FROM TRADITIONAL TO OUTCOME- BASED MEDICAL EDUCATION RESULTS OF A RANDOMIZED CONTROLLED TRIAL AT THE...
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Transcript of FROM TRADITIONAL TO OUTCOME- BASED MEDICAL EDUCATION RESULTS OF A RANDOMIZED CONTROLLED TRIAL AT THE...
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
RUHR-UNIVERSITÄT BOCHUMZENTRUM FÜR MEDIZINISCHE LEHRE
ZENTRUM FÜR MEDIZINISCHE LEHRE | 2
ZENTRUM FÜR MEDIZINISCHE LEHRE | 4
| 7
Facts
The University Hospital10 hospitals
at 6 locations
3.500 beds200 medical practices
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
RUHR-UNIVERSITÄT BOCHUMZENTRUM FÜR MEDIZINISCHE LEHRE
9
TerminologieTerminologie
PreclinicalStudies
2 years
practicalpractical seminarseminar disciplinesdisciplines Cross-sectionalCross-sectional
Clinical Studies
3 years
Practi-cal
1 year
1st S
tate
Exa
min
ation
2nd
Stat
e Ex
amin
ation
Medical Studies in Germany
10
TerminologieTerminologiePhysicsPhysics
practicalpractical
Chemistry
Chemistry
BiologyBiologyPhysiology
PhysiologyBiochemistry
Biochemistry
MacroAnatomy
MacroAnatomy
MicroAnatomyMicroAnatomy
Psychology
Psychology
PsychologyPsychologyPhysiology
Physiology
BiochemistryBiochemistry
Anatomy
AnatomyClinical Med.Clinical Med.
seminarseminar
Terminology
Terminology
Job Explorat.
Job Explorat.Clin.
References
Clin. References
Integrated
Integrated
1 General Med.1 General Med.2 Anesthesiol.2 Anesthesiol.
3 Social Med.3 Social Med.4 Ophthalmol.4 Ophthalmol.
5 Surgery5 Surgery6 Dermatology6 Dermatology7 Gynecology7 Gynecology8 ENT Med.8 ENT Med.
9 Hum. Genetics9 Hum. Genetics10 Hyg.Microbiol10 Hyg.Microbiol11 Internal Med.11 Internal Med.
12 Pediatrics12 Pediatrics13 ClinicalChem.13 ClinicalChem.
14 Neurology14 Neurology15 Orthopedics15 Orthopedics16 Pathology16 Pathology
17 Pharmacol.17 Pharmacol.18 Psychiatry18 Psychiatry
19 Psychosomat.19 Psychosomat.20 Legal Med.20 Legal Med.
21 Urology21 Urology22 Elective22 Elective
1 Epidemiology
1 Epidemiology
2 History/Ethics
2 History/Ethics
3 Economics
3 Economics
4 Infect./Imm
un.
4 Infect./Imm
un.
5 Clin. Patholoy
5 Clin. Patholoy
6 Environm.M
ed
6 Environm.M
ed
7 Aging/Elderly
7 Aging/Elderly
8 Emergency M.8 Emergency M.9 Clin.Pharmacol9 Clin.Pharmacol
10 Prevention10 Prevention11 Imaging11 Imaging
12 Rehabilitation12 Rehabilitation13 Palliative M.
13 Palliative M.
Internal Med
Internal Med
Surgery
Surgery
Electi
ve
Electi
ve
disciplinesdisciplines Cross-sectionalCross-sectional
Medical Studies in Germany
12BiologyBiology
AnatomyAnatomy BiochemistBiochemist PhysiologyPhysiologyPsycholog.Psycholog.
TerminologyTerminology ChemistryChemistry PhysicsPhysics
First State ExamFirst State Exam
Psychiattrics
Psychiattrics
Internal Med.
Internal Med.
Surgery
Surgery
Second State ExamSecond State Exam
His-toryHis-tory
Patho-logyPatho-logy
PYSurgery
PYSurgery
PharmacolPhar
macolPathophys.Pathophys.
PYElective
PYElective
PY Internal Med.
PY Internal Med.
Conservativ
e
Conservativ
e
The Medical Curriculum Idea
14BiologyBiology
AnaAnaBiochemistBiochemist
PhysiologyPhysiology Psycholog.Psycholog.
TerminologyTerminologyChemistryChemistry PhysicsPhysics
1st State Examination
1st State Examination
Psychiattry…
Psychiattry… Inte
rnal Med…
Internal Med…
Surgery,…
Surgery,…
2nd State Examination2nd State Examination
Clin. Chem.Clin.
Chem.
Patho-logyPatho-logy
PYSurgery
PYSurgery
Phar
mac
ol
Phar
mac
ol
PYElective
PYElective
PYInternal Med.
PYInternal Med.
