Undergraduate Mobility in Medical Education in the European Higher Education Area

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7th International Follow-Up Conference on the Bologna Process in Medical Education

3rd - 7th July, 2008

Berlin (Germany)

Contents 1 Preamble 2 Curricula 3 Language 4 The role of universities and faculties 5 ECTS 6 Quality assurance 7 References

Preamble

For the last five years the International Federation of Medical Students’ Associations (IFMSA) has participated in developing the European Higher Education Area in the field of medicine. This has resulted in widely recognized position papers. In July 2008, the 7th Bologna Process Follow-up Workshop was held in Berlin, Germany.

Mobility is one of the key action lines of the Bologna Process, and therefore European medical students’ representatives chose to discuss mobility in the scope of medical education.

We consider student mobility in higher education to be the participation of a student in an educational programme in a higher education institution other than their home institution.

Mobility of students varies in purpose and outcomes, and can include both elective and core parts of the curriculum. Furthermore, it can vary in length, from short periods to indefinite. Enrolment in a Master‘s programme at another university after a finished Bachelor degree is an example of indefinite mobility which we do not address specifically in this document, since we have already thoroughly discussed it in our Bachelor/Master-paper.(1)

We consider mobility in general an important aspect of higher education. We believe that a student will achieve several academic benefits, such as access to a wider range of learning opportunities and studies in a desired field. Benefits also include improvement of language skills and broadening of students’ horizons through experiencing different cultures and societies.

Furthermore, we consider the development of international cooperation between individuals and institutions involved in higher education to be of great value for the improvement of quality of higher education and research, healthcare systems and thereby patient safety.

We also believe that student mobility enhances the European idea providing an opportunity for students to grow into a common identity as European doctors who strive for fair health care systems and for equal treatment of all patients regardless of their national, social or cultural background.

We therefore regard mobility as beneficial. However, if mobility is not carried out appropriately, it can have a negative impact on diversity, quality and innovation in education, as well as on patient safety.

We acknowledge and appreciate the already existing mobility in the European Higher Education Area. However, we have identified fields within which we believe further action should be taken in order to overcome the existing obstacles to mobility and to increase the quantity and quality of mobility in medical education. This document states a series of ideas and recommendations on how to achieve this. We have decided to only address the academic aspects of mobility in medical education. We recognize that social inequalities between students can limit mobility. We consider this an important issue, but we have chosen not to address it since it is a general aspect of mobility. For our opinion on this matter, we refer to statements made by the European Students’ Union.(2)(3)

Curricula

• European Core Curriculum – learning outcomes. We strongly recommend the implementation of a European core curriculum as suggested by EMSA and IFMSA. As stated in the "European Core Curriculum for Medicine – the students’ perspective", we support the idea of defining expected learning outcomes of medical education.(4) This can assist mobility even in the core parts of the curriculum by facilitating comparison of curricula and courses. Aiming for common core goals can enhance mobility by increasing trust between institutions. Hence, every medical school should specify learning outcomes for their curriculum and make these publicly available. We support the faculties’ autonomy and their right to define their curriculum within the framework of the European Core Curriculum and following the Students’ Specifications on the WFME Global Standards for Basic Medical Education.(5)
• Recognition. When comparing and recognizing courses provided at other universities, achieved learning outcomes should be considered more important than teaching and assessment methods, duration of study or title of course. The learning outcomes a student expects to achieve at the host university should be agreed upon prior to the commencement of the programme. Meeting these learning outcomes must lead to automatic recognition at the student’s home university. Furthermore, upon finishing the course, students should be provided with supplementary documents stating which of the previously specified learning outcomes have been achieved. Additional achieved learning outcomes should also be stated. We encourage higher education institutions to use the tools for comparability implemented by European institutions, such as the Europass and the European Qualifications Framework.(6)
• Decision making. Decisions about recognition should be made in best interest of the student, the student’s study progress and the quality of medical education. This decision should be made by the academic staff and students in charge of mobility. The decision should be based upon predefined criteria. The students applying for recognition must have the right to ask for the decision to be revised.
• Assessment. Assessment should preferably be done at the host university following the course taken, but students should be offered the flexibility to be assessed at the home university if this serves to avoid adverse effects on the student’s academic, professional and personal progress.
• Flexibility. Universities should allow and facilitate medical students to combine courses from different periods of studies to facilitate the achievement of the expected learning outcomes. They should also provide incoming students with guidance during their study period in order to help them in meeting all expected learning outcomes. If the host faculty cannot enable the students to fulfil the expected requirements, the home institution should actively support the students in achieving the required learning outcomes.
• Electives. We strongly recommend every medical faculty to offer elective parts within their medical curriculum. Students should be allowed to take electives at their own university or elsewhere.
• Research. As stated in the "European Core Curriculum for Medicine – the students’ perspective", students should be involved in research work.(4) It should be possible for students to do this at another university.

