PregraduatePregraduate andand postgraduatepostgraduate

educationeducation - regardingregarding clinicalclinical biochemistrybiochemistry

T. Zima, P. Štern, I. Šebesta

PraguePrague 1717thth MarchMarch,, 20122012 1 PregradualPregradual coursescourses

general l MedicalMedical schoolsschools dentistry for l FacultiesFaculties ofof sciencescience biomedical sciences chemistry biochemical sciences l PharmaceuticalPharmaceutical schoolsschools medical pharmacy biochemistry and biotechnology l TechnologicalTechnological institutesinstitutes clinical biology and chemistry biomedical sciences

2 LengthLength ofof studystudy atat medicalmedical schoolsschools

l 5 y in some Irish medical schools (Cork, Dublin) l 66 yy usuallyusually – according to the EU regulations, the studies should include 55005500 hh oror 66 yy l 7 y in Belgium l discussions in Ireland regarding the possibility of studying medicine as a second school – e. g., after legal studies – medical studies would, in that case, last 4 years

3 LengthLength ofof studystudy atat otherother schoolsschools

l Biomedical sciences 4 – 5 y usually in all types of schools l Pharmacy 5 – 7 y l Biology, chemistry, biochemistry and biotechnology 5 y usually

4 TheThe BolognaBologna DeclarationDeclaration l to create a European space for higher education l the adoption of a common framework of readable and comparable degrees l the introduction of undergraduate and postgraduate levels in all countries – with first degrees no shorter than 3 years l ECTS-compatible credit systems l a European dimension in quality assurance l the elimination of obstacles to the free mobility of students and teachers

5 OrganizationOrganization ofof medicalmedical educationeducation StudiesStudies areare organizedorganized inin 22 waysways::

l GraduallyGradually,, l ClassicClassic subjectsubject problemproblem basedbased learninglearning arrangementarrangement – Is utilized in Austria Teachers have problems with – in other countries it is either this organization, because prevalent or utilized by only many modules in several terms, but always just a few some schools hours l CombinedCombined systemssystems withwith subjectsubject--orientedoriented modulesmodules – in the pre-clinical part or – in the clinical part

The Bologna process of education standardization is discussed6 OrganizationOrganization ofof medicalmedical educationeducation BachelorBachelor''ss andand mastermaster''ss studiesstudies

l OnlyOnly inin BelgiumBelgium are medical studies divided into – bachelor's studies (3 y - preclinical) – and master's studies (4 y - clinical) l DivisionDivision intointo thethe prepre--clinicalclinical andand thethe clinicalclinical partpart ofof studystudy isis usedused inin numerousnumerous countriescountries – some schools require a state examination upon completion of the pre-clinical part – although the programme of study is not called a bachelor's or master's programme

7 OrganizationOrganization ofof medicalmedical educationeducation PrePre--graduategraduate EnglishEnglish languagelanguage studiesstudies outsideoutside IrelandIreland andand thethe UnitedUnited KingdomKingdom

l Schools of large EU countries do not offer pre- graduate education in English and do not intend to make any changes in the future – except for Spain l PrePre--graduategraduate educationeducation inin EnglishEnglish isis notnot availableavailable inin somesome otherother countriescountries eithereither – e.g. in Belgium, Denmark, Finland, the Netherlands, and Sweden – special courses or individual lectures presented by hosting professors may be in English

8 MedicalMedical schoolsschools CoursesCourses inin chemistrychemistry l ChemistryChemistry classesclasses werewere traditionallytraditionally aa prerequisiteprerequisite toto biochemistrybiochemistry – many medical schools have terminated chemistry classes – the other have kept as a part of the module-oriented studies – or in the classic subject arrangement. l the chemistry may be taught from the faculty of chemistry l TheThe chemistrychemistry isis taughttaught inin thethe 11stst,, 22ndnd oror 33rdrd termterm – lectures are usually complemented with practical training

9 MedicalMedical schoolschool CoursesCourses inin biochemistrybiochemistry l BiochemistryBiochemistry is taught – as an individual subject – or as a part of several modules l e.g., , biology, or – some medical schools do not offer biochemistry l ClassesClasses usuallyusually startstart duringduring thethe 22ndnd termterm andand endend inin thethe 44thth termterm – lectures are usually complemented with seminars – the proportion of teaching is decreasing and self-directed learning is increasing – some medical schools offer a plethora of specialized seminars l the number of students may decrease to two participants

10 MedicalMedical schoolschool CoursesCourses inin biochemistrybiochemistry l PracticalPractical trainingtraining inin biochemistrybiochemistry is offered at approximately half of the schools – The organization of practical training is either: l all students (divided into pairs) work on the same task l or there are several tasks and students rotate between them (more demanding for the leading practitioner) – Some schools have very large rooms for practical courses (up to 90 students) – There is usually a large difference in equipment between research laboratories and teaching laboratories

