gms | German Medical Science

Abstract: This paper describes how a project, which arose as an international collaboration between two faculties in the UK and Denmark, was subsequently developed to result in a two-tier medical education aligned to the objectives of the Bologna Declaration. It describes the processes involved and lessons learned from the experience. It is hoped that these experiences and lessons will encourage others to develop similar projects.

Background: The Hull York Medical School (HYMS) is a new United Kingdom (UK) Medical School, opened in 2003. The HYMS programme utilises PBL as the core pedagogical method in the context of a spiral, integrated undergraduate curriculum. A particular characteristic of the HYMS implementation of PBL is that all PBL facilitators are practising clinicians who work with their PBL group for the whole of the academic year. These facilitators train and develop as professional educators as a part of their portfolio careers alongside their clinical commitments. HYMS students have produced a comprehensive guide to PBL at HYMS which is available on the HYMS website (http://www.hyms.ac.uk/documents/pbl_guide_student.pdf).

Aalborg University in Denmark, has developed its own variant of PBL. This is based on the acquisition of learning and researching skills arising from students’ involvement in projects [1].

The project: In 2005, the Aalborg University (AAU) consulted the UK General Medical Council (GMC) in order to establish contact with a UK medical school for guidance in setting up their ‘Bachelor programme in Medicine with Industrial Specialisation’. New medical schools in the UK are subject to scrutiny, particularly in the early years, from the GMC. Their role is to assure the quality of both the programme and its graduates. The HYMS course is regarded favourably by the GMC, particularly in one specified area of the collaboration, PBL (http://www.gmc-uk.org/education/undergraduate/medical_school_reports_full_list.asp). The GMC recommended that AAU contact staff at HYMS for this support.

In consultation with AAU, HYMS staff designed a training programme to be delivered by a delegation of HYMS staff and students. During this initial training event in the summer of 2006, an agreement was made that AAU could use the well-developed teaching/curriculum materials in use in Phase 1 of the HYMS curriculum, to facilitate the development of the AAU curriculum.

These same materials are used across the three years of the AAU Bachelor course, the remaining time being occupied by the AAU programme of additional work in their own project-based learning activities.

A vital component of the HYMS curriculum is the clinical placements which begin in the first weeks of the undergraduate course. These allow the students to establish the relevance of their scientific learning and to practice the communication and clinical skills, which they are learning at the university. At the outset, there were no equivalent placements for the AAU students registered for the ‘Medicine with Industrial Specialisation Programme’.

The extended project: Establishing clinical placements for students in the AAU programme was a major step in the continued development of the programme. In doing this, the faculty could offer students a similar experience to HYMS students, following the same academic programme in conjunction with consistent clinical experience to contextualise and integrate that learning. This then paved the way for consideration of student exchange between the two faculties.

This then represented a very specific implementation of a Bologna type of process facilitating international student mobility. There is enthusiasm in the UK for the mobility of students in medical education but with recognition that there are obstacles, which need to be overcome (http://www.europeunit.ac.uk/resources/Full seminar report.doc).

Obstacles to progress: Within the EU policies exist which are designed to overcome administrative barriers to student mobility, including the agreed equivalence of qualifications. The absence of a two-tier medical education process in the UK and linguistic and financial considerations are significant obstacles [2].

To progress this project, the AAU faculty required further support in the development of both its curriculum content and its curriculum delivery, with the goal of equipping a small number of its students to be able to enter Phase 2 of the HYMS curriculum (years 3-5).

An agreed level of attainment in the AAU Bachelor Degree was considered to be equivalent to the Phase 1 HYMS written assessments, as their curriculum so closely mirrored the HYMS curriculum. However, in the absence of established and validated clinical examinations at their home faculty, the AAU students would be required to pass the HYMS end-of-Phase 1 clinical examination in order to enter Phase 2 of the HYMS programme.

