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

The influence of the Bologna Process on medical education in Croatia

Extended Abstract

  • corresponding author presenting/speaker Nada Cikes - University of Zagreb, School of Medicine, Dean, Zagreb, Croatia
  • Miljenko Kapovic - University of Rijeka, School of Medicine, Dean, Rijeka, Croatia
  • Stipan Jankovic - University of Split, School of Medicine, Dean, Split, Croatia
  • Pavo Filakovic - University of Osijek, School of Medicine, Dean, Osijek, Croatia

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. Doc08hrk13

doi: 10.3205/08hrk13, urn:nbn:de:0183-08hrk132

Veröffentlicht: 13. Januar 2011

© 2011 Cikes et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen ( Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.



Introduction of the Bologna Process: Croatia joined the Bologna Process and signed the Bologna Declaration ( in Prague, in May 2001. Implementation of the Bologna Process in higher education started in the academic year 2005/2006. However, the Bologna Declaration was introduced into the Croatian medical education system in 2000, when the European Credit Transfer System (ECTS) was first to be applied at the University of Zagreb School of Medicine (UZSM).

Founded in 1917, the UZSM is the leading institution in undergraduate, postgraduate, and continuous education for health care professionals in Croatia and South-East Europe, with almost 20 years of experience in promoting the improvement of teaching skills through continuous teacher training. Less than a year after the Bologna Declaration was adopted, UZSM decided to introduce the ECTS and assigned the credits to all courses taught. In order to properly define the student workload for each course – as basis for the relative value within 60 ECTS per year – a questionnaire requesting information about teaching hours and the hours needed to accomplish each educational unit of each course was developed. Faculty and students were asked to estimate the time needed and to calculate the total number of hours needed to pass the relevant exam. Interestingly enough, there was no big deference between faculty’s and students’ estimation. The results of the survey, being formulated as the total student working hours for each course, were used as a student workload coefficient to establish the relative value of ECTS for each course, within the total of 60 ECTS as the representative sum of all course credits in one academic year.

From the academic year 2000/20001 on, the calculated ECTS was introduced into the study programme at UZSM and evaluated after 3 years. Its analysis has shown the role of ECTS in the teaching load, particularly in the evaluation of less successful teaching blocks, where the ECTS were not adequately assigned. The evaluation has been an excellent basis for development of a new study programme, since UZSM was ready to change the curriculum, to keep the specific approaches based on positive experience, to apply benchmarking and quality assurance.

The Croatian Government decided to implement the Bologna Process in higher educational institutions in Croatia from the academic year 2005/2006. Thus, all four medical schools in Croatia (from the Universities of Zagreb, Rijeka, Split, and Osijek) decided to work jointly on the improvement of the medical education system, as well as on the implementation of the Bologna Process in the curricula. All four medical schools consented to create together a core curriculum and to evaluate its implementation on the principles of the Bologna Process. Based on the UZSM experience in implementing the ECTS, all medical schools decided to formulate the ECTS as an indicator of student workload, as well as to emphasise the importance of quality assurance, to promote mobility within the Croatian universities, to develop life-long learning skills, to define national competences and qualifications, to work on joint degrees in doctoral studies and to enhance the European cooperation. These joint actions were also decisive for bridging the gap between the academic community and professional societies.

The new core curriculum: The new core curriculum was developed after an exhaustive needs assessment analysis, including identification of actual deficits in knowledge, skills, and attitudes, as well as through defining goals, objectives, and educational strategies to be implemented. Various medical education resources and models have also been studied and discussed on that occasion. The new curriculum was applied on the first generation of students in the academic year 2005/2006. The modular system was introduced, electives were mutually offered to all schools promoting students' and teachers' mobility. Thus, on the grounds of the electives jointly offered, students’ mobility within the Croatian universities was established and was well accepted by the students. Consequently, education became more student-centred, emphasising the position of students as partners in the educational process. The Interactive Medical Education Center (InterMeCo) for estimating educational needs was established, resulting in several elective e-courses which are very popular among students from all schools. The project declared several goals: to bring standardisation and quality assurance into teaching, to introduce new content of studies through the use of information technology, to develop learning facilities and services necessary for building virtual and real-life network connection.

Additionally, all four university senates decided that the Croatian curricula should remain integrated, which means that a two-cycle system was not accepted for medical education in Croatia. All other postulates of the Bologna Process have been acknowledged for medical curricula (see table 1 [Tab. 1]), as well as for other university studies in Croatia.

