Education survey

Activities concerning this theme are coordinated by the reference group on education survey.

The reference group aims to inventorize the available databases and to define the critical indicators for education and medical teaching. The group collects data on the methods of assessment of the quality of education and of assessment of the quality of doctors.

The group exists of :

 Enzo Molina
 Roland Möllby
 Alberto Torres
 Wolfram Antepoh
 Sjoert Willemstein.

Ideas and opinions on education survey can be send to the contact person of the group:
Prof. Enzo Molina, University of Parma, E-mail:

 Progress reports

Report of the reference group on education survey

 Reviews

Overall survey of education in medicine in Europe

 Case studies

Compiling an international database on medical education: Experiences with the 'European Medical School Information System (EMSIS)'

 Favourite links

 EMSIS
 ETM (EuroTransMed Foundation)
 To ECTS Homepage

Numbers of years of undergraduate medical education

int=integrated
courses p=part-time

Clinical Rotations

GENERAL

Both in Denmark and The Netherlands the national evaluation committees recommend a better preparation of the students in the clerkships with regard to post-graduate education. In Denmark it is recommended that an appropriate forum is established for coordination of the pre-graduate and post-graduate programmes. In The Netherlands it is recommended that the students acquire more own responsibility in the final clerkship in order to prepare them for the next phase (specialisation) of their studies. Internal quality assessment should be obligatory for all subjects and be published for the institution and be publically accessible. Practice in The Netherlands and Denmark.

APPENDIX 1

Short survey of the recommendations of the ADVISORY COMMITTEE ON MEDICAL TRAINING OF THE EUROPEAN UNION (1993)

RECOMMENDATIONS FOR UNDERGRADUATE MEDICAL EDUCATION

• the primary goal of the undergraduate curriculum is the provision of appropriate knowledge, skills, attitudes and ethical values;
• the number of years should remain unchanged at six, or at least 5.500 hours of theoretical and practical teaching;
• during his undergraduate training the doctor must be prepared to adjust to changes in medical practice during his postgraduate and continuing medical education;
• the curricula should be composed of two core parts, the basic sciences and the clinical sciences which may be integrated. The sciences basic to medicine include also psychology and human behaviour;
• basic sciences teaching should be medically oriented, more practical and tailored to the needs for clinical sciences teaching;
• attention should be drawn not to overload the medical curricula;
• a switch should be made from passive instruction to active learning;
• core and options within the curricula should be reviewed regularly;
• clinical bedside teaching should be increased both by enlarging teacher/student and student/patient contacts;
• attention should be drawn to methods of learning and examinations. The latter must remain compatible with the learning process;
• participation of students in evaluation of the curriculum should be stimulated;
• clinical teaching outside the hospital (ward) is recommended.

Furthermore the Advisory Committee recommended the following:

• medical education should concentrate on students and not on subject matter;
• attention for learning of methods of finding, wording and solving specific - fundamental, but especially clinical problems, on the basis of a multidisciplinary approach;
• Theoretical and practical training of clinical methodology are essential;
• it is recommended to develop a European medical final examination and a system of quality control.

By Anesti Kondili and Xheladin Ceka
Dean of Faculty of Medicine, University of Tirana

Number of schools, number of graduates
Albania (3,4 Million inhabitants) has one Faculty of Medicine of Tirana. Approximately 300 students graduate every year. This number has been fairly constant over the last five years, and we hope not to have any change in the nearer future years.

There are also two high medical schools, respectively in Tirana and Vlora. The aim of these schools is preparing of nursing. Their curricula is in the process of consolidation.

Administration
The Faculty of Medicine is part of the University of Tirana. There is no notion of "Medical faculty" as a seperate entity. Consequently the Faculty of Medicine is under the Ministry of Education and Science as well as pre-education is under the responsibility of the Ministry of Education.

Postgraduate training (to become licensed as specialist) is both under the Ministry of Education and Science and the Ministry of Health. During this year we are engaged in order to fulfill all the curriculum of the Faculty of Medicine, as well as the legislation of high education, including high medical school, such us: the Law of High Education, the Statute of the Tirana University, the Regulation of the Faculty of Medicine.

Actually the Faculty of Medicine has the departmental structure, where the dean is responsible to all teaching activities.

Postgraduate training of specialists requires 2-4 years (dental medicine is a separate education branch of the Faculty of Medicine of Tirana).

National goals for undergraduate medical education
Undergraduate medical education is aimed at scientific and practical training for the profession, development of medical sciences and formation of scientific offspring.

Admission of students
Admission of students is dependant on a national competitive examination, for a close posts of students at national level.

Curriculum structure
The Faculty of Medicine is organized in two cycles. Three years of pre-clinical training are followed by six semesters with practical teaching and clinical topics. The Faculty of Medicine is discipline- based.

Department structure is in the process of consolidation.

Teaching and learning methods
The teaching strategy consists of lectures complemented by laboratory work, seminars and especially of clinical work as appropriate. The proportion of lectures to practical work varies from one subject to another within different range depend of the subject. The ratio of lecture/practical training is 0,6.

Training setting
Training of medical students is based on tertiary hospitals, like this University Hospital Center of Tirana, and some other central hospitals of Tirana. Postgraduate training, except the Family medicine (general practitioner), is based on tertiary hospitals too, as well as on a primary care setting. Training of dental medicine students is based mainly in a primary care setting.

Curriculum contents
PRECLINICAL SCIENCES (the first cycle)
YEAR 1, 2 AND 3
Philosophy, Sociology, Foreign language, Latin, General and inorganic chemistry, Organic chemistry, Biology, Informatics, Medical psychology, Biostatistics, Physical training, History of medicine, Ethics and dentology, Biophysics, Human anatomy, Histology and Embryology, Physiology, Biochemistry, Pathological physiology, Pharmacology, Genetics, Immunology, Semiology, Microbiology.

EXAMINATION AT THE END OF THE SEMESTERS OR AT THE END OF THE YEARS

CLINICAL SCIENCES (The second cycle)
Pathological Anatomy, Urology, Clinical biochemistry, Rheumatology, Gastropathology, Orthopaedics and traumatology, Anaesthesia-Reanimation, Pneumology, Nephrology and Hypertension, Allergology, Haematology, Neurology, Infectious disease, Oncology, Endocrinology, Surgery, Obstetrics-Gynaecology, Paediatrics and Infantile surgery, Psychiatry, Cardiology and Angiology, Clinical pharmacology, Clinical toxicology, Dermatology, Otorhinolaryngology, Ophthalmology, Professional diseases, Forensic medicine, Stomatology, Hygiene and health, Medical organization, Epidemiology, Medical economics.

EXAMINATION AT THE END OF THE SEMESTERS OR AT THE END OF THE YEARS

Evaluation of students
Examinations are discipline-based and given as oral or/and written forms. There are two final examinations at the end of the sixth year:

• Pediatrics and Internal disease, and
• Surgery and Obstetrics-Gynecology

M. Lischka
Studienzentrum, Faculty of Medicine, University of Vienna

Number of schools, number of graduates
Austria (7.5 Million inhabitants) has three medical faculties, which are part of the universities of

• Graz (Styria)
• Innsbruck (Tyrol)
• Vienna

Approximately 1,000 students graduate every year (statistics per 1995). Despite serious disputes about an "over production" of medical doctors versus the necessity to provide the workforce for health services requirements, this number has remained fairly constant over the last three years, but it is likely to decrease during the next few years.

Administration
All medical faculties are part of universities. There is no notion of "medical school" as a separate entity. Consequently, all faculties are under the Ministry of Science and Research, whereas pre-entrance education is under the responsibility of the Ministry of Education.

Postgraduate training (to become licensed as general practitioner or specialist) is both under the Ministry of Health and Welfare and the Medical Professional Board, the latter being almost exclusively responsible for Continuing Medical Education.

Since 1997 undergraduate medical education is governed by a new federal law, which will come to be effective to it's full extent in the year 2002. Now, great emphasis is laid on comparability and interchangeability of curriculum requirements. Federal and faculty regulations provide subjects and sequential arrangement, scope regarding teaching hours and examination procedures. Within this framework academic teachers are free to teach whatever they deem appropriate according to scientific standards. By 2002 much more autonomy will be with the faculty of medicine, which will also have a Dean of Studies as a powerful steering person instead of the traditional departmental structure. Funding of teaching activities will then be a responsibility of the Dean.

After graduation from medical school at least 2.5 years of hospital-based training and six months in free practice situations are required to become liscenced as a general practitioner. Postgraduate training of specialists requires 6 years (dental medicine, which up to now was a medical spcialty with two years postgradutae training, at present is becoming an entirely separate educational track according to EC regulations).

National goals for undergraduate medical education
Medical education is corresponding to the development of medical sciences and its help and border sciences are designed to serve scientific and practical training, development of medical sciences and extension of scientific offspring. Besides that the surveying knowledge and basic understanding should be passed on, which are necessary for the ability of exemplaric learning.

Admission of students
Students who fulfill certain legal (general eligibility and educational) requirements are freely admitted. This policy has often been criticised and at present is accompanied by an attrition of approximately one-third of the beginners, the majority of them leaving medical school during the pre-clinical period.

Curriculum structure
Two years of pre-clinical training are followed by one and a half year of practical teaching and five semesters with clinical topics. The medical faculties are discipline-based. Electives are required to a certain extent. A thesis is optional and may help students to enter a scientific career.

Departmental structure is very powerful (1997), and the curriculum committee (in which professors, assistants and medical students are represented on a 1:1:1 basis) is concerned with recommendations on co-ordination and contents. It will have legislative power under the new law.

Teaching and learning methods
The teaching strategy consists of lectures complemented by laboratory work, seminars and clinical work as appropriate. The promotion of lectures to practical work varies from one school to another within a narrow range given by federal legislation. The average is four hours of lectures to one hour of practical training. Currently, a vivid discussion about the need for more student orientation is under way.

Training settings
Training of medical students is mainly based on tertiary hospitals. As it applies for postgraduate training a certain proportion of practical training in a primary care setting is recommended for medical students.

Curriculum contents
Generalized Medical Curriculum Austria

PRE-CLINICAL SCIENCES

YEAR 1 AND 2
Medical Biology; Biophysics; Chemistry and Biochemistry; Anatomy, Histology and Embryology; Physiology

CLINICAL SCIENCES

YEAR 3 AND 4 (semester 7)
Medical Psychology; Pathological Anatomy; Functional Pathology; Pharmacology and Toxicology; Radiology and Radiation Protection; Hygiene; Microbiology and Preventative Medicine, with attention for Industrial Medicine and Environment

YEAR 4 (semester 8), 5 AND 6 (pars)
Internal Medicine, Surgery, Paediatrics, Gynaecology/Obstetrics; Psychiatry; Neurology; Ophthalmology; Dermatology/Venereology; Otorhinolaryngology; Social Medicine; Forensic Medicine and Law for Medical Practitioners

CLINICAL TRAINING

YEAR 6
16 weeks of HOSPITAL CLERKSHIPS of which:

• at least 4 weeks Internal Medicine
• at least 4 weeks Surgery
• 8 weeks electives

Evaluation of students
Examinations are discipline-based and mainly given as orals. Students can move to the next phase of the Curriculum only if the preceeding phase has been finished completely. There is no final examination at the end of the sixth year.

Future Perspectives
There is a strong tendency to comply with EC regulations (see, for example, the implementation of dental medicine as a completely separate track). Even though most of the regulations are meeting EC Requirements (f.i. 86/457/EEC), a long-lasting debate on educational issues in the training of medical doctors will eventually lead to new regulations both on undergraduate and postgraduate levels. New legislation has been brought into action at both levels (for the undergraduate level, see "Administration"). At the postgradute level licencing examinations for general practitioners as well as specialists will be in effect by the turn of the century.

Prof. dr. H. Jaspaert, educational department, Faculty of Medicine, K.U. Leuven (Belgium)
H. Groenen, Faculty of Medicine, K.U. Leuven (Belgium)

General Introduction and admission of students
Belgium has 10 Universities who organise medical education:

• Universiteit Antwerpen
• Université Libre de Bruxelles
• Vrije Universiteit Brussel
• Universiteit van Gent
• Katholieke Universiteit Leuven
• Université de lEtat à Liège
• Limburgs Universitair Centrum (only degree of candidate)
• Université Catholique de Louvain
• Université de Mons (only degree of candidate)
• Facultés Universitaires Notre-Dame de la Paix (Namur) (only degree of candidate)

Education was the subject of a national government policy until 1991. From that year on it has been transferred to the Flemish and French Community in Belgium. The Flemish Community regulates (basic, secondary, higher and university) education and therefore also medical education. The degree of medical doctors in Flanders can only be obtained at university level. All faculties of medicine are part of a university. The following Flemish universities offer medical education in order to obtain the degree of medical doctor:

• Universiteit Antwerpen
• Vrije Universiteit Brussel
• Universiteit van Gent
• Katholieke Universiteit Leuven
• Limburgs Universitair Centrum (only degree of candidate)

In 1996, 636 students graduated after a 7-year study. There used to be free entrance to medical education for all students complying with legal regulations. Since the academic year 1997-1998 an interuniversity admission exam has been organised. Passing the examination is obligatory in order to commence medical education. This requirement has been established after in-depth discussion with all parties involved. The number of medical doctors and dentists in Belgium is too high related to the total number of inhabitants. Therefore the federal government decided that urgent measures had to be taken in order to decrease the total number of medical doctors and dentists. For the profession of medical doctor the Flemish Community decided that in 2006 a total of 360 graduates will be admitted to the profession.

Administration
All medical faculties are part of a university. Legal requirements and regulations are determined by the Flemish Community. The Ministry of Education of the Flemish Community is responsible for the academic training. The Ministry of Health can forward recommendations regarding medical education to the Flemish Community and to the faculties.

Postgraduate education in Flanders is mostly arranged by the professional medical organisations. The training of general practicioners is a university matter. The training of other specialists is handled by the professional medical organisations. The presentation of a Masters degree or a Doctorates degree can only take place by a university. An overall discussion has started about the fact whether specialists training should partly be rather a matter of universities than of professional organisations. A plan has been proposed by the previous rector of the Katholieke Universiteit Leuven, Prof. dr. em. R. Dillemans, to assign also the training of specialists to the universities.

