Article Of the MOnth: I m p r o v i n g f u t u r e p h y s i c i a n s ’ e d u c at i o n

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Standing Committee on Medical Education Newsletter International Federation of Medical Students’ Associations - IFMSA

www.ifmsa.orgifmsa-scome@yahoogroups.com

WhAt’s inside:pAge One: I m p r o v i n g F u t u r e P h y s i c a n s ’ E d u c at i o n pAge tWO: C u r r i c u lu m D e s i g n # 1

pAge fiVe: Da i s y P r o j e c t - M a r g a r i ta pAge eight: Wh at ’s u p i n t h e R e g i o n s

S-comedy

take the extra effort to acquire the competences necessary to assess the quality of the education we receive and to propose, or even implement ourselves, ways to improve it.

There has been, traditionally, a split between students working in project-oriented medical education and those working in politically-oriented medical education. This gap loses its meaning when we realise that both are ways of getting to the same goal, and that none of them is complete without the other.

Improvement of medical education is not possible without analysing curricula, pointing out its flaws and proposing ways to correct them. But also, many times, the best way to prove that a certain competence can be evaluated or that a certain program can be implemented is to do it. Projects also have an

It’s only a few years in our lives. Just a bunch of hours, almost nothing if compared to the overall time we will spend before our patients during our whole professional career. But these few hours that we spend in medical school determine the kind of doctors we will be for the rest of our lives. That is why medical education is essential for us, future physicians, and, specially, for our patients. And that is the reason why we care so much about it.

But… are students important in the improvement of medical education?

There is no other group that could spend as many hours as we do in lectures, rotations, seminars, etc. Therefore, there is no other group that could constitute a better evaluation body for undergraduate medical education… if we are willing to

A b o u t t h e a u t h o rI’m a 5th year medical student trying to prove the world that both IFMSA heavy involvement and medical studies can be carried out at the same time :) I started in IFMSA only 3 years ago, as a LOME in my med school, and I’m positive sure that what I’ve learnt in IFMSA these years is going to come in very handy in my future life,whenever working with a group of people, in my job as a physi-can....

immediate effect, while changes in policy and curricula take longer.

Daniel Rodriguez Muńoz

Director on Medical Education 2007/08

International Federation of Medical Students’ Associations (IFMSA)

MedicAl educAtiOn: C u r r i c u lu m D e s i g n # 1

The curriculum represents the expression of educational ideas in practice’, saying it in words: the curriculum answers the questions of what to teach and how to teach it.

Curriculum and curriculum design

There are many definitions of curriculum as well as many views how curricula should be developed and structured. As Prideaux says, ‘ The curriculum represents the expression of educational ideas in practice’, saying it in words: the curriculum answers the questions of what to teach and how to teach it.

There are no scientifically-

proved, evidence-based approaches to curriculum design. There are many curriculum models and its selection is largely based on ideological, political, social and managerial imperatives rather than on research evidence. So there is no ‘universal and best’ template of curriculum design. Wisely and good constructed curricula should involve in its design specialists from many fields – both clinical and non-clinical, as well as learners and teachers, managers, patients. It has two unchangeable components: the structure and the content. The first one consists of teaching and learning strategies, assessment and evaluation processes. Once again quoting Prideaux1 ‘the process of defining and organizing the components of curriculum into a logical

MedciAl educAtiOn: C u r r i c u lu m D e s i g npattern is known as curriculum design’.

How it all started

It all started in the mid-20th century when Ralph Tyler published his work from, which the ‘objectives model’ arose – it was/is based on the purposes and their statements were/are called objectives. Tyler’s paper thoroughly described how objectives should be framed and described. This objective-based curriculum model was teacher-centered and didn’t focus on learner’s activity.

The ‘objectives model’ evolved an in 1961 there was an idea to combine objectives and experiences, so that the curriculum would partly meet the health needs of society.

A b o u t t h e a u t h o r

I’m fifth year medical student at Medical University of Silesia in Poland.I began my work in IFMSA 3 years ago and from the begining I was actively invloved in SCOME. I was trying to improve medical education on local and nationallevel, and finally on an international field, as Regional Assistant for Europe. When not otherwise busy, I indulge in sport,travels and scientific work.

MedicAl educAtiOn: C u r r i c u lu m D e s i g n

Finally in 1972 Simpson suggested that objectives should be described more precisely, with the use of appropriate verbs – so called ‘behavioral objectives’. It was a very important step, because defined objectives are the foundation of the other elements of the curriculum (mainly teaching and learning strategies) and emphasize what the student and the community require. It was the beginning of student-centered approach, which change the focus and emphasize the importance of students achievement rather than teachers activity. Also the development of assessment methods starts from here – curricula were/are used as the base of assessment. The general approach was not anymore ‘this has to be taught’, but ‘this is what the student must be able to do’, and because of that, the professor must do this or that.

