MED-NET Newsletter 3
January 1999

• Report on the Members Consultation Meeting
• Irish Erasmus Experience
• MED-NET 3rd Conference
• Visiting Professor Harris
• MAACIMED
• med-net.nl
• MED-NET grows!
• Constitution and Bylaws
• Your input at the 3rd Med-Net conference
• Kiki Thermos,
  Assoc Prof Pharmacology
  University of Crete, School of Medicine

Report on the Members Consultation Meeting

Jan de Koning
Lille, May 16

On the occasion of the 2nd Med-Net conference some important issues of the network and its future were discussed with the membership. The highlights of this discussion are presented here.

DENTED

Prof. Diarmuid Shanley presented Dented, the thematic network on dentists education. Prof. Shanley is the co-ordinator of the network. The objectives of DENTED are to promote better understanding of each others education and care systems in dentistry, to share innovations and good practices, to promote convergence towards higher standards through peer exchange and without prescription, and evidence-based clinical teaching/treatment, and finally to agree common competences in Primary Health Care.

The thematic network seeks to explore the possibilities of peer reviewed interactive learning programmes on the Internet, multimedia conferencing and diagnostic services. An important target for DENTED is to act as a medium for explaining and collaborating in EU policies & grants.

Since the aims and objectives of both networks (DENTED and MED-NET) are similar, the possibilities for co-operation and/or merging of were discussed with the members. One objective of DENTED (peer review) was an important topic in the discussion, since it seems somewhat controversial. The membership agreed that peer reviewing on a European scale is not an issue in the medical discipline, since such systems are being developed on a national scale already. Med-Nets task should be more directed towards promotion of quality assurance and self assessment at medical schools by collecting and providing information, rather than initiating an additional review system on a European scale. All members are convinced that medical faculties should continuously work on such assessment and improvement of the quality of their education.

Concerning merging or co-operation with Dented, the membership agreed that merging of the two networks might be a step too far at this moment. The identity of Med-Net as representative of medical education is still in a developing phase. Merging with Dented could well lead to a loss of identity and credibility. On the other hand at this stage close co-operation is of crucial importance in order to have a strong negotiating position with Brussels and to act as a powerful advisory board.

MED-NET in the future

In the future MED-NET should change from a EU-project to a self reliant organisation. A proposal for a future structure was proposed by J. de Koning and R. Möllby. This proposal leads to the common conclusion that our network should proceed as an EU-supported and recognised project. Also the membership criticised the quality of the work of the Med-Net-reference groups until now. There should be a better reference system to evaluate the quality of the output. On the other hand the membership argued for an extension of objectives, ambitions, activities and assignments. Still the question remained how to achieve these objectives within the present budget limitations.

A summary of the discussion concerning the reasons for the existence of Med-Net:

• Concerning the first objective of Med-Net, "getting the complete picture of education", we have not completed the job as yet. The presented data are still incomplete, the quality of data was also criticised.
• Evaluating what Med-Net has accomplished during the first 1.5 year, the members conclude:

1. there is a possibility that medical schools will be marginalised in the future.
   
2. collecting information and promoting the exchange of students is not a basis for survival of the network. We should formulate clear objectives having a higher level of ambition.
   
3. besides a communication gap between medical faculties in Europe, there exists a communication gap between the various associations in medical education. Med-net should also work on this issue

It was the general opinion that Med-Net should continue as a network for communication and exchange between medical schools and medical faculties. However, Med-Net has to work harder to increase its authority and position. The broader goal should be more focussed on improvement of the quality of education and on the development of an active role as a forum towards the European Commission.

Extended ambitions

The necessary conditions for a stronger position of Med-Net are:

1. more professional work concerning the collection and analysis of data on medical education.
2. regular evaluations of progress and results of Med-Net activities
3. more involvement and active participation of the members
4. extended co-operation with the associations in medical education (AMSE, AMEE, EMSA, IFMSA etc.)
5. transparency and accountability concerning what is happening in the network and why.
6. a stronger organisation in which the interests of the members are better expressed.

It is the main task of the Task Force to take these recommendations into account when developing and presenting the activity plan for the next year of Med-Net.

With respect to the organisation structure, the first step is to install a Steering or Advisory Board, consisting of established experts in medical education and having as tasks: evaluation of progress, approval of network policy and representing the members interests. The meeting assigned Prof. Frank Harris to propose the membership of such a Steering Board. The present Task Force has to work on the strengthening of itself. The group will continue to elaborate the organisation structure proposal by At the next conference the bylaws of Med-Net as well as the personnel roles in the organisation will be discussed again.

