Roll Back Stroke: The Way Forward for Physicians and Patients

The 6-lettered word "Stroke" is an ancient disease, likened Biblicallyto "666" in Revelation 13 verse 18. Globally, it is the commonestcause of acquired long-term disability. While its incidence has beendeclining in high-, low/middle-income countries (LMICs) have witnessed an increase. This increase is driven byepidemiologic-transition/modernizatio n-complex, healthcaredisparities, and increasing prevalence of vascular risk-factors. Despitethe disproportionate burden of stroke in LMICs, these countrieshave the lowest rate of access to acute reperfusion-interventions leadingto greater stroke-related morbidity /mortality. Effective primordial,primary, secondary, and quaternary prevention-strategies coordinated at all levels of care are needed to reduce stroke incidenceand poor outcomes. The World Stroke Organization (WSO) hasproposed achieving global primary prevention through 1) Population-wide approach to limiting stroke risk-factors exposure, 2) App-basedmotivational population-wide approach to mitigating stroke risk-fa cto rs, 3 ) u se of lo w-co st co mbi n at io n /po ly- p il l to tre at hypertension/dyslipidemia and 4) addressing behavioural risk-factorsthrough interventions by community health-workers.The need to set-up stroke-units, post-hospitalisation rehabilitation-centres, stroke-registers/registries, stroke-clubs, and encouragecommunity health-education, must be emphasised for optimal care inLMIC.13 Community Health Empowerment (CHE) withthe AcronymBE FAST / STRoke as warning signs of stroke must be emphasised(B: Balance-loss; E: Eye vision-loss; F: Facial Asymmetry; A: Armweakness; S: Speech difficulties; T: Time is brain; Or first 3-lettersof STRoke ­ Can Patient Smile? Talk? Or Raise-arm?). Strokehemorheology/blood-flow and treatment involve 3Ps' of pathogenicprinciples/strategies (Passenger, Passage, Power). Its complicationsinclude the 10D's: Death, Disability, Depression, Dementia, Delirium,Dysphagia, Dehydration, Deep-Venous Thrombosis, Decubitus-ulcers, Dysphasia, Seizures.

Hipólito Unanue en Cádiz / Hipolito Unanue in Cadiz

RESUMEN La participación de Hipólito Unanue en las Cortes de Cádiz no ha sido objeto de una investigación detallada que permita conocer su actuación pública y privada durante la estancia en España. El objeto del presente artículo es hacer un primer acercamiento a este episodio poco estudiado de la vida del "padre de la medicina peruana".

ABSTRACT Hipólito Unanue's participation in the Cortes of Cádiz has not been the subject of a detailed investigation that allows to know his public and private performance during his stay in Spain. The purpose of this article is to make a first approach to this under-studied episode of the life of the "father of Peruvian medicine".

Dr. Eduardo Sabas Alomá, profesor de la Escuela Cubana de Medicina

El Dr. Eduardo Sabas Alomá cursó la carrera de Medicina en la Universidad de La Habana y realizó estudios de postgrado en las universidades Harvard, Estados Unidos y San Marcos, Perú. Participó en actividades revolucionarias y políticas contra el gobierno del dictador Gerardo Machado que lo condujeron al exilio en los Estados Unidos, regresó a Cuba en 1937. Después del golpe de Estado de Batista en 1952, fue cesanteado por sus actividades contra el régimen. Profesor de Fisiología en la Facultad de Medicina de la Universidad de La Habana y profesor de Bacteriología de la Escuela de Enfermeras, ubicada en el Hospital Universitario "Calixto García", también trabajó como médico en el propio hospital y en Maternidad Obrera. Al triunfo revolucionario, permaneció en el claustro de profesores de la Escuela de Medicina, mientras que la mayoría renunciaba y marchaba a los Estados Unidos alentados por la contrarrevolución. Fundador del Instituto de Ciencias Básicas y Preclínicas "Victoria de Girón". Profesor Titular de Fisiología.

