[Joint Medical Master University of Lucerne and University of Zurich]. / Joint Master Medizin Universität Luzern und Universität Zürich.

Joint Medical Master University of Lucerne and University of Zurich Abstract. The medical education in Switzerland is changing. On the one hand, the new, competence-based catalogue of learning objectives PROFILES has to be implemented. On the other hand, new training locations and cooperations have been created within the context of the special program 'Increasing the number of degrees in human medicine'. One of these cooperations is the Joint Medical Master of the Universities of Lucerne and Zurich. Since 2017, students have had the opportunity to complete their Bachelor's degree at the University of Zurich in the 'Lucerne Track'. In the subsequent joint Master's program (start fall semester 2020), the approximately 40 students are primarily enrolled at the University of Lucerne, which together with its partner institutions in the health care region of Central Switzerland offers about two thirds of the courses. At the University of Lucerne, which has a strong emphasis on social and human sciences, the Department of Medicine is part of the Department of Health Sciences and Medicine and focuses on a holistic, interdisciplinary understanding of health, illness and human functioning. In the training of medical students, the Joint Medical Master primarily offers interactive, practice-oriented courses in small groups, based on the new catalogue of learning objectives, and uses innovative didactic concepts and digital learning programs. The Lucerne curriculum focuses on interprofessional education, especially with health science students, as well as basic medical care and the interface between in- and outpatient care, respectively. In the last year of the course, which is currently in its final development phase, the topics of emergency medicine and patient safety will be a particular focus. Due to the manageable cohort size, the Joint Medical Master in Lucerne offers a family environment and a close exchange between students and lecturers. The students are involved in the further development of the curriculum as well as in the evaluation of the courses, and the lecturers are prepared as well as possible for their teaching duties by continuing medical education events. In the medium term, the University of Lucerne would also like to focus more on the continuum of pre- and postgraduate training, and to network nationally and internationally in the medical education landscape.

The introduction of a standardised national licensing exam as a driver of change in medical education: A qualitative study from Switzerland.

INTRODUCTION: Only a few studies have described the impacts, strengths and needs for further development of national licensing exams (NLE). To gain such insights regarding the Swiss NLE, which includes a multiple-choice and a standardised clinical skills exam, we explored the perceptions of involved experts and stakeholders. METHODS: We explored participants' perceptions in four focus group discussions. The interviews were recorded, transcribed verbatim and qualitatively analysed using a thematic analysis approach. RESULTS: The analysis resulted in five perceived impacts, two strengths and two needs for further developments of the NLE. Perceived impacts were (1) steering students' learning behaviour, (2) supporting teachers and assessors to align teaching to competencies, (3) elevating the importance of the Swiss Catalogue of Learning Objectives, (4) setting incentives for the further development of curricula, and (5) fostering the collaboration between the faculties of medicine. Perceived strengths were the blend of assessment formats, including their competency-based orientation, and the collaborative development approach. Perceived needs lay in the NLE's further development to sustain its fit for purpose and in incentives for people involved. CONCLUSION: According to our study, this NLE had, and has, notable impacts on medical education in Switzerland. Our insights can be useful for others planning a similar undertaking.

Looking back: twenty years of reforming undergraduate medical training and curriculum frameworks in Switzerland.

Introduction: To date, hardly any reports exist that outline the reforms in medical studies in Switzerland from the first partial reforms in the 1970s until today. Methods: This article outlines the recent history of medical curricula, their reforms in the early 1970s and, based on these, the key reasons for the major curricular reforms of the 2000s from the perspective of the authors. Results: The various projects, initiatives and legislative elements at the national level include the introduction of new quality control instruments - federal examination and programme accreditation, the introduction of a national catalogue of learning objectives and its two follow-up editions, as well as the implementation of the Bologna reform in undergraduate medical curricula. Examples of the key new elements found in all medical training in Switzerland include: the interdisciplinary orientation of learning content in organ and functional system-oriented subject areas or modules, the enhanced valorisation of practical clinical training, as well as the introduction of problem-oriented formats and the integration of partly formative, partly summative exams according to the format of the objective structured practical examination (OSCE). Characteristics unique to the four medical faculties and their medical training programme are also highlighted. Discussion: The described projects, initiatives and legislative elements have led to a dynamic, continuous development of medical curricula in Switzerland. The close cooperation between the faculties and the Federal Office of Public Health (FOPH) has also resulted in a redefinition of the roles and responsibilities of universities and the Federal Government according to the new Law on Medical Professions. This guarantees the medical faculties a great deal of autonomy, without neglecting quality assurance.

[Effects of examinations on learning and the curriculum: A position from Switzerland]. / Lern- und curriculumsteuernde Effekte von Prüfungen: Eine Standortbestimmung aus der Schweiz.