The only determination up-to-now, made by the Flemish Community, concerning medical education is that it should contain two cycles: one of 3 years and another of 4 years. Every faculty is free to determine the goals and criteria of medical education she offers. This results in different kinds of training, characteristic to each university. There is however interuniversity discussion in the VLIR (Vlaamse Interuniversitaire Raad) and in the Committee of Rectors.

Universities are funded partly by the government (amount in relation to the number of students) and partly by own income (out of research and/or other services).

National goals of undergraduate education
Following basic characteristics of a graduate in medical education has been described by the visitation committee (*): "Undergraduate medical education aims to form medical doctors who are capable of medical problem solving and who possess a broad package of knowledge and skills to be able to follow any continuing education. He/she possesses knowledge, attitudes and skills for teamwork and is scientifically formed and handles towards it. The graduate will have the right attitudes to form him(her)self permanently and is flexible to adapt to social changes. He/she is legally authorised and competent to perform medical acts and to carry the responsibilities related to it. The graduate knows his/her limits regarding performing medical acts, determined by education and experience."

* Visitation Committee: In 1996 a committee was founded, existing of professionals in medical education in Flanders and the Netherlands. In 1997 the committee visited the Flemish and Dutch medical faculties, who prepared a report on the organisation of their educational training in medicine. An evaluation report was composed by the committee describing all positive and negative aspects of medical education in each faculty. A comparison of medical education in the various medical faculties was presented.

Curriculum Structure
Medical education forms medical doctors and exists in Flanders traditionally of 2 cycles.

The first cycle encompasses 3 years (candidature years) and aims to give students a scientific basis. Especially the exact sciences (a.o. physics, chemistry and biology) are fundamental to obtain scientific thinking and they form the basis for applications in biochemistry, physiology etc. The second and third year also studies the healthy human being, but already lies the basis for connections towards pathology in courses like anatomy, physiology, embryology etc.

The second cycle consists of 4 years and the student will then follow theoretical courses as well as clinical demonstrations. This cycle is a continuing scientific formation towards obtaining clinical knowledge and skills in order to be able to perform proper medical acts. These 4 years teach the student about the sick human being. The first and second year of this cycle (fourth and fifth year of study) is dedicated to theory and practice, related to human health care. All medical faculties organise clinical clerkships for a total of 12 months. This can be organised in one year full-time or partly full-time or partly part-time, spread over different years. During the last (seventh) year part of the programme is a common study for general practicioners as well as for future specialists.

After graduation
Already during the last year of study students are obliged to orient their study towards a specialty: general practice, specialisation, health care systems or research. The training of general practice encompasses three years. For students choosing general practice in their last year of study the first year is equated with the seventh year of study for the degree of medical doctor. Graduates choosing general practice work after graduation for 2 years in a practice or association as general practice trainee. Graduates who would like to specialise and who are accepted to specialise usually work in that discipline in a hospital. Social health care functions are situated in the field of insurance medicine, prevention etc. Scientific research can be performed o.a. in universities, private companies or governmental services.

Teaching and learning methods/ Training Settings
During the first cycle especially traditional lectures are given; seminars as appropriate. Afterwards more clinical work in small groups is introduced. The legally obliged clerkships (internal medicine, surgery, obstetrics/gynaecology and paediatrics) are performed in affiliated and university hospitals. A certain consciousness towards more student-oriented and less traditional teaching is taking place.

Evaluation of students
The majority of examinations are oral examinations. Where appropriate, written examinations can be organised. Clinical oral examinations are preferred for clinical courses (during the clinical years: fourth to seventh year). Each university advises her medical faculties on examination forms.

Future developments
The visitation committee visited the medical faculties in Flanders in 1997. She made some general suggestions towards a more student-oriented education. The traditional existing teaching methods should be transformed to a more two-way communication. Curriculum innovation and evaluation are in this framework important concepts.

International cooperation is well-structured but student exchange especially takes place in the frame of clinical clerkships and less during theoretical years. One of the reasons is the existing language problem.

It is clear that in the future European Community international standards, regulations and recommendations will be created. How and when each faculty will apply these regulations will depend on the fact whether the Flemish Government will incorporate these regulations in her legislation and of course also on the type of regulations to be forwarded.

Curriculum structure
The instruction of students in medicine is organised in three stages with a total duration of six years.

• first stage of pre-clinical training gives the students the necessary biological and medical knowledge forming the basis for their clinical instruction;
• second stage of clinical training aims at acquiring knowledge for diagnosing and treating the sick. The instruction is given in a cyclic way after the third academic year;
• third stage is a pregraduation internship in the university hospitals and aims at applying the knowledge at the patient bedside and at the outpatients clinics.

After the final state examination the sudent becomes doctor in medicine.

Student evaluation
Examination of students takes place at the end of courses taken. The study is terminated with a state examination in internal medicine, surgery, paediatrcs, gynaecology/obstetrics, hygiene and ecology. These examinations are subject-based.

Number of schools, number of graduates

• Brno
• Hradec Kralove
• Olomouc
• Plzen
• Prague

Curriculum structure
Medical education lasts six years and is subdivided into three cycles:

• first cycle of preclinical sciences: information of a more general nature with a biological orientation, inclusive details, structure and functions of the humen body;
• second cycle of para-clinical and clinical sciences: introduction to diseases, their structural and functional aspects, causes of diseaeses, and the basis of their medical treatment; students also learn to take medical histories and how to examine patients;
• third cycle of clinical subjects and clerkships (pregraduation clerkship) in the last one or two semesters.

Curriculum contents
Generalized medical curriculum in the Czech Republic

PRE-CLINICAL SCIENCES
YEAR 1: Chemistry; Biophysics; Biology; Anatomy; Histology and Embryology; First Aid; Latin

EXAMINATIONS
YEAR 2: Biochemistry; Anatomy; Histology and Embryology; Psychology; Microbiology

EXAMINATIONS (Practical experience during summer vacation in hospital 1-3 weeks)

CLINICAL SCIENCES
YEAR 3 : Microbiology; Pathology; Patho-physiology; Pharmacology; Internal Propaedeutics; Internal Medicine; Patien Care; Medical Psychology; Social Medicine and Ethics; Surgery; Electives

EXAMINATIONS (Practical experience during summer vacation in hospital 1-3 weeks)

YEAR 4: Pharmacology; Internal Medicine; Radiology and Nuclear Medicine; Clinical Oncology; Neurology; Psychiatry; Paediatrics; Dermatology/Venereology; Dental Medicine; Surgery; Immunology; Electives EXAMINATIONS Summer Practical Training: 2 weeks Surgery; 2 weeks Internal Medicine or Paedriatics

YEAR 5 : Internal Medicine; Infectious Diseases; Paediatrics; Gynaecology/Obstetrics; Ophthalmology; Otorhinolaryngology; Forensic Medicine; Epidemiology; Social Medicine and Ethics; Urology; Orthopaedic Surgery; Neurosurgery; Anaesthesiology/Resuscitation; Electives

EXAMINATIONS Summer Practical Training: 2 weeks Gynaecology/Obstetrics

CLINICAL TRAINING
YEAR 6

FULL TIME CLERKSHIPS 10 weeks Internal Medicine 4 weeks Gynaecology/Obstetrics 8 weeks Surgery 6 weeks Epidemiology, Social Medicine etc.

FINAL STATE (COMMISSIONAL) EXAMINATIONS: Internal Medicine; Surgery; Gynaecology/Obstetrics; Epidemiology; Social Medicine; Medical Law

Evaluation of students
Each course is concluded by some kind of assessment. For the main courses assessment takes the form of an examination before a board of examiners, while other courses are concluded by less formal examinations or assessments. In the third cycle fundamental courses and clerkships are concluded with qualifying state examinations.

Number of schools, number of graduates
Denmark has 3 medical schools:

• Aarhus
• Copenhagen
• Odense

Administration
Medicine is studied at the Faculties of Medicine or Health Sciences which are part of universities.

After undergraduate medical education of 6.5 years, 1.5 years of pre-registration and another 3.5 years of mandatory post-graduate training are necessary to qualify as general practitioner.

Specialist training takes 36-60 months after the period of preregistration of 18 months which is obliged after graduation.

National goals for undergraduate medical education
The official guidelines for the programme are laid down in the Ministerial Order regarding the Medical Education Programme. According to the Ministrial Order, the objective of the programme is: on a scientific basis, to impart to students those prerequisites in natural, behavioural and social science disciplines, and also paraclinical and clinical disciplines, which are necessary to be able, after graduation from medical school, to perform the duties of subordinate physician satisfactorily with regard to knowledge, capability and attitude, including matters pertaining to medical ethics. Moreover, the programme is to give students a mutual basis for continued training after graduation, regardless of which area of medical profession, including medical research, students come to engage in.

Curriculum structure
Medical study in Denmark takes six years of which the first 3 years are pre-clinical and the last 3.5 years treat predominantly clinical subjects.

The main elements of the education shall have a balance of:

25% basic natural sciences 10% social and behavioural sciences 40% clinical subjects 15% optional elements

Clinical clerkships (defined as full time clinical work) should amount at least 44 weeks. Actually they do: 45 - 53 weeks.

Upon graduation, the graduate is awarded the title of medical doctor. After completing an additional 18 months of compulsory post-graduate service (internship with 6 months general surgery, 6 months internal medicine and 6 months general practice) the physician is conferred the unlimited license to practise medicine by the Danish National Board of Health. The national Steering Committee (external quality assessment) advised in 1996 to reduce the extent (both with regard to contents) of the natural sciences to as maximum of 25 % of the study. Basic sciences should be more integrated in courses of clinical sciences. Theory and practice of clinical sciences should be more integrated.

An in depth training is recommended, for example in the form of a research elective of 3 to 6 months.

Teaching and learning methods
Classroom teaching/group lessons: resembles ordinary school teaching in classes of approximately 25 students. It is a variation of discussions and examination as well as practical exercises and exposition of the subject.

Lectures: for 50 students or more: purpose is to give the students inspiration and an appetite for the subject and to facilitate their studies at home.

Teaching by bedside and in General Practice: the starting point is the patient. A doctor trains the student in solving problems by combining theoretical knowledge from different subjects; Coincidentally the student is introduced to a number of practical aspects of the work as a doctor: keeping of medical records, clinical examinations, the initiation of examination programmes, etc.

Clinic: a student writes a medical record on a patient and presents the patient to the rest of the class and the patient's doctor.

Internship: full-time (37 hours a week) of clinical work. The National Steering Committee recomments more student-oriented instruction and suggests Problem-Based-Learning elements.

Curriculum contents
Generalized Medical Curriculum Denmark

PRE-CLINICAL SCIENCES
YEAR 1: Semesters 1 and 2: First Aid; Physics (practical); Chemistry (inorganic and organic); Anatomy; Introduction to Medicine (Propaedeutics)
YEAR 2:
Semester 3: Biochemistry and Molecular Biology; Cell Biology (Biochemistry)
Semester 4: Anatomy, Histology and Embryology; Physiology; Clinical Propaedeutic and Social Medicine
YEAR 3
Semester 5 : Neuroanatomy and Neurophysiology; Genetics; Clinical Propaedeutics
Semester 6 : Microbiology and Immunology (general); Chemistry (clinical) and Pharmacology

CLINICAL SCIENCES
YEAR 3
Semester 6 continued: General Practice (theory) Clinical Clerkships of 1 month in: - Medicine , Surgery , General Practice
YEAR 4
Semester 7 : Medical Psychology and Psychiatry; Epidemiology and Medical Statistics; Pharmacology, Toxicology and Nutrition; Microbiology
Semester 8 : Pathology (anatomical and physiological); Dermatology/Venereology, Sexuology, Paediatrics and Gynecology/Obstetrics; Public Health, Environmental Medicuine and Radiology

CLINICAL TRAINING  Note:  see also Clinical Clerkships in Semester 6 
YEAR 5
Semester 9: HOSPITAL CLERKSHIPS (TRAINING 7 HOURS PER DAY) Gynaecology/Obstetrics, Paediatrics, Neurology, Psychiatry, Dermatology/Venereology, Clinical Chemistry and Clinical Physiology
Semester 10: MEDICAL TRAINING: Neurology, Cardiology, Pulmonology, Hepatology, Gastereenterology, Endocrinology, Haematology, Rheumatology, Allergology, Infectious Diseases and Tropical Medicine
SURGICAL TRAINING: Thorax, Vascular, Abdominal and Plastic Surgery, Orthopaedics and Urology
COURSES: Pathology, Paediatrics, General Practice, Ophthalmology and Forensic Medicine YEAR 6
Semester 11: COURSES: Gynaecology/Obstetrics, Otorhinolaryngology, Anaesthesiology and Psychiatry
Semester 12 : CLINICAL RESIDENCIES (INTERNS):

• Surgery: 6 weeks
• Internal Medicine: 6 weeks
• Oncology: 20 hours
• Clinical Electives: 7 weeks

YEAR 7
Semester 13: 10 INTENSIVE CORSES OF ONE WEEK (20 H) IN: Internal Medicine; Surgery; General Practice; Anaesthesiology; Pathology; Psychiatry
EXAMINATIONS/EVALUATIONS: Usually when a subject has been covered

Evaluation of students
There are both oral and written examinations.

National Steering Committee (1996): During the course of the programme, students are tested by means of a long series of examinations, primarily in individual subjects. The number of examinations which are graded by external examiners. The examination system must satisfy several interests. It is necessary that students secure factual knowledge in a number of subjects, while at the same time, students must also learn to utilize this knowledge in a reflective and integrated manner. Instruction, as well as examinations - including the weighting among differing modes of examination - should reflect these various interests.

In clinical education actual evaluation of individual students should be introduced in connection with each clinical study period. This should be accomplished by means of counsellors evaluating their students in terms of the objectives/subject descriptions which are to exist for the clinical study period.

Future Perspectives
In reaction to the recommendations of the Neational Steering Committee all three faculties of medicine are restructuring their curricula. All do so in a different way, but all aim at more student-directed education.