International students gaining admission to HYMS are required to demonstrate adequate proficiency in the English language by obtaining an average score of 7.5 across all components of the IELTS - International English Language Teaching Services (http://www.ielts.org). In addition, all entrants to HYMS are required to take an onscreen aptitude for medicine test (http://www.ukcat.ac.uk/)

How to overcome the obstacles? In the absence of an established exchange mechanism between the two faculties, the HYMS’ admissions team needed to establish UK equivalent grades for the AAU Bachelor Degree classification. The HYMS Directors of PBL have now developed a protocol for the AAU faculty to follow for students applying to HYMS, to help them to navigate the admission process effectively.

A number of interfaculty visits were arranged. The HYMS’ Directors of PBL delivered training programmes to the AAU faculty staff who would be involved in the delivery of PBL and clinical skills teaching. Observation of PBL and clinical placement sessions enabled HYMS staff to advise AAU on how best they could develop their clinical placement teaching in order to align closely with the HYMS curriculum outcomes. In addition, AAU faculty staff visited HYMS to observe PBL sessions in progress and to consult with various members of HYMS staff in driving the development of their own curriculum.

From the outset, HYMS students were actively involved in the interfaculty work. Groups of undergraduate students accompanied HYMS’ faculty staff delivering training programmes in AAU. This permitted the delivery of live PBL demonstrations to engage the faculty staff in experiential learning in developing their own facilitation skills. Students from the two faculties had opportunities to discuss the details of the course to allow students interested in undertaking an exchange to obtain a student’s view of many aspects of our curriculum.

Subsequently, a group of four selected students undertook a 3-week study period in Denmark, evaluating current curriculum development in order to identify key areas for continued development, to facilitate the exchange of students between the two faculties.

The Danish students applying to HYMS have worked closely with an identified member of staff on the AAU campus to complete their applications to HYMS, following the protocol developed as described above. In addition, these students have visited the HYMS campus, to observe teaching sessions in progress, to meet British students and to familiarise themselves with the live examination procedures which were not part of their home campus experience.

Outcomes: The AAU ‘Bachelor Degree in Medicine with Industrial Specialisation’ is now running autonomously with little need for further collaboration in its continued success, though faculty staff remains in contact for the continuing exchange of ideas and information. Both faculties have benefited because of the collaboration.

AAU offers placements for intercalated degrees to HYMS students at the end of the second year of their studies, providing opportunities expanding the range of intercalated programmes offered in the UK.

HYMS students have contributed to the development of the AAU faculty, with the learning outcomes for the HYMS students being formally assessed as parts of their HYMS programme. AAU and HYMS have subsequently collaborated in a tour of four medical schools in China, presenting models of PBL to the Chinese medical education community.

HYMS has established a two-tier medical education, which is applicable in the specific set of circumstances described in this paper. One AAU student, graduated in 2009, successfully completed the application process to gain entry to Phase 2 of the HYMS curriculum in 2009, but was unable to commence due to personal circumstances. However, the pathway is now established and groups of students, under the direction of AAU staff are now working towards future applications.

Transferable and generalisable principles: This paper is a description of an evolving project between two European faculties resulting in the establishment of a specific two-tier medical education that is faculty-specific.

The paper relates the obstacles to be overcome in the establishment of this exchange. The following points highlight the areas HYMS can identify from this experience which may help other faculties to develop similar projects.

• Close interfaculty collaboration is required over lengthy periods to establish such exchanges.
• Key academic staff need to be able to work together to become familiar with the details of curricula and their delivery in order to develop the project. Frank exchange of views and identification of areas for development is necessary.
• In the absence of established exchange systems, attention to detail on the part of admission staff is required to facilitate entry for the students to the UK organisation; protocols for the European faculty to follow are helpful in assisting students to navigate through the complex admission requirements.
• Staff mobility is a pre-requisite. Visiting the partner faculty has been a valuable experience for both faculties, in staff development and in identification of key areas for development.
• Student involvement at all stages is beneficial in faculty development and in facilitating the student exchanges, and as advocates for development of their curriculum.
• The process requires identified members of staff who will continue to progress the project and to work with the students in the European faculty to address both the learning needs and technical requirements to gain entry to the UK school.