Pusat held on3-5 February 2006 and organized jointlyby Forum Ukhuwah Lembaga DakwahFacultas Kedoketran se-Indonesia andForum Studi Islam Kedokteran UniversitasIndonesia. Source: http://omarkasule-04.tripod.com.211. ---Medicine as a Profession: Presentedat a MINI MEDICAL SCHOOL for HighSchool students held on Sunday 25 th June2006 at Dewan Cancelor Universiti BruneiDarussalam. Source: http://omarkasule-04.tripod.com.212. ---Four Dimensions Of Being A MuslimDoctor. Written for the memorial journal ofthe 5 th year student graduating class of 2003.May 2003. Source: http://omarkasule-03.tripod.com.213. ---The Concept Of A Muslim Doctor:Outline of a presentation to medicalstudents and academic staff at the NorthernInternational College of Medicine andHospital Dhakka on 31 st August 2007.Source: http://omarkasule-04.tripod.com.214. --- Medical Practitioners as Leaders:Myth or Reality. Paper presented at the 5 thNational Scientific Meeting of the IslamicMedical Association of Malaysia held on29th June 2003 at Allson Klana, Seremban.Source: http://omarkasule-03.tripod.comFIMA YearBook 200927

A 13-Year Experience215. ---The Medical Profession BeyondTreatment. Paper presented to the freshmanclass Faculty of Medicine, NationalUniversity of Malaysia on 9 th June 2003.Source: http://omarkasule-03.tripod.com.216. ---Medics And Paramedics As Da’ie: Paperpresented at the Friendly ComparativeReligion Program organized by theNuqaba Management Secretariat and theStudent Development and Co-CurricularActivity Center on 24 th -25 th April 2004 atthe Kulliyah of Medicine, InternationalIslamic University, Malaysia. Source: http://omarkasule-03.tripod.com217. ---Ikhlaas & Niyyat In Work. MotivationalLecture to staff of Kampung Baru MedicalCenter Kuala Lumpur on 18 th July 2003.Source: http://omarkasule-03.tripod.com218. ---Spiritual Development. Paperat Kampung Baru Medical Centeron 22 nd August 2003. Source: http://omarkasule-03.tripod.com219. ---Training of Excellent MedicalProfessionals. Paper presented at aSymposium for Medical Students organizedby the Medical Students Association at theFaculty of Medicine, National University ofMalaysia on 25 th July 2004. Source: http://omarkasule-03.tripod.com220. ---Definition of A Muslim Doctor:Presented at a Workshop on Islamic MedicalEducation organized by the Faculty ofMedicine Universitas MuhammadiyahJogjakarta and the Forum of IslamicMedicine (FOKI – Forum ke dokteranIslam) at Jogjakarta on 24-25 th August 2007.Source: http://omarkasule-04.tripod.com221. ---Towards A Motivated Medical Student:Presented to freshmen students of theFaculty of Medicine Indonesia IslamicUniversity Yogyakarta, Indonesia onFriday 7 th September 2007. Source: http://omarkasule-04.tripod.com222. ---Diseases Of Leaders And Followers:Lecture for 5 th year students by ProfessorOmar Hasan Kasule Sr. at the Kulliyahof Medicine UIA Kuantan Malaysiaon November 3, 2007. Source: http://omarkasule-04.tripod.com223. ---Leadership Skills Module: Backgroundmaterial at a postgraduate leadershipworkshop held at the Institute ofMedicine Universiti Brunei Darussalamon 20 th November 2007. Source: http://omarkasule-04.tripod.com224. ---Character Building: Prepared presentedin absentia at the 3 rd International Seminaron ‘Medical Curriculum: The HolisticApproach’ organized jointly by the IslamicMedical Association of Malaysia. TheFederation of Islamic Medical Associations,and the International Islamic University,Malaysia at Hospital Universiti Kebangsaan,Cheras, Malaysia 19-21 February 1999.Source: http://omarkasule-02.tripod.com.FIMA YearBook 200928

Inculcating Islamic Input in the Curriculaof Medical Sciences at Pre-clinical years(basic medical sciences)Tayyab Hassan* and Hamdan NoorAbstract:In the pre-clinical years of medical education, the inculcation of a soundeducational attitude is crucial for optimal student education with emphasis onbasic knowledge, skills, as well as insights into nature of disease and the healthprocess.Since the eighteenth century, the Western biomedical model of health andhealing, which adopts the concept of technical aspects of healing, has been thebackbone of medical education and patient care.This concept, however, was challenged by a wealth of literature that recognizedthe role of spirituality as a significant aspect of healing and perception of themeanings of illness, sorrow, happiness, life and end of life issues.Publications addressing the issue of spirituality and healthcare, came up fromvarious cultures and the concept was adopted by increasing numbers of medicalschools in various countries all over the world.The Islamic input in medical education provides both professionalism, withdivine injunctions of perfection and competence, together with a holisticapproach towards patients, family, society, disease, health, life and death.Unlike the Western biomedical model, in the Islamic holistic approach, Allah(SWT) is the ultimate source of healing. Medical professionals are only means ofhealing as transferred to them by the Creator.Moreover, this holistic concept adopts prevention and proper lifestyle andbehavior in addition to therapeutic modalities. It integrates both Islamic valueswith maximum exposure to innovations of modern medicine.This approach should be inculcated in medial curriculum in Islamic medicalcolleges from the first year of training.Keywords: Medical education, educational attitude, spirituality, Islamic values.Dr. Tayyab HassanLecturer, Medical Education DivisionFaculty of Medicine, Cyberjaya UniversityCollege of Medical Sciences (CUCMS), MalaysiaE-mail: tayyabhassan@yahoo.comFIMA YearBook 200929

Inculcating Islamic InputIntroduction:The first issue is to understand thedifference between pre-clinical andclinical years. As we know there isno direct contact with the patient inpre-clinical years though spiral andintegrated curriculum introducesclinical topics to the students. In clinicalyears the most important part is directcontact with the patient and morecomprehensive clinical subjects. Thisdistinction of topic areas and patientcontact clearly divides pre-clinical andclinical years into two separate systemsof teaching and learning, inspite ofhaving a horizontally and verticallyintegrated curriculum.Institutions provide educationalprograms and resources to their studentsbut they can not inculcate knowledgeand skill in them. It is the `educationalattitude` of students that provides asource to transform these programsand resources into required knowledgeand skills. Knowledge and skills can beused to provide good patient care butagain having required knowledge andskills alone is not enough to providepatient care. A student must haveproper `professional attitude` to usehis knowledge and skills for patientcare. As mentioned earlier, there is nopatient contact in pre-clinical years, soprofessional attitude is not importantin those years but educational attitudeis the most important and mandatorycomponent to gain knowledge andskills. In clinical years, with patientcontact, professional attitude is the mostrequired component in addition to theeducational attitude (1) . This argumentmay help in deciding the content of preclinicaland clinical years’ curriculum.Pre-clinical years should stress more onbasic knowledge and skills; insight intothe nature of disease, health and healingprocess; and the role of the health careprovider. Clinical years should stress onprofessionalism, disease patterns andpatient management.Proper attitude, is mandatory to gainmaximum benefit from education.In order to identify and inculcatethis appropriate attitude somedivine guidance is essential. Besides,`Istiqamah` i.e. steadfastness is anotherquality required and it is in fact moreimportant than just inculcating theright attitude. Inculcation of Islamicinput is vital in achieving both thedivine guidance and the Istiqamah.Introducing Islamic input in pre-clinicalyears will make students realize theseissues from the very beginning of theirtraining.Philosophy of Modern Medicine:Rene Descartes, a 17 th centuryphilosopher described the philosophyof modern medicine. He stated thatall the systems in this world operateunder mechanical laws and that thereis no meaning or purpose related tothese laws (2) . This philosophy gave abiomedical model of health and healing,practiced widely in the Western world.Current medical education system isalso based on this biomedical model (3) .Health professionals are trained to beFIMA YearBook 200930

Inculcating Islamic Inputvery objective and instead of a caringhealer, they work like scientists.Figure 1: Three Domains of EducationThis biomedical model and the scientificand medical advances during last 3decades have given the technical aspectsof healing to our medical educationsystem. Disease is considered as animbalance of normal physiology andtreatment is based on the restoration ofbody systems to a normal state. But it isevident that healing involves some otheraspects as well. Disease disrupts normallife pattern and people start thinkingabout their career, family, meaning oflife and happiness (4) . The importance ofattitude and behavior has recently beenrealized and an affective componentwas included as an important domainof education as shown in Fig. 1, butstill some aspects of healing are missingand need modification of philosophy ofmodern medicine.What is missing?If the current curriculum of preclinicalyears is good enough to providerequired knowledge, skills and attitudeto the students with understandingof disease and healing process, thenwhat is missing? Literature shows thatspirituality has been recognized as animportant aspect of the healing processand efforts have been made to includespirituality in the medical educationcurriculum (See Appendix A).All cultures and societies describe theconcept of spirituality. Spirituality isconcerned with the search for meaningof different life events especially illnessand sorrows through religion or beliefin God, family, humanism, etc.An increasing number of medicalschools are offering courses inspirituality in medicine. It increasedfrom 17 out of 126 accredited USmedical schools in 1994 (5) to 84 schoolsin 2004 (6) . The Association of AmericanMedical Colleges also recognizedspirituality in Medical School ObjectivesReport III released in 1993 as a factorthat contributes to health.In his book “Timeless Healing”, Bensondescribes various studies that showthe beneficial effects of religion. Thestudies done on the effect of religionon reduction in alcohol consumption,reduction in nicotine use and druguse, decrease in depression, reductionin blood pressure, reduction in anxietyand improvement in quality of life (7) .Dr. Dossey, in his book “Healing Words”,describes an experiment done in 1988at San Francisco General Hospital. Theexperiment was done on prayer andhealing. The researchers divided 293critically ill patients in the coronary careunit into 2 groups.FIMA YearBook 200931

Inculcating Islamic InputGroup A: Patients, prayed for by nameby prayer makers.Group B: Patients not prayed for.The results showed fewer complicationsand less congestive heart failure, lessantibiotic usage, less cardiac arrestand earlier discharge from hospital ingroup A patients as compared to groupB patients. Prayer makers were notadvised for any specific prayer. In factmost of them used simple words i.e.“Lord have mercy on this patient (7) .In a recent article published in “TheLancet”, in 2003, researchers studiedthe effect of spirituality in terminallyill patients. Patients with terminalcancer who were expected to live lessthan 3 months were selected. Theirunderstanding of the meaning of life andreligion and their behavior toward theillness was evaluated. The researchersconcluded that spirituality helpedthese patients to cope much better byavoiding despair and willingness todie as compared to the control groupwithout spirituality.Some researchers have recommendedthat “health care providers shouldincorporate psychological and spiritualelements into the palliative care of dyingpatients” (8) .The impact of religious belief andpractices on both physical and emotionalhealth has been widely accepted in thelast few decades. Scientific research hasdemonstrated the effect of spiritualityin the prevention and treatment ofemotional disorders, disease and injuryand in enhancing recovery (9) . Variousrenowned universities around the worldhave already incorporated spiritualityas an important component of theircurriculum (See Appendix A).What is spirituality?Spirituality is considered to influencethe perception of health and disease andtheir interaction with one another bothby the patients and health professionals.Researchers recommend making aclear distinction between the terms“spirituality” and “religion.” Theyemphasize the need to have a universaldefinition of spirituality acceptable toall religions that includes both religiousand nonreligious perspectives (10-15) . Forpractical purposes, spirituality can bedefined as `divine guidance` to searchfor the meaning of life and its events.Divine guidance comes through somesource. Holy Books revealed to mankindand the messengers of God providegood source of divine guidance.Why inculcate the Islamic input?The last revealed Holy Book is theQur’an, the book of Islam. The Qur’ancommands to follow the sayings(ahadith’) and ways (Sunnah’) ofProphet Muhammad (PBUH). Thus theQur’an and the Sunnah’ are the ultimatesources of divine guidance and becausethey are sent to Muslims, this guidanceor spirituality can be achieved byinculcating the Qur’an and the Sunnah’in the curriculum.Why is the Qur’an chosen for thispurpose? The reason is that the Qur’anFIMA YearBook 200932

Inculcating Islamic Inputis the last revealed book from God andit verifies all the previous revealedHoly Books So it is very logical toquote from the latest edition of a bookinstead of some old edition as it coversall the previous books and hence gives aholistic approach to spirituality.In the Qur’an it is stated :`“And this is a blessed scripture which Wehave revealed, confirming that which(was revealed) before it, that you maywarn the Mother of Villages and thosearound it. Those who believe in theHereafter believe herein, and they arecareful of their worship” (16)`And this Quran is not such as could everbe invented in despite of Allah; but it is aconfirmation of that which was before itand an exposition of that which is decreedfor mankind - Therein is no doubt - fromthe Lord of the Worlds.` (17) .It can be concluded that spirituality andreligion are not necessarily different asshown in the equation below:Spirituality = Divine Guidance = Religion ORSpirituality = ReligionAs mentioned earlier, Islamic inputwill provide appropriate attitude andIstiqamah. In addition to this, theinculcation of Islamic input will alsohelp students to understand their roleand to identify appropriate behaviorexpected in the healing process. TheQur’an states:“Now when hurt touches a man he criesunto Us, and afterward when We havegranted him a boon from Us, he saith:only by force of knowledge I obtained it.Nay, but it is a test. But most of themknow not.” (18)Current affective domain models mainlycover those aspects that are concernedwith dealing with the patient or inother words professionalism. Islamicinput covers all these aspects relatedto the professionalism and in additionprovides a holistic approach to thepatient, his family, his understanding ofdisease and healing process and aboveall, the value of divinity. This holisticapproach brings doctor and patientclose to God and helps them in makingdecisions and accepting outcomes.The philosophy of Islamic Medicine:Before inculcating the Islamic input itis wise to understand the philosophyof Islamic medicine to appreciate thedifference between Modern medicineand Islamic medicine and to establishwhether there are any major differencesbetween the two. Islam gives guidancefor all aspects of human life includingpersonal affairs, social, political,financial, marital, religious, health andillness issues, etc. Careful analysis ofthe Qur’anic verses provides divineguidance related to the philosophy ofmedicine and this will further help us todecide which is the better philosophicalapproach to medicine.Islamic medicine as described in theQur’an has two components:1. Physical component and2. Spiritual component.The physical component is described byFIMA YearBook 200933

Inculcating Islamic Inputmentioning items like honey and plantsas a medium of healing,“Then eat of all fruits, and follow theways of your Lord, made smooth (foryou). There comes forth from their belliesa drink divers of hues, wherein is healingfor mankind. Lo! herein is indeed aportent for people who reflect”. (19) .“Then We cast him on a desert shorewhile he was sick; and We caused a treeof gourd to grow above him.” (20) .The spiritual component is described bymentioning the Qur’an as a medium ofhealing,“We send down (stage by stage) in theQur’an that which is a healing and amercy to those who believe... “ (21)“O mankind! There has come unto you anexhortation from your Lord, a balm forthat which is in the breasts, a guidanceand a mercy for believers.” (22)This same philosophy was alsoacknowledged by the Prophet Ibrahim,“and when I am ill, it is He who curesme” (23)God Himself attests to it by saying“If God touches you with an affliction, noone can remove it but He” (24) .“And verily, if you should ask them: whocreated the heavens and the earth? theywill say: Allah. Say: think you then ofthose you worship beside Allah, if Allahwilled some hurt for me, could theyremove from me His hurt; or if He willedsome mercy for me, could they restrainHis mercy? Say: Allah is my all. In Himdo (all) the trusting put their trust.” (25)God has also described the way to getrelief from sufferings,“And your Lord has said: pray unto Meand I will hear your prayer. Lo! thosewho scorn My service, they will enter hell,disgraced.” (26)The Qur’an categorizes the causes ofdiseases into physical, evils, magical andpsychological causes.“Say: I seek refuge in the Lord of thedaybreak: from the evil of that whichHe created; from the evil of the darknesswhen it is intense, and from the evil ofmalignant witchcraft, and from the evilof the envier when he envies.” (27)The Qur’an also describes the basicphilosophy of illness,“Who so does right it is for his soul, andwho so does wrong it is against it. Andyour Lord is not at all a tyrant to Hisslaves” (28)“Whatever of misfortune strikes you; it iswhat your right hands have earned. AndHe forgives much. “ (29) .These verses clearly suggest that certaindeeds of man cause illness and sufferingand thus the Qur’an highlights the roleof preventive medicine because if manknows that certain acts of him can causeillness he can try to avoid those acts andcan prevent illness as well.The Qur’an also describes the basicmechanism which leads to illness i.e. allexcesses.“Know that the life of this world is onlyplay, and idle talk, and pageantry, andboasting among you and rivalry in respectFIMA YearBook 200934

Inculcating Islamic Inputof wealth and children; as the likeness ofvegetation after rain, whereof the growthis pleasing to the husbandman, butafterward it dries up and you see it turningyellow, then it becometh straw. And in theHereafter there is grievous punishment,and (also) forgiveness from Allah and Hisgood pleasure, whereas the life of the worldis but matter of illusion.” (30)It can be concluded that God is theultimate source of healing but thishealing is transferred to man by usingsome medium that may be physical orspiritual. Disease and illness may resultfrom misdeeds of man. The philosophyof Islamic medicine clearly stress onprevention by improving the way ofliving in all aspects of human life. Inother words the Islamic philosophyemphasizes a holistic approach tohealth and living.Role of health care providers:Previous and subsequent discussionswill help us in identifying that theIslamic philosophy of medicine is notsomething totally new or differentfrom the current practices of medicine.Many of these are not against thenorms currently practiced. All civilizedcultures, regardless of their religion,recommend certain acceptable andnoble attitudes and behaviors; Islam onlyintensifies and completes those attitudesand behaviors in a more coherent waythat is the basis of its holistic nature.God describes human life as animportant issue,`For that cause We decreed for theChildren of Israel that who so ever kills ahuman being for other than manslaughteror corruption in the earth, it shall be asif he had killed all mankind, and who soever saves the life of one, it shall be asif he had saved the life of all mankind.Our messengers came unto them of oldwith clear proofs (of Allah’s Sovereignty),but afterwards lo! many of them becameprodigals in the earth.`(31)The first statement drives mankindtowards competence and perfectionin order to avoid any mistakes ordeficiencies and not shoulder the blameof killing the whole of mankind.Similarly, the second statement providesan enormous motivation to enhancelearning and competency to enjoy thefeeling of saving the whole of mankind.This statement can be applied to medicaleducation without any doubt and it givesa very fundamental goal of medicaleducation. This goal can guide traineestowards the right direction in theirmedical education and can shape theirattitude appropriately. Some sayings ofthe Prophet Muhammad (PBUH) alsostress on the quest for excellence in theacquisition of knowledge and skills.A careful study of the Holy Booksshows that God has clearly describedthe goal of saving life in His revelations.Almost all the major religions of theworld accept that both disease and curecomes from Almighty God and doctorscan not give cure or life to any one.The role of a doctor is to transfer thehealing given by God to the patient. ToFIMA YearBook 200935

Inculcating Islamic Inputbe eligible as His instrument of cure ,one needs to be perfect in knowledgerelated with his selected mode of therapyi.e. contemporary medicine, allopathic,homeopathic, herbal, acupuncture, etc.The doctor ought to strive for maximumknowledge and competence so thathe may qualify to be a source of thetransference of His cure. God suggeststhis in the Qur’an.” and say: My Lord! Increase me inknowledge.” (32)What is meant by the integration ofIslamic and modern medicine?The most important point here is tomake a clear understanding about theintegration of Islamic and modernmedicine. The three possibilities ofintegration are as follows:1. Introducing Islamic philosophy tomodern medicine2. Introducing Islamic methods ofhealing to modern medicine3. Introducing the contributions ofMuslims to modern medicineIn the first case, there is no need tochange the content and subjects ofmedicine. The only thing that needsto be done is to add some contentsregarding the Islamic philosophy andexpose students to these concepts. Theaim should be to change the thinkingof the trainers and trainees so thatthey clearly understand their role andstrive for divine guidance when treatingtheir patients. This is the most difficultprocess and needs lot of motivationfrom the trainers and traineesIn the second case, most of the contentsand subjects needs to be changed.Students should be taught variousIslamic methods of healing and theyshould learn about the qualities andmedicinal effects of various plants(herbs), honey and other naturalproducts to apply to their patients.This is easy but it will change the wholestructure of modern medicine.In the third case, nothing requires to bechanged. The only thing is to add somecontent about the Muslim scholars,especially physicians, to understandtheir role in modern medicine.The third option is not related to Islamicinput and hence we have only twooptions to consider. The second optioncan easily be achieved by improving`Traditional and ComplementaryMedicine` (TCM) or `Complementaryand Alternative Medicine` (CAM).The first option is the best way ofintegrating Islamic and modernmedicine and poses a great challenge toall Muslim medical scholars.Training of health care providers - AnIslamic perspective:Referring back to figure 1, the training ofhealth care providers should encompassall the three domains of educationi.e. Attitude (Affective domain),Knowledge (Cognitive domain) andskills (Psychomotor domain). HowIslamic input may affect these domainsis discussed below.FIMA YearBook 200936

Inculcating Islamic InputAttitude:The general attitude for all Muslims,including health providers, is describedin the following verse,“O my dear son! Lo! though it be but theweight of a grain of mustard-seed, andthough it be in a rock, or in the heavens,or in the earth, Allah will bring it forth.Lo! Allah is Subtle, Aware of all things.O my dear son! establish worship andenjoin kindness and forbid iniquity,and persevere whatever may befall you.Lo! this is firmness(of purpose) in (theconduct of affairs”. Turn not your cheekin scorn toward folk, nor walk withpertness in the land. Lo! Allah loves noteach braggart boaster. Be modest in yourbearing and subdue your voice. Lo! theharshest of all voices is the voice of theass.” (33)The Qur’an suggests ProphetMuhammad (PBUH) as a role model byattesting,“And lo! you are of a tremendouscharacter.” (34)Attitude training models can beextracted from the Qur’an by analyzingthe following verses that describe thestages of explanation, partial restrictionand total prohibition for drinkingintoxicants.“They question you about intoxicants andgames of chance. Say: in both is great sinand (some) utility for men; but the sin ofthem is greater than their usefulness” (35)“O you who believe! Draw not near untoprayer when ye are drunken, till youknow that which you utter”, (36)-O you who believe! Intoxicants andgames of chance and idols and diviningarrows are only an infamy of Satan’shandiwork. Leave it aside in order thatyou may succeed. (37)“Satan seeks only to cast amongyou enmity and hatred by means ofintoxicants and games of chance, andto turn you from remembrance of Allahand from (His) worship. Will you thenabstain?” (38)Qur’anic model of affectivedomain trainingExplanationProhibitionRestrictionKnowledge:It is a well known fact that humanbrain contains 100 billion neuronsand 100 trillion neuronal connectionsand information is stored in theseconnections. The Qur’an describedthis neuronal model of learning 1400hundred years ago by mentioningthat Adam was taught the names(knowledge) of everything.`And He taught Adam all the names,then showed them to the angels, saying:inform Me of the names of these, if ye aretruthful. ` (39)In this world, bounded by time andspace, we need a source or medium toFIMA YearBook 200937

Inculcating Islamic Inputget something.We need external stimuli to activatethe information wired in the neuronalconnections or synapses in order to geta complete picture of what nature hasalready imprinted in our brain.The dot book example shows that if onlya few dots are connected, one can notget a complete picture but if all the dotsare connected then one can get the fullpicture. Hence maximum exposure toinformation is necessary in order toget a full understanding of any subjectmatter.The brain receives an enormousamount of information but can notprocess all of them and hence about99.5% of this information undergoesextinction and only 0.5% becomesavailable for further processing.Attention is a process which protectsthis small amount of information fromfurther extinction and the Qur’andescribed the mechanism of givingattention in the very first verse by askingthe illiterate Prophet to read i.e. torepeat whatever he listens (40)The verse reads`Read: In the name of thy Lord Whocreateth.` (41)“Stir not your tongue herewith to hastenit. Lo! upon Us (rests) the putting togetherthereof and the reading thereof. And whenWe read it, follow you the reading.” (42)The Qur’an also described themechanism to enhance retention andretrieval of information by mentioningthat the pen gives knowledge to man.The function of the pen is writing andthis explains that writing is the bestway of learning new information. Thissuggests the involvement of the motorsystem in memory and learningprocessing (43) .` He (Allah) who taught by the pen,taught man that which he knew not.` (44)The Qur’an also described the researchor inquiry based learning method (45) .For example the Qur’an gives a statementabout the human development andleaves the remaining information for usto discover.`(Allah) Created man from a clot. Read:and your Lord is the Most Bountiful. (46)Evidence based practice is also evidentfrom the Qur’an.“And if any tidings, whether of safety orfear, come unto them, they noise it abroad,whereas if they had referred it to themessenger and to such of them as are inauthority, those among them who are ableto think out the matter would have knownit. If it had not been for the grace of Allahupon you and His mercy you would havefollowed Satan, save a few (of you).” (47)The role of supervision is also describedin the Qur’an,“And We sent not (as Our messengers)before you other than men whomWe inspired - Ask the followers of theRemembrance if ye know not!” (48)“Musa said unto him: May I follow you,to the end that you may teach me rightconduct of that which you have beenFIMA YearBook 200938

Inculcating Islamic Inputtaught ?” (49)Skills:The Qur’an describes demonstration asthe basic principle of teaching a skill.“Then Allah sent a raven scratching upthe ground, to show him how to hide hisbrother’s naked corpse. He said: woe untome! am I not able to be as this raven andso hide my brother’s naked corpse and hebecame repentant.” (50)Assessment methods:Assessment methods may be `Normreferenced`or `Criterion-referenced`.In `Norm-referenced` assessment,students` abilities are judged againstthe performance of others and thisgives a sense of competition which isconsidered detrimental for educationalenvironment. On the other hand, in`Criterion-referenced` assessment,students are assessed against some preselectedcriteria i.e. whether they haveachieved the required standard or not.Their performance is not related to theperformance of others. Competition asa source of motivation is good but ifstudents struggle to perform better thantheir fellow students then it may affectlearning as a group.The Qur’an clearly suggests a criterionbasedassessment method wherecandidates are assessed against somepre-set criteria independently and notas compared to the performance Ofother students This method avoidsa competitive environment andencourages collaborative learning.“Those are a people who have passedaway; theirs is that which they earnedand yours that which you earn. Andyou will not be asked of what they usedto do.” (51)There are several assessment methods inuse and their selection is based on thecontent and objectives of the course orprogram. Islamic input suggests a basicprinciple of assessment that is criterionbasedto encourage students` learning.This may be applied to continuous,formative, summative or any other typeof assessment. Assessment tools mustcomply with this basic requirement.The Qur’an also describes continuousformative and summative assessmentsby mentioning about the record of allour deeds throughout our life and afinal grand assessment on the Day ofJudgment.Cyberjaya University College of MedicalSciences (CUCMS) curriculum – Is it anIslamic Curriculum?The philosophy of CUCMS, “To harnesshuman potential in a comprehensivemanner to produce holistic healthcare providers who are intellectually-,emotionally- and spiritually-balancedbased on the principles of Islamand the obedience to the AlmightyAllah” clearly indicates the intention ofproviding holistic health care educationbased on Islamic principles andproducing doctors who are intellectually,emotionally and spiritually balanced.The affective domain in CUCMSis composed of 9 outcomes whichstudents are expected to achieve atthe end of their training. StudentsFIMA YearBook 200939

Inculcating Islamic Inputare closely observed from the verybeginning under the mentorshipprogram to ensure supervised trainingand assessment of their attitude andbehavior. Weekly reflection sessionsof small groups of students with theirmentors facilitate the development ofrelationship among students and theirteachers. These sessions also help inidentifying the right attitudes expectedand monitoring of progress in achievingaffective domain outcomes. Reflectionon academic and non-academic issuesprovides a holistic perspective to theAffective domain. In addition, studentsare continuously exposed to variousIslamic concepts and behaviors throughtalks, lectures, community activities andsharing of experiences.For the Knowledge domain, students areprovided access to information throughthe availability of online resources,library and web portals. Small groupteaching is the main teaching methodwhich provides close monitoring ofstudents and identification of weakstudents to provide remedial measures.Student Centered Team-based Learning(SCTL) method engages studentsthrough various activities like drawingsand work books completion to enhancetheir memory and retention. ProblemBased Learning (PBL), Clinical SkillsTraining (CST) and Clinical Correlation(CC) courses provide thinking andproblem solving exercises under thesupervision of facilitators. Large classsessions provide a portal to conveyimportant topics to the whole class atonce to give them better understandingand planning of upcoming small groupsessions.Skills’ training is also conducted as aseparate course and explanation anddemonstration by experts is the mainstrategy adapted before allowing themto practice individually.Community and Health ExposureTraining (CHET) course, Personaland Professional Development (PPD)course, Military medicine, Disasterand Relief Medicine (DRM), electivesfor both non-medical and medicalsubjects and voluntary work underYoung Mercy all contribute towards aholistic approach to the patient and thecommunity.Traditional and ComplimentaryMedicine (TCM) is another importantcourse to integrate Islamic and otheralternative treatment methods intomodern medicine.Introduction to research topics andencouragement to conduct researchduring electives is also in accordancewith the Islamic philosophy.Criterion based continuous formativeand summative assessment is helpfulin creating a collaborative learningenvironment instead of competitiveenvironment.This bird’s eye view analysis of CUCMScurriculum clearly indicates thedirection of education towards Islamicphilosophy of medicine which is inaccordance with the Philosophy ofCUCMS as well.There is still a need to introduce fewFIMA YearBook 200940

Inculcating Islamic Inputmore strategies in order to achieve athorough and complete model Islamicmedical curriculum at CUCMS.Recommendations on Islamic input inpre-clinical medical curriculum:1. Introducing `Spiritual History` takingfrom the first year: Performing aspiritual history facilitates the practice ofcompassion with one’s patients, and helpsthe clinician learn to integrate spiritualityinto the therapeutic plans (52) . AppendixB shows some models of spiritual historytaking developed and used in someinstitutions (53-55) .A study was conducted to evaluate the impactof a spiritual history-taking curriculum onthe skills, knowledge, and attitudes of 1styear medical students (56)The results showed slightly improved abilityin recognizing the patient’s spiritual concernsand in accommodating the patients’ beliefs.The researchers concluded that “spiritualhistory taking can be integrated effectivelyinto the existing history-taking curriculumin first year of medical training”.Another study concluded that studentsexposed to material on spirituality inmedicine have shown greater understandingof the issue but no difference in clinicalperformance (57) .2. Maximum exposure to knowledge:Students should not be asked to limit theirknowledge only to the `must know` topics,instead they should be encouraged to obtainas much information about a subject ortopic as possible in order to enhance theirunderstanding and lateral thinking skills.3. Students should be advised to use propertechniques to gain attention: i.e. sub-vocalrepetition of presented material.4. Motor system involvement to enhancememory and retention: Writing ordrawing are crucial memory enhancingtools as they incorporate the motor systemin the learning process.5. Large class lectures: to introduce topicsrelated to philosophy of Islamic medicine.For example, introducing revelation asa prime source of knowledge, as Islampointed out the scientific truths of anatomy,physiology, biochemistry, etc. centuries agobut were only known by modern sciencecenturies later through decades of trials,errors and experiments6. Introducing the `Life of ProphetMuhammad (PBUH) ` as role model:Students should be exposed to `Sunnah`and `Hadith` in order to develop anappropriate attitude and behaviour(Affective Domain).7. Teaching prayers (Duaa) and Names ofAllah ( al-Asma-al-Husna): Studentsshould learn and memorize some prayersfrom the Qur’an and Sunnah and the namesand the meanings of the names of Allahand His attributes, to be a helpful source ofguidance to patients.8. Evidence-Based Medicine (EBM) andResearch methods: EBM and researchshould be encouraged from the verybeginning of training.9. Complimentary and Alternative Medicine(CAM): CAM should be introduced fromthe beginning to help students in studyingcomparative medicine. Stress should begiven to Islamic methods i.e. prayers,plants and herbs, honey and cupping (al-Hijamah).10. Personal and Professional Development(PPD): Students should be encouragedto develop themselves as pious Muslims,life-long learners and competent and kindphysicians.FIMA YearBook 200941

Appendix A:No. Institution name and web address1.Inculcating Islamic InputThe Association for Spirituality and Mental Health at St. Paul University, Ottawa,Ontario, Canada.http://www.spiritualityandmentalhealth.org/home.htm2.3.4.5.6.7.8.9.10.11.12.Institute for Spirituality and Health at the Texas Medical Center.http://www.ish-tmc.org/history.phpMedical University of South Carolina Center for Spirituality and Health.http://www.musc.edu/dfm/Spirituality/Spirituality.htmIndiana State University Center for the Study of Health, Religion and Spirituality.http://www1.indstate.edu/psychology/cshrs/addictions_conference.htmUniversity of Florida Center for Spirituality and Health mission.http://www.ufspiritualityandhealth.org/mission/The George Washington Institute for Spirituality and Health (GWish). http://www.gwish.org/Royal College of Psychiatrists' Spirituality and Psychiatry Special Interest Group. http://www.rcpsych.ac.uk/college/specialinterestgroups/spirituality.aspxCenter for Spirituality and Healing at University of Minnesota.http://www.csh.umn.edu/home.htmlThe Benson-Henry Institute for Mind Body Medicine at Massachusetts GeneralHospital (BHI).http://www.mbmi.org/about/default.aspCentre for Spirituality, Health and Disability at University of Aberdeen. http://www.abdn.ac.uk/cshad/about.shtml3 rd Australian Conference on Spirituality & health, Integrating Spirituality in thePractice of health care, 13-15 July 2009, Elder hall, Adelaide.http://www.spiritualityhealth.org.au/Spirituality in Higher Education: A National Study of College Students’ Searchfor Meaning and Purpose, Higher Education Research Institute University ofCalifornia, Los Angeles.http://www.spirituality.ucla.edu/FIMA YearBook 200942

Inculcating Islamic Input1. SPIRITmodel53(Maugans,1996)2. The HOPEquestions54(Anandarajah &Hight, 2001)3. The FICASpiritualHistory Tool55(The GeorgeWashingtonInstitute forSpirituality andHealth, 2001).Appendix B:S—Spiritual Belief SystemP—Personal SpiritualityI—Integration and Involvement In a Spiritual CommunityR—Ritualized Practices and RestrictionsI—Implications for Medical CareT—Terminal Events Planning (Advance Directives)Each letter represents an important component of the impactthat spirituality may have on patients' experiences with Wellnessand illness.H—sources of hope, strength, comfort, meaning, peace, love andconnection;O—the role of organized religion for the patient;P—personal spirituality and practices;E—effects on medical care and end-of-life decisions.F – Faith and BeliefDo you consider yourself spiritual or religious?" or "Do you havespiritual beliefs that help you cope with stress?"I – Importance"What importance does your faith or belief have in our life?Have your beliefs influenced how you take care of yourself inthis illness? What role do your beliefs play in regaining yourhealth? “C – Community"Are you part of a spiritual or religious community? Is this ofsupport to you and how? Is there a group of people you reallylove or who are important to you?"A – Address in Care"How would you like me, your healthcare provider, to addressthese issues in your healthcare?"FIMA YearBook 200943

Inculcating Islamic InputReferences:1. Hassan, T., (2009). Educational Attitude:A source of transforming educationalprograms and resources into knowledgeand skills. Presented at InternationalMedical Education Conference (IMEC) atthe International Medical University, KualaLumpur, Malaysia on 1-3 April 2009.2. Droege, T.A., (1991). The faith factor inhealing. Philadelphia: Trinity Press.3. Lynch, J.J., (1977). The broken heart: themedical consequences of loneliness. NewYork: Basics Books.4. Puchalski, C. M., (2001). Spirituality andHealth: The Art of Compassionate Medicine.Hospital Physician. Obtained from: www.turner-white.com5. Puchalski, C.M., & Larson, D.B., (1998).Developing curricula in spirituality andmedicine. Acad Med. 73:970-974.6. John Templeton Foundation Spiritualityand Health Programs, (2009). Availableat: http://www.templeton.org/spirituality_and_health/programs.asp.7. Athar, S., (2009). Spirituality, Medicineand Religion. Obtained on May 15, 2009from: http://islam-usa.com/ind200615.htm8. Rosenfield et al, (2003). Effects of SpiritualWell Being on End of Life in Terminally IllCancer patients. Lancet, 361, 1603-1607.9. Matthews, D. (2000) Is Religion Good forYour Health in Stannard, R. (Ed)God for the 21st Century Philadelphia:Templeton Foundation Press.10. Sulmasy, D.P., (1999). Is medicine aspiritual practice? Acad Med. 74:1002-5.11. McKee, D.D. & Chappel, J.N., (1992).Spirituality and medical practice. J FamPract.35:201,205-8.12. Thomason, C.L. & Brody, H., (1999).Inclusive spirituality. J Fam Pract. 48:96-7.13. Hay, M.W., (1989). Principles in buildingspiritual assessment tools. Am J Hosp Care.6:25-31.14. Craigie, F.C., (1999). Hobbs RF 3d.Spiritual perspectives and practices of familyphysicians with an expressed interest inspirituality. Fam Med. 31:578-85.15. Derrickson, B.S., (1996). The spiritualwork of the dying. Hosp J. 11:11-30.16. The Glorious Qur’an: 6,92.17. The Glorious Qur’an: 10,37.18. The Glorious Qur’an: 39,49.19. The Glorious Qur’an: 16,69.20. The Glorious Qur’an: 37,145-146.21. The Glorious Qur’an: 17,82.22. The Glorious Qur’an: 10-57.23. The Glorious Qur’an: 26,80.24. The Glorious Qur’an: 6,17.25. The Glorious Qur’an: 39,38.26. The Glorious Qur’an: 40.60.27. The Glorious Qur’an: 113,1-5.28. The Glorious Qur’an: 41,46.29. The Glorious Qur’an: 42,30.30. The Glorious Qur’an: 57,20.31. The Glorious Qur’an: 5,32.32. The Glorious Qur’an: 20,114.33. The Glorious Qur’an: 31,16-19.34. The Glorious Qur’an: 68,4.35. The Glorious Qur’an: 2,219.36. The Glorious Qur’an: 4,43.37. The Glorious Qur’an: 5,90.38. The Glorious Qur’an: 5,91.39. The Glorious Qur’an: 2,31.40. Hassan, T. (2008).The role andmechanism of `Attention` in medicaleducation. Presented at InternationalFIMA YearBook 200944

