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Tuning (Medicine) 2007. MEDINE Thematic Network. THE TUNING PROJECT “HARMONISATION OF LEARNING OUTCOMES FOR HIGHER EDUCATION”. Funded by European Commission Learning outcomes/ competences for graduates Generic and subject-specific outcomes

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tuning medicine 2007

Tuning (Medicine) 2007

MEDINE Thematic Network

the tuning project harmonisation of learning outcomes for higher education
  • Funded by European Commission
  • Learning outcomes/ competences for graduates
  • Generic and subject-specific outcomes
  • Europe-wide survey and consultation → consensus
the tuning project medicine process and methods
The Tuning Project (Medicine) - process and methods
  • Review of existing outcomes / competency frameworksExisting institutional or national learning outcomes/competency frameworks reviewed by the Project steering group
  • Development of draft frameworkPreliminary draft learning outcomes/competency framework for Tuning (Medicine) generated by the Project steering group
the tuning project medicine process and methods1
The Tuning Project (Medicine) - process and methods
  • Tuning (Medicine) Task Force workshops -
    • Budapest (April 2005)
    • Amsterdam (September 2005)
    • Edinburgh (February 2006)
    • Prague (May 2006)
    • [Genoa (September 2006) – mapping workshop]
  • Members of Tuning (Medicine) Taskforce sequentially reviewed draft framework and progressively refined it in the light of expert opinion
  • Also: presentations at Learning and Teaching Support Network UK (Nov 2005), Chinese Association for Medical Education (Dec 2005), European Medical Students Association (July 2006), Rektors of German Medical Schools (Oct 2006)
the tuning project medicine process and methods2
The Tuning Project (Medicine) - process and methods
  • Web-Based Opinion Survey
  • Tuning methodology - include academics, graduates and employers. Rate learning outcomes for importance for graduates in the discipline. Ratings combined and outcomes arranged in a rank order. Informs the formulation of final Tuning report.
  • Questionnaire based on draft learning outcomes, incorporated into the Surveymonkey.com on-line survey instrument, translated into German and French.
  • Through MEDINE Network, primary contacts identified for each European member state. Asked to identify respondents under each heading and circulate the url. In later stages, url sent to all members of Network to increase number of respondents.
  • Respondents rated 115 learning outcomes/competences on four point Likert scale as essential, very important, quite important or not important for primary medical degree.
the tuning project medicine process and methods3
The Tuning Project (Medicine) - process and methods
  • First section - 29 generic outcomes for Higher Education degrees, from previous phases of “parent” Tuning Project”. Minor amendments made to take account of specific requirements of medical practice.
  • Second section - 12 discipline-specific Level 1 outcomes which together describe the competences required of medical graduates.
  • Third section - for each Level 1 outcome, discipline-specific Level 2 outcomes (74 in total)
  • Fourth section - 39 knowledge domains and 14 practice settings in which students might gain experiential learning.
  • Information regarding respondents - background (academic, graduate, employer, student or other), country and institution.
  • Free text comments - qualitative analysis using the NVivo7 software tool.
the tuning project medicine process and methods4
The Tuning Project (Medicine) - process and methods
  • Ratification of findings by MEDINE Thematic Network. AGM of MEDINE Thematic Network, Oslo, May 2007. Informed by the analyses and by agreement of the Task Force members, low-scoring outcomes may be omitted from the final Tuning document outcomes framework, or new outcomes added derived from the free text comments.
  • Validation of Tuning Outcomes by Expert Panel. Presentation of final outcomes framework at Sectorial Validation Conference, Brussels, June 2007. Expert Panel invited by the European Commission to review the outcomes framework, meet members of Task Force, leading to a Validation statement for the discipline. Same process for each health-care Tuning project (medicine, nursing, physiotherapy, occupational therapy).
  • Final report to the European Commission. At the conclusion of MEDINE Thematic Network, October 2007.
tuning medicine survey results
  • 10th April – 30th October 2006
  • 1302 responses
    • 830 English version
    • 453 German version
    • 19 French version
  • All EU member states except

