EDITORIAL

The Bologna Declaration and Process must be reconsidered

La Declaración y el Proceso de Bolonia deben reconsiderarse

Andrzej Wojtczak

Exdirector del International Institute for Medical Education (IME).
Expresidente de la Association for Medical Education in Europe (AMEE).
E-mail: wojtczak@cmkp.edu.pl

What is known as the 'Bologna Process', which is materialised in the so-called 'Bologna Declaration', arose from a series of Conferences of European Ministers responsible for Higher Education that focused their attention on a number of different aspects, such as enhancing the transparency and the quality of university education. To date, 46 European countries have signed the Bologna Declaration and although many have welcomed this process as something positive for higher education, others have concentrated on what they see as its potential dangers.

For those working in medical education, the Bologna Process has been seen above all as an attempt to divide undergraduate medical studies up into two cycles: one would be the first three years of study leading to a degree and the other would also last three years and would lead to a master's degree. Right from the outset, many of those who teach medicine have considered that such a division makes little sense in the case of medical studies and also endangers the integration of preclinical and clinical education. Thus, to date, with the exception of just a few European countries that have implemented the two-cycle system, most faculties of medicine, with the support of their governments, have decided not to adopt this division which is fully justified in most other university studies. The upshot of all this is that it has become an issue that has eclipsed other important aspects of the Bologna Process and its key goals. These goals have to do with such important topics as the general recognition of qualifications throughout the whole of Europe, student-centred learning, cooperation to ensure quality, fostering the mobility of students and teaching staff, and the internalisation of studies that deserve attention and backing.

Yet, an even more important fact and one of its strong points is the dynamic nature of the Bologna Process and, hence, its ongoing evolution and expansion. If used appropriately, it can serve as a catalyst for the changes that medical education needs and help find solutions to many problems that can be very beneficial for those involved in medical teaching. Thus, medical education and medical teachers must participate actively in many aspects of the Bologna Process. The revitalisation of the important elements of this process among medical teachers comes at just the right time because now, more than ever before, we need international cooperation and guidance, the mobility of students and staff, and cooperation between medical teachers and medical schools.

What is needed is a transparent system that allows countries to understand the other European educational systems and the specific subjects of other courses of study. The main aim is not conformity and a uniform curriculum, but instead to harmonise and smooth out the complexities of different educational systems. The mobility of teaching staff, students and graduates is crucial and is another of the core elements of the Bologna Process that were highlighted by the ministers responsible for higher education who attended the 5th Ministerial Conference in Bologna in 2007. With the aim of accomplishing this ambitious goal, several instruments have gradually been implemented. These tools include ECTS credits, a framework of three cycles with well-specified learning outcomes for each of them and the required qualifications. Nevertheless, there is still a lot of work to be done in this field, despite the advances that have been made to overcome the bureaucratic obstacles that exist in some countries. Some tools that make recognition of qualifications easier are the learning outcomes that are included in the descriptions of the different modules that make up each packet of ECTS credits. This is an important step towards achieving greater clarity and quality in teaching, with greater emphasis placed on student-centred learning.

It is also important to underline the fact that the Bologna Process must be seen as a commitment to improve the quality of teaching by shifting the focus to student-centred learning and to the success of students' individual learning. There is a need to implement curricula oriented towards clearly defined learning outcomes, something which has been set out in the 'Tuning Project'. The aim of the project is to adopt a system of qualifications that is easy to understand and compare by identifying points of reference for general and specific skills.

Cumming and Ross [1] specified the learning outcomes (competencies) to be reached in undergraduate medical education in Europe as part of the development of the so-called Medine-1 project. It is important to bear in mind that the competencies are described as points of reference for the sake of curricular design and assessment, and not as a rigid set of rules. They allow curricula to be developed in a flexible autonomous manner. At the same time, they introduce a common language for describing the targets of the different curricula. Mobility rates have therefore been suggested as a criterion for determining the success of the Bologna reforms. Bologna aims to create opportunities for personal growth and the development of international cooperation among individuals and institutions, which are necessary to improve the quality of higher education and research.

Another area that is under discussion is the recognition of qualifications. The objective is to make it possible for students to use the qualifications they obtain in one educational system in another educational system, or in another country, without them losing their real value. Joint degrees are something that should be considered in the near future. Furthermore, one very important line of action in the Bologna Process is quality assurance. This refers to all the policies, assessment processes and actions geared towards ensuring that institutions, programmes and qualifications fulfil and maintain certain standards as regards educational, academic and infrastructure quality. Its objective is to help establish a culture of quality in universities in a sustainable, long-lasting manner, while at the same time contributing to institutional autonomy and social responsibility. Quality assurance must be seen as part of the ongoing process of development and improvement of higher education and is a fundamental requisite for the mobility of teaching staff. The objective of the Bologna Process is to foster European cooperation in quality assurance so as to be able to develop comparable criteria and methodologies.

Very recently, the Conference of Ministers drew attention to the urgent need to improve students' capacity for permanent lifelong learning as a fundamental element of the Bologna Process, which is a lot more than just a simple structural reform. Awareness of the need to integrate permanent education within higher education is growing. This continuous development of medical education is a necessary requirement in order to satisfy the needs of the 21st century. It may act as a catalyst that triggers a new examination of the current approaches employed in medical education in terms of curricula planning, learning outcomes, teaching and learning methods, and assessment, which is so necessary as regards the international perspectives of medical education.

Finally, it should be emphasised that there is not enough strategic awareness among the staff of medical schools of the importance of the Bologna Process in the development of the European educational policy, which could be a powerful driving force in improving the quality of today's medical education. Information about the goals of the Bologna Process must therefore reach the ears of all the members of medical schools in a more intensive and generalised way, thereby stimulating their active participation. It is thus essential that everything the stems from the Bologna Declaration, its importance and the whole process, should be reviewed again and the most significant aspects reconsidered so that they can be implemented as quickly as possible.

References

1. Cumming A, Ross M, Steering Group and Task Force of the MEDINE Thematic Network. The Tuning Project for Medicine-learning outcomes for undergraduate medical education in Europe. Med Teach 2007; 29: 636-41.        [ Links ]