World Federation of Medical Education

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WFME Global StandardSFor Quality

iMprovEMEntin MEdical Education

EuropEan SpEciFicationS

MEDINEThe Thematic Network on Medical Education in Europe

Quality Assurance Task Force WFME Ofce University o Copenhagen Denmark 2007

WORLD FEDERATION FOR

MEDICAL EDUCATION


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MEDINE

The Thematic Network on Medical Education in Europe

WFME GLOBAL STANDARD S F ORQUALITY

IMPROVEMENT IN MEDICAL EDUCATION

EUROPEAN SPECIFICATIONS

For Basic and Postgraduate Medical Education andContinuing Professional Development

Developed by aWFME/AMSE International Task Force

MEDINE Quality Assurance Task ForceWFME Office University of Copenhagen Denmark 2007


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CONTENTS

PREFACE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Thematic Network MEDINE and the Quality Assurance Task Force . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

PREMISES FOR EUROPEAN SPECIFICATIONS . . . . . . . . . . . . . . . . . . . . . 9The WFME Global Standards Programme . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Delineation of the European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Diversity of medical education in the European Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Europe in a global context . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Needs for standards in medical education in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Concept and use of standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

European standards or regional specifications for global standards? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

THE WFME GLOBAL STANDARDS WITH EUROPEAN SPECIFICATIONS 13WFME Trilogy of Standard Documents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Areas and sub-areas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Definitions of standards and annotations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

European specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

STANDARDS IN BASIC MEDICAL EDUCATION WITH EUROPEANSPECIFICATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

STANDARDS IN POSTGRADUATE MEDICAL EDUCATION WITHEUROPEAN SPECIFICATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

STANDARDS IN CPD OF MEDICAL DOCTORS WITH EUROPEANSPECIFICATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

BIBLIOGRAPHY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56ANNEXES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 611. Preface to the Trilogy of WFME Documents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

2. WFME Standards in Basic Medical Education: Introduktion and Definitions . . . . . . . . . . . . . . . . . . . . . . . . . 63

3. WFME Standards in Postgraduate Medical Education: Introduktion and Definitions . . . . . . . . . . . . . . . . . . 67

4. WFME Standards in Continuing Professional Development (CPD) of Medical Doctors:

Introduktion and Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

5. Members of Task Forces of the WFME Global Standard Project . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77


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PREFACE

The proposal for European Specifications in Medical Education presented in this document is an adaptation ofglobal standards in medical education to the European Region. The proposal covers all three phases of med-ical education: basic medical education; postgraduate medical education; and continuing professional devel-opment. It was developed by an international Task Force set up by the Thematic Network on MedicalEducation in Europe (MEDINE), chaired jointly by the World Federation for Medical Education (WFME) and

the Association of Medical Schools in Europe (AMSE) and sponsored by the Commission of the EuropeanUnion.

The World Health Organization (WHO) Regional Office for Europe, as part of its commitment to ensure qual-ity of health care in Europe, and in the framework of the WHO-WFME Strategic Partnership to ImproveMedical Education, has facilitated publication and dissemination of the booklet.

In publishing these specifications, MEDINE intends to provide a tool for reform processes, and criteria for therecognition and accreditation of medical education institutions and programmes, for the benefit of the con-stituency of medical education, health services and health systems throughout the region.


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INTRODUCTION

Over the past decade, a number of quality assuranceinitiatives have been taken on internationally in med-ical education. They include the setting of standardsand the establishment of systems for recognition andaccreditation of educational institutions and pro-

grammes. The focus on the need for internationalstandards in medical education has been driven bythe expansion of globalization, as manifested byexchange of medical students, migration of medicaldoctors and cross-border education. However, stan-dards are also important in addressing national pro-blems and challenges that result from changes in thehealth care delivery service, from institutional con-servatism and inadequate management and leader-ship, and from the rapid growth in the number ofnew medical schools. At the same time, common

trends in curricular developments and the manage-ment of medical education have facilitated attemptsto define international standards. The ultimate goal isto improve health care across Europe.

It was therefore natural that MEDINE, with fundingfrom the Commission of the European Union, shoulddecide to include in its objectives activities thataddress quality assurance and standard setting inmedical education in the European Region.

This document presents the considerations of the

MEDINE Task Force on Quality Assurance Standardsand the results of its work. The vision of the TaskForce is that the recommendations regarding stan-dard setting outlined in this document could be usedby the European Commission, national educationand health authorities, institutions and organisationswith responsibility for medical education, in theirendeavours to achieve quality assurance andimprovement in medical education throughout itscontinuum in the European Region.

THEMATIC NETWORK MEDINE ANDTHE QUALITY ASSURANCE TASKFORCE

The Thematic Network MEDINE on medical educa-tion in Europe, which comprises more than one hun-dred institutions, addresses educational, institutionaland quality issues in European medical education. Itworks within the framework of European initiativeslike the Bologna Declaration and Process, includingthe European Credit Transfer System (ECTS), theDiploma Supplement initiative and the Tuning proj-ect. It has to take account of previous work in medicaleducation done by, for example, the EuropeanCommission, the Association for Medical Educationin Europe (AMEE), the Association of Medical

Schools in Europe (AMSE) and the World Federationfor Medical Education (WFME). The target groupsfor this work are students, medical educators, healthcare providers, ministries of health and education, theEuropean Commission, professional bodies, patientsand the public in general.

The Task Force on Quality Assurance Standardswas led jointly by the World Federation for MedicalEducation (WFME) and the Association of MedicalSchools in Europe (AMSE).

The objectives of the Task Force were:

To work to enhance overall standards of medicaleducation in Europe through sharing of ideas, dis-semination of best practice, and quality assurance,in conjunction with other European agencies suchas ENQA and the regional ERA and making use ofthe work already carried out by the WFME.

To analyse how to adapt the WFME standards tothe European context of medical education and tothe Bologna process in order to establish minimumrequirements for accreditation at Medical Schoolsin Europe.

To produce a set of quality assurance standards formedical education in Europe, building on andadapting existing work such as the WFME GlobalStandards framework.

The list of Task Force members is presented inside thecover.


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In trying to define specifications for the WFMEGlobal Standards in medical education in a Europeancontext, a number of questions had to be discussed.In the following, only central issues related to stan-dard setting in the European Region will be covered.

THE WFME GLOBAL STANDARDSPROGRAMME

The WFME programme on definition of internationalstandards in medical education was launched in1998. The purpose was to provide a mechanism forquality improvement in medical education, in a glob-al context, to be applied by institutions, organisationsand national authorities responsible for medical edu-

cation. Standards were developed by three interna-tional Task Forces with broad representation ofexperts in medical education from all six WorldHealth Organization (WHO)/WFME Regions.Following initial publication of a draft of Standards inBasic Medical Education and presentation at variousinternational conferences, the final Trilogy of WFMEGlobal Standards was published in 2003 (a1, a2, a3).

The Trilogy was the essential background material forthe 2003 World Conference in Medical Education:Global Standards in Medical Education for BetterHealth Care (a4), which endorsed the StandardsProgramme (a5, a6). The Standards have been validat-ed in a number of pilot studies and have been used byan increasing number of institutions and nationalagencies in all regions of the world. Since 2004, theyhave been promoted by the WHO/WFME StrategicPartnership to Improve Medical Education (a7).

General principles for and considerations regardingdefinition of international standards for medical edu-cation institutions and programmes, as discussed in

the WFME Trilogy of Global Standards for QualityImprovement of Medical Education, can be found inAnnexes 1-4. These include the concepts, rationalebehind, the purposes and use of international stan-dards as well as a description of fundamental condi-tions of the various phases of medical education

DELINEATION OF THE EUROPEAN REGION

The European Region is delineated differently by var-

ious international organisations and authorities. TheEuropean Union currently (January 2007) includes 27

countries. Closely related to the EU are the 4 EFTAcountries. The Council of Europe comprises at themoment 46 countries. The group of countries (totalnumber in 2006: 45) which signed the BolognaDeclaration corresponds closely to the Council of

Europe.