In 1975 Mager tried to describe objectives in more measurable terms – so called ‘instructional objectives’. That change focuses on student’s achievements and generates a whole new set of assessment and evaluation processes (the last two parts of curriculum). This was the beginning of outcomes-based curriculum.

In the eighties there was a trend to developing teaching methods which would involve students more actively in the learning process - this was the beginning of the development of innovate teaching approaches. The only

problem was how to structure the curriculum and integrate basic and clinical sciences to make the learning process more appropriate to clinical practice.

From this perspective, we can see that the process of curriculum design was developing from teacher-centered to student-centered with a focus on outcomes, integration and recognition of the societal needs, and of course good preparation of the student for the future practice. Some of the theories described above are still alive; a good example of it is Tyler’s work. He developed the ‘objective model of four important questions’, which every process of curriculum design must answer:

1.What educational purposes should the institution seek to attain ?

2.What educationalexperiences are likely to attain the purposes?

3.How can these educational experiences be organized effectively?

4.How can we determine whether these purposes are being attained?

Nowadays modern curricula are competence-based, which are student-centered and put the spotlight on the skills, behavior and knowledge that the learner should display by the end of program and are more directed to learner, teacher, institution and society.

Learning theories

There is strong correlation between learning theories and curricula models. This symbiotic relationship was evolving and developing. While one learning theory was in its prime, so was the corresponding curricula model (eg. objective-based curriculum and behavioral theory).

Our knowledge of approaches to learning, learning styles, effective group work is very wide and many innovate theories have been published recently. In this article we don’t have enough space to report and describe all learning theories and only few, which have a strong influence will be emphasized.

Before explaining learning theories we should say a few words about deep- and surface-level learning approaches. The first one actively involves students into teaching process, promotes students’ thinking, finding relationships between different information by constructive, logical argument and a system of questions and answers. The latter takes a passive approach, where the learner is more focused on text books and self-directed learning to pass exams. Of course these two different approaches have diverse implications. Deep-level strategy is more related to the clinical experience gained by medical students. Together with student-centered approach methods it

is a powerful technique, which is implemented in competence-based curricula today.

Some authors suggest that there are no learning styles at all, there are different personalities. Many arguments support this presumption – we have 71 different and competing learning styles theories, many of which contradict each other; we don’t have evidence that learning styles actually exist.

Steps in curriculum design

Now let’s try to summarize everything said above and list the steps and options in curriculum design. It’s not an easy task, because once again - there are many approaches to curriculum design. Theoretically speaking we can point out two models of curriculum design – prescriptive and descriptive.

The first one is based on outcomes as the most important factor, this models start from desired outcomes through content, teaching and learning strategies, assessment process and finally evaluation.

The descriptive models are mainly represented by ‘situational model’ – described by Malcolm Skillbeck in 1976 - which main important component is situational analysis. This analysis consists of external and internal factors and should (although not necessarily) be undertaken at the first place during curriculum design. It could also start form the review of content or teaching

and learning methods as well. That’s why this model is very flexible and depends mainly on the demands and/or context of the curriculum. All the elements of curriculum design in descriptive model are linked.

But it’s not as easy as it seemed to be and often the organization of curriculum design has to be changed to fit the needs and to be more convenient to implement and monitor. So what’s the universal path ‘from ideas to evaluation’ in curriculum design. One very good model proposed by Janet Grant include following steps in curriculum design:

(1) character of the course, (2) statement of overall purpose of the curriculum, (3)specific intended achievements, (4) curriculum organization, (5) educational experiences, (6) curriculum evaluation plan. In the second part of the article, which you will find in next issues of our SCOME Newsletter, we will discuss each of these steps with its elements thoroughly.

Blazej Trela

Regional co-Assistant for Europe 2007/08

Standing Committee on Medical Education

International Federation of Medical Students’

Associations (IFMSA)

“An understanding heart is everything

in a teacher, and cannot be esteemed

highly enough. One looks back with

appreciation to the brilliant teachers,

but with gratitude to those who

touched our human feeling. The

curriculum is so much necessary raw

material, but warmth is the vital

element for the growing plant”

Carl Jung

MedicAl educAtiOn: C u r r i c u lu m D e s i g n

“In true education, anything that

comes to our hand is as good as a book:

the prank of a page- boy, the blunder

of a servant, a bit of table talk - they

are all part of the curriculum”

Michel de Montaigne

prOjects: Da i s y P r o j e c t - M a r g a r i ta

“Daisy project – Margarita” is a pilot educational c o m m u n i t y - b a s e d project which is proposed on a voluntary basis to medical students and takes place in cooperation with International Association of Health Policy (IAHP).

