gms | German Medical Science

The structure of Medical Education in Europe: Implementing Bologna – On the way to a European success story?
International Conference hosted by the German Rectors' Conference (HRK)

10 - 11 October 2008, Berlin

Suggestions for the implementation of a BaMa system at the Yerevan State Medical University

Extended Abstract

  • corresponding author presenting/speaker Astghik Markosyan - Yerevan State Medical University, Department of External Affairs, Yerevan, Armenia
  • L. Avetisyan - Yerevan State Medical University, Department of External Affairs, Yerevan, Armenia
  • R. Aristakesyan - Yerevan State Medical University, Department of External Affairs, Yerevan, Armenia
  • G. Yaghjyan - Yerevan State Medical University, Department of External Affairs, Yerevan, Armenia
  • G. Kyalyan - Yerevan State Medical University, Department of External Affairs, Yerevan, Armenia

The Structure of Medical Education in Europe: Implementing Bologna – On the way to a European success story?. International Conference hosted by the German Rectors’ Conference (HRK). Berlin, 10.-11.10.2008. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc08hrk12

DOI: 10.3205/08hrk12, URN: urn:nbn:de:0183-08hrk120

Veröffentlicht: 13. Januar 2011

© 2011 Markosyan et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Abstract: According to the law adopted in 2005 in the Republic of Armenia, a higher education must adopt the Bologna 2-cycle system. Since 2005, the new model of a Bachelor programme has been implemented at YSMU as a pilot project. In the suggested model, undergraduate medical education lasts 5 years and results in a Bachelor Degree. According to the standards defined by the state, the Bachelor of Medicine is a health care professional, qualified to perform biomedical research, administrative and organizational tasks related to basic and fundamental medical disciplines.

After passed through the Bachelor programme, focus in eight major divisions of medicine will be offered in the Master programme: internal medicine, general surgery, obstetrics and gynaecology, paediatrics, general practice (family medicine), general practice (military medicine), and public health biomedical sciences.

Introduction: The Bologna Declaration, signed in 1999 by Ministers of Education of 29 European countries, has defined six action lines (http://www.ond.vlaanderen.be/hogeronderwijs/bologna/) which are:

  • Adoption of system of easily readable and comparable degrees.
  • Adoption of a system essentially based on two main cycles.
  • Establishment of a system of credits.
  • Promotion of mobility for students, academic and administrative staff.
  • Promotion of European cooperation in quality assurance.
  • Promotion of the European dimension in higher education.

In 2004 the Republic of Armenia joined the signatory countries. The Law on Higher and Postgraduate Professional Education was adopted in Armenia in 2005. The law ensures the state policy of having comparable degrees with those of European countries and recognition of diplomas and their supplement. Among others it set also goals to switch to the two-cycle system of education, implementation of the European Credit Transfer System and quality assurance. According to this law, the two-cycle system is adopted with Bachelor and Master qualifications for medical specialties with duration of education of at least five years for Bachelor programmes and up to 4 years for Master programmes (http://www.education.am/english/education/turizm.html).

Since the adoption of this law, the Yerevan State Medical University (YSMU) began the implementation of reforms related to the Bologna Declaration.

History: During the past decades education of General Medicine at YSMU has been carried out according to the following model of Higher Medical Education: Medical training and education lasted six years. During the first three years basic medical sciences were taught. During the following three years students learned clinical subjects in hospitals. Upon graduation the degree ‘MD Physician” was conferred. The graduate was allowed to practice medicine after completion of subsequent one year internship or a 1 to 4 years residency programme (so-called ‘clinical ordinatura’).

Bachelor of Medicine: Since 2005 the new model, the Bachelor programme has been implemented at YSMU as a pilot project: An intensive curriculum development project is undertaken. The curriculum has been fully revised horizontal integration has been introduced in the premedical curriculum.

In this curriculum, undergraduate medical education lasts five years and results in a Bachelor Degree. This duration is justified by the fact that education in the secondary school in Armenia lasts 10 years, as opposed to 12 years secondary education in Europe. Thus, during the first year of the Bachelor programme medical students learn medical biology, medical physics and chemistry. The next two years (year 2 and 3) are preclinical were students learn fundamental medical disciplines, such as human anatomy, normal physiology, histology, biochemistry, pathology and pharmacology. The last two years (year 4 and 5) are clinical with clinical rotations in major surgical, therapeutic, and preventive disciplines. According to the Bologna Process action lines, each academic year corresponds to 60 ECTS credits (30 credits per semester).

