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 Bologna Process and scientifically qualified doctors - no conflict of interest

Extended Abstract

Search Medline for

  • corresponding author presenting/speaker Jörg Pelz - Charité - Universitätsmedizin Berlin, Prodekanat Studium und Lehre, Berlin, Germany
  • Manfred Gross - Charité - Universitätsmedizin Berlin, Prodekanat Studium und Lehre, Berlin, Germany

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. Doc08hrk10

DOI: 10.3205/08hrk10, URN: urn:nbn:de:0183-08hrk106

Published: January 13, 2011

© 2011 Pelz et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

The German Medical Licensure Act (Approbationsordnung für Ärzte, ÄApprO) describes as one of the aims of medical education ‘the scientifically and practically qualified doctor in medicine’. Accordingly, the education is scientifically based, conveys knowledge and practical skills, and is oriented towards service to the patients. Scientifically based means in form university-based and in content in line with scientific principles and knowledge. This reflects the history of the medical education in Germany and it is in accordance with the proposals of Flexner whose report revolutionised the American Medical Education and induced the development of its standardisation about 100 years ago: Medical schools (faculties) need proper equipment and have to be linked to excellent teaching hospitals. Students admitted to medical studies had been selected for their highest order of qualification. Training is based on the scientific method and ‘its critical method will dominate all teaching whatsoever’ [1]. Research and investigation are conducted in every medical school stimulated by problems that emerge from patient care. This is important because it improves patient care as well as teaching. These well intended proposals of Flexner were soon modified in daily round. Research got ahead of teaching in importance in university hospitals. Basic science content mainly taught context-free by nonclinical scientists grew in breadth and became widely unnecessary for prospective doctors. 15 years after his revolutionary report Flexner wrote ‘Scientific medicine in America – young, vigorous, and positivistic – is today sadly deficient in cultural and philosophic background’ [2]. What Flexner originally intended with scientific education was not pure content but rather method.

Today it is widely accepted that for doctors to be competent they have to acquire a substantial knowledge of basic sciences. Translated into practice this means that medical training in Germany in the regular curriculum is divided into a pre-clinical and a clinical stage. The first two years of study focus on natural sciences (anatomy, biology, biochemistry, chemistry, molecular biology, physics, and physiology) and social sciences (medical psychology and sociology). This is thought to be scientific education. Students complain about theory overload with topics taught three or four times from slightly different perspectives. Practical courses are mainly dull repetitions of boring experiments which have nothing to do with interesting and enthusiastic scientific working, nothing to do with curiosity and the use of scientific reasoning, which are fundamental to the practice of medicine. Teachers admit that after these first two years and the first state examination students forget most of the content (http://www.mft-online.de/buch9/pdf/Seite_207.pdf). Given this unwanted result the answer is not search for an alternative approach but stick to the usual one.

Many opponents of the Bologna Process express their concern that the scientific character of medical studies and education will be lost if we change the present way of teaching the so called ‘systematic’ presentation of basic science content. The German spokesman admits that the medical curriculum in Germany is ‘sick yes, dying not. The medical education system is far from perfect but it is still in working order, even though we have reached – and partly transgressed – the limits of its capacity.’ [3]. Cause for the grievance is seen in an unacceptable student/teacher ratio – an attempt of an explanation that quite obvious goes awry. The student/teacher ratio can be quite easily alleviated by the introduction of new teaching formats e.g. teambased learning. Cure is needed for the content-overload of the curriculum, the teacher-centred education and the mix-up of scientific content and scientific method. The Bologna Process can be used as an initiation and a turn for the better of the current curriculum without compromising the scientific basis and character of medical education. The scientific basis is scientifically justified if understood as the necessary knowledge (not in-depth or encyclopaedic knowledge) of scientific facts and how current medical knowledge and what is more important scientific principles and methods which do not change from one day to the other. Scientific education is often misunderstood as context-free formulated scientific knowledge grounded in the basic sciences with the experiment as the paradigm of scientific research. In the realm of medicine free living human beings are often involved in research projects as subjects of interest. Therefore students have to familiarise themselves with far more scientific methods right from the beginning: epidemiologic study designs, qualitative studies, biostatistics, and ethics of research.

Different medical schools put different emphasis on the diverse aspects of medical training. The faculty of the Charité chose the physician as a scientist and as a researcher as the key element of the academic education without neglecting practice, interaction, communication and ethical aspects. The Charité was the first German Medical School to introduce an obligatory research elective. Thus, in the two current curricula of the Charité, the regular one and the reformed one, students have to complete two scientific projects during their studies and have to present their results as a poster or an oral presentation respectively. In the reformed curriculum students carry out a first tiny scientific project at the end of the second year and present its result as a 10 minute oral presentation followed by 5 minutes discussion during an internal student conference. The second project is a small research project at the end of the fifth year – students publish their results as a poster. This is identical to the second project in the regular curriculum. The first project of the students of this track is a written report similar to a scientific article in the middle of the third year.

The Bologna Process with the three cycles of higher education qualification supports this concept with its weight to practical training and an emphasis on more or less intensive research projects which complete the first cycle with a Bachelor Degree, the second cycle with a Master Degree and the third cycle with a Doctoral Degree. Medical faculties can emphasise science and research in their curricula without the Bologna Process, but there is no reason to refuse an educational reform that sings from the same hymn sheet.

Beginning with the winter term 2010/2011 the Charité introduces a Bologna compatible model curriculum (compatible not a Bologna curriculum!). Three 4-week modules are devoted to scientific methods and research. They are scheduled at the end of the second, in the middle of the sixth (followed by an elective) and at the end of the tenth semester. The first module is an introduction into science and scientific working in the realm of medicine. On the one hand students get the opportunity to develop a feeling about ‘what is this thing called science?’ on the other hand they become familiarised with methods of data collection and data analysis, principles of study design and basic methods of research, finally they conduct projects in small groups as a teaser.

The second module will focus on a small research project and the presentation of the results, the third module on science and research in the clinical environment. The emphasis of the curriculum on the physician as a scientist/researcher is going to be supported by PBL as a teaching method in about 80% of all modules of the model curriculum [4]. This student-centred and active-learning pedagogy is commonly used in science education. The model curriculum of the Charité is going to show that a Bologna compatible curriculum is not inconsistent with a scientific education in medicine – quite the contrary.


References

1.
Flexner A. Report on Medical Education in the United States and Canada. A report to the Carnegie Foundation for the Advancement of Teaching. New York: The Carnegie Institution Bulletin; 1910. No. 4.
2.
Flexner A. Medical education: A comparative Study. New York: Mac Millan; 1925.
3.
Pfeilschifter J. The Bologna agreement is not suitable for medical education: a German view. GMS Z Med Ausbild. 2010:27(2):Doc32. DOI: 10.3205/zma000669. Available under: http://www.egms.de/static/de/journals/zma/2010-27/zma000669.shtml External link
4.
Eberlein T, Kampmeier J, Minderhout V, Moog RS, Platt T, Varma-Nelson P, White HB. Pedagogies of engagement in science. Biochem Mol Biol Educ. 2007;38(4):262-273.