As it is implied by the project’s name, it is comprised by a central activity (“core”) which is attended by all participants and 4 peripheral activities which are optional according to the students’ preference.

“Training in communication skills” is the project’s core. All participants attend the weekly sessions which are coordinated by a professional psychologist, specialized in the field of health. Some of the

topics being discussed during the sessions are: patient-doctor communication, ways of dealing with uncooperative patients , announcement of bad news etc.

“Health Education Intervention in Secondary Schools” is the oldest of the peripheral activities. The medical students are trained throughout the year on health intervention applications, concerning topics such as STD, AIDS, contraception and general public health issues.

“Nurse Aid” is one of the most popular of the peripheral activities. The students are working as aids of previously trained and informed nurses following the workload of the day and the ward they are allocated to. Thus, they are trained in nursing and clinical

I n t r o d u c t i o nskills and in the same time they are exposed in personal contacts with patients, relatives and co-workers.

“Medicine in Community” gives the opportunity to students to get to know with Primary Health Care and preventive medicine. In cooperation with general practitioners who act as trainers, the students familiarize with the role of doctor as advisor and medical information source for the community.

“Research in Social Medicine” is the last of the peripheral activities of the “Daisy Project – Margarita”. It enables students to train and practice on research techniques, by participating also in other current research projects.

About the authors

Myrsini LemonakiNOME HelMSIC (Greece) 2007-8In SCOME since: 2006Last meeting attended: AMEE 2007 –Trondheim

To find her travel to: Thessaloniki- Greece

Nikos Davaris SCOME Regional co-Assistant for Europe 2007-8In SCOME since: 2005Last meeting attended: EuRegMe 2008- Brijuni

To find him travel to: Aachen- Germany

prOjects: Da i s y P r o j e c t - M a r g a r i ta

Methods1.In order to achieve its goals, the “Daisy Project – Margarita” focuses on 3 main principles, promoted by IAHP:

-Treatment of the patient as psychosocial entity

-Research and evaluation through development of systematic research thinking

-Interaction and inter- professional coperation

2.The “Daisy Project – Margarita” covers a very wide range of activities and skills that medical students should possess, which leads to the division of the project in sub-activities. Each sub-activity comes as a complement to the different fields of medical education and public health where deficiencies are found, as mentioned above.

3.Communication skills are essential for every peripheral activity and thus “Training in communication skills” activity is the “core” of the project. The participation in the core is therefore obligatory for everyone attending the program. In the peripheral activities medical students apply the communication skills and techniques they gain in the communication groups, whereas the experiences acquired during the peripheral activities are used as feedback in the communication group sessions.

4.Flexibility between peripheral activities: after taking part

in one peripheral activity, students are encouraged to take full advantage of the project’s potentials by participating in another activity.

The ExpectedOutcome 1.The exposure of medical students to the real working conditions in the field of community-based medicine and the application of theoretical knowledge in order to deal with public health problems

2.The increase of awareness and the development of skills concerning the communication with the patients and their relatives and the approach of the patient as psychosocial entity by medical students

3.The recognition of the doctor’s role as health professional towards the direction of disease prevention and the promotion of health, as science researcher and as active citizen with social responsibility

4.The development of critical scientific spirit within the framework of inter-professional cooperation

Our Experience The organizing committee of the project has to:

1.Make some contacts with all the involved authorities (High Schools, Hospitals, Primary Health Care Centers), so as to

M e t h o d s , O u t c o m e & O u r E x p e r i e n c egive their permission for the realization of the program.

2.Get in touch with the university, the professors and all involved health professionals in order to ensure their will to participate in the program.

3. Work for the publicity of the project by making posters, leaflets, announcements through the mailing lists and the project’s website.

4.Make all the necessary arrangements in order to organize the meetings and create the weekly schedule.

5. Be constantly the contact link between the students, the involved health professionals and IAHP.

6.Buy and distribute any necessary material to participants.

7.Maintain and administrate the project’s website and database.

8.Solve any problem that may take place.

9.Provide the participants with certificates of attendance .

Daisy Project - Margarita

12345

Training in communication skills

Health Education Intervention in Secondary

Schools

5 components of Daisy Project

M a r g a r i t a

Nurse Aid

Medicine in Community

Research in Social Medicine

Ev a l u a t i o n

Daisy Project Activities are recognized as elective lessons in the Curriculum of the Medical School of Aristotle University of Thessaloniki, organized by HelMSIC and IAHP.

