from traditional to outcome- based medical ... · pdf filefrom traditional to outcome-based...

RUHR-UNIVERSITÄT BOCHUMZENTRUM FÜR MEDIZINISCHE LEHRE

FROM TRADITIONAL TO OUTCOME-BASED MEDICAL EDUCATIONBASED MEDICAL EDUCATIONRESULTS OF A RANDOMIZED CONTROLLED TRIAL AT THE RUHR-UNIVERSITY BOCHUM, GERMANYThorsten Schäfer Study Dean, Centre for Medical Education

ZENTRUM FÜR MEDIZINISCHE LEHRE | 2

Europe @ NightEurope @ Night

Bochum

Ruhr-University BochumFacts

Degree Programmes: 150 55 Bachelor, 81 Master, 4 State exam / Ministry, 10 Other

Facilities20 Faculties10 Central Academic Facilities (ZWEs)7 Affiliated Institutes

Budget 2009 (incl. medicine, without clinics)about EUR 423 m EUR, h f l f di 92 EUR

7 Affiliated Institutes

Coordinated Research Programmes9 Collaborative Research Centres (SFBs and

therefrom external funding: 92.5 m EUR

Students Total: 31994 (Women: 48%) Term 2009/10

SFB/Transregio)4 Collaborative Research Centres -Cooperations6 (+15 cooperations) Research UnitsTotal: 31994 (Women: 48%) Term 2009/10

Employees (31.12.2009)Total: 5200

6 (+15 cooperations) Research Units3 (+2 cooperations) Research Training Groups5 Graduate School,15 Junior Research G393 Professors, 22 in Clinics;

40Juniorprofessors, 4 in Clinics2.440 Non-professorial academic staff; 2.323 Non-academic staff

Groups

International Partnerships and Special Co-operation Agreements: more than 350 p g


Impressions: Campus and Hospital


FactsFacts

The University Hospital

10 hospitalsat 6 locations

3.500 beds200 medical practices200 medical practices

| 7

Medical Studies in GermanyMedical Studies in Germany

PreclinicalStudies

Clinical Studies

Practi‐cal

ination

mination

2 years 3 years 1 yearate Exam

tate Exam

1st S

t

2nd St

9

Terminologie

practical seminar disciplines Cross‐sectional

Medical Studies in GermanyMedical Studies in Germany

12 Rehabilitation

Psychology11 Internal Med.

12 Pediatrics

13 ClinicalChem.

9 Clin.Pharmacol

10 Prevention

11 Imaging

Psychology

8 ENT Med.

9 Hum. Genetics

10 Hyg.Microbiol

21 Urology

22 Elective

8 Emergency M.

5 Surgery

6 Dermatology

7 Gynecology

18 Psychiatry

19 Psychosomat.

20 Legal Med.

Physics2 Anesthesiol.

3 Social Med.

4 Ophthalmol.

15 Orthopedics

16 Pathology

17 Pharmacol.

10

TerminologiePhysics

practical seminar

1 General Med. 14 Neurology

disciplines Cross‐sectional

The Medical CurriculumThe Medical Curriculum

Zweiter Abschnitt der Ärztlichen PrüfungÄrztlichen Prüfung

PJChirurgie

PJWahlfach

PJ Innere Med.

Psychiattrie

Innere Me

Chirurgie,

Konservativtrie

…Med…

e,…

Anam Patho Phar Patho

ative…

A t i Bi h i Ph i l iPsycholog./

Erster Abschnitt der Ärztlichen Prüfung‐nese ‐logie makol phys.

11Biologie

Anatomie Biochemie Physiologiey g /

Soziologie

Terminologie Chemie Physik

The Medical Curriculum IdeaThe Medical Curriculum Idea

Second State Exam

PYSurgery

PYElective

PY Internal Med.

Psychiati

Internal Me

Surgery

Conservativ

tricsMed.

ery

His‐ Patho Phar Patho

ative

A t Bi h i t Ph i lP h l

First State Examtory ‐logy macol phys.

12Biology

Anatomy Biochemist PhysiologyPsycholog.