The European Region of the World HealthOrganization (WHO-EURO) goes beyond these bound-aries of Europe by including also the Central AsianRepublics and comprises at the moment 53 countries.The total number of countries in Europe (2007) is 55.

Considering the constant growth so far of theEuropean Union and the relationship between EUand other parts of Europe as exemplified by the

extension of the Bologna Process, the Task Force, inaccordance with the Board of MEDINE, decided towork with standards for Europe in a broad sense.The conclusion was that at the moment, the EuropeanRegion relevant for definition of European medicaleducation standards would be comparable to the geo-graphical area covered by the Council of Europe.

The Task Force is, however, aware of the increasingrelationships between the European Region asdefined above and other countries, e.g. the CentralAsian Republics. These countries are increasingly try-

ing to adapt their medical education systems toEuropean principles. This situation means that fur-ther expansion of the European Region in terms ofrelevance for medical education and mobility of med-ical doctors might be expected in the near future.

DIVERSITY OF MEDICAL EDUCATION IN THEEUROPEAN REGION

Although there is some uniformity in the European

Union with respect to tradition and structure of high-er education, medical education has developed inseveral different ways.

The variations can be explained by differences in:

teaching tradition cultural background socio-economic conditions health and disease spectrum organisation of the health care delivery system and

distribution of health care service activities to var-ious cadres of the health care workforce.

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PREMISES FOR EUROPEAN SPECIFICATIONS


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The Advisory Committee on Medical Training(ACMT) which was established in conjunction withthe introduction of the first Medical Directives of theEuropean Commission in 1975 worked to safeguardthe mobility of doctors in the EU by producing anumber of important reports (b20, c14, d11). ACMTobserved a clear distinction in the principles underly-ing training between Northern and North-WesternEurope on the one side and Southern Europe on theother side. Many recent discussions and initiativeshave resulted in some harmonisation of the educa-tional process, which made the relatively weakly for-mulated rules in the Directives acceptable, andallowed for free mobility of medical doctors. TheDirectives never adressed quality assurance.

With the expansion of the European Union east-wards, the diversity of medical education furtherincreased, creating doubts among many stakeholders

as to the feasibility and acceptability of the Directivesbeing a basis for regulation of doctors mobility with-in the EU. The Directives have only undergonechanges in the formal presentation, and the educa-tional requirements of the latest Directive (EUDirective 2005/36/EC) (a8) are almost identical tothose in the first two Directives of 1975, which wereconsolidated in EU Directive 1993/16/EU.

The Task Force is aware of the differences betweencountries in the European Region, and to some extent

within countries, with respect to organisation,process, content and outcome of medical education.

The spectrum of variability is probably greatest withrespect to postgraduate medical education and con-tinuing professional development; basic medical edu-cation in all countries has been influenced by princi-ples which are common to most university traditions.

It has been central to the Task Force that the spectrumof medical educational systems and conditions inEurope are comparable to those in most regions of the

world. This is a strong argument for operating withsimilar standards at two levels of attainment as usedin the WFME Trilogy of Global Standards.

EUROPE IN A GLOBAL CONTEXT

The Task Force emphasises that standard setting forEurope should not create a situation of isolation fromother parts of the world. Europe has a long traditionof exchange of students and health professionals

worldwide. Standards in medical education shouldbe used as an instrument to safeguard the quality of

the medical profession, and should not work as anunnecessary barrier preventing adequately trainedmedical doctors moving between Europe and otherparts of the world.

Basically, medical education in Europe is facing thesame problems and challenges as the rest of theworld, and therefore standard setting must be madeon a common basis.

NEEDS FOR STANDARDS IN MEDICAL EDUCA-TION IN EUROPE

In a global perspective, the needs for standards inmedical education in the European Region mightseem less of a problem than in many other regions.However, the creation of the European HigherEducational (EHEA) and Research Areas (ERA) with-

in the framework of the Bologna Process (a9) is lead-ing to increased mobility of students and profession-als and so increases the need for common principlesof quality assurance processes. When seen as a qual-ity improvement tool, the need for standards is stillthe same and must address challenges due to:

political, socio-economic and cultural realities institutional conservatism faculty staff inertia lack of clearly defined educational budgets

insufficient supervision of programmes lack of incentives and insufficient leadership.

Another need for standards is exemplified in the caseof new medical schools, which may currently neitherhave externally set standards to work to nor anyguidance as to what is acceptable. The explosion inthe number of medical schools, which has raised con-cern about the quality of medical education in otherRegions, has so far not been a prominent phenome-non in Europe. However, Europe should be aware of

the threats of uncontrolled establishment of newmedical schools. Experiences from other Regions andcases within Europe show how private schools with afor profit purpose tend to neglect basic require-ments such as the sufficiency of financial resources,the adequacy of the settings for clinical training, andthe necessary research attainment facilities.

Closely related to this is the phenomenon of off-shore medical schools, being established as satellitesof foreign medical schools for commercial reasons

and potentially characterised by lower quality of theeducational product compared to the mother institu-

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tions. In some countries, this new trend of commer-cialisation of higher education, including medicaleducation, has now led to deliberate overproductionof graduates for the purpose of export. This situationis a clear threat to the quality of medical education.Although not so far involved to a great extend in thistype of cross-border education, Europe should pro-tect itself against this tendency by setting relevantquality standards for medical education institutionsand their programmes.

In formulating standards for medical education inEurope, special European needs should also be con-sidered and defined. This would first of all includethe basic requirements of medical education whichare stated in the present Directive on recognition ofprofessional qualifications (Directive 2005/36/EC of7 September 2005) (a8) and the consequences of com-mitment to the Bologna Process, which raised some

questions for the quality of medical education, nowbeing discussed all over Europe (a10).

CONCEPT AND USE OF STANDARDS

Standards in medical education can be used as a qual-ity improvement tool in institutional self-evaluationsand peer review or as a basis for official recognitionand accreditation. There is a clear overlap betweenthese functions.

Apart from general educational standards as pro-posed by the European Association for QualityAssurance in Higher Education (ENQA) (a11), thereis a need for subject specific standards in medicine.Studies of the use of the WFME Global Standardshave shown that institutional self-evaluation basedon these standards has fundamental positive influ-ence on reform processes (a12).

Ideally, the standards to be used for reform purposesshould be comprehensive like the WFME Global

Standards, covering all aspects of medical education,including the organisation, structure, process, curric-ular content, learning environment and outcome. Asregards outcomes, the Global Minimum EssentialRequirements (GMER) standards as produced by theInternational Institute of Medical Education (a13) orequivalent standards describing expected outcomecompetences of graduates should be taken into con-sideration; this subject is dealt with in detail by theMEDINE Task Force on Tuning (a14).

Recommendations for proper accreditation systems

can be found in the WHO/WFME Guidelines forAccreditation in Basic Medical Education (a15), pub-lished in 2005 as a result of an international TaskForce with broad representation from all Regions.Another outcome of that Task Force was the recom-mendation that accreditation should primarily beconsidered to be a national responsibility, the exemp-tions being countries with only one or few medicalschools.

In this regard, it is the opinion of the MEDINE TaskForce that at the present time there is no justificationfor the establishment of a common European accred-itation system for medical schools. Small countrieswho do not have their own accreditation systemcould either be affiliated with a neighbouring countryor, where appropriate, join Sub-regional accreditationsystems. These questions should be discussed by afuture Task Force.

There is potentially already more coordination inpostgraduate medical education and continuing pro-fessional development. For example, the role of pro-fessional associations and organisations such as theEuropean Union of Medical Specialists (UEMS) (a16,a17) and the Standing Committee of EuropeanDoctors (CPME) (a18) should be noted. European col-laboration in quality assurance and developmentshould be encouraged throughout the spectrum ofmedical education.

