WHY MEDICAL SCHOOLS HAVE PROBLEMS WITH THE BOLOGNA DECLARATION?

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1 WHY MEDICAL SCHOOLS HAVE PROBLEMS WITH THE BOLOGNA DECLARATION? Jadwiga Mirecka Executive Committee of AMEE Commission for Accreditation of Medical Universities in Poland Department of Medical Education Medical College of Jagiellonian University, Krakow 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: 1

2 1. Adoption of a system of easily readable and comparable degrees - Definition of a degree in terms of requirements and /or competencies) - Implementation of the Diploma Supplement (Standartised document in national and European languages, describing the nature, context, content of studies, as well as educational system in the country) In medicine The need for comparability of studies in medicine is commonly accepted General frame for comparability had been already established by the Council Directive 93/16/EEC Diploma Supplement is currently being implemented in all types of HE institutions including medical schools (dead-line 2005) 2

3 In medicine Further understanding of medical studies should be achieved within the Thematic Network Medical Education in Europe (MEDINE): - Tuning Project Task Force - Transparency Task Force 2.Adoption of a system essentially based on two main cycles, undergraduate and graduate. II cycle Graduate studies No less than 2 years (120 ECTS) I cycle Undergraduate studies No less than 3 years (180 ECTS) 3

4 Acc.. to the Bologna concept 1st cycle studies - relevant for the labour market - enable access to different types of the 2 nd cycle studies (network rather than ladder system) Master Master Master Master Bachelor Bachelor Bachelor Other forms of education Arguments for the two cycles 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 4

5 In medicine Three approaches to the two cycles in medicine could be imagined: 1. Division of the existing curricula into two halves 2. Complete restructuring of the existing curricula 3. Restructuring of the entire education system 1. Division of the existing curricula into two halves 5

6 Problems: Poorly defined competencies of the 1-st cycle graduate on a labour market (neither laboratory aid nor health care professional) Vast majority of students not interested in an intermediate degree Problems: Separation of basic and clinical sciences Clinical sciences Basic sciences Basic sciences Clinical sciences undergraduate medical education could and should not be separated into two cycles: pre-clinical and clinical The Advisory Committee on Medical Training (1993) 6

7 Problems: Medical studies too expensive to train non-medical graduates Numerus clausus combined with highly selective admission to medical schools (why to loose places for candidates not aiming to graduate in medicine?) With an early patients exposure would it be ethical to expose sick people to non-medical students? 2. Complete restructuring of the existing curricula Physician Paramedic? + 3 years 3 years 7

8 Problems: Creation of a new profession for which might not be a need on the market implementation of the two-cycle structure in medical studies would create an artificial qualification without a defined role in the medical profession CPME Artificial fragmentation of some long / or closely related subjects Problems: In both instances: A need to comply with the Council Directive 93/16/EEC which defines medical studies as 6 years or 5500 hours and including basic sciences, clinical sciences, as well as practical training No direct access to the 2nd cycle from other types of studies 8

9 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 and students? Would it be competitive towards extra European systems? What to do with the EC Directive? 9

10 In medicine There is a great resistance against the 2 cycles: Among countries Among medical schools and academic communities (including students) Among professional organisations 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 long integrated programmes of 300 or more ECTS credits Trends III Report. Reichert & Tauch 10

11 The possibility of 5 years integrated programmes leading to a Master degree should be admissible The Seminar on Transnational Education- Malmö 2001 Modern educational practice is for medicine to be taught as a coherent programme extending 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 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 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 The statement of AMEE/WFME/AMSE/WHO-Euro

12 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) - as a way of measuring and comparing learning achievements and transporting them from one institution to another - reflects student workload (30 points per semester) - awarded if achievements confirmed by evaluation - now rather accumulation than transfer of credits 12

13 In medicine - medical studies require 360 credit points - ECTS system used by medical schools for students exchange - the system will be further improved within the MEDINE Project (Task Force on international recognition of qualifications) Problems: Due to the highly regulated nature of medical studies (with strictly defined mandatory subjects) the system can not be used for individual mapping of studies it is the content of studies abroad which is more valid than students workload 13

14 4. Promotion of mobility - of students on all levels of studies, from individual courses to degree studies - of teachers, researches and administrative staff to get training ot to participate in research or teaching Mobility requires recognition and valorisation of periods spend abroad In medicine Mobility of medical students quite frequent: (offices for international exchange) often restricted to: - elective periods - research projects - summer practice 14

15 Problems: Mobility of medical students impaired by the: - varying models of curricula - rigid structure of curricula - a need to know the language of local patients 5. Promotion of European co-operation in quality assurance with a view to developing comparable criteria and methodologies - Development of comparable criteria and methodologies - Accreditation ante steering or post steering - Cooperation between agencies, cross-countries accreditation and/or European meta accreditation 15

16 In medicine There is a general consensus as to the need for quality assurance in medical education In many countries the process of accreditation has already started There are examples of international (crosscountries) cooperation in accreditation Problems: 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 16

17 6. Promotion of the European dimensions in higher education - curricular development - inter institutional co-operation - integrated (joint) programmers - provision for linguistic diversity - ensuring a substantial period of study abroad In medicine - Many medical schools express interest in European core curriculum - Several initiatives have been undertaken, the last one being Tuning project within the MEDINE Network 17

18 Problems: Medical schools must take into account not only European but global dimension outlined in: - WFME Global Standards for Quality Improvement in Basic and Postgraduate Medical Education as well as in Continuing Professional Development (CPD) of Medical Doctors - Global Essential Requirements in Medical Education 7. Integrate life long learning into the overall strategy 18

19 In medicine 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 obligation and a fundamental right. Is needed for the individual professional competence and for safeguarding quality improvement of the overall health care system. CPME Problems: inadequate preparation of undergraduate student for independent self-learning inadequate financial resources to support doctors in their training working overload of practicing doctors 19

20 8. Students involvement Students as competent, active and constructive partners Should participate in and influence the organisation and content of education Praha Communique 2001 In medicine Students participation in general accepted by institution involved in medical education and medical schools : on European (International) level (IFMSA, EMSA) on national level (national associations) on institutional level (members of Senate, Faculty Council, Programm Committees?) 20

21 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 In medicine Promotion of the European education in medicine world-wide is one of the goals of the network MEDINE (task Force Transparency) 21

22 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 In medicine It has always been a strong link between research and teaching It will be further explored within the MEDINE Project (Task Force on links between medical education and research) 22

23 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) Problems: - 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) 23

24 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 24

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