In course of the development and implementation of the new curriculum associated with the Bologna Recommendations, UZSM has also respected the World Federation for Medical Education (WFME) Global Standards for Quality Improvement in Basic Medical Education, particularly in the context of the European educational situation, as well as the WFME and AMEE Statement on the Bologna Process and Medical Education [1], [2].

The legal framework for medical schools’ cooperation was defined by two recently adopted laws in Croatia: the National Health Care Law, and the Law on Scientific Activities and Higher Education, both adopted by the Croatian Parliament in 2003.

National qualifications framework: After the requirements established at the Berlin Conference 2003 and the Copenhagen Conference in 2005, the need for a national and European overarching qualification framework was formulated. Basic components of the European Qualification Framework have been defined as the common orientation points related to learning outcomes. Common principles and procedures in the European Qualification Framework stimulated the cooperation guidelines with emphasis on quality assurance, clearly related to academic standards. It was understood that public trust in academic standards requires the general understanding of achievements represented by various qualifications and titles in the area of higher education (

After study and analysis of various national and international documents, progress has been made in defining competences and learning outcomes for the Croatian medical doctors. Based on the old ‘Catalogue of Knowledge’ published by the UZSM in 1982, and the needs of the present curriculum, the medical schools have completed the catalogue coordinated by all schools, defining the level of knowledge and skills, as well as the Booklet of Skills. Presently UZSM is in the process to develop learning outcomes for medical doctors in Croatia on all educational levels. Competences are being defined for courses within the undergraduate curriculum; learning outcomes are discussed in the light of several European documents as well as benchmarking with other national and institutional acts. Medical schools have also given impetus to the development of new competency-based postgraduate specialty training programmes which are nearly completed. At all educational levels, special attention is paid to the development of generic competencies (, [3], [4].

In the meantime, the Croatian government has initiated the development of the Croatian Quality Framework. Owing to the Croatian medical schools’ initiative, the role of medical education in the development of a national qualification framework has been additionally recognised.

Doctoral Studies: According to the Bologna Process, doctoral studies have been declared as a third cycle, but of the European Research Area. It has become clear that the dominant component in doctoral studies has to be the research part, while the educational part should support the research. So far, there are large differences among the European universities in organising doctoral studies. This is particularly important for biomedicine. In 2004, UZSM organised the European Conference on Harmonisation of PhD-Programmes in Biomedicine and Health Sciences with delegates from 33 universities and institutions from 21 countries. Standards for doctoral studies in health sciences were discussed and defined. The conference concluded with ‘The Declaration of the European Conference on Harmonisation of PhD-Programmes in Medicine and Health Sciences’ (the so-called ‘Zagreb Declaration’). The Zagreb Declaration defines the expected content of a PhD-thesis in the biomedical context. At the second conference, organised at UZSM in 2005, the European Association for Doctoral Programmes named ORPHEUS (Organisation for PhD-Education in Biomedicine and Health Sciences in the European System) was established. Since then several European conferences have been organized by the ORPHEUS group, promoting the advancement of clinical research, as well as strengthening basic research in the area of biomedicine and health sciences. Consequently, there is a growing interest for the ORPHEUS membership, as well as for spreading its mission (

Another initiative aimed at the development of a doctoral study network in biomedicine and health sciences at the Croatian universities is also gaining momentum. Besides the existing agreements which facilitate the medical schools’ cooperation in PhD programmes, other faculties in the area of biomedicine are invited to participate. It is expected that cooperation in both research and organised teaching will increase mobility and interdisciplinary co-operation, leading to the joint programmes offered to the biomedical community.

Conclusion: The Bologna Process is implemented in Croatian medical education at national level in concert with other developments in medical education in order to promote both educational and health systems. The Bologna Process contributes to many aspects of medical education, all more important than deciding on the 2-cycle system. Critical analysis reveals that not all Bologna Process principles have been equally implemented: the quality assurance culture, mobility of faculty and students should be further promoted, students to be seen as full partners, particularly their sensitivity for the social dimension should be adequately respected. There is a growing need to secure significant funding and to rethink the position of doctoral students in research projects. Finally, the synergy between the European Higher Education Area and the European Research Area still has to be developed both in Croatia, as well as at the European level.


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WFME, AMEE. Statement on the Bologna Process and Medical Education. Copenhagen: WFME, University of Copenhagen; 2005. Available under: Externer Link
Bologna Seminar. Using Learning Outcomes. Edinburgh: Bologna Seminar; 2004. Aviable under: Externer Link
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