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EUROPEAN STANDARDS ORREGIONAL SPECIFICATIONS FORGLOBAL STANDARDS?

As a consequence of the considerations above, theTask Force came to the conclusion that presently thereis no need for a separate set of European standards in

medical education. The increasing collaborationbetween countries in an ongoing expandingEuropean Region, a spectrum of diversity of medicaleducation in the Region comparable to other regionsof the world, the perspectives of the European Regionin a broader global context and type of standardsneeded are factors that point to rejection of separatestandards for Europe. It is the opinion of the TaskForce that it will be sufficient to state EuropeanSpecifications for the WFME Global Standards.Elements of such specifications are shown below.

The WFME Global Standards with the EuropeanSpecifications could be used as a template for nation-al standards. These could then become relevant in

institutional reform processes and act as a basis forthe establishment of accreditation systems in medicaleducation.

As a logical consequence, it is the opinion of the TaskForce that there is no rationale for an intermediarylevel between global and national standards in theEuropean Region.

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TYPES OF EUROPEAN SPECIFICATIONS

Considerations of changing the division lines between basic standards or minimum requirements andstandards for quality development. This takes into account the general social and economicconditions as well as recent improvements and endeavours in quality assurance and development ofmedical education in Europe which allow higher standards to be set.

This kind of modification of the WFME Global Standards could for example be motivated byinfluence of modern teaching and learning theory, definition of outcome and performance compe-tences, enhancement of the integration of basic biomedical, behavioural and social sciences withclinical sciences in the medical programme or new settings for and other innovations inclinical training.

Supplements necessitated by special European political conditions as consequences of, for example,EU Directives, or determined by commitments to the European Higher Education Area.

Other additions to the global standards which would be relevant for the Region and perhaps alsoincluded in a future revision of the WFME Global Standards.


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WFME Trilogy of Standard DocumentsEach of the three documents of The Trilogy of WFMEGlobal Standards (a1, a2, a3) is structured accordingto 9 Areas and 36-38 Sub-areas.

Areas are defined as broad components in the struc-ture, process and outcome of medical education andcover all education and institution aspects (Table 1).

Sub-areas are defined as specific aspects of an area,corresponding to performance indicators.

Definitions of standardsStandards are specified for each sub-area. Withineach sub-area there can be one or more standards.

Standards are formulated at two levels of attainment:

Basic standard,meaning that the standard mustbe met from theoutset.

Standard for quality development,meaning that the standard is in accordance withinternational consensus about best practice.Fulfilment of or initiatives to fulfil some or allof such standards shouldbe documented.

AnnotationsAnnotations are used to clarify, amplify or exemplifyexpressions in the standards.

European specificationsIn formulating specifications to the WFME GlobalStandards, which are relevant for Europe, the TaskForce has followed the principles mentioned above,i.e. the need to change the division line between the

two levels of the WFME Standards and the need toadd new elements to the standards and modifyingsome of the annotations.

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THE WFME GLOBAL STANDARDS WITH EUROPEAN SPECIFICATIONS

Table 1 WFME TRILOGY OF STANDARDS: AREAS

Basic Medical Education Postgraduate Medical Education Continuing ProfessionalDevelopment (CPD)

1. Mission and Objectives Mission and Outcomes Mission and Outcomes

2. Educational Programme Training Process Learning Methods

3. Assessment of Students Assessment of Trainees Planning and Documentation

4. Students Trainees The Individual Doctor

5. Academic Staff/Faculty Staffing CPD Providers

6. Educational Resources Training Settings and Educational Educational Context andResources Resources

7. Programme Evaluation Evaluation of Training Process Evaluation of Methodsand Competencies

8. Governance and Administration Governance and Administration Organisation

9. Continuous Renewal Continuous Renewal Continuous Renewal

STRUCTURE OF EUROPEANSPECIFICATIONS FOR WFME GLOBALSTANDARDS:

For every sub-area in each of the three sectionsrepresenting standards for Basic Medical

Education (BME), Postgraduate MedicalEducation (PME) and Continuing ProfessionalDevelopment (CPD), respectively, the wordingof the WFME Basic and Quality DevelopmentStandards and the Annotations is initially out-lined as in the WFME Trilogy.

For relevant sub-areas, this is followed by a sec-tion with European specifications. For eachspecification, reference is given to the section towhich the specification belongs:BS: Basic standard;QD: Quality development standard;

A: Annotation.


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1.1 STATEMENTS OF MISSION

AND OBJECTIVES

Basic standard:The medical school must define its mission and objec-tives and make them known to its constituency. Themission statements and objectives must describe theeducational process resulting in a medical doctorcompetent at a basic level, with an appropriate foun-dation for further training in any branch of medicineand in keeping with the roles of doctors in the healthcare system.

Quality development:The mission and objectives should encompass socialresponsibility, research attainment, communityinvolvement, and address readiness for postgraduatemedical training.

Annotations: Statements of mission and objectives would include general and

specific issues relevant to institutional, national and regionalpolicy.

Any branch of medicine refers to all types of medical practiceand medical research.

Postgraduate medical training would include preregistrationtraining, vocational training, specialist training and continu-ing medical education/professional development.

1.2 PARTICIPATION IN FORMULA-TION OF MISSION AND OBJEC-TIVES

Basic standard:The mission statement and objectives of a medical

school mustbe defined by its principal stakeholders.

Quality development:

Formulation of mission statements and objectivesshould be based on input from a wider range ofstakeholders.

Annotations: Principal stakeholders would include the dean, members of

the faculty board/council, the university, governmentalauthorities and the profession.

A wider range of stakeholders would include representatives ofacademic staff, students, the community, education andhealth care authorities, professional organisations and post-graduate educators.

1.3 ACADEMIC AUTONOMY

Basic standard:

There mustbe a policy for which the administrationand faculty/academic staff of the medical school areresponsible, within which they have freedom todesign the curriculum and allocate the resources ne-cessary for its implementation.

Quality development:The contributions of all academic staff shouldaddress the actual curriculum and the educationalresources shouldbe distributed in relation to the edu-cational needs.

1.4 EDUCATIONAL OUTCOME

Basic standard:The medical school must define the competenciesthat students should exhibit on graduation in relationto their subsequent training and future roles in thehealth system.

Quality development:The linkage of competencies to be acquired by grad-

uation with that to be acquired in postgraduate train-

BS The quality development standard is consid-ered a basic standard.

A Principal stakeholders would include regulato-ry authorities.


BS Statements of mission and objectives musttake into consideration the European per-spective in the Higher Education andResearch Areas.

BS The medical school mustbe part of a univer-sity or be an institution of equivalent level.

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STANDARDS IN BASIC MEDICAL EDUCATIONWITH EUROPEAN SPECIFICATIONS

1. MISSION AND OBJECTIVES


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ing should be specified. Measures of, and informa-tion about, competencies of the graduates shouldbeused as feedback to programme development.

Annotations: Educational outcome would be defined in terms of the com-

petencies the students must acquire before graduation. Competencies within medicine and medical practice would

include knowledge and understanding of the basic, clinical,behavioural and social sciences, including public health andpopulation medicine, and medical ethics relevant to thepractice of medicine; attitudes and clinical skills (withrespect to establishment of diagnoses, practical procedures,communication skills, treatment and prevention of disease,health promotion, rehabilitation, clinical reasoning andproblem solving); and the ability to undertake lifelong learn-ing and professional development.

BS In defining competencies, the medical schoolmust take into account current Europeandevelopments in defining European core

learning outcomes.

A Definition ofcompetencies would consider theEuropean Framework of Qualifications andthe results of the Tuning medical educationproject of MEDINE and other related initia-tives.

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2.1 CURRICULUM MODELS ANDINSTRUCTIONAL METHODS

Basic standard:The medical school must define the curriculum mo-dels and instructional methods employed.

