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 MED-NET Newsletter 4
January 2000
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In this issue:
Editorial
It has been relatively quiet in MED-NET after the Maastricht Conference. This was due to a lack of financial means as you might have noticed. However, we managed to gain a grant again for the next MED-NET year (1999-2000).
.........And here we are again.
The coordinatorship of MED-NET has transferred to the University of Nijmegen. The MED-NET team at the coordinating institute consists of Jan de Koning (coordinator), Professor Jaap Metz (known from the "Blueprint"), professor Rob Holdrinet (chairman of the Dutch workshop of continuing education), and professor Jos van der Meer (chairman of the internationalization committee). Mrs Niki Linders is the web master for the home page. Sjoert Willemstein from the Erasmus University of Rotterdam will continue being active in the management of MED-NET. The composition of the TASK FORCE has changed a little bit, because of some resignations. According to the bylaws the resigning members have proposed new persons. In this newsletter you will find the updated composition.
Above all, MED-NET is a network for communication on educational and didactic developments in Medical Education. For this academic year two main issues in Medical Education are addressed: the developments in student mobility in the SOCRATES program (medical part of the Institutional Contracts or IC's compared with the former ICP's or Inter university Co-operation Programmes) and the internal quality management at Medical Faculties and schools in Europe. We lan to complete a survey on Quality Assessment Systems at national levels in the European member states.
The web site is ready and in the near future we will open the café for online discussions. The discussions will be guided by leading people from the various field in medical education development. A number of issues were already inventoried, but we invite everybody to come with suggestions. Our proposal is to start with the actual topic: Mobility and Quality, and to renew the discussion topics every two or three months.
Please admissions officers, heads of administration offices, local co-ordinators, heads of education offices, educationalists, quality assessors, student counsellors, international relation managers, teachers of basic, paraclinical, clinical sciences and of clinical practice, consultants and policy makers, and last but not least deans, vice deans, students and future students, KEEP AN EYE ON THE WEB SITE med-net.nl and join in as soon as we start.
MED-NET is a dynamic network, and dynamic are the European Universities. In order to keep in pace with the developments, continuous updating of contact persons, educational specialists, and 'supporters' of the European Dimension is requested. We invite all who receive this newsletter to provide us with mutations, and/or corrections of names and addresses of people locally active and interested in MED-NET. This facilitates the efficient collection of data and dissemination of results.
In MED-NET the developments will come on stage and the target audience is invited to take part in the play.
With kind regards,
Central MED-NET Board
New Funding for MED-NET
We are pleased to announce that the European Commission have once again agreed to support our project. This time with a grant for Euro120,000. This grant is for the period September 1999 - September 2000.
As anticiptated, this grant is less than we applied for; therefore, our activities and budgets have been revised until we can receive further financial support via sponsors. If anyone has ideas for further financial support of the MED-NET project, we would be very pleased to hear from you.
The fourth MED-NET conference
June 8,9 and 10, 2000 in Padova, Italy
Themes: "Student Mobility", "Quality Assessment of European Medical Education", and the "Renewal of Socrates"
The next MED-NET conference will be held in Padova, Italy on June 8,9 and 10, 2000. Paola Arslan, member of the Task Force, will be our host and we would like to thank her in advance for organising this conference. The lay-out of the conference will be more or less the same as the previous years. We noticed that the members are enthusiastic about the formula, especially as there is always some space for individual contacts. The plenary sessions provide us with a picture of a current situation at a certain University and give us ideas regarding the organisation of Medical Education in our own Faculty. The working sessions give us the opportunities to discuss further in depth a certain topic and to be informed on the pro's and con's of some activities. In the poster session and market we will have the opportunity to have contacts in fields which interest us specifically and some space to contact our partners within other projects of the European Commission (e.g. Socrates).
Personal contact is extremely important in international relations. In the current situation it is not always possible to find finances for traveling and meeting your partners personally. This conference also aims to stimulate these contacts and to give everyone the opportunity to meet each other.
The themes to be presented at the conference have not yet been finalised. Some suggestions, however, have been made. The Task Force has proposed to discuss student mobility in education (within and outside ECTS) in view of the renewal of Socrates 2000 (deadline October-November 2000): mobility pattern, occurring difficulties and developments. Also, a thorough evaluation of mobility and strategies would be made. The meeting will be also the unique occasion to renew and revise the bilateral agreements and to focus on E.U. Socrates project (how did it work, worthwhile to continue, etc). Another topic can be quality assessment of medical education in Europe: How do Faculties assess, on what level and what are the criteria / methodology? A first invitation will be sent to you at the beginning of this year. We hope to welcome you all and look forward to receiving your suggestions.
