Undergraduate Education Programme in Medicine

Markku Koulu and Pekka Kääpä

Faculty of Medicine in the University of Turku

• University founded in 1640 (Academy of Turku)• Faculty of Medicine founded in 1943• Four Master's Degree Programmes in the

Faculty:• Medicine• Dentistry• Nursing Science• Health Life Science

• 1198 students (874 in Medicine)• 356 teachers• Programme in Medicine 360 ECTS /

6 yearsTURKU *

Challenges in the Undergraduate Medical Education

• Expansion of the biomedical and clinical knowledge

• Insufficient consideration of cultural, psychological and social dimensions in undergraduate medical education

• Need of optimal balance between different learning environments (university hospital vs. health care centre)

• Relevance of education for working life • Multiprofessionalism in patient care (team work;

patient-centered approach)• Humanism in Medicine

The Process of the Curriculum Renewal

• Based partly on the recommendations of an international evaluation panel in 1996 and self-evaluation in 1999

• Performed under the guidance of the Faculty during years 2001-2008

• Main principles of the new curriculum was outlined by a steering group

• Core modules designed by multidisciplinary working groups with students representations

• Coordinating role in the renewal process was dedicated to Medical Education Research and Development Centre founded in 2002

Central Aims of Reformulation"Doors open to science, culture and society"

• To stress the significance of evidence-based medicine and scientific thinking

• To improve students' perception of the competencies reached during the education

• To enhance students' understanding of cultural and psychosocial factors for health and disease

• To decentralise a substantial part of teaching outside the university hospital

• To utilise electronic learning environments and teaching technologies

• To support professional growth of students• To offer pedagogic education to teachers

Best Practices in the Undergraduate Programme in Medicine

1. New, innovative educational collaboration with society: • Extensive decentralisation of medical education• Medical Humanities Programme (Asklepios Programme)• Swedish language course "Medicine and Culture in the Archipelago"• Course on exercise, health and nutrition with the Sports Institute of Finland in

Vierumäki• Doctor and Civil Defence-course, in co-operation with the Finnish Defence Forces • Great variety of elective courses provided by the Faculty

2. Comprehensive and developing student and teachers support mechanisms:

• Comprehensive personal tutoring of the students since 2003• Pedagogical training of the teachers since 2003

3. Foundation of the Medical Education Research and Development Centre:

• Organisation and evaluation of personal tutoring of the students and pedagogical education of the teachers in the Faculty

• Development and organisation of feedback systems in the Faculty• Pedagogic research and research-based development of education• National and international collaboration in medical education

4. Progressive personal and professional growth of the students: • Professional Growth Track• Early Patient Contact

Aims of Decentralisation of Medical Undergraduate Education

1. To provide sufficient educational impact on general medical problems2. To increase insight into family and preventive medicine3. To illustrate functions of health care organisations 4. To improve learning environment and learning 5. To provide more opportunities to practise clinical skills during training6. To expose young doctors to working life outside the university hospital

Loimaa regional hospital

Raisio Hospital Vakka-Suomi Hospital, Uusikaupunki

Salo regional hospital

The Turku University The Turku University Hospital (Hospital (TYKS)TYKS),,Main Hospital Main Hospital

FACULTY OF FACULTY OF MEDICINEMEDICINE

Paimio HospitalTurku City

hospital

Turunmaa regional hospital

Turku Teaching Health centre

© V-ML 2006

Satakunta, Pori: Central hospital + Teaching

Health centre

Medicine and Culture in the Archipelago

•Swedish is the second official language of Finland and all graduating doctors and dentists should have sufficient oral and written skills in Swedish. •The course of Medicine and Culture in the Archipelago addresses these dimensions and also gives insight to the culture of the Swedish speaking Finns.