Quality development:The curriculum and instructional methods shouldensure that students have responsibility for theirlearning process and should prepare them for life-long, self-directed learning.

Annotations: Curriculum models would include models based on disci-

pline, system, problem and community, etc. Instructional methods encompass teaching and learning

methods. The curriculum and instructional methods should be based on

sound learning principles and should foster the ability toparticipate in the scientific development of medicine as pro-fessionals and future colleagues.

2.2 SCIENTIFIC METHODBasic standard:The medical school must teach the principles of sci-entific method and evidence-based medicine, includ-ing analytical and critical thinking, throughout thecurriculum.

Quality development:The curriculum should include elements for trainingstudents in scientific thinking and research methods.

Annotation: Training in scientific thinking and research methods may

include the use of elective research projects to be con-ducted by medical students.

2.3 BASIC BIOMEDICAL SCIENCES

Basic standard:The medical school must identify and incorporate inthe curriculum the contributions of the basic biomed-ical sciences to create understanding of the scientificknowledge, concepts and methods fundamental toacquiring and applying clinical science.

Quality development:The contributions in the curriculum of the biomed-

ical sciences shouldbe adapted to the scientific, tech-nological and clinical developments as well as to thehealth needs of society.

Annotation: The basic biomedical sciences would - depending on local

needs, interests and traditions - typically include anatomy,biochemistry, physiology, biophysics, molecular biology, cellbiology, genetics, microbiology, immunology, pharmacology,

pathology, etc.

2.4 BEHAVIOURAL AND SOCIALSCIENCES AND MEDICALETHICS

Basic standard:The medical school must identify and incorporate inthe curriculum the contributions of the behaviouralsciences, social sciences, medical ethics and medicaljurisprudence that enable effective communication,clinical decision making and ethical practices.

Quality development:The contributions of the behavioural and social sci-ences and medical ethics shouldbe adapted to scien-

tific developments in medicine, to changing demo-


QD Proper integration between basic medical sci-ences and clinical sciences and skills shouldbe assured.


BS In EU member states the curriculum mustcomply with the EU Directive 2005/36/EU of

7 September 2005 on the recognition of pro-fessional qualifications.

BS It mustbe clearly stated if a one or two cyclesystem (according to the Bologna Declaration)is used in structuring the curriculum.

QD The instructional methods shouldbe basedon modern adult learning theory.

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2. EDUCATIONAL PROGRAMME


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graphic and cultural contexts and to health needs ofsociety.

Annotations: Behavioural and social sciences would - depending on local

needs, interests and traditions - typically include medicalpsychology, medical sociology, biostatistics, epidemiology,hygiene and public health and community medicine etc.

The behavioural and social sciences and medical ethics shouldprovide the knowledge, concepts, methods, skills and atti-tudes necessary for understanding socio-economic, demo-graphic and cultural determinants of causes, distributionand consequences of health problems.

2.5 CLINICAL SCIENCES AND SKILLS

Basic standard:The medical school must ensure that students havepatient contact and acquire sufficient clinical knowl-edge and skills to assume appropriate clinical respon-sibility upon graduation.

Quality development:Every student should have early patient contact lead-ing to participation in patient care. The different com-ponents of clinical skills training should be struc-tured according to the stage of the study programme.

Annotations: The clinical sciences would - depending on local needs, inter-

ests and traditions - typically include internal medicine(with subspecialties), surgery (with subspecialties), anaes-thesiology, dermatology & venereology, diagnostic radiolo-gy, emergency medicine, general practice/family medicine,

geriatrics, gynecology & obstetrics, laboratory medicine,neurology, neurosurgery, oncology & radiotherapy, oph-thalmology, orthopaedic surgery, oto-rhino-laryngology,paediatrics, pathological anatomy, physiotherapy & rehabil-itation medicine and psychiatry, etc.

Clinical skills include history taking, physical examination,procedures and investigations, emergency practices andcommunication and team leadership skills.

Appropriate clinical responsibility would include health pro-motion, disease prevention and patient care.

Participation in patient care would include relevant communi-

ty experience and teamwork with other health professions.

2.6 CURRICULUM STRUCTURE,COMPOSITION AND DURATION

Basic standard:The medical school must describe the content, extentand sequencing of courses and other curricular ele-ments, including the balance between the core and

optional content, and the role of health promotion,preventive medicine and rehabilitation in the curricu-lum, as well as the interface with unorthodox, tradi-tional or alternative practices.

Quality development:Basic sciences and clinical sciences should be inte-grated in the curriculum.

Annotations: Core and optional content refers to a curriculum model with

a combination of compulsory elements and electives or

special options. The ratio between the two components canvary. Integration of disciplines would include both horizontal (con-

current) and vertical (sequential) integration of curricular

components.

2.7 PROGRAMME MANAGEMENT

Basic standard:A curriculum committee mustbe given the responsi-bility and authority for planning and implementingthe curriculum to secure the objectives of the medicalschool.

Quality development:The curriculum committee shouldbe provided withresources for planning and implementing methods ofteaching and learning, student assessment, courseevaluation, and for innovations in the curriculum.

There should be representation on the curriculumcommittee of staff, students and other stakeholders.

QD Organisation of the curriculum shouldbebased on estimated student workload asexpressed in the European Credit TransferSystem (ECTS).

QD At least one third of the study period shouldbe spent in contact with patients in relevantclinical settings. The medical school shouldspecify the amount of time spent in trainingin medicine, surgery, paediatrics, obstetricsand gynaecology, psychiatry and generalpractice/family medicine.


QD Behavioural and social sciences shouldbeintegrated with other knowledge and skills,and medical ethics with biomedical and clini-

cal sciences.

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Annotations: The authority of the curriculum committee would include

supremacy over specific departmental and subject interests,and the control of the curriculum within existing rules andregulations as defined by the governance structure of theinstitution and governmental authorities.

Other stakeholders would include other participants in theeducational process, representatives of other health profes-

sions or other faculties in the University.

2.8 LINKAGE WITH MEDICALPRACTICE AND THE HEALTHCARE SYSTEM

Basic standard:Operational linkage must be assured between theeducational programme and the subsequent stage oftraining or practice that the student will enter aftergraduation.

Quality development:The curriculum committee should seek input fromthe environment in which graduates will be expectedto work and should undertake programme modifica-tion in response to feedback from the community and

society.

Annotations: Subsequent stages of training would include pre-registration

training, and specialist training. Operational linkage would imply clear definition and descrip-

tion of the elements and their interrelations in the variousstages of training and practice, and should pay attention tothe local, national, regional and global context.


BS The representation on the curriculum com-mittee of staff and students is considered abasic standard.

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3.1 ASSESSMENT METHODS

Basic standard:The medical school must define and state the meth-ods used for assessment of its students, including the

criteria for passing examinations.

Quality development:The reliability and validity of assessment methodsshould be documented and evaluated and newassessment methods developed.

Annotations: The definition of methods used for assessment may include con-

sideration of the balance between formative and summativeassessment, the number of examinations and other tests, the

balance between written and oral examinations, the use of

normative and criterion referenced judgements, and the useof special types of examinations, e.g. objective structuredclinical examinations (OSCE).

Evaluation of assessment methods may include an evaluationof how they promote learning.

New assessment methods may include the use of external

examiners.

3.2 RELATION BETWEEN ASSESS-MENT AND LEARNING

Basic standard:

Assessment principles, methods and practices mustbe clearly compatible with educational objectives andmust promote learning.

Quality development:The number and nature of examinations should beadjusted by integrating assessments of various cur-ricular elements to encourage integrated learning.The need to learn excessive amounts of informationshouldbe reduced and curriculum overload prevent-ed.

Annotation: Adjustment of number and nature of examinations would

include consideration of avoiding negative effects onlearning.

BS Assessment must test student achievementof learning objectives and competences.