Fo l l o w - u p

After the end of the project (in May) all participants fill out the same questionnaire, which is used to notice the changes in their attitudes relevant to the aims of the project.

Furthermore, according to the activity each participant has attended, there is a different evaluation form, which is focused on the aims of the activity and the way it was organized. This form contains the main clinical and/or communication skills that the students were expected to acquire during the program. There is also an open part of the evaluation form aiming to collect qualitatively the perceptions, feedback and suggestions of the participants.

Last but not least, the whole project is constantly evaluated by external observers, who are approved by the scientific coordinator of the project, Dr Alexis Benos, President of IAHP.

During the introductory meeting, all participants (regardless the activity of the project they attend) fill out a questionnaire concerning their expectations from the project.

Myrsini Lemonaki

NOME HelMSIC (Greece) 2007-8

Nikos Davaris

SCOME Regional co-Assistant for Europe 2007-8

WhAt’s up in the regiOns: Bologna Process Workshop

The purpose of the Bologna process is to create the European Higher Education Area (EHEA) by harmonising academic degree standards and quality assurance standards throughout Europe for each faculty and its development.

Since 2003, the International Federation of Medical Students’ Associations (IFMSA) and the European Medical Students’ Association (EMSA) have jointly organised workshops dedicated to the study of the development of the Bologna Process in the European Higher Education Area.

During these workshops, both organisations have tried to develop statements to representstudents’ views and perspectives, and to influence European policy-makers and other relevant stakeholders in the process of development and

implementation of the Bologna Process.

These workshops take place annually in different cities in Europe. Each year we aim to analyse one of the most important topics that are being discussed within European institutions regarding the Bologna Process.

Berlin invites you

This year the IFMSA will be organising the Bologna Process follow-up Workshop at the“University Charité”, in Berlin, with the cooperation of the faculty and students’ body of Berlin. The event will take place from 3rd to 7th of July. Working time will be from July 3rd (afternoon) until July 7th (morning) both included.

Mobility, my friend

This year’s topic: “Increasing undergraduate mobility by establishing international

WhAt’s up in the regiOns: Bologna Process Workshopquality labels”

We believe that, for medical students, the possibility to carry out part of their studies in other countries can have a highly positive impact on their skills, their range of knowledge and their attitudes towards medical profession. We also see mobility of students as an opportunity for academic institutions to develop, especially if the institution allows and encourages students’participation in curriculum development.

Why to participate ?

The Bologna Process follow-up Workshops are one of the most important SCOME events in Europe. It gathers all people from the continent interested in medical education development.

The Bologna Process follow-up Workshop also gathers the

WhAt’s up in the regiOns: Bologna Process Workshop

perspective of many important medical education experts working in many influential medical education institutions and networks, such as the international Association for Medical Education (AMEE), the WorldFederation for Medical Education (WFME) or the Thematic Network on Medical Education in Europe (MEDINE).

The Bologna Process follow-up Workshops are not only lectures, debates, Small Working Groups, but also great opportunity to meet new people and discover the beauty of Berlin and its nightlife.

... and how to register ?

Each country within the Bologna area will be given 3 registration spots, initially, that could be increased after

the early registration period closes if there are any spots still vacant.

Each country will have a “head of delegation”, that must be confirmed by the NMO Presidentor the NOME to the organising committee. The head of delegation must confirm the registrationof any other member from his/her country.

The early registration fee is 150 euros (Closes on May 30th, 2008), and the late registration fee is 200 euros (Closes on June 2nd, 2008).

So, if you want to participate just contact your NOME or NMO President.

If you have any problem in contacting or communicating with the NMO President of the NOME of your country’s IFMSA NMO, please don’t

hesitate to ask for help at: scomed@ifmsa.org.

Organising Committee and the

SCOME-Europe Team.

WhAt’s up in the regiOns:5th European Regional Meeting of IFMSA

Students from all around Europe met between the 10th and 13th of April 2008 in Brijuni- Croatia for the 5th European Regional Meeting of IFMSA.

Medical education sessions

held during EuRegMe gave us and more than 20 country representatives from 16 countries (Austria, Bosnia and Herzegovina, Bulgaria, Czech Republic, France, Greece, Italy, Netherlands, Norway, Poland, Portugal, Romania, Slovenia, Spain, Switzerland and UK) the chance to discuss and exchange

WhAt’s up in the regiOns:5th eurOpeAn regiOnAl Meeting Of ifMsA“the Knights Of the rOund tAble Meeting in brijuni islAnd”

knowledge, experience and ideas for the future of medical education in Europe.