Inculcating Islamic InputMedical Education Conference (IMEC)in International Medical University, KualaLumpur, Malaysia on 13-14th March 2008.41. The Glorious Qur’an: 96,1.42. The Glorious Qur’an: 75,16-18.43. Hassan, T., (2008). PolysynapticSensory-Motor Learning Model: Use yourmuscle power to enhance learning inmedical education. Presented at 5th AsiaPacific Medical Education Conference inNational University Singapore, 25-27thJanuary 2008.44. The Glorious Qur’an: 96,4-5.45. Hassan, T. (2008). TriangularCurriculum: A three dimensionalpostgraduate medical education structure.Presented at International Conference onPostgraduate Education (ICPE), 16-17December, 2008 organized by UniversityScience Malaysia, Penang, Malaysia.46. The Glorious Qur’an: 96,2-3.47. The Glorious Qur’an: 4,83.48. The Glorious Qur’an: 16,43.49. The Glorious Qur’an: 18,66.50. The Glorious Qur’an: 5,31.51. The Glorious Qur’an: 2:141.52. Puchalski, C.M. & Romer, A.L., (2000).Taking a spiritual history allows clinicians tounderstand patients more fully. J Pall Med.3:129–37.53. Maugans, T. A., (1996).The SPIRITualHistory. Arch Fam Med. 5:11-16.http://archfami.ama-ssn.org/cgi/reprint/5/1/1154. Anandarajah, G. & Hight, E., (2001).Spirituality and Medical Practice: Usingthe HOPE Questions as a Practical Tool forSpiritual Assessment. Am Fam Physician.63:81-8, 89.55. The George Washington Institute forSpirituality and Health (GWish), (2001).http://www.gwumc.edu/gwish/clinical/fica.cfm56. King, D.E.; Blue, A.; Mallin, R. &Thiedke, C., (2004). Implementation andAssessment of a Spiritual History TakingCurriculum in the First Year of MedicalSchool. Teaching and Learning in Medicine,Volume 16, Issue 1 January 2004, pages64 – 68. http://www.informaworld.com/smpp/content~db=all?content=10.1207/s15328015tlm1601_1357. Musick, D.W., Cheever, T.R., Quinlivan,S., & Nora, L.M., (2003). Spirituality inMedicine: A Comparison of MedicalStudents’ Attitudes and Clinical Performance.Academic Psychiatry. 27:67–73.FIMA YearBook 200945

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Problem Based Learning in Medical CurriculaAn Islamic PerspectiveAfshan Khan*Abstract:Problem based learning, PBL, has been used in medical educationsince 1970. It is one of the techniques used in “Student CenteredLearning”. It is known that Self Directed Learning, SDL, has clear longterm benefits in enhancing student learning.. Educational institutionsin Muslim countries have similarly incorporated these new teachingparadigms and educational methodologies with significant progressand success. Though not the only method of learning in SDL, PBLremains one of its cornerstone strategy. Various tertiary educationalinstitutions in Muslim countries, amongst them the InternationalIslamic University of Malaysia have adopted this teaching modalityand have infused it with affective and Islamic values.This paper reviews the literature about PBL and concepts related toit and attempts at conceptualizing medical education through PBLfrom an Islamic framework.Keywords: Problem based learning, student centered learning, Islamicmedical education.Dr. Afshan Khan, AP PMC PediatricsDirector, Undergraduate Medical ResearchPeshawar Medical College, Peshawar, PakistanE-mail: palwasha.bibi@gmail.comFIMA YearBook 200947

Problem Based LearningIntroduction:Learner centered education is currentlyan accepted international standard ofexcellence in the world of graduate aswell as undergraduate education. Theconcept of learner centered education isnot a new one. The shift from traditionalTeacher Centered Learning to currentStudent Centered Learning in medicineoccurred in 1970’s. Student CenteredLearning is also termed self directed orlearner centered learning. Self directedlearning, SDL, is defined as studentstaking the initiative and subsequentsteps for their own learning: studentslead in diagnosing their learning needs,formulating multidimensional goals anddesired learning outcomes, identifyingacademic and contextual resources,working in groups in prioritizing andimplementing appropriate tasks andactions and finally evaluating their ownoutcomes (1) .Learner Centered Education is,therefore, the most widely acceptedapproach to fulfilling the needs of AdultLearning in any educational systemincluding medical education (2) .Adults are motivated by learning that:• Is perceived as relevant• Is based on, and builds on, theirprevious experiences• Is participatory and activelyinvolves them• Is focused on problems• Is designed so that they cantake responsibility for their ownlearning• Can be immediately applied in practice• Involves cycles of action andreflection• Is based on mutual trust andrespect, (3)It can be clearly seen from abovedescriptions that concepts of SDL andAdult Learning are quite concordant.Self directed learning is an activeprocess. It encourages the adoptionof the deep approach to learningfirst. Deep learning, as opposed tosurface learning, is an active search forunderstanding. Surface learning merelyencourages students to reproduce whathas been learnt. Research has identifiedthe student’s approach to learningsurfaceor deep-as the crucial factorin determining the quality of learningoutcomes, (5) . A surface approach iscommon in courses that have a heavyworkload, an unrealistic and excessiveamount of course material, little orno opportunity to pursue subjects indepth, dictated choice over study areasand topics, and an examination orassessment system that provokes anxietyand mainly rewards rote memory andreproduction of facts even in absence ofability to apply that knowledge in reallife situations.Education systems that aim for deeperlearning, on the other hand, providea context in which main motivationis the learner’s need to know, (5) . Suchsystems support active learning andexploratory study through researchin small groups supported by a wellstructured knowledge base and preconceivedlearning outcomes. Aimsand objectives, modes of informationFIMA YearBook 200948

Problem Based Learningtransfer and techniques of assessmentare continuously validated by facultiesin these systems. Excellence is thusa product of an ongoing process ofconstant reviews aimed at improving theeducational material and methodologyfor better learning.SDL is suggested as the most efficaciousapproach for all tiers of medicaleducation, pre-medical, undergraduate,graduate training and sub-specialtytraining up to various stages and typesof continuing medical education, (7) . SDLassumes central role with or withoutinstitutional intervention or willingnessto implement it when learning is basedon experience, and new knowledge andunderstanding can be integrated intothe personal and professional contextof the individual. Strategies that havebeen developed as self directed learninginclude:• Problem based learning• Discovery learning• Task based learning• Experiential and reflective learning• Portfolio based learning• Small group, self instructional, andproject based learning• Peer evaluation and learningcontracts. (7)SDL has been used extensively in variousinstitutions of academic excellence,both in the East and the West. Thearchetype methodology in LearnerCentered Education is Problem BasedLearning, PBL, (8, 9) . The application ofproblem based approaches in educationis not new. In 1889 a method knownas “multiple working hypotheses”was advocated, (10) . Dewey, one of theeducational theorists of the early partof twentieth century, recommendedthat students should be presented withreal life problems and then helpedto discover the information requiredto solve them. Later, other workersshowed that giving students ready madesolutions for problems was “manifestlyineffective” for learning, (11) . In the late1960s, McMaster medical school inOntario, Canada, pioneered the firstcompletely problem based medicalcurriculum, with Maastricht followingin 1974 as the first in Europe, (11) . Around150 medical schools worldwide (some10% of the total) have adopted problembased curricula.Problem based learning can be seenas “a systematic attempt to applyfindings of cognitive psychology toeducational practice”, (12) . Relevant areasinclude: activation of prior knowledge(a major determinant of what can belearnt); learning in context (enhancingtransfer of knowledge); elaborationof knowledge (enhancing subsequentretrieval); and fostering of competenceby an inquisitive style of learning, (12,13) .Problem based learning fits with whatis known about the development ofclinical reasoning and the processby which so called “illness scripts”—cognitive structures describing thefeatures of “proto typical” patients—areacquired, (13) .There is no evidence, however, thatgeneric problem solving skills areenhanced through problem basedlearning, (14) . Several authors haveFIMA YearBook 200949

Problem Based Learningreviewed the evidence for and againstproblem based learning, (14-16) , and inspite of semantic difficulties, differentstudy designs, confounding variables,and different interpretations of theevidence, several benefits have beenidentified. The identified benefits of PBLcan be summarized as follows:• Promotes deep, rather than surface,learning• Enhances and retains self directedskills• Learning environment is morestimulating• Promotes interaction betweenstudents and staff• Promotes collaboration betweendisciplines—for example, basic andclinical scientists• More enjoyable for students andteachers• Promotes retention of knowledge• Improves motivation, (17)Some of these benefits may beindistinguishable from those relatedto other curricular innovations.Maudsley, (17) , however, considersproblem based learning to havesurvived unprecedented scrutiny. Aboveadvantages have been demonstratedseveral times , in different studiesconducted in different countrieswith differing systems of medicalinstruction, (17) . Several disadvantageshave also been identified includingthe initial costs and human resourcerequired for the start up and maintenanceof PBL systems, excessive demands onstaff time and efficiency, increased stressdue to higher learning needs on bothstudents and faculty, relatively reducedacquisition of knowledge of purebasic sciences, and implementationdifficulties when class sizes are large orwhere there is an absolute or relative lackof enthusiasm among the implementingmembers of faculty and staff for theapproach, (16) . Finucane and colleaguesprovide a balanced consideration ofthe advantages and disadvantages ofadopting a curriculum for problembased learning, (18) . There is as yet noconcrete and mutually agreed uponevidence that graduates of problembased medical instruction programsmake better, worse or exceptionalteachers or practitioners in the longterm.It is easy to gather from abovebackground information that PBL,although a very elegant and attractivephilosophy of medical instruction,nonetheless comes at a price; bothliterally and metaphorically speaking.Following is a list of pre-requisitesto the institution of PBL as the maineducational strategy compiled as aconsensus document in 1993 WorldSummit on Medical Education ofthe World Federation for MedicalEducation, (19, 20) :• Class size limited to 100 students, (20)• “Small Groups” of students with,preferably 6 students per group, (20)• Infrastructure support with tutorialrooms, computers, libraries and skill(21, 22)labs,• Faculty commitment withsubsequent integration of medicalcurriculum PRIOR to placing PBL asFIMA YearBook 200950

Problem Based Learningmain mode of instruction, (23)• “PBL Supporting Curriculum”, (23)• Administrative commitment torevision of curricula and acceptanceof financial implications, (24)• Faculty and staff committed andtrained in PBL Instruction, (24,25)• Specially trained PBL Instructors, (26)PBL In Islamic Medical Instruction, IMIIslamic Medical Education, IMI, isa relatively new term introduced inthe 1980’s and presented as a viableconcept in Medical Education inFirst International Islamic MedicineConference in Kuwait, (27) . IslamicMedicine was the original term used inKuwait at that time and was acceptedgenerally to embody the ethical andmedical conduct of a Muslim Physician.Islamic Medicine can only result fromprovision of Islamic Medical Education.As a logical step in reverse engineeringof the term Islamic Medicine, we findthat in order to have a system of IslamicMedical Education, we have to devise aschool of Islamic Medical Instruction.The aims and objectives, curriculardesign and assignment of modes ofinformation transfer; all form parts ofthis greater whole.As already identified above, an integratedmedical curriculum is a pre-requisitefor institution of PBL, (23) . In case of IMIthis integration will not only bind thesciences together but it will also bringrelevant principals of Islamic MedicalEthics and references from IslamicMedical History into play. The resultingcurriculum will be a vibrant and richtapestry of pure sciences, Humanora,Islamic and general medical ethics andlearning in Islamic medical historyand civilization. PBL or the proposedIslamic PBL can only then be institutedin a medical institution possessing sucha curriculum. Few successful examplescan be quoted about such endeavorsin Islamic Medical CurriculumDevelopment. After an exhaustivereview, one can quote the example ofInternational Islamic University ofMalaysia. This curriculum is pioneeredby the Faculty of Medicine under Dr.Omar Hasan Kasule, Sr in 1997, (27)Dr. Omar Hasan Kasule, Sr. in a paperpresented to the first InternationalIslamic Medicine Conference,Kuwait (Kasule 1980) argued that Islamicmedicine can be defined only as valuesand ethics and not as any specific medicalprocedures or therapeutic agents. Thisdefinition allows Islamic medicine tobe a universal all-embracing conceptthat has no specific or particular timespacecharacteristics. A definition basedonly on values is however too generalto be useful operationally. Values canbe very subjective and difficult to defineexactly. An excerpt from Dr. Omar HasanKasule’s paper is given here for betterunderstanding of the concept of IMI.“There is an argument that you canget to Islamic medicine by ‘Islamizing”the physician especially duringtraining. Then you are sure that hisresearch, work and practice will bein conformity with the teachingsof Islam. Naqib (1984) proposed acomplete Islamically-based educationFIMA YearBook 200951

Problem Based Learningsystem for an aspiring physicianstarting from elementary to postgraduate levels including describingattributes of a physician, his rightsand obligations. Deep study ofmedicine with reflection shows thephysician the majesty of the Creatorand this deepens and strengthensiman (Jalabi 1974, Jalabi 1978,Kasule 1980). A believing physicianwill be more ethical in his researchand practice. Ethics involves: makingsure the physician has the appropriatelevel of knowledge and skill, chargingreasonable fees for services, etiquettewith patients especially of the oppositegender, treating patients after theirconsent. There have been severalattempts to define medical ethics fora Muslim physician, ancient andmodern. Al Tabari described theIslamic code of medical ethics in 970AD to include the following: personalcharacteristics of the physicianobligations towards patients,obligations towards the community,obligations towards colleagues, andobligations to his assistants. TheIslamic Medical Association ofthe US and Canada (presently theIslamic Medical Association ofNorth America -IMANA) adoptedthe Oath of a Muslim Physicianin 1977 as an alternative to theHippocratic oath. The Islamic Codeof Medical Ethics was issued by theIslamic Organization for MedicalSciences, Kuwait 1981. Amine andEl Kadi (Athar, 1993) based medicalethics on the Qur’an “the physicianmust believe in God, and in theIslamic teachings and practice it inprivate and public life; be gratefulto his parents, teachers, and elders;be humble, modest, kind, merciful,patient, and tolerant; follow the pathof the righteous; and always seekGod’s support. The Muslim physicianmust stay abreast of current medicalknowledge, continuously improve hisskills, seek help whenever needed,and comply with legal requirementsgoverning his profession; realize thatGod is the maker and owner of hispatient’s body and mind and treathim within the framework of God’steachings; realize that life was given toman by God, that human life starts atthe time of conception, and that humanlife cannot be taken away except byGod or with His permission; realizethat God is watching and monitoringevery thought and deed; follow God’sguidelines as his only criteria, even ifthey differ with popular demand orthe patient’s wishes; not recommendnor administer any harmful material;render needed help regardless offinancial ability or ethnic origin ofthe patient; offer needed advice withconsideration for both the patient’sbody and mind; protect the patient’sconfidentiality; adopt an appropriatemanner of communication; examinea patient of the opposite sex in thepresence ot a third person wheneverfeasible; not criticize anotherphysician in the presence of patientsor health personnel, refuse paymentfor treatment of another physician orFIMA YearBook 200952

Problem Based Learninghis immediate family; and strive touse wisdom in all his decisions”. (28)Inculcation of principals of PBL inIMI is a natural consequence once aneducational system is committed toIMI. IMI demands a basic paradigmchange from conventional teaching ofmedicine. It places the physician in theposition of a servant of Allah ratherthan the “Godplayer” role assigned tophysicians in the West. Such paradigmor attitude change is possible after theprinciples of “Affective or Attitudinal”education are followed.Educational psychologists have drawnon findings from a number of studiesto create a series of six guidelines foreffective design of attitude instruction.The best set of guidelines, which is mostfrequently used in adult instruction, isform Simonson and Maushak, (29) . Theseare:1. Make the instruction realistic,relevant, and technically stimulating2. Present new information3. Present persuasive messages in acredible manner4. Elicit purposeful emotionalinvolvement5. Involve the learner in planning,production or delivery of the message6. Provide post-instruction discussionor critique opportunitiesA review of principles and benefits ofPBL given earlier in this paper showsthe close concordance of PBL strategywith the requirements of IMI.Institutional commitment is thefoundation to any educationalintervention. Once an institution ofmedical education is committed toplacing IMI as its main instructionalstrategy, the next step is involvementof its faculty and staff in this processof change of paradigms. A series ofworkshops and interactive sessionsshould be conducted in order to giveeveryone an opportunity to voice theiropinions and have their reservationsaddressed at the outset. The next andmost important step from here onwardsis curricular revision and innovationsneeded to place identified areas of IMI tobe integrated with medical curriculum.It is the opinion of the author thata SPIRAL integration of medicalcurriculum with pre-identified coreareas of IMI in tandem with medicalsubjects is the most suitable amongknown designs of medical instruction.It is easy to visualize for someone withbasic know-how of PBL strategy thatstudents can be asked problems thatdirectly or indirectly address aspectsof Islamic medical ethics or IslamicCivilization. PBL packages can bewritten so that participants researchissues related to Shari’ah or Fiqh inorder to understand the trigger problemcompletely.For purpose for further clarificationof the concept of Islamic PBL, let usconsider a PBL trigger given students ofsecond year medical studies:“You are working as senior medicalofficer in a basic health unit in a poorslum area near a big city. On onemorning, you are seeing patients inyour daily OPD when a young womanFIMA YearBook 200953

Problem Based Learningof 23 years, who is a regular patient atyour unit, approaches and asks to seeyou in private. She tells you that she ismarried with 5 children and is currentlypregnant with her 6 th baby. She asksfor advice about termination of thispregnancy. You inform her that suchservices are not offered at your unit andbesides it is not allowed in Islam to doso. She gets visibly upset and tells youthat she will go to a nearby roadside Daiand get an abortion done if you did nothelp her. You try your best to counselher but she is adamant and leaves yourunit in a hurry.”It is evident from the above scenario thatthe student will consider Islamic verdicton termination of pregnancy whenidentifying the Learning Outcomes forthis trigger. Facilitators can be trainedto explain this issue with reference toQur’an, Hadith and Fiqh. A simple caseof illegitimate abortion can be usedto explain complex concepts such assanctity of life in Islam.In conclusion, PBL appears to be asatisfactory, if not perfect, answer toaddressing many questions relatedto provision of effective IMI inIslamic institutions. The key stepsin placement of Islamic PBL, inessence, are wholehearted institutionalcommitment, involvement of all keyplayers in planning and implementation,extensive curricular planning withIslamic inputs, patient redress ofproblems and open minded approachto constructive critique, and finallywell designed educational research tovalidate the methods as well as resultslocally and internationally.FIMA YearBook 200954

Problem Based LearningReferences1. Harden RM, Sowden S, Dunn WR.Some educational strategies incurriculum development: the SPICESmodel. Dundee: Association for theStudy of Medical Education, 1984.(Medical education booklet No 18.)2. Knowles M. The adult learner: aneglected species. Houston, TX: GulfPublishing, 1990.3. Regehr G, Norman GR. Issues incognitive psychology: implicationsfor professional education. Acad Med1996; 71:988 1001.4. Coles C. How students learn: theprocess of learning. In: Jolly B,Rees L, eds. Medical education inthe millennium. Oxford: OxfordUniversity Press, 1998:63 82.5. Report of the Council for NationalAcademic Awards Improving StudentLearning Project. Improving studentlearning. Oxford: Oxford Centre forStaff Development, 1992.6. Chastonay P, Brenner E, Peel S,Guilbert J J. The need for more efficacyand relevance in medical education.Med Educ 1996; 30:235 8.7. Harden RM, Laidlaw JM, Ker JS,Mitchell HE. Task based learning: aneducational strategy for undergraduate,postgraduate and continuing medicaleducation. Dundee: Association forMedical Education in Europe, 1996.(Medical education booklet No 7.)8. Dolmans D, Schmidt H. Theadvantages of problem based curricula.Postgrad Med 1996; 72:535 8.9. Barrows HS. Problem based, selfdirectedlearning. JAMA 1983;250:3077 80.10. Chamberlin TC. The method ofmultiple working hypotheses. Science1965;148:745 911. Salih MA. History of problembasedmedical education. In: deGrave WS, Moust JHC, SchmidtHG, eds. Tutorials in problem basedlearning. Vol 2. Maastricht: Networkof Community Oriented EducationalInstitutions for the Health Sciences,198512. Schmidt HG. Problem based learning:rationale and description. Med Educ1983; 17:11 6.13. Schmidt HG, Norman GR, BoshuizenHPA. A cognitive perspective onmedical expertise: theory andimplications. Acad Med 1990; 65:611-21.14. Albanese MA, Mitchell S. Problembasedlearning: a review of literatureon its outcomes and implementationissues. Acad Med 1993; 68:52 81.15. Vernon DTA, Blake RL. Doesproblem based learning work? A metaanalysisof evaluative research. AcadMed 1993; 68:550 63.16. Berkson L. Problem based learning:have the expectations been met? AcadMed 1993;68(suppl):79 88S.17. Maudsley G. Do we all mean the samething by `problem based learning?‘A review of the concepts and aformulation of the ground rules. AcadMed 1999; 74:178 85.18. Finucane PM, Johnson SM, PrideauxDJ. Problem based learning: itsrationale and efficacy. Med J Aust1998; 168:445 8.19. Walton H, ed. Proceedings of the 1993world summit on medical educationof the World Federation for MedicalEducation. Med Educ 1994;28(suppl1):1 117.20. General Medical Council. Tomorrow’sdoctors: recommendations onundergraduate medical education.London: General Medical Council,FIMA YearBook 200955

Problem Based Learning1993.21. Wetberg J, Jason H. Collaborativeclinical education. The foundationof effective health care. New York:Springer; 1993.22. Van Der Hem-Stokroos HH,Daelmans HE, Van Der VleutenCP, Haarman HJ, Scherpbier AJ. AQualitative study of constructiveclinical learning experiences. MedTeach. 2003;25(2):12023. Curry RH, Del Bene VE, EnarsonC, Irby DM, Kirkland RT, KoeppenBM, et al. The education of medicalstudents: ten stories of curriculumchange. [Monograph on the Internet].New York: Milbank Memorial Fund;2000. [Cited April 2006]. Availablefrom: http://www.milbank.org/reports/americanmedicalcolleges/0010medicalcolleges.html24. University of Arizona Teaching TeamsProgram. How to create learnercenteredcourses with teachingteams: a faculty resource manual forparticipants in the Teaching TeamsProgram and the Einstein’s ProtégésProgram. [Homepage on the Internet].Arizona: University of Arizona;c2004 [updated 2005 Aug 18; citedApril 2006]. Available from: http://teachingteams.arizona.edu/manual.htm25. Schwartz PL, Heath CJ, Egan AG.The art of the possible: ideas from atraditional medical school engagedin curricular revision. Dunedin:University of Otago Press, 199426. Mayo WP, Donnelly MB, SchwartzRW. Characteristics of the idealproblem based learning tutor inclinical medicine. Evaluation HealthProfessions 1995;18:124 36.29Simonson, M. (1980). Instructionalmedia, attitude formation and change:a critical review of the literature.27. Kasule,OH Presentation at theInternational Islamic CharityFoundation Kuwait 21 st December2005.28. Kasule,OH Presentation at theFirst International Islamic MedicineConference, Kuwait .FIMA YearBook 200956

Teaching Medical Professionalism:An Islamic ApproachMohamed Hatta Shaharom*AbstractThe universal concept of teaching of medical professionalism highlights thepractice of medicine as a moral endeavour that requires a rigorous applicationof behavioral and ethical standards and scientific training. Before the medicalstudent becomes a medical practitioner, he must be taught and trained topractice the core values of professionalism in his life: dedication, respect,compassion and empathy, honesty, altruism, responsibility, integrity, selfimprovement,magnanimity and accountability.The student-centred approach of learning is an effective way for the medicalstudent to acquire the understanding of medical professionalism.Through an integrated Islamic approach on the teaching-learning of medicalprofessionalism, medical students in their early years in colleges, who areidentified to be unwilling to be properly educated, should be counseledand if they show no signs of improvement, they should be guided to leaveundergraduate medicine and choose a different course in their lives.Keywords: Medical professionalism, student-centred approach, Islamic MedicalEducation.Prof. Mohamed Hatta ShaharomDean, Faculty of MedicineCyberjaya UniversityCollege of Medical Sciences (CUCMS)MalaysiaE-mails: hatta@cybermed.edu.myhattashaharom@yahoo.comFIMA YearBook 200957

Teaching Medical ProfessionalismIntroductionThis is a preliminary thought on theIslamic approach to the teaching ofmedical professionalism. It consists ofthree parts:1. The universal concept and teachingof medical professionalism;2. The student-centred approach oflearning medical professionalism;3. An integrated Islamic approach onthe teaching-learning of medicalprofessionalism.1.The Universal Concept andTeaching of Medical ProfessionalismIn the West, the term “professionalism”has been in use for more than a century.It describes:• professional character, spirit, ormethods;• the standing, practice, or methodsof a professional; and• traits that are accepted by peers asprofessional and not amateurish.This description of a professionaldistinguishes the professional from anamateur who lacks any one or all ofthese criteria.1.1 Professionalism and MedicineMedicine is considered to be the classicexample of a profession. The termprofessionalism embraces a set of attitudes,skills and behaviors, attributes and values.These are expected from those to whomsociety has extended the privilege of beingconsidered a professional. In other words, aperson claiming to be a professional mustprove that a set of attitudes and attributesare found in his life.Being a profession, the practice ofmedicine has the following criteria:• It is a moral endeavour;• It requires a rigorous application ofbehavioral and ethical standards;• It requires scientific training;• It is the ability to care for humansin distress with compassion andempathy; and• It is the ability to discipline theemotion and the mind when facedwith a situation that can threatenthe integrity of the set standards ofprofessionalism.1.2 The Medical PractitionerAfter undergoing training, a medicalpractitioner• masters a body of knowledge andskills to be used in the service ofmankind;• upholds the highest standards ofethical and professional behaviour;and• is a trusted professional in apatient-doctor relationship.1.3 Professional ValuesBefore the medical student becomes amedical practitioner, he must be taughtand trained to practise the followingcore values of professionalism in hislife (the combination of the first lettersof all core values form the words DR.CHARISMA):• Dedication• Respect• Compassion and Empathy• HonestyFIMA YearBook 200958

Teaching Medical Professionalism• Altruism• Responsibility• Integrity• Self-improvement• Magnanimity• AccountabilityDuring the last decade of the lastcentury, the teaching of professionalismhas become one of the priorities inmedical education. There is even a chairfor professionalism training in at leastone North American university whoseacademic-professional commitmentcan be quoted:“In parallel, we the teaching faculty aregiven the responsibility for ascertainingthat our students have the knowledgeand skills to embark on the nextstage of their preparation to becomedoctors, either family practitioners orspecialists.” (1)2. The Student-centred Approach ofLearning Medical Professionalism2.1 Student-Centred Curriculum onMedical ProfessionalismDr. Gregory A. Plotnikoff, of KeioUniversity in Tokyo and Dr.TakahiroAmano, director of the sameuniversity’s Medical Education Center,summarised their findings in an August2007 Minnesota Medical Associationreport “A Culturally Appropriate,Student-Centered Curriculum onMedical Professionalism: SuccessfulInnovations at Keio University inTokyo” in the following words:“Professionalism is a Western conceptwithout a precise equivalent in Asiancultures. The term itself cannot betranslated directly into any Asianlanguage, nor does the spectrum of wordsbased on the verb “to profess” exist inany Asian language. In addition, thefoundational assumptions found in theWest’s celebrated Charter on MedicalProfessionalism do not match Asianways of thinking regarding autonomy,service, and justice. Finally, there is notradition in Asia of reciting an oath atmedical school graduations. Despite thefact that professionalism is literally aforeign concept in Asia, Keio UniversitySchool of Medicine in Tokyo hassuccessfully introduced a professionalismcurriculum that both supports Japan’scultural traditions and affirms the school’sacademic mission. This article describesa series of educational events for medicalstudents in the university’s 6-yearundergraduate program. These includedevelopment of a course on medicalprofessionalism for students in their thirdyear, a year-long extracurricular oathwritingproject for fourth-year students,introduction of a White Coat Ceremonyat the start of the fifth year (when studentsbegin their clinical rotations), and areflective writing requirement for sixthyearstudents on professionalism andhumanism as witnessed during clinicalrotations.” (2)Their conclusion:“At Keio University School of Medicine,we are teaching professionalism using asequential, overlapping, student-centeredapproach that is incorporated into theformal curriculum and extracurricularFIMA YearBook 200959

Teaching Medical Professionalismactivities. Although efforts to instillprofessionalism are focused on studentsin their final 4 years of medical school,in the near future, activities will beincorporated into the first- and secondyearcurriculum. The extremely positiveresponse we’ve received since startingthis initiative demonstrates that even ina culture unfamiliar with the concept ofmedical professionalism, it can be taughtin a way that is appreciated by studentsand faculty.” (2)2.2 Student-Centred Team-BasedLearning (SCTL) at CUCMSSince the inception of Malaysia’sCyberjaya University College of MedicalSciences (CUCMS) in 2005, the SCTLis applied from the 1 st to the 5 th Yearof the five-year medical programme.(1)(The Bachelor of Medicine andBachelor of Surgery (MBBS) degreeis conferred on successful graduates).Medical professionalism is anotherarea of medicine that can be learned bymedical students through the SCTL.3. An Integrated Islamic Approach onThe Teaching-Learning Of MedicalProfessionalismThis section is divided into five subsections:2.1 Holistic EducationIslamic education is an essentiallyholistic teaching-learning-training triadthat covers all the four aspects of life:• Bio-physical;• Psychological;• Social; and• Spiritual.These four aspects are never separatedat any one time of the student-novice’slife. They are constantly interacting. Forinstance, while the student-novice isseating in the lecture hall, he would befeeling comfortable or finds his physicalenvironment too warm or too cold. If hesuccumbs to worries about his family’slatest crisis, he would not be able toconcentrate. Then there is the spiritualblessing he seeks from God and yearnsto see it as always present in his life. Themeans employed during this process arealso important. Legal and ethical meansare related to socially accepted normsand spiritually blessed methods.Thus education (al-tarbiyyah) can bepresented in the following Figure 1. Theteacher is a murabbi (the enlightenededucator-trainer), a model for thestudent who needs a guide for righteousliving; while the student is a novice andseeker of truth.Figure 1: Education (Al-Tarbiyyah)FIMA YearBook 200960

ِهّ‏ هّ‏Teaching Medical Professionalism3.2 Human Psychology and DivineEnlightenmentComponents of human psychology are:• The cognition (al-‘aql) which canbe divinely enlightened and has thediscerning ability to differentiateright from wrong, truth fromfalsehood; and• Emotion (al-qalb) which is theinnermost feeling and essence of thehuman heart that has the spiritualcapacity to be the receptacle fordivine light, thus enabling it toperceive correctly this fleeting lifeand not be ensnared by it.To gain the Pleasure of Allah, one’sheart must be sincere. This principle isfound in a well known Hadith narratedby ‘Umar ibn al-Khattab (RA) whoheard it from the Prophet Muhammad(PBUH) who stated in part“Verily, all deeds are according tothe intentions and everyone (will berewarded) according to what he hasintended…” (3)The sincerity that is sustained and wellmaintained brings tranquillity to theheart. It must be emphasised too thatthe emotional-spiritual heart that istranquil is the one that remembers andis close to Allah.الَّذِينَ‏ آمَنُواْ‏ وَتَطْ‏ مَئِنُّ‏ قُلُوبُهُ‏ م بِذِكْ‏ رِ‏ ِ الل أَالَ‏ بِذِكْ‏ رِ‏ اللتَطْ‏ مَئِنُّ‏ الْقُلُوبُ‏“Those who believe, and whose heartsfind tranquillity in the remembranceof Allah; for in the remembrance ofAllah do hearts find tranquillity.” (4)The direct opposite of the tranquil andhealthy heart is the diseased heart. Itspathology is the result of the deceitfulowner’s own doing.فِي قُلُوبِهِ‏ م مَّرَضٌ‏ فَزَادَهُمُ‏ اللهّ‏ ُ مَرَضاً‏ وَلَهُ‏ م عَذَابٌ‏أَلِيمٌ‏ بِ‏ ‏َا كَ‏ انُوا يَكْ‏ ذِبُونَ‏“In their hearts is a disease; and Allahhas increased their disease; and grievousis the penalty they (incur), because theyare false (to themselves).” (5)In brief, the basic state of the cognition(mind) is sanity, while its excellent statewould be maturity. The basic state forthe emotion (heart) is sincerity, while itsexcellent state would be tranquillity. (6)There would be times too, duringmoments of supreme enlightenment,that both the cognition (al-‘aql) andthe emotion (al-qalb) become one asevident from the following verse:أَفَلَمْ‏ يَسِ‏ يرُوا فِي الْ‏ ‏َرْضِ‏ فَتَكُ‏ ونَ‏ لَهُ‏ مْ‏ قُلُوبٌ‏ يَعْقِلُونَ‏بِهَ‏ ا أَوْ‏ آذَانٌ‏ يَسْ‏ مَعُ‏ ونَ‏ بِهَ‏ ا فَإِنَّهَ‏ ا الَ‏ تَعْمَى الْ‏ ‏َبْصَ‏ ارُ‏ وَلَكِ‏ نتَعْمَى الْقُلُوبُ‏ الَّتِي فِي الصُّ‏ دُورِ‏“Do they not travel through the land,so that their hearts gain understandingand causing their ears to hear? Trulyit is not their eyes that are blind, butblind have become their hearts whichare in their breasts.” (7)3.3 The Quranic Principles ofProfessionalism.The basic principle of Islamic medicineis the concept of the Oneness of Allah(tawhid). It is on this sound principlethat the whole edifice of Islamicmedicine is built. Every Muslimmedical science student or practicingphysician must have the followingFIMA YearBook 200961

Teaching Medical ProfessionalismQuranic verse safely kept in his heart.It is manifested in his daily attitudes,actions and practice. Only then will henot lose his bearing as a believer in theOneness of Allah. His undivided beliefin Allah as the Supreme Healer will notbe compromised. This is the first stageof medical professionalism.وَإِذَا مَرِضْ‏ تُ‏ فَهُ‏ وَ‏ يَشْ‏ فِنيِ‏“When I am ill, it is He (Allah) Whocures me.” (8)This verse is actually a statement oftawhid in his professional practice.When coupled with the next verse, thebeliever finds a pair of Quranic versesthat will strengthen his resolve as abeliever who practices medicine:وَلَوْ‏ جَ‏ عَلْنَاهُ‏ قُرْآنًا أَعْجَ‏ مِيًّا لَّقَالُوا لَوْالَ‏ فُصِّ‏ لَتْ‏ آيَاتُهُ‏أَعْجَ‏ مِيٌّ‏ وَعَرَبِيٌّ‏ ، قُلْ‏ هُوَ‏ لِلَّذِينَ‏ آمَنُوا هُدًى وَشِ‏ فَاءوَالَّذِينَ‏ الَ‏ يُؤْمِنُونَ‏ فِي آذَانِهِ‏ مْ‏ وَقْرٌ‏ وَهُوَ‏ عَلَيْهِ‏ مْ‏ عَمًىأُوْلَئِكَ‏ يُنَادَوْنَ‏ مِن مَّكَ‏ انٍ‏ بَعِيدٍ‏“Had We sent this as a Qur’an (inthe language) other than Arabic,they would have said: “Why arenot its verses explained in detail?What! (a Book) not in Arabic and(a Messenger) an Arab?” Say: “It isa Guide and a Healing to those whobelieve; and for those who believe not,there is a deafness in their ears, andit is blindness in their (eyes); They are(as it were) being called from a placefar distant!”” (9)It is only from here that the studentor practitioner proceeds on to thenext stage of professionalism – that ofphysical and moral strength, of normalphysical health and trustworthiness.قَالَتْ‏ إِحْ‏ دَهُمَا يَأبَتِ‏ اسْ‏ تَأْجِ‏ رْهُ‏ إِنَّ‏ خَ‏ يْرَ‏ مَنْ‏ اسْ‏ تَأجَ‏ رْتَ‏الْقَوِيُّ‏ الْ‏ ‏َمِنيُ‏“Said one of them: “O my father!employ him, surely the best of thosethat you can employ is the strong, thetrustworthy one.”” (10)3.4 Islamic Code of Medical EthicsThe medical community within theMuslim Nation (Ummah) has alwaysbeen fortunate for it has never needed togrope in the dark as regards guidelinesand principles of medical practice andprofessionalism are concerned. TheIslamic Organisation of Medical Sciences’Islamic Code of Medical Ethics (11) standswitness to the untiring efforts of theMuslim medical community to alwaysimprove itself and its services. TheCode’s 12 chapters become beacons ofprofessionalism in a practice that is atonce honourable as it is demanding:• Definition of Islamic Medicine• Characteristics of the doctor• Relationship among doctors• Relationship between the doctorand the patient• Professional secrecy• Responsibility of the doctor duringwar• Responsibility of the doctor• The doctor and the sanctity ofhuman life• The doctor and society• The doctor and the developmentof modern medical science• Medical education• Oath of the Muslim doctor.FIMA YearBook 200962

Teaching Medical Professionalism3.5 Islamic Approach to MedicalProfessionalismThe Qur’an warns the Prophet (PBUH)about hypocrites who are not trainableor who are not willing to be educated.وَمِنْهُ‏ م مَّن يَسْ‏ تَمِعُ‏ ونَ‏ إِلَيْكَ‏ أَفَأَنتَ‏ تُسْ‏ مِعُ‏ الصُّ‏ مَّ‏ وَلَوْ‏كَ‏ انُواْ‏ الَ‏ يَعْقِلُونَ‏“Among them are some who (pretendto) listen to you; but can you makethe deaf hear, even though they arewithout understanding?” (12)Sometime, the likes of them are foundin the medical profession. They must beidentified even while they were at thepreparatory stage as a first or secondyear medical student. They should becounseled and if they show no signs ofimprovement, they should be guidedto leave undergraduate medicine andchoose a different course in their lives.“Abu Hurairah (RA) narrated that theProphet (PBUH) said, “People are ofsubstance like the substance of goldand silver; the best of them duringjahiliyyah are the best in Islam if theygain knowledge; and the souls are hostswhich are sent around, the similar onesget acquainted, and the different onesseparate from one another.”” (13)While medical students undergointensive medical education andtraining, they must learn at a veryyoung age that apart of professionalismis the understanding and attitude thatprevention is better than cure.Figure 2: “Prevention is Better than Cure”.This familiar medical adage is written in thenasta‘liq style of calligraphy by an Iranianfarmer-calligrapher.To teach medical students Islamicmedical professionalism, it is bestthat the teaching institution has aphilosophy that is Islamic. An exampleis the CUCMS Philosophy:“To harness human potential in acomprehensive manner to produceholistic health care providers whoare intellectually, emotionally andspiritually-balanced based on theprinciples of Islam and the obedienceto the Almighty Allah.”وَنُنَزِّلُ‏ مِنَ‏ الْقُرْآنِ‏ مَا هُوَ‏ شِ‏ فَاء وَرَحْ‏ مَةٌ‏ لِّلْمُ‏ ؤْمِنِنيَ‏ وَالَ‏يَزِيدُ‏ الظَّ‏ الِ‏ ‏ِنيَ‏ إَالَّ‏ خَ‏ سَ‏ ارًا“We send down (stage by stage) in theQur’an that which is a Healing anda Mercy to those who believe, to theunjust it adds nothing but loss afterloss.” (14)There may be various ways to teachmedical professionalism to medicalstudents. The SCTL approach hasproven to be effective and exciting.Instead of undergoing passive learning,the students are encouraged to becreative and proactive. They are alsoable to own up the experience ofdiscovering themselves how medicalprofessionalism can begin very early intheir lives as students.The White Coat Ceremony at thestart of the clinical phase mentionedabove is a commendable idea worthconsidering.FIMA YearBook 200963

