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Relationship University and Academic Hospital in Medical Education. Between Charybdis and Scylla ? Ben Van Camp, MD, PhD. A birds view on the general structure of Medical Education in Europe. Secundary school. Entrance prerequisites. Master Bachelor. Biomedical sciences.
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Between Charybdis and Scylla ?
Ben Van Camp, MD, PhD
Specialisation Training :
Clinical specialist ( n > 30 )
Medical Research (PhD)
Continuous education: life long
Basic clinical skills
General clinical training
Clinical specialist ( > 30 )
Public health organisation
Revue of medical education offered at the beginning of 20th century in US and Canada. Taking into account the emerging scientific knowledge towards patientcare as was pioneered at Johns Hopkins
Guidelines to best practice in medical education
( generally accepted in US and EU today )
( problematic fulfillment )
Faculty of medicine (= medical school )
core departments with associated research facilities:
- biomedical sciences
- pre-clinical sciences
- clinical sciences
Other faculties or associated departements
- basic sciences ( fac. Sciences )
- public health ( fac. Humanities )
- bio-engineering ( fac. of Engineering )
- medical biotechnology and molecular biology ( fac. of Science )
- medical ethics, law, economics, sociology ( fac. Humanities )
- medical communication and psychology ( fac. Humanities )
- medical IT, etc. ( fac. Engineering )
Clinical and translational research in medical disciplines
Skills training center (faculty medicine)
Comprehensive teaching (= academic) Hospital:
- specific teaching wards (“bedside teaching”)
- complete spectrum of specialities (postgraduate)
- academic- clinical teaching staff
- evidence based medicine (“rounds”)
Affiliated (non academic) hospitals:
- pre-specialist practice
- specialist training (“maitre de stage”)
General Practice training
- academic – clinical teaching staff
Teaching Staff under supervision of Medical School
How to integrate scientific and clinical environment ?
Who is paying for Medical Education: social security, ministry of health, ministry of education ?
Will Odysseus pass Charybdis and Scylla undamaged ?
University main campus
Campus: 37 hectare
Faculty of Medicine
Faculty of Medicine
- beds: 729 (occupancy 76 %)
- personel: 3003 (413 MD – 84% FT)
- 26.252 hospitalisations (av. 7d)
- 18.125 day hospitalisations
- 488.414 ambulant patients
- 55.489 emergency patients
additional criteria: - 1MD/3 beds
- > 70% fulltime MD’s
- > 70% MD employed by Hospital
- all clinical disciplines accredited for postgraduate training
UZBrussel global income: 263.000.000 EUR (2007)
Income for academic task:
B7 parameter: Federal budget is allocated to 7 University Hospitals weighted on the basis of
- 25% for n. scientific publications
- 15% for n. postgrad.stud./”maître de stage”
- 60% for global budget
total 9,3 %
Estimated real academic cost (Antares Study): 25,0 %
Note: Cost of UZBrussel buildings ( taking into account the academic function ) separate budget (1970’s); 100m²/UZ bed compared to 80m²/non-U.b.
CEO (MD, PhD)
VUB: 5 delegates
UZB: 5 delegates (MC)
External: 5 members
5 departements: - basic clinical sciences (5 divisions)
- pre-clinical sciences (5)
- clinical sciences (7) (linked to UZdepartements)
- Farmacy departement (4)
- Primary Health and Social Medical Sciences (6)
- ( Dentistry )
VUB total income: 200.600.000 EUR ( 2007)
- regular budget (min.education): 83.3 milj. (output based system)
- infrastructure: 3.4 milj.
- social student facilities: 2.0 milj.
- Special Research Fond (min. Science): 11.9 milj.
- External Research programmes: 32.8 milj.
- international organisations 7.7 milj
- patrimonium and (diverse): 59.5 milj
Centralised Academic and A/T services for education, infrastructure, student-facilities,research, innovation, etc.
Faculty budget (2007):
( UZBr based: 3.0 milj !!!! )
- Educational working credit: 0.540 milj.
- Research money ( competition based): > 20.0 milj.
All MD’s (413)
Biomedical Sciences program
Integration between hospital and faculty is paramount for MD Education but hampered by differences in:
- governance structure
- income sources
- salaries of MD versus AP
Integration “top-down” versus “bottom up”
“If you have seen one medical center ....
you have seen that one medical center!!”
- curriculum committee
- quality control on curriculum/courses/academics/teaching facilities
- appointment of Academic Personel (even MD in UZB)
- MD appointment in UZBrussel is approoved by joint faculty/medical council committee
Note: 67 joint appointments MD-AP (26 % of total faculty AP)
- grant application and financial-legal matters aided by R&D-VUB
- R&D-UZB aids clinical research in accordance with R&D-VUB
- UZBrussel (legal entity VUB, but delegated power)
- Erasmus Health college (associated to VUB)
- Sportscenter (PP enterprise)
- financing system (direct cost driven, different financing bodies)
- output guided budgets
- specific task, with centrifugal goals