Conserv
ative
Conserv
ative
Pathophys.Pathophys.
tomytomy
The Medical Curriculum, Reality2
15
2nd State Examination2nd State Examination
The Medical Curriculum
Changes: „from H to N“
Basics
Clinical
Ärztliche Prüfung, 1. Abschnitt
Ärztliche Prüfung, 2. Abschnitt
1
4
5
12
„Equivalent Exams“- 3 MEQs, 2 OSCEs
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
The Curricula
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
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 | 20
Medical Studies: 2 Ways
GOAL
START
Oct. 01, 2010: 302 Students105 applied42 randomly chosen
Organ Systems, multi-disciplinary
No lectures, buttime for self-directed learning
Problem-based Learning
1. Understanding2. Topics of Interest3. Brainstorming4. Hypotheses, Sorting5. Learning Objectives
6. Selfdirected Learning
7. Discussion of Results
8. Feedback
Instrument: Progress Test in Medicine200-item Multiple-Choice-Test
66 items basic sciences: (32 physiology, 26 anatomy)
Level: End of studiesAt the beginning of each semester to all
studentsDeveloped at the Charité and Uni W/H and
used by 7 universities
Study Design: RCT
Randomized controlled trialN = 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
0
10
20
30
40
50
60
Ba
sic
Sci
ence
s[%
corr
ect]
1. Sem. PTM09 3. Sem. PTM11 5. Sem. PTM 13
RSM
MSM-
MSM+
***
0
10
20
30
40
50
60
Clin
ical
Kno
wle
dge
[%co
rrec
t]
1. Sem. PTM09 3. Sem. PTM11 5. Sem. PTM 13
RSM
MSM-
MSM+
***
*
Longitudinal Observation: Traditional – Problem-based
2003 2004 2005 2003 2004 2005
preclinical clinical
Number of Successful Students within Shortest Time
0
20
40
60
80
100
120
140
160
180
200
Num
bers
C P- P+
101 15 30184 38 42
1st
5th
0,0
0,1
0,2
0,3
0,4
0,5
0,6
0,7
0,8
%S
ucce
ss
C P- P+
0,55 0,39 0,71
71 % in MSM+ versus 39 % in MSM- and 55 % in RSM
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
Further Educational Goals
In my opinion, my medical studies have enabled me…
Item 1: to make the physical situation of my patients base of my medical practice.
Item 2: to make the psychological situation of my patients base of my medical practice.
Item 3: to make the social situation of my patients base of my medical practice.
Item 4: to think and work in a scientific way.
Item 5: with general knowledge and skills in the field of diagnostics.
Item 6: with general knowledge and skills in the field of therapy.
Item 7: with general knowledge and skills in the field of health promotion and prevention.
Item 8: with general knowledge and skills in the field of rehabilitation.
Item 9: with practical experience in dealing with patients, including the interdisciplinary approach to disease.
Item 10: with mental skills necessary for the primary care of patients.
Item 11: to conduct independent, continuous training, using modern information sources.
Item 12: to own decisions and solving problems.
Self-Assessement of 6th Year Students
physical
scientific
social
psychological
Diagnosis
Therapy
Health Promotion
Rehabilitation
PracticalExperience
CME
Problem Solving
Psychol. Ab.
Assessment byTeachers
physical
scientific
social
psychological
Diagnosis
Therapy
Health Promotion
Rehabilitation
PracticalExperience
CME
Problem Solving
Psychol. Ab.
Students‘Self-
Assessment
Teachers‘Assessment
über-wiegend
teil-weise
40
Correlation Self-Assessment vs. Scores
0
10
20
30
40
50
60
70
80
90
100
Fre
mde
insc
hätz
ung
du
rch
Leh
rend
e
0 10 20 30 40 50 60 70 80 90 100
Selbsteinschätzung der Studierenden
r = 0,90***Eta2
adj = 0,79
r = 0,83***Eta2
adj = 0,66
Lehrende RSM
Lehrende MSM
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.
„Latest News“
Progress-Test Medicine (PTM)
ZENTRUM FÜR MEDIZINISCHE LEHRE | 45
0
10
20
30
40
50
60
70
% r
icht
ig b
ean
twor
tete
r F
rage
n
1 2 3 4 5 6 7 8 9 10
Semester
gesamt_MSM
gesamt_RSMb
gesamt_RSMn
PTM – Preclinical Questions
ZENTRUM FÜR MEDIZINISCHE LEHRE | 46
0
10
20
30
40
50
60
70
% r
icht
ig b
ean
twor
tete
r "v
orkl
inis
cher
" F
rage
n
1 2 3 4 5 6 7 8 9 10
Semester
Vorklinik_MSM
Vorklinik_RSMb
Vorklinik_RSMn
PTM – Cross Sectional
ZENTRUM FÜR MEDIZINISCHE LEHRE | 47
0
10
20
30
40
50
60
70
% r
icht
ig b
ean
twor
tete
r F
rage
n
1 2 3 4 5 6 7 8 9 10
Semester
QB_MSM
QB_RSMb
QB_RSMn
Clinical Pathology, Pharmacology, Radiology, Biometrics, Ethics,…
PTM - Clinical
ZENTRUM FÜR MEDIZINISCHE LEHRE | 48
0
10
20
30
40
50
60
70
% r
icht
ig b
ean
twor
tete
r F
rage
n
1 2 3 4 5 6 7 8 9 10
Semester
Klinik_MSM
Klinik_RSMb
Klinik_RSMn
Scores in the State Exam (09)
ZENTRUM FÜR MEDIZINISCHE LEHRE | 49
Proportion of „Fast Students“
ZENTRUM FÜR MEDIZINISCHE LEHRE | 50
32,7 % 47,6 %
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 | 52
The Future
Combination of the two tracks Scientific and practical Interdisciplinary and theme-oriented Problem-based
ZENTRUM FÜR MEDIZINISCHE LEHRE | 53
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
RUHR-UNIVERSITÄT BOCHUMZENTRUM FÜR MEDIZINISCHE LEHRE