Maastricht 의과대학 교육과정 관련 (1)

Changing face of medical curricula

Roger Jones, Roger Higgs, Cathy de Angelis, David Prideaux

네덜란드에서는 과부하가 걸린 교육과정을 감축하고, 더 흥미를 유발할 수 있는, 적극적인 형태의 교육을 하라는 정부의 압박에 따라 전통적 교육과정과 PBL교육과정이 같이 이뤄지고 있다. 소규모의, 문제중심학습 그룹에 기반을 둔 통합교육과정은 첫 4년간은 공통적이다. 일부 학교들은 학생들의 술기 학습을 위해서 시뮬레이션 기술을 이용하고 있는데, Limburg, Maastricht등의 의과대학이 이러한 능동적 학습 전략을 적용하는데 앞장서고 있다.

In the Netherlands, both traditional and problem-based curricula are taught in response to pressure from the government to reduce overloaded curricula, and to create more attractive and active forms of teaching. Modular, integrated courses based on small, problem-based learning groups, are common in the first 4 years. Some schools also make extensive use of simulation techniques to help students master professional skills; the medical school of Limburg, Maastricht, has had a leading role in the development and application of these active learning strategies.28

---

Lancet. 2001 Mar 3;357(9257):699-703.

Changing face of medical curricula.

Jones R1, Higgs R, de Angelis C, Prideaux D.

Author information

Abstract

The changing role of medicine in society and the growing expectations patients have of their doctors means that the content and delivery of medical curricula also have to change. The focus of health care has shifted from episodic care of individuals in hospitals to promotion of health in the community, and from paternalism and anecdotal care to negotiated management based on evidence of effectiveness and safety. Medical training is becoming more student centred, with an emphasis on active learning rather than on the passive acquisition of knowledge, and on the assessment of clinical competence rather than on the ability to retain and recall unrelated facts. Rigid educational programmes are giving way to more adaptable and flexible ones, in which student feedback and patient participation have increasingly important roles. The implementation of sustained innovation in medical education continues to present challenges, especially in terms of providing institutional and individual incentives. However, a continuously evolving, high quality medical education system is needed to assure the continued delivery of high quality medicine.

Comment in

• Fallacies in modern medical education. [Lancet. 2001]
• Medical education. [Lancet. 2001]

---

Medical curriculum reform in North America, 1765 to the present: a cognitive science perspective. 

Papa FJ, Harasym PH.

1765년 이후로, 북미의 의과대학에서는 다섯 개의 주요한 교육과정 개혁 움직임이 있었다. 여기서는 각각에 대해서 그것의 기저에 있는 교육방법과 원칙, 내재적 한계, 극복을 위한 움직임 등을 보고자 한다. 이러한 개역 움직임의 원동력을 살펴보면 공통의 주제가 드러난다. 지식기반구조(knowledge-base structure)와 인지과정(cognitive process)에 대한 관심과 이해, 그리고 전문가와 초보자의 구분에 대한 관심과 이해이다. 이렇게 반복적으로 나타나는 주제들은 의학교육자들이 연구문헌, 연구방법, 인지과학의 이론적 관점들을 잘 활용해야만이 미래의 개혁을 효율적/효과적으로 이끌 수 있음을 보여준다. 저자들은 여기서 논의된 주제들과 관점들이 더 확장되고, 촉진되어 교육자들이 앞으로 21세기 의학교육 개혁 움직임을 만들어나가는데 도움이 되기를 바란다. 

---

Acad Med. 1999 Feb;74(2):154-64.

Medical curriculum reform in North America, 1765 to the present: a cognitive science perspective.

Papa FJ1, Harasym PH.

Author information

Abstract

Since 1765, five major curricular reform movements have catalyzed significant changes in North American medical education. This article describes each reform movement in terms of its underlying educational practices and principles, inherent instructional problems, and the innovations that were carried forward. When considering the motivating factors underlying these reform movements, a unifying theme gradually emerges: increasing interest in, attention to, and understanding of the knowledge-base structures and cognitive processes that characterize and distinguish medical experts and novices. Concurrent with this emerging theme is a growing realization that medical educators must call upon and utilize the literature, research methods, and theoretical perspectives of cognitive science if future curricular reform efforts are to move forward efficiently and effectively. The authors hope that the discussion and perspective offered herein will broaden, stimulate, and challenge educators as they strive to create the reformmovements that will define 21st-century medical education.

