Bologna in Medicine: the Situation in Switzerland

Tijdschrift voor Medisch Onderwijs, maart 2010 | Vol. 29, nr. 1, p. 106-108

Bologna in Medicine: the situation in Switzerland

P. Kuendig

Introduction as if they are back at school: lectures are Switzerland was among the 29 countries scheduled in fixed order and have to be that signed the Bologna Declaration in attended in that order if students are to be 1999. Several years went by before finally, able to take the exams at the end of a se- in 2006, Basel was among the first univer- mester. These requirements have become sities to implement the Bologna reforms even more binding with the introduction in its medical curriculum, an example of Bologna and the credits system. that was followed by the other Swiss uni- However, students do acknowledge that versities. Unfortunately, each university is the reforms have some good points as free to decide ‘how’ to implement the well. The modular system, for example, is Bologna reforms. As a result, different generally appreciated. Nevertheless, the universities started with the implementa- whole Bologna process invariably raises tion at different times and proceeded in questions. different ways. The Basel model The student perspective The medical curriculum at Basel is based The discrepancies between the universi- on the spiral model of the Murrhardter ties in the way in which the Bologna re- circle, which was first described 1989.1 forms are implemented explain why stu- Luckily the reform towards the organiza- dent endorsement of Bologna varies so tion in organ-related modules had already strongly. It very much depends on the been completed before the Bologna re- local model. newal. So all that remained to be done In Zürich, for example, the Bologna was to rearrange the modules and decide reforms made study programmes even which content was to be included in the more rigid and practically ruled out stu- bachelor programme and which content dent mobility, because most of the in the master programme. courses and the exams have to be taken at The Faculty of Medicine at Basel agreed the home university if they are to be on the following model: each organ-re- recognised. Students are very discerning lated module is taught twice: during the and are under the impression that the re- bachelor programme the focus is on form was introduced for its own sake anatomy, physiology and pathophysiol- only. ogy, while during the master programme Today, as a result of the reforms, many the focus is on clinical training, diagnos- universities have tightly structured curric- tics, therapy and differential diagnosis. ula and academic freedom seems to have Additionally, there are various areas of been lost completely. Many students feel competencies, such as emergency medi-

* Schweizerische Gesellschaft für Notfall- und Rettungsmedizin (Swiss Society for Emergency Medi cine and Rescue).

106 Students’ experiences The Swiss experience | P. Kuendig

cine (leading to the SGNOR*-certificate of I already mentioned timetables. But it is Dienstarzt), the humanities, scientific an even bigger strain not knowing what work, communication, clinical skills, etc. your next semester is going to be like. It With regard to student involvement, I feels as if you are running full speed into can only applaud the University of Basel. a dark tunnel, not knowing when the next Students are represented on all the im- curve is coming or if there will be any portant boards and committees. Unfortu- light. And worse still, it basically reduces nately, students are not yet making full student mobility to zero. How do you de- use of these opportunities that are offered cide in which courses to enrol at your to them. This is probably largely due to host university, when you do not know lack of information about and insight into which content will be taught at your the organization of the university. home university? Even moving to another university within Switzerland has become The student perspective difficult, because every university has The universities of Basel and Zürich con- developed its own curriculum structure. ducted a survey to investigate the student As a consequence the second-year stu- perspective on the Bologna reforms.2 The dents at Basel do not necessarily follow preliminary results revealed a devastating the same programme as the second-year verdict: the students were very much dis- students at Z rich. satisfied with the Bologna model and its A very good idea, in principle, is the implementation at their universities. integration of clinical subjects into the But why should they be so unhappy? I bachelor programme. However, since am convinced that the biggest problem is everything has to be reorganized and lack of background information. The no-one is used to the new system yet, it students only see the outward manifesta- happens that pathophysiology is taught tions of reform. They see problems like before anatomy and physiology or that late publication of timetables, professors students are supposed to learn how to ex- complaining that they have less time for amine an eye before they even know its their lecture than they did last year, etc. basic structures. So there is a huge gap between what the The last important topic I would like to average student notices and what is actu- touch on is the master’s thesis and the doc- ally taking place within the faculty. It is torate. In Switzerland the title of “Dr. only understandable that this should lead med.” represents much more than just a to misunderstandings and discontent. scientific degree: it is an occupational title It took me some six months and several – one with which doctors identify very hours of reading, attending meetings and strongly indeed. Therefore the majority of talking to the people involved before I students are very keen to receive their doc- even partly understood the Bologna tor’s degree. In this context it is only un- process. That is too much to ask of every derstandable that fierce opposition should student. But in fact that is what it would be aroused when students are made to take for students to be able to make an wait for one year after their final exam be- appropriate judgement of the Bologna re- fore they can hand in their doctorate. forms. So, how do we solve these problems? The keyword seems to be information! Let’s go into some detail now. What exactly Students need to know what the is it that students are complaining about? Bologna declaration is about, what it im-

107 Students’ experiences The Swiss experience | P. Kuendig

plies, why it is implemented and what the References local model looks like. Also it is crucial to 1. Arbeitskreis Medizinerausbildung der Robert- involve students in the development of Bosch-Stiftung – Murrhardter Kreis. Das Arztbild der Zukunft – Analysen künftiger Anforderungen reformed curricula, which by the way is an den Arzt. Konsequenzen für die Ausbildung one of the aims of the Bologna declara- und Wege zu ihrer Reform. Gedingen: Arbeit- tion. The results of the student survey skreis Medizinerausbildung der Robert-Bosch- Stiftung – Murrhardter Kreis; 1989. [Project mentioned earlier showed that agreement group on medical education of the Robert Bosch with the implementation of the Bologna Foundation – Murrhardt district. The doctor of model was stronger among students who the future – analysis of the demands of future felt they had been involved in the devel- doctors. Consequences for education and ways to educational reform]. opment process. 2. Voigt G, Schirlo Ch. “The student's perspective on Bologna” – Survey at the Medical Faculties of To conclude, I would like to highlight the Basle and Zürich. Results presented at the AMEE- main points and make some recommen- Workshop “The swiss experience – chances and pitfalls with Bologna”. Malaga: AMEE; 2009. dations: Zugänglich unter: http://www.amee.org/documents • Students must be informed properly, /AMEE%202009%20FINAL%20ABSTRACT%20B this helps prevent rejection and discon- OOK.pdf.

tent. The author • Integration of clinical subjects into the Patrizia Kündig is student in medicine at the University bachelor programme is important but of Basel in the 4th year. careful attention to the sequencing of Correspondence lectures is of the essence. Patrizia Kündig, Feldbergstraße 60, CH-4057 Basel. • Universities should adhere to the same Tel.: +41 61 681 89 14. model! Mobility is torpedoed if every E-mail: [email protected] university implements its own curricu- No potential conflict of interest relevant to this articlewas reported lum. • Involve students in the development process.

And finally: I think Bologna is achievable, also for medicine. Most of the problems are related to the implementation process and inadequate information for students.

108 Students’ experiences