Dr. Eduardo Sabas Alomá studied Medicine in the University of Havana and carried out postgraduate studies at Harvard University, the United States of America and at the University of San Marcos in Peru. He participated in revolutionary and political activities against the government ruled by the dictator Gerardo Machado that led him to the exile in the United States. He returned to Cuba in 1937. After Batista´s coup d´état in 1952, he was interrupted because of his activities against the regime. He was professor of Physiology in the Medical Faculty of the University of Havana and professor of Bacteriology in the Nursing School located in "Calixto García" University Hospital; he also worked as a doctor in this hospital and in "Maternidad Obrera" Hospital. After the triumph of the Revolution, he was member of the Medical School teaching staff while most of the doctors renounced their professional work and went to the United States of America encouraged by the counterrevolution. He was founder of the Higher Institute of Basic and Pre-Clinical Sciences "Victoria de Girón" and Full Professor of Physiology

Professor Fernando Costa ­ A Man Ahead of His Time

This article describes the milestones in the life Brazil's greatest neurosurgeons, Professor Fernando Costa. Born and raised in the city of Pelotas, RS, Professor Fernando was an exemplary doctor. As former director and professor at the Catholic University of Pelotas, School of Medicine, his courage as well as his ethical attitude and transparency were the central traits of this masterful teacher. He will be eternally remembered as a great physician, teacher, father, husband, grandfather and friend.

Prevalencia y factores asociados a sintomatología depresiva y ansiedad rasgo en estudiantes universitarios del área de la salud / Prevalence of depressive and anxiety symptomatology/traits and its associated factors in university students from a medical faculty

Resumen Los estudiantes universitarios del área de la salud describen una mayor prevalencia de sintomatología depresiva y ansiosa asociada a fallas en su rendimiento académico. La comprensión de esta relación es crucial para la implementación de intervenciones en salud mental. Este trabajo pretende determinar la prevalencia de sintomatología depresiva y ansiedad rasgo y su relación con factores demográficos y asociados con el desempeño académico en estudiantes de pregrado. Se realizó un estudio transversal en 325 estudiantes de medicina de la universidad de Antioquia. De la población estudiada el 30,15% presentó algún síntoma de depresión, mientras que el 26,5% describió alta ansiedad. Los modelos de regresión sugieren que variables académicas como sentir angustia ante una actividad evaluativa, dificultades en la relación con sus compañeros y sentirse decaído explican la presencia de los síntomas/rasgos. Se sugiere implementar estrategias institucionales para mitigar estos síntomas y fortalecer el apoyo psicopedagógico.

Abstract University students from health careers describe a high prevalence of depression and anxiety symptoms. This situation has been associated with lower academic performance. The comprehension of this relationship is crucial for the implementation of interventions in mental health from higher education institutions. This work aims to determine the prevalence of depressive and anxiety symptoms/traits in undergraduate students and its relation with demographic factors and academic performance. We used a cross-sectional approach in 325 medical students from the University of Antioquia. A 30.15% of them described at less one symptom of depression. A 26.5% of the sample reported high anxiety traits scores. The logistic regression models implemented suggested that academic variables such as feeling distress before presenting an academic test; presenting difficulties with their classmates, and feeling sadness, explain the presence of symptoms/traits. To implementing institutional strategies might strengthen the psycho-pedagogical support.

Evaluation of the knowledge level and usage attitudes of the medical students on the medicinal herbs and herbal products: a project of special study module in the first three years of the school of medicine

Background: In this survey, it was aimed to determine the types of medicinal herbs and herbal products, reasons of use and consciousness levels among the medical students in the first three years of the School of Medicine.Methods: A cross-sectional descriptive questionnaire consisting of 50 questions was applied to all the students in the first three years of Dokuz Eyl黮 University School of Medicine between September 1, 2016 and June 1, 2017.Results: The results of 571 participating students were evaluated. Of these students, 301 (52.7%) were females and 270 (47.3%) were males. It was found that 73.4% (n=419) of the students used these products for treatment and mostly consumed linden, sage tea, mint and rosehip. Also, 11.6% of the students had chronic diseases (n=66). It was determined that 69.7% (n=46) of these students having chronic diseases used medicinal herbs and herbal products. Only 12.0% of the students had an opinion about the legal regulations regarding the use of herbs and herbal products in Turkey, while 39.7% of them had no idea, and 48.3% stated that such regulations on this matter were unreasonable. However, 59.7% of the respondents stated that legal regulations were necessary. It was found that the participating students used herbs and herbal products generally for therapeutic purposes without having sufficient knowledge about medicinal herbs; therefore it was necessary to increase their level of consciousness.Conclusions: Medical students neither have adequate medical information about medicinal herbs and herbal products, nor about the regulations on these products. It is crucial to revise the courses in the medical education so that the students would get informed about the regulations as well as potential risks of herbal plants while still in the medical schools.

