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SEPTEMBER / OCTOBER 2003

FEATURES

LMU students propose structure for Practical Year

Claudius Conrad, left, talks about the advantages of standardizing the way skills are taught.

On July 31st, a group of fourth-year medical students from Ludwig Maximilians University (LMU) in Munich capped off their four-month stay at various Harvard teaching hospitals with a visit to HMI, where they presented their ideas for reforming the “Practical Year”—or sixth year—of the LMU curriculum. Since 1997, students from LMU have come to Boston to complete core and elective clinical rotations and take a special course in medical education, which requires that they work on a curriculum design project. The task of this year’s group was to create a curriculum for the final Practical Year in the new LMU curriculum, and their proposal includes elements of problem-based learning, student teaching, and clinical skills development.

In Germany, medical students receive sound theoretical training, and during the sixth year, they must translate that knowledge into clinical care abilities. For the first five years of study, students at LMU work from disease to symptom, starting with an understanding of the ailment and then learning about the symptoms associated with that disease. But in the Practical Year, they must learn to do exactly the opposite—to diagnose patients based on information that they collect.

The curriculum design project, said Christoph Scholz, “drew individuals together as a unified group.”

To address the need to cultivate these practical capabilities, the students proposed a symptoms-based course that would address all specialties, and use problem-based learning and strategies of evidence-based medicine to teach clinical decision-making. The students also described a clinical skills course that would be taught by an attending physician, divided according to sub-specialty, and present the most relevant practical skills of each.

“Tell it in confidence”
An interesting component of the Practical Year designed by the students is the participation of more experienced students as instructors. Recent legislation in Germany calls for more bedside teaching in groups of maximally three students, but this poses a challenge for schools like LMU with large student populations. So the LMU student delegation proposed that students fill this need for teachers. The logic is simple—young doctors need teaching experience, and the evolving curriculum needs them to step in and become leaders. Using student teachers blurs the hierarchy between teacher and learner by fostering a mutual learning experience, and the new teachers are able to readily apply their own recent study experience to the task. This practice has gained acceptance in many parts of the world, and has been very successful.

The students also emphasized a very important facet of the Practical Year that currently does not exist in a standardized fashion—evaluation. “The overall idea of the Practical Year is to grow in responsibility, and evaluation is an important part of that,” said Tobias Moehlmann. Two key areas that should be considered, he said, are history taking and the physical exam, and the ability to “tell it in confidence.” The former is part of a physician’s basic skill set, but the latter—which encompasses strong communication skills, the desire to learn, and professionalism—is one of the characteristics that often distinguishes the best doctors from the crowd.

“Teamwork is a kind of leadership”
Dr. Tom Aretz, HMI director of international education, said that the students did an excellent job of structuring their program around four pillars—knowledge, skills, evaluation, and environment—and the five key themes of learning, teaching, ability, helping, and evaluating. Earlier in the week, the students presented their ideas via teleconference to faculty at LMU.

Toni Peters, PhD, director of curriculum development in the HMS Office for Educational Development, directed the student course in medical education. Dr. Peters applauded the students’ efforts, saying, “To me, it’s very gratifying to see how [the LMU students] have integrated what [they have] learned along the way at HMS,” adding that she was impressed by how they were “able to draw so many different pieces together in a meaningful way,” a way that she believes will work in Germany. Like Aretz, she praised the ten students’ ability to collaborate. “Teamwork,” she told them following their presentation, “is a kind of leadership.”