The federal law for higher academic medical professions (MedBG) constitutes a program accreditation as well as a federal licensing exam in medicine; both instruments influence the curricula and their further development.Parallel to the Bologna reform in Switzerland for all university degrees the federal licensing exam in medicine has been revised. The swiss catalogue of learning objectives (SCLO, 2nd edition 2008) served as mandatory content reference for the exam and initiated numerous curricular developments. The new federal licencing exam has been implemented in 2011 comprising a MCQ-Part and a structured clinical practical exam in the OSCE format. Particularly this exam triggered the introduction of OSCEs in Zürich as well as in other Swiss universities.The latest national initiative to increase the number of medical students and the introduction of the new edition of the catalogue of learning objectives in 2017 will have relevant effects on curricular developments in Switzerland.

How the Start into the Clinical Elective Year Could be Improved: Qualitative Results and Recommendations from Student Interviews.

Background: Entering the Clinical Elective Year (CEY) is a challenging transition phase for undergraduate medical students. Students become members of a professional team, thereby taking over certain tasks, which are executed more or less independently. Factors which facilitate (or impede) this transition in the perception of students are not well described. We therefore wanted to explore, what students perceived to be helpful during the first phase of the CEY and possibly derive respective recommendations. Methods: We conducted semi-structured interviews with 5th year medical students after they had completed the first two months of their CEY. Students were asked which problems they had faced and how they felt prepared for the CEY. Interviews were audio-recorded, transcribed, and analysed by qualitative content analysis. Results: From 34 interviews, we included 28 into analysis. Overall, 24 students were satisfied or very satisfied with their start into the CEY. Satisfaction was expressed with respect to workplace experiences, learning progress, responsibilities and team integration. Especially, students appreciated if they were integrated as active members of the team, were given responsibility for certain units of work, and received well-structured formal teaching and supervision. Students had divergent opinions about the quality of teaching and supervision, about their own achievements, and the recognition they received. Students recommended improvements in respect to formal teaching and supervision by clinical supervisors, preparation of the CEY by university, and supporting structures in the hosting institution. Conclusion: Students in this study were generally satisfied with the first two months of their CEY. Facilitating factors were active and responsible involvement into routine patient care, and high quality formal teaching and supervision. Findings may inform universities, teaching hospitals, and students how to better shape the first phase of the CEY.

The Learning Objective Catalogue for Patient Safety in Undergraduate Medical Education--A Position Statement of the Committee for Patient Safety and Error Management of the German Association for Medical Education.

BACKGROUND: Since the report "To err is human" was published by the Institute of Medicine in the year 2000, topics regarding patient safety and error management are in the focal point of interest of science and politics. Despite international attention, a structured and comprehensive medical education regarding these topics remains to be missing. GOALS: The Learning Objective Catalogue for Patient Safety described below the Committee for Patient Safety and Error Management of the German Association for Medical Education (GMA) has aimed to establish a common foundation for the structured implementation of patient safety curricula at the medical faculties in German-speaking countries. METHODS: The development the Learning Objective Catalogue resulted via the participation of 13 faculties in two committee meetings, two multi-day workshops, and additional judgments of external specialists. RESULTS: The Committee of Patient Safety and Error Management of GMA developed the present Learning Objective Catalogue for Patient Safety in Undergraduate Medical Education, structured in three chapters: Basics, Recognize Causes as Foundation for Proactive Behavior, and Approaches for Solutions. The learning objectives within the chapters are organized on three levels with a hierarchical organization of the topics. Overall, the Learning Objective Catalogue consists of 38 learning objectives. All learning objectives are referenced with the National Competency-based Catalogue of Learning Objectives for Undergraduate Medical Education. DISCUSSION: The Learning Objective Catalogue for Patient Safety in Undergraduate Medical Education is a product that was developed through collaboration of members from 13 medical faculties. In the German-speaking countries, the Learning Objective Catalogue should advance discussion regarding the topics of patient safety and error management and help develop subsequent educational structures. The Learning Objective Catalogue for Patient Safety can serve as a common ground for an intensified, constructive, subject-specific discussion about these topics at the medical faculties, and guide the implementation of hopefully multiple patient safety curricula in undergraduate medical education.

The new final Clinical Skills examination in human medicine in Switzerland: Essential steps of exam development, implementation and evaluation, and central insights from the perspective of the national Working Group.