Integración de contenidos de salud bucal en las carreras de medicina de la República Argentina / Integration of oral health contents to the medical careers in the Argentine Republic

La literatura revela un creciente interés en desarrollar reformas curriculares que integren la medicina y odontología. Sin embargo, en Argentina no hemos encontrado investigaciones referidas a analizar, desde esta perspectiva interdisciplinaria, la presencia de contenidos de salud bucal en las carreras de medicina. El objetivo de este trabajo fue determinar los contenidos de grado y posgrado referidos a la salud buco dental incluidos en las estructuras curriculares de las facultades de medicina de la República Argentina. Para analizar los contenidos de salud bucal incluídos en el grado, se elaboró un cuestionario que se remitió vía correo electrónico a los decanos. Para analizar los contendidos de posgrado fueron relevadas las ofertas publicadas en los portales oficiales de las facultades. La muestra sometida a evaluación fue de 23 facultades de medicina legalmente habilitadas en el territorio de la República Argentina. Cinco instituciones respondieron el cuestionario y sólo tres incluían contenidos de salud bucal en el grado, en materias básicascon bajo impacto potencial en futuras prácticas profesionales y estímulo al trabajo interdisciplinario. No se encontraron actividades de posgrado ofertadas en los sitios web de las facultades de medicina que incluyan temas de salud bucal. Este estudio demuestra poca integración entre la enseñanza de medicina y odontología, evidenciada por la falta de respuesta institucional y el tipo de contenidos incluidos. Sería necesario profundizar esta línea de trabajo utilizando estrategias de comunicación alternativas y evaluando conocimientos y prácticas de médicos graduados (AU)

Desempeño académico estudiantil en el tramo inicial de la carrera de Doctor en Medicina de la Universidad de la República / Academic student performance in the initial section of the Doctor of Medicine degree from the Universidad de la República / Desempenho estudantil acadêmico na parte inicial da carreira de Doutor em Medicina da Universidade da República

En este trabajo se presentan los resultados de una indagación de carácter diagnóstico acerca del desempeño académico de los estudiantes de Medicina en los cursos y exámenes correspondientes al ciclo Básico Clínico Comunitario (semestres 2 al 6 de la carrera) en el lapso 2009 a 2016. Los datos correspondientes a inscripciones, aprobaciones y no aprobaciones de cursos y exámenes se obtuvieron y sistematizaron a partir de fuentes secundarias oficiales de origen institucional. Se realizó un análisis cuantitativo ex-post en un estudio de tipo descriptivo que incluyó análisis estadístico inferencial en uno de sus ítems. El análisis evidenció que: I) en la evaluación de los exámenes predomina como resultado la no aprobación sin embargo en la evaluación de cursos predomina la aprobación; II) recursar tras renunciar a cursos aprobados no mejora el desempeño estudiantil en los cursos; III) el desempeño en cursos y exámenes de una cohorte es superior en los estudiantes que aprueban el examen final de BCC1 en el primer o segundo período que en quienes no lo hacen (test χ2; p < 0,001). Además, existió asociación positiva entre aprobar BCC1 en el primer o segundo período y la aprobación de mayor cantidad de cursos (V de Cramer 0,508; p < 0,001) y exámenes (V de Cramer según períodos 0,813 y 0,727; p < 0,001) en el tramo de carrera considerado. Estos datos constituyen un insumo para la evaluación de la implementación del plan de estudios y de la necesidad eventual de realizar ajustes a la normativa vigente.

This paper presents the results of a research that deals with the academic performance of medical students in the courses and exams corresponding to semesters from 2 to 6 of medical school, which includes basic, clinical and community studies. Data about enrollment, approval and non-approval of courses and exams, between 2009 and 2016, were obtained and systematized from official secondary sources of institutional origin. A quantitative ex-post analysis was performed in a descriptive study that included inferential statistical analysis in one of its items. Results showed:I) non-approval condition predominates in the exams califications, however, approval condition predominates at the courses evaluations; II) recoursing after renouncing to a previously approved course does not improve performance; III) performance in courses and exams of a cohort is better in those students who approved the final exam of BCC1 immediately after course than in those that did not (test χ; p < 0,001). In addition, it was detected a positive association between approving BCC1 immediately after course and the approval of a greater number of courses (Cramer´s V 0.508, p < 0.001) and exams (Cramer´s V according to periods 0.813 and 0.727, p < 0.001) in the considered lapse at medical school. These data will be useful for the evaluation of the curriculum structure implementation and for an eventual adjustment of the current regulations.

