MED-NET Conferences 1998, Lille & 1999, Maastricht
Anthology of presentations 2.2.

2.2. Curriculum innovations in Europe

G.D. Majoor (Maastricht, The Netherlands)

Introduction

At the 1997 (Rotterdam) and 1998 (Lille) Medische hulpbron meetings a questionnaire was made available to the attendants on which recent, current and planned innovations in the curricula of the attendents institution could be described. This report documents the outcomes of this enquiry.

Methods

The six questions posed in the questionnaire have been summarized in Table 1. Also in the full text of the questionnaire advertedly no attempt was made to define the term innovations. Consequently, it was left to the respondent to determine whether any changes introduced in the schools curriculum were to be considered innovations. If question (Q) 1, 2 or 3 was answered with yes, the respondent was requested to describe the three most important examples of those innovations.

Results

Thirty responses were received but one did not match the format of the questionnaire (Table 2). At the 1997 and the 1998 Medische hulpbron meetings together approximately 120 Faculties were represented, yielding a response rate of about 25%.

Among the 29 digestible responses only one respondent answered no to questions 1, 2 and 3; indicating that nothing had changed nor would change at his institution in the near future (Table 3). Twenty-seven out of the 29 respondents felt their school had implemented innovations over the last five years, one had not done so before but was currently implementing innovations. Thus, 28 out of 29 responding institutions (96%) stated to have implemented innovations and/or were currently doing so.

Twenty out of the 27 institutions (74%) stating they had implemented innovations over the past five years claimed also currently to be involved with implementation of innovations. Fifteen out of those 27 institutions (55%) also specified plans for innovations in the near future; in all but one cases these 15 institutions were among those currently implementing innovations (Table 3).

Table 4 provides a "hit-list" of innovations as specified by the respondents. If a certain innovation was mentioned in response to each of the questions Q1, Q2 and Q3, it contributed three times to the ranking on this frequency list. The eight items mentioned only once were: a) definition of literature references; b) teaching in English; c) set-up of a students ward; d) differentiation in graduation profiles; e) set-up of MSc and PhD programmes for medical graduates; f) assessment of post-graduate anaesthetics; g) research on the transition from under- to post-graduate education; and h) establishment of a Department of Medical Education.

In response to Q4 19 out of 27 schools indicated that external factors had stimulated and/or inhibited the change process. Legislation and directions from professional bodies were most frequently mentioned as stimulatory or even forcing factors; lack of financial resources and legislation most frequently as inhibiting external factors.

Nine out of 27 respondents pointed at other medical schools that provide examples of good practice in innovation of the curriculum. Belfast (Queens), Glasgow, Hamilton (Canada: McMaster), Liverpool, London ((UMDS Guys Hospital), Manchester, Rome (La Sapienza and Campus Bio-Medico) and Witten/Herdecke were mentioned here.

Eight out of 27 respondents used the opportunity in Q6 to add comments. None disclaimed the enquiry as such.

Discussion

The reliability and validity of the data derived from this questionnaire should be judged with caution mainly due to the low response rate. Moreover, in this case there may be significant differences among responders and non-responders as suggested by the fact that only one respondent answered no to each of the questions Q1-Q3. Obviously, representatives of institutions that so far withstood the "winds of change in medical education" may not feel inclined to fill in this questionnaire. The other way around, if one accepts the schools represented at the 1997 and 1998 Medische hulpbron conferences to be a representative sample from all medical schools in Europe, one might assume that about a quarter of the medical schools in Europe is involved in innovating their curricula.

