45(1):1-7,2004

COVER PAGE

Mostar University , : First Graduates

Colleagues of mine who work in medical com- detailed Proposal for Founding the Medical School, munities outside of region frequently ask me which contained the preliminary curriculum, names why we established Mostar Medical School, whether of lecturers, financial structure, facilities that could be it would not be better for these 40-45 students per used, and other necessary elements. After a short pe- generation to attend larger medical schools else- riod of lobbying for support from other important BH where, where they might have better academic condi- and Croatian institutions, the founding ceremony of tions, and then return to their people after the comple- Mostar Medical School was finally held at the Mostar tion of the studies. My answer is simple - No, beca- University Rectorate on April 18, 1997. The event use few of them come back to work and live in Bosnia was attended by high representatives of the Croat and Herzegovina (BH), especially if they studied in Community of Herzeg-Bosnia government, relevant (1). It is, therefore, plausible to expect that the ministries of the Federation of Bosnia and Herzego- students who complete their studies in Mostar, spend- vina, City of Mostar, Croatian government, Croatian ing one of the most exciting periods of their lives right universities, and Croatian medical schools. Prof Filip there, will decide to stay and work in the county. Èulo was appointed the Dean, and Profs Ljubo Šimiæ Another opinion I often hear is that having only and Vladimir Šimunoviæ became Vice-Deans for Cur- 40-45 students per generation will not solve the prob- riculum and Science, respectively. The members of lem of the lack of physicians in due time. According the Initiative Board were the first official teachers at to Šarac et al (1), the physician-to-population ratio the Mostar Medical School. The priority of the School among Croats in BH was 1:969 at the end of the officials was then to define the curriculum, organize 1991-1995 war. In comparison with the ratios in the admittance exam for the first generation of Croatia (1:465) and the rest of the world (1:400) in the students, and elect the teaching for the first given period, there is a clear shortage of physicians year of studies. among the BH Croats. However, the Medical School in Mostar has been founded not only to produce phy- Curriculum sicians, but also to raise the overall quality of health While making the Curriculum, we kept in mind care in the region. Moreover, a good medical school that, during the six years of studies, students should and high quality health care might even attract physi- gain knowledge of basic medical sciences, acquire cians who studied elsewhere to come to live and good theoretical and practical knowledge of clinical work in the region. to be able to provide competent care for pa- The idea of founding a medical school in Mostar tients, and grasp the elementary in public first appeared in the late 1970s, when medical health to be aware of the importance of preventive schools were being established throughout Yugosla- medicine and patients’ education. We studied the via; however, unlike the cities of Tuzla and Banja curricula of many medical schools around the world, Luka, Mostar was not given green light to do it at the from the curricula in Austria and Germany, to those in time. It was only in 1992 that a small group of aca- Eastern Europe, Francophone and Anglo-Saxon coun- demic teachers, mostly born in the CCHB region and tries, to curricula of the strong science-based medical working at the Zagreb University School of Medicine schools such as Oxford, Cambridge, Harvard, and in Croatia or Sarajevo Medical School in Bosnia and Yale, as well as the so-called reformed schools like Herzegovina, began making serious plans to found a McMaster’s in Canada and Maastricht in the Nether- medical school in Mostar. Indeed, early April of 1993 lands (2-5). We paid special attention to the curricu- brought a meeting in Èitluk and formation of the Ini- lum of Split Medical School in Croatia (6), since this tiative Board, whose main task was to establish the school was of similar student capacity and had be- School. The meeting was acknowledged and at- come independent from the Zagreb University tended by several high government officials, church School of Medicine only a year before our School was representatives, and highly acclaimed academics founded (7). We tried to take the best from all these from Croatian medical faculties and the Croatian Min- curricula and incorporate it into Mostar School curric- istries of Health and Science. Due to the war, our ef- ulum, provided it was applicable to the situation in forts soon came to a halt, but in 1996 a group of teach- Mostar. ers and physicians initiated again the establishment of Since most of our lecturers are guest-teachers a medical school, this time with financial support from other medical schools, mostly from Croatia, from the BH Croat health institutions. We created a block-lectures are still the only option for organiza-