Report of the MED-NET Members Consultation Meeting
April 24, 1999, Maastricht
Chairman: F. Harris, Leicester
Parts 1.
Constitution and Bylaws
A general overview of the proposed constitution and bylaws was presented by Jan de Koning. Since MED-NET is a university project, based on a contract between the European Commission and the contracting university, the regular rules for an association are not applicable in some aspects.
However, having started the network the usual project structure was not adequate to manage it. Therefore, we designed and presented last year in Lille a draft organisation for the future; and during the past year we elaborated this draft to a set of constitution and bylaws that you have found in the conference documentation. The constitution and bylaws are resembling those of an association very much.
But there are some important concessions to the staus of an EU project. The main concession being the role of the contractors and the composition of the Task Force.
On the other side of this concession is the status of our network as a European project. In fact, and this gives us a unique position in Europe. MED-NET is the only external body in formal communication with the European commission on the topic of medical education. The contract is the formal relationship with the commission. The funding allows MED-NET to participate in the European dimension in an interactive way. Not only the annual conference but thoughout the year.
Against this background the participants discussed some crucial points. The aim of the discussion was to gain the principle approval to proceed with MED-NET according to the regulation of the bylaws.
The basic principles are:
- Unity of purpose: the MED-NET project has a defined mission; we have general agreement on this mission and the mission is the driving force for the organisation.
- Common sense: it is not advisable to continue detailed discussion on the constitution if we agree on the principles.
- Good will: we start from the motivation of members to contribute actively to the MED-NET tasks.
- Participation: we expect that all members participate to make MED-NET a success.
- Communication: on all aspects, an open communication has to be possible. Especially to promote and facilitate the influence of the membership on the policy of the network. The MED-NET Board has to take care of good and reliable communication, that all members already contribute in the form of participation in enquiries, workshops and meetings. In general the feeling is that any membership fee will lower the interest in MED-NET as long as the added value is not explicitly clear. The Task Force will discuss this topic and prepare new proposals. Some suggestions were: sponsoring, less activities, more own efforts in mastering the web page, etc.
Composition of the Task Force
The Task Force members are in principle members on the basis of commitment and motivation. The membership has influence on the composition. However, at the start of the project the Task Force constituted itself. At the annual membership consultation meeting the Task Force should give a transparent insight into its activities.
Membership Participation/Communication
The participation of the membership should be facilitated. This is the task of the Task Force and reference groups. Bottom up communication is possible via the MED-NET site, in chat boes or via e-mail. The regular inquiries and newsletters are crucial in keeping the communication channel open and functional.
Task Force Members from all EU Countries?
The issue of national representation of countries in the network was discussed. Although there is sympathy for national representation, it does not have a high priority since national representation supposes a national authorisation (which is not feasible). Looking for the 'European dimension' rather implies representation of a specific form or tradition of education rather than for a national oriented approach. Moreover experience, commitment and effort are regarded as more important to contribute to a success. Since the background of the Task Force is formed by I.C.P.'s contact with, and balance of experience across all participating organisations and countries shall continuously be taken into account.
Membership Fee
The issue of membership fee was discussed on the basis of a financial analysis. There was no agreement to proceed with this.
Written Comments
Some written comments were received. The textual corrections will be carried out. The major points were discussed in the foregoing.
Part 2.
Med-Net future
- Willemstein reports on the achievements of last year:
- The membership expects a transparent overview of all expenditures. This will be submitted to the members as soon as ready and approved by the Socrates Administrative Office.
- The link of the thematic networks and the Socrates Institutional Contracts is not understood. Especially a financial link is regarded as not feasible nor practical. In organisational sense it was suggested that Med-Net as a thematic network could provide international offices with a facility to publish student flows within the I.C. on the web page.
- The present composition of the Task Force is presented, and the members present at the meeting are introduced.
- A short introduction on the new application of Med-Net is presented. The starting points are:
- Medical education as a continuous process (preclinical and clinical undergraduate education, postgraduate education, and continuous education)
- Societies expectations of (European) doctors i.e. compentencies, knowledge and sensitivity for ethical, technical, social, cultural and economic aspects
- Project structuring of activities; such as the KIOSK project, the projects on development of master courses, the Euroskills project etc.