Ants Peetsalu, Dean of the Faculty of Medicine,
Enn Seppet, Vice-Dean of the Faculty of Medicine
University of Tartu, Estonia, Tartu- 1998

Number of schools, number of graduates
Estonia with a population of 1.5 Million has a single Faculty of Medicine, one of the ten Faculties of the University of Tartu. The University of Tartu was founded in 1632 by King Gustavus II Adolphus II, and since then the history of the Faculty of Medicine starts as well. Forced to close by the Great North War in the beginning of 18th century, the University was re-opened in 1802 as the Kaiserliche Universität zu Dorpat by Czar Alexander I. In the independent Estonia, the university was re-opened on December 1st, 1919, as the University of Tartu, and till 1936 it was the only University in Estonia.

During Soviet occupation times from 1939-1941 and 1945-1991 the education and research were tightly connected with political ideology. However, the University still exerted dominating impact on development of Estonian culture.

After Estonia regained its independence in 1991, the University of Tartu started to revive and to re-establish the western curricula and degree systems.

Structure of the Faculty of Medicine
Faculty of Medicine includes four Departments: Medicine, Pharmacy, Stomatology and Nursing. The youngest of them is Department of Nursing where the teaching started in 1991.

Numbers of graduates
Since 1995, the total number of graduates has been decreasing from 250 to 198 in 1997. This has been mostly due to decreased number of MD-s: from 171 in 1995 to 130 in 1997. At the same time, the changes in numbers of graduates from Departments of Stomatology, Pharmacy and Nursing Particularly have been from 42 to 39, from 20 to 17, and from 17 to 12, respectively.

In recent years, the number of MDs that Estonia needs, has been a matter of active discussion. From the Faculty´s standpoint, it seems appropriate to increase the number of graduates during next years, in order to guarantee 26 MDs per 10 000 inhabitants in the beginning of next millennium. Also, it is important to increase the number of nurses with Bachelor and Master of Sciences degrees, to prepare the qualified teachers for Estonian Schools of Nursing and for Department of Nursing in the Faculty of Medicine.

Administration
University of Tartu is an independent and autonomous institution acting according to Estonian constitution and law of the University of Tartu. In its academic activities, the University is guided by the principles of Magna Charta of European universities. The University is governed by the Ministry of Education in a sense that the Ministry evaluates and corroborates the curricula, sets the requirements for the number of graduates and provides the funds for teaching and research. The distribution of funds between the different departments in the Faculty is a responsibility of the Faculty´s Dean. Postgraduate medical training (internship and residentship) is regulated and funded by both the Ministry of Education and the Ministry of Social Affairs. However, the scientific postgraduate studies (M. Sci and Dr. Sci.) are funded by the Ministry of Education. In addition, the Estonian Science Foundation provides grants for research on the basis of evaluation of the projects applied for. The Faculty consists of the preclinical institutes and clinical departments (clinics). The latter form the University Clinicum, governed by the council which includes the representatives from the University, Tartu City government and Ministry of Social Affairs. The funds for medical treatment in the University Clinicum are provided by the Estonian Health Insurance Company. However, the teaching in the Clinicum is governed by the Dean and Council of the Faculty.

With the exception of a small but increasing number of foreign students (presently 92 students in undergraduate study groups), tuition fees are not charged for higher education, and students are eligible for state-subsidized loans.

The Faculty carries a responsibility for the quality of the curriculum and teaching staff, but also for scope regarding teaching hours and the examination procedures. Within this framework academic teachers are free to teach whatever they deem appropriate according to scientific standards.

Professional education
In the University of Tartu, the duration of medical undergraduate studies is six years and the basic degree received in medicine is equivalent to a North American MD. In order to qualify as a Licenced Physician, the students have to continue the studies in Internship in Medicine for one year. Thereafter, 2-5 more study-years are needed to receive the Specialized Physician degree (Residency).

In Stomatology, the basic education lasts for 5 years (MD in Stomatology), followed by 1 year internship (Licenced Stomatologist) and 2-5 years residency (Specialized Physician in Stomatology).

In Pharmacy , the basic education lasts also for 5 years (Bachelor of Science in Pharmacy), followed by 5 months internship (Licenced Pharmacist).

In Nursing, the basic education consists of three years Diploma studies (Registered Nurse) and 1 year Bachelor studies.

Scientific postgraduate education
Scientific postgraduate education includes the Masters of Sciences program in Biomedicine (2 years) and in Nursing (2 years), and Doctors of Sciences programs (4 years) in Departments of Medicine, Stomatology and Pharmacy.

In 1997, the new reformed curricula were implemented in all Departments. The goal of the reforms was to meet the requirements of EC directives, as well as other guidelines set by the competent international commissions and advisory boards. One of the features of the new medical curriculum is that it contains sufficient practical training so that students may enter the specialist training (lasting for 2-6 years) immediately after basic six-year studies.

National goals for undergraduate medical education
Undergraduate medical education is aimed at scientific and practical training for the medical profession, development of medical sciences and formation of scientific offspring.

Admission of students
The Estonian Matriculation Examination taken at the end of the high schools (gymnasiums) provides general eligibility for University education. The students are selected on the basis of their marks received in Matriculation Examination. The Department of Nursing accepts the students who have completed a three year Diploma program in Nursing at the University of Tartu.

Language of instructions in Estonia
The basic language is Estonian. However, teaching in English and Russian is available for the first two years only in the Department of Medicine.

Curriculum structure
The new curriculum of Medicine (enclosed below) has the following features:

1. The total volume of the curriculum is 240 credit points. One credit point is equivalent to 1 week of studies which comprises 23 hours of classes and 17 hours of self-work.
2. The curriculum comprises the core part that is obligatory for any student (about 80% of the total volume), electives and free subjects. The last two categories together comprise about 20% of the curriculum. The electives are considered to be chosen from the medical subjects that are related to some of the core subjects. Thus, the electives afford an opportunity to study certain subjects more deeply, or complete the studies with experimental work in a given field. Free subject is considered to be taken from any Faculty and any University, and may not be related to medicine.
3. The curriculum consists of the subject blocks, which end with the common exam. Such a block-structure should improve the interaction between different but related disciplines, avoid overlapping of the subjects programs, and implement the elements of problem-based learning.
4. The curriculum offers an early contact of students with the patients, within the real clinical situation; in frames of the blocks such as the First aid, Nursing and Ethics in Year I, and Family Medicine I (that is included in the Public Health II block).
5. Several subjects are studied throughout the curriculum. For example, the Public Health block is taught in Year I, II, III, and IV. So this subject can be reasonably fitted to increased clinical knowledge and experience in the later phases of the studies.
6. Several preclinical subjects are continously studied in parallel with the clinical subjects in later years, e.g. Clinical Pharmacology.
7. The curriculum includes the extended periods of practical training. This allows to obtain the medical experience enough for continuing studies in the residentship, which follows the 6-years undergraduate curriculum.

It should be mentioned that the other curricula (Stomatology, Pharmacy and Nursing) are composed on the same principles as the Medical curriculum, as they also contain a core part, electives and free subjects. In fact, the first-year program for stomatology students exactly follows the program for medical students. This allows more economical use of funds for teaching.

The implementation of the Medical curriculum and other curricula is planned to occur stepwise, so that in 1997/1998 the first - year students will take courses according to the new curriculum, whereas others learn according to the former one. The curriculum and the study programs are the objects for regular revisions carried out by the curriculum development committee which includes not only the teaching staff members but also the students (one representative from each department).

Structure and content of the MD curriculum
YEAR ICredits Form of control
Core Curriculum 33
Anatomy and histology 10.5 Credit test

• Anatomy 7.5
• Histology 3

Medical Biology I 8 Exam

• Biology 6
• General histology and human
• embryology 2

Medical Biology II 8 Exam

• Medical chemistry 3
• Medical biochemistry 2
• Biophysics 3

Public Health I 3 Credit test

• Epidemiology and biostatistics

First aid, nursing & ethics 2 Credit test
Latin language 1.5 Credit test
*Electives 6 Credit test
Free subject 1 Credit test

YEAR II
Core curriculum 31
Medical Biochemistry 7 Exam"
Physiology 8 Exam
Immunology 2 Credit test
Medical microbiology 6 Exam
Anatomy and histology 3 Exam
Public health II 5 Exam

• Health promotion 5
• Medical sociology 1
• Family medicine I 1

*Electives 8 Credit test
Free subject 1 Credit test

YEAR III
Core curriculum 32
Pathology 11 Exam

• Pathological anatomy 5.5
• Pathological physiology 5.5

Farmacology and toxicology 6 ExamFundamentals of diagnostics 12 Exam

• Propedeutics of internal medicine 3
• Propedeutics of surgery 4
  - anesthesiology 1
  - traumatology 1
  - general surgery 2
• Laboratory medicine 1
• Radiology and clinical anatomy 3
• Sport medicine and rehabilitation I 1

Public health III 3 Exam

• Environmental and occupational med.

*Electives 7 Credit test
Free subject 1 Credit test

YEAR IV
Core curriculum 33
Internal medicine 17 Exam

• Cardiology 3.5
• Pulmonology 2.5
• Gastroenterology 2.5
• Rheumathology 2
• Endocrinology 1.5
• Nephrology 1
• Hematology 1.5
• Laboratory medicine 0.5
• Infectious diseases 2

Oncology and radiotherapy 2.5 Credit test
Anesthesiology and intensive care 1 Credit test
Surgery 8.5 Exam

• General and abdominal surgery 2
• Thorax and blood vessel surgery 2
• Urology 1
• Pediatric surgery 1.5
• Traumatology and orthopedics 2

*Electives 6 Credit test
Practical training 4 Credit test

• Surgery 2
• Internal medicine 2

Free subject 1 Credit test

YEAR V
Core curriculum 34
Public health IV 4 Exam

• Health care management 2
• Health economics 2

Obstetrics and gynaecology 6 Exam
Pediatrics 6 Exam
Neurology 5 Exam
Psychiatry 7 Exam
Ophthalmology 2 Exam
Medical genetics 2 Exam
*Electives 5 Credit test
Free subject 1 Credit test

YEAR VI
Core curriculum 35
Family medicine II 4 Credit test

• Family medicine 2
• Policlinic 2

Dermatology 4 Exam
Sport medicine and rehabilitation 2 Credit test
Forensic medicine 2 Credit test
Clinical pharmacology 2 Credit test
Otorhinolaryngology 3 Exam
Practical training 18 Credit test

• Internal medicine 6
• Surgery 4
• Family medicine and policlinic 3
• Pediatrics 3
• Obstetrics and gynecology 2

* Electives 3 Credit test
MD Exam 2

• Theoretical knowledges
• Practical skills

Teaching and learning methods
The teaching in the Faculty is still predominantly carried out by means of traditional lectures and small group teaching (laboratory works, seminar works and clinical works). Attending lectures is optional, whereas participation in other modes of teaching is compulsory and is monitored rather strictly. However, the Faculty is moving away from the traditional lecturing system towards more discussion-oriented teaching in small groups. The new curriculum is structured in a way which should stimulate interaction between different disciplines and also to encourage teachers to implement the problem-centered learning/teaching methods.

During recent years, a computer-based teaching is getting popular both among the teachers and students. The students have access to www and local networks. There are several computer classes at their disposal, and the number of such classes is steadily increasing.

Training settings
During undergraduate studies, training of medical students is mainly based on tertiary hospitals located in Tartu. Internship and residentship is accomplished in the tertiary hospitals in Tartu and Tallinn.

Evaluation of students
The teachers are free in selecting the modes of assessing the students learning. Written examinations, often in a combination of multiple-choice, true-or-false, and short essays, are the most frequently employed modes; however, the oral examinations are also in use in some departments. Care is taken to evaluate the students knowledge throughout the semester that forces them to work in a regular basis. In clinical departments the practical skills of the students are also evaluated at actual patient contacts. Students can move to the next phase of the curriculum only if the preceding phase has been finished completely. The sixth year ends with a complex exam consisting of testing the thoretical knowledge and of assessment of the practical skills.

Evaluation of teachers
Two years ago, the Faculty has launched the system of students writing an informal and anonymous critique and suggestions on the teaching course and on the teachers performance. These evaluations are coordinated by students, but the results are passed to the Faculty administration, in order to identify the problem areas.

Future Perspectives
Since Estonia became a candidate for membership in EU, the Faculty of Medicine is complying the curriculae with EC regulations. In parallel, the legislation will be appropriately suited at the levels of Faculty, University and Estonian government. By September 2000, a modern building for preclinical Departments will be erected. This allows significant improvement of the levels of research and teaching of medicine in Estonia.

Number of schools, number of graduates
Medical degree programmes are offered at five major universities:

• Helsinki
• Kuopio
• Oulu
• Tampere
• Turku

Administration
In Finland, the National Board of Medicolegal Affairs is responsible for awarding legal status for doctors and for overseeing the medical profession. After taking the first medical degree, a doctor can apply for restricted legal recognition from the National Board of Medicolegal Affairs. This entitles the young medical graduate to take certain posts in hospitals and health centres undet supervision and guidance. After the graduate doctors have worked for two years under supervision in health centres and hospitals the National Board of Medicologeal Affairs will grant full recognition, which is the prerequisite for working as a private practitioner and for applying for medical posts and duties in Finland.

After undergraduate education two years of mandatory post-graduate training and a period of 4 or 6 years of voluntary post-graduate training preceed qualification as general practioner.

Specialization takes 4 years after mandatory post-graduate training.

National goals for undergraduate medical education
The aim of studies leading to the basic degree of Licentiate in Medicine is to prepare the students to work as a physician as well as to take postgraduate studies. The degree also provides training for research work and the administrative duties requiring medical expertise.

Curriculum contents
Generalized Medical Curriculum Finland
[example Tempere]

PRE-CLINICAL SCIENCES
YEAR 1 to 3-5: Integrated blocks which comprise basic, clinical, behavioural and social studies) All bocks are accompanied by development of clinical skills. Other items to be developed.

CLINICAL SCIENCES
YEAR 3.5 to 5.5: Clinical courses All courses are accompanied by development of clinical skills

CLINICAL TRAINING
YEAR 5.5 to 6: Practical training period The blocks and courses developed are:

1. Introduction
2. The cell
3. Oxygen supply
4. Reproduction, Growth and Development
5. Locomotion
6. Fundamentals of research
7. Nutrition
8. Hormonal regulation
9. Man as Individual
10. External and internal Messages
11. Attack and Defence
12. Ageing
13. Prevention
14. Elective
15. Fluid and Electrolytic
16. Therapy
17. Infection
18. Chest Pain and Shortness of Breath
19. Stroke
20. Methods of Clinical Examination
21. Elective
22. Abdominal Pain
23. Fatigue
24. Arthralgia
25. Emergency Situations

Evaluation of students
In the framework of the Problem-Based-Learning education type Tampere and Oulu introduce the progress test.

