Basic Features of the Program

BASIC FEATURES OF THE PROGRAM

1. Program title

Integrated undergraduate and graduate study program in Medicine

2.Holder (institution-proposer) and implementer of the program (component which implements or coordinates the program)

School of Medicine, University of Split

3. Duration of the program

6 years

4. Admission requirements

Based on the score on the national final exam (Croatian: državna matura).

5. If an integrated undergraduate and graduate program is proposed, the reasons for their integration should be specified

It is a regulated profession for which integration into a six year program is agreed upon at the level of the European Union.

6. Professional or academic title or degree awarded upon completion of studies.

Medical Doctor (MD).

7. In relation to the recommendations of the Mission of experts to assess the situation in five of the regulated professions in the health sector in the Republic of Croatia conducted from 7 to 10 July 2008 for the new study program in Medicine, the key determinants of the new program are the number of hours of direct teaching - 5500 hours and 360 ECTS credits and a relative abundance of elective courses, so that now the whole program has 250 hours of elective courses (two in the first 4 years of study, 20 ECTS credits) and 640 hours (24 ECTS credits) of clinical rotations, a total of 890 hours or 45 ECTS credits, which makes 16.1% of the total number of hours of the Program, or 12.5% of ECTS credits. Furthermore, four courses are “verticalized”.

Firstly, in the first two years, Clinical Skills are added to Propedeutics which keeps the same number of hours in the third year. Clinical skills, Propedeutics, classical clinical courses and clinical rotations are carried out so that the acquisition of skills begins by practising first on anatomic preparations then through models to patients, gradually reaching the most complex procedures (according to Skills catalogue) at the sixth year of the program.

Other verticalized courses are: Psychological Medicine, Medical Humanities and Research in Biomedicine and Health.

Medical humanities course unites Introduction to medicine, Medical Sociology, Medical Ethics, History of Medicine, Medical English and Medical Humanities. Introduction of Medical Humanities into the Medicine curriculum is considered to be one of the latest achievements of medical education and it is attributed with the functions of expanding the physician’s worldview, “softening” the hard and specific program and the potential influence on the empathy of the future physician towards the patient. Psychological Medicine, which is verticalized on the third and the fourth year of the program, aims to contribute to all of this at the time of student’s direct contact with the patients.

Family medicine became an 80 hour course (3 ECTS credits). It consists of 20 hours of lectures and a practical part which includes two students working in the School of Medicine’s Family Medicine clinic throughout the sixth year until they have carried out 60 hours of work. Services at the Clinic are free of charge and students’ work is supervised by two family medicine physicians employed by the School of Medicine.

Furthermore, 100 additional hours of Family Medicine are treated as Clinical rotations, and are conducted, according to student’s choice, in Family Medicine clinics operating in different conditions (countryside, city, mountain or island). We believe that these changes in the Family Medicine education will ensure that the graduate physician is capable to become quickly and efficiently involved in further education and work of Family Medicine doctors on field.

Research in biomedicine and health course was introduced upon the recommendation of the World Federation for Medical Education (WFME) from 2003 (WFME Office: University of Copenhagen, Denmark). From the first year of the program, it introduces students to the concept of evidence-based medicine and teaches them to constantly use that concept in learning and practice in order for it to become adopted as a worldview for each medical student.

Clinical rotations are a new and modern form of education which basically replaces the former internship with the aim to provide the student with the experience of independent medical work. In Clinical rotations, students integrate the acquired knowledge and skills and apply them to everyday work on patients. Clinical rotations refer to four medical branches: Internal Medicine, Surgery, Mother and Child and Family Medicine. The first three listed last for 4.5 weeks each (180 hours) and Family Medicine lasts for 2.5 weeks (100 hours) of full working time. Students are guided by their supervisors during clinical rotations – one mentor per student. The rotation consists of students following the full time work of their respective supervisors. In order to achieve this, students are distributed in different wards and after they have completed the practice they are rotated amongst themselves. This means that one person can mentor more then one student in a year.