The ambitions as formulated in the new application are:
- improved dissemination and exchange of information
- increased political impact on the European stage
- initiatives for cooperation with existing associations on medical education in the various European countries
- The reference groups present achievements and new plans for the next Med-Net application:
- Education survey > Q management: J Rotgans
- Curriculum Innovation > progress test: G. Majoor
- Professionalisation of theachers > inquiry & p..? : M. Pats
- Postgraduate education: P. Arslan
- International Health > masters: Hoffman
- ECTS: Willems
- Other topics: Creusy
- Next Med-Net conference
- The next Med-Net conference will be organised by the university in Pandora. The organising university receives some suggestions by the members:
- one afternoon for Task Force meetings and reference groups workshops
- the education market parallel to regular lectures
- invited lectures on one theme are appreciated
- publish abstracts and documents on the net, one week prior to the meeting
Organisation of MED-NET
At the previous MED-NET conferences in 1998 and 1999 the organisation structure of MED-NET was discussed. It seems obvious that some changes concerning administration and decision-making have to be made to have a clear view on the organisation.
Administrative and decision-making bodies have been contructed. Herewith you will find a scheme, explaining the new organisation structure of MED-NET.
Welcome to the University of Pavia
A. Morandi, A. Marinoni, A. Soresini, C. Meloni
Department of Applied Health Sciences, University of Pavia, Medical School, Pavia, Italy
Pavia is located in the Lombardy region in the North of Italy, near the confluence of the river Ticino and the river Po.
Pavia is now a municipality of about 75.000 inhabitants and 29.335 students.
The University of Pavia is one of the oldest in the world, established in 1361 by Emperor Charles IV.
During the 19th Century medical sciences were improved by the very famous scientists such as the Nobel Prize Camillo Golgi for his studies on nervous system and Carlo Forlanini who made important discoveries about tuberculosi.
An appreciable contribution to maintaining and increasing its role and importance is also given by the numerous private and public student residences, which have existed since the 15th century (Borromeo and Ghislieri Colleges for example).
The Faculty of Medicine and Surgery of the University of Pavia adopted the new regulation for degree courses in Medicine and Surgery in the 1988/89 academic year. The syllabus provided for under these new regulations is set out in Table XVIII ter.
We have 2 Degree courses, 13 Short term courses and 54 Specialisalisation Schools.
In the academic year 1998/99 the students enrolled to the study courses of the Faculty of Medicine and Surgery have been 3.805 andthe staff of the Faculty consists of 310 teachers. The ratio teachers/students is 8% and the average of the didactic burden is 515 hours per teacher.
The mobility of medical students began in 1988 and now involves more than 20 places. The trend of exchanges for the medical school is increasing while the one of the whole University is steady.
The assessment of outgoing students is for 70% above average and the assessment of incoming students is for 43% exceptional.
Socrates experience is a very positive one!
Bratislava, School of Medicine, Comenius University, appeals for co-operation with foreign partners
by Peter Cikatriks
Bratislava - the Capital of Slovak Republic- lies on the crossroad of ancient trading roads and the greatest European river - the Danube.
The School of Medicine of the Comenius University is one of 12 university faculties. It started its activities in September 1919 under the leadership of the dean, gynaecologist Prof. Dr. Gustav Mueller, in the working places of the State hospital, built in 1864.
Today the School of Medicine in Bratislava has 58 clinics and institutes. It educates physicians in two medical branches - General Medicine and Stomatology, both in Slovak and English language. Every year approximately 300 students in Slovak language and 100 students in English language start their medical voyage there. In the year 1998 there were 1269 students attending the school of medicine and 308 graduated.
The School of Medicine, CU in Bratislava started its activities within the Socrates/Erasmus programme in 1997/98, being in the front line in Slovakia, by including its first contracts with foreign partners into the Institutional Contract (IC) of Comenius University in Bratislava for the academic year 1998/99. The number of foreign partner institutions has been increasing dramatically ever since. For the future, we hope to involve in more activities SOCRATES/ERASMUS programme offers and, of course, we would be glad to find new partners to arrange contracts with in order to exchange more students and teachers.
Improving the MED-NET Web Site
I think we can all agree that it is important to improve our web site.... For this to be achieved everyone's help is needed. We would like to add under the heading Education Services an extensive list (including contact information) of the following:
- Courses and Summer Schools
- National Associations for Medical Education
Furthermore, we would like to issue a list of publications (journals, books & web sites) on medical education to picture the renewal of medical education, education policy, new education methods, education publication and materials. In order to get a European overview we request you to send ALL relevant material from your surroundings.
Could you please look for photographs (portraits and educational situations), this will make our web site more attractive to it's visitors.
Last, but most important of all.....please do not forget that this is MED-NET's web site, therefore EVERYONE's ideas are important. If you have any ideas for improvements, or if you have an article or information you would like to see in the web site, please do not hesitate to contact Niki Linders.
