Towards Innovation of Curriculum of Clinical Instruction at the First Faculty of Medicine
In the beginning was the word... the word of students and graduates of our faculty who participated in the reconstruction of curriculum of clinical instruction in general medicine. After all, which teacher would not, in the spirit of Comenius, try to constantly improve the way they teach? Over the past twenty years, all Dean’s Colleges at the First Faculty of Medicine have been working on improvements, while evaluation of teaching on the level of individual institutes, departments, and the faculty as a whole provided regular feedback to the management.
At a meeting of all Czech and Slovak medical faculties in the autumn 2019, the First Faculty of Medicine of the Charles University shared an overview of individual curricula of general medicine. This was clearly an important step towards self-assessment and comparison of curricula and time spent on the same subjects at different domestic and Slovak medical schools.
The first stage of reconstruction of curriculum of especially the clinical instruction at the First Faculty of Medicine was importantly inspired with respect to robustness and importance of data by a poll organised by our recent graduates. In early November of last year, their representatives met with the faculty management to discuss the results of this poll. They spoke about the relation of graduates to their alma mater, about how well-prepared they felt for medical practice, debated ways of acquiring more practical skills, standardisation of learning resources and requirements regarding evaluation of knowledge, but also ways of expanding clinical internships outside university hospitals and changes to the curricula. All agreed that graduates’ perspective is valuable to the First Faculty management and this communication channel became a valid instrument in a reconstruction of the curriculum especially with respect to improvements in clinical instruction at the First Faculty of Medicine. (Editor’s note: Further information about this meeting between faculty management and both graduates and current students can be found in this year’s first issue of this newsletter.)
The subject most frequently voiced by representatives of our graduates pertained to the need to change clinical instruction, especially in the sixth year, and to spend more time in internships during studies. Their responses led to the following:
* A recommendation that only state-exam subjects be taught in the sixth year.
* Suggestion that practical instruction be expanded beyond summer vacation internships.
* Observation that internships in state-exam subjects (gynaecology and obstetrics, surgery, internal medicine) should not be divided among several years.
* Renewed demand for inclusion of a course in introduction to paediatric medicine.
* Introduction of a course on x-ray diagnostics was appreciated and extension of e-learning in clinical subjects was proposed.
* Graduates pointed to duplicity of content in courses on Hygiene and Epidemiology and Occupational Medicine. They proposed that the two courses be merged, and the number of hours dedicated to them reduced.
Facts About Clinical Instruction
Management of the First Faculty of Medicine presented arguments pertaining to clinical instruction and pointed to the following:
* It has been monitoring and supporting an extension of bedside instruction in clinical subjects outside the clinical basis of the General University Hospital for several years, the level of externalisation of instruction varies among subjects and is within the responsibility of subject guarantor.
* It perceives the need to unify instruction and teaching among various teachers, institutes, clinics, and faculties on the foundations of evidence-based medicine.
* Already in 2003, the faculty management had compiled a logbook of mandatory procedures with the aim to unify acquisition of clinical skills by students. Meeting the demands listed in the logbook is a necessary condition for passing a separate subject Minimum of Practical Procedures in the last year of study. This was already the second logbook of mandatory procedures and moreover, our clinics and departments continuously offer students opportunities to expand their medical skills via so-called facultative procedures.
* The faculty supports the development of simulator learning and instruction based on the use of dummies and manikins at almost all institutes but especially at the Centre of Medical Simulations of the Institute of Physiology.
* The Faculty supports the involvement of undergraduate students in extracurricular teaching at some clinics, institutes, and departments with the aim of improving their clinical skills. Unfortunately, capacities offered to this purpose, aimed especially at practical skills, are not sufficiently used.
* The management works on transferring the evaluation of teaching by students outside the SIS system. The aim of the Committee for Evaluation of Teaching is to improve the effectiveness of teaching evaluation and adequate presentation of its results.
Dean’s College and Its Plans Regarding Further Changes to the Curriculum
The main motivation and goal of all changes is to improve the education students receive, with emphasis on maximal expansion of its practical parts. In early January of this year, the Dean’s College analysed the proposals, suggestions, and critical notes it had received from all sources regarding an update of curriculum of clinical instruction in general medicine and then summarised the priorities of necessary and urgent changes as follows:
* To concentrate majority of instruction in state-exam subjects and all final state examinations into the last year, in particular thus to move the state-exam subject Hygiene and Epidemiology from year four to year six;
* Expand the course in Gynaecology and Obstetrics in year six by two weeks and cancel it in year five
* Add one week of teaching of a new subject Introduction into Paediatric Medicine and Simulation in year four;
* Newly introduce an obligatory summer internship in Paediatric Medicine (two weeks) in year five;
* Concentrate the teaching of subjects that are not part of state exams in year four.
