petersuter ppt

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Porto 23 – 24 /2 2007 Bologna – the Swiss case Peter M. Suter, Geneva

Bologna in medicine: the Swiss case. Chapters of my presentation:: 

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: 

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.

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Switzerland: 7.5 million inhabitants - - 12 Universities ●

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Swiss Universities: Have different sizes and budgets

Swiss Universities:  governance and finances: 

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

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Auto-financed 5,3 % Cantonal budget, DIP 43,5 % Cantonal budget, non-DIP 7,4 % National allocation 18,6 % SNRF 9,3 % Other non-public 16 % Sources of finances: University of Geneva AH/pt 23.11. 2005 Source: Budget 2005

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12 Swiss Universities + 5 Medical Faculties ● ●

Medicine in Switzerland: 

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

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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 …: 

High costs of health care … Numerus clausus introduced – - but only in the German speaking part of Switzerland

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300 400 500 600 700 800 900 1997 1998 1999 2000 2001 2002 2003 2004 Total Number of medical diplomas per year Switzerland 1997 - 2004 P.M. Suter / ea, selon statistiques Facultés de Médecine suisses, 2002

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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

Reform of the curriculum – 1990ies: 

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 »

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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)

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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 ….

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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

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Reformed Medical Curriculum, Genève Example 1st Year 2004/2005

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Wave of the reform from and to the 5 Swiss Medical Faculties ● ●

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+ the creation of a catalogue of learning objectives http://www. iawf.unibe.ch/slo/

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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:: 

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: 

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)

Bologna in medecine - the Swiss case: 

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

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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.

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Version PMS / PA 30.09.04

Bologna allows to go further: 

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: 

The concept of « Kern +Mantel » core parts and options

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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

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Swiss Medical Faculties have undergone an in-depth revision by 3 distinct means: Reform of curriculum (PBL, student autonomy, human sciences) since 1995, with new pedagogic concepts Accreditation of all Med. Faculties 1999 - by foreign experts – 2nd time 2006 Bologna system introduced 2006

Will Bologna provide better doctors ?: 

Will Bologna provide better doctors ? Not necessarily … But all efforts together have provided substantial improvements

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Porto – River Douro Monte Rosa Glacier Thankyou !