www.cmj.hr 1 Cover Page: Mostar Medical School Croat Med J 2004;45:1-7

tion of classes. However, such program – followed Table 1. Mostar Medical School curriculum (total 5530 class also at Harvard and many other respectable medical hours) schools – enables students to focus on the subject Courses No. of hours they attend and thus increase their chances to pass the First year (total 765 class hours): examination. We also managed to organize elective Introduction to medicine (including Medical 90 courses, but did not take the approach of the so-called sociology, First aid, and Patient care) reformed schools, where the functional units (mod- Scientific methodology (including Medical 90 informatics and Methods of learning) ules where students learn about particular organ sys- Cell biology and genetics 180 tems) replace traditionally taught subjects at medical Histology and embryology 135 schools (3). We felt that this method was not suffi- Anatomy 210 ciently affirmed at the time. English 60 Second year (total 795 class hours): First Year Biochemistry and medical chemistry 180 Physiology and Biophysics 180 During the first two and a part of the third year of Physiology and Biochemistry of the metabolism 150 the studies, our students have to attend mandatory Basic principles of neuroscience 100 courses in basic medical sciences, such as anatomy, Medical psychology 45 histology, physiology, and biochemistry (Table 1). English language II 45 Immunology 50 The first course is Introduction to Medicine, where Elective course 30 students are taught on the basics of the first aid, pa- Third year (total 765 class hours): tient care, patient-physician relationship, and medical Microbiology (Bacteriology; Parasitology and 95 sociology. The courses that follow are the Scientific mycology; and Virusology) Methodology and Informatics (which includes a short Pathology 210 Pathophysiology 135 course on efficient studying), Cell Biology and Genet- Pharmacology 135 ics, Histology and Embryology, and Anatomy, which Clinical propedeutics (Internal medicine, Surgery, 90 are all very similar in content to the corresponding Neurology and psychiatry, Dermatology and subjects at Croatian medical schools. venereal diseases, and Infectious diseases) Psychiatry 100 Second Year Fourth year (total 1040 class hours): Radiology and nuclear medicine 130 Chemistry and Physics are taught on the second Internal medicine I (Cardiovascular diseases and 240 year, when students already have some knowledge of hypertension, Pulmonology, Gastroenterology, the human body and basic medical subjects. Chemis- Nephrology and urinary tract, and Toxicology and try is taught together with Biochemistry, and Biophys- Internal medicine emergencies) Internal medicine II (Endocrinology and metabolic 180 ics is taught within a major part of Physiology (a small diseases, Hematology, Oncology and Clinical part of Physics is taught on the fourth year within Ra- immunology and rheumatology) diology and Nuclear Medicine course). Such a con- Neurology 100 Skin and venereal diseases 80 cept allows studying of pre-medical courses in the Infectious diseases 120 context of medicine, adding to the medical applica- Elective course 30 bility of this knowledge. The remaining part of Physi- Field practice – internal medicine 120 ology (about one third, including Digestive system, Fifth year (total 945 class hours): Metabolism, and Endocrinology) is combined with Surgery I (General surgery, Surgery of digestive tract, 170 similar biochemistry subjects in the course Physiol- Thoracic surgery, Cardiovascular surgery, and Urology) ogy and Biochemistry of the Metabolism of Food- Surgery II (Neurosurgery, Pediatric surgery, 145 stuffs. The Basics of Neuroscience, Immunology, and Anesthesiology, reanimatology, and transfusiology, Medical Psychology are similar in the content and Plastic and reconstructive surgery, and Surgery in performance to the corresponding subjects at Zagreb emergency situations) Gynecology and obstetrics 200 and Split Medical Schools. After the completion of Diseases and injuries to the locomotor system 130 these subjects, students choose one of the two cur- (Orthopedics and traumatology and Physical rently offered 30-hour elective courses (Minor Elec- medicine and rehabilitation) Ophthalmology 70 tive Courses; MEC): Molecular Basis of Medicine and Head and neck diseases and surgery (Ear, nose, and 110 Physiology of Sports. A course in English (a total of throat and Dentistry and maxillofacial surgery) 120 hours) is primarily targeted