gms | German Medical Science

For medicine in higher education, the Bologna Process is more a chance than a risk. Even controversial issues such as the continuation of state examinations and tiered-structure of curricula can be resolved as experience in other countries demonstrates. Above all, the students can benefit from a reform of the medical degree programmes.

In higher education, the area of medicine represents an exception with regard to the Bologna reforms. A certain duration of study or a certain amount of minimum hours serves as the requirement for medical curricula to be recognized in other EU member states. As of now, the issue of comparable degrees would thus seem to be resolved; in practice however, there is and will continue to exist a number of serious obstacles concerning stays abroad for medical students as long as the European Credit Transfer System (ECTS) is not implemented extensively in this field.

Meanwhile, there is already a great deal of positive experience with the reforms. Several countries are at the forefront such as Switzerland and, among the EU-member states, Belgium, Denmark, the Netherlands, and Portugal, having already made the transfer to tiered medical curricula with Bachelor and Master Degrees, while Switzerland even maintained the state examination for medicine. In Germany, the initial results from the CHE higher education rankings show that students have an above-average positive view of the model degree programmes in medicine. Particularly the linkage between clinical and pre-clinical content, the practice-oriented elements, as well as the inclusion of patient contact and care in the curriculum have received considerable praise. Surely these model curricula do not constitute the only way to develop good teaching and education – but they can be used as instruments in medical education for improvements that the students highly value, as the examples illustrate.

Probably the most controversial issue in the context of converting degree programmes in medicine concerns the possible introduction of the tiered structure of Bachelor and Master. For precisely this reason, a large number of the German academic and professional associations oppose the Bologna Process. In the reform discussion, a main topic is professional qualification and “employability” of Bachelor degree-holders. From the perspective of the German Rectors’ Conference (HRK), it is clear that they will not be qualified for the physician profession with a Bachelor degree alone. Most likely, a large majority of the Bachelor graduates would enter Master degree programmes, which could then qualify (eventually with the 'Staatsexamen') for the medical profession.

As of now, particularly in the field of medicine, there is still indeed a lack of suitable occupations commensurate to the model of a fully-fledged, professional qualifying Bachelor degree. But it would be utmost worthwhile for the Bachelor degree to serve as a transfer option – as an interface, upon which students could pursue subjects such as molecular medicine, epidemiology or health sciences, which are being increasingly established at higher education institutions.

Closely correlated to the issue of tiered degree programmes is the question of student mobility. Introducing the ECTS credit transfer system on a wide scale in the medical disciplines could help to resolve the remaining problems in cross-border recognition. Consequently, students could easily study or even transfer abroad, in contrast to the past and even current situation. That would constitute an important step to establishing a transparent and international study of medicine that prepares students for changing working conditions and international challenges in their future professions.

Moreover, it is also crucial to have clearly defined learning outcomes. What should the graduates of a medical degree programme know and be able to do? Which skills are they supposed to acquire? What should they learn and in which courses? The so-called “Qualification Framework” for higher education degrees can provide a helpful tool for answering these key questions. Of course, a catalogue of learning outcomes would need to be developed within the discipline of medicine, at the higher education institutions and in exchange with professional practice. There has long been basic agreement on the need for a nationally applicable set of learning outcomes, through which certain skills and achievements are tied to the needs and demands of a professional physician. This sort of catalogue would prevent each faculty from developing its own reform curricula separately, a situation which would otherwise undermine any nation-wide comparability.

The issue of the first state examination, its sustainability, and role in the future still needs to be discussed. Until now, the exam is taken after the first two years of the uniform state curriculum – a rule that would probably make less sense, if the Bachelor is to be seen as the first academic degree after a period of three years of study. Nevertheless, most medical professionals in Germany support a comprehensive, cross-university exam like the state examination. In light of this, a tiered structure for the degree programmes as well as the examinations seems realistic – as does the integration of clinical phases already in the first study phase. The state examination could take place, for instance, following the Master phase.

In the long-term, the medical discipline should establish structures that are compatible with those of other subjects and the principles of the Bologna Declaration. Certainly, there could be subject-specific regulations, for example in issues like the duration of studies or access to the physician profession. Similar arrangements have been made and work in Germany, as the case of Theology illustrates: those (limited) study programmes in this subject that qualify for direct professional access to the pastoral care will not be tiered into Bachelor and Master in the short-term, and the reforms must take church rules and regulations in Germany into account. Nonetheless, all theological degree programmes are set to be modularised and to carry ECTS-points.

The discipline of medicine in higher education does not need to shy away from study reform, if the latter is properly understood. Clearly, Bologna can work here just as well. As the case may be, the structural discussion up to now about the sense and nonsense of a Bachelor of Medicine has been to almost no avail. From the outset, concrete objectives need to be defined as to what a Bachelor degree-holder should be capable of at the end of studies. Following on that, one can certainly develop an excellent degree programme. The Bologna Process means more a chance than a risk. Academics and professionals of medicine can only profit from a reform of this discipline rich with tradition – in taking on this endeavour, they receive the opportunity to readjust a great deal of that material.