Teaching Medical ProfessionalismCONCLUSIONIn this three-part article, the author proposes an Islamic approach to the teaching ofmedical professionalism. It is still a preliminary thought on the subject. Commentsand criticisms are welcome. It is hoped that by quoting experiences of medicaleducators in the West and in the East, Islamic medical educators will widen thehorizons of their own experiences, enabling a cross-pollination of ideas with thebetterment of mankind in mind.We seek the Guidance of Allah in our academic-professional pursuits. It is only forHis Pleasure that we strive for.References:1. Hendelman, W, M.Ed. Chair, Professionalism, Faculty of Medicine, University of Ottawa, October10,2007.2. Plotnikoff, GA and Amano T. A Culturally Appropropriate, Student centered curriculum onMedical Professionalism: successful innovations at kelo university in Tokyo. Minnesota MedicalAssociation Report, August, 2007.3. Al-Bukhari and Muslim.4. Glorious Qur’an: 13,28.5. Glorious Qur’an: 2,10.6. Shaharom M.H., 2009. Allah: A psychospiritual contemplation on His Name. Kuala Lumpur:CERT Publications, p 146.7. Glorious Qur’an: 22,46.8. Glorious Qur’an: 26:80.9. Glorious Qur’an: 41,44.10. Glorious Qur’an: 28,26.11. The Islamic Organization of Medical Sciences-Kuwait Document, 1981/1401 H: The Islamic Codeof Medical Ethics.12. Glorious Qur’an: 10,42.13. Muslim and al-Nawawi.14. Glorious Qur’an: 17,82.FIMA YearBook 200964

Workshop for Teaching Medical Professionalismat the Kulliyah (faculty) of Medicine at InternationalIslamic University Malaysia (IIUM)Ariff bin Osman*AbstractTraining medical professionals requires thorough planning through wellthoughtmedical curriculum that takes into account the changes surroundingintends the profession itself and the expectations of the community with regardto the graduate that it intends to produce. The Kulliyah (faculty) of Medicine,International Islamic University Malaysia, (IIUM) pioneered what it called,Islamic Input Medical Program (IIMP) since its inception in 1995, in its effortto produce a different ‘breed’ of doctors who not only excel in their professionalduty but also portray conduct, (akhlaq) expected of a good Muslim.A good Muslim doctor is expected to portray a highest degree of medicalprofessionalism and demonstrate proper etiquette while dealing with his/herpatients and community. However, inculcating professionalism and properetiquette among medical undergraduates is not an easy matter. Learning thisvalue could be done through a workshop activity whereby students demonstratetheir understanding on these aspects of care through discussion of case studiesgiven to them prior to the scheduled activity. This article describes the approachthat has been implemented over the past two years at this faculty.Keywords: Medical curriculum, professionalism, Islam, Islamic input.Dr. Ariff bin OsmanHead, Department of Anaesthesiology and Intensive CareCo-coordinator of the Islamic Input in Medical ProgramKulliyah of Medicine, International Islamic University of Malaysia (IIUM)E-mail: ariff.osman@gmail.comFIMA YearBook 200965

WorkshopIntroductionIt is the medical lecturers’ responsibilitiesto train their students to internalisethe meaning and later live up withthe desired level of professionalismexpected by the medical profession andmore importantly, the patients whomthey treat. Their attitude and practiceof professionalism have importantimpact on the minds of these futuredoctors. Nurturing this value couldbe done through many ways andobviously lectures alone are inadequate.Students must first be made aware ofits importance and become motivatedto internalise and demonstrate thebehavior diligently during theirinteraction with patients. They mustknow that their duties require a certainlevel of professionalism, failing whichwould land them into problems.With regards to teachingprofessionalism, introductory lectureson the subject is all that is required.Students, as adult learners should bemotivated to search for additionalinformation on the subject, decipheringits meaning and translating it intoaction during their encounters withpatients. Over the years of training,with perseverance, they should beable to develop the desired level ofprofessionalism in managing theirpatients. At the Kulliyah (faculty)of Medicine, International IslamicUniversity Malaysia (IIUM), aspecifically designed module onmedical professionalism and properphysician etiquette is structured forthird year medical students prior totheir first encounter with patients inthe ward. Carried out as a workshopand named, “Workshop on MedicalProfessionalism and Proper PhysicianEtiquette”, it is a student-centredapproach of learning that is integratedwith Islamic values, in line with thevision and mission of the Universitythat subscribes to the agenda ofIslamisation of knowledge (1) . A briefaccount of the Islamic Input in MedicalProgram (IIMP) is highlighted in thiswriting together with the operationaldefinition of professionalism and thedetail of the above teaching-learningmodule.Teaching of medical professionalismIslamic Input in Medical Program orIIMP represents a new paradigm shiftin medical education that aims toinculcate ethical values in the studentsso that upon graduation, they wouldbe a different ‘breed’ of doctors whonot only excel in their professionalduty but also portray conduct, (akhlaq)expected of a good Muslim (2) . The“Workshop on Medical Professionalismand Physician Etiquette” is the first stepof a long journey in training doctorsof tomorrow, where they are expectedto serve their patients in the mostprofessional way and with the rightetiquette, in line with the principlesof Islam. It is envisaged that afterundergoing the integrated educationsystem, the graduates should be ableto carry the heavy trust, (amanat)of being professionally competentFIMA YearBook 200966

Workshopand having good conduct, (akhlaq)and develop the following attributessuch as being highly motivated forimprovement of personal, professional,intellectual and spiritual development;observing proper etiquette of dealingwith patients and colleagues and havinggood leadership and managerial skillsFor practical purposes, the IIUMincludes the operational definition (3)of professionalism that evolves aroundacquiring four main attributes,summarised as 2E’s and 2C’s. The 2E’sstands for Expert and Ethical whilethe 2C’s represent Communicationand Compassion. Students shouldunderstand that it is their duty todevelop optimal level of professionalismby first ensuring that they live up tothe expectation of their profession asexperts. In carrying out their duties,they should perform them in the mostethical way; be able to communicateappropriately and effectively whiledemonstrating compassion andinterest to help alleviate their patients’problems.Workshop on Medical Professionalismand Proper Physician EtiquetteThe “Workshop on MedicalProfessionalism and PhysicianEtiquette” is designed as a forumthat facilitates the understanding ofstudents of their duties as doctors.Learning in small groups, they discuss acase study assigned to them and discussthe issue presented in it. The casestudies represents common realitiesencountered in daily clinical practicethat students would face as doctors,where they are expected to give theirservices in the most professional andethical way. Through discussion of thecases, they would learn the importanceof exercising professionalism anddemonstrating proper physicianetiquette while dealing with patients.Hopefully, the hands-on experienceand skill obtained from the workshopwould make them better doctors asthey would be more knowledgeable andmotivated to practice professionalismand proper etiquette in dealing withtheir patients.The objectives of the workshop are toeducate students about the importanceof medical professionalism andphysician etiquette in patient care;to provide hands-on knowledge andskill on medical professionalism andphysician etiquette in patient care andto integrate Islamic values into clinicalpractice. At the end of the workshopeach student should be able to applythe general principles of medicalprofessionalism and proper physicianetiquette in providing total patientcare; demonstrate professionalism andproper etiquette of a Muslim Physicianwhen dealing with patients andrecognize the various needs of patientsand their environment which are prerequisitesfor good clinical practice.Each group is given a Case Study atleast two weeks prior to the workshopscheduled day. In order to enhancethe good team work each group isrequired to choose a team leader whoFIMA YearBook 200967

Workshoptakes charge of the group activitiesand a secretary who keeps track ofdiscussions and record the decisionmade by the group. All the case studiesportray the lacking of professionalismand proper physician etiquette, whicheach group has to identify. They shouldthen discuss on how best to treat thepatient (i.e. the Case Study) where theywould be seen as behaving appropriatelyas Medical Doctors in terms ofprofessionalism and proper physicianetiquette. The learning activityprovides opportunities to sharpencommunication skills and to integrateIslamic values which are necessaryfor effective and confident interactionwith patients and their families. Italso allows them to appreciate thatmost patient care requires team workthat involves interaction with fellowcolleagues, superiors, subordinates andother health care workers.Conducting the WorkshopMany of the lectures covered inthe four-week Elementary Clinicare in consonance to the themeof professionalism and etiquette.Consequently, these lecture notesbecome important references forstudents in the discussion of theCase Studies assigned to them, whichwould be discussed in their respectivegroups. Each group is given a CaseStudy two weeks prior to the workshop.This learning activity is meant to beinteractive and lively where everyonetakes initiative and interest to learnabout medical professionalism whichcan be simply defined as values,attitudes and behavior expected bysociety of a medical professional. Eachgroup is required to demonstrate theirunderstanding on professionalism andproper etiquette in managing their‘patient’ (Case Study) using audiovisualaid and other methods suchas role play. They are also requiredto write a report and submit it to thecoordinator/facilitator of the workshopon the workshop scheduled day forgrading purposes.This learning methodology is a betterapproach to achieve the novel objectivesof inculcating medical professionalismand proper physician etiquette in theminds of our future doctors. Under theguidance of medical teachers, medicalstudents learn the importance of theseissues and demonstrate them throughdiscussion of the Case Studies. Theknowledge and skills acquired at theworkshop would make them moreconfident as they start seeing patientsin the wards and clinics. Eight commonclinical situations, appropriate for theirlevel, are selected for discussions at theworkshop and represent importantthemes listed below:i. The first impression – appearanceand composureii. Examining patient of differentgenderiii. Medical confidentialityiv. Taking verbal consentv. Refusal of treatment and at ownrisk dischargeFIMA YearBook 200968

Workshopvi. Breaking bad newsvii. Making du’a’ before a procedureviii. Salat for the sickStudents are required to demonstratetheir professionalism and properetiquette in managing the ‘case study’.Each group decides the role thateach member plays in dealing withthe ‘patient’ in the case study anddemonstrates his/her professionalattitude and proper etiquette expectedof a safe practitioner.The role of the facilitatorIn order to ensure that the learningobjectives are reached, each group isassigned a lecturer who shall guideand motivate the students under theircharge. The medical lecturers functionas facilitators who ensure that thelearning objectives are achieved. Afacilitator, assigned to each group is aresource person for the students andwhose experience is readily soughtafter in discussing the case study. Theirprofessionalism and etiquette (‘adab) indealing with the patient in the case studyis a source of inspiration for students toemulate. The leadership role of teachersis important as role modelling is apowerful force in medicine (4) .The kind of leadership teachers give iscritical to the quality of medical practiceand education and to professional selfregulation. Marinker used the term“the hidden curriculum” to describethe effect of the professional attitudesand behavior of clinical teachers onstudents and doctors in training. Theeveryday behavior of clinical teachersis the living demonstration of theirexpertise, ethics, and commitment:their professionalism. What they doand how they do it matters as muchas what they say-as in, for example,communicating with patients, studentsand colleagues; recognising the limits oftheir own practice; using clinical auditto improve their practice; applyingformative peer appraisal for their ownprofessional development; handlingpersonal criticism; tackling poorperformance in themselves and others;and caring for colleagues in difficulty.This is indeed a heavy task, more so atthis Kulliyah as we aspire to producedoctors who will be able to carry outthe heavy trust, (amanah) of a MuslimPhysician which is defined as beingprofessionally competent and havinggood conduct, (akhlaq) as a Muslim.Group presentationEach group is expected to present theassigned Case Study and to demonstrateto the rest what they believe to be thebest approach in managing the Casein the most professional and ethicalway. Use of multi-media presentationsuch as Power Point and video ishighly encouraged. Video presentationallows for peers and facilitators toreview the group performance withrespect to medical professionalism andproper physician etiquette, especiallyin the areas of communication, teammanagement, multi-tasking andresource utilization.DebriefingFIMA YearBook 200969

WorkshopGroup debriefing is recommendedwith all team members present. Themain objective of the debriefing sessionis to ensure that the learning objectivesare achieved. Feedback from fellowcolleagues and facilitators would befactual, focused on performance andkey learning so that everyone wouldfeel happy and enjoy the learningactivity. The Chief Facilitator wouldsolicit the trainee’s perception of howthey did, discuss specific performanceissues and then review the key teachingpoints outlined in the case studies.EvaluationFeedback from students is importantfor future improvement of theworkshop. Evaluation forms aredistributed to students before andafter the workshop to find out theirexpectations and experiences aboutthe workshop. Students may alsosubmit their journals and they wouldalso be encouraged to express whatthey thought especially if they believethat there were areas for improvementwhich had been overlooked by theteachers/facilitators. This is importantfor continuous improvement of theworkshop so that it meets the verypurpose of the University’s agenda, i.e.Islamization of knowledge through theIslamic Input in the Medical Program.Prizes given for the “Best GroupPresentation” and “Best Case StudyReport” is an incentive for them to givetheir best performance in portrayingtheir understanding and commitmentto medical professionalism andproper physician etiquette. Thislearning activity should make themmore confident as they are now moreknowledgeable and thus be at easeseeing patients in the ward as theygo through their respective clinicalrotations. Equally important is theirability and commitment to integrateIslamic values in discussing the casestudies and hopefully be able to translatewhatever they learn into practice as theysee patients in wards, clinics, operationtheatres, etc. Hopefully, this workshopenhances their understanding andcommitment of true professionalism inmedical practice and portraying properetiquette (‘adab) while dealing withpatients and their family members.Keeping a JournalStudents are encouraged to write theirexperiences, comments and ideas in ajournal. They may write on anythingthat interest them, either about theworkshop or any other issues whichcause displeasure to them in terms ofthe ‘ideal Islamic environment’ thatthey would wish it to be implemented.Journal-writing helps them reflecton themselves and work out howmuch they have learnt from the casestudies that were discussed duringthe workshop. It also allows themto appreciate different ideas, or newinterpretations in the managementof these cases. Finally, they would beencouraged to write down the mostvaluable experience they get from thisparticular learning activity.FIMA YearBook 200970

WorkshopConclusionsThis workshop is an important learning activity for students to understand theconcept of medical professionalism and proper physician etiquette. It is a venuefor them to learn, internalize and demonstrate their understanding of the issuesfrom discussion of the case study as well as learning from the medical teachers, i.e.the facilitators. It is a hands-on learning experience for students, with respect tointegrating the Islamic values and practicing Islamic culture (such as giving Salam,giving advice and observing good akhlaq, (manners) while dealing with patientsin the case studies. The experience obtained from the workshop would make themmore confident seeing patients and their relatives as they would then be moreknowledgeable in demonstrating professionalism and good etiquette. From theKulliyah’s perspective, this workshop is an important mileage in its continuouscommitment of strengthening the Islamic Input in its Medical Program.FIMA YearBook 200971

WorkshopReferences1. A Student Guide to “Workshop onMedical Professionalism and ProperPhysician Etiquette”. Kulliyah of Medicine,International Islamic University Malaysia(IIUM); 20082. Osman A. Islamic Input in MedicalProgram at IIUM: The way forward.International Medical Journal, Vol (9) No(1) 20103. Quality Management of Islamisation ofKnowledge in University (Perceptions andDirections); Quality Enhancement Series:3/2007. International Islamic UniversityMalaysia; 20074. Charlotte E Rees. The trouble withassessing student’s professionalism.Theoretical insights from sociocognitivepsychology. Academia Medicine, Vol. 82,No 1/January 2007FIMA YearBook 200972

The Concept OfIslamic Medical Education And BioethicsAly A. Misha’lAbstract:The concept of medical education, aiming at preparation of the properMuslim medical practitioner and researcher, is based on the paritybetween teaching medical sciences and proper upbringing (Tarbiyah).Tarbiyah is indispensable in preparing medical students to receivemedical education.Tarbiyah derives its roots from the Tawhid paradigm of Islam whichintegrates harmony of matter and soul, body and mind, and emphasizesthinking, contemplation and discovery of new knowledge. The questfor knowledge functions as a means to understand various phenomenaof human life, health and disease, and by doing so, worshipping theCreator, the Source of all knowledge and wisdom.This concept comprises both education, medical conduct as well asbioethics which is a built-in value in the spirit of Islam.Keywords: Medical education, Islam, Tarbiyah, Tawhid, bioethics.Aly A. Misha’l MD, FACPSenior Consultant in EndocrinologyIslamic Hospital, Amman- JordanE-mail: fimainfo@islamic-hospital.orgFIMA YearBook 200973

The ConceptIntroduction:Medical curricula, in almost all medicalschools in Muslim countries, have beenfollowing the Western-European stylesover the past century. (1)During the period of Westerncolonization and subsequently postindependence,educational institutionsin Muslim countries have copied andapplied Western curricula until thepresent time.In some countries, attempts wereexercised to add some courses in Islamicmedical ethics and the history of pastIslamic civilization.As a consequence there existed thisdichotomoy between the teachingof medical sciences and the properpersonality building along Islamic beliefsand guidance (Tarbiyah). This separationfeature of the curriculum has always beena cornerstone of the Western medicaleducation system . (1)This educational style has achievedsignificant innovations and progressin the prevention and therapy of manyillnesses, but failed in dealing withlifestyle-related dilemmas. The majorchallenge, however, being in the area ofbioethics.Over the past decades, the world enteredinto an era of globalization which carriedwith it a dominant monoculture. Inthe medical field, this Western culturebecame controlled by big business whichthrives on a culture of profiteering,domination and control, which notinfrequently impinges and violates moralnorms.Globalization of health governancehas its own philosophical background.Health is considered as a commoditywhich has a fiscal value.. (2) Disease and itstherapy becomes pivotal and the holisticcare of the person becomes peripheral.It marginalizes preventive medicine,healthcare promotion and only pays lipservice to the wellness paradigm.. Asa consequence, spiritual and culturalaspects of health are not consideredas priorities nor crucial in health caredelivery , instead, they only add to thecost of health care. (2)Inevitably, the medical profession,practitioners, researchers and healthcareleaders included, became increasinglyoverwhelmed and influenced by thisnew philosophy of big business inpharmaceutical companies, equipmentmanufacturers and insurance companies.Worldwide proliferation of medicalinventions and breakthroughs thattook place over the past decades, haveraised wide hopes and expectations forremedies to many unresolved humanailments. At the same time, they haveposed major dilemmas to the Westernbiomedical model. The medical andscientific world has witnessed a plethoraof complicated ethical, religious, socialand legal implications. Although codesof medical ethics have been adopted afterWorld War II, yet, unethical practicescontinued to proliferate.Humanity has suffered disastrousFIMA YearBook 200974

The Conceptoutcomes of deviations in the utilizationof scientific and technological progress,of which the deviations in atomic energyutilization and environmental calamitiesare horrific reminders.The scientific literature has carefullydocumented the various types ofunethical deviations and misconduct inmedical practice and research.One such example took place 40 yearsin the city of Tuskegee, Alabama,USA. In this study, Afro-Americanpatients suffering from syphilis, wereintentionally left untreated from theearly 1930s to the late 1970s, in order tostudy the natural course of the disease inits various stages. (3)Another ethical dilemma took placemore recently in 2009. It is of paramountsignificance because it involves theglobal organization that is consideredthe world authority in setting up ofbioethical codes, namely the WorldMedical Association (WMA)!.WMA had formulated the Declarationof Helsinki in 1964 to uphold bioethicalstandards of research on humans, andthe ensuing Declaration of Tokyo in 1975included a section on the preventionof any participation of physicians inany torture, punishment or inhumantreatment of prisoners.Despite that, the president of the IsraeliMedical Association was elected as thepresident of WMA although there wasoverwhelming evidence to suggest theactive participation of Israeli physiciansin the torture of Palestinian prisoners. (4)In fact 725 physicians and researchers,including 114 professors, from 43countries signed and presented apetition to the WMA council in protestand demanded an investigation of theseallegations (5) . The petition was evidencebasedand was supported by documentsfrom various local and internationalNGO s demonstrating the complicity ofthe Israeli Medical Association in thepersecution of Palestinian prisoners..It is noteworthy that the doctors whoenthusiastically led the worldwidecampaign were from among British andother Western professors and medicalprofessionals under the leadership ofDr. Derek Summerfield. Until now, theWMA council has not responded to thispetition. (6,7)Medical Education and Tarbiyah:Medical education aims at the teaching,transfer and sharing of core knowledgeand the exploration of new medicalknowhow, technology and skills..Tarbiyah (moral upbringing), on theother hand, aims at building the properpersonality, human qualities and values,to enable the future medical professionalsand researchers to perform their vitalroles in human societies according tobuilt-in ethical codes and values.Tarbiyah functions to prepare the medicalstudent to receive medical education.However, the separation of teachingand tarbiyah has contributed to theproduction of unbalanced medicalpractitioners, with narrow, materialisticand self-centered conducts. (1)FIMA YearBook 200975

The ConceptTarbiyah: The Islamic Concept:Tarbiyah, in the Islamic sense, derivesits origin from Islamic values whichharmonize man’s relationships with hisCreator, fellow humans and environment.Spiritual nurturing and developmentaims at the purification of the soul. Ifthe soul is pure, sincere and tranquil,all human behavior and conduct willsimilarlty follow suit. (2)The concept of Tawhid is the pivotalparadigm of Tarbiyah. It integrates theharmony of matter and soul, body andmind, individual parts and the whole. (8)Al-Faruqi describes Tawhid “as thesource of truth, cosmic and social order.It insures the unity of truth and, therefore,prevents contradictions betweendifferent disciplines of knowledge”. (9)The Tawhidi approach integrates medicalknowledge, teaching and practice ina wider context, making sure it is inharmony, and is well coordinated withother related medical, or non-medicalphenomena. The “integrated” doctor willapproach the patient as a whole human,and not just as organs or tissues.Dr. Ziauddin Sardar aptly stressed thesignificance of the Tawhidi concept (10) :“It becomes an all embracing value whenthis unity is asserted in the unity ofmankind, unity of man and nature, andthe unity of knowledge and values. FromTawhid emerges the concept of Khilafah:that man is not independent of God,but is responsible and accountable toGod for his scientific and technologicalactivities…”.The concept that regulated the conductof Muslims in the pursuit of sciences wasprecisely this concept of al-Tawhid, i.e.the unity of Allah, and His creation.Verily, this brotherhood of yours isa single brotherhood, and I am yourLord and Cherisher: therefore serveMe (and no other). (11)Think … Contemplate …and Discover:When we navigate through thevarious verses of the Qur’an, we wouldundoubtedly encounter the emphasison the necessity of observing naturalphenomena. Man is continuously invitedto study creation as a handiwork of Allah(SWT), which, in itself, is tantamount toa religious duty and obligation. (12)The motivating factor behind theMuslims’ quest for knowledge in thescientific and medical fields was primarilyfor them to understand the creation ofAllah (SWT), so as to be drawn closer totheir Creator.Seeking truthful knowledge is the Islamicway of education. Truthful knowledgeincludes calling upon man to think andcontemplate about the universe andman’s role in this life.The acquisition of profit and fame arenot the primary objectives. They mayhowever come as a byproduct.In the Islamic concept of medicaleducation, the sciences represent themeans to understand various phenomenaFIMA YearBook 200976

The Conceptrelated to human life, health and disease,and to understand man’s relationshipwith his Creator, the universe and othercreatures. (1)The following are only a few examplesof Qur’anic injunctions to think andcontemplate:“On the earth are signs for those ofassured Faith, as also in your ownselves: Will ye not then see?. (13) .Now let man but think from what hewas created!.” (14)“Soon will We show them our Signs inthe (furthest) regions (of the earth),and in their own souls, until it becomesmanifest to them that this is the Truth.Is it not enough that thy Lord dothwitness all things?.” (15)“Thou seest the mountains andthinkest them firmly fixed: but theyshall pass away as the clouds passaway: (such is) the artistry of Allah,who disposes of all things in perfectorder: for He is well acquainted withall that ye do.” (16)“Do they see nothing in the governmentof the heavens and the earth and allthat Allah hath created? (Do theynot see) that it may well be that theirterms is nigh drawing to an end? Inwhat message after this will they thenbelieve?.” (17)In the Islamic concept, human life on thisearth has a basic goal: To worship Allah( SWT )“I have only created Jinns and humans,that they may serve Me.” (18)Medical sciences are proper means tothink, contemplate and understand thesesigns of creation.Medical students, educated along theseconcepts from their early days in medicalschools, will proceed to acquire balancedpersonalities, equipped with harmoniousoutlook of the unity of science and faith.Science in general, and medicine inparticular, is a form of worship andtool for the students’ minds to exercisethinking and contemplation in thecreation of Allah ( SWT ).“Men who celebrate the praises ofAllah, standing, sitting, and lyingdown on their sides, and contemplatethe (wonders of) creation in theheavens and the earth, (With thethought): “Our Lord! not for naughtHast Thou created (all) this! Gloryto Thee! Give us salvation from thepenalty of the Fire.” (19)“Those truly fear Allah, among HisServants, who have knowledge:for Allah is Exalted in Might, Oft-Forgiving.” (20)This kind of Tarbiyah is instrumental inthe evolution of medical practitioners,scientists and researchers who complywith the divine guidance to discoversound basis of health and disease, to exertthe needed diligent effort to investigate,discover and remedy human disease, andin doing so, to discover Allah’s healing,power, wisdom and perfection.Through uncovering these secrets,FIMA YearBook 200977

The ConceptMuslim practitioners and scientistsdevote themselves to the worship ofAllah (SWT) through saving humanlives and alleviating human sufferingsand miseries, and in doing so, endeavorto uphold their role as the vicegerent ofAllah on this earth.Medical sciences uncover the fact thateverything in this universe, includinghumans, were created in the best ofmoulds, in utter perfection, with specificroles in this life. Man benefits from theother creations of God and utilizes themappropriately. Whenever this utilizationis contrary to their creation, anydeviation or mis-utilization becomes aform of abuse and destruction, whichcreates mischief and evil in humansociety.The Islamic concept of medicaleducation is geared towards embracing aholistic outlook to life and all creations. (8)Various substances, issues and practicesare looked upon in a holistic manner.Their nature, constituents, origins andhow they were created in the shapewe encounter them, all are consideredinclusively and comprehensively.Medical students do not need to goto a special institution to be taughtreligious faith. They could be taught intheir medical schools and by the sameteachers, side by side with the othersciences. (1)Without this kind of holistic curriculumin medical education and training,medical schools may producepractitioners and researchers who may bewell versed in sciences, but with hollowconscience and empty faith which willdominate their attitude and performancetowards patients and society.Medicine: Fardh Kifayah: (21)Most past Muslim jurists and scholarsconsidered the medical profession as themost noble and dignified career that isonly second to specialization in sciencesof Qur’an and Sunnah. (22)In view of the vital role of the medicalprofession in society, Muslim scholarsconsidered it a Fardh Kifayah, i.e. areligious duty that the whole society, orUmmah, will be held guilty and sinful,if it failed to induce and support someof its members to become medicalprofessionals.Some Muslim scholars went further byadvocating relief of medical liabilityagainst qualified medical professionalsbecause of un-intended medicalmistakes, when there is no provenneglect. (23)Medicine is closely associated with allfive purposes of the law (Maqasid al-Shari’ah): Up keeping of and preservingreligion, life, mind, progeny andwealth. (2)Intention (Niyyah), together withcommitment and motivation, arehallmarks of sound attitude of themedical student, practitioner, researcher,faculty members and administrators.This concept will create a sound andhealthy attitude in all concerned to rejectall forms of negative values, includingFIMA YearBook 200978

The Conceptfalsehood, obscenity and corruption.Seek remedy (24) :The injunctions of the Glorious Qur’anand Sunnah of the Prophet (PBUH) toseek remedy from ailments, constitute asystem in medical care and research.Let us study the implications of oneProphetic Hadith:“ For every disease there is a cure” or itsother version “seek remedy, for verify,Allah has not created a disease withoutproviding its cure...”. (25)First: There is an injunction to seek curefrom illnesses.Second: There must be well trainedand qualified medical practitioners toprovide medical care.Third: All diseases, including lethal ones,or diseases considered incurable in ourcurrent level of knowledge, have curableremedies which are unknown to us at thepresent point in time. Allah (SWT), thesource of all knowledge, has not revealedthem to us yet. We need to exert moreefforts of research, perseverance andmental process to discover their cure.A medical student nurtured with thisattitude of openness, research anddiscovery as an integral part of his faith,will grow and develop into the practitioneror researcher, that the Muslim society,and humanity at large needs.Bioethics:Medical bioethics is the application ofrecognized principles and standardsin making decisions towards medicalpractice and research.The last decades have witnessed majorscientific and medical achievementsand breakthroughs, with significant,unprecedented influences on human lifeand health.Across the world, complicated ethical,religious, social and legal implicationshave arisen.Ethical councils and organizations havebeen established worldwide, whichrecognized standards that regulatemedical and research behavior.The flood of non-ethical conduct,together with the influences ofglobalization and big business onmedical practice and research havecreated major bioethical challenges tothe scientific fraternity.In most Islamic countries, medicalinstitutions lack sound curricula onbioethics and biomedical jurisprudence.Past Muslim jurists had pioneeringroles in bioethical issues derivedfrom Islamic Jurisprudence. They hadcomprehensively addressed all medicalissues and developments of their times.Virtually all medical issues wereaddressed by jurists over the extendedcenturies of Islamic scientific civilization.Over the past 3-4 decades it was noteworthyto witness the close collaboration andunderstanding between jurists and expertsin medical-scientific issues.We currently have a considerableFIMA YearBook 200979

The Conceptand valuable wealth of biomedicaljurisprudence that we have acquiredfrom our predecessors, which wecontinue to build upon.Islamic Bioethics cannot be divorcedfrom morality, and can not be separatedfrom Shari’ah (The Islamic Law). (8)What we call “Islamic Medical Ethics” isthe same general ethical standards, usingmedical terminology and with medicalapplications.The basic moral and legal codes arederived from the Islamic Law (Shari’ah).The detailed applications, however,require further intellectual effort:“Ijtihad”.The principles of justice, autonomy,beneficence and non-maleficence arederived from the broad principles ofShari’ahIslamic bioethics is based on the supremeguidance of Allah (SWT), and is faithcentric.The spirit of Islam is translated intothe practice of medicine and researchthrough the codification of divinerevelations into regulations referred toas the Shari’ah or Islamic Law. Shari’ahis the epitome of the Islamic spirit, amanifestation of the Islamic way of life.The late professor Ismail al-Faruqi wasquoted as saying:In Islam, ethics is inseparable fromreligion and is built entirely on it. TheIslamic mind knows no pair of contrariessuch as “religious-secular”.The universe, according to Islam, isteleological in the sense that it is basedon the belief that the world was createdfor a divine purpose. Hence, “Nature isequally a realm of ends where everythingfulfills a purpose and thereby contributesto the prosperity and balance of all”. (26)Conclusions:The Curricula for medical education,research, tarbiyah and bioethics shouldproceed concurrently, hand in hand,beginning from the early stages ofall teaching and training programs inIslamic medical institutions.The vision of medical educationand Tarbiyah is to mould medicalpractitioners and researchers withbalanced, dynamic and wholesomepersonalities, owing total allegianceto Allah (SWT), and imbuing inthemselves the sense of responsibilityand accountability.FIMA YearBook 200980

The ConceptReferences:1. Al Kassar, M.O., Al-Manhaj Al Islami Fi TaalimAl. Ulum Al Tibieyyah-Muslim WorldLeague-Makkah, 1984.2. Kasule, OH, Medical ethics from Maqasid Al-Shari’ah: presented at the 4th InternationalScientific Convention of the Federationof Islamic Medical Associations (FIMA)-Amman, Jordan, 15-17 July 2004. http://omarkasule.tripod.com3. Jones J. 1981. Bad Blood, The Tuskegee SyphilisExperiment: A Tragedy of Race and Medicine.NY: The Free Press. ISBN0029166764.4. Public Committee Against Torture in Israel.Ticking Bombs. Testimonies of torturevictims in Israel. PCATI 2007.5. Kmietowicz Z. Doctors call for head of WorldMedical Association to quit as “matter ofpriority”. BMJ 2009, 338, b2556.6. Summerfield DA. The WMA speaks out on Iranbut not on Israel. Why not?. BMJ 2009, 339,b4635.7. Marton R. At stake is the reputation ofinternational medical ethical codes as asystem that works. BMJ 4 January 2010. www.bmj.com8. Kasule, OH Holistic vs. Biomedical Medicine.Presented at the combined scientificconvention of the Federation of IslamicMedical Associations (FIMA) and the IslamicMedical Association of Malyaisa (IMAM) inSelongor-Malaysia, 4-7 July 2002.9. Al-Faruqi, R.I. Tawhid: Its implications forthought and life Wyncote PA: InternationalInstitute of Islamic Thought: 1982, p73.10. Sardar, Ziauddin: “Islamic Science or Sciencein Islamic Policy: What is the Difference?”,Journal of Islamic Science (Aligarh: TheMuslim Association for the Advancement ofScience). Jan 1985, vol 1, No 1, P 42.11. The Glorious Qur’an: 21,92.12. Ebrahim, Abul Fadl Mohsin, BiomedicalIssues-Islamic Perspectives. Published by:IMA of South Africa-Mobeni-South Africa,1988.13. Glorious Qur’an: 51, 20-21.14. Glorious Qur’an: 86, 5.15. Glorious Qur’an: 41,53.16. Glorious Qur’an: 27,88.17. Glorious Qur’an: 7, 185.18. Glorious Qur’an: 51, 56.19. Glorious Qur’an: 3, 191.20. Glorious Qur’an: 35: 28.21. Abu Ghuddah AS, Bohouth Fi Al-Fiqh Al-Tibbi (Studies in Medical Jurisprudence).Published by Dar ul Aqsa, Cairo-Egypt 1991.22. Imam Al-Thahabi, Mohammad bin Ahmadbin Othman. Al Tibb Al Nabawi-Mustafa AlBabi Al Halabi, Cairo, 1961.23. Ibn Qudamah, Muhammad Abu Abdullah.Al Mughni. Cairo, Egypt. Maktabat al-Jamhuriyyah al Arabiyyah. 5/298.24. Albar M.A seeking remedy, Abstainingfrom Therapy, Do Not Resuscitate: AnIslamic Perspective. Presented at the 4thInternational Scientific Convention of theFederation of Islamic Medical Associations( FIMA ), Amman-Jordan, 15-17 July 2004.25. Sunan Abi Dawud, op.cit, Kitab Al Tibb, part4, p. 7.26. AlFaruqi, R.I, Islamization of knowledge. IIITReston VA, 1982.FIMA YearBook 200981

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Ethical Issues Related ToMedical EducationIn The Light Of Islamic PrinciplesMuhammad Iqbal khan* , Rehan Ahmed Khan, Masood AnwarAbstract:Ethical dimension of Medical education necessitates a dedicated perception of explicit moralcodes, delivering medical knowledge and training of medical professionals, not only atundergraduate and postgraduate levels, but till the end of one’s professional life. Going back inhistory, we find that Islamic culture is most fascinating, complex, and dynamic in the world.Medical knowledge remained the vital part of learning objectives even as early as the time ofProphet Muhammad (PBUH). Muslim medical scholars contributed a great deal in impartingmedical knowledge to every student irrespective of race, religion or ethnic group. Medical ethicsis one of the important subjects stressed in modern age medical education. However, it is by nomeans the Islamic ethics. Islamic ethics is far superior than the “medical ethics” as it protects bothmedical practitioner and the patient, not only from the sins of worldly standards but those ofdivine standards too. Unfortunately medical ethics is not an essential part of medical curricula ofmost of the universities and medical schools. The learning behaviors and modalities of deliveringmedical education need certain ethical precincts. These ethical boundaries are well drawn byIslamic education system. During the selection process of a medical student and of a residentfor higher training, the main criterion should be that leaders of the future are being selected.Physicians may be leaders of people, whose moral principles and attitudes should be a role modelfor the society. The most significant constituent of an effective curriculum for a Muslim doctor isthe integration of behavioral changes based on truthful understanding of Islamic medical ethicalvalues. A curriculum is never inclusive and up to the mark if it is lacking fundamental ethicalissues pertaining to medical practice with special reference to faith, knowledge and practice offaith. Medical curriculum must also meet the requirements of the society. In Muslim countries,very little has been done in the postgraduate curricula and training programs. Though it hasbeen greatly emphasized in Islam to acquire knowledge at an incessant pace, little has been donefor continuous medical education and personal development of doctors. A medical teacher isfully aware of the fact that he is the responsible role model for his students and graduates. Allefforts and techniques to prepare and train a Muslim medical professional will be fruitless, if theeducational environment and intellectual disposition of a medical educational institution andteaching hospital are not in accordance with Islamic teachings. The doctor must seek and advancehis knowledge until the end of his life. To attain an exceptional level of knowledge, continuingeducation is essential, so that the scholar’s knowledge will be functional for all communities.Keywords: Ethics, Islamic ethics, medical education, curriculum, continuing medical education.Muhammad Iqbal KhanMD; FRCS ( Eng); FRCS (Glasg); Dip Vas Surg (UK)Professor and head of SurgeryIIMC/ Riphah University, Islamabad- PakistanE-mail: mikhandr@gmail.comFIMA YearBook 200983

Ethical IssuesKnowledge and Medical SciencesLearning and teaching has been greatlystressed in the Qur’an in variousrevelations. The very first revelation ofQur’an commanded to read and learn:“Read in the name of your Rabb whocreated, Created man from a leechlikemass. Read, your Rabb is the mostGracious Who taught by pen; taughtman what he knew not. (5) .Right at the time of creation, Allahput all the knowledge in the humanbrain “He taught Adam the names ofall things then he presented to angelsand said: “Tell Me the names of these ifwhat you say is true?” (6) . Man only hasto re-discover all what he has alreadybeen taught and this phenomenonis continuing. Muslims are the onlyUmmah today that possess the firstright to this knowledge provided theystrive for it. The Prophet of Islamstressed the learning and acquiringknowledge in various ahadith “Learnfrom infancy to death (Muslim)” Theimportance of learning for the Muslimscan best be judged from the fact thatwhen prisoners of war were takeninto custody by Muslims in the firstever battle between the Islamic state ofMedina and nonbelievers of Makkah atBader, the Prophet (PBUH) ordered theprisoners of war to educate 10 Muslimsof Medina to get freedom without anyransom (Fidyah). Prophet Muhammad(PBUH) said: “The seeking of knowledgeis obligatory on every Muslim…” (7)“If anyone travels on a road in searchof knowledge, Allah will cause him totravel on one of the roads of Paradise.”“The angels will lower their wings intheir great pleasure with one who seeksknowledge”, “the inhabitants of theheavens and the Earth and the fish inthe deep waters will ask forgiveness forthe learned man”. “The superiority of thelearned man over the devout is like thatof the moon, on the night when it is full,over the rest of the stars”. “The learnedare the heirs of the Prophets, and theProphets leave neither dinar nor dirham(money), leaving only knowledge, andhe who takes it takes an abundantportion.” (8) .The text of the Qur’an is rich with versesinviting man to use his intellect (mind,intelligence), to ponder (contemplate),to think and to know. To Muslims,“the goal of human life is to discoverthe Truth which is none other thanworshiping Allah in His Oneness.”Prophet Muhammad (PBUH) in hishadiths provide very rich source ofreferences to the importance of seekingknowledge, from wherever it mightbe found. During most of its history,Islamic civilization has been witness toa true celebration of seeking knowledge.That is why every traditional Islamiccity possessed public and privatelibraries, and some cities like, Qurtobaand Baghdad, boasted of libraries withover 400,000 books. Scholars havealways been held in the highest esteemand respect in Islamic society. (9)There is a famous saying; “Knowledgeis of two types: the knowledge of thereligion and the knowledge of thehuman body”. (10) Therefore studyingFIMA YearBook 200984