Este artigo apresenta os resultados de um inquérito de diagnóstico sobre o desempenho acadêmico dos estudantes de medicina nos cursos e exames correspondentes ao ciclo clínico comunitário básico (semestres 2 a 6 do curso) no período de 2009 a 2016. Os dados para inscrição, aprovação e não aprovação de cursos e exames foram obtidos e sistematizados a partir de fontes secundárias oficiais de origem institucional. Uma análise quantitativa ex-post foi realizada em um estudo descritivo que incluía análise estatística inferencial em um de seus itens. A análise mostrou que: I) na avaliação dos exames, a não aprovação predomina como resultado, no entanto, na avaliação dos cursos, a aprovação predomina; II) voltar a cursar cursos já aprovados não melhora o desempenho dos alunos nos cursos; III) o desempenho em cursos e exames de uma coorte é maior nos alunos que passam o exame BCC1 final no primeiro ou segundo período do que naqueles que não (teste χ2; p <0,001). Além disso, houve associação positiva entre a aprovação de BCC1 no primeiro ou segundo período e a aprovação de mais cursos (Cramer V 0.508; p <0.001) e exames (Cramer V de acordo com os períodos 0.813 e 0.727; p <0.001) no trecho considerado. Esses dados constituem um insumo para a avaliação da implementação do currículo e a eventual necessidade de fazer ajustes aos regulamentos vigentes.

A questão racial na obra de Domingos Guedes Cabral / The issue of race in the work of Domingos Guedes Cabral

Resumo Na Bahia de 1875, a medicina e o evolucionismo foram utilizados pelo médico, jornalista e militante republicano Domingos Guedes Cabral como armas ideológicas para propor um programa radical de reformas sociais no país. O programa incluía diversas propostas no campo da educação, controle dos casamentos, assistência médica aos alienados, mudanças no sistema penal etc., tudo com base em conhecimentos científicos da época. Entre as ideias sociais de Guedes Cabral, a questão racial será nosso principal foco de análise. Nesse sentido, Domingos Guedes Cabral constitui um exemplo particularmente significativo para entender como foram os primeiros passos na peculiar aliança estabelecida entre evolucionismo, medicina e racismo científico no Brasil desde a década de 1870, momento de chegada do darwinismo no país.

Abstract In 1875 Bahia, medicine and evolutionism were used by the physician, journalist, and republican militant Domingos Guedes Cabral as ideological weapons to propose a radical program of social reforms in Brazil in the areas of education, marriage control, medical care to the alienated, changes in the penal system, etc., all of which were based on the scientific knowledge of that time. Among the social ideas of Guedes Cabral, the question of race will be the main focus of this analysis. In this sense, Domingos Guedes Cabral is a particularly significant example for understanding the initial steps in the peculiar alliance between evolutionism, medicine, and scientific racism in Brazil since the 1870s, when Darwinism first arrived in the country.

2. Particularity of educational evaluation in the School of Medicine / 医学教育

<p> Recently, the roles of educators in clinical medicine have increased and diversified, such as lecturers, preceptors in clinical settings, tutors or small-group leaders or facilitators, and educational administrators. In such a situation, clinical faculties are fulfilling their missions as clinical educators, researchers, and clinicians through systematically sharing educational duties with other faculties. A system to evaluate educational achievements is needed that corresponds to the various affairs of faculties and complicated implementation system in clinical medical education. In addition, novel methods that can be used to quantitatively and qualitatively evaluate educational achievements should be established as well as achievements of research and medical care.</p>

El archivo histórico de la Facultad de Medicina: su pasado y su presente / Facultad de Medicina's historical archive: Its past and present

El Archivo Histórico de la Facultad de Medicina, ubicado en el Palacio de la Antigua Escuela de Medicina, se formó y organizó hace poco más de 55 años por el Dr. Francisco Fernández del Castillo. En este repositorio se salvaguarda la memoria institucional desde la fundación del Establecimiento de Ciencias Médicas, hasta mitad del siglo pasado. Con el propósito de dar a conocer este rico legado de la Facultad de Medicina, en este artículo se muestra la historia de su conformación, además de recordar que los médicos egresados de la ahora Facultad de Medicina, abrevaron en el pasado de esa información para la escritura de sus contribuciones histórico médicas.