Luxembourg, Estonia, Cyprus

interpreting survey results
Interpreting Survey Results


1 2 3 4


1 2 3 4




med3 ability to recognise limits and ask for help

med4 probity (honesty, maintaining good practice)

imp2 capacity for applying knowledge in practice

imp16m ability to make decisions

imp10m capacity to learn (including lifelong self-

directed learning)

imp15m ability to solve problems

imp12 critical and self-critical abilities

imp18 interpersonal skills

Average Rating 1=not important 2=quite important 3=very important 4=essential

imp29 concern for quality

imp28 ethical commitment

imp20m ability to work in a multidisciplinary team

imp13 capacity to adapt to new situations

med1 empathy

Generic Tuning Competency

imp1 capacity for analysis and synthesis

imp21 ability to communicate with experts in other



imp25 ability to work autonomously

imp3 capacity for organisation and planning

(including time management)


imp17 appreciation of diversity and multiculturality

imp30 will to succeed

med2 ability to teach others


imp24 understanding of cultures and customs of

other countries

imp4m basic general knowledge outside medicine


imp27 initiative and entrepreneurial spirit

imp19m ability to lead others

imp7 knowledge of a second language

imp9 research skills

imp14m creativity

imp26m ability to design and manage projects

imp23 ability to work in an international context





the tuning project
The Tuning Project
  • Not about identity or conformity (the European Commission values diversity)
  • Identifying common ground to build on
  • “Just a little more tuneful”

WORLD FEDERATION FOR MEDICAL EDUCATION TASK FORCE (2000) Defining international standards in basic medical education. Report of a Working Party, 1999, Medical Education, 34(8), 665-675.

the wfme standards
The WFME standards


Basic standard:

The medical school must define the competencies that students should exhibit on graduation in relation to their subsequent training and future roles in the health system.

Quality development: The linkage of competencies to be acquired by graduation with that to be acquired in postgraduate training should be specified. Measures of, and information about, competencies of the graduates should be used as feedback to programme development.

Annotations: • Educational outcome would be defined in terms of the competencies the students must acquire before graduation. • Competencies within medicine and medical practice would include knowledge and understanding of the basic, clinical, behavioural and social sciences, including public health and population medicine, and medical ethics relevant to the practice of medicine; attitudes and clinical skills (with respect to establishment of diagnoses, practical procedures, communication skills, treatment and prevention of disease, health promotion, rehabilitation, clinical reasoning and problem solving); and the ability to undertake lifelong learning and professional development.



Basic standard: The medical school must define the curriculum models and instructional methods employed.

Quality development: The curriculum and instructional methods should ensure that students have responsibility for their learning process and should prepare them for lifelong, self-directed learning.

Annotations: Curriculum models would include models based on discipline, system, problem and community, etc.Instructional methods encompass teaching and learning methods. The curriculum and instructional methods should be based on sound learning principles and should foster the ability to participate in the scientific development of medicine as professionals and future colleagues.


Basic standard: The medical school must teach the principles of scientific method and evidence-based medicine, including analytical and critical thinking, throughout the curriculum.

Quality development: The curriculum should include elements for training students in scientific thinking and research methods.

Annotation: Training in scientific thinking and research methods may include the use of elective research projects to be conducted by medical students.


Basic standard: The medical school must identify and incorporate in the curriculum the contributions of the basic biomedical sciences to create understanding of the scientific knowledge, concepts and methods fundamental to acquiring and applying clinical science.

Quality development: The contributions in the curriculum of the biomedical sciences should be adapted to the scientific, technological and clinical developments as well as to the health needs of society.


The basic biomedical sciences would - depending on local needs, interests and traditions - typically include anatomy, biochemistry, physiology, biophysics, molecular biology, cell biology, genetics, microbiology, immunology, pharmacology, pathology, etc.