Within the clinical rotations for Internal Medicine, Surgery and Mother and Child students are given the choice of sub profession (e.g. neurology in Internal Medicine rotations)while in Family Medicine they can experience working at a specific environment of a Family medicine clinic (city-countryside, island etc.). Supervisors are chosen from senior residents and junior ward physicians. Their only mission is to make their student-protégé a close follower of their work and their substitute whenever that is possible.

8. Reasons for launching the program

According to the letter from the Minister, professor Radovan Fuchs from 25 January 2010, class 602-04/10-13/00003, register number 533-07-10-0001, School of Medicine in Split had to make new curricula for Medicine, Dental Medicine, Pharmacy and Nursing/Physiotherapy/Radiological Technology by 2 March 2010 and in accordance with the provisions of the Regulated Professions and Recognition of Foreign Professional Qualifications Act passed by the Croatian Parliament in 2009 (Official Gazette no. 124/09).On 1 March 2010 we sent the new curricula for Medicine, Dental Medicine Pharmacy and Nursing/Physiotherapy/Radiological Technology which were in complete accordance with the law and directions received from him on 25 January. On 11 June 2010 we requested the Agency for Science and Higher Education (ASHE) to conduct a thematic evaluation of the new program (in this case Medicine). On 12 July ASHE sent a letter regarding our request asking for data now given by this document.

9. Purposefulness of the Program with respect to the needs of the labour market in public and private sector

This program refers to the already existing Medicine program which has existed since 1979, initially as a Regional Medicine department of the University of Zagreb School of Medicine and since 1997 as an independent School of Medicine of the University of Split. Accordingly, its purposefulness with respect to the labour market needs in public and private sector has been verified and confirmed many times.

In short, we believe that the current number of students who annually enrol in an integrated undergraduate and graduate program Medicine (75) is in accordance with the actual social needs. According to the latest data from the Employment Service, as well as the data from the Symposium of employees and unions from the health sector held in Opatija (Medical Gazette, May 2008.), The Republic of Croatia needs 925 specialists only in four major clinical fields (paediatrics, gynaecology, internal medicine and surgery). Also according to the latest data, number of unemployed physicians with the state exam is negligible and there is a pronounced deficit in medical teams, especially on islands, in rural areas and areas of special state concern.

10. Connection with modern scientific discoveries and/or skills based on them

a) In accordance with the Provisions of Directive 2005/36/EC of the European Parliament and the European Council on recognition of professional qualifications from 7 September 2005 and its amendments, this Program redefines the competencies of a medical doctor by taking into account our original experiences with teaching and modern trends in medical education. Recommendations from Article 27 of the Regulated Professions and Recognition of Foreign Professional Qualifications Act are specifically applied:

Training for medical doctors guarantees that the student acquired following knowledge and skills:

- Adequate knowledge of sciences on which medicine is based and good understanding of scientific methods including the principles of biological functions and evaluation of scientifically established facts and data analysis.

- Sufficient understanding of the physique, functions and behaviour of healthy and sick people as well as the interrelation of a person’s health and his physical and social environment.

- Adequate knowledge of clinical disciplines and procedures which gives an integral image of mental and physical illnesses, of medicine from the preventive point of view, of diagnosis and therapy and of human reproduction, and

d) Adequate clinical experience in health care facilities under appropriate supervision

b) Program insists on strict compliance with the Bologna rules, guidelines and principles in accordance with the Regulations on the study and studying at the University of Split and School of Medicine in Split.

c) This School particularly recognizes the need for increasing the level of clinical skills of medical doctors and this is incorporated in the Program.

d) Basic elements of former (cancelled) internship are incorporated in the sixth year curriculum as "clinical rotations". Choice of this form of teaching is based on the perception of medical education as the source of a) knowledge, b) skills and c) attitudes, in which the teaching units, at the end of the program, integrate the previously acquired knowledge, skills and attitudes into medical care for the patient.

