**10. Medical schools' curricula: mission and core values**

A curriculum is a universally acknowledged course of study or training of an educational program [47]. All educational programs must have a set curriculum plan. In an introduction to highlight the importance of writing a curriculum in educational programs, Parkay, Anktil, and Hass [48] as cited in Iwasiw [47] offered a very relevant curriculum definition to the context of this chapter. This definition emphasizes a written plan that considers the theoretical and research aspects of the courses besides the social context such as the classroom experiences. "The curriculum is all of the educational experiences learners have in an educational program, the purpose of which is to achieve broad goals and related specific objectives that have been developed within a framework of theory and research, past and present professional practice, and the changing needs of society [47]. According to Simiao Li-Sauerwine and Andrew King [49], a curriculum is a map that can help both educators and learners to be oriented to the key elements of a curriculum and the role of each during the learning process [49].

A curriculum is composed of essential components that reflect its construction, purposes and outcomes. The principle component of the curriculum is a strategic plan that consists of a mission statement and a vision statement [50–53]. Campbell [54] defined a mission statement as a reflection of the institution's purpose, values, strategy and standards and behaviors. A mission statement is also described as defining the organization's scope of business operations/activities, provides a common purpose/direction, promotes a sense of shared expectations, and guides leadership styles [55].

A vision statement is a visual statement that describes where the organization wants to be in the future or what it hopes to achieve. Vision statements are broad and do not provide specific targets [56, 57].

The values statement, also called the code of ethics, provides a moral direction for the organization that guides decision making and establishes a standard for assessing actions. A value can act as an ultimate control system when there is a need for control [58, 59]. Although it is essential to have a vision and a value statement in a curriculum, we decided to exclude these components as they do little contribution to the aim of this discussion.

Having introduced the meanings and definitions of the core concepts in a curriculum plan, herein we discuss examples of mission statements of some medical schools as our guide to understand the current medical schools' programs and the focus of the educational programs run by some medical institutions.

In one statement, it is stated that the school's mission is "to improve the health of the community through a set of medical education, research and clinical care". The statement continues to put more focus on the provision of patient-centered 'medicine' that aims at preventing, diagnosing and treating illness. On the positive side, this statement includes 'the health of the community' and to 'preventing, diagnosing and treating illness' as elements of care that are parts of today's emphasis on primary health care, and it uses the concept of illness rather than disease in recognition of the subjective dimension of human's wellbeing. However, this statement falls short of recognizing the social contextual factors that perceives health as a 'whole' and places more emphasis on diagnosing and treating illnesses. Although community was the target of care management, the community or social structure were not recognized as factors contributing to illnesses and should be considered in preventing and diagnosing illnesses. Socio-cultural factors, economy, lifestyle, individual responses, and social support as contributing to illnesses were kept implicit in this statement.

In a second mission statement that aims "to improve human health through …, and the delivery of outstanding patient-centered care", it is noted that human health is distinct for its social context, and the effect of the environment or the external influences. This is also emphasized when it singles out care as patient-centered ignoring the role of the community as a factor in influencing health and illness. In other words, there is no recognition of the clients as being a family, a larger community, and probably not having a disease, but having a social and psychological issue that needs to be tackled to prevent an illness as in primary care services.

In a third example of a medical school, the mission statement specifies clearly its graduate preparation by stating: "to educate health science professionals in biomedical and social sciences, and model the best practices in clinical care and public health". In this statement, we see the recognition and inclusion of social sciences and public health as part of the learning content material and context of care.

A fourth example of a stated medical school mission is from another region of the world. The mission has stated its aim as: "providing the society with qualified physicians that are capable of delivering quality healthcare services" at more than one level, that is the national, regional and international". In this statement, it has ignored the kind of service and the targeted people of this service, i.e., the individual client and the community. The focus of this mission is to prepare scientists that are specialized in higher studies and engaged in scientific research, and interacting with the world medical community". This mission statement is limited in identifying its target group, in its instructional strategies, and the kind of service provided by its graduates (bio-psycho-social). Many questions would be raised regarding the complexity and diversity of meeting the national, regional and the global needs in one single program. A major goal of the curriculum reformers is to produce physicians who can deliver an individualized plan of care that reflects the physician's mastery of basic anatomy and physiology, awareness of the best current evidence, skillful patient communication, and shared decision-making [43, 44].

A final and more comprehensive and holistic mission statement was that which stated, "nurturing a diverse, inclusive community that is dedicated to alleviating suffering and improving health and well-being for all through excellence in teaching and learning, discovery and scholarship, and service and leadership". In this statement, we captured more than one concept that recognized a more holistic and advanced meaning in the type of service and pedagogy in the program and the program's graduates. The statement recognizes "nurturing", "alleviate suffering", (and not treating disease), "improving health and well-being" (Well-being as more of a subjective nature of a definition of the health status). It also acknowledges a more active role of learners by identifying teaching and 'learning' excellence, besides adding other than the biomedical clinical skills by including discovery, scholarship and leadership.

With this analysis of a few examples of mission statements, although not many to make conclusions from, we think it is appropriate to reflect on the theoretical frames of the caring sciences explained earlier in this chapter. These frameworks set the floor for a more holistic caring approach that considers both the learners as active participants, and the teachers employing the most recent andragogy and sources of online, interactive, and blended learning strategies in the learning process. It is also central in today's medical caring professions to be more considerate of the bio-psycho-social aspects of care by the judicious use of the modern technological advancement of sciences within a contextual and global aspects of care.
