A New Era in Medical Training

Medical student Nasir still seems unsure of himself in conversations with patients, according to the feedback he got in his clinical examination class. Nasir now wants to find out how he can improve his communication skills and confidence.

The Swiss catalogue of learning objectives for human medicine (PROFILES) follows a skills-based approach: the PROFILES catalogue defines the roles, professional activities and situations that students need to master in everyday medical practice. In order to achieve these learning objectives, it’s not enough for students to pore over textbooks – as well as learning theory, they need to acquire hard and soft skills. Whereas the previous curriculum focused on imparting and testing theory, the new curriculum focuses on clinical thinking and practice. Clinical skills are no longer seen as something medics will just pick up on the job: instead, students will now receive explicit training and be tested in these areas during their studies. This change of approach requires a complete overhaul of the classical medical program to make it a skills-oriented program. But how exactly will the existing and deeply traditional curriculum be changed to incorporate the new learning objectives and teaching concepts?

Using evidence-based educational approaches for medicine, and in close collaboration with other medical schools, the Faculty of Medicine’s curriculum development team has come up with an overall strategy for skills-oriented medical training at UZH. The project is supported by the UZH Teaching Fund as part of the “program_innovation” funding line. It is split into three sub-projects – learning support, new assessment formats, and faculty development – which together promised to usher in a modern culture of teaching and learning at the faculty.

“To develop their skills, students need regular feedback,” says Anna Brunello, who is responsible for implementing learning support structures. In coaching sessions offered every three to six months, students will have the opportunity to reflect on their strengths as well as areas with room for improvement, and adapt their own learning strategies accordingly. The multiple-choice exams used hitherto are far too limited in terms of providing students with constructive feedback on their skills. “We need to develop new formative assessments that show students’ potential – for example, simulations or reflective exercises,” says Judith Engeler Dusel, overall project leader at the Faculty of Medicine. The reform process will be closely accompanied by the faculty development team, who will introduce the new educational concept to teaching staff and deliver training on how to implement the new approach in the classroom.

Engeler Dusel and Brunello are currently trying out the abovementioned coaching with 36 students and six members of the professorial staff from the Joint Medical Master’s program run by UZH and the University of Lucerne, to test the feasibility and success of this kind of learning support. In preparation for the coaching session, students reflect on an e-portfolio, which contains their own experience notes, ongoing assessments, and end-of-unit exam results. Ideally the students already have a question or two in mind ahead of the session – like Nasir.

The coaching takes place in groups of six students led by an instructor who is also a trained coach. The coach asks guiding questions and uses coaching techniques to nudge the students toward independently identifying a way to fill the gaps in their skills or knowledge. For medical students, personal development is just as important as subject knowledge. The coachees therefore discover how to develop their own strategies for dealing with individual challenges, overcoming psychological stumbling blocks, or learning new material using evidence-based approaches. The aim of the learning support is for students to become Master Adaptive Learners who take a self-directed and lifelong attitude to education.

The groups of six are deliberately mixed, with one student from each year of the medical degree. “Students can support each other and develop their own coaching skills in the process”, says Brunello. Studies also show that students who feel socially connected perform better and are less likely to drop out of university.

This form of learning support is unique in Switzerland and is also unknown in most larger medical schools around the world. But even the best curriculum development concept will fail if people aren’t on the same page. That’s why training for teaching staff, as provided by the faculty development team, is at the heart of the overall strategy. “We want to get the whole faculty excited about this new approach,” says Engeler Dusel. From 2024, the curriculum development team will give a first group of instructors an introduction to the new educational concepts and support them to successfully implement the new approach in the classroom. Those staff will then deliver the same training to other instructors, thereby creating a multiplier effect. In this way, knowledge and skills will spread quickly and easily among the teaching staff across the whole faculty.

The experiences gained by the Faculty of Medicine in redesigning its curriculum are of value for the rest of the university too, as other disciplines are also starting to move toward planning curricula that are skills-based and focused on learning objectives.
 

Find out more here about the Future of Teaching at UZH initiative.