Ethical Issueshuman body is a source of recognition ofAllah’s power and is a source of openingnew chapters of the universe whichAllah has created. Several quotationsfrom the ahadith of the Prophet(PBUH) greatly emphasise acquiringand dispersing of knowledge. Scholarsshould endeavor to spread knowledgeand provide education to people whohave been deprived of it. For, whereknowledge is hidden it disappears.”Someone asked the Prophet: “Whois the biggest scholar?” He replied:“He who is constantly trying tolearn from others, for a scholar isever hungry for more knowledge.”“Seek knowledge and wisdom, orwhatever the vessel from which it flows,you will never be the loser”. These andmany other quotations from the sunnahof Prophet Muhammad (PBUH) havemuch relevance to human life and dutyof every one who believes in Allah andHis prophets. (11)Traditionally, knowledge is dividedinto two main portions:Applied sciences such as chemistry,physics, medicine and agriculturewhich should be connected to theexperimental methods. This knowledgeand its application are not strictlyguided by the Qur’an and Hadith,provided it does not conflict with broadteachings of Islam. As narrated by Raf ’ebin Khadeej, the Prophet’s idea aboutpollination was disagreed with by someexperienced farmers. The Prophet(PBUH) then said: “I am but a humanbeing; you take whatever I commandyou of your religion. Whatever else Icommand you of the world’s affairsare of my own opinion, I am not buta human being.” In the narration of‘Aisha, (RA), “...you know best of yourown life affairs.”1. The knowledge of religion, however,can not be accepted from otherthan divine sources. The knowledgerelated to faith (Aqeeda), such asthe knowledge of the Islamic law,religious observances, values andgeneral concepts of the universe,human soul, and the social system,can only be obtained from thesole divine source. This type ofknowledge cannot be achieved byexperimental and inductive methods,for two reasons. One, in studying therelationship between two variables,it is not possible to achieve voluntarycontrol of the factors affecting thesevariables either by confirmationor change of postulates; while thiscould be achieved in applied sciencese.g. the effect of heat on iron. Second,the study of these sciences does notyield the same results if repeatedin the same way and in the samecircumstances, whereas in appliedsciences this is not the case e.g. ironexpands each time when subjectedto heat.2. Islamic faith dictates that man isdistinguished from other creaturesin that he is endowed with theDivine Breath which has grantedhim will, power and knowledge.Therefore, due to man’s free will,FIMA YearBook 200985

Ethical Issuesnobody can positively predict hisbehavior towards certain situationsin a scientific manner. Tests onhumans are not always reproducible.However, if the human behavior isstrictly guided by the principles laiddown in the divine source, then itbecomes predictable. The Muslimshould not, therefore, receive hiscodes of behavior or the ethics of hissociety from non-Islamic sources (12)Allah says; “Therefore shun thosewho turn away from our Messageand desire nothing but the life of thisWorld. That is as far as knowledgewill reach them. Verily thy Lordknoweth best those who stray fromHis path, and He knoweth best thosewho receive guidance.” (13) . It is theresponsibility of a Muslim to seekthe correct way of life and to rightlyguide others to the righteous wayof life: “Ye are the best of peoples,evolved for mankind, enjoining whatis right and forbidding what is wrong,and believing in Allah.” (14) . There isgreat reward of acquiring knowledgeand graded very high in the verses ofQur’an:“Allah will exalt in degree those of youwho believe, and those who have beengranted knowledge. And Allah is Well-Acquainted with what you do”. (15)Medical education combines these twogroups of knowledge; applied sciencesand humanities Its application is onhumans by humans whose behaviorhas to be guided by the divine source.Therefore a Muslim doctor needs to bedifferent from a non-Muslim doctor(not by appearance alone but by virtuesand deeds). He must be fully aware ofhis obligations both to the patient andto Allah. The process of raising such adoctor is long and tedious. (16)Medical ethics is one of the importantsubjects stressed in modern eramedical education. However it is by nomeans the Islamic ethics. Islamic ethicsis far more superior than the “medicalethics” as it protects both doctor andthe patient not only from the sins ofworldly standards but those of divinestandards too. A medical school thatclaims to be a pioneer of Islamic ethicalvalues must observe certain standardsright from the beginning. Theeducational contents and the deliverysystem should be designed accordingto the divine guidance and must reflectthe requirements of the society at large.Acquiring medical Knowledge,dispersing it and practicing medicineremain an integral part of the Muslimsociety.Imam Al-Shafei said: “I know nonobler science than medicine exceptthe sciences of religion”.Medical education remained anessential part of learning and teachingin the Muslim society from its veryearly days. Medical education, despitebeing a specialty, is but one fiber in awhole mesh founded on the belief inAllah, His oneness and absolute ability,and that He alone is the Creator andGiver of life, knowledge, cure fromailments, death, this world and thehereafter. In planning the making ofa medical doctor, a prime goal is toFIMA YearBook 200986

Ethical Issuesmake him a living example of all thathis Creator loves, free from all thatAllah hates, well saturated with the loveof Almighty Allah, of people and ofknowledge. (16)There is not a better way to translatethe theoretical aspects of medical ethicsthan to prepare an ethically motivateddoctor. Medical ethics is not an essentialpart of medical curricula of most ofthe universities and medical schools.The learning behaviors and modalitiesof imparting medical educationneed certain ethical boundaries.These ethical boundaries are verywell drawn by the Islamic educationsystem. In the framework of goodeducational methodologies, certainresponsibilities lie on the educationalsystem, curriculum, teachers,students, learning environmentand pedagogical methodologies.This list is never exhausted andneeds continuous upgradationand modification according to theemerging requirements. Teachingand training of medical students toupbring good Muslim doctors is theprime responsibility of all those whoare involved in medical educationprograms and their implementation.The knowledge and expertise whicha Muslim medical practitioner oracademician acquires is a bounty ofAllah (SWT) and he/she will be askedabout all bounties bestowed to him/her. Imparting obsolete knowledge andtraining doctors through outmodedmethodology does not match thedemands of taqwa (God fearing).Achieving excellence in academia isthe prime responsibility of a Muslimmedical teacher. “The reward of everyexcellence is excellence” (17) Inferiorquality of medical training andeducation at under or postgraduatelevels is a deviation from Islamicteachings. In the history of Islam,Muslim medical teachers always kepttheir students with them during theirpractice hours. They used to learn andacquire the behaviors of their teachersand used to follow what they learndirectly from their teachers. At thesame time they were researchers andinnovators thus contributing directlyto the progress of medical knowledgeand expertise. Ethical dimensions ofmedical education commence rightfrom the time of selection of thestudents to train them as medicaldoctor or for post graduate residencyprograms.The selection criteria in MedicalSchoolThe selection and training of medicalstudents should emphasize serviceswithin the Islamic system of mutualsocial support. During the selectionprocess the main emphasis shouldbe that we are selecting leaders ofthe future, whose moral values andattitudes should be a role model for thesociety. A medical institution shouldaim to train physicians who must beable to conduct research to extend thefrontiers of knowledge. The processof training at undergraduate and postgraduate levels must motivate theFIMA YearBook 200987

Ethical Issuesfuture physician to excellence andcommitment following the model ofthe early Muslim physicians. Thereforethe selection of the undergraduateand postgraduate candidates must bestrictly on merit cum aptitude basis.The selection criteria, including entrytests and interviews, must be designedin accordance with the best Islamicideological concepts, reflecting the bestpractical examples of Islamic justiceand competency. The selection systemmust be just and in accordance with theentire objectives of medical educationdescribed elsewhere. (18)CurriculumCurriculum must be designed to achievepre-defined competence. Competenceincludes a broad range of knowledge,attitudes, and observable patterns ofbehaviors which together account for theability to deliver a specified professionalservice (19) . Professional competenceis the habitual and judicious use ofcommunication, knowledge, technicalskills, clinical reasoning, emotions,values, and reflection in daily practiceto improve the health of the individualpatient and community (20) . Competencyis a complex set of behaviors built on thecomponents of knowledge, skills, attitudeand competence as a personal ability (21) .A modern medical curriculum needsfrequent evaluation based on continuousaudit and performance-based efficacyof the curriculum matching with setgoals and mission of the institutionswhere it is applicable. The curriculummust be a source of transmission ofcompetent knowledge and acquiringrequired skills. The most importantcomponent of an effective curriculumfor a Muslim medical practitioner isto incorporate behavioral changesbased on correct understanding ofIslamic medical ethical values. Thisincludes, not only sound knowledgeof medicine and its proper application,but necessarily includes ethical issuesin Islamic perspective without whichthe essence of good curriculum cannever be achieved. In addition tothe competencies defined in medicalscience e.g. effective communications,performing basic clinical skills,application of principles frombiomedical, clinical and behavioralsciences and epidemiology in thepractice of family medicine; it mustinclude management of specific healthissues related to Muslim faith andpractices. For example, while examiningor operating upon the patient, how muchintimacy and exposure is essential,whether in a given circumstance familyplanning and abortion are permissible,whether a porcine product can be usedto treat an ailment, and many others.The curriculum must be a methodologyrather than reflection of accumulationof scientific information and there mustbe an early student involvement in directhealth care delivery system as a partof the curriculum and the educationstrategy. (22) . Biotechnology and genetics(cloning, stem-cell…etc) from anIslamic perspective should be part ofthe curriculum. The Islamic approachto the prevention of HIV-AIDS andFIMA YearBook 200988

Ethical Issuesother sexually transmitted diseases aswell as the rapidly increasing diseaseslike cancer, cardiovascular, respiratory,digestive and other diseases should alsobe included. The Islamic life style and itsrole in the prevention of cardiovascularand other diseases should be part ofthe curriculum, as well as the effect ofprohibited food, intoxicants, and thedifferent food ingredients on humanhealth and behavior. The Islamicperspective in neurosciences, obstetricsand gynecology, human reproduction,sex education for Muslim youth andtheir parents should also be included,The Islamic perspective on geriatrics,health promotion through life styles,the Amman Declaration, WHOcommunity health guidelines shouldbe also included, The Islamic rulingon smoking, the Islamic perspectiveon environmental health, should allbe part of the curriculum. Medicalschool curricula should comprise theteaching and study of the “IslamicCode of Medical Ethics”. MedicalSchool curricula should emphasize thatmedicine is worship both as an approachto belief by contemplation on the signsof God, as well as from the appliedaspect by helping man in distress.Medical school curricula should includethe teaching of matters of jurisprudenceand worship pertaining to or influencedby various health aspects and problems,as well as of Fiqh (Jurisprudence) rulespertaining to medical practice, researchand development.A curriculum is never comprehensiveand up to the mark if it is lacking basicethical issues pertaining to medicalpractice with special reference to faithand knowledge of the practice of faith.The issues of professional ethics needto be included in basic as well as inclinical sciences. Moreover a holisticcurriculum must include the coreIslamic references, history of Islamicmedicine, contribution of Muslimscholars in research and developmentof medical knowledge and expertise,as well as health guidelines from theQur’an and the Sunnah of the Prophet(PBUH). Ethical values speciallyemphasized in Qur’an and Sunnah ofour Prophet, rights of the sick personin particular and human rights asdescribed in Qur’an, Hadith and Islamicliterature should be stressed. Medicalschool curricula should familiarizethe student with the medical and otherscientific heritage of the era of Islamiccivilization, the factors underlying therise of Muslim civilization, those thatlead to its eclipse, and the way(s) to itsrevival. (23)Medical curriculum must also meetthe requirements of the society. Thecurriculum must address the commonproblems of the society and must notbe adopted as such cooked by theWestern institutions for their own use.The stimulation for research based onloco-regional issues and issues of theMuslim Ummah must be includedin the curriculum. Thus at all levelsof the physician training, the aim ofacquisition of values, attitudes, andethics must be existing. At the nationallevel, training of both Muslim andFIMA YearBook 200989

Ethical Issuesnon-Muslim physicians within aninstitution based on Islamic teachingswill contribute directly to a moral andethical change in the national healthcare delivery system.The Islamic teachings related to theunderstanding and practice of medicinemust be an integral part of conceptsrather than patching these teachings tothe curriculum, and must be directed atsupplying conceptual tools that makethe scientific study of medicine and itsmethodology deeper, universal, andobjective. The dichotomy that existsin many Muslim institutions of higherlearning should be removed such thatthere are no religious sciences distinctfrom non-religious ones. The Islamicinput should be fully integrated intothe medical curriculum and shouldpreferably be taught by the sameprofessors who teach other medicalsubjects. Moreover, our professionalshave to be trained to internationalstandards such that they can workanywhere in the world.In Muslim countries, very little hasbeen done on postgraduate curriculaand training programs. Thoughacquiring knowledge with a continuouspace has been greatly emphasized andstressed in Islam, little has been donefor continuing medical educationand personal development of doctors.Our medical institutions must adopta regular system of training andeducation with special reference to ourloco- regional requirements withoutmarginalizing the internationalneeds and requirements. Training ofMuslim doctors for specialization andsuperspecialization mainly dependsupon the Western institutions. Muslimcountries, inspite of having sometraining programs in their institutions,are lacking properly designedtraining programs with specialreferences of Islamic ethical values.Moreover, knowledge duplicationand consumption of techniques areso prevalent in our societies that weeven do not bother to look into thoseprograms which are designed in a setof reference for particular reasons, inparticular ethical framework and insecular environment. This ultimatelycreates contradictions and conflictsamong our trainees and we have beenneither able to prepare Muslim nornon Muslim specialists. Our doctorsneed to be trained with clarity of mind,sound faith and up-to-date expertise intheir respective fields. Our continuingmedical education programs, as arequirement of a faithful and correctdoctor, must also include continuousupgrading of knowledge of ethicalissues including ethics of human andanimal research in addition to newdevelopments in medicine. (24)Pedagogical methodology andthe learning process in medicalinstitutions:The teaching methodologies andpedagogical instruments in medicalschools must be designed in such afashion that these techniques shouldreflect Islamic ideology and Islamicway of life. Any uncertain ways andFIMA YearBook 200990

Ethical Issuesmeans of communication should notbe used.Teaching modules must includeeffective modalities of learning, mustnot be overwhelmed by authoritativebehaviors, and students must beprovided with a good chance of selflearning and thinking and ponderingupon the best creation of Allah that isthe human being.”We have indeed created man in thebest stature; then we abase him to thelowest of low; except those who believeand do good deeds- for they shall havenever ending reward.” (25) . “Those whoremember Allah while standing, sittingand lying on their sides, and meditate( think and ponder upon) the creationof the heaven and earth, then say:Our Rabb You have not created thisin vain, glory to You Save us from thepunishment of fire” (26) .Our teaching effort must stimulate ourstudents to think and to ponder uponthe creation: its structure, functions,purpose of creation and if a persondeviates from the actual purpose ofcreation or misuse his body, what typeof disease could develop in his bodyand soul.Moreover, our pedagogical effortsmust reflect the evidence- basedpractice of medicine, which is the trueIslamic medicine. There is no doubtmedical practice needs continuousevolution and continuous assessmentof its performance. There are severalmodalities of medical educationprograms and none of the teaching orinstructive methodology is perfect toproduce the needed doctor meetinghealth challenges. Therefore all sorts ofcurricula are in continuous evolutionand rearrangement in search of thebest possible means of instruction toproduce the required doctor. In Islamicteaching there is one very importantinstruction to all human beings and tothe doctors in particular: “ the rewardsof excellence is excellence”. One mustperform his job in such a way thathe tries to achieve excellence in hisprofession. Our Prophet said that “aMuslim does his job in the best possibleway” (27) . These instructions enlightenus to secure the best possible means oftransmission of our medical knowledgeto our successors with excellent ways,which is “amanah” (trust) with us.Whether we adopt the new trendsin medical education, like integratedteaching, problem based learning orstudent centered learning, or adopt ourown ways of instructions and teachingmodalities based on our own situations,we must achieve excellence and that isone of the dictates of our religion. (28)At the same time, our curriculumand teaching tools should not befragmented and sanctioned leading tocrowding of minor things and leavingbehind, or less emphasizing, thepractical contents. The specializationand super-specialization might be agood effort but we need to know whythe people in the West are not satisfiedby methodology of instruction andtraining programs of the doctors andcame up with the ideas of vertical andhorizontal integration among differentFIMA YearBook 200991

Ethical Issuesdisciplines of medicine, and developedthe problem centered approach. Onemust clearly understand that integrationis not just putting two or moredisciplines together. It is a fundamentalphilosophical attitude based on a visionand a guiding paradigm. Only Islam,which has holistic approach to lifeand universe and every thing in it, canprovide this paradigm. Not knowingthis paradigm, people without faithare lacking equilibrium as a secondarymanifestation of lack of integration.A lot of human illness is due to lackof balance and equilibrium. Amongdifferent teaching models in practicein the western countries, the diseasestudy model is predominating. The biasto the disease model explains Westernmedicine being more curative thanpreventive. Since the ultimate goal ofour effort is health, every model mustbe health oriented and not diseaseoriented. This attitude has developedin the West because of their negativeattitude towards disease, while illnessto a Muslim has its positive aspectsand can be a blessing and reasonfor expiation of sins. When viewedin a larger context, illness need notalways be seen as bad. Falling sick,may save a person from going wherehe would be hurt more seriouslyor where he could commit a sin. Incertain instances, alarming signs giveindications of tissue damage and canbe helpful in managing symptoms. Forexample, pain is an indication of tissuedamage whether actual or impending.Fatigue is the body’s way of forcingus to rest when we are over-stressedor overworked without adequate rest.Much of what manifests as disease is thebody’s attempt to return to natural ornormal form. Moreover Islam assertsthat the ultimate cure of illness is fromAllah. Man can only put his maximumeffort to alleviate the suffering with bestpossible medical art and knowledge. (29)Islamic medical education aimsto achieve the supreme purposes(Maqasid ) of al- Shari’ah described inIslamic jurisprudence i.e. protection ofreligion, life, procreation, intellect andproperty. The Medical profession is theonly profession involved with all fivepurposes. Therefore, medical educationmust produce such doctors who, intheir practice, will fulfill these purposeswithin holistic context. They should behealth oriented.This approach can only be applied toproduce a desirable doctor who hasa tawhidi (Unity of ALLAH and Hiscreation) approach to integration. He/she places the medical knowledge,teaching and practice in larger contextto making sure it is in harmony withother related medical or non medicalspheres of knowledge. This purpose ofmedical education could be achievedby holistic view of medical education,including selection of students intothe medical schools, changing andreforming curriculum, emphasizingbasic methodological and conceptualissues, and involvement of studentsfrom their early days of medicalschools as were practiced by prominentMuslim physicians in the early IslamicFIMA YearBook 200992

Ethical Issuesera. Besides acquiring knowledgeand skills, medical education impartsattitudes and assumptions. These arepart of the non factual learning thatstudents acquire by watching theirteachers.A system under control of the medicalschool should ensure systematiccontinuing medical educationacknowledging the fact that much ofwhat is taught is soon overtaken by newmedical discoveries in rapidly changingknowledge and results of researchand innovation in medical sciences.Medical education must shift fromtraditional teaching system to characterbuilding along with producingcompetent doctors who acquire thequalities of IMAN (faith- Tawhid,Adl, tafakkur, Taqwa ( God fearing),Amanah: (commitment, sincerity ofintention and quality of work), andAkhlaq (best moral attitudes). (30)Medical education must be researchbasedand should be in the processof continuous evoluation. Islamicapproach to medical educationprovides wide scope of research evenfor diseases where we do not knowthe proper pathophysioplogy andcure. As the Qur’an denounces blindfollowing and imitation (Taqlid), thisattitude provides great motivation forresearch and a Muslim doctor knowsthat his scope of research is wider thana non believer, knowing the fact thatunderstanding more signs of AlmightyAllah leads to even more Iman. AMuslim doctor strives to know moreabout Allah’s signs to become closer toHim.The physician of the future will haveto change easily between interrelatedroles of research and innovation,clinical and preventive work andmedical education. A doctor is also asocial worker without which he can notperform his other functions. All theseduties can be performed by correct timemanagement. A medical educationsystem must be designed in such a waythat a balance is created among medicalresearch, education, clinical, preventiveand social work. A researcher, who isa clinician, knows basic problems inhis day to day practice A teacher andclinician knows these problems betterand knows how to put maximum effortto come up with better solutions ofthese problems based on his studiesand research.The Teacher as a Role modelThe purposes of any education processcan never be achieved until teachers orfacilitators imparting such educationor training are fully equipped withrequired knowledge, expertise andattitude required for that particulareducation process. A medical teachershould be fully aware of the fact thathe is the responsible role model for hisstudents and graduates. He should befully aware of the fact that to learn andacquire the state of the art educationaltechniques and pedagogical tools isessential for a God-fearing medicalteacher. The medica1 teacher oweshis students the provision of the goodexample, adequate teaching, soundFIMA YearBook 200993

Ethical Issuesguidance and continual care in and outof classes, before and after graduation.Medical education is neitherpassive nor authoritarian. It aims atsparking mental activity, fosteringobservation, analysis and reasoning,development of independent thoughtand the evolvement of fresh questions.Stagnation of medical knowledgeis strongly condemned in Islamicteachings, continuous and enhancingof medical knowledge and expertiseto provide best medical care topatients and society can only bepossible if the teacher is well versedwith these techniques and capable ofefficiently transmitting to his studentsat undergraduate and postgraduatelevels. Medical education has to bepurified from every activity towardsatheism or infidelity, yet it picks fromall trees without refractoriness orprejudice. (31) Only following out-datedideas and methodologies learnt froma teacher years ago and not adoptingthe newest better ideas , is stronglycondemned in Qur’an “As such we havefound our fathers and we will follow ontheir footsteps” (32) . This is the reasonthat the Muslim teacher is progressiveand forward looking rather thandeveloping an attitude which is onlyconducive to stagnation and arrest ofprogress. A Muslim medical teacheris a role model for his students andhis life reflects the Islamic behavior.“For surely I have been sent to be ateacher.” (33) . An attitude that “Faith” isremedial, a healer, a conqueror of stressand a procurer of cure is needed. Thetraining of the doctor should preparehim/her to bolster “Faith” and availthe patient of its unlimited blessings.This can only be done if the medicaltrainees acquire sound knowledge ofIslam related to medicine and healthsciences, as well as comprehensive anduptodate knowledge of Medicine andrelated arts. Thereafter he must developthe abilities to decide and implementmedical knowledge within the frame ofIslamic medical ethics. (31)Conducive Environment of MedicalSchool/ Institution:All efforts and techniques to prepareand train a Muslim medical professionalwill be ineffective if the educationalenvironment and academic atmosphereof the medical educational institutionsand teaching hospitals are not inharmony with Islamic teachings. Allmedical institutions, including teachinghospitals and allied specialties, mustfollow and adopt Islamic ideologicalvalues with correct understandingof their application without anyreservations. It is impossible to importeducation in a secular environmentand prepare a true Muslim doctor whocould acquire all qualities of a goodMuslim in general and good Muslimdoctor in particular. At least a medicalinstitution must follow the policy ofavoidance of improper and unnecessaryikhtilat (mixed sex gatherings), properIslamic dress code, lay out of theinstitution, separate civic facilities formale and female staff, etc. The campusmust reflect Islamic symbols and thereFIMA YearBook 200994

Ethical Issuesmust be complete obedience of Allahand His messenger, respect to Islamicvalues and norms. (24) All anti Islamicand secular elements indicating shirk(associating partners with Allah)must be removed from the premises,otherwise a severe contradiction maydevelop among the minds of students.It is against the teachings of Qur’an tosay something and not do accordingly.“O’ believers! Why do you say somethingwhich you do not do? It is very hateful inthe sight of Allah that you say somethingwhich you do not do” (34) . There must bea complete harmony and concordancebetween their sayings, admonitionsand practice. Campus of a medicalinstitution should be self-sufficient inall basic needs for training of doctorsin Islamic environment, and selfcontainedwith most modern and stateof the art educational instruments,including clinical materials. Clinicaland basic sciences must be fullyfurnished with required equipmentso that training could be impartedwith up to the mark standards. TheIslamic medical education is evidencebased,modern, ethical and efficient.A Muslim doctor should acquire allthose qualities to achieve these goals.The educational premises should beconducive for the implementations ofIslamic ethical values.Continuous Medical Education (CME)Medical knowledge is ever expandingand medicine is one of the fastestadvancing fields of sciences. In thepast, Muslim medical scholars werethe source of expansion of medicalknowledge and expertise, and playedcrucial roles in creating and dispersingknowledge. Over the past five hundredyears, Muslim medical professionalsgradually lagged behind. Medicalpractice has become the means toattain a distinguished position insociety and to gain profitable earnings.Mostly medical professionals in thethird world are neither creative northe source of enhancement of medicalknowledge and expertise. To remainat the cutting edge of knowledge andexpertise, Muslims doctors will haveto acquire medical knowledge morepersistently and continuously. (35)In their pursuit to acquire and increasetheir knowledge, Muslim doctors arefollowing the example of the Prophet(PBUH) who is taught by the Qur’anhow to invoke Allah saying“O my Lord! Advance me inknowledge.” (36) .The Prophet (PBUH) used to pray;“O, my Lord, I seek refuge of youfrom four: non-useful knowledge, anunfearful heart, an unsatisfied soul andan unanswered prayer.” (37) .Continuing medical education ismandatory for every Muslim medicalpractitioner, He is not at liberty toshun passively such a pursuit. TheProphet (PBUH) said; “Seekingknowledge is a duty prescribed onevery Muslim.” (38) Allah will raise up,to (suitable) ranks (and degrees), thoseof you who believe and who have beengranted knowledge”. (39)FIMA YearBook 200995

Ethical IssuesIn order to achieve this high rank,there are prerequisites for the scholar ofknowledge to fulfill, the most importantof which is for his knowledge to beintended for the pleasure of Allahand for the best interest of Islam andhumanity.If the duties of religious observancehave maximum limits to attaincompleteness, seeking knowledge,on the other hand, has no limits, andextends into man’s entire life. TheProphet (PBUH) said; “The faithful willnever be fully satisfied of the good hehears, until his final goal is paradise.” (40) .If knowledge is related to the healthand safety of Muslim Ummah, andhumanity at large, as well as preservingthe aims of Islamic legislations, as suchis the case in medical sciences, thenperfecting and becoming advancedin such sciences is more of a priorityand a duty. In this contexts, acquiringmedical knowledge is necessary fromMuslim or non Muslim countries. Inacquiring such knowledge a Muslimdoctor must adhere with the massageof Islam and divine guidelines. (44)The doctor must seek and advance hisknowledge until the end of his life. Hemust be a source of inspiration for thecoming generations. He must alwaysand persistently explore new andbetter diagnostic and therapeutic toolsfor his time and times to come. Hisadditions in knowledge and expertisewould then be a running charity tobe rewarded for, even after his death.The concept of Islamic message shouldbe acknowledged by every scholarof medicine. He/she has to seekknowledge for the cause of Allah, withno regard to achieving material welfareor distinguished social status. But ifhe/she intends to study medicine forthe sake of mean ephemeral worldlyaims, the Prophet (PBUH) warns himin the hadith narrated by Abu Huraira;“Whoever learns a knowledge, that ofwhich Allah’s sight would be sought, toseek a worldly benefit, will never find thefragrance of paradise on Doomsday.” (42) .Acquiring knowledge and practicingmedicine should entirely be to pleaseAllah and for the cause of Islam thoughthe byproduct could be earning orstatus but these should not be the majoraim of a Muslim doctor. And thereforeacquiring knowledge raises the degreesof people to the highest ranks of faith,righteous work and Jihad (holy cause).Allah says; “We gave (in the past)knowledge to Dawod and Solaiman:And they both said: “Praise be to Allah,Who has favored us above many of hisservants who believe!””And Solaimanwas Dawod’s’ heir. He said: “O ye people!We have been taught the speech ofbirds, and on us has been bestowed (alittle) of all things: this is indeed Gracemanifest”(from Allah) (43) .It is therefore required to achieve thishigh rank, and all those prerequisitesfor the scholar of knowledge. A Muslimdoctor is aware that he has to make acontinuous research and enhance hisdiagnostic and therapeutic skills to findout the treatment of all those incurableconditions as an application of theProphet’s saying; “Seek remedy forFIMA YearBook 200996

Ethical Issuesverity, Allah has not created a diseasewithout providing its cure ....” (44)Many eminent Muslim scholars believethat acquiring technical knowledge inthe best interest of the society is FardKifayah. This is an act in Shari’ah thatis not essential for every one. If fewor some persons from the society dothat job it is being accepted by Allah(SWT) from the whole society. In thislist of technical knowledge essentialfor the society, medical knowledgeis on the top (31,41) . In fact, acquiringmedical knowledge and dispersing it isin the best interest of humanity and isa means for strengthening one’s faith(Iman). “Such is He, the Knower of allthings, hidden and open, the Exalted (inPower), the Merciful; He Who has madeeverything which He has created mostwell: He began the creation of man with(nothing more than) clay.” (45) .At the end, one must always pray toAlmighty in accordance to Sunnah of ourProphet for al-ilm al-nafe (knowledgewhich is useful in this world and in thehereafter). It becomes a compulsorysegment of one’s professional life toacquire current medical knowledgeand expertise for the best care of hispatients and his society and humanity.Perfecting his profession to preservepeoples’ lives in compliance withAllah’s command to colonize theuniverse and to serve humanity at largeis a duty for the Muslim physician. Theconcept of Islamic message shouldbe acknowledged by every scholar ofmedicine. To attain an outstanding levelof knowledge, continuing educationis essential, so that the scholar’sknowledge will be most useful for allcommunities. It is the tool to providethe best possible care to one’s patientsand to meet Allah knowing that onehas done his share to improve the lot offellow human beings.FIMA YearBook 200997

Ethical IssuesReferences:1.Emanuel EJ. Changing premed requirements andthe medical curriculum. JAMA. 2006; 296:1128-1131.2.Follow L Amold RM Frader J. Teaching clinicalethics in the residency years preparing competentprofessionals J Med Philos 1991: 16, 93 – 112.3. Forty Hadiths by Dr. Ezzuddin Ibrahim and DavidJohnson, published by the Holy Koran PublishingHouse, Beirut, Lebanon.4.Kuwait Document, Islamic Code of Medical Ethics,International Organization of Islamic Medicine,1981.5. The Glorious Qur’an, 96:1-5.6. The Glorious Qur’an, 2:31.7. Al-Tirmidhi Hadith No. 218. Darussalm-Lohare-Pakistan 1998.8. Sunan of Abu-Dawood Hadith #3634. TahaPublication, Cairo 1989.9. Proposed Medical Research Projects, edited by:Abdul Jawad M. As Sawai, Commission onScientific Signs of Qur’an and Sunnah, 1992.10.Encyclopedia Religious and Ethics James HostingPart 16, Page 649.11. The Sayings of Muhammad (PBUH) edited andarranged by: A. Suhrawardy, Tarek Press, Cairo,Egypt, 1991.12. 200 Hadith by Mr. Abdul Rahim Ismail Al Faheem,Makkah Printing Press, 1411H.13. The Glorious Qur’an, 53:29-30.14. The Glorious Qur’an, 3:110.15. The Glorious Qur’an, 58:11.16. Khalid s khan Am Coomarasamy A hierarchyof effective teaching and learning to acquirecompetence in Evidence- based Medicine BMCMedical education 2006, 6:9.17. The Glorious Qur’an, 55:60.18. Ten Cate O, Snell L, MANN k, Vermunt Orientingteaching towards the learning process Acad Med2004, 79: 219-28.19. Mc.Gaghie,William C. et al. Competency-basedcurriculum development in medical educationan introduction, World Health Organization:[Albany,N.Y.:obtainable from WHO PublicationsCentre] (Geneva) 1978.20. Wilkinson Tim J, Suzanne Gower & RichardSainsbury The earlier, the better: the effect of earlycommunity contact on the attitudes of medicalstudents to older people’ Medical Education,volume 36 issue 6, pages 540-452 publishedonline: 31 May 2002.21. Harden RM Ten questions to ask when planning acourse or curriculum Medical education, volume20, issue4, pages 356-365 published online:29 Jan2009.22. M. Siddiqi, “Studies in Arabic and Persian MedicalLiterature”, Calcutta University, Calcutta, 1959, p.20.23.SAYRAWAN, Sheikh Abd al Aziz Izz al Istishifamin al almradhi al Nafsiyyaat wa al Jasadiyyahbi Adiyat al Qur’an wa al hadith Dar al Afaq alJadidah Beirut No Date.24. SHAHINE YA Arab Contribution to Medicine.Longman London 197125. The Glorious Qur’an,95:4-6.26. The Glorious Qur’an, 3:191.27. Hadith reported by injalal al-deen al-Suyyti. Al-Jami al-Saghir.28. GRAZIANI JS Arabic Medicine in the EleventhCentury As Represented in the Works of IbnJazalah Hamdard Academy, Hamdard FoundationKarachi 198029. MOORE K &AA al Zindani the DevelopingHuman: with Islamic Additions, CorrelationStudies with Qur’an and Sunnah (3rd edition) WBSaunders Company Philadelphia 1993.30. NAQIB, al Abd al Rahman Abd al Rahman AlI’daad al Tarbawi wa al Mihani li al Tibiib Indaal Muslimeen .Dar al Fikir al Arab Cairo. 1984.31. Kasule, Sr., Omar Hasan: An Islamic Introductionto the Study and Practice of Medicine. Vol 2: BasicMedical Sciences and revelation. (Manuscript inpreparation). International Islamic University,Kuala Lumpur, Malaysia 1998.32. The Glorious Qur’an, 43:22.33. Sunan Ibni Majah # 2704. DarussalamPublications-Riyadh-KSA 1993.34. The Glorious Qur’an,61:2-3.35. Bakar, Osman. Philosophy of Islamic Medicineand Its Relevance to the Modern World. Secretariatfor Islamic Philosophy and Science. Penang. 1996.36. The Glorious Qur’an,20:114.37. Muslim Book 35: Hadith 6518.38. Narrated by Anas bin Malik, Sunnan Ibni Majah#220.39. The Glorious Qur’an,58:11.40.Sunnan abi Dawud 23/491 -The Taha Publicaiton-Cairo 1989.41. Al Bar, Muhammad Ali. [al Adwah Bayn alTiobb wa Hadith al Mustafa] Contagion betweenMedicine and the Hadith of the Prophet. 4 thedition. Al Dar al Saudia li al Nashr wa al Tawzi’i.Jeddah 1981/1401.42. Sunnan Ibni Majah 61-556. DarussalamPublications-Riyadh-KSA 199343. The Glorious Qur’an, 27:15-16.44. Sunnan Abi Dawud, Op.cit. Kitab Al Tibb, part 4,page 7.45. The Glorious Qur’an, 32:6-7.FIMA YearBook 200998

Muslim Contributions To Research:Past, Present And FutureTayyab Hassan*, Afshan Khan, and Abdul Rashid Abdul RahmanAbstractIslamic contributions to medical research are indeed unquestionable. Althoughthese contributions have remained hidden from western public domain for a verylong time, attempts have been made by the international scientific communityto slowly, but surely acknowledge the contributions made by Muslim medicalscientists and doctors of the past. However this acknowledgment is taintedwith the innuendo that those were historical contributions with very littlecontemporary relevance. Indeed many have insinuated that Muslims ought tocome out from their cocoon and rise to the challenge of contributing to thefuture, and desist from merely resting on past laurels. Since the bulk of ideasand innovations in research emanate from the ‘ivory towers’, it is importantthat Muslim-based institutions of higher learning take up the challenge. TheFederation of Islamic Medical Associations (FIMA) through its Consortium ofIslamic Medical Colleges (CIMCO), must take the bold step in working towardsa transformation within Muslim Institutions of Higher Learning to be centersof excellence in research and innovations. Such novel and noble efforts mustbegin with us identifying the recipe for our past glory, introspectively and soulsearchingly looking at our present state of affairs and strategizing action plansfor the future. This article attempts to cover all those areas and is hoped that itwill be a blue print to call for action within CIMCO, FIMA and beyond.Keywords: Muslim scientists, past Islamic civilization, Islam, history of medicalresearch.Dr. Tayyab Hassan MBBS (Pakistan),PG Dip Med Ed (Dundee), MHPE (Netherlands)Lecturer, Medical Education Division,Faculty of Medicine, Cyberjaya UniversityCollege of Medical Sciences, Malaysia:E-mail: tayyabhassan@yahoo.comFIMA YearBook 200999

Muslim ContributionsMuslims’ contribution to medicalresearch during the glorious eraHistory has witnessed that ProphetMuhammad (PBUH) united thenomadic Arab tribes and successfullyproduced a strong and united nation.The two most powerful empires at thattime were the Persian and Byzantineempires. The boundaries of the IslamicEmpire were the Atlantic Ocean onthe West and the borders of China onthe East. Only 80 years after the deathof Prophet Muhammad (PBUH), theMuslims crossed to Europe and ruledSpain for more than 700 years.For 1,000 years, the Islamic empire wasthe most advanced and civilized nationin the whole world (1) . The reason for thisglorious era was the teachings of Islam,i.e. importance and respect of gainingknowledge, respect for authority, othercultures and religions, discipline andtolerance to other societies includingthe insatiable desire to gain knowledgefrom various sources. The origin of thismarvellous development and progresswas the efforts put by Muslim scholarsin translating the entire essentialGreek, Syriac (the language of easternChristian scholars), Pahlavi (thescholarly language of pre-Islamic Iran),and Sanskrit medical works and otherwritings on various topics into Arabic.The process of translation reachedits peak with the establishment of the“House of Wisdom” (Bayt ul-Hikma)by the Abbasid Caliph Al-Ma’mun inBaghdad in 830 CE (2) . This task wascompleted by 10 th century CE andDamascus, Cairo and Baghdad were themain centres for this work. During thatperiod Baghdad emerged as the centerof the scientific knowledge and activityand Arabic became the internationallanguage of science and diplomacy.Muslims not only translated theworks of previous civilizations butthey developed their own scientificknowledge by conducting enormousresearch in various fields especiallymedicine. The European medicalsystem is based not only on Arabianphilosophy but still follows the samesystem introduced by Muslim scholarsand physicians, as pointed out in thefollowing paragraphs. The impact ofIslamic civilisation on Western science,technology, and medicine between theyears 800 and 1450 cannot be ignored (3) .Similarly today’s Western world mightlook very different without the legacyof Muslim scholars in Baghdad, Cairo,Cordoba, and elsewhere (4) .Medical Education was taken as aserious matter and a system wasdeveloped to train physicians. Themedical teaching was based on theapprentice system and the Islamicmedical schools were developed onthe pattern of university and hospitalof Jundi-Shapur, a Persian cityconquered by Muslims in 636 C.E. Thewhole medical teaching method canbe traced back to the advice of Ali ibnal-Abbas (Haly Abbas: -994 -C.E.) tomedical students (1)“And of those things which wereincumbent on the student of this artFIMA YearBook 2009100