11 MedicalMedical schoolschool CoursesCourses inin clinicalclinical biochemistrybiochemistry l ClinicalClinical ((biobio))chemistrychemistry is taught – as an independent subject in Scandinavia and some other countries – in France, Portugal, and in most of Ireland, it is a part of another subject l e.g., biochemistry, internal medicine, or l LecturesLectures maymay startstart inin thethe 44thth termterm butbut usuallyusually inin thethe 55thth termterm – several-hour lectures can be a part of subject-oriented modules – lectures are complemented by seminars l case reports are discussed in very small groups (6 students) – there is usually no practical training in clinical (bio)chemistry l there are renowned schools (Oxford, Munich), which allot more than 30 h for practical training

12 TotalTotal numbernumber ofof biochemistrybiochemistry andand clinicalclinical biochemistrybiochemistry classesclasses inin medicalmedical studystudy programsprograms

CCA 2008;393:45-5013 TotalTotal numbernumber ofof biochemistrybiochemistry andand clinicalclinical biochemistrybiochemistry classesclasses inin medicalmedical studystudy programsprograms

14 Curriculum for clinical biochemistry at the 1st Faculty of Medicine in Prague

l Preanalytical phase, POCT and interpreting results l Electrolyte balance disordres and acid base balance l Indications and Interpretation of test – Gastroenterology – Hepatology – Nephrology l Cardic markers l Functional and screening tests l Tumor markers l Markers of inflammation l Therapeutic drug monitoring l Molecular biology methods aand l Laboratory diagnostics of inborn errors of metabolism

15 NonNon--medicalmedical healthcarehealthcare fieldsfields ofof studystudy atat medicalmedical schoolsschools l ItalianItalian medicalmedical schoolsschools offer a wide variety of three-year medical fields of study – In connection with biotechnology for health care, major attention is paid to laboratory practice and to final single-semester works l the subject of biochemistry and human biochemistry represents 160 h, l and laboratory practice with a final work represents 245 h – Technicians for Biochemical Laboratories take a total of l 500 h of biochemistry, clinical biochemistry, molecular biology, and cellular biology – Clinical biology and POCT take 60 h in the nursing bachelor's programme l The majority of CzechCzech medicalmedical schoolsschools provide 3-y bachelor's studies – two of them also provide follow-up two-year master's programmes 16 PregradualPregradual coursescourses inin nonnon--medicalmedical schoolsschools

biology l FacultiesFaculties ofof sciencescience biomedical sciences chemistry biochemical sciences l PharmaceuticalPharmaceutical schoolsschools medical biochemistry pharmacy biochemistry and biotechnology l TechnologicalTechnological institutesinstitutes clinical biology and chemistry biomedical sciences

17 OrganizationOrganization ofof educationeducation inin nonnon--medicalmedical schoolsschools l e.g. FranceFrance – 85% of the directors or deputy directors of private laboratories have pharmacy degrees – 15% are medical biologists l Pharmacy studies are divided into 3 cycles: – 1-2 y: biology, physics, mathematics, chemistry, physiology, and public health – 3-4 y: principal diseases, analytical chemistry, drugs, farmacology, TDM, , bacteriology, , haematology, immunology, serology – 5-6y: the organization of the health system, hospital training l Study of medical biology has been structured as 2 levels: – 1-2 y: haematology, biochemistry, bacteriology, or immunology – 3-5 y: hospital pharmacy, pharmacotoxicology, pharmacokinetics, public health and environment, pharmaco-epidemiology, gene and cell therapy, hospital hygiene, biotechnology and nanosciences, diagnosis in vitro, nutrition, and new therapies (12months part-time practical training)

Am J Pharm Educ. 2008; 72(6):18 132 OrganizationOrganization ofof educationeducation inin nonnon--medicalmedical schoolsschools l e.g. BradfordBradford l BiomedicalBiomedical sciencessciences –– 11--33//44 yy bachelorbachelor''ss studiesstudies:: , biological molecules and biochemistry, human , , medical physiology, reproductive biology and , clinical and analytical biochemistry, human physiology and pharmacology, immunology, pathology, biotechnology and the human , gene expression and cellular communication – Educational program exceeding 4 y, may be divided into bachelor's and master's sections (Germany, Sweden)

19 OrganizationOrganization ofof educationeducation inin nonnon--medicalmedical schoolsschools l e.g. ZagrebZagreb ll FacultyFaculty ofof PharmacyPharmacy andand BiochemistryBiochemistry –– 11--44 yy:: basic chemistry, analytical chemistry, biochemistry, clinical biochemistry, immunochemistry, hematology, transfusional medicine, pharmaceutical chemistry, toxicology, molecular diagnostics, cytology and histology, neurochemistry

