STATEMENT
ON
THE
February 2005
World Federation for Medical Education Association
for Medical Education in
Faculty of Health
Sciences
The Panum Institute
Copenhagen UK
Denmark Tel:
+44 1382 631967
Tel: +45 35 32 71 03/05 E-mail:
p.m.lilley@dundee.ac.uk
E-mail: wfme@wfme.org
STATEMENT ON
THE
BOLOGNA PROCESS AND MEDICAL EDUCATION
The
following statement on medical education in the
In
preparation of this statement the policy statements of the medical students of
The main
points of the statement are:
The
organisations acknowledge the initiative, the activities and achievements
within the
Problems in
implementing the Bologna objectives in medical education may be the result of
contradictions between on the one hand the European or the trans-disciplinary
nature of actions within the Bologna process and on the other hand the global
nature of medical education, the special characteristics of medical education
as a professional education with its strong relations to the health care
systems and the trends in the ongoing quality improvement of medical education.
In the
implementation of the
Firstly,
most medical schools in the European region have especially within the last
decade been actively engaged in reforming their medical programmes. This
process of reform is still going on with a focus on aspects of the programme
somewhat different from the issues in the mainstream of the
The
structure and duration of basic medical education as it is addressed in the
Secondly,
it has to be noted that knowledge and understanding of the Bologna Declaration
and involvement of medical education in the
Thirdly, it
should be observed, that while the subject matter of medical education compared
to other professional programmes often is perceived to be to a large extent
identical in
Most of the
objectives of the Bologna Declaration and Process seem to be in line with
considerations and recent changes in medical education and the implementation
must be regarded as advantageous for most medical schools. This is the case
regarding the following objectives:
·
Adoption
of a system of easily readable and comparable degrees
·
Establishment
of a system of credits such as in the European Credit Transfer System (the ECTS
system)
·
Promotion
of mobility by overcoming obstacles to the effective exercise of free movement
·
Promotion
of European co-operation in quality assurance
·
Promotion
of the European dimension in higher education
·
Lifelong
education
·
Involvement
of institutions and students
·
Promotion
of the attractiveness of the European Higher Education Area
·
Promotion
of closer links between the European Higher Education Area and the European
Research Area
It should
be noted that it is expected that involvement of institutions and students can
take place with a broader scope e.g. with involvement of other stakeholders
primarily the profession and the health care system. Also, it is expected that
co-operation in quality assurance can continue in a broader, global
perspective.
One
objective, the adoption of a system essentially based on two main cycles,
undergraduate and graduate in medical education is by several countries and
many medical schools regarded as problematic and potentially harmful to the
quality of medical education. Implementing this objective will require careful
analysis and considerations.
To some of
the abovementioned objectives or action lines the following comments should be
added:
Easily readable and
comparable degrees. Most likely, all medical schools
will favour easily readable degrees, including introduction of the long overdue
Diploma Supplement and similar measures. However, to obtain comparable degrees
it is not enough to use the same terms or names (bachelor and master). The
competencies and the level achieved should be defined to make degrees
comparable in reality. In several projects attempts are being made to develop
qualification frameworks and descriptors for the different levels of
accomplishment and in all cases without regard to or participation of medicine.
This endeavour is closely linked to the adoption of a system based on two main
cycles and could confront medical education with abstract requirements out of
line with recent quality improvements of medical education.
The ECTS system. Medicine was one of the 5 subject
areas involved in the pilot scheme introducing and testing the ECTS system. Use
of ECTS within medical education ought not to pose problems, provided that
medical schools new to the ECTS system are assisted in clear understanding and
the proper application of ECTS-credits. It should be noted that an ECTS credit
is intended as a pure measure of the workload involved in a specific
learning/teaching activity or unit in the curriculum e.g. a module, a course, a
subject or discipline. The success of the ECTS pilot project depended to a
large extent on the accompanying information package including a precise description
of the unit in the curriculum, its content, level, learning/teaching methods
and assessment. Consequently, recent discussions and developments within the
Promotion of mobility.
