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

Public health education integrating mobility: The MOCCA approach

Extended Abstract

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  • corresponding author presenting/speaker Henny Annette Grewe - University of Applied Sciences Fulda, Faculty of Nursing and Health Sciences, Fulda, Germany
  • Markus Heckenhahn - University of Applied Sciences Fulda, Faculty of Nursing and Health Sciences, Fulda, 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. Doc08hrk18

doi: 10.3205/08hrk18, urn:nbn:de:0183-08hrk182

Published: January 13, 2011

© 2011 Grewe et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Background: The Bologna Process was initiated to establish the European Area of Higher Education with increasing transnational mobility of students as integral part of study programmes. Though main recommendations, as outcome orientation, modularisation, and the application of the European Credit Transfer System (ECTS) have successfully been implemented, the frequency of students’ transnational mobility and the length of study times abroad are still not satisfying. German medical students in particular show an increasing interest in mobility but they prefer short time practical placements without integration into theoretical courses of the host university. Less than a third of all German students are mobile during their study period with students in technical disciplines showing the lowest mobility rates (

The MOCCA project (Model for Core Curricula with Integrated Mobility Abroad), financed by the European Commission (2006-2008) was initiated to bring the views of national agencies and comparable organisations, professors, lecturers, programme coordinators and students from five European countries onto the integration of student mobility in regular study programmes together. All participating universities already delivered a postgraduate course in public health. The universities were sufficiently diverse in their higher educational infrastructures, regulations, approach to curriculum development and module delivery to enable the working group to gain a good understanding of the contextual factors that can promote or impede the development of study programmes embodying the Bologna aims and recommendations. Furthermore, the five countries have different public health systems which have evolved over centuries within different social and political contexts and legislative frameworks, and which have developed to meet the challenges of different health problems. Consequently, the professional profiles, the academic requirements, and the employment expectations of public health graduates also vary, thereby, providing the group with an additional insight into identifying core competences and learning outcomes which are coherent across several different institutions and countries.

Aim: Against the background described above, the aim of the MOCCA project was to develop concepts for study programmes that enhance mobility on students’ individual choice. For that reason, joined programmes or double degree programmes were not in the remit of the project because they limit the student’s choice onto declared study parts and fixed places of studying abroad. In contrast, the aim of the MOCCA project was to identify structural elements that enhance student mobility and that can be integrated in every study programme of the ‘Bologna area’, regardless of the field or the level of study.

Though the objectives of the project focused on the integration of mandatory mobility, the project results should also be applicable for curricula that enhance optional mobility of students. The objectives were set on to identify and to use the chances of the Bologna tools at programme design level to overcome barriers which students face when considering mobility within their course of study. For that reason, subjects as financing, language problems and personal responsibilities at home that are proven to hamper mobility regardless of the Bologna Recommendations [1], (, but are out of the decided scope of curriculum design, were not in the focus of the project.

Method: The representatives of the five national agencies developed general guidelines [2]. They checked the guidelines for feasibility by designing a Master programme in public health [3]. The project partners agreed on a consensus-based procedure, always taking the perspective of a sending institution, and reflecting the conditions for integrating mobility in study programmes, the recognition modalities, and assessment procedures etc. against their national regulations and manners. The partners decided to design a Master programme covering 120 ECTS which for a two years course seemed to be a realistic frame for discussing integrated mobility.

Following the Bologna Recommendations, in the first step the descriptors of the Qualifications Framework of the European Higher Education Area [4] were used to describe the learning outcomes of the 120 ECTS credits programme in public health. They were then translated and bundled into learning outcomes on module level, each module covering 10 ECTS credits. Taking the perspective of a sending institution, options for structural integration of mobility into study programmes were developed by

identifying those learning outcomes whose achievement could be enhanced by an international experience,
systematising the workload and outcomes of informal learning in context of mobility, and
developing an assessment procedure for those competences.

Results: In the main, the results concern methodological issues of programme development that can be transferred to all fields of study, developed along the example of public health.

In principle, the needs of the labour market should be taken into account when designing a study programme. For many fields of study, especially on Master’s level, the ‘corresponding labour market’ can be divided into two main sections: the ‘classical’ labour market and the scientific/research section.

Although the scientific dimensions of public health are widely accepted, the roles and functions of public health professionals vary in different countries due to the diversity of the health systems. A shared approach to curriculum design at the Master’s level, therefore, firstly requires the identification of core functions of public health and elements of public health practice that are common across European health systems. Furthermore, to define the scope and depth of a study course, skills and competences that should be developed by studying have to be distinguished from skills and competences that will develop later through ongoing practical experience.

The identified skills and competences that are required at graduate level, regardless of the specific shape of the very health system, then have to be translated into learning outcomes on programme level. To describe the learning outcomes with the level descriptors of the chosen qualifications framework is crucial for the differentiation between the Bachelor and the Master level. Even in the field of public health there is a need for differentiation, for some European countries have developed complementary Bachelor programmes in public health to meet the national requirements for public health practitioners working in different settings.

When using the terms of the European Higher Education Area (EHEA) framework, that means using the Dublin Descriptors to specify the range and the level of skills and competences that a public health graduate is expected to achieve, it is to recommend to start with the higher order descriptor ‘Making Judgements’ and then to reflect on the skills and knowledge required to achieve these capabilities. The process can further be facilitated by translating the descriptors in simple questions related to the specific field of study, so that all the crucial elements will be answered in a logical sequence (see table 1 [Tab. 1]).

At module level, the learning outcomes can be defined in the same manner. A simple structure of the curriculum, i.e. the predefinition of identical module sizes, is one contributing factor to facilitate mobility because modules of identical ECTS value can more easily be changed in their sequence, for example, when arranging an individual study plan for students who want to be mobile. When describing the learning outcomes on module level, mandatory and optional elements will be defined. A second effective option to facilitate mobility is to order the optional modules into one semester, thus creating a ‘mobility window’.

The third opportunity to foster mobility on programme design level is the assessment of subject related outcomes of self-directed learning abroad in line with the ECTS principles, thus defining a ‘mobility module’. Regardless of the modules studied or the practical work done abroad, the students will develop intercultural sensibilities and the competence to act in their field of study with a broader view than could be achieved by remaining within a familiar cultural environment. Concerning public health, the students will, for example, have greater exposure to different social processes and environmental factors which influence living conditions and health. The time abroad will allow students to reflect on different approaches to health problems and how these compare with strategies used by their home nation. The results of the MOCCA project illustrate that the EHEA descriptors are applicable even when describing learning outcomes expected for a mobility experience, and that the distinction between learning outcomes on Bachelor and Master level can be made even for a ‘mobility module’. Concerning the mode of assessment, oral presentations or poster presentations are recommended for they offer the opportunity to fellow students and the home university staff to attend the exam sessions, thus fostering a ‘collective body of experience’ and knowledge about mobility related issues in the specific field of study.

Figure 1 [Fig. 1] illustrates the structure of a public health curriculum covering 120 ECTS with both an integrated ‘mobility window’ and ‘mobility module’.

Conclusions: The ‘mobility window’ and the ‘mobility module’ are two options for fostering student mobility even within short study cycles. Bundling of flexible study parts to one semester (30 ECTS) opens a time slot for mandatory/optional mobility. Outcomes of informal learning in context of mobility can be systematised using the EHEA-descriptors and, hence, be assessed and credited, that way rewarding the students’ efforts for mobility.


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