Design and Rationale of a New UME Curriculum: Recent

Plans at One Institution in the Netherlands

Olle ten Cate PhDCenter for Research and Development of

EducationUniversity Medical Center Utrecht

Some background notes on Dutch Medical Education

• The Netherlands has eight medical schools• Courses are (generally) six years• Students enrol directly from high school• The government determines total national

enrolment of medical students (now 3150)• Admission procedure in transition: 100%

weighted lottery to 100% school-determined selection

• National blueprint of objectives (now based on CanMEDS); no national exams

The International Conference on Residency Education | La conférence internationale sur la formation des résidents 3

Utrecht

Short history of the Utrecht undergraduate medical

curriculumUntil 1999: curriculum considered old-fashioned and inadequate (national review committee)

1999: Curriculum Utrecht 1999 (“CRU’99”): totally new concept

2006: The EU Bachelor-Master structure for higher education applied to medicine slight rearrangements in CRU2006 (3 yrs Ba + 3 yrs Ma)

2015: New curriculum to start (both Ba and Ma phases)

Current features of Utrecht’s 6 year UME curriculum

(CRU99/CRU06)- Annual enrolment of 304 (government determined); entrance selection through weighted lottery

- Integration of basic sciences in 5-week almost full time blocks in first two years (B1+B2)

- Much small group work; limited lectures; constructivist philosophy, not fully PBL

- Early clinical rotations in 3rd year (6 weeks internal medicine; 6 weeks surgery)

- PGY 6: transition to residency: longer clerkships, more responsibility

Curriculum innovation planning process

• Decision to innovate: September 2011 (after national “LCME” review)

• “Horizon Scanning Committee” report July 2012

• Curriculum committee installed September 2012

• Blueprint for a New Curriculum 2015 (July 2013)

• UMCU Board of Directors to allocate funds for renewal (September-October 2013)

• Experiments and preparations before 2014/15

• New Ba and Ma curricula starting Sept 15

Actions and conclusions of the Horizon Scanning and

Curriculum Committees 2011-2013• Literature scanning: a.o. 2010

Carnegie report; 2010 Frenk Lancet paper; LIC literature

• Visit of Dr David Hirsh 2012 to explain LICs

• Consultations with target groups on clinical teaching, student assessment, admission and selection, small group teaching and with many individuals

Actions and conclusions of the Horizon Scanning and

Curriculum Committees 2011-2013Retaining and strengthening what was

already satisfactory:- Vertical integration of basic sciences with

clinical teaching and roughly its balance- Small group, active education- Opportunities for electives (20% of the

program)- Teaching roles and opportunities for

students- Professionalism, scholarship

Actions and conclusions of the Horizon Scanning and

Curriculum Committees 2011-2013Innovations / adaptations:

- Retention of acquired knowledge in the bachelor needs strengthening

- Selection of students in unavoidable- Profiling opportunities of students in the master

years, serving UME-GME continuum is desired- Acquaintance with elderly health and some

other less visible but critical clinical domains need attention

- Educational technology should be blended in- Curriculum should serve motivation of learners

and teachers

New features planned in CRU 2015

Bachelor phase• Qualitative entrance selection; no lottery• Small group teaching: an option to register for • Every small group session requires preparation

through e-learning assignment the previous day• Focus on knowledge retention. Repeated testing

of knowledge. Students must pass block tests and four “Crux” tests (each including the content of one semester)

New features planned in CRU 2015

Bachelor phase• The class of B1 & B2 to be organised in 4

communities of learners of 76 students each• B3 will include an integrated clerkship of 12

weeks (internal medicine, surgery and family medicine)

• Every student to be assigned a panel of 10 patients to adopt for 3-4 year

New features planned in CRU 2015Master phase• M1 & M2: 4 big units of 6 weeks block

preparation + 12 weeks of longitudinal Integrated clerkship (LIC), each including 2-4 disciplines

• Every student has own clinical preceptor for each LIC

• Clinical training preparing to bear responsibility will be structured using EPAs and entrustment decisions

New features planned in CRU 2015Master phase• M1 & M2 each have a 6 week profiling block.

Every student to develop a clinical profile, but to remain eligible for all residencies

• M3 basically remains in tact.

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UMCU Board

Education Center (until recently: “Directorate of

Education”)• +/- 150 personnel• Responsible for university programs

(medical, health, life sciences; BSc, MSc, MD, PhD)

• Responsible for non-university health professions eduction (nursing specialities etc)

• Departments: Student admin and educational affairs; Allied health education; Biomedical science training (Ba and Ma); Clinical health sciences (Ma); UME (6 & 4 year courses); PGME; Center for Res and Dev of Education

Center for Research and Development of Education

Established 2005; 6 Task fields1. Development and Educational

advice/consultancy2. Quality Assurance3. IT in education support and development4. Faculty Development5. Teaching of Students6. Research19 fte (tenure to 65 and temporary)Budget 1.4 m€; 60% fixed; 40% paid services