Proposal for awarding the title "Centre of Excellence in University Education": Undergraduate Education Programme in Medicine, Faculty of Medicine, University of Turku

1. Mission of the unit

The main mission of the Undergraduate Education Programme in Medicine is to educate professionally competent physicians for the needs of the public health care system. The Faculty has recognised that biomedical and clinical knowledge, based largely on natural sciences, is of central importance in medical practice, but that, in addition, medical students should conceptualise health as a multifactorial entity having cultural, psychological and social dimensions. Consideration of these aspects in undergraduate medical education is also emphasised by profound structural changes and increased demands in the functional environment of the health care services. In response to these challenges, the Faculty has reformed its teaching and learning philosophy, restructured the curriculum and initiated pedagogic research projects to guide changes in undergraduate medical education.

According to the new education philosophy, the purpose of the Medical Faculty is to educate experts of medicine, who are knowledgeable and responsible physicians for clinical work as well as for biomedical and clinical research and administration. It is suggested that the future physician has integrated competence and holistic view of patient treatment, in which scientific thinking, knowledge of behavioural science and ethics are integrated with clinical knowledge. As a part of its renewed teaching culture, the Faculty recognises the central role of students in the planning and development of curriculum, and is therefore strongly committed to student-centred education. A further basic cornerstone in the curriculum design and support of learning and teaching in the Faculty is the relevance of the degree in working life. In order to support the above-mentioned activities and to allocate the resources optimally, a Centre for Medical Education Research and Development (R&D) was founded for the needs of Faculty members in 2002.

The Faculty has a unique profile among the Finnish Medical Faculties, since it hosts several Master’s degree programmes (Dentistry, Medicine, Nursing Science and Health Bioscience) allowing productive multidisciplinary collaboration within the Faculty. This can be considered as a special strength for the Medical Undergraduate Programme in terms of joint resources and fruitful learning environment for the students. This application was prepared jointly by a group representing the administration of the Faculty (Vice Dean), Centre for Medical Education Research and Development (Professor and Head of the Unit) and representatives of teachers and medical students.

2. Programme and course design

Based on the recommendation put forward by the international evaluation of the Undergraduate Medical Education Programme in 1996 and on the critical self-evaluation of the Programme carried out in 1999, reform of the undergraduate curriculum into a one-cycle Master’s Degree Programme in Medicine was performed under the guidance of the Faculty during the years 2001-2008. The reform aimed to stress the significance of evidence-based medicine and scientific thinking, and to improve the students’ perception of the competencies reached during their education as well as the importance of cultural and psychosocial factors for health and diseases. At the same time, students´ understanding of the rapid growth of medical knowledge and the essential need for continuous and life-long learning were emphasised. In this process, the Faculty has launched horizontal and vertical integration of biomedical and clinical knowledge into multidisciplinary study modules, included humanistic and psychosocial sciences as well as medical ethics in the curriculum, decentralised teaching, initiated pedagogic education of the teachers, and personal tutoring of the students. All these activities can be considered as best practices of the faculty. Special attention in the reformulation was paid to the balance between medical knowledge and requirements of the working life. The Faculty nominated representatives of teachers, students and physicians from public health services to the planning groups of the modules. This underlines the responsibility and coordinating role of the Faculty for the curriculum. On the other hand, this arrangement emphasises the commitment of the whole faculty, specifically that of the students and teachers, to continuous critical development of the curriculum. A new, open-minded approach to improved understanding and respect for multiprofessional attitudes in undergraduate medical education was the initiation of graduate entry studies for other health care professionals in the Programme. This unique 4-year trial in medical education in Finland has offered new tools for the development of medical education and acknowledgement of previous health care expertise in medical undergraduate training.