How to achieve the Med-Net goals?

Concerning the question how to accomplish the tasks from a financial point of view. It was mentioned that Med-Net probably has to work with limited financial support from Brussels for one year. This is due to the late submission of the renewal application. However the responsible DG has assured us that Brussels wants to continue the formal contract with Med-Net. The temporary budgetary problems will be solved by additional grant application and/or sponsoring activities.

Irish Erasmus Experience

A report by Katrien Keppens, an ERASMUS student

Erasmus, the man died centuries ago, the exchange project is replaced by Socrates 3 years ago, but the experience lives in the memories of many students. In 1994 I knew I could go to another European University Hospital as a medical student for 4 months, doing clinical work. I preferred Galway, Ireland. I knew little about the place itself.

It was a late winter evening in February 1996 when I left Belgium, destination Galway, with only a basic knowledge of English and a pocket book "Irish for beginners". In the airport I felt lost, I didnt know anybody. Why didnt I stay in Belgium like the others? Why did I take the adventure? I had to miss all my friends for 4 months! I didnt realize I would make lots of new friends in Galway. Another Belgian student had left Galway 2 days before my arrival. She had organized a place to live. I stayed together with 3 French girls. They waited for me at the bus stop. The very first evening we went together to the beach. It was very close. When I saw the Atlantic, I realized I wouldnt miss home.

The next day I went to the Paediatric Department. From the first morning on I had tutorials, real bedside teaching, which is still a dream in Belgium. We were 430 students in our year. Its impossible to organize bedside teaching for such a group. Prof. Loftus didnt hesitate to ask me questions from the first morning on. When I didnt find the right English medical expression, I tried a description or a French or Flemish expression. Sometimes I pronounced it wrong. Writing down helped a lot. And Irish? Once we took the history from an Irish speaking boy. Some Irish medical students didnt understand him either. I realized I wouldnt learn Irish in 4 months. I might learn it, whenever I go to Ireland for a few years.

Once we discussed about the differences between Irish and Flemish culture. An example: A baby keeps crying and the parents are exhausted at your clinic. What is your advice? My proposal was, they would write down all the hours the baby sleeps and the ones the baby cries. They could also introduce a rotating system, the mother gets up when the baby cries the first night, and the father the following one. They all looked at me with wondering eyes. I could try this out in Belgium, but Irish fathers wouldnt accept it. Looking after babies was a mothers work.

After Paediatrics came Obstetrics and Gynaecology. I never did a delivery in Flemish, I did lots in English. Last moth a pregnant English woman presented in the hospital Im working in now as an assistant in Paediatrics somewhere in Flanders. She was about to deliver. None of the midwives ever accompanied a delivery in English. I was called in to look after the child because of meconial fluid. As a reflex all the English came back. I felt so much at ease and helped the nearly mother breathing and pushing throughout the delivery. You see: an international experience is always useful.

Out of the hospital? We tried to live a little bit Irish. Our landlady told us "Irish never go to bed early, and youth should enjoy music and pubs. Sometimes we went to the Irish pubs with traditional music. We drank some cider or Irish coffee, but no Guinness for us. During the weekends I tried to explore the rest of Ireland. The bicycle on the bus, I went North, East or South. I got the bus some 100 kilometres further and cycled along the coast or in the mountains. I enjoyed new friends and beautiful nature. Most of all I enjoyed rest and peace.

I felt sad when I had to leave. I know I will go back.

I left Ireland over 2 years ago. My English got much worse again (as you can see and read). I went back already last year. I was surprised so many doctors, nurses, midwives and medical students still recognized me. Its my deepest wish to return to Ireland for work and stay for a few years or (even better) the rest of my career.

Katrien Keppens
Ex-Medical Student at K.U. Leuven, Belgium

MED-NET 3rd Conference:
European Physicians, Implications for Medical Education

We succeeded in organizing the third MED-NET conference in a beautiful environment of Maastricht. The conference will be held in a real Dutch castel: Vaeshartelt Castle Conference Centre, Maastricht, The Netherlands. The date: April 22 - 24, 1999. The 3rd MED-NET conference will convene in conjunction with the The MAAstricht Conference to exchange experiences with implementation of Innovations in Medical EDucation in Europe ehich will take place from April 17 -22, 1999.

