The Future of Medical Education Not Only at the First Faculty
Soon, on 25–26 October, the First Faculty of Medicine will host the annual meeting of medical faculties in the Czech and Slovak Republic. This time, the top management of the individual schools, secretaries, representatives of academic senates, and students will meet top representatives of the relevant ministries of health and education and of the Institute of Medical Information and Statistics of the Czech Republic in the Marienbad spa (Léčebné lázně Mariánské Lázně), with which, as well as the town itself, our Faculty has been collaborating for the past five years. The motto of this meeting is ‘The future of medical education’.
Let us look behind the most obvious reading of the ‘marketing’ aspect of this phrase and consider its actual content. Medical faculties must react not only to the needs of modern medicine but also to the development of the healthcare system. They must not only prepare sufficient numbers of future professionals capable of covering the broad range of medical fields but also do well in confrontation with the growing demands and expectations of patients. They must deal with changes in preparedness of students from secondary schools but also keep trying to find an effective balance between academic conservativism and scientific and social progressivism. And while doing that, they must be cautious at points where factual medical needs intersect with political games and interests of various lobbies.
Photo: Veronika Vachule Nehasilová
Money did arrive but no one used it yet
The Marienbad meeting will take place at a relatively favourable time for the medical faculties. The Association of Deans of Medical Faculties of the Czech Republic was formally established less than two years ago and since that time, it became an important partner in negotiations with both of the relevant government ministries. So far, discussions took place in a highly constructive atmosphere and among other things resulted in a definition and launch of a programme of support to medical faculties. The investment of seven billion Czech krones, aimed at addressing a looming demographic disaster in the form of shortage of teachers at medical faculties, is ultimately an important step towards addressing personnel problems in national healthcare.
The programme of support to medical faculties should help address the dangerous disbalance in salaries for healthcare and teaching activities in the various departments of the faculties, but we also want to use it to make academic career more attractive to the young generation. Deans and secretaries of medical faculties will discuss the executive details of the programme with the aim of making sure that its settings at all faculties encourage development (from the point of view of investments but mainly with respect to salaries) and are fair to all professional groups. At our faculty, we set salary ceilings of the individual departments depending on measurable performance parameters. Personnel policy and remuneration within the salary limits are fully in the hands of department heads, since they know best both the performance of their colleagues and their income from resources of the faculty, hospital, grants, etc. That is one of the reasons why for instance ‘0.3 workload of teaching assistant’ can mean different sums of money at different departments, which should moreover be viewed in a year-long perspective that includes special bonuses and the like. Unfortunately, there are also departments where their heads did not yet use the increased resources of salary limits to increase salaries, extend employment, or increase benefits and bonuses. Much like failures to ‘remember’ to specify bonuses to team members, such managerial shortcomings damage not only the particular people concerned but unfortunately also the more general awareness, philosophy, and culture of remuneration at the faculty. It is then viewed in the spirit of ‘I heard how X said that Y things ...’. In any case, individual errors in managing the increased salary resources, which could, however, be generalised and interpreted as an argument against the support of salary increases at medical faculties, will be addressed without delay.
Development of the curriculum is an ongoing process
The deans’ association is actively involved in a discussion on balancing the relations between faculties and university hospitals. Although despite repeated legislative efforts a law on university hospitals is not in existence yet, relations between the faculties and ‘their’ hospitals are currently very good. Directors and deans address topics of mutual concern, ranging from organisational to personnel issues, consensually within the existing legislative framework and neither of the partners calls for urgent legal codification. Individual attacks at some parameters of collaboration, which might potentially harm good relations between faculties and hospitals, are marginal and tend to be personal rather than institutional.
Another important subject to be discussed at this meeting is the development of undergraduate curricula both for general medicine and dentistry. What we want is for them to correspond to international standards and to contain a balanced amount of theory and practice, including the use of modelling and simulation technologies as well as a further broadening of extracurricular education and optional subjects. Optional subjects should be, however, perceived not in a utilitarian fashion as merely alternative sources of credits, but as the first step in the direction of particular future professional interest. The development of curricula is continuous. It is a never-ending effort to react to new impulses and needs and to define what must be taught and how much can be learned within the allotted time. We are still not – and perhaps we never will be – happy with the amount of coordination between various subjects taught. We know of shortcomings in the teaching of clinical subjects where theoretical parts should not outweigh the practical ones. At the same time, however, we know that neither the students nor the teachers are personality-wise homogeneous groups, and that is why the need to recap and repeat, but also the level of personal motivation and competence are highly individual.
