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

G2010 - a competence based medical 3-cycle curriculum in Groningen, The Netherlands

Extended Abstract

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  • corresponding author presenting/speaker Jan B. M. Kuks - University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
  • Jan C. C. Borleffs - University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands

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. Doc08hrk5

doi: 10.3205/08hrk05, urn:nbn:de:0183-08hrk058

Published: January 13, 2011

© 2011 Kuks 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.



Within living memory, it is known that the House of Wisdom is built on Seven Pillars. This allegory is used for many processes. Virtual pillars to be the fundaments for modern medical education may be described as

the need of a trainee-centred approach,
competency-based assessment,
service-based education with real world clinical problems,
quality assured curricula according to international standards,
flexibility for individual needs of students with
person-directed coaching instead of ex cathedra teaching, and
a well-structured learning course.

These principles may be thought-leading considering the usefulness and desirability of the Bachelor/Master (BaMa) system in medical education. On the one hand there is the need for a personal approach to enhance the development of the individual student on the other hand international collaboration to reach high standards is crucial. Add to these the increasing trend to mobility of students – and people in general – across the borders and it becomes evident that a successful medical education system may not be confined to one medical school or even to one country. To come to a European system for medical education many barriers have to be levelled and the challenge is to find an acceptable uniform standard without losing all the specific features of the distinct medical schools.

Although many sceptics and doubters exist (and their voice should be heard anyway!) there is also a huge movement of enthusiastic and creative advocates for the BaMa implementation in medical education. Caution is dictated not to walk into the pitfall of writing high-handed credos, of developing singular BaMa directed curricula and of promoting them to others without considering the problems of implementation elsewhere.

Aware of this possible trap this paper will present the structure of the Groningen Medical 3-cycle Curriculum without pretending this to be the only way to get to an ideal model but to show that it is possible to design a BaMa structured course.

The Groningen curriculum offers the capacity for enrolment of 440 students per year. It consists of a 3-year Bachelor and a 3-year Master programme (see figure 1 [Fig. 1]), each year corresponding with 60 European credits. The first four years are divided in two semesters each containing two blocks of 10 weeks. Four out of the 12 Bachelor blocks are completely reserved for theoretical education without small group and other practical sessions in order to allow students to do elective activities. Beside the blocks, there is a line for professional development except for the last Master year.

Patient problems have a central place in the whole curriculum to motivate the students for studying basic concepts and to teach them what is important for practice of daily life. The emphasis in the very first year of the Bachelor curriculum is on basic sciences like (microscopic) anatomy, physiology, cell biology, immunology, and psychology. In the second and third year, clinical sciences are leading with frequent referral to basic concepts. Communication skills are teached in the Bachelor curriculum but furthermore education in clinical skills mostly is postponed to the Master curriculum. In addition, the other (CanMeds oriented) competencies have a place all over the curriculum and are practically trained in tutorial groups. Students are sent to patients at home to interview them and attend medical clinics together with their tutors during the whole Bachelor programme. In the Master curriculum, the clerkships are included with dual learning in the first year (four blocks with 5 weeks skillslab coupled to 5 weeks work on the ward) and full time clinical work on several departments during 10-12 blocks of 4 weeks in the second year. Finally, the third Master year consists of a 20 weeks clinical electives and a 20 weeks period with scientific research.

For those students who have scientific ambitions there is a Bachelor honours stretch (30 European credits) beside the regular Bachelor programme. These students get the opportunity to enter a combined clinical and scientific course in order to obtain both a MD and a PhD award after 5 years (see figure 2 [Fig. 2]). About 10% of our students does so and succeeds to pass through all three cycles, Bachelor, Master, and Doctorate (PhD).

One of the possibilities the BaMa structure offers is the opportunity to decide for another Master study after finishing the medical Bachelor programme. This is hardly done in the Groningen system (<1%). In The Netherlands, the medical Bachelor Degree does not result in a formal professional license. On the other hand, there may be lateral enrolment in the medical Master programme of students with another Bachelor Degree. Practically this concerns students who ran a Bachelor course with some links to Medicine (e.g. psychology, pharmacy, biology, chemistry, etc.). After selection, they run a one-year graduate entry programme equivalent to the second and third year of the regular Bachelor programme.

The University Medical Centre Groningen (UMCG) feels that the requirements as set in the Bologna Declaration have been met in its curriculum, and delivered the first medical Masters in September 2009. UMCG realize not to have invented the ideal and everywhere applicable programme but it feels this curriculum might provide some ideas for designing a more uniform European BaMa curriculum. Complete uniformity of all medical curricula in Europe should not be a Utopia to be quested because unique features for an individual medical school might be attractive for students and encourage them to cross their horizons. Furthermore it is mortal for enthusiast educators to be put into trammels of convention without possibilities for own creativity. However, to enhance interuniversity mobility, the duration and outcomes for Bachelor and Master programmes definitely should be standardized. Furthermore, universal quality standards and an international evaluation system are to be pursued amongst those universities who want to participate in a European network that meets the criteria of modern medical education.