OBJECTIVE: Since 2011, the new national final examination in human medicine has been implemented in Switzerland, with a structured clinical-practical part in the OSCE format. From the perspective of the national Working Group, the current article describes the essential steps in the development, implementation and evaluation of the Federal Licensing Examination Clinical Skills (FLE CS) as well as the applied quality assurance measures. Finally, central insights gained from the last years are presented. METHODS: Based on the principles of action research, the FLE CS is in a constant state of further development. On the foundation of systematically documented experiences from previous years, in the Working Group, unresolved questions are discussed and resulting solution approaches are substantiated (planning), implemented in the examination (implementation) and subsequently evaluated (reflection). The presented results are the product of this iterative procedure. RESULTS: The FLE CS is created by experts from all faculties and subject areas in a multistage process. The examination is administered in German and French on a decentralised basis and consists of twelve interdisciplinary stations per candidate. As important quality assurance measures, the national Review Board (content validation) and the meetings of the standardised patient trainers (standardisation) have proven worthwhile. The statistical analyses show good measurement reliability and support the construct validity of the examination. Among the central insights of the past years, it has been established that the consistent implementation of the principles of action research contributes to the successful further development of the examination. CONCLUSION: The centrally coordinated, collaborative-iterative process, incorporating experts from all faculties, makes a fundamental contribution to the quality of the FLE CS. The processes and insights presented here can be useful for others planning a similar undertaking.

Clinical training in the clinical electives year in the medical curricula in Switzerland - considerations regarding content and structure.

With their publication on quality management of clinical-practical instruction for Practical Year medical students in Germany and the preparation of a catalogue of criteria, Raes et al. tackle questions, both in terms of content and structural framework, in a current and relevant subject area [1]. The following commentary provides an additional outline of the current situation of clinical-practical instruction during the so-called "clinical electives year" in Switzerland, which broadly corresponds to the Practical Year in Germany.

The new licencing examination for human medicine: from concept to implementation.

A new Swiss federal licencing examination for human medicine (FLE) was developed and released in 2011. This paper describes the process from concept design to the first results obtained on implementation of the new examination. The development process was based on the Federal Act on University Medical Professions and involved all national stakeholders in this venture. During this process questions relating to the assessment aims, the assessment formats, the assessment dimensions, the examination content and necessary trade-offs were clarified. The aims were to create a feasible, fair, valid and psychometrically sound examination in accordance with international standards, thereby indicating the expected knowledge and skills level at the end of undergraduate medical education. Finally, a centrally managed and locally administered examination comprising a written multiple-choice element and a practical "clinical skills" test in the objective structured clinical examination (OSCE) format was developed. The first two administrations of the new FLE show that the examination concept could be implemented as intended. The anticipated psychometric indices were achieved and the results support the validity of the examination. Possible changes to the format or content in the future are discussed.

Bologna in Medicine Anno 2012: experiences of European medical schools that implemented a Bologna two-cycle curriculum--an AMEE-MEDINE2 survey.

BACKGROUND: The 1999 Bologna Agreement implies a European harmonization of higher education using three cycles: bachelor and master before doctorate. Undergraduate medical programmes were restructured in only seven of the 47 countries. AIM: Given the debate about a two-cycle system in undergraduate medical education, providing an overview of experiences in medical schools that applied this structure was the purpose of this investigation. METHODS: In 2009, an AMEE-MEDINE2 survey was carried out among all the 32 medical schools that applied the two-cycle system in medicine. At the end of 2011, a member-check validation using a draft manuscript was carried out to complete an accurate up-to-date impression. RESULTS: All the 32 schools responded initially; 26 schools responded to the second round. All schools had implemented the two-cycle system (all but one in a 3 + 3 year model) with hardly any problems. All reported smaller or larger curriculum improvements, often triggered, but not caused, by the two-cycle system. No school reported that introducing the system interfered with any desired curriculum development, particularly horizontal or vertical integration. CONCLUSION: In 32 of the 442 medical schools in Bologna signatory countries, introducing a two-cycle model for basic medical education was successfully completed. However, harmonization of medical training in Europe requires further international collaboration.

The clinical electives year in undergraduate medical training in Switzerland: an overview.

In Switzerland undergraduate medical training has undergone several reforms over the last decade which also affected the integration, the structure as well as the learning content of the so-called "Wahlstudienjahr" (clinical electives year). The first section of this paper gives a short overview of the current status of the clinical electives year in Switzerland. In the second section some descriptive data concerning the Faculty of Medicine in Zurich are summarized to exemplify current and future aspects of the quality development in the clinical electives year in Switzerland.

Quality assurance of medical education: a case study from Switzerland.

In the light of ongoing changes and challenges in the European health systems which also have significant implications for undergraduate medical education, the present paper describes the accreditation of medical education programmes in Switzerland focussing on undergraduate medical education. A summary of the methodology used is provided and first experiences as well as future perspectives are discussed in the light of the aim to achieve continuous quality assurance and improvement in medical education.

Cognitive and emotional processing at high altitude.