QD Assessment practices should include alldomains: knowledge, skills and attitudes.

BS European best practice implies that docu-mentation of reliability and validity ofassessment methodologies is considered abasic standard.

QD Assessments and methodologies usedshouldbe open to scrutiny by externalauthorities.

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4.1 ADMISSION POLICY ANDSELECTION

Basic standard:The medical school must have an admission policyincluding a clear statement on the process of selectionof students.

Quality development:The admission policy shouldbe reviewed periodical-ly, based on relevant societal and professional data, tocomply with the social responsibilities of the institu-tion and the health needs of community and society.The relationship between selection, the educationalprogramme and desired qualities of graduatesshouldbe stated.

Annotations: The statement on process of selection of students would include

both rationale and methods of selection and may includedescription of a mechanism for appeal.

The review of admission policies and the recruitment of stu-dents would include improvement of selection criteria, toreflect the capability of students to become doctors and tocover the variations in required competencies related to

diversity of medicine.

4.2 STUDENT INTAKE

Basic standard:The size of student intake mustbe defined and relat-ed to the capacity of the medical school at all stages ofeducation and training.

Quality development:The size and nature of student intake should bereviewed in consultation with relevant stakeholdersand regulated periodically to meet the needs of com-munity and society.

Annotations: The needs of community and society may include consideration

of balanced intake according to gender, ethnicity and othersocial requirements, including the potential need of a specialadmission policy for underprivileged students.

Stakeholders would include those responsible for planningand development of human resources in the national health

sector.

4.3 STUDENT SUPPORT ANDCOUNSELLING

Basic standard:A programme of student support, including coun-selling, mustbe offered by the medical school.

Quality development:Counselling should be provided based on monitor-ing of student progress and should address socialand personal needs of students.

Annotation: Social and personal needs would include academic support,

career guidance, health problems and financial matters.

4.4 STUDENT REPRESENTATION

Basic standard:The medical school must have a policy on studentrepresentation and appropriate participation in thedesign, management and evaluation of the curricu-lum, and in other matters relevant to students.

Quality development:Student activities and student organisations shouldbe encouraged and facilitated.

Annotation: Student activities and organisations would include student self-

government and representation on educational committeesand other relevant bodies as well as social activities.

BS The quality development standard is consid-

ered a basic standard.


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5.1 RECRUITMENT POLICY

Basic standard:The medical school must have a staff recruitmentpolicy which outlines the type, responsibilities and

balance of academic staff required to deliver thecurriculum adequately, including the balancebetween medical and non-medical academic staff,and between full-time and part-time staff, theresponsibilities of which mustbe explicitly specifiedand monitored.

Quality development:Apolicy shouldbe developed for staff selection crite-ria, including scientific, educational and clinicalmerit, relationship to the mission of the institution,

economic considerations and issues of local signifi-cance.

Annotations: Balance of academic staff/faculty would include staff with joint

responsibilities in the basic and clinical sciences, in the uni-versity and health care facilities, and teachers with dualappointments.

Issues of local significance may include gender, ethnicity, reli-gion, language and others of relevance to the school.

Merit can be measured by formal qualifications, profession-al experience, research output, teaching experience, peer

recognition, etc.

5.2 STAFF POLICY ANDDEVELOPMENT

Basic standard:The medical school must have a staff policy whichaddresses a balance of capacity for teaching, researchand service functions, and ensures recognition ofmeritorious academic activities, with appropriateemphasis on both research attainment and teachingqualifications.

Quality development:The staff policy should include teacher training anddevelopment and teacher appraisal. Teacher-student

ratios relevant to the various curricular components

and teacher representation on relevant bodies shouldbe taken into account.

Annotations: Service functions would include clinical duties in the health

care system, administrative and leadership functions etc. Recognition of meritorious academic activities would be by

rewards, promotion and/or remuneration.


QD Faculty development programmes shouldinvolve all teachers, not only new teachers.

BS The staff policy must ensure that there aresufficient high level academic experts todeliver the curriculum and sufficient highquality researchers in relevant disciplines.

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6.5 EDUCATIONAL EXPERTISE

Basic standard:The medical school must have a policy on the use ofeducational expertise in planning medical educationand in development of teaching methods.

Quality development:There should be access to educational experts andevidence demonstrated of the use of such expertisefor staff development and for research in the disci-pline of medical education.

Annotations: Educational expertise would deal with problems, processes

and practice of medical education and would include med-ical doctors with research experience in medical education,educational psychologists and sociologists, etc. It can be pro-vided by an education unit at the institution or be acquiredfrom another national or international institution.

Medical education research investigates the effectiveness ofteaching and learning methods, and the wider institutional

context.

6.6 EDUCATIONAL EXCHANGES

Basic standard:The medical school must have a policy for collabora-tion with other educational institutions and for thetransfer of educational credits.

Quality development:Regional and international exchange of academicstaff and students shouldbe facilitated by the provi-sion of appropriate resources.

Annotations: Transfer of educational credits can be facilitated through

active programme coordination between medical schools. Other educational institutions would include other medical

schools or public health schools, other faculties, and institu-tions for education of other health and health-relatedprofessions.

QD Exchange of students shouldbe facilitatedby implementing the European CreditTransfer System (ECTS).

QD The requirements regarding courses shouldbe interpreted flexibly for exchange of stu-dents.

QD Administrative staffshouldbe included inexchange programmes.

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7.1 MECHANISMS FOR PRO-GRAMME EVALUATION

Basic standard:The medical school must establish a mechanism forprogramme evaluation that monitors the curriculumand student progress, and ensures that concerns areidentified and addressed.

Quality development:Programme evaluation should address the context ofthe educational process, the specific components ofthe curriculum and the general outcome.

Annotations: Mechanisms for programme evaluation would imply the use of

valid and reliable methods and require that basic data aboutthe medical curriculum are available. Involvement ofexperts in medical education would further broaden the

base of evidence for quality of medical education at the insti-tution.

Identified concerns would include problems presented to thecurriculum committee.

The context of the educational process would include the organ-isation and resources as well as the learning environmentand culture of the medical school.

Specific components of programme evaluation would includecourse description and student performance.

General outcomes would be measured e.g. by career choice

and postgraduate performance.

7.2 TEACHER AND STUDENTFEEDBACK

Basic standard:Both teacher and student feedback mustbe systemat-ically sought, analysed and responded to.

Quality development:Teachers and students shouldbe actively involved inplanning programme evaluation and in using itsresults for programme development.

7.3 STUDENT PERFORMANCE

Basic standard:Student performance mustbe analysed in relation tothe curriculum and the mission and objectives of themedical school.

Quality development:Student performance should be analysed in relationto student background, conditions and entrance qual-ifications, and shouldbe used to provide feedback tothe committees responsible for student selection, cur-riculum planning and student counselling.

Annotation: Measures ofstudent performance would include informationabout average study duration, scores, pass and failure ratesat examinations, success and dropout rates, student reportsabout conditions in their courses, as well as time spent bythe students on areas of special interest.

7.4 INVOLVEMENT OFSTAKEHOLDERS

Basic standard:

Programme evaluation must involve the governanceand administration of the medical school, the aca-demic staff and the students.

Quality development:A wider range of stakeholders should have access toresults of course and programme evaluation, andtheir views on the relevance and development of thecurriculum shouldbe considered.


QD National evaluation agencies and regulatoryauthorities shouldbe involved in pro-gramme evaluation.

QD A programme shouldbe evaluated by com-prehensively considering process and out-come of education.

QD When used, national license examinationshouldbe taken into account.

QD Information about medical careers of gradu-ates should, if possible, be used in evalua-tion of the study programme.

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Annotation: A wider range of stakeholders would include educational and

health care authorities, representatives of the community,professional organisations and those responsible for post-graduate education.

BS External evaluation mustbe carried out reg-ularly and may be linked to formal accredita-

tion.

