Porto 23 – 24 /2 2007

Bologna – the Swiss case

Peter M. Suter, Geneva

Bologna in medicine: the Swiss case. Chapters of my presentation:

Swiss university landscape National and regional governance Medicine: reform since 1995 -

PBL, student autonomy, medical humanities Bologna as an opportunity to improve teaching

and training of doctors for tomorrow One step further: earlier specialisation

Swiss Academy of Medical Sciences

Foundation created by the Swiss Medical Faculties in 1947, supported + financed by the Federal governement

Moral instance for ethical questions and the limits of medicine in general

Edicts guidelines and directives for common problems and border areas Examples: Palliative medicine, definition of brain death, human dignity and limits for clinical research, role and training for ethical committees, etc.

Switzerland: 7.5 million inhabitants - - 12 Universities

●

Swiss Universities:

Have different sizes and budgets

Swiss Universities: governance and finances

2 Technical Universities: national governance (Council, headed by an academic manager) + financed by national budget

10 Cantonal Universities: governance, structure and management depending on cantonal laws, regulations, budgets and political bodies (and humors)

5 Medical Faculties within Cantonal Universities, coordination of teaching aspects by Swiss Medical Interfaculty Commission

Auto-financed5,3 %

Cantonal budget, DIP43,5 % Cantonal budget, non-DIP

7,4 %

Nationalallocation

18,6 %SNRF 9,3 %

Other non-public16 %

Sources of finances: University of Geneva

AH/pt 23.11. 2005Source: Budget 2005

12 Swiss Universities + 5 Medical Faculties

●

●

Medicine in Switzerland

Good results and accessibility Expensive health care services Shortage of Swiss MDs and other health care

professionals Reform in curriculum (1995), Bologna (2006) A new law for medical professions

Health care expendiures in % of GDP (gross domestic product), 1990 - 2004

Kocher G. Schweizerische Ärztezeitung (BMS) 87: 1649-52, 2006.

High costs of health care …

Numerus clausus introduced –

- but only in the German speaking part of Switzerland

300

400

500

600

700

800

900

1997 1998 1999 2000 2001 2002 2003 2004

Total

Femmes

Hommes

Number of medical diplomas per year Switzerland 1997 - 2004

P.M. Suter / ea, selon statistiques Facultés de Médecine suisses, 2002

2003

7’000 650

11’000 7’000 4’000

36 %

14’000

2005

7’000 623

12’000 6’500 5’500

46 %

15’000

1995-2000

5 Medical Faculties- Students 8’000

- Diplomas per year 800

Posts, hospital physicians 10’000 - occupied with Swiss diplomees 7’000

- with foreign diplomees 3’000 or ... 30 %

Physicians in private practice 13’000

Students in medicine, diplomas, and MDs in Switzerland

In Medicine, in the 15 years before Bologna, important things happened:

The expectations of students, patients and society have changed markedly, imposing

The reform of the curriculum, which produced an earthquake (happening in a number of dynamic institutions), and

New law defining training for the medical professions prepared

Reform of the curriculum – 1990ies

Why ?

Student dissatisfaction + insufficient results Changes in societal expectations New concepts: soft sciences, student autonomy Initiative of a few « young turks » in the faculty:

let’s take the « taureau par les cornes »

Medical practice – societal demands in Switzerland, late nineties

Care of the patient in a global way Good communication and a relation of con-

fidence with the patient and his family Provide benefit for the patient and the society: maximal care, economy, efficiency Observe and react to new demands . . (demography, etc)

… the scientific evidence linking biological, behavioural, psychological and

social variables to health, illness and disease is impressive …

US Institute of Medicine (IOM), March 2004www.iom.edu

www.nap.edu/books/030909142X/html/

Improving medical education, enhancingthe behavioural and social science

of medical school curricula

• Hard sciences: anatomy, physiology, microbiology, pharmacology.

• Soft sciences: behavioural, psychological and social factors, physician role and behaviour, physician-patient interactions, efficient communication, health policy and economics.

• The importance of soft sciences must be increased during all phases of training.

Editorial, Lancet 2004, 363: 1247

The soft science of medicine

Reform of Swiss Medical Curriculum 1995 - 2005

More human and social sciences. Increased student autonomy + responsability Problem based learning (PBL) Increased clinical contact from the beginning

of the pregraduate formation – - follow-up of chronic patients - contact with community medicine

Clinical skills and Savoir-être ….

