A growing voice for
education reform in Germany

Dr. Frank Christ, secretary of programs for the Munich-Harvard alliance, has been a driving force in the program’s development

Ludwig Maximilians University (LMU) in Munich has been helping to lead a wave of change in how medicine is taught in Germany. In partnership with HMI, the students, faculty, and administration of LMU have led a series of educational reforms in the school’s curriculum that have spurred similar programs at other schools in Germany. Now, with an eye to helping develop its model for educational innovation throughout the region, LMU is creating a center of excellence in Munich that will help develop programs to improve medical education, health care management, and the conduct of clinical trials, and will serve as a non-governmental voice for reform in Germany and Europe.

A ceremony in Munich on February 28 celebrated the opening of the center, called the Institute for Improvement in Health Education. During the ceremony, LMU honored Dr. Daniel Tosteson, former dean of the faculty of medicine at Harvard, with an honorary doctorate for his outstanding contributions to medical education and commitment to the partnership between LMU and Harvard Medical School.

Revamping the medical curriculum
The Institute’s first program offerings will continue to focus on undergraduate medical curriculum reform, building from the success of LMU’s work with HMI. The partnership between LMU and HMI began in 1996 with the goal of introducing a problem-based learning component to the educational curriculum at LMU, adapting some of the principles and elements of the New Pathway, Harvard Medical School’s innovative curriculum. Complicating the process for LMU, however, were the strict laws (Approbationsordnung) governing the undergraduate medical curriculum in Germany and the large student numbers—currently more than 4000 students in medical school at Munich. Despite these limitations, LMU has introduced integrated courses and problem-based tutorials into the curriculum and has been highly successful in establishing a philosophy of life-long learning for student physicians. In fact, the “Munich-Harvard” model was presented a national prize for educational innovation by the President of Germany, Roman Herzog, and was awarded the First Prize for Prominent Achievement in Teaching Excellence by the Society of Friends and Patrons of Ludwig Maximilians University. The program caught on, and several schools have subsequently approached the two schools to help develop similar programs.

One aspect of the program’s success is the mutual involvement of students, tutors, faculty, and administration working toward a common goal. In Germany, students in general have a sound theoretical training, but they have voiced their desire for a more integrated curriculum that better prepares them for the clinical problems they will encounter as doctors. In addition to educational development programs for its course directors and instructors, LMU has sent selected groups of medical students to HMS every year to participate in six-month clinical rotations at Harvard-affiliated hospitals, during which time they also take a course in medical education and develop proposals for curriculum design. These students return with cases, assessment exercises and on occasion lead problem-based tutorials with other students, ensuring that their experiences are carried forward into the teaching at LMU.

A broader scope for change
With several years of experience implementing undergraduate medical curriculum reform within its own institution, LMU will now be using the Institute to expand these programs for other organizations in the region and elsewhere.

The Institute will work with educators and leaders from other German medical schools interested in adapting some of LMU’s educational innovations, including tutor training programs, problem-based education tools, and the use of information technology and simulation in education.

	The 2001 group of medical students from LMU were able to participate in the reform process

In addition to undergraduate medical education, the Institute will offer programs that bring the same emphasis on innovation to postgraduate and continuing medical education, executive education, the education of allied health personnel, and possibly the general public. It also is considering establishing a center for the education of medical personnel involved in the conduct of clinical trials.

Both LMU and HMS are committed to ongoing efforts to continue the reform process in medical education throughout Germany and Europe. Together they have collaborated in tutor-training programs and a multinational medical student exchange program that promotes comparative analysis of health care delivery systems in Europe and the United States, USEUMEE. Leaders from LMU now join other HMI curriculum programs in Europe to describe their experiences. “In addition to HMI’s expertise, participants benefit from LMU’s invaluable example of reform within a political, economic, and cultural system that may more closely match their own,” said Tom Aretz, HMI director of medical education. The Institute is a first step toward coordinating multiple efforts in educational change that are occurring throughout the region. For example, the European Union has begun the process of moving towards harmonizing and improving of the quality of medical education within its member states, and the Institute is in a position to contribute to this process.