The place was for sure different from the usual ones, a room with a big round table that reminded to some of us the knights in medieval England. With one main difference:

WhAt’s up in the regiOns:5th European Regional Meeting of IFMSA

women were also attending our sessions! Our meeting time, following the wishes of most NMOs, was mainly focused on the Bologna Process, an initiative of many countries with the aim of creating a European Higher Education Area by 2010. It is a process that affects medicine and our studies and IFMSA works on it since 5 years in order to form policies and give feedback about the students’ perspective to all involved stakeholders. The basic action lines of Bologna Process, the increase of medical migration in or outside Europe and all relevant policy papers of IFMSA were presented and discussed among SCOMEdians. We also had the chance to find out about the ways this process is implemented in two European countries, Switzerland and Portugal and thus get an idea of the changes Bologna brings to our studies. Apart from these issues, participants shared information about national and international projects, like the Austrian “Aches and Pains Workshop” or “Medical Education Journal Review Project” and had the chance to work in Small Working Groups on the promotion of our Standing Committee in Europe and the variations of undergraduate medical curricula among different faculties and countries. Last of all, a training on “Time Management” was provided by IFMSA trainers to our participants -thanx Simona

and Andrei!- and we made a presentation of future medical education events and important tools in our work, such as the “Project Report Form” and the “Work in Medical Education Report Form”.

More information can be found in our precious SCOME wiki (http://www.ifmsa.org/scome/wiki) using the keyword “Brijuni 2008”. Details about the follow-up of the work done in our EuRegMe 5 sessions will be sent through IFMSA-Europe server and will be published in SCOME wiki. We would like to thank all participants for their active involvement and encourage the rest of you to be active parts of our European family! See you in Berlin, 3-7 July 2008

to work on medical students’ mobility in the context of the Bologna Process.

SCOME-Europe Team.

dAtes fOr yOur diAry:

Bologna Process WorkshopsIncreasIng undergraduate mobIlIty

by establIshIng InternatIonal qualIty labels

3rd - 7th July 2008, Berlin, Germany

SCOME preGAPatIent safety and malPractIce In the

scoPe of medIcal educatIon

3rd - 6th August 2008, Kingston, Jamaica

August General Assembly7th - 13th August 2008, OchosRios, Jamaica

next issue: t i t l e o f t h e a rt i c l e s

next issue:

In next issue you’ll find second part of the Curriculum Development article, IFMSA-Poland will also reveal some secrets of their BLS/AED Project. There will be also articles describing regional events and activities. That’s all in June :)

editOriAl teAM Of scOMe neWsletter

www.ifmsa.org

editOr in chief:Blazej Trela, IFMSA-Poland

MedicAl educAtiOn:Nikos Davaris, HelMSIC

prOjects:Simona Studineanu, IFMSA-Romania

WhAt’s up in the regiOns:

dtp:Blazej Trela, IFMSA-Poland

scOMe neWsletter: Guidelines for Authors

How to submit your articleTo submit an article, you have to send an e-mail with attached file to scome.newsletter@gmail.com . All articles should be written in Microsfot Word or Open Office format using Times New Roman font, size 12. In the e-mail you should indicate what kind of article you are submitting. There should be also information about the author of the article – up to 100 words (university, NMO, position in the NMO, previous IFMSA experience etc), including photograph. In around 3-7 days after sending an article, you will get confirmation e-mail with further information. Submitted articles will be copy edited for style.

SCOME Project ArticlesThese are articles, describing local/national/transnational SCOME projects, initiatives or proposals. The articles cover the most important aspects of projects expanding upon theory and ways it is developed, including personal reflections. Each article should be between 1000 and 2000 words long, with up to 3 tables and the title should be a maximum of 15 words. The article ought to be divided into five parts: introduction, methods, aims and outcomes, evaluation and follow-up, our experience. The author should also write five reasons why to run this project with short description of each (approx 30 words). There is room for up to six photographs per article.

Medical Education Issues ArticlesThese may include articles cover: general medical education knowledge, educational startegies and approaches, assessment, educational encounters, research and evaluation in medical education field. Articles should be emphasized on illuminating the principles of medical education knowledge with the use of simple terminology and thorough explanations. Each article should be 2000 words maximum, up to 3 tables or figures, the title should be a maximum of 15 words. It is strongly recommended to implement references/suggestions for further reading. There is room for up to six photographs per article.

What’s up in the RegionsUp to 1000 words articles, describing medical education events in your region – meetings, conferences, workshops. Usually written in a personal style and covering past or future events. There is room for up to two photographs per article.