20 OrganizationOrganization ofof educationeducation inin nonnon--medicalmedical schoolsschools l e. g. PraguePrague l InstituteInstitute ofof ChemicalChemical TechnologyTechnology – Bachelor study of biochemistry and biotechnology 1-3 y: biology, toxicology, foods, biochemistry, analytical chemistry, microbiology, molecular genetics – Master study of general and applied biochemistry 4-5 y: molecular biology, genetic engineering, enzymology, pathobiochemistry, human pathology, biochemistry of microbes, hematology and immunology, biological active natural products, determination of analytes in medicine

21 PostgraduatePostgraduate

studystudy

SpecializationSpecialization PhDPhD degreedegree clinicalclinical educationeducation scientificscientific education education

22 CurrentCurrent statestate ofof postpost--graduategraduate,, butbut specializationspecialization trainingtraining inin LaboratoryLaboratory MedicineMedicine -- ECEC44 ECEC44 hashas establishedestablished standardsstandards toto recogniserecognise aa highhigh levellevel ofof educationeducation andand professionalprofessional trainingtraining inin thethe EUEU whichwhich includeinclude:: –– aa)) universityuniversity degreedegree inin medicinemedicine,, biochemistrybiochemistry,, chemistrychemistry,, biologybiology,, pharmacypharmacy ;; –– bb)) 99 yearsyears universityuniversity andand postgraduatepostgraduate studystudy;; –– cc)) 44 yearsyears specialistspecialist trainingtraining afterafter 11stst degreedegree;; –– dd)) multidisciplinemultidiscipline oror singlesingle disciplinediscipline;; –– ee)) registeredregistered inin countrycountry ofof originorigin ((ifif applicableapplicable).).

23 StandardsStandards forfor thethe PhDPhD degreedegree inin biomedicinebiomedicine AA proposalproposal fromfrom::

l Organisation for PhD Education in and Health Sciences in the European System (ORPHEUSORPHEUS) l The Association of Medical Schools in Europe (AMSEAMSE) l The World Federation for Medical Education (WFMEWFME)

24 StandardsStandards forfor thethe PhDPhD degreedegree inin biomedicinebiomedicine

ll TwoTwo typestypes ofof standardsstandards:: –– BasicBasic standardstandard

l describes standards that must be met from the outset –– QualityQuality developmentdevelopment

l describes standards that are in accordance with international consensus about good practice

25 StandardsStandards forfor thethe PhDPhD degreedegree inin biomedicinebiomedicine

l Applicants for a PhD programme must have an educationaleducational levellevel corresponding to a master’s degree, or to a medical degree AA PhDPhD programmeprogramme mustmust notnot bebe initiatedinitiated unlessunless thethe resourcesresources forfor completioncompletion ofof thethe PhDPhD researchresearch projectproject areare availableavailable l In choosing PhD students, thethe potentialpotential of the applicant forfor researchresearch should be considered, and notnot justjust pastpast academicacademic performanceperformance

26 StandardsStandards forfor thethe PhDPhD degreedegree inin biomedicinebiomedicine

l PhD programmes must be performedperformed underunder supervisionsupervision l PhD programmes must be structured with a clear time limit, a lengthlength equivalentequivalent toto 33--44 yearsyears fullfull timetime l The programme must include formalisedformalised coursescourses totalling aboutabout 66 monthsmonths (~30 ECTS points) parallel with the PhD project l There must be arrangements to allow PhD students, if relevant, toto performperform partpart ofof theirtheir PhDPhD programmeprogramme atat anotheranother institutioninstitution

27 StandardsStandards forfor thethe PhDPhD degreedegree inin biomedicinebiomedicine

l The principal supervisor, at least, should have some formalformal trainingtraining asas aa supervisorsupervisor l An abstractabstract of the PhD thesis shouldshould bebe publishedpublished inin EnglishEnglish l PhDPhD thesestheses shouldshould bebe publishedpublished onon thethe graduategraduate schoolschool''ss homehome pagepage – preferably in extenso l The assessment committee has at least twotwo scientistsscientists fromfrom anotheranother institutioninstitution – at least one should be from another country l TheThe supervisorsupervisor mustmust notnot bebe aa membermember ofof thethe assessmentassessment committeecommittee 28 PhDPhD degreedegree inin biomedicinebiomedicine

l TheThe majoritymajority ofof studentsstudents traineestrainees inin clinicalclinical biochemistrybiochemistry areare notnot graduatesgraduates ofof medicalmedical schoolsschools – mostly graduates of scientific, pharmaceutical, and biotechnological schools –– strongstrong supportsupport forfor postgraduatepostgraduate educationeducation maymay bringbring veryvery positivepositive resultsresults

l at the medical school in Würzburg up to 5% of graduates continue in scientific work in their Ph.D. programme 29 PhDPhD degreedegree inin biomedicinebiomedicine

l InIn somesome countriescountries,, thisthis typetype ofof studystudy isis notnot particularlyparticularly popularpopular due to the limited number of options upon completion of demanding studies – scholarship is low, – and sometimes students are legally prohibited from having any other commitments l Staff members at biochemical and clinical chemistry institutions explain the limited interest in doctoral studies by the fact that these highlyhighly qualifiedqualified expertsexperts areare relativelyrelatively poorlypoorly paidpaid andand faceface difficultiesdifficulties inin thethe jobjob-- marketmarket