"Då jag var 15 år tänkte jag att jag aldrig skulle tala svenska men där satt jag hos dessa trevliga människor i flera timmar och talade. Vi hade jätteroligt. Jag log hela vägen hem och var glad i tre dagar.// When I was 15 years I thought I would never be speaking Swedish but there I was sitting with these nice people for hours and speaking. We had a very great time. I smiled all the way home and was glad for three days.”

"Det här var första gången i mitt liv som jag talade med en över 70 år gammal person utanför sjukhuset. Givande.// It was the first time I discussed something outside a hospital with a person over 70 years of age. It was rewarding."

Medicine and Culture in the Archipelago

Medical Ethics at the University of Turku, Faculty of Medicine

Medical ethics covers issues such as the ethics of medical care in general, terminal care, the treatment and care of disadvantaged and vulnerable persons, end-of-life decisions and euthanasia as well as issues concerning priorities within medical and health care. Widely interpreted, the discipline also covers (bio)medical research ethics.

Aims of Medical Ethics Education:1.Awareness of the values and principles that commonly apply to discussions on medical ethics, such as human dignity, informed consent and patient autonomy, confidentiality, and justice2.Improved communication and decision-making skills in ethically and culturally problematic situations3.Familiarity with ethical and professional guidelines and recommendations and relevant health care and medical legislation

Elective Studies

• Large selection and volume of elective courses (up to 50 ECTS / 360 ECTS

• Several elective study tracks: Cardiovascular Medicine 16 ECTSNeuroscience 10 ECTSNutrition Science 11 ECTSInfections and Immunological Diseases 12

ECTSOperative Medicine 17 ECTSDoctor´s Work in Health Care 10

ECTSMultiprofessional Pain Treatment 6 ECTS

• Medical Humanities (Asklepios Programme) 15 ECTS

Medical Humanities Programme,"ASKLEPIOS Programme"

Aims of the Medical Humanities Programme (15 ECTS):1. Discussion and interaction of students in the medical, humanities and social science faculties of the university 2. Introduction and comparison of the scientific methods of the medical, humanistic and social sciences 3. Critical study of the different human concepts and needs of health and illness

• The modules in the Programme comprise symposia and seminars. Each module has a tutor who organises the module. Students prepare learning diaries of each module which are assessed by the tutors.

• 170 student participated since 2002

• Course of the Year in the University of Turku in 2006.

Medical Humanities Programme, "ASKLEPIOS Programme"

Special study modules 2008-2009 (Theme: Suffering and Health)•Asklepios: Introduction Course (2 ECTS)•Asklepios I: Art and Suffering (3 ECTS)•Asklepios II: Values of Health (3 ECTS)•Asklepios III: Suffering, Disgrace and Medicine (3 ECTS)•Asklepios IV: Research Project (4 ECTS)

Special Research Tracks

In order to emphasise the important link between education and research, the Faculty has organised two specific research tracks: an early-starting biomedical and a later clinical track.

The Modules of the Biomedical Research TrackYear 1 Spring 12 ECTS Basics of Working in the Laboratory Basic Techniques of Cell Biology Basic Biomolecular Techniques Year 2 Autumn 12 ECTS Basic biomolecular techniques Bioinformatics Animal Research Course Year 2 Spring 8 ECTS Medical Biotechnology Theory of Medical ScienceYear 3 Autumn 8 ECTS Conference Procedures and Communication Theory and Ethics of Science Philosophy of Science Career of the Researcher

Medical Education Research and Development Centre

• The Centre was founded in 2002• The Centre acts as a community of scholars to

investigate, plan, prepare, implement and develop education.

• Professor, 2 study coordinators, project leader, 2 study designers

• Advisory Committee, which brings the interest groups of medical education, e.g. professional experts as well as representatives of education, health care services and other faculties of the University, together to review and anticipate the future needs of the educational function of the Faculty.

