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Jadwiga Mirecka

Executive Committee of AMEE

Commission for Accreditation of

Medical Universities in Poland

Department of Medical Education

Medical College of Jagiellonian

University, Krakow

WHY MEDICAL SCHOOLS HAVE PROBLEMS WITH THE BOLOGNA

DECLARATION?

The goal of the Bologna Declaration is to establish the European area of higher education and to promote the European system of higher education world wide

The following objectives have been defined:

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1. Adoption of a system of easily readable and comparable degrees

- Definition of a degree in terms of requirementsand /or competencies)

- Implementation of the Diploma Supplement

(Standartised document in national andEuropean languages, describing the nature, context, content of studies, as well aseducational system in the country)

• The need for comparability of studies in medicine is commonly accepted

• General frame for comparability had beenalready established by the CouncilDirective 93/16/EEC

• Diploma Supplement is currently beingimplemented in all types of HE institutionsincluding medical schools (dead-line 2005)

In medicine

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• Further understanding of medical studies shouldbe achieved within the Thematic Network –Medical Education in Europe (MEDINE):

- Tuning Project Task Force

- Transparency Task Force

In medicine

Undergraduate studies

Graduate studiesII cycle

I cycle

No less than 2 years (120 ECTS)

No less than 3 years (180 ECTS)

2.Adoption of a system essentially based on two main cycles, undergraduate and graduate.

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AccAcc. to . to the Bolognathe Bologna conceptconcept

1st 1st cycle studiescycle studies

Master Master Master Master

Bachelor Bachelor Bachelor Other forms

of education

- relevant for the labour market

- enable access to different types of the 2nd cycle studies (network rather than ladder system)

ArgumentsArguments forfor the the twotwo cycles in medicinecycles in medicine

b compatibility with other types of studies

b 1-st cycle a chance for students to mature & make a better choice for further carrieer

b less able students can end midway with a diploma

b two cycle system facilitates mobility between countries & schools

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Three approaches to the two cycles in medicine could be imagined:

1. Division of the existing curricula into two halves

3. Restructuring of the entire education system

2. Complete restructuring of the existing curricula

In medicine

1. Division of the existing curricula into two halves

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• Poorly defined competencies of the 1-st cycle graduate on a labour market (neither laboratory aid nor health care professional)

Problems:

• Vast majority of students not interested in an intermediate degree

• Separation of basic and clinical sciences

Problems: Problems:

Basic

sciences

Clinical

sciences

Clinical

sciences

Basic sciences

“undergraduate medical education could and should not be separated into two cycles: pre-clinical and clinical”

The Advisory Committee on Medical Training (1993)

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• Medical studies too expensive to train non-medical graduates

• Numerus clausus combined with highly selectiveadmission to medical schools (why to „loose”placesfor candidates not aiming to graduate in medicine ?)

• With an early patients exposure would it beethical to expose sick people to non-medicalstudents ?

ProblemsProblems::

2. Complete restructuring of the existing curricula

Physician

+

Paramedic?

3 years 3 years

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Problems:

• Creation of a new profession for whichmight not be a need on the market

• Artificial fragmentation of some long / orclosely related subjects

„ implementation of the two-cycle structure in medical studies would create an artificial qualification without a defined role

in the medical profession”CPME

In both instances:

• A need to comply with the Council Directive93/16/EEC which defines medical studies as 6 years or 5500 hours and including basic sciences, clinical sciences, as well as practicaltraining

Problems:

• No direct access to the 2nd cycle from othertypes of studies

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3. Restructuring of the entire education system

1-st cycle – (3-4) years

+

2-nd cycle (4 years)

=

Physician

Problems:

• Would extension of medical studies to 7-8 years be desirable for governments andstudents?

• Would it be competitive towards extraEuropean systems?

• What to do with the EC Directive?

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• Among countries

There is a great resistanceagainst the 2 cycles:

• Among professional organisations

• Among medical schools and academiccommunities (including students)

In medicine

“The continuation of long one-tier curricula in a number of areas does not contradict the overall objectives of the Bologna declaration

(even though there is no convincing arguments except maybe in medicine- that the adoption of a new two-tier structure would not provide benefits”

Trends II Report. Haug,& Tauch

“medicine and related disciplines still require a different scheme in many countries, namely longintegrated programmes of 300 or more ECTS

credits”

Trends III Report. Reichert & Tauch

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„Modern educational practice is for medicine to be taught as a coherent programmeextending normally over six years; to attempt to

break this into two separate cycles is not practicable or educationally desirable”

Second European Conference on Harmonisation of PhD

Programmes in Biomedical and Health Sciences , Zagreb 2005

“The possibility of 5 years integrated programmes leading to a „Master” degreeshould be admissible”

The Seminar on Transnational Education- Malmö 2001

University may decide to establish an integrated curriculum leading directly to a Master-level degree. Subject-based networks have an important role to play to inform such decisions”

Message from the Salamanca Convention (2001)

The statement of AMEE/WFME/AMSE/WHO-Euro 2004

The organisations strongly urge the countries and ministers not to make decisions of fundamental importance to medical education without the

necessary evidence and without involvement of schools

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We are concerned about the negative implications of the two cycle structure on medical education ”

A position paper of IFMSA – Macedonia 2004

“CPME strongly opposes the implementation of a two-cycle structure (bachelor/master) in medical education”

CPME comments on the Bologna process (2004)

!