The reform in medical education includes:

Integration of basic and clinical disciplines to facilitate problem-based learning (PBL)

Recognition of social, ethic and community aspects of medicine Inclusion of economic and cost-effectiveness

domains Development of clinical skills and self-recognition (« savoir-être ») Promotion of autonomous learning and life-

long training

Reformed Medical Curriculum, Genève

Example 1st Year 2004/2005

Wave of the reform from and to the 5 Swiss Medical Faculties

●

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http://www.iawf.unibe.ch/slo/+ the creation of a catalogue

of learning objectives

http://www.

iawf.unibe.ch/slo/

Leitmotiv – New Swiss Law (Fleiner II)Tasks of the Physician (1998)

Respects human dignity and automony; follows ethical principles for the wellfare of the patients

Knows structures and function of the human organism Masters diagnosis and therapy of frequent diseases Is able to summarize and communicate observations Understands health problems in a global way; capacity

to identify the elements of physical, psychological, social, economic, cultural and ecological origin; takes into account health for an individual and society

Takes care of patients as individuals in their social environment Acts for prevention of diseases and for health promotion

Bologna in medicine: the Swiss case Chapters:

Swiss university landscape National and regional governance Medicine: reform since 1995 -

PBL, student autonomy, medical humanities Bologna: a nightmare - or

additional opportunity to improve teaching + training for the needs of tomorrow

One step further: earlier specialisation

In Switzerland, the Bologna system had to be discussed, adapted and adopted by

CRUS Conférence des recteurs des Universités Suisses: 2003/2004

CUS Conférence universitaire Suisse: December 4, 2004

Cantons adaptation to (11) different laws and autonomies of the universities

Genève: french translation of « bachelor » and « master » had to be discussed in the parlament (grand conseil)

But: an important element in the University landscape could be

preserved

The relative autonomy of each university to organize the curriculum within the given framework -

e.g. to introduce relevant reforms

Bologna in medecine - the Swiss case

Now the technical part:

structure and philosophy

Basic principles of the Bologna system Better permeability for and to other branches Individual adaptation of curriculum to student wishes for career possibilities

Bologna - Basics

Bachelor: 3 years, 180 ECTS Master: 2-3 years, 120-180 ECTS Doctorate: 2-3 years

ECTS – European Credit Transfer System students charge in hours, 1 ECTS = 30 h, 1 year = 60 ECTS = 1800 h (including self-learning, exams).

This can be applied to medicine, to a reformed curriculum, to PBL, but good organi- sation and priority definition must be ensured.

Version PMS / PA30.09.04

Bologna+ in Medicine

Bachelor inBasic Medical

Sciences

Bachelor inSciences,

Arts, Economics,

etc

Cre

dit

s

Master inSciences,

Arts, Economics

etc

Masterin

Medicine

Medicalspecialities

Research +Teaching

Other careers(industry,

administration, etc)

Student file Student file

Credits Credits

Doctorates, MD / PhD

Bologna allows to go further Earlier options for professional careers:

- Do all speciality tracks need the same amount of knowledge in anatomy, biochemistry, genetics ?

Early + more extensive contact with public health, research, etc. are needed

The concept of « Kern +Mantel »

core parts and options

Year 5

4 60%

60%

40% +Exam

+Exam+ Master thesis

40%Master in medical sciences

Bologne in Medecine (CIMS): Nucleus + Options

Integrated Master with mention MD-PhD

100%1

2

3

90%

80%

10

20

+Exam

+Exam

+ExamBachelor in Medical Sciences

Optional modules

Compulsory - nucleus

MD-PhDprogram

2 –3 years

Doctorate

Pract/clinics

Federal Exam

MD working underSupervison (2 years)

Year 6

Examples of optional modules

Specific clinical tracks Programme MD/Ph International health Public health Law, Arts, Litterature etc.

Bologna in Medicine -

Advantages for Basic Medical Sciences

Maintaining a strong role in Bachelor Increased possibilities to include

« Basic Sciences » in Master (options) Better possibilities by Bologna to

motivate and train for research careers

Swiss Medical Faculties have undergone an in-depth revision by 3 distinct means:

1. Reform of curriculum (PBL, student autonomy, human sciences) since 1995, with new pedagogic concepts

2. Accreditation of all Med. Faculties 1999 - by foreign experts – 2nd time 2006

3. Bologna system introduced 2006

Will Bologna provide better doctors ?

Not necessarily … But all efforts together have provided

substantial improvements

Porto – River Douro

Monte Rosa Glacier

Thankyou !