RUHR-UNIVERSITÄT BOCHUMZENTRUM FÜR MEDIZINISCHE LEHRE
FROM TRADITIONAL TO OUTCOME-BASED MEDICAL EDUCATIONBASED MEDICAL EDUCATIONRESULTS OF A RANDOMIZED CONTROLLED TRIAL AT THE RUHR-UNIVERSITY BOCHUM, GERMANYThorsten Schäfer Study Dean, Centre for Medical Education
Ruhr-University BochumFacts
Degree Programmes: 150 55 Bachelor, 81 Master, 4 State exam / Ministry, 10 Other
Facilities20 Faculties10 Central Academic Facilities (ZWEs)7 Affiliated Institutes
Budget 2009 (incl. medicine, without clinics)about EUR 423 m EUR, h f l f di 92 EUR
7 Affiliated Institutes
Coordinated Research Programmes9 Collaborative Research Centres (SFBs and
therefrom external funding: 92.5 m EUR
Students Total: 31994 (Women: 48%) Term 2009/10
SFB/Transregio)4 Collaborative Research Centres -Cooperations6 (+15 cooperations) Research UnitsTotal: 31994 (Women: 48%) Term 2009/10
Employees (31.12.2009)Total: 5200
6 (+15 cooperations) Research Units3 (+2 cooperations) Research Training Groups5 Graduate School,15 Junior Research G393 Professors, 22 in Clinics;
40Juniorprofessors, 4 in Clinics2.440 Non-professorial academic staff; 2.323 Non-academic staff
Groups
International Partnerships and Special Co-operation Agreements: more than 350 p g
ZENTRUM FÜR MEDIZINISCHE LEHRE | 5
FactsFacts
The University Hospital
10 hospitalsat 6 locations
3.500 beds200 medical practices200 medical practices
| 7
RUHR-UNIVERSITÄT BOCHUMZENTRUM FÜR MEDIZINISCHE LEHRE
FROM TRADITIONAL TO OUTCOME-BASED MEDICAL EDUCATIONBASED MEDICAL EDUCATIONRESULTS OF A RANDOMIZED CONTROLLED TRIAL AT THE RUHR-UNIVERSITY BOCHUM, GERMANYThorsten Schäfer Study Dean, Centre for Medical Education
Medical Studies in GermanyMedical Studies in Germany
PreclinicalStudies
Clinical Studies
Practi‐cal
ination
mination
2 years 3 years 1 yearate Exam
tate Exam
1st S
t
2nd St
9
Terminologie
practical seminar disciplines Cross‐sectional
Medical Studies in GermanyMedical Studies in Germany
12 Rehabilitation
Psychology11 Internal Med.
12 Pediatrics
13 ClinicalChem.
9 Clin.Pharmacol
10 Prevention
11 Imaging
Psychology
8 ENT Med.
9 Hum. Genetics
10 Hyg.Microbiol
21 Urology
22 Elective
8 Emergency M.
5 Surgery
6 Dermatology
7 Gynecology
18 Psychiatry
19 Psychosomat.
20 Legal Med.
Physics2 Anesthesiol.
3 Social Med.
4 Ophthalmol.
15 Orthopedics
16 Pathology
17 Pharmacol.
10
TerminologiePhysics
practical seminar
1 General Med. 14 Neurology
disciplines Cross‐sectional
The Medical CurriculumThe Medical Curriculum
Zweiter Abschnitt der Ärztlichen PrüfungÄrztlichen Prüfung
PJChirurgie
PJWahlfach
PJ Innere Med.
Psychiattrie
Innere Me
Chirurgie,
Konservativtrie
…Med…
e,…
Anam Patho Phar Patho
ative…
A t i Bi h i Ph i l iPsycholog./
Erster Abschnitt der Ärztlichen Prüfung‐nese ‐logie makol phys.
11Biologie
Anatomie Biochemie Physiologiey g /
Soziologie
Terminologie Chemie Physik
The Medical Curriculum IdeaThe Medical Curriculum Idea
Second State Exam
PYSurgery
PYElective
PY Internal Med.
Psychiati
Internal Me
Surgery
Conservativ
tricsMed.
ery
His‐ Patho Phar Patho
ative
A t Bi h i t Ph i lP h l
First State Examtory ‐logy macol phys.