Future Perspectives
Undergraduate medical education is in full movement in Finland. Curricula are restructured and aim at Problem-based and Student-centred Learning.

Number of schools, number of graduates
France has 47 Medical Schools:
Amiens: Université de Picardie Jules Verne Faculté de Médecine
Angers: Université d'Anger, Faculté de Médecine
Besançon: Université de Franche-Comté Faculté de Médecine et de Pharmacie
Bordeaux: Université Victor Segalen Bordeaux II - Faculté de Médecine Paul Boca
Bordeaux: Université Victor Segalen Bordeaux II - Faculté de Médecine Hyacinthe Vincent
Bordeaux: Université Victor Segalen Bordeaux II - Faculté de Médecine Victor Pachon
Brest: Université de Bretagne occidentale - Faculté de Médecine
Caen : Université de Caen - Faculté mixte de Médecine et de Pharmacie
Clermont-Ferrand: Université d'Auvergne Clermont-Ferrant I - Faculté deMédecine
Dijon: Université de Bourgogne - Faculté de Médecine
Grenoble: Université Grenoble I Joseph Fourier - UFR de Médecine et de Pharmacie
Lille: Université de Lille II Droit et Santé - Faculté de Médecine Henri Warembourg
Lille: Institut Catholique de Lille - Faculté de Médecine
Limoges: Université de Limoges - Faculté de Médecine
Lyon: Université Claude Bernard Lyon I - UFR-Faculté de Médecine Grange Blanche
Lyon: Université Claude Bernard Lyon I - UFR-Faculté de Médecine RTH Laënnec
Lyon: Université Claude Bernard Lyon I - UFR-Faculté de Médecine Lyon Nord
Lyon: Université Claude Bernard Lyon I - UFR-Faculté de Médecine Lyon Sud
Lyon: Université Claude Bernard Lyon I - Département
Marseille: Université de la Méditerranée - Faculté de Médecine
Montpellier: Université de Montpellier I - Faculté de Médecine
Montpellier : Université de Montpellier I - Faculté de Médecine - Annexe de Nîmes
Nancy: Université Nancy I Henri Poincaré - Faculté de Médecine
Nantes: Université de Nantes - Faculté de Médecine
Nice: Université de Nice-Sophia-Antipolis - Faculté de Médecine
Paris: Paris V René Descartes - Faculté de Médecine Cochin-Port Royal
Paris: Paris V René Descartes - Faculté de Médecine Necker-Enfants malades
Paris: Paris V René Descartes - Faculté de Médecine Paris Ouest
Paris: Paris V René Descartes - UFR Biomédicale des Saints Pères
Paris: Paris VI Pierre et Marie Curie - Faculté de Médecine Broussais-Hôtel Dieu
Paris: Paris VI Pierre et Marie Curie - Faculté de Médecine Pitié-Salpêtrière
Paris: Paris VI Pierre et Marie Curie - Faculté de Médecine Saint Antoine
Paris: Paris VII Denis Diderot - Faculté de Médecine Xavier Bichat-Beaujon
Paris: Paris VII Denis Diderot - Faculté de Médecine Lariboisière-Saint Louis
Paris: Paris XI Paris Sud - Faculté de Médecine Paris Sud-UFR Kremlin-Bicêtre
Paris: Paris XII Van de Marne - Faculté de Médecine
Paris: Paris XIII Paris Nord - UFR Santé, Médecine et Biologie Humaine Léonard de Vinci
Poitiers: Université de Poitiers - Faculté de Médecine et de Pharmacie
Reims: Université Champagne-Ardenne - Faculté de Médecine
Rennes: Université de Rennes I - Faculté de Médecine
Rouen: Université de Rouen - Faculté de Médecine et de Pharmacie
Saint-Etienne: Université Jean Monnet - Faculté de Médecine Jacques Lisfanc
Strasbourg: Université Louis Pateur Strasbourg I - Faculté de Médecine
Toulouse: Université Paul Sabatier Toulouse III - Faculté de Médecine Toulouse Purpan
Toulouse: Université Paul Sabatier Toulouse III - Faculté de Médecine Toulouse Rangueil
Tours: Université François Rabelais - Faculté de Médecine
Guadeloupe: Université Antilles-Guyane - Faculté de Médecine de 3e cycle

Administration
After undergraduate education another two years of mandatory post-graduate training are necessary to qualify as general practitioner. Specialist training (third cycle) takes 4-5 years after graduation.

National goals for undergraduate medical education
Besides the theoretical education aimed at the acquisition of integrated knowledge the student has to do practical work in the hospital settings. In the 2nd year of the first cycle and the 1st year of the 2nd cycle the student has to develop relations with the patients, learn to pose the right questions, develop medical examination and making a written and oral synthesis of the information collected. He also has to get insight into the Hospital hygiene. During the last 3 years of the 2nd cycle the student has to acquire a competence in clinics, diagnostics and therapeutics; insight into clinical methods; indication of professional work; reflection on diagnostical and therapeutical risks; insight into prevention, economy of health care and ethical questions. The education shall take place in direct contact with patients, their family and collegues in the hospital settings.

Admission of students
At the beginning of the first year students are admitted having passed the bacalauréat. The numerus clauses is at the end of the first year. Students are selected by the concours.

Curriculum structure
Undergraduate medical education comprises the first two cycles in university education. The third cycle contains the specializations, including general practice.

The first cycle lasts two years and is devoted to basic sciences, human and social sciences, semeiology, foreign languages and the intitation at hospital functions. At the end of the first year students have to classify for continuation of the studies (concours). The second cyle lasts four years: The first year of the second cycle initiates students to the hospital setting. It includes: general bioclinical sciences to complete the training begun in the first cycle; initiation to medical-surgical pathology and practical semeiology; elementary concepts for emergency and intensive care. The second to fouth year of the second cycle prepares the student in clinical subjects. The studies include: - Integrated hospital training; - Acquiring basic knowledge of pathology; - Obligatory supplemental training.

Integrated hospital training is structured in modules and consist of theory, practice and clinical training (in morning hours) Acquiring basic knowledge of pathology either by lectures or by self study. Obligatory supplemental training: with choices of: - general practice: 100 hours per year: public health; consultation and nutrition; family medicine; medicine and law; medications; traumatology for general practitioners and family practice in the sixth year - research training: based on 100 hours per year following one of the Certificates for a Master's Degree in biological and medical sciences - internship preparation (5th and 6th year students): based on obligatory attendance at teaching conferences and internship preparation modules in the medical disciplines.

Curriculum contents
Generalized Medical Curriculum France

Pre-clinical SCIENCES
YEAR 1
Mathematics, Statistics; Physics, Biophysics; Chemistry, Biochemistry; Biology (Cytology, Microbiology); Anatomy, Embryology and Histology; Physiology (general) Initiation to nursing-care
EXAMINATIONS

YEAR 2
Biophysics; Biochemistry; Anatomy and Histology; Embryology; Physiology (special); Symptomatology (Semeiology)
EXAMINATIONS CLINICAL SCIENCES

Note: the two "certificates" (c) from the third year can be taken ahead of time)

YEAR 3
Biochemistry and Pharmacology; Pathology (general); Radiology (general); Microbiology. Parasitology and Virology; Infectious and Parasitic Diseases (c); Symptomatology (Semeiology); Locomotory System Diseases and Rheumatology (c)
EXAMINATIONS

Note: the two "certificates" (c) from the fourth year can be taken ahead of time)

YEAR 4
Haematology, Immunology and Cancerology (c); Cardiology and Angiology (c); Pulmonology (c); Nephrology and Urology (c); Dermatology, Venereology and Allergology (c)
EXAMINATIONS

Note: the two "certificates" (c) from the fifth year can be taken ahead of time)

YEAR 5
Gastroenterology (c); Endocrinology and Metabolic Diseases (c); Neurology and Psychiatry (c); Otorhinolaryngology, Stonatology and Ophthalmology (c); Forensic Medicine, Social Medicine and Deontology (c)
EXAMINATIONS

Note: the two "certificates" (c) from the sixth year can be taken ahead of time)

YEAR 6
Gynaecology and Obstetrics (c); Paediatrics (c)

CLINICAL TRAINING
SIX FULL TIME HOSPITAL CLERKSHIPS of 4 months each are required during the 5th and 6th year in the following disciplines, regardless of the sequence:

• two in Internal Medicine and Gynaecology/Obstetrics 
• two in Surgery (including Neurosurgery) and Neurology or Paediatrics 
• two in Otorhinolaryngology or Geriatry, Ophthalmology, Anaesthesiology, Orthopaedics, Psychiatry etc. (The students are paid for their work at the hospital)

FINAL EAMINATIONS

Evaluation of students
The main selection (numerus clausus) is at the "concours at the end of the first year.

In the first three years examinations take place either at the end of the year.

Integrated university hospital training: - Evaluation of the clinical experience performance as reported on the students record by the head of service for the particular hospital department; - Written tests and evaluations consist of two parts: - clinical competence in practice: - validation of the teaching observations done during the morning clinical work at the rate of one observation per month; - testing in the clinical setting with follow-up discussion on diagnosis and principle care protocols is done at the end of the trimester by an Examining Board; - the grade given to the student includes the student's behavior towards patients and how information is gathered, presentation of observations and responses to the examiners - Clinical theory written examinations

D. Bingmann, Institute of Physiology, Medical Faculty, University-GH Essen

Germany has 36 Medical Faculties which most often are part of Universities:

General Aspects
According to the Constitution the control of the health services in the Federal Republic of Germany is the task of state institutions. Highest authority is the government, represented by the Minister of Adolescents, Family, Women and Health (Minister für Jugend, Familie, Frauen und Gesundheit), which is assisted by the federal state governments, represented by the respective health ministers, which supervises the training in different medical and paramedical specialities. The course of medical studies is laid down in Regulations (Approbationsordnung (AO) for physicians).

In the 'Approbationsordnung' is laid down:

• that a minimum of six years of studies is compulsory. A minimum of 2 years of preclinical studies and a minimum of 4 years of clinical studies and training at a university institution is necessary.
• that after having finished the studies an education period of at least 18 months as 'Arzt/Ärztin im Praktikum' (AiP) at an accredited hospital has to be completed.

Having met the two requirements above, or after having achieved equivalent, recognised results outside of the FRG any possible applicant of medicine from any of the EC Member States - if he/she has a good command of German, and is physically as well as mentally in good health and is not a drug addict - may apply for registration (Approbation). The Minister of Health of the respective Federal State reviews the applications on behalf of the Federal Ministry for Health (Bundesgesundheitsministerium). Registration is issued when the Minister of Health considers the entitlement to be valid.

Structure of Medical Studies
According to the Regulations for Registration (Approbationsordnung) the medical studies and training at the university is subdivided into:

• a preclinical part of a minimum of 2 years of studies (4 half-year periods = semesters) and
• a clinical part of a minimum of 4 years of studies (8 half-year periods = semesters)

Preclinical Part
The preclinical part comprises the following compulsory courses:

1. Practical Exercise of Physics
2. Practical Exercise of Chemistry
3. Practical Exercise of Biology
4. Practical Exercise of Physiology
   Seminar: Physiology
5. Course of Biochemistry
   Seminar: Biochemistry
6. Course of Macroscopic Anatomy
   Seminar: Anatomy
7. Course of Microscopic Anatomy
   Seminar: Anatomy
8. Course of Medical Psychology
9. Course of Medical Sociology
10. Practical Exercise of Medical Terminology
11. Introductory Course for Clinical Medicine
12. First Aid Course
13. Work as attendant in a hospital (2 months)
14. First contacts with the various medical professions (Berufsfelderkundung)

In addition to these courses systematic and supplementary lectures are held which are not compulsory.

The student can enter for the preclinical examination (Ärztliche Vorprüfung) at the respective examining board of the Federal State (Landesprüfungsamt) when he/she has regularly attended and successfully completed all compulsory courses, has studied medicine for 4 semesters according to the regulations.

Preclinical examination (Ärztliche Vorprüfung, 'Physikum')
The preclinical examination is divided into a written (multiple choice questions) and an oral part. The written test comprises all preclinical subjects, the oral part examines the field of anatomy, biochemistry, physiology, medical psychology and medical sociology. The written and oral parts must both be passed in order for a student to pass the preclinical examination.

Clinical Part
The clinical part takes at least 4 years (8 semesters) and is subdivided into:

• a clinical-theoretical part (duration: 1 year = 2 semesters),
• a clinical-practical part (duration: 2 years = 4 semesters) and
• a clinical Practical Year (Praktisches Jahr (PJ)) lasting 1 year.

Clinical-theoretical part
The clinical-theoretical part comprises the following compulsory courses:

1. Course of General Pathology
2. Course of General Pharmacology and Toxicology
3. Courses of General Clinical Examination in non-operative and operative disciplines
4. Course of Radiology / Protection from Radiation
5. Practical Exercises of Microbiology and Immunology
6. Practical Exercises of Clinical Chemistry and Haemotology
7. Practical Training for Acute Emergencies and First Aid
8. Exercises of Biomathematics

In addition to these courses systematic and supplementary lectures are given.

First part of Medical Examination
If the student has regularly attended all compulsory courses of the clinical-theoretical part, completed them with success and has studied clinical medicine for two semesters, he/she can enter for the first part of medical examinations (Erster Abschnitt der Ärztlichen Prüfung) at the examining board of the Federal State. The student has to take a written examination (Multiple choice test). All subject areas of the clinical-theoretical part are included in this examination. In addition, an oral examination has to be passed.

Clinical-practical part
The clinical-practical part comprises the following compulsory courses:

1. Course of Special Pathology
2. Course of Special Pharmacology
3. Practical Exercises of Internal Medicine plus Lectures:Intern. Medicine I and II
4. Practical of Paediatrics with the Lecture Paediatrics
5. Practical of Dermatology and Venereology
6. Practical of Urology
7. Practical of Surgery plus Lectures Surgery I and II
8. Practical of Gynaecology and Obstetrics
9. Practical of Orthopaedics
10. Practical of Ophthalmology
11. Practical of Oto-Rhino-Laryngology
12. Practical of Neurology
13. Practical of Psychiatry
14. Practical of Psychosomatic Medicine and Psychotherapy
15. Course of Ecology (Hygienics, Forensic Med., Social Med., Statistics)
16. Introductory Course to Problems of General Medicine
17. Practical Exercises of Medicine in an Emergency

Additionally, supplementary lectures will be offered that are not compulsory.

Second part of Medical Examination
The student can enter for the second part of the medical examination (Zweiter Abschnitt der Ärztlichen Prüfung) at the examining board of the Federal State after having attended regularly all compulsory clinical courses mentioned above and after having completed them successfully, after having passed the first part of the clinical examinations, after having done an elective period in an accredited medical institution for 4 months, and after having studied clinical medicine for 6 semesters. The examination consists of a written (Multiple choice test) and an oral part. When the student of medicine has passed the first and second part of the medical examination, he/she is entitled to do the Practical Year (Praktisches Jahr (PJ)), i.e. to continue the training in a hospital.

Practical Year ('PJ')
The Practical Year (Praktisches Jahr) is divided into 3 parts:

• four months of work on a surgical ward
• four months of work on a ward of internal medicine
• four months of work on a ward of a special area chosen by the candidate

Third part of Medical Examination
After the Practical Year, the student is entitled to enter for the third part of medical examination (Dritter Abschnitt der Ärztlichen Prüfung). This is an oral examination (surgery, internal medicine, speciality chosen).

If the student has passed all parts of clinical examinations, he/she has completed medical studies at university and is allowed to work as Arzt/Ärztin im Praktikum (AiP). If a medical doctorate is intended, the ECTS-student has to consult the Departmental Co-ordinator for further information.

Example of a Regular Course of Medical Studies (University-GH Essen)
cf. Internet-addresses: http://www.uni-essen.de/ects/ (Info-package Essen)
http://stunt1.meb.uni-bonn.de/sokrates (list of equivalence)

Preclinical Part

1st Preclinical Semester (Winter Semester)

Lectures: (Weekly semester hours in brackets)

Chemistry (4)
Physics (4)
Biology (5)
Professional orientation (1)
Supplementary lecture for the Course for Microscopic Anatomy I
- (First half of semester; 3)
Supplementary lecture for the Course for Macroscopic Anatomy I
- (Second half of semester; 5)

Practicals and Seminars:

Course for Medical Terminology (1)
Practical in Chemistry (4)
Practical for Physics (4)
Course for Microscopic Anatomy
Course for Macroscopic Anatomy

2nd Preclinical Semester (Summer Semester)

Lectures:

Physiology I (4)
Supplementary lecture for the Course Microscopic Anatomy II (2)
Supplementary lecture for the Seminar Anatomy I (2.5)
Embryology (1)
Biochemistry I (2)
Medical Psychology (1)
Medical Sociology (1)

Compulsory Practicals and Seminars

Microscopic Anatomy II (Second half of semester; 5)
Practical of Biology (4)
Seminar of Physiology (2.5)
Seminar of Biochemistry I (1)
Seminar of Anatomy I
Seminar of Anatomy II

3rd Preclinical Semester (Winter Semester)

Lectures:

Physiology II (4)
Biochemistry II (4)
Topographical Anatomy (3)

Compulsory Practicals and Seminars:

Macroscopic Anatomy II (10)
Seminar Biochemistry II (1.5)
Seminar Physiology (altern. 2nd preclinical semester; 2.5)
Medical Psychology (4)
Medical Sociology (1)
Practical exercises for professional orientation (1)

4th Preclinical Semester (Summer Semester)

Lectures:

Introduction to Clinical Medicine (4)
Biochemistry III (2)

Compulsory Practicals and Seminars:

Practical for Physiology (8)
Anatomy II
Practical for Biochemistry (8)
Practical for Introduction to Clinical Medicine (2)

Preclinical Examination: Ärztliche Vorprüfung

Clinical Part: Clinical-theoretical Part

1st Clinical Semester (Winter Semester)

Lectures:

General Pathology (3)
General Pharmacology (5)
Pathophysiology I (2)
Biomathematics (1)
Human Genetics I (1)
Radiology (Clinical and theoretical) (2)
Clinical Chemistry and Haemotology (1)
Microbiology I (3)

Compulsory Practicals:

Course of Clinical Examination Methods I
- (Internal Medicine, Surgery and Dermatology; 2.5)
Pathology (3)
Microbiology and Immunology (3)
Clinical Chemistry and Haemotology (2)
First Aid (2)

2nd Clinical Semester (Summer Semester)

Lectures:

Pathophysiology II (2)
General Pathology (3)
Microbiology II (3)
Clinical Chemistry and Haemotology (1)
History of Medicine (1)

Practicals:

Seminar for Biomathematics (2)
Course in Clinical Examination Methods II
(Neurology, Ophthalmology, Oto-Rhino-Laryngology and Paediatrics; (2)
Course of Radiology including Radiation Protection (2)
Course of Pharmacology (3)

First Part of Medical Examination

Clinical Part: Clinical-practical Part

3rd Clinical Semester (Winter Semester)

Lectures:

Special Pathology and Neuropathology I (2)
Surgical Clinic I or II (5)
Internal Medicine I or II (5)
Paediatrics (4)
Forensic Medicine (2)
Hygienics (2)

Practicals:

Ophthalmology (4)
Ecological Course:
- Forensic Medicine (1)
- Hygiene, Occupational Medicine, Social Medicine (3)
- Medical Statistics (0,5)
Medicine in Emergencies (or in the 4th Clinical Semester; 2)

4th Clinical Semester (Summer Semester)

Lectures:

Special Pharmacology and Neuropathology II (2)
Surgical Clinic I or II (5)
Plastering (2)
Internal Medicine II or I (5)
Orthopaedics (2)
Radiological Clinic (3)

Practicals:

Special Pathology and Neuropathology (3)
Urology (or in the 5th Clinical Semester; 2)
Surgery I or II (2)
Paediatrics (3)
Orthopaedics (1.5)
Medicine in Emergencies (or in 2nd Clinical Semester; 2)

5th Clinical Semester (Winter Semester)

Lectures:

Dentistry and Oral Surgery (1)
Gynaecology and Obstetrics (2)
Psychiatry (2)

Practicals:

Internal Medicine (or in 6th Clinical Semester; 7)
Surgery II or I (2)
Psychiatry (2)
Gynaecology and Obstetrics (4)
Dermatology and Venerology (4)
Neurology I (4)
Oto-Rhino-Laryngology (4)
Urology (or in 4th Clinical Semester; 2)

6th Clinical Semester (Summer Semester)

Lectures:

Psychosomatic Medicine and Psychotherapy (1)
Urological Rounds (1)

Practicals:

Special Pharmacology (or in 5th Clinical Semester; 2)
Psychosomatic Medicine and Psychotherapy (4)
General Medicine (1)
Neurology II (2)
Internal Medicine (or in 5th Clinical Semester; 7)

Second Part of Medical Examination
Practical Year
Third Part of Medical Examination
End of University Studies
Trainee Doctor (Arzt im Praktikum; 18 Months)

Administration
After undergraduate training of 6 years, 1 year of pre-registration and 3 years of mandatory post-graduate training are necessary to qualify as general practitioner. Specialization takes 3-6 years.

Curriculum contents
Generalized Medical Curriculum Greece

PRE-CLINICAL SCIENCES
YEAR 1
Semester 1
Statistics and Computers in Medicine; Medical Physics; Chemistry; Medical Biology; History of Medicine; (Foreign Languages)
EXAMINATIONS
Semester 2
Biochemistry; Anatomy; General Physiology; Genetics; (Foreign Languages)
EXAMINATIONS

YEAR 2
Semester 3
Biochemistry (cont.); Anatomy, Histology and Embryology; Physiology; (Foreign Languages)
EXAMINATIONS
Semester 4
Anatomy, Histology and Embryology; Physiology; Pharmacology; (Foreign Languages)
EXAMINATIONS

YEAR 3
Semester 5
Pharmacology; Microbiology and Immunology; Hygiene and Public Health
EXAMINATIONS

CLINICAL SCIENCES

YEAR 3
Semester 6
Pathology; Diagnostic Radiology
Physical Examination and diagnosis in Surgery Physical Examination and diagnosis in Internal Medicine
EXAMINATIONS

YEAR 4
Semester 7
Anaesthesiology; Surgery, Urology and Orthopaedics; Forensic Medicine and Toxicology
EXAMINATIONS
Semester 8
Neurology and Psychiatry; Otorhynolarngology and Ophthalmology; Social Medicine
EXAMINATIONS

YEAR 5
Semester 9
Clinical Radiology; Internal Medicine3 and Chest Medicine; Dermatology and Venereology
EXAMINATIONS
Semester 10
Paediatrics and Paediatric Surgery; Neurosurgery; Gynaecology and Obstetrics
EXAMINATIONS

CLINICAL TRAINING (CLERKSHIPS)

Semester 11
Clinical Clerkships 6 weeks: three clinical clerkships of two weeks each of Urology, Paediatric Surgery, Cardiothoracic Surgery, Vascular Surgery or Neurosurgery 6 weeks General Surgery 3 weeks Gynaecology and Obstetrics 6 weeks Paediatrics
EXAMINATIONS
Semester 12
Clinical Clerkships 12 weeks Internal Medicine: three clinical clerkships of four weeks each of Haematology, Cardiology, Chest Medicine, Gastroenterology or Nephrology 6 weeks Internal Medicine: two clinical clerkships of three weeks each of Endocrinology, Rheumatology or Immunology 3 weeks Neurology and Psychiatry FINAL EXAMINATIONS Medical Degree (MD)

ELECTIVES
From semester 1 to 12 students must attend 8 from 33 elective courses

Number of schools, number of graduates
Medical education is offered at the four medical universities:

• Budapest
• Debrecen
• Pecs
• Szeged

Administration
Education takes place in Medical Universities

National goals for undergraduate medical education
The curriculum is designed to serve the educational and teaching objectives of the university (Szeged): - to promote the intellectual development of its undergraduates and graduates, to prepare them to fulfill sophisticated and highly important roles in society. - to provide a scientific basis through teaching basic science disiplines for realizing skills in the treatment of human diseases. - to educate students how to apply their knowledge of ethics in interpersonal relationships in order to become effective health care providers. - to develop responsibility for organizing community health care systems, for a life-long continuation of studies, for developing personality, character values, aesthetic appreciation, becoming a competent physician of high moral and professional excellence complying with the expectations of the society which he/she will be serving.

The primary goal of Medical education is to educate students to become professionals capable of solving complex health care problems in a creative way, of further developing existing health care systems and of bringing medical methods and technology into the next century. Therefore the students are expected to have a high moral standing, strictly adhering and conforming to the guiding principles of medical ethics with highlights obligations of a moral nature, governing the practice of medicine.

The student/graduate should: - accept personal committment for continued professional development, build the habit of participation in continuing education and systematic study, learn the skills to help the acquisition and critical assessment of ever-increasing flow of new information; - be able to evaluate his/her own identity and intellectual capability in order to achieve further personality, expansion and enrichment in accordance with growing responsibilities in the fast-paced world of medicine; - be aware of and sensitive to the needs of the community, devlop an orientation towards improving patient care through personal example and self-discipline, professional excellence and enthousiastic human concern, even at personal sacrifice; - maintain meticulous accuracy and honesty in person-to-person communication and in reporting scientific and clinical information; - develop an atmosphere of mutual respect and not impose personal values and biases on patients; - try to be objective - recognise the goals and importance of research; acquire skills for the use of medical literature and reference materials for answering scientific questions and managing clinical cases; - apply the insights derived from the training process to clinical problem-solving.

Furthermore: - observe high standards of performance; adhere to the best available treatment modalities, seek consultation and referral to specially qualified colleagues, as the situation warrants; - develop awareness of obligations to patients by confidentiality and availability, and respect for the patient's physical and emotional comfort; - recognize confidentiality in communication as one of the most important ethical principles as emphasized in the Hippocratic Oath and also stressed in the Declaration of Geneva*; - the graduate should demonstrate ability to develop social skills and adequacy, and an effective interpersonal communication style suitable for team work; - persue thoughtful cooperation and relationships with patients, the patients family and allied heath personnel; - the graduate should assume responsibility for learning a careing attitude, relate to patients in an emphatic, understanding and supportive manner, respect their individuality and dignity and consider them as participants in decisions regarding their medical care; - the graduate should appreciate the need for educating and teaching patients, fellow colleagues, junior medical and pharmacy students and other participants of the health care delivery system; - the student should recognize that effectiveness of the health care team is highly dependent upon improved communication in problem-solving, coordination and collaboration of health care providers, such as physicians, pharmacists, nurses, midwives, nutritionists, and social workers; - students should realize through their university studies and education that in medicine, character orientation or personality style cannot be separated from sensitivity, flexibility, skill and intelligence; - students should develop their cooperataive, thoughtful and result-oriented personality to meet patients' needs and feelings, to function efficiently as a team participant or leader, to become a good, compassionate physician, with moral and intellectual excellence.

* The Declaration of Geneva (194, amended 196) is the most generally accepted form of words appropriate as a promise by those entering the medical profession, It may be taken as the modern equivalent of the Hippocratic Oath.

At the time of being admitted to the medical profession:

- I will solemny pledge myself to consecrate my life to the service of humanity; - I will give to my teachers the respect and gratitude which is their due; - I will practise my profession with respect and dignity; - The health of my patient will be my first consideration; - I will respect the secrets which are confided in me, even after the patient has died; - I will maintain by all means in my power the honour and noble traditions of the medical profession; - My colleagues will be my brothers; - I will not permit consideration of religion, nationality, race, party politics or social standing to intervene between my duty and my patient; - I will maintain the utmost respect for human life from the time of conception even under threat, I will not use my medical knowledge contary to the laws of humanity; - I make these promises selemnly, freely and upon my honour.

Curriculum contents
Generalized curriculum Hungary

PRE-CLINICAL SCIENCES
YEAR 1 to 2
The main objective of the first two academic years is to provide the student with fundamental knowledge in basic sciences such as anatomy, histology, embryology, chemistry, biology, biochemistry, physics and physiology.

CLINICAL SCIENCES
YEAR 3 to 5
Three years are devoted to preclinical disciplines, such as microbiology, pathology, pathophysiology and pharmacology as well as to various clinical sciences: internal medicine, surgery, dermatology, paediatrics, gynaecology/obstetrics, neurology and psychiatry, ophthalmology, radiology, otorhinolaryngology, urology, anaesthesiology, pulmonology and stomatology, together with social medicine, forensic medicine, public health, epidemiology, heatlth service organization, and medical ethics.

The 4th and 5th year are full-clinical years, and students rotate through departmental practical sessions and mini-clerkships. During clinical activities students are expected to acquire skills and learn how to relate their background preparation to solving complex clinical problems. The teaching process is aimed at clinical judgement, critical sense, sustained hard working ability, skills in establishing rapport with patients and coworkers. Students learn the methods of clinical data collection through participation in a problem-oriented system. They are expected to develop skills to decide whether a cause-effect relationship exists. They should develop comprehension, discrimination and sound reasoning, based on information from different sources (from patients, family, colleagues, laboratory workups, etc.)

CLINICAL TRAINING
YEAR 6
In the last year the students follow a carefully developed programme of clinical clerkships at the University Departments or Affiliated Teaching Hospitals. This programme is concluded by a series of closing examinations of internal medicine, surgery, paediatrics, gynaecology/obstetrics, neurology and psychiatry.

At the end of the sixth year students must take their State Board Examination consisting of three parts: - writing a thesis - passing a multiple-choice test examination - oral examination, including a clinical case At this examination students must prove their skills and cognitive ability in dealing with complex issues; organizational, intellectual and clinical capabilities are tested. Questions scan a wide range of clinical situations. The examinees must demonstrate competence in handling clinical details. Upon passing the examination, a Doctor of Medicine will be awarded.

Based on Reykjavík

The study of Medicine in Iceland takes six years and leads to the degree of Candidatus Medicinae et Chirurgiae.The maximum time allowed to complete the studies is 8 years. The Faculty of Medicine is open to all students who have obtained the secondary school certificate from a recognized school (The secondary school certificate is obtained after four years of secondary education following six years of primary education).

The Faculty has the power to restrict admission as necessary and since 1993 only 30 students have been allowed to continue on to the second semester. A competitive examination is held in December at the end of the first term and the 30 students with the highest marks are allowed to continue in the medical programme.

In selecting these students the following rules apply:

Students must sit for all examinations the term the selection is made. Prior examinations will not be considered. Examinations are held in the subjects which are taught during the autumn term of the first year. The Dean of the Faculty of Medicine shall determine the relative value of each subject in consultation with the Director of Curriculum and the Curriculum Committee. The results of each subject shall be averaged with the prescribed value to give the final grade, calculated to two decimal places, in accordance with the University Regulation. B. Those students successful in all the examinations in subjects taught during the autumn term of the first year are ranked in order of decreasing final grade. The 30 getting the highest grades are permitted to continue study in the spring term. Should two or more students have the same final grade in the last position they shall both/all be entitled to continue study in the spring term of the first year. C. There are four separate examination subjects, the value of which is at present as follows:

Chemistry 3 Physics 2 Introduction to anatomy and physiology 3 Behavioural science and psychology 1

Faculty of Medicine: Rules on examinations
Examinations in the Faculty of Medicine shall as a rule be in written format; the Faculty can also decide to hold oral and practical examinations. Plans for oral examinations must be approved by the Faculty Board. The Dean of the Faculty may grant individual exceptions from the main rule regarding written examinations under special circumstances. All requests for such exceptions shall be addressed to the Director of Curriculum of the Faculty of Medicine.

Generalized curriculum of Iceland

PRE-CLINICAL SCIENCES
YEAR 1
Courses: Medical Physics; Introduction to Anatomy and Physiology; Cell Biology; Anatomy; Chemistry; Behavioural Sciences and Psychology; Behavioural Sciences - Methodology
YEAR 2 
Courses: Behavioural and Communication Science ; Physiology ; Physics; Biochemistry and Molecular Biology; Anatomy; Behavioural and communication Science
Internal Medicine and Surgery: two weeks at the Internal Medicine and Surgical Wards of the State and City Hospitals. Examination: No examination, but 95% attendance is compulsory.
YEAR 3 (pars)
Courses: Pathology; Pharmacology; Microbiology ; Immunology; Virology

CLINICAL SCIENCES
YEAR 3 continued
Introduction to Clinical Medicine; Family Medicine
YEAR 4
Surgery; Anaesthesiology; Internal Medicine; Otorhinolaryngology; Dermatology and sexually transmitted diseases; Diagnostic Imaging; Preventive Medicine; Clinical Chemistry Research Project
YEAR 5
Courses: Pediatrics; Psychiatry; Obstetrics and Gynaecology; Neurology; Ophthalmology
Family Medicine 35-42 wks and 3-10 wks clinical training

CLINICAL TRAINING
YEAR 6
Courses: Rehabilitation; Forensic Medicine; Legal Aspects of Medicine; Toxicology; Surgery and Orthopaedics; Internal Medicine education types:
Lectures, Exercises, Clinical, Laboratory, Practical, Seminars

Ireland has six medical schools in:

• Cork
• Dublin
• Galway
• Limerick

Administration
After undergraduate education another year of pre-registration and 3 years of mandatory post-graduate training are necessary to qualify as general practitioner.

Curriculum structure
The six year course of undergraduate medicine has two broad phases, pre-clinical and clinical.

Pre-clinical studies commence in the first year with the study of Anatomy and Functional Histology. During this year courses in the basic sciences, Physics, Chemsistry, Biology and Medical Informatics are also given. In the second year, tuition is given in Anatomy, Biochemistry, Public Health Medicine and Epidemiology and Functional Histology. The subjects of the third year are Physiology, Pharmacology and Pathology. Throughout this phase of the curriculum, students attend teaching sessions in the general hospitals and clinical aspects of the subjects are stressed.

The third year and first two terms of the fourth medical year are devoted to Pathology and Microbiology. Towards the end of the year students commence their clinical training. There are periods of residency in the general and specialist hospitals, attachment to a general practice and attendances at community health facilities.

During the fifth and final medical years, systematic instruction is given in the hospitals in Medicine and Surgery and in their subspecialities and in Therapeutics, Public Health Medicine and Epidemiology, General Practice, Legal Medicine, Obstetrics and Gynaecology, Paediatrics, Ophthalmology, Otorhinolaryngology, and Ethics.

After graduation, a doctor must spend one year as a hospital intern before being eligible for full registration with the Medical Council.

Curriculum contents
Generalized Medical Curriculum Ireland

PREMEDICAL EDUCATION
Mathematics; Physics; Chemistry; Biology PRE-CLINICAL SCIENCES

YEAR 1
Biochemistry; Physiology; Anatomy; Histology and Cytology; Genetics*; Psychology*
REPETITIVE TESTS

YEAR 2
Biochemistry; Anatomy; Physiology; Pharmacology*; Microbiology*
REPETITIVE TESTS FIRST EXAMINATIONS

* Not provided in all Irish Universities at the place indicated in this curriculum

CLINICAL SCIENCES
YEAR 3
Pathology; Microbiology; Pharmacology; Introduction to Clinical Disciplines; Internal Medicine (general); Surgery (general)
REPETITIVE TESTS

CLINICAL TRAINING and special CLINICAL SCIENCES
YEAR 4
Part time Hospital Clerkships Internal Medicine; Paediatrics; Gynaecology and Obstetrics; Surgery; Otorhinolaryngology; ....; Dermatology and Venreology; Social and Preventive Medicine; General Practice*; Anaesthesiology*; Forensic Medicine*
SECOND "FORMAL" EXAMINATIONS
YEAR 5
Full time Hospital Clerkships Internal Medicine; Paediatrics; Gynaecology and Obstetrics; Surgery; General Practice*; Psychiatry*; Odontology*; Radiology*
LAST ORAL AND WRITTEN EXAMINATION MEDICAL DEGREE MD

* Not provided in all Irish Universities at the place indicated in this curriculum

Number of schools, number of graduates
Faculties of medine: at the "Università degli studi di"

• Ancona
• Bari
• Bari Foggia
• Bologna
• Brescia
• Cagliari
• Catania
• Chieti - G. D'Annunzio
• Ferrara
• Firenze
• Genova
• L'Aquila
• Messina
• Milano
• Milano - Univ. Cattolica Roma
• Modena
• Napoli - Federico II
• Napoli - II Università Caserta
• Napoli - II Università Napoli
• Padova
• Palermo
• Parma
• Pavia
• Pavia Varese
• Perugia
• Pisa
• Reggio Calabria Catanzaro
• Roma - La Sapienza
• Roma - Tor Vergata
• Roma - Campus Biomedico
• Sassari
• Siena
• Torino
• Torino Novara
• Trieste
• Udine
• Verona

Administration
After undergraduate education, half a year of pre-registration and 2 years of mandatory post-graduate training are necessary to qualify as general practitioner. Specialization takes 4-5 years

National goals for undergraduate medical education
Pisa:
Final aims of medical education:
to educate a physician with a solid general, cultural and practical training, who can face the multiple and diversified clinical problems. In this prospective is decided to introduce initial and continuous education in applications of diagnostics, therapy, preventive medicine and rehabilitation.

• a solid biological culture with adequate knowledge of the scientific method, including the relevant principles of the biological function, of interpretation of scientific facts and analysis of data;
• a good knowledge of the human phytopathology and of the relations between physical and social environment of man and of its state of health;
• the understanding of the causes and mechanisms of the fundamental psychological and biological processes in man. At the end of medical studies the students have to demonstrate by verification of the benefitted, having a scientific attitude, the fundamental notions, sufficient capacity and experience to examine patients, effecting laboratory examinations, knowing to decide on specialized examinations or analyses, being able to stabilize therapeutical measures (inclusive the first urgent measures and the most simple first aid), to formulate the probable diagnosis of the most common illnesses with regard to frequence and risk, being able to communicate clearly and human with patients and family, taking preventive and protective measures for health, knowing the normative and legislative health care and knowing to respect the ethical aspects of medicine. Possessing the methodological and cultural basis for subsequent specialization and lifelong learning.

Admission of students
Selection by the separate faculties of medicine

Curriculum contents
Generalized Medical Curriculum Italy

PRE-CLINICAL SCIENCES
YEAR 1
Semester 1
Statistics and Mathematics in Medicine; Medical Physics; Chemistry; Biochemistry (introduction);
EXAMINATIONS

Semester 2
Medical Biology; Genetics; Histology and Embryology
EXAMINATIONS

YEAR 2
Semester 3
Biochemistry; Anatomy
EXAMINATIONS

Semester 4
Biochemistry; Anatomy; Physiology
EXAMINATIONS

YEAR 3
Semester 5
Biophysics and Biomedical Technology; Physiology; Microbiology and Immunology; General Pathology
EXAMINATIONS

Semester 6
Microbiology; General Pathology; General and Practical Physiopathology Introduction in Experimental Research
EXAMINATIONS

CLINICAL SCIENCES
YEAR 4
Semester 7
Pharmacology (general); Laboratory (clinical); Methodology (clinical); Infectious Diseases; Pathological Anatomy
EXAMINATIONS

Semester 8
Cardiology, Angiology and Pulmonology; Gastroenterology; Nephrology and Urology; Endocrinology and Metabolic Disorders
EXAMINATIONS

YEAR 5
Semester 9
Pathological Anatomy; General Internal Medicine; Haematology and Clinical Oncology; Clinical Rheumatology and Immunology; Clinical Radiology and Radiotherapy; General Surgery
EXAMINATIONS

Semester 10
Neurology, Psychiatry and Clinical Psychology; Dermatology and Venereology; Ophthalmology, Otorhinolaryngology and Odontology; Medical Therapy; Orthopaedy
EXAMINATIONS

YEAR 6
Semester 11
Internal Medicine; Paediatrics; Special Surgery; Gynaecology and Obstetrics
EXAMINATIONS

Semester 12
Internal Medicine; Forensic Medicine and Toxicology; Hygiene and Social and Professional Medicine; Traumatology and First AID; Special Surgery
FINAL EXAMINATION and MEDICAL DEGREE MD

Training is almost only theoretical. The 6 months to a year practical training, prior to the "authorization to practice" is not necessarily carried out in a clinical environment.

Number of schools, number of graduates
The Netherlands (15 million inhabitants) has 8 medical faculties:

• Amsterdam (Municipal university)
• Amsterdam (Free university)
• Groningen
• Leiden
• Maastricht
• Nijmegen
• Rotterdam
• Utrecht

The number of graduates is ca. 1200 per year. This is estimated somewhat too few with regard to developments in medical professions (more part-time working medical doctors are expected in the future). Measures are to be taken in the numerous clausus in the recent years to increase the number of graduates.

Administration
The faculties of medicine all are part of multi-faculty universities. They come under the Ministry of Education, Culture and Sciences.

Within the universities the academic hospitals and faculties of medicine tend to merge to university medical centres.

After undergraduate education it takes another 3 years of mandatory post-graduate training to become a general practitioner.

Specialization takes 4-6 years after graduation.

National goals for undergraduate medical education
The major qualities and characteristics of the new medical doctor by the end of undergraduate medical education are:

• has acquainted himself with the process of medical problem-solving:
• he is capable of medical decision-making;
• must have adequate knowledge and skills to be able to handle all types of problems (skill of systematic working, using the right diagnostic process, depending on type of aid required and choosing the right policy for the problem);
• has a broad set of knowledge and skills, which enable him to enter any postgraduate training and cooperate with other disciplines/providers of health care:
• he has to acquire knowledge and experience of aspects of general as well as specific health care, supported by basic and behavioural sciences and has gained insight into the structure of health care;
• is scientifically educated: - he is acquainted with the basic principles of research, not only in the form of scientific knowledge, but also in the form of practical experience through active participation in a scientific project;
• he is able to approach scientific data critically and is able to form independent opinions;
• he has a reasonable insight in the scientific foundations of medicine and to what extent this is not the case;
• he can verify the scientific foundations of medicine and is able to transmit information to others;
• has the right attitudes: - he is willing to dedicate himself and feels responsible for the physical, mental and social well-being of people;
• he has social and communication skills;
• he treats the patient respectfully, disregarding gender, race, age, social and economic status, education, cultural background, sexual preferences and philosophy of life;
• he can give clearly formulated information to his patients and is sufficiently emphatic with the patient and his environment;
• he has learned to take responsibility and to make independent medical decisions, as far as his knowledge and experience will allow and taking into account ethical aspects;
• he is able to participate actively in the improvement and preservation of public health: preventing disease and handicap, contributing to cure and recovery of the sick, easing suffering and discomfort and attending the sick in their environment/social situation;
• he has a critical attitude towards his own work and that of others;
• he is aware of his responsibility for the functioning of health care as an organization, taking into account financial, logistic, and other restrictive factors in health care;
• he realizes that good cooperation with other disciplines/carers is necessary to offer good quality of care and to guarantee continuity of care;
• he is aware of the necessity of continuing education and assessment;
• is flexible: can anticipate developments - he has to be able to adapt his knowledge, skills and attitudes to changing health care, to scientific and social possibilities and developments and to economic, legal and ethical limitations, and must keep abreast of these developments;
• is legally qualified and capable to act medically and carries responsibility for this. In medical practice, personal limits, set by education and experience, are taken care of.

Admission of students
Out of 6,000 students interested, ca. 1800 are admitted to first year medical education. Admitted students are obliged to have the knowledge of secondary education with regard to Chemistry and Physics. In near future a special differentiation will be incorporated in secondary education specially aimed at medicine and health sciences. The sharply defined knowledge of Chemistry and Physics means that very little students drop out. About 85% of all students which are admitted will pass the final MD examination.

Selection of the students is partly based on a lottery. Students with very good results have a great chance to be admitted, while students with average degrees have a much smaller chance. Discussions run to admit all very good students without lottery or at any rate give the separate faculties of medicine an own choice for part of the new students.

Teaching and learning methods
Curriculum structure and teaching methods vary in The Netherlands. Maastricht has an entirely Problem Based curriculum. Nijmegen and Groningen have mixtures. At the other extreme Leiden and Rotterdam have traditional curricula with lots of lectures, but both reform their curricula with maximally 30% contact hours (lectures, practical courses, seminars and working groups). The other 70% is meant for self-study by the students.

Curriculum contents
Generalized Medical Curriculum Netherlands

PRE-CLINICAL SCIENCES
YEAR 1
Very diverse curricula, mostly integrated courses (inclusive clinical disciplines) with emphasis on the following disciplines: Statistics, Informatics and Methodology; Biophysics; Biochemistry; Physiology; Anatomy and Embryology; Histology and Cytology
Nursing training
EXAMINATIONS AT THE END OF DISCIPLINES OR INTEGRATED COURSES
"PROPAEDEUTICAL EXAMINATION"

YEAR 2
Note: particularly the "paraclinical" disciplines are often integrated with the clinical ones; emphasis on the following disciplines:
Pathology; Microbiology Parasitology and Virology; Epoidemiology; Pharmacology; Genetics; Social Medicine, Health Care, Family Practice; Psychology and Sociology
EXAMINATIONS AT THE END OF DISCIPLINES OR INTEGRATED COURSES

CLINICAL SCIENCES
YEAR 3 AND 4
Note: mainly integrated courses; emphasise on the following disciplines:
Internal Medicine; Neurology;Psychiatry;Paediatrics; Gynaecology and Obstetrics; Surgery; Anaesthesiology; Pharmacology (special); Otorhinolaryngology and Stomatology; Ophthalmology; Dermatology and Venereology; Emergency Medicine; Radiology
Various amounts of elective courses
Research electives in fourth year (3 to 6 months) or in sixth year
Introductory courses in clinical skills ("Junior Clerkships) in some cases in 3rd and 4th year
EXAMINATIONS AT THE END OF INTEGRATED COURSES "DOCTORAL" EXAMINATION CLINICAL TRAINING

YEAR 5 AND 6
INTRODUCTORY COURSES IN CLINICAL SKILLS up to 15 weeks
OBLIGATORY CLERKSHIPS Internal Medicine 3-4 months Neurology and Psychiatry 3 months Paediatrics 1,5-2 months Surgery 3 months Gynaecology and Obstetrics 2 months General Practice 1,5 months Otorhinolaryngology 3 weeks Ophthalmology 3 weeks Dermatology and Venereology 3 weeks
ELECTIVE CLERKSHIPS Inclusive research electives 3-4 months
EXAMINATIONS AT THE END OF CLERKSHIPS FINAL EXAMINATION MEDICAL DEGREE MD

Note: The "Propaedeutic", "Doctoral" and Final Examinations are based upon the results accumulated for all courses and clerkships passed
Note: In actual medical education in the Netherlands it is difficult to present a generalized curriulum. In most cases their is no, or hardly question of separate periods in which pre-clinical and clinical sciences are educated. In most cases courses are integrated, which means that pre-clinical sciences may dominate in the earliest years, but still are present in later years.

Evaluation of students
Evaluation of student varies in the faculties of medicine in The Netherlands. Most examinations are written (multiple choice).

Future Perspectives  
Medical education in the Netherlands is aimed at problem-solving and preparing the student to life-long learning.

Number of schools, number of graduates

• Det medisinske fakultet, Oslo
• Det medisinske fakultet, Bergen
• Det Medisinske Fakultet, Trondheim
• Det medisinske fakultet, Tromsø
• Det Norske Radiumhospital
• Rikshospitalet
• Ullevål sykehus

Administration
To obtain a licence to practise, the doctor must attend an additional practical training 0f 1.5 years: that is one year in a hospital as a House Officer and half a year as an Assistant to a General Practitioner. Specialist training then, lasts 5-8 years

Admission of students
The admission to the medical studies is highly restricted. In addition to the general admissions requirements for the university, students must document qualifications in mathematics, physics and chemistry at a certain level. International students are usually only admitted if they are permanent residents in Norway.

Curriculum structure
Programme of study for the Cand.Med. (medical doctor) degree (old curriculum): 165 students are accepted each year for the study towards the degree candidatus/candidata medicinae (Cand.Med.) - Medical Doctor. The study lasts for 6 years and is divided into 2 parts: a preclinical (2 1/2 years) and a clinical (3 1/2 years). Having obtained their degree, the students must complete 1 1/2 years of internship (turnustjeneste) to become fully licensed physicians.

Teaching and learning methods
In the first 2 1/2 preclinical years, students attend lectures, laboratory courses, seminars, and demonstrations. Since all students start their studies in August, all pre-clinical courses are offered only once a year. After completing the preclinical part of the studies, the class of 165 students is divided in two halves for the rest of the studies. The second half of the class must wait for 3 months to start their clinical part. Clinical courses are, consequently, offered twice a year. In the clinical years, teaching in theoretical subjects also takes the form of lectures, seminars, demonstrations and laboratory courses. In the clinical subjects the teaching takes place in the various hospital departments in the form of: Lectures - for the whole class or parts of the class. Clinics - normally for 20-25 students. Either the teacher presents the patient, or one or two students present a patient previously examined by them for the rest of class in the presence of the teacher. Independent work in hospital wards by individual students - normally with the purpose of practicing history taking and physical examination. Practical clinical teaching in small groups of 2-8 students. Observing and assisting doctors at work in the ward, operating theatre or outpatient department. Clinical attachments in general practice and in psychiatric institutions.

Curriculum contents
Generalised curriculum of medical education in Norway

PRE-CLINICAL SCIENCES
YEAR 1
Trimester 1
Chemistry (general and organic); Medical Terminology EXAMINATIONS: written
Trimester 2
Chemistry (general and organic); Medical Statistics EXAMINATIONS: Written
Trimester 3
Cellbiology; Medical Genetics

YEAR 2
Trimester 4
Cellbiology; Medical Genetics EAMINATIONS: written
Trimester 5
Pre-clinical Medical Biology Trimesters 5-7: Neurobiology/Endocrinology; Circulation/Respiration; Nephrology/Acid-Base Balance; Digestion/Nutrition
Trimester 6
Reproduction; Locomotor Apparatus; Neurobiology

YEAR 3
Trimester 7
Head/neck; Integrating seminars EXAMINATIONS: written and oral
Trimester 8
Behavioural Scoences/History of Medicine EXAMINATIONS: written

CLINICAL SCIENCES AND TRAINING
YEAR 3
Trimester 8 continued Introductions to Internal Medicine, Surgery and Psychiatry; General Pathology; Clinical Biochemsitry and Psychology; Medical Ethics
Trimester 9
Internal Medicine; Pathology; Clinical Biochemistry and Physiology; Pharmacology

YEAR 4
Trimester 10
Surgery; Anaesthesiology; Roadiology; Pharmacology EXAMINATIONS: written
Trimester 11
Otorhinolaryngology; Ophthalmology; Microbiology (laboratory course) EXAMINATIONS: clinical
Trimester 12
Dermatology; Infectious Diseases; Pathology; Clinical Biochemistry and Physiology; Microbiology (inclusive Immunology and Haematology) EXAMINATIONS: clinical

YEAR 5
Trimester 13
Neurology; Pathology; Clinical Biochemistry and Physiology EXAMINATIONS: clinical, oral and written
Trimester 14
Gynaecology/Obstetrics; Paediatrics* EXAMINATIONS: written
Trimester 15
Psychiatry* EXAMINATION: written * A small number of students is chosen at random to have a clinical examination in these subjects

YEAR 6
Trimester 16
Community Medicine: General Practice, Social Medicine, Preventive Medicine and Forensic Medicine
Trimester 17 and 18
Emergency Medicine; Internal Medicine; Surgery; Radiology EXAMINATIONS: Clinical and oral

Evaluation of students
There is one examination in each subject, 23 examinations in all. Where subjects run through several terms, there is one examination at the end of the last term, not after individual terms. In addition, students have to hand in one independent written assignement during the entire course of study, corresponding to 6 weeks' work. Examinations are: - Written. Short answer or essay questions. Multiple choice questions are not used. - Oral. This form is used in practical, non-clinical subjects like anatomy, pathology and radiology and utilizes prosected specimens, microscopic material, x-rays, living models, and other material. - Clinical. The examination is in the form of a clinic. The student examines a patient, gives suggestions or diagnosis, treatment and further examinations and is also examined on the theoretical aspects. - Groups project. A group of students work on a topic throughout the term and presents it to the rest of the class in the presence of the examinors at the end of the term. No formal assessment is given outside the examinations. Teachers have to confirm the attendance of students at all compulsory lessons (laboratory courses, sessions of practical clinical teaching and clinical placements) in a satisfactory manner.

Number of schools, number of graduates
Portugal has five medical schools

Administration
After undergraduate education, 1.5 years of pre-registration and 3 years of mandatory post-graduate training are necessary to qualify as general practitioner. Specialization lasts 4-6 years after graduation and the pre-registration period.

National goals for undergraduate medical education
Educating students in the field of sciences, which form the basis of the professional practice of medicine. General purposes are promotion of health, prevention and treatment of disease, and patient rehabilitation, training in human and biological sciences in order to a sound application of knowledge, skills and attitudes.

Curriculum contents
Generalized Medical Curriculum Portugal

PRE-CLINICAL SCIENCES
YEAR 1
Biomathematics; Biochemistry; Anatomy; Biophysics; Cellbiology; Preventive Medicine
EXAMINATIONS

YEAR 2
Anatomy; Histology and Embryology; Chemical Pathology; Physiology; Basic Medical Psychology
EXAMINATIONS

CLINICAL SCIENCES
YEAR 3
Physiopathology; Epidemiology and Hygiene; Pathological Anatomy; Pharmacology; Microbiology; Immunology; Genetics
EXAMINATIONS

YEAR 4
Imagiology (X-ray, Echo, etc.); Clinical Laboratory; General Paediatrics; General Internal Medicine; General Surgery; Psychiatry; History of Medicine; General Therapy; Nuclear Medicine; Deontology
EXAMINATIONS

YEAR 5
Pathological Anatomy (special); Ophthalmology; Dermatology and Venereology; Special Interrnal Medicine; Special Surgery; Orthopaedy; Special Paediatrics; Neurology; Forensic Medicine and Toxicology
EXAMINATIONS

YEAR 6
Advanced Internal Medicine; APaediatrics and Paediatric Surgery; Advanced Surgery Electives: Gynaecology and Obstetrics; Psychiatry; Otorhinolaryngology; Odontology; Infectious/Parasitic Disorders; Social and Professional Medicine; Geriatry

CLINICAL TRAINING
CLERKSHIP IN INTERNAL MEDICINE: one semester in any of the following: Cardiology; Haematology; Gastroenterology; Nephrology; Endocrinology; Clinical Immunology CLERKSHIP IN SURGERY: one semester in one of the following: Cardiothoracic Surgery; Vascular Surgery; Plastic and Reconstructive Surgery; Neurosurgery; Anaesthesiology and Intensive Care

Curriculum contents
Generalised curriculum of medical education in Romania

PRE-CLINICAL SCIENCES
YEAR 1
Semester 1
Anatomy; Bio-organic Chemistry; Biochemistry; Biophysics; Physiology; Cellbiology; Romaninan Language; Physical Education
Semester 2
Anatomy; Biochemistry; Physiology; Medical Informatics; Biostatistics; Romanian Language; Physical Education
In the first year: 90 hours of Medical Practice

YEAR 2
Semester 3
Anatomy; Physiology, Histology and Cellbiology; Biochemistry; Microbiology, Virology and Parasitology; Romanian Language; Modern Languages; Sports
Semester 4
Anatomy; Physiology; Histology and Cellbiology; Genetics; Microbiology, Virology and Parasitology; Philosophy; Romanian Language; Modern Languages; Sports
In the second year: 90 hours of Medical Practice CLINICAL SCIENCES

YEAR 3
Semester 5
Medical Semeiology; Surgical Semeiology; Pharmacology; Pathophysiology; Pathology; Tropical Parasitology
Semester 6
Medical Semeiology; Surgical Semeiology; Pharmacology; Pathophysiology; Pathology; Medical Electronics; History of Medicine
In the third year: 90 hours of Medical Practice

CLINICAL SCIENCES AND TRAINING: course with practical training YEAR 4
Semester 7 Internal Medicine; Cardiology; Medical Radiology and Imagery; Paediatrics; Hygiene; Medical Psychology
Semester 8
Surgery; Orthopaedics; Urology; Industrial Medicine; Hygiene; Medical Biotechnics; Medical Ethics
In the fourth year: 90 hours of Medical Practice

YEAR 5
Semester 9
Internal Medicine; Ophthalmology; Neurology and Brain Surgery; Otorhinolaryngology; Medical Sociology; Medical Psychology
Semester 10
Endocrinology; Paediatrics; Paediatric Surgery; General Oncology; Pathoimmunology
In the fifth year: 90 hours of Medical Practice

YEAR 6
Semester 11
Gynaecology/Obstetrics; Psychiatry; Dermatology; Paediatric Psychiatry; Social Medicine
Semester 12
Policlinics and Emergency Medicine, Watering Therapy and Rehabilitation; Infectious diseases and Epidemiology; Legal Medicine; Surgical Emergencies; Tropical Infectious Diseases; Clinical Genetics

Curriculum of the Faculty of Medicine of the Moscou University
PRE-CLINICAL SCIENCES
YEAR 1
Human Gross Anatomy and Topographic Anatomy; Cytology and General Histology; Embryology and Biology of Development; General Parasitology; Medical Botany; Higher Mathematics; Physics; General and Non-Organic Chemistry; Amalytical Chemistry; Latin Language and Medical Terminology; English; History of Russia; Philosophy; Physical Training

YEAR 2
Human Gross Anatomy and Topographical Anatomy; Special Histology; Normal Physiology; General and Medical Genetics; Physics; Organic Chemistry; Physico-Chemical Basis of Medicine; Physical Principles of Laboratory Analysis; Informatics and Medical Statistics; Biomedical Ethics; English; Philosophy; Poltiticology; History of Medicine

CLINICAL SCIENCES
YEAR 3
Internal Medicine; Surgery and Anaesthesiology; Pathological Anatomy; Pathophysiology of Organ Systems; Pharmacology; Biochemistry; Medical Mictrobiology; General Immunology; General Hygiene with Ecology

YEAR 4
Internal Medicine; Surgery; Urology; Gynaecology/Obstetrics; Dermatology and Venereology; Neurological Diseases; Ophthalmology; Human Genetics; Endocrinology; Operative Surgery; Stomaltology; Paediatrics; Radiology; Clinical Biochemistry; Medical Jurisprudence

YEAR 5
Internal Medicine; Surgery; Paediatrics; Infectious Diseases; Otorhynolaryngology; Epidemiology; Professional Diseases; Psychiatry; Social Medicine and Public Health Service; Oncology; Traumatology and Orthopaedics; Forensic Medicine; Clinical Biochemistry

CLINICAL TRAINING
YEAR 6
Therapeutics; Surgery; Gynaecology/Obstetrics; Clinical Pharmacology; Physical Training in Medicine

Number of schools, number of graduates
Spain has 31 medical schools:

• Alcala
• Alicante
• Almeria
• Baleares
• Barcelona
• Burgos
• Cadiz
• Cordoba
• Coruna
• Gerona
• Granada
• La Laguna
• Las-Palmas
• Lleida
• Madrid
• Malaga
• Mancha-Castilla
• Navarra
• Oviedo
• Pais-Vasco
• Salamanca
• Santander
• Santiago
• Sevilla
• Valencia
• Valladolid
• Vigo
• Zaragoza

Administration
After undergraduate medical education of 6 years another 3 years of mandatory post-graduate training are necessary to qualify as general practitioner.

Curriculum structure
The undergraduate study lasts six years divided into two stages of three years each: preclinical and clinical, the third year being a kind of interface between both parts.

Curriculum contents
Generalized Medical Curriculum Spain

PRE-CLINICAL SCIENCES
YEAR 1
Biostatistics; Biophysics; Biochemistry; Biology; Anatomy; Embryology; Histology (general); Physiology (general)
EXAMINATIONS

YEAR 2
Anatomy; Histology; Physiology; Medical Psychology; Symptomatology (Semeiology)
EXAMINATIONS

CLINICAL SCIENCES
YEAR 3
Pharmacology (general); Pathology (general); Pathology (anatomical); Microbiology, Parasitology and Virology
EXAMINATIONS CLINICAL SCIENCES and CLINICAL TRAINING

YEAR 4
Internal Medicine; Surgery (general); Gynaecology and Obstetrics; Ophthalmology; History of Medicine
Hospital Clerkships: ca. 30% of total time
EXAMINATIONS

YEAR 5
Internal Medicine; Surgery; Dermatology and Venereology; Otorhinolaryngology and Stomatology; Psychiatry; Forensic Medicine
Hospital Clerkships: ca. 30 % of total time
EXAMINATIONS

YEAR 6
Internal Medicine; Surgery; Paediatrics; Radiology and Physical Therapy; Social and Preventive Medicine
Hospital Clerkships: ca. 30% of total time
FINAL EXAMINATIONS MEDICAL DEGREE

Number of schools, number of graduates
Sweden with 9 million inhabitants has 6 medical schools:

• Umeå, Umeå University, http://www.umu.se
• Uppsala, Uppsala University, http://www.uu.se
• Stockholm, Karolinska Institutet, http://info.ki.se
• Linköping, Linköping University, http://www.liu.se
• Göteborg, Göteborg University, http://www.gu.se
• Lund, Lund University, http://lu.se
  

The annual intake is approximately 750 students. About 85% of the students admitted graduate.

Administration
The faculties of medicine are all, with one exception, part of multi-faculty universities. The exception is Karolinska Institutet which is an autonomous medical university. All universities come under the Ministry of Education.

To obtain a licence to practice medicine, 18 months of pre-registration is required. General Practice is one of around 60 specialisations available in Sweden. Specialist training takes 4-5 years subsequent to the pre-registration period.

National Goals for Undergraduate Education
Among the objectives of undergraduate medical education, besides knowledge and skills, is the development of the student's capacity to make independent and critical judgements, to solve problems indepently and also to keep up with developments in the field.

On completing undergraduate medical education, students should thus have acquired the knowledge and skills that form the basis of the medical profession and which facilitate the successful completion of the internship required for unlimited authorisation to practise medicine. In order to work preventatively as physicians, students should also be familiar with the societal conditions affecting people's health. In addition to an ethical attitude and a holistic view of humanity, students should have developed the self-knowledge and powers of empathy necessary for successful interaction with patients and those close to them. Students must also have acquired an adequate knowledge of both financial and organisational aspects of the health care system, and also have developed the capacity for teamwork and collaboration with other professional groups.

Admission of Students
Admission to medical studies is highly restricted. Every year between 6000 an 7000 students apply for admission to the medical degree programmes in Sweden. In addition to general admissions requirements for university studies, students must have attained qualifications in mathematics, physics, biology and chemistry to a certain level. For home students and international students applying for the full study program, admission is granted by a central admissions office for Swedish Universities and Colleges (VHS). Selection is based on grades from Upper Secondary School or result from the National Aptitude Test. In Stockholm, Linköping, Umeå and Göteborg between 50 and 60% of the students are admitted through local admissions procedures in which the results from interviews are taken into consideration.

Curriculum Structure, Teaching and Learning Methods
Curriculum structure and teaching methods vary across Sweden.

Training Settings
The training of medical students is mainly based at teaching hospitals and also to some extent in Primary Health Care Centres. Early patient contact is emphasised.

Curriculum Contents
As the structure and content vary across the faculties we kindly ask you to look for detailed information on curriculum content in the respective ECTS-catalogue, most of them available via links from the Med-Net website.

Evaluation of Students
Swedish medical students are not awarded differentiated grades. Courses and exams are only graded Fail or Pass. Examinations aim to test understanding and the application of knowledge as well as personal performance in realistic situations, rather than the recall of details. There are exams at the end of either a course, a course-block or a semester, but no final exams at the end of the degree programme.

Future Perspectives
Integration of clinical and basic sciences
Training in research methods by in depth studies
Student activating learning methods
Multi-professional integration
Skills lab
Student-run wards
Internationalisation of the curriculum
Elective periods
Clinical Attachments in "non-teaching hospitals", such as local hospitals and medical centres in a wider region. The aim is to ensure contacts with a broad range of health problems and to achieve a number of only one to three medical students on each ward or in an outpatient department.

Jean-Pierre WAUTERS - Medical Faculty - Lausanne

Number of medical faculties - Number of graduates
Switzerland (6.5 millions inhabitants) has 5 medical faculties, which are part of cantonal universities supported by cantonal and federal funds.

• Basel
• Bern
• Geneva
• Lausanne
• Zürich

In addition, two faculties of Sciences offer the possibility to start medical studies :

• Neuchâtel : only 1^st year
• Fribourg : 1^st and 2^nd year.

Approximately 1400 enter medical studies each year while approximately 800 students graduate every year.

Administration
All medical faculties are part of universities. All universities are supported by public funds. There is no private university or faculty of medicine in Switzerland. In contrast, post-graduate training is covered by a private medical professional association which is also in charge of the recently introduced obligatory continuing medical education.

National goals for undergraduate medical education
For more than 100 years, the medical studies are organized according to a federal law voted by the Parliament. Since 1995, with an individual federal derogation, the Faculties of Medicine of Geneva, Lausanne and later Bern and Basel have initiated a change in their medical curriculum. Each Faculty has planned its own reform. When compared to the previous discipline - oriented curriculum, it is more student - and community - oriented, going from exclusive PBL modules in Geneva, towards more integrated curricula combining PBL with ex-cathedra teaching in Lausanne, Bern and Basel.

A federal committee is presently working on a change of the federal law covering the medical pre-graduate education. An accreditation procedure of the pre-graduate medical teaching is now also being set-up at a national level as a pilot project during the following academic year.

Admission of students
So far, no numerus clausus existed in Switzerland. Due to the regular increase in the number of students entering medicine over the last years, a pre-university "test d'aptitude" is going to be applied during this summer. However this introduction is planned only for 4 Medical Faculties (Basel, Bern, Fribourg and Zurich), the 3 other Faculties dispensing the 1^st year curriculum which are not introducing this test, will increase the severity of the examinations at the end of the 1^st year. Despite the necessity of a national solution, the different cantonal laws governing the university education make a homogeneous approach still difficult.

Curriculum structure
The previous classical curriculum consisted of 2 years of basic sciences followed by 4 years of clinical sciences, among which 10 months are devoted to clinical clerkship. The federal committee planning the new law for medical education will probably favor integrated module-based curricula with annual examinations at the faculty level and federal exams at two steps of the medical studies (after 2 or 3 years and final exam). This new curriculum will combine obligatory and optional courses. These optional courses will consist of medical and non-medical disciplines. The ECTS credit system will be used.

Teaching and learning methods
While the traditional curriculum mostly consisted of ex-cathedra teaching and practical work, in the renovated curricula small group teaching and PBL sessions are also introduced.

Training settings
Clinical clerkships are organized during the 5^th or 6^th medical year. This take place in University hospitals, regional hospitals and in general practice offices.

Evaluation of students
In the classical curriculum examinations are still discipline - based; some discipline examinations organised at the federal level allow a comparison among different faculties.

Examinations are supervised by an "ad-hoc" federal committee and take place at the end of the 1^st, 2^nd, 3^rd and 6^th year.

Recently, in an attempt to reduce the number of medical students, only 2 examination sessions have been allowed for the students at the end of the 1^st and 2^nd year.

Present and future
Many things are changing in the medical education offered by the Swiss Medical Faculties : new curricula, a new federal law governing pre- and post-graduate medical education, a new accreditation procedure.

Therefore, the present situation is a period of transition and adaptation, where we try to remain as eurocompatible as possible.

Number of schools, number of graduates
Great Britain has 28 medical schools:

England

• Anglia
• Aston
• Bath
• Birmingham
• Bournemouth
• Bradford
• Brighton
• Bristol
• Brunel
• Cambridge
• Coventry
• Derby
• EdgeHill
• Essex
• Exeter
• Greenwich
• Guildford
• Hertfordshire
• Huddersfield
• Hull
• Keele
• Kent
• Kingston
• Lancaster
• Leeds
• Leicester
• Liverpool
• London
• Manchester
• Newcastle
• Norwich
• Salford
• York

Nothern Ireland

• Belfast
• Ulster

Scotland

• Aberdeen
• Dundee
• Edimburgh
• Glasgow
• Paisley
• St.Andrews

Wales

• Cardiff

Administration
After undergraduate education, one year of pre-registration and another 3 years of mandatory post-graduate training is necessary to qualify as general practioner. Specialist training consists of 2-6 years to become a Registrar, another 4 years to become a Senior Registrar.

Admission of students
For a great number of years, the United Kingdom has known how to regulate the flow of student admission in medicine, in relation to the number of positions offered by the National Health Service. Selection is strict with each university having its own rules. Most often, grades obtained for the General Certificate of Education and the entry examination organized by the university as well as the results of an interview are taken into consideration.

Curriculum contents
Generalized Medical Curriculum Great Britain (UK)

Pre-clinical SCIENCES
YEAR 1 AND 2
Biochemistry; Physiology; Anatomy; Histology and Cytology; Pathology; Microbiology; Genetics; Pharmacology
FIRST EXAMINATIONS CLINICAL SCIENCES and CLINICAL TRAINING

YEAR 3
Introduction to Clinical Disciplines; Clinical Bedside Teaching; Pathology; Microbiology; Pharmacology (repetitive tests) SECOND "FORMAL" EXAMINATIONS

YEAR 4
Emergency Surgery; Orthopaedics; General Medicine; Paediatrics; Gynaecology and Obstetrics; Psychiatry
ORAL AND WRITTEN TEST AFTER COMPLETION OF EACH DISCIPLINE

YEAR 5
FULL TIME HOSPITAL CLERKSHIPS IN: Internal Medicine; Surgery; Anaesthesiology
LAST ORAL AND WRITTEN EXAMINATION IN INTERNAL MEDICINE AND SURGERY MEDICAL DEGREE MD