Terminology Chemistry Physics

The Medical Curriculum RealityThe Medical Curriculum, Reality

PYSurgery

PY

Psychiattrics

PYElective

Internal Med.

AP h l mistry

t

13Biology

AnaPsycholog.

Terminology

Che

Physics

tomy

The Medical Curriculum Reality2The Medical Curriculum, Reality2

2nd State Examination

Surgery,

PYPsychiattry… Inte

… PYSurgery

PY

Physiology Psycholog.

rnal Med… PY

El ti

Internal Med.

AnaBiochemist

y gy y g

Clin. Chem.

Elective

tomy

14BiologyTerminology

Chemistry Physics Patho‐logy

Pathophys.

The Medical Curriculum2nd State Examination

The Medical Curriculum

15

Changes: from H to N“Changes: „from H to N

Basics1

Basics

Ärztliche Prüfung, 1. Abschnitt45 E i l t E “„Equivalent Exams“

- 3 MEQs, 2 OSCEs

Clinical Ärztliche Prüfung, 2. Abschnitt12

FEATURES OF A MODELL CURRICULUM

Replacement of the first state examby equivalent testsby equivalent tests

Different timing of trainings in nursing, first aid and elective clerkshipsand elective clerkshipsModification of the Practical YearInclusion of non-university hospitals and ambulatory care facilities in medical education

Research QuestionResearch Question

Is there a difference in the progress of basic science and clinical knowledge of students in a traditional (T) versus an integrated, problem-based (P) curriculum?Hypotheses:

T > P in basic sciencesT > P in basic sciences P > T in clinical knowledge

The CurriculaThe Curricula

TraditionalDiscipline-based

Integrated CurriculumProblem-based

Teacher-centeredMain Lectures

Student-centeredSelf-directed learning

SeminarsWritten exams (MCQ)

gSeminars

Formative feedback( Q)Practical Courses

Oral examsPractical Courses

Clinical integrationO a e a s C ca eg a o

Lots of changesLots of changes…

Theme-based CurriculumInterdisciplinary Modulesp yBochum Catalogue of Learning ItemsMedically Relevant Learning ObjectivesMedically Relevant Learning ObjectivesProblem-based Learning GM Internship ProgramFocus on

Communication Skills, Health Economics, ,Medical Ethics


Medical Studies: 2 WaysMedical Studies: 2 Ways

GOALOct. 01, 2010: 302 Students105 applied105 applied42 randomly chosen

START

O S t lti di i liOrgan Systems, multi-disciplinary

No lectures, buttime for self-directed learningg

Problem based LearningProblem-based Learning

1. Understanding2. Topics of Interest3. Brainstorming4. Hypotheses, Sorting5. Learning Objectives5. Learning Objectives

6. Selfdirected Learning

7. Discussion of Results

8 Feedback8. Feedback

Instrument: Progress Test in Medicine200-item Multiple-Choice-Test

66 items basic sciences: (32 physiology, 26 ( p y gyanatomy)

Level: End of studiesAt the beginning of each semester to all studentsstudentsDeveloped at the Charité and Uni W/H and

d b 7 i itiused by 7 universities

Study Design: RCTStudy Design: RCT

Randomized controlled trialN = 868 students in 3 cohortsN = 868 students in 3 cohorts

251 applied for the new PBL-curriculum122 d l l t d122 were randomly selected129 were assigned to the traditional curr. (Control group)group)

617 remaining students: traditional curr.Statistics: ANOVA, post-hoc Bonferroni

External Comparison: pInter-University Comparison of Total Scores

70

80%

] ***ext. RSM

60

70

wer

s[%

*** *** ***ext. MSMBochum RSMBochum MSM

40

50

ecta

nsw Bochum MSM

20

30

ofco

rre

0

10No.

