FROM TRADITIONAL TO OUTCOME- BASED MEDICAL EDUCATION RESULTS OF A RANDOMIZED CONTROLLED TRIAL AT THE...

FROM TRADITIONAL TO OUTCOME-BASED MEDICAL EDUCATION

RESULTS OF A RANDOMIZED CONTROLLED TRIAL AT THE RUHR-UNIVERSITY BOCHUM, GERMANY

Thorsten Schäfer Study Dean, Centre for Medical Education

RUHR-UNIVERSITÄT BOCHUMZENTRUM FÜR MEDIZINISCHE LEHRE

ZENTRUM FÜR MEDIZINISCHE LEHRE | 2


| 7

Facts

The University Hospital10 hospitals

at 6 locations

3.500 beds200 medical practices





9

TerminologieTerminologie

PreclinicalStudies

2 years

practicalpractical seminarseminar disciplinesdisciplines Cross-sectionalCross-sectional

Clinical Studies

3 years

Practi-cal

1 year

1st S

tate

Exa

min

ation

2nd

Stat

e Ex

amin

ation

Medical Studies in Germany

10

TerminologieTerminologiePhysicsPhysics

practicalpractical

Chemistry

Chemistry

BiologyBiologyPhysiology

PhysiologyBiochemistry

Biochemistry

MacroAnatomy

MacroAnatomy

MicroAnatomyMicroAnatomy

Psychology

Psychology

PsychologyPsychologyPhysiology

Physiology

BiochemistryBiochemistry

Anatomy

AnatomyClinical Med.Clinical Med.

seminarseminar

Terminology

Terminology

Job Explorat.

Job Explorat.Clin.

References

Clin. References

Integrated

Integrated

1 General Med.1 General Med.2 Anesthesiol.2 Anesthesiol.

3 Social Med.3 Social Med.4 Ophthalmol.4 Ophthalmol.

5 Surgery5 Surgery6 Dermatology6 Dermatology7 Gynecology7 Gynecology8 ENT Med.8 ENT Med.

9 Hum. Genetics9 Hum. Genetics10 Hyg.Microbiol10 Hyg.Microbiol11 Internal Med.11 Internal Med.

12 Pediatrics12 Pediatrics13 ClinicalChem.13 ClinicalChem.

14 Neurology14 Neurology15 Orthopedics15 Orthopedics16 Pathology16 Pathology

17 Pharmacol.17 Pharmacol.18 Psychiatry18 Psychiatry

19 Psychosomat.19 Psychosomat.20 Legal Med.20 Legal Med.

21 Urology21 Urology22 Elective22 Elective

1 Epidemiology

1 Epidemiology

2 History/Ethics

2 History/Ethics

3 Economics

3 Economics

4 Infect./Imm

un.

4 Infect./Imm

un.

5 Clin. Patholoy

5 Clin. Patholoy

6 Environm.M

ed

6 Environm.M

ed

7 Aging/Elderly

7 Aging/Elderly

8 Emergency M.8 Emergency M.9 Clin.Pharmacol9 Clin.Pharmacol

10 Prevention10 Prevention11 Imaging11 Imaging

12 Rehabilitation12 Rehabilitation13 Palliative M.

13 Palliative M.

Internal Med

Internal Med

Surgery

Surgery

Electi

ve

Electi

ve

disciplinesdisciplines Cross-sectionalCross-sectional

Medical Studies in Germany

12BiologyBiology

AnatomyAnatomy BiochemistBiochemist PhysiologyPhysiologyPsycholog.Psycholog.

TerminologyTerminology ChemistryChemistry PhysicsPhysics

First State ExamFirst State Exam

Psychiattrics

Psychiattrics

Internal Med.

Internal Med.

Surgery

Surgery

Second State ExamSecond State Exam

His-toryHis-tory

Patho-logyPatho-logy

PYSurgery

PYSurgery

PharmacolPhar

macolPathophys.Pathophys.