at understanding Field practice – surgery 120 medical literature written in English. Sixth year (total 1140 class hours): Pediatrics 200 Third Year Forensic medicine 50 Physician and the society (Social medicine, Medical 120 The third-year courses are almost identical in ethics and human rights, Management, financing, their content to those taught at the Zagreb University and health policy, and History of medicine) School of Medicine in Croatia: Pathology, Patho- Health ecology and occupational medicine 90 physiology, Microbiology, Pharmacology, and Clini- Epidemiology and statistics (General epidemiology, 80 Epidemiology of communicable diseases, cal Propedeutics. Psychiatry is now also a third-year Epidemiology of non-communicable diseases, and course. We moved it from the later years because it Statistics) fits better with the subjects in the third year. Family medicine (Family medicine, Prevention and 180 promotion, and Geriatrics and caring for the Fourth Year terminal patient) Major elective course 60 The fourth year starts with Radiology and Nu- Graduate thesis 265 clear Medicine (including 30 hours of Physics remain- Graduate exam 100

2 Cover Page: Mostar Medical School Croat Med J 2004;45:1-7 ing from the second year), and continues with Internal ly, students start working on their graduation thesis Medicine. Because of practical reasons, the Internal (the subject of the thesis must be approved before the Medicine course was divided into two parts: Internal beginning of the summer semester), which they de- Medicine part I (the major part of classical internal fend in front of a three-member Committee. The grad- medicine) and part II (includes oncology, which is a uation thesis must be a small proprietary scientific re- sub-specialty within the Internal Medicine in Bosnia search, which requires knowledge of informatics and and Herzegovina). Since Internal Medicine is a very statistical methods, as well as epidemiological meth- extensive subject matter and requires a large number ods. Once the graduation thesis is defended, the stu- of teaching hours (and oncology only adds to this), the dent must pass the graduation exam consisting of 50 division into two parts enables students to pass the multiple-choice questions from clinical subjects course more easily. Furthermore, having in mind that (same as at the Zagreb University School of Medicine most of the teachers are visiting professors, this facili- in Croatia). To a minor extent, the students’ grades tates the organization of the courses. Dividing the In- earned at the summer trainings and elective subjects ternal Medicine course, as well as Surgery, into two or are also included in the final grade at the Graduation three separate subjects is common in French-speak- Exam. ing and Benelux countries (2). After the courses in Neurology, Dermatovenerology, and Infectious Dis- Organization of Classes eases with Clinical Microbiology, at the end of the school year the students choose one of the three MEC The organization and execution of seminars and subjects. practical work are similar to those at Croatian Schools of Medicine (11). Fifth Year The equipment at the Laboratory Center, ie, the The fifth year starts with Surgery, which is di- quality of the practical work and exercises in some vided into Surgery I and Surgery II. Surgery I covers courses, is excellent (e.g., Cell Biology and Genetics), mainly General Surgery, whereas Surgery II deals partly because the visiting professors bring along the with various surgical subspecialties, including Anes- necessary equipment from their institutes. In other thesiology with Reanimation and Basics of Transfu- subjects, the achieved quality of practical work is sion Medicine. Gynecology with Obstetrics, Locomo- comparable to that at medical schools in Croatia (His- tor System Diseases (includes Orthopedics, Trauma- tology and Embryology, Physics and Physiology, tology, and Physical Rehabilitation Medicine), and Medical Chemistry and Biochemistry, Basics of Neu- Head and Neck Diseases (includes Otorhinolaryngo- roscience, Immunology, Pathophysiology, Pharma- logy, Maxillofacial Surgery, and Dentistry) follow af- cology, and other). For these classes we managed to ter the Surgery courses. Ophthalmology is being organize two computer rooms and a microscopy taught as a separate subject, the last in the fifth year. room, but we still do not have anatomy dissection We are currently considering the possibility of intro- room and cadavers. To compensate for this, we orga- ducing an additional MEC at the end of the fifth year. nized one-week student visits to the Rijeka University After the fourth and the fifth year, students un- School of Medicine in Croatia, and procured plasti- dergo three-week summer trainings in internal medi- nated models of anatomic structures and