Curriculum reform in practice – what is expected of medical education in the 21st century?

The dynamic development of health care, global challenges and the internationalization of higher education have called for a paradigm shift in the way we think about educating physicians and health care workers of the future. Working together with internationally renowned experts and following the examples of some of the world’s leading universities, the 250-year-old Semmelweis University implemented an extensive curriculum development. The new curriculum focuses on practical education even more than before and aims to train graduates with competitive skills on the global market who are also able to successfully adapt to and manage critical events like the COVID-19 epidemic. In our article, Professor Miklós Kellermayer, Dean of the Faculty of Medicine and one of the main figures behind the curriculum reform, speaks about the main elements of Semmelweis University’s new curriculum and its reception.

1. The shifting landscape of medical sciences – changing needs and approaches

Over its 250 years of history, Semmelweis University has undergone many changes, as have medical sciences. The changes have been driven by the dynamics of the social and economic environment, which the university has always tried to address on time. Yet, the speed of these changes has accelerated by the 21st century and medical education was unable to follow the emerging needs. Since the beginning of the new millennium the boundaries between disciplines have been blurred and remote fields have proven to be interconnected. This paradigm shift gives the backbone of Semmelweis University’s latest reform of the medical curriculum: it promotes the development of flexible competencies and emphasizes transformative learning in a system of interdependencies.

2. First steps to tackle the challenges: speeding up knowledge sharing by an efficient system of e-learning

Since the beginning of the 2010s emphasis on the use of digital communication has been increasing at Semmelweis University. Providing intelligent learning environment, accruing electronic content and preparing students for lifelong learning are among the priorities of institutional development. The flexibility and adaptability of digital learning tools empower traditional learning environment, by allowing the quick incorporation of the latest research results and scientific trends. Students have also been able to personalize and structure their studies based on their own needs, which also facilitate their conscious orientation regarding their study and career choices. However, a well-operating digital learning system cannot be efficient without a curriculum tailored to the needs of the third millennium.

3. Training healthcare professionals prepared to harness the opportunities of a multifaceted medical landscape

The university of the 21st century should understand and tackle the dynamic changes of medical sciences along with the variable needs of society and the profession. The need for a curriculum reform arose in response to the rapid transformation of the scientific landscape, where the amount of knowledge grows exponentially. Thus, medical education should focus on the promotion and improvement of skills that help doctors of the future work efficiently in a dynamic setting.
Practical skills have become the prerequisite of the medical profession in the 21st century. While preparing the new curriculum, we made sure that there is enough room to teach and practice these skills. However, one should not forget that graduates of the 6-year-long medical programme have not yet acquired the competencies and the authorization that a medical doctor needs in order to work independently. To allow our graduates successfully enter the next level of training, the new curriculum needs to provide students with knowledge that prepares them for clinical practice.

The medical profession today is a multidisciplinary field, which requires professionals to be able to form a comprehensive view of interlocking areas including social, political and economic factors. Market-driven forces have also had a considerable effect on medical education. Medicine has become a strongly competitive sector and is currently one of the most successful export products of Hungary. This business-like approach had to be embraced while drawing up the new curriculum; to provide graduates of Semmelweis University with the competitive edge that makes them stand out from the medical society worldwide. Our educational model should train professionals who fulfil the requirements of the 21st-century physician: independent, has the ability of critical thinking, excels in decision making both in case of diagnostics and emergency situations, can act like a “pluripotent stem cell” by being able to achieve specializations and is capable of lifelong learning.

4. The logic and building blocks of the curriculum: first-hand experiences from students

The most important task of the new curriculum was to create a framework which is based on strong cooperation between different departments when deciding on the content of the different educational modules. Previously, individual departments were in charge to define what and how they would teach, which created fragmented knowledge. To make the 6 years of medical education a well-balanced and comprehensible programme, a hierarchical structure of subjects and a modular arrangement were set up. While maintaining the traditionally high quality of theoretical education, redundancies among subjects were eliminated, structural optimization was carried out and four modules arching over the study programme were created.

The four modules are: theoretical, preclinical, clinical and practical (internship), in this order. The modules provide a solid foundation for the curriculum supporting the dynamics of the medical landscape. By creating a flexible structure, our medical programme is empowered to keep pace with international trends and create new ones. There is also room for the introduction of emerging specialized disciplines, thus students can get first-hand information on the latest trends in medicine. The new curriculum promotes the tight incorporation of associative, service-providing disciplines, such as laboratory medicine or medical imaging into clinical subjects encouraging their better understanding through actual clinical cases.

One of the greatest developments of the new curriculum is the transformation of the clinical module into teaching-block-based instruction. These blocks allow students to be engaged in only one clinical subject at a time and to be involved in the actual work of the department. This way, students become more engaged with the different disciplines, which helps them choose their future specialization.
To further facilitate their conscious career decisions, a new 6-week course has been introduced at the end of the internship module, which the students spend at the clinical department of their own choice.

5. At the crossroads: opportunities of scientific and clinical careers

Giving students the possibility to take a quick peek into the actual work of clinical departments is only part of providing them with career options. Semmelweis University has a long-standing tradition of talent support promoting scientific activities on graduate level. Students are offered opportunities that enable them to get involved in research and to gain experience at domestic and international conferences. One such platform for self-instruction and scholar training is the Student’s Scientific Research Association: talented students are encouraged to participate in research from their early pre-clinical years. The programme allows students to build personal and professional relationships that prepare them for their scientific career and endow them with invaluable laboratory and research skills and competencies.

In addition to the Student’s Scientific Association, the Kerpel-Fronius Talent Support Programme at Semmelweis University has been supporting exceptionally talented students since 2007. The programme offers individual mentoring and scholarship opportunities at Heidelberg University and the University of Freiburg. Since 2017, application has been open to our international students as well.

6. Focusing on the next quarter millennium

The 250th anniversary of Semmelweis University’s foundation has given us a great opportunity to redefine our goals and find new means and paths to pursue our ambitions without giving up on the values rooted in our traditions. Designing and implementing the curriculum reform cannot be carried out without embracing the paradigm shift that define the future of medical education. Interdisciplinarity, the rapid accumulation of knowledge, the expansion of the international market make medicine part of the global competition. This competition requires a dynamic framework that can be fine-tuned to the movements of the environment. Recently, all six faculties of Semmelweis University have shown a clear demonstration of the new system’s adaptability by switching to distance learning within a week.

The emergency situation caused by the coronavirus epidemic has made it necessary to implement digital means of education across the entire curriculum, so that personal presence of the students is not essential. Lectures, seminars and exams have successfully been conducted and the experiences of distance education so far have confirmed the new curriculum’s flexibility and adaptability to sudden, unforseen events. In order to maintain the high quality of education even in an online form, we are committed to constantly monitoring the results of the curriculum reform and distance education on the basis of feedback from students and lecturers. We are also dedicated to involve international students more in the life of the university. To this end, we offer joint lectures for the Hungarian, German and English programmes, organize events and provide students with platforms to formulate their opinion regarding their studies, scientific activities and university life as citizens of Semmelweis University.