PYElective

PYElective

PY Internal Med.

PY Internal Med.

Conservativ

e

Conservativ

e

The Medical Curriculum Idea

14BiologyBiology

AnaAnaBiochemistBiochemist

PhysiologyPhysiology Psycholog.Psycholog.

TerminologyTerminologyChemistryChemistry PhysicsPhysics

1st State Examination

1st State Examination

Psychiattry…

Psychiattry… Inte

rnal Med…

Internal Med…

Surgery,…

Surgery,…

2nd State Examination2nd State Examination

Clin. Chem.Clin.

Chem.

Patho-logyPatho-logy

PYSurgery

PYSurgery

Phar

mac

ol

Phar

mac

ol

PYElective

PYElective

PYInternal Med.

PYInternal Med.

Conserv

ative

Conserv

ative

Pathophys.Pathophys.

tomytomy

The Medical Curriculum, Reality2

15

2nd State Examination2nd State Examination

The Medical Curriculum

Changes: „from H to N“

Basics

Clinical

Ärztliche Prüfung, 1. Abschnitt

Ärztliche Prüfung, 2. Abschnitt

1

4

5

12

„Equivalent Exams“- 3 MEQs, 2 OSCEs

Research Question

Is there a difference in the progress of basic science and clinical knowledge of students in a traditional (T) versus an integrated, problem-based (P) curriculum?

Hypotheses: T > P in basic sciences P > T in clinical knowledge

The Curricula

Traditional Discipline-based Teacher-centered Main Lectures Seminars

Written exams (MCQ) Practical Courses

Oral exams

Integrated Curriculum Problem-based Student-centered Self-directed learning Seminars

Formative feedback Practical Courses

Clinical integration

Lots of changes…

Theme-based Curriculum Interdisciplinary Modules Bochum Catalogue of Learning Items Medically Relevant Learning Objectives Problem-based Learning GM Internship Program Focus on

Communication Skills, Health Economics, Medical Ethics


Medical Studies: 2 Ways

GOAL

START

Oct. 01, 2010: 302 Students105 applied42 randomly chosen

Organ Systems, multi-disciplinary

No lectures, buttime for self-directed learning

Problem-based Learning

1. Understanding2. Topics of Interest3. Brainstorming4. Hypotheses, Sorting5. Learning Objectives

6. Selfdirected Learning

7. Discussion of Results

8. Feedback

Instrument: Progress Test in Medicine200-item Multiple-Choice-Test

66 items basic sciences: (32 physiology, 26 anatomy)

Level: End of studiesAt the beginning of each semester to all

studentsDeveloped at the Charité and Uni W/H and

used by 7 universities

Study Design: RCT

Randomized controlled trialN = 868 students in 3 cohorts

251 applied for the new PBL-curriculum 122 were randomly selected 129 were assigned to the traditional curr. (Control

group)

617 remaining students: traditional curr.

Statistics: ANOVA, post-hoc Bonferroni

0

10

20

30

40

50

60

Ba

sic

Sci

ence

s[%

corr

ect]

1. Sem. PTM09 3. Sem. PTM11 5. Sem. PTM 13

RSM

MSM-

MSM+

***

0

10

20

30

40

50

60

Clin

ical

Kno

wle

dge

[%co

rrec

t]

1. Sem. PTM09 3. Sem. PTM11 5. Sem. PTM 13

RSM

MSM-

MSM+

***

*

Longitudinal Observation: Traditional – Problem-based

2003 2004 2005 2003 2004 2005

preclinical clinical

Number of Successful Students within Shortest Time

0

20

40

60

80

100

120

140

160

180

200

Num

bers

C P- P+

101 15 30184 38 42

1st

5th

0,0

0,1

0,2

0,3

0,4

0,5

0,6

0,7

0,8

%S

ucce

ss

C P- P+

0,55 0,39 0,71

71 % in MSM+ versus 39 % in MSM- and 55 % in RSM

Summary

Equal achievements in basic sciences after 2 years (higher after 1 year in PBL)

Higher number of successful students in the PBL-curriculum

Higher scores in clinical items in the PBL-curriculum

Further Educational Goals

In my opinion, my medical studies have enabled me…

Item 1: to make the physical situation of my patients base of my medical practice.