12Biology
Anatomy Biochemist PhysiologyPsycholog.
Terminology Chemistry Physics
The Medical Curriculum RealityThe Medical Curriculum, Reality
PYSurgery
PY
Psychiattrics
PYElective
Internal Med.
AP h l mistry
t
13Biology
AnaPsycholog.
Terminology
Che
Physics
tomy
The Medical Curriculum Reality2The Medical Curriculum, Reality2
2nd State Examination
Surgery,
PYPsychiattry… Inte
… PYSurgery
PY
Physiology Psycholog.
rnal Med… PY
El ti
Internal Med.
AnaBiochemist
y gy y g
Clin. Chem.
Elective
tomy
14BiologyTerminology
Chemistry Physics Patho‐logy
Pathophys.
Changes: from H to N“Changes: „from H to N
Basics1
Basics
Ärztliche Prüfung, 1. Abschnitt45 E i l t E “„Equivalent Exams“
- 3 MEQs, 2 OSCEs
Clinical Ärztliche Prüfung, 2. Abschnitt12
FEATURES OF A MODELL CURRICULUM
Replacement of the first state examby equivalent testsby equivalent tests
Different timing of trainings in nursing, first aid and elective clerkshipsand elective clerkshipsModification of the Practical YearInclusion of non-university hospitals and ambulatory care facilities in medical education
Research QuestionResearch Question
Is there a difference in the progress of basic science and clinical knowledge of students in a traditional (T) versus an integrated, problem-based (P) curriculum?Hypotheses:
T > P in basic sciencesT > P in basic sciences P > T in clinical knowledge
The CurriculaThe Curricula
TraditionalDiscipline-based
Integrated CurriculumProblem-based
Teacher-centeredMain Lectures
Student-centeredSelf-directed learning
SeminarsWritten exams (MCQ)
gSeminars
Formative feedback( Q)Practical Courses
Oral examsPractical Courses
Clinical integrationO a e a s C ca eg a o
Lots of changesLots of changes…
Theme-based CurriculumInterdisciplinary Modulesp yBochum Catalogue of Learning ItemsMedically Relevant Learning ObjectivesMedically Relevant Learning ObjectivesProblem-based Learning GM Internship ProgramFocus on
Communication Skills, Health Economics, ,Medical Ethics
ZENTRUM FÜR MEDIZINISCHE LEHRE | 20
Medical Studies: 2 WaysMedical Studies: 2 Ways
GOALOct. 01, 2010: 302 Students105 applied105 applied42 randomly chosen
START
Problem based LearningProblem-based Learning
1. Understanding2. Topics of Interest3. Brainstorming4. Hypotheses, Sorting5. Learning Objectives5. Learning Objectives
6. Selfdirected Learning
7. Discussion of Results
8 Feedback8. Feedback
Instrument: Progress Test in Medicine200-item Multiple-Choice-Test
66 items basic sciences: (32 physiology, 26 ( p y gyanatomy)
Level: End of studiesAt the beginning of each semester to all studentsstudentsDeveloped at the Charité and Uni W/H and
d b 7 i itiused by 7 universities
Study Design: RCTStudy Design: RCT
Randomized controlled trialN = 868 students in 3 cohortsN = 868 students in 3 cohorts
251 applied for the new PBL-curriculum122 d l l t d122 were randomly selected129 were assigned to the traditional curr. (Control group)group)
617 remaining students: traditional curr.Statistics: ANOVA, post-hoc Bonferroni
External Comparison: pInter-University Comparison of Total Scores
70
80%
] ***ext. RSM
60
70
wer
s[%
*** *** ***ext. MSMBochum RSMBochum MSM
40
50
ecta
nsw Bochum MSM
20
30
ofco
rre
0
10No.