(CPME – Standing Committee of European Doctors)

3. Establishment of credits - such as the ECTS system (European Credit Transfer System)

- reflects student workload (30 points per semester)

- awarded if achievements confirmed by evaluation

- now rather accumulation than transfer of credits

- as a way of measuring and comparing learningachievements and transporting them from oneinstitution to another

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- medical studies require 360 credit points

- ECTS system used by medical schools for students exchange

- the system will be further improved withinthe MEDINE Project (Task Force oninternational recognition of qualifications)

In medicine

Due to the highly regulated nature of medical studies (with strictly defined mandatory subjects)

Problems:

• it is the content of studies abroad which is more valid than students workload

• the system can not be used for individual“mapping “ of studies

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4. Promotion of mobility

- of students on all levels of studies, fromindividual courses to degree studies

Mobility requires recognition and valorisation of periods spend abroad

- of teachers, researches and administrativestaff to get training ot to participate inresearch or teaching

Mobility of medical students quite frequent:

(offices for international exchange)

often restricted to:

- elective periods

- research projects

- summer practice

In medicine

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Mobility of medical students impaired by the:

- varying models of curricula

- rigid structure of curricula

- a need to know the language of local patients

Problems:

5. Promotion of European co-operation in quality assurance with a view to developing comparable criteria and

methodologies

- Development of comparable criteria andmethodologies

- Accreditation ante steering or post steering

- Cooperation between agencies, cross-countriesaccreditation and/or European

meta – accreditation

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There is a general consensus as to the need for quality assurance in medical education

There are examples of international (cross-countries) cooperation in accreditation

In many countries the process of accreditation has already started

In medicine

• Medical schools are interested not in general but in the area (discipline) specific accreditation

• They have own Standards for Accreditation of Basic Medical Education, prepared by WHO/WFME

Problems:

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6. Promotion of the European dimensionsin higher education

- curricular development

- ensuring a substantial period of study abroad

- provision for linguistic diversity

- integrated (joint) programmers

- inter institutional co-operation

- Many medical schools express interest inEuropean core curriculum

- Several initiatives have been undertaken,the last one being Tuning project within theMEDINE Network

In medicine

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Medical schools must take into account not only European but global dimension outlined in:

- WFME Global Standards for Quality Improvement in Basic and PostgraduateMedical Education as well as in Continuing

Professional Development (CPD) of MedicalDoctors

- Global Essential Requirements inMedical Education

Problems:

7. Integrate life long learning into the overall strategy

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Continuing Medical Education (CME)

/Continuing Professional Development (CPD)

“Engagement in CME/CPD is a life-long necessity for each doctor and is both an ethical obligationand a fundamental right. Is needed for the individual professional competence and for safeguarding quality improvement of the overall health care system.“

CPME

In medicine

Problems:

• inadequate preparation of undergraduate student for independent self-learning

• working overload of practicing doctors

• inadequate financial resources to supportdoctors in their training

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8. Students involvement

• “Students as competent, active and constructive partners “

• Should participate in and influence the organisation andcontent of education

Praha Communique 2001

Students participation in general accepted by institution involved in medical education and medical schools :

• on institutional level (members of Senate,Faculty Council, Programm Committees?)

• on national level (national associations)

• on European (International) level (IFMSA, EMSA)

In medicine

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9. Promoting the attractiveness of the European Higher Education Area

“ The readability and comparability of European

HE degrees should be enhanced by the development of a common framework of qualifications, coherent quality assurance and increased information efforts”

Praha Communique 2001

• Promotion of the European education inmedicine world-wide is one of the goals ofthe network MEDINE – (task Force – Transparency)

In medicine

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10. Establish a European research area

“To promote links between the EHEA and

ERA in a Europe of Knowledge ..Ministers consider it necessary to go beyond the focus on two cycles to include the doctoral level as the third cycle”

Berlin Communique

• It has always been a strong link betweenresearch and teaching

• It will be further explored within the MEDINEProject (Task Force on links betweenmedical education and research)

In medicine

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PhD studies as the 3-rd cycle

(doctorate)

- lasting 3-4 years (or defined in ECTS credit points)

- after the 2-nd (or 1-st cycle)

- access from different type of studies

- European dimension (cooperation, mobility)

- PhD studies in medicine less accessible

to graduates from other disciplines

- PhD studies most often combined with specialist training

- clinical research being different from research in basic sciences

- Inconsistent terminology (MD vs PhD)

Problems:

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Conclusions

1. Out of the 10 objectives of the Bologna Declaration, medical schools have serious problem with one only: two-cycle system

2. As regards the remaining goals medical schools are involved in their implementation albeit specific aspects related to the discipline can be observed