  • Basic standard: The medical school must identify and incorporate in the curriculum the contributions of the behavioural sciences, social sciences, medical ethics and medical jurisprudence that enable effective communication, clinical decision making and ethical practices.
  • Quality development: The contributions of the behavioural and social sciences and medical ethics should be adapted to scientific developments in medicine, to changing demographic and cultural contexts and to health needs of society.
  • Annotations: Behavioural and social sciences would - depending on local needs, interests and traditions - typically include medical psychology, medical sociology, biostatistics, epidemiology, hygiene and public health and community medicine etc.
  • The behavioural and social sciences and medical ethics should provide the knowledge, concepts, methods, skills and attitudes necessary for understanding socio-economic, demographic and cultural determinants of causes, distribution and consequences of health problems.
  • Basic standard: The medical school must ensure that students have patient contact and acquire sufficient clinical knowledge and skills to assume appropriate clinical responsibility upon graduation.
  • Quality development: Every student should have early patient contact leading to participation in patient care. The different components of clinical skills training should be structured according to the stage of the study programme.
  • Annotations: The clinical sciences would - depending on local needs, interests and traditions - typically include internal medicine (with subspecialties), surgery (with subspecialties), anaesthesiology, dermatology & venereology, diagnostic radiology, emergency medicine, general practice/family medicine, geriatrics, gynaecology & obstetrics, laboratory medicine, neurology, neurosurgery, oncology & radiotherapy, ophthalmology, orthopaedic surgery, oto-rhino-laryngology, paediatrics, pathological anatomy, physiotherapy & rehabilitation medicine and psychiatry, etc.
  • Clinical skills include history taking, physical examination, procedures and investigations, emergency practices and communication and team leadership skills.
  • Appropriate clinical responsibility would include health promotion, disease prevention and patient care.
  • Participation in patient care would include relevant community experience and teamwork with other health professions.
socrates as reported in plato the republic book 4 360 bc

The worth of an intellectual construction is to be found in its value as an ideal…. That it also has potential for full realization is a further, but not the exclusive, benefit.

Socrates (as reported in Plato, The Republic, book 4, 360 BC)

what is a european medical graduate
  • “Basic medical training: admission to basic medical training shall be contingent upon possession of a diploma or certificate providing access to universities or equivalent institutes which provide higher education, and shall comprise a total of at least six years of study or 5500 hours of theoretical and practical training provided by, or under the supervision of, a university.”


Universal cross-recognition of primary medical qualifications within Europe

Directive 2005/36/EC of the European Parliament and of the Council of 7 September 2005

european medical education out of tune
European medical education – out of tune?
  • Wide variation in admission standards and selection procedures
  • Degree programmes vary from 4 to 7 years (or longer)
  • May involve one, two, or three degrees
  • Graduation may or may not = license to practise
  • No agreement on graduating learning outcomes/competences

?? “a system of easily readable and comparable degrees”

the scottish doctor
The Scottish doctor



The UK Doctor

Tomorrow’s Doctors



the national european doctor
The national European doctor
  • BLOCH, R. & BURGI, H. (2002) The Swiss Catalogue of Learning Objectives, Medical Teacher 24(2), pp. 144-150.
  • METZ, J.C.M., STOELINGA, G.B.A. et al. (1994) Blueprint 1994: Training of Doctors in The Netherlands, Objectives of Undergraduate Medical Education (Nijmegen, University Publications Office).
  • GUAL, A., PALÉS, J., PARDELL, H. & ORIOL-BOSCH, A (2005).Doctors in Spain. An old country, old and new structures, and a new future.The Clinical Teacher2 (1), 59-63.

+ many others


The WFME standards


Scientific method

Basic biomedical science

Behavioural and Social Sciences and Medical Ethics

Clinical Sciences and Skills

learning outcomes for medicine out of tune

Vary enormously in –

  • Overall structure
  • Level of detail
  • Content
  • Application - theory v practice, accreditation
tuning task force medine 2

Aims of the Tuning (Medicine) Task Force will be:

  • To build on the work of the current network, MEDINE.
  • To consider how the “Dublin Descriptors” and the Bologna 3 cycle model can be integrated with the new Tuning (Medicine) competency framework. To investigate how competences for 1st and 3rd cycles might relate to those for primary medical qualifications.
  • To apply new systems for mapping other competency frameworks to Tuning.
  • To develop new systems for categorising competences and defining level statements.
  • To promote use of Tuning (medicine) tools within and outside Europe, linking with the Tuning Project and Tuning Latina America.
  • To relate the Tuning competences to curriculum design, including a model core undergraduate medical curriculum which will allow students to achieve the Tuning competences at the point of graduation.
  • To generate guidance on best practice in assessing theTuning (medicine) competences.