porto 23 – 24 /2 2007 bologna – the swiss case peter m. suter, geneva
TRANSCRIPT
Porto 23 – 24 /2 2007
Bologna – the Swiss case
Peter M. Suter, Geneva
Bologna in medicine: the Swiss case. Chapters of my presentation:
Swiss university landscape National and regional governance Medicine: reform since 1995 -
PBL, student autonomy, medical humanities Bologna as an opportunity to improve teaching
and training of doctors for tomorrow One step further: earlier specialisation
Swiss Academy of Medical Sciences
Foundation created by the Swiss Medical Faculties in 1947, supported + financed by the Federal governement
Moral instance for ethical questions and the limits of medicine in general
Edicts guidelines and directives for common problems and border areas Examples: Palliative medicine, definition of brain death, human dignity and limits for clinical research, role and training for ethical committees, etc.
Switzerland: 7.5 million inhabitants - - 12 Universities
●
Swiss Universities:
Have different sizes and budgets
Swiss Universities: governance and finances
2 Technical Universities: national governance (Council, headed by an academic manager) + financed by national budget
10 Cantonal Universities: governance, structure and management depending on cantonal laws, regulations, budgets and political bodies (and humors)
5 Medical Faculties within Cantonal Universities, coordination of teaching aspects by Swiss Medical Interfaculty Commission
Auto-financed5,3 %
Cantonal budget, DIP43,5 % Cantonal budget, non-DIP
7,4 %
Nationalallocation
18,6 %SNRF 9,3 %
Other non-public16 %
Sources of finances: University of Geneva
AH/pt 23.11. 2005Source: Budget 2005
12 Swiss Universities + 5 Medical Faculties
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Medicine in Switzerland
Good results and accessibility Expensive health care services Shortage of Swiss MDs and other health care
professionals Reform in curriculum (1995), Bologna (2006) A new law for medical professions
Health care expendiures in % of GDP (gross domestic product), 1990 - 2004
Kocher G. Schweizerische Ärztezeitung (BMS) 87: 1649-52, 2006.
High costs of health care …
Numerus clausus introduced –
- but only in the German speaking part of Switzerland
300
400
500
600
700
800
900
1997 1998 1999 2000 2001 2002 2003 2004
Total
Femmes
Hommes
Number of medical diplomas per year Switzerland 1997 - 2004
P.M. Suter / ea, selon statistiques Facultés de Médecine suisses, 2002
2003
7’000 650
11’000 7’000 4’000
36 %
14’000
2005
7’000 623
12’000 6’500 5’500
46 %
15’000
1995-2000
5 Medical Faculties- Students 8’000
- Diplomas per year 800
Posts, hospital physicians 10’000 - occupied with Swiss diplomees 7’000
- with foreign diplomees 3’000 or ... 30 %
Physicians in private practice 13’000
Students in medicine, diplomas, and MDs in Switzerland
In Medicine, in the 15 years before Bologna, important things happened:
The expectations of students, patients and society have changed markedly, imposing
The reform of the curriculum, which produced an earthquake (happening in a number of dynamic institutions), and
New law defining training for the medical professions prepared
Reform of the curriculum – 1990ies
Why ?
Student dissatisfaction + insufficient results Changes in societal expectations New concepts: soft sciences, student autonomy Initiative of a few « young turks » in the faculty:
let’s take the « taureau par les cornes »
Medical practice – societal demands in Switzerland, late nineties
Care of the patient in a global way Good communication and a relation of con-
fidence with the patient and his family Provide benefit for the patient and the society: maximal care, economy, efficiency Observe and react to new demands . . (demography, etc)
… the scientific evidence linking biological, behavioural, psychological and
social variables to health, illness and disease is impressive …
US Institute of Medicine (IOM), March 2004www.iom.edu
www.nap.edu/books/030909142X/html/
Improving medical education, enhancingthe behavioural and social science
of medical school curricula
• Hard sciences: anatomy, physiology, microbiology, pharmacology.
• Soft sciences: behavioural, psychological and social factors, physician role and behaviour, physician-patient interactions, efficient communication, health policy and economics.
• The importance of soft sciences must be increased during all phases of training.
Editorial, Lancet 2004, 363: 1247
The soft science of medicine
Reform of Swiss Medical Curriculum 1995 - 2005
More human and social sciences. Increased student autonomy + responsability Problem based learning (PBL) Increased clinical contact from the beginning
of the pregraduate formation – - follow-up of chronic patients - contact with community medicine
Clinical skills and Savoir-être ….