European Physicians, Implications for Medical Education

In socio-economic respect the unification of Europe has already made great progress. In addition, over the past five years several European trans-boundary regions have initiated experiments concerning co-operation in the field of health care. With these experiments the differences in the health care systems of the member states of the European Union (EU) became evident in practice. Consequently, if we aim for a Europe without frontiers in the field of health care, we must also widely discuss its implications for medical education in European countries. During the third MED-NET conference we will present some practical experiences and typical operational issues encountered in trans-border health projects to launch discussions on content and organization of medical education in the near future.

Examples of cross-border projects in health care are found in the EU-regions ëRhine-Meuseí (involving Belgium, Germany and The Netherlands) and ëRhine-Waalí (Germany and The Netherlands). Quality criteria concerning medical and clinical competencies are applied in each of these countries, but the answers to the question: ìWhat doctors does society need?î turn out to differ even within small geographical areas like the EU-regions. Typical examples showing variable impacts on the health care systems of the different countries concern multidisciplinary care, doctor-patient relations, and attitudes towards ethical issues, application of medical technology, quality of life, and health insurance systems.

Keeping the mutual recognition of the medical graduates and the freedom of establishment of medical practitioners within the EU in mind, major issues with respect to medical education concern the importance of acquiring skills in multi-professional co-operation and in communication. In order to function well as a health professional in any European country knowledge of, and the ability to cope with the local health care structure and its peculiarities are important prerequisites. To that aim, spending a study period in another European country might be a crucial element of medical education. Hence, the fundamental questions posed during the third MED-NET conference will be: Can there be one European health care system and if so, what should be the outlines of such uniform European health care system? In other words: What does the EU expect from competent doctors? After exploration of the answers to these questions, we should ask ourselves: What are the implications of a European health care system for medical education at the various European medical Faculties?

Structure of the Conference

There are four main parts, i.e.:

1. Introductions and discussions on the conference theme
   A number of invited guest speakers will present lectures on examples of trans-border co-operation experiments in health care, adult education, and reflect on the future. These lectures will be followed by workshops.
   
2. MED-NET reports
   The reference groups and project groups will report on their progress concerning the collection of data in order to achieve the complete picture on medical education in Europe.
   
3. Members consultation meeting
   This meeting of the members will address MED-NETís organizational development. (New) projects and proposals will be presented.
   
4. Education market
   Free discussions on staff and student exchange, separate meetings of co-operating faculties, ECTS meeting, poster presentations on Faculties, and demonstrations.

MED-NET Organising Committee and Conference Secretariat

The organising committee consists of:

Dr. Gerard Majoor Maastricht University
Ms. Milou Stassen Maastricht University
Drs. Marguerite Franssen Aachen University
Prof. Dr. Khosrow Mottaghy Aachen University
Ir. Jan de Koning University of Nijmegen

MED-NET Conference Secretariat (c/o Milou Stassen)
Faculty of Medicine, Maastricht University
P.O. Box 616, 6200 MD Maastricht, The Netherlands
Telephone: (31) 43 3882440/1524
Telefax: (31) 43 3670708
Email:

Visiting Professor Harris

Report of a meeting with prof. F. Harris, University of Leicester, Date: 18-06-1998
J. de Koning

During the Med-Net conference (May 1998, Lille) the members assembly authorised prof. F. Harris to prepare a proposal for a steering or advisory board of the Med-Net thematic network. Such proposal should include advice concerning the role of such committee as well as a suggestion for the personnel composition.

Firstly we discussed the organisation structure of MED-NET and the role of the (future) steering board in this organisation. Concerning the co-ordinating office professor Harris advised that such an office should have full executive power as a management team. He further supports the formation of the task force on the basis of thematic projects rather than on the basis of sub-networks. Thematic projects should focus on pre-graduate education. Prof. Harris recommends to extend the task force with dr. Kiki Thermos (Crete) and dr. Madelena Patricio (Lisbon). Together with dr. Jan Ygge, who was proposed by R. Mollby (Karolinska Institute), in doing this the task force will come on full strength again. Moreover the task force should look at representatives from Eastern European countries. With respect to post-graduate education, a strong link with specialists organisations and associations is mandatory. The present reference group is regarded as being on a too small a basis for a post-graduate project.

