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

Specificity of the accreditation of medical schools: The '2 in 1'- or '1 in 2'-model

Extended Abstract

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  • corresponding author presenting/speaker Jadwiga Mirecka - Jagiellonian University Medical College, Department of Medical Education, Caracow, Poland

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. Doc08hrk25

DOI: 10.3205/08hrk25, URN: urn:nbn:de:0183-08hrk250

Published: January 13, 2011

© 2011 Mirecka.
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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Introduction: In the year 2010, the Jagiellonian University Medical College could celebrate its 100 years anniversary of accreditation of its medical school, which had started in USA and Canada in 1910. Since the very beginning, accreditation had a significant impact on quality of medical schools and medical education in North America. On a long distance, it had also influenced development of the accreditation systems in other parts of the world. By now, the need for accreditation of schools and programmes leading to qualifications of a medical doctor, is understood and supported in all six regions of the World (Africa, Americas, Europe, Eastern Mediterranean, South-East Asia and Western Pacific) although such an accreditation is not yet commonly established [1].

In Europe, the Bologna Declaration has stipulated an interest in accreditation and the process related to its implementation. The accreditation systems established in Europe within the Bologna Process, in principle follow the European Standards and Guidelines for Quality Assurance (http://www.enqa.eu/files/ENQA%20Bergen%20Report.pdf), which have been designed to fit all institutions of Higher Education (HE). Therefore, most of the accreditations carried actually in Europe do not reflect the specificity of medical education.

Yet the experience gathered so far from medically tailored accreditation (including the experience of the Accreditation Committee for Medical Universities in Poland) indicates that accreditation of medical schools should not rely on ‘one fits all size” model, but combine a ‘generic framework’ with specific elements and criteria (‘2 in 1’-model meaning here two perspectives in a single approach).

General accreditation aspects: Regardless the type of HE institution and the programme evaluated, the procedure of accreditation usually remains the same and includes institutional self-evaluation, analysis of the self-report by the accreditation commission, the site visit of the accrediting team, the report of the visiting team, and the decision about accreditation. The following aspects are usually evaluated in relation to all HE institutions:

  • Specification of the institutional mission, its educational objectives, and its reflection on the curriculum.
  • Organization of the educational programme (use of ECTS, appropriateness of the weekly and yearly schedule, adequacy of self-study time, opportunities for electives).
  • Methods of assessment used to monitor students’ progress (different formats, appropriateness for the purpose, availability of feedback).
  • Academic staff (number, professional and educational qualifications, development of teaching skills).
  • Internal systems for quality assurance (permanent control of the teaching effectiveness, students feedback regarding the teaching process and teachers, monitoring the further careers of graduates, regular surveys on students’ and staff’s satisfaction).
  • Facilities (lecture halls, library, computer rooms, and laboratories).
  • Institutional management (information gathering, data collection, financial aspects, prospects of future development).
  • The role of students and student support for extra-curricular activities.
  • Internationalisation (student exchange programmes, visiting teachers from abroad, courses in foreign languages).

Medical accreditation aspects: In relation to medical curricula, the general aspects as mentioned above should be viewed from the perspective of the European Parliament’s Directive 2005/36/EU (from 7 September 2005) on the recognition of professional qualifications which outline the borderline requirements for medical education. Specific standards defined for medical education are the WFME Global Standards for Quality Improvement in Basic Medical Education [2] and their later adoption specific for Europe [3] should be also taken into consideration.

The main concept promoted by the WFME documents is a combination of the basic standards, which must be met by every school, with standards for quality development in relation to examples of best practice in the field. The school which can demonstrate a compliance with some of the latter standards deserves a certificate confirming a higher quality.

The WFME Global Standards require in addition much deeper insight into the above listed parameters as compared with accreditation of other disciplines (to mention only characteristics of the curriculum models, the mechanism for programme evaluation, various formats of assessment, student representation, student support, and the role of stakeholders). Up to now, quality criteria used for evaluation of medical schools do not include implementation of the Bachelor/Master system in the medical curriculum but this might change after the revision of the European Parliament’s Directive 2005/36/EU which is planned for the year 2012.

In order to check compliance with the specific standards, the commission to accredit a medical school should review in addition the following aspects: Adequate content of basic, preclinical, and clinical sciences.