Strengthening the role of the student community
Selection of students via high-quality admission process and frequent testing is a precondition of achieving good quality graduates and a low dropout rate. Evaluation of teaching by students is an important instrument in analysing some aspects of teaching, and especially the human dimension of teachers as such, but curricula must also react to international and inter-institutional needs. We feel that the student body should play a greater role. At our Faculty, students form almost a half of the Academic Senate, they are represented in the Dean’s College, as well as in various committees and workgroups dedicated to planning and execution of various agendas of the First Faculty of Medicine. Even so, it sometimes happens that the broader student body knows nothing about the activities of its own representation and about activities of organs in which its representatives participate. In this area, improvement can be achieved by sustained effort to expand communication, but student associations and organisations could also help and make sure that students’ representatives truly represent the community.
Specialty education is a separate chapter, which logically follows on undergraduate training. It is mostly carried out by academic clinicians, and education of future medical specialists is thus an integral part of mission of medical faculties. At the moment, medical faculties intensively collaborate with a number of other players on a definition of a legal measure that would codify not only a clear administrative framework but also adequate content of particular medical specialties.
Accurate public awareness as a prevention of rumours
High quality medical faculties are global players. I do not mean various courtesy or short-term visits or congress tourism, but collaborations which enable us to take a critical look at the readiness of our students, attractivity of our faculties for international applicants, strengths of our research in international scientific teams and projects, and our role in specialised international medical societies. Our Faculty has been the most productive scientific institution in biomedicine in our country for a number of years, and this is also linked to our search for suitable criteria of evaluation of science, criteria that would stimulate quality, doctoral studies, and habilitation and appointment procedures.
Growing demands of teaching, research work, and the need to increase the number of hospital beds...all these elements play a role in the strategic planning of our future orientation. In the case of the First Faculty of Medicine, this also concerns the development of our scientific infrastructures, simulation centre, or virtual interinstitutional and national centres, such as for instance the Centre of Tumour Ecology. But when discussing the future of medical education, we also plan to discuss subjects relevant to non-medical fields, financing of medical faculties within their universities, cultivation of relations between teachers and students, academic legislation, logbooks, the MD/PhD programme, etc.
The Association of Deans of Medical Faculties of the Czech Republic shares the results of its consultations with relevant partners in state administration and tries to medialise some of the main subjects. Accurate public awareness of medical education and the reality of medicine and healthcare constitutes a rational protection against various rumours, scaremongering, and fake news motivated either politically or by insufficient knowledge of the real state of affairs. And moreover, it can help attract future students to the study of medicine and promote their interest in particular medical fields.
Aleksi Šedo, dean of the First Faculty of Medicine of the Charles University and president of the Association of Deans of Medical Faculties of the Czech Republic
The Present and Future Through Students’ Eyes
It seems that nowadays, almost everyone has an opinion on ideal organisation of healthcare and on education of medics as well as nonmedical healthcare personnel. It is hard to say who is right. What is certain, however, is that medicine is quickly changing and with it also medical education and medics’ view of it.
During our studies, we experience many changes to teaching and most of these changes are welcome. All faculties are expanding their simulator training and renovate teaching facilities. There is support for involvement of students as demonstrators, their engagement in tutoring of freshmen, and their participation in the work of the Academic Senate. Expansion of teaching of imaging methods is also highly popular. Many teachers are trying to improve their courses based on students’ feedback. We hope these changes will continue and will improve the quality of even some of the less popular subjects.
Students keenly follow all changes in the rules of study. These may be sometimes hard to understand and that is something that students in the Academic Senate should help with. It is, however, often even harder to explain why certain rules are made stricter, although the administration means well. But it is good to see that the rules of studies are as dynamic as the development of medicine itself. In this way, hopefully one day a balance will be found between students’ wishes and ideas and the ideal curriculum from the perspective of the Faculty and needs of contemporary medicine.
Schools nowadays offer many options, and although students’ influence on mandatory courses is limited, there are countless possibilities for expanding one’s studies. We travel with Erasmus or other international exchange programmes, choose from numerous elective subjects, do our training with welcoming physicians, and on our own, we organise courses in suturing skills, sonography, and many other subjects. We wish all students that their options keep expanding and that some minor nuisances, for instance in the organisation of internships, be quickly solved.
When looking into future, however, our enthusiasm is tinged with uncertainty. Medicine is moving ahead at breakneck speed towards incredible results and opportunities, but we will also be faced with many hotly debated problems. How is our healthcare system going to deal with a financial crisis and shortage of personnel? How are conditions for postgraduate certification going to develop? How is healthcare going to be affected by a marked decrease in male presence? How is this situation going to be affected by politicians’ attempts at addressing these issues, for instance by support of medical education? We shall see.
David Novotný, Student Chamber of the Academic Senate