Concerning the function of the Steering Board Prof. Harris recommends as follows:

• The steering board is a think-tank with no executive power
• It is composed out of individuals, and on the basis of expertise and merit in medical education
• Its membership should be recommended by the members, but not represent them. Therefore the spread of members over five EU-regions (East, West, Nord, South, Central) is recommended.
• The Steering boards main task is monitoring the progress of Med-Net. This means evaluation of the professional outcome of the projects (i.e. ref. groups), of the management quality and transparency, and of the strategic role of Med-net in relation to universities and associations in the European context. Also the board should make the task force and the co-ordinating office aware of opportunities and new developments on Medical Education

Prof. Harris invited a number of well-known experts in medical education exploring their willingness to join the Board. Already some of them have given their commitment. Some others still have the membership in consideration. We plan to present the complete advisory board at the next member consultation meeting, which is at the occasion of the third MED-NET conference.

MAACIMED

The MAAstricht Conference to exchange experiences with implementation of Innovations in Medical EDucation in Europe

An expanding number of medical schools in Europe is experimenting with far-reaching innovations in education. Conceptually, the trend is to increase the relevance of the educational programs with respect to the functioning of the future physician, which implies a shift from the established approach to provide undergraduate students with a comprehensive, up-to-date knowledge base to the design of more competence and skills-orientated programs. Such programs rather aim to learn students how to learn, how to retrieve information, how to co-operate with other health professionals, how to communicate, how to adequately perform clinical skills, etc. To that end, pedagogical approaches have changed from teacher-driven to student-centred, and programs from disciplines-oriented to integrated, using problem-oriented and problem-based approaches applying small group tutorials rather than class-room lecturing. In an existing medical school such fundamental changes are obviously not implemented overnight.

The change in the organization of education associated with the choice for integration of the undergraduate medical program (as briefly indicated above) already represents a strong barrier. Therefore, the leadership of schools considering change may greatly benefit from lessons learned elsewhere, and faculty of schools that already embarked on change may be reasserted by hearing about the accomplishments and failures encountered at institutions that went ahead or who are at comparable stages of change. For all those, MAACIMED will provide a forum to exchange experiences and to get informed about the latest developments.

In May 1995, the MAACIMED meeting had its predecessor in the MedEd-21 meeting held at Vaalsbroek Castle in Vaals, The Netherlands. Because of the homology of that acronym with that of MED-NET, a Socrates Thematic Network (that will convene in conjunction with MAACIMED), it was decided to change MedEd-21 into MAACIMED.

Scope of the Conference

MAACIMED is open for any contribution in the framework of reorientation and innovation of undergraduate and postgraduate medical education. In addition, inspiring examples from other health sciences curricula are most welcome. Potential topics for sessions are:

• Strategies for change
• Instructional methods
• Curriculum development
• Practicals and skills training
• Electives
• Practical medical training
• Student assessment
• Quality assurance
• Learning resources

Conference Secretariat

MAACIMED Conference Secretariat (c/o Milou Stassen)
Faculty of Medicine, Maastricht University
P.O. Box 616, 6200 MD Maastricht, The Netherlands
Telephone: (31) 43 3882440/1524
Telefax: (31) 43 3670708
Email:
Internet: http://www.unimaas.nl/~maacimed

med-net.nl

In May last year the MED-NET site became operational. Already over 2300 people visited our site. Managing the site and keep the data up-to-date is the next issue, which becomes urgent then. It seems that information is becoming old-dated faster than it is published on the net. We are already working on a completely revised version, which will become operational in January. In the mean time we apologise that some of the data are not up to date. However if you have any suggestions or comments please do not hesitate to contact us.

Niki Linders:

We invite all Med-Net members to include in their homepage a link to the Med-Net site. Its for free and it offers to your faculty staff members and students a view on what is going on in Europe.

MED-NET grows!

Although the financial support by the EU for this year is badly missed, the activities to establish a platform for discussion on educational issues, exchange and mobility, and the complete picture on medical education in Europe are continuing. This indicates the severe needs for contacts and co-operation between medical faculties, teachers and students. During the last year we received letters of endorsement from over 40 institutions, expressing their commitment to the network. In the mean time our list of contact persons increased to 1200. The attention at this moment is directed to development of databases to structure the accessibility to the information collected.

Constitution and Bylaws

During the meetings of the Task Force in Prague (September) and Brussels (December) A lot of work has been done to elaborate the constitution and bylaws for MED-NET. In the documents, the organisation structure, and tasks and responsibilities of all who are involved in our network were clearly identified and described.