Muslim Contributions(medicine) are that he should constantlyattend the hospitals and sick houses; payunremitting attention to the conditionsand circumstances of their inmates, incompany with the most astute professorsof medicine, and inquire frequently as tothe state of the patients and symptomsapparent in them, bearing in mind whathe has read about these variations, andwhat they indicate of good or evil.” (1)Similarly, al- Razi (Rhazes: 841-926C.E.) asked the medical students tolook for the classic symptoms of adisease as described in the text booksand then compare them with what theyfound in their patients (1) .Physicians such as al-Razi (-Rhazes),Ibn-Sina (Avicenna: 980-1037 C.E.)and Ibn Zuhr (Avenzoar: 116 C.E.)were involved not only in treatingpatients but they worked both ashospital directors and deans of medicalschools at the same time. The selectionof patients with important symptomsand signs for teaching purposes,writing clinical reports on differentcases, using them for teaching andmaintaining registers of patients`records were part of medical educationduring that early period.Training in basic and clinical scienceswere carried out separately inprominent centers of learning suchas in Jundi-Shapur and Baghdad.Baghdad medical school was moreadvanced with anatomy beingtaught by dissecting apes while inother medical schools only lecturesand illustrations were used to teachanatomy. The concept of prerequisitesfor admission in medical school wasenforced and Alchemy (chemistry)was one of the prerequisites. Medicinalherbs and pharmacognosy was part ofbasic training and most of the hospitalsused to maintain herbal gardens as asource of drugs for patients and meansof instruction for the students.After completing basic training,students were admitted as apprenticesto a hospital for pre-clinical trainingthat included joining a large groupsupervised by young physicians forindoctrination, preliminary lectures,and familiarization with libraryprocedures and uses. Lectures onpharmacology, toxicology and the useof antidotes were delivered at this stageof medical training.Clinical training started immediatelyafter completing the pre-clinicaltraining and students were assignedin small groups to famous physiciansand experienced instructors. Studentsjoined ward rounds, discussions,lectures, and reviews. Therapeutics andpathology were introduced at this levelwith strong emphasis given on clinicalinstruction. Upon showing progress,more subjects were introduced to helpstudents in making diagnosis andin their clinical judgment. Clinicalobservation and physical examinationincluding general physical examinationwere important components duringthis phase and students were asked toexamine a patient and make a diagnosisof the illness under supervision of aFIMA YearBook 2009101

Muslim Contributionssenior physician.Once students learned to performwell in wards, they were assignedto outpatient areas. In outpatientclinics, students examined the patientsand reported their findings to theinstructors. After discussion, treatmentwas decided on and prescribed to thepatients but patients who were too illwere admitted as inpatients. Studentswere also responsible for keepingrecords for every patient.Selecting and developing a curriculumfor medical schools was anotherimportant area for effective training.Different schools used to have somedifference in the clinical curriculumin their courses; however the mainemphasis in all curricula was usuallyinternal medicine and surgery.Specialization in specific areas wasalso available under famous specialists.Many surgical procedures such asamputation, excision of varicoseveins and hemorrhoids were requiredknowledge.Orthopedic procedures includingthe use of plaster and reduction offracture were widely taught and shownto students (this method of treatingfractures was rediscovered in theWest in 1852). Ophthalmology andObstetrics were not taught regularlyin medical schools and apprenticeshipto an eye doctor was the preferredway of specializing in ophthalmologywhile obstetrics was for the midwives.Surgical treatment of cataract wasvery common. Ibn Sina was known topractice and teach psychotherapy.Following completion of formaltraining, there was a licensureexamination students had to take.Passing this examination was a prerequisite to enter practice. Licensing ofphysicians was introduced in Baghdadin 931 C.E. when Caliph al-Muqtadirlearned that a patient had died as theresult of a physician’s error. He orderedhis chief physician, Sinan-bin Thabitbin Qurrah to examine all those whopracticed the art of healing. Fromthat time on, licensing examinationswere required and administered invarious places. Licensing Boards wereset up under a government officialcalled Muhtasib or inspector general.Pharmacists were also employedas inspectors to inspect drugs andmaintain quality control of drugs soldin a pharmacy. The chief physician gaveoral and practical examinations, and ifthe young physician was successful, theMuhtasib administered the HippocraticOath and issued a license. According toal-Razi, a physician had to satisfy twoconditions for selection. First he had tobe fully conversant with the new andthe old medical literature and secondly,he must have worked in a hospital ashouse physician.The development of efficient hospitalswas an outstanding contribution ofIslamic medicine. Hospitals servedall citizens free of charge regardlessof their color, religion, sex, age orsocial status. The hospitals were runby the government and the directorsFIMA YearBook 2009102

Muslim Contributionsof hospitals were physicians. Manymodern hospitals have been developedon the same model as hospitals inIslamic era i.e. separate wards for maleand female patients, special apparel forin- patients, nursing staff and porters,qualified and licensed physicians topractice medicine, teaching facilitiesfor educating medical students, outpatientand inpatient departments,housing for students and house-staffand pharmacies dispensing drugsto patients. Hospitals kept recordsof patients and were equipped withconference rooms and librariescontaining the most up-to-date books.Holistic approach towards healingwas evident by the fact that in TulunHospital ( founded in Cairo in 873 CE)each patient on discharge received fivegold pieces to support himself untilhe could return to work (an exampleof holistic approach to patient care,considering not only the medicalcauses but the social, psychological andspiritual aspects as well).The libraries were well stocked withreference materials. The library of theTulun hospital had 100,000 books,Mustansiriyya University in Baghdadcontained 80,000 volumes; the libraryof Cordova had 600,000 volumes;Cairo had 2,000,000 and that of Tripoli3,000,000 books).State of the art hospital concept wasalso evident. The al-Adudi hospitalof Baghdad (built in 981 C.E.) wasfurnished with the best equipmentand supplies known at the time. It hadinterns, residents, and 24 consultantsattending its professional activities.The professional activities were notconfined to hospitals; an Abbasidminister, Ali bin Isa, requested thecourt physician, Sinan bin Thabit, toorganize regular visiting of prisons bymedical officers.The hospitals were of two types - thefixed and the mobile. The mobilehospitals were transported uponbeasts of burden and were erectedfrom time to time as required. Similarmoving hospitals accompanied thearmies in the field. The field hospitalswere well equipped with medications,instruments, tents and a staff of doctors,nurses, and orderlies. The travelingclinics served the profoundly disabled,the disadvantaged and those in remoteareas. These hospitals were also used byprisoners, and by the general public,particularly in times of epidemics.Famous Muslim Physicians andSurgeonsSome of the great scholars of earlyIslamic era, who contributed not only tomedicine but several other disciplines,are as follows:Al-Razi (Rhazes born 865 C.E.) wrotethe first medical description of smallpoxand measles. He described the clinicaldifference between the two diseasesso vividly that nothing since has beenadded. His practical implementationof “infection” knowledge is reflectedfrom the incident when he was askedto choose a site for a new hospital inBaghdad. He hung fresh pieces of meatFIMA YearBook 2009103

Muslim Contributionsin various places and observed the areawhere the meat was least decomposed.Al-Razi was the first to use animalgut for sutures. He started using silksutures and alcohol for hemostatis.Al-Razi introduced mercurycompounds as purgatives (aftertesting them on monkeys); mercurialand lead ointments. His interest inurology focused on problems involvingurination, venereal disease, renalabscess, and renal and bladder calculi.He described hay-fever or allergicrhinitis.Some describe al-Razi, asthe greatest physician of the Islamicworld. He wrote Kitab Al-Mansuri(Liber Almartsoris in Latin), a 10volume treatise on various disciplines,including Greek medicine (5) . His textscontinued to be reprinted well into the19th century.Ibn Sina ( Avicenna) in his masterpieceal-Qanun fi al- tibb (The Canon ofMedicine) containing over a millionwords described complete studies ofphysiology, pathology and hygiene.He specifically discoursed uponbreast cancer, poisons, diseases ofthe skin, rabies, insomnia, childbirthand the use of obstetrical forceps,meningitis, amnesia, stomach ulcers,and tuberculosis as a contagiousdisease, facial tics, phlebotomy, tumors,kidney diseases and geriatric care. Herecognized ‘physiological psychology’in treating illnesses involving emotions.From the clinical perspective, Ibn Sinadeveloped a system for associatingchanges in the pulse rate with innerfeelings which has been viewed asanticipating the word associationtest of Jung. Ibn Sina suggested thecommunicable nature of tuberculosis.His recommendation of wine as thebest dressing for wounds was verypopular in medieval practice. He wasthe first to use alcohol as an antiseptic.Ibn Sina also originated the idea of theuse of oral anesthetics. He recognizedopium as the most powerful mukhadir( intoxicant drug). Less powerfulanesthetics known were mandragora,poppy, hemlock, hyoscyamus, deadlynightshade (belladonna), lettuce seed,and snow or ice cold water.Ibn Sina’s description of the surgicaltreatment of cancer holds true eventoday after 1,000 years. He said theexcision must be wide and bold; allveins running to the tumor must beincluded in the amputation. If this isnot sufficient, then the area affectedshould be cauterized.Ibn Sina was known in the West as “theprince of physicians.” His synthesis ofIslamic medicine, al-Qanun fi’l tibb , wasthe most authoritative book on medicalmatters in Europe for several centuries.Although Ibn Sina made advances inpharmacology and in clinical practice,his greatest contribution was probablyin the philosophy of medicine. Hecreated a system of medicine that todaywe would call holistic and in whichphysical and psychological factors,drugs, and diet were combined intreating patients (6) .Abu al-Qasim Khalaf bin Abbas al-FIMA YearBook 2009104

Muslim ContributionsZahrawi (Abulcasis born 930 CE) isconsidered to be the most famoussurgeon in Islamic medicine. In hisbook al-Tasrif, he described hemophiliafor the first time in medical history.The book contains the descriptionand illustration of about 200 surgicalinstruments many of which weredevised by al- Zahrawi himself. In ital- Zahrawi stressed the importance ofthe study of anatomy as a fundamentalprerequisite to surgery. Al- Zahrawi isprobably the first surgeon in history touse cotton (an Arabic word) in surgicaldressings, in the control of hemorrhage,as padding in the splinting of fractures,as a vaginal padding in fractures of thepubis and in dentistry. He introducedthe method for the removal of kidneystones by cutting into the urinarybladder. He was the first to teachthe lithotomy position for vaginaloperations. He described tracheotomy,distinguished between goiter andcancer of the thyroid, and explained hisinvention of a cauterizing iron whichhe also used to control bleeding. Hisinitial description of varicose veinsstripping, is very similar to what isstill done in surgery. In orthopedicsurgery he introduced what is todaycalled Kocher’s method of reduction ofshoulder dislocation and patelectomy,1,000 years before Brooke reintroducedit in 1937.Al-Tasrif was translated into Latinand became the leading medical textin European universities during thelater middle ages. Al-Zahrawi wasalso a noted pathologist, describinghydrocephalus and other congenitaldiseases as well as developing newsurgical technologies such as catgutsutures (7,8) . The surgeons of Islampracticed three types of surgery:vascular, general, and orthopedic.Surgeons all over the world todayunknowingly practice several surgicalprocedures that al- Zahrawi introduced1,000 years ago.The use of anesthesia was one of thereasons for the rise of surgery inthe Islamic world to the level of anhonorable specialty, while in Europesurgery was belittled and practiced bybarbers and quacks. The Council ofTours in 1163 C.E. declared surgeryis to be abandoned by the schools ofmedicine and by all decent physicians.The medical texts of ibn Rushd(Averroes) were also widely used inEuropean universities. Ibn al-Nafis, a13th century Arab physician, describedthe pulmonary circulation more than300 years before William Harvey (9) .Ophthalmic surgery was a specialtywhich was quite distinct bothfrom medicine and surgery. Inophthalmology and optics ibn al-Haytham (Alhazen born 965 C.E.)wrote the Optical Thesaurus fromwhich such worthies as Roger Bacon,Leonardo da Vinci and Johannes Keplerdrew theories for their own writings.Words such as retina and cataract areof Arabic origin. In his Thesaurus heshowed that light falls on the retinain the same manner as it falls on asurface in a darkened room throughFIMA YearBook 2009105

Muslim Contributionsa small aperture, thus conclusivelyproving that vision happens when lightrays pass from objects towards theeye and not from the eye towards theobjects as thought by the Greeks. Hepresented experiments for testing theangles of incidence and reflection, anda theoretical proposal for magnifyinglens (made in Italy three centurieslater). He also taught that the imagemade on the retina was conveyed alongthe optic nerve to the brain. Al- Raziwas the first to recognize the reactionof the pupil to light and Ibn Sina wasthe first to describe the exact number ofextrinsic muscles of the eyeball, namelysix. The greatest contribution of Islamicmedicine in practical ophthalmologywas in the matter of cataract. Themost significant development in theextraction of cataract was developedby Ammar bin Ali of Mosul, whointroduced a hollow metallic needlethrough the sclera and extractedthe lens by suction. In Europe, thistechnique was rediscovered in thenineteenth century.Pharmacology took roots in Islamduring the 9th century. Yuhanna binMasawayh (777-857 C.E.) startedscientific and systematic applications oftherapeutics at the Abbasids capital. Hisstudent Hunayn bin Ishaq al-lbadi (809-874 C.E.) established solid foundationsof Arabic medicine and therapeuticsin the ninth century. In his book al-Masail, Hunayn outlined methodsfor confirming the pharmacologicaleffectiveness of drugs by experimentingwith them on humans. He alsoexplained the importance of prognosisand diagnosis of diseases for better andmore effective treatment.Methods of extracting and preparingmedicines were brought to a high art,and their techniques of distillation,crystallization, solution, sublimation,reduction and calcinations becamethe essential processes of pharmacyand chemistry. With the help ofthese techniques, the Sayadelah(pharmacists) introduced new drugssuch as camphor, senna, sandalwood,rhubarb, musk, myrrh, cassia,tamarind, nutmeg, alum, aloes, cloves,coconut, nuxvomica, cubebs, aconite,ambergris and mercury. The importantrole of the Muslims in developingmodern pharmacy and chemistryis memorialized in the significantnumber of current pharmaceuticaland chemical terms derived fromArabic: drug, alkali, alcohol, aldehydes,alembic, and elixir among others, notto mention syrups and juleps. Theyinvented flavorings extracts madeof rose water, orange blossom water,orange and lemon peel, tragacanthand other attractive ingredients.There are numerous contributions topharmacology and therapeutics madeby al-Razi, al- Zahrawi, al- Biruni, ibnButlan, and al-Tamimi..In the realmof psychosomatic disorders both al-Razi and ibn Sina achieved dramaticresults, antedating Freud and Jung bya thousand years. When al-Razi wasappointed physician-in-chief to theBaghdad Hospital, he made it the firsthospital to have a ward exclusivelyFIMA YearBook 2009106

Muslim Contributionsdevoted to the mentally ill.Najib ul- Din Muhammad, acontemporary of al- Razi, left manyexcellent descriptions of variousmental diseases. His carefully compiledobservation on actual patients madeup the most complete classification ofmental diseases theretofore known.Najib described agitated depression,obsessional types of neurosis, NafkhaeMalikholia (combined priapism andsexual impotence), Kutrib (a form ofpersecutory psychosis) and Dual-Kulb(a form of mania).An asylum for the mentally ill wasbuilt early in the 8th century at Fez,Morocco. This was followed by others;in Baghdad (705 C.E.), in Cairo(800CE), in Damascus and Aleppo(1270C.E.). In addition to baths,drugs, kind and benevolent treatmentgiven to the mentally ill, music-therapyand occupational therapy were alsoemployed. These therapies were highlydeveloped at that time.Unfortunately the great Islamiccivilization constructed by the Muslimsin that era went into decline after1000 years of glory and progress (10) .The flow of technology, research anddevelopment from the Islamic worldto the West gradually slowed down andultimately completely reversed in thepast 500 years (11) .Over the last decades, Westerneducators have been trying toimprovise the medical educationsystem by emulating the Muslimsystem of the past but at the same timeavoiding mentioning that Islamic andArab systems pre dated their efforts.A case in point is the introduction ofan integrated and spiral curriculuminstead of dividing curriculum intobasic and clinical sciences based ondisciplines.The best way to inculcate Islamic inputin our medical education system is torediscover and revive the methodologyadopted by the great Muslim scholarscited above.The rise and decline of Muslims’contribution: why and how?The enormous contributions of theMuslims to science in general andmedicine in particular are hardlysurprising. Islam has always extolledits followers to explore the frontiers ofknowledge beginning with the very firstwords revealed by Jibrail to ProphetMuhammad (PBUH) “ Read” (12) . Thisis followed by many other verses whichchallenge the human mind to look andstudy Allah’s creation (13-16). In at leasttwo such verses, Allah challenged thebelievers to look around themselves andthen at themselves, a clear challengefor humans to understand themselvesbetter (17, 18) . The Qur’an also remindedthe believers that whatever they knowat the time of revelation was but a dropfrom an ocean of knowledge that iswith the Creator (19) . It was such versesfrom the Qur’an which spurred thethought processes of those generationsand which led to inquisitive mindsexploring the frontiers of knowledgeculminating in boundless discoveriesFIMA YearBook 2009107

Muslim Contributionsand inventions. Very unlike theEuropean Renaissance researchers whopursued knowledge with vigor to provethat God (aka the Church) was wrong,the Muslim scientists and researchersdrew closer to the Creator the more theydiscovered. Indeed Allah made it clearin the Qur’an that those believers withknowledge are not the same as thosewithout it (20) . Establishing harmonybetween the human reasoning and theverses of the Glorious Qur’an was oneof the mostimportant catalysts for theinsatiable thirst for knowledge at thattime. Muslim scholars studied varioustypes of sciences from various sourcesto identify the relation between theuniverse and humans on one handand the Creator on the other. Texts ofancient Greek, Persians and Indianswere translated by Muslim scholars andfrom this healthy cross fertilization theydeveloped their own philosophy andextended the frontiers of knowledge.The Muslims’ earlier contributions thushelped create the foundation for thephilosophical basis of the EuropeanRenaissance which was to follow 21 . TheEuropeans took inspiration from theIslamic philosophy which constantlyencouraged scientific inquisitivenessand eventually paved the way fora large number of discoveries madeby the Muslims. The Europeanstook inspiration from the IslamicRenaissance a few centuries earlier.This made it possible for the Europeansto present new, radical ideas withoutconsulting religious fundamentalistsand potential opponents, the RomanCatholic Church, at that time. Howeverdespite its remarkable emergence andcontributions, several factors andevents culminated in the fall of Islamiccivilization and contributions of theMuslims to the development of scienceand technology (22) .Lack of promotion of science in anunstable political stateState policies to promotecommunications, trade and economicprosperity pursued during the earlycenturies of Islam, helped in promotingthe demand for science and technology.The Islamic caliphate of the Umayyadfrom the 7 th Century C.E. showed aninterest in science. It translated thescientific tradition of late antiquitybut went further by elaborating andexpanding on it. The consequencewas while Europe was still in the DarkAges, Muslim scholars were already atthe age of philosophical and scientificdevelopment. Khalid bin Yazid (oneof the early Umayyad princes at theend of the 7th century) encouragedMuslim scholars to study medicineand chemistry by donating his treasurefor the cause. He also encouragedtranslation of several Greek and Copticmedical books into Arabic.The Abbasid Caliphs (8th century)followed the traditions and encouragedthe translation of Persian medicalknowledge into Arabic. New ideaswere also brought from India andChina not only in medicine butalso in mathematics, chemistry andFIMA YearBook 2009108

Muslim Contributionsphilosophy. Khalifah al-Ma’mun(813-833 CE) and al-Mutawakkil(847-861 C.E.) were supportive toscience, research and development.Al-Mutawakkil reopened the Daral-Hikmah and further encouragedtranslation of books into Arabic.As a result, during the Umayyadand Abbasid periods, their capitalsDamascus and Baghdad attractedscholars and scientists from the thendeveloped world. When the centers ofpower moved to Cairo, Spain, Persiaand Istanbul, the flow of scholarsfollowed suit.Unfortunately with the political declineof the Islamic state, due to factorswithin and without, the lack of relevantpolitical patronage resulted in a paralleldecline in developments in knowledgeand with it science and technology.Indeed ibn Khaldun, in his book al-Muqaddima (23) described the factorsessential for the development of scienceand the decline which will ensue ifthese factors are lacking. Accordingto him knowledge is perfected andbecomes ubiquitous when the demandfor it increases because people try tolearn new knowledge but if there is nodemand for new knowledge then itbecomes neglected and will eventuallydisappear (24) .States, especially if politically stable, arethe greatest marketplaces for knowledgebase because of the huge demandsthey (the states) create. Consequently,if states were to decline, knowledgeand knowledge based professions willdecline too. Ibn Khaldun also describedthat if a region becomes weak, loses itsinfluence and its population decreases,the professions also decrease anddisappear(25). As for sciences, hedescribed that sciences increase withthe increase in prosperity and thegreatness of civilization in a region (26) .Baghdad, Cordoba, al-Qayrawan, al-Basra, and al-Kufa were cities whichwere populous and prosperous in theearly centuries of Islam. This led tocivilization and sciences to establishthemselves in these areas. But whenthese cities became less prosperousand their population also decreased,science and learning disappeared fromthese cities and moved to other regionsof Islam. The lack of political stabilitycreated a situation where furtherprogress became almost impossible. Forany further breakthroughs in science, arevolution was necessary to overthrowthe old dominant systems. This typeof revolution needs a well establishedcommunity of scientists working in astable and flourishing economy andsupportive atmosphere for a long time.This community was present in Europeafter the 15 th century and continued todevelop with the increase of Europeanwealth and population. Islamic worldwas lacking this type of communityand hence there was no developmentin scientific knowledge. Some authorssuggested the negative attitude ofMuslim theologians as an importantreason for the decline of science inIslamic regions especially in 19 thcentury (27, 28) .FIMA YearBook 2009109

Muslim ContributionsThe rise of the Madrasah systemand the compartmentalisation ofknowledge.Some writers suggest that the‘Madrasah’(school) system was oneof the contributing factors for thedecline of sciences in Islam. TheMadrasah system flourished afterthe first Madrasah called MadrasahNizamiyyah was established inBaghdad by Nizam al-Mulk in 459Hijri (1067 C.E .) that favored thestudy of theology and law (29) . Thissystem unfortunately divided theinstitutions for the study of sciencesand theology. Medical sciences andother sciences were studied in variousplaces like medical schools or hospitals,observatories, libraries, academies andunder individual renowned scientistssupported by the rulers. Madaris (sing.Madrasah) meanwhile were developedby powerful and wealthy individualswho contributed their wealth to supportthem. The purpose of establishing theseMadaris was always religious and theywere the forerunners of the collegesystem in Western Universities (30) .However while Western universitiescombined colleges for theology, law,arts, science and medicine, Madarisonly concentrated on theology andlaw. Madrasas run by independentindividuals continued to exist withoutany interruption whereas other centersof study for sciences which weredependent on prosperity of the statedeteriorated and disappeared with thedecline of Islamic states. Madaris runby individuals ended up propagatinga particular individual’s paradigms ofeducation and Islam. This contributedto “secularisation of knowledge” and“Tunnel Vision Syndrome” of presentday Muslim societies.Geographical factors and naturaldisasters.Most of the then Islamic regionsconsisted of arid or semi-arid landswith only a small proportion ofscattered heavily inhabited areas.These inhabited areas were alsodependent on irrigation and because oflack of enough rainfall in these areas,it was not sufficient for agriculture.The only productive agricultural areaswere located along the great riversof Nile, the Euphrates and the Tigrisbut individuals were unable to takeadvantage of this water and centralgovernments were responsible fordeveloping the irrigation system. Withthe decline of central governments,irrigation works were neglected andagriculture was affected severely.Small agricultural lands became aridand economy and civilization of thewhole region were destroyed. Naturaldisasters are another important factorcontributing to the depopulationof Islamic regions especially Egypt,Syria and Iraq in the middle ages (31) .A famine caused by low levels of Nilein 968 C.E. resulted in death of about600,000 people. Between 1201-1202C.E. a famine was followed by plaguein Egypt and caused death of largenumber of people. The plague between1347-1349 C.E., known as Black Death,FIMA YearBook 2009110

Muslim Contributionsswept across the Islamic world andEurope and thousands of people dieddaily. The population of Egypt, Syriaand Iraq was reduced to one third.Several epidemics of plague recurred inEgypt and Syria in 1363 and 1515 C.E.These recurring natural disasters anddisease epidemics affected agricultureand animal husbandry leading tocollapse of these industries due todeath of skilled workers. These factorsaccelerated the process of economicdecay. This, coupled with the declinein political stability, led to a lackconducive environment for knowledgeand science to thrive because society’spriority had to be refocused.Attacks from external enemiesThe Muslim world, at its height wasattacked by two sets of invaders, onefrom the West and the other from theEast. From the West came the EuropeanCrusaders. Seven Crusades werewaged against Syria, Palestine, Egyptand Tunisia between 1096 – 1291 C.E.These Crusades helped Western Europeto grow united on all fronts and helpedincrease trade and capital amongthemselves (32) . New maritime colonieswere developed under Crusaders`rule and they survived the Muslim reconquest(33) . Syria and Egypt struggledtogether under the Ayyubids and theMamlukes and adopted a militarysystem that defeated and expelledthe Crusaders. The efforts to stop theCrusaders weakened the Muslim worldand their economy for two centuries.After the unsuccessful Crusades, TheWestern forces also attacked the cradleof knowledge in Andalusia, carving outbit by bit the Muslim land until the lastbastion in Granada fell in 1492 C.E.While the Western front was busyrepelling the Crusaders, a bigger andmore formidable threat emerged, thistime it came from the East. By themiddle of the 13 th century, GenghisKhan united the nomadic tribes ofMongolia and attacked the EasternIslamic lands. Samarkand, Bukharaand Khwarizm were conquered anddestroyed by them. In 1221 CE theyentered Persia. Another invaderfrom East, Hulagu together with hisarmy of 200,000 men marched witha plan to conquer all Islamic lands asfar as Egypt. He managed to conquerBaghdad in 1258 CE and killed theAbbasid caliph al-Musta`sim andabolished the caliphate. The riverEuphrates was reported to be a mosaicof red and black from the blood ofMuslims killed and from the ink ofcountless books thrown into the river.This was the beginning of the end of thegreat Islamic civilization on the Easternfront, more than two centuries beforethe fall of Granada.These invasions and assault on theMuslim land led to massive massacresand significant loss in terms of humanand other valuable resources. TheMongols slaughtered up to 2 millionpeople in Baghdad alone (34) . Thiscontributed greatly to the processof depopulation and decline ofcivilization. The Muslims howeverFIMA YearBook 2009111

Muslim Contributionsmanaged to regain some lost grounds.The Egyptian Mamlukes for examplemanaged to defeat the Mongols in1259 C.E. and during the same periodthe Crusaders and the Mongols werecompletely expelled from Syria. Thiswas however not enough to recoverall the lost treasurers of the Islamiccivilisation in all its former shape andglory. Although the Mongol invadersembraced Islam, their subsequentactions only contributed further to thedecline of the glorious era of Islamicsciences. For example, one of them bythe name of Timur (Tamerlane), whoruled from 1370-1405 CE, devastatedIslamic world in the name of Islam. Heinvaded Iraq and Syria between 1400-1401 CE destroying two important seatsof knowledge and civilisation, Baghdadand Damascus. He took several learnedmen and artisans from Damascus tohis capital in Central Asia and causedfurther decline of Islamic civilization inthose areas.The rise of Europe as a world power.The strategic location of the Islamicworld between East and West,its leadership role in science andtechnology, coupled with its militarystrength, were reasons for its prosperity.In terms of economic clout, the Muslimworld controlled international tradeuntil the end of 15 th century. The Muslimmonopoly of the land route for trade,commerce and all that came with it ledthe enemies, especially Europe to seekan alternative route. In the same yearGranada fell to the Christian invaders,the victorious King Ferdinand andQueen Isabella dispatched ChristopherColumbus to find a route to Indiato bypass the Islamic lands which atthat time was under the Ottomans.Although Columbus never discoveredthe route, it accidentally led to thediscovery of the so called New World.A flurry of activities was initiatedfollowing this adventure with theEuropean racing each other for worldmaritime domination. The Portuguesealso tried to bypass the Islamic lands toreach to the East and they discoveredthe route around Africa. Becauseof lack of Islamic naval posts alongthese routes, the Portuguese occupiedalmost all the strategic trading postsin the East. The Europeans came withthree clear missions; Gold, Glory andGospel. They established direct tradewith Europe. In most places theEuropeans unexpectedly encounteredthriving Muslim civilisation; in partsof Africa, the Indian Subcontinent, andall of South East Asia. The Crusadersmentality resurfaced leading toinevitable clashes. With their superiormilitary technology many of theseclashes favored the more well equippedand ruthless Europeans. Thus beganthe rise of European power and eraof subsequent subjugation of Muslimland in the East. Spain and Portugalpaved the way and by the end of the16 th century C.E, Holland, Englandand France developed as the dominantforces in international trade andwere the major colonisers. AlthoughEuropeans were competing with oneFIMA YearBook 2009112

Muslim Contributionsanother in their quest, they generallycomplemented each other’s role inbringing wealth and stability to theirmotherland; Europe. The center ofinternational trade quickly shifted fromthe Muslim dominated Mediterraneanto the European dominated Atlanticand colonial outposts of Asia .Thenew found wealth brought economicprosperity and political stability toEurope. With it came further scientificprogress.Ironically some of the Muslims policiescontributed to the rise of Europe. Forexample in Ottoman caliphate, foreignnon-Muslim trading communities weregiven privileges and immunities knownas Capitulations. The Ottomans thoughtthese policies would help in improvingthe economy of the caliphate but theseconcessions allowed the Europeansto gain control of the economic life ofthe Islamic regions (35) . Gradually withthe fall of Islamic states, more foreigncountries demanded these privilegesand these concessions were extendedto non-commercial entities. By the19th century European imperialismincreased under Britain and becauseof several unfavorable commercialtreaties, the revenue of Ottomangovernment dropped drastically (36) .The Muslim world was also deprivedof the scientific revolution engulfingEurope from the 18 th Century onwards.The cultural barrier between ChristianEurope and Muslim world isolatedthe latter from the revolutions takingplace in the science and technology inEurope. This was one of the importantfactors contributing to the decline ofthe Islamic dominant position. WhileEurope continued to develop andflourish with science and technology,the Muslims began to fragment underthe weight of colonisation. Rapiddeterioration within the Muslim worldensued. With practically no progressin any field of science, the sense ofisolation from scientific progressdeepened within the Muslim world.The gap between the Muslim worldand Europe in terms of scientificachievement continued to increase (11) .Disunity among MuslimsMost of the factors outlined abovecould have been prevented had theMuslims been more united and showeda sense of togetherness during timesof trials and tribulations. Despite theefforts of their forefathers in spreadingthe Tawhidic message from Moroccoin the West to the Philippines andIndonesia in the East, the Muslimsfailed to maintain and consolidateunity among the Ummah. The Muslimworld became fragmented into smallsultanates each wary of each other,oblivious of threats from outside.In the West, the Christians saw thiswindow of opportunity and createdmore dissension among the Muslims.One by one the desperate sultanateswere defeated until Granada wasnon defensible by 1492 C.E. Uponretreating from Granada the motherof the last sultan Boabdil saw her sonweeping while leaving the Alhambrathe Ghurnata (Granada) Palace behind.FIMA YearBook 2009113

Muslim ContributionsShe famously told the son ‘weep like awoman what you cannot defend likea man’. In the East, disunity was alsoevident, making them too weak tocollectively defend against the Mongolonslaught. In the Malay Peninsula,the Portuguese were successful indefeating the Malacca sultanatewith help from dissenting sultanatesneighbouring Malacca. When wealthwas in abundance, Muslims were busywith the luxuries of life at the expenseof pursuit of knowledge and spreadingtruth. This was reminiscent of thewarning the second Caliph Umar binal- Khattab gave when he said he wasworried about luxury permeatingthe Ummah. Healthy discourses onadvancement knowledge gave wayto polemics and arguments on thebranches of Islamic knowledge whichwere not fundamental to the Ummah’sprogression. The ultimate insult waswhen Muslim blood was spilled byfellow Muslims under the guise ofliberation, independence and in thename of Allah. While the Europeanscould draw the line when to fight amongthemselves and when to cooperate fortheir greater good, the Muslims werestruggling to find common ground onmost things. All in all, the Muslimsthemselves partially contributed totheir decline and with it their demise inthe field of scientific advancementStatus of contemporary Muslimcontribution in Medical ResearchWhile it is inevitable that Muslims havethe sense of pride with the contributionsof their forefathers, they have to facethe bitter truth; they currently lagbehind the rest of the world withregards scientific advancement. Thecolonization of the Muslim world,which preceded the fragmentationand eventual demise of the OttomanCaliphate, was the culmination ofcenturies of decline. During the eraof colonization, Muslims were madeto look and feel inferior viz a viz thesuperiority of the Western colonizers.It was beneficial to the interest of thecolonizers to sustain this inferioritycomplex within the psyche of theircolonial subjects. Whatever potentialwhich emerged from the Muslimcolony were quickly capitalized, andbrought into the Western fold. A casein point is an aspiring Indian Muslimsurgeon Shaykh Din Muhammadwho migrated to Ireland, marriedan Irish lady and converted toChristianity changing his name toSake Dean Mahomed (37) . Althoughhe did not produce any contributionsto medicine, his grandson, FrederickAkbar Mahomed made majorcontributions. As a young doctor at theend of the 19 th Century, he invented aninstrument which was 100 years aheadof his time. The instrument, called asphygmogram, can accurately trace theradial pulse waveform and based on theobtained waveform one can diagnosedisease of the arterial system. Hiswork has recently been revived withgreat interest to the modern medicalscientific community (38) .In the latter half of the 20th centuryFIMA YearBook 2009114

Muslim ContributionsMuslim countries were grantedindependence by their colonialmasters. More recently, Muslimcontribution is better acknowledgedeven by mainstream Western media.However, the contributions of theMuslims are portrayed as invention ofan ‘ancient world’ with only peripheralsignificance to modern science. Aftergaining independence, many Muslimscientists had to travel to the Westto pursue undergraduate and laterpost graduate studies due mainly tothe lack of adequate infrastructure intheir newly independent homeland.Many successful researchers and highachieving professionals among theMuslims decided to stay in Westerncountries for the same reasons; theirown countries may not be able tosupport their career pathway for morescientific achievements. In the fieldof cardiology for example, Muslimresearchers with major and significantcontributions are mainly from SouthAsia. Names such as Salim Yusof, HamidIkram and Shahabuddin Rahimtoolaare contemporary giants who are worldfamous. All had to ply their trade andexpertise in the West, primarily inNorth America. In 2009, ShahabudinRahimtoola ( a graduate of KarachiUniversity ) was awarded the EuropeanSociety of Cardiology Gold MedalAward for his lifelong contributions inthe field. Prominent Muslim physicianscientists have also held very importantand prestigious positions, arguably themost notable being the immediate pastdirector of the National Institute ofHealth ( NIH ) in the United States ofAmerica, Dr.Elias A. Zerhouni, a worldrenowned radiologist and formervice dean of Johns Hopkins School ofMedicine.Excellent individual Muslims residingin the West aside, how have Muslimnations fared in their contemporarycontributions to medical research?A search of credible databases suchas the Medline showed a stark realitywhich we all would like to improveon. For example in 2005 there werealtogether 35,431 cited publicationsfrom 6 Muslim countries (Indonesia,Pakistan, , Egypt, Iran, Saudi Arabia,and Malaysia). This total is only slightlymore than that of a small Europeannation, Netherlands (35,027) and lessthan 10% that of the United Kingdom(372,243) while the United States iseven far ahead (1, 529,164 ). A sizeablecontribution made by the UnitedStates emanates from work doneby Muslim scientists working there.However on a positive note there hasbeen close to a tripling of publishedresearch output from these Muslimnations by 2009 ( 94,034). While thisis encouraging, we as a nation still lagbehind the non Muslim nations. Forexample over the same period, theNetherlands has increased their outputby 6 fold (to 220,123). Israel meanwhilepublished more than all the six Muslimcountries put together (111,842). Thisrepresents a 9 fold increase from theiroutput in 2005 (18,217). Since mostof the published work originate frominstitutions of higher learning, thisFIMA YearBook 2009115

Muslim Contributionsstate of affairs may be reflective of thestate of such institutions in the Muslimworld. Indeed the latest Times HigherEducation Survey showed that none ofthe universities in the Muslim worldranked in the top 100, the highest beingthe University of Malaya in Malaysiaat a lowly 180 (39) . In fact the Universityof Malaya is the only university from aMuslim country which is listed in thetop 200. This in turn is a reflection ofpriorities given to research funding inmost Muslim countries.Not only are Muslims despondent at therelative lack of Muslim contributions toresearch and knowledge generation,even the non Muslims are asking thequestion (40) . Some have even proposedways for the Muslims to reformthemselves (41) . Others are perplexed asto why despite such a strong heritagein science, why are Muslims laggingbehind (42) . As a nation we have toanswer the questions being asked of ourconviction and rise up to the challengeof reliving our glorious distinguishedpast. We should not just lay on ourlaurels and sing the same old mantraabout how great we were in the past.We have to face the stark reality thatwe are way behind in contemporarysetting. We should also stop blamingeverything on Western conspiracytheories. Adopting an attitude of‘Western phobia’ and ‘Western bashing’does not help either. We must strategiseto bring back the glorious past.Strategies to increase Muslims’contributions to medical researchWhat is required in the Muslim worldis no less than a major transformationin order for us to return to our gloriouspast. It is important to begin with theend in mind and think long term. Anexercise in “Reverse Engineering” istherefore pertinent. Clear end points oroutcomes must be identified and thisoutcome extrapolated in the reversedirection to present day situation.This will provide an opportunity torecognize immediate requirementsin the present system to reach theidentified end point. Major barriers andhurdles must also be anticipated andstrategies to circumvent them thoughtof. Any major transformation must bedone in an integrated and collectiveapproach. Muslim nations shouldwork together towards this noble goal.This obviously is a tall order based onour track record in tackling commonissues in the recent past. However theMuslim scientist community shouldnot be disheartened and take this as acollective challenge.Listed in Table 1 are the desiredend points which we should strivetowards. Once this is agreed upon, astepwise approach must be adoptedand the end point projected intopresent day situation. This will allowfor adequate opportunity to visualizeand reflect upon present and futureprospects and alignment of availableresources with projected end points (43) .The overall aim of targeting theseend points is to create respectableMuslim Medical Institutions whichare capable of generating respectableFIMA YearBook 2009116

esearch output. There are essentiallytwo main components to this exercise:inculcation of research culture andinculcation of Islamic values (whichas discussed above encourages andpromotes research) among MuslimMuslim Contributionsmedical institutions. These twocomponents are addressed in tandemthroughout the body of this paper.Working backwards; efforts towardsachieving the desired endpoints willrequire the following pre requisite aslisted in tables 2 – 7Table 1: Desired End Points: Respectable Research Output from MuslimMedical Institutions• Publications in medical research journals of international repute.• Publications of medical books from Muslim authors• Establishment of centers of excellence in medical research in Muslimcountries• Formation of international research collaboration between Muslimmedical institutions and other international medical institutions of repute• Formation of industrial research collaboration between Muslimmedical institutions and various health related industries• Medical research fairs and conferences with involvement ofinternational medical communityTable 2: Establishment of “Muslim” Medical Institutions• Paradigm shift from “medical school” to “Muslim medical school”and from “Linear Instruction” models of teaching to constructivistcurricula that nurture curiosity• Visible inculcation of Islamic input in all areas of medical instruction• SPIRAL integration of research and Islamic values with medicalcurricula. Students to learn research as a standard subject, not anoption or an area of interest• Include Islamic injunctions in “Criteria for Recognition” for medicalinstitutionsTable 3: Enhancing Research and Islamic Input into Existing MedicalInstitutions in Muslim Countries• Basic Islamic knowledge pre-requisite for entrance to medicalinstitutions• Islamic studies examinations included in the“ promotionalexaminations” each year• Optional courses in Islamic Medicine and Islamic civilization withFIMA YearBook 2009117

incentivesMuslim Contributions• Complete SPIRAL integration of medical curriculum with Islamicvalues and researchTable 4: Identifying Islamic Input as an Urgent Requirement for MuslimMedical Institutions• Sharing of results of “Needs Assessment Exercise” by the InternationalFaculty of Islamic Medical Education and Research with medicalinstitutions, Muslim leaders and financial support groups• Resolution of “Striving for Excellence in Islamic Medical Educationand Research” to be passed with specific time bound roles and goalsdescriptionTable 5: In-Depth Analysis of Existing Curricula, Status of Medical Researchand Modus-Operandi for Medical Education in Islamic MedicalInstitutions• International Faculty of Islamic Medical Education and Research toperform a pre-planned, standardized analysis of respective medicalcurricula according to pre-specified schedule and compile resultsTable 6 : Establishment of a Motivated International Faculty of IslamicMedical Education and Research with Specific Terms of Referenceand Time-Lined Planning, under supervision of CIMCO or the “KeyOrganization” undertaking this exercise• A set of pre-requisites to be provided to medical institutions fornomination of faculty members to the International Faculty• Individual medical institutions to nominate their representatives tothe International FacultyTable 7: Identification of Muslim Medical Institutions/ Associations/ NonGovernmental Organisations Motivated to Participate in Rejuvenation( Tajdid ) Process• Clear time line specified• Utilising enhanced method of communication in the identificationprocess.Applying the method of ‘Reverse Engineering’, we will now take all the steps in theirlogical order, present to future, and analyze each step taking into consideration theavailability of resources and expertise required for each step.STEP – 1: Identification of Muslim Medical Institutions/ Associations/ Non GovernmentalOrganisations Motivated to Participate in the Rejuvenation ProcessFIMA YearBook 2009118

