Modern Trends in Medical Education

Undergraduate Medical Education

David Gordon

Undergraduate Medical Education

•  Models world-wide, and in Europe •  How is the state of undergraduate ME – is

there a crisis? •  Course structures •  Teaching and learning methods •  Assessment •  The Bologna process

Patterns of undergraduate ME •  Much less variability than in PGME •  In Europe, DIRECTIVE 2005/36/EC

defines: –  “Basic medical training shall comprise a total of at

least six years of study or 5 500 hours of theoretical and practical training provided by, or under the supervision of, a university”

–  Knowledge of sciences –  Understanding of sciences and behaviour of humans –  Prophylaxis, diagnosis and therapy –  Clinical experience

Patterns of undergraduate ME (2) •  The education of a doctor in Europe is

recognisably the same as in almost all countries, world-wide

•  In some cases, the hours may be more… •  In a few cases, there are shorter courses

Reply! 1.  Medical Education as a developing

academic discipline 2.  Standards for medical education 3.  Methods for assessment of progress and

attainment 4.  Accreditation of medical schools and

programmes of medical education 5.  Responsibility for medical education

Reply continued… 1.  The development and use of student-activating instructional methods such

as problem-based learning, of proven value in enhancing educational outcomes

2.  Integration of basic and clinical sciences in teaching and assessment 3.  The increasing emphasis on practical clinical skills, and skills in

communication with both patients and with colleagues in the health care team

4.  Curricular models with elective components, with a core curriculum and student-selected options

5.  Greater awareness of the role of the medical doctor in the health care team, of the professional role of the doctor, and of medical ethics

6.  An increased focus on the outcomes of medical education and the competencies of graduates (but note the caveats, above, about the risks of excessive reliance on competence-based assessment)

7.  Broadening of clinical training settings, including community based clinical teaching, and the use of clinical skills laboratories.

… and continued further .. 1.  Much increased recognition by educational institutions of their

social responsibility, and increased awareness of the educational needs of societies

2.  More influence of curriculum committees, and decreased control of the curriculum by individual departments, with increasing student influence on the ethos and curriculum of medicine

3.  Clearer budgetary responsibility for education within the medical school

4.  Strengthening of educational leadership.

Course structures •  Integration of basic and clinical sciences in

teaching and assessment •  The increasing emphasis on practical

clinical skills, and skills in communication with both patients and with colleagues in the health care team

•  Curricular models with elective components, with a core curriculum and student-selected options

Teaching and learning methods •  The development and use of student-activating

instructional methods such as problem-based learning, of proven value in enhancing educational outcomes

•  Broadening of clinical training settings, including community based clinical teaching, and the use of clinical skills laboratories.

•  More influence of curriculum committees, and decreased control of the curriculum by individual departments, with increasing student influence on the ethos and curriculum of medicine

Assessment – and the virtues and dangers in competence-based

assessment •  Much progress in development of reliable and

valid methods of assessment (OSCEs, MCQs etc.) – but –

•  “Examinations are often designed to test specific competencies, but there may be concerns about the validity of the competency-based education model ... which can, if used without appropriate controls, introduce reductionism and, in particular, can be misused politically”

The Bologna Process and medical education

•  Structure of this part of the talk: – The origin and history of the Bologna Process – The virtues of the Bologna action lines – and

the problems – Why the subject is not resolved, and the

positive aspects – Putting the “two-cycle” model in perspective

History of Bologna – what was the aim at the start?

•  Sorbonne 1998 and Bologna 1999 – ministers recognising the need for reform in higher education (why?)

•  The entire Bologna process was intended as a tool for better European integration in higher education

•  Bologna signatories never considered the position of medicine (and the related subjects)

Bologna Action Lines – almost all good for Medicine

•  Adoption of a system of easily readable and comparable degrees

•  Adoption of a system essentially based on two cycles •  Establishment of a system of credits •  Promotion of mobility •  Promotion of European co-operation in quality assurance •  Promotion of the European dimension in higher education •  Focus on lifelong learning •  Inclusion of higher education institutions and students •  Promotion of the attractiveness of the European Higher Education

Area •  Doctoral studies and the synergy between the European Higher

Education Area and the European Research Area

Important Bologna Lines •  Adoption of a system of easily readable and comparable

degrees? –  The medical qualifying degree – whatever its

name – is one of the best understood and recognised

•  Promotion of mobility? –  Medical graduates are potentially amongst the

most mobile in Europe •  Promotion of the European dimension in higher

education? –  Academic medicine is one of the most interactive

communities within Europe and beyond

More history …

•  The two cycle model was intended as a tool to get educated people into the workforce after 3 years and as a tool for better European integration, not necessarily as an objective in its own right.

•  “...first cycle studies, lasting a minimum of three years. The degree awarded after the first cycle shall also be relevant to the European labour market as an appropriate level of qualification....”

•  Bologna signatories never considered the position of medicine (and the related subjects) and there is no evidence of any intention to split the medical course into two cycles

•  “The Bologna Process is not based on an intergovernmental treaty.”

•  “There are several documents that have been adopted by the ministers responsible for higher education of the countries participating in the Process, but these are not legally binding documents (as international treaties usually are). Therefore, it is the free will of every country and its higher education community to endorse or reject the principles of the Bologna Process, although the effect of “international peer pressure” should not be underestimated.”

(Council of Europe website)

How widespread will a “real” two-cycle model be?

Why is the subject not resolved? What are the positive aspects of

two cycles?

•  Time to re-think the structure of the course •  An opportunity to revise outdated curricula •  Mobility?

– and student support for all of these

What are potential negative aspects of two cycles?

•  Artificial division of the medical course •  Expenditure of time •  Risks to funding •  Broader international impact

To return to the Bologna Action Lines •  Adoption of a system of easily readable and comparable

degrees •  Adoption of a system essentially based on two cycles •  Establishment of a system of credits •  Promotion of mobility •  Promotion of European co-operation in quality assurance •  Promotion of the European dimension in higher education •  Focus on lifelong learning •  Inclusion of higher education institutions and students •  Promotion of the attractiveness of the European Higher Education

Area •  Doctoral studies and the synergy between the European Higher

Education Area and the European Research Area

Bengali, traditional, reported by Amartya Sen

…knowledge is a very special commodity: the

more you give, the more you have.