EDITORIAL

Curricular change

Cambio curricular

Jorge Palés

Presidente de la SEDEM

Last April, the Spanish Ministry of Education and Science announced its proposal on the directives for the organization of the Bachelor´s Degree in Medical Teaching, in order to conform to the European Convergence in Higher Education program. This proposal should form the basis of the directives for planning new medical curricula in Spain. The aim of the current phase is to provide the necessary information so that those involved can express their opinions and suggest modifications. The definitive directives will then be published and medical schools will have a maximum of 3 years in which to draw up their own curricula that will have to be implemented as of 2010.

The limited size of an editorial prevents me from offering a comprehensive assessment of the above document. However, the executive committee of the Spanish Society of Medical Education is compiling an ad hoc report for public distribution. Nevertheless, I would like to take the opportunity given to me by Medical Education International to briefly express some opinions on this document.

The document presents the objectives of the degree, the common training criteria and certain conditions for the development of these criteria, as well as a series of recommendations for the creation and development of the curricula and their academic purpose. My first impression is that this is a positive proposal since it provides great flexibility for the planning of curricula, considering the undergraduate medical education as a continuum without the traditional division between preclinical and clinic periods, and allowing medical schools to introduce innovative strategies and methodologies in their study programs.

If given every facility we are not able to carry out a fundamental reform of the methodology and contents of degree-level medical teaching, it will certainly not be the result of legislative restrictions.

The document also dictates that this degree will allow students access pursue PhD courses, thus solving one of the problems that caused greatest concern among medical schools: namely the discrimination to which their students could be subjected by those from other disciplines which require longer courses to be completed.

Moreover, the document offers some very positive recommendations on curriculum development. We must also consider the recommendations on the integration of new content both across different disciplines and at all levels, the importance of giving students early contact with clinical disciplines, the inclusion of basic subject matter in the final courses, establishing global methods for evaluating competencies, the structuring of courses and subsequent specialized training. All of these recommendations were proposed some time ago by the Spanish Society for Medical Education. (Educación Médica 8, 3-7, 2005).

It is, however, also necessary to consider the weaknesses of the proposal. For example, it lacks a clear definition of the concept of competence. The alternating use of terminology such as competencies, knowledge, skills and attitudes, betrays a certain confusion between terms and questions the validity of the document. This is no small matter, since in order to create a curriculum based on competencies, which is what the European Convergence in Higher Education proposes, all parties must have a clear understanding of the concept and be able to use the term without the risk of ambiguity. Without a universally accepted definition of the term, it would be difficult, if not impossible, to define and agree upon the competencies that students must acquire.

Another weak point of the document is the description of objectives in the section entitled Objectives of the Degree, as well as the section dedicated to common training criteria. In the first case, the presentation of objectives is somewhat confusing, with no distinction drawn between general and specific aims. In the second case, the seven main subject areas proposed correspond suitably to those outlined in the White Book on Medicine drawn up at the Conference of Spanish Medical Deans, but a detailed analysis of the different contents described reveals omissions, various repetitions and a number of inaccuracies. It is therefore necessary to revise these two sections and provide more precise terminology and definitions of objectives.

It should be concluded that the positive aspects of the document outweigh its weak points and that any faults can easily be corrected through a critical review of the document. The final document will allow us to work comfortably towards a very real and ambitious reform of our undergraduate medical education. If really we genuinely open to an in-depth reform, in the spirit of the European Convergence in Higher Education, hard work awaits us for which help of all kinds will be required. In this respect, we would do well to consult the article on curriculum planning within the continuous training program of Educación Médica Internacional published in this very issue, as it could be a useful tool for the work to be developed in the near future.