Item 2: to make the psychological situation of my patients base of my medical practice.

Item 3: to make the social situation of my patients base of my medical practice.

Item 4: to think and work in a scientific way.

Item 5: with general knowledge and skills in the field of diagnostics.

Item 6: with general knowledge and skills in the field of therapy.

Item 7: with general knowledge and skills in the field of health promotion and prevention.

Item 8: with general knowledge and skills in the field of rehabilitation.

Item 9: with practical experience in dealing with patients, including the interdisciplinary approach to disease.

Item 10: with mental skills necessary for the primary care of patients.

Item 11: to conduct independent, continuous training, using modern information sources.

Item 12: to own decisions and solving problems.

Self-Assessement of 6th Year Students

physical

scientific

social

psychological

Diagnosis

Therapy

Health Promotion

Rehabilitation

PracticalExperience

CME

Problem Solving

Psychol. Ab.

Assessment byTeachers

physical

scientific

social

psychological

Diagnosis

Therapy

Health Promotion

Rehabilitation

PracticalExperience

CME

Problem Solving

Psychol. Ab.

Students‘Self-

Assessment

Teachers‘Assessment

über-wiegend

teil-weise

40

Correlation Self-Assessment vs. Scores

0

10

20

30

40

50

60

70

80

90

100

Fre

mde

insc

hätz

ung

du

rch

Leh

rend

e

0 10 20 30 40 50 60 70 80 90 100

Selbsteinschätzung der Studierenden

r = 0,90***Eta2

adj = 0,79

r = 0,83***Eta2

adj = 0,66

Lehrende RSM

Lehrende MSM

Conclusions

Self-assessment and teachers‘ assessment show high correlations and similar strengths and weaknesses.

„Goals achieved“ in practical experience, problem solving skills, as well as psychological and social aspects.

Weaknesses in the field of rehabilitation. The survey is useful for developing the

curriculum.

„Latest News“

Progress-Test Medicine (PTM)


0

10

20

30

40

50

60

70

% r

icht

ig b

ean

twor

tete

r F

rage

n

1 2 3 4 5 6 7 8 9 10

Semester

gesamt_MSM

gesamt_RSMb

gesamt_RSMn

PTM – Preclinical Questions


0

10

20

30

40

50

60

70

% r

icht

ig b

ean

twor

tete

r "v

orkl

inis

cher

" F

rage

n

1 2 3 4 5 6 7 8 9 10

Semester

Vorklinik_MSM

Vorklinik_RSMb

Vorklinik_RSMn

PTM – Cross Sectional


0

10

20

30

40

50

60

70

% r

icht

ig b

ean

twor

tete

r F

rage

n

1 2 3 4 5 6 7 8 9 10

Semester

QB_MSM

QB_RSMb

QB_RSMn

Clinical Pathology, Pharmacology, Radiology, Biometrics, Ethics,…

PTM - Clinical


0

10

20

30

40

50

60

70

% r

icht

ig b

ean

twor

tete

r F

rage

n

1 2 3 4 5 6 7 8 9 10

Semester

Klinik_MSM

Klinik_RSMb

Klinik_RSMn

Scores in the State Exam (09)


Proportion of „Fast Students“


32,7 % 47,6 %

Summary:New Curriculum

Higher efficiency: more graduates, with same levels of scores

Basic science knowledge: same achievements, higher scores at end of studies

Clinical and „soft“ skills: higher scores


The Future

Combination of the two tracks Scientific and practical Interdisciplinary and theme-oriented Problem-based






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