A scientific approach to the reform of a medical curriculum : A personal account of the Vienna experience.

Planning and implementing a new curriculum at the Medical Faculty of the University of Vienna was a bold attempt to use a scientific approach. A curriculum of sequentially presented and departmentally controlled subject areas using oral examinations was replaced with horizontally and vertically integrated organ/function modules. The reform also introduced integrated written year-end examinations, a required research thesis, stronger clinical orientation starting already in the 1st semester and more elective components. The starting point, preparatory work, the legal framework, as well as the formal planning process from January 1998 until October 2001 are described and explained.

Tuning research competences for Bologna three cycles in medicine: report of a MEDINE2 European consensus survey.

Medical curricula, like healthcare systems and medical practice, have a strong cultural component and vary considerably between countries. Increasing mobility of medical graduates, and increasing pressure to ensure they are all fit for practice, have highlighted an urgent need to establish common ground in learning outcomes at all stages of training. A research-based approach, developed by the Tuning project, was used previously by the MEDINE Thematic Network to gain consensus on core learning outcomes/competences for primary medical degrees ( www.tuning-medicine.com ), but no consensus was reached for learning outcomes relating to research. As part of MEDINE2, a focussed Tuning project was undertaken to explore opinions on more detailed core learning outcomes in research for all three Bologna cycles (Bachelor, Master, and Doctor). Responses from 417 stakeholders, representing 29 European and 13 non-European countries, revealed a relatively high degree of consensus. The findings strongly suggest that these stakeholders think that learning outcomes related both to 'using research' and 'doing research' should be core components of medical curricula in Europe. The challenge now, however, is to promote further local and international discussion on these issues, and to find ways of achieving these competences within the context of already crowded medical curricula.

Team-based learning in intensive course format for first-year medical students.

AIM: To examine the impact of team-based learning (TBL) on educational outcomes in the first year of the curriculum of the Medical University of Vienna. METHODS: TBL was first offered to students as a single-group exercise to illustrate the value and dynamics of a learning team. In a second step, TBL was provided in an intensive course format with six 2-hour sessions over a 3-day period as an elective course covering the material of a critical teaching block. Students' responses to the program and the impact on the final exam were analyzed. RESULTS: Out of 1417 eligible students, 386 participated in 8 parallel courses offered in the TBL block. The reaction of students to TBL was highly positive. Using the final exam as an outcome measure, 220 students who completed the intensive courses had a 25.3% higher score (non-TBL vs TBL students: 22+/-9 vs 28+/-9 points) in the TBL block. They also had a 16.5% higher score (non-TBL vs TBL students: 94+/-29 vs 109+/-26 points) in the remaining 5 non-TBL blocks of the year. CONCLUSIONS: TBL in an intensive course format seems to be especially attractive for the best students of the year, making them even more successful in the key exam. Even the students who usually learned alone highly appreciated learning in teams, thereby developing the understanding and skills needed to work productively in task-groups.

A comprehensive assessment of medical schools in Bosnia and Herzegovina.

OBJECTIVES: To perform internal and external evaluations of all 5 medical schools in Bosnia and Herzegovina against international standards. METHODS: We carried out a 2-stage survey study using the same 5-point Likert scale for internal and external evaluations of 5 medical schools in Bosnia and Herzegovina (Banja Luka, Foca/East Sarajevo, Mostar, Sarajevo and Tuzla). Participants consisted of managerial staff, teaching staff and students of medical schools, and external expert assessors. Main outcome measures included scores on internal and external evaluation forms for 10 items concerning aspects of school curriculum and functioning: 'School mission and objectives'; 'Curriculum'; 'Management'; 'Staff'; 'Students'; 'Facilities and technology'; 'Financial issues'; 'International relationships'; 'Internal quality assurance', and 'Development plans'. RESULTS: During internal assessment, schools consistently either overrated their overall functioning (Foca/East Sarajevo, Mostar and Tuzla) or markedly overrated or underrated their performance on individual items on the survey (Banja Luka and Sarajevo). Scores for internal assessment differed from those for external assessment. These differences were not consistent, except for the sections 'School mission and objectives', 'Curriculum' and 'Development plans', which were consistently overrated in the internal assessments. External assessments was more positive than internal assessments on 'Students' and 'Facilities and technology' in 3 of 5 schools. CONCLUSIONS: This assessment exercise in 5 medical schools showed that constructive and structured evaluation of medical education is possible, even in complex and unfavourable conditions. Medical schools in Bosnia and Herzegovina have successfully formed a national consortium for formal collaboration in curriculum development and reform.

Computer literacy and attitudes towards e-learning among first year medical students.

BACKGROUND: At the Medical University of Vienna, most information for students is available only online. In 2005, an e-learning project was initiated and there are plans to introduce a learning management system. In this study, we estimate the level of students' computer skills, the number of students having difficulty with e-learning, and the number of students opposed to e-learning. METHODS: The study was conducted in an introductory course on computer-based and web-based training (CBT/WBT). Students were asked to fill out a questionnaire online that covered a wide range of relevant attitudes and experiences. RESULTS: While the great majority of students possess sufficient computer skills and acknowledge the advantages of interactive and multimedia-enhanced learning material, a small percentage lacks basic computer skills and/or is very skeptical about e-learning. There is also a consistently significant albeit weak gender difference in available computer infrastructure and Internet access. As for student attitudes toward e-learning, we found that age, computer use, and previous exposure to computers are more important than gender. A sizable number of students, 12% of the total, make little or no use of existing e-learning offerings. CONCLUSION: Many students would benefit from a basic introduction to computers and to the relevant computer-based resources of the university. Given to the wide range of computer skills among students, a single computer course for all students would not be useful nor would it be accepted. Special measures should be taken to prevent students who lack computer skills from being disadvantaged or from developing computer-hostile attitudes.

Temptation of academic medicine: second alma mater and "shared employment' concepts as possible way out?

Apparently, in developing and in well-developed societies we are confronted with a crisis of academic medicine in all aspects: health care, teaching, and research. Health care providers in teaching hospitals are under pressure to generate revenues, academic research is pressed to keep pace with institutions devoted solely to research, and teaching is often understood not as privilege and honor but as burden and nuisance. The key problem and the principal cause of the crisis are low interest of the best young graduates to follow an academic career in a world where the benefits and values of the private sector are prevailing. Confronted with these circumstances and the continuous perils of permanent brain-drain, we developed an innovative concept of "shared employment' where two academic institutions (one in a developed and one in a developing country) will collaborate in development and support of fresh talents, building elite academic staff. Most academic exchange programs developed so far have proved to be ineffective and of poor vitality, in spite of loud exclamations, high expectations, and a huge amount of good will involved. In contrast, the suggested cooperation will be based exclusively on mutual interest and clearly defined benefits for all involved parties.

Reform of medical education in Bosnia-Herzegovina: luxury or necessity?

We present the current status of medical education in Bosnia-Herzegovina to set the stage for the curriculum reform. Two principal questions are asked: is the reform necessary, and is it possible? In spite of the differences in size and tradition of medical schools in Bosnia and Herzegovina (BH), they have more features in common than not: all of them are under internal and external pressures for change and reform, which will eventually be inevitable. The history and strategy of reform in Heidelberg, Germany, and Vienna, Austria, are described and recommendations are made on the basis of their experience. The consensus on the need for reforms has to be reached by all parties involved, ie, faculty, administration, students, and the medical community. After that, the reform process must proceed according to the agreed timetable. The job should be delegated to a dedicated task force and work coordinated through the ongoing "Dictum" project, directed exclusively at reform of medical curricula in BH. The project is funded by a European Union TEMPUS program.