According to the standards defined by the state, the Bachelor of Medicine is a health care professional, qualified to perform biomedical research, administrative and organizational tasks related to basic and fundamental medical disciplines. Upon graduation the Bachelor of Medicine can carry out his/her own research, educational and organizational activities in the following way:

  • Perform basic science research in biomedical labs.
  • Teach professional disciplines in vocational schools.
  • Perform preventive and educational activities for patients and their families.
  • Perform administrative duties, updating and filing medical records in health care institutions.
  • Provide medical aid to the population during epidemics and emergency situations.
  • Perform advocacy and educational public health activities.

Upon completion of the subsequent one-year internship, the Bachelor of Medicine is allowed to perform the following preventive activities under the supervision of a licensed physician:

  • Primary, secondary, and tertiary preventive activities, among healthy people, people with illnesses, their families, and community members.
  • Diagnostic examinations and first aid.
  • Treatment of patients with therapeutic and surgical methods.
  • Diagnosing and following-up pregnancy.
  • Ability-to-work assessment.
  • Forensic inquiry.

These Bachelors can choose one of the two paths to continue their education, i.e. internship or a Master Programme.

Master Programmes: After the Bachelor qualification opportunities in eight major divisions of medicine are at choice for students for a Master qualification to gain the necessary skills for both general medical practice and their Master subspecialty. Upon completion, this track confers a ‘MD-MSc’ Degree. The following Master programmes are offered for graduates of the Bachelor of Medicine programme: internal medicine, general surgery, obstetrics and gynaecology, paediatrics, general practice (family medicine), general practice (military medicine), public health, and biomedical sciences.

The duration of Master programmes is two years (120 credits) during which students mostly perform practical tasks. The programme is structured to promote student mobility: the student is allowed to take courses in other countries/institutions and bring back up to 12 credits. 75% of disciplines in the Master curricula are mandatory for the chosen specialty, 25% are voluntary to choose disciplines. Among these disciplines, the student has a choice of four electives out of eight.

For ‘narrower’ medical specialties, graduates may apply for residency programmes following the corresponding Master programmes. The residency programmes must be complemented before entering Master programmes. The duration of the residency programmes will depend on the chosen specialty (1-4 years).

Schematically, the medical education path can be presented in the following way (see figure 1 [Fig. 1]):

Discussion: Introduction of a Bachelor/Master model in medical education is a time-consuming and expensive task that requires resources (both human and financial) and corresponding reforms in the health care system. Alongside with these reforms the quality of education should be placed in the forefront. Naturally, this process will meet a lot of resistance.

Having a Bachelor of Medicine as a graduate of a medical school implies that she/he should have a relevant place in the labour market. This is also one of the prerequisites of the Bologna Process related to the implementation of the two-cycle system, which has not been met by any of the signatory countries up to now. The definition of job description for a Bachelor of Medicine helps understanding better their place in the labour market and leads to a reform in health care system of Armenia, aiming at the introduction of an ‘Assistant Physician’ as a separate group of healthcare providers.

The two-cycle system will allow a selective awarding of the ‘Medical Doctor’ Degree, on a competitive basis, i.e. students with poor performance on entry exams to the Master programme will not be admitted, as opposed to students with high academic achievements. Later on, upon graduation in the Master programme, only a limited number of best graduates will get spots in residency programmes, thus assuring the quality of specialized medical education and provision of medical care in the country.

Those students who wish to pursue a career in biomedical research only, may continue their education in a corresponding Master programme, and subsequently in a PhD programme. In this sense, the concept implies a more rational use of time and resources, since instead of six years of medical education (previous model) its students will study only five years and obtain the necessary skills and knowledge for doing research in biomedical science.

The five year duration of the Bachelor programme is also temporary, since recent educational reforms in the country lead to an increase of the secondary education time from 10 to 12 years. In a few years, this will allow YSMU to cut the first year of the Bachelor programme, leaving it for 4 years in total.