Tel: +31 24 3619419
Fax: +31 24 3540529
Email:
Sharing Know-how in Students' Exchange
How MED-NET can help in the implementation of ECTS procedures
Among the most tangible activities in the field of internationalisation of the academic world is the exchange of students. Although not qualitatively, the mobility is, in quantitative terms, something new. The number of university students exchanged by higher education institutions between different countries in Europe is now well in the range of tenths of thousands per year. Erasmus has made it possible or at least has facilitated in a great extent the development of operational tools that can be adopted by the universities throughout Europe. The requisite of total recognition of the studies done abroad, was at the beginning poorly accomplished. In 1989 the European Credit Transfer System was launched as a pilot experiment in order to test the feasibility of full recognition using standardised methods. Until 1995 the users of ECTS were a very limited number of specialities: History, Chemistry. Business Studies, Mechanical Engineering and Medicine, as it was also the number of Universities invited to participate. These were the so-called Inner Circle Institutions. Having proved its success, the implementation of ECTS procedures was recommended and even granted, when it was included in the Socrates Institutional Contracts.
The former members of the Inner Circle in Medicine have accumulated a very long experience in the field of students exchange and kept together in order to maintain their long running partnership and also with the aim of further develop ECTS philosophy and actions. The group adopted the name ECTS-ICMG (for ECTS-Inner Circle Medicine Group).
ECTS has been included as a reference group in Med-Net and the institutions of the ECTS-ICMG were included as members in the thematic network. This provides a unique capability of sharing a vast experience on students exchange among a very large number of institutions that belong to Med-Net.
Certainly, the ECTS-ICMG will be happy giving advice for the implementation of ECTS procedures to any of its partners in the frame of Med-Net. This could be of particular interest in the case of those institutions that do not use it yet. The new projection of EU through the East of Europe makes such possibility even more interesting for institutions from several countries that progressively are joining the trend of globalisation.
ECTS Basics
ECTS is based on three core elements : Information, mutual trust and workload accreditation.
Information is made available through the publication of a more or less standardised Information Package (IP). This booklet, normally written in English and in the local language, contains information concerning the institution, the department (faculty or school of medicine) and a description of the study plan including every subject, as well as its teaching and assessment methods and ideally a calendar. The annually up-dated IP is circulated among the partner institutions and now is also made public through Internet where last minute changes can be accessed without difficulty.
Mutual trust among the institutions is based on transparency which is reflected in the content of the IP and build-up on the knowledge derived from preparatory visits and personal contacts among representatives and co-ordinators of the partner institutions. The use of standard procedures including an official Learning Agreement, assures that the student and the home and host institutions are legally committed.
Workload accreditation is the core element of ECTS. A total of 60 credits is the equivalent to the workload of the student during a full academic year, including lectures, practical work, seminars, tutorials hospital work, private study and examinations. Every compulsory, non-compulsory and elective subject included in the IP must reflect its number of ECTS credits.
ECTS set-up and use
In practical terms, the use of ECTS implies :
- The appointment of a co-ordinator at the faculty. This person is responsible for all daily work related to the exchanges, starting by finding-out suitable partners which should be included in the so-called Institutional Contract that every University willing to participate in the Socrates Programme has to submit every year to Brussels. For the inclusion of a partner in the Institutional Contract, a Bilateral Agreement in which the number of students and conditions of the exchange are specified, must be previously signed. The co-ordinator has also the duty of compiling and editing the IP.
- The selection of the local candidates for next year exchange. This normally is made considering the records, language capabilities, personal aptitude and the convenience of the proposed plan of studies abroad of the student. The co-ordinator has a key role tutoring this step in order to achieve a reasonable agreement among the student and the home institution on the proposed equivalencies for subjects and workload. Knowledge, flexibility and common sense are essential elements at this stage of the process. Finally a formal Application form is sent to the host institution.
- The Applications of foreign students should be analysed and its feasibility assured. Sometimes changes in the study plan are necessary or recommended and when a good agreement is reached, the Application is accepted, including the signature of the student and that of the responsible persons of the home and host universities. This has to be done necessarily before the student leaves for the host institution.
- After the completion of the studies by the foreign student (including successful examinations), an Official transcript of records is issued.
- The final stage of the exchange procedure consists of the accreditation of the studies successfully completed abroad by making a translation (accreditation) in the standard record of the student at the home university. In order to simplify the process a universal grading scale is used in ECTS. Local equivalencies are made public in the IPs.