The organisations
support continuous growth in international mobility and student exchange. It
has to be acknowledged that the reforms of medical education tends to
complicate international mobility. The new curricula are less known,
transparent and comparable than the classical teacher, knowledge and discipline
based medical curriculum. The commitment to mobility need to be expressed in
efforts to overcome these and other obstacles.
Quality assurance. European co-operation in quality
assurance is in itself necessary and laudable, but implementing the objective
could be counterproductive to recent developments in medicine and to the still
premature development towards global co-operation in accreditation of medical
education.
Firstly,
accreditation of medical education in
Secondly,
the question of recognition and accreditation in medicine should not be handled
by educational authorities alone (e.g. the Ministry responsible for higher
education and the medical
schools).
The process should include the profession and the regulatory bodies responsible
for authorisation or licensing of medical doctors in the individual countries
and other stakeholders from the health care system.
Thirdly,
there is the problem of the criteria or standards used in the evaluation and
accreditation process. Medical education will most likely not benefit from
using abstract criteria and standards developed by other or all subject areas
in
The need
for specific criteria and standards is illustrated by existing accreditation
systems (e.g.
in
Lifelong education. Lifelong education in medicine is
extremely important, but also a very complicated issue. Continuing medical
education (CME) or the more comprehensive continuous professional development
(CPD) has long traditions, resulting in a situation characterised by an extreme
variety of activities between countries and within the individual countries.
This complexity is composed by many different educational providers (public,
private and private for-profit institutions, scientific societies, professional
associations, private companies) and different forms of delivery (formal
courses, seminars and conferences, distance learning, self-study etc.). Also
the regulation of CME/CPD is very different, ranging from no regulation at all
to highly developed systems of regulation specifying requirements directed
towards the medical doctor and/or accreditation of providers/activities.
Furthermore there are differences regarding the regulatory body, which can be
under the auspices of the Ministry of Education or the Ministry of Health or a
professional organisation. There is, however, need for European initiatives and
agreements on this objective in professional medical education.
Involvement of
institutions and students. The organisations strongly support this objective added in 2001. Without
involvement and commitment by institutions and their staff and students to the
The two cycles. This development within the
It is hard
to point at occupations where an ‘unfinished’ study of medicine is an obvious
qualification. A bachelor degree in medicine could be a stepping stone to
further studies leading to a masters degree for instance in biology, in public
health, dentistry, etc. and could possibly with a short (½ - 1 year)
supplementary education in management, media, educational studies etc. qualify
the bachelor in medicine for positions in the pharmaceutical industry, in
public relations, newspapers and TV specialising in health issues and as
teachers in educational programmes for other health personnel. However, medical
education is costly and most countries need the medical doctors they can afford
to educate. To divert the students from the path to a full medical
qualification must be regarded as a debatable educational policy. To finalize
medical studies with a bachelor degree should be a rare exception, but could be
an opportunity only for the few drop-outs from medicine.
If
employability of a bachelor in medicine has priority, the curriculum for the
first 3-4 years (180-240 ECTS credits) will have to be planned accordingly,
hereby jeopardizing the efficiency and/or the quality of the full programme in
medicine. Especially, it could be harmful by reinforcing the traditional sharp
division between an early pre-clinical or basic biomedical part followed by the
clinical part of the medical programme. One of the most widespread and irreversible
international trends in quality improvement of medical education is integration
of the basic biomedical disciplines and the clinical disciplines, hereby
subordinating the teaching/learning of the basic biomedical disciplines to
their present and future application in clinical practice.
Finally, it
should be noted that the introduction of the ‘new’ masters degree in some
countries can cause problems because of unclear relations to existing
terminology and other degrees, their content (e.g. a thesis) and the
professional status.
Countries
and medical schools should for the time being be allowed to opt out regarding
the two-cycle system and continue having the long (6 years/360 ECTS credits or
more) integrated programme or alternatively to establish the first cycle as the
first part of the medical programme without planning for special use or
employability of the bachelor.
The
organisations strongly urge the countries and the ministers responsible for
higher education to make decisions of fundamental importance to medical
education only with the necessary evidence for action and with involvement of
the medical schools, their staff and students, and the stakeholders, primarily
the profession and the health care system.