e) Knowledge and skills are gained gradually during the program to be finally integrated in clinical rotations which make the independent medical work with adequate supervision possible.

f) Knowledge is acquired by acquiring knowledge from natural sciences followed by basic medical sciences to clinical sciences.

g) Skills are acquired by learning clinical skills, propedeutics and by practicing clinical medicine.

h) According to latest European and American trends, Medical humanities course was introduced (see above).

i) According to the basic standard of the World Federation for Medical Education (WFME) from 2003 (WFME Office: University of Copenhagen, Denmark) Research in Biomedicine and Health course was introduced. It includes the courses from the old program: Introduction to research in medicine, Medical statistics, and Medical informatics but also the principles of Evidence Based Medicine (EBM), Evaluation of health care excellence and Diploma thesis. First part of the classes (first five years) prepares the student for research in biomedicine and the second part, on the sixth year comprises the making of the Diploma thesis.

j) Family Medicine became the course in which two students a day work at the School’s Family Medicine Clinic throughout the sixth year until each of them has completed 50 hours of work. Service at the Clinic will be free of charge and the students’ work will be supervised by two Family Medicine physicians employed by the School. A small portion of given hours will be used for lectures/seminars and the remaining part of practical work will be held in the usual manner. Until it becomes possible to organize all 180 hours (minus lectures) of teaching at the School Clinic, the remaining part of practical work will be done as it was done so far.

k) Medical genetics is modernized towards bioinformatics, genomics and proteomics and is associated with Immunology in a single department and a single exam.

l) A new course, Medical diagnostics, was introduced on the sixth year since even routine medical diagnosis is becoming more and more complicated for the individual patient (e.g. genomics, bioinformatics, proteomics, and individualized medicine).

m) (Sub)courses Gerontology (15 hours) and Naval medicine (20 hours) become regular obligatory courses integrated into Internal Medicine or Occupational and Naval Medicine with Environmental Health.Gerontology has been recommended to the level of basic standard (WFME), and naval medicine is necessary in a seaside city such as Split, Mediterranean region such as Dalmatia and a maritime country such as Croatia. We believe that this course will mark this Program in a particular way.

11. The comparability of the program with the programs of prominent foreign institutions of higher education (universities, colleges, polytechnics, etc.), especially from the European Union countries

A careful and objective analysis of the academic programs for Medicine in Europe shows a surprising variety of programs (Dusek T, Bates T. Analysis of European medical schools' teaching programs. Croat Med J. 2003; 44:26-31.), so vast that it is impossible to find an “average form”. Instead, the options are either to copy the program of one school of medicine or take the parts which seem best applicable in our own environment from a larger number of different programs. We opted for the latter approach bearing in mind the weaknesses of our School, primarily the relatively small size and the number of teachers, and secondly the lack of tradition and expertise in some contemporary approaches to medical training, such as “problem-based learning” (PBL) or complete orientation of preclinical curriculum to “organ oriented” organization of courses and learning. In the case of these two concepts, the development of PBL is expected in a year or two as a part of elective courses and “organ oriented” teaching is emphasized in clinical courses. We estimated that it is not possible, or even good, to insist on this concept in preclinical teaching, especially because it works really well in all the main courses in the “discipline oriented” concept.

Overall, we mostly followed the programs of schools of medicine in Germany (Chenot J.-F. Undergraduate medical education in Germany. GMS German Medical Science. 2009; 7:1-11.), and especially the one in Heidelberg because of its strong orientation towards teaching and implementation of scientific research, high criteria for the development of the Diploma thesis and the flexibility of conducting clinical teaching and in particular clinical rotations.