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8.1 GOVERNANCE

Basic standard:Governance structures and functions of the medicalschool mustbe defined, including their relationshipswithin the University.

Quality development:The governance structures should set out the com-mittee structure, and reflect representation from aca-demic staff, students and other stakeholders.

Annotations: The committee structure would include a curriculum commit-

tee with the authority to design and manage the medicalcurriculum.

Relationships within the University and its governance struc-

tures should be specified, if the medical school is part of oraffiliated to a University.

Other stakeholders would include ministries of higher educa-tion and health, other representatives of the health care sec-tor and the public.

8.2 ACADEMIC LEADERSHIP

Basic standard:The responsibilities of the academic leadership of themedical school for the medical educational pro-gramme mustbe clearly stated.

Quality development:The academic leadership should be evaluated at

defined intervals with respect to achievement of themission and objectives of the school.

8.3 EDUCATIONAL BUDGET ANDRESOURCE ALLOCATION

Basic standard:The medical school must have a clear line of respon-sibility and authority for the curriculum and itsresourcing, including a dedicated educational bud-

get.

Quality development:There should be sufficient autonomy to directresources, including remuneration of teaching staff,in an appropriate manner in order to achieve theoverall objectives of the school.

Annotation: The educational budget would depend on the budgetary prac-

tice in each institution and country.

8.4 ADMINISTRATIVE STAFF ANDMANAGEMENT

Basic standard:The administrative staff of the medical school mustbe appropriate to support the implementation of theschools educational programme and other activitiesand to ensure good management and deployment ofits resources.

Quality development:The management should include a programme ofquality assurance and the management should sub-mit itself to regular review.

8.5 INTERACTION WITH HEALTHSECTOR

Basic standard:The medical school must have a constructive interac-tion with the health and health-related sectors of soci-ety and government.

QD The management of the programme shouldalways consider the need for qualityimprovement.


QD The medical school should have a budgetarystrategic plan, and the financial sources andall conditions attached to the financing

shouldbe stated transparently.


QD Lines of accountability of committees shouldbe clearly defined.

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Quality development:The collaboration with partners of the health sectorshouldbe formalised.

Annotations: The health sector would include the health care delivery sys-

tem, whether public or private, medical research institu-tions, etc.

The health-related sector would, depending on issues and localorganisation, include institutions and regulating bodieswith implications for health promotion and disease preven-tion (e.g. with environmental, nutritional and social respon-sibilities).

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Basic standard:The medical school must as a dynamic institutioninitiate procedures for regular reviewing andupdating of its structure and functions and mustrectify documented deficiencies.

Quality development:The process of renewal shouldbe based on prospec-tive studies and analyses and should lead to the revi-sions of the policies and practices of the medicalschool in accordance with past experience, presentactivities and future perspectives. In so doing, itshould address the following issues:

Adaptation of the mission and objectives of the medicalschool to the scientific, socio-economic and cultural

development of the society. Modification of the required competencies of the gradu-ating students in accordance with documented needs ofthe environment graduates will enter. The modificationshall include the clinical skills and public health train-ing and involvement in patient care appropriate toresponsibilities encountered upon graduation.

Adaptation of the curricular model and instructionalmethods to ensure that these are appropriate and rele-vant.

Adjustment of curricular elements and their relation-ships in keeping with developments in the biomedical

sciences, the behavioural sciences, the social sciences,the clinical sciences, changes in the demographic profileand health/disease pattern of the population, and socioe-conomic and cultural conditions. The adjustment shallassure that new relevant knowledge, concepts andmethods are included and outdated ones discarded.

Development of assessment principles, and the methodsand the number of examinations according to changesin educational objectives and learning goals andmethods.

Adaptation of student recruitment policy and selection

methods to changing expectations and circumstances,human resource needs, changes in the premedical edu-cation system and the requirements of the educationalprogramme.

Adaptation of recruitment and staffing policy regardingthe academic staff according to changing needs of themedical school.

Updating of educational resources according to chang-ing needs of the medical school, i.e. the student intake,size and profile of academic staff, the educational pro-gramme and contemporary educational principles.

Refinement of the process of programme monitoring and

evaluation. Development of the organisational structure and man-

agement principles in order to cope with changing cir-cumstances and needs of the medical school and, overtime, accommodating to the interests of the differentgroups of stakeholders.

QD Adaptation of instructional methods shouldtake into account new developments in edu-cational theories, adult learning methodolo-gy, active learning principles, etc.

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1.1 STATEMENTS OF MISSION AND

OUTCOMES

Basic standard:The competent authorities must define, in consulta-tion with the professional organisations, the missionand outcome objectives for the various types of post-graduate medical training and make them known.The statements of mission and outcomes mustdescribe the practice - based training process result-ing in a medical doctor competent to undertake com-prehensive up-to-date medical practice in the defined

field of medicine in a professional manner, unsuper-vised and independently or within a team, in keepingwith the needs of the health care system.

Quality development:The mission and outcome objectives should encour-age appropriate innovation in the training processand allow for development of broader competenciesthan minimally required and constantly strive toimprove patient care that is appropriate, effective andcompassionate in dealing with health problems andpromotion of health. The training should encouragedoctors to become scholars within their chosen fieldof medicine and should prepare them for lifelong,self-directed learning and readiness for continuingmedical education and professional development.

Annotations: Statements of mission and outcomes would include general and

specific issues relevant to national and regional policy. Competent authorities would include local and national bodies

involved in regulation of postgraduate medical training, andcould be a national governmental agency, a national board, auniversity, a competent professional organisation or a com-

bination. Types of postgraduate medical training would include pre-regis-tration training, systematic vocational training, specialisttraining and other formalised training for expertise in speci-fied areas of medicine.

Scholar refers to deeper and/or broader engagement in thedevelopment of the discipline, including responsibility foreducation, development, research, management, etc.

Chosen field of medicine would include recognised specialties,including general practice, subspecialties and expert func-tions.

1.2 PARTICIPATION IN THEFORMULATION OF MISSIONAND OUTCOMES

Basic standard:The statement of mission and outcomes of postgrad-uate training mustbe defined by its principal stake-holders.

Quality development:Formulation of mission and outcomes statementsshould be based on input from a wider range ofstakeholders.

Annotations: Principal stakeholders would include trainees, programme

directors, scientific societies, hospital administrations, gov-ernmental authorities and professional associations ororganisations.

A wider range of stakeholders would include representation ofsupervisors, trainers, teachers, other health professions,patients, the community, organisations and health careauthorities.

1.3 PROFESSIONALISM ANDAUTONOMY

Basic standard:

The training process must, based on approved basicmedical education, further strengthen professional-ism of the doctor.

A Trainee, wherever it is used in this document,is meant as a medical doctor in training.

BS Development of broader competences aswell as enhancement of the commitment tolifelong, self-directed learning and readinessfor continuing medical education and profes-sional development is considered a basicstandard.

A Where reference is made to national andregional issues in this document it will alsorefer to European issues.

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STANDARDS IN POSTGRADUATE MEDICAL EDUCATIONWITH EUROPEAN SPECIFICATIONS

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Quality development:The training should foster professional autonomy toenable the doctor to act in the best interests of thepatient and the public.

Annotation: Professionalism describes the knowledge, skills, attitudes and

behaviours expected by patients and society from individu-

als during the practice of their profession and includes con-cepts such as skills of lifelong learning and maintenance ofcompetence, information literacy, ethical behaviour, integri-ty, honesty, altruism, service to others, adherence to profes-sional codes, justice and respect for others.

1.4 TRAINING OUTCOMES

Basic standard:The relevant competent authorities must, in consulta-tion with the professional organisations, define thecompetencies, which must be achieved by trainees asa result of the training programmes.

Quality development:Both broad and specific competencies to be acquiredby trainees should be specified and linked with thecompetencies acquired as a result of basic medical

education. Measures of competencies achieved bytrainees should be used as feedback for programmedevelopment.