computer cine and surgery, respectively. The training can be simulation programs. The Pathology classes fall be- done at the Mostar University Hospital, as well as in hind the level of the classes at the Croatian medical other hospitals and health centers with internal medi- schools, primarily due to the fact that the Mostar Uni- cine and surgery departments in the wider Mostar versity Hospital does not perform autopsies of the de- region. ceased (although there is an excellently equipped dis- section and microscopy room), as well as lack of Sixth Year pathohistological preparations. We experimented with two-day student trips to Sarajevo, but this option During the sixth year of the studies, classes begin was abolished since it did not yield any significant with Pediatrics, followed by Forensic Medicine. After improvement in the classes. these two courses, students attend a subject called “Physician and Society”, which includes Manage- Despite the integration of premedical and clini- ment in Health Care Systems, Social Medicine, His- cal subjects, premedical classes are still not taught in tory of Medicine, and Medical Ethics and Human the best possible way, one which would put the em- Rights. The courses that follow are Health Ecology phasis on the contents applicable in medicine. This and Occupational Medicine, Epidemiology and Sta- could be improved, in particular after we will have tistics, and Family Medicine. The course in Family the majority of local teaching staff employed. Medicine is organized and executed (similarly to Clinical practice is based, as in the majority of Family Medicine courses at other medical schools in schools, on student education at hospital wards – the Bosnia and Herzegovina) by teachers from the Medi- so-called clinical clerkship. Students work at particu- cal School of the Queen’s University in Kingston, lar clinical (hospital) wards for several weeks (same as Canada, where a worldwide-renowned way of teach- at medical schools in Croatia). A common drawback ing this subject was developed (8-10). Hereafter, stu- of this form of teaching is that students are often left to dents take the Major Elective Subject (60 hours); in ac- themselves and do not profit enough from the prac- ademic year 2002/2003 students could choose be- tice as they would if teachers worked more with tween the course in Skeletal and Muscular Diseases them. We will try to avoid this problem by creating and the course in Emergency Medicine. Subsequent- catalogues of skills which students have to master in

3 Cover Page: Mostar Medical School Croat Med J 2004;45:1-7 each department/course, similar to the one in Split into postgraduate studies, with some already having Medical School (11). This scheme will be applied defended their master’s degree thesis or doctoral dis- from the beginning of the next year. Also, night calls sertation, is highly encouraging. However, the lack of within Surgery, and Gynecology and Obstetrics basic sciences teachers represents a special problem. courses will become mandatory, as well as work in The interest in basic sciences teaching career is low, polyclinic outpatient units. The course in Family Me- primarily due to the lack of the equipped laboratories dicine takes place in the Center of Family Medicine for experimental research and shortage of financial within the Mostar Health Center, where both theoreti- support to scientific research in Bosnia and Herzego- cal and practical parts of the course are taught. vina. Additionally, basic sciences teachers have lo- For the purpose of lecturing, the textbooks pub- wer income than clinical teachers. Hence, in the co- lished in Croatia are almost exclusively used. Unfor- operation with Mostar University Hospital Manage- tunately, we have not yet introduced problem-based ment, we opened the possibility of offering younger learning, except for a single elective subject, because associates in basic sciences clinical residency once we have no teaching staff trained in problem-based they have gained the teaching experience in the field teaching methods. However, we plan to bring experi- and completed their master’s degree, or received the enced teachers and assistants from Zagreb Medical approval of the topic of their doctoral dissertation the- Faculty to train Mostar Medical Faculty in problem- sis. Upon the completion of the residency, the associ- based teaching. ate would be employed part-time at the Mostar Uni- versity Hospital, and part-time at Mostar Medical Furthermore, many subject integrations, even School where they would teach the basic sciences. horizontal ones, are more formal than real, and there- Another possibility is that clinical specialists sub-spe- fore can easily be lost as has happened with inte- cialized in a certain field and interested in research grated