The 55% of the schools that provided positive answers to Q1, Q2 and Q3 suggests that those institutions embarking on implementation of innovations are likely to stay involved in adapting their curriculum for several years. Different, though not mutually exclusive explanations may apply to this finding. First, it is common practice nowadays to carefully evaluate the effects of introduction of innovations, frequently resulting in a process of adjustment of the new curriculum, re-evaluation and readjustment for several years in a row. Second, if a nucleus of faculty becomes interested in introducing certain innovations, the ground may be prepared to consider other kinds of innovations at a later stage. This effect may lead to a "chain-reaction" of innovations over a period of many years. Third, the introduction of an innovation affecting the curriculum as a whole (e.g. changing from a discipline-based curriculum to an integrated curriculum) may take four or more years to be completed, followed by the sequence of evaluations and adjustments mentioned first. In general it may be concluded that once a (medical) school starts changing its curriculum, it may be dealing with change for a time span of many years.

The innovations as specified by the respondents represented a broad range of topics. Some addressed the design of the curriculum as such (e.g. integration, inclusion of skills training, insertion of new disciplines), some the educational approach (problem-based / student-centred / self-directed learning, computer-assisted learning, interdisciplinary / multiprofessional education) whereas others were linked to (e.g. new approaches to assessment) or supportive for (e.g. rewarding faculty for efforts in education, different organisational formats) certain primary innovations.

Even taking the technical shortcomings of this enquiry into consideration, two issues may be identified that are noteworthy for any organisation supporting innovation in medical education.

First, even if the estimation calculated here that about 25% of all medical schools in Europe are involved in innovating their curricula is quite inaccurate, it would be hard to assume that more than half of all schools are actively involved. Apparantly, those organisations in favour of change in medical education [e.g. the World Health Organisation (1), World Federation for Medical Education (2), the Network of Community-Oriented Educational Institutions for Health Sciences (3), and national bodies like the General Medical Council in the United Kingdom (4)] may fail to convince many medical schools on the reasons to innovate their curricula. Either their reasons may not be convincing enough, or these organisations do not adequately advocate their messages.

Second, the collected responses leave the impression of a technological, rather than a missionary motivation for change. In none of the questionnaires received there was a clear indication of a motivated paradigm shift that subsequently had inspired a series of curricular innovations. Rather, the aswers to Q4 suggested that recommendations and prescriptions by legislative or professional bodies had more or less forced the schools to adopt innovations. Although some of the innovative topics mentioned did suggest a new philosophy underpinning the curricular change (e.g. more training in General Practice / Family Medicine; interdisciplinary / multidisciplinary education) the rationale for changes in the orientation of medical educational programmes as formulated by most of the organisations specified above were never quoted. Consequently, one wonders sometimes whether some schools implementing innovations just do so to be trendy or whether they really have a wider vision on the reasons to adopt changes in their medical educational programmes.

References

1. Doctors for health. A WHO global strategy for changing medical education and medical practice for health for all. 1996; Geneva, World Health Organisation, document WHO/HRH/96.1.
2. World Federation for Medical Education. Walton HJ (Ed.). Proceedings of the World Summit on Medical Education. Medical Education 1993; 28, Suppl. 1: 140-9.
3. Schmidt HG, Neufeld VR, Nooman ZM, Ogunbode T. Network of community-oriented educational institutions for health sciences. Academic Medicine 1991; 65: 259-63.
4. Tomorrows doctors. Recommendations on undergraduate medical education. 1993; London, General Medical Council.

Table 1. Summary of the 1997 questionaire on curriculum innovation

Table 2. List of Medical Faculties that responded to the questionnaire

• Amsterdam VU
• Bari
• Beer Sheva
• Berlin Charité
• Bern
• Bratislava
• Brest
• Cadiz
• Fribourg
• Galway
• Gent
• Granada
• Grenoble
• Hadassah
• Helsinki
• København*
• Köln
• Lausanne
• Leicester
• Leuven
• Linköping
• London S. Thames
• Maastricht
• Nottingham
• Nijmegen
• Rotterdam
• Sofia
• Tampere
• Tromsø
• Ulm

*København responded by sending information not adjustable to the questionnaire and is excluded from the data presented here.

Table 3. Continuity of the change process

Table 4. What are considered innovations?

ISBN Number 90.805758.1.X

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