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MARCH - APRIL 2003

FEATURES

Faculty from Dresden put theory into practice in Harvard Macy program

After working with HMI for several years in a partnership to reform its undergraduate medical curriculum, faculty members from Carl Gustav Carus Medical Faculty of the Technical University Dresden (TUD) are also getting some input from the Harvard Macy Institute.

Dr. Michael MŸller, Dr. Volker Kšllner, and Dr. Oliver Tiebel

Left to right: Dr. Michael Müller, Dr. Volker Köllner, and Dr. Oliver Tiebel

The German university has been working on systematically reforming its six-year curriculum. Now, a group of faculty members is working on the final year, in which students are completely immersed in clinical experiences. To get a new perspective on this project, three faculty members are participating in the Harvard Macy Program for Physician Educators, which met in Boston January 12-22 and will convene again for five days in May.

A new responsibility for students
During the sixth year, called the Practical Year (PY), German medical students are working on hospital wards, and are in charge of patients under the supervision of a physician. ÒThe students for the first time have a real responsibility to take care of patients,Ó explained Dr. Oliver Tiebel, who came to Boston with colleagues Dr. Volker Kšllner and Dr. Michael MŸller.

The faculty members named their project “Theory Meets Praxis” to emphasize the unique challenge of the PY. While the students have clinical experiences in the fifth year too, they are still primarily in the role of learners, and receive structured teaching. In the PY, they take on the role of caregivers, and it can be hard to find time even for self-directed learning. Some students are in affiliated hospitals away from the medical school, where it is harder to maintain communication. “It’s difficult to be one faculty together with teachers in the affiliated hospitals,” Tiebel added. The Dresden team is hoping to make a more solid connection between the fifth and sixth years, create more structured learning opportunities for PY students, and improve the level of contact between faculty and students in the PY.

German medical education is also undergoing a dramatic change in response to growing interest in case-based learning, which is emphasized in a recent national law governing the medical curriculum. The Dresden faculty needs to prepare its students for a new case-based examination system, and a major exam that has shifted from the fifth to the sixth year.

Putting ideas to the test
By coming to the Macy program, the faculty members were able to test their ideas in an international group of peers, and after the session they found they had altered some of their plans based on input from the others. MŸller said that the group provided a positive pressure for the team to set a timetable and have some of their goals achieved by the time they return in May. One of his goals is to publish some of the educational experiences and research at Dresden, so he appreciated the systematic approach to education that the Harvard Macy program emphasizes. Kšllner added that the practicality of the course was unique, providing participants with specific tools to carry out their projects


	Köllner gets feedback from Dresden students on the school’s curriculum.

During their stay in Boston, the faculty members had a chance to solicit advice from another important group: their students. Five students from Dresden are currently participating in clinical rotations at Harvard-affiliated hospitals, through TUD’s partnership with HMI. In meetings with the faculty team, the students were able to offer some input into the design of reforms. Once they return to Germany, they will serve as student leaders to help implement the programs.

Bringing structure into the clinical year
The first change that the team would like to introduce is to add time for structured seminars in the PY. The weekly seminars would emphasize the application of evidence-based medicine to clinical cases, and may involve social and ethical aspects of care as well as science.

The second proposed change is to assign students to a single clinical tutor during a rotation, to provide for better continuity in the clinical experience. “We would like to establish a model by which each student is supervised by one person for their time in the hospital,” said Tiebel.

The faculty would also like to make more use of the patient simulator and skills lab that the Medical Faculty of TUD recently established. While simulation allows students to practice skills they would not be able to test on real patients, there is still an opportunity to reflect on their responsibility over the lives of patients and the doctor-patient relationship, Kšllner noted. Therefore, training in communication skills and Balint-Group meetings will be part of the program. A fourth priority is improving the IT systems to facilitate information posting and sharing among students and faculty.

Students commented on the details of the plans and pointed out some of the approaches at HMS that they found useful, such as the use of task-based exams on medical basics that could be given before the sixth year, rather than just one cumulative exam. Representatives from HMI, including Dr. Elizabeth Armstrong, director of the Harvard Macy Institute, and Dr. Tom Aretz, medical director for international education, provided strategic input on the proposals as well.

Now the team will be working to put some of their changes in place, and will report back to the Harvard Macy group in May. In the meantime, a group of department chairs and course directors for the two basic science years also came to Boston in February for an intensive ten-day workshop, designing the first two years of the curriculum in Dresden in accordance with the new medical education law in Germany.