In comparison to other institutions of higher education in the European Union, and particularly those in Scandinavia, we imitated the following:

a)Significant strengthening and verticalization of training and acquisition of clinical skills from the first year of the program as can be found in a large number of European schools of medicine.

b)Introduction, systematization and verticalization of Medical Humanities, as can be seen, for example, in schools of medicine in Lausanne and Vilnius.

c)Research in Biomedicine and Health course found at the University of Heidelberg School of Medicine, even though our School is actually one of the pioneers in the world of this concept in medical education (Marusic A, Marusic M. Teaching students how to read and write science: a mandatory course on scientific research and communication in medicine. Acad Med 2003; 78:1235-9.).

d)PsychologicalhMedicine

Psychological Medicine course is represented in other Medicine programs in the country. In the School of Medicine in Zagreb it is taken at the second and the third year, and in Rijeka at the first year. This course is taught at other universities in Europe, e.g. in schools of medicine in London (King's College), Glasgow, Cardiff. Given the reputation of King's College, we will follow its program in relation to this course. It focuses somewhere between psychiatry and medicine, studies the common mental disorders, perinatal psychiatry, disorders related to stress and trauma, eating disorders and mental disorders in primary physical disease (metabolic, endocrine, diabetes, chronic fatigue syndrome). Psychological Medicine course is also present in most other European programs (Netherlands - Utrecht, Belgium - Antwerp, Sweden - Goteborg), permeating all specialties of somatic medicine. Students learn communication skills from the first semester; they learn how to establish communication with the patient. With each clinical branch they learn how to communicate with a particular group of patients. (Mayo R, Sharpe M, Carson A. ABC of Psychological Medicine, London: BMJ Books, 2003).

e)Family Medicine from the School of Medicine in Ljubljana, whose professor of family medicine and president of the committee for the reform of curricula, professor Igor Švab also teaches at the School of Medicine in Split.

f)Medical Genetics (with immunology), according to the advice of our colleagues and collaborators from the University of Edinburgh.

g)Laboratory diagnosis, which is a part of the program in nearly all German schools of medicine and, for example, School of Medicine at Padua and the first School of Medicine at the CharlesUniversity, Prague.

h)Gerontology is recommended as an undergraduate content (World Health Organization, International Association of Gerontology and Geriatrics, Geriatric Medicine: basic contentshforhUndergraduatehMedicalhTeaching.hAvailablehat: http: so we introduced the basics of this subject as a part of the Internal Medicine course.

i)One of the subjects at the fifth year of the program is called the Occupational and Naval Medicine with Environmental Health, which contains, alongside the usual contents from occupational medicine and environmental health, the naval medicine appearing for the first time in Europe as a part of the obligatory curriculum of medicine. We are very proud of that fact, especially as we have experienced and qualified teachers for this area and the subject already has a tradition as a popular elective course.

12. Previous experience of program proposers in the implementation of equivalent or similar programs

The recent history of educating medical doctors in Split begins in 1974 when the School of Medicine, University of Zagreb launches a two-year program for students in the fourth and the fifth year. Full five-year medical program began in 1979 (Marusic M. History of School of Medicine in Split. In: Jankovic S, Boban M, editors. University of Split, School of Medicine, 1997-2007 Split: SplitUniversity of Split, School of Medicine; 2007 p. 16-35.) . This program became the independent School of Medicine of the University in Split in 1997. Today, School of Medicine is one of the most prestigious institutions of the University of Split with significant human potential that provides the highest standards in the education of medical doctors. During that period slightly less than 1000 medical doctors graduated in Split.

13. Openness of the program towards student mobility

Due to the diversity of European schools of medicine, it is very difficult to find a partner university for student exchange with the intent for students to accurately and literally, at a given time, carry out undergraduate studies abroad. Even the noble and well intentioned program ERASMUS is unsuitable for this purpose, since it requires student’s uninterrupted stay abroad of at least three months. We bypassed this by connecting options for work at foreign universities during summer holidays and elective subjects of this program, as follows: