Tuning medical education in Europe

Oviedo 10 May 2003Medical education must continuously adapt to changes in the relevant environment. In Europe some of the most important changes to be addressed include: 1) the reality that increasingly "external" factors affect health (e.g. smoking, traffic accidents) that are beyond the scope of medicine; 2) the increasing ageing of the population; and 3) the consequences of the increasing impact of the European Union (EU) on higher education. These issues were among those discussed at a recent joint meeting of Mednet2, an EU-sponsored "Socrates Thematic Network" of (European) medical schools (Majoor, 1998) and ECTS/ICMG, a network of approximately 40 medical schools that on request of the EU initially developed and tested a standardised European course credit transfer system (ECTS) (www.med-ects.org). The meeting was held on 9 and 10 May, 2003 and hosted by the Medical Faculty of the University of Oviedo, Spain.


Mednet2 was in charge of the programme for the first day of the meeting. In the first plenary address Dr. Charles Boelen emphasised the role of medical education in the perspective of health and societal needs. He made a plea for establishing partnerships between academic institutions and society; to initiate collaboration with stakeholders outside the university campus and for medical schools to take a more pro-active role in promoting health of the society by "educating doctors to meet people's needs". As he phrased it: "Medical schools have the obligation to direct education, research and service activities towards addressing the priority health concerns of the community, region or nation they have a mandate to serve." Dr. Boelen strongly advocated The Network: TUFH's stakeholders pentagram as the organisational framework to initiate changes from (Boelen, 2000).

As the next speaker, Dr. Vincenzo Costigliola, chair of the European Medical Association (EMA) stated, his talk was more to address the needs of doctors than that of patients. He had identified several current challenges for doctors in Europe like changing management of the health system, requirements for quality assurance e.g. by peer review, the need to participate in multicentric clinical trials and the need to respond to bioethics. EMA intends to assist doctors in meeting these challenges by improving post-graduate medical education, partly by organising courses itself but also by attempting to streamline the domain. For instance EMA had found in a survey of 15 European countries 280 different grades pertaining to post-graduate training levels - certainly a problem to be addressed in the EU!

Third and last speaker in this tryptich was Dr. Jan de Maeseneer, chair of the Department of General Practice at the Medical Faculty of Ghent University in Belgium. He listed changes in society also referred to in the second sentence of this report and added changes in patients' attitude like them being better informed, requiring shared decision-making, expecting full service and striving for the ideal health status. His school had adopted the five-star doctor profile (WHO, 1996) for the design of a new medical curriculum and following Kotter's "eight-stage process of creating major change" (Kotter, 1996) he described progress and problems encountered when introducing this new curriculum in Ghent.

In the late afternoon, due to the Spanish order of the day, Mr. Ad Emmen of the Lecturing Institute for Information Engineering in Almere, The Netherlands shared the experiences of GridSET, a project in the domain of e-learning (www.hoise.com:8081/exchange/vmp/articles/contentsstandard.html). The project's aim is to develop 3-D virtual reality software for the training of surgical procedures now including vertricular catheterisation, lumbar punction and laparoscopy. Preliminary research has indicated the effectiveness of these programmes in preparing surgeons for performing these procedures.

Second day's programme was arranged by the ECTS-ICMG group. In the plenary part Dr. Steve Adams from the University of Westminster elaborated on the implications of the 1999 Bologna Declaration - the European agreement to align continental higher education with the Anglosaxon Bachelor/Master format - for medical education (http://europa.eu.int/comm/education/socrates/erasmus/bologna.pdf). Adherence by universities to that declaration does not just imply adoption of a Bachelor/Master structure but also includes tuning of degrees and diploma supplements, adoption of a European Credits Accumulation and Transfer System (CATS), and convergence of quality assurance systems.

In some domains of higher education, but not yet in medicine, EU-sponsored "Tuning" projects have been launched to promote these processes (http://europa.eu.int/comm/education/tuning.html). The consequences of the implementation of the Bologna Declaration may come as a surprise to universities that fail to keep up. The expectation is that competition among higher education institutions all over Europe will greatly increase and the tradition of students preferring to study at the university closest to their parents' home will soon become part of history. These developments will soon also greatly affect medical education in Europe.


  • Majoor, G.D. (1998). MEDNET: A European Network of Medical Schools. Education for Health 11, 110-111.
  • Boelen, C. (2000). Towards unity for health. Challenges and opportunities for partnership in health development. Geneva: World Health Organization.
  • Kotter, J.P. (1996) Leading change. Boston: Harvard Business School press.
  • WHO (1996). Doctors for health. A WHO global strategy for changing medical education and medical practice for health for all. Geneva: World Health organization.

Gerard Majoor, Medical Education Institute, Maastricht University, The Netherlands

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