Comment in

• Curricular changes must be reflected in student assessment. [Acad Med. 1999]

---

The challenge of reform: 10 years of curricula change in Italian medical schools

HUON SNELGROVE, GIUSEPPE FAMILIARI, PIETRO GALLO, EUGENIO GAUDIO, ANDREA LENZI, VINCENZO ZIPARO & LUIGI FRATI

First and Second Faculty of Medicine, Sapienza University of Rome, Italy

진단검사와 피드백 Progress tests and feedback

10년 전, 이탈리아의 일부 교수들의 European comparative study를 한 이후로, 이탈리아는 학생의 functional knowledge 평가를 위하여 Maastricht의 모델을 본떠서 National Longitudinal Progress Test 를 도입했다. 이 시험은 학생과 교사들에게 피드백을 줄 수 있는 거대한 자원이다. 학생들은 현재 같은 학년내에서, 과목별, 국가 순위를 받게 된다. 이 시험이 다른 시험들과 함께 EU 면허시험의 한 부분으로 쓰일지는 두고 봐야 할 것이다.

After early experimentation in some Italian medical faculties in a European comparative study over 10 years ago (Albano et al. 1996) Italy introduced a National Longitudinal Progress Test based on the Maastricht model in 2006 to assess the functional knowledge of students. Under the auspices of the National Committee of Medical Degree Course Heads this could become a systematic nationwide instrument. The test provides a huge resource for feedback to students, teachers and for internal and external evaluation (Feletti et al. 1983, van Der Vleuten et al. 1996; Tenore 2008). Students currently receive feedback on their rankings compared to class, subject area and national rankings. Whether the progress test in combination with other test formats, will be used as part of a wider EU licensure exam, as its authors had originally speculated, remains to be seen (van Der Vleuten 1990; Albano et al. 1996).

---

Med Teach. 2009 Dec;31(12):1047-55. doi: 10.3109/01421590903178506.

The challenge of reform: 10 years of curricula change in Italian medical schools.

Snelgrove H1, Familiari G, Gallo P, Gaudio E, Lenzi A, Ziparo V, Frati L.

Author information

Abstract

Italy has a long history of versatility in medical training in which the tension between 'knowing' and 'doing' is a recurrent theme dating from the origins of the first European medical faculties in Bologna in the eleventh century. Italian medical schools are currently undergoing widespread reforms building on two decades of concerted efforts by medical educators to move from traditional teacher and subject-centred degree programmes to integrated student-centred curricula. European higher education policies have helped drive this process. A challenge in these developments is that the adoption of integrated and outcomes-based curricula in medicine requires a discursive shift in teaching practices. While investment in teacher training is essential, it is also important for educational leaders in medicine to communicate a compelling vision of the type of health professional medicalschools are aiming to produce. Systematic educational research should accompany this transition to evaluate the process and gauge sustainability. Investigation should also examine how external influences and pressures are calibrated and adapted to the national context and epistemology. The adoption of a common international vocabulary to describe educational processes means Italy will be able to participate more fully in the Europeanmedical education debate in future.

PMID:

 

19995166

 

[PubMed - indexed for MEDLINE]

---

The Association of Faculties of Medicine of Canada

SUPPLEMENTAL REPORT OF THE INTERNATIONAL COMPARISONS - THE NETHERLANDS

JAY ROSENFIELD, MD

NOVEMBER 2008

2. Organization of medical education in the Netherlands:

네덜란드의 의과대학 시스템은, 대부분 고등학교를 졸업하고 바로 입학하게 되는데, secondary school 학생은 요구조건인 고등학교 교과과정을 마치고 국가시험을 치러야 한다. 네덜란드에 독특한 점은, 그렇게 시험을 보고 나서 학생은 의과대학에 입학하기 위해서 국가 가중추첨(weighted national lottery procedure)에 지원하게 된다는 점이다. 그러나 매우 고득점을 받은 사람은 바로 의과대학에 들어갈 수 있다. 두 번째 입학 방법은 미국 의과대학과 유사한데, Utrecht와 Maastricht에 존재하는 방법으로서 의과학분야에서 학사를 받은 사람이 4년제 의과대학 프로그램에 입학하는 것이다.