Medical Education Research and Development Centre

Medical Education Research and Development Centre

Tasks of the R&D Centre:1.Development of Teaching and Learning in the Faculty

a. Decentralised teachingb. Core and general knowledge and skillsc. Assessment methods of teaching and learningd. feedback on learning

2.Promotion of professional growth of the students3.Personal Tutoring of Students4.Pedagogical Training of Teachers5.Quality Assurance of Undergraduate Education in the Faculty6.Research Projects

a. Learning Medical Expertise (LeMEx)b. Conceptual change during medical studies

Professional growth - track

• Early Patient Contact Year 1• Simulated Patient Exercises: communication Year 3• Meet Medical Practitioners – seminars Years 1 and 6• Medical Ethics Years 1, 3

and 6• Graduating Medical Student-module Year 6• Personal Tutoring Years 1-6• Regular Self-reflections Years 1, 3

and 5

Supporting Professional Growth – the Programme of Early Patient Contact (EPC)

•Since 1993 organized by the Department of Family Medicine. •The aims of the programme are orientation of the students to

phycian’s work in primary health care and learning the basics of doctor-patient communication• "The most impressible were the patients. In them we saw a wide

cross-section of finnish people during only one day. There were infants and elderly, and they all had different problems and illnesses. I learned that a physician must have a wide and comprehensive view to be able to do this work and I learned how differently young and elderly patients have to be observed both in terms of their illnesses and in terms of communication." (PV, fragment of a diary).

• "I believe, that the first EPC-day will have influence on my future studies. This was the first time that I was in a doctor’s appointment room not as a patient but as something else. It was breathtaking to understand, that so it will be from now on. It takes time to get used to that. It makes me wonder, how I am going to feel next time I go to see a doctor as a patient, as I have seen the other side of the doctor-patient relationship." (KR, fragment of a diary).

Personal Tutoring Programme of the Undergraduate Students

Aims of the Personal Tutoring Programme:1.Learning support2.Support of personal growth of the students3.Support of professional development of the students4.Regular feedback to students

Plan for Personal Tutoring

Year 6

Year 5

Year 4

Year 3

Year 2

Year 1

Early Patient Contact

Death

PatientDisease

Working Life

Professional Growth

Self-

refle

ction

Studying

Personal Tutoring

Knowledge, skills and attitudes

Group Meetings

PSP/Portfolio

Group Meetings

PSP/Portfolio

PSP/Portfolio

Group Meetings

PSP/Portfolio

Group Meetings

PSP/Portfolio

Group Meetings

HOPS/Portfolio

Peer

tu

torin

g

Learning Portfolio in Undergraduate Medical Education

Aims of the portfolio:1.support of personal and professional growth2.promotion of feedback3.development of reflective learning

Learning Portfolio in Undergraduate Medical Education

Pedagogical Educationand Training of the Medical Teachers

Medical Pedagogy (10 ECTS)

Learning environments

Current Challenges in Medical Education

Teaching with foreign language (5 ECTS) P

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ag

og

ical

me

eti

ng

s in Fa

culty

of

Me

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Further pedagogical training in Educational Development Unit of University of Turku

up to teachers formal qualification (60 ECTS)

Paths of pedagogical education and training in the Medical Faculty

Teaching and learning concepts in medicine

Small group instructionand interaction

Communication and educational technology

Guidance and assesment in medical education

Quality evaluation in medical curriculum

Basics of problem based learning (half-day)

Web-based teaching (3-5 ECTS)

Learning Medical Excellence (LeMEx)

• A multi-center multidisciplinary education research project together with the University of Oulu and Tampere

• longitudinal follow-up of a chort of medical and dental students (n=343), started in 2006

• main goals:• cumulative learning• development of medical expertise• conceptual change during medical studies

LeMEx : Research Questions

• What is the study orientation of medical students like at different stages of medical education?

• How does medical knowledge become organized into wholes during the course of medical education?

• How does the students’ medical thinking develop in the course of the studies?

• How do the students see, at different stages of their education, their role and duties in the doctor-patient relationship?

• What properties do the students consider to be characteristic of a good physician at different stages of their studies?

• How can the learning follow-up data be used as a tool of continuous quality assessment in medical education?