To meet these goals, it was necessary to:
* Move subjects Emergency Medicine, Clinical Biochemistry, and Urology, which are not part of state exams, from year six into year five;
*Move subjects Rehabilitation Medicine, Neurosurgery, and possibly also Oncology from year five into year four;
* Shorten the duration of subjects Bioethics or Medical Psychology in year four and move it into year three.
Favourable with respect to introduction of changes in the curriculum by moving subjects into different years is the fact that in academic years 2020/2021 and 2021/2022, there will be less students in the clinical years than in previously.
What Do Current Students Think About It?
Proposed changes to the curriculum were presented to our medics who were able to voice their views using a very competently prepared questionnaire prepared by student representatives in the Academic Senate and Committee for Evaluation of Teaching. They deserve to be especially commended because they not only prepared the poll and sent it around, but then also evaluated its results. And all this took place during the COVID-19 pandemic, that is, at a time when most of them were extremely busy with their involvement in volunteer or other activities. We should name at least David Kulišiak, David Novotný, Lukáš Panenka, Jakub Danzig, but there were more.
A total 239 respondents answered the questionnaire and most answered all questions. At the same time, there was also a somewhat less stringent poll among students of the English parallel organised by their representatives in the Academic Senate. In the first part, students described their views of the planned changes which were proposed at ‘task force’ meetings in a finished form: this pertained to the shifts of a number of courses into different years or restructuring of the final, sixth year. Students could express what they especially like and what they do not welcome. In the second part, they could evaluate various alternatives of final proposals, mainly expansion of simulation learning, the notion of a new course on introduction to paediatric medicine, and teaching that would replace the now cancelled vacation internship in gynaecology and obstetrics.
For the most part, students (including those from the English parallel) supported the proposed changes. They liked the notion of expanding simulation learning and inclusion of introduction to paediatric medicine. With respect to adding to the minimum of hours of accreditation, the idea of vacation internship in paediatric medicine receive the most support among the proposed alternatives. Many students in their written comments also proposed an optional internship at a department of one’s own choice, as it is done at other medical schools. What students welcomed the most were proposed changes in year six, while most criticised was the change in timing of the state exam in Hygiene and Epidemiology. Changes in the teaching of gynaecology are perceived rather positively but with some reservations, especially because of removing the possibility of a more personal contact during the vacation internship.
In general, one could say that students do welcome the new outlook of the curriculum and hope it will become the foundation of further modernisation of learning at the First Faculty of Medicine even in other parts of the curriculum..
Facultas prima semper reformanda est
Changes in clinical instruction were discussed mainly by the vice dean for this area, who conducted many discussions either in person or by email exchanges with guarantors of the relevant subjects. Almost all these exchanges were collegial and constructive, although views sometimes significantly diverged. Special thanks should go especially to those heads of institutes and departments and their teams who will, due to innovations in the curriculum, have to teach twice as much in the following academic year. Unfortunately, no consensus was found, mostly due to valid argumentation of guarantors of the subjects, regarding the shift of Neurosurgery and possibly also Oncology from year five to year four. The proposed changes were thus finalised only thanks to a daring consent of teachers from the Department of Urology who agreed to an organisation-wise highly complicated shift of the Urology course from year six into year four. For them, it means having to teach twice as many students for not just one but two following academic years. This attitude was much appreciated not only by the ‘task force’ but also the Teaching Commission and Dean’s College.
The fact that a consensus was reached regarding all changes, including those that will have an impact on the timing of courses, not only by guarantors of the areas concerned but also by the Teaching Commission, members of the working group, Dean’s College, and the Academic Senate is important but it is just the first step in the reorganisation of the curriculum. The entire process and changes to the schedules of years three through six could not take place and be prepared without collaboration of the Study Department.
We can but hope that a reconstruction of the curriculum of clinical instruction in general medicine at the First Faculty of Medicine will never end, because not only ‘ecclesia’ or ‘universitas’, as Master John Hus, Rector of the Charles University, famously said, but also ‘facultas prima semper reformanda est’.
Tomáš Hanuš, Vice Dean for Clinical Teaching