§
1. Semester 3. Semester 5. Semester
Longitudinal Observation: Traditional – Problem-based
60
RSM
60
RSM
preclinical clinical
40
50
orre
ct]
RSMMSM-MSM+
40
50
corre
ct]
RSMMSM-MSM+
30
40
cien
ces
[%co
***
30
40
now
ledg
e[%
c
*
10
20
Basi
cS
c
10
20
Clin
ical
Kn
***
0
1. Sem. PTM09 3. Sem. PTM11 5. Sem. PTM 13
0
1. Sem. PTM09 3. Sem. PTM11 5. Sem. PTM 13
2003 2004 2005 2003 2004 20052003 2004 2005 2003 2004 2005
Cross Sectional Analysis 2005Cross Sectional Analysis 2005
40
50nc
es
40
50
wle
dge
preclinical clinical
30
40
asic
Scie
n
30
40
nica
lKno
w
*
20
tSco
reBa
20
Sco
reC
lin
**
**
0
10
%Te
st
0
10
%Te
stS
.PTM
13
.PTM
13
PTM
13
.PTM
13
.PTM
13
PTM
13
RSMMSM-
1.Se
m.
3.Se
m.
5.Se
m.
1.Se
m.
3.Se
m.
5.Se
m.
MSM+
Number of Successful Studentswithin Shortest Time
200101 15 30184 38 42
0,80 55 0 39 0 71
140
160
180
s
101 15 30184 38 42
1st5th0 5
0,6
0,7
s
0,55 0,39 0,71
80
100
120
Num
bers
0,3
0,4
0,5
%S
ucce
s
20
40
60
0,1
0,2
%
0
C P- P+
0,0
C P- P+
71 % in MSM+ versus71 % in MSM versus 39 % in MSM- and 55 % in RSM
SummarySummary
Equal achievements in basic sciences after 2 years (higher after 1 year in PBL) y ( g y )
Higher number of successful students in the PBL curriculumthe PBL-curriculum
Higher scores in clinical items in the PBL-gcurriculum
In my opinion, my medical studies have enabled me…
Item 1: to make the physical situation of my patients base of my medical practice.
Item 2: to make the psychological situation of my patients base of my medical practice.
Item 3: to make the social situation of my patients base of my medical practiceto make the social situation of my patients base of my medical practice.
Item 4: to think and work in a scientific way.
Item 5: with general knowledge and skills in the field of diagnostics.
Item 6: with general knowledge and skills in the field of therapy.g py
Item 7: with general knowledge and skills in the field of health promotion and prevention.
k l d kill h bilit tiItem 8: with general knowledge and skills in the field of rehabilitation.
Item 9: with practical experience in dealing with patients, including the interdisciplinary approach to disease.
Item 10: with mental skills necessary for the primary care of patients.
Item 11: to conduct independent, continuous training, using modern information sources.
Item 12: to own decisions and solving problems.
Self-Assessement of 6th Year Students
physical
psychologicalProblem
social
Solving
socialCME
scientificPsychol Ab scientificPsychol. Ab.
DiagnosisPracticalE i
ThR h bilit ti
Experience
Therapy
Health Promotion
Rehabilitation
Assessment byTeachers
physical
psychologicalProblem
social
Solving
socialCME
scientificPsychol Ab scientificPsychol. Ab.
DiagnosisPracticalE i
ThR h bilit ti
Experience
Therapy
Health Promotion
Rehabilitation
Studierende RSM Studierende MSM
triff tri
triff
triff tri
trifftrifft voll zu
ft überwiegend
ifft teilweise z
ft überhaupt nizu
trifft voll zu
ft überwiegend
ifft teilweise z
ft überhaupt nizu
d zu
u
icht
d zu
u
icht
1 - körperlich0 13,4% 63,9% 95,0% 5,0% 6,5% 74,2% 100,0% 0,0%