Anatomy/Histology course. take part in teaching basic sciences courses pertaining to their area of expertise (e.g., cardiologist teaching Teachers the physiology of the heart within the Physiology Course). There are four Medical Faculty members em- ployed as full-time teachers, 5 research fellows in ba- sic medical sciences as part-time teachers, and 92 Students teachers and 113 assistants employed as associate teachers. Research fellows have to fulfill 50% of the To enroll into Mostar Medical School, the stu- teaching norm, enroll into postgraduate course, and dents must pass the admission exam, which is identi- work on their MS and PhD theses. The visiting (associ- cal to the exam used at Croatian medical schools (13). ate) professors are mostly from Croatian medical There are 80-120 applicants each year, ie, 25-50% schools, and a few of them are from the Medical Fac- less than estimated by Šarac et al (1). The capacity of ulty in Sarajevo. Associated assistants are predomi- the School is 48 students; in the past six years there nantly employees of the Mostar University Hospital. were 40-47 students enrolled each year. In some aca- Such a large number of visiting (guest) associates is a demic years, a few more were students admitted in result of the lack of local teaching staff, and our wish the first or second year, having moved from other to engage the best professionals, both as the teachers medical schools (the optimal number of students en- and experts in the Mostar University Hospital. At the rolled would be around 50; ref. 1). Also, 7 to 8 stu- same time, we hope to educate local professionals for dents out of 15 who score the best on the admission the Hospital, as future teacher at medical schools. exam still try to enroll into Croatian medical schools, and usually succeed in doing so. The applicants have The total number of assistants and teachers with very good high schools grades (around 4.15 on aver- the full annual teaching norm is 63. In the 2002/2003 age out of a maximum of 5.00 ), but still half of a grade academic year, 255 students were enrolled in the less than applicants to Zagreb Medical School (un- Medical School, meaning there were 3.96 students published data). They also score 50-100 points less on per teacher. Zagreb School of Medicine has a similar the admission test than do Zagreb Medical School ap- ratio – 3.8 undergraduates per teacher (unpublished plicants (unpublished data). However, our prelimi- data). nary results have shown no correlation between suc- Full-time and part-time teachers and assistants cess in high school and admission test results (unpub- may be re-elected or promoted into scientific-aca- lished data). demic posts by the Faculty according to the by-laws of Although students enrolled in Mostar Medical the Faculty Council, which correspond to the mini- School score significantly less on admission test than mal conditions as regulated by the Croatian Ministry their colleagues in Zagreb or Split, they are assessed of Health for biomedical field (12). Each teacher has by majority of the lecturers and other staff as very dili- to publish at least half of their scientific papers in the gent and motivated, which is the reason why they area of their expertise. Students’ evaluation of teach- manage to catch up and make up quickly for the ers and classes is also taken into account. poorer knowledge gained in high school. On aver- Professionals at the Mostar University Hospital age, 82% of the students pass the year. For example, are offered part-time position at the School. In this 25 out of 41 (60%) students of the first generation en- way, we recruited a number of motivated but not rolled in Mostar Medical School graduated in time. overburdened teachers. The fact that most teaching The first graduates are shown on the Cover Page: Ivica assistants/associates among physicians have enrolled Briziæ, Tanja Šimiæ, Tomislav Sušac, Bruno Bundiæ,

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Tina Krišto, Ivan Šariæ, Pero Bubalo, Ante Bošnjak, time in the future to obtain long-term feedback on the Filipa Markotiæ, Josip Petroviæ, Ivana Tica, Sandra School’s program and quality of teaching. Juriæ, Lamia Bubalo (bottom row); Filip Èulo (Dean), Spomenka Kristiæ, Jurica Arapoviæ, Sanja Selak, Postgraduate Studies Blanka Lukiæ, Helena Radiæ, Julijana Soldo, Maristela Šakiæ, Milena Dalto, Goran Ðuzel, Daniela Matušiæ, Many associates of the Mostar University Hospi- Valentina Ratkajec, and Oliver Radoš (top row). In the tal (now teaching assistants at the Medical School) at- past three academic years, the passing rate for all stu- tended postgraduate studies before and/or after the dents has been significantly higher than in earlier 1991-1995 war (14), mostly at medical schools in years. Croatia or Bosnia and Herzegovina. However, due to