Annotation: Competencies can be defined in broad professional terms or as

specific knowledge, skills, attitudes and behaviours.Competencies relevant for postgraduate training (see refer-ences 9-12) would, at a level dependant on the chosen fieldin medicine, include the following areas: Patient care that is appropriate, effective and compassion-

ate for dealing with health problems and health promotion Medical knowledge in the basic biomedical, clinical,

behavioural and clinical sciences, medical ethics and med-ical jurisprudence and application of such knowledge inpatient care

Interpersonal and communication skills that ensure effec-tive information exchange with individual patients andtheir families and teamwork with other health professions,the scientific community and the public

Appraisal and utilisation of new scientific knowledge tocontinuously update and improve clinical practice

Function as supervisor, trainer and teacher in relation tocolleagues, medical students and other health professions

Capability to be a scholar contributing to development andresearch in the chosen field of medicine

Professionalism Interest and ability to act as an advocate for the patient

Knowledge of public health and health policy issues andawareness and responsiveness to the larger context of thehealth care system, including e.g. the organisation ofhealth care, partnership with health care providers andmanagers, practice of cost-effective health care, health eco-nomics, and resource allocations

Ability to understand health care, and identify and carryout system-based improvement of care.



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2.1 LEARNING APPROACHES

Basic standard:Postgraduate medical training must follow a system-atic training programme, which describes generic

and discipline-specific components of training. Thetraining must be practice - based involving the per-sonal participation of the trainee in the services andresponsibilities of patient care activities in the train-ing institutions. The training programme mustencompass integrated practical and theoreticalinstruction.

Quality development:Postgraduate medical training should interface withbasic medical education and continuing medical edu-

cation/professional development. The trainingshould be directed and the trainee guided throughsupervision and regular appraisal and feedback. Thetraining process should ensure an increasing degreeof independent responsibility as skills, knowledgeand experience grow. Every trainee should haveaccess to educational counselling.

Annotations: The training process would, when appropriate, proceed via a

common trunk from general to more specialised content. Educational counselling would include access to designated

tutors or mentors.

2.2 SCIENTIFIC METHODS

Basic standard:The trainee must achieve knowledge of the scientific

basis and methods of the chosen field of medicine,and through exposure to a broad range of relevantclinical/practical experience in different settings inthe chosen field of medicine become familiar withevidence-based medicine and critical clinical deci-sion-making.

Quality development:In the training process the trainee should have formalteaching about critical appraisal of literature, scien-tific data and evidence-based medicine, and beexposed to research.

Annotation: Training in scientific basis and methods may include the use

of elective research projects to be conducted by trainees (cf.6.5).

2.3 TRAINING CONTENT

Basic standard:The training process must include the practical clini-cal work and relevant theory of the basic biomedical,

clinical, behavioural and social sciences; clinical deci-sion-making; communication skills, medical ethics,public health policy, medical jurisprudence and man-agerial disciplines required to demonstrate profes-sional practice in the chosen field of medicine.

Quality development:The training process should ensure development ofknowledge, skills, attitudes and personal attributes inthe roles as medical expert, health advocate, commu-nicator, collaborator and team-worker, scholar,administrator and manager.

Annotations: The basic biomedical sciences would - depending on local

needs, interests and traditions typically include anatomy,biochemistry, physiology, biophysics, molecular biology, cellbiology, genetics, microbiology, immunology, pharmacology,pathology, etc.

Clinical sciences would include the chosen clinical or labora-tory disciplines and in addition other relevant clinical/labo-ratory disciplines.

Behavioural and social sciences would, depending on localneeds, interests and traditions, typically include medicalpsychology, medical sociology, biostatistics, epidemiology,

hygiene and public health and community medicine, etc. The behavioural and social sciences and medical ethics shouldprovide the knowledge, concepts, methods, skills and atti-tudes necessary for understanding socio-economic, demo-graphic and cultural determinants of causes, distribution

and consequences of health problems.


QD Exposure to research should especiallyinclude understanding of research method-ology.


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2.4 TRAINING STRUCTURE, COMPO-SITION AND DURATION

Basic standard:The overall composition, structure and duration oftraining and professional development must bedescribed with clear definition of goals and expected

task-based outcomes and explanation of their rela-tionship to basic medical education and health caredelivery. Components which are compulsory andoptional mustbe clearly stated.

Quality development:Integration of practice and theory shouldbe ensuredin the training process.

Annotations: Structure of training refers to the overall sequence of attach-

ment to the training settings and responsibility of the doctor

and not the details of the training experiences. Integration of practice and theory would include didactic learn-ing sessions and supervised patient care experiences.

2.5 THE RELATIONSHIP BETWEENTRAINING AND SERVICE

Basic standard:The apprenticeship nature of professional develop-ment mustbe described and respected and the inte-gration between training and service (on-the-jobtraining) mustbe assured.

Quality development:The capacity of the health care system should beeffectively utilised for service based training purpo-ses. The training provided shouldbe complementaryand not subordinated to service demands.

Annotations: Integration between training and service implies on one hand

delivery of proper health care service by the trainees and onthe other hand that learning opportunities are embedded inservice functions.

Effective utilisation refers to optimising the use of different

clinical settings, patients and clinical problems for trainingpurposes, and at the same time respecting service functions.

2.6 MANAGEMENT OF TRAINING

Basic standard:The responsibility and authority for organising, coor-dinating, managing and assessing the individualtraining setting and the training process must beclearly identified.

Quality development:Coordinated multi-site training within the chosenfield of medicine shouldbe ensured to gain exposureto different areas and management of the discipline.The authority responsible for the training programmeshouldbe provided with resources for planning andimplementing methods for training, assessment oftrainees and innovations of the training programme.There should be representation of staff, trainees andother relevant stakeholders in the planning of thetraining programme.

Annotation: Other relevant stakeholders would include other participants in

the training process, representatives of other health profes-sions and health authorities.




BS In EU member states the curriculum mustcomply with the EU Directive 2005/36/EUof 7 September 2005 on the recognition ofprofessional qualifications.

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3.1 ASSESSMENT METHODS

Basic standard:Postgraduate medical training must include a processof assessment, and the competent authorities mustdefine and state the methods used for assessment oftrainees, including the criteria for passing examina-tions or other types of assessment. Assessment mustemphasise formative in-training methods and con-structive feedback.

Quality development:The reliability and validity of assessment methodsshouldbe documented and evaluated and the use ofexternal examiners shouldbe encouraged. A comple-mentary set of assessment methods should be

applied. The different stages of training should berecorded in a training log-book. An appeal mecha-nism concerning assessment results shouldbe estab-lished and, when necessary, second opinion, changeof trainer/supervisor or supplementary trainingshouldbe arranged.

Annotations: The definition of methods used for assessment may include con-

sideration of the balance between formative and summativeassessment, the number of examinations and other tests, the

balance between different types of examinations, the use ofnormative and criterion - referenced judgements, and the useof portfolio and special types of examinations, e.g. objectivestructured clinical examinations (OSCE).

Evaluation of assessment methods may include an evaluation ofhow they promote training and learning.

External examiners or auditors may increasingly representglobal perspectives.

3.2 RELATION BETWEEN ASSESS-MENT AND TRAINING

Basic standard:Assessment principles, methods and practices mustbe clearly compatible with training objectives andmust promote learning. Assessment must documentadequacy of training.

Quality development:The assessment methods and practices shouldencourage integrated learning and should assess pre-defined practice requirements as well as knowledge,skills and attitudes. The methods used shouldencourage a constructive interaction between clinicalpractice and assessment.

3.3 FEEDBACK TO TRAINEES

Basic standard:Constructive feedback on the performance of thetrainee mustbe given on an ongoing basis.