The planning of the study modules is based on the idea of continuous accumulation of medical knowledge, skills and attitudes, as well as professional identity. A pioneering programme of Early Patient Contact during the first year of studies, organised by the Department of Family Medicine together with the local health care centres, introduces students to clinical work, the doctor-patient relationship and goals of medical education in a multiprofessional environment. Since this programme partly runs in health care centres with a significant number of patients being of various ethnic backgrounds, aspects of multicultural communication are encouraged. Early integration of clinically relevant information into the theoretical studies as well as practical training of communication further provides foundation for competencies of a physician and strengthens the cumulative nature of professional growth of the students. An increased amount of clinical training in local health care centres and municipal hospitals allows the students to identify the functional roles of a physician as well as the interactions on different levels of the health care services. During the clinical training periods in teaching health care centres, special emphasis is paid to the responsibility of the students for their learning, patient contacts and communication within the multiprofessional environment. To further stress the importance of preventive medicine for students, student-based longitudinal health surveys (health risk analysis, health counselling and follow-up) of their own family members are included in the curriculum. All these activities in the curriculum are assisted by the personal tutoring programme. The final year of the studies has been totally restructured in order to give broad overviews on diagnosis, treatments, prevention and rehabilitation of common diseases in the society.

The Faculty has put special emphasis on elective courses by offering the largest selection and volume (up to 50 ECTS from total 360 ECTS of the Degree Programme) of them among the Finnish medical faculties. It is recognised that the special value of elective studies is to promote multidimensionality. They strengthen the integration of research and teaching, as well as induce the utilization of the knowledge and teaching resources of all researchers in the Faculty. Elective study modules are also seen as flexible tools for the development of innovative core study modules, and for the promotion of joint courses of various faculties within the University. Purposeful development of the elective study modules is partly restructured into special elective study tracks, such as Cardiovascular Track, Neuroscience Track and Nutritional Science Track. This allows the students to deepen and integrate special medical knowledge in the field and personalise their studies according to their own interests.

A central coordinating role in the planning process has been dedicated to the Medical Education R&D Centre. The Centre is headed by a professor, and the Vice Dean, Senior Education Officer, Coordinators of Clinical and Dental Studies and Education Officers of the Faculty are taking part in the activity of its directing board. The Centre also has an 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.

Doors open to science, culture and society

The Medical Faculty has recognised that, in addition to biomedical and clinical knowledge, multicultural and social aspects are of importance in medical practice. Consequently, courses dealing with human beings as part of the social network (e.g. family, relatives, society) have been integrated into the curriculum. The new curriculum thus incorporates courses like human growth and life cycle, ageing, confrontation of disease and death, as well as courses on impact of culture on human health behaviour and illnesses. The core curriculum also contains studies on ethics, philosophy and medical history. Accordingly, the Faculty has appointed as the only medical faculty in Finland a professor in Medical Ethics.

The Medical Humanities Programme in the Faculty, Asklepios Programme (15 ECTS), has been organised together with the Faculties of Humanities and Social Sciences since 2002. The programme forms an important part of the curriculum in the conceptualisation of health as a multifactorial and multicultural entity. The elective programme provides a unique opportunity for students of medicine, humanities and social sciences to explore together the concepts and cultural dimensions of health and illness from a multidisciplinary scientific perspective. An introduction course and four special study modules over a 1-year period are offered to survey relevant scientific issues of medicine and humanities. The students also prepare an interdisciplinary research project. In 2006, the Asklepios Programme was awarded the title of Educational Course of the Year in the University.

The renewal of Swedish Language Education in the Faculty is another innovative approach to teaching. In addition to mere language teaching, aspects of culture and history of the Swedish-speaking citizens (6 % of population) living mostly in the archipelago and coastal areas have been included into the core curriculum as a new intergrated course called "Medicine and Culture in the Archipelago". The course is developed in co-operation with the Language Centre of the University and offers the students opportunities for home visits and communication in Swedish language in the archipelago. The course was also designed as an introduction into living conditions, health and culture of elderly people representing the Swedish speaking minority in Finland. The course was selected as an Educational Course of the Year in 2007 in the University. In a similar fashion, a new innovative course on "Physical Exercise and Health (including nutrition)" is organised in co-operation with the Sports Institute of Finland located in Vierumäki in the vicinity of the city of Heinola. The Faculty recognises the importance of exercise, nutrition and preventive medicine, and has therefore appointed a professor of Health Exercise. Another course that is called "Doctor and Civil Defence", is planned and organised together with the Finnish Defence Forces in the Centre for Military Medicine in the city of Lahti. These abovementioned unique approaches are seen as outstanding additions in medical undergraduate education, since they open outside the traditional health care environment important new views on human health, exercise, nutrition and culture.