Muslim ContributionsThe first step will require compiling a resource list of Muslim medicalinstitutions and associations complete with individual contact details.There are several such “directories” available online. One such example islisted in table 8. An organisation like FIMA must take the lead to gather therequisite information. The organization conducting the exercise will thencommunicate with all the identified muslim institutions/ associations/ NonGovernmental Organisations (NGOs) and invite them to participate in theexercise.A finite time line is proposed for communication exchanges with therelevant bodies. All available lines and modes of communication mustbe explored and utilised. In this age of information and communicationtechnology explosion, miscommunication must be kept to the barestminimum if not totally eradicated. The short term outcome will lead tocompilation of a list of participants, by the key organizations, willing toundertake the challenge. The list will have to be dynamic, allowing forexpansion and even withdrawal of membership. This is to ensure that thevery first step is done meticulously and successfully. Muslims unfortunatelyhave been stigmatised by some quarters, sometimes justifiably, as a groupwho make more noise than they can perform.Table 8: List of Useful Websites for Networking• Islamic Medical Association of South Africa• Islamic Organization for Medical Sciences (IOMS).• The International Association of Muslim Psychologists• USC Muslim Students Association Islamic Server• Institute for the Restoration of Science• Medical Links at IslamiCity• Muslim Doctors and Dentists Association (MDDA), in UK.• UMMAA Free Clinic (University Muslim Medical Association)• Islamic Medicine Institute• International Society for History of Islamic Medicine (ISHIM)• ISLAMIC Global Health Network (IGHNet)• Ibn Sina Academy of Medieval Medicine and Sciences• International Society for Ramadan Fasting Research.• World Islamic Association for Mental Health.STEP – 2: Establishment of a Motivated International Faculty of Islamic Medical Educationand Research.Once Step – 1 is successfully executed, the key organizations conductingthis exercise will then develop a set of selection criteria for an InternationalFIMA YearBook 2009119

Muslim ContributionsFaculty of Islamic Medical Education and Research. Specific terms ofreference and requisite academic background and experience will beprescribed and finalized into, “Consensus Document on Selection Criteriafor Members of International Faculty of Islamic Medical Education andResearch”.This document will be shared with all the resource institutions andassociations identified in Step-1, Resource institutions will be asked tonominate one or two faculty members for final selection. A final selectioninterview shall be conducted by the key organization and InternationalFaculty of Islamic Medical Education and Research will be finalized.Once the key organizations have finalized their decision, a FacultyDevelopment Program will be conducted. Faculty development programsvary widely from institution to institution, and encompass both formaland informal offerings. Offerings in a comprehensive faculty developmentprogram should include the following focus areas: (1) professional,including individual scholarship; (2) instructional; (3) leadership; and(4) organizational, eg, time management (44,45) These focus areas may beaddressed through workshops, seminars, teleconferences, electronic media,mini-courses, mentoring programs, sabbaticals, and directed publications.External resources can also be effectively utilized for this purpose. Theaim of this part of the exercise should be to develop a consensus amongthe International Faculty about an in depth screening of existing medicalcurricula with special emphasis on Islamic Education and Research.Required reading and assignments should be in place for these facultymembers to facilitate their work. Examples of such literature are limitless.Al Hassani’s Thousand Years of Missing History and work of Van Alphin onOriental Medicine (46,47) are two such examples.The ultimate aims from Step – 2 are first, the accumulation of thisInternational Faculty and second, the development of a standard screeningprocess for medical curricula of participating institutions re. IslamicEducation and Research. This faculty will be authorized by the keyorganization to provide practical input and plans of implementation forrevised curricula..It is proposed that this step should not take more than 6 months to complete.STEP – 3: In-Depth Analysis of Existing Curricula, Status of Medical Research and Modus-Operandi for Medical Education in Islamic Medical Institutions.Once steps 1 and 2 are achieved, the stage is ready for Step – 3. Participatinginstitutions in Step 2 should identify resource persons who haveexpertise and are passionate about curriculum review and development.Medical training; both at the undergraduate and postgraduate levels isFIMA YearBook 2009120

Muslim Contributionsundergoing an era of transformation with emphasis on outcome basededucation preparing doctors and specialists for the new millennium. Thetransformation process is typically done after a comprehensive review ofexisting curriculum and identifying the needs of the future practitioners. Inmany countries, the review is ‘bottom up’ i.e initiated by individual medicalschools. In others it is prescribed or instructed by national regulatoryauthorities like the General Medical Council of the United Kingdom (48) .For postgraduate training requiring high level of skills, expert societies inconjunction with national ministry of health are typically involved (49,50) .In aspiring to relive our glorious era in Medicine, a relook at how we arecurrently training doctors in the Muslim world is imperative. Many atime we tend to adopt the so called ‘best practice approach’ by Westernbased medical educationist. We sometimes fail to dig deep into our strongheritage and ask the critical question ‘what kind of training did the likes ofibn Sina, al- Zahrawi and al- Razi went through to become the toweringfigures they were? ’ A critical appraisal of the current curriculum fromthe Islamic perspective and with the aim of training the future ibn Sina,al- Zahrawi and al- Razi is needed. It is inevitable that a strong emphasison training the inquisitive, critical and exploratory mind should appearprominent in the curriculum.The goal of Step – 3, then, is for our International Faculty of IslamicMedical Education and Research to share their curriculum analysis andrecommendations with participating institutions in depth. They will makechanges to their recommendations in consort with participating institutionsto develop practical curricula for implementation. The curricula will addressmedical education as well as education in Islamic values and research at thesame time.This step will be critical to the success of the subsequent steps. It will be therate limiting step in the overall scheme of things It will require more timeand effort but there is also an urgency to complete this step as soon as isfeasibly possible. Although daunting, it is proposed that this step should nottake more than 18 months to be completed.STEP – 4: Sharing of results of “Needs Assessment Exercise” by the International Facultyof Islamic Medical Education and Research with Medical Institutions, MuslimLeaders and Financial Support Groups.Once step 3 is accomplished, the International Faculty of Islamic MedicalFIMA YearBook 2009121

Muslim ContributionsEducation and Research will share their findings and recommendationswith all the participating institutions and associations in a conferenceformat. The aim of this part of exercise is clearly stated above. At the endof this activity, all the participating institutions and associations will leavewith a clear documented vision of Roles and Goals, evaluation strategiesand academic success measurement tools for the new curricula. Thereby,the key organization will assume a supervisory role, instead of theassistance role, in the process of striving for excellence in Islamic MedicalEducation and Research. The conference should aim to pass a resolution on“Striving for Excellence in Islamic Education and Research” to be adoptedby participating institutions.It is proposed that the conference be organised within 3 months of theFaculty submitting its report.STEP – 5: Implementing Research and Islamic Input into Existing Medical Institutions inMuslim Countries.Upon adopting the resolution, participating institutions should aim toimplement the recommendations within 2 years in the entering class (i.e,year 1 students ) in participating institutions. All the participants will beprovided with evaluation strategies and measurement tools for the successof new curricula. There are tools available to academicians and managerstoday, that assist in correct evaluation of success or failure in variousdomains of organizational set ups. Focal concept in healthcare as well asacademic management is “Organizational Capacity” (51) . Organisationalcapacity refers to the organisation’s ability to take effective action, in thiscontext for the purpose of continually renewing and improving its healthcarepractices through academic and technological innovation. Absorptive andreceptive capacities are theorized as important antecedents to innovationin healthcare (52) as well as academic excellence. Broadly, the concept ofabsorptive capacity is the organization’s ability to recognise the value of newexternal knowledge and to assimilate it, while receptive capacity is the abilityto facilitate the transfer and use of new knowledge (53) . Empirical studieshave identified some general antecedent conditions (54,55) , and have testedapplication of the concept of absorptive capacity to healthcare (55) , althoughreceptive capacities are less well studied. Application of these conceptsto purely academic endeavours is even less well studied but proposed onseveral occasions. Empirically supported features of organisational contextthat impact on absorptive and receptive capacities in healthcare includeprocesses for identifying, interpreting, and sharing new knowledge; alearning organisation culture; network structures; strong leadership, vision,and management; and supportive technologies (55,56) .Organizational Capacity for our purpose can be divided into 4 wellresearched and valid categories, borrowed from management sciences.FIMA YearBook 2009122

Muslim Contributions1. Research Activity2. Research Utilization3. Knowledge Management4. Organizational LearningA new concept here is that of “Knowledge Management” (KM). Definitionsof KM vary, but many include the core processes of creation or developmentof knowledge, its movement, transfer, or flow through the organisation, andits application or use for performance improvement or innovation (57) .Early models of KM focused on the measurement of available knowledgeassets and intellectual capital, with later models focusing on processes ofmanaging knowledge in organisations, split into models where technicalrationalityand information technology solutions were central and academicmodels focusing on human factors and transactional processes (57) . The moreemergent view is of the organisation, academic or otherwise, as ‘milieu’ orcommunity of practice, where the focus on explanatory variables shiftsaway from technology towards the level of interactions between individuals,and the potential for collective learning. However, technical models andsolutions are also still quite dominant in healthcare and academics (58,59) .STEP – 6 and 7: Establishment of Muslim Medical Colleges with Respectable Research Output.It is the writers’ sincere belief that, provided all the preliminary steps ( 1-5 )are followed, realization of goals outlined in Tables 1 and 2 will be achievedin due course, insha’Allah. One key critical success factor towards achievingthese goals is for the institution involved to be proactive and methodicalin identifying the goals and implementing steps to achieve it. This articleis concluded with a brief outline of factors that, if found in participatinginstitutions, will either prove detrimental or beneficial in achieving theintended goals of the whole exercise. These factors need to be recognized,pursued, removed or implemented either prior to initiating this exercise orin the course of doing it. These factors include, but not limited to:• Lack of organizational motivation to carry out the exercise: Althoughheads of institutions may be highly motivated, the level of involvementof their faculties is the key to their long term commitment to success. Itshould be presented as a basic requirement to qualify for participation.Coherence of institutional heads with their faculties is very easy toassess in open exchange of dialogue.• Strength of Department of Medical Education and Research: Sincethis is actually a capacity building exercise, the actual qualificationsand personnel of these key areas at ground level may not besatisfactory. However, the key organization needs to assure high levelof understanding, professionalism, sincerity, transparency and above allFIMA YearBook 2009123

Muslim Contributionsacceptance among faculties that these two departments have in theirinstitutions.• Appointment of Nominees to International Faculty: Importanceof this point cannot be overstated. The key organization must be wellacquainted and satisfied with the credentials and personalities ofnominees. Appointment of nominees with any intention other thanaiming for the “Best for the Best Job” is an in-built mechanism forfailure.• Pyramidal System of Operation: All the participants will agree tomaintaining logs and abiding by the timeline. Failure to do so shouldresult in suspension of that nominee from the International Faculty.Failure of the participating institution to replace the person may resultin suspension of institution from the exercise.• Involvement of Key Organization in the Process: It isproposed that FIMA through CIMCO spearhead the wholeinitiative. Whether this organization is CIMCO or otherwise,it goes without saying that the ultimate outcome will bedetermined by how closely they supervise each step of the process.Close consort and understanding among members of participatinginstitutions is vital for optimum benefit from this exercise.• “The Missionary Zeal”: It is indeed sad that we have to exemplify therequired spirit in these words but that is exactly what is needed. Anyquest for personal gain is going to go unanswered by Allah (SWT) in thenext world. Therefore, the right intention (niyyah) must be implantedat the outset. Provided it is performed with a certain zeal and passion,the exercise is guaranteed to bring high level of institutional and evenpersonal recognition but that should be taken as a byproduct and notthe actual fruit of effort.FIMA YearBook 2009124

Muslim ContributionsReferences:1. Islam for Today, (2009). Islamic Medicine:1000 years ahead of its times. Obtained from:http://www.islamfortoday.com/athar04.htm2. Islamic Research Foundation InternationalInc., (2005). How Islam changed medicine.Obtained from: http://www.irfi.org/articles2/articles_2751_2800/How%20Islam%20changed%20medicine.HTM3.HRH Prince of Wales. Islam and the West:speech at Oxford Centre for Islamic Studies,1993. www.princeofwales.gov.uk/speeches/religion_27101993.html4. Drabu R, Nanji A, Greenfield S. Science andlearning in Islam—a shared legacy. RoyalInstitution of Great Britain, London, 1December 2005.5. Van Alphen J, Aris A. Oriental medicine: anillustrated guide to the Asian arts of healing.London: Serindia, 2003.6.Wear A, Geyer-Kordesch J, French R. Doctorsand ethics: the historical setting of professionalethics. Rodopi: Amsterdam, 1993.7.Aschoff A, Kremer P, Hashemi B, Kunze S. Thescientific history of hydrocephalus and itstreatment. Neurosurg Rev 1999; 22: 67-938. Al-Hassani STS. Thousand years of missinghistory. Manchester: Foundation for Science,Technology and Civilisation, 2004.9.Soubani AO, Khan FA. The discovery of thepulmonary circulation revisited. www.kfshrc.edu.sa/annals/152/mh9422ar.html10.Fletcher R. Moorish Spain. London: Phoenix,2001.11. Bulliet R. The case for Islamo-Christiancivilization. Irvington, NY: ColumbiaUniversity Press, 2004.12. The Glorious Quran; Chapter 96, verse 113. The Glorious Quran, Chapter 3, verse 19014. The Glorious Quran; Chapter 6, verse 3815. The Glorious Quran; Chapter 7; verse 5716. The Glorious Quran, Chapter 88, verse 17-2017. The Glorious Quran; Chapter 41, verse 5318. The Glorious Quran; Chapter 67, verse 3-419. The Glorious Quran; Chapter 18, verse 10920. The Glorious Quran; Chapter 39, verse 9.21. Islamic Research Foundation Inc., (2008).Obtained on June 7, 2009 from:h t t p : / / w w w . i r fi . o r g / a r t i c l e s 2 /articles_2751_2800/How%20Islam%20changed%20medicine.HTM22. History of Science and Technology in Islam,(2009). Obtained on June 7, 2009 from:http://www.history-science-technology.com/Articles/articles%208.htm23. Ibn Khaldun, al-Muqaddima, fifth offsetreproduction, Beirut, 198424. Ibn Khaldun, ibid. p. 403.25. Ibn Khaldun, ibid. p. 403.26. Ibn Khaldun, ibid. p. 434.27. Aydin Sayili, The Observatory in Islam, NewYork, Arno Press, 1981, p.410.28. E. G. Browne, Literary History of Persia, 1,1908, p. 286; see G. Sarton, Introduction to theHistory of Science, New York, Krieger, 1975,I, p. 626.29. Sayili, The Observatory..., op. cit., pp.414-415.30. George Makdisi,`On the Origin andDevelopment of the College’, in Islam and theWest, Articles in Islam and the Medieval West,ed. by Khalil I. Semaan, New York, 1980, pp.26-49.31. E. Ashtor, A Social and Economic Historyof the Near East in the Middle Ages, London,1976.32. Jacques Bernard, `Trade and Finance inthe Middle Ages 900-1500’, article 7 in TheFontana Economic History of Europe — TheMiddle Ages, edited by Carlo Cipolla, Collins/Fontana, London, 1977, pp. 274-275.33. Jacques Bernard, ibid. p.292.34. Abd al-`Aziz al-Duri, ‘Baghdad’, inEncyclopedia of Islam, I, p.902.35. William McNeil, The Rise of the West,Chicago, 1963, p.614.36. P. Mansfield, A Histoy of the Middle East,London, Viking, 1991,37. Ansari, Humayun The Infidel Within: TheHistory of Muslims in Britain, 1800 to thePresent, C. Hurst and Co. Publishers, 2004;p. 5838 . O’Rourke, Michael F. “Frederick AkbarMahomed”, Hypertension. 1992; 19: 212–217FIMA YearBook 2009125

Muslim Contributions39. Times Higher Education – QS WorldUniversity Ranking 2009 .http://www.timeshigher education .co.uk (accessed on 2/1/2010 )40. Herwig Schopper . Islam and Science : Whereare the new patron of science? Nature 2006;447 (7115):35-3641. Fergany N. Islam and Science : steps towardsreform. Nature 2006;444( 7115) :33-3442. Butler D. Acadamies wrestle with issue ofIslam’s flagging science base. Nature 2003;422( 6928):101-10243. “Wishcraft” Barbara Sher with AnnieGottlieb; Kindle Edition, 197944. Wilkerson L, Irby DM. Strategies forimproving teaching practices: a comprehensiveapproach to faculty development. AcadMed. 1998;73:387–96.45. Schrubbe KF. Mentorship: a criticalcomponent for professional growth andacademic success. J Dent Educ.2004;68:324–8.46. Al-Hassani STS. Thousand years of missinghistory. Manchester: Foundation for Science,Technology and Civilisation, 2004.47. Van Alphen J, Aris A. Oriental medicine: anillustrated guide to the Asian arts of healing.London: Serindia, 2003.48. General Medical Council. Tomorrow’sdoctors. London: General Medical Council;2002. ( http://www.gmc-uk.org/med_ed/tomdoc.htm).49. The Foundation Program Committee of theAcademy of Medical Royal Colleges, in cooperationwith Modernising Medical Careersin the Departments of Health. Curriculumfor the Foundation Years in PostgraduateEducation and Training. Department ofHealth, London; 2005.50. UK Health Departments. The Next Steps:The Future Shape of the Foundation,Specialist and General Practice TrainingPrograms. Department of Health, London;2004.51. Pablo AL, Reay T, Dewald JR, Casebeer AL.Identifying, enabling and managing dynamiccapabilities in the public sector. J ManageStud. 2007;44:687–708.52. Greenhalgh T, Robert G, Macfarlane F, BateP, Kyriakidou O. Diffusion of innovations inservice organizations: Systematic review andrecommendations. Milbank Q. 2004;82:581–629.53. Cohen WM, Levinthal DA. Absorptivecapacity – a new perspective on learning andinnovation. Adm Sci Q.1990;35:128–152.54 Zahra SA, George G. Absorptive capacity:A review, reconceptualization, andextension. Acad Manage Rev.2002;27:185–203.55. Jansen JJ, Van den Bosch FA, Volberda HW.Managing potential and realized absorptivecapacity: How do organizational antecedent’smatter? Acad Manage J. 2005;48:999–1015.56. Fosfuri A, Tribó JA. Exploring theantecedents of potential absorptivecapacity and its impact on innovationperformance. Omega. 2008;36:173–187.57. Scarbrough H, Laurent S, Bresnen M, EdelmanL, Newell S, Swan J. Organizational Learningand Knowledge 5th International Conference;20 May 2003. Lancaster University; Learningfrom projects: the interplay of absorptive andreflective capacity.58. Lloria MB. A review of the main approachesto knowledge management. KnowledgeManagement Research and Practice. 259.Bali RK, Dwiveci AN. Healthcare knowledgemanagement: issues, advances andsuccesses. Berlin: Springer Verlag; 2007.FIMA YearBook 2009126

Clinicians As Effective ResearchersFaroque A. Khan*AbstractThis article addresses the commonly asked question: Can clinicians be effectiveresearchers?The author draws on historical discoveries by inquisitive physicians and hisown experience, which involves extensive clinical research in various aspectsof pulmonary medicine in the United States and his more recent experience ofoverseeing the development of research at King Fahd Medical City in Riyadh,a major tertiary care center in Saudi Arabia. From this experience, the authordraws conclusions as to the key aspects required for successful research. Theseinclude inquisitiveness, patience, and perseverance on the part of the clinician,along with a nurturing and supportive environment and appropriate financial,emotional, and administrative institutional support. The importance ofcollaboration and, finally, the need for appropriate data collection and followingthe Belmont principles should be emphasized.The author strongly believes that the answer to the question “Can clinicians beeffective researchers?” is a most definitive “yes.”Keywords: Clinical research, history of medicine.With special permission to reprint from the Journal of Islamic Medical Association of NorthAmerica (JIMA) 42;2010-9-14.Faroque Ahmad Khan, MB, MACPProfessor of MedicineSUNY at Stony Brook, New York, New YorkMaster, American College of PhysiciansConsultant and ChairInstitutional Review Board- King Fahd Medical CityRiyadh, Kingdom of Saudi ArabiaE-mail: faroquekhan@yahoo.comFIMA YearBook 2009127

Clinicians As Effective ResearchersIntroductionIn December 2006, I was asked to helpdevelop the research program at KingFahd Medical City (KFMC), a newtertiary care hospital in Riyadh, SaudiArabia, consisting of four hospitals— general, rehabilitation, women’s,children’s — staffed by professionalsfrom all parts of the world. As I beganto establish the institutional reviewboard (IRB) and plant the seeds fora research enterprise, some of thefrequently heard responses were: “Whybother doing research in a clinicallyoriented hospital devoted to patientcare?” “We are clinically oriented anddo not have the expertise or know-howto do meaningful research.” “We donot have the time.” “We already have ajob.” “Give me the space and staff and Iwill do the research.” I could add manymore comments to the ones listed.As I began to ponder the strategy todevelop and answer some of thesereal concerns, I reflected on my ownexperience in the United States, whereafter basic medical training in Kashmir,with no experience in research, I endedup, unplanned I might add, doing a fairamount of clinical research. Over a twodecade period, the research resultedin substantial grants and publications,including some original observations.I reflected on the studies that resultedin grants totaling more than U.S. $2.5million from the National Institutesof Health (NIH), World HealthOrganization (WHO), AmericanLung Association, and pharmaceuticalsponsors. Additionally, as chair ofmedicine at Nassau County MedicalCenter in New York, my departmentreceived an additional $4 million ingrants for the state’s primary careupweighting program and the HIV/AIDS Designated Center.As I shared my experience with theinterested staff at KFMC, the interestslowly started to blossom. One of themost popular presentations I madeat KFMC and other institutions was“Clinicians as Effective Researchers.” Inthis article, I will briefly outline the keycharacteristics of a successful clinicalresearcher, relying heavily upon mypersonal experience. Clinicians needa supportive environment within theinstitution and also a country thatunderstands and invests in research anddevelopment with the anticipation oflong-term benefits for the community.The institutional and national prioritieswill not be addressed in detail in thisarticle.Individual’s RoleThe key element needed in a researcheris curiosity. The researcher should notbe afraid to ask questions and shouldbe willing to follow through and takechances. A few historical examples willbring home this point:Werner ForssmannIn 1929, Werner Forssmann, 25-yearoldintern from Germany, had beendeeply impressed by a sketch in hisphysiology textbook showing a FrenchFIMA YearBook 2009128

Clinicians As Effective Researchersphysiologist standing in front of ahorse, holding a thin tube that hadbeen put into the jugular vein in theanimal’s neck and then guided into oneof the heart’s chambers. He could notunderstand why this simple technique,which would avoid the complications ofopening the chest, had not already beentried on humans. Forssmann asked hissupervisor, Dr. Richard Schneider, forpermission to try this procedure on aterminally ill patient. The request wasflatly refused, and Schneider forbadeForssmann from doing the experimentat all on any person, including himself.Forssmann decided to do the experimentanyway, in secret. With the help of nurseGerda Ditzen, Forssmann successfullypassed a ureteral tube through a largeantecubital vein into his right atriumand confirmed this historical successwith a chest Xray (1) . Thus began theera of intravascular catheterization, aprocedure now taken forgranted andsometimes even overused and abused,as was the case with Swanz Ganzcatheter. (2) It was Werner Forssmann’scuriosity, persistence, and willingnessto experiment on himself thatresulted in the advent of intravascularcatheterization, for which he receivedthe Nobel Prize in Physiology orMedicine in 1956.Victor HerbertIn 1959, Victor Herbert was a 32-yearoldhematologist who believed,contrary to prevailing views, thatdietary deficiency alone can result infolate-deficient anemias. Sometimes,experience with a single patient canchange a researcher’s thinking, and thatwas the case with Herbert when he sawan engineer who had retired from theBoston subway system and presentedwith a combination of scurvy andfolate deficient megaloblastic anemia.Herbert learned that his patient, whowas on a very tight budget, ate all hismeals at a chain of fast-food hamburgerstands in Boston. As Herbert stated:“After a diet of 15-cent hamburgers,donuts, and coffee for five years,my patient developed scurvy andmegaloblastic anemia, which I believedwas due to folate deficiency.” To provehis hypothesis, Herbert went on a strictvitamin- deficient diet, and after 133days of a folate-deficient diet, a weightloss of 26 pounds, a drop of hematocritfrom 48-42%, and nine bone marrowexaminations, Herbert developedmegaloblastic anemia, confirmingcause and effect.Songtao ShiSongtao Shi observed red tissue insidethe deciduous tooth of his 6-year-olddaughter. From these and other teethShi developed stem cells from humanexfoliated deciduous teeth (SHED) atthe NIH laboratories These cells havepotential to develop dentin, which oneday may be used to repair damagedteeth, induce regrowth of bone, andtreat nerve injury or disease. This workis currently in progress. (3)FIMA YearBook 2009129

Clinicians As Effective ResearchersThe Story of Stomach Ulcers:Acid or Bacteria?As a student in Kashmir, I was taughtthat acid in the stomach is the cause ofthe very prevalent stomach ulcers inKashmir. We would even provide milkvia nasogastric tubes for hospitalizedpatients with stomach ulcers, therationale being that the milk wouldneutralize the acid, which was supposedto be the cause of the ulceration. Allthis changed with the discovery ofHelicobacter pylori (H. pylori) as a causeof stomach ulcers.Helicobacter pylori was first discoveredin the stomachs of patients with gastritisand stomach ulcers nearly 27 yearsago by Barry J. Marshall and J. RobinWarren of Perth, Western Australia. Atthe time (1982-1983), the conventionalthinking was that no bacterium can livein the human stomach, as the stomachproduced extensive amounts of acid.The bacterium had been observed in1979 by Warren, a pathologist, whobeginning in 1981 did further researchon it with Marshall, a physician. Afternumerous unsuccessful attemptsat culturing the bacteria from thestomach, they finally succeeded invisualizing colonies in 1982, whenthey unintentionally left their Petridishes incubating for 5 days over theEaster weekend. In their original paper,Warren and Marshall contended thatmost stomach ulcers and gastritis werecaused by infection by this bacteriumand not by stress or spicy food, aspreviously assumed. (4)To demonstrate that H. pylori causedgastritis and was not merely a bystander,Marshall drank a beaker of H. pylori.He became ill several days later withnausea and vomiting. An endoscopy10 days after inoculation revealedsigns of gastritis and the presence ofH. pylori. These results suggested thatH. pylori was the causative agent ofgastritis. Marshall and Warren went onto show that antibiotics are effective inthe treatment of many cases of gastritis.Warren and Marshall were awarded theNobel Prize in Medicine in 2005 fortheir work on H. pylori.Asbestos as a CarcinogenIn the 1960s Irving Selikoff documentedasbestos-related diseases amongindustrial workers. This discoverycame more or less inadvertently. In the1950s Selikoff had opened a generalmedicine practice in Paterson, NewJersey. A few years later, the AsbestosWorkers Union asked him to addtheir membership to his practice.Selikoff noticed several new cases ofmesothelioma were diagnosed in a yearin his practice, whereas the expectedincidence was only about 5/100,000.This happened while the new cohort(asbestos workers) were still a smallfraction of the clinic’s patient list. Thisanomaly led Selikoff to examine therelationship between asbestos exposureand mesothelioma. He conductedvarious studies and established a linkbetween asbestos and cancer. Asbestosremovalbecame a big issue; many largebuildings contained tons of asbestosFIMA YearBook 2009130

Clinicians As Effective Researchersembedded in walls and ceilings.Controversies arose, because theworkers removing the asbestos openedup intact structures, scattered toxic dustaround, and left chaos behind them.Laws were passed to require betterplanning, preparation, and cleanupprocedures. The situation eventuallyimproved. For his pioneering work Dr.Irving Selikoff received many awards,including the Albert Lasker Award forClinical Medical Research.There are many examples of such astuteobservations by curious practicingphysicians, which are highlighted inthe book, Who Goes First. (1)What is Research?The common perception of research isexperimenting in a laboratory. A moreappropriate definition of research, inmy view, is careful investigation intosome subject or area of study with theaim of discovering and applying newfacts or information, in short , acquiringnew knowledge that eventually leadsto better patient care. The examples Icited above are classic cases of research,which fit this definition. One couldexpand the scope and do research inareas such as epidemiology, why peoplesmoke knowing that it is harmful;why obesity is becoming so prevalent,particularly in some ethnic groups;why Saudi Arabia has the highestincidence of spinal cord injuries fromroad traffic accidents; why Saudis drivethe way they do; why some centers havebetter outcome in common conditionssuch as myocardial infarction, strokeetc. what is the most effective way ofdelivery of health care; and why, inspite of spending the largest amountof money per capita on health care inUnited States, the country does nothave the best outcomes in objectiveparameters of health delivery. These aresome of the many areas of great interestawaiting clinicians’ research.Two Examples from PersonalExperienceData CollectionAfter completing my training inmedicine / pulmonary medicine,I worked in a newly establishedrespiratory intensive care unit inQueens Hospital Center (QHC) in NewYork. It became apparent very quicklythat a significant number of the patientsadmitted who became intubated weredeveloping complications manifestingas massive gastrointestinal (GI)bleeding, renal failure, nosocomialinfections, and tracheal complicationsfrom endotracheal tubes andtracheostomies. To develop dataregarding the incidence, causes, andimpact on morbidity and mortalityof these complications, with thehelp of the cooperative nursing staffand an investment of 85 cents in anotebook, we recorded all admissionsand marked any complications thatdeveloped. At the end of the week, Ianalyzed this data, and over a month’sadmission of 25 to 30 patients wewould have a few GI bleeders and a fewwith other complications. Gradually,over a period of several months, weFIMA YearBook 2009131

Clinicians As Effective Researchershad data on hundreds of patients and,during my stay at QHC, I accumulateddata on more than 3,000 patients. Thenursing staff did the data entry, while Ireviewed the accumulated data. Therewas no protected time in a busy publichospital. We found an incidenceof more than 10% with massive GIbleeding, requiring a transfusionof two or more units of blood. Toreduce the incidence of GI bleeding,we adopted a gastric neutralizationprogram, initially with antacidsand later on with H2 blockers, withdramatic improvement. We reportedthe largest series on this subject. (5) Wehad similar experience in addressingcomplications of renal failure,and tracheal complications. Afterpresenting our findings at nationalmeetings, we were asked to write amonograph on the subject. (6) The takehomemessage from this experience isthat you need to have accurate reliabletransparent data and from suchaccumulated experience one can makeinteresting observations, which canlead to better patient care.Lengthy Investigation and ResearchIn mid 1980s I served as an externalexaminer for the medical school inAmman, Jordan. One of the short casespresented was that of a boy in his teenswith classic saccular bronchiectasis.The diagnosis was obvious, and thestudents had no difficulty in describingthe clinical findings. However, laterthat evening, Professor Naif Slimanposed the following question: “Thecase of bronchiectasis you saw todayis rather unusual in that he and severalof his brothers have the same problem,and they are challenged intellectually.The sisters and other siblings do nothave this problem, can you help us sortthis out?”It was clear that there was some inheritedgenetic disorder affecting some, but notall, male siblings in this rather largePalestinian family of 14-plus siblings.We went through the usual differentialdiagnosis, did the chromosomeanalysis, studied the cilia from theaffected patients, and conducted otherroutine investigations. The affectedfamily was living in a refugee camp inJordan, and I was in New York. Thiscreated many interesting challenges inlogistics. We had to seek the assistanceof experts from diverse fields involvinggenetics, ciliary sampling, and motilitystudies. After 15 years of collaborationand work with many investigators inAmman as well as in the United Statesin Atlanta, Georgia; Stony Brook,New York; and Charleston, SouthCarolina, we were able to identify anew inherited genetic disease. (7) Thelessons learned from this experienceare that investigation and researchcan take a long time. One needs to bepatient and, most important, one needsto collaborate with the appropriateinvestigators within and outside theparent institution. This study “research”took 15 years.Ethics in ResearchAfter serving on the board of theFIMA YearBook 2009132

Clinicians As Effective Researchersprofessional medical conduct in NewYork, it became apparent to me thatphysicians are not immune to ethicallapses. This becomes even moreimportant in research where patientsare entrusting the physicians to beingtested with an unproven, often notapproved, medication or device. Twopersonal examples will highlight this.a) I did sizable clinical research in theapplication of fluoroquinolones inrespiratory tract infections. Asour team published and presentedour findings in professionalmeetings, I began to receiverequests from several differentpharmaceutical companies to testtheir brand of fluoroquinolones.One such product had obviousneurologic complications, everythird or fourth of my enrolledpatients had some evidence ofneurologic stimulation: irritability,sleeplessness, and even seizures. Ifelt exposing my patients to suchside effects was not appropriateand quickly informed my IRB thatI was canceling the study.b) While studying Ciprofloxacin,which had been showing excellentclinical results (8) one of ourenrolled patients had a grandmal seizure, which she neverhad before. After careful clinicalinvestigation, we determined it wasmost likely the result of a very highblood theophylline level resultingfrom the interaction between theCiprofloxacin and theophylline.Up to that time, Ciprofloxacinhad not been known to increasethe blood theophylline level. Thesponsoring company was quicklyadvised of this complication, and,to its credit, it encouraged us tostudy this interaction in greaterdetail, which we did and thusestablished the Cipro-theophyllineinteraction. (9)The point of these two examples is thatbecause complications can occur whiledoing research, it is the investigators’responsibility and moral/ethical dutyto weigh the risk/benefit ratio carefully,keeping the patients’ interest and wellbeinguppermost in mind.Dr. Stephen E. Straus is a highlyrespected researcher at the NIH.He was the principal researcher in aresearch study on a new investigationaldrug for the treatment of hepatitis.Five patients he treated at the NIHhospital in Bethesda, Maryland,died, which led to news reports andcongressional hearings. The studywas discontinued, and eventually heand his colleagues were cleared ofany wrongdoing. Later on they foundout that the investigational drugwas a mitochondrial poison leadingto severe metabolic acidosis. Strausregularly presents this incident atthe annual NIH course on research.Understanding the importance ofunanticipated risks in clinical researchis highly recommended for all who doclinical research. (10)FIMA YearBook 2009133

Clinicians As Effective ResearchersFinancial SupportDeveloped countries have recognizedthat support for research anddevelopment pays rich dividends inthe long run. The amount invested inresearch and development in Japanis 2.9% of the gross domestic product(GDP). In the United States and Europe,it averages between 1.5% and 3% of theGDP. The Southeast Asian countriesaverage 0.89% of their GDP, and in theArab countries it averages only 0.23%of the GDP, with the exception of Qatar,where the percentage is 2.8%. Thesenumbers translate to $19 per personin Saudi Arabia, $665 per person inthe United States, and $649 per personin Japan. In developed countries, theprivate sector plays a major role insupporting research and development.For example in the United States, thegovernment provides the NIH with anannual budget of around $28 billion,whereas the private sector supportfor research in the United States isestimated to be double that amount.A good example of the rich returnsfor research investment are evidentwith the recent epidemic of HIV/AIDS, which, in the mid 1980s, had notreatment and had a very high mortalityrate. If this trend had continued, it isestimated that in the United States wewould have more than 200,000 hospitalbeds occupied by AIDS patients.Thankfully, with an investment of $10billion dollars over 10 years the viruswas identified, drugs were discovered,and the treatment of this deadly diseasechanged from inpatient treatment tooutpatient long-term care. Thus the $10billion investment saved $1.4 trillion inhealth-care costs, or a 1:140 return (11) .SummaryBased on the author’s personalexperience as a clinical researcherand having overseen the expandingresearch at KFMC since 2007, wherethe submissions of research proposalshave grown from 27 in 2007 to 62 in2008. Submissions are projected toreach close to 100 in 2009. The keyfactors for success in research areintellectual curiosity; asking the keyquestions; “but why,” persistence; followup to test hypotheses; honesty andintegrity in collecting data; reportingall findings, both the expected and theunexpected; assessing what is availableand doable in the place you work, asthere is no point in doing researchin transplantation if your institutiondoes not have a transplant program;and most of all, learning to collaborateand cooperate. On top of that, there isan element of luck involved, being inthe right environment, having accessto role models, and having a helpfulmentor and cooperative peers.Follow UpAll of the good work is of little value ifit does not get presented or publishedso the results of the investigators’ workcan be shared with a larger community.Here are a few suggestions in getting thematerial published: The qualities of themanuscript and the journal must match;FIMA YearBook 2009134

Clinicians As Effective Researchersevaluate journal quality by its editorialoffice, publishing, and distributionfactors; read the instructions to authorscarefully; and novelty, creativity, andlevel of interest are important factors.The abstract you submit must have allkey findings and elements listed; checkfor methodological quality; registerhuman studies/clinical trial; placeyour findings in perspective; ensureclarity of presentation; avoid paucityof data; check the appropriateness ofthe statistical methods; emphasizethe clinical significance of the study;and, most important, do not getdisheartened if you receive a rejection.The rate of acceptance in high-impactjournals can be as low as 10-15% of allsubmissions. I have had my share ofrejections over the years.FIMA YearBook 2009135