Language

High standards of language skills are particularly important in medicine, since medical education includes contact with patients. Therefore, we believe that:

• Language courses. Universities should offer language courses in order to enhance mobility.
• Requirements. Appropriate minimum language standards, as required by a host faculty, should be communicated by the home faculty. This should occur prior to the commencement of a period of study abroad.
• Appropriate language skills. If a faculty allows part of the curriculum to be taught in a non-native language, it should be ensured that students enrolled in that course have appropriate skills in the language of delivery.
• Native language courses. We encourage host faculties to offer native language courses, including medical vocabulary, in order to help the incoming students to gain the appropriate skills required to communicate with patients and health care professionals.
• Online medical dictionaries. We encourage the further development of online multilingual dictionaries of medical terms.

The role of universities and faculties

• Information to students. Faculties should recognize that student mobility is a part of the academic development and therefore encourage students to take parts of their studies at another

institution. In order to give students the best opportunity to participate in mobility programmes, faculties should communicate mobility opportunities to the students early in their studies. Faculties should also provide students with up-to-date information about their partner universities, as advised in the ECTS guide, and about the possibilities of recognition of courses. We strongly encourage all faculties to participate in initiatives aimed at creating an accurate and up-to-date database containing relevant information about medical schools, e.g. the Avicenna Directories.(7)

• Cooperation between faculties. Universities are encouraged to seek new possibilities for students to study at another university. Faculties are also encouraged to establish different types of cooperation, including bilateral agreements and networks with other universities. This will help improve mobility and foster the mutual trust between the faculties within the network. These networks should always be open to the incorporation of new faculties. Mobility of students enrolled in a faculty member of a network should also be possible to universities that are not members of that network. Networks should not be seen as a tool to reduce the diversity and autonomy of faculties or to standardize educational systems and curricula, but as a tool for all member faculties within them to learn from each other. We also encourage the creation of mobility programmes, such as ERASMUS, specifically applied to medicine and to the different kinds of medical mobility. Faculties are encouraged to improve mobility of academic staff to enhance academic cooperation and gain trust.
• Protocol of procedures. Faculties should provide a protocol of procedures helping students to arrange a period of studies at another university. To enhance the contact between students and

faculties in already existing networks, we also recommend the creation of web based forums to facilitate the communication between everyone participating in mobility.

• Quality and quantity. We support the idea of unilateral mobility programmes, as long as the increase in numbers of students does not negatively affect the quality of education. Faculties must always ensure that an increase in quantity would not compromise the quality of medical education.
• Application. All application and selection processes should be transparent, fair, easily accessible and comprehensible. Application requirements should be adequate for the type of exchange,

especially considering whether the student will have contact with patients or not.

• International office. To maximize the academic achievements of the exchanges there should be a centralized international office at every faculty. This office should be responsible for informing and assisting incoming and outgoing students as well as faculty members in all practical and academic aspects. Local students could be mentors for incoming and outgoing students, thereby increasing the motivation of local students to become more mobile themselves.
  

Furthermore, this office should encourage and assist members of staff to establish exchange programmes and cooperation between faculties. The staff of the international office should include students. Students should take an active part within the selection and application process, including participating in the definition of the selection criteria.

