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FROM TRADITIONAL TO OUTCOME-BASED MEDICAL EDUCATION

RUHR-UNIVERSIT Ä T BOCHUM ZENTRUM F Ü R MEDIZINISCHE LEHRE. FROM TRADITIONAL TO OUTCOME-BASED MEDICAL EDUCATION. RESULTS OF A RANDOMIZED CONTROLLED TRIAL AT THE RUHR-UNIVERSITY BOCHUM, GERMANY Thorsten Schäfer Study Dean, Centre for Medical Education. Facts. The University Hospital

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FROM TRADITIONAL TO OUTCOME-BASED MEDICAL EDUCATION

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  1. RUHR-UNIVERSITÄT BOCHUM ZENTRUM FÜR MEDIZINISCHE LEHRE FROM TRADITIONAL TO OUTCOME-BASED MEDICAL EDUCATION RESULTS OF A RANDOMIZED CONTROLLED TRIAL AT THE RUHR-UNIVERSITY BOCHUM, GERMANY Thorsten Schäfer Study Dean, Centre for Medical Education

  2. ZENTRUM FÜR MEDIZINISCHE LEHRE

  3. ZENTRUM FÜR MEDIZINISCHE LEHRE

  4. Facts The University Hospital • 10 hospitals • at6 locations • 3.500 beds • 200 medicalpractices

  5. RUHR-UNIVERSITÄT BOCHUM ZENTRUM FÜR MEDIZINISCHE LEHRE FROM TRADITIONAL TO OUTCOME-BASED MEDICAL EDUCATION RESULTS OF A RANDOMIZED CONTROLLED TRIAL AT THE RUHR-UNIVERSITY BOCHUM, GERMANY Thorsten Schäfer Study Dean, Centre for Medical Education

  6. Medical Studies in Germany Preclinical Studies 2 years Clinical Studies 3 years Practi-cal 1 year 1st State Examination 2nd State Examination Terminologie practical seminar disciplines Cross-sectional

  7. Medical Studies in Germany Integrated Clin. References Job Explorat. 13 Palliative M. Terminology Clinical Med. 12 Rehabilitation 13 ClinicalChem. 11 Imaging Anatomy Biochemistry 12 Pediatrics 10 Prevention 7 Aging/Elderly Physiology 11 Internal Med. 9 Clin.Pharmacol Psychology Elective 6 Environm.Med 10 Hyg.Microbiol 8 Emergency M. 9 Hum. Genetics 22 Elective MicroAnatomy 5 Clin. Patholoy 8 ENT Med. 21 Urology Psychology 4 Infect./Immun. 7 Gynecology 20 Legal Med. Surgery MacroAnatomy 6 Dermatology 19 Psychosomat. 3 Economics Physiology 5 Surgery 18 Psychiatry Biochemistry 2 History/Ethics Biology 4 Ophthalmol. 17 Pharmacol. 1 Epidemiology 3 Social Med. 16 Pathology Internal Med Chemistry 2 Anesthesiol. 15 Orthopedics Physics Terminologie 1 General Med. 14 Neurology practical seminar disciplines Cross-sectional

  8. The Medical Curriculum Idea Second State Exam PY Surgery PY Elective PY Internal Med. Psychiattrics Surgery Conservative Internal Med. His-tory Patho-logy Pharmacol Pathophys. First State Exam Psycholog. Anatomy Biochemist Physiology Terminology Biology Chemistry Physics

  9. The Medical Curriculum, Reality2 2nd State Examination Surgery, … Psychiattry… PY Surgery Internal Med… PY Internal Med. 1st State Examination Conservative Physiology Psycholog. PY Elective Clin. Chem. Biochemist Ana tomy Pharmacol Chemistry Physics Patho-logy Pathophys. Terminology Biology

  10. 2nd State Examination The Medical Curriculum

  11. Ärztliche Prüfung, 1. Abschnitt Changes: „from H to N“ 1 Basics 4 5 „Equivalent Exams“ - 3 MEQs, 2 OSCEs Clinical Ärztliche Prüfung, 2. Abschnitt 12

  12. Research 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 sciences • P > T in clinical knowledge

  13. Traditional Discipline-based Teacher-centered Main Lectures Seminars Written exams (MCQ) Practical Courses Oral exams Integrated Curriculum Problem-based Student-centered Self-directed learning Seminars Formative feedback Practical Courses Clinical integration The Curricula