The Historical Archive of the Faculty of Medicine, located in the Old Palace School of Medicine was formed and organized a little over fifty-five years ago by Dr. Francisco Fernandez del Castillo. In this repository is safeguarded institutional memory from the foundation of the Establishment of Medical Sciences, to mediate the past century. In order to raise awareness of this rich legacy that has the Faculty of Medicine, this article shows the history of its formation, in addition to remember that medical graduates of the old National School of Medicine, drew on the past of that information to the writing medical historical contributions.

Evidence from scores of written examinations in physiology for the lowering of academic performance levels of medical students in Japan / 医学教育

Objectives: The aim of this study was to investigate the yearly changes in scores of medical students’ written examinations in physiology and to find evidence in these scores for the lowering of academic performance levels of medical students in Japan after the number of medical students was increased.<br>Methods: With the scores of examinations in physiology from 2002 through 2012, the mean scores, standard deviations（SD）, the mean±SD, the numbers of students, the numbers of failing students, and the percentages of failing students were examined.<br>Results: The scores of examinations in physiology decreased significantly after the number of medical students was increased.<br>Conclusion: One cause of the lowering of academic performance levels of medical students in Japan is the increase in the number of medical students.

Strengthening the admissions process in health care professional education: focus on a premier Pacific Island medical college / 보건의료교육평가

Relying solely on measures of intellectual aptitude and academic performance in university admissions can be disadvantageous to underprivileged students. The Fiji School of Medicine primarily uses such measures to evaluate and select student applicants, and the introduction of supplementary assessments could provide better access for students from disadvantaged backgrounds. This study examined the need for supplementary assessments in the admission process, types of additional assessments needed, and stakeholders' views on a multi-entry multi-exit strategy currently in use at the Fiji School of Medicine. A survey of the key stakeholders was conducted in February and March 2012 using closed and open ended questionnaire. One hundred and twenty-two validated questionnaires were self-administered by key stakeholders from the College of Medicine, Nursing and Health Sciences (CMNHS) and Fiji Ministries of Education and Health, with a response rate of 61%. Returned questionnaires were analysed quantitatively and qualitatively. Sixty-five percent of respondents supported the introduction of supplementary assessments, 49% favoured admissions test, and 16% preferred assessing non-academic factors. Many respondents supported the School's multi-entry multi-exit strategy as a 'good policy' that provided 'flexibility' and opportunity for students, but should be better regulated. These findings demonstrate the need for supplementary assessments in the selection process and for continued support for the use of multi-entry multi-exit strategy at the school.

La enseñanza y la práctica de la medicina legal en eritrea / Teaching and practice of legal medicine in eritrea

Introducción: Existe en Asmara, República de Eritrea, la Escuela de Medicina Orotta, única de ese tipo en el país; diseñada y fundada por la Colaboración Médica Cubana. Los estudiantes son formados con el programa tradicional cubano y realizan la educación en el trabajo con los médicos del Programa Integral de Salud (PIS) que allá cumplen misión internacionalista, insertados en los centros asistenciales que existen a lo largo de todo el país. El programa incluye la asignatura de Medicina Legal que se imparte durante todo un semestre. Con el arribo de la profesora cubana de Medicina Legal, se iniciaron las actuaciones medicolegales en el país. Objetivo: Informar sobre las actuaciones medicolegales realizadas por primera vez en Eritrea por especialistas cubanos. Método: Se reportan los detalles de las actividades docentes de pre y postgrado y las principales experiencias del trabajo médicolegal asistencial, realizado en Eritrea, a través de un estudio descriptivo y transversal en el período de julio del 2008 a septiembre del 2010. Resultados: En un año de trabajo la cantidad de actuaciones se fue incrementando de manera sistemática y el trabajo medicolegal ganó en organización. A pesar de no haber experiencias en la población ni en el personal de salud del país, la necropsia es una actuación identificada como necesaria y aceptada por la población eritrea. Conclusiones: Se demostró lo necesario que resulta el trabajo en el lugar del hecho, y el trabajo en equipo de los integrantes de la brigada médica cubana. Se confirmó la importancia de la ayuda que brinda el Programa Integral de Salud (PIS) de Cuba a los países en desarrollo.

