**1. Introduction**

#### **1.1 Overview**

Medical education process has faced many challenges which have to be considered and have not to be omitted in the current 21th century by clinical educators and administrators. Pandemic covid-19 has invaded the earth and has made forcibly its own characteristic troublesome era [1]. Technology has disseminated and has profoundly integrated in the whole life; social, educational, political, societal, and professional/clinical life with its positive and negative impacts [2, 3]. Moreover, there are other deeply forked challenges into medical education practice, likewise the challenge of practicing clinical education being a secondary mission by many clinicians after their primary clinical profession, the challenge of commercialization of many health institutions, the challenge of narcissism overwhelming phenomenon in clinical skills education regardless ethics regard, the challenge of marketing which has been exploded and has devitalized emotional intelligence, ethical values

and humane morals in medical field communication and the challenge of multitude of variable curricula types, thoughts, models, and aspects that have to be merged to achieve overarching holistic safe and successful medical practice [4, 5]. Continuous change of the medical education process, which has depended and has reflected mainly on curricula reforms, has become indispensable to meet stakeholders and societies' needs.

Indeed, explicit (formal) aligned to implicit (informal) curricula are the flux and estuary of medical education and clinical training that link between educational and administrative aspects [6]. Explicit curriculum is considered the organized systematic plan model that most institutions follow in clinical training [6]. However, implicit curriculum is always extracted and is never separated from practicing the explicit one despite practicing it unconsciously and unsystematically in most times in real world. So, achieving an ideal curriculum is prospective complex aspiration within the upcoming medical education renaissance that has been evolved to encompass many aspects not only knowledge.

Curriculum design, being a sophisticated structure, should be planned considering multitude of factors, not related to content only but also to stakeholders (medical trainees, trainers, patients, administrators, and other healthcare workers) and institutional, environmental and local and global societies' needs [7]. Hence, planning an ideal curriculum, which is suited all these factors, is somehow fallacious and antiquated and this requires pragmatic changes to execute individual, local and global benefits from it. This is closely related to the standpoint in the written articles about general learning issues by the writer, May Zyiada within the first half of 20th century. She advocated, at that time, that "not all learning rules and projects that show success in west mean achieving the same success in east, however coping up what are updated is mandatory to apply what is suited with each community". Accordingly, there is no ideal universal curriculum for every place or every time, because of many social, societal, cultural, political, economic, intellectual, emotional and psychological contexts that have to be considered [7, 8]. So, the impact of considering these detailed variables in tandem in each curriculum is reflected positively on medical education and health not only locally but also globally.

Despite the associated logic caveats on standardization a universal curriculum, outlining a contextual framework connecting the most fundamental elements can empower broad and profound success through constructing it in an organized coherent manner [9, 10]. Moreover, each curriculum should be supplied by metacognitive thinking about soft system approaches which interconnect all these elements and associated factors together in a coherent comprehensive emerging plan [11, 12]. These recent upcoming approaches are expected to tower curricula designs up to higher levels of thinking theoretically and achievement pragmatically through integrating health system care with clinical knowledge and skills.

In this chapter we will retrieve curriculum etymology origin and its historical story. We will touch on crucial curriculum criteria regardless the place of its execution. We will elucidate the importance of curricula designs in educational process. We will demonstrate diverse curricula types and frameworks, particularly Kern's foundational six steps framework and PRISMS strategy. Emerging metacognition within the already used curricula designs is the recent trajectory in clinical education to interconnect all elements of curricula and surrounding factorial circumstances to be attuned, so we will read this out under the term 3P-6Cs toolkit. Hoping this chapter will be a catalyst to invest ecology in constructing more effective and efficient curricula ideas in this widely opened era that only accepts everlasting adventurous progress. Finally, you will face some footnotes through reading this chapter which are little bit away from medical writing rules. However these are not

so far from the aim of this chapter which is to interlink medical to societal, psychological, administrative or even literary aspects. These footnotes help to approximate the meaning of integrating ecological life into medical practice.