the war, many PhD students took a break from their Students who fail the year but pass all the pre- studies for a few years and therefore missed some scribed exams before the summer semester have the deadlines. In the meantime, the Croatian system of possibility to partially enroll and attend the classes in postgraduate studies changed, requiring from PhD the summer semester of the current year. Thus they students additional research and other experience not are given a possibility to finish two years of studies in easy to obtain in Bosnia and Herzegovina. The three academic years. Zagreb University School of Medicine acknowledged In the past 6 years, a total of 19 students dropped the circumstances and granted the students from out of School for different reasons. Four of them lost Bosnia and Herzegovina special treatment, enabling their student status (after having failed the exam for them to graduate after all. However, attending post- the fourth time, they took the course again and failed graduate studies outside of BH proved to be expen- again to pass the exam after four attempts). More stu- sive for both the health care system (absence from dents transferred to Mostar Medical School from other work) and students themselves (costs of living away schools than the other way around (15 vs 11 stu- from home), as well as inconvenient (students being dents). away from their families for longer periods of time). Therefore, we decided to organize postgraduate med- Student Representatives ical studies in Mostar (Table 2). Due to the lack of lab- There are student representatives for each under- oratory and other equipment, we could not afford to graduate year in the Faculty Council, the most impor- organize science-based postgraduate studies in bio- tant School’s management body. The so-called “stu- medicine, but we opted for the PhD program focusing dent issues” are a regular part of each Faculty Council on medical care and public heath, for which both the meeting agenda, which gives the students opportu- need and facilities existed. The aim of the studies is nity to comment on teaching, textbooks, exams, and “to introduce the physicians and other health workers teaching programs and plans. At the end of each se- in the region to the basic principles, elements, organi- mester, students are surveyed for their opinion on zation, and measures of improving quality of medical teaching and lecturers, and the results of surveys are care, as well as to the contemporary aspects of man- presented at the Faculty Council meetings. agement and education in the health care system, its organization, and the promotion of health and bio- Students occasionally invite experts to give lec- ethics in the health care sector. To achieve these tures on topics that are not sufficiently elaborated in goals, all physicians need to acquire basic education the regular curriculum. The Faculty tends to support in medical informatics and statistics, and in rational such student initiatives, but should do more where fi- use of diagnostic and therapeutic methods. Our final nancial aspects of support are concerned. goal is to raise physicians’ awareness of the current International Student Collaboration organizational principles and rationalization in medi- cine, enabling them to play a vital part in providing Every year, four to eight students visit Medical quality health care and health promotion in the School in Heidelberg, Germany, or University of region.” Cork in Ireland, or Zagreb and Osijek School of Medi- cine in Croatia, usually during summer clinical trai- The postgraduate studies are primarily organized nings. Also, two students spend a month during sum- for the teaching assistants who are physicians and mer break doing scientific research in the Laboratory teach clinical courses, whereas teaching assistants in of Immunology at the Rijeka University School of the basic medical sciences still need to attend the Medicine in Croatia. postgraduate studies in biomedicine (experimental medicine) in Croatia or other universities in Bosnia Follow-up and Employment Opportunities for and Herzegovina. To assistants with Master of Sci- Graduates ence degree, we offer the possibility to attend doc- toral studies in Mostar, which are almost identical to According to the data of the Employment Bureau those taught at Croatian medical schools. in the Herzegovina- County, there have been practically no unemployed physicians since 2002. Af- Scientific Work ter the first generation of physicians graduated from Mostar Medical School in 2003, we decided to estab- Our School is not in the position to support sci- lish the association Alma Matris Alumni of the Mostar entific work at the moment, primarily due to the lack Medical Faculty, to facilitate monitoring of the em- of equipment, staff, and financial resources. Still, ployment rate and flow of respective information. some members of the staff work on research projects Furthermore, we will try to survey our graduates some on their own, with the support of guest-professors and