Medical education aims to educate physicians, who are capable of scientific thinking and linking theoretical scientific medical knowledge to practical skills. The Faculty has recognised the important link of research and education, and has organised special research tracks for the undergraduate medical students. Currently, the Undergraduate Education Programme in Medicine contains two research tracks: an early-starting biomedical and a later clinical track, with a volume of 30 ECTS. Research tracks are closely connected with teaching and training activity of the Postgraduate School (PGS) of the Faculty . The aims of the tracks are to guide the students through various research methods, laboratory practices, biostatistics, research ethics as well as training in communication and performing skills. The research tracks help the students to integrate into the research community of the University and further serve as flexible routes into Graduate Schools of Biomedical Sciences and Clinical Sciences of the Faculty.

3. Delivery of education

Based on careful planning carried out by study committees, diverse and pioneering teaching and assessment methods are utilised throughout the curriculum. Improved training of doctor-patient contact, communication and other clinical skills has been made possible through increased decentralisation of the clinical education, the establishment of a Clinical Skills Centre (e.g. Simman, phantoms), and extensive organisation of clinical training periods in hospital wards, such as "One week on call in Obstetrics" and outpatient clinics as well as in health care centres. A special innovative approach is the two-week "Minihospital" (ie. a third of one hospital ward) period during the 6th year, where the students actively take care of all aspects of patient examination, planning of diagnostic tests and treatments under close supervision of a full-time senior teacher. Web-based learning environments and teaching technologies, as well as a comprehensive personal tutorial system for students further promote students´ academic and professional growth. Frequent feedback from recently graduated physicians and their employers is an important part of the quality control of the Education Programme.

New learning environments

The role of learning environment in supporting the development of medical expertise is essential. The Faculty has recognised that the university hospital, with its highly selected patient material, is often not an optimal learning environment for teaching diseases and problems commonly seen in public health care services. Consequently, the Faculty has decentralised the clinical teaching to a substantial part outside the university hospital, to several health care centres and municipal hospitals. Two teaching health care centres designed specifically for medical education purposes have been established in the area, both of which have adopted a multiprofessional education policy. The network based on decentralisation of undergraduate education offers excellent possibilities for training the future doctors to understand the function of different levels of health care system. Furthermore, the relevance of undergraduate education for working life has thereby significantly improved.

The Faculty has decisively developed electronic learning environments and teaching technologies. The Medica-portal of the Faculty, serving as an electronic base for various teaching and learning materials for students and teachers, has been operative since 2002. The portal allows organisation of web-based national and international medical courses. In the near future, Medica-portal will promote the use of electronic portfolios of the students, utilised in the tutorial programme. Other developmental steps in web-based teaching are the MedImage-portal offering hundreds of patient cases with clinical and radiological data, and a video network between the University and decentralised health care centres allowing joint lectures and conferences. For these activities the Faculty has provided special resources (a professorship for development of medical teaching technology, a coordinator of electronic network teaching and a teaching technologist).

Assessment

This curriculum based on cumulative knowledge is followed by systematic feedback from students and teachers. Electronic feedback is collected by the teachers responsible for the courses and semesters, and then analysed and taken up for general discussion in special feedback seminars. All the teachers, students and their tutors take part in these seminars. In addition, in cooperation with the Faculty of Education, the Medical Education R&D Centre has designed a unique feedback form usable for all courses and semesters. Students’ opinions on the course objectives, teaching and learning as well as their own activity are collected in a unified form and analysed. A summary of the results comparing different courses is finally presented to the Board of Education of the Faculty, and also made visible in the Medica-portal to serve the planning of the forthcoming courses and semesters. Through systematic review of the feedback results, the Medical Education R&D Centre is able to assess the influence of the feedback on the curriculum design.

Towards academic professionalism

Today’s physicians work as experts of medicine in multidisciplinary teams. The education strategy of the Faculty recognises the need of support for the students to grow and ultimately work as physicians. Based on the recommendation of an international evaluation of Medical Undergraduate Education at our University, the Medical Faculty decided to establish a programme of personal tutoring for all undergraduate students in 2003.