ECTS

• Correct implementation of ECTS. We strongly encourage the correct implementation of ECTS credits across Europe with consistency between faculties according to the ECTS guide of the European Commission.(8) It is recommended that all faculties use the ECTS framework and its nomenclature. This should be done for both local and incoming students.
• Transparency of ECTS Framework. Transparency of the framework and its validation are imperative. European or national bodies should supply training and recommendations to help faculties implement the ECTS framework properly according to the ECTS guide. This could be done through, among others, providing more information and guidelines about the importance, meaning and implementation of the ECTS framework. The guidelines should be kept up-to-date and accessible in relevant languages for both students and faculties. Student organizations can assist in the wide distribution of information concerning the ECTS framework amongst their peers.
• Supplementary documents. Faculties are strongly encouraged to provide supplementary documents indicating the student’s achieved learning outcomes and study progress at any time during studies to increase mobility and transparency. Including learning outcomes in supplementary documents is a prerequisite for using the ECTS point system as a functional measure. In this case, the ECTS credit would provide quantitative information and the supplementary documents would provide information about the content of the studies. This would increase comparability and thus promote mobility. The TUNING project has developed a format for this purpose.(9)
• Students’ involvement. Students should be involved in the implementation of the ECTS framework, including the definition of ECTS points and in the evaluation of students’ workload estimation.

Quality assurance

In order to improve quality of mobility, internal quality assurance systems should be implemented in each faculty. The quality of these systems should be assured by national accreditation bodies. The national accreditation bodies should be accredited by a common European accreditation institution. It is essential for the improvement of quality in mobility that this quality assurance scheme is regularly evaluated as well as transparent and accessible.(10) We recommend the use of:

• Standards and Guidelines. We strongly recommend the implementation of international standards and guidelines within the European Higher Education Area, e.g. WFME Global Standards for Basic Medical Education and the Students’ Specifications to these, to assure transparency and to have a common reference level.(5)
• Databases. We encourage the establishment of a database providing accurate information about medical schools. In order to achieve this, we welcome the idea of the elaboration of the Avicenna Directories.(8)
• Quality assured assessment methods. To increase recognition between medical schools and therefore increase mobility, faculties’ chosen assessment methods should be quality assured, transparent and based on best evidence.
• Internal quality assurance. The university and/or faculty should be responsible for the evaluation of both its mobility programmes and its international office or other relevant departments responsible for mobility. The evaluation should involve both students (local, incoming and outgoing) and academic staff. Incoming students should give feedback about the relevant medical education programme at the host university and, by this, promote innovation and improvement. Outgoing students should be encouraged to give recommendations to improve medical education at their home faculty. Evaluation, recommendation and feedback results should be publicly available and accessible.
• External quality assurance. Accreditation systems ensure the quality of the programme, and thus could improve the recognition of achieved learning outcomes by the home faculty. National or regional accreditation systems for medicine should cooperate on a European level.

References

1. IFMSA/EMSA (2007), The Bachelor and Master Structure in Medicine. Amsterdam (The Netherlands).
2. ESIB-The National Unions of Students in Europe (2007): PROMOTING MOBILITY - a study on the obstacles to student mobility. Berlin.
3. ESIB-The National Unions of Students in Europe (2005): Bologna with student eyes. ESIB Bologna Analysis 2005. Bergen.

http://www.esib.org/index.php?option=com_docman&task=doc_download&gid=316&Itemid=263, 17.01.2007

1. IFMSA/EMSA (2006), European Core Curriculum - the Students’ Perspective. Bristol (UK).
2. IFMSA, Standing Committee on Medical Education (2008), Basic Medical Education WFME Global Standards for Quality Improvement – Students’ Specifications. Monterrey (Mexico).
3. Recommendation 2008/C 111/01 of the European Parliament and of the Council (April 2008) on the establishment of the European Qualifications Framework for lifelong learning. http://ec.europa.eu/education/lifelong-learning-policy/doc44_en.htm, 03.07.08
4. The Avicenna Directories - Global directories of education institutions for health profession. A partnership of the World Health Organization and the University of Copenhagen. www.avicennadirectories.org, www.avicenna.ku.dk
5. ECTS Users’ guide – European Credit Transfer and Accumulation System and The Diploma Supplement.

http://ec.europa.eu/education/programmes/socrates/ects/doc/guide_en.pdf, 04.07.08

1. TUNING EDUCATIONAL STRUCTURES IN EUROPE - A pilot project supported by the European Commission in the framework of the Socrates programme. http://ec.europa.eu/education/policies/educ/tuning/tuning_en.html, 03.07.08
2. IFMSA/EMSA (2005), Quality Assurance in Medical Schools - Moving from Quality Assurance to Quality Improvement. Copenhagen (Denmark)