Introduction:¼Orotta¼ school of medicine in Asmara, Republic of Eritrea is the only one in existence in this country and it was designed and founded by the Cuban Medical collaboration. Students at the school are formed by the traditional Cuban program vinculating them to practical work with Cuban doctors of the integral health program (IHP) that fulfill internationalist mission inserted to the different care centers along the country. Legal medicine is included in this program and it is taught during a complete semester. At the arrival of the Cuban Legal Medicine professor medicolegal performances started in this country. Objectives: Explain about the medicolegal performances made by Cuban specialists for the first time in Eritrea. Method: Details of Pre and Postgrades teaching activities and the main experiences of medicolegal assistance work made in Eritrea are reported through a descriptive and tranversal study in the period of July 2008 to September 2011. Results: Medicolegal performances were sistematically increasing and gained organization in a year of work in spite of the abscence of experience of both, health personnel and population. Necropsies are already accepted and dentified as necessary by Eritrean population. Conclusion: It was proved how important is the team work of the Cuban Medical brigade and the need of working at the scene of facts. The importance of the Cuban help through the Integral Health Program to countries in development was also confirmed.

El doctor Pedro Morán, la Escuela Médica de 1833 y la batalla de Rancagua / Dr. Pedro Morán, the Medical School of 1833, and the Battle of Rancagua

With the foundation of the Medical School of 1833, the figure of Pedro Moran, the first professor of anatomy, physiology and hygiene, stands out. Diverse comments of his acts are recounted, some praising him and others revealing his concealment during the heat of the battle. His humble origins, competence and perseverance in the fulfilment of the teaching duties are extolled.

Junto con la fundación de la Escuela Médica de 1833, se destaca la figura del primer profesor de anatomía, fisiología e higiene, doctor Pedro Morán. Además se exponen diversos comentarios sobre su actuación, como cirujano militar en la batalla de Rancagua, unos alabándola y otros mostrando su ocultamiento durante el fragor de la contienda. Se enaltece su origen modesto, competencia y perseverancia en el desempeño de las funciones docentes asignadas.

Graduate schools of medicine in Japan: The status and problems of researcher training / 医学教育

1) Common training for the introduction of research and the elective and individual guidance for research should be devised in a manner attractive to graduate students of medicine.<BR>2) To train researchers, a graduate school of clinical medicine should be established as a professional school, separate from an ordinary graduate school.<BR>3) To promote basic medical sciences, the capacity of graduate schools of basic medical sciences should be reduced despite the number of teachers and the bold plan for the financial support of students.

New Curriculum at Kyungpook National University School of Medicine / 한국의학교육

The curriculum reform was undertaken at Kyungpook National University School of Medicine (KNUSM) to meet new educational objectives in order to cope with a rapid societal changes anticipated occurring in 21st century. The KNUSM Curriculum Development Committee was charged to formulate a new curriculum, which consisted of enhancement of patient-centered care based clerkship, integrated courses based on organ systems, problem-based learning, and additional teaching on social medicine, medical informatics and biomedical engineering. The philosophy of this curricular reform has been to modify methods of teaching medical students toward self-directed learning and student-centered. This whole concept was a drastic departure from the traditional lecturing. In the new curriculum, total of 180 credit courses, 4395 hours to graduate medical school were reduced to 170 credit courses, 4250 hours. As a part of the social medicine course, a 2 credit-hour course on patient-doctor relationship was taught and two credit-hour PBL tutorials were added to freshman, sophomore and junior years. In order to carry out this education reform, three new departments were inaugurated such as Biomedical Engineering, Medical Informatics and Medical Education. The school facility has also been improved during this preparatory period. The new curriculum has been implemented in 1999 academic year after approximately 4 years of preparatory period and annual faculty workshops have been held to monitor the progress of the reform and improve courses by evaluating impact of the change on both faculty members and students as well. The interim evaluation revealed several issues remained to be resolved. In conclusion, the acceptance of this reform was excellent from both faculty members and students although there have been continuous problem solving and adjustments necessary. The real assessment of the outcome of the reform requires many years to come and there has to be continuous monitoring of the progress and adjustment of curriculum are the pivotal of a success of the sort of education reform.