§

1. Semester 3. Semester 5. Semester

Longitudinal Observation: Traditional – Problem-based

60

RSM

60

RSM

preclinical clinical

40

50

orre

ct]

RSMMSM-MSM+

40

50

corre

ct]

RSMMSM-MSM+

30

40

cien

ces

[%co

***

30

40

now

ledg

e[%

c

*

10

20

Basi

cS

c

10

20

Clin

ical

Kn

***

0

1. Sem. PTM09 3. Sem. PTM11 5. Sem. PTM 13

0

1. Sem. PTM09 3. Sem. PTM11 5. Sem. PTM 13

2003 2004 2005 2003 2004 20052003 2004 2005 2003 2004 2005

Cross Sectional Analysis 2005Cross Sectional Analysis 2005

40

50nc

es

40

50

wle

dge

preclinical clinical

30

40

asic

Scie

n

30

40

nica

lKno

w

*

20

tSco

reBa

20

Sco

reC

lin

**

**

0

10

%Te

st

0

10

%Te

stS

.PTM

13

.PTM

13

PTM

13

.PTM

13

.PTM

13

PTM

13

RSMMSM-

1.Se

m.

3.Se

m.

5.Se

m.

1.Se

m.

3.Se

m.

5.Se

m.

MSM+

Number of Successful Studentswithin Shortest Time

200101 15 30184 38 42

0,80 55 0 39 0 71

140

160

180

s

101 15 30184 38 42

1st5th0 5

0,6

0,7

s

0,55 0,39 0,71

80

100

120

Num

bers

0,3

0,4

0,5

%S

ucce

s

20

40

60

0,1

0,2

%

0

C P- P+

0,0

C P- P+

71 % in MSM+ versus71 % in MSM versus 39 % in MSM- and 55 % in RSM

SummarySummary

Equal achievements in basic sciences after 2 years (higher after 1 year in PBL) y ( g y )

Higher number of successful students in the PBL curriculumthe PBL-curriculum

Higher scores in clinical items in the PBL-gcurriculum

Further Educational Goals

In my opinion, my medical studies have enabled me…

Item 1: to make the physical situation of my patients base of my medical practice.

Item 2: to make the psychological situation of my patients base of my medical practice.

Item 3: to make the social situation of my patients base of my medical practiceto make the social situation of my patients base of my medical practice.

Item 4: to think and work in a scientific way.

Item 5: with general knowledge and skills in the field of diagnostics.

Item 6: with general knowledge and skills in the field of therapy.g py

Item 7: with general knowledge and skills in the field of health promotion and prevention.

k l d kill h bilit tiItem 8: with general knowledge and skills in the field of rehabilitation.

Item 9: with practical experience in dealing with patients, including the interdisciplinary approach to disease.

Item 10: with mental skills necessary for the primary care of patients.

Item 11: to conduct independent, continuous training, using modern information sources.

Item 12: to own decisions and solving problems.

Self-Assessement of 6th Year Students

physical

psychologicalProblem

social

Solving

socialCME

scientificPsychol Ab scientificPsychol. Ab.

DiagnosisPracticalE i

ThR h bilit ti

Experience

Therapy

Health Promotion

Rehabilitation

Assessment byTeachers

physical

psychologicalProblem

social

Solving

socialCME

scientificPsychol Ab scientificPsychol. Ab.

DiagnosisPracticalE i

ThR h bilit ti

Experience

Therapy

Health Promotion

Rehabilitation

Students‘Self-

Assessment

über- teil-Teachers‘

Assessmentwiegend weise

Studierende RSM Studierende MSM

triff tri

triff

triff tri

trifftrifft voll zu

ft überwiegend

ifft teilweise z

ft überhaupt nizu

trifft voll zu

ft überwiegend

ifft teilweise z

ft überhaupt nizu

d zu

u

icht

d zu

u

icht

1 - körperlich0 13,4% 63,9% 95,0% 5,0% 6,5% 74,2% 100,0% 0,0%

2 li h*** 6 7% 35 8% 92 5% 7 5% 16 1% 71 0% 100 0% 0 0%2 - seelisch*** 6,7% 35,8% 92,5% 7,5% 16,1% 71,0% 100,0% 0,0%