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Table 2. The curriculum of the Postgraduate Course at the ganize student exchange (Heidelberg and Cork), Mostar Medical School guest-lectures (Heidelberg and Queen’s), and join our Course/semester No. of hours forces when applying for TEMPUS projects. We cur- I. Medical Care Courses rently have two TEMPUS projects – one that has First semester: started only recently, and the other that enabled us to Principles of scientific work 20 Health management 27 organize a modern and well-equipped medical lib- Basic use of information technologies 25 rary (18). Total 72 Second semester: Principles of medical care 45 Applying the Principles of Bologna Components of medical care 25 Declaration Protection measures for the patient and the care 25 provider The Bosnia and Herzegovina High Education Rational laboratory diagnostics (elective course) 25 Coordination Board requires from all Universities in Total 125 Third semester: the country to implement the principles defined by Statistical methods in medicine 25 the Bologna Declaration and the documents follow- Epidemiological research methods 25 ing from it (Prague 2001 and Berlin 2003) (19). Thus, Rational pharmacotherapy (elective course) 30 Mostar Medical School applied the European Credit Basics of general psychopathology and behavioral medicine (elective course) Transfer System (ECTS) scoring and ECTS Brochure Total 105 for the undergraduate studies, and is currently devel- Fourth semester: oping a diploma supplement project (to be realized Radiological diagnostic methods (elective course) 25 Applied medical informatics (elective course) 25 by the end of 2005). We also expect the results of the Master's thesis 10 European University Association’s external evalua- Total 60 tion, which is due in March 2004 (20). Medical care total 362 II. Public Health Courses First semester: Impact of Mostar Medical School on Principles of scientific work 20 Development of Health Care System in the Health management 27 Herzegovina Region Basics of using information technologies 25 Total 72 Although our first generation of physicians has Second semester: Principles of medical care 45 graduated only recently, some effects of the School’s Components of medical care 25 positive influence on the health care in the region have Protection measures for the patient and the care 25 already become evident. We believe that monthly pro- provider fessional and scientific lectures organized regularly by Financing and organization of health care 25 Total 125 the School, newly-founded medical library, and infor- Third semester: matization infrastructure development were the activ- Statistical methods in medicine 25 ities that contributed the most to increasing the level Epidemiological research methods 25 of knowledge and motivation among the physicians New public health - health promotion 25 Health care and ethics 25 and other health care workers in the region. Further- Total 100 more, some of our guest-lecturers have broadened Fourth semester: their activities by signing contracts of professional co- Principles of medical informatics (elective course) 25 Master's thesis 10 operation with the Mostar University Hospital. It was Total 35 also interesting to witness rapid and enthusiastic pro- Public health total 332 fessional development of physicians who became teaching assistants at the newly founded medical school. We expect that our postgraduate studies, researchers from other countries. In the last two years, where a special emphasis will be put on the imple- we have regularly organized two-day courses in “Re- mentation of the principles of evidence-based medi- search Planning and Writing a Scientific Paper”, held cine in everyday practice, will further increase the by the staff from the Croatian Medical Journal. Physi- quality of health care in the region. cians, teaching assistants, and sixth-year students, for whom it proved to be a great help with writing of their graduating theses, attended the courses. Some of the Problems and Perspectives successfully defended theses are published in the stu- The principles and criteria of educational quality dent issue of the Croatian Medical Journal (15-17). we aim to achieve should fulfill basic standards fac- Regular organization of monthly scientific and profes- ulty must meet to create conditions for development sional lectures, given by the most prominent re- of quality assurance, which were well defined by the searchers in the region or guest-teachers, is another World Federation for Medical Education. Aside from form of School’s support for scientific work. the shortage of our own teaching staff, two major problems of our young School are the lack of a contin- International Cooperation uous financial support (and we share this problem with the rest of the Mostar University faculties) and The School cooperates with several medical inadequate School facilities. schools from around the world, e.g., Heidelberg, Ger- Mostar Medical School uses an improvised space many; Semmelweis, Budapest; Cork, Ireland; and of about 1,000 square meters, provided by Mostar Uni- Queen’s University at Kingston, Canada (18). We or- versity Hospital. We managed to equip this space rela-