2 li h*** 6 7% 35 8% 92 5% 7 5% 16 1% 71 0% 100 0% 0 0%2 - seelisch*** 6,7% 35,8% 92,5% 7,5% 16,1% 71,0% 100,0% 0,0%
3 - sozial* 5,1% 28,0% 85,6% 14,4% 0,0% 51,6% 93,5% 6,5%
4 - wiss. Denken0 18,1% 48,0% 89,0% 11,0% 9,4% 62,5% 100,0% 0,0%, , , , , , , ,
5 - Diagnostik0 12,6% 50,4% 86,6% 13,4% 6,3% 65,6% 100,0% 0,0%
6 - Therapie0 6,3% 46,0% 86,5% 13,5% 0,0% 59,4% 96,9% 3,1%
7 - Gesundheitsförderung0 10,2% 51,2% 92,9% 7,1% 6,3% 56,3% 93,8% 6,3%
8 - Rehabilitation0 4,9% 23,6% 84,6% 15,4% 3,1% 37,5% 87,5% 12,5%
9 P kti h E f h *** 10 2% 47 2% 82 7% 17 3% 41 9% 83 9% 100 0% 0 0%9 - Praktische Erfahrung*** 10,2% 47,2% 82,7% 17,3% 41,9% 83,9% 100,0% 0,0%
10 - Psychische Fähigkeiten** 9,7% 36,3% 74,2% 25,8% 10,0% 70,0% 90,0% 10,0%
11 Fortbildung0 24 0% 56 0% 88 0% 12 0% 25 0% 75 0% 100 0% 0 0%
Büro für Studienreform MedizinRUHR-UNIVERSITÄT BOCHUM
38
11 - Fortbildung0 24,0% 56,0% 88,0% 12,0% 25,0% 75,0% 100,0% 0,0%
12 - Problemlösung*** 10,5% 41,1% 79,8% 20,2% 18,8% 84,4% 96,9% 3,1%
1-12 - Durchschnitt 11,0% 44,0% 86,4% 13,6% 11,9% 65,9% 96,5% 3,5%
Studierende RSM Studierende MSM
triff tri
triff
triff tri
trifftrifft voll zu
ft überwiegend
ifft teilweise z
ft überhaupt nizu
trifft voll zu
ft überwiegend
ifft teilweise z
ft überhaupt nizu
d zu
u
icht
d zu
u
icht
1 - körperlich0 13,4% 63,9% 95,0% 5,0% 6,5% 74,2% 100,0% 0,0%
2 li h*** 6 7% 35 8% 92 5% 7 5% 16 1% 71 0% 100 0% 0 0%2 - seelisch*** 6,7% 35,8% 92,5% 7,5% 16,1% 71,0% 100,0% 0,0%
3 - sozial* 5,1% 28,0% 85,6% 14,4% 0,0% 51,6% 93,5% 6,5%
4 - wiss. Denken0 18,1% 48,0% 89,0% 11,0% 9,4% 62,5% 100,0% 0,0%, , , , , , , ,
5 - Diagnostik0 12,6% 50,4% 86,6% 13,4% 6,3% 65,6% 100,0% 0,0%
6 - Therapie0 6,3% 46,0% 86,5% 13,5% 0,0% 59,4% 96,9% 3,1%
7 - Gesundheitsförderung0 10,2% 51,2% 92,9% 7,1% 6,3% 56,3% 93,8% 6,3%
8 - Rehabilitation0 4,9% 23,6% 84,6% 15,4% 3,1% 37,5% 87,5% 12,5%
9 P kti h E f h *** 10 2% 47 2% 82 7% 17 3% 41 9% 83 9% 100 0% 0 0%9 - Praktische Erfahrung*** 10,2% 47,2% 82,7% 17,3% 41,9% 83,9% 100,0% 0,0%
10 - Psychische Fähigkeiten** 9,7% 36,3% 74,2% 25,8% 10,0% 70,0% 90,0% 10,0%
11 Fortbildung0 24 0% 56 0% 88 0% 12 0% 25 0% 75 0% 100 0% 0 0%11 - Fortbildung0 24,0% 56,0% 88,0% 12,0% 25,0% 75,0% 100,0% 0,0%
12 - Problemlösung*** 10,5% 41,1% 79,8% 20,2% 18,8% 84,4% 96,9% 3,1%
1-12 - Durchschnitt 11,0% 44,0% 86,4% 13,6% 11,9% 65,9% 96,5% 3,5%
Correlation Self-Assessment vs. Scores
100
80
90
nde
60
70du
rch
Lehr
e
40
50
nsch
ätzu
ng d
r = 0 90***Lehrende RSM
20
30
Frem
dein r = 0,90
Eta2adj = 0,79
Lehrende MSM
0
10
0 10 20 30 40 50 60 70 80 90 100
r = 0,83***Eta2
adj = 0,66
40
0 10 20 30 40 50 60 70 80 90 100
Selbsteinschätzung der Studierenden
ConclusionsConclusions
Self-assessment and teachers‘ assessment show high correlations and similar strengthsshow high correlations and similar strengths and weaknesses.Goals achieved“ in practical experience„Goals achieved in practical experience,
problem solving skills, as well as psychological and social aspectspsychological and social aspects.Weaknesses in the field of rehabilitation. The survey is useful for developing theThe survey is useful for developing the curriculum.