The reform in medical education includes:
Integration of basic and clinical disciplines to facilitate problem-based learning (PBL)
Recognition of social, ethic and community aspects of medicine Inclusion of economic and cost-effectiveness
domains Development of clinical skills and self-recognition (« savoir-être ») Promotion of autonomous learning and life-
long training
Reformed Medical Curriculum, Genève
Example 1st Year 2004/2005
Wave of the reform from and to the 5 Swiss Medical Faculties
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http://www.iawf.unibe.ch/slo/+ the creation of a catalogue
of learning objectives
http://www.
iawf.unibe.ch/slo/
Leitmotiv – New Swiss Law (Fleiner II)Tasks of the Physician (1998)
Respects human dignity and automony; follows ethical principles for the wellfare of the patients
Knows structures and function of the human organism Masters diagnosis and therapy of frequent diseases Is able to summarize and communicate observations Understands health problems in a global way; capacity
to identify the elements of physical, psychological, social, economic, cultural and ecological origin; takes into account health for an individual and society
Takes care of patients as individuals in their social environment Acts for prevention of diseases and for health promotion
Bologna in medicine: the Swiss case Chapters:
Swiss university landscape National and regional governance Medicine: reform since 1995 -
PBL, student autonomy, medical humanities Bologna: a nightmare - or
additional opportunity to improve teaching + training for the needs of tomorrow
One step further: earlier specialisation
In Switzerland, the Bologna system had to be discussed, adapted and adopted by
CRUS Conférence des recteurs des Universités Suisses: 2003/2004
CUS Conférence universitaire Suisse: December 4, 2004
Cantons adaptation to (11) different laws and autonomies of the universities
Genève: french translation of « bachelor » and « master » had to be discussed in the parlament (grand conseil)
But: an important element in the University landscape could be
preserved
The relative autonomy of each university to organize the curriculum within the given framework -
e.g. to introduce relevant reforms
Bologna in medecine - the Swiss case
Now the technical part:
structure and philosophy
Basic principles of the Bologna system Better permeability for and to other branches Individual adaptation of curriculum to student wishes for career possibilities
Bologna - Basics
Bachelor: 3 years, 180 ECTS Master: 2-3 years, 120-180 ECTS Doctorate: 2-3 years
ECTS – European Credit Transfer System students charge in hours, 1 ECTS = 30 h, 1 year = 60 ECTS = 1800 h (including self-learning, exams).
This can be applied to medicine, to a reformed curriculum, to PBL, but good organi- sation and priority definition must be ensured.
Version PMS / PA30.09.04
Bologna+ in Medicine
Bachelor inBasic Medical
Sciences
Bachelor inSciences,
Arts, Economics,
etc
Cre
dit
s
Master inSciences,
Arts, Economics
etc
Masterin
Medicine
Medicalspecialities
Research +Teaching
Other careers(industry,
administration, etc)
Student file Student file
Credits Credits
Doctorates, MD / PhD
Bologna allows to go further Earlier options for professional careers:
- Do all speciality tracks need the same amount of knowledge in anatomy, biochemistry, genetics ?
Early + more extensive contact with public health, research, etc. are needed
The concept of « Kern +Mantel »
core parts and options
Year 5
4 60%
60%
40% +Exam
+Exam+ Master thesis
40%Master in medical sciences
Bologne in Medecine (CIMS): Nucleus + Options
Integrated Master with mention MD-PhD
100%1
2
3
90%
80%
10
20
+Exam
+Exam
+ExamBachelor in Medical Sciences
Optional modules
Compulsory - nucleus
MD-PhDprogram
2 –3 years
Doctorate
Pract/clinics
Federal Exam
MD working underSupervison (2 years)
Year 6
Examples of optional modules
Specific clinical tracks Programme MD/Ph International health Public health Law, Arts, Litterature etc.
Bologna in Medicine -
Advantages for Basic Medical Sciences
Maintaining a strong role in Bachelor Increased possibilities to include
« Basic Sciences » in Master (options) Better possibilities by Bologna to
motivate and train for research careers
Swiss Medical Faculties have undergone an in-depth revision by 3 distinct means:
1. Reform of curriculum (PBL, student autonomy, human sciences) since 1995, with new pedagogic concepts
2. Accreditation of all Med. Faculties 1999 - by foreign experts – 2nd time 2006
3. Bologna system introduced 2006
Will Bologna provide better doctors ?
Not necessarily … But all efforts together have provided
substantial improvements
Porto – River Douro
Monte Rosa Glacier
Thankyou !