Quality development:Acceptable standards of performance should beexplicitly specified and conveyed to both trainees andsupervisors.

Annotation: Feedback would include assessment results and planned dia-

logues about clinical performance between trainees and train-

ers/supervisors with the purpose of ensuring instructionsand remedies necessary to enhance competence development.


QD Feedback from the supervisor to the traineeshouldbe based on information and reportsfrom all members of the clinical team.

QD Potential unsuitability of the trainee for the cho-

sen speciality shouldbe voiced as early as pos-sible and alternative career options discussed.


A Adequacy of training would include assess-ment of relevant skills and competencies.

BS Statements about reliability and validity ofassessment methods in the quality develop-ment standards is considered a basic stan-dard.

A By a complementary set of assessment methods ismeant a variety of methods to ensure assess-ment of learning competencies.

A Criterion-referenced judgements should beused whenever possible.

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4.1 ADMISSION POLICY ANDSELECTION

Basic standard:The competent authorities and the medical profes-sional organisations must agree upon a policy on thecriteria and process for selection of trainees and mustpublish and implement it.

Quality development:The selection policy should define criteria, whichconsiders specific capabilities of potential trainees inorder to enhance the result of the training process inthe chosen field of medicine. The selection procedureshould be transparent and admission open to allqualified graduates from basic medical education.

The selection procedure should include a mechanismfor monitoring and appeal.

Annotations: The statement on process of selection of trainees would include

both rationale and methods of selection and may includedescription of a mechanism for appeal.

Monitoring of admission policies would include improvementof selection criteria, to reflect the capability of trainees to becompetent and to cover the variations in required competen-cies related to diversity of the chosen field of medicine.

Criteria for selection may include consideration of balancedintake according to gender, ethnicity and other social

requirements, including the potential need of a specialadmission policy for underprivileged groups of doctors.

4.2 NUMBER OF TRAINEES

Basic standard:

The number of trainees mustbe proportionate to theclinical/practical training opportunities, supervisorycapacity and other resources available in order toensure training and teaching of adequate quality.

Quality development:The number of trainees shouldbe reviewed throughconsultation with relevant stakeholders. Recognisingthe inherent unpredictability of physician manpowerneeds in the various fields of medicine, the number oftraining positions should currently be changed withcareful attention to existing needs of the community

and society and the market forces.

Annotations: Stakeholders would include those responsible for planning

and development of human resources in the local andnational health sector.

Forecasting of the needs of the community and society fortrained physicians includes estimation of various market

and demographic forces as well as the scientific develop-ment, migration patterns of physicians, etc.

4.3 SUPPORT AND COUNSELLINGOF TRAINEES

Basic standard:The competent authorities must, in collaborationwith the profession, ensure that a system for support,counselling and career guidance of trainees is avail-able.

Quality development:Counselling should be provided based on monitor-ing the progress in training and incidents reported

and should address social and personal needs oftrainees.

Annotation: Social and personal needs would include professional support,

health problems, housing problems and financial matters.

4.4 WORKING CONDITIONS

Basic standard:Postgraduate training must be carried out in appro-priately remunerated posts/stipendiary positions inthe chosen field of medicine and must involve parti-cipation in all medical activities - including on-callduties - relevant for the training, thereby devoting


QD Counselling shouldbe available for doctors

in training who, for whatever reason, have tochange their chosen specialty.

BS Mechanisms to ensure that the number oftraining positions in different specialities iskept under constant review by all stakehold-ers and regulated to societal needs is consid-ered a basic standard.


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professional activities to practical training and theo-retical learning throughout standard working time.The service conditions and responsibilities of traineesmustbe defined and made known to all parties.

Quality development:The service components of trainee positions shouldnot be excessive and the structuring of duty hoursand on-call schedules should consider the needs ofthe patients, continuity of care and the educationalneeds of the trainee. Part-time training should beallowed under special circumstances, determined bythe competent authorities and structured accordingto an individually tailored programme and the serv-ice background. The total duration and quality ofpart-time training should not be less than those offull-time trainees. Interruption of training for reasonssuch as pregnancy (including maternity/paternityleave), sickness, military service or secondment

shouldbe replaced by additional training.

Annotations:

Contractual service positions would include internship, resi-dency, registrar, senior registrar, etc.

The service components of trainee positions must be subject todefinitions and protections embodied in the contract.

4.5 TRAINEE REPRESENTATION

Basic standard:

There mustbe a policy on trainee representation andappropriate participation in the design and evalua-tion of the training programme, the working condi-tions and in other matters relevant to the trainees.

Quality development:Organisations of trainees shouldbe encouraged to beinvolved in decisions about training processes, condi-tions and regulations.

Annotation: Trainee representation would include participation in groups

or committees responsible for programme planning at thelocal or national level.

A Policy on trainee representation would includea transparent and democratic process forselection of representatives and involvementof representatives in decisions about thetraining programme at all levels.


BS Service conditions must specify that there isprotected educational time for the trainees.

BS Training and service functions of medicaldoctors in training must respect theEuropean Working Time Directive.

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5.1 APPOINTMENT POLICY

Basic standard:The policy on appointment of trainers, supervisorsand teachers must specify the expertise required andtheir responsibilities and duties. The policy mustspecify the duties of the training staff and specificallythe balance between educational and service func-tions and other duties.

Quality development:All physicians should as part of their professionalobligations recognise their responsibility to partici-pate in the practice-based postgraduate training ofmedical doctors. Participation in postgraduate train-ing should be awarded. The staff policy should

ensure that trainers generally are current in the rele-vant field to its full extent and sub-specialised train-ers only approved for relevant specific periods dur-ing the training.

Annotations:

Expertise would include recognition as a specialist in the rel-evant field of medicine

Training staffwould include medical doctors and other healthpersonnel

Other duties would include administrative functions as wellas other educational or research responsibilities.

5.2 OBLIGATIONS AND DEVELOP-MENT OF TRAINERS

Basic standard:Instructional activities mustbe included as responsi-bilities in the work-schedules of trainers and theirrelationship to work-schedules of trainees must bedescribed.

Quality development:Staff policy should include support of trainersincluding training and further development, if appro-priate, and should appraise and recognise meritori-

ous academic activities, including functions as train-ers, supervisors and teachers. The ratio between thenumber of recognised trainers and the number oftrainees should ensure close personal interaction andmonitoring of the trainee.

Annotation: Recognition of meritorious academic activities would be by

rewards, promotion and/or remuneration.



A Awarded should be read as rewarded orrecognised.

A Physicians in this context should also beunderstood as medical doctors.

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6.1 CLINICAL SETTINGS ANDPATIENTS

Basic standard:The training locations must be selected and recog-nised by the competent authorities and must havesufficient clinical/practical facilities to support thedelivery of training. Training locations must have asufficient number of patients and an appropriatecase-mix to meet training objectives. The trainingmust expose the trainee to a broad range of experi-ence in the chosen field of medicine and, when rele-vant, include both inpatient and outpatient (ambula-tory) care and on-duty activity.

Quality development:

The number of patients and the case-mix shouldallow for clinical experience in all aspects of the cho-sen specialty, including training in promotion ofhealth and prevention of disease. Training shouldbecarried out in academic teaching hospitals and, whenappropriate, part of the training should take place inother relevant hospitals/institutions and community-based settings/facilities. The quality of training set-tings shouldbe regularly monitored.

Annotations: Community-based settings would include specialist practices,

specialty clinics, nursing homes, primary health care stationsand other facilities where health care is provided.

The quality of training settings can e.g. be evaluated throughsite visits.

6.2 PHYSICAL FACILITIES ANDEQUIPMENT

Basic standard:The trainee must have space and opportunities forpractical and theoretical study and have access toadequate professional literature as well as equipmentfor training of practical techniques.

Quality development:The physical facilities and equipment for trainingshould be evaluated regularly for their appropriate-ness and quality regarding postgraduate training.

Annotatio