The task force wants to present the constitution and bylaws to the Med-Net membership, asking for response and comments. The documents will be discussed during the members consultation meeting at the 3d Med-Net conference in Maastricht (April 23 and 24). The documents are available at the Med-Net site. However you may also order them from the Med-Net co-ordinating office.

In the next table the key elements of the proposed constitution and bylaws are mentioned

Your input at the 3rd Med-Net conference

The first day of the conference is dedicated to the theme. The issue that will be introduced by invited speakers concern:

• Mobility and free establishment of doctors: what is the present practice in Europe, and what should happen in medical education to facilitate?
• Ethical dilemma's in various health care systems of European countries: what are implications for education?
• Case report on cross-border patient exchange and cross boundary co-operation in health care (Euregio Maas,Waal)
• Considering cross boundary co-operation: what is the relative importance of medical competencies, communication and clinical skills, and multiprofessional approach in various health care systems, and what are implications for medical education?

In between the lectures there will be group discussions, wherein state of the art in various countries and discussions concerning the theme will take place.

During the second day the following activities are planned:

• Med-net members consultation meeting: discussion of the constitution and bylaws, appointments and voting, and presentation of the report of the last year

• New application: Med-Net projects and plans, presentations of the general policy and of new projects to be developed in the coming year. Topics of interest are:

• European masters in professionalisation of teachers
• European masters in clinical skills and communication training
• Progress test: pilot implementations
• Economics and medical education

• Education market:

• Members are invited to submit an abstract for a poster presentation at the education market and publication in the proceedings and on the internet. The contents of presentations may concern:

• innovation projects,
• demonstrations of courses in multimedia,
• university profiles,
• new project ideas,
• possibilities for student and teachers mobility
• cases of good practice in education

• ECTS meeting, project meetings and bilateral contacts

• Project meetings and small workshops

Kiki Thermos,
Assoc Prof Pharmacology
University of Crete, School of Medicine

Dear Medische hulpbron colleagues,

It is a great pleasure for me to be able to contribute to this newsletter, as is a great honour for me to be invited to join the Medische hulpbron task force. It is not too long ago, when many of us members of the different ICP networks met in Sardinia ( May 1996) and discussed in a heated but meaningful manner the future of these networks under the changing policies of the EC. The era of the Erasmus program (ICPs and ECTS) was coming to an end and Socrates (bilateral agreements between Universities) was beginning to rule. The Medische hulpbron program was the creation of the Sardinia meeting and its goals were specific. Medische hulpbron aimed to provide a forum of discussion for medical education in a larger scale than each individual ICP network could provide. The ICPs created a structure, a mechanism via which collaboration between the different Universities in Europe (exchange of students) was established.

It was up to Medische hulpbron to continue this process of collaboration and to carry it even further. Its role was to sow the seeds of the desired internationalisation process, through a dynamic dialogue on medical education all over Europe. Medische hulpbron has been in existence now for almost three years. Soon we will be seeing each other again for its 3rd meeting, in Maastricht. Has Medische hulpbron been successful in its endeavours? In answering this question one must be critical, but also fair. Medische hulpbron has strove over these past two years to establish itself as a new organisation by laying down the agenda that would ensure its success, and its continuation. It created reference groups with the goal to obtain information on medical education issues that would provide a data base accessible to all medical faculties all over Europe.

While the projects are not completed, very important information will arise from these reference groups, that will be accessible to all. Medical education is a dynamic process with no date of expiration. While the pillars of the medical curricula are very strong, the world around us is changing and we are confronted with new innovations. We must seize these innovations, for we owe our students, the future doctors of the EC, the best possible education. Each one of us, from his own part of the world, can be well informed, but only through a constructive dialogue among faculties from all over Europe can we ensure the best quality doctor in Europe. I believe in this internationalisation process, the expression of ideas, and in the sharing of information. This is why I believe in Medische hulpbron. Maybe the question I posed above is a bit premature, and therefore warrants no answer. I would like, however, to see Medische hulpbron deal with the issues in a more professional manner, as I would also like to see a better involvement of the large number of colleagues who have attended the two last meetings. The task force members will be much aided by your input on different issues, for the members are the driving force of any organisation. What we all share in common is the belief that a forum for discussion in medical education in Europe is essential. Thus, I call on all of you to join forces for a successful and meaningful forum.

Kiki Thermos,
Assoc Prof Pharmacology
University of Crete, School of Medicine