The Dutch medical school system, which is predominantly direct entry from high school, requires that secondary school students finish a pre-requisite high school curriculum and take a national examination. Unique to the Netherlands, students then apply to a weighted national lottery procedure for entrance selection to medical school. However, those with very high scores on the national exam may freely enter the medical school of their choice. A second entry route, similar to the North American system, exists at two schools, Utrecht and Maastricht, and allows for graduate entry into a four year medical programme for those with a prior bachelor diploma in biomedical sciences.

국가가 입학 정원을 조정하며, 현재는 매년 2850명이 입학한다. 그러나 지원자는 항상 이 정원을 넘어서서 30~50%의 지원자가 탈락한다. 탈락하는 이유는 추첨에서 떨어졌거나 기준에 맞지 않기 때문이다. 학생들은 교육의 질을 자세히 살피고 의과대학을 선택하기 보다는, 대부분 secondary school학생을 위해서 열리는 미팅에서 받은 인상에 따라서 이루어진다. 네덜란드의 대중들은 대개 대부분의 학교들이양질의 교육을 제공한다고 믿고 있으나, 사실 그렇지는 않다. 대학들이 생각하는 것에 비해서 지역적 요소가 차지하는 비중이 크다.

“The Government regulates the enrolment number, currently 2850 students per year (Table 1). As the interest among high school graduates has always exceeded this numerus fixus, 30 to 50% of applicants are turned down, either because they fall out of the lottery, or they do not meet selection criteria. The choice of a medical school is mostly based on impressions from organised meetings for secondary school students, more than from thorough investigation of the educational quality; the Dutch public usually trusts that all schools deliver adequate education which in itself is not untrue. Geographical convenience is a more important determining factor than universities would like to believe.

네덜란드의 의과대학은 6년제이며, Bologna framework를 따른다(학사+석사). 미국과 달리 네덜란드 학생들은 정부에서 상당한 생활비와 교육비 지원을 받는다. 많은 학생들이 용돈을 위해 부업을 한다. 매우 소수의 학생만이 빚 없이 졸업하게 된다. European 근무시간 지침에 따라서 근무시간은 매우 제한적이며, 의과대학에서 졸업한 학생들은 졸업후 교육에 지원하게 되는데, 대학병원이 주로 이를 담당함에도 학생의 지원은 대학의 관할 밖에 있다.

The medical program in the Netherlands is six years in length, and follows the Bologna framework. (bachelor plus master) Unlike North America, Dutch students receive significant government financial grants for their living expenses and education. Many students also work in jobs to make extra money needed. Very few students graduate with any significant debt. The work week is limited in hours as per the European work-time directive. Most students who graduate from medical school apply for postgraduate training, which is not under the jurisdiction of the Universities, though the University Medical Centres play a major role in the delivery of such training.

주요 이슈들

대학과 병원의 거버넌스 문제 : 학장은 병원에서 부원장을 맡고 있으며, 병원장은 부학장을 맡고 있다.

• Governance -integrated structures between academic health science centre and university— Dean is Vice-President of Hospital and Hospital President is Vice-Dean of Faculty— integrated, small and nimble governing board (Maastricht)

의과대학 시작과 함께 임상 실습을 하는 것(예컨대, 생리학 학습을 위해서 첫 해에 응급의학과 로테이션을 함)

• Introduction of clinical training right at beginning of medical school (eg emergency rotation in first year to demonstrate physiology) (Maastricht)

모든 학생들이 연구 프로젝트를 이수함

• All students complete research scholarly project (Maastricht)

학생이 교육과정 개발에 파트너로서 참여

• Students as partners in curriculum development (Maastricht)

(출처 : http://www.afmc.ca/future-of-medical-education-in-canada/medical-doctor-project/pdf/Netherlands%20Comparison%20report.pdf)