A tutorial group consists of 8-10 students. Regular group and individual meetings of the tutors and their students are organised through the 6-year medical curriculum. The tutors have a pastoral role in facilitating the students to learn, checking their personal study plans and portfolios, identifying personal problems as well as supporting the development of the professional identity of a medical doctor. To foster students´ development, a structured self-assessment for reflection on their personal, academic and professional performance has been connected to students´ portfolio work for several years. The Faculty has presently over 60 trained tutors who participate in further development of the tutoring system. In the feedback surveys, the tutors perceived the programme to be highly supportive for the students´ academic and professional development. The supportive value of the programme was also recognised by the students. This programme of personal tutoring in Medical Undergraduate Education is pioneering in Finland, and it needs careful follow-up to prove its ultimate influence on educational outcome.

In addition to tutoring by faculty members, senior medical undergraduate students are also trained as peer tutors. Their role is to provide social support to 1st years students and aid them in learning the practicalities of studying medicine in the Faculty. Their work is, according to the yearly assessments, considered essential by the student body in integrating new students into the faculty community. The social support provided by the peer-tutoring activities in seen by the Faculty as a vital part in supporting the welfare of medical students and maintaining a student-friendly learning atmosphere.

The improvement of pedagogical abilities of the teachers is vital for the continuing development of the teaching and learning culture of the Faculty. The Medical Education R&D Centre of the Faculty has organised pedagogic courses (10 ECTS) for medical teachers since 2003. So far, over 100 teachers have taken part. During the course, they have prepared their own pedagogical development project continuously reflected in curriculum design; teachers and students are also encouraged to actively participate in national and international conferences on medical education.

4. Outputs

In order to educate physicians with integrated clinical knowledge, holistic view of patient treatment, scientific thinking and knowledge of behavioural sciences and ethics, the main objectives of the Faculty in the delivery of the Undergraduate Education Programme in Medicine are: strengthening of the teaching and learning culture of the Medical Faculty; promotion of pedagogical education of the teaching staff; longitudinal support of the students; and fostering of the commitment of our students to the academic community and to lifelong learning. The qualitative output of the Programme is followed by frequent and longitudinal analysis of students’ study orientations, progress and professional development. This gives useful general knowledge about the quality and efficiency of the Degree Programme. Although the high student group-size poses a key challenge for the development of medical education, a vast majority of the medical students graduate successfully. Post-graduation feedback surveys have so far proved the Degree Programme to be well designed for the needs of working life.

Assessment of student learning is in central focus of educational development in the Faculty. In addition to traditional examinations, other assessment methods, including learning and lecture diaries, are increasingly used in the Faculty. Assessment of clinical skills is also taken into special consideration, and several clinical courses have introduced OSCE (Objective Structured Clinical Examination) – examinations that will be also in the focus of the future curriculum development. The feedback on learning as well as individual academic and professional development of the students, based on their self-reflections, is of special and unique significance and is the central tasks of the tutors. Assessment of learning as an important focus in the Undergraduate Education Programme of the Faculty is additionally supported by a joint research project on cumulative learning and investigation of longitudinal development of expertise during medical studies (LeMEx Project) , conducted by the Medical Education R&D Centre. Several research reports on learning, both oral and posters, have been presented in national and international educational conferences.

5. Continual development

The explosive growth of medical knowledge and technology together with the increasing demands of society on the medical profession place continual challenges on medical education. The Faculty sees that participation of students and newly graduated colleagues is essential in creating new educational visions and adequate timely revisions of the Programme. The importance of complementing these approaches by detailed feedback surveys from employers, medical associations and especially from patients and patient organisations is also recognised. To support further educational reform the Faculty has also initiated benchmarking projects on curriculum development with other medical faculties in Finland and abroad.

Rapid development of web-based learning environments and electronic databases strongly challenges traditional views of learning requirements. Optimal utilisation of electronic learning tools is therefore of utmost importance in future medical education and in professional working life. The Faculty recognises, however, that this requires a strong basic knowledge and understanding of medical science as well as ability for scientific thinking among the students. Therefore, accumulative learning and medical thinking by students, and the balance between optimal learning environments are needed. Ultimately, however, the Faculty aims that the graduates of the Programme are aware of the importance of empathetic and supportive attitude towards patients and their family members and have a holistic view of health, illness and society.

Professor Markku Koulu, MD, PhD
Vice Dean, Undergraduate Medical Education
tel +358-2-333 7548
gsm +358-44-504 8861

Professor Pekka Kääpä, MD, PhD
Head, Medical Education R&D Centre
tel +358-2-333 7651
gsm +358-41-448 7747