30 ThereThere areare twotwo keykey factorsfactors determiningdetermining thethe respectiverespective competencecompetence ofof laboratorylaboratory staffstaff::

-- professionalprofessional trainingtraining

-- appropriateappropriate humanhuman resourcesresources managementmanagement

B. Solnica, M. Dabrowska, G. Sypniewska 31 BB.. RR.. SmithSmith 20082008

ChangeChange fromfrom aa 55 yy minimumminimum forfor trainingtraining inin bothboth AA..PP.. andand CC..PP.. toto aa 44 minimumminimum inin UU.. SS.. hadhad hadhad anan adverseadverse effecteffect onon attainingattaining competencycompetency inin clinicalclinical chemistrychemistry

32 MarioMario PlebaniPlebani 20082008

Medical education may seem to be in a perpetual state of unrest, but the education of laboratory professionals is an even more challenging and controversial issue

33 ProfessorProfessor MitchellMitchell ScottScott

1. Should we train anyone in laboratory medicine? 2. If so, should we train more or fewer people? 3. How should they be trained?

There is a need to train more laboratory physicians and , not fewer

34 GrahamGraham HH.. BeastallBeastall l MedicalMedical laboratorylaboratory assistantsassistants inin UKUK do not require formal qualifications and do not currently require registration to practice, although local assessment of competence is standard. l The largest staff group, technologists called biomedicalbiomedical scientistsscientists, acquire a Bachelor of Science degree, require to be registered to practice with the Health Professions Council and must undertake continuing professional development.

35 l Approximately 1000 individuals function at the level MembershipMembership ofof thethe RoyalRoyal CollegeCollege ofof PathologistsPathologists inin UKUK clinical biochemistry, of which – some 25% are medical graduates – and 75% science graduates l The curriculum is designed to take 5 y to complete ll MedicalMedical andand clinicalclinical scientistsscientists sitsit thethe identicalidentical examinationexamination

G.H. Beastall / CCA 393 (2008) 17–2136 ContinuingContinuing professionalprofessional developmentdevelopment inin thethe UKUK l Participants are required to complete and record a total of at least 250 h of structured CPD over a 5-y period l One feature of clinical biochemistry education and training in clinical biochemistry that is especially well developed in the UK is recognition that both scientific and medical graduates can function at consultant level

G.H. Beastall / CCA 393 (2008) 17–2137 ConclusionConclusion l EducationEducation providedprovided byby individualindividual EUEU medicalmedical schoolsschools isis notnot properlyproperly harmonizedharmonized l Schools are independent institutions that are extremely proud of their past and traditions – cooperation in the innovation of study programmes of the individual schools is not often sought after or achieved l TheThe futurefuture dependsdepends onon ourour traineestrainees andand thusthus onon ourour trainingtraining programsprograms D.E.Bruns / CCA 393 (2008) 3-4 38 ConsensusConsensus documentdocument BasicBasic levellevel inin CCCC && LMLM PregradualPregradual educationeducation Whats we need l Introducing laboratory tests l Core biochemistry l Specialized investigations and other laboratory fields – Tests in endocrinology, Tumor markers, TDM, Molecular biology etc.

39 ConsensusConsensus documentdocument PhDPhD degreedegree inin biomedicinebiomedicine

DocumentDocument approvedapproved byby thethe ORPHEUSORPHEUS ExecutiveExecutive CommitteeCommittee

PraguePrague,, 1212 OctoberOctober 20112011

40 ConsensusConsensus documentdocument CombinedCombined PhDPhD -- clinicalclinical specialisationspecialisation programmesprogrammes TheThe aimaim ofof aa combinedcombined programmeprogramme isis toto traintrain medicalmedical doctors doctors toto becomebecome professionalprofessional clinicalclinical specialistsspecialists withwith aa PhDPhD

Training needs to consider the following components: ¾ the student to have time sharing between the clinic and research ¾ research work to be in an area related to the clinical specialization ¾ the theoretical training to include issues relevant for clinical research ¾ this involves making an annual progress report ¾ the student should interact with other PhD students

ORPHEUS 2011, Izmir Conference 41 ThankThankThank you youyou for forfor your youryour attentionattention attention

42