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

Implementing Bologna Standards in the medicine curriculum at the Royal College of Surgeons in Ireland

Extended Abstract

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  • corresponding author presenting/speaker David T. Croke - The Royal College of Surgeons, Faculty of Medicine & Health Science, Dublin, Ireland

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. Doc08hrk11

DOI: 10.3205/08hrk11, URN: urn:nbn:de:0183-08hrk117

Published: January 13, 2011

© 2011 Croke.
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

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Historical background: The Royal College of Surgeons in Ireland (RCSI) is the second oldest third-level academic institution in Ireland. Preceded by the University of Dublin (Trinity College; founded in 1592), RCSI was established in 1784 and provided the only training in surgery in Ireland until 1851. In its early years, RCSI trained over 1,000 surgeons for service in the Napoleonic Wars. RCSI existed for 60 years prior to the foundation of the forerunners of the Irish University Colleges dating from 1845. It provided early recognition of academic qualifications in medicine from the Catholic University School of Medicine - the precursor of today’s University College Dublin - from its foundation in 1855. RCSI is one of the four Royal Colleges of Surgeons in Great Britain and Ireland (Dublin, London, Glasgow, and Edinburgh) and, as such, is the professional body governing education, training, accreditation, and professional standards for surgery and related disciplines in Ireland.

Arising from the Medical Act of 1886, RCSI established an undergraduate School of Medicine under the aegis of the Conjoint Board of the Royal College of Surgeons in Ireland and the Royal College of Physicians of Ireland (RCPI). The graduates received the historical Licentiates of the RCSI and the RCPI. Since 1978 the College is a Recognised College of the National University of Ireland (NUI) with the award of the MB, BCh, BAO degrees to its graduates in addition to the historic Licentiates. Since the foundation of the undergraduate School of Medicine, some 20,000 students have graduated in medicine at RCSI, many of them international students. In addition to undergraduate medicine, the College also delivers undergraduate and postgraduate degree programmes in nursing, pharmacy, and physiotherapy.

Medical degree programmes at the Royal College of Surgeons in Ireland: The RCSI has offered a 5-year medical degree programme for over 25 years, accredited by the Irish Medical Council and leading to the award of the Licentiates and the degrees of MB, BCh, and BAO (NUI). A proportion of students are admitted to a 6-year programme which commences with Foundation Year and feeds students into the 5-year degree programme. Since 2004 the same degree programme has been offered in Bahrain at the RCSI Medical University of Bahrain (RCSI-MUB). In 2006 RCSI became the first medical school in Ireland to offer a 4-year Graduate Entry Programme (GEP) in medicine, the first such programme to receive full accreditation from the Irish Medical Council.

The undergraduate medical curriculum at RCSI has evolved considerably in the past decade, moving from a traditional discipline-based model via a partially integrated systems-based model to the current integrated, modularised, and semesterised curriculum. The curriculum, implemented in October 2005, divides the 5-year undergraduate medical degree programme into three cycles: Junior Cycle (JC), Intermediate Cycle (IC), and Senior Cycle (SC) (see figure 1 [Fig. 1]). JC and IC each run over three semesters (1.5 academic years) while SC runs over two full academic years. In addition to modules running horizontally within cycles, key vertical themes run across all years of the programme including biomedical sciences & research, clinical medicine, clinical competence, personal & professional development, and population & international health. Content in the Junior & Intermediate Cycles is packaged as integrated modules whereas the Senior Cycle is more discipline-focused; this reflects the need to divide Senior Cycle students into groups for rotation through specialist clinics in the principal teaching hospitals (in Dublin) and the affiliated hospitals of RCSI (located outside of the greater Dublin area). Curriculum delivery involves didactic lectures, small-group tutorials, case-based teaching, and clinical skills tutorials. The curriculum becomes progressively more case-focused as students progress from JC, through IC and into SC. The 6-year programme involves students undertaking a Foundation Year (FY) programme before entering the 5-year programme (see figure 1 [Fig. 1]). The more recent RCSI GEP medicine degree is a 4-year programme, which compresses the Junior and Intermediate Cycles into two academic years, following which the GEP students join the 5-year degree programme for a common Senior Cycle (see figure 1 [Fig. 1]). The GEP JC & IC are identical in modular content to the 5-year programme but there is a proportionately greater emphasis on small-group work and on case-based teaching.