Instrument: Progress Test in Medicine200-item Multiple-Choice-Test
66 items basic sciences: (32 physiology, 26 ( p y gyanatomy)
Level: End of studiesAt the beginning of each semester to all studentsstudentsDeveloped at the Charité and Uni W/H and
d b 7 i itiused by 7 universities
Progress Test Medicine (PTM)Progress-Test Medicine (PTM)
70
50
60
er F
rage
n
30
40
g be
antw
orte
t
gesamt_MSMgesamt_RSMbgesamt_RSMn
10
20
% ri
chtig
0
1 2 3 4 5 6 7 8 9 10
Semester
ZENTRUM FÜR MEDIZINISCHE LEHRE | 45
PTM Preclinical QuestionsPTM – Preclinical Questions
70ag
en
50
60
klin
isch
er" F
ra
30
40
wor
tete
r "vo
rk
Vorklinik_MSMVorklinik_RSMbVorklinik_RSMn
10
20
richt
ig b
eant
w
0
% r
1 2 3 4 5 6 7 8 9 10
Semester
ZENTRUM FÜR MEDIZINISCHE LEHRE | 46
PTM Cross SectionalPTM – Cross Sectional
70
50
60
er F
rage
n
30
40
g be
antw
orte
te
QB_MSMQB_RSMbQB_RSMn
10
20
% ri
chtig
0
1 2 3 4 5 6 7 8 9 10
Semester
ZENTRUM FÜR MEDIZINISCHE LEHRE | 47
Clinical Pathology, Pharmacology, Radiology, Biometrics, Ethics,…
PTM ClinicalPTM - Clinical
70
50
60
er F
rage
n
30
40
g be
antw
orte
te
Klinik_MSMKlinik_RSMbKlinik_RSMn
10
20
% ri
chtig
0
1 2 3 4 5 6 7 8 9 10
Semester
ZENTRUM FÜR MEDIZINISCHE LEHRE | 48
Scores in the State Exam (09)Scores in the State Exam (09)
points
238 3
240.9240242
238.3
234236238240
229.7
228230232234
Punkte
224226228
( S )f SRegelstudiengang (RSM)Referenzkohorte RSMModellstudiengang
ZENTRUM FÜR MEDIZINISCHE LEHRE | 49
Proportion of Fast Students“Proportion of „Fast Students
32,7 % 47,6 %
ZENTRUM FÜR MEDIZINISCHE LEHRE | 50
3 , % ,6 %
Alumni SurveyAlumni-Survey
PositiveGroup dynamics
NegativePerceived missingGroup dynamics
Interaction trainingPerceived missing basics in pharmacologyEarly contact with
patients
pharmacology, pathology, anatomypatients
Context learning Compulsory attendance
Supportattendance
ZENTRUM FÜR MEDIZINISCHE LEHRE | 51
Summary:New Curriculum
Higher efficiency: more graduates withHigher efficiency: more graduates, with same levels of scoresBasic science knowledge: same achievements, higher scores at end of gstudiesClinical and soft“ skills: higher scoresClinical and „soft skills: higher scores
ZENTRUM FÜR MEDIZINISCHE LEHRE | 52
The FutureThe Future
Combination of the two tracks Scientific and practicalScientific and practicalInterdisciplinary and theme-orientedP bl b dProblem-based
ZENTRUM FÜR MEDIZINISCHE LEHRE | 53
Quality ManagementQuality Management
Common Goals, Guide-Lines, Specifications
OperationalizedLearning Objectives
Medical Teachers‘ Training Program
| 54
Performance-based Allocation of Funds
2,0
1,0
note
(1 -
5)
n=6 n=6
20
)
4,0
3,0
Schu
ln
Uni Ext
p>0,36
10
15
-Sco
re (m
ax. 2
0)
Uni
Uni Ext
Studentische Evaluation[n: Fach x Haus]
Innere, Chirurgie, Gyn.
0
5P
unkt
e- AKL
Studentische Evaluation, Sommer 2009, PJ Innere MedizinMittelwerte der Häuser
| 56