3 - sozial* 5,1% 28,0% 85,6% 14,4% 0,0% 51,6% 93,5% 6,5%

4 - wiss. Denken0 18,1% 48,0% 89,0% 11,0% 9,4% 62,5% 100,0% 0,0%, , , , , , , ,

5 - Diagnostik0 12,6% 50,4% 86,6% 13,4% 6,3% 65,6% 100,0% 0,0%

6 - Therapie0 6,3% 46,0% 86,5% 13,5% 0,0% 59,4% 96,9% 3,1%

7 - Gesundheitsförderung0 10,2% 51,2% 92,9% 7,1% 6,3% 56,3% 93,8% 6,3%

8 - Rehabilitation0 4,9% 23,6% 84,6% 15,4% 3,1% 37,5% 87,5% 12,5%

9 P kti h E f h *** 10 2% 47 2% 82 7% 17 3% 41 9% 83 9% 100 0% 0 0%9 - Praktische Erfahrung*** 10,2% 47,2% 82,7% 17,3% 41,9% 83,9% 100,0% 0,0%

10 - Psychische Fähigkeiten** 9,7% 36,3% 74,2% 25,8% 10,0% 70,0% 90,0% 10,0%

11 Fortbildung0 24 0% 56 0% 88 0% 12 0% 25 0% 75 0% 100 0% 0 0%

Büro für Studienreform MedizinRUHR-UNIVERSITÄT BOCHUM

38

11 - Fortbildung0 24,0% 56,0% 88,0% 12,0% 25,0% 75,0% 100,0% 0,0%

12 - Problemlösung*** 10,5% 41,1% 79,8% 20,2% 18,8% 84,4% 96,9% 3,1%

1-12 - Durchschnitt 11,0% 44,0% 86,4% 13,6% 11,9% 65,9% 96,5% 3,5%

Studierende RSM Studierende MSM

triff tri

triff

triff tri

trifftrifft voll zu

ft überwiegend

ifft teilweise z

ft überhaupt nizu

trifft voll zu

ft überwiegend

ifft teilweise z

ft überhaupt nizu

d zu

u

icht

d zu

u

icht

1 - körperlich0 13,4% 63,9% 95,0% 5,0% 6,5% 74,2% 100,0% 0,0%

2 li h*** 6 7% 35 8% 92 5% 7 5% 16 1% 71 0% 100 0% 0 0%2 - seelisch*** 6,7% 35,8% 92,5% 7,5% 16,1% 71,0% 100,0% 0,0%

3 - sozial* 5,1% 28,0% 85,6% 14,4% 0,0% 51,6% 93,5% 6,5%

4 - wiss. Denken0 18,1% 48,0% 89,0% 11,0% 9,4% 62,5% 100,0% 0,0%, , , , , , , ,

5 - Diagnostik0 12,6% 50,4% 86,6% 13,4% 6,3% 65,6% 100,0% 0,0%

6 - Therapie0 6,3% 46,0% 86,5% 13,5% 0,0% 59,4% 96,9% 3,1%

7 - Gesundheitsförderung0 10,2% 51,2% 92,9% 7,1% 6,3% 56,3% 93,8% 6,3%

8 - Rehabilitation0 4,9% 23,6% 84,6% 15,4% 3,1% 37,5% 87,5% 12,5%

9 P kti h E f h *** 10 2% 47 2% 82 7% 17 3% 41 9% 83 9% 100 0% 0 0%9 - Praktische Erfahrung*** 10,2% 47,2% 82,7% 17,3% 41,9% 83,9% 100,0% 0,0%

10 - Psychische Fähigkeiten** 9,7% 36,3% 74,2% 25,8% 10,0% 70,0% 90,0% 10,0%

11 Fortbildung0 24 0% 56 0% 88 0% 12 0% 25 0% 75 0% 100 0% 0 0%11 - Fortbildung0 24,0% 56,0% 88,0% 12,0% 25,0% 75,0% 100,0% 0,0%

12 - Problemlösung*** 10,5% 41,1% 79,8% 20,2% 18,8% 84,4% 96,9% 3,1%

1-12 - Durchschnitt 11,0% 44,0% 86,4% 13,6% 11,9% 65,9% 96,5% 3,5%

Correlation Self-Assessment vs. Scores

100

80

90

nde

60

70du

rch

Lehr

e

40

50

nsch

ätzu

ng d

r = 0 90***Lehrende RSM

20

30

Frem

dein r = 0,90

Eta2adj = 0,79

Lehrende MSM

0

10

0 10 20 30 40 50 60 70 80 90 100

r = 0,83***Eta2

adj = 0,66

40

0 10 20 30 40 50 60 70 80 90 100

Selbsteinschätzung der Studierenden

ConclusionsConclusions

Self-assessment and teachers‘ assessment show high correlations and similar strengthsshow high correlations and similar strengths and weaknesses.Goals achieved“ in practical experience„Goals achieved in practical experience,

problem solving skills, as well as psychological and social aspectspsychological and social aspects.Weaknesses in the field of rehabilitation. The survey is useful for developing theThe survey is useful for developing the curriculum.