INTRODUCTION: Exposure to altitude reduces oxygen supply to the central nervous system and may cause a variety of neuropsychological impairments. We investigated the relationship between certain cognitive functions and cardiovascular and respiratory variables during acute hypobaric hypoxia. METHODS: There were three groups of seven men who were each exposed to a 2-h altitude profile (AP) involving 30 min at each of the following simulated altitudes (m): AP1, 450-1500-3000; AP2, 450-1500-4500; Control 450-650-650. The neuropsychological tests included word fluency and three word-association tasks tapping processes of cognitive flexibility and emotion regulation. A lateralized tachistoscopic lexical decision task with high and low emotional target words was also administered to assess possible shifts in hemispheric superiorities for positive and negative affect. RESULTS: No significant differences in word fluency, word association, or lateralized lexical decision performances were found, despite a significant oxygen desaturation and a drop in diastolic BP at 4500 m, indicating the beginning of central hypoxia in terms of a functional impairment of the vasomotor center. CONCLUSION: During acute exposure to hypobaric hypoxia, selected cognitive and affective functions mediated by the frontal lobe were preserved. Functional hemispheric asymmetries for emotional processes remained unchanged.

Influence of altitude exposure on coronary flow reserve.

BACKGROUND: Although no data exist on the effect of altitude exposure on coronary flow reserve (CFR), patients with coronary artery disease (CAD) are advised not to exceed moderate altitudes of approximately 2500 m above sea level. We studied the influence of altitude on myocardial blood flow (MBF) in controls and CAD patients. METHODS AND RESULTS: In 10 healthy controls and 8 patients with CAD, MBF was measured by positron emission tomography and 15O-labeled water at rest, during adenosine stress, and after supine bicycle exercise. This protocol was repeated during inhalation of a hypoxic gas mixture corresponding to an altitude of 4500 m (controls) and 2500 m (CAD). Workload was targeted to comparable heart rate-blood pressure products at normoxia and hypoxia. Resting MBF increased significantly in controls at 4500 m (+24%, P<0.01) and in CAD patients at 2500 m (+24%, P<0.05). Altitude had no influence on adenosine-induced hyperemia and CFR. Exercise-induced hyperemia increased significantly in controls (+38%, P<0.01) at 4500 m (despite a reduction in workload, -28%, P<0.0001) but not in CAD patients at 2500 m (moderate decrease in workload, -11%, P<0.05). Exercise-induced reserve was preserved in controls (+10%, P=NS) but decreased in CAD patients (-18%, P<0.005). CONCLUSIONS: At 2500 m altitude, there is a significant decrease in exercise-induced reserve in CAD patients, indicating that compensatory mechanisms might be exhausted even at moderate altitudes, whereas healthy controls have preserved reserve up to 4500 m. Thus, patients with CAD and impaired CFR should be cautious when performing physical exercise even at moderate altitude.

Characteristics of the ventilatory response in subjects susceptible to high altitude pulmonary edema during acute and prolonged hypoxia.

The present study compares the changes in ventilation in response to sustained hypobaric hypoxia and acute normobaric hypoxia between subjects susceptible to high altitude pulmonary edema (HAPE-S) and control subjects (C-S). Seven HAPE-S and five C-S were exposed to simulated high altitude of 4000 m for 23 h in a hypobaric chamber. Resting minute ventilation (V(E)), tidal volume (V(T)), and respiratory frequency (f(R)), as well as the end-tidal partial pressures of oxygen (P(ET(O2))) and carbon dioxide (P(ET(CO2))) were measured in all subjects sitting in a standardized position. Six measurement periods were recorded: ZH1 at 450 m at Zurich level, HA1 on attaining 3600 m altitude, HA2 after 20 min at 4000 m, HA3 after 21 h and HA4 after 23 h at 4000 m altitude, and ZH2 immediately after recompression to Zurich level. At ZH1 and HA3, the measurements were first done in lying, then in sitting, and afterwards in standing. Peripheral arterial oxygen saturation (Sa(O2)) was continuously recorded. All respiratory parameters were also measured during exercise lasting 30 min, the work load being 50% of maximal oxygen consumption (V(O2max)) at Zurich level and 26% of the Zurich V(O2max) at 4000 m. V(E), P(ET(O2)) and P(ET(CO2)) did not significantly differ between HAPE-S and C-S at rest and during exercise periods at Zurich level and at high altitude. However, Sa(O2) was significantly lower in HAPE-S than in C-S at rest and during exercise at 4000 m. Breathing through the mouthpiece during ventilation measurements increased significantly the Sa(O2) in HAPE-S in posture tests at HA3. This effect was most pronounced in the supine posture, in which HAPE-S had the lowest Sa(O2) values. These data provide evidence that (1) gas exchange might be impaired on the level of ventilation-perfusion mismatch or due to diffusion limitation in HAPE-S during the first 23 h of exposure to a simulated altitude of 4000 m, and (2) contrary to C-S, the Sa(O2) in HAPE-S is significantly affected by body position and by mouthpiece breathing.