  • Incorporation of clinically relevant material.
  • Provision of a scientific basis for clinical decisions (evidence-based medicine).
  • Methods of teaching and assessment in regard to clinical reasoning, problem solving, and team working.
  • Premises for clinical training (hospital, outpatient clinics, emergency, community, and chronic care units).
  • Variety of patients experience (full representation of ‘typical diseases’).
  • Range of diagnostic methods and specialist procedures available for use of demonstration.
  • Direct access of students to patients (number of patients contacts, characters of tasks required, the level of personal responsibility expected from students).
  • Practical training of clinical skills (list of skills, training laboratories, training methods and specific assessment of skills).
  • Organization and supervision of internship/clerkship periods.
  • Preparation of students to the doctor’s role (ethical issues, attitudes, professionalism).
  • Teaching role of clinical staff (qualifications, school supervision, conflict of duties between medical service and teaching).

The competent evaluation of the parameters specific for medical education requires not only specific criteria to compare with but also an adequate composition of the accreditation committee. According to the Guidelines for Accreditation of Basic Medical Education, proposed by WHO and WFME [4]. One third of the members of the accreditation committee should represent the academic community (academic teachers, school management, full time senior staff), one third should represent the medical profession (physicians from hospitals, general practice, professional bodies), and the final third should consist of other stakeholders (representatives of the government, authorities in charge of the national health care system, students). In fact, a stress on involvement of practicing physicians and students distinguishes the teams that evaluate medical schools from others dealing with general education only.

The dilemma: As practical point remains how to arrange the medical-specific accreditation in countries where the national regulations require a mandatory accreditation of all high education institutions by the one accrediting body. This is actually the situation in Poland where the Accreditation Committee for Medical Universities was established in 1996 due to a joint initiative of the rectors of medical universities, but in the year 2000, the State Accreditation Commission was set by the governmental decision. It is the latter which has a statutory obligation to evaluate all programmes in universities and higher education institutions. Whereas such an accreditation fulfils national requirements, in relation to medical schools it does seem adequate for an international recognition, which according to the WHO/WFME documents should be based on compliance both with their standards as well as with their procedural guidelines. In addition, the US Department of Medical Education requires a specific, medical-oriented accreditation of foreign medical schools in order to allow American citizens who undertake medical studies abroad to apply for the Federal Loans Programme.

The possible solution could then be a combination of the two accreditation procedures into a one process (another meaning of the ‘2 in 1’-model). It means the creation of a joint ‘ad hoc Accreditation Team’ for every medical school which would represent both the State Commission and the Accreditation Committee for Medical Universities. Alternatively, the two, separately carried out processes can be summed up for a final report (‘1 in 2’-model).

Jagiellonian University Medical College is now trying to solve the dilemma. Most of the accreditation procedures regarding medical education were until now focusing on the school structure and teaching process. An approach focusing on competencies achieved by graduates, used by the Council of Medical Colleges in the UK is at the moment rather exceptional. This will have to change when implementation of the National Qualifications Framework will lead to a mandatory redefinition of the curricula in terms of learning outcomes. Therefore, the standards of programme (courses, hours) and standards of content (topics covered) will become replaced by the standard of (core) competencies. Such a switch from an input measure (curriculum characteristics, teaching methods, educational environment) towards outcomes measure (learning outcomes) will be certainly reflected in the accreditation criteria.

Apart from USA and Canada, where positive influence of the accreditation on quality of medical schools have been reported, there are no scientific data to support an assumption that implementation of the accreditation will improve both quality of medical education and of health care worldwide [1]. One of the main reasons why it is so difficult to prove it, are variations in the methodology of accreditation as applied in different countries and sometimes even a misinterpretation of the very term of accreditation. As a first step leading to clarification of this issue the Foundation for Advancement of International Medical Education and Research (FAIMER) has undertaken an initiative to register and compare accreditation systems operating in relation to medical undergraduate education all over the world [1].


References

1.
van Zamten M, Norcini JJ, Boulet JR, Simon F. Overview of accreditation of undergraduate medical education programmes worldwide. Med Educ. 2008;42(9):930-937. DOI: 10.1111/j.1365-2923.2008.03092.x External link
2.
WFME. Basic Medical Education - Global Standards for Quality Improvement. Copenhagen: WFME Office, University of Copenhagen; 2003. Available under: http://www.wfme.org External link
3.
WFME. Global Standards for Quality Improvement in Medical education - European specifications. Quality Assurance Task Force. Copenhagen: WFME Office, University of Copenhagen; 2007. Available under: http://www.wfme.org External link
4.
WHO/WFME. Guidelines for Accreditation of Basic Medical Education. Geneva/Copenhagen: WFMW Office, University of Copenhagen; 2005. Available under: http://www.wfme.org External link