As a resolve of the University of Ilorin, in order to produce doctors that are sensitive to the community health needs of a majority of our populace the College of Health Sciences established the Community Based Experience and Services (COBES) programme as an innovative medical education program. The curriculum is student-centred, community-based and centered around problem-solving. During COBES, medical students are posted to the communities at the 2nd, 3rd, 5th and 6th year of their training with specific learning objectives tailored at the achievement of the cardinal objectives of at the medical college. The students are evaluated through field assessments by faculty members, community based medical personnel, oral and written presentations of reports and written examinations. Some medical schools have remodeled their curricula to accommodate programmes similar to COBES and some of our staff have been resources to other institutions within and outside Nigeria
The College of Health Sciences, University of Ilorin at its inception in 1977, decided to pursue a curriculum which is different in its approach from the older medical schools in Nigeria by the establishment of an innovative medical curriculum with Community Based Experience and Services (COBES) as its fulcrum. It is a programme designed to introduce students to the community at the earliest phase of their medical education with the view to sensitizing them to the community health needs. This exposure presents health problems through which the students learn actively. The students are encouraged and stimulated to be actively involved in their own learning process rather than be passive recipients of information. The curriculum is oriented towards studying medicine in the community using the community as a teaching laboratory and learning environment for studying medicine. The curriculum thus has three pillars: student centered, community based, and problem solving. The working principle of the COBES programme is to create awareness in students to formulate hypothesis, collect, analyze and interpret data, suggest solutions and to evaluate methods, thereby ultimately providing services to the community. The students start their COBES programme in the first eight weeks of the 200 level academic year. The 200 level and the 300 level COBES constitute the pre-clinical programme while 500 level and 600 level postings form the clinical COBES. At each level of the academic year except the 400 level the students spend four weeks each (posting) in the community.
Some of the cardinal objectives of COBES are:
To sensitize the students to community Health needs and enable them to identify themselves with such health needs.
To assist community health efforts and be able to work in any community regardless of the cultural and socio-economic peculiarities.
To develop team spirit towards promotion of community health and to develop individual habits to study.
To encourage students to learn and put into practise basic and applied principles of Epidemiology, statistics and preventive medicine.
There are four COBES postings, spanning the entire undergraduate medical curriculum. Two of these postings take place in the pre-clinical wing of the faculty, each at 200 and 300 levels. The 200 level posting usually takes place immediately following the Cell and Body Defence and Introduction to Body System programmes, eight weeks into the first pre-clinical year. The 300 level posting usually marks the beginning of the 300 level academic year. The remaining two postings, the clinical COBES postings, usually take place during the second and third clinical years, i.e. at 500 and 600 levels, respectively. Each COBES posting has its set of objectives. For example, the minimum learning objectives of the 200 level COBES posting are:
To demonstrate skills in entering a new community with the view of assessing the community health status.
To make a simple map of the community and carry out its census in order to determine the socio-demographic characteristics of the community.
To determine the life pattern of the people and relate its relevance to health.
To identify the existing health facilities in the community and verify their level of utilization.
To identify the social facilities in the community and determine their relevance to health.
To identify the common health problems in the community and the factors that may be responsible for such problems and to prioritise the identify health problems.
To appreciate man and his environment and how the environment is related to health.
To carry out health education that is relevant to the community’s health needs.
To carry out one or two optional projects that are relevant to the community.
To present a properly written report and orally present the same to the College.
Unlike the standardized 200 level minimum learning objectives, the objectives for 300 level COBES are usually based on the World Health Organization (WHO) theme for each year in question. The WHO theme is unveiled April 7th each year at the commemoration of the World Health Day. Thus, the 300 level COBES objectives vary from year to year, depending on the WHO theme for the year. For the 500 level COBES posting, experience has shown that problems relating to maternal and child health need the most urgent attention in most Nigerian communities. Accordingly, the overall, but not exclusive, objectives of this posting generally focus on maternal and child health. The 600 level COBES posting, which comes up towards the tail end of the undergraduate medical curriculum, when practically all postings in Medicine, Surgery, Epidemiology and Community Health, Pathology, Pharmacology, Obstetrics and Gynecology and Child Health and Psychiatry would have been completed, was designed in order to reinforce and improve upon the gains of the 500 level COBES. At each level the students are assessed and scored based on laid down criteria during the oral presentation of their report, a written examination at the end of the posting and field assessment by the supervisors who are both college faculty members and senior health workers at the communities of posting.
Over the years COBES has been able to achieve the following:
Early exposure of the students to health problems (student-centred, problem-solving);
Enhanced the maturity of our students as demonstrated by confidence exhibited at clinical and scientific presentations (student-centred problem-solving);
Community awareness of health problems through dissemination of yearly World Health Organization (WHO) themes (community based);
Our products are community friendly and work effectively anywhere: local, state, national and international (community based);
Because of COBES our College and University of Ilorin has been designated a WHO collaborating centre for Innovative Medical Education and Manpower Development in community based medical education and we are also member of the NETWORK (International Network of Community Oriented Institutions for the Health Sciences) based in Maastricht, the Netherlands; and
The posting of heightened commitment of the students’ participation in special health programmes e.g. Guinea worm eradication campaign, mectizan distribution for the prevention of Onchocerciasis, Malaria prevention, Immunization against childhood diseases, HIV/AIDS awareness and control, etc..
By using the COBES programme the College of Health Sciences of the University of Ilorin has been producing doctors who are sensitive to community health needs and capable of working in any community through team spirit and scientific principles in solving community health problems.
An enviable medical innovation in medical education, first of its kind in Nigeria to:
Integrate basic and clinical sciences horizontally and spirally.
Stimulate medical students to self-discover their abilities as well as offer some service to the community.
Help to maintain continuity with the community over a long period during which health improvements can be measured.
Enhance production of young doctors that are committed to work in the rural communities and primary health care centres (PHC) which hitherto wouldn’t have been possible, thereby contributing to the achievement of the millennium development goals (MDG) in Nigeria
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