Implementation of Bologna action-lines in the RCSI medicine programmes

  • Adoption of a system of easily readable & comparable degrees: The best guarantor of readability and comparability is a structured and outcomes-focused curriculum. The RCSI curriculum centres on the Medical Graduate Profile (MGP), a high-level outcomes document that specifies the knowledge, skills, and attitudes of the RCSI medical graduate under the five vertical curriculum themes: biomedical science & research, clinical medicine, clinical competence, population & international health, and personal & professional development (http://www.rcsi.ie). The subsidiary learning outcomes of every module, clinical discipline and activity in the programme are linked to the high-level curriculum themes in the MGP through the ARIADNE curriculum database [1]. This database plays a central role in curriculum review and in routine blueprinting to ensure constructive alignment between curriculum and assessment at all levels of the programme. ARIADNE maps curriculum elements also to the learning outcomes defined by the Tuning Project (Medicine) (http://www.tuning-medicine.com/). In addition, a Diploma Supplement, which confirms the level, context, content, and status of the degree programme, is issued to students at graduation.
  • Implementation of the European Credit Transfer & Accumulation System: To-date, the semesters of FY, JC and IC have been structured as ECTS-compliant modules (see table 1 [Tab. 1]). In the 5-year programme, students passing through JC and IC accumulate 30 credits per semester to a total of 180. Students entering the 6-year programme accumulate 240 credits by the end of IC. The Senior Cycle programme remains discipline-based and is not modularized. Within the next two academic years, the RCSI School of Medicine plans
    • to rationalise the modular structure of the Intermediate Cycle to sub-divide the 15-credit CR module and to reduce the number of 10-credit modules.
    • to review curriculum content in SC1 and SC2 with a view to extending the existing system of ECTS-compliant modules to include the Senior Cycle.
  • Focus on life-long learning: The RCSI MGP enshrines life-long learning among the key outcomes under the vertical theme of Personal & Professional Development. The degree programme includes training in information retrieval skills, critical evaluation of research studies, aspects of evidence-based health etc., and seeks to produce graduates who can define their own learning needs and who practice in a reflective manner.
  • Promotion of the European dimension in higher education including mobility: The promotion of mobility is hampered somewhat by variations across the European Higher Education Area (EHEA) in medical curriculum structure and delivery, particularly the extent to which clinical skills form part of undergraduate training. RCSI has developed a programme of semester-long exchanges of undergraduate medical students between RCSI (Dublin) and its sister campus in Bahrain (the RCSI Medical University of Bahrain). The greatest range of student exchange activities occurs in the context of the elective programme which is undertaken by almost all students at the end of IC3 or of SC1. Historically this has focused on partner institutions in North America (e.g. the Johns Hopkins Medical School & McMaster University) but, increasingly, elective agreements within Europe are being developed. Opportunities for staff exchange with comparable European institutions are being explored currently.
  • Promotion of European cooperation in quality assurance: RCSI adopted its Quality Strategy in 2002, which included adoption of the World Federation of Medical Education (WFME) Global Standards for Quality Improvement in Basic Medical Education as key quality metrics for the School of Medicine (http://www.wfme.org). Professor Dame Lesley Southgate (Professor of Medical Education, St. George’s School of Medicine, University of London) was commissioned by the Quality Board to assemble an Independent Review Group, which comprises experts in medical education drawn from a range of EHEA countries. This Group is engaged with the School of Medicine in a cyclical Quality Assurance/Quality Improvement process that is currently in its second cycle. The first cycle (2005) was the first time that the WFME Global Standards had been used in an independent quality review of this type. Furthermore, this initiative on the part of RCSI served also to prompt the Irish Medical Council to adopt the WFME Global Standards as the framework for their regular accreditation inspections of medical schools in the Republic of Ireland.
  • Adoption of a 2-cycle system: The 2-cycle model (3-year Bachelor Degree + 3-year Master Degree) envisaged for medicine in the Bologna Process remains controversial. The February 2005 joint WFME/AMEE statement on the Bologna Process rejected the two-cycle model, while a subsequent AMEE/MEDINE survey of its implementation across the Bologna signatory countries demonstrated its adoption by less than 20% of the schools surveyed [2], [3]. No guidance regarding national policy on the implementation of a two-cycle structure in medical education in the Republic of Ireland has issued thus far, either from the Irish Medical Council or from Government. Accordingly RCSI has no immediate plans to implement a two-cycle model. However, an outline plan is under discussion for a response to a possible future national policy decision mandating the adoption of a two-cycle structure. In brief this would involve:
    • to develop a Bachelor Cycle terminating at the end of IC3; this would equate to 180 credits in the case of students in the 5-year programme.
    • to develop a Master Cycle terminating at the end of SC2. This, in itself, would equate to 180 credits giving a total of 360 credits on final graduation.

Summary: In common with other Irish medical schools, RCSI is committed to implementing the Bologna Process. While this remains a ‘Work in Progress’, a substantial amount has been achieved across the majority of the action lines. The issue of the two-cycle structure remains controversial, just as much in Ireland as elsewhere within the EHEA.


References

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Forte EN, Wentland Forte MH, Duval E. The ARIADNE Project (Part 1): Knowledge Pools for Computer-based and Telematics-supported Classical, Open and Distance Education. Eur J Eng. 1997;22(1):61-74. Available under: http://www.informaworld.com/smpp/566491672-69820592/content~db=all~content=a746422982~frm=abslink External link
2.
WFME, AMEE. The joint WFME – AMEE Statement on ‘The Bologna Process and Medical Education’. Copenhagen: WFME: 2005; Dundee: AMEE; 2005. Available under: http://www3.sund.ku.dk/Hovedside%20dokumenter/Bolognastatement_final%20LC210205_pdftest.pdf External link
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Patricio M, Den Engelsen C, Tseng D, Ten Cate O. Implementation of the Bologna two-cycle system in medical education: Where do we stand in 2007? - Results of an AMEE-MEDINE survey. Med Teach. 2008;30(6):597-605. DOI: 10.1080/01421590802203512 External link