Instrument: Progress Test in Medicine200-item Multiple-Choice-Test

66 items basic sciences: (32 physiology, 26 ( p y gyanatomy)

Level: End of studiesAt the beginning of each semester to all studentsstudentsDeveloped at the Charité and Uni W/H and

d b 7 i itiused by 7 universities

„Latest News“

Quelle: AG Progress Test


Quelle: AG Progress-TestCharité, 2010

Progress Test Medicine (PTM)Progress-Test Medicine (PTM)

70

50

60

er F

rage

n

30

40

g be

antw

orte

t

gesamt_MSMgesamt_RSMbgesamt_RSMn

10

20

% ri

chtig

0

1 2 3 4 5 6 7 8 9 10

Semester


PTM Preclinical QuestionsPTM – Preclinical Questions

70ag

en

50

60

klin

isch

er" F

ra

30

40

wor

tete

r "vo

rk

Vorklinik_MSMVorklinik_RSMbVorklinik_RSMn

10

20

richt

ig b

eant

w

0

% r

1 2 3 4 5 6 7 8 9 10

Semester


PTM Cross SectionalPTM – Cross Sectional

70

50

60

er F

rage

n

30

40

g be

antw

orte

te

QB_MSMQB_RSMbQB_RSMn

10

20

% ri

chtig

0

1 2 3 4 5 6 7 8 9 10

Semester


Clinical Pathology, Pharmacology, Radiology, Biometrics, Ethics,…

PTM ClinicalPTM - Clinical

70

50

60

er F

rage

n

30

40

g be

antw

orte

te

Klinik_MSMKlinik_RSMbKlinik_RSMn

10

20

% ri

chtig

0

1 2 3 4 5 6 7 8 9 10

Semester


Scores in the State Exam (09)Scores in the State Exam (09)

points

238 3

240.9240242

238.3

234236238240

229.7

228230232234

Punkte

224226228

( S )f SRegelstudiengang (RSM)Referenzkohorte RSMModellstudiengang


Proportion of Fast Students“Proportion of „Fast Students

32,7 % 47,6 %


3 , % ,6 %

Alumni SurveyAlumni-Survey

PositiveGroup dynamics

NegativePerceived missingGroup dynamics

Interaction trainingPerceived missing basics in pharmacologyEarly contact with

patients

pharmacology, pathology, anatomypatients

Context learning Compulsory attendance

Supportattendance


Summary:New Curriculum

Higher efficiency: more graduates withHigher efficiency: more graduates, with same levels of scoresBasic science knowledge: same achievements, higher scores at end of gstudiesClinical and soft“ skills: higher scoresClinical and „soft skills: higher scores


The FutureThe Future

Combination of the two tracks Scientific and practicalScientific and practicalInterdisciplinary and theme-orientedP bl b dProblem-based


Quality ManagementQuality Management

Common Goals, Guide-Lines, Specifications

OperationalizedLearning Objectives

Medical Teachers‘ Training Program

| 54

Skills LabsSkills-Labs

Blended Learning, eTutors, U-Tutors, curricular Teaching

| 55

Performance-based Allocation of Funds

2,0

1,0

note

(1 -

5)

n=6 n=6

20

)

4,0

3,0

Schu

ln

Uni Ext

p>0,36

10

15

-Sco

re (m

ax. 2

0)

Uni

Uni Ext

Studentische Evaluation[n: Fach x Haus]

Innere, Chirurgie, Gyn.

0

5P

unkt

e- AKL

Studentische Evaluation, Sommer 2009, PJ Innere MedizinMittelwerte der Häuser

| 56

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