Clinicians As Effective ResearchersReferences1. Altman LK. Who Goes First?: Story of selfexperimentationin medicine. University ofCalifornia Press; 1998.2. Hakim FA, Khan FA. Tale of Swan-Ganz(pulmonary artery) catheter. J of Islam MedAssn. 2008;40:82-4. Available from http://jima.imana.org/ article/view/4450.3. U.S. Department of Health and HumanServices. NIH: overview of ResearchActivities: Publication Number 04-5488, Sept2004:18.4. Marshall BJ, Warren JR. Unidentifiedcurved bacilli in the stomach of patientswith gastritis and peptic ulceration. Lancet.1984;1(8390):1311-5.5. Khan F, Parekh A, Patel S, et al. Results ofgastric neutralization with hourly antacidsand cimetidine in 320 intubated patients withrespiratory failure. Chest. 1981;79(4):409-12.Available from http://dx. doi.org/10.1378/chest.79.4.409.6. Wollschlager C, Conrad A, Khan F. Commoncomplications in critically ill patients.Dis Mon. 1988;34(5):221-93. Availablefrom http://dx.doi.org/ 10.1016/0011-5029(88)90009-0.7. Al-Shroof M, Karnik AM, Karnik AA, et al.Dyskinesia associated with hydrocephalusand mental retardation in a Jordanian family.Mayo Clin Proc. 2001;76:1219-24.8. Khan FA, Basir R. Sequential intravenousoraladministration of ciprofloxacin vsceftazidime in serious bacterial respiratorytract infections. Chest. 1989;96(3):528-37.Available from http://dx.doi.org/ 10.1378/chest.96.3.528.9. Raoof S, Wollschlager C, Khan FA.Ciprofloxacin increases serum levelsof theophylline. Am J Med. 1987 Apr27;82(4A):115-8.10. Straus SE. Unanticipated Risk in ClinicalResearch. In: Gallin JI, Ognibene FP, editors.Principles and practice of clinical research.New York. Elsevier; 2007.11. Culliton BJ. Extracting knowledge fromscience: a conversation with Elias Zerhouni.Health Affairs. 2006;25:w94-103. Availablefrom http://dx.doi.org/ 10.1377/hlthaff.25.w94.FIMA YearBook 2009136

Ethics of Clinical Research:An Islamic PerspectiveHossam E. Fadel *AbstractMedical progress depends on clinical research which has to involve, at somepoint, human subjects. The human rights of research subjects must be protected.Ethical principles and guidelines have been developed by internationalorganizations; the World Medical Association (WMA) and the Councilfor International Organizations of Medical Sciences (CIOMS). The IslamicOrganization for Medical Sciences (IOMS), Kuwait, convened a meeting inCairo, Egypt 2004, and produced a document advancing an Islamic viewpointon these principles and guidelines.In this paper I discuss all these documents. The guidelines developed by CIOMSare in general agreement with Islamic principles i.e. respect for the person,bringing benefit, avoiding harm, and justice. However some differences exist towhich I alluded. I also added some personal opinions.Muslim physicians and scientists should get involved in clinical as well as othermedical research. It is fard kifāya (collective religious duty). They should befamiliar with the ethical principles and guidelines and abide by them in theirown research. Also, they should monitor externally sponsored research in theirown countries to ensure that these guidelines are followed.Keywords: Clinical research, ethics, Islam, Declaration of Helsinki, Council for InternationalOrganizations of Medical Sciences, Islamic Organization of Medical Sciences.With special permission to reprint from the Journal of Islamic Medical Association of NorthAmerica (JIMA).42;2010 - Page 59.Hossam E. Fadel, MD., PhD., FACOGMaternal Fetal Medicine.Clinical Professor, Department of Obstetrics and Gynecology, Medical College of Georgia,Augusta, GA, USAE-mail: hefadel@gmail.comFIMA YearBook 2009137

Ethics of Clinical ResearchIntroductionAcademicians in faculty positionsare traditionally involved in clinicalresearch. Private practitioners canand should be involved in clinicalresearch as well. (1) A requirement ofclinical research is that it conformsto internationally recognized ethicalguidelines. For Muslim physicians,conforming to Islamic ethicalguidelines is an added requirement.In this article, I will discuss theinternational guidelines and Islamicviewpoints regarding these guidelines.Muslim Obligation to Conduct ResearchMuslim countries are, in general,lagging behind in research includingmedical research despite their collectivematerial and human potential. Thisis very ironic noting that Muslimphysicians of the past were the pioneersof scientific and medical researchand were the first to employ scientificexperimentation. (2-5)It is worthwhile to emphasize theimportance laid by Islam on the pursuitof learning. There are several Qur’anicverses and traditions of the Prophet(PBUH) to that effect. The first revealedverses of the Quran state:Recite in the name of your Lord,Who created. He created man froma leech-like structure. Recite, andyour Lord is Most Generous, Whohas taught by the pen. He taughtMan that what he knew not. (6)Allah (SWT) also says, addressing theProphet (PBUH),Say, “My Lord, increase my knowledge.” (7)Allah (SWT) asks us to look insideourselves and at the universe todiscover God’s laws.Let man consider from what he iscreated. (8)And in another verse:Will they not reflect on camels, howthey are created; the sky, how it israised; the mountains, how theyare erected; and the Earth, how itis leveled. (9)Learning in Islam is not limitedto religious studies. Early Muslimscholars used to acquire an extensiveknowledge, not only in jurisprudence(fiqh), Qur’an and linguistic studies,but also in medicine, chemistry, andnatural sciences. Knowledge has to bebased on evidence. Allah (SWT) says:...Can there be another god besidesAllah? Say bring forth your proof ifyou are telling the truth! (10)Based on the above, scientificresearch is considered by some scholarsas fard kifāya (collective religious duty).The Prophet Muhammad (PBUH) isreported to have said:Allah created disease and its cureexcept senility (death). Sons ofAdam, seek the cure but do not useharam (forbidden) things. (11)This hadith makes it incumbent onus to investigate the causes of diseaseand to try to find cures. This can onlybe achieved by undertaking both basicand clinical research.FIMA YearBook 2009138

Ethics of Clinical ResearchInternational Ethical Guidelines forClinical ResearchClinical research must rest in part onexperimentation involving humansubjects. Research involving humansubjects creates a lot of potential pitfallsthat unfortunately led to tragedies inthe last century. The most well-knownof which are the experimentationby Nazis on the prisoners and theTuskegee study of untreated syphilis (12)in USA. This study was conducted bythe US Public Health Service (USPHS).Over the period of 40 years (1932-72),399 syphilitic African Americans werefollowed without treatment to studythe natural course of the disease. (13-6)The study patients were never informedof the availability of Penicillin whichwas found to be an effective treatmentfor their disease in the late forties. TheNuremberg Code was promulgated in1947 as a direct consequence of thetrial of Nazi physicians who conductedresearch on the prisoners of World WarII without their consent. The UnitedNations General Assembly adoptedthe Universal Declaration of HumanRights in 1948 and the InternationalConvention on Civil and PoliticalRights in 1966. Its article seven statesin part: “In particular, no one shall besubjected without his free consent tomedical or scientific experimentation.”In parallel with these efforts, medicalprofessionals worked on formulatingprinciples of ethical use of humansubjects in research. The first suchdocument, the Declaration of Helsinki,was adopted by the World MedicalAssociation (WMA) in 1964 inHelsinki, Finland. This was updatedseveral times. The last was in Seoul,South Korea in 2008 at the WMA 59thGeneral Assembly Meeting. (17) Thecentral point of the Declaration is thatmedical research should be subject toethical standards that promote respectfor all human beings and protect theirhealth and rights.The Declaration of Helsinki consists of35 articles divided in 3 sections. Theseare an introduction, “Principles forAll Medical Research” and “AdditionalPrinciples for Medical Researchcombined with medical care”.This document stresses that in the fieldof biomedical research, fundamentaldistinction should be recognizedbetween medical research in whichthe aim is essentially diagnostic ortherapeutic for a patient and medicalresearch the essential object of whichis purely scientific and without directdiagnostic or therapeutic value to theperson subjected to research. Medicalresearch should be subject to ethicalstandards that promote respect for allhuman beings and protect their healthand rights.The Declaration of Helsinki alsostresses the fact that some researchparticipants are vulnerable and needspecial protection. The research shouldbe approved by especially appointedEthical Review Committees. Eachpotential research subject should beadequately informed of the aims,FIMA YearBook 2009139

Ethics of Clinical Researchmethods, sources of funding, andpotential risks of the study. Theyshould be informed about their rightto abstain from participation or towithdraw from the study without anyreprisal. For a research subject whois a minor or legally incompetent, theinvestigator must obtain informedconsent from the legal guardian. Theseand other vulnerable groups shouldnot be included in research unless it isnecessary to promote the health of theparticular group from which they arerecruited.In the United States, the US NationalCommission for the Protection ofHuman Subjects of Biomedical Researchwas created in 1974 and produced theBelmont Report in 1979 which distilledprinciples of ethics related to research. (18)It addresses boundaries between medicalpractice and research; basic ethicalprinciples such as respect for persons,beneficence, and justice; and informedconsent, assessment of risks and benefits,and selection of subjects.Another international organization,The Council for InternationalOrganizations of Medical Sciences(CIOMS), was founded in 1949 underthe auspices of the World HealthOrganization (WHO) and the UnitedNations Educational Scientific CulturalOrganization (UNESCO). CIOMS,in association with WHO undertookits work on the ethics of biomedicalresearch in the 1970s . It producedguidelines to enable the effectiveapplication of the ethical principles setforth in the Declaration of Helsinki,particularly in developing countries.Their first report was published in1982. Following that, there were majordevelopments such as the outbreak ofthe HIV/AIDS pandemic and proposalsto undergo large scale experiments withvaccines and medications. There werealso rapid advances in biotechnologyand an increase in multinational fieldtrials involving vulnerable populationsin developing countries. Thesedevelopments raised new ethical issuesand in 1996 CIOMS updated its reportand published International EthicalGuidelines for Biomedical Researchinvolving Human Subjects and updatedit in 2002. This consisted of a statementof general ethics, a preamble and 21guidelines. (19)The Islamic Viewpoint on CIOMSGuidelinesThe Islamic Organization of MedicalSciences (IOMS), based in Kuwait,translated this document into Arabic.It was then reviewed by a scholarof Islamic Jurisprudence principles.The document along with the latter’scomments were discussed by a group ofMuslim scholars, physicians, includingmyself, and other individuals withinterest in ethics and the law. TheIslamic viewpoint on each of theseguidelines was studied in depth bythis group and discussed in a threeday conference held in Cairo, Egypt,December 2004. The results of thesedeliberations were published as theInternational Ethical Guidelines forFIMA YearBook 2009140

Ethics of Clinical ResearchBiomedical Research involving HumanSubjects: An Islamic Perspective. (20) Inthis paper I will summarize the CIOMSguidelines, the IOMS document, andadd my personal opinions.The CIOMS guidelines as well asthe principles of the Declaration ofHelsinki are based on the generallyaccepted ethical principles of respectof person, beneficence, nonmaleficenceand justice. (21)These four principles are in agreementwith Islamic rules. Allah (SWT) says“We have honored Adam’s children.” (22)Respect of the person is a major aspectof the dignity of a human being. Respectof the person gives him the right tomake his own choices and decisions.In the context of research it means thatno one should be involved in a researchproject without his free and voluntaryconsent. The Islamic principle thatapplies here is “No one is entitled todispose of the right of a human beingwithout his permission.” (20)A basic purpose of Islamic law is to“secure benefits for people and toprotect them from harm”. (20) This istermed beneficence in our lexicon atpresent. Another Islamic law states that“every action that leads to harm or thatprevents a benefit is forbidden. That iswhat is now called “nonmaleficence.”In cases where benefit and harm arenot absolute, which is the usual casein biomedical research, the rule thatapplies is that “if a less substantialinstance of harm and an outweighingbenefit are in conflict, the harm isforgiven for the sake of the benefit”.Justice is an established principlein Islamic law. Allah (SWT) says“God enjoins justice and charity.” (23)Justice means equity and fairness,and charity is either the acquisition ofbenefit or the prevention of harm.Now, I will discus these guidelinesindividually.Guideline 1: Ethical Justificationand Scientific Validity of BiomedicalResearch involving Human SubjectsIn agreement with this guideline, theperformance of research on humansubjects is Islamically acceptable.However, it should be useful andresponsive to the five purposes ofIslamic law (maqāsid al-sharī`ah),i.e. the safeguarding of one’s religion,life (and health), intellect, progeny,and property/resources, and that itshould not cause harm. On the otherhand, a person who pursues scientificknowledge to cause harm is subject toGod’s wrath. God (SWT) says,And they learn what causesthem harm and brings them nobenefit, and they already knowthat whoever purchases it hasno share in the hereafter. (24)The Prophet (PBUH) asked God’srefuge from learning that brings nobenefit. (25) The research should by nomeans lead to something prohibited.A researcher should comply withFIMA YearBook 2009141

Ethics of Clinical Researchthe framework of Islamic law in anyresearch he undertakes. Moreover, aresearcher should observe the rules andethics of the profession especially asthey relate to the ethics of biomedicalresearch. To be more specific, theresearch is Islamically acceptable underthe following conditions:1) The purpose of the study is to securean absolute benefit i.e., enhancinghuman health, or to prevent aninstance of absolute harm whichimpairs health, or to give priorityto securing an outweighing benefitover preventing a less substantialinstance of harm.2) The benefit does not violate alegal stipulation nor contradictany absolute ruling of Islamicjurisprudence.3) The research itself should belegitimate i.e. both the means andends must be legally permissible.4) The design of study should bescientifically sound so that itshould be more likely to achievethe purpose it is expected toaccomplish. This is based onthe rule that “every action thatceases to pursue its objective isunacceptable.” (20)5) That the research team is qualifiedand competent to conduct theresearch as consistent with theQur’anic guidance “God enjoinsyou to deliver your trusts to theirrightful owners” (26)And the Prophetic saying “Allah lovesthe person who is performing a job, todo it in the best possible way.” (27)Guideline 2: Ethical Review CommitteesThis guideline addresses the formationand role of the ethical reviewcommittees. A universally acceptedstandard is the establishment ofethical review committees to evaluatebiomedical research and to ensure thatits purpose and methodology are inaccordance with the ethical guidelines.This concept is Islamically ordained.Medicine and biomedical researchare so important that it needs to bepracticed under supervision. In thatregard I like to point out the fact thatMuslims were the first to establish thepractice of licensure to physicians andthe system of Hisba (inspection). (28)This was meant to ensure that all peoplein trades, including physicians, werebehaving justly.The ethical review committees usuallycalled institutional review boards(IRBs) committees consist of scientists,physicians, lay people and legalpersonnel. In an Islamic country, it isrecommended that the ethical reviewcommittee gets the opinion of anIslamic jurisprudence (fiqh) committeeto be certain that the proposed studyis within the guidelines of Islam. AnIslamic rule is “A responsible adultis not to embark on any undertakingbefore he finds out how it is regardedby God.” (20)The guideline that ethical reviewcommittees should be independentof the research teams and sponsors isFIMA YearBook 2009142

Ethics of Clinical Researchin agreement with Islamic principles.The ethical review committee is ineffect giving testimony. For such tobe Islamically acceptable, it must bemade by a neutral party. To satisfy therequirement of validity of testimony,any material or nonmaterial rewardsfor the committees should not becontingent on the outcome of thereview (testimony).Guideline 3. Externally SponsoredResearchIn case the research is externallysponsored, i.e. by an institution oran industrial or drug company fromanother country, the scientific andethical review should be conductedobjectively, independently and honestlyin the country of the sponsoringorganization. This is to guaranteethat the standard ethical controlsare applied. These should not be lessstringent when applied in another,possibly less-developed country, thanthe controls normally applied in thecountry of the sponsoring organization,as all members of the human raceshould be treated equally. Equity for allpeople is a basic tenet of Islam. Allah(SWT) says:“O mankind reverence yourGuardian Lord who created youfrom a single person”. (29)In addition, another ethical reviewshould be conducted in the hostcountry to make sure that the proposedresearch meets the health needs andpriorities of that country. One of thepurposes of Islamic law is “To placeeverything in its right place [on the listof priorities]” (20)Guideline 4. Individual Informed ConsentThis guideline stipulates that theinvestigator must obtain a voluntaryinformed consent from eachprospective study subject. This is inconformity with Islamic law that callsfor respect of the independence ofevery individual, his right to make hispersonal choices and arrive at decisionssuitable for him, without any trace ofcoercion or deception, and his right tobe protected from injury, misleadinginducement, or exploitation by othersThe consent should be given willinglyafter the subject, if fully competent,receives and understands the necessaryinformation. This is stipulated in thefiqh rule, “No one is entitled to disposeof the rights of a human being withouthis permission” and “no right of ahuman being can be cancelled withouthis consent.” (20) The informationshould be given in a written format ina language easily understood by theindividual, and the consent should bedocumented.Guideline 5. Essential Informationfor Prospective ParticipantsThis guideline details the necessaryinformation that should be given tothe potential subjects for the research.The informed consent should begiven with full knowledge and correctunderstanding, on the part of thesubject of the content of his consent.FIMA YearBook 2009143

Ethics of Clinical ResearchGuideline 6. Obligations of Sponsors/InvestigatorsThis guideline details the duties ofboth the sponsors and investigators togive the subjects accurate informationand neither withhold any informationthat may negatively influence thepotential research subjects’ decision toconsent nor deceive them in any way.They should not include any explicitor implicit threats in their discussionswith the potential subjects. Islamicjurisprudence stipulations supportthis guideline. These stipulations are“mutual agreement can not be reachedunder conditions of ignorance,” and“consent to an unknown thing andacquittal from an unknown thing arenot valid.” (20)Guideline 7. Inducement to ParticipateThere is no objection, from the Islamicpoint of view, to compensate researchsubjects for lost earnings, transportand other expenses that might beincurred as a result of participatingin the research. Actually, the ruleof reparation and the principles ofjustice and fairness make it necessaryto compensate the subjects adequatelyfor what they have paid. Additionalfinancial or in-kind payments made toinduce participation in research mayimply undue inducement. If it pressuresthe subject to give consent not based onconviction, then it is legally prohibited.However, if such payment doesnot influence the subject’s decisionmaking and he gives his consent, withhis free will, his consent in Islamicjurisprudence is valid. Neverthelessthere should be – in my view – somerestriction. The additional paymentsgiven to a poor person, or the provisionor even the promise of medical care toa person who does not have access tothat care in less developed countriesor uninsured individuals in Westernsocieties, could be a significantinducement that may cloud the abilityof the person to make a true informeddecision. The person may consentto participate and expose himself tocertain risks he would avoid were he isnot in need of such incentives.Guideline 8. Benefits and Risks ofStudy ParticipationThe investigators must ensure thatpotential benefits and risks arereasonably balanced and the risks areminimized. The need to strike a balancebetween potential benefits and risks inresearch involving human subjects,with the prospective benefits beingmore likely and the need to minimizerisks, is included in a basic principleof Islamic Law, “if a less substantialinstance of harm and an outweighingbenefit are in conflict, the harm isforgiven for the sake of the benefit.” Ifa benefit and an instance of harm are inconflict, priority should be given to theweightier of the two. (20)It is acceptable from a religiousperspective to use the expected,significant benefits to society as ajustification of the risks interventionspose to an individual who has nopossible direct diagnostic, therapeutic,FIMA YearBook 2009144

Ethics of Clinical Researchor preventive benefit. This is based on arule of jurisprudence, “Public intereststake precedence over private ones.” (20)This is different from the HelsinkiDeclaration and the CIOMS guidelineswhich emphasize that individual benefitprecedes social benefits. This point needsfurther study by Islamic scholars. Theyneed to determine to what extent publicinterest supersedes individual interest asit relates to human clinical research.Guideline 10. Research in Populations andCommunities with Limited ResourcesBefore undertaking research in apopulation or a community with limitedresources, the sponsor and investigatormust make every effort to ensure thatthe research is responsive to the healthneeds and priorities of the communityin which the research will be conducted.Also, any knowledge generated or anyintervention or product developed asa result of that research must be madereasonably available for the benefit ofthat population or community.This guideline is consistent with theIslamic principle of justice and charity. (23)Guideline 11. Choice of Controls inClinical TrialsThis guideline can also be endorsedfrom an Islamic point of view as itrequires the researchers to observe,in dealing with human subjects, theobligation of trust when choosing themethod of intervention to protect theirhuman rights fully and ensure theirsafety. “God enjoins you to deliver yourtrust to their rightful owners.” (26)Whether the use of a placebo arm inclinical trials is ethically acceptable hasbeen vigorously debated. (30) Againstobjection by scientists, the 2000 versionof the Helsinki Declaration specificallyprohibits the use of placebos except inlimited situations. CIOMS recommendsthe use of equivalency trials or add-onstudies. Equivalency trials comparean investigational intervention withan established effective treatment andproduce scientifically reliable data.An add-on design may be employedwhen the investigational therapy anda standard therapy have differentmechanisms of action. The treatmentto be tested and the placebo are eachadded to the standard treatment todetermine if the investigational therapyleads to a better outcome or to fewerside effects.If the use of a placebo arm is essentialfor the clinical trial to produce usefulinformation and there is no resultingharm to the subjects in the controlarm, it will be Islamically acceptable.The rationale for that is that “althougha sort of deception is practiced, theconsequences are safe.” (20) In my view,it may cause harm if the researchsubject in the control arm is deprivedof a currently accepted treatment.I believe that the concerned ethicsreview committee has to carefullyexamine each specific case, evaluate thepossibility of harm to the subjects inthe placebo arm and try to work withthe investigator to find an alternativestudy design.FIMA YearBook 2009145

Ethics of Clinical ResearchGuideline 12. Equitable Distributionof Burdens and Benefits in theSelection of Groups of Subjects inResearchThis guideline is again in harmony withIslamic law which calls for justice inall affairs of life. (23) So, it is unfair thatparticipants in a study share in theburdens i.e. the potential side effectsor other hardships but they do notshare in the benefits when a successfulintervention is achieved but is notmade available to them.Guideline 13. Research InvolvingVulnerable PersonsThese include persons with limitedcapacities or freedom to consentor decline to consent. They may bementally incapacitated, elderly peoplewho developed varying degrees ofdementia, residents of nursing homes,people receiving welfare benefits, theunemployed, patients in emergencyrooms, some ethnic or racial minoritiesgroups, homeless persons, nomads,refugees, prisoners and patientswith incurable diseases. Junior orsubordinate members of hierarchicalgroups, for example medical andnursing students, employees ofpharmaceutical companies andmembers of the armed forces or police,are all considered vulnerable groups.Their agreement to volunteer maybe influenced by the expectation ofpreferential treatment if they agree andretaliation if they refuse.Ethical justifications for theinvolvement of these vulnerable groupsare:1. The research could not be carried outequally well with less vulnerablepersons.2. The research will lead to improvedtreatment of health problemsunique to the vulnerable class.3. They are assured that they will havereasonable access to any productthat comes out of the research4. The risk is minimal.5. The agreement to participate issupplanted by the permission of alegal guardian or other appropriaterepresentative.This CIOMS guideline is in conformitywith Islamic law. These individuals needtheir rights and interests protected.They should not be forced, pressured,deceived, or subjected to exploitationof their psychological condition orfinancial difficulties in order to makethem consent to be research subjects.Such coercion or exploitation involvesinjustice that is disapproved by Islamiclaw. In a divine tradition, ProphetMuhammad (PBUH) quotes his Lord(SWT), as saying,“My worshippers, I have forbiddeninjustice on my part and made itforbidden among you, so do not beunjust to one another”. (31)Thus, a special justification of recruitingvulnerable individuals to serve asresearch subjects is required in IslamicLaw, and, as stipulated in the CIOMSFIMA YearBook 2009146

Ethics of Clinical Researchguideline, strict measures to protecttheir personal rights and interestsshould be taken.Guideline 14. Research InvolvingChildrenThe participation of children isessential in research on childhooddiseases and treatments given tochildren including medications andvaccines. However, the researcher mustensure that the research could not becarried out equally well in adults andthat the knowledge to be acquired isrelevant to the health needs of children.Further, a parent or guardian must givepermission and the assent of the childshould be obtained to the extent of thatchild’s capabilities and a child’s refusalto participate or to continue in theresearch should be respected.Under Islamic rulings, a child underthe age of puberty is incompetentand his “consent” to participate inbiomedical research is not valid.Moreover, in variance with this CIOMSguideline, Islamically the permissionof the guardian is not legitimateexcept a) when there is an absolute oroutweighing benefit or when the child’scondition needs urgent participationb) when there is general need toconduct research relevant to children’sdiseases, drugs or vaccines and c)if the risks involved do not exceedwhat is associated with a normalmedical or psychological examinationof the child or when the increase inrisk level is slight and approved byan ethical review committee. Thesespecial circumstances are considered“necessities which render permissiblewhat is usually prohibited” in Islamiclaw. (20)In another variance from the CIOMSguideline, a child’s objection toparticipate in the study is not takenin consideration. The authority towithdraw from a study is only given tothe guardian. An exception would beif the child is perceptive i.e. is close topuberty and his perception skills havedeveloped sufficiently even though heis still under a guardian.Guideline 16. Women of ReproductiveAge as Research SubjectsInvestigators should not exclude womenof reproductive age from biomedicalresearch. If participation may behazardous if a woman conceives, theinvestigator/sponsor should offer thempregnancy testing and provide themwith access to effective contraceptionbefore the research.In agreement with this guideline,Islamic jurisprudence considers theexclusion of women of reproductiveage from biomedical research asunjust because it deprives them frompotential benefit. Their participationis conditional on voluntary informedconsent, including information on theprecautions taken to spare her andher fetus, if she becomes pregnant,from any hazards. In Islamic law, it isunacceptable for the permission of ahusband to replace that of his wife.That would be an affront to her humanrights. Although not a requirement, itFIMA YearBook 2009147

Ethics of Clinical Researchis preferable for a married woman toobtain her husband’s consent. (20) Nosuch point is included in the CIOMSguidelines.Guideline 17. Pregnant Women asResearch SubjectsResearch involving pregnant womenis complicated by the fact that it maypresent potential benefits and risksto two beings; the woman and herfetus. However, pregnant womenshould be presumed to be eligiblefor participation in biomedicalresearch as long as they are adequatelyinformed about the benefits and risksto themselves, their pregnancies, theirfetuses, their subsequent pregnanciesand their fertility. The research shouldbe relevant to the particular healthneeds of pregnant women in general.Investigators should include in theirprotocols a plan to monitor theoutcome of the pregnancy with regardto both the health of the woman andthe short- and long-term health of thenewborn.Islamically, there is no objection tothe participation of pregnant womenin biomedical research because of thepotential benefit to them and to theirfetuses that can be derived from suchresearch. Ideally, before enrollingpregnant women in biomedicalresearch, the investigators should ruleout any harm to the fetus. Howeverthat is almost impossible to achieve.The safety of new medications can notbe assumed from animal experimentsor from the study of the pharmacologyof the used medication. There willalways be some risk. Islamically,accepting the possibility of such harmwould nevertheless be permissible ifthe mother or the fetus is likely to gainan absolute or outweighing benefit.When there are potential risks for thefetus, even when they are minor oroutweighed, the investigator shouldalso obtain the consent of the father.This is not a requirement of the CIOMSguidelines. It states “..it is desirable inresearch directed at the health of thefetus to obtain the father’s opinion also,when possible.” (20)In some instances, the clinical trials aremeant for the treatment of the fetus andnot the mother. In these cases there aremore risks to the mother without anybenefit to her. In my opinion the mostobvious example is in utero (prenatal)fetal surgery to correct a fetal birthdefect. In these cases, the maternalinstinct may unduly influence herto agree to such trials. Ethically andIslamically, the investigators shouldmake an extra effort to explain the trial,the potential benefit to the fetus and thepotential complications in the neonatalmanagement, the short and long termprognosis for the fetus/neonate/childand especially the short- and long-termcomplications for the mother beforeshe agrees to participate in the trial.Safeguards should be established toprevent undue inducement to pregnantwomen to participate in the researchfor the sole benefit of the fetus. In thesecircumstances I recommend that theethics review committee establishes aFIMA YearBook 2009148

Ethics of Clinical Researchspecial counseling team independentof the investigator.Guideline 18. Safeguarding ConfidentialityThe subjects’ research data should beheld in strict confidentiality. However,the subjects should be told the limits,legal or otherwise, to the investigator’sability to absolutely safeguardconfidentiality and the possibleconsequences of possible breeches ofconfidentiality.Safeguarding confidentiality is abasic tenet of Islamic law. This is the“trust” between an individual and thephysician/investigator. Exceptionsfrom the requirement of safeguardingconfidentiality are made in caseswhere concealing the confidentialinformation causes greater harm forthe person involved than that caused byrevealing it or when revealing it bringsa benefit that outweighs the harm ofconcealing it. This is based on the ruleof the permissibility of commissionof the lesser of two injuries to preventthe greater injury. Also, there arecases where revealing confidentialinformation is permitted because itbrings a social benefit or preventspublic harm. (20)Guideline 19. Right of InjuredSubjects to Treatment and ReparationResearch subjects are entitled to freemedical treatment when they incurany injury or any other harm as a resultof their involvement in the research.They are also entitled to equitablecompensation for any impairment,disability or handicap that result fromtheir participation. In the case ofdeath, their dependents are entitledto compensation. Their entitlement isbased on the principle of justice, thefourth principle of ethics. The sameis true from the Islamic point of view.This is based on the Islamic legalrule of reparation, which makes it anobligation for a person who causes anydamage to another to make equitablecompensation for the loss. When asubject dies as a result of his participationin research, his heirs are entitled tomonetary compensation, which is theblood money stipulated in Islamiclegislation for accidental homicide. Theimplicit agreement between researchsponsor(s) and involved subjects entailsa religious responsibility on the partof the former party to make up forthe damages suffered by a subject as aresult of participation in the research.However, it was pointed out during thedeliberations in the Cairo conferencethat it is permissible for the investigatorsor sponsors to obtain in advance thesubjects’ informed consent to waive theinvestigators’ responsibility, includingtheir research subjects’ entitlementto compensation for disability andhandicaps, when they are not deliberatelycaused based on the fact that Islamically,a competent individual is entitledto waive voluntarily any right of his,provided that he does that completelyvoluntarily without any pressure,inducement or deception (20) . While thisis true, in my opinion there is danger ofit being abused as it will be impossibleFIMA YearBook 2009149

Ethics of Clinical Researchto prove that the waiver was given trulyvoluntarily. I would think that waivingof the right to reparation ought not to bepermitted. In my view, allowing waiverswill make the investigator less careful inavoiding harm to the research subject.Further, I believe there is a differencebetween harm resulting from acceptedtreatment versus that resulting frominvestigational treatment in the courseof conducting a clinical trial. CIOMSguideline 19 specifically prohibits suchwaivers.Guideline 20. Strengthening Capacityfor Ethical and Scientific Review andBiomedical ResearchIn externally sponsored research,sponsors and investigators have anethical obligation to ensure thatbiomedical research projects forwhich they are responsible in thehost countries contribute effectivelyto national or local capacity to designand conduct biomedical research andto provide scientific and ethical reviewand monitoring of such research.Guideline 21. Ethical Obligations ofExternal Sponsors to Provide HealthCare ServicesExternal sponsors are ethically obligedto ensure the availability of health careservices that are essential to the safeconduct of the research and for thetreatment of subjects who suffer injuryas a consequence of the research as wellas the availability of services to makea beneficial intervention developedas a result of the research reasonablyavailable to the population.Guidelines 20 and 21 both fall under theIslamic principles of justice and charityand that of reparation previouslydiscussed.Summary of the Differences BetweenThe Islamic Viewpoint and CIOMSGuidelinesFew differences exist between the twodocuments. A major difference is theimportance that Islam puts on ‘publicinterest.’ It takes precedence overprivate interest in special cases. Thiscontrasts with guideline eight as well aswith the Declaration of Helsinki.CIOMS guideline 14 requires theconsent of the guardian for a child toparticipate in research study. UnderIslamic rulings this is also necessarybut the permission of the guardianis legitimate under strict conditionsoutlined above. Further, the CIOMSguideline stipulates that the assent ofthe child should be obtained if possible.Islamically, that is not required. At thesame time, the child’s objection toparticipation in the study is not to beaccepted if the guardian believes thatparticipation is beneficial. On the otherhand, the CIOMS guideline respects achild’s objection to participate.When recruiting a married woman forresearch, it is Islamically preferable toobtain the husband’s consent. This isnot included in CIOMS guideline 16.When recruiting a pregnant womanfor a research study, if there is anypotential risk to the fetus even whenminimal or outweighed, the husband’sconsent should be obtained accordingFIMA YearBook 2009150

Ethics of Clinical Researchto Islamic rulings but not according toCIOMS guideline 17.Islamic rulings allow revealingconfidential information if it bringssocial benefit or prevents public harm.This is not mentioned explicitly inCIOMS guideline 18 but is implied incertain situations. The concept of publicversus private interest is again invokedhere as in the discusson about guidelineeight. It needs further elaboration byIslamic scholars.Another difference relates to guideline19. Whereas Islamic rulings willallow waiving of liability againstthe investigator(s) under certainconditions, the guideline prohibits suchwaivers. I expressed my stand againstthe waiver.Integrity in Clinical ResearchIt has been stressed in guideline1 and in the Islamic prerequisitesfor research that the investigatorsshould be qualified and competent toconduct the study by virtue of theireducation and experience. I believeit is important to add that they needto be honest. Although honesty isimplied in competency, it is betterand more practical to have it as aseparate trait. Integrity or honestycan be manifested in two aspects. Thefirst is for an investigator, upon notingunexpected side effects or harm to thestudy subjects, to discontinue the studyand notify the concerned IRB or ethicsreview committee. An example ofthis has been reported. (32) The secondaspect is to never falsify researchdata. Unfortunately, there have beeninstances of “competent” researchersfalsifying data.Article 30 of The Declaration ofHelsinki touches on the subject:Authors, editors and publishers allhave ethical obligations with regardto the publication of the results ofresearch. Authors have a duty to makepublicly available the results of theirresearch on human subjects and areaccountable for the completenessand accuracy of their reports. Theyshould adhere to accepted guidelinesfor ethical reporting. Negative andinconclusive as well as positive resultsshould be published or otherwise madepublicly available. Sources of funding,institutional affiliations, and conflictsof interest should be declared in thepublication. Reports of research not inaccordance with the principles of thisDeclaration should not be accepted forpublication. (17)These points can not be stressedenough. Islam stresses honesty andtruthfulness. It abhors false testimonyunder which falsification of scientificdata falls:“O you believe! Be staunch in justice,witness for Allah even though it beagainst yourselves or your parentsor your kindred …” (33)“...So shun the filth of idols, andshun lying speech” (34)FIMA YearBook 2009151

Ethics of Clinical ResearchConclusionIn this paper I presented the current ethical principles embodied in the HelsinkiDeclaration and the guidelines established by CIOMS for the application of theseprinciples. They are mostly in conformity with Islamic law. I did point out some ofthe differences. Some of these are outlined in the “International Ethical Guidelinesfor Biomedical Research (An Islamic Perspective).” Other differences represent mypersonal viewpoints.It behooves Muslim researchers to fully abide by these principles and guidelines.Muslims who have taqwā (God consciousness) should be the first to promulgatethose ideals as we are given the privilege by Allah (SWT) to care for His mosthonored creation, humans.FIMA YearBook 2009152

Ethics of Clinical ResearchReferences1. Khan FA. Clinicians as effective researchers.J Islam Med Assoc. 2010;42:9-14. Availablefrom http://jima.imana.org/article/view/4846.2. Muazzam MG, Muazzam N. Importantcontributions of early Muslim period tomedical science. I. Basic sciences. J Islam MedAssoc. 1989;21:8-13. Available from http://jima.imana.org/article/view/5513.3. Muazzam MG, Muazzam N. Importantcontributions of early Muslim period tomedical Science. II. Clinical sciences. J IslamMed Assoc. 1989;21:64-70. Available fromhttp://jima.imana.org/article/view/5514.4. Khan HR. Contribution of Muslims tomedicine and science: up to the middleof thirteen century. J Islam Med Assoc.1982;14:111-4. Available from http://jima.imana.org/article/view/5526.5. Haddad FS. Original contributions ofphysicians during the Islamic era. J Islam MedAssoc. 1996;28:103-12. Available from http://jima.imana.org/article/view/5530.6. The Glorious Quran Chapter 96, Verses 1-5.7. The Glorious Quran Chapter 20, Verse 114.8. The Glorious Quran Chapter 86, Verse 5.9. The Glorious Quran Chapter 88, Verses 17-20.10. The Glorious Quran Chapter 27, Verse 64.11. Sunan Abī Dāwūd. Kitāb al-Tibb.Bāb fīal-adwiya al-makrūha. Hadith no. 3874.Available from http:// www.muhaddith.org.12. Pressel DM. Nuremberg and Tuskegee: lessonsfor contemporary American medicine. J NatlMed Assoc. 2003;95:1216-25. Available fromhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2594827/.13. Vonderlehr RA, Clark T, Wenger OC etal. Untreated syphilis in the male Negro: acomparative study of treated and untreatedcases. JAMA. 1936;107:856-60. Availablefrom http://jama.ama-assn.org/cgi/content/summary/107/11/856.14. Schuman SH, Olansky S, Rivers E et al.Untreated syphilis in the male Negro:background and current status of patientsin the Tuskegee study. J Chronic Dis.1955;2:543-58. Available from http://dx.doi.org/10.1016/0021-9681(55)90153-3.15. Olansky S, Schuman SH, Peters JJ et al.Untreated syphilis in the male Negro:X. Twenty years of clinical observationof untreated syphilitic and presumablynonsyphilitic groups. J Chronic Dis.1956;4:177-85. Available from http://dx.doi.org/10.1016/0021-9681(56)90019-4.16. Rockwell DH, Yobs AR, Moore MB. TheTuskegee study of untreated syphilis: the30th year of observation. Arch InternMed. 1964;114:792-8. Available fromhttp://archinte.ama-assn.org/cgi/content/summary/114/6/792.17. 59 th World Medical Association GeneralAssembly. Declaration of Helsinki: ethicalprinciples for medical research involvinghuman subjects. 2008. Available from http://www.wma.net/en/30publications/10policies/b3/17c.pdf.18. The National Commission for the Protectionof Human Subjects of Biomedical andBehavioral Research. Department of HealthEducation and Welfare. The Belmont Report.Ethical principles and guidelines for theprotection of human subjects of research.April 18, 1979. Available from: http://www.hhs.gov/ohrp/humansubjects/guidance/belmont.htm.19. Council for International Organizationsof Medical Sciences. International ethicalguidelines for biomedical research involvinghuman subjects. Geneva: World HealthOrganization; 2002. Available from: http://www.cioms.ch/frame_guidelines_nov_2002.htm.20. Islamic Organization for Medical Sciences.International ethical guidelines for biomedicalresearch involving human subjects “an Islamicperspective.” In El-Gendy AR, Al-AwadiARA, editors. The international Islamic codefor medical and health ethics. Kuwait: IslamicOrganization for Medical Sciences; 2005:Vol2, 121-276.FIMA YearBook 2009153

Ethics of Clinical Research21. Beauchamp TL, Childress JF. Principles ofbiomedical ethics. 5 th ed, Oxford (UK) andNew York: Oxford University Press; 2001.22. Glorious Quran, Chapter 17, Verse 70.23. Glorious Quran, Chapter 16, Verse 90.24. Glorious Quran, Chapter 2, Verse 102.25. Sahih Muslim. Siddiq AH, translator. Lahore:Sh. Muhammad Ashraf; 1987: 1425, hadith no6568.26. Glorious Quran, Chapter 4, Verse 58.27. Jalāl al-dīn al-Suyūti. Al-Jāmi` al-Saghīr. Vol2. Chapter of Alif. Hadith no 1861. Availablefrom http://muhaddith.org.28. Chiarelli LC. Muslim Sicily and thebeginnings of medical licensing in Europe. JIslam Med Assoc. 1999;31:79-82. Availablefrom http://jima.imana.org/article/view/5551.29. Glorious Quran, Chapter 4, Verse 1.30. Vastag B. Helsinki discord? a controversialdeclaration. JAMA. 2000;284:2983-5.31. Sahih Muslim. Siddiq AH, translator. Lahore:Sh. Muhammad Ashraf; 1987: 1365, hadithno. 6426.32. Straus SE. Unanticipated risk in clinicalresearch. In: Gallin JI, Ognibene FP, editors.Principles and practice of clinical research. 2 nded. New York: Elsevier; 2007: 78-94.33. Glorious Quran, Chapter 4, Verse 135.34. Glorious Quran, Chapter 22, Verse 30.FIMA YearBook 2009154