  14. Lots of changes… • Theme-based Curriculum • Interdisciplinary Modules • Bochum Catalogue of Learning Items • Medically Relevant Learning Objectives • Problem-based Learning • GM Internship Program • Focus on • Communication Skills, • Health Economics, • Medical Ethics ZENTRUM FÜR MEDIZINISCHE LEHRE

  15. GOAL START Medical Studies: 2 Ways Oct. 01, 2010: 302 Students 105 applied 42 randomly chosen

  16. Organ Systems, multi-disciplinary

  17. No lectures, but time for self-directed learning

  18. Problem-based Learning • Understanding • Topics of Interest • Brainstorming • Hypotheses, Sorting • Learning Objectives • Selfdirected Learning • Discussion of Results • Feedback

  19. Instrument: Progress Test in Medicine 200-item Multiple-Choice-Test • 66 items basic sciences: (32 physiology, 26 anatomy) • Level: End of studies • At the beginning of each semester to all students • Developed at the Charité and Uni W/H and used by 7 universities

  20. Study Design: RCT • Randomized controlled trial • N = 868 students in 3 cohorts • 251 applied for the new PBL-curriculum • 122 were randomly selected • 129 were assigned to the traditional curr. (Control group) • 617 remaining students: traditional curr. • Statistics: ANOVA, post-hoc Bonferroni

  21. Longitudinal Observation: Traditional – Problem-based preclinical clinical 2003 2004 2005 2003 2004 2005

  22. Number of Successful Studentswithin Shortest Time 71 % in MSM+ versus 39 % in MSM- and 55 % in RSM

  23. Summary Equal achievements in basic sciences after 2 years (higher after 1 year in PBL) Higher number of successful students in the PBL-curriculum Higher scores in clinical items in the PBL-curriculum

  24. Further Educational Goals

  25. Self-Assessement of 6th Year Students physical psychological Problem Solving social CME Psychol. Ab. scientific Practical Experience Diagnosis Rehabilitation Therapy Health Promotion

  26. Assessment by Teachers physical psychological Problem Solving social CME Psychol. Ab. scientific Practical Experience Diagnosis Rehabilitation Therapy Health Promotion

  27. Students‘ Self- Assessment über- wiegend teil- weise Teachers‘ Assessment

  28. Correlation Self-Assessment vs. Scores

  29. Conclusions • Self-assessment and teachers‘ assessment show high correlations and similar strengths and weaknesses. • „Goals achieved“ in practical experience, problem solving skills, as well as psychological and social aspects. • Weaknesses in the field of rehabilitation. • The survey is useful for developing the curriculum.

  30. „Latest News“

  31. Progress-Test Medicine (PTM) ZENTRUM FÜR MEDIZINISCHE LEHRE

  32. PTM – Preclinical Questions ZENTRUM FÜR MEDIZINISCHE LEHRE

  33. PTM – Cross Sectional Clinical Pathology, Pharmacology, Radiology, Biometrics, Ethics,… ZENTRUM FÜR MEDIZINISCHE LEHRE

  34. PTM - Clinical ZENTRUM FÜR MEDIZINISCHE LEHRE

  35. Scores in the State Exam (09) ZENTRUM FÜR MEDIZINISCHE LEHRE

  36. Proportion of „Fast Students“ 32,7 % 47,6 % ZENTRUM FÜR MEDIZINISCHE LEHRE

  37. Summary:New Curriculum • Higher efficiency: more graduates, with same levels of scores • Basic science knowledge: same achievements, higher scores at end of studies • Clinical and „soft“ skills: higher scores ZENTRUM FÜR MEDIZINISCHE LEHRE

  38. The Future • Combination of the two tracks • Scientific and practical • Interdisciplinary and theme-oriented • Problem-based ZENTRUM FÜR MEDIZINISCHE LEHRE

  39. RUHR-UNIVERSITÄT BOCHUM ZENTRUM FÜR MEDIZINISCHE LEHRE FROM TRADITIONAL TO OUTCOME-BASED MEDICAL EDUCATION RESULTS OF A RANDOMIZED CONTROLLED TRIAL AT THE RUHR-UNIVERSITY BOCHUM, GERMANY Thorsten Schäfer Study Dean, Centre for Medical Education

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