Final remarks
Complexities of the ECTS are more apparent than real. The system is pretty automatic once it has been put in practice during one or two years. The Socrates National Agencies have appointed experts for every country in order to teach new institutions in the use of ECTS procedures. Unfortunately, there are no experts for every possible speciality. This is why the expertise of ECTS long users belonging to the former ECTS Inner Circle in Medicine (included in Med-Net), can be of a great help in order to ease the adoption of the system by institutions willing to do so.
Manuel Vijande
ECTS Med-Net Reference group
Skills
Teaching skills has now been recognised fully as an assignment of medical training of each medical faculty. Teaching skills on a quality level asks for a systematic, continuous and gradual approach until the ultimate goals have been realised. Central guiding of teaching skills is absolutely necessary. The planning of the skills training in many faculties is inefficient. There is no definite outline of skills to be trained and therefore there is no gradual planning throughout the whole medical training. There is no overview on the different existing activities and teaching moments.
The faculties, however, realise that skills training is essential to acquire medical competence. Skills training has also an individual aspect because students experience their own growing competence. The effects of the skills training must be evaluated by the faculty supervisors. Also, the students themselves need a method to evaluate their own progress concerning skills.
Technical and Manual Skills
Starting from the objectives for technical instrumental and manual skills as described in national and international documents (a.o. Tomorrows Doctors, General Medical Council, Recommendations on Undergraduate Medical Education, London, 1993 and Raamplan 1994, eindtermen van de artsopleiding, J.C.M. Metz, E.H. Pels Rijcken e.o., Nijmegen, 1994), the current efforts should be coordinated and spread over the entire training. A practical booklet gives the students and teachers a method to evaluate the progress. The document contains results of self study as a feedback for the teachers. The students themselves will keep track of the file. The faculty should have a parallel file with all feedback and data of evaluation.
Technical and manual skills are already taught in a lot of medical faculties. Examples of these skills could be:
Surgery: general physical examination, orthopedic examination, first aid, therapeutical skills (treatment of burns, stitching, &)
Gynaecology: physical examination (rectal touchier, speculum, &), therapy and prevention (laparoscopy, &), anticonception (giving information, &)
Paediatrics: anamnesis, baby (check reflexes, evaluate general behavior, &), all ages (evaluate speaking behavior, measure length, measure bloodpressure, measure temperature, &)
The skills should be included in the medical training continuously throughout the different years of training. The most important skills should be taught to the students and practised by them. Testing moments can be introduced.
Communication skills
These skills are often not included in a medical curriculum, although they are extremely important. It is the intention that the student realises that his/her communication skills are an essential part of his/her future profession and that working on these skills will have a visible progress as a result. It is expected that by the proposed exercises he/she gets a realistic view on personal acts and given the chance to compare his/her own reaction to that of colleagues and supervisors, and , if necessary, to correct it.
The overall goals to be realised are:
- the students should improve basic skills in doctor-patient communication
- the students should acquire a positive attitude towards the importance of communication in the medical relationship
- the students get acquainted with one or more consultation models and learn to practise it
- the students should acquire insight into specific problems concerning communication in general, in their own practice and they should acquire skills and attitudes to deal with it in a positive way
- the students acquire insight and basic skills in communication with colleagues and team members and specifically concerning leading groups
The concrete goals to be realised by the end of the medical training can be described as:
- basic skills in the doctor-patient relationship
- normal listening skills
- non selective basic skills (non verbal behavior, verbal listening, use of silences)
- selective listening skills (asking questions, paraphrasing the contents, reflection of feeling, giving concrete form, summarising)
- regulating skills (opening a conversation, formulating goals, clearing up the situation, ending a conversation, ..)
- consulting and negotiating with patients
- basic ingredients in a consultation (active listening, informing, motivating the therapy)
- handling difficult conversation situations:
- talking to couples/family
- psychosocial and psychosomatic exploration
- informed consent
- conflict conversation/dealing with irritation
- Bad News/palliative situations
- uncertainty
Other important aspects in the skills training can also be self reflection by the students, multicultural experiences, prevention, &
These skills can be stimulated by means of exercises, between two persons and afterwards discussed in a group and re-exercised. The use of video and discussion should be stimulated.
The teachers propose cases. Different communication styles should be tried and pros and cons of different approaches will be defined. The exercise and development of skills is based on literature that will be diffused by the teacher. The students will be motivated to study specific literature as background of their training. The teachers should discuss the development of the program at least twice a year.
Prof.dr. H. Jaspaert (chairman)
Working Committee 'Skills', Faculty of Medicine, Katholieke Universiteit Leuven, Belgium
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