Quality Assurance and AccreditationIn Medical Education: An Islamic PerspectiveMohammad Iqbal Khan*, and Anis AhmedAbstract:Quality control in higher education has become an essential part of the educational processat all levels. Most of the educational objectives can be quantified and standardized usingquality assurance mechanisms. Market forces and globalization’ are the reasons for theincreasing emphasis on the concept of quality and its impact on the providers of educationprograms. There is increasing need to understand quality assurance and different modalitiesof quality control. In higher education, hybridization of two or three quality control models isrequired to address the most important issues of learning. Quality control demands the crispapplication of tools which must assess and quantify all three basic domains of learning i.e.cognitive, psychomotor and effective domains. Based on these studies a quality managementstrategy is designed for every program. Based on quality management studies, a qualityassurance process is designed which is a continuous process and is frequently modifiedaccording to the emerging situations. A quality culture needs to assure quality controlmechanisms at all levels. It must address the requirements of infrastructure, services, humanresources, selection of students, curriculum, instructional strategies, assessment system,research quality, graduates’ as well as alumni’s performance, student reporting system,academic counsel and faculty development. Benchmarks have become essential tools toimprove the overall look of the institution. Islamic perspectives and concepts of excellence(ihsan) have been greatly emphasized in the Qur’an and the tradition (Sunnah) of ProphetMuhammad (PBUH). Work ethics, responsibility, accountability, sense of being answerable,not only in this life, but also in the hereafter and rewards of proper performance with utmosteffort and best manners makes a believer strives for the best. Responsibilities need to bebestowed according to the best available abilities to achieve the best possible results. On thebasis of Qur’anic teachings and the traditions of the Prophet (PBUH), certain criteria arededuced which every Muslim medical educationist must acquire to achieve and maintain therequired quality assurance in medical education.Keywords: Quality control, quality assurance, medical education, accreditation, Ihsan,excellence, Islamic perspectives.*Mohammad Iqbal KhanMD; FRCS (Eng); FRCS; (Glasg.)Professor and head of the Department of SurgeryIslamic International Medical CollegeRiphah International University Islamabad- PakistanE-mail: mikhandr@gmail.comFIMA YearBook 2009155

Quality AssuranceIntroduction:Quality is the means through whichan institution can guarantee, withconfidence and certainty that thestandards of its educational objectivesmaintained and enhanced. Quality inhigher education is a dynamic processwhich is the outcome of interactionof multiple factors that determinethe state of equilibrium reached atvarious levels. These include, inter alia,leadership, quality of faculty, qualityof students, infrastructure, facilities,research and learning environment,governance, strategic planning,assessment procedures, market forcesand several other factors dependingupon the type, nature and level ofeducational processes. (1)How quality and standards are different?Several keywords, often confused,require to be defined. Firstly, it isimportant to be clear that whereas‘quality’ relates to process (for example,the quality of the educational processexperienced by students), ‘standards’refers to outcomes, or achievement.The link between them can beexpressed in terms of the contributionof the educational process (or ‘quality’),to the attainment of a defined standardof higher education. Secondly, ineducation, standards relate to threeareas of activity: academic standardsmeasure ability to meet a specifiedlevel of academic attainment; servicestandards assess service provided; whilequality standards can be describedas norms or expectations expressedin formal statements about desiredpractice, for example the ENQAStandards and Guidelines. (2)Quality control in medical educationand training comprises activities atdifferent levels of the curriculum ofmedical schools, residency programsand postgraduate education. In Islamictheology quality arises from innermotivation and emanates from ihsan(excellence) which is the greatestachievement in Islamic work afterIslam and iman. Quality culture isan indigenous product of Islamiccivilization. Islam sets quality work andexcellent performance in all spheresof life including education. Qualityand its controlling mechanisms mustpermeate all activities. The Islamicconcept of performance of a job is toachieve excellence. The Prophet saidthat Allah loves ihsan in everything andadvised Muslims to perfect every workthat they undertake.In Western societies the concept ofquality and Total Quality Management(TQM) was introduced in highereducational institutions not verylong ago. However, it has rapidlypermeated the thinking of manyhigher education managers duringthe past several years. It was basicallyintroduced, developed and applied inthe industrial environment where itnot only gained high acceptance, butalso has become a symbol of quality.Institutions have always held academicexcellence and high quality as theFIMA YearBook 2009156

Quality Assurancehighest goals. Achieving these goals waseasier in a time of abundant resourcesand favorable demographics. Theenvironment has changed. Institutionsare facing decreasing enrolments andrevenues while costs and competitionfor students are increasing. Qualityassurance and quality managementhave become an essential part of themanagerial skills in higher education.Quality assurance and quality culture,though an old prerequisite for academicand business attraction, has generatedimmense interest recently with theincreased competition in medicaleducation and market requirements.At present, it is addressed in numerousacademic and trade publications, by themedia, and in training seminars. It isperhaps the most frequently repeatedmantra among managers and executivesin contemporary institutions of higherstudies and excellence. The main ideaof its application in medical educationis persistence and continuous qualityimprovement, consistency of quality,staff (and student) participation,meeting customer needs, coordination,and management procedures whichdetect poor quality and stimulate good,all have a significant contribution tomake to the development of efficientand effective mass higher educationsystems (3) . We must not forget that everyeffort to achieve the quality in Westernsystems was a market demand ratherthan inner motivation of believers as wesee in Islamic way of life.“Who has created death and life thatHe may test you which of you is best indeed And He is the All-Mighty, the Oft-Forgiving”. (4)The purpose of the creation of thehuman being is to achieve excellencein all his deeds irrespective of one’sprofession, status, education or anyother gain. It is clearly stated inthe Qur’an: “Is there any reward forexcellence other than excellence?” (5)These and many other verses in theQur’an clearly emphasize the qualityconcept and its mechanism in all fieldsincluding education.Quality management in medicaleducationQuality control in medical educationis a recently evolving concept, whichunderwent series of changes sinceits inception. A well-planned systemof education aimed at achieving thegoals and objectives set for it and acomprehensive quality infrastructurefor the productive implementation andsystematic evaluation of that system.Medical education has to be of thehighest quality to produce graduatescapable of delivering the highest qualityof medical care by not only satisfyingthe consumers i.e. patients, theirfamilies, community and employersbut even going beyond the expectationsof everyone.To achieve the set goals, severalmechanisms of quality assurancewere adopted such as Total QualityManagement (TQM) or Total QualityControl (TQC) in industry andFIMA YearBook 2009157

Quality Assurancebusiness. None of these systemsof quality assurance proved to beeffective as a single entity. Totalquality management (TQM) and itsapplication in a health care institutionhas remarkably improved the standardof service provision and professionalsatisfaction. Quality assurance canbe achieved through other models ofquality care as well. There are soundreasons for being quality conscious ina medical organization and especiallywhere teaching and training are alsobeing provided to the health careworkers. (6)There are several reasonsfor today’s quality consciousness:ethical, economical, professionalsatisfaction, customer’s need andothers. Quality assurance should be anessential mechanism operating in anyhealth care facility.However, TQM model alone hascertain inherent difficulties in itsapplications in academic institutions.Many questions of academic interestcan not be answered in the TQMmodel. Experts have proposed othermodels in addition to TQM to addressthe unanswered questions of qualityassurance in academic institutions:Harvey and Knight (1996) presented‘transformation model’ EngagementModel of Program Quality’. (7) Theseprograms invest in five separateclusters of program attributes, eachof which contributes to enriching thelearning experiences for students.These includes: Diverse and EngagedParticipant, Participatory Culture,Interactive Teaching and Learning,Connected Program Requirementand Adequate Resources. Thistheory advances a new perspectiveon program quality management,support for students, faculty and basicinfrastructure. In broad terms, theengagement theory emphasizes studentlearning as the primary purpose ofhigher education.In 1998, Bowden and Marton proposedthe University of Learning Model (8) ,and postulated that in all the commonlyperceived functions of a university:teaching, research or communityinvolvement, the core process is oneof learning, arguing that ‘quality in auniversity context has a lot to do withthe quality of learning and the qualityof learning has a lot to do with qualitiesof different ways of seeing when thelearner widens the range of possibilitiesof seeing the same thing.The University of learning model ismore appropriate because:1. Teaching, research, and service aredistinguished only by the durationand level at which learningtakes place: teaching serves tofacilitate learning at the level ofthe individual student; serviceinvolves learning at the locallevel; and research contributes toknowledge formation on a societywidebasis.2. For students to be able to copewith the unknown future ongraduation, the curriculumFIMA YearBook 2009158

Quality Assurancewould need to be designed sothat students experience variationand develop the capabilities tolook at the situation, discern therelevant aspects, and address themsimultaneously3. It follows that assessment methods,in turn, should contribute toand reflect learning objectives.Assessment tools should be able toidentify students who demonstratemastery over the concepts andskills the course seeks to promote.Assessment should measure notonly what students have learnedbut also the quality of their‘learning’ since this, they argue, isthe most reliable measure of theirfuture effectiveness. The shift froman input-oriented educationalapproach to a learning-focusedapproach requires not onlythat academics develop newapproaches and skills but alsorequires universities to reorganizethemselves. (9)In 1998 Tierney proposed the Modelfor a Responsive University (10) : Thismodel is based on the premise that thepublic will judge the university in termsof the quality of their relationshipsand the quality of the outcomes. Theuniversity should be more responsiblein communications and response,service oriented and meeting the needsof their communities. Every effortis diverted to student requirementsand demand matching the missionstatement of the institution.Proposed strategy for QualityManagement in Our institutions:In light of understanding of differentmodels of quality control in a medicalinstitution, we propose that a hybridmodel of quality control will besuitable for our institutions. For servicedepartments like transport, residences,patient care and other hospital servicesTQM will be suitable to maintain andassesses the quality. To make the processmore comprehensive and practical weneed to apply “university of learningmodel” which addresses the qualityissues in the learning environment, inresearch and developing skills in thestudents. It also assesses the quality ofthe academic staff work and academicprocess as a whole. Quality controlshould be a continuous process andmany more models may be developedand proposed. Quality control processshould not be cumbersome, difficult,and stringent or skeptic in nature.Instead, it should be user friendly andencouraging. Continuous research anddevelopment on regular basis in qualitycontrol mechanisms will make thequality management tools acceptableacross the board. (8)Proposed models of quality managementin teaching and learning:Another aspect of quality medicaleducation is that learning must beholistic, comprehensive and balanced.In other words medical education mustinclude the cognitive, psychomotorand affective domains of knowledge. IfFIMA YearBook 2009159

Quality Assurancewe combine the two systems of qualitycontrol namely TQM and Universityof Learning Models, the quality inalmost all domains can be assured. Butstill there are several areas in highereducation where we need to devisemore comprehensive mechanisms ofquality control. Other models whichare still in use are TransformativeModel clearly focusing on total studentexperience. Another model is based onthe premise that learning is a dialoguebetween participants and providers.Dialogue involves the discussionsbetween learners and teachers aboutthe nature, scope and style of theirlearning. Dialogue also requires adynamic exchange among the teachersabout the teaching and learningprocess.In 1997 Haworth and Conrad proposedthe Engagement Model of ProgramQuality (11) : which is organized aroundthe principal stakeholders – academics,students and administrators engaged inteaching and learning. Based upon anextensive interview of persons involvedin higher education, the authors define‘high quality programs as those whichcontribute to the learning, that provideexperiences for students and havepositive effects on their growth anddevelopment. Five clusters of programsare evolved, each of which contributestowards enriching the learningexperiences for students.1. Diverse and Engaged Participants:faculty (academics), students andleaders.2. Participatory cultures: Sharedprogram direction, Communityof learners, and risk takingenvironments.3. Interactive Teaching and learning:Critical dialogue, IntegrativeLearning, Mentoring, CooperativePeer learning, and Out of Classactivities.4. Connected Program Requirements:Planned Breadth and Depth ofCoursework, Professional Residency,and Tangible Product.5. Adequate Resources: Supportfor students, faculty and basicInfrastructure.In broad terms, the engagement theoryadvances a new perspective on programquality management that emphasizesstudent learning as the primary purposeof higher education and highlights thepivotal role that people – primarilythe academicians, administrators andstudents – play, and provides a templatefor assessing quality. (12)In 1988 the World Federation ofMedical Education held a conferenceat Edinburgh and laid down anorganizational structure at six regionslinked with WHO, UNICEF, UNESCO,UNDP and WORLD BANK to supportand sustain quality medical education.In its first policy statement, called theEdinburgh Declaration, it laid downtwelve principles for reforming medicaleducation. Those principles are:1) Relevant educational settings.2) A curriculum based on nationalhealth needs.FIMA YearBook 2009160

Quality Assurance3) Emphasis on disease prevention andhealth promotion.4) Life long active learning.5) Competency based learning.6) Teacher’s training as educators.7) Integration of science with clinicalpractice.8) Selection of entrants for noncognitiveas well as intellectualattributes.9) Co-ordination of medical educationwith health care system.10) Balance production of doctors.11) Multi-professional training and12) Continuing medical educationWHO proposed to medical colleges theworld over to produce doctors, whocan: “assess and improve the qualityof health care, make optimal use ofnew technologies, promote healthylifestyles, reconcile individual andcommunity health requirements andwork efficiently in teams”.It is therefore crucial to develop amodel of quality management inall institutions and make them thecenters of excellence in their respectivespecialties.Quality Assurance ProcessQuality management is theresponsibility of the top management.The top management should leadby example. In order to achievethe above, in addition to patience,participatory management amongwell-trained and educated partnersis crucial to the success of TQM andUniversity of Learning model ineducation; everyone involved mustunderstand and believe in principles.Personnel who are committed to theprinciples can facilitate success withthis strategy. Their vision and skills inleadership, management, interpersonalcommunication, problem solving andcreative cooperation are importantqualities for successful implementationof this set of strategy. (13)Continuous progress and ongoingprocess of Quality ManagementThe work done within the organizationmust be seen as an ongoing process.Quality speaks to working on thesystem, which must be examinedto identify and eliminate the flawedprocesses that allow its participantsto fail. Since systems are made up ofprocesses, the improvements made inthe quality of those processes largelydetermine the quality of the resultingproduct. Continuous research,evaluation audit and audit of auditwill make the quality assurance systemmore competent and more reliable.Quality Assurance and QualityCulture in Medical EducationMedical education has become a moreglobal phenomenon than merely aneducational process. The competitorsare global and are no longer confinedwithin national boundaries. Winnersof the competition are those with thehighest quality in terms of productsand services. Quality assuranceprograms have been set up by thestates and medical professional bodies.FIMA YearBook 2009161

Quality AssuranceAccreditation and recognition ofdegree programs depends upon qualityculture in the respective universityat all levels and is being monitoredby the respective bodies. Since, in theglobalized economy, people seek workoutside their country of birth, henceit is very important to ensure thatmedical qualifications of the mothercountry are accepted worldwide (14).This acceptance will occur only if thehighest international standards ofquality are maintained. Cooperationamong various universities and facultiesat national and international levels arenow coming up with formulation ofunified quality assurance guidelinesand criteria. These criteria also providea framework for benchmarking. Thepractical process of quality assuranceincludes setting up a quality assurancesystem, as well as implementation andevaluation of this system. At every levelquality assurance process is to be set upmeeting specific criteria (15) .Human resourcesTeaching facility and academic staffmust be appropriately qualified, trainedand experienced. Appointment andpromotion of academic staff shoulddepend only on academic merit,suitability and character. Good staffmeans high quality. The minimumqualification for basic medical sciencelecturers is a doctoral degree. Clinicalteachers must have the professionalspecialist qualification for theirrespective fields. All academic staffmust undergo training workshopsand courses on pedagogical strategiesand teaching methodology includingwriting course descriptions, learningobjectives, lesson planning, effectiveuse of audio-visual aids, and assessmentsystems. The teacher to studentratio could vary by department andnature of discipline but must be fixedand documented in the QA manual.The university must have personnelpolicies that motivate the academicstaff to produce their best. Financialand administrative proceduresmust be clearly spelled out in a staffhandbook. Faculty members must beaware of the disciplinary measuresto be taken in case of violation of anyrules and regulations. It should bemandatory for all teachers to upgradetheir knowledge, skills and trainingby participating in conferences andspecial training workshops, courses orseminars (16) . In this coyest, it has beenstated:“Anyone who stops learningis old, whether at twenty or eighty”“Be a student so long as you still havesomething to learn, and this will meanall your life”. A Muslim Educationistis a life long learner and continuouslyimproves his knowledge and skills. Thisis considered continuous performanceof righteous deeds: Allah’s Messenger(PBUH) said: “The best loved deeds toAllah are the ones that are continuouseven if they are not very many.” (17)The best of deeds are the mostconsistent of them.” (18)Pedagogical tools and curricula:Well-documented and holisticFIMA YearBook 2009162

Quality Assurancecurricula that must reflect a statedunderlying vision and mission of thefaculty is required. All basic domainsof education including knowledge,skills, and attitudes should beadequately covered in these medicalcurricula with full integration bothvertically and horizontally. Theyshould be benchmarked against thebest faculties of medicine in the regionand internationally. They should alsobe accredited by the national medicallicensing and regulatory authorityto make sure that graduates will beregistrable and employable in the localhospitals. Quality in medical educationalso implies the recognition of thefinal qualification by other universitiesespecially overseas. However, denialof recognition does not alwaysindicate poor quality because politicalfactors might be responsible for suchrejections.The exponential growth in medicalknowledge and continuous research inmedical education requires continuousrevision of the teaching strategiesand curricula. These reviews shouldresult in refining, redirecting, andrestructuring the curriculum. Theprocess of curriculum review shouldbe evolutionary and not revolutionary.Abrupt changes and redoing everything might raise serious issues inthe learning and educational process.Therefore such actions should begradual and well consulted (19) .All learning resources must be adequate,fully supported by the requiredliterature and audio visual aids. Qualitystarts from the facilities, infrastructureand management. If those are done wellonly visionary and qualified teachersare needed to ensure quality products.Library books, digital libraries, learningresource centers and internet access areessential prerequisites for achievingquality education (11) .The evaluation system of studentsreflects its quality management andcontrol. Commencing from theenrollment of the students duringthe course and exit assessments, bothsummative and continuous, reflect thepreparation of the students and qualityof the end product. A systematicassessment scheduled accordingly andwell designed standing procedures ofassessments and exams are essential tomaintain quality of medical education.All faculty members must havewritten policies and guidelines forexaminations and assessment process.Baseline criteria for assessment ofstudents including all three essentialdomains of learning: (cognitive,effective and psychomotor domains),passing score as well as transparency inthe assessment system are hallmarks ofquality assessment.Internal and external examiners areappointed to achieve the requiredstandard of evaluation. To maintainquality, medical educators faculty fromother institutions should be involved asexternal examiners. Their involvementshould include comments on theexamination system; questions as wellFIMA YearBook 2009163

Quality Assuranceas marking a sample of the answer sheetsto make sure those internal markingstandards are comparable to externalones and meeting the requirementsnationally and internationally.Evaluation of the systemAdmitting good students meanshigh quality. Only the best shouldbe admitted. Besides the academicgrades, consideration should begiven to character and motivationto study medicine. Experience hasshown that diversity improves quality.Student counseling services should beprovided for all students. There mustexist mechanisms for identifying andcounseling failing students as early aspossible (20) .Students are the most importantstakeholders in the educationalprocess. Therefore their satisfactionis very important. We have to listento them and address their concerns.We can get student feedback from theexaminations. This feedback is collectedthrough use of questionnaires. Thesequestionnaires are more effective ifadministered regularly usually at theend of each unit or module. Studentsshould be asked to indicate their degreeof satisfaction with each individuallearning objective. If there are toomany objectives we may group theminto natural categories and select afew objectives from each category forinclusion in the questionnaire. Alongthe formal feedback there should bean informal mechanism of feedbackfrom the students and faculty reflectingupon the process of learning as awhole as well as on individual sectorsof learning and education. It is alwaysmore realistic to get feedback from thestudents, faculty members and otherstakeholders during informal meetings.Quality control in research at alllevelsThe quality culture can never beembedded in teaching and learninguntil it is fully supported and enhancedby continuous research and innovationprocess in the university or faculty.The university must allocate fundsfor research. The research budgetshould not be less than one percentof the university operational budget.Academic staff must be given incentivesfor good research. They must be giventime for research. This requires carefulbalancing of teaching and researchwhich may be difficult when there isa shortage of teaching staff. Researchcommittees must exist at the universityand faculty levels. The researchprotocols, strategies and outcomesshould be closely monitored and linkedwith the postgraduate strategy becauseacademic staff undertakes research bydirecting and supervising postgraduatestudents. It is research which measuresthe standard of any faculty or university.It also enhances the academic standardsby making the medical teachers ascreators of knowledge instead of beingonly consumers of knowledge who justpass it on to the students. The researcheralways keeps maintaining a cuttingFIMA YearBook 2009164

Quality Assuranceedge knowledge in his specialty. Qualityresearch addressing the requirementsof society should be based on a strategicplan detailing what is to be achievedwithin the next 2, 5, or 10 or 20 years.The research should be attractive and ofgreat interest and value. Even though itmay be simple but, if it is focused andwell designed, it can still yield usefulresults. Outcome of research must bemonitored by committees of peersand research output shall be judgedfor each individual faculty member aswell as for the faculty as a whole. Thefaculty should have a well representedand empowered research ethicscommittee. Research publicationsmust be periodically evaluated andthose having good impact on teachingand learning, as well as patient care,must be rewarded by all possiblemeans. Faculty members should beasked to present their research findingsat all possible levels both nationally andinternationally.In the Islamic reference, research is anintegral part of life of every Muslim,irrespective of his/ her profession or job:”Verily! In the creation of the heavens andthe earth, and in the alternation of nightand day, there are indeed signs for menof understanding. Those who rememberAllah (always, and in prayers) standing,sitting, and lying down on their sides,and think deeply about the creation ofthe heavens and the earth, (saying):“Our Lord! You have not created (all)this without purpose, glory to You!(Exalted are You above all that theyassociate with You as partners). Give ussalvation from the torment of the Fire (26) .In other verses it has been emphasizedwhy it is essential for Muslim scholarsto indulge into research. Those whoare knowledgeable and those who donot acquire knowledge are never equalaccording to Qur’an. “If you don’t knowask those who know“ (27) . “For everynews there is a reality and you will cometo know” (28)Graduate- Alumni follow upThe most important indicator ofthe quality of a medical educationalsystem is the product (graduates).After graduation they take knowledgeand skills learned to the outside world.Their job performance and characterreflects, to a maximum extent, thequality of education they received.Thus a faculty of medicine shouldfollow up and trace its graduates tofind out their performance in practicallife. This tracing and evaluation can bedone through designed questionnairesor through electronic communicationand even via telephone.Students and staff exchange programsExchange of faculty among like-mindedfaculties, regionally and globally, forshort periods as well as for electivesof students and refresher courses forteachers, will also maintain the qualityin a teaching facility. The students canjoin classes in other faculties and thelecturers can give lectures in otherfaculties. In the process they get to drawcomparisons with other faculties. TheyFIMA YearBook 2009165

Quality Assurancemay learn new strategies and methodsthat can be instrumental in improvingtheir faculty (10,22-25,29) .Annual reports of staff and studentsAcademic staff should have annualperformance appraisals of their work.Any deficiencies detected should thenbe rectified. Those contributing morein nurturing quality culture must beappropriately rewarded. Students’annual reports must come from theirmentors on a regular basis. A yearlyreport with critical analysis presentedand discussed in a faculty boardmeeting will lead to improved qualityof knowledge, skills and attitudes of thestudents (22) .Academic council and faculty boardRegular meetings of faculty boardsand academic councils with criticalreview of the educational reports ofongoing academic activities, reviewingexamination questions, and reviewingminutes of monthly departmentalmeetings and academic performance,including research done in a particularfaculty, is an important tool to assurequality.BenchmarkingThe curricula should not be designedand progressed in isolation. Ratherthe curricula in the faculty shouldbe compared with curricula in otherfaculties. This process has now becomeeasier because many universities puttheir curricula on their websites. Thepurpose of benchmarking is not tocopy other’s performance. It servesthe purpose of indicating whether,in general, we are ‘moving with thecrowd’. If a curriculum differs in majorways from comparable institutions, arational explanation must be found.Other approaches to benchmarkingcould be achieved by registeringstudents to take international medicalexaminations. In USA there is MCATand USMLE examinations. The MCATexamination is taken by pre-medicalstudents. The USMLE I examination istaken by students who have completedthe medical sciences curriculum. TheUSMLE II is taken at the end of clinicaltraining. GMC of UK has designedtheir own system of evaluation ofquality products. The same is done byother countries to assure quality intheir respective environments. Manycountries now stress on adequatelinguistic proficiency which is used asthe medium of educational process (23) .English has become an internationallanguage of scientific and professionalcommunication. Internet informationis predominantly in English. Thereforequality teaching and quality learningrequire mastery of the English language.Special courses of English proficiencyshould be conducted for students andacademic staff whenever it is requiredin the faculty or institution (24, 29) .Quality Assurance is an IslamicconceptIhsan (Excellence) in the Qur’anFourteen centuries ago, Islam enjoinedFIMA YearBook 2009166

Quality Assuranceperfection in all domains of humanendeavors. The Prophet (PBUH) laidthe foundation for quality assurancewhen he said:”Verily, Allah loves thatwhenever any one of you performs anykind of work, he should perfect it” (30) .The Qur’an and Sunnah, describe aconcept which is pivotal in the workculture and ethics of any individual,organization, society and nation, thisis the concept of Ihsan. Ihsan is asupreme and superlative concept ofexcellence based on purity of intent,sincerity, righteousness and true loveand obedience to the Creator, in pursuitof His pleasure in every sphere of life,including seeking the best interests ofHis creation.The Qur’an describes this quality as thebasic reason for the creation of humanbeings and the blessings of divinerewards for the pursuit of excellentdeeds: “Who has created death and lifethat He may test who of you is the bestin deeds” (31) .“Is there any reward for ihsan (excellence)other than ihsan” (32) .Based on these noble and pristine values,a Muslim educationist strives diligentlyto acquire the best possible abilities andcapabilities to train and educate newgenerations of professionals who willcontinue to maintain and perpetuatethe highest moral values and quality ofhuman care. and they would undertakethis task with utmost sincerity, genuineinterest and unparalleled zeal guidedby the benchmark ethics and goldstandards of human behavior.Islam enjoins and sets rewards forpursuit of knowledge: “Allah will exalt indegree those of you who believe, and thosewho have been granted knowledge” (33) .“Allah makes the way to Jannah(Paradise) easy to him who treads thepath in search of knowledge” (34) .A very high sense of responsibilityand accountability is a moral valuethat Islamic teachings imbues in thehearts and minds of Muslims. There isno better quality control mechanismcompared to Qur’anic and Propheticguidance which inspires the best formsof behavior in the believers, giving themost comprehensive and perfect modelof quality assurance of the highestforms:“And pursue not that of which thouhastno knowledge, for every act of hearingor of seeing or of (feeling in) the heartwill be enquired into (on the Day ofReckoning” (35) .“Then shall anyone who has done anatom’s weight of good, see it! And anyonewho has done an atom’s weight of evil,shall see it” (36) .Thus, a Qur’anic model of qualityassurance in learning and educationprovides the most efficient and idealmechanism of quality control at alllevels and every step of the educationalprocess. Not only it controls thephenotypic quality assurance, butevery follower of this system has thegenotype correction as well, which is adeep stimulant to remain upright andtruthful in every walk of life (1) .FIMA YearBook 2009167

Quality AssuranceReferences1.Al-Abd OM. Islamic Organization forMedical Sciences. Islamic Law Ruling onCertain Medical Questions-The Argumentand Supporting Evidence, 2004. [on-line]Available from: http://www.islamset.com/ioms/Code2004/Islamic_vision2.html.2. Argyris, C. & Schon, D.A. [1978].Organisational Learning: A Theory of ActionPerspective,Reading: Addison Wesley.3. Bensimon, E.M. [1995]. “Total QualityManagement in the Academy: A RebelliousReading”,Havard Educational Review, vol.65,no.4, pp. 593-611.4. Glorious Qur’an: 67,2.5. Glorious Qur’an: 55,60.6. Birnbaum, R. & Deshotels, J. [1999]. “Hasthe Academy Adopted TQM ?”, Planning forHigher Education, vol.28, no.1, pp.29-37.7ICIT-2002: Developing a Holistic Model forQuality in Higher Education 19/04/02 13:44Srikanthan and Dalrymple7.Harvey, L. & Knight, P.T. [1996]. TransformingHigher Education,Society for Research intoHigher Education and Open University PressUK.8. Bowden, J. & Marton, F. [1998]. The Universityof Learning - beyond Quality and Competencein Higher Education, first edition, KoganPage, London, UK.9. Bowden, J., Hart, G., King, B., Trigwell, K.& Watts, O. Generic capabilities of ATNuniversity graduates: http://www.clt.uts.edu.au/ATN.grad.cap.project.index.html.10. Tierney, B. [1998]. Responsive University:Restructuring for High Performance, JohnHopkins University Press.11. Haworth, J.G. & Conrad, C.F. [1997].Emblems of Quality in Higher Education,Allyn and Bacon. Julius, D.J. [2000]. “BookReview”, The Journal of Higher Education,vol.71, no.3, pp. 373-6.12.Boyer, E.L. [1987]. College: UndergraduateExperience in America, Harper and Row, NewYork.13.Brigham, S.E. [1993]. “TQM :Lessons We CanLearn From Industry”, Change, May/June,vol.25,no.3, pp. 42-48.14.Duke, C. [1992]. The Learning University:Towards a New Paradigm?, Society forResearch into Higher Education and OpenUniversity Press, UK.15.Freed, J.E., Klugman, M.R. & Fife J.D. [1997].A Culture for Academic Excellence, TheGeorge Washington University, WashingtonD.C., USA.16.Harvey, L. [1995a]. “Beyond TQM”, Qualityin Higher Education, vol.1, no.2, pp. 123-146.17. Al-Bukhari, Book 55, #644.18. Tirmidhi, #1235.19.Harvey, L. [1995b]. “The new collegialism:improvement with accountability”, TertiaryEducation and Management, vol. 2, no.2, pp.153–160.20. Lenning, O. T. & Ebbers, L.H. [1999]. ThePowerful Potential of Learning Communities:Improving Education for Future, ERICClearinghouse on Higher Education,Washington DC, USA.21.Lieberman, D. & Wehlburg, C. (Eds.)[2001]. To Improve the Academy: (Volume19) Resources for Faculty, Instructional,and Organizational Development, AnkerPublishing Company, Inc,Bolton, MA , USA.22.Newby, P. [1999]. “Culture and Quality inHigher Education”, Higher Education Policy,no.12, pp. 261-75.23.Piper, D.W. [1996]. “Identifying GoodPractice in Higher Education”, Proceedings ofthe 8 th International Conference on AssessingQuality in Higher Education , Gold Coast,Australia, pp.117-123.24.Senge, P.M. [1990]. Fifth discipline, Reprinted,Random house, Australia. Senge, P.M.,FIMA YearBook 2009168

Quality AssuranceRoberts, C., Ross, R. B., Smith, B.J. & KleinerA. [1994]. The Fifth Discipline Field book,Nicholas Brealey, London, UK.25. Sims, S.J. & Sims, R.R. [1995]. TotalQuality Management in Higher Education–Is it working? Why or why not?, Praeger,London,UK.26. Glorious Qur’an: 3,190-191.27. Glorious Qur’an: 16,43.28. Glorious Qur’an: 6,67.29.Smith, B. L. & McCann, J. (Eds.) [2001].Reinventing Ourselves: InterdisciplinaryEducation, Collaborative Learning, andExperimentation in Higher Education, AnkerPublishing Company, Bolton, MA, USA.30. Al-Bayhiqi, Vol 6, ch.32: 66.31. Glorious Qur’an: 67,2.32. Glorious Qur’an: 55,60.33. Glorious Qur’an: 58,1.34. Sahih Muslim, Book 35, #6518.35. Glorious Qur’an: 17,36.36. Glorious Qur’an: 99,7-8.FIMA YearBook 2009169

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Instructions To AuthorsAuthors should submit a statement indicating that their opinions do not reflect theopinions or policies of the institutions with which they are affiliated if required bythose institutions.Authors are also expected to submit a statement informing the editor of anycommercial association that might pose a conflict of interest.Manuscript Preparation1. Print the manuscript on one side only of white bond paper, 22 by 28 cm (8.5by 11 inches) in size, with 2.5-cm (1-inch) margins at top, bottom and sides. Itshould be double-spaced throughout.2. Begin each of the following sections on a separate page: title page, abstract andkey words, the text, acknowledgements, references, individual tables and legendsof figures (if any). Number the pages consecutively beginning with the title page.3. The title page should contain:(a) the title of the article.(b) names of all authors (first name, middle initial, and then last name).(c) highest degrees of each of the author(s).(d) name(s) and address(s) of the institution(s) with which the authors areaffiliated.(e) name, address, phone number, fax number, and e-mail address of the authorwho assumes all responsibility for correspondence with the editors.4. The abstract should be limited to 200 words and double-spaced, with therequired margins and headed by the title of the article and name(s) of author(s).Below the abstract, list three to five key words or short phrases for indexingpurposes. Whenever possible, use the terms from the Medical Subjects list ofIndex Medicus.5. The manuscript text should be divided into appropriate headings.Quoting Qur’anic verses and Ahadith is encouraged. The quotation should be onFIMA YearBook 2009171

Instructionsa separate line in the text. It should be given a reference number in the text andlisted in the reference section. See examples in the Reference Section.6. Use standard abbreviations only. Abbreviations should not be used in thetitle and should be avoided as much as possible in the abstracts. In the text,abbreviations should be kept to a practical minimum. The full term for whicha given abbreviation stands should precede its first use in the text, unless it isa standard unit of measurement. Consult Scientific Style and Format by theCouncil of Science Editors (www.councilscienceeditors.org) or the AmericanMedical Association’s Manual of Style.9. References should be numbered consecutively as they appear in the text. Use theformat of the Uniform Requirements for Manuscripts Submitted to BiomedicalJournal (www.icmje.org). Journal titles should conform to abbreviations used inCumulated Index Medicus.a. Standard journal article: List all authors if three or fewer. If more than three,list the first three authors followed by et al.Example: Halpern SD, Ubel PA, Caplan AL. Solid-organ transplantation in HIVinfectedpatients. N Engl J Med. 2002 Jul 25;347(4):284-7.b. Organization as author:Example: Diabetes Prevention Program Research Group. Hypertension, insulin,and proinsulin in participants with impaired glucose tolerance. Hypertension.2002;40(5):679-86.c. No author given:Example: 21st century heart solution may have a sting in the tail. BMJ.2002;325(7357):184.d. Personal author(s) of books and monographs:Example: Murray PR, Rosenthal KS, Kobayashi GS, Pfaller MA. Medicalmicrobiology. 4th ed. St. Louis: Mosby; 2002.e. Editor(s), compiler(s) as author:Example: Gilstrap LC 3rd, Cunningham FG, VanDorsten JP, editors. Operativeobstetrics. 2nd ed. New York: McGraw-Hill; 2002.f. Author(s) and editor(s):Example: Breedlove GK, Schorfheide AM. Adolescent pregnancy. 2nd ed.Wieczorek RR, editor. White Plains (NY): March of Dimes EducationFIMA YearBook 2009172

Services; 2001.Instructionsg. Chapter in a book:Example: Meltzer PS, Kallioniemi A, Trent JM. Chromosome alterations inhuman solid tumors. In: Vogelstein B, Kinzler KW, editors. The genetic basisof human cancer. New York: McGraw-Hill; 2002. p. 93-113.h. Conference proceedings:Example: Harnden P, Joffe JK, Jones WG, editors. Germ cell tumours V.Proceedings of the 5th Germ Cell Tumour Conference; 2001 Sep 13-15;Leeds, UK. New York: Springer; 2002.i. Newspaper article:Example: Tynan T. Medical improvements lower homicide rate: study sees dropin assault rate. The Washington Post. 2002 Aug 12;Sect. A:2 (col. 4).j. Audiovisual material:Example: Chason KW, Sallustio S. Hospital preparedness for bioterrorism[videocassette]. Secaucus (NJ): Network for Continuing Medical Education;2002.k. In press:Example: Tian D, Araki H, Stahl E, Bergelson J, Kreitman M. Signature ofbalancing selection in Arabidopsis. Proc Natl Acad Sci U S A. In press 2002.l. Homepage/website:Example: Cancer-Pain.org [homepage on the Internet]. New York: Associationof Cancer Online Resources, Inc.; c2000-01 [updated 2002 May 16; cited 2002Jul 9]. Available from: http://www.cancer-pain.org/.m. Qur’anic Verse:Example: The Glorious Qur’an Chapter 40, Verse 68.n. Hadith from printed volume:Example: Ibn Hajar al-‘Asqalani. Fath al-Bari bi-Sharh Sahih al-Bukhari (TheCreator’s Inspiration in Interpreting the Verified Collection of al-Bukhari).Cairo, Egypt: Al-Bahiyyah Egyptian Press; 1930. Vol 11, p. 405.o. Hadith from database:Example: Sahih Al-Bukhari, Book 79, Kitaab al-Tibb, Chapter 1, Hadith 5354.[on-line] Available from: http://www.muhaddith.org.FIMA YearBook 2009173

Instructions10. Print each table on a separate sheet. Number the tables consecutively and useArabic numerals. Each table must be cited in sequence at an appropriate pointin the text. Each table has to have a caption. These should be brief yet indicateclosely the purpose or content of the table. Each column should be preciselydefined by headings. Abbreviations and special designations should be explainedin a footnote to the table.11. The term figure includes all types of illustrations such as graphs, diagrams,photographs, flow charts, and line drawings. Figures must be cited consecutivelyin the text with Arabic numerals. Figures should be 12.5 cm by 17.5 cm (5 inchesby 7 inches). Consistency in size is strongly preferred. Any special instructionsregarding sizing should be clearly noted. Freehand lettering on the figure isnot acceptable. All lettering must be in proportion to the drawing, graph, orphotograph. Figure legends should not appear on the figure. Multiple figures ona page cannot be accepted.All figures must be submitted in triplicate. Illustrations should be professionallydrawn. Photographs must be sharp and glossy. Do not send negatives or originalartwork. Each figure or photograph should have a label on its back indicatingauthor’s name, figure number and its top (indicated by an arrow).13. Direct quotations, tables, or figures that have appeared in copyrighted materialmust be accompanied by written permission for their use from the copyrightowner and original author along with complete reference information.14. Author(s) is/are responsible for all the statements made in his/their workincluding changes made by the copy editor.Preparation of CDThe manuscript title page, abstract and key words, text, acknowledgements andreferences should be in one file, which can be edited with Microsoft Word 2002.Individual tables (if any) should be in a file called tables.doc, and legends of figures(if any) should be in one file called legends.doc.Figures are encouraged in electronic format with a printed proof on glossy orhigh-quality photographic printer paper.Manuscripts or CDs should be mailed to the Editorial BoardIf submitted electronically use the same guidelines for preparation of manuscriptsand submit to The Editorial Board.FIMA YearBook 2009174