6 Cover Page: Mostar Medical School Croat Med J 2004;45:1-7 tively well, and it now suffices for the first three years of 6 Marušiæ M, Sapunar D. Explanation to the necessity of the studies, except for the dissection classes in human founding Split University School of Medicine [in Cro- anatomy and pathology. Thus, our students unfortu- atian]. Lijeè Vjesn. 1996;118:133-8. nately do not have the opportunity to study these two 7 Sapunar D, Marušiæ M. Curriculum of Split University subjects on human models. Clinical courses are School of Medicine – modern concept for the new taught at the adapted facilities of the Mostar Univer- school [in Croatian]. Lijeè Vjesn 1999;121:208-12. sity Hospital. 8 Hrabaè B. Family-centered care as a framework for pri- mary health care development in Bosnia Herzegovina. We were unable to organize a research labora- Croat Med J. 1997;38:9-12. tory, although we have relatively modern laboratory 9 Queen’s University Family Medicine Development equipment donated from Germany. Another draw- Program in Bosnia and Herzegovina. Available from: back is no study room, where students could study http://www.queensu.ca/fmed/bosniafm/aboutus.html. and search the literature during the breaks. The Medi- Accessed: January 5, 2004. cal library is unfortunately too far away from the 10 Queen’s University Faculty of Health Sciences – MD School premises for students to be able to use it dur- Program. 1997-1998. Available from: http://meds-s ing their breaks. We have started with the construc- 10meds.queensu.ca/medicine. Accessed: January 4, tion of the School’s own facilities, a project financed 2004. by the Croatian government (as part of cultural sup- 11 Rumboldt Z. Medical school in Split: intentions and port to Croatian entity in Bosnia and Herzegovina). achievements. Croat Med J. 2000;41:361-7. However, the resources have only sufficed for the 12 Bošnjak D, Rajèiæ D. The new structure of higher edu- completion of the reinforced concrete works. We are cation in the Republic of Croatia. Croat Med J. 1995;36: now in search of the additional resources, which 81-4. would help us solve the burning problem of lack of 13 Prka M, Pulaniæ D, Glavaš E. Paying tuition and aca- space. demic performance of students at the Zagreb University School of Medicine. Croat Med J. 2001;42:74-8. 14 Horton R. Croatia and Bosnia: the imprints of war – II. Filip Èulo Restoration. Lancet. 1999;353:2223-8. 15 Šimiæ T, Šumanoviæ-Glamuzina D, Boraniæ M, Vukšiæ I, Dean, Mostar University School of Medicine Boban A. Breastfeeding practice in Mostar, Bosnia and Herzegovina: cross-sectional self-report study. Croat Med J. 2004;45:38-43. 1 Šarac I, Bagariæ I, Oreškoviæ S, Reamy J, Šimunoviæ V. 16 Selak S, Juriæ V, Hren D, Juriæ M. What young people Lang S. Physican requirements for Croat population in from Mostar, Bosnia and Herzegovina, know about Bosnia and Herzegovina. Croat Med J. 1997;38:83-7. contraception and sexual health. Croat Med J. 2004;45: 2 World Health Organization, Regional Office for Eu- 44-9. rope. European medical curricula access diskette 17 Bubalo P, Curiæ I, Fišter K. Characteristics of venomous (EMCAD). Geneva: WHO; 1994. snake bites in Herzegovina. Croat Med J. 2004;45:50-3. 3 Èulo F, upan G. Development of medical teaching 18 Šimunoviæ VJ, Sonntag HG, März R, Horsch A. Reform (basic directions). Teaching material for postgraduate of medical education in Bosnia-Herzegovina: luxury or professional education of teachers [in Croatian]. In: The necessity? Croat Med J. 2004;45:31-7. art of medical teaching. Zagreb: Croatian Society for 19 . European credit transfer system. Medical Education, Zagreb University School of Medi- Sveuèilišni vjesnik, vol. XLVI. Special issue. Zagreb: cine; 2000, p. 1-7. University of Zagreb; 2000. 4 Dušek T, Bates T. Analysis of European medical schools’ 20 World Federation for Medical Education. Basic medical teaching programs. Croat Med J. 2003;44:26-31. education – WFME global standards for quality im- 5 Èulo F. On Mostar Medical School: introduction. Mo- provement